Guidilene Linfoma PDF

WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA S A N T ~
CL.ASSIFICATION OF TUMOURS
IM
DOMESTIC ANIMALS
ED I TED
BY
L, N , OWEN
First Edition
Geneva - 1980
The issue of this document does not constitute Ce document ne constitue pas irne publication.
formal publication. It shouid not be reviewed, 11 ne doit faire I'objei d'aucun compte rendu ou
abstracted or quoted without the agreement of rCsum6 ni d'aucune citation sans I'autorisaticn de
rhe World Health Organization. Authors alone I'Organisation Mondiale de la Sante. Les opinions
are responsible for views expressed in signed exprirnees dans Ies articles signes n'engagent
articles. que leurs auteurs.
VPH/CMO/~O.
20
page 3
C O N T E N T S
Page
Preface . 4
Participants . 5
Introduction . 6
The T N M system . 6
The anatomical sites . 11
Skin (excluding lymphosarcoma and mastocytoma) 12
Skin - mastocytoma 14
Mammary glands . 16
Head and neck 21
Alimentary system, pancreas, liver . 26
Urological system . 32
Genital system . 35
Bones and joints . 43
Lymphoid and haemopoietic tissues (including lymphosarcoma of skin) . 46
Respiratory system 48
Endocrine glands (thyroid, adrenal) . 51

PREFACE
An International Histological Classification of Tumours of Domestic Animals

complementing the classification of tumours of man was comp eted in 1975 and
published in the Bulletin of the World Health Organization.t Since that time
great advances have been made in other aspects of comparative oncology, notably
in prognosis and therapy.
The TNM Classification of Malignant Tumours in man was first published in

1968 by the International Union against Cancer (UICC). As part of the WHO
Programme on Comparative Oncology this method of classification has now been
adapted as closely as possible for many of the tumours occurring in domestic
animals, allowing for the many anatomical and pathological differences. This
was done at two consultations held in Geneva on 18-20 April 1978 and 13-15 March
1979, and the participants who formulated the TNM Classification of Tumours in
Domestic Animals are listed on page 5.
The TNM system for domestic animal tumours should be of great value in
recording clinical cases and it is proving particularly useful in planning
international clinical trials on comparative oncology, some of which (e.g. canine
mammary carcinoma) are already in progress.
Like the histological classification, the domestic animal TNM system reflects
the present state of knowledge and will require modification in the future but
it should provide some essential groundwork in clinical veterinary oncology.
In ~articular,this classification records the manv malignant tumours in

domestic animals which have already proved to be useful models for cancer research in
man.
'Bull. Wld Hlth Org. 1976, 50, (1-2)

II II II
" 1976, 53, (2-3)
Participants in WHO consultations in 1978 and 1979 who formulated the TNM Classification
of Tumours in Domestic Animals:
Dr R.S. Brodey, University of Pennsylvania School of Veterinary Medicine, Philadelphia,

Pa 19104, United States of America
Dr E.L. Gillette, Colorado State University, Comparative Oncology Unit, Room 100,
Veterinary Science, Fort Collins, Colorado 80523, United States of America
Dr V.N. Milouchine, formerly Veterinary Public Health Unit, WHO, Geneva, Switzerland
Dr W. Misdorp, Nederlands Kanker Instituut, Antoni van Leeuwenhoek Ziekenhuis,
-
Plesmanlaan 121, Amsterdam Slotervaart, The Netherlands
Dr L.N. Owen, WHO Collaborating Centre for Comparative Oncology, Dept of Clinical
Veterinary Medicine, Madingley Road, Cambridge CB3 OES, United Kingdom
Professor A.-L. Parodi, Ecole national vgtgrinaire, 94701 Alfort, France
Dr A.B. Syrkin, Laboratory of Pharmacology, Cancer Research Centre (AMS/USSR),
Kashirskoje SH. 6, Moscow 115478, USSR
Dr G.H. Theilen, University of California School of Veterinary Medicine, Davis 95616,
California, United States of America
The participants are pleased to acknowledge the technical assistance of Miss P.C. Botton,
Veterinary Public Health, WHO, in the preparation and editing of this classification.
l
I
INTRODUCTION
THE PURPOSE OF CLASSIFICATION
The p r a c t i c e of d i v i d i n g c a n c e r cases i n t o groups according t o " s t a g e s " has a l r e a d y been

