The staging of colon cancer remains, to this day, one of the impenetrable mysteries of our cancer journey. It seemed clear enough in the beginning, right after what we thought of as “John’s colon explosion”. I still have the piece of paper that his colon surgeon handed me when he delivered his diagnosis the next morning in the hospital. He had written these words:
Adenocarcinoma of colon. Moderately differentiated. T4 (perforated)– margins clear. NO (16 nodes negative). MO (no mets noted at surgery or on CRR). Stage III. CEA 0.8.
That morning in the hospital, the surgeon told us,
“Best possible outcome given the circumstances. The tumor had only partially invaded the wall of the colon. The tumor itself did not rupture; the rupture was adjacent to the tumor. I’ve staged it as a T4 tumor but even this is controversial because T4 means the tumor has completely invaded the colon wall. In this case, it is classified as a T4 because of the perforation, but otherwise it would be a T2. I may present this very unusual case to the tumor board.”
This all seemed fairly clear-cut, the way he presented it that morning. But then, my mind went back ….
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