Description
The fourth edition of the TNM Classification was published in 1987,1 and a revision in 1992.2 It was the result of efforts by all national TNM Committees towards a worldwide uniform classification. The classifica tion criteria are identical with the fourth edition of the Manual for 3 Staging of Cancer of the American Joint Committee on Cancer (AJCC). Although the classification has found wide acceptance, some workers have pointed out that individual definitions and rules for staging are not sufficiently detailed. This can lead to inconsistent application of the clas sification. the antithesis of standardization. This source of differences in interpretation applies not only to the classification of individual organs but also to the general rules of the system, especially to the definitions of the requirements for the pathological classification (pT, pN). These are specified only for carcinoma of the breast; for other sites, reference must be made back to the general rules. which can lead to variable interpreta tions. The TNM Project Committee of the UICC has addressed this prob lem and collected and considered the criticisms and suggestions from the national TNM Committees as well as from cancer registries, oncolo gical associations and individual users. The result was the decision to complement the 4th edition of the TN M Classification 1.2. 3 with the publi cation of a TNM Supplement containing recommendations for the uni form use of TNM. Explanatory Notes – General.- The General Rules of the TNM System.- The TNM Clinical and Pathological Classifications.- T / pT Classification.- Regional Lymph Nodes.- N / pN Classification.- M Classification.- Who Is Responsible for TNM Coding?.- The Significance of X.- Stage Grouping.- Residual Tumour (R) Classification.- L Classification.- Recurrent Tumour, r Symbol.- Patients with Unknown Primary Tumour.- Staging of Tumours for Which No TNM Classification Is Provided.- Histopathological Grading.- References.- Explanatory Notes – Specific Anatomical Sites.- Head and Neck Tumours.- General.- Lip.- Oral Cavity.- Pharynx.- Larynx.- Maxillary Sinus.- Salivary Glands.- Digestive System Tumours.- Oesophagus.- Stomach.- Small Intestine.- Colon and Rectum.- Anal Canal.- Liver.- Gallbladder.- Extrahepatic Bile Ducts.- Ampulla of Vater.- Pancreas.- Lung Tumours.- Bone Tumours.- Soft Tissue Tumours.- Skin Tumours.- Carcinoma of Skin.- Malignant Melanoma of Skin.- Breast Tumours.- Gynaecological Tumours.- Vulva.- Vagina.- Cervix uteri.- Corpus uteri.- Ovary.- Urological Tumours.- Penis.- Prostate.- Testis.- Kidney.- Renal Pelvis and Ureter.- Urinary Bladder.- Urethra.- Ophthalmic Tumours.- Brain Tumours.- Hodgkin Disease and Non-Hodgkin Lymphomas.- Paediatric Tumours.- References.- Site-Specific Recommendations for pT and pN.- Head and Neck Tumours.- pT.- pN.- Digestive System Tumours.- pT.- pN.- Lung and Pleural Tumours.- Tumours of Bone and Soft Tissues.- Skin Tumours.- Breast Tumours.- Gynaecological Tumours.- Urological Tumours.- Ophthalmic Tumours.- Brain Tumours.- Hodgkin Disease and Non-Hodgkin Lymphomas.- Paediatric Tumours.- Appendix 1. Stomach Carcinoma.- Appendix 2. Colorectal Carcinoma.- Appendix 3. Malignant Melanoma of Skin.- References.- New Classifications Recommended for Testing.- Nasal Cavity and Paranasal Sinus (Other Than Maxillary Sinus).- Gastrointestinal Sarcomas.- Malignant Thymoma.- Cranial and Facial Bones.- Cutaneous T-Cell Lymphoma (Excluding Lip, Eyelid, Vulva and Penis).- Fallopian Tube.- Gestational Trophoblastic Tumours.- Chronic Myeloid Leukemia.- Primary Liver Carcinoma in Infants and Children.- References.- Optional Proposals for Testing New Telescopic Ramifications of TNM.- All Tumour Sites.- Fixation of Lymph Nodes.- Micrometastasis.- Markers of Residual Tumour.- Head and Neck Tumours.- N Classification Proposal 1 Larynx Carcinoma.- N Classification Proposal 2 Any Site Except Thyroid and Nasopharynx.- Lip and Oral Cavity / T Classification.- Hypopharynx / T Classification.- Nasopharynx / T and N Classification.- Invasive Larynx Carcinoma / T Classification.- Noninvasive Larynx Carcinoma / T Classification.- Maxillary Sinus / T Classification.- Salivary Glands / T Classification.- Thyroid Gland / T and N Classification.- Digestive System Tumours.- All Sites Except Oesophagus / M Classification.- Oesophagus / T Classification.- Oesophagus / N Classification.- Oesophagus / M Classification.- Stomach / T Classification.- Stomach / N Classification.- Colon and Rectum / pT Classification.- Liver / T Classification.- Gallbladder / T Classification.- Extrahepatic Bile Ducts / T Classification.- Pancreas / T Classification.- Pancreas / N Classification.- Lung Tumours.- T Classification.- N Classification.- M Classification.- Tumour of Bone and Soft Tissues.- Bone / T Classification.- Soft Tissues / T Classification.- Skin Tumours.- Carcinoma of Skin / T Classification.- Malignant Melanoma of Skin / pT Classification; Ulceration.- Malignant Melanoma of Skin / Consideration of the Clark Levels in pT Classification.- Malignant Melanoma of Skin / N Classification.- Breast Tumours.- T Classification.- Satellites.- N Classification.- M Classification.- Gynaecological Tumours.- Cervix uteri / T Classification.- Cervix uteri / N Classification.- Cervix uteri / M Classification.- Urological Tumours.- Penis / T Classification.- Prostate / T Classification.- Prostate / pN Classification.- Prostate / M Classification.- Testis / pT Classification.- Testis / N Classification.- Kidney / T Classification.- Ophthalmic Tumours.- Retinoblastoma / T Classification.- Paediatric Tumours.- Neuroblastoma / M Classification.- References.
