TNM 7 classification





TNM 6 classification



1. Rules for Classification


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. Anatomical Subsites



  1. Duodenum (C17.0)

  2. Jejunum (C17.1)

  3. Ileum (C17.2) (excludes ileocecal valve C18.0)


Note: This classification does not apply to carcinomas of the ampulla of Vater (see here).



3. Regional Lymph Nodes


The regional lymph nodes for the duodenum are the pancreaticoduodenal, pyloric, hepatic (pericholedochal, cystic, hilar), and superior mesenteric nodes.



The regional lymph nodes for the ileum and jejunum are the mesenteric nodes, including the superior mesenteric nodes, and, for the terminal ileum only, the ileocolic nodes including the posterior cecal nodes.



4. TNM Clinical Classification


4.1. T - Primary Tumour



TX. Primary tumour cannot be assessed

T0. No evidence of primary tumour

Tis. Carcinoma in situ

T1. Tumour invades lamina propria or submucosa

T2. Tumour invades muscularis propria

T3. Tumour invades through muscularis propria into subserosa or into non-peritonealized perimuscular tissue (mesentery or retroperitoneum*) with extension 2 cm or less

T4. Tumour perforates visceral peritoneum or directly invades other organs or structures (includes other loops of small intestine, mesentery, or retroperitoneum more than 2 cm and abdominal wall by way of serosa; for duodenum only, invasion of pancreas)



4.2. N - Regional Lymph Nodes



NX. Regional lymph nodes cannot be assessed

N0. No regional lymph node metastasis

N1. Regional lymph node metastasis



4.3. M - Distant Metastasis



MX. Distant metastasis cannot be assessed

M0. No distant metastasis

M1. Distant metastasis

5. pTNM Pathological Classification


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



pN0. Histological examination of a regional 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.



6. G Histopathological Grading


See definitions here.



7. Stage Grouping







































Stage 0
 Tis
 N0
 M0
Stage I
 T1. T2
 N0
 M0
Stage II
 T3. T4
 N0
 M0
Stage III
 Any T
 N1
 M0
Stage IV
 Any T
 Any N
 M1







8. Summary
































Small Intestine
T1
 Lamina propria, submucosa
T2
 Muscularis propria
T3
 Subserosa, non-peritonealized perimuscular tissues (mesentery, retroperitoneum) ≤2 cm
T4
 Visceral peritoneum, other organs/structures (including mesentery, retroperitoneum) <2 cm
N1
 Regional