Salivary gland malignancy TNM

Scottish Cancer Network: Clinical Management Pathways
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TNM Classification of Malignant Tumours (8th Edition, UICC, 2017)

Primary Tumour (T)

TX        Primary tumour cannot be assessed

T0        No evidence of primary tumour

Tis        Carcinoma in situ

T1        Tumour 2 cm or less in greatest dimension without extraparenchymal extension*

T2        Tumour more than 2 cm but not more than 4 cm in greatest dimension without
extraparenchymal extension*

T3        Tumour more than 4 cm and/or tumour with extraparenchymal extension*

T4a       Tumour invades skin, mandible, ear canal, and/or facial nerve

T4b       Tumour invades base of skull, and/or pterygoid plates, and/or encases carotid artery

Note: *Extraparenchymal extension is clinical or macroscopic evidence of invasion of soft tissues or
nerve, except those listed under T4a and T4b. Microscopic evidence alone does not constitute
extraparenchymal extension for classification purposes.

 

Regional Lymph Nodes (N)

NX        Regional lymph nodes cannot be assessed

N0        No regional lymph node metastasis

N1        Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension without
extranodal extension

N2        Metastasis described as:

N2a      Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm
in greatest dimension without extranodal extension

N2b      Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest
dimension, without extranodal extension

N2c      Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest
dimension, without extranodal extension

N3a      Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal
extension

N3b      Metastasis in a single or multiple lymph nodes with clinical extranodal extension*

Notes: *The presence of skin involvement or soft tissue invasion with deep fixation/tethering to
underlying muscle or adjacent structures or clinical signs of nerve involvement is classified as
clinical extra nodal extension.


Midline nodes are considered ipsilateral nodes.

 

Distant Metastasis (M)


M0       No distant metastasis

M1       Distant metastasis

The pT categories correspond to the clinical T categories

 

Pathological classification of Regional Lymph Nodes (pN)

Histological examination of a selective neck dissection specimen will ordinarily include 10 or
more lymph nodes. Histological examination of a radical or modified radical neck dissection
specimen will ordinarily include 15 or more lymph nodes.

pNX       Regional lymph nodes cannot be assessed

pN0       No regional lymph node metastasis

pN1       Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension without
extranodal extension

pN2       Metastasis described as:

pN2a     Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
with extranodal extension or, more than 3 cm but not more than 6 cm in greatest
dimension without extranodal extension

pN2b     Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest
dimension, without extranodal extension

pN2c     Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in
greatest dimension, without extranodal extension

pN3a     Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal
extension

pN3b     Metastasis in a lymph node more than 3 cm in greatest dimension with extranodal
extension or multiple ipsilateral, or any contralateral, or bilateral node(s) with extranodal
extension