e s t a b l i s h e d f o r tumours of man.* The system a r o s e from t h e f a c t t h a t s u r v i v a l r a t e s were
h i g h e r f o r cases i n which t h e d i s e a s e was l o c a l i z e d t h a n f o r those i n which t h e d i s e a s e had
extended beyond t h e organ of o r i g i n . These groups were o f t e n r e f e r r e d t o a s " e a r l y cases'' and
" l a t e cases" implying some r e g u l a r p r o g r e s s i o n w i t h time. The s t a g e of d i s e a s e a t t h e time of
d i a g n o s i s may b e a r e f l e c t i o n , n o t only of t h e r a t e of growth and e x t e n s i o n of t h e neoplasm,
b u t a l s o of t h e t y p e of tumour, t h e tumour-host r e l a t i o n s h i p and t h e i n t e r v a l between recogni-
t i o n of t h e f i r s t symptom o r s i g n and t h e d i a g n o s i s o r t r e a t m e n t .
The p r i n c i p a l purpose of i n t e r n a t i o n a l agreement on c l a s s i f i c a t i o n of cancer c a s e s by

e x t e n t of d i s e a s e i s t o provide a method of conveying one p e r s o n ' s c l i n i c a l o b s e r v a t i o n s t o
o t h e r s without ambiguity.
The v e t e r i n a r y c l i n i c i a n ' s t a s k i s t o make a p r o v i s i o n a l prognosis and a d e c i s i o n on t h e

most e f f e c t i v e course of t r e a t m e n t . These r e q u i r e , among o t h e r t h i n g s , an o b j e c t i v e a s s e s s -
ment of t h e anatomical e x t e n t of t h e d i s e a s e .
The o b j e c t i v e s of s t a g i n g animal tumours a r e :
1. to a i d t h e v e t e r i n a r y c l i n i c i a n i n planning t r e a t m e n t
2. to g i v e some i n d i c a t i o n of prognosis
3. to a s s i s t i n e v a l u a t i o n of t r e a t m e n t r e s u l t s
4. to f a c i l i t a t e t h e exchange of information between t r e a t m e n t c e n t r e s
5. to c o n t r i b u t e t o t h e c o n t i n u i n g i n v e s t i g a t i o n of animal cancer
6. to c o n t r i b u t e information t h a t i s of comparative v a l u e between man and animal.
To meet t h e s e o b j e c t i v e s a system of c l a s s i f i c a t i o n i s r e q u i r e d (1) i n which t h e b a s i c

p r i n c i p l e s a r e a p p l i c a b l e t o a l l s i t e s , r e g a r d l e s s of t r e a t m e n t and (2) which may b e supple-
mented l a t e r by informat ion t h a t becomes a v a i l a b l e from h i s t o p a t h o l o g y o r surgery.
The TNM system meets t h e s e requirements. It provides an e s s e n t i a l communication and

information exchange device and a u s e f u l guide f o r prognosis and t h e r a p y .
THE TNM SYSTEM
The TNM system i s based on t h e assessment o f :
- t h e e x t e n t of t h e primary tumour T
- t h e c o n d i t i o n of t h e r e g i o n a l lymph nodes N
- t h e absencelpresence of d i s t a n t m e t a s t a s e s M
The a d d i t i o n of numbers t o t h e s e t h r e e components (e.g. T 1 , T2 ... e t c . , NO, N 1 ... e t c . ,

MO, M 1 ...
e t c . ) i n d i c a t e s t h e e x t e n t of t h e malignant d i s e a s e .
For example, a v e t e r i n a r i a n f a m i l i a r w i t h t h e system might d e s c r i b e a dog w i t h cancer of

t h e mammary gland a s "T3b N2 MO". This would i n d i c a t e t h a t t h e tumour was of a c e r t a i n s i z e
(more t h a n 3 cm i n diameter) w i t h f i x a t i o n t o t h e underlying f a s c i a o r muscle; t h a t e i t h e r t h e
a x i l l a r y o r i n g u i n a l lymph nodes were p a l p a b l e and f i x e d ; and t h a t t h e r e was no c l i n i c a l evi-
dence of d i s t a n t m e t a s t a s e s .
I n o t h e r words it i s a kind of shorthand n o t a t i o n f o r t h e d e s c r i p t i o n of a malignant

