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 Union for International Cancer Control

TNM
Atlas
Illustrated Guide to the TNM Classification
of Malignant Tumours

ffirs.indd 1 2/24/2021 10:28:44 AM

 Companion website

www.wileyanduicc.com

Visit the companion website to find out more about:

TNM Online
TNM on your mobile
Latest UICC books and journals

ffirs.indd 2 2/24/2021 10:28:44 AM

 Union for International Cancer Control

TNM
Atlas
Illustrated Guide to the TNM Classification
of Malignant Tumours

SEVENTH EDITION

EDITED BY

James D. Brierley
University of Toronto, Canada

Hisao Asamura
Tokyo, Japan

Elisabeth Van Eycken

Brussels, Belgium

Brian Rous
Cambridge, United Kingdom

ffirs.indd 3 2/24/2021 10:28:45 AM

 This edition first published 2021
© 2021 UICC. Published 2021 by John Wiley & Sons, Ltd This Work is a co‐publication between the UICC and
John Wiley & Sons, Ltd.
Edition History
UICC (6e, 2014). Published 2014 by John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in
any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by
law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/
go/permissions.
The right of James D. Brierley, Hisao Asamura, Elisabeth Van Eycken, Brian Rous to be identified as the authors
of the editorial material in this work has been asserted in accordance with law.
Registered Offices
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
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Library of Congress Cataloging‐in‐Publication Data
Names: Brierley, James, editor. | Asamura, H., editor. | Eycken, E. Van,
editor. | Rous, Brian Arthur, 1967– editor. | Union for International
Cancer Control.
Title: TNM atlas : illustrated guide to the TNM classification of malignant
tumours / edited by James D. Brierley, Hisao Asamura, Elisabeth
Jozefa Van Eycken, Brian Arthur Rous.
Description: Seventh edition. | Hoboken, NJ : Wiley-Blackwell, 2020.
Identifiers: LCCN 2020025431 (print) | LCCN 2020025432 (ebook) | ISBN
9781119263845 (paperback) | ISBN 9781119263913 (adobe pdf) | ISBN
9781119263838 (epub)
Subjects: MESH: Neoplasms–classification | Atlas
Classification: LCC RC258 (print) | LCC RC258 (ebook) | NLM QZ 17 | DDC
616.99/40012–dc23
LC record available at https://lccn.loc.gov/2020025431
LC ebook record available at https://lccn.loc.gov/2020025432
Cover Design: Wiley
Cover Images: (figures) Wiley, (flag) © UICC
Set in 9/12pt and Frutiger LT Std by SPi Global, Pondy, India

10 9 8 7 6 5 4 3 2 1

ffirs.indd 4 2/24/2021 10:28:45 AM

 CONTENTS

Preface to the Seventh Edition, vii

Acknowledgements, ix
Contributors to the Seventh Edition, xi
Preliminary Note, xiii

HEAD AND NECK TUMOURS, 1

Section Editors Brian O’Sullivan and Shao Hui Huang
Regional Lymph Nodes, 1
Lip and Oral Cavity, 15
Pharynx, 26
Larynx, 47
Nasal Cavity and Paranasal Sinuses, 57
Unknown Primary – Cervical Nodes, 66
Malignant Melanoma of Upper Aerodigestive Tract, 70
Major Salivary Glands, 73
Thyroid Gland, 77

DIGESTIVE SYSTEM TUMOURS, 85

Section Editor James D. Brierley
Oesophagus Including Oesophagogastric Junction, 86
Stomach, 94
Small Intestine, 101
Appendix, 106
Colon and Rectum, 112
Anal Canal, 122
Liver – Hepatocellular Carcinoma, 129
Liver – Intrahepatic Bile Ducts, 135
Gallbladder, 139
Extrahepatic Bile Ducts – Perihilar, 145
Extrahepatic Bile Ducts – Distal, 149
Ampulla of Vater, 152
Pancreas, 159
Well-Differentiated Neuroendocrine Tumours of the Gastrointestinal Tract, 165
Well-Differentiated Neuroendocrine Tumours of the Pancreas, 177

LUNG, PLEURAL AND THYMIC TUMOURS, 181

Section Editor Hisao Asamura
Lung, 182
Pleural Mesothelioma, 193
Thymic Tumours, 200

ftoc.indd 5 2/26/2021 6:47:37 AM

 vi   Contents

BONE AND SOFT TISSUE TUMOURS, 209

Section Editor Brian O’Sullivan
Bone, 210
Soft Tissues, 217
Gastrointestinal Stromal Tumours (GIST), 223

SKIN TUMOURS, 227

Section Editor Brian Rous
Carcinoma of the Skin, 233
Carcinoma of Skin of the Head and Neck, 237
Carcinoma of the Skin of the Eyelid, 248
Malignant Melanoma of Skin, 255
Merkel Cell Carcinoma of Skin, 263

BREAST TUMOURS, 267

Section Editor Elisabeth Van Eycken

GYNAECOLOGICAL TUMOURS, 287

Section Editor Brian Rous
Vulva, 288
Vagina, 293
Cervix Uteri, 300
Uterus Endometrium, 310
Uterus – Uterine Sarcomas, 315
Ovarian, Fallopian Tube and Primary Peritoneal Carcinoma, 323
Gestational Trophoblastic Tumours, 331

UROLOGICAL TUMOURS, 335

Section Editor Elisabeth Van Eycken
Penis, 336
Prostate, 345
Testis, 353
Kidney, 371
Renal Pelvis and Ureter, 380
Urinary Bladder, 387
Urethra, 394
Adrenal Cortex Tumours, 404

