Herman S Fernando
Tables 15.1 through to 15.7 describe the latest TNM staging system for individual urological cancers.
Table 15.1 TNM (8th edition) staging of bladder cancer
|
Tx |
Primary tumour cannot be assessed |
|
Ta |
Non-invasive papillary carcinoma |
|
Tis |
Carcinoma in situ:‘flat tumour’ |
|
T1 |
Tumour invades subepithelial connective tissue |
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T2 |
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T2a: Tumour invades superficial muscularis propria (inner half) |
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T2b: Tumour invades deep muscularis propria (outer half) |
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T3 |
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T3a: Tumour invades perivesical tissue microscopically |
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T3b: Tumour invades perivesical tissue macroscopically (extravesical mass) |
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T4 |
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T4a: Tumour invades prostate stroma, seminal vesicles, uterus or vagina |
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T4b: Tumour invades pelvic wall or abdominal wall |
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Nx |
Regional lymph nodes cannot be assessed |
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N0 |
No regional lymph node metastasis |
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N1 |
Metastasis in a single lymph node in true pelvis (hypogastric, obturator; external iliac or presacral) |
|
N2 |
Metastasis in multiple lymph nodes in true pelvis (hypogastric, obturator; external iliac or presacral) |
|
N3 |
Metastasis in common iliac lymph node(s) |
|
Mx |
Distant metastasis cannot be assessed |
|
M0 |
No distant metastasis |
|
M1 |
MIa: Non-regional lymph nodes |
|
MIb: Other distant metastases |
Table 15.2 TNM (8th edition) classification for upper tract urothelial carcinoma
|
Tx |
Primary tumour cannot be assessed |
|
TO |
No evidence of primary tumour |
|
Ta |
Non-invasive papillary carcinoma |
|
Tis |
Carcinoma in situ |
|
TI |
Invades subepithelial connective tissue |
|
T2 |
Tumour invades muscularis propria |
|
T3 |
Renal pelvis - Tumour invades beyond muscularis into peripelvic fat or renal parenchyma Ureter - Tumour invades beyond muscularis into periureteric fat |
|
T4 |
Tumour invades into adjacent organs or through kidney into perinephric fat |
|
Nx |
Regional lymph nodes cannot be assessed |
|
NO |
No regional lymph node metastasis |
|
N1 |
Metastasis in a single lymph node 2 cm or less in the greatest dimension |
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N2 |
Metastasis in a single lymph node more than 2 cm, or multiple lymph nodes |
|
Mx |
Distant metastasis not assessed |
|
MO |
No distant metastasis |
|
MI |
Distant metastasis |
Table 15.3. TNM (8th edition) classification for penile cancer (note that the pathological classification is given here as candidates often have difficulty with this)
|
TX |
Primary tumour cannot be assessed |
|
TO |
No evidence of primary tumour |
|
Tis |
Carcinoma in situ (penile intraepithelial neoplasia [PeIN]) |
|
Ta |
Non-invasive localised squamous cell carcinoma/non-invasive verrucous carcinoma (not associated with destructive invasion) |
|
TI |
Tumour invades subepithelial connective tissue (lamina propria) |
|
TIa: Tumour invades subepithelial connective tissue without perineural or lymphovascular invasion and is not poorly differentiated or undifferentiated (TIGI-2) |
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TIb: Tumour invades subepithelial connective tissue with perineural or lymphovascular invasion or is poorly differentiated or undifferentiated (TIG3-4) |
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T2 |
Tumour invades corpus spongiosum with or without invasion of the urethra |
|
T3 |
Tumour invades corpus cavernosum (including tunica albuginea) with or without invasion of the urethra |
|
T4 |
Tumour invades other adjacent structures (scrotum, prostate, bone) |
|
NX |
Regional lymph nodes cannot be assessed |
|
NO |
No lymph node metastasis |
|
pNI |
Metastasis in one or two unilateral inguinal lymph nodes, but without extra-nodal extension |
|
pN2 |
Metastasis in three or more unilateral inguinal lymph nodes without extra-nodal extension, or, any number of bilateral positive inguinal lymph nodes without extra-nodal extension |
|
pN3 |
Metastasis to any number of inguinal lymph nodes with extra-nodal extension, or, metastasis to pelvic lymph nodes |
|
MO |
No distant metastases |
|
MI |
Distant metastases |
Table 15.4 TNM (8th edition) classification for renal cancer
|
Tx |
Primary tumour cannot be assessed |
|
TO |
No evidence of primary tumour |
|
TI |
Tumour <7 cm in greatest dimension, limited to the kidney |
|
TI a: Tumour <4 cm in greatest dimension, limited to the kidney |
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TI b: Tumour >4 cm but <7 cm in greatest dimension |
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T2 |
Tumour >7 cm in greatest dimension, limited to the kidney |
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T2a: Tumour >7 cm but < IO cm in greatest dimension |
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T2b:Tumour > IO cm limited to the kidney |
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T3 |
Tumour extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota’s fascia |
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T3a: Tumour extends into the renal vein or its segmental branches, or tumour invades the pelvi-calyceal system or tumour invades perirenal and/or renal sinus fat (peripelvic fat) but not beyond Gerota’s fascia |
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T3b: Tumour extends into the vena cava (VC) below the diaphragm |
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T3c: Tumour extends into vena cava above the diaphragm or invades the wall of the vena cava |
