DESEASE

T

(Primary Tumour)

N
(Regional Lymphnodes)

M

(Distant metastasis)

2002

6^th ED.

2009

7^th ED.

2002

6^th ED.

2009

7^th ED.

2002

6^th ED.

2009

7^th ED.

2002

6^th ED.

2009

7^th ED.

ANAL CANAL CANCER

Tis: Carcinoma in situ

Tis: Carcinoma in situ, Bowen disease, High grade Squamous Intraepithelial Lesion (HSIL), Anal Intrepithelial Neoplasis II-III (AIN II-III)

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

BREAST CANCER

Tis (Paget’s)
Paget’s disease of the nipple with no tumor

Note : Paget’s disease associated with a tumor is classified according to the size of the tumor

Tis (Paget) disease of the nipple not associated with invasive carcinoma and/or carcinoma in situ (DCIS and/or LCIS) in the underlying breast parenchyma. Carcinomas in the breast parenchyma associated with Paget disaese are categorized based on the size and characteristics of the parenchymal disease, although the presence of Paget disaese should still be noted

N1 Metastasis in movable ipsilateral axillary lymph node(s)

N2: Metastasis in ipsilateral axillary lymph nodes fixed or matted, or in clinically apparent* ipsilateral internal mammary nodes in the absence of clinically evident axillary lymph node metastasis

N2b

Mtastasis only in clinically apparent* ipsilateral internal mammary nodes and in the absence of clinically evident axillary lymph node metastasis

N3

Metastasis in ipsilateral infraclavicular lymph node(s) with or without axillary lymph node involvement , or in clinically apparent* ipsilateral internal mammary lympj node(s) and in the presence of clinically evident axillary lymph node metastasis; or metastasis in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement

N3a

Metastasis in ipsilateral infraclavicular lymph nodes

N3b

Metastasis in ipsilateral internal mammary lymph node(s) and axillary lymph node(s)

N3c

Metastasis in ipsilateral supraclavicular lymph node(s)

*Note: clinically apparent is defined as detected by imaging studies (excluding lymphoscintigraphy) or by clinical examination or grossly visible pathologically

N1:

Metastasis in movable ipsilateral Level I, II axillary lymph node(s)

N2

Metastasis in ipsilateral Level I, II axillary lymph node(s) that are clinically fixed or matted; or in clinically detected* ipsilateral internal mammary lymph node(s) in the absence of clinically evident lymph node metastasis

N2b

Metastasis only in clinically detected* internal mammary lymph node(s) and in the absence of clinically detected axillary lymph node metastasis

N3

Metastasis in ipsilateral infraclavicular (Level III axillary) lymph node(s) with or without Level I, II axillary lymph node involvement; or in clinically detected* ipsilateral internal mammary lymph node(s) with clinically evident level I, II axillary lymph node metastasis; or metastasis in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement

N3a

Metastasis in infraclavicular lymph nodes

N3b

Metastasis in internal mammary and axillary lymph node(s)

N3c

Metastasis in supraclavicular lymph node(s)

*Note: Clinically detected is defined as detected by clinical examination or imaging studies (excluding lymphoscintigraphy) and having characteristics highly suspicious for malignancy or a presumed pathological macrometastasis based on fine-needle aspiration biopsy with cytological examination. Confirmation of clinically detected metastatic disease by fine-needle aspiration without excision biopsy is designated with an (f) suffix, e.g., cN3a(f).

Excisional biopsy of a lymph node or biopsy of a sentinel node , in the absence of assignment of a pT, is classified as a clinical N, e.g., cN1. Pathological classification(pN) is used for excision or sentinel node biopsy only in conjuction with a pathological T assignment.

Mx

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

Stage I

T1, N0, M0

Stage IA

T1, N0, M0

Stage IB

T0-1, N1mi, M0

BLADDER CANCER

No modifications

Regional lymph nodes are those within the true pelvis; all others are distant lymph nodes

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 dimension

N3 Metastasis in a lymph node > 5 cm in greatest dimension

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

N1 Metastasis in a single lymph node in the true pelvis (hypogastric, obturator, external iliac, or presacral)

N2: Metastasis in multiple lymph nodes in the true pelvis (hypogastric, obturator, external iliac, or presacral)

N3: Metastasis in a common iliac lymph node(s)

