title: TNMF versus TNM in staging of colorectal cancer.
abstract: OBJECTIVE
  TNM staging and histological grading of rectal cancer has undergone no or minimal changes during the past 20 years despite their major impact on planning, reporting and outcome of the disease. The addition of category 'F' to the 'TNM' staging of colorectal cancer, which becomes TNMF will accommodate the expanding list of risk factors that may affect the management and thus avoid squeezing them into the TNM categories.
  
  
  METHODS
  Reporting of the following risk factors was traced in 730 (664 retrospective and 66 prospective) cases of colorectal cancer: age, Tumor location, preoperative CEA, intraoperative tumor perforation and blood transfusion, quality of TME, tumor grade, non nodal T.Ds, Lymphovascular invasion, lymph node ratio, circumferential tumor margins, apical lymph nodes, infiltrating or pushing and K-ras gene mutation.
  
  
  RESULTS
  The reporting of most risk factors was inadequate; also there is marked improvement in reporting in the prospective cases in preoperative CEA, intra operative blood transfusion and tumor perforation, quality of TME, tumor grade and non-nodal T.Ds (P-value <0.0001).
  
  
  CONCLUSIONS
  The addition of category 'F' to the TNM staging system to become TNMF may avoid ignoring already established risk factors due to our inability to accommodate them in the inhospitable TNM categories.
authors.affiliation: General Surgery Department, Cairo University, Egypt. Electronic address: Farag2a@gmail.com.
authors.forename: Ahmed Farag
authors.initials: AF
authors.lastname: Ahmed Farag
authors.affiliation: General Surgery Department, Cairo University, Egypt. Electronic address: dr.yeho@yahoo.com.
authors.forename: Mohamed Yehia
authors.initials: MY
authors.lastname: Elbarmelgi
authors.affiliation: Medical Oncology Department, Cairo University, Egypt. Electronic address: azimonc@cairocure.com.
authors.forename: Hamdy A
authors.initials: HA
authors.lastname: Azim
authors.affiliation: General Surgery Department, Ain Shams University, Egypt. Electronic address: Ahabaz@hotmail.com.
authors.forename: Ahmed Abdelaziz
authors.initials: AA
authors.lastname: Abozeid
authors.affiliation: General Surgery Department, Cairo University, Egypt. Electronic address: mashour24@yahoo.com.
authors.forename: Abdrabou N
authors.initials: AN
authors.lastname: Mashhour
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Colorectal cancer; Prognosis; Staging; TNM