0:01

And so, first of all, what is the nodal staging,

0:03

and what constitutes regional versus

0:07

non-regional lymph nodes and rectal cancer?

0:10

So, let's first look at the TNM staging of

0:13

rectal cancer, and the TNM staging of rectal cancer,

0:16

as it is outlined in the AJCC 8th

0:20

edition, is based on the number of lymph nodes.

0:25

And so, N1A is when you have a single metastatic node

0:32

N1B is when you have two to three metastatic nodes.

0:36

N2A is when it is four to six metastatic

0:40

nodes, and N2B is when it is seven or more.

0:44

So, as you can see, the number of lymph

0:46

nodes is what governs the nodal staging.

0:48

Now, for practical purposes, we don't typically

0:50

dwell on, you know, most sites, they usually

0:54

in their reports, they say, is there or

0:56

is there not a positive lymph node present?

0:59

And they give a rough estimate

1:00

of the size of the affected node.

1:02

And a rough estimate of the number of

1:04

affected, or you don't have to nickel and

1:06

dime in terms of the precise number of nodes.

1:09

The more generic sort of concept is to look

1:12

for the presence or absence of lymph nodes.

1:14

So, that's sort of nodal staging.

1:16

Now, in the nodal staging, there is one component

1:19

that is very key, and that is what falls in N1C,

1:24

and that is referred to as a tumor deposit.

1:27

And we'll talk about what a tumor deposit

1:29

means and what the implications are.