TNM Major Flashcards
T staging for salivary gland
T1 - </= 2 cm without extraparenchymal extension
T2 - 2 - 4 cm without extraparnchymal extension
T3 - > 4 cm and/or tumour having extraparenchymal extension
T4a - Invades skin, mandibles, ear canal, and/or facial nerve
T4b - Invades skull base and/or pterygoid plates and/or encases carotid artery
N staging salivary gland
N1 - Single ipsilateral < or = 3 cm
N2a - Single ipsilateral 3 - 6 cm
N2b - Multiple ipsilateral LN, > 6 cm
N2c - Bilateral or contralateral LN, > 6 cm N3 - > 6 cm
T staging Lung
T1 - < or = 3 cm, away from pleura and distal to lobar bronchus T2 - Any of the following: i) > 3 cm ii) Main bronchus, 2 cm or less distal to carina iii) invades visceral pleura iv) assoc with atelectasis of obstructive pneumonitis of hilar region T3 - Invades: diaphragm, 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 entire lung T4 - Invades: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; separate nodules in the same lobe; tumour with malignant pleural effusion
N staging for lung
N1 - Ipsilateral peribronchial and/or ipsilateral hilar LN and intrapulmonary nodes N2 - Ipsilateral mediastinal and/or subcarinal N3 - Contralateral mediastinal and/or subcarinal, ipsilateral scalene or supraclavicular LN
T staging for esophagus
T1 - Invades lamina propria T2 - Invades musclaris T3 - Invades adventitia T4 - Invades adjacent structures
N staging for esophagus
N1 - Regional LN
T staging Stomach
T1 - Invades lamina propria T2a - Invades muscularis propria T2b - Invades subserosa T3 - Penetrates serosa without invading other structures T4 - Invades adjacent structures
N staging for stomach
N1 - 1-6 LN N2 - 7-14 LN N3 - > 15 LN
T staging for Small Bowel
T1 - Invades lamina propria T2 - Invades muscularis propria or submucosa T3 - Invades through muscularis propria into the subserosa or into the nonperitonealised e perimuscularis tissue with extension 2 cm or less T4 - Perforation of viseral peritoneum or directly invades other organs or structures (includes other loops of small intestine, mesentery or retroperitoneum > 2 cm and abdominal wall by way of serosa or duodenum only invasion of pancreas)
T staging for colorectal
T1 - Invades lamina propria T2 - Invades muscularis propria T3 - Invades subserosa or into retroperitoneal pericolic or perirectal tissues T4 - Invades other organs or structures and/or perforation
N staging for colorectal
N1 - 1-3 regional LN N2 - >3 regional LN
T staging for Cervix
pT1- Confined to uterus
___ pT1a [IA]: Invasive carcinoma diagnosed by microscopy only. All macroscopically visible lesions
(even with superficial invasion) are pT1b/1B.
___ pT1a1 [IA1]: Stromal invasion ≤3.0 mm in depth and horizontal spread ≤7.0 mm
__ pT1a2 [IA2]: Stromal invasion >3.0 mm but not more than 5.0 mm in depth and horizontal spread≤7.0 mm
___ pT1b [IB]: Clinically visible lesion confined to the cervix or microscopic lesion greater than
___ pT1b1 [IB1]: Clinically visible lesion ≤4.0 cm in greatest dimension
___ pT1b2 [IB2]: Clinically visible lesion >4.0 cm in greatest dimension
pT2 - Beyond the uterus but not to pelvic wall or to lower third of vagina
___ pT2a [IIA]: Tumor without parametrial invasion
___ pT2a1 [IIA1]: Clinically visible lesion ≤4.0 cm in greatest dimension
___ pT2a2 [IIA2] Clinically visible lesion >4.0 cm in greatest dimension
___ pT2b [IIB]: Tumor with parametrial invasion
pT3 - Extends to the pelvic wall and/or involves the lower third of the vagina and/or causes
hydronephrosis or non-functioning kidney
___ pT3a [IIIA]: Tumor involves lower third of vagina, but not pelvic wall
___ pT3b [IIIB]: Tumor extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney
pT4 [IVA]: Tumor invades the mucosa of bladder or rectum and/or extends beyond true pelvis
T staging for testis
pTis: Intratubular germ cell neoplasia (carcinoma in situ)
pT1: Tumor limited to the testis and epididymis without vascular/lymphatic invasion; tumor may invade tunica albuginea but not tunica vaginalis
pT2: Tumor limited to the testis and epididymis with vascular/lymphatic invasion, or tumor extending through the tunica albuginea with involvement of the tunica vaginalis
pT3: Tumor invades the spermatic cord with or without vascular/lymphatic invasion
pT4: Tumor invades the scrotum with or without vascular/lymphatic invasion
T staging Urinary bladder
