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Anal Cancer Treatment (PDQ®)

  • Last Modified: 07/31/2014

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Stage Information for Anal Cancer

Definitions of TNM

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
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisCarcinoma in 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

aReprinted 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.
bDirect invasion of the rectal wall, perirectal skin, subcutaneous tissue, or the sphincter muscle(s) is not classified as T4.

Table 2. Regional Lymph Nodes (N)a
aReprinted 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
aReprinted 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.

Table 4. Anatomic Stage/Prognostic Groupsa
Stage T N M 
aReprinted 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.
0TisN0M0
IT1N0M0
IIT2N0M0
T3N0M0
IIIAT1N1M0
T2N1M0
T3N1M0
T4N0M0
IIIBT4N1M0
Any TN2M0
Any TN3M0
IVAny TAny NM1

References
  1. Anus. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 167-169.