Dukes' staging

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Info bulb.pngFirst described by the English pathologist Cuthbert Esquire Dukes (1890-1977).[1]

A system of staging colorectal cancer. At the time of data collection, stages B and C had additional B1 and C1 categories, but the first published version of the system was intended only for rectal cancers, was based on histology alone and had 3 stages, A to C, with no subdivisions. [2] At the time of publication it was a seminal staging system that allowed a more objective comparison of surgical procedures.

In a later publication by Dukes and Bussey, Stage C was subdivided.[3]. Other modifications since have included its adoption for use in colon cancers as well and the addition of stage D for distant metastases. Several derivatives of the basic system are compared in this paper.[4]

The simplicity of the staging system is its strength, but also its weakness. Its prognostic value is limited by not being able to distinguish between T3 N0 and T4 N0 tumours as defined by the TNM classification. Both these TNM categories would be classed as Dukes B even though it is known that T4 tumours, i.e. tumours that breach the serosa or invade adjacent organs, carry a much poorer prognosis.

Dukes' staging is generally accepted as:

  • A - growth confined to (colo)rectum, no extra-rectal spread (interpreted as no breach of the muscularis propria)
  • B - spread by direct continuity into extra-(colo)rectal tissues, but no lymphatic metastases (interpreted as breach of the muscularis propria but no lymph node involvement)
  • C - lymph node metastases
    • C1 - regional lymph node spread, but apical lymph node not involved
    • C2 - apical lymph node involvement
  • D - distant metastases