Tumor node metastasis (TNM) staging classification for breast cancer
- Daniel F Hayes, MD
Daniel F Hayes, MD
- Section Editor — Breast Cancer
- Professor of Medicine
- University of Michigan School of Medicine
- Section Editor
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
The tumor node metastasis (TNM) staging system for breast cancer is an internationally accepted system used to determine the disease stage. This disease stage is a measure of the extent of disease, which is used to determine prognosis and guide management.
The seventh edition of the TNM staging system, and the evidence supporting it, are described here (table 1). The sixth edition of the TNM staging system is included for comparison (table 2). The initial evaluation, clinical manifestations, diagnosis, treatment, and prognosis of breast cancer are reviewed elsewhere. (See "Overview of the treatment of newly diagnosed, non-metastatic breast cancer" and "Clinical features, diagnosis, and staging of newly diagnosed breast cancer".)
TNM STAGING SYSTEM
The tumor node metastasis (TNM) staging system for breast cancer is based upon a retrospective analysis of survival in diverse samples of patients representing all stages of disease. It reflects the clinical evaluation methods and treatments that are applied to the particular study population.
The TNM staging system is used to facilitate discussions about treatment and prognosis between collaborating providers, as well as between providers and patients. An individual patient's clinical course and outcome cannot be predicted with certainty. However, available survival data can help direct treatment decisions and provide an estimate of the likely prognosis. The TNM staging system correlates important tumor characteristics with survival data to help estimate and follow outcomes.
Periodic revisions are necessary because advanced imaging techniques and treatments evolve and impact survival. The seventh edition of the TNM staging system, published in 2010, is the most recent version (table 1) . The sixth edition of the TNM staging system is shown in the table (table 2) .
- AJCC (American Joint Committee on Cancer). Cancer Staging Manual, 7th edition, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer-Verlag, New York 2010. p.347.
- AJCC (American Joint Committee on Cancer). Cancer Staging Manual, 6th edition, Greene FL, Page DL, Fleming ID, et al (Eds), Springer-Verlag, New York 2002. p.223.
- TNM STAGING SYSTEM
- CLINICAL VERSUS PATHOLOGIC STAGING
- REVISIONS IN BREAST CANCER STAGING
- Changes in Tumor (T) classification
- Changes in Nodes (N) classification
- Changes in Metastases (M) classification
- Changes in postneoadjuvant therapy (yc or ypTNM) classification
- CURRENT (SEVENTH EDITION) TNM BREAST CANCER STAGING SYSTEM
- Primary tumor classification
- Regional lymph nodes (N)
- - Clinical classification of regional lymph nodes
- - Pathologic classification of regional lymph nodes
- Distant metastasis (M)
- STAGE GROUPINGS
- Stage 0
- Stage IA
- Stage IB
- Stage IIA
- Stage IIB
- Stage IIIA
- Stage IIIB
- Stage IIIC
- Stage IV
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS