Union for International Cancer Control (UICC)
Eighth Edition
Editors in Chief
James D. Brierley BSc, MB, FRCP, FRCR, FRCPC
Mary K. Gospodarowicz MD, FRCPC, FRCR (Hon)
Christian Wittekind MD
Editors
B. O’Sullivan MD
M. Mason MD
H. Asamura MD
A. Lee MD
E. Van Eycken MD
L. Denny MB, ChB
M.B. Amin MD
S. Gupta MD
This edition first published 2017 © 2017 UICC
Published 2017 by John Wiley & Sons, Ltd
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Library of Congress Cataloging‐in‐Publication Data
Names: Brierley, James, editor. | Gospodarowicz, M. K. (Mary K.), editor. | Wittekind, Ch. (Christian), editor.
Title: TNM classification of malignant tumours / editors in chief, James D. Brierley, Mary K. Gospodarowicz, Christian Wittekind ; editors, B. O’Sullivan [and 7 others].
Description: Eighth edition. | Oxford, UK ; Hoboken, NJ : John Wiley & Sons, Inc., 2017. | Includes bibliographical references.
Identifiers: LCCN 2016039430| ISBN 9781119263579 (paper) | ISBN 9781119263548 (Adobe PDF) | ISBN 9781119263562 (epub)
Subjects: | MESH: Neoplasms–classification
Classification: LCC RC258 | NLM QZ 15 | DDC 616.99/40012–dc23
LC record available at https://lccn.loc.gov/2016039430
Cover image: © UICC
They are called wise
who put things in their right order
This Eighth Edition is dedicated to Dr Leslie H. Sobin MD, a pathologist and previous long term Chair of UICC TNM Prognostic Factor Committee. Les, as he is known to colleagues all over the world, has devoted most of his career to help promote globally unified classifications of disease in particular in pathology and cancer staging. This is the first edition since the fourth that has not benefitted from his direct involvement; however his imprint is found throughout this edition.
James D. Brierley, BSc, MB, FRCP, FRCR, FRCPC
Professor, Department of Radiation Oncology, University of Toronto; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Dr Brierley trained in Clinical Oncology in the UK and developed his interest in cancer staging and surveillance when moving to Canada and has been involved in cancer surveillance, locally, nationally and internationally. He is Co‐Chair of the UICC TNM Prognostic Factors Project. He has co‐edited the TNM Supplement 4th edition (Wiley 2012) and the UICC Manual of Clinical Oncology (Wiley 2015).
Mary K. Gospodarowicz, MD, FRCPC, FRCR (Hon)
Professor, Department of Radiation Oncology, University of Toronto; Medical Director, Princess Margaret Cancer Centre, University Health Network; Regional Vice‐President of Cancer Care Ontario for Toronto South, Toronto, Ontario, Canada
Dr Gospodarowicz is the Past‐President of UICC. She has a long‐standing interest in cancer classification with an emphasis on staging and prognostic factors and she has been involved in the UICC TNM Project for many years. Her interests include the application of modern information and communication technologies in cancer control. Dr Gospodarowicz was co‐editor of the 7th edition of the TNM Classification of Malignant Tumours (Wiley 2009) and editor of the 2nd and 3rd editions of the UICC Prognostic Factors in Cancer (Wiley 2001, 2006).
Christian Wittekind, MD
Professor of Pathology, Chairman Institute of Pathology, University of Leipzig, Leipzig, Germany
Dr Wittekind been involved in cancer staging and tumour classifications for over 20 years. He is a member of the UICC TNM Core Committee, Head of the German Speaking TNM‐Komittee, and personally responds to all the questions to the UICC TNM helpdesk. He was the co‐editor of the 5th, 6th and 7th editions of the TNM Classification of Malignant Tumours (Wiley 1997, 2002, 2009), editor of the 2nd 3rd, and 4th editions of the TNM Supplement (Wiley 2001, 2003 and 2012) and editor of the 6th edition of the TNM Atlas (Wiley 2014).
B. O’Sullivan, MD
Professor, Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
M. Mason, MD
Professor of Cancer Studies, School of Medicine, Cardiff University, Cardiff, UK
H. Asamura, MD
Professor of Surgery, Chief, Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
A. Lee, MD
Professor and Head, Department of Clinical Oncology, The University of Hong Kong and the University of Hong Kong‐Shenzhen Hospital, Hong Kong, China
E. Van Eycken, MD
Belgian Cancer Registry, Brussels, Belgium
L. Denny, MB, ChB
Head, Department of Obstetrics and Gynaecology, SA Medical Research Council, Gynaecological Cancer Research Centre, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
M.B. Amin, MD
Professor and Chair of the Department of Pathology, the College of Medicine, University of Tennessee, Tennessee, USA
S. Gupta, MD
Assistant Professor, Department of Paediatrics, University of Toronto, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
In this eighth edition of TNM Classification of Malignant Tumours, many of the tumour sites are unchanged from the seventh edition1. However, some tumour entities and anatomic sites have been newly introduced and some tumours contain modifications: this follows the basic philosophy of maintaining stability of the classification over time. The modifications and additions reflect new data on prognosis as well as new methods for assessing prognosis.2 Some changes had already appeared in the TNM Supplement3 as proposals. Subsequent support warrants their incorporation into the classification. New proposals for tumours of parathyroid carcinoma, and paraganglionoma will be published in the next edition of the TNM Supplement.
In the seventh edition a new approach was adopted to separate stage groupings from prognostic groupings in which other prognostic factors are added to T, N, and M categories. These new prognostic groupings were presented for oesophagus and prostate. In this eighth edition, the term ‘stage’ is used when only descriptions of anatomic extent of disease are used and ‘prognostic group’ for when additional prognostic factors are incorporated.
