2020/03/26
폐암 4기 생존률 5%를 15%로 - 분당차병원 종양내과 김주항 교수 : 네이버 포스트
폐암 4기 생존률 5%를 15%로 - 분당차병원 종양내과 김주항 교수 : 네이버 포스트
폐암 4기 생존률 5%를 15%로 - 분당차병원 종양내과 김주항 교수
차병원
2018.03.26. 13:1612,576 읽음
전문적인 의료 지식에 어려움을 느끼고, 질병과 치료법에 대한 정확한 정보를 찾기 위해 애쓰는 환자와 그 가족을 위해 분당차병원의 명의들이 나섰다. 각 분야의 명의를 만나 난치병의 최신 치료법(수술법)을 들어본다. 그 두 번째 주인공은 분당차병원 종양내과 김주항 교수다. 종양선택적 살상 아데노 바이러스를 개발하는 등, 암 유전자 치료 분야의 발전을 선도해 온 김주항 교수가 말하는 폐암 치료 이야기를 소개한다.
진단이 늦어 치료도 어려운 폐암,
환자를 살리려면 어떻게 해야 할까?
질환 중 사망률 세계 1위, 진단 후 5년 이상 생존 확률 23.5%, 4기 암 환자 생존률 5% 이하, 치료가 가장 어려운 암. 폐암을 설명하는 수식어는 무시무시하다. 일반적으로 흡연으로 인해 발생하지만, 유해물질에 장기간으로 노출되는 경우 또는 가족력으로 인해 걸리기도 한다. 조기 발견도 쉽지 않아 치료 시기를 놓치는 일도 흔하다.
폐에만 암세포가 국한되어 있는 1~2기의 경우 수술 치료가 가능하지만, 암이 림프절을 통해 기관지 등 폐 주변 기관으로 전이된 3기의 경우에는 수술 후에도 재발 가능성이 높다. 심지어 간이나 뼈 등 다른 부위로 전이된 경우라면 4기로 분류하며 수술 치료가 불가능하다. 분당차병원 종양내과 김주항 교수는 폐암을 잡기 위해 수술 대신 항암제·표적치료제·면역항체 치료제로 눈을 돌린 선구자다.
“폐암은 조기 발견이 어렵고 진행이 많이 된 상태에서 확인되는 경우가 많아 치료가 어렵습니다. 주로 흡연으로 인해 발생하지만, 흡연을 하지 않는 여성 환자들도 곧잘 걸립니다. 특히 동양 여성에게서 이런 경우가 많이 나타납니다. 흡연자와 비흡연자 사이에는 폐암 유발 유전자에 차이가 있습니다. 그렇다면 개별 환자에서 폐암 발생의 정확한 원인을 분석해 폐암을 치료하거나 예방할 수 있지 않은가? 질문할 수 있겠지요. 실제로 암은 세포에서 유전자에 돌연변이가 일어나 생깁니다. 그럼 돌연변이를 일으킨 세포를 수술로 모두 떼어내 버리는 대신, 돌연변이를 가지고 있는 암세포만을 선택적으로 제거하는 약을 쓰는 것은 어떨까요? 아주 좋은 생각인데, 이것이 바로 표적치료제입니다.”라는 것이 김주항 교수의 설명이다.
수술 대신 표적치료제에서 희망을 찾다
표적치료제는 암세포만 선택적으로 제거하고, 정상세포는 보호하면서 암을 치료한다.
표적치료제의 역사는 2000년대 초반으로 거슬러 올라간다. 최초로 등장한 표적치료제는 폐암에 적용 가능한 제제인 ‘이레사(Iressa)’와 ‘타세바(Tarceva)’로, 비소세포폐암에서 많이 나타나는 EGFR(Epidermal growth factor receptor, 상피세포 성장인자 수용체) 돌연변이를 표적으로 한 약물이다. 이 표적치료제를 복용함으로써 세포의 성장과 분열조절에서 중요한 역할을 하는 효소인 ‘티로신 키나제(Tyrosine Kinase)’의 활성을 억제하여 암세포의 성장을 억제하는 것이 기본 원리이다.
