The staging system for bowel cancer
How Dukes staging of bowel cancer relates to survival after treatment.
The boxes on the left show diagrams of colorectal cancers.
- Box A shows a cancer that has not spread through the muscle layer of the bowel wall.
- Box B shows a cancer that has spread through this layer but not anywhere else.
- Box C shows a Dukes’ C cancer that has spread into lymph nodes beyond the bowel wall (the black dots).
- Box D shows a Dukes D cancer that has spread to the liver – the black dots in the liver represent metastases.
- The graph to the right is a survival curve and shows the percentage of people surviving with the different stages of colorectal cancer over a five year period. Note how the curve for Dukes’ D hits 0% after 3 years when Dukes A survival is around 80%.
Dukes' staging shows how likely someone is cured after treatment of bowel cancer with surgery and what further treatment may be required. For Dukes' A there is an excellent chance of the cancer not coming back, no further treatment such as chemotherapy is needed. If the risk of the tumour coming back is higher - a Dukes' B or C - chemotherapy treatment can reduce the risks of that happening. People with Dukes’ C disease are routinely given chemotherapy if they are well enough. People with Dukes' B disease may be given chemotherapy. A person with Dukes' A, B or C disease will be given potentially curative treatment; these stages mean that no secondary disease has been identified. If metastatic disease is found this may be referred to directly in the medical evidence, or the terms ‘advanced’; or sometimes ‘Dukes’ D’ may be used.
Amended February 2009
