T Union for International Cancer Control Union for International Cancer Control N M TNM Atlas TNM sixth edition A TNM Atlas The complete, authoritative TNM cancer classification and staging system—now t illustrated with new, full-colour figures for fast, effective, anatomical referencing l Referring to “Tumour,” “Node,” and “Metastasis,” the TNM system is the most widely used a means for classifying and staging the extent of cancer spread. Published in affiliation with the Union for International Cancer Control (UICC), TNM Atlas, Sixth Edition presents s the illustrated version of the TNM Classification of Malignant Tumours, Seventh Edition, promoting the uniform application of the TNM classification in cancer practice. Utilizing beautiful, full-colour medical artwork—illustrating the T and N categories in s clear, easily understood graphics—this book aides in the practical application of the TNM i classification system. It enables all disciplines involved in cancer classification, staging, x and treatment to reach a more standardized understanding and documentation of the t sixth edition h anatomical spread of tumours, and further enhances the dissemination and use of the TNM classification. e d The TNM Atlas, Sixth Edition: i edited by • Is based upon the very latest TNM Classification data available in TNM Classification of t Malignant Tumours, Seventh Edition i ch. wittekind | h. asamura | l. h. sobin o • Features over 500 full-colour figures that clearly illustrate and highlight anatomical sites n of cancer involvement • Makes TNM classification even more clinically applicable in the day-to-day environment • Is an extremely useful tool for clinical reference, teaching, discussion, and patient education w Based in Geneva, the UICC is one of the most widely affiliated cancer organisations in the i t world, with its core mission being cancer classification and control. Its TNM Atlas, Sixth t Edition is a valuable reference for all medical, surgical, and radiation oncologists, anatomical e k and surgical pathologists, cancer registrars, oncology nurses and physician extenders, i n international cancer care centres, and governmental and NGOs dedicated to cancer control. d | Companion website a mpa n ion we www.wileyanduicc.com sa b Visit the companion website to find out more about: m co site • TNM Online u r • TNM on your mobile a • Latest UICC books and journals | s o b i n ISBN 978-1-4443-3242-1 9 781444 332421 Wittekind_TNM_9781444332421_pb.indd 1 05/02/2014 11:00 Union for International Cancer Control Tnm atlas illustrated guide to the Tnm classification of malignant Tumours 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 Union for International Cancer Control Tnm atlas illustrated guide to the Tnm classification of malignant Tumours sixTH ediTion EDITED BY Ch. Wittekind h. asamura l. h. sobin This edition first published 2014 © 2014 by UICC. Published 2104 by John Wiley & Sons, Ltd This Work is a co-publication between the UICC and John Wiley & Sons, Ltd. Registered Office John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Offices 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030–5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. 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No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data TNM atlas / edited by Ch. Wittekind, H. Asamura, L. H. Sobin. – Sixth edition. p. ; cm. ISBN 978-1-4443-3242-1 (pbk.) I. Wittekind, Ch. (Christian), editor. II. Asamura, H., editor. III. Sobin, L. H., editor. [DNLM: 1. Neoplasms–classification–Atlases. QZ 17] RC258 616.9940012–dc23 2013049545 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Cover image: Copyright UICC Cover design by Andy Meaden Set in 9/12pt Frutiger Light by SPi Publisher Services, Pondicherry, India. 1 2014 Contents Foreword to the First Edition, vii Preface to the Sixth Edition, viii Acknowledgements, ix Contributors to the Sixth Edition, x Contributors to the Fifth Edition, xi Contributors to the Fourth Edition, xii Contributors to the Third Edition, xiii Contributors to the Second Edition, xiv Preliminary Note, xv Residual Tumour (R) Classification, xvi Head and neck Tumours, 1 Lip and Oral Cavity, 8 Pharynx, 18 Larynx, 35 Nasal Cavity and Paranasal Sinuses, 46 Malignant Melanoma of Upper Aerodigestive Tract, 56 Major Salivary Glands, 59 Thyroid Gland, 64 digesTive sysTem Tumours, 72 Oesophagus including Oesophagogastric Junction, 73 Stomach, 81 Gastrointestinal Stromal Tumour (GIST), 88 Small Intestine, 91 Appendix – Carcinoma, 96 Appendix – Carcinoid, 101 Gastric, Small and Large Intestinal Carcinoid Tumours, 107 Colon and Rectum, 115 Anal Canal, 127 Liver – Hepatocellular Carcinoma, 135 Liver – Intrahepatic Bile Ducts, 141 Gallbladder, 145 Extrahepatic Bile Ducts – Perihilar, 151 Extrahepatic Bile Ducts – Distal, 155 Ampulla of Vater, 160 Pancreas, 167 v vi Contents Lung and PLeuraL Tumours, 173 Lung, 174 Pleural Mesothelioma, 185 Bone and sofT Tissue Tumours, 193 Bone, 194 Soft Tissues, 197 skin Tumours, 201 Carcinoma of the Skin, 207 Carcinoma of the Skin of the Eyelid, 211 Malignant Melanoma of Skin, 216 Merkel Cell Carcinoma of Skin, 225 BreasT Tumours, 229 gynaecoLogicaL Tumours, 248 Vulva, 249 Vagina, 254 Cervix Uteri, 261 Uterus Endometrium, 271 Uterus – Uterine Sarcomas, 276 Ovary, 284 Fallopian Tube, 292 Gestational Trophoblastic Tumours, 298 uroLogicaL Tumours, 301 Penis, 302 Prostate, 311 Testis, 319 Kidney, 337 Renal Pelvis and Ureter, 346 Urinary Bladder, 354 Urethra, 361 Adrenal Cortex Tumours, 372 Hodgkin LymPHoma, 376 non-Hodgkin LymPHomas, 390 FoReWoRD to the FIRst eDItIon Confronted with a myriad of T’s, N’s and M’s in the UICC TNM booklet, classifying a malignancy may seem to many cancer clinicians a tedious, dull and pedantic task. But with a look at the TNM Atlas all of a sudden lifeless categories become vivid images, challenging the clinician’s know-how and investigational skills. B. van der Werf-Messing, M.D. Professor of Radiology Chairman of the International tnM Committee of the UICC Rotterdam, July 1982 vii PReFaCe to the sIxth eDItIon This new sixth edition of the TNM Atlas incorporates the changes in the TNM System that are in the seventh edition of the TNM Classification of Malignant Tumours.1 The most important additions and modifications concern carcinomas of the oesophagus and the oesophagogastric junction, stomach, lung, appendix, biliary tract, skin, and prostate. There are several new classifications: upper aerodigestive mucosal melanoma, gastrointestinal stromal tumour, gastrointestinal carcinoids (neuroendocrine tumours), intrahepatic cholangiocarcinoma, Merkel cell carcinoma, uterine sarcomas, and adrenal cortical carcinoma. The rules of classification and staging correspond with those appearing in the seventh edition of the AJCC Cancer Staging Manual (2009).2 Although the Atlas’s content follows the time-honoured approach of depicting the Ts, Ns, and Ms in graphic terms, the all-new design, layout, and full-colour artwork provide a refreshing approach to cancer staging. As Professor van der Werf-Messing stated in her Foreword to the First Edition over forty years ago, “all of a sudden lifeless categories become vivid images”. 1 Sobin LH, Gospodarowicz MK, Wittekind C (eds.) TNM Classification of Malignant Tumours, Seventh Edition. Oxford: Blackwell Publishing Ltd; 2010 2 American Joint Committee on Cancer (AJCC) Cancer Staging Manual 7th ed. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. Eds. New York: Springer; 2009 viii