Jacques wrote:Nik Colon wrote:...
I found this, which may be why they said stage 3, but I would ask to clarify.Problematic issues in N staging (see also miscellaneous issues below)
Direct invasion of a node by the carcinoma counts as nodal involvement
Only regional draining nodes count for N staging
Nodes draining other bowel areas count towards M staging
If the primary spreads longitudinally to an adjacent bowel area, nodes draining that area count towards N staging
Involvement only of afferent lymphatics in a node counts as pL1, not as pN1
Nodules in the extra-tumoral soft tissue, discontinuous from intramural carcinoma:
(If there is any evidence of residual lymph node, they should be considered nodal metastases)
They should be recorded as Tumor Deposits (pTD)
They are not counted as nodes
They do not constitute evidence of pT3
If no lymph nodes are involved by carcinoma, these tumor deposits qualify for pN1c
If nodes are involved, they are not designated pN1c and have no impact on TNM
pN1c affects the overall Stage Group in the same manner as pN1a and b
This applies only to deposits within the lymphatic drainage of the tumor
Thus Tumor Deposits function as nodal metastases in staging when they are needed, but do not contribute to your node count
http://surgpathcriteria.stanford.edu/gitumors/colorectal-adenocarcinoma/grading.html
Nik - Thanks very much for posting the link above. I think that this is a very important resource, because it shows very clearly that, from time to time, the TNM staging system needs to be supplemented by detailed analyses of the pathology report findings. This seems to be the case in the current diagnosis. It was also true in my owm case as well. Technically, I am classified as Stage II according to a strict interpretation of the TNM system, however, my doctor said that I was, in effect, equivalent to a Stage III, so that is why he insisted on having me do both adjuvant chemo/radiation plus adjuvant Xelox after my LAR surgery.
glad I could help