Staging of colorectal carcinoma
Astler-Coller modification of Dukes’ Classification (most commonly used classification)
Stage A: Limited to mucosa and submucosa. Nodes negative.
Stage BI: Extends into, but not through, muscularis propria; nodes negative.
Stage B2: Extends through muscularis propria; nodes negative.
Stage CI: Same as B1, except nodes positive.
Stage C2: Same as B2, except nodes positive.
TNM Classification (International standard)
TX: Tumor cannot be assessed.
T0: No tumor in specimen (prior polypectomy done).
Tis: Carcinoma in situ.
T1: Invades into submucosa.
T2: Invades into muscularis propria.
T3: Invades through muscularis propria.
T4: Invades adjacent organs or into free peritoneal cavity.
NX: Nodes cannot be assessed.
N0: No regional nodal metastasis.
N1: 1-3 nodes positive.
N2: More than 3 nodes positive.
N3: Central nodes positive.
MX: Presence of distant metastases cannot be assessed.
M0: No distant metastasis.
M1: Distant metastasis present.
Management of obstructing carcinomas of the left colon
Correct fluid deficits and electrolyte abnormalities. Nasogastric suction is useful, but it is not adequate to decompress the acutely obstructed colon.
The Hartmann procedure is indicated for distal descending and sigmoid colon lesions. This procedure consists of resection of the obstructing cancer and formation of an end colostomy and blind rectal pouch. The colostomy can be taken down and anastomosed to the rectal pouch at a later date.
Primary resection with temporary end colostomy and mucous fistula should be done for lesions of the transverse and proximal descending colon. This procedure consists of resection of the obstructing cancer and creation of a functioning end colostomy and a defunctionalized distal limb with separate stomas. The colostomy can be taken down and continuity restored at a later date.
An emergency decompressive loop colostomy can be considered for acutely ill patients. After four to six weeks, a hemicolectomy can be completed.
A primary anastomosis may be done in selected patients with a prepared bowel.
Management of obstructing carcinomas of the ascending colon
Correct fluid deficits, electrolyte abnormalities, and initiate nasogastric suction.
A right hemicolectomy with primary anastomosis of the terminal ileum to the transverse colon can be performed on most patients. A temporary ileostomy is rarely needed.