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TNM Staging

Tumour, node and metastasis (TNM) staging is one of the systems used to stage bowel (colon and rectal) cancer.

Doctors may also use the number staging or the Duke's staging system.

Tumour (T)

Tumour describes the size of the tumour. This is a simplified description of the T stage.

There are 4 stages of tumour size in bowel cancer:

T1 means the tumour is only in the inner layer of the bowel.

T2 means the tumour has grown into the muscle layer of the bowel wall.

T3 means the tumour has grown into the outer lining of the bowel wall but has not grown through it.

T4 is split into 2 stages, T4a and T4b:

  • T4a means the tumour has grown through the outer lining of the bowel wall and has spread into the tissue layer (peritoneum) covering the organs in the tummy (abdomen)
  • T4b means the tumour has grown through the bowel wall into nearby organs
Diagram showing T stages of bowel cancer

Node (N)

Node (N) describes whether the cancer has spread to the lymph nodes.

There are 3 possible stages describing whether cancer cells are in the lymph nodes – N0, N1 and N2:

N0 means there are no lymph nodes containing cancer cells.

N1 is split into 3 stages – N1a, N1b and N1c:

  • N1a means there are cancer cells in 1 nearby lymph node
  • N1b means there are cancer cells in 2 or 3 nearby lymph nodes
  • N1c means the nearby lymph nodes don’t contain cancer, but there are cancer cells in the tissue near the tumour

N2 is split into 2 stages – N2a and N2b:

  • N2a means there are cancer cells in 4 to 6 nearby lymph nodes
  • N2b means there are cancer cells in more than 7 nearby lymph nodes

Metastasis (M)

Metastasis (M) describes whether the cancer has spread to a different part of the body.

There are 2 stages of cancer spread (metastasis):

M0 means the cancer has not spread to other organs.

M1 means the cancer has spread to other parts of the body such as the lung or liver. It is split into 3 stages, M1a, M1b and M1c:

M1a means the cancer has spread to 1 distant site or organ, for example the liver, but it hasn’t spread to the tissue lining your tummy (peritoneum)

M1b means the cancer has spread to 2 or more distant sites or organs, but it hasn’t spread to the tissue lining your peritoneum

M1c means the cancer may have spread to distant organs and it has spread to your peritoneum

Diagram showing the most common sites for bowel cancer to spread to

Treatment

The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is in your bowel (colon or rectum)
  • other health conditions that you have

The stage of the cancer and these other factors can also give an idea of your outlook (prognosis).

The main treatments for cancer of the large bowel (colon cancer) are:

  • surgery
  • chemotherapy

The main treatments for cancer of the back passage (rectal cancer) are:

  • surgery
  • radiotherapy
  • chemotherapy
  • chemotherapy and radiotherapy together (chemoradiotherapy)
Last reviewed: 
31 Jul 2019
  • Colorectal cancer: the diagnosis and management of colorectal cancer
    The National Institute for Health and Care Excellence (NICE), 2011 

  • Primary colon cancer: ESMO Clinical Practice Guidelines for diagnosis, adjuvant treatment and follow-up
    Labianca and others. Annals of Oncology, 2010. Vol 21 

  • AJCC Cancer Staging Manual (8th Edition)
    American Joint Committee on Cancer, 2017

  • Rectal cancer: ESMO clinical practical guidelines for diagnosis, treatment and follow up
    R Glynne-Jones and others
    Annals of Oncology, 2017. Volume 28, Pages 422-440

  • Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the management of cancer of the colon, rectum and anus (2017) – diagnosis, investigations and screening 
    C Cunnigham and others  
    Colorectal disease, 2017. Volume 19, Pages 1-97

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