Which of the following best describes the Dukes–Astler–Coller (modified Dukes) classification stage C2 of colorectal carcinoma?

• A Tumor confined to mucosa with no lymph node involvement
• B Tumor through all layers with regional lymph nodes positive but apical node negative
• C Distant metastases present regardless of local extent
• D Tumor through all layers of bowel wall with apical lymph node positive ✓

Explanation

In the modified Dukes (Astler–Coller) classification: Stage A = confined to mucosa; B1 = into muscularis propria, nodes negative; B2 = through full wall, nodes negative; C1 = nodes positive, apical node negative; C2 = nodes positive including the apical (highest) node. Stage D = distant metastases. Apical node positivity in C2 denotes more extensive nodal spread and carries a worse prognosis than C1.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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