Mx

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

BRAIN CANCERS

TNM not applicable

TNM not applicable

TNM not applicable

TNM not applicable

CHOLANGIOCARCINOMA

COLON AND RECTUM

T4: Tumour directly invades other organs or structures and/or perforates the visceral peritoneum**, ***

T4: Tunour directly invades other organs or structures and or perforates visceral peritoneum

T4a: Tumour perforates visceral peritoneum

T4b: Tumour directly invades other organs or structures **, ***

**Note: Direct invasion in T4b includes invasion of other organs or segments of the colorectum by way of the serosa, as confirmed on microscopic examination, or for tumours in a retroperitoneal or subperitoneal location, direct invasion of other organs or structures by virtue of extension beyond the muscularis propia

*** Tumor that is adherent to other organs or structures, macroscopically, is classified cT4b . However, if no tumor is present in the adhesion, microscopically, the classification should be pT1-3, depending on the anatomical depth of wall invasion .

N1: Metastasis in 1 to 3 regional lymph nodes

N2: Metastasis in 4 or more regional lymph nodes

N1: Metastasis in 1 to 3 regional lymph nodes

N1a: Metastasis in 1 regional lymph node

N1b: Metastasis in 2-3 regional lymph nodes

N1c: Tumour deposit(s), i.e., satellites*, in the subserosa, or in non-peritonealized pericolic or perirectal soft tissue without regional lymph node metastasis

*Note Tumour deposits (satellites), i.e., macroscopic or microscopic nests or nodules, in the pericolorectal adipose tissue’s lymph drainage area of a primary carcinoma without histological evidence of residual lymph node in the nodule, may represent discontinuous spread, vanous invasion with extravascular spread (V1/2) or a totally replaced lymph node (N1/2). If such deposits are observed with lesions that would otherwise be classified as T1 or T2, then the T classification is not changed, but the nodule(s) is recorded as N1c. If a nodule is considered by the pathologist to be a totally replaced lymph node (generally having a smooth contour), it should be recorded as a positive lymph node and not as a satellite, and each nodule should be counted separately as a lymph node in the final pN determination.

N2: Metastasis in 4 or more regional lymph nodes

N2a: Metastasis in 4-6 regional lymph nodes

N2b: Metastasis in 7 or more regional lymph nodes

MX: Presence of distant metastasis cannot be assessed

M1: Distant metastasis

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

M1: Distant metastasis

M1a: Metastasis confined to one organ (liver, lung, ovary, non-regional lymph node(s))

M1b: Metastasis in more than one organ or the peritoneum

Stage IIB

T4, N0, M0

Stage IIIA

T1-2, N1, M0

Stage IIIB

T3-4, N1,M0

Stage IIIC

T, N2, M0

Stage IV

Any T, any N, M1

Stage II

T3-4, N0, M0

Stage IIB

T4 a, N0, M0

Stage IIC

T4b, N0, M0

Stage III

Any T, N1-2, M0

Stage IIIA

T1-2, N1, M0

T1, N2a, M0

Stage IIIB

T3-4a, N1,M0

T2-3, N2a, M0

T1-2, N2b, M0

Stage IIIC

T4a, N2a, M0

T3-4a, N2b, M0

T4b, N1-2, M0

Stage IVA

Any T, Any N, M1a

Stage IVB

Any T, Any N, M1b

ENDMETRIUM

T1 (FIGO I) : Tumout confined to corpus uteri

T1a (FIGO IA): Tumour limited to endometrium

T1 (FIGO I) : Tumout confined to corpus uteri *

T1a (FIGO IA): Tumour limited to endometrium or inavding less than half of myometrium*

*Note: Endocervical glandular involvement only should now be condìsidered as Stage I.

N1 (FIGO IIIC): Regional lymph node metastasis to pelvic and or para-aortic nodes

N1 (FOGO IIIC) : Metastasis to pelvic or para-aortic lymph nodes*

IIIC1: Metastasis to pelvic lymph nodes

*Note: Positive cytology has to be reported separately without changing the stage

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

ESOPHAGUS

T1: Tumour invades lamina propria or submucosa

T4 : Tumour invades adjacent structures

T1: Tumour invades lamina propria, muscularis mucosae, or submucosa

T1a : Tumour invades lamina propria or muscularis mucosae

T1b : Tumour invades submucosa

T4 : Tumour invades adjacent structures

T4a : Tumour invades pleura, pericardium, or diaphragm

T4b : Tumour invades other adjacent structures such as aorta, vertebral body, or trachea