, tumour.
*UICC TNM C l a s s i f i c a t i o n of Malignant Tumours, Ed. M. Harmer, 3rd ed., Geneva, 1978.
General r u l e s
The g e n e r a l r u l e s a p p l i c a b l e t o a l l s i t e s a r e a s follows:
1. I n a l l c a s e s confirmation of malignancy by h i s t o l o g i c a l o r c y t o l o g i c a l examination is

obligatory. Any c a s e s n o t s o proved must b e recorded s e p a r a t e l y .
A t many s i t e s s e v e r a l d i s t i n c t types of c a n c e r may occur, d i f f e r i n g n o t only i n t h e i r

h i s t o l o g i c a l p a t t e r n b u t a l s o i n t h e i r c l i n i c a l behaviour. It would c l e a r l y b e wrong t o con-
s i d e r a l l such types t o g e t h e r .
An example i s cancer of t h e mammary gland of t h e dog. W e l l d i f f e r e n t i a t e d t u b u l a r adeno-

carcinomas have a good prognosis following mastectomy b u t a n a p l a s t i c carcinomas have a poor
prognosis.
2. A l l c a s e s a r e i d e n t i f i e d by T , N and M c a t e g o r i e s , which must b e determined and recorded

p r i o r t o d e f i n i t i v e treatment. They remain unchanged although t h e y may b e q u a l i f i e d by addi-
t i o n a l h i s t o p a t h o l o g i c a l o r s u r g i c a l information.
The reason f o r t h i s i s c l e a r . The c o n d i t i o n of many animals w i t h cancer p r e c l u d e s surgery

when they f i r s t a t t e n d f o r t r e a t m e n t . Consequently they would be excluded from a u n i v e r s a l
c l a s s i f i c a t i o n i f evidence o b t a i n e d only a t o p e r a t i o n w e r e r e q u i r e d .
The TNM system i n man d e s c r i b e s two c l a s s i f i c a t i o n s f o r each s i t e :
(a) pre-treatment, c l i n i c a l c l a s s i f i c a t i o n
(b) p o s t - s u r g i c a l h i s t o p a t h o l o g i c a l c l a s s i f i c a t i o n d e s i g n a t e d pTNbf
For most tumours t h e pTNM c a t e g o r i e s correspond t o t h e TNM c a t e g o r i e s b u t d i f f e r e n c e s have

been noted and a d d i t i o n s made f o r t h y r o i d , b r e a s t , oesophagus, stomach, b l a d d e r , p r o s t a t e and
melanoma. This dual c l a s s i f i c a t i o n h a s n o t been attempted a t t h i s s t a g e f o r tumours i n domes-
t i c animals. It i s t h e pre-treatment c l i n i c a l TNM c l a s s i f i c a t i o n which i s of paramount
importance f o r purposes of r e p o r t i n g and e v a l u a t i o n .
It i s recognized, however, e s p e c i a l l y i n t h e a l l o c a t i o n of animals w i t h c e r t a i n tumours

i n c l i n i c a l t r i a l s , t h a t d e t a i l e d h i s t o p a t h o l o g i c a l information supplementing t h e c l i n i c a l
diagnosis i s e s s e n t i a l , e.g. grading of mastocytomas, i n v a s i o n o r l a c k of i n v a s i o n by mammary
t u b u l a r adenocarcinoma.
3. I n t h e c l i n i c a l assessment of an animal tumour numerous i n v e s t i g a t i o n s may b e done. It i s

important t o d i s t i n g u i s h o b l i g a t o r y i n v e s t i g a t i o n s from t h o s e which add refinement t o t h e diag-
n o s i s of t h e e x t e n t of t h e malignant d i s e a s e . For each s i t e minimum c r i t e r i a f o r TNM
classification are listed. The r e g i o n a l lymph nodes f o r each s i t e a r e d e f i n e d .
4. A f t e r a s s i g n i n g T, N and M c a t e g o r i e s (with d e g r e e of e x t e n s i o n ) t h e s e may b e grouped i n t o

a number of c l i n i c a l s t a g e s f o r c e r t a i n tumours.
It i s obvious t h a t tumours of some s i t e s l e n d themselves more e a s i l y and s a t i s f a c t o r i l y t o

c l a s s i f i c a t i o n than others. These a r e t h e a c c e s s i b l e s i t e s where eye and hand can a s s e s s by
d i r e c t v i s i o n , p a l p a t i o n and measurement t h e primary tumour and i t s r e g i o n a l lymph nodes. The
mammary gland, t h e upper a i r and food p a s s a g e s , t h e s k i n and long bones a r e examples. The
l e a s t s a t i s f a c t o r y s i t e s f o r c l a s s i f i c a t i o n of t h e i r tumours a r e t h e deep-seated v i s c e r a , e.g.
stomach, colon, kidney and ovary.
It i s necessary t h e r e f o r e t h a t , although t h e r u l e s of t h e TNM system s h o u l d be r i g i d l y

