The future of the TNM staging system in colorectal cancer: time for a debate?

Summary TNM staging has made a major contribution to the clinical management of patients with cancer over the past 50 years, but are we sure it delivers what is needed to provide adequate advice in the 21st century, and are there ways in which the system can be improved? This article, by pathologists with a special interest in colorectal cancer, is intended to offer constructive criticism towards the TNM classification of colorectal cancer, make suggestions for improvement, and recommend the adoption of a robust evidence base for this system.