HODGKIN LYMPHOMA, 409

Section Editor James D. Brierley

NON‐HODGKIN LYMPHOMAS, 424

Section Editor James D. Brierley

Index, 425

ftoc.indd 6 2/26/2021 6:47:38 AM

 PREFACE TO THE SEVENTH EDITION

This new seventh edition of the TNM Atlas incorporates the changes in the TNM System
that are in the eighth edition of the TNM Classification of Malignant Tumours.1 In the
eighth edition of the TNM Classification staging at many of the tumour sites is unchanged
from the seventh edition. However, some tumour entities and anatomical sites have been
newly introduced and some tumours contain modifications; this follows the basic phi-
losophy of maintaining stability of the classification over time. The new additions are:
p16 oropharyngeal carcinomas, carcinomas of the thymus, neuroendocrine carcinomas
of the pancreas and sarcomas of the spine, pelvis, head and neck, retroperitoneum and
thoracic and abdominal viscera. In addition, many tumour sites have important updates.
The Atlas’s content follows the approach of depicting the Ts, Ns and Ms in graphic
terms. The full‐colour artwork is augmented with an increased number of clinical imag-
ing studies illustrating many of the changes between the seventh and eighth editions of
the TNM Classification of Malignant Tumours.

1
Brierley, J.D., Gospodarowicz, M.K., Wittekind, C. (eds.) (2017) TNM Classification of Malignant
Tumours, 8th edn. Chichester: Wiley-Blackwell.

vii

fpref.indd 7 01/27/2021 8.48.50 PM

fpref.indd 8 01/27/2021 8.48.50 PM
 ACKNOWLEDGEMENTS

The editors wish to express their thanks to all who contributed to this seventh edition by
comments, questions and their critical interest. In particular we would like to thank Professor
Ch. Wittekind, Leipzig, Germany for his enormous contributions as co‐editor of the 4th, 5th
and 6th editions of the TNM Atlas, the 5th, 6th, 7th and 8th editions of the TNM Classification
of Malignant Tumours and the 2nd, 3rd, 4th and 5th editions of the TNM Supplement.
He was the driving force behind many of these editions.
The Editors have much pleasure in acknowledging the great help received from the
members of the TNM Prognostic Factors Project Committee and the National Staging
Committees Global Representatives and International Organizations listed on pages xv–
xvi of the TNM Classification of Malignant Tumours, 8th edition. In addition, we would
like to thank, Dr Brian O’Sullivan and Dr Shao Hui Huang for providing clinical images
for the Head and Neck Tumours chapter, Mr Anthony Griffin, Dr Peter Chung and Dr
Ali Hosni for providing clinical images for the Tumours of the Bone and Soft tissues chap-
ter and Dr Richard Tsang for clinical Images in the Lymphoma chapter.
This edition builds on the work by contributors to all previous editions. In particular we
would like to thank Dr Leslie Sobin and Dr Christian Wittekind, who along with Dr Hisao
Asamura edited the 6th edition. Contributors to all previous editions are listed in the 6th
edition pp. x–xiv.

ix

flast.indd 9 02-15-2021 19:22:13

flast.indd 10 02-15-2021 19:22:13
 CONTRIBUTORS TO THE SEVENTH
EDITION

Asamura, H. Tokyo, Japan Lung

Brierley, J. Toronto, Canada Digestive System, Thyroid, Lymphoma
Huang, Shao Hui. Toronto, Canada Head and Neck Tumours
O‘Sullivan, B. Toronto, Canada Head and Neck Tumours
Tumours of the Bone and Soft Tissue
Rous, B. Cambridge, UK Gynaecological Tumours, Skin Tumours
Ruffino, E. Torino. Italy Thymic Tumours
Van Eycken, E, Brussels, Belgium Breast, Urological, Adrenal Cortex Tumours

xi

flast.indd 11 02-15-2021 19:22:13

flast.indd 12 02-15-2021 19:22:13
 PRELIMINARY NOTE

Digestive
The TNM System for describing the anatomical extent of disease is based on assessment
of three components:

T – The extent of the primary tumour

N – The absence or presence and extent of regional lymph node metastasis
M – The absence or presence of distant metastasis

The addition of numbers to these three components indicates the extent of the malig-
nant disease, thus:

T0, T1, T2, T3, T4 N0, N1, N2, N3 M0, M1

In effect, the system is a “short‐hand notation“ for describing the extent of a particular
malignant tumour.

Each site is described under the following headings:

1)  Anatomy
Drawings of the anatomical sites and subsites are presented with the appropriate
ICD‐O‐3 topography numbers.1
2) Regional Lymph Nodes
The regional lymph nodes are listed and shown in drawings.
3) T/pT Clinical and Pathological Classification of the Primary Tumour
The definitions for T and pT categories are presented. In the eighth edition (2017) of
the TNM Classification the clinical and pathological classifications (T and pT) generally
coincide, therefore the same illustrations are valid for the T and pT classifications for
most sites.
4) N/pN Clinical and Pathological Classification of Regional Lymph Nodes
The N and pN categories are presented in a fashion similar to the T and pT categories.
Differences between N and pN definitions in the seventh edition arise in the case of
carcinomas of the breast and penis and germ cell tumours of the testis.
5) M/pM Clinical and Pathological Classification of Distant Metastasis
M localization is given only in selected cases because of its many possible variables.

Please visit the UICC https://www.uicc.org/resources/tnm/publications-resources or Wiley websites

for any errata or updates.
1
ICD-O International Classification of Diseases for Oncology, 3rd edn (2000), WHO, Geneva.

xiii

flast.indd 13 02-15-2021 19:22:13

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