TNM 7 classification





TNM 6 classification



1. Rules for Classification


The anal canal extends from rectum to perianal skin (to the junction with hair-bearing
skin). It is lined by the mucous membrane overlying the internal sphincter,
including the transitional epithelium and dentate line. Tumours of anal margin
(ICD-O C44.5) are classified with skin tumours.



The classification applies only to carcinomas. There should be histological confirmation of the disease.



The following are the procedures for assessing T, N, and M categories.



T categories. Physical examination, imaging, endoscopy, and/or surgical exploration

N categories. Physical examination, imaging, and/or surgical exploration

M categories. Physical examination, imaging, and/or surgical exploration



2. Regional Lymph Nodes


The regional lymph nodes are the perirectal, the internal iliac, and the inguinal lymph nodes.

3. TNM Clinical Classification


3.1. T - Primary Tumour


TX. Primary tumour cannot be assessed

T0. No evidence of primary tumour

Tis. Carcinoma in situ

T1. Tumour 2 cm or less in greatest dimension

T2. Tumour more than 2 cm but not more than 5 cm in greatest dimension

T3. Tumour more than 5 cm in greatest dimension

T4. Tumour of any size invades adjacent organ(s), e.g., vagina, urethra, bladder



Note: Direct invasion of the rectal wall, perirectal skin, subcutaneous tissue,
or the sphincter muscle(s) alone is not classified as T4.



3.2. N - Regional Lymph Nodes


NX. Regional lymph nodes cannot be assessed

N0. No regional lymph node metastasis

N1. Metastasis in perirectal lymph node(s)

N2. Metastasis in unilateral internal iliac and/or unilateral inguinal lymph node(s)

N3. Metastasis in perirectal and inguinal lymph nodes and/or bilateral internal iliac and/or bilateral inguinal lymph nodes



3.3. M - Distant Metastasis


MX. Distant metastasis cannot be assessed

M0. No distant metastasis

M1. Distant metastasis



4. pTNM Pathological Classification


The pT, pN, and pM categories correspond to the T, N, and M categories.


pN0. Histological examination of a regional perirectal-pelvic lymphadenectomy
specimen will ordinarily include 12 or more lymph nodes; histological examination
of an inguinal lymphadenectomy specimen will ordinarily include 6 or more lymph
nodes. If the lymph nodes are negative, but the number ordinarily examined is
not met, classify as pN0.


5. G Histopathological Grading


See definitions on Digestive System.


6. Stage Grouping



























































Stage 0
Tis
N0
M0
Stage I
T1
N0
M0
T2
N0
M0
T3
N0
M0
Stage IIIA
T1, T2, T3
N1
M0
T4
N0
M0
Stage IIIB
T4
N1
M0
Any T
N2, N3
M0
Stage IV
Any T
Any N
M1



7. Summary









































Anal Canal
T1
≤2 cm
T2
>2 to 5 cm
T3
>5 cm
T4
Adjacent organ(s)
N1
Perirectal
N2
Unilateral internal iliac/inguinal
N3
Perirectal and inguinal, bilateral internal iliac/inguinal