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May 16, 1986

Three early staging systems

JAMA. 1986;255(19):2536. doi:10.1001/jama.1986.03370190018004

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Dukes' initial staging system for rectal cancer is described in his paper (J Pathol Bacteriol 1932; 35:323-332).

Later, Dukes divided his original stage C (lymph node involvement) into two parts, Cl and C2 (Br J Surg 1935;23:395-413). Subsequently, R. S. Grinnell, MD (Ann Surg 1939;109:500-533) demonstrated that Dukes' system could also be applied to colon cancer. Thus, the Dukes staging system is as follows:

  • Stage A: Carcinoma limited to the wall of the rectum or colon; no extension beyond the wall; no lymph node involvement.

  • Stage B: Carcinoma extending to extrarectal tissues or beyond the wall of the colon by direct continuity; negative lymph nodes.

  • Stage Cl: Only regional lymph nodes involved or lymph nodes below the high point of the resection of the mesenteric blood vessels.

  • Stage C2: Lymph nodes involved at the high point of the resection of the mesenteric blood vessels.

In 1949, J. W. Kirklin, MD,