Treatment Desired Outcome

Staging is required to determine the extent of disease and is necessary in developing patient treatment options and determining patient prognosis. The tumor-node-metastasis (TNM) classification system that takes into account T (tumor size and depth of tumor invasion), N (lymph node involvement), M (presence or absence of metastases) is used to stage patients from stage I to stage IV. CT scans and appropriate assessment of lymph node involvment during surgical resection are essential in determining the stage of disease and subsequent treatment options. At this time, routine MRI and PET scans for initial staging are not recommended. Figure 91-3 depicts how the three categories are used in combination to determine the stage of disease. The stage of colorectal cancer upon diagnosis is the most important prognostic factor for survival and disease recurrence. Stages I, II, and III disease are considered potentially curable and are aggressively treated in an attempt to cure these patients. Patients who develop stage IV disease are treated to reduce symptoms, avoid disease-related complications, and prolong survival.

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