N1: Regional lymph node metastasis

N1: Metastasis in

1-2 regional lymph nodes

N2: Metastasis in

3-6 regional lymph nodes

N3: Metastasis in 7 or more regional lymph nodes

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

Stage I

T1 N0 M0

Stage IIA

T2 NO MO

T3 NO MO

Stage III

T3 N1 MO

T4 AnyN MO

Stage IV

AnyT,AnyN,M1

Stage IVA

AnyT,AnyN,M1a

Stage IVB

AnyT AnyN,M1b

Stage IA

T1, N0, M0

Stage IB

T2, N0, M0

Stage IIA

T3, N0, M0

Stage IIIA

T4a, N0, M0

T3, N1, M0

T1-2, N2, M0

Stage IIIB

T3, N2, M0

Stage IIIC

T4a, N1-2, M0

T4b, AnyN, M0

AnyT, N3, M0

Stage IV

AnyT,AnyN,M1

GASTRIC CANCER

Tis: Carcinoma in situ: intraepithelial tumour without invasion of the lamina propria

T1 Tumour invades lamina propria or submucosa

T2 Tumour invades muscularis propria or subserosa*
T2a Tumour invades muscularis propria
T2b Tumour invades subserosa

T3 Tumour invades the serosa (visceral peritoneum) without invasion of adjacent structures**,***

T4 Tumour directly invades adjacent structures**,***

Notes:
* A tumour may penetrate the muscularis propria with extension into the gastrocolic or gastrohepatic ligaments or into the greater or lesser omentum without perforation of the visceral peritoneum covering these structures. In this case, the tumour would be classified as T2. If there is perforation of the visceral peritoneum covering the gastric ligaments or omenta, the tumour is classified T3.

** The adjacent structures of the stomach are the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum.

***Intramural extension into the duodenum or oesophagus is classified by the depth of greatest invasion in any of these sites, including the stomach.

Tis:Carcinoma in situ: intraepithelial tumour without invasion of the lamina propria, high grade dysplasis

T1: Tumour invades lamina propria, muscularis mucosae, or submucosa

T1a : Tumour invades lamina propria or muscularis mucosae

T1b : Tumour invades submucosa

T2 : Tumour invades muscularis propria

T3 : Tumour invades serosa

T4: Tumour perforates serosa or invades adjacent structures*,**,***

T4a : Tumour perforates serosa

T4b : Tumour invades adjacent structures*,**,***

Notes :

*the adjacent structures of the stomach are the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperineum.

**Intramural extension to the duodenum or oesophagus is classified by the depth of greatest invasion in any of these sites, including stomach.

*** Tumour that extends into gastrocolic or gastro-hepatic ligaments or into greater or lesser omentum, without perforation of visceral perineum, is T3.

N1 Metastasis in 1 to 6 regional lymph nodes

N2 Metastasis in 7 to 15 regional lymph nodes

N3 Metastasis in more than 15 regional lymph nodes

N1: Metastasis in 1 to 2 regional lymph nodes

N2: Metastasis in 3 to 6 regional lymph nodes

N3: Metastasis in 7 or more regional lymph nodes

N3a: Metastasis in 7-15 regional lymph nodes

N3b: Metastasis in 16 or more regional lymph nodes

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

Note: Distant metastasis includes peritoneal seeding, positive peritoneal cytology, and omental tumour not part of continuous extension.

Stage 0
Tis N0 M0
Stage I A
T1 N0 M0

Stage IB

T1 N1 M0

T2a/b N0 M0
Stage II
T1 N2 M0, T2a/b N1 M0, T3 N0 M0

Stage IIIA
T2a/b N2 M0

T3 N1 M0

T4 N0 M0

Stage IIIB

T3 N2 M0

Stage IV
T4 N1-3 M0

T1-3 N3 M0

Any T Any N M1

Stage 0
Tis N0 M0
Stage I A
T1 N0 M0

Stage IB

T2 N0 M0

T1 N1 M0

Stage IIA

T3 N0 M0

T2 N1 M0

T1 N2 M0

Stage IIB

T4a N0 M0

T3 N1 M0

T2 N2 M0

T1 N3 M0

Stage IIIA

T4a N1 M0

T3 N2 M0

T2 N3 M0

Stage IIIB

T4b N0-1 M0

T4a N2 M0

T3 N3 M0

Stage IIIC

T4a N3 M0

T4b N2-3 M0

Stage IV

Any T Any N M1

GASTROINTESTINAL STROMAL TUMOUR (GIST)

