Dukes' staging system

Doctors use different systems for staging bowel cancer. The most common system for bowel cancer is TNM staging. But you might hear your doctor talking about your bowel cancer as Dukes’ A,B,C or D.

Dukes' A

The cancer is in the inner lining of the bowel. Or it is slightly growing into the muscle layer.  

Diagram showing Dukes' A bowel cancer

Dukes' B

The cancer has grown through the muscle layer of the bowel. 

Diagram showing Dukes' B bowel cancer

Dukes' C

The cancer has spread to at least 1 lymph node close to the bowel. 

Diagram showing Dukes' C bowel cancer

Dukes' D

The cancer has spread to another part of the body, such as the liver, lungs or bones. 

In the number staging system, this is the same as stage 4. It is also called advanced bowel cancer.

Diagram showing Dukes' D bowel cancer


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)

Advanced cancer means your cancer has spread away from where it started. You might have chemotherapy or radiotherapy for advanced bowel cancer. Sometimes you can also have surgery. This is to remove as much cancer as possible and help with your symptoms.

Other stages

Last reviewed: 
13 Sep 2018
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