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Stage Information for Anal Cancer

    The anal canal extends from the rectum to the perianal skin and is lined by a mucous membrane that covers the internal sphincter. The following is a staging system for anal canal cancer that has been described by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer.[1] Tumors of the anal margin (below the anal verge and involving the perianal hair-bearing skin) are classified with skin tumors.

    Definitions of TNM

    The following is a staging system for anal canal cancer that has been described by the AJCC and the International Union Against Cancer.[1]

    Table 1. Primary Tumor (T)a

    a Reprinted with permission from AJCC: Anus. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 165-73.
    b Direct invasion of the rectal wall, perirectal skin, subcutaneous tissue, or the sphincter muscle(s) is not classified as T4.
    TXPrimary tumor cannot be assessed.
    T0No evidence of primary tumor.
    TisCarcinomain situ(i.e., Bowen disease, high-grade squamous intraepithelial lesion, and anal intraepithelial neoplasia II–III.)
    T1Tumor ≤2 cm in greatest dimension.
    T2Tumor >2 cm but ≤5 cm in greatest dimension.
    T3Tumor >5 cm in greatest dimension.
    T4Tumor of any size invades adjacent organ(s), e.g., vagina, urethra, and bladder.b

    Table 2. Regional Lymph Nodes (N)a

    a Reprinted with permission from AJCC: Anus. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 165-73.
    NXRegional lymph nodes cannot be assessed.
    N0No regional lymph node metastasis.
    N1Metastases in perirectal lymph node(s).
    N2Metastases in unilateral internal iliac and/or inguinal lymph node(s).
    N3Metastases in perirectal and inguinal lymph nodes and/or bilateral internal iliac and/or inguinal lymph nodes.

    Table 3. Distant Metastasis (M)a

    a Reprinted with permission from AJCC: Anus. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 165-73.
    M0No distant metastasis.
    M1Distant metastasis.
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