NOT PREVIOUSLY CLASSIFIED

Tx: Primary tumour cannot be assessed

T0: No evidence for primary tumour

T1: Tumour 2 cm or less

T2: Tumour more than 2 cm but not more than 5 cm in greatest dimension

T3: Tumour more than 5 cm but not more than 10 cm in greatest dimension

T4: Tumour more than 10 cm in greatest dimension

Nx: Regional lymph nodes cannot be assessed*

N0: No regional lymph node metastasis

N1: regional lymph node metastasis

*Note: Nx: Regional lymph node involvement is rare for GISTs, so that cases in which the nodal status is not assessed clinically or pathologically could be considered N0 instead of Nx or pNx.

M0: No distant metastasis

M1: Distant metastasis

GASTRIC GIST*

Stage IA

T1-2, N0, M0

Mitotic rate: Low

Stage IB

T3, N0, M0

Mitotic rate: Low

Stage II

T1-2, N0, M0

Mitotic rate: High

T4, N0, M0

Mitotic rate: Low

Stage IIIA

T3, N0, M0

Mitotic rate: High

Stage IIIB

T4, N0, M0

Mitotic rate: High

Stage IV

AnyT, N1, M0

Mitotic rate: Any rate

AnyT, AnyN, M1

Mitotic rate: Any rate

SMALL INTESTINAL GIST*

Stage I

T1-2, N0, M0

Mitotic rate: Low

Stage II

T3, N0, M0

Mitotic rate: Low

Stage IIIA

T1, N0, M0

Mitotic rate: High

T4, N0, M0

Mitotic rate: Low

Stage IIIB

T2,3.4, N0, M0

Mitotic rate: High

Stage IV

AnyT, N1, M0

Mitotic rate: Any rate

AnyT, AnyN, M1

Mitotic rate: Any rate

*Note: Staging criteriafor gastric tumours can be applied in primary, solitary omantal GISTs. Staging criteria for intestinal tumours can be applied to GISTs in less common sites, such as oesophagus, colon, rectum, and mesentery.

LIVER

The classification applies to hepatocellular carcinoma. Cholangio-(intrahepatic bile duct) carcinoma of the liver has a separate classification. There should be histological confirmation of the disease

T3: Multiple tumours more than 5 cm or tumours involving a major branch of the portal vein(s)

T3: Multiple tumours more than 5 cm or tumours involving a major branch of the portal vein(s)

T3a: Multiple tumours any more than 5 cm

T4b: Tumour involving a major branch of the portal or hepatic vein(s)

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

Stage I

T1, N0, M0
Stage I I

T2, N0, M0
Stage IIIA

T3, N0, M0
Stage IIIB

T4, N0, M0
Stage IIIC

AnyT, N1, M0
Stage IV

AnyT, AnyN, M1

Stage I

T1; N0; M0
Stage II

T2; N0; M0

Stage IIIA

T3a, N0, M0

Stage IIIB

T3b, N0, M0

Stage IIIC

T4, N0, M0

Stage IVA

AnyT, N1, M0

Stage IVB

AnyT, AnyN, M1

LUNG

T1: Tumour 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus)*

T2: Tumour with any of the following features of size or extent:

· More than 3 cm in greatest dimension

· Involving main bronchus, 2 cm or more distal to the carina

· Invading the visceral pleura

· Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung

T3: : Tumour of any size that directly invades any of the following: chest wall (including superior sulcus tumours), diaphragm, mediastinal pleura, parietal pleura or parietal pericardium; or tumour in the main bronchus less than 2 cm distal to the carina but without involvement of the carina, or

associated atelectasis or obstructive pneumonitis of the entire lung

T4: Tumour of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or separate tumour nodules in the same lobe; or tumour with malignant pleural effusion**

*Note: The uncommon superficial tumour of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus, is also classified T1.

**Note: Most pleural effusions associated with lung cancer are due to tumour. However, there are a few patients in whom multiple cytopathologic examinations of pleural fluid are negative for tumour. In these cases, fluid is non-bloody and is not an exudate. When these elements and clinical judgement dictate that the effusion is not related to the tumour, the effusion should be excluded as a staging element and the patient should be staged T1, T2, or T3.

