KIDNEY
TNM Classification – 8th Edition 2017
T - Primary Tumour
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
T1 Tumour < 7 cm or less in greatest dimension, limited to the kidney
T1a Tumour < 4 cm or less
T1b Tumour > 4 cm but < 7 cm
T2 Tumour > 7 cm in greatest dimension, limited to the kidney
T2a Tumour > 7 cm but < 10 cm
T2b Tumours > 10 cm, limited to the kidney
T3 Tumour extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland
and not beyond Gerota fascia
T3a Tumour extends into the renal vein or its segmental branches, or tumour invades the pelvicalyceal
system or tumour invades perirenal and/or renal sinus fat (peripelvic fat), but not beyond Gerota
fascia
T3b Tumour extends into the vena cava below diaphragm
T3c Tumour extends into vena cava above the diaphragm or invades the wall of the vena
cava
T4 Tumour invades beyond Gerota fascia (including contiguous extension into the ipsilateral adrenal
gland)
N - Regional Lymph Nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in regional lymph node(s)
M - Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis
Stage grouping
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
T1, T2, T3 N1 M0
Stage IV T4 Any N M0
Any T Any N M1
PROSTATE
TNM Classification – 8th Edition 2017
T - Primary Tumour
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
T1 Clinically inapparent tumour that is not palpable
T1a Tumour incidental histological finding in 5% or less of tissue resected
T1b Tumour incidental histological finding in more than 5% of tissue resected
T1c Tumour identified by needle biopsy (e.g. because of elevated PSA level)
T2 Tumour that is palpable and confined within the prostate
T2a Tumour involves one half of one lobe or less
T2b Tumour involves more than half of one lobe, but not both lobes
T2c Tumour involves both lobes
T3 Tumour extends through the prostatic capsule
T3a Extraprostatic extension (unilateral or bilateral) including microscopic bladder neck involvement
T3b Tumour invades seminal vesicle(s)
T4 Tumour is fixed or invades adjacent structures other than seminal vesicles: external sphincter,
rectum, levator muscles, and/or pelvic wall
N - Regional Lymph Nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
M - Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis
M1a Non-regional lymph node(s)
M1b Bone(s)
M1c Other site(s)
G Histopathological Grading
GX Grade cannot be assessed
G1 Well differentiated (slight anaplasia) (Gleason 2–4)
G2 Moderately differentiated (moderate anaplasia) (Gleason 5–6)
G3–4 Poorly differentiated/undifferentiated (marked anaplasia) (Gleason 7–10)
Stage Grouping
Stage I T1, T2a N0 M0
Stage II T2b, T2c N0 M0
Stage III T3, T4 N0 M0
Stage IV Any T N1 M0
Any T Any N M1
URINARY BLADDER
TNM Classification – 8th Edition 2017
T - Primary tumour
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
Ta Non-invasive papillary carcinoma
Tis Carcinoma in situ: ‘flat tumour’
T1 Tumour invades subepithelial connective tissue
T2 Tumour invades muscularis propria
T2a Tumour invades superficial muscularis propria (inner half)
T2b Tumour invades deep muscularis propria (outer half)
T3 Tumour invades perivesical tissue
T3a Microscopically
T3b Macroscopically (extravesical mass)
T4 Tumour invades any of the following: prostate stroma, seminal vesicles, uterus, vagina, pelvic
wall, abdominal wall
T4a Tumour invades prostate stroma, seminal vesicles, uterus or vagina
T4b Tumour invades pelvic wall or abdominal wall
N – Regional lymph nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single lymph node in the true pelvis (hypogastric, obturator, external iliac, or
presacral)
N2 Metastasis in multiple regional lymph nodes in the true pelvis (hypogastric, obturator, external
iliac, or presacral)
N3 Metastasis in common iliac lymph node(s)
M - Distant metastasis
M0 No distant metastasis