observed, t h e r e must b e , f o r any p a r t i c u l a r s i t e , some method f o r t h e i d e n t i f i c a t i o n and recor-
ding of a d d i t i o n a l i n f o r m a t i o n considered e s s e n t i a l f o r t h a t s i t e . The f o l l o w i n g i s a n example
of such a d d i t i o n a l informat i o n .
Most dogs w i t h mammary cancer o f p o s t e r i o r glands have a mastectomy, which u s u a l l y means
t h e i n g u i n a l lymph node i s removed and examined h i s t o l o g i c a l l y . I f mobile nodes a r e p a l p a b l e
c l i n i c a l l y before operation t h e designation N 1 is applied t o t h e case. I f these nodes a r e
found on h i s t o l o g i c a l examination t o b e tumour-free, t h e cypher (-) (minus) i s added, t h u s :
NI(-). I f t h e y c o n t a i n tumour d e p o s i t s , t h e cypher (+) ( p l u s ) is added, t h u s : NI(+).
PRIMARY TUMOUR (T)
T1, T2, T3, T 4 i n d i c a t e i n c r e a s i n g degrees of e x t e n t of t h e primary tumour. The number

of t h e s e T c a t e g o r i e s may vary a c c o r d i n g t o t h e p a r t i c u l a r s i t e b u t i t i s recommended t h a t i n
g e n e r a l t h e r e should be f o u r . For each s i t e t h e i d e a l s i t u a t i o n i s when tumours can b e accu-
r a t e l y d e f i n e d , a c c u r a t e l y a s s e s s e d on c l i n i c a l examination and have p r e c i s e "boundariest', such
a s a s i z e - l i m i t a t i o n o r a "yes o r no" d i s t i n c t i o n , e.g. movable o r f i x e d .
1. The tumours e a s i e s t t o c l a s s i f y a r e t h o s e which a r i s e i n a s i n g l e organ. I n these the

tumour can b e simply d e s c r i b e d i n terms of i t s anatomical e x t e n t .
I n t h e mannnary gland of t h e dog f o r i n s t a n c e , t h e t h r e e main q u a l i t i e s w h i c h . d e t e m i n e t h e

T category a r e s i z e , involvement o f s k i n and involvement of underlying t i s s u e s . There a r e f o u r
degrees of T and any agreed c l i n i c a l f e a t u r e can determine t h e degree of T, as i n d i c a t e d i n t h e
following s i m p l i f i e d t a b l e :
- T
T1 T2 T3 T4
Size
Less t h a n 3 cm 3-5 cm More than 5 cm
l
Major
Skin Minor involvement
involvement
Fascia,
with o r without Thoracic o r
Muscle and abdominal w a l l
f a s c i a o r muscle f i x a t i o n
Thoracic w a l l fixation
It i s n o t known i f t h e l o c a l i z a t i o n of t h e tumour w i t h i n t h e mammary g l a n d ( s ) i s as impor-

t a n t i n animals a s it i s i n women. However, although p o s i t i o n i s n o t included i n t h e T
d e f i n i t i o n s , t h e r e i s no d i f f i c u l t y i n comparing, f o r example, a group of T 3 o u t e r h a l f c a s e s
and a group o f T3 i n n e r h a l f c a s e s , provided t h i s i n f o r m a t i o n i s recorded i n t h e animal's
hospital chart.
2. A second group of tumours o c c u r s i n s i t u a t i o n s which a r e n o t s o circumscribed and i n which

t h e s i z e and e x t e n t cannot b e s o e a s i l y a s c e r t a i n e d , e.g. tumours of t h e b l a d d e r a r e a s s e s s e d
on cystoscopy, radiography, manual examination under a n a e s t h e s i a and t h e e x t e n t of p e n e t r a t i o n
of t h e b l a d d e r w a l l by t h e tumour ( a s i n d i c a t e d by t h e microscopic examination of t i s s u e removed
f o r biopsy).
3. A t h i r d t y p e cannot b e diagnosed a t a l l w i t h o u t t a k i n g o p e r a t i v e f i n d i n g s i n t o account, e.g.

