Historically, staging systems for colon cancer have evolved over the last century. In the 1930s Dukes originally proposed a system for the classification of large bowel cancer based on depth of tumor wall penetration and nodal status. Subsequent modifications in the 1950s included the Astler-Coller modification based on refinements of the original Dukes classification. Stage A was limited to tumors that involved the mucosa and submucosa only. Stage B1 described tumors penetrating into the muscularis propria but not through it whereas B2 described penetration through the bowel wall and B3 represented invasion of adjacent organs. Stage C were those cancers with nodal involvement with stage C1 describing node positive cancers without transmural disease, C2 those with transmural disease, and C3 those with invasion into adjacent organs. Stage D described distant metastases.

In the last decade, these previous staging systems have largely been supplanted by the TNM staging system (Table 96-1). This system was developed by the American Joint

Committee on Cancer (AJCC) in cooperation with the TNM Committee of the International Union Against Cancer (UICC), and is currently accepted as the universal staging system for colon cancer. With this staging system, stage I and II describe tumors without evidence of nodal or distant disease, without or with transmural involvement, respectively. Stage III are those with nodal involvement and stage IV have distant metastatic disease. More recently, the TNM staging system has been modified to include subdivision of stage III into stage IIIA describing tumors without transmural involvement and limited nodal spread, stage IIIB for those with transmural involvement and limited nodal spread, and stage IIIC for those with any degree or wall penetration and significant nodal spread.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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