Table Of ContentTNM
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TNM
Supplement
A Commentary on Uniform Use
FiFTh EdiTioN
EDITED BY
Christian Wittekind
Leipzig, Germany
James D. Brierley
Toronto, ON, Canada
Anne Lee
Hong Kong, China
Elisabeth van Eycken
Brussels, Belgium
This edition first published 2019 © 2019 UICC
Published 2019 by John Wiley & Sons Ltd
This work is a co‐publication between the UICC and John Wiley & Sons, Ltd
Edition History
ISBN 3‐540‐56556‐6 Springer‐Verlag Berlin Heidelberg New York 1993
ISBN 0‐387‐56556‐6 Springer‐Verlag New York Berlin Heidelberg 1993
ISBN 0‐471‐37939‐5 Wiley‐Liss New York 2001
ISBN 0‐471‐46666‐2 Wiley‐Liss New York 2003
ISBN 978‐1‐4443‐3243‐8 John Wiley & Sons, Ltd Oxford 2012
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Library of Congress Cataloging‐in‐Publication Data
Names: Wittekind, Ch. (Christian), editor. | Brierley, James, editor. | Lee, A. W. M. (Anne W. M.), editor. |
Eycken, E. van, editor. | Union for International Cancer Control, issuing body.
Title: TNM supplement : a commentary on uniform use / edited by Ch. Wittekind,
J.D. Brierley, Anne Lee, Elisabeth van Eycken.
Other titles: Tumour-node-metastasis supplement
Description: Fifth edition. | Hoboken, NJ : Wiley-Blackwell ; [Geneva, Switzerland] : UICC, 2019. |
Includes bibliographical references and index. |
Identifiers: LCCN 2019003455 (print) | LCCN 2019005429 (ebook) | ISBN 9781119263944
(Adobe PDF) | ISBN 9781119263920 (ePub) | ISBN 9781119263937 (pbk.)
Subjects: | MESH: Neoplasms–classification
Classification: LCC RC258 (ebook) | LCC RC258 (print) | NLM QZ 15 | DDC 616.99/40012–dc23
LC record available at https://lccn.loc.gov/2019003455
Cover image: © UICC
Cover design by Wiley
Set in 9.25/13 pt Frutiger Light by SPi Global, Pondicherry, India
10 9 8 7 6 5 4 3 2 1
CONTENTS
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
v
vi CONTENTS
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
CONTENTS vii
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
PREFACE
First published in 1987 [1], and revised in 1992 [2], the fourth edition of the
TNM Classification of Malignant Tumours was the result of a push from all
national TNM committees towards the establishment of a uniform classification
system that could be used worldwide. It was, therefore, the first edition of the
text in which the featured classification criteria were identical to those detailed
in the fourth edition of the AJCC’s Manual for Staging of Cancer of the American
Joint Committee on Cancer [3].
Although the classification system was, by 1987, widely accepted, medical
professionals had pointed out that some of its definitions and rules for staging
were imprecise and could lead to inconsistency in its application. Discrepant
understandings of organ classifications, general rules and, in particular, the
requirements of pathological classification (pT, pN) were all potential risks.
In an effort to address these concerns, the TNM Project Committee of the
UICC collected and reviewed criticisms and suggestions from the national TNM
committees, as well as from registries, oncological associations and individual
users. The solution that they found was to complement the fourth edition of the
TNM Classification [1, 2] with the publication of a new book: the TNM
Supplement [4]. Designed to provide guidance on the uniform use of the clas-
sification system, the first edition of this new text was published in 1993.
By 1997, the TNM Classification was in its fifth edition [5], though most
descriptions of tumour sites had remained largely unchanged, with only minor
additions made so as to reflect new data on prognosis and new methods of
outcome assessment. The TNM Project Committee of the UICC was aware that
not all classification proposals and updates received could be included in this
fifth edition and so the decision was made to produce another TNM Supplement
within which they may be accommodated [6]. The second edition of the TNM
Supplement therefore comprised, for the most part, of the first edition’s con-
tents, amended to include a number of new items.
Retaining much of its predecessor’s content, the sixth edition of the TNM
Classification [7] again featured only small revisions but was elaborated upon in
a third edition of the TNM Supplement [8].
The TNM Classification’s seventh edition [9] saw the inclusion of several novel
tumour classifications. While comments on the new entities and modifications
concerned had been published elsewhere [10], it was nevertheless deemed
viii