laparotomy i n o v a r i a n tumours and s u r g i c o - p a t h o l o g i c a l f i n d i n g s i n colon and bone tumours.
M u l t i p l e tumours have t o be c o n s i d e r e d under s e v e r a l headings:

( a ) t h o s e o c c u r r i n g simultaneously i n p a i r e d organs (e.g. c h a i n of mammary glands) should b e
c l a s s i f i e d independently.
(b) t h o s e o c c u r r i n g simultaneously i n t h e s k i n should have t h e a c t u a l number recorded. The
tumour w i t h t h e h i g h e s t T category i s s e l e c t e d and t h e number of tumours i n d i c a t e d i n paren-
t h e s i s , t h u s T2(5).
( c ) t h o s e o c c u r r i n g i n hollow v i s c e r a o r c a v i t i e s , e.g. b l a d d e r , vagina, p e n i s , and i n which
t h e e x a c t number i s immaterial, a r e denoted by a d d i t i o n o f t h e s u f f i x (m) t h u s : T3(m). This
may a l s o b e a p p l i e d t o t h e h i s t o p a t h o l o g i c a l c l a s s i f i c a t i o n , t h u s : P2(m) - s e e "Histopathologi-
c a l e x t e n t and grading, page .
I n a d d i t i o n t o t h e degrees ,of T needed t o d e s c r i b e t h e l o c a l e x t e n t of a tumour, o t h e r
T symbols r e q u i r e mention:
TO means "no evidence of primary tumour". This category i s necessary t o cover c a s e s

where lymphatic o r blood-borne m e t a s t a s e s o c c u r w h i l e t h e primary neoplasm remains o c c u l t .
TX means t h a t i t i s impossible t o a s s e s s f u l l y t h e e x t e n t of t h e primary tumour.
T i s i s r e s e r v e d e x c l u s i v e l y f o r carcinoma --
i n s i t u ( p r e i n v a s i v e carcinoma). This i s a n
e s s e n t i a l c a t e g o r y i n some s i t e s , e.g. cornea and s c l e r a , e y e l i d s and nose.
REGIONAL LYMPH NODES (NI
N 1 , N2, N3 i n d i c a t e t h e c h a r a c e r i s t i c s of lymph nodes, which may be a s s e s s e d by p a l p a t i o n ,

lymphangiography o r o t h e r procedures. The number of t h e s e c a t e g o r i e s v a r i e s according t o s i t e .
E x a m ~ l eof N c l a s s i f i c a t i o n : o r a l cavitv
NO No p a l p a b l e r e g i o n a l lymph nodes, i . e . no r e g i o n a l lymph nodes a r e p a l p a b l e o r t h e y

appear t o be normal on o t h e r d i a g n o s t i c procedures
N1 Movable r e g i o n a l i p s i l a t e r a l lymph nodes
N2 Movable c o n t r a l a t e r a l o r b i l a t e r a l lymph nodes
N3 Fixed lymph nodes
H i s t o l o g i c a l information concerning t h e s t a t e of t h e lymph nodes obtained from a biopsy o r

following o p e r a t i o n may b e added t o any N category by t h e use of t h e cyphers (-) (minus) o r (+)
( p l u s ) , i n d i c a t i n g t h e absence o r presence o f m e t a s t a t i c involvement. This i s a l s o a p p l i c a b l e
t o NX, t h u s : NX- o r NX+.
When r e g i o n a l lymph nodes a r e p a l p a b l e they must b e c l a s s i f i e d a s N 1 o r N2 b u t an examining

