Assurance de qualité pour le cancer rectal – phase 2 ...

158 PROCARE- Phase 2 KCE Reports 81APPENDIX 6: TNM CLASSIFICATION ADAPTEDFROM UICC AND AJCC [24, 25]T - Primary tumourTx Primary tumour cannot be assessedT0 No evidence of primary tumourTis* Carcinoma in situ: intraepithelial or invasion of lamina propriaT1° Tumour invades submucosaT2 Tumour invades muscularis propriaT3 Tumour invades through muscularis propria into subserosa or into non-peritonealized perirectaltissuesT4 Tumour perforates visceral peritoneum or directly invades other organs or structures* The extent of mucosal cancer can be expressed in depth of invasion relative to the thickness ofthe mucosa: i.e. superficial third m1, middle third m2 and deepest third m3.° The extent of submucosal cancer can be assessed absolutely (sm1 = less than 0.5 mm; sm2 =0.5–1 mm; sm3 = more than 1 mm) or relatively (sm1 = superficial third; sm2 = middle third; sm3= invasion reaching the deepest third) [26].Tis – Primary tumour: invasion of lamina propriam1 Superficial third of the mucosam2 Middle third of the mucosam3 Deepest third of the mucosaT1 – Primary tumour: invasion of submucosasm1 Superficial third of the submucosa or invasion depth of less than 0.5 mmsm2 Middle third of the submucosa or invasion depth of between 0.5 and 1mmsm3 Deepest third of the submucosa or invasion depth of more than 1 mmN – Regional lymph nodesRegional lymph nodes cannot be assessed. It should be mentioned if noNxnodes are found.No regional lymph node metastasis. The number of nodes examined shouldN0be mentionedN1 Metastasis in 1 to 3 regional lymph nodesN2 Metastasis in 4 or more regional lymph nodesFor this project, extramural deposits of tumour that are not obviously within lymph nodes areregarded as discontinuous extensions of the main tumour if they measure 3 mm in diameter [25].M – Distant metastasisMxDistant metastasis cannot be assessedM0No distant metastasisM1Distant metastasisPathological M staging can only be based on distant metastases that are submitted for histology.Pathologists will therefore only be able to use M1 (distant metastasis present) or Mx (distantmetastases unknown).TNM Stage groupingStage 0 Tis N0 M0Stage I T1 or T2 N0 M0Stage II A T3 N0 M0Stage II B T4 N0 M0Stage III AStage III BStage III CT1 or T2T3 or T4Any TN1N1N2M0M0M0Stage IV Any T Any N M1