In the Dukes classification of colorectal carcinoma, which modification correctly describes Dukes C2 stage?
- A Tumor extending through the bowel wall without lymph node involvement
- B Tumor limited to the bowel wall with regional lymph node metastases at the apical lymph node ✓
- C Distant metastases to liver or lungs
- D Regional lymph node metastases without apical node involvement
Correct answer: B. Tumor limited to the bowel wall with regional lymph node metastases at the apical lymph node
Explanation
The Dukes classification was modified by Astler-Coller. In the modified Dukes system, C is split: C1 = lymph node metastases with apical node negative; C2 = lymph node metastases with apical (highest point of ligation) node positive. C2 indicates the lymph node nearest to the surgical tie of the supplying artery is involved, which carries a worse prognosis than C1. Dukes A = tumor confined to bowel wall; B = through the wall; D (added later by Turnbull) = distant metastases.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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