폐암 4기 환자에게 처방한 표적치료제
완치 판정을 이끌다
김주항 교수는 표적치료제가 선보인 직후부터 표적치료제를 적극적으로 활용해 왔다. “2000년대 초반, 지금으로부터 15년 정도 전의 일입니다. 50대 초반의 여성 환자 한 분이 폐암 4기로 투병 중이었습니다. 좌 기관지와 우 기관지의 중심에 암세포가 발생해 수술이 어려운 상황이었습니다. 2년간 항암제를 14차례나 맞아도 차도가 없을 만큼 상태가 좋지 않았죠. 사실 당시까지만 해도 폐암 4기면 거의 사망한다고 여겼습니다. 마지막 희망의 끈을 잡는다는 생각으로, 당시 막 도입되고 있던 표적치료제를 제안했습니다.”
운도 따랐다. 당시 환자에게 투여한 1세대 표적치료제는 폐에서도 모서리 부분에 생기는 선암(腺癌)에 효과적이고, 아시아계 비흡연자 여성에게 가장 효과가 좋은 약이었다. 다만, 1년 정도 투약하면 저항성이 생겨 치료 효과가 떨어진다는 보고도 많았는데, 다행히도 그 환자는 표적항암제를 10년 이상 복용해도 저항성이 나타나지 않았다. 최적의 치료법이었던 셈이다. 15년이 지난 지금 환자는 사실상 완치 판정을 받고 노래 강사로 활동하고 있다. 표적치료제를 처방하지 않았더라면 지금의 건강한 그녀의 모습을 상상이나 할 수 있었을까?
차세대 염기서열 분석을 통해 엿보는 치료 가능성
분당차병원 NGS 정밀 의료 검사실에서는 암 환자의 유전자 염기서열을 분석해 보다 정확하게 암을 진단하고 환자 맞춤형 암 치료를 제공하고 있다.
주사제가 대부분인 일반항암제와 달리 표적치료제는 간단히 먹을 수 있는 복용약이 대부분이다. 표적치료제는 부작용도 적다. 가려움증이나 설사 등이 나타나면 약물로 상태를 조절할 수도 있다. 표적치료제를 처방한 환자들에게서는 70% 전후의 치료반응을 거둘 수 있다. 일반 항암제가 30% 정도의 치료반응을 보이는 것에 비하면 매우 높은 수치다. 이쯤 되면 거의 꿈의 치료제에 가깝다.
“다만 모든 환자가 표적치료제를 시도할 수 있는 것은 아닙니다. 표적치료제는 환자의 암 세포 중 어떤 유전자에 이상이 있는지를 먼저 확인해야 합니다. 특정 유전자에서 발생한 돌연변이에 한해 약효가 나타나기 때문입니다. 차세대 염기서열분석(NGS, Next Generation Sequencing) 검사를 시행해 유전자 이상 여부를 확인한 후, 해당 유전자의 돌연변이를 치료하는 약이 있다면 시도할 수 있는 거죠.”
NGS(Next Generation Sequencing, 차세대 염기서열 분석) 검사는 환자의 종양 조직과 혈액을 통해 암 유전자를 확인해 그 환자에서 암을 유발하거나 일으키는 유전자를 찾아낼 수 있는 최신 진단기술이다. 검사에는 보통 4주 정도가 소요되는데, 결과가 나오면 이를 바탕으로 개인별 암 유전체 변이 정보에 근거해 질병의 세부 진단 및 개별 환자의 특성에 따른 맞춤 치료가 가능해 진다.
다만, 아직 표적치료제가 개발되지 않은 암을 앓는 환자의 경우 효과가 낮고 부작용이 심한 기존의 항암치료에 매달려야 한다. 김주항 교수가 신약 개발에 박차를 가하고 있는 이유도 이 때문이다. 최근에는 암 면역 치료법에서 중요한 발전도 포착되고 있다고 김주항 교수는 말한다.