T1: Tumour 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus)*

T1a: Tumour 2 cm or less in greatest dimension*

T1b: Tumour more than 2 cm but not more than 3 cm in greatest dimension*

T2: Tumour more than 3 cm but not more than 7 cm; or tumour with any of the following features**

· Involves main bronchus, 2 cm or more distal to the carina

· Involves visceral plaura

· Associated qith atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung

T2a: Tumour more than 3 cm but not more than 5 cm in greatest dimension

T2b: Tumour more than 5 cm but not more than 7 cm in greatest dimension

T3: Tumour more than 7 cm or one that directly invades any of the following: chest wall (including superior sulcus tumours), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumour in the main bronchus less than 2 cm distal to the carina* but without involvement of the carina; or associated atelectasis or obstructive pneumonitis of the entire lung or separate tumour nodule(s) in the same lobe as the primary

T4: Tumour of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, vertebral body, carina; separate tumour nodules(s) in a different ipsilateral lobe to that of primary tumour

*Note: The uncommon superficial tumour of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus, is also classified T1a.

**Note: T2 tumours with these features are classified T2a if 5 cm or less, or if size cannot be determined and T2b if greater than 5 cm but not larger than 7 cm

Mx:

Distant metastasis cannot be assessed

M1: Distant metastasis present

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

M1: Distant metastasis

M1a: Separate tumour nodule(s) in a contralateral lobe; tumour with pleural nodules or malignant pleural or pericardial effusion***

M1b: Distant metastasis

***Note: Most pleural (pericardial) effusions with lung cancer are due to tumour. In a few patients, however, multiple microscopical examinations of pleural (pericardial) fluid are negative for tumour, and the fluid is non-bloodyand is not an exudate. Where these elements and clinical judgement dictate that the effusion is not related to the tumour, the effusion should be excluded as a staging element and the patient should be classified as M0

Occult arcinoma

TX, N0, M0

Stage 0

Tis, N0, M0

Stage IA

T1, N0, M0

Stage IB

T2, N0, M0

Stage IIA

T1, N1, M0

Stage IIB

T2, N1, M0

T3, N0, M0

Stage IIIA

T1, N2, M0

T2, N2, M0

T3, N1, M0

T3, N2, M0

Stage IIIB

AnyT, N3,M0

T4, AnyN, M0

Stage IV

AnyT, AnyN, M1

Occult carcinoma

TX, N0, M0

Stage 0

Tis, N0, M0

Stage IA

T1a-b, N0, M0

Stage IB

T2a, N0, M0

Stage IIA

T2b, N0, M0

T1a-b, N1, M0

T2a, N1, M0

Stage IIB

T2b, N1, M0

T3, N0, M0

Stage IIIA

T1a-b, T2a-b, N2, M0

T3, N1-2, M0

T4, N0-1, M0

Stage IIIB

T4, N2, M0

AnyT, N3, M0

Stage IV

AnyT, AnyN, M1

NASOPHARYNGEAL CANCER

T1: Tumour is confined to the nasopharynx

T2: Tumour extends to soft tissues

T2a: Tumour extends to the oropharynx and/or nasal cavity without parapharyngeal extension*

T2b: Any tumour with parapharyngeal extension*

*Note: Parapharyngeal extension denotes posterolateral infiltration of tumour beyond the paharyngobasilar fascia

T1: Tumour is confined to the nasopharynx, or extends to oropharynx and/or nasal cavity

T2: Tumour with parapharyngeal extension

*Note: Parapharyngeal extension denotes posterolateral infiltration of tumour

N1 Unilateral metastasis in lymph node(s), 6 cm or less in greatest dimension, above the supraclavicular fossa

N1: Unilateral metastasis, in cervical lymph node(s), and/or unilateral or bilateral metastasis in retropharyngeal lymph nodes, 6 cm or less in greatest dimension, above the supraclavicular fossa

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

Stage IIA

T2a,N0, M0

Stage IIB

T1-2N1M0

T2a-b, N1, M0

T2b, N0-1, M0

Stage III

T1, N2, M0

T2a-b, N2, M0

T3, N0,1,2, M0

Stage II

T1, N1, M0

T2, N0-1, M0

Stage III

T1-2, N2, M0

T3, N0,1,2, M0

T3: Tumour more   than 4 cm in greatest dimension

T3: Tumour more than 4 cm in greatest dimension or extension to lingual surfaceor rpiglottis*

