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Understanding Staging

TNM Staging

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The TNM system is one of the most commonly used staging systems. 

The TNM system is based on the following:

  • The extent of the tumor (T) 
  • The extent of spread to the lymph nodes(N) 
  • The presence of metastasis (M).

A number is added to each letter to indicate the size or extent of the tumor and the extent of spread.

The National Cancer Institute provides the following examples of TNM Staging:

Primary Tumor (T)
TX Primary tumor cannot be evaluated
T0 No evidence of primary tumor
Tis Carcinoma in situ offsite link (early cancer that has not spread to neighboring tissue)
T1, T2, T3, T4 Size and/or extent of the primary tumor

 

Regional Lymph Nodes (N)
NX Regional lymph nodes cannot be evaluated
N0 No regional lymph node involvement (no cancer found in the lymph nodes)
N1, N2, N3 Involvement of regional lymph nodes (number and/or extent of spread)

 

Distant Metastasis (M)
MX Distant metastasis cannot be evaluated
M0 No distant metastasis (cancer has not spread to other parts of the body)
M1 Distant metastasis (cancer has spread to distant parts of the body)

For example:

  • Breast cancer T3 N2 M0 refers to a large tumor that has spread outside the breast to nearby lymph nodes, but not to other parts of the body. 
  • Prostate cancer T2 N0 M0 means that the tumor is located only in the prostate and has not spread to the lymph nodes or any other part of the body.

For many cancers, TNM combinations correspond to one of five stages. Criteria for stages differ for different types of cancer. For example, bladder cancer T3 N0 M0 is stage III; however, colon cancer T3 N0 M0 is stage II.

Stage Definition
Stage 0 Carcinoma in situ (early cancer that is present only in the layer of cells in which it began).
Stage I, Stage II, and Stage III Higher numbers indicate more extensive disease: greater tumor size, and/or spread of the cancer to nearby lymph nodes and/or organs adjacent to the primary tumor.
Stage IV The cancer has spread to another organ.





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