Liver and Intrahepatic Bile Ducts

TNM 7 classification

TNM 6 classification

1. Rules for Classification

The classification is intended primarily for hepatocellular carcinoma. It may also be used for cholangio- (intrahepatic bile duct) carcinoma of the liver. There should be histological confirmation of the disease and division of cases by histological type.

The following are the procedures for assessing T, N, and M categories.

T categories. Physical examination, imaging, and/or surgical exploration
N categories. Physical examination, imaging, and/or surgical exploration
M categories. Physical examination, imaging, and/or surgical exploration

Note: Although the presence of cirrhosis is an important prognostic factor it does not affect the TNM classification, being an independent prognostic variable.

2. Anatomical Subsites

1. Liver (C22.0)
2. Intrahepatic bile duct (C22.1)

3. Regional Lymph Nodes

The regional lymph nodes are the hilar, hepatic (along the proper hepatic artery), periportal (along the portal vein) and those along the abdominal inferior vena cava above the renal veins (except the inferior phrenic nodes).

4. TNM Clinical Classification

4.1. T - Primary Tumour

TX. Primary tumour cannot be assessed
T0. No evidence of primary tumour
T1. Solitary tumour without vascular invasion
T2. Solitary tumour with vascular invasion or multiple tumours, none more than 5 cm in greatest dimension
T3. Multiple tumours more than 5 cm or tumour involving a major branch of the portal or hepatic vein(s)
T4. Tumour(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum

4.2. N - Regional Lymph Nodes

NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Regional lymph node metastasis

4.3. M - Distant Metastasis

MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis

5. pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M categories.

pN0. Histological examination of a regional lymphadenectomy specimen will ordinarily include 3 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.

6. G Histopathological Grading

For histopathological grading see: Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 1954;7:462-504.

Edmonson/Steiner grades are numbered Grades 1, 2, 3, and 4.

7. Stage Grouping

Stage I T1 N0 M0 Stage II T2 N0 M0 Stage IIIA T3 N0 M0 Stage IIIB T4 N0 M0 Stage IIIC Any T N1 M0 Stage IV Any T Any N M1

8. Summary

Liver T1 Solitary without vascular invasion T2 Solitary with vascular invasion Multiple ≤5 cm T3 Multiple >5 cm Invades major branch of portal or hepatic vein(s) T4 Invades adjacent organs other than gallbladder Perforates visceral peritoneum N1 Regional

TNM 7 classification

TNM 6 classification