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CLASSIFICATION OF COLORECTAL CARCINOMA

to make a few comon a recent article by Harwood and Noel!. 1 In 1932, Dr. Cuthbert E. Dukes had published a classification system for colorectal cancer2 widely known as Dukes classification (or Dukes' classification). Dr. Harwood and Noel I have been calling this classification as "Duke's classification," thus altering the author's last name from Dukes to Duke. In "Dukes A" cases the cancer is limited to the rectal wall, in "Dukes B" cases the cancer has extended into extrarectal tissues but has not metastasized to lymph nodes, and in "Dukes C" cases there is lymph node metastasis. Dukes classification has been modified by many authors in later years. In 1949, Kirklin, Dockerty, and Waugh3 had modified the Dukes classification as follows: Stage A tumor limited to mucosa, Stage B1 tumor extending into muscularis propria but not penetrating it, Stage B2 tumor penetrating through muscularis propria, and Stage C lesions of either B1 or B2 with involved lymph nodes. This classification is properly referred

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to as "Kirklin's modification of Dukes classification." In 1954, Astler and Coller4 described another modification of Dukes cfassification. These authors retained tfie Kirklin staging for A, B1, and B2 himors, but subdivided the C stage into C1 and C2. Thus in "Astler-Coller's modification of Dukes classification" (also called Astler-Coller system) the colorectal cancer is staged as follows: Stage A tumor limited to mucosa, Stage B1 tumor extending into muscularis propria but not penetrating it with negative nodes, Stage B2 tumor penetrating muscularis propria with negative nodes, Stage C1 tumor limited to the wall with positive nodes, and State C2 tumor penetrating through all layers of the bowel wall with positive nodes. Harwood and Noell's 1 description of "Astler-Coller system" in Table 2 more accurately corresponds to "Kirklin's modification of Dukes classification" as elaborated above. As physicians we should be specific which classification we are using "Dukes classification," "Kirklin's modification of Dukes classification," "Astler-Coller's modification of Dukes classification" or others. This may be the time for all of us to look seriously into the recently proposed universal

staging system for colorectal cancer 5 so that the various confusing classifications can be dropped in favor of a specific, easily understood, universally acceptable system.

Deba P. Sarma, MD
Staff Pathologist, Veterans Administration Medical Center and Associate Professor of Pathology, LSU Medical School,

New Orleans.

REFERENCES
1. Harwood AR, Noell KT: Role of radiation therapy in the management of gastrointes tinal malignancies. I La State Med Soc 1986;138:21-24. 2. Dukes CE: The classification of cancer of the rectum. / Pathol Bacteriol 1932;35:323-332. 3. Kirklin JW, Dockerty MB, Waugh JM: The role of the peritoneal reflection in the prog nosis of carcinoma of the rectum and sigmoid colon. Surg Gynecol Obstet 1949;88:326-331. 4. Astler VB, Coller FA: The prognostic signif icance of direct extension of carcinoma of the colon and rectum. Ann Surg 1954;139:846-852. 5. Hutter RVP, Sobin LH: A universal staging system for cancer of the colon and rectum. Arch Pathol Lab Med 1986;110:367-368.

JOURNAL VOL 138 NO 7 JULY

1986

Sarma DP(1986): Classification of colorectal carcinoma. J La State Med Soc 138:3. PMID: 3734761 [PubMed - indexed for MEDLINE]