Report in English with a Dutch summary (KCE reports 45A)

26 Screening for Colorectal Cancer KCE reports vol.45
Figure 4: Invasive colorectal primary tumor localisations (n = 7.091,
including appendix) in Flanders 2000 2001 (source: Vlaams
Agentschap Zorg en Gezondheid 39)
2.4 STAGING
The TNM staging system (Tumor, Node, Metastasis) 40, 41 of the American Joint
Committee on Cancer (AJCC) and the International Union Against Cancer
(Union Internationale Contre le Cancer - UICC) is now the standard for
colorectal cancer staging widely used by national, regional, and local tumor
registries in the United States and internationally. In short, it is the international
language of colorectal cancer staging in all disciplines. The TNM system has
three additional advantages over other staging systems. First, it is data-driven
and has a process in place for continuous improvement based on ongoing
expert review of existing data. Second, it has a comprehensive set of definitions
and rules of application that ensure uniform use. Third, it is multidisciplinary in
design and is pertinent to all modern techniques of stage evaluation.
Figure 5 shows the distribution of colorectal cancer TNM stages in males and
females in Flanders for the years 2000 - 2001. Stage distributions in males and
females show a very comparable pattern. These data also show that the stage
distribution is very similar in the different age categories (not shown). This
staging illustrates the extent of colorectal cancer at the time of diagnosis and
enabled the classification of patients into prognostically comparable categories.
Although the importance of good staging is well-recognised, these data were
not always passed on to the cancer registry. In addition, these data may have
been incomplete or missing from the medical files. These are possible reasons
why the cancer registry encountered an important percentage of missing data.
With the introduction in 2003 of financial reimbursement for multidisciplinary
oncological consultations, it might be expected that these data will be more
complete in the future because payment is only made if these data are
completed.