TNM Supplement

The Union for International Cancer Control�s (UICC) TNM classification system is the most widely used cancer classification and staging system in the world. It is used to describe the anatomical extent of disease and it is essential to patient care, research and cancer control.

This fifth edition of the TNM Supplement: A Commentary of Uniform Use offers practitioners a wealth of material intended to complement the system�s day-to-day use. The volume features:

• Updated definitions of terms used in cancer staging.
• New sections on carcinomas of the thymus, sarcomas of the spine and pelvis and soft tissue sarcomas of the head and neck, and comprehensive updates to the head and neck carcinomas, carcinomas of the lung and neuroendocrine tumours sections.
• Frequently asked questions from the UICC helpdesk.

The Supplement may be treated as a companion text to the recent eighth edition of the TNM Classification of Malignant Tumours (978-1-119-26357-9), supporting the correct and uniform application of the TNM classification system. The TNM Supplement can also be utilised as a standalone book, providing explanations and examples to answer many questions that arise during the daily use of the TNM cancer classification and staging system, particularly in unusual cases.

Das TNM-Klassifizierungssystem der Union for International Cancer Controls (UICC) ist das weltweit am meisten eingesetzte Klassifizierungs- und Staging-System. Es beschreibt das anatomische Ausmaß der Krankheit und ist für die Patientenversorgung, die Forschung und Krebskontrolle maßgebend.
Die 5. Auflage von TNM Supplement: A Commentary of Uniform Use bietet Medizinern eine Fülle von Informationen als Ergänzung im Klinikalltag.
- Aktualisierte Definitionen zu Begriffen aus dem Krebs-Staging.
- Neue Abschnitte zu Karzinomen der Thymusdrüse, Sarkomen der Wirbelsäule und des Beckens, Weichteil-Sarkomen von Kopf und Nacken, umfassende Überarbeitungen der Inhalte zu Kopf- und Nackenkarzinomen, Lungenkarzinomen und neuroendokrinen Turmoren.
- FAQ aus der Hotline der UICC.

Die Ergänzung kann durchaus als Begleitpublikation zur neuen 8. Auflage von TNM Classification of Malignant Tumours (978-1-119-26357-9) dienen, die die korrekte und einheitliche Anwendung des TNM-Klassifizierungssystem unterstützt. Weiterhin lässt es sich als eigenständiges Referenzwerk nutzen mit Erläuterungen und Beispielen zu vielen Fragestellungen, die beim täglichen Einsatz des TNM-Krebsklassifizierungssystem sowie des Staging-Systems auftauchen, insbesondere bei nicht alltäglichen Fällen.

Preface viii

Organizations Associated with the TNM System xiii

National Committees xiii

Acknowledgements xv

Abbreviations xvi

Chapter 1 Explanatory Notes – General

The General Rules of the TNM System 1

The TNM Clinical and Pathological Classifications 7

Residual Tumour (R) Classification 15

Additional Descriptors 20

Optional Descriptors 24

Unknown Primary 25

Staging of Tumours for Which No TNM Classification is Provided 25

Histopathological Grading 26

References 28

Chapter 2 Explanatory Notes – Specific Anatomical Sites

Head and Neck Tumours 34

Digestive System Tumours 54

Lung, Pleural and Thymic Tumours 85

Bone Tumours 104

Soft Tissue Tumours 106

Gastrointestinal Stromal Tumour (GIST) 108

Skin Tumours 110

Breast Tumours 118

Gynaecological Tumours 122

Urological Tumours 131

Ophthalmic Tumours 142

Hodgkin and Non‐Hodgkin Lymphomas 149

References 150

Chapter 3 Site‐Specific Requirements for pT and pN

Introduction 157

Head and Neck Tumours 160

Digestive System Tumours 166

Lung and Pleural Tumours 173

Tumours of Bone and Soft Tissues 176

Skin Tumours 179

Breast Tumours 183

Gynaecological Tumours 185

Urological Tumours 188

Adrenal Cortex Tumours 192

Ophthalmic Tumours 193

Hodgkin and Non‐Hodgkin Lymphomas 195

References 196

Chapter 4 New TNM Classifications Recommended for Testing and Other Classifications

Introduction 198

General 198

Specific 198

Non Upper Aerodigestive Tract Mucosal Melanoma 199

Primary Liver Carcinoma of Infants and Children/Hepatoblastoma 200

Primary Cutaneous Lymphomas 202

Cutaneous T‐Cell Lymphomas 202

Primary Cutaneous Lymphomas 203

Histopathologic Staging of Lymph Nodes in Mycosis Fungoides and Sézary Syndrome 204

Primary Cutaneous B‐Cell/T‐Cell Lymphoma (Non‐MF/SS Lymphoma) 206

Multiple Myeloma 207

Leukaemia 208

References 208

Chapter 5 Optional Proposals for Testing New Subcategories of TNM

All Tumour Sites 210

Head and Neck Tumours 210

Digestive System Tumours 211

Lung Tumours 213

Breast Tumours (ICD‐0‐3 C50) 214

Gynaecological Tumours 215

Urological Tumours 215

References 216

Chapter 6 Frequently Asked Questions

General Questions 218

Site‐Specific Questions 229

References 289

Index 291

Plate section facing p. 48

Christian Wittekind, MD; Professor of Pathology, Chairman Institute of Pathology, University of Leipzig, Germany.

James D Brierley, BSc, MB, FRCP, FRCR, FRCPC; Professor, Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada.

Anne W. M. Lee, MD; Clinical Professor, Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China.

Elisabeth van Eycken, MD; Director, Belgium Cancer Registry, Brussels, Belgium.

TNM Supplement A Commentary on Uniform Use

Fifth Edition

The Union for International Cancer Control's (UICC) TNM classification system is the most widely used cancer classification and staging system in the world. It is used to describe the anatomical extent of disease and is essential to patient care, research and cancer control.

This fifth edition of the TNM Supplement: A Commentary on Uniform Use offers practitioners a wealth of material intended to complement the system's day-to-day use. The volume features:

• Updated definitions of terms used in cancer staging.
• New sections on carcinomas of the thymus, sarcomas of the spine and pelvis, and soft tissue sarcomas of the head and neck, as well as comprehensive updates to sections on head and neck carcinomas, carcinomas of the lung and neuroendocrine tumours.
• Frequently asked questions from the UICC helpdesk.

The supplement may be treated as a companion text to the recent eighth edition of the TNM Classification of Malignant Tumours (978-1-119-26357-9), supporting the correct and uniform application of the TNM classification system. The TNM Supplement can also be utilised as a standalone book, providing explanations and examples to answer many questions that arise during the daily use of the TNM cancer classification and staging system, particularly in unusual cases.