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T4 |
Tumour invades beyond Gerota’s fascia (including contiguous extension into the ipsilateral adrenal gland) |
|
Nx |
Regional LNs cannot be assessed |
|
NO |
No regional LN metastasis |
|
NI |
Metastasis in regional LN |
|
MO |
No distant metastasis |
|
MI |
Distant metastasis |
Table 15.5. TNM (8th edition) classification for prostate cancer
|
TX |
Primary tumour cannot be assessed |
|
TO |
No evidence of primary tumour |
|
TI |
Clinically inapparent tumour not palpable or visible by imaging |
|
TIa: Tumour incidental histological finding in 5% or less of tissue resected |
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TIb: Tumour incidental histological finding in more than 5% of tissue resected |
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TIc: Tumour identified by needle biopsy (e.g. because of elevated prostate-specific antigen level) |
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T2 |
Tumour that is palpable and confined within the prostate |
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T2a: Tumour involves one-half of one lobe or less |
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T2b: Tumour involves more than half of one lobe, but not both lobes |
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T2c: Tumour involves both lobes |
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T3 |
Tumour extends through the prostatic capsule |
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T3a: Extraprostatic extension (unilateral or bilateral) including microscopic bladder neck involvement |
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T3b: Tumour invades seminal vesicle(s) |
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T4 |
Tumour is fixed or invades adjacent structures other than seminal vesicles: external sphincter, rectum, levator muscles, and/or pelvic wall |
|
Nx |
Regional lymph nodes cannot be assessed |
|
NO |
No regional lymph node metastasis |
|
NI |
Regional lymph node metastasis |
|
Mx |
Distant metastasis cannot be assessed |
|
MO |
No distant metastasis |
(Continued)
Table 15.5 (Continued TNM (8th edition) classification for prostate cancer
|
MI |
Distant metastasis |
|
MIa: Non-regional lymph node(s) |
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MIb: Bone(s) |
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MIc: Other site(s) |
Table 15.6 TNM (8th edition) classification for testicular cancer
|
pTX |
Primary tumour cannot be assessed |
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pTO |
No evidence of primary tumour (e.g. histological scar in testis) |
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pTis |
Intratubular germ cell neoplasia (testicular intraepithelial neoplasia) |
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pTI |
Tumour limited to testis and epididymis without vascular/lymphatic invasion; tumour may invade tunica albuginea but not tunica vaginalis |
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pT2 |
Tumour limited to testis and epididymis with vascular/lymphatic invasion, or tumour extending through tunica albuginea with involvement of tunica vaginalis |
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pT3 |
Tumour invades spermatic cord with or without vascular/lymphatic invasion |
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pT4 |
Tumour invades scrotum with or without vascular/lymphatic invasion |
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|
NX |
Regional lymph nodes cannot be assessed |
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|
NO |
No regional lymph node metastasis |
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NI |
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 |
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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 |
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N3 |
Metastasis with a lymph node mass more than 5 cm in greatest dimension |
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|
MX |
Distant metastasis cannot be assessed |
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|
MO |
No distant metastasis |
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|
MI |
Distant metastasis |
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MIa: Non-regional lymph node(s) or lung |
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MIb: Other sites |
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SX |
Serum marker studies not available or not performed |
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|
SO |
Serum marker study levels within normal limits |
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|
LDH (U/L) |
hCG (mlU/mL) |
AFP (ng/mL) |
|
|
SI |
< I.5 x N and |
<5,OOO and |
< I ,OOO |
|
S2 |
I.5-IO x N or |
5,OOO-5O,OOO or |
I,OOO-IO,OOO |
|
S3 |
>IO x N or |
>5O,OOO or |
> IO,OOO |
Table 15.7 TNM (8th edition) classification for primary urethral cancer (male and female) (note that the staging system for primary prostatic urethral cancer is not included)
|
Tx |
Primary tumour cannot be assessed |
|
Tis |
Carcinoma in situ |
|
TO |
No evidence of primary tumour |
|
Ta |
Non-invasive papillary, polypoid or verrucous carcinoma |
|
TI |
Tumour invades subepithelial connective tissue |
|
T2 |
Tumour invades any of the following structures: corpus spongiosum, prostate, peri-urethral muscle |
|
T3 |
Tumour invades any of the following structures: corpus cavernosum, invasion beyond prostatic capsule, anterior vaginal wall, bladder neck |
|
T4 |
Tumour invades other adjacent organs (bladder proper, rectum) |
|
Nx |
Regional lymph nodes cannot be assessed |
|
NO |
No regional lymph-node metastasis |
|
NI |
Metastasis in a single lymph node |
|
N2 |
Metastasis in multiple nodes |
|
Mx |
Distant metastasis cannot be assessed |
|
MO |
No distant metastasis |
|
MI |
Distant metastasis |
Further Reading
1. Brierley JD et al. The TNM Classification of Malignant Tumours, 8th edn. 2017. http://www. uicc.org/resources/tnm/publications-resources