Dukes' staging system

Doctors use different systems for staging bowel cancer. The most common system for bowel cancer is TNM staging. But you might hear your doctor talking about your bowel cancer as Dukes’ A,B,C or D.

Dukes' A

The cancer is in the inner lining of the bowel. Or it is slightly growing into the muscle layer.  

Diagram showing Dukes' A bowel cancer

Dukes' B

The cancer has grown through the muscle layer of the bowel. 

Diagram showing Dukes' B bowel cancer

Dukes' C

The cancer has spread to at least 1 lymph node close to the bowel. 

Diagram showing Dukes' C bowel cancer

Dukes' D

The cancer has spread to another part of the body, such as the liver, lungs or bones. 

In the number staging system, this is the same as stage 4. It is also called advanced bowel cancer.

Diagram showing Dukes' D bowel cancer

Treatment

The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is in your bowel (colon or rectum)
  • other health conditions that you have

The stage of the cancer and these other factors can also give an idea of your outlook (prognosis).

The main treatments for cancer of the large bowel (colon cancer) are:

  • surgery
  • chemotherapy

The main treatments for cancer of the back passage (rectal cancer) are:

  • surgery
  • radiotherapy
  • chemotherapy
  • chemotherapy and radiotherapy together (chemoradiotherapy)

Advanced cancer means your cancer has spread away from where it started. You might have chemotherapy or radiotherapy for advanced bowel cancer. Sometimes you can also have surgery. This is to remove as much cancer as possible and help with your symptoms.

Other stages

  • Colorectal cancer
    The National Institute for Health and Care Excellence (NICE), 2020. Updated December 2021

  • Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
    G Argilés and others
    Annals of Oncology, 2020. Volume 31, Issue 10 Pages 1291-1305

  • Rectal cancer: ESMO clinical practical guidelines for diagnosis, treatment and follow up
    R Glynne-Jones and others
    Annals of Oncology, 2017. Volume 28, Pages 422-440

  • Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    E. Van Cutsem and others
    Annals of Oncology, 2014. Volume 25 (Supplement 3)

Last reviewed: 
21 Jan 2022
Next review due: 
21 Jan 2025

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