The Dukes staging for colorectal cancer has been largely superseded by TNM, but remains tested. Dukes C2 in the modified Astler-Coller classification refers to:
- A Tumour confined to the mucosa with no nodal involvement
- B Tumour confined to muscularis propria with regional node involvement
- C Tumour through the bowel wall with involvement of apical lymph node (highest surgical tie node) ✓
- D Distant haematogenous metastases
Correct answer: C. Tumour through the bowel wall with involvement of apical lymph node (highest surgical tie node)
Explanation
In the modified Astler-Coller classification (MAC, 1954): A — mucosa; B1 — into muscularis propria, node-negative; B2 — through muscularis propria (serosa/pericolic fat), node-negative; B3 — adherent to adjacent organ, node-negative; C1 — B1 + positive regional nodes; C2 — B2 with apical (highest tied) node positive (worse prognosis than C1); D — distant metastases. C2 specifically denotes involvement of the node at the highest surgical tie point, indicating inadequate resection margin or aggressive disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.