“우리 몸에 암세포가 생기면, 암을 없애고자 우리 몸 속에서는 암세포와 면역체계 사이에서 전쟁이 일어납니다. 우리 몸의 백혈구, T세포, 자연살해세포 등 다양한 면역세포들이 암세포 들을 공격하게 되죠. 이 전쟁에서 이기면 건강을 지키는 거고, 지면 암에 걸리는 거고요. 암세포도 나름대로 자신을 방어하기 위해 면역을 억제하는 물질을 분비하여 면역세포를 공격합니다. 오늘날 암 면역 치료제의 기본 원리는 암세포가 분비하는 면역 억제 물질이 면역세포 들을 억제하는 과정을 차단하여 면역 세포의 활성이 유지되게 하는 것입니다. 우리 몸의 면역 세포 주변에 방어막을 만들어 면역세포를 보호하거나, 암세포가 분비하는 면역억제물질 주변에 막을 형성해서 무력화 시키는 방법으로요.”
실제로 김주항 교수의 환자 중 한 명은 가능한 모든 항암제 치료를 다 시도해보았는데도 차도가 없어 절망하던 차에 새로운 면역항암제 임상연구를 시작하면서 면역항암제 치료를 받았고, 투약 후 3년 가까이 생존하고 있다. 기존의 항암제로 치료한 4기 암환자의 평균 생존 기간이 6개월에서 1년이었던 것에 비해, 면역항체치료제를 처방한 환자는 5년 이상 생존률이 15%에 달한다. 길게는 10년 까지 생존하는 사례가 늘고 있어, 완치에 대한 희망도 품을 수 있다. “그러니 신약 개발에 욕심이 날 수 밖에요”라는 김주항 교수의 말에 고개를 끄덕이게 된다.
아데노 살상 바이러스의 개발자,
또 다른 신약치료제를 향한 노력은 계속된다
현재 다양한 제약사와 연구팀이 암을 정복하기 위해 표적치료제, 면역치료제, 신약 등에서 임상 연구를 시행하고 있다. 김주항 교수도 이 중 하나다. 그는 이미 지난 2006년 바이러스를 조작해 암세포만 파괴하는 ‘종양선택적 살상 아데노바이러스’를 개발한 바 있다. 최근에는 헤르페스 바이러스를 이용해 암세포를 선택적으로 죽일 수 있는 암 유전자 치료제에 총력을 기울이고 있다.
“미국 식품의약품안전청 FDA에서 최초로 허가를 받은 암 유전자 치료제 T-Vec이 헤르페스 바이러스를 이용한 치료제입니다. 악성 흑색종에서 효능이 있는 약품인데요, 여기서 힌트를 얻어 헤르페스 바이러스를 이용한 암 치료제 개발 연구를 시행하고 있습니다. 이 연구가 잘 진행되면 폐암은 물론 간암, 흑색종, 두경부암 등 다양한 암에서 효과를 거둘 수 있을 것으로 기대하고 있습니다.”
김주항 교수는 이제 암 역시 혈압이나 당뇨처럼 조절이 가능한 만성질환이라고 생각한다. 폐암 4기 환자의 5년 생존률이 0%로 여겨지던 때도 있었지만 이제 최고 15%까지 생존률이 높아졌고, 앞으로 새로운 치료법과 약물이 출시되면 30~40%까지 올라갈 수도 있다.
“현대의학으로는 희망이 없다고 여겨지는 환자들이 암을 다스리며 살아갈 수 있었으면 좋겠습니다. 언젠가 완치라는 기쁜 소식을 들려줄 수 있다면 더 바랄 것이 없겠지요. 환자들의 건강하고 행복한 모습을 보는 것만큼 기쁜 일은 없습니다. 더 많은 환자들에게 완치의 소식을 전할 수 있기를 바라며, 앞으로도 연구에 힘쓰겠습니다.”
