TNM Classification of Malignant Tumours


Kidney : Renal Pelvis and Ureter : Urinary Bladder : Prostate : Urethra : Testis : Penis


Kidney

TNM Clinical Classification

T - Primary Tumour

  • TX Primary tumour cannot be assessed

  • T0 No evidence of primary tumour

  • T1 Tumour 7 cm or less in greatest dimension, limited to the kidney

    1. T1a Tumour 4 cm or less

    2. T1b Tumour more than 4 cm but not more than 7 cm

  • T2 Tumour more than 7 cm in greatest dimension, limited to the kidney

  • T3 Tumour extends into major veins or directly invades adrenal gland or perinephric tissues but not beyond Gerota fascia

    1. T3a Tumour directly invades adrenal gland or perinephric tissues - includes renal sinus (peripelvic) fat - but not beyond Gerota fascia

    2. T3b Tumour grossly extends into renal vein(s) - includes segmental (muscle-containing) branches - or vena cava or its wall below diaphragm

    3. T3c Tumour grossly extends into vena cava or its wall above diaphragm

  • T4 Tumour directly invades beyond Gerota fascia

N - Regional Lymph Nodes

The regional lymph nodes are the hilar, abdominal para-aortic, and paracaval nodes. Laterality does not affect the N categories.

  • NX Regional lymph nodes cannot be assessed

  • N0 No regional lymph nodes metastasis

  • N1 Metastasis in a single regional lymph node

  • N2 Metastasis in more than one regional lymph node

M - Distant Metastasis

  • MX Distant metastasis cannot be assessed

  • M0 no distant metastasis

  • M1 Distant metastasis


pTNM Pathological Classification

PN0 Histological examination of a regional lymphadenectomy specimen will ordinarily include 8 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.


G Histopathologocal Grading

  • GX Grade of differentiation cannot be assessed

  • G1 Well differentiated

  • G2 Moderately differentiated

  • G3-4 Poorly differentiated/undifferentiated


Renal Pelvis and Ureter

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TNM Clinical Classification

T - Primary Tumour

  • TX Primary tumour cannot be assessed

  • T0 No evidence of primary tumour

  • Ta Noninvasive papillary carcinoma

  • Tis Carcinoma in situ

  • T1 Tumour invades subepithelial connective tissue

  • T2 Tumour invades muscularis

  • T3 (Renal pelvis) Tumour invades beyond muscularis into peripelvic fat or renal parenchyma
    (Ureter) Tumour invades beyond muscularis into periureteric fat

  • T4 Tumour invades adjacent organs or through the kidney into perinephric fat


N - Regional Lymph Nodes

The regional lymph nodes are the hilar, abdominal para-aortic, and paracaval nodes and , for ureter, intrapelvic nodes. Laterality does not affect the N classification.

  • NX Regional lymph nodes cannot be assessed

  • N0 No regional lymph node metastasis

  • N1 Metastasis in a single lymph node 2 cm or less in greatest dimension

  • N2 Metastasis in a single lymph node more than 2 cm but no more than 5 cm in greatest dimension, or multiple lymph nodes, none more than 5 cm in greatest dimension

  • N3 Metastasis in a lymph node more than 5 cm in greatest dimension


M - Distant Metastasis

  • MX Distant metastasis cannot be assessed

  • M0 No distant metastasis

  • M1 Distant metastasis


P TNM Pathological Classification

The pt, pN, and pM categories correspond to the T, N, and M categories.


G Histopathological Grading

  • GX Grade of differentiation cannot be assessed

  • G1 Well differentiated

  • G2 Moderately differentiated

  • G3-4 Poorly differentiated-undifferentiated


Urinary Bladder

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TNM Clinical Classification

T - Primary Tumour

The suffix (m) should be added to the appropriate T category to indicate multiple tumours. The suffix (is) may be added to any T to indicate presence of associated carcinoma in situ.

  • TX Primary tumour cannot be assessed

  • T0 No evidence of primary tumour

  • Ta Noninvasive papillary carcinoma

  • Tis Carcinoma in situ: "flat tumour"

  • T1 Tumour invades subepithelial connective tissue

  • T2 Tumour invades muscle

    1. T2a Tumour invades superficial muscle (inner half)

    2. T2b Tumour invades deep muscle (outer half)

  • T3 Tumour invades perivescical tissue:

    1. T3a microscopically

    2. T3b macroscopically (extravescical mass)

  • T4 Tumour invades any of the following: prostate, uterus, vagina, pelvic wall, abdominal wall

    1. T4a Tumour invades prostate, uterus, or vagina

    2. T4b Tumour invades pelvic wall or abdominal wall

N - Regional Lymph Nodes

The regional lymph nodes are the nodes of the true pelvis, which essentially are the pelvic nodes below the bifurcation of the common iliac arteries. Laterality does not affect the N classification.