c l i n i c i a n may wish t o i n c l u d e h i s assessment of whether a lymph node c o n t a i n s m e t a s t a t i c tumour
o r not. Thus f o r a l l lymph nodes d r a i n i n g head and neck tumours t h e d e f i n i t i o n s a r e :
N1 Movable r e g i o n a l nodes
N l a nodes n o t considered t o c o n t a i n growth
Nlb nodes considered t o c o n t a i n growth
N2 Movable i p s i l a t e r a l o r b i l a t e r a l nodes
N2a nodes n o t considered t o c o n t a i n growth
N2b nodes c o n s i d e r e d t o c o n t a i n growth
DISTANT FIETASTASES (M)
The absence o r presence of m e t a s t a s e s i s i n d i c a t e d by t h e l e t t e r M.
MO No m e t a s t a s e s a r e d e t e c t e d c l i n i c a l l y
M1 M e t a s t a s i s o t h e r than t o r e g i o n a l lymph nodes i s p r e s e n t
VPH/CM0/80.20
page 10
I f n e c e s s a r y M 1 may be subdivided i n t o f u r t h e r c a t e g o r i e s t o i n d i c a t e t h e t y p e of
m e t a s t a s i s , e.g. t o bone, l i v e r , lung e t c .
MX Impossible t o a s s e s s t h e presence of m e t a s t a s e s .
H i s t o p a t h o l o g i c a l e x t e n t (P) and g r a d i n g (G)
Information o b t a i n e d a t o p e r a t i o n i s not g e n e r a l l y c o n s i d e r e d a d m i s s i b l e f o r c l i n i c a l
c l a s s i f i c a t i o n b u t may b e used a s an a d d i t i o n . Two a s p e c t s of h i s t o p a t h o l o g y may be recorded.
The symbol P r e f e r s t o t h e depth of i n f i l t r a t i o n of t h e tumour w i t h i n t h e organ o r t i s s u e ,
while t h e symbol G r e f e r s t o t h e p a t h o l o g i c a l g r a d i n g of t h e tumour,
For example, f o r tumours of some hollow organs t h e h i s t o p a t h o l o g i c a l e x t e n t i s expressed

i n f o u r degrees of P:
P1 Tumour confined t o t h e mucosa

P2 Tumour i n v o l v e s t h e mucosa and t h e submucosa and e x t e n d s t o o r i n t o t h e s e r o s a ,
b u t does not p e n e t r a t e through t h e s e r o s a
P3 Tumour p e n e t r a t e s through t h e s e r o s a w i t h o r w i t h o u t i n v a s i o n of contiguous s t r u c t u r e s
P4 Tumour d i f f u s e l y i n v o l v e s t h e e n t i r e t h i c k n e s s of t h e organ w a l l without obvious
boundaries.
P a t h o l o g i c a l g r a d i n g i s expressed i n t h r e e d e g r e e s :
G1 Low grade malignancy

G2 Medium grade malignancy
G3 High g r a d e malignancy
A d d i t i o n a l p a t h o l o g i c a l c a t e g o r i e s may be used i n c e r t a i n s i t e s , f o r example, t o record i n v a s i o n

of lymphatics o r v e i n s i n u r o l o g i c a l s i t e s . These a r e d e s i g n a t e d L and V.
Thus f o r tumours of t h e b l a d d e r t h e d e f i n i t i o n s a r e :
L0 No lymphatic i n v a s i o n
L1 S u p e r f i c i a l lymphatics invaded
L2 Deep lymphatics invaded
For tumours of t h e kidney t h e d e f i n i t i o n s a r e :
V0 The v e i n s do n o t c o n t a i n tumour
V1 Renal v e i n c o n t a i n s tumour
V2 Vena cava c o n t a i n s tumour
Stage grouping
A s s t a t e d e a r l i e r t h e "staging" of tumours h a s been p r a c t i s e d f o r many y e a r s i n medicine,

and t h e system can be a p p l i e d e q u a l l y w e l l t o animal tumours. C l a s s i f i c a t i o n by T, N and M
aims a t a more p r e c i s e r e c o r d i n g of t h e a p p a r e n t e x t e n t of t h e d i s e a s e and t h e c a s e s can then
be grouped according t o c r i t e r i a t h a t a r e s t a t i s t i c a l l y p r e d i c t i v e . I n a tumour w i t h f o u r
p o s s i b l e degrees of T, f o u r degrees of N and two degrees of M , t h e number o f groups. extending
from T I NO MO a t one end of t h e s c a l e t o T4 N 3 M 1 a t t h e o t h e r . i s 32. To r e c o r d i n d i v i d u a l
c a s e s i n t h e s e groups i s simple; t o reproduce t a b l e s c o n t a i n i n g t h a t number i s i m p r a c t i c a l
* e x c e p t f o r very l a r g e s e r i e s .
V P H / C M ~80.20
/
page 11
A t h e o r e t i c a l example may c o n t a i n t h e following stage-grouping:
TNM Groups C l i n i c a l Stage No of Groups per

Stage
Any TN symbols + M 1 IV 16
It w i l l be seen t h a t t h e 12 TNM groups i n S t a g e 111 span a range from T1 NZ MO t o T4 N 3 MO.

