Liver and Intrahepatic Bile Ducts
TNM 7 classification
TNM 6 classification
1. Rules for ClassificationThe 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 Subsites1. Liver (C22.0)
2. Intrahepatic bile duct (C22.1)
3. Regional Lymph NodesThe 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 Classification4.1. 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 ClassificationThe 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