TNM_Breast v.1
The American Joint Committee on Cancer (AJCC) TNM staging system reports on the severity of breast cancer based on tumor, lymph node and metastasis characteristics.
The American Joint Committee on Cancer (AJCC) TNM staging system reports on the severity of breast cancer based on tumor, lymph node and metastasis characteristics. The characteristics of the size of the tumour, the extent of spread to local lymph nodes and body organs. These aspects are captured in 3 ways that make up the mnemonic TNM: T: Tumour size; N: Number of regional lymph nodes affected and M: whether the cancer has spread/metastasised beyond the primary organ and regional nodes. Each major category is further subdivided to help classify the picture further. These subdivisions are given suffixes or numbered as shown below.
The TNM staging system is used with breast cancer patients post biopsy. The system allows clinicians to provide staging and prognosis information on their patients and the TNM staging system for breast cancer is regularly updated through the NCCN (National Comprehensive Cancer Network) breast staging guidelines (3) Breast cancer staging has several detailed subdivisions which are briefly described below. For more detail, please look at the AJCC staging information. (1) Staging based on multiple factors including: Primary Tumor (T) characteristics Regional lymph nodes (N) Clinical Pathological Distant metastasis (M) The Tumor (T) Node (N) Metastases (M) classification diversifies further in Breast cancer staging as follows: T TX: Primary tumor cannot be assessed. T0: No evidence of primary tumor. Tis: Carcinoma in situ (DCIS, LCIS, or Paget disease of the nipple with no associated tumor mass) T1 (includes T1a, T1b, and T1c): Tumor is 2 cm (3/4 of an inch) or less across. T2: Tumor is more than 2 cm but not more than 5 cm (2 inches) across. T3: Tumor is more than 5 cm across. T4 (includes T4a, T4b, T4c, and T4d): Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer. N An area of cancer spread < 0.2 mm (or fewer than 200 cells) doesn't affect the stage, but is recorded with abbreviations (i+ or mol+) that indicate the type of special test used to find the spread but this level of staging does not affect the overall staging classification of the N subset. If the area of cancer spread is > = 0.2 mm (or 200 cells), but still not larger than 2 mm, it is called a micrometastasis. Micrometastases are counted only if there aren't any larger areas of cancer spread (> 2mm). NX: Nearby lymph nodes cannot be assessed N0: Cancer has not spread to nearby lymph nodes. N0(i+): Cancer spread < 200 cells and is < 0.2 mm [\"i+\" = presence of small numbers of isolated tumor cells) in immunohistochemistry. N0(mol+): Cancer cells cannot be seen in underarm lymph nodes but traces of cancer cells were detected using RT-PCR. N1: Cancer spread to 1 to 3 axillary (underarm) lymph node(s), and/or tiny amounts of cancer in internal mammary lymph nodes N1mi: Micrometastases in 1 to 3 lymph nodes under the arm. The areas of cancer spread in the lymph nodes are 2 mm or less across (but at least 200 cancer cells or 0.2mm across). N1a: Cancer has spread to 1 to 3 lymph nodes under the arm with at least one area of cancer spread greater than 2 mm across. N1b: Cancer has spread to internal mammary lymph nodes, but this spread could only be found on sentinel lymph node biopsy N1c: Both N1a and N1b apply. N2: Cancer has spread to 4 to 9 lymph nodes under the arm, or cancer has enlarged the internal mammary lymph nodes (either N2a or N2b, but not both). N2a: Cancer has spread to 4 to 9 lymph nodes under the arm, with at least one area of cancer spread larger than 2 mm. N2b: Cancer has spread to one or more internal mammary lymph nodes, causing them to become enlarged. N3: Any of the following: N3a: either: Cancer has spread to 10 or more axillary lymph nodes, with at least one area of cancer spread greater than 2mm, OR cancer has spread to the lymph nodes under the collar bone (infraclavicular nodes), with at least one area of cancer spread greater than 2mm. N3b: either: Cancer is found in at least one axillary lymph node (with at least one area of cancer spread greater than 2 mm) and has enlarged the internal mammary lymph nodes, OR cancer has spread to 4 or more axillary lymph nodes (with at least one area of cancer spread greater than 2 mm), and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy. N3c: Cancer has spread to the lymph nodes above the collar bone (supraclavicular nodes) with at least one area of cancer spread greater than 2mm. M MX: Distant spread (metastasis) cannot be assessed. M0: No distant spread is found on x-rays (or other imaging tests) or by physical exam. cM0(i+): Small numbers of cancer cells are found in blood or bone marrow (found only by special tests), or tiny areas of cancer spread (no larger than 0.2 mm) are found in lymph nodes away from the breast. M1: Cancer has spread to distant organs (most often to the bones, lungs, brain, or liver). Staging: Stage T N M 0 Tis N0 M0 IA T1 N0 M0 IB T0 N1mi M0 T1 N1mi M0 IIA T0 N1 M0 T1 N1 M0 T2 N0 M0 IIB T2 N1 M0 T3 N0 M0 IIIA T0 N2 M0 T1 N2 M0 T2 N2 M0 T3 N1 M0 T3 N2 M0 IIIB T4 N0 M0 T4 N1 M0 T4 N2 M0 IIIC Any T N3 M0 IV Any T Any N M1
Using the TNM classification alone is not recommended in providing diagnostic assessment. Clinical evidence is required to back up the staging suggestions.
Ref. 1: AJCC Cancer Staging Atlas A Companion to the Seventh Editions of the AJCC Cancer Staging Manual and Handbook Carolyn C. Compton David R Byrd; Julio Garcia-Aguilar; American Joint Committee on Cancer Content Provider. New York, NY : Springer New York : Imprint: Springer 2nd ed. 2012 Ref. 2: Theriault RL, Carlson RW, Allred C, et al. Breast Cancer, Version 3.2013: Featured Updates to the NCCN Guidelines. Journal of the National Comprehensive Cancer Network : JNCCN. 2013;11(7):753-761. Ref. 3: Regular updates for breast cancer staging and treeatment can be found on the NCCN (National Comprehensive Cancer Network) website, accessed at: www.nccn.org
OBSERVATION.tnm_breast_cancer_staging.v1, EVALUATION.tnm_breast_cancer_assessment.v1