M1a Non-regional lymph nodes
M1b Other distant metastases
G Histopathological Grading (WHO 1973) 2004 WHO grading system (papillary lesions)
GX Grade of differentiation cannot be assessed Papillary urothelial neoplasm of low malignant
G1 Well differentiated potential (PUNLMP)
G2 Moderately differentiated
Low-grade (LG) papillary urothelial carcinoma
G3–4 Poorly differentiated/undifferentiated
High-grade (HG) papillary urothelial carcinoma
Stage Grouping
Stage 0a Ta N0 M0
Stage 0is Tis N0 M0
Stage I T1 N0 M0
Stage II T2a, b N0 M0
Stage III T3a, b N0 M0
T4a, b N0 M0
Stage IVA Any T Any N M1a
Stage IVB Any T Any N M1b
PENIS
TNM Classification – 8th Edition 2017
Clinical classification
T - Primary Tumour
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
Tis Carcinoma in situ
Ta Non-invasive localized squamous cell carcinoma (including verrucous carcinoma)
T1 Tumour invades subepithelial connective tissue*
T1a Tumour invades subepithelial connective tissue without lymphovascular invasion and is not
poorly differentiated (T1G1-2)
T1b Tumour invades subepithelial connective tissue with lymphovascular invasion or is poorly
differentiated (T1G3-4)
T2 Tumour invades corpus spongiosum with or without invasion of the urethra
T3 Tumour invades corpus cavernosum with or without invasion of the urethra
T4 Tumour invades other adjacent structures
N - Regional Lymph Nodes
NX Regional lymph nodes cannot be assessed
N0 No palpable or visibly enlarged inguinal lymph nodes
N1 Palpable mobile unilateral inguinal lymph node
N2 Palpable mobile multiple or bilateral inguinal lymph nodes
N3 Fixed inguinal nodal mass or pelvic lymphadenopathy, unilateral or bilateral
M - Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis
* Glans: Tumor invades lamina propria; Foreskin: Tumor invades dermis, lamina propria or dartos fascia;
Shaft: Tumor invades connective tissue between epidermis and corpora and regardless of location
Pathological classification
pN - Regional Lymph Nodes
pNX Regional lymph nodes cannot be assessed
pN0 No regional lymph node metastasis
pN1 Metastasis in one or two inguinal lymph nodes
pN2 Metastasis in more than two unilateral inguinal nodes or bilateral inguinal lymph nodes
pN3 Metastasis in pelvic lymph node(s), unilateral or bilateral extranodal extension of regional lymph
node metastasis
pM - Distant Metastasis
pM0 No distant metastasis
pM1 Distant metastasis
G - Histopathological Grading
GX Grade of differentiation cannot be assessed
G1 Well differentiated
G2 Moderately differentiated
G3-4 Poorly differentiated/undifferentiated
Stage Grouping
Stage 0 Tis, Ta N0 M0
Stage I T1a N0 M0
Stage II T1b, T2, T3 N0 M0
Stage IIIA T1, T2, T3 N1 M0
Stage IIIB T1, T2, T3 N2 M0
Stage IV T4 Any N M0
Any T N3 M0
Any T Any N M1
TESTIS
TNM Classification – 8th Edition 2017
pT - Primary Tumour
pTX Primary tumour cannot be assessed
pT0 No evidence of primary tumour (e.g. histological scar in testis)
pTis Intratubular germ cell neoplasia (carcinoma in situ)
pT1 Tumour limited to testis and epididymis without vascular/lymphatic invasion; tumour may
invade tunica albuginea but not tunica vaginalis
pT2 Tumour limited to testis and epididymis with vascular/lymphatic invasion, or tumour
extending through tunica albuginea with involvement of tunica vaginalis
pT3 Tumour invades spermatic cord with or without vascular/lymphatic invasion
pT4 Tumour invades scrotum with or without vascular/lymphatic invasion
N - Regional Lymph Nodes - Clinical
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis with a lymph node mass 2 cm or less in greatest dimension or multiple lymph
nodes, none more than 2 cm in greatest dimension
N2 Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest
dimension, or multiple lymph nodes, any one mass more than 2 cm but not more than 5 cm
in greatest dimension.
