Staging of rectal cancer means determining the extent to which it has developed by growing and spreading to near and distant sites. Staging is important because it helps plan cancer management besides knowing what the disease outlook and prognosis will be like. Thus, after diagnosing rectal cancer, doctors explore whether the cancer is limited to its site of origin or spread to nearby or distant sites.
Staging is done through a combination of:
- Clinical assessment
- Imaging studies (such as computed tomography [CT] scan, X-ray, ultrasound, magnetic resonance imaging [MRI] scan, and positron emission tomography [PET] scan)
- Colonoscopy (a procedure to look inside the rectum and colon for any abnormal areas or growths)
What is rectal cancer?
Rectal cancer refers to the uncontrolled growth of the cells in the rectum which is the last part of the large bowel close to the anus. It may occur in isolation or along with cancer of the colon (the longest part of the large bowel). Rectal and colon cancer are together called colorectal cancer.
- The rectum is around six inches long.
- It serves the purpose of storing the stools until a person has bowel movements.
Rectal cancer may develop gradually over several years. It usually starts as a small growth or mass, called a rectal polyp, confined to the inner lining of the rectum. Some of the rectal polyps when left untreated may grow into rectal cancer. Untreated rectal cancer can spread over time to involve other organs, particularly the liver and lungs.
What is the rectal cancer staging system?
The staging system most often used for colorectal cancer is the TNM system of the American Joint Committee on Cancer (AJCC). The system depends on:
- The extent (size) of the tumor (T).
- The spread to the nearby lymph nodes (N).
- The spread (metastasis) to distant sites (M).
Various combinations of TNM intensity help the surgeon classify the tumor.
What are the 5 stages of rectal cancer?
Rectal cancer is divided into the following five stages:
- Stage 0: This stage is also called rectal carcinoma in situ, which means that the cancerous cells are limited to the mucosa (innermost layer) of the wall of the rectum. Cancer may appear as a polyp (growth) that just about projects from the mucosa into the lumen of the rectum. These cancerous cells, however, have the potential of spreading to the deeper layers of the rectum. Thus, treatment at this stage is expected to give the best outlook for the patient. Cancer may be removed at this stage by surgery such as local excision, a polypectomy or polyp removal surgery. More extensive surgeries may be needed in cases where the growth is large.
- Stage I: In this stage, the cancerous cells have spread into the deeper layers of the rectal wall beyond the mucosa. Cancer may have spread up to the submucosa (the tissue layer under the mucosa) or the muscle layer of the rectal wall. Surgery is generally done for the treatment at this stage. If the cancer is extensive or not completely removable by surgery, chemotherapy or radiation may also be given. Chemotherapy and radiation are also given as the mainstay of treatment in patients who are unfit for surgery or have poor general health.
- Stage II: This stage is further divided into three substages. Different combinations including chemotherapy, radiation, and surgery are generally considered at this stage.
- Stage IIA: Rectal cancer has spread beyond the muscle layer to involve the outermost layer or serosa of the rectal wall.
- Stage IIB: In this stage, cancer invades the serosa to involve the visceral peritoneum (the tissue lining the abdominal organs).
- Stage IIC: Cancer has crossed the serosa to invade the nearby organs.
- Stage III: In this stage, cancer has further advanced to invade the lymph nodes in the pelvic area. It is further divided into stages IIIA, IIIB and IIIC depending upon the extent of lymph node involvement. A combination of surgery, radiation, and chemotherapy prioritized according to the patient’s needs is considered at this stage.
- Stage IV: It is the most advanced stage where cancer spreads to different distant organs (such as the liver, lungs, and ovaries) and distant lymph nodes. Depending upon how extensive the spread is, this stage is further divided into stages IVA, IVB and IVC. A combination of surgery, radiation, and chemotherapy prioritized according to the patient’s needs is considered at this stage. The focus is to improve the quality of life of the patient.
- What Is Avascular Necrosis and How Does It Affect Bones?
- The Arch of the Human Foot Was Key to Upright Walking, Scientists Say
- Worried About Cataracts? Here's What You Need to Know
- FDA Issues Warning About Compounded Versions of Wegovy, Ozempic
- Sick Restaurant Workers Fuel Many Foodborne Illness Outbreaks
- More Health News »
Health Solutions From Our Sponsors
Top How Do You Stage Rectal Cancer? Related Articles
Blood in the Stool (Rectal Bleeding, Hematochezia)Blood in the stool or rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Common causes include anal fissures, hemorrhoids, diverticulitis, colitis, Crohn's disease, colon and rectum polyps, and cancer. The color of the blood in the stool may provide information about the origin of the bleeding. The color of stool with blood in it may range from black, red, maroon, green yellow, gray, or white, and may be tarry, or sticky. Treatment of blood in the stool depends on the cause.
CancerCancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Colon Cancer (Colorectal Cancer)Colon Cancer (Colorectal Cancer) is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers, develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Colon Cancer: How Your Food and Diet Can Affect Colorectal Cancer HealthDiet, including nutrient, antioxidant, and vitamin intake, affects colon cancer risk. Certain dietary factors either decrease or increase the risk of colorectal cancer, breast cancer, and other diseases. Dietary factors may either inhibit or stimulate the development of cancer cells. Have a nutrition plan that decreases the risk.
Colon and Colorectal Cancer ScreeningColon cancer is preventable by removing precancerous colon polyps, and it is curable if early cancer is surgically removed before cancer spreads to other parts of the body. Therefore, if screening and surveillance programs were practiced universally, there would be a major reduction in the incidence and mortality of colorectal cancer.
Colorectal (Colon) Cancer QuizWhat is colorectal (colon) cancer and who gets it? Take this quiz to find out how this disease may be prevented.
Colon Cancer SlideshowColorectal cancer (colon cancer) is the cause of many cancer deaths. Learn about the warning signs, symptoms, screening process, stages, and treatment related to colorectal cancer.
Colorectal Cancer: What to Expect With a ColonoscopyLearn more about what happens during a colonoscopy, how to prepare for it, and how you’ll feel afterward.
Do I Have Hemorrhoids or Rectal Prolapse?Learn more about the major differences between hemorrhoids and rectal prolapse and the kinds of treatment available.
How Do You Shrink Rectal Prolapse?Rectal prolapse is a condition in which the last part of your large bowel (rectum) comes out of your anus. Ideally, you cannot shrink the prolapse. You can just restore your rectum to its normal position by manual reduction or surgery. In rectal prolapse, the rectum can only be shrunk when its mucosa is swollen due to the buildup of fluid in it. For this, before pushing it inside the anus, you can apply a few granules of sugar on it, and let it rest there for a few minutes. Sugar will absorb the excess water in the rectum and cause it to shrink.
How Do You Treat Rectal Prolapse in Kids?Learn what medical treatments can help ease symptoms of rectal prolapse in kids and speed up recovery.
How Is a Digital Rectal Exam Performed?During a digital rectal exam (DRE), your doctor inserts a gloved and lubricated finger into your rectum to check for problems including prostate enlargement, tenderness, or lumps.
What Is a Transrectal Ultrasound of the Prostate?Transrectal ultrasound of the prostate is a procedure done using high-energy sound waves generated by a probe inserted into the rectum.
What Is Rectal Foreign Body Removal Procedure?Once the presence of the rectal foreign body has been confirmed, the doctor will attempt at removing it in the emergency department. This can only be done if the object is felt by the digital rectal examination or is within 10 cm of the anal margin.