  • NX Regional lymph nodes cannot be assessed

  • N0 No regional lymph node metastasis

  • N1 Metastasis in a single lymph node 2 cm or less in greatest dimension

  • N2 Metastasis in a single lymph node more than 2 cm but not more than 5 cm in greatest dimension, or multiple lymph nodes, none more than 5 cm in greatest dimension

  • N3 Metastasis in a lymph node more than 5 cm in greatest dimension

M - Distant Metastasis

  • MX Distant metastasis cannot be assessed

  • M0 No distant metastasis

  • M1 Distant metastasis


pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M categories.


G Histopathological Grading

  • GX Grade of differentiation cannot be assessed

  • G1 Well differentiated

  • G2 Moderately differentiated

  • G3-4 Poorly differentiated/undifferentiated


Prostate

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TNM Clinical Classification

T - Primary Tumour

  • TX Primary tumour cannot be assessed

  • T0 No evidence of primary tumour

  • T1 Clinically inapparent tumour not palpable or visible by imaging

    1. T1a Tumour incidental histological finding in 5 % or less of tissue resected

    2. T1b Tumour incidental histological finding in more than 5% of tissue resected

    3. T1c Tumour identified by needle biopsy (e.g., because of elevated PSA)

  • T2 Tumour confined within prostate - tumour found in one or both lobes by needle biopsy, but not palpable or visible by imaging, is classified as T1c

    1. T2a Tumour involves one half of the lobe or less

    2. T2b Tumour involves more than half of the lobe, but not both lobes

    3. T2c Tumour involves both lobes

  • T3 Tumour extends through the prostatic capsule - invasion into the prostatic apexor into (but not beyond) the prostatic capsule is not classified as T3, but as T2

    1. T3a Extracapsular extension (unilateral or bilateral)

    2. T3b Tumour invades seminal vesicle(s)

  • T4 Tumour is fixed or invades adjacent structures other than seminal vesicles: bladder neck, external sphincter, rectum, levator muscles, or pelvic wall

N - Regional Lymph Nodes

The regional limph nodes are the nodes of the true pelvis, which essentially are the pelvic nodes below the bifurcation of the common iliac arteries. Laterality does not affect the N classification.

  • NX Regional lymph nodes cannot be assessed

  • N0 No regional lymph nodes metastasis

  • N1 Regional lymph nodes metastasis

Note: Metastasis no larger than 0.2 cm can be designated pN1mi.

M - Distant Metastasis

  • MX Distant Metastasis cannot be assessed

  • M0 No distant metastasis

  • M1 Distant metastasis

    1. M1a Non-regional lymph node(s)

    2. M1b Bone(s)

    3. M1c Other site(s)


pTNM Pathological Classification

The pT, pN and pM categories correspond to the T, N, and M categories. However, there is no pT1 category because there is insufficient tissue to assess the highest pT category.


G Histopathological Grading

  • GX Grade cannot be assessed

  • G1 Well differentiated (slight anaplasia) (Gleason 2-4)

  • G2 Moderately differentiated (moderate anaplasia) (Gleason 5-6)

  • G3-4 Poorly differentiated/undifferentiated (marked anaplasia) (Gleason 7-10)


Urethra

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TNM Clinical Classification

T - Primary Tumour

  • TX Primary tumour cannot be assessed

  • T0 No evidence of primary tumour

Urethra (male and female)

  • Ta Noninvasive papillary, polypoid, or verrucous carcinoma

  • Tis Carcinoma in situ

  • T1 Tumour invades subepithelial connective tissue

  • T2 Tumour invades any of the following: corpus spongiosum, prostate, periurethral muslce

  • T3 Tumour invades any of the following: corpus cavernosum, beyond prostatic capsule, anterior vagina, bladder neck

  • T4 Tumour invades other adjacent organs

Transitional cell carcinoma of prostate (prostatic urethra)

  • Tis pu Carcinoma in situ, involvement of prostatic urethra

  • Tis pd Carcinoma in situ, involvement of prostatic ducts

  • T1 Tumour invades subepithelial connective tissue

  • T2 Tumour invades any of the following: prostatic stroma, corpus spongiosum, periurethral muscle

  • T3 Tumour invades any of the following: corpus cavernosum, beyond prostatic capsule, bladder neck (extraprostatic extension)

  • T4 Tumour invades other adjacent organs (invasion of bladder)

N - Regional Nodes

The regional lymph nodes are the inguinal and the pelvic nodes. Laterality does not affect the N classification.

  • NX Regional nodes cannot be assessed

  • N0 No regional lymph node metastasis

  • N1 Metastasis in a single lymph node 2 cm or less in greatest dimension

  • N2 Metastasis in a single lymph node more than 2 cm in greatest dimension, or multiple lymph nodes

M - Distant Metastasis

  • MX Distant metastasis cannot be assessed

  • M0 No distant metastasis

  • M1 Distant metastasis


pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M categories.