*Note: Mucosal extension to lingual surface of epiglottis from primary tumours of the base of the tongue and vallecula does not constitute invasion of the larynx

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

PENILE CARCINOMA

T1: Tumour invades subepithelial connective tissue

T3: Tumour invades urethra or prostate

T1: Tumour invades subepithelial connective tissue

T1a: Tumour invades subepithelial connective tissue without lymphovascular invasion and is not poorly differentiated or undifferentiated

T1b: Tumour invades subepithelial connective tissue with lymphovascular invasion or is poorly differentiated or undifferentiated

T3: Tumour invades urethra

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

N0: No palpable or visibly enlarged inguinal lymph nodes

N1: palpable mobile unilateral inguinal lymph node

N2 : Palpable mobile multiple or bilateral inguinal lymph nodes

N3 : Fixed inguinal nodal mass or pelvic lymphadenopathy unilateral or bilateral

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

Stage I

T1, N0, M0
Stage II

T1, N1, M0

T2, N0, M0

T2, N1, M0
Stage III

T1, N2, M0

T2, N2, M0

T3, N0, M0

T3, N1, M0

T3, N2, M0

Stage I

T1a, N0, M0

Stage II

T1b, N0, M0

T2, N0,1, M0

T3, N0, M0

Stage IIIA

T1,2,3, N1, M0

Stage IIIB

T1,2,3, N2, M0

PROSTATE CANCER

T3a: Extracapsular extension (unilateral or bilateral)

T4: Tumour is fixed or invades adjacent structures other than seminal vesicles: bladder neck, external sphincter (deleted) , rectum, levator muscles, and/or pelvic wall

T3a: Extracapsular extension (unilateral or bilateral) including microscopic bladder neck involvement

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

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

Stage I

T1a, N0, M0

Stage II

T1a, N0, M0

T1b. N0, M0

T1c, N0, M0

T1-2, N0, M0

Stage I

T1,2a, N0, M0

Stage II

T2b,c, N0, M0

RENAL CANCER

T2: Tumor more than 7 cm in greatest dimension, limited to the kidney

T3 Tumor extends into major veins or invades adrenal gland or perinephric tissues but not beyond Gerota's fascia

T3a Tumor directly invades adrenal gland or perineal and/or renal sinus fat but not beyond Gerota's fascia

T3b Tumor grossly extends into the renal vein or its segmental (muscle-containing) branches, or vena cava below

the diaphragm

T3c Tumor grossly extends into vena cava above diaphragm or invades the wall of the vena cava

T4 Tumor invades beyond Gerota's fascia

T2:Tumor more than 7 cm in greatest dimension, limited to the kidney

T2a: Tumour more than 7 cm but not more than 10 cm

T2b: Tumour more than 10 cm, limited to the kidney

T3: Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota fascia

T3a: Tumour grossly extends into the renal vein or its segmental (muscle containing) branches, or tumour invades perirenal and/or renal sinus fat (peripelvic) fat but not beyond Gerota fascia

T3b: Tumour grossly extends into vena cava below the diaphragm

T3c: Tumor grossly extends into vena cava above diaphragm or invades the wall of the vena cava

T4:Tumor invades beyond Gerota fascia (including contiguous extension into the ipsilateral adrenal gland)

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

THYROID CANCER

T1: Tumour 2 cm or less, limited to the thyroid

T1: Tumour 2 cm or less, limited to the thyroid

T1a: Tumour 1 cm or less in greatest dimention, limited to the thyroid

T1b: Tumour more than 1 cm but not more than 2 cm in greatest dimension, limited to the thyroid

Mx:

Distant metastasis cannot be assessed

Mx

The Mx category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of Mx may result in exclusion from staging)

PAPILLARY OR FOLLICULAR 45 years or older

Stage I

T1, N0, M0

MEDULLARY

Stage I
T1, N0, M0

Stage II

T2, N0, M0

Stage III

T3, N0, M0

T1,2,3, N1a, M0

PAPILLARY OR FOLLICULAR 45 years or older

Stage I

T1a,b, N0, M0

MEDULLARY

Stage I

T1a,b, N0, M0

Stage II

T2,3, N0, M0

Stage III

T1,2,3, N1a, M0