Changes made between the seventh and eighth editions are indicated by a bar at the left‐hand side of the text. To avoid ambiguity, users are encouraged to cite the edition and year of the TNM publication they have used in their list of references.
A TNM homepage with Frequently Asked Questions (FAQs) and a form for submitting questions or comments on the TNM can be found at: http://www.uicc.org. Readers are also encouraged to go to http://www.uicc.org for updates and errata.
The UICC’s TNM Prognostic Factors Project has a process for evaluating proposals to change the TNM Classification. This procedure aims at a continuous systematic approach composed of two arms: (1) review formal proposals from investigators and (2) an annual literature search for articles concerning improvements to TNM. The proposals and results of the literature search are evaluated by a UICC panel of experts as well as by the TNM Prognostic Factors committee members.5 The national TNM Committees participated in this process. More details and a checklist that will facilitate the formulation of proposals can be obtained at www.uicc.org.
Union for International Cancer Control (UICC)
62, route de Frontenex
CH‐1207 Geneva, Switzerland
Fax +41 22 8091810
The Editors have much pleasure in acknowledging the great help received from the members of the TNM Prognostic Factors Project Committee and the National Staging Committees Global Representatives and international organizations listed on pages xvi, all of whom volunteered their time.
We thank Professor Patti Groome and Ms Colleen Webber for supervising and performing the literature watch from its inception until 2015 and 2016, respectively. The eighth edition of the TNM Classification is the result of a number of consultative meetings organized and supported by the UICC and AJCC secretariats.
This publication was made possible by grants 1U58DP001818 and 1U58DP004965 from the Centers for Disease Control and Prevention (CDC) (USA). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.
| CDC | Centers for Disease Control and Prevention (USA) |
| FIGO | International Federation of Gynaecology and Obstetrics |
| IACR | International Association of Cancer Registries |
| IARC | International Agency for Research on Cancer |
| IASLC | International Association for the Study of Lung Cancer |
| ICCR | International Collaboration on Cancer Reporting |
| WHO | World Health Organization |
| Australia and New Zealand | National TNM Committee |
| Austria, Germany, Switzerland | Deutschsprachiges TNM‐Komitee |
| Belgium | National TNM Committee |
| Brazil | National TNM Committee |
| Canada | National Staging Steering Committee |
| China | National TNM Cancer Staging Committee of China |
| Denmark | National TNM Committee |
| Gulf States | TNM Committee |
| India | National TNM Committee |
| Israel | National Cancer Staging Committee |
| Italy | Italian Prognostic Systems Project |
| Japan | Japanese Joint Committee |
| Latin America | Sociedad Latinoamericana y del |
| and Caribbean | Caribe de Oncología Médica |
| Netherlands | National Staging Committee |
| Poland | National Staging Committee |
| Singapore | National Staging Committee |
| Spain | National Staging Committee |
| South Africa | National Staging Committee |
| Turkey | Turkish National Cancer Staging Committee |
| United Kingdom | National Staging Committee |
| United States of America | American Joint Committee on Cancer |
In 1950 the UICC appointed a Committee on Tumour Nomenclature and Statistics. In 1954 this Committee became known as the Committee on Clinical Stage Classification and Applied Statistics and in 1966 it was named the Committee on TNM Classification. Taking into consideration new prognostic factors the Committee was named in 1994 the TNM Prognostic Factors Project Committee, and in 2003 the main committee was named “TNM Prognostic Factors Core Group”. A list of members who have served on these committees is available at: www.uicc.org
| Asamura, H. | Japan |
| Brierley, J.D. | Canada |
| Compton, C.C. | USA |
| Gospodarowicz, M.K. | Canada |
| Lee, Anne | China |
| Mason, M. | UK |
| O'Sullivan, B. | Canada |
| Van Eycken, E. | Belgium |
| Wittekind, Ch. | Germany |
| General Rules | J.D. Brierley M. K. Gospodarowicz B. O’Sullivan Ch. Wittekind |
| Head and Neck | B. O’Sullivan |
| Thyroid | J.D. Brierley |
| Upper Gastrointestinal Tract | Ch. Wittekind |
| Lower Gastrointestinal Tract | J.D. Brierley |
| Hepatobiliary | Ch. Wittekind |
| Lung, Pleura and Thymic Tumours | H. Asamura |
| Bone and Soft Tissues | B. O’Sullivan |
| Skin | A. Lee, J.D. Brierley, B. O’Sullivan |
| Breast | E. Van Eycken |
| Gynecological | L. Denny |
| Genitourinary | M.K. Gospodarowicz, M. Mason |
| Ophthalmic Tumours | Ch. Wittekind |
| Malignant Lymphoma | M.K. Gospodarowicz |
| Paediatric Tumours | S. Gupta, J.D. Brierley |
| Essential TNM | J.D. Brierley, B. O’Sullivan |
| AJCC Liaison | M.B. Amin |
In addition, the Editors wish to acknowledge the invaluable contributions of:
| Head and Neck Cancers | UICC Advisory Committee (see www.uicc.org) |
| Thymic Tumours | F. Detterbeck |
| Cutaneous Squamous Cell Carcinoma | C. Schmults, K. Nehal |
| Essential TNM | F. Bray, M. Parkin, M. Pineros, K. Ward, M. Ervik, A. Znaor |
| Paediatric Tumours | L. Frazier, J. Aitken |
| Expert Panel Members | See www.uicc.org |
| Global Advisory Group Members | See www.uicc.org |