N3 Metastasis with a lymph node mass more than 5 cm in greatest dimension
Pn - Regional Lymph Nodes - Pathological
pNX Regional lymph nodes cannot be assessed
pN0 No regional lymph node metastasis
pN1 Metastasis with a lymph node mass 2 cm or less in greatest dimension and 5 or fewer
positive nodes, none more than 2 cm in greatest dimension
pN2 Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest
dimension; or more than 5 nodes positive, none more than 5 cm; or evidence or extranodal
extension of tumour
pN3 Metastasis with a lymph node mass more than 5 cm in greatest dimension
M - Distant Metastasis
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
M1a Non-regional lymph node(s) or lung metastasis
M1b Distant metastasis other than non-regional lymph nodes and lung
S - Serum Tumour Markers
SX Serum marker studies not available or not performed
S0 Serum marker study levels within normal limits
LDH (U/L) hCG (mIU/mL) AFP (ng/mL)
S1 < 1.5 x N and < 5,000 and < 1,000
S2 1.5-10 x N or 5,000-50,000 or 1,000-10,000
S3 > 10 x N or > 50,000 or > 10,000
Stage grouping
Stage 0 pTis N0 M0 S0, SX
Stage I pT1 – T4 N0 M0 SX
Stage IA pT1 N0 M0 S0
Stage IB pT2 – T4 N0 M0 S0
Stage IS Any pT/TX N0 M0 S1 – S3
Stage II Any pT/TX N1 – N3 M0 SX
Stage IIA Any pT/TX N1 M0 S0, S1
Stage IIB Any pT/TX N2 M0 S0, S1
Stage IIC Any pT/TX N3 M0 S0, S1
Stage III Any pT/TX Any N M1a SX
Stage IIIA Any pT/TX Any N M1a S0, S1
Stage IIIB Any pT/TX Any N M0, M1a S2
Stage IIIC Any pT/TX Any N M0, M1a S3
Any pT/TX Any N M1b Any S
URETHRA
TNM Classification – 8th Edition 2017
T - Primary Tumour
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
Urethra (male and female)
Ta Non-invasive papillary, polypoid, or verrucous carcinoma
Tis Carcinoma in situ
T1 Tumour invades subepithelial connective tissue
T2 Tumour invades any of the following structures: corpus spongiosum, prostate, periurethral muscle
T3 Tumour invades any of the following structures: corpus cavernosum, beyond prostatic capsule,
anterior vagina, bladder neck (extraprostatic extension)
T4 Tumour invades other adjacent organs (invasion of the bladder)
Urothelial (transitional cell) carcinoma of the prostate
Tis pu Carcinoma in situ, involvement of prostatic urethra, periuretheral and prostatic ducts without
stromal invasion
T1 Tumour invades subepithelial connective tissue (for tumours involving prostatic urethra only)
T2 Tumour invades any of the following: prostatic stroma, corpus spongiosum, periurethral muscle
T3 Tumour invades any of the following: corpus cavernosum, beyond prostatic capsule, bladder neck
(extraprostatic extension)
T4 Tumour invades other adjacent organs (invasion of the bladder or rectum)
N - Regional Lymph Nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single lymph node
N2 Metastasis in multiple lymph nodes
M - Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis
Histopathological Grading
PUNLMP Papillary urothelial neoplasm of low malignant potential
Low grade Well differentiated
High grade Poorly differentiated
Non-urothelial urethral carcinoma
Gx Tumour grade not assessable
G1 Well differentiated
G2 Moderately differentiated
G3 Poorly differentiated
Stage Grouping
Stage 0a Ta N0 M0
Stage 0is Tis N0 M0
Tis pu N0 M0
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T1, T2 N1 M0
T3 N0, N1 M0
Stage IV T4 N0, N1 M0
Any T N2 M0
Any T Any N M1
RENAL PELVIS & URETER
TNM Classification – 8th Edition 2017
T– Primary Tumour
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
Ta Non-invasive papillary carcinoma
Tis Carcinoma in situ
T1 Tumour invades subepithelial connective tissue
T2 Tumour invades muscularis
T3 (Renal pelvis) Tumour invades beyond muscularis into peripelvic fat or renal parenchyma
(Ureter) Tumour invades beyond muscularis into periureteric fat
T4 Tumour invades adjacent organs or through the kidney into perinephric fat
N – Regional Lymph Nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single lymph node 2 cm or less in greatest dimension
N2 Metastasis in a single lymph node more than 2 cm or multiple lymph nodes
M – Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis
G Histopathological Grading (WHO 1973) 2004 WHO grading system (papillary lesions)
GX Grade of differentiation cannot be assessed Papillary urothelial neoplasm of low malignant
G1 Well differentiated potential (PUNLMP)
G2 Moderately differentiated Low-grade (LG) papillary urothelial carcinoma
G3–4 Poorly differentiated/undifferentiated High-grade (HG) papillary urothelial carcinoma
Stage Grouping
Stage 0a Ta N0 M0
Stage 0is Tis N0 M0
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
Stage IV T4 N0 M0
Any T Any N M0
Any T Any N M1
ADRENAL
TNM Classification – 8th Edition 2017
T – Primary Tumour
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
T1 Tumour 5 cm or less in greatest dimension, no extra-adrenal invasion
T2 Tumour greater than 5 cm, no extra-adrenal invasion
T3 Tumour of any size with local invasion, but not invading adjacent organs*
T4 Tumour of any size with invasion of adjacent organs*
*Adjacent organs include kidney, diaphragm, great vessels, pancreas, and liver.
N – Regional lymph nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in regional lymph node(s)
M – Distant Metastasis
M0 No distance metastasis
M1 Distance metastasis
Stage Grouping
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T1, T2 N1 M0
T3, T4 N0, N1 M0
Stage IV Any T Any N M1