분당차병원 종양내과 김주항 교수
폐암 항암치료 분야의 명의인 김주항 교수는 대한 폐암학회 회장, 한국유전자세포치료학회 회장, 한국임상암학회 회장을 역임했을 만큼 의사에게서도 인정받는 의사다. 보건복지부가 인증한 NGS검사를 활용해 유전자 특성에 기반한 항암치료를 시행하고 있다.
- 국가 암 관리 사업과 암 유전자 치료 분야의 발전을 선도한 부분을 인정받아 홍조근정훈장 수훈(2013)
- 미국 유전자치료학회 우수 논문상 (2012)
- 한국산업기술평가원 우수성과상 (2008)
- 암세포만 파괴하는 신 유전자 치료(종양선택적 살상 아데노 바이러스) (2006)
- 미국 유전자치료학회 우수 연구상 (2002)
After Treatment
After Treatment
Get information about life as a cancer survivor, next steps, and what you can do to help.
Living as a Cancer Survivor
For many people, cancer treatment often leads to questions about the next steps as a survivor or about the chances of the cancer coming back.
Living as a Colorectal Cancer Survivor
For many people with colorectal cancer, treatment can remove or destroy the cancer. The end of treatment can be both stressful and exciting. You’ll be relieved to finish treatment, yet it’s hard not to worry about cancer coming back. This is very common if you’ve had cancer.
For other people, colorectal cancer may never go away completely. Some people may get regular treatment with chemotherapy, radiation therapy, or other treatments to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful.
Life after colorectal cancer means returning to some familiar things and also making some new choices.
Cancer Concerns After Treatment
Treatment may remove or destroy the cancer, but it's very common to worry about the risk of developing another cancer.
Second Cancers After Colorectal Cancer
Treating Colorectal Cancer
Treating Colorectal Cancer
If you’ve been diagnosed with colorectal cancer, your cancer care team will discuss your treatment options with you. It’s important that you think carefully about each of your choices. Weigh the benefits of each treatment option against the possible risks and side effects.
Local treatments
Some treatments are called local therapies. This means they treat the tumor without affecting the rest of the body. These treatments are more likely to be useful for earlier stage cancers (smaller cancers that haven't spread), but they might also be used in some other situations. Types of local therapy used for colorectal cancer include:
Systemic treatments
Colorectal cancer can also be treated using drugs, which can be given by mouth or directly into the bloodstream. These are called systemic therapies because they can reach cancer cells throughout the body. Depending on the type of colorectal cancer, different types of drugs might be used, such as:
Common treatment approaches
Depending on the stage of the cancer and other factors, different types of treatment may be combined at the same time or used after one another.
Who treats colorectal cancer?
Based on your treatment options, you might have different types of doctors on your treatment team. These doctors could include:
- A gastroenterologist: a doctor who treats disorders of the gastrointestinal (GI or digestive) tract
- A surgical oncologist (oncologic surgeon): a doctor who uses surgery to treat cancer
- A colorectal surgeon: a doctor who uses surgery to treat diseases of the colon and rectum
- A radiation oncologist: a doctor who treats cancer with radiation therapy
- A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy or targeted therapy
You might have many other specialists on your treatment team as well, including physician assistants (PAs), nurse practitioners (NPs), nurses, psychologists, nutritionists, social workers, and other health professionals.
Making treatment decisions
It’s important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. It’s also very important to ask questions if there's anything you’re not sure about.
If time permits, it is often a good idea to seek a second opinion. A second opinion can give you more information and help you feel more confident about the treatment plan you choose.
Thinking about taking part in a clinical trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they're not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
Considering complementary and alternative methods
You may hear about alternative or complementary methods that your doctor hasn’t mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor’s medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision.
Help getting through cancer treatment
People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services – including rides to treatment, lodging, and more – to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.
Choosing to stop treatment or choosing no treatment at all
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but it’s important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.
The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.
Survival Rates for Colorectal Cancer
Survival Rates for Colorectal Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
What is a 5-year relative survival rate?
