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Stage Information for Thyroid Cancer

Definitions of TNM

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define thyroid cancer.[1]

Table 1. Primary Tumor (T)a,b

a Reprinted with permission from AJCC: Thyroid. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 87-96.
b All categories may be subdivided: (s) solitary tumor and (m) multifocal tumor (the largest determines the classification).
c All anaplastic carcinomas are considered T4 tumors.
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
T1Tumor ≤2 cm in greatest dimension limited to the thyroid.
T1aTumor ≤1 cm, limited to the thyroid.
T1bTumor >1 cm but ≤2 cm in greatest dimension, limited to the thyroid.
T2Tumor >2 cm but ≤4 cm in greatest dimension, limited to the thyroid.
T3Tumor >4 cm in greatest dimension limited to the thyroid or any tumor with minimal extrathyroid extension (e.g., extension to sternothyroid muscle or perithyroid soft tissues).
T4aModerately advanced disease.
Tumor of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve.
T4bVery advanced disease.
Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels.
c T4aIntrathyroidal anaplastic carcinoma.
c T4bAnaplastic carcinoma with gross extrathyroid extension.

Table 2. Regional Lymph Nodes (N)a,b

a Reprinted with permission from AJCC: Thyroid. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 87-96.
b Regional lymph nodes are the central compartment, lateral cervical, and upper mediastinal lymph nodes.
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Regional lymph node metastasis.
N1aMetastases to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes).
N1bMetastases to unilateral, bilateral, or contralateral cervical (Levels I, II, III, IV, or V) or retropharyngeal or superior mediastinal lymph nodes (Level VII).

Table 3. Distant Metastasis (M)a

a Reprinted with permission from AJCC: Thyroid. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 87-96.
M0No distant metastasis.
M1Distant metastasis.

Table 4. Anatomic Stage/Prognostic Groupsa,b

StageTNM
a Reprinted with permission from AJCC: Thyroid. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 87-96.
b Separate stage groupings are recommended for papillary or follicular (differentiated), medullary, and anaplastic (undifferentiated) carcinoma.
c All anaplastic carcinomas are considered Stage IV.
Papillary or follicular (differentiated)
YOUNGER THAN 45 YEARS
IAny TAny NM0
IIAny TAny NM1
45 YEARS AND OLDER
IT1N0M0
IIT2N0M0
IIIT3N0M0
 T1N1aM0
 T2N1aM0
 T3N1aM0
IVAT4aN0M0
 T4aN1aM0
 T1N1bM0
 T2N1bM0
 T3N1bM0
 T4aN1bM0
IVBT4bAny NM0
Stage IVCAny TAny NM1
Medullary carcinoma (all age groups)
IT1N0M0
IIT2N0M0
 T3N0M0
IIIT1N1aM0
 T1N1aM0
 T2N1aM0
 T3N1aM0
IVAT4aN0M0
 T4aN1aM0
 T1N1bM0
 T2N1bM0
 T3N1bM0
 T4aN1bM0
 Stage IVBT4bAny N
IVBT4bAny NM0
IVCAny TAny NM1
Anaplastic carcinomac
IVAT4aAny NM0
IVBT4bAny NM0
IVCAny TAny NM1
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