G Histopathological Grading

  • GX Grade of differentiation cannot be assessed

  • G1 Well differentiated

  • G2 Moderately differentiated

  • G3-4 Poorly differentiated/undifferentiated


Testis

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TNM Clinical Classification

T - Primary Tumour

Except for pTis and pT4, where radical orchiectomy is not always necessary for classification purposes, the extent of the primary tumour is classified after radical orchiectomy; see pT. In other circumstances, TX is used if no radical orchiectomy has been performed.

N - Regional Lymph Nodes

The regional lymph nodes are the abdominal para-aortic (periaortic), preaortic, interaortocaval, precaval, paracaval, retrocavavl, and retroaortic nodes. Nodes along the spermatic vein should be considered regional. Laterality does not affect the N classification. The intrapelvic nodes and the inguinal nodes are considered regional after scrotal or inguinal surgery.

  • NX Regional lymph nodes cannot be assessed

  • N0 No regional lymph node metastasis

  • N1 Metastasis with a lymph node mass 2 cm or less in greatest dimension or multiple lymph nodes, none more than 2 cm in greatest dimension

  • N2 Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension, or multiple lymph nodes, any one mass more than 2 cm but not more than 5 cm in greatest dimension

  • N3 Metastasis with a lymph node mass more than 5 cm in greatest diemnsion

M - Distant Metastasis

  • MX Distant metastasis cannot be assessed

  • M0 No distant metastasis

  • M1 Distant metastasis

    1. M1a Non regional lymph node(s) or lung

    2. M1b Other sites


pTNM Pathological Classification

PT - Primary Tumour

  • pTX Primary tumour cannot be assessed (see T-Primary Tumour, above)

  • pT0 No evidence of primary tumour (e.g. histologic scar in testis)

  • pTis Intratubular germ cell neoplasia (carcinoma in situ)

  • pT1 Tumour limited to testis and epididymis without vascular/lymphatic invasion; tumour may invade tunica albuginea but not tunica vaginalis.

  • pT2 Tumour limited to testis and epididymis with vascular/lymphatic invasion, or tumour extending through tunica albuginea with involvement of tunica vaginalis.

  • pT3 Tumour invades spermatic cord with or without vascular/lymphatic invasion.

  • pT4 Tumour invades scrotum with or without vascular/lymphatic invasion.

PN - Regional Lymph Nodes

  • pNX Regional lymph nodes cannot be assessed

  • pN0 No regional lymph nodes metastasis

  • pN1 Metastasis with a lymph node mass 2 cm or less in greatest dimension and 5 or fewer positive nodes, none more than 2 cm in greatest dimension

  • pN2 Methastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension; or more than 5 nodes positive, none more than 5 cm; or evidence of extranodal extension of tumour

  • pN3 Metastasis with a lymph nodes mass more than 5 cm in greatest dimension

pM - Distant Metastasis

The pM category corresponds to the M category

S - Serum Tumour Markers

  • SX Serum marker studies not available or not performed
    Serum marker study levels within normal limits


LDH

 

hCG(mIU/ml)

 

AFP (ng/ml)

  • S1  

<1.5 x N

and

<5,000

and

<1,000

  • S2  

1.5-10 x N

or

5,000-50,000

or

1,000-10,000

  • S3  

>10 x N

or

>50,000

or

>10,000

     N indicates the upper limit of normal for the LDH assay



Penis

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Anatomical Subsites

  1. Prepuce (C60.0)

  2. Glans penis (C60.1)

  3. Body of penis (C60.2)


TNM Clinical Classification

T - Primary Tumour

  • TX Primary tumour cannot be assessed

  • T0 No evidence of primary tumour

  • Tis Carcinoma in situ

  • Ta Noninvasive verrucous carcinoma

  • T1 Tumour invades subepithelial connective tissue

  • T2 Tumour invades corpus spongiosum or cavernosum

  • T3 Tumour invades urethra or prostate

  • T4 Tumour invades other adjacent structures

N - Regional Lymph Nodes

The regional lymph nodes are the superficial and deep inguinal and pelvic node.

  • NX Regional lymph nodes cannot b assessed

  • N0 No regional lymph node metastasis

  • N1 Metastasis in a single superficial inguinal lymph node

  • N2 Metastasis in multiple or bilateral superficial inguinal lymph nodes

  • N3 Metastasis in deep inguinal or pelvic lymph node(s), unilateral or bilateral

M - Distant Metastasis

  • MX Distant metastasis cannot be assessed

  • M0 No distant metastasis

  • M1 Distant Metastasis


G Histopathological Grading

  • GX Grade of differentiation cannot be assessed

  • G1 Well differentiated

  • G2 Moderately differentiated

  • G3-4 Poorly differentiated/undifferentiated






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