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Anal Cancer Staging: TNM Classification System

Anal cancer staging helps to determine the disease prognosis and to select an appropriate treatment strategy. The AJCC (American Joint Committee on Cancer) or TNM is the most commonly used system for staging anal cancer by the medical community.

The system utilizes 3 parameters (represented by letters – T, N, and M) for assigning a stage to anal cancer. “T” stands for “Tumor Size”, “N” for “Lymph Nodes”, “M” for “Metastasis”.

Numbers. and/or letters after T (0, is, 1, 2, 3, and 4), N (0 and 1), and M (0 and 1) provide more details about each of these parameters. Once T, N, and M categories are determined, this information is combined to assign an overall stage (from 0 to IV) to the disease.

Following table describe the characteristics of anal cancer according to different stages:

STAGE TNM DESCRIPTION
0 Tis N0 M0 Pre-cancerous cells (CIS or high-grade AIN) found only in the surface layer of the anal canal. No evidence of primary tumor mass.
I T1 N0 M0 The primary tumor is </=2 cm in size. No spread to nearby lymph nodes or distant body parts.
IIA T2 N0 M0 The primary tumor is >2 cm but </=5 cm in size. No spread to nearby lymph nodes or distant body parts.
IIB T3 N0 M0 The primary tumor is >5 cm in size. No spread to nearby lymph nodes or distant body parts.
IIIA T1-2 N1 M0 The primary tumor is </=5 cm in size and it has spread to nearby lymph node(s). No spread to distant body parts.
IIIB T4 N0 M0 The primary tumor of any size that has invaded in a nearby organ, such as the vagina, prostate gland, urethra, or bladder. No spread to nearby lymph nodes or distant body parts.
IIIC T3-4 N1 M0 The primary tumor is >5 cm in size or it has invaded in a nearby organ and it has spread to nearby lymph node(s). No spread to distant body parts.
IV Any T Any N M1 The primary tumor has spread to the distant site(s), such as the lung, liver, peritoneum, etc.

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