- Tumor invades subepithelial connective tissue (lamina propria)
- Tumor invades muscularis propria (detrusor muscle) - 2a inner half; 2b outer half
- Tumor invades perivesical tissue - 3a microscopic, 3b macroscopic
- Tumor invades any of the following: prostatic stroma (a), seminal vesicles (a), uterus (a), vagina (a), pelvic wall (b),
abdominal wall (b)
T staging prostate
- CAP says no T1
- pT2: Organ confined - Unilateral, involving one-half of 1 side or less (a), Unilateral, involving more than one-half of 1 side but not both sides (b), Bilateral disease (c)
- Extraprostatic extension - Extraprostatic extension or microscopic invasion of bladder neck (a), Seminal vesicle invasion (b)
- Invasion of rectum, levator muscles and/or pelvic wall (Note J)
T staging kidneyKK
- Tumor 7 cm or less in greatest dimension, limited to the kidney -4 cm or less in greatest dimension, limited to the kidney (a), More than 4 cm but not more than 7 cm in greatest dimension, limited to the kidney (b)
- Tumor more than 7 cm in greatest dimension, limited to the kidney - More than 7 cm but less than or equal to 10 cm in greatest dimension, limited to the kidney (a), More than 10 cm, limited to the kidney (b)
- Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota’s fascia - Grossly extends into the renal vein or its segmental (muscle containing) branches, or tumor invades perirenal and/or renal sinus fat but not beyond Gerota’s fascia (a), Grossly extends into the vena cava below the diaphragm (b), grossly extends into vena cava above diaphragm or invades the wall of the vena cava (c)
- Tumor invades beyond Gerota’s fascia (including contiguous extension into the ipsilateral adrenal gland)
T staging for Uterus
- pT1a [IA]: Tumor limited to endometrium or invades less than one-half of the myometrium
- pT1b [IB]: Tumor invades greater than or equal to one-half of the myometrium
- pT2 [II]: Tumor invades stromal connective tissue of the cervix, but does not extend beyond uterus
- pT3a [IIIA]: Tumor involves serosa and/or adnexa (direct extension or metastasis)
- pT3b [IIIB]: Vaginal involvement (direct extension or metastasis) or parametrial involvement
- pT4 [IVA]: Tumor invades bladder mucosa and/or bowel mucosa (bullous edema is not sufficient to classify a tumor as T4)
T staging Ovary
- pT1 [I]: Tumor limited to ovaries (one or both)
- pT1a [IA]: Tumor limited to one ovary; capsule intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings#
- pT1b [IB]: Tumor limited to both ovaries; capsule intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings
- pT1c [IC]: Tumor limited to one or both ovaries with any of the following: capsule ruptured, tumor on ovarian surface, malignant cells in ascites or peritoneal washings
- pT2 [II]: Tumor involves one or both ovaries with pelvic extension and/or implants
- pT2a [IIA]: Extension and/or implants on uterus and/or tube(s). No malignant cells in ascites or peritoneal washings
- pT2b [IIB]: Extension to other pelvic tissues. No malignant cells in ascites or peritoneal washings
- pT2c [IIC]: Pelvic extension and/or implants (T2a or T2b / IIa or IIb) with malignant cells in ascites or peritoneal washings
- pT3 and/or N1 [III]: Tumor involves one or both ovaries with confirmed peritoneal metastasis outside the pelvis (including liver capsule metastasis and/or regional lymph node metastasis [N1])
- pT3a [IIIA]: Microscopic peritoneal metastasis beyond pelvis (no macroscopic tumor)
- pT3b [IIIB]: Macroscopic peritoneal metastasis beyond pelvis ≤2 cm in greatest dimension
- pT3c and/or N1 [IIIC]: Peritoneal metastasis beyond pelvis >2 cm in greatest dimension and/or regional lymph node metastasis
T staging Trophoblastic Tumours
- pT1 [I]: Tumor confined to uterus
- pT2 [II]: Tumor extends to other genital structures (ovary, tube, vagina, broad ligaments) by
metastasis or direct extension
T staging Vagina
- pT1 [I]: Tumor confined to vaginal wall
- pT2 [II]: Tumor invades paravaginal tissues but not the pelvic wall
- pT3 [III]: Tumor extends to pelvic wall
- pT4 [IVA]: Tumor invades mucosa of bladder or rectum and/or extends beyond true pelvis
T staging Vulva
- pT1a [FIGO IA]: Lesions 2 cm or less in size, confined to the vulva or perineum, and with stromal invasion 1.0 mm or less
- pT1b [FIGO IB]: Lesions more than 2 cm in size or any size with stromal invasion more than 1.0 mm,
