TNM Classification for Urologic Tumors by Dr. Jeffrey Wong

TNM Classification for Urologic Tumors

Renal Tumors

T1: Tumor 7 cm or less, limited to kidney
T2: Tumor greater than 7 cm, limited to kidney
T3: Tumor extends into major veins/adrenal/perinephric tissue; not beyond Gerota's fascia
T3a: Tumor invades adrenal/perinephric fat
T3b: Tumor extends into renal vein or vena cava below the diaphragm
T3c: Tumor extends into vena cava above the diaphragm
T4: Tumor invades beyond Gerota's fascia
N0: No regional lymph node metastasis
N1: Metastasis in a single regional lymph node
N2: Metastasis in more than one regional lymph node
M0: No distant metastasis
M1: Distant Metastasis

Bladder Tumors

Ta: Papillary epithelial confined tumors
Tis: Flat in situ carcinoma
T1: Tumors that have invaded lamina propria
T2: Tumors that invade superficial muscle
T3a: Tumors that invade deep muscle
T3b: Tumors that invade perivesical fat
T4: Tumors invading pelvic viscera, prostatic stroma, rectum, uterus or vagina, or pelvic side walls
N0: No lymph nodes
N1: Single positive node less than or equal to 2 cm in diameter
N2: Single positive lymph node greater than 2 cm but less than 5 cm in diameter
N3: Positive lymph nodes greater than 5 cm
M0: No distant mets
M1: Distant mets

Ureteral Tumors

Tis: Carcinoma in situ
T1: Tumors invade the lamina propria
T2: Tumors invade muscularis propria
T3: Tumors invade the peripelvic /periureteral tissue or invade the renal parenchyma
T4: Tumors involve contiguous organs
N0: No nodes
N1: One involved lymp node that is less than or equal to 2 cm
N2: One positive node greater than 2 cm but less than 5 cm or multiple lymph nodes less than 5 cm
N3: Positive nodes > 5 cm
M0: No distant mets
M1: Hematogenous or distant nodal mets

Testis Tumors

Tis: Intratubular tumor, CIS
T1: Confined to testis
T2: Beyond tunica albuginea
T3: Invades rete testis or epididymis
T4a: Invades the cord
T4b: Invades the scrotum
N0: No nodes
N1: Mets in a single lymph node, 2 cm or less in greatest diameter
N2: Mets in single lymph node, more than 2 cm but not greater than 5 cm in greatest diameter, or multiple lymph nodes, none more than 5 cm
N3: Mets in lymph nodes more than 5 cm in greatest diamer
M0: No distant mets
M1: Disstant Mets

Penile Tumors

Prostate Cancer

T1: Clinically unapparent tumor-not palpable or visible by imaging
T1a: Tumor found incidentally in tissue removed at TUR; 5% or less of tissue is cancerous
T1b: Tumor found incidentally at TUR; more than 5% of tissue is cancerous
T1c: Tumor identified by prostate needle biopsy because of elevated PSA
T2: Palpable tumor confined within the prostate
T2a: Tumor involves half of a lobe or less
T2b: Tumor involves more than half of lobe but not both lobes
T2c: Tumor involves both lobes
T3: Palpable tumor extending through prostate capsule and/or involving seminal vesicle(s)
T3a: Unilateral extracapsular extension
T3b: Bilateral extracapsular extension
T3c: Tumor invades seminal vesicle(s)
T4: Tumor is fixed or invades adjacent structures other than seminal vesicles
T4a: Tumor invades bladder neck and/or external sphincter and/or rectum
T4b: Tumor invades levator muscles and/or is fixed to pelvic wall
N0: No regional lymph node met
N1: Mets in a single regional lymph node, less than or equal to 2 cm
N2: Mets in single lymph node, > 2 cm but not >5 cm, or multiple regional lymph nodes, none > 5 cm
N3: Mets in regional lymph nodes > 5 cm
M0: No distant mets
M1: Distant mets
M1a: Involvement of nonregional lymph nodes
M1b: Involvment of bones
M1c: Involvement of other distant sites

Urethral Carcinoma

Ta: Noninvasive papillary, polypoid, or verrucous carcinoma
Tis: Carcinoma in situ
T1: Tumor invades subepithelial connective tissue
T2: Tumor invades corpus spongiosum or prostate, or periurethral muscle
T3: Tumor invades the corpus cavernosum or beyond the prostatic capsule, or anterior vagina or bladder neck
T4: Tumor invades other adjacent organs
N0: No regional lymph nodes
N1: Mets in a single lymph node , less than or equal to 2 cm
N2: Mets in single lymph node, > 2 cm but < 5 cm, or multiple lymph nodes, none > 5 cm
N3: Mets in lymph node > 5 cm
M0: No distant mets
M1: Distant mets

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