A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of colon or rectal cancer is 80%, it means that people who have that cancer are, on average, about 80% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed.
Where do these numbers come from?
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for colon and rectal cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.). Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the colon or rectum.
- Regional: The cancer has spread outside the colon or rectum to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the liver, lungs, or distant lymph nodes.
5-year relative survival rates for colon cancer
These numbers are based on people diagnosed with cancers of the colon between 2009 and 2015.
SEER stage
|
5-year relative survival rate
|
Localized
|
90%
|
Regional
|
71%
|
Distant
|
14%
|
All SEER stages combined
|
63%
|
5-year relative survival rates for rectal cancer
These numbers are based on people diagnosed with cancers of the rectum between 2009 and 2015.
SEER stage
|
5-year relative survival rate
|
Localized
|
89%
|
Regional
|
71%
|
Distant
|
15%
|
All SEER stages combined
|
67%
|
Understanding the numbers
- These numbers apply only to the stage of the cancer when it is first diagnosed. They do not apply later on if the cancer grows, spreads, or comes back after treatment.
- These numbers don’t take everything into account. Survival rates are grouped based on how far the cancer has spread, but your age, overall health, how well the cancer responds to treatment, and other factors will also affect your outlook.
- People now being diagnosed with colon or rectal cancer may have a better outlook than these numbers show. Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
*SEER = Surveillance, Epidemiology, and End Results
Colorectal Cancer Stages
Colorectal Cancer Stages
After someone is diagnosed with colorectal cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.
The earliest stage colorectal cancers are called stage 0 (a very early cancer), and then range from stages I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
How is the stage determined?
The staging system most often used for colorectal cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:
- The extent (size) of the tumor (T): How far has the cancer grown into the wall of the colon or rectum? These layers, from the inner to the outer, include:
- The inner lining (mucosa), which is the layer in which nearly all colorectal cancers start. This includes a thin muscle layer (muscularis mucosa).
- The fibrous tissue beneath this muscle layer (submucosa)
- A thick muscle layer (muscularis propria)
- The thin, outermost layers of connective tissue (subserosa and serosa) that cover most of the colon but not the rectum
- The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
- The spread (metastasis) to distant sites (M): Has the cancer spread to distant lymph nodes or distant organs such as the liver or lungs?
The system described below is the most recent AJCC system effective January 2018. It uses the pathologic stage (also called the surgical stage) which is determined by examining tissue removed during an operation. This is also known as surgical staging. This is likely to be more accurate than clinical staging, which takes into account the results of a physical exam, biopsies, and imaging tests, done before surgery.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information see Cancer Staging.
Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.
AJCC Stage
|
Stage grouping
|
Stage description*
|
0
|
Tis
N0
M0
|
The cancer is in its earliest stage. This stage is also known as carcinoma in situ or intramucosal carcinoma (Tis). It has not grown beyond the inner layer (mucosa) of the colon or rectum.
|
I
|
T1 or T2
N0
M0
|
The cancer has grown through the muscularis mucosa into the submucosa (T1), and it may also have grown into the muscularis propria (T2). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
|
IIA
|
T3
N0
M0
|
The cancer has grown into the outermost layers of the colon or rectum but has not gone through them (T3). It has not reached nearby organs. It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
|
IIB
|
T4a
N0
M0
|
The cancer has grown through the wall of the colon or rectum but has not grown into other nearby tissues or organs (T4a). It has not yet spread to nearby lymph nodes (N0) or to distant sites (M0).
|
IIC
|
T4b
N0
M0
|
The cancer has grown through the wall of the colon or rectum and is attached to or has grown into other nearby tissues or organs (T4b). It has not yet spread to nearby lymph nodes (N0) or to distant sites (M0).
|
IIIA
|
T1 or T2
N1/N1c
M0
|
The cancer has grown through the mucosa into the submucosa (T1), and it may also have grown into the muscularis propria (T2). It has spread to 1 to 3 nearby lymph nodes (N1) or into areas of fat near the lymph nodes but not the nodes themselves (N1c). It has not spread to distant sites (M0).
