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Dukes' staging system

Doctors use different systems for staging 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 
  • other health conditions that you have

Surgery is the main treatment for bowel cancer that hasn’t spread to other parts of the body (early stage bowel cancer). But some people may also have chemotherapy and radiotherapy.

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

Last reviewed: 
13 Sep 2018
  • Colorectal cancer: the diagnosis and management of colorectal cancer
    The National Institute for Health and Care Excellence (NICE), 2011 

  • Primary colon cancer: ESMO Clinical Practice Guidelines for diagnosis, adjuvant treatment and follow-up
    Labianca and others
    Annals of Oncology, 2010. Vol 21 

  • 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

Information and help

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