From the Research
The correct staging for a case of rectal cancer invading the serosa with positive 3 pelvic lymph nodes is Stage C2. This staging follows the modified Astler-Coller classification system, which is an older but still sometimes used staging method for colorectal cancer. In this system, Stage C2 represents a tumor that has penetrated through the bowel wall (reaching the serosa) and has spread to regional lymph nodes. The presence of positive lymph nodes automatically places the tumor in the C category, and the invasion through to the serosa (rather than being limited to the muscularis propria) makes it C2 rather than C1. In modern practice, this would correspond approximately to TNM stage IIIB or IIIC (T3N1-2M0), depending on the exact number of involved nodes, as supported by the study 1. This staging has important implications for treatment planning, typically indicating the need for adjuvant chemotherapy following surgical resection to reduce the risk of recurrence, as lymph node involvement significantly increases the risk of distant metastasis, as noted in the study 2. Key factors to consider in staging and treatment planning include:
- The depth of tumor invasion
- The number of involved regional lymph nodes
- The presence of distant metastasis
- The potential need for adjuvant chemotherapy to reduce recurrence risk, as discussed in the study 3. Given the most recent and highest quality evidence, the staging of rectal cancer is critical for determining prognosis and guiding treatment decisions, with lymph node ratio being an independent risk factor for overall survival and local recurrence, as found in the study 3.