|
OR
| ||
T1
N2a
M0
|
The cancer has grown through the mucosa into the submucosa (T1). It has spread to 4 to 6 nearby lymph nodes (N2a). It has not spread to distant sites (M0).
| |
IIIB
|
T3 or T4a, N1/N1c
M0
|
The cancer has grown into the outermost layers of the colon or rectum (T3) or through the visceral peritoneum (T4a) but has not reached nearby organs. It has spread to 1 to 3 nearby lymph nodes (N1a or N1b) or into areas of fat near the lymph nodes but not the nodes themselves (N1c). It has not spread to distant sites (M0).
|
OR
| ||
T2 or T3
N2a
M0
|
The cancer has grown into the muscularis propria (T2) or into the outermost layers of the colon or rectum (T3). It has spread to 4 to 6 nearby lymph nodes (N2a). It has not spread to distant sites (M0).
| |
OR
| ||
T1 or T2 N2b
M0
|
The cancer has grown through the mucosa into the submucosa (T1), and it may also have grown into the muscularis propria (T2). It has spread to 7 or more nearby lymph nodes (N2b). It has not spread to distant sites (M0).
| |
IIIC
|
T4a
N2a
M0
|
The cancer has grown through the wall of the colon or rectum (including the visceral peritoneum) but has not reached nearby organs (T4a). It has spread to 4 to 6 nearby lymph nodes (N2a). It has not spread to distant sites (M0).
|
OR
| ||
T3 or T4a
N2b
M0
|
The cancer has grown into the outermost layers of the colon or rectum (T3) or through the visceral peritoneum (T4a) but has not reached nearby organs. It has spread to 7 or more nearby lymph nodes (N2b). It has not spread to distant sites (M0).
| |
OR
| ||
T4b
N1 or N2
M0
|
The cancer has grown through the wall of the colon or rectum and is attached to or has grown into other nearby tissues or organs (T4b). It has spread to at least one nearby lymph node or into areas of fat near the lymph nodes (N1 or N2). It has not spread to distant sites (M0).
| |
IVA
|
Any T
Any N
M1a
|
The cancer may or may not have grown through the wall of the colon or rectum (Any T). It might or might not have spread to nearby lymph nodes. (Any N). It has spread to 1 distant organ (such as the liver or lung) or distant set of lymph nodes, but not to distant parts of the peritoneum (the lining of the abdominal cavity) (M1a).
|
IVB
|
Any T
Any N
M1b
|
The cancer might or might not have grown through the wall of the colon or rectum (Any T). It might or might not have spread to nearby lymph nodes (Any N). It has spread to more than 1 distant organ (such as the liver or lung) or distant set of lymph nodes, but not to distant parts of the peritoneum (the lining of the abdominal cavity) (M1b).
|
IVC
|
Any T
Any N
M1c
|
The cancer might or might not have grown through the wall of the colon or rectum (Any T). It might or might not have spread to nearby lymph nodes (Any N). It has spread to distant parts of the peritoneum (the lining of the abdominal cavity), and may or may not have spread to distant organs or lymph nodes (M1c).
|
* The following additional categories are not listed in the table above:
- TX: Main tumor cannot be assessed due to lack of information.
- T0: No evidence of a primary tumor.
- NX: Regional lymph nodes cannot be assessed due to lack of information.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Last Medical Review: February 21, 2018 Last Revised: February 21, 2018
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
EARLY DETECTION, DIAGNOSIS, AND STAGING
- Can Colorectal Polyps and Cancer Be Found Early?
- American Cancer Society Guideline for Colorectal Cancer Screening
- Colorectal Cancer Screening Tests
- Insurance Coverage for Colorectal Cancer Screening
- Colorectal Cancer Signs and Symptoms
- Tests to Diagnose and Stage Colorectal Cancer
- Colorectal Cancer Stages
- Survival Rates for Colorectal Cancer
- Questions to Ask Your Doctor About Colorectal Cancer
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