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Dukes' Staging of Colorectal Cancer

History:

Staging system originally published by C.E. Dukes in 1932 for rectal cancer only; did not include distant metastases.

  • Adapted by Kirklin in 1949 and later by Astler and Coller in 1953 for colon and rectum.
  • Revised by Turnbull in 1967 to include stage for unresectable tumors and distant metastases.
  • Astler-Coller and Turnbull stagings are also sometimes called Dukes or modified Astler-Coller (MAC).

Criteria:

Dukes' staging (generic term) is a pathological staging based on resection of the tumor and measures the depth of invasion through the mucosa and bowel wall. It does not take into account the level of nodal involvement nor the grade of the tumor.

Categories:

  1. Confined to mucosa
  2. Varies by system
  3. Positive lymph nodes
  4. Distant metastases (Turnbull system only)

Guidelines for Dukes' and Summary stagings for colon cancer:

  • Invasion of serosa. Serosa, or outside layer of the colon is only one cell thick, so involvement of serosa means that cancer is through the serosa and can spread.
  • Serosa is also called the visceral layer of peritoneum, so serosal invasion is considered regional stage unless there is definite evidence of distant spread.
  • Muscular layer is sometimes called the bowel wall, but in colon the subserosa and serosa lay beyond the muscular layer.
  • Be mindful of words "extension through bowel wall" and "penetration of entire muscularis" : both cases are still considered localized.
  • Find out from your pathologist whether he means "muscularis" or "all layers of bowel" when he refers to "wall."
  • It is important to find out which version of Dukes staging is being referred to, and to use that version consistently when doing studies.