1. The document discusses the TNM classification system for staging tumors, which evaluates the size of the primary tumor (T), whether the cancer has spread to regional lymph nodes (N), and the presence of distant metastasis (M). 2. Staging provides information on cancer prognosis and treatment by assessing how far the cancer has progressed. The TNM system is overseen by organizations like the International Union Against Cancer and the American Joint Committee on Cancer. 3. In addition to staging, tumors are also graded based on their histopathological characteristics like differentiation and growth rate, with higher grades indicating faster growth and worse prognosis. Grading provides additional details beyond tumor staging.

1. TNM CLASSIFICATION OF
TUMOR
Dr. Binu Babu
Ph. D (N), MSN, MBA
Mrs. Jincy Ealias
MSN, RN

2. DEFINITION
• Tumor: A Tumor is a swelling or mass
of tissue that may be benign or
malignant.
• Benign- A noncancerous growth
• Malignant- Dangerous to health;
characterized by progressive and
uncontrolled growth

3. Benign and Malignant Tumor
Characteristics
Benign Malignant
Slow growing Rapid growing
Tumor stasis occur It invade surrounding
tissue
Do not occur adjacent
tissue
They are anaplastic
Death from benign tumor
is rare

4. STAGING
Staging is a way of describing how much a
cancer has grown and spread.
Purpose of staging
To know the amount of cancer and where it
is in the body to be able to choose the best
possible treatment.

5. Aims of cancer staging
1. Selection of primary and adjuvant therapy
2. Estimation of prognosis,
3. Assistance in evaluation of the results of
treatment
4. Facilitation of the exchange of information
among treatment
5. Contribution to the continuing
investigation of human cancers

6. Elements of Staging
Staging is based on the following factors:
• Location of the primary (original) tumor
• Tumor size and number of tumors
• Lymph node involvement
– whether or not the cancer has spread to the
nearby lymph nodes
• Presence or absence of metastasis
– whether or not the cancer has spread to distant
areas of the body

7. • Gather different types of information about
a cancer to determine its stage. The various
tests used for staging depend on the type of
cancer. Tests include the following:
Physical exams provide clues as to the
extent of the cancer.
Imaging tests
Laboratory tests

8. Pathology reports may include information
about the size of the tumor, the growth into
other tissues and organs, the type of cancer
cells, and the grade of tumor.
Surgical reports tell what is found during
surgery.

9. Factors of Cancer Staging
The staging is based on 3 main factors, T, N,
and M:
• T: is based on the size of the original
(primary) tumor and whether or not it has
grown into nearby tissues
• N: whether or not the cancer has spread to
the nearby lymph nodes
• M: whether or not the cancer has spread to
distant areas of the body

10. • TNM committe on International Union
against cancer (UICC) and American Joint
Committee on cancer (AJCC) have agreed on
the TNM staging system.
• In the TNM system, TNM stands for Tumor,
Nodes, and Metastases.

11. T: Tumor
• T Classifies the extent of the primary
tumor, and is normally given as T0 through
T4.
• T0 represents a tumor that has not even
started to invade the local tissues. This is
called "In Situ".
• T4 on the other hand represents a large
primary tumor that has probably invaded
other organs

12. N: Lymph Nodes
• N classifies the amount of regional
lymph node involvement. N0 means
no lymph node involvement while N4
means extensive involvement.

13. M: Metastasis
• M is either M0 if there are no
metastases or M1 if there are
metastases.

14. TNM classification system
 PRIMARY TUMOR (T)
• Tx Primary tumor
cannot be assessed
• T0 No evidence of
primary tumor
• Tis Carcinoma in situ
• T1, T2, T3, T4
Increasing size and /or
local extent of the
primary tumor

15.  REGIONAL LYMPH
NODES (N)
• Nx regional lymph
nodes cannot be
assessed
• N0 no regional lymph
node metastasis
• N1,N2,N3 increasing
involvement of
regional lymph nodes

16.  DISTANT
METASTASIS (M)
• Mx Distant metastasis
cannot be assessed
• M0:- No distant
metastasis
• M1 Distant metastasis

17. Classification of TNM
• Clinical classification, designated cTNM or
TNM
• Pathologic classification, designated pTNM
• Retreatment classification, designated
rTNM
• Autopsy classification, designated aTNM

18. Clinical classification
• It is based on evidence acquired before
primary treatment. Clinical assessment
uses information available prior to first
definitive treatment, including but not
limited to physical examination,
imaging, endoscopy, biopsy, and
surgical exploration.

19. Pathologic classification
Which uses the evidence acquired
before treatment, supplemented or
modified by the additional evidence
acquired during and from surgery,
particularly from pathologic
examination.

20. Retreatment classification
• It is assigned when further treatment
(such as chemotherapy) is planned for
a caner that recurs after a disease-free
interval. All information available at
the time of retreatment should be used
in determining the stage of the
recurrent tumor (rTNM).

21. Autopsy classification
• Occurs when classification of a cancer
by postmortem examination is done
after the death of a patient (cancer was
not evident prior to death). The
classification of the stage is identified
as aTNM and includes all pathologic
information obtained at the time of
death.

22. AJC (American Joint Committee)
system
Divides all cancers into stages 0 to IV.
• Stage 0: Tumor of microscopic size (carcinoma in
situ)
• Stage I: tumor confined to the organ of origin
(cancers are localized to one part of the body)
• Stage II: Local spread, not interfering with surgical
removal.
• Stage III: Fixation to the surrounding structures.
• Stage IV: Distant metastasis.

24. GRADING
• Grading is a method of classification based
on histopathologic characteristics of the
tissue.
• The grade is a measure of how abnormal the
cancer cells look under the microscope, is
called differentiation.
• Cancers with more abnormal-looking cells
tend to grow and spread faster. The grade is
usually assigned a number from 1 to 3 or 4.

25. • Grading is based on two important
histological features.
– Degree of anaplasia
– Rate of growth

26. Two grading systems are
commonly seen
• One descriptively identifies the tumor as
well differentiated, moderately well
differentiated, poorly differentiated, or
undifferentiated.
• The other system numerically grades from 1
to 3 or 4, with 1 being the most
differentiated and 3 and 4 being the least
well-differentiated ; grade 4 applies to
tumors with no specific diffentiation.

27. The AJCC recommends the grading classification
as:
• GX Grade cannot be assessed
• G1 well diffentiated (<25% anaplastic cells)
• G2 moderatly well-diffentiated (25-50%
anaplastic cells)
• G3 Poorly diffentiated (>75% anaplastic
cells)
• G4 Undifferentiated

28. Bibliography
• Michele Goodman,Cancer Nursing, principle
and Practise, 6th edition, 172-177.
• Brunner and Sidharth, Text book of Medical
Surgical Nursing, 11th edition.
• AJCC Cancer Staging Atlas
• Understanding Cancer types and Staging
• SEER program: comparative staging guide
for cancer