confined to the vulva or perineum - pT2 [FIGO II]: Tumor of any size with extension to adjacent perineal structures (lower/distal 1/3 urethra, lower/distal 1/3 vagina, anal involvement)
- pT3 [FIGO IVA]: Tumor of any size with extension to any of the following: upper/proximal 2/3 of urethra, upper/proximal 2/3 vagina, bladder mucosa, rectal mucosa, or fixed to
pelvic bone
Neuroblastoma favourable histological features
- Any age; ganglioneuroma (Schwannian stroma-dominant); maturing or mature
- Any age; ganglioneuroblastoma, intermixed (Schwannian stroma-rich)
- Less than 18 months old; neuroblastoma (Schwannian stroma-poor) or nodular ganglioneuroblastoma; poorly differentiated or differentiating subtypes with low or intermediate mitosis-karyorrhexis index (MKI)
- 18 months up to less than 5 years old; neuroblastoma (Schwannian stroma-poor) or nodular ganglioneuroblastoma; differentiating subtype and low MKI
Neuroblastoma Unfavourable histological features
- Any age; neuroblastoma (Schwannian stroma-poor) or nodular ganglioneuroblastoma with
undifferentiated histology and any MKI - Less than 18 months old; neuroblastoma (Schwannian stroma-poor) or nodular
ganglioneuroblastoma with poorly differentiated or differentiating subtypes with high MKI - 18 months up to less than 5 years old; neuroblastoma (Schwannian stroma-poor) or nodular ganglioneuroblastoma; poorly differentiated and any MKI, or differentiating and intermediate
or high MKI - Equal to or greater than 5 years old; neuroblastoma (Schwannian stroma-poor) or nodular
ganglioneuroblastoma; any subtype and any MKI
Neuroblastoma International Staging (INSS)
- Stage 1
• localized tumor with complete gross excision, with or without microscopic residual disease
• representative ipsilateral nonadherent lymph nodes negative for tumor microscopically (nodes
attached to and removed with the primary tumor may be positive) - Stage 2A
• localized tumor with incomplete gross excision; representative ipsilateral nonadherent lymph
nodes negative for tumor microscopically - Stage 2B
• localized tumor with or without complete gross excision with ipsilateral nonadherent lymph
nodes positive for tumor; enlarged contralateral lymph nodes must be negative microscopically - Stage 3
• unresectable unilateral tumor infiltrating across the midline,## with or without regional lymph
node involvement
• localized unilateral tumor with contralateral regional lymph node involvement
• midline tumor with bilateral extension by infiltration (unresectable) or by lymph node involvement - Stage 4
• any primary tumor with dissemination to distant lymph nodes, bone, bone marrow, liver, skin, and/or other organs (except as defined for stage 4S) - Stage 4S
• localized primary tumor (as defined for stage 1, 2A, or 2B), with dissemination limited to skin,
liver, and/or bone marrow (limited to infants less than 1 year old)
T staging for melanoma
- pT1: Melanoma 1.0 mm or less in thickness, with or without ulceration
- pT1a: Melanoma 1.0 mm or less in thickness, no ulceration, <1 mitoses/mm2
- pT1b: Melanoma 1.0 mm or less in thickness with ulceration and/or 1 or more mitoses/mm2
- pT2: Melanoma 1.01 to 2 mm in thickness, with or without ulceration
- pT3: Melanoma 2.01 to 4.0 mm in thickness, with or without ulceration
- pT4: Melanoma greater than 4.0 mm in thickness, with or without ulceration
Staging for SCC (exclusive of eyelid, vulva and penis)
- pT1: Tumor 2 cm or less in greatest dimension with fewer than two high-risk features
- pT2: Tumor greater than 2 cm in greatest dimension with or without one additional high-risk feature, or any size with two or more high-risk features
- pT3: Tumor with invasion of maxilla, mandible, orbit, or temporal bone
- pT4: Tumor with direct or perineural invasion of skull base or axial skeleton
High risk SCC features that can upgrade T1 to T2
- anatomic site
- poor differentiation (high grade)
- tumor thickness
- anatomic level
- presence of perineural invasion
- presence of lymph-vascular invasion
- Prognostic features mentioned but not in AJCC: inflammatory response; association with actinic keratosis; association with human papillomavirus (HPV); association with Bowen’s disease; acantholytic, basaloid, small cell, signet ring, desmoplastic, or spindle cell histological subtypes; and follicular SCC