The one-year s u r v i v a l of t h e f i r s t group may b e about 60% w h i l e of t h e l a s t group only 15%.
This shows t h e l i m i t a t i o n of s t a g i n g where it i n c l u d e s such d i s s i m i l a r groups and demonstrates
a t t h e same time t h e advantage of TNM c a t e g o r i e s .
THE ANATOMICAL SITES
The s i t e s now c l a s s i f i e d cover t h e g r e a t e r p a r t of t h e v e t e r i n a r y f i e l d f o r dogs and c a t s

and most a r e s u i t a b l e f o r o t h e r animals. Each s i t e i s considered i n t h e same g e n e r a l manner,
t h e f o l l o w i n g d e t a i l s b e i n g s e t o u t i n s h o r t i n t r o d u c t o r y remarks:
1. D e s c r i p t i o n of t h e s i t e and r e g i o n s
2. D e f i n i t i o n of t h e r e g i o n a l and, where a p p l i c a b l e , t h e j u x t a - r e g i o n a l lymph nodes f o r each
site
3. Where necessary, t h e c l i n i c a l and s u r g i c a l methods recommended f o r e s t a b l i s h i n g t h e TNM
categories.
The s i t e s a r e grouped under 11 headings:
1. Skin (excluding lymphosarcoma and mas tocytoma)

2. Skin (mastocytoma)
3. Mammary glands
I
4. Head and neck
5. Alimentary system, i n c l u d i n g pancreas, l i v e r
6. U r o l o g i c a l s y s tem
7. G e n i t a l system
8. Bones and j o i n t s
9. Lymphoid and haematopoietic t i s s u e s ( i n c l u d i n g lymphosarcoma of s k i n )
10. R e s p i r a t o r y system
11. Endocrine glands ( t h y r o i d , a d r e n a l )
Tumours of t h e eye, CNS, h e a r t and endocrine glands ( o t h e r t h a n a d r e n a l and t h y r o i d ) a r e

n o t i n c l u d e d because i t is d i f f i c u l t t o c l a s s i f y them c l i n i c a l l y a t t h e p r e s e n t time and many
of t h i s group a r e only l o c a l l y i n v a s i v e .
VPH/CM0/80.20
page 12
1. SKIN
(excluding lymphosarcoma and mastocytoma)
The c l a s s i f i c a t i o n a p p l i e s t o primary tumours of t h e s k i n . There must be h i s t o l o g i c a l

v e r i f i c a t i o n t o p e r m i t grouping of c a s e s by h i s t o l o g i c a l type.
The c l a s s i f i c a t i o n i s b a s e d on d i v i s i o n i n t o s i x r e g i o n s .
I n d e f i n i n g t h e lymph nodes f o r each r e g i o n , t h e body i s d i v i d e d v e r t i c a l l y a t
t h e umbilicus.
The r e g i o n s and r e g i o n a l nodes a r e a s follows:
Regions Regional nodes
(a) e y e l i d , e a r and nose cervical (bilateral)

(b) f a c e (excluding "a"), cervical (bilateral)
s c a l p and neck submandibular ( b i l a t e r a l )
auricular (bilateral)
(c) upper limb a x i l l a r y and p r e s c a p u l a r ( i p s i l a t e r a l )
(d) trunk a n t e r i o r t o t h e axillary (bilateral)
umbilicus prescapular ( b i l a t e r a l )
(e) trunk p o s t e r i o r t o t h e inguinal (bilateral)
umbilicus
(f) lower limb i n g u i n a l and p o p l i t e a l ( i p s i l a t e r a l )
The e x t e n t of t h e d i s e a s e i s a s s e s s e d on c l i n i c a l examination and radiography. The primary

tumour i s a s s e s s e d on s i z e , i n f i l t r a t i o n of s u b c u t i s o r involvement of o t h e r s t r u c t u r e s such a s
f a s c i a , muscle, bone o r c a r t i l a g e . The s i z e , t o b e recorded i n cm., may be measured by c a l -
liper.
The p a t h o l o g i c a l grade o f tumour should b e recorded when a v a i l a b l e b u t does n o t modify t h e

classification.
TO = no evidence of tumour. Use f o r rechecks f o r malignancy a f t e r s u r g i c a l removal of

primary tumour.
M u l t i p l e tumours
I n t h e c a s e o f m u l t i p l e simultaneous tumours, t h e tumour w i t h t h e h i g h e s t T category should

be i d e n t i f i e d and t h e number of s e p a r a t e tumours i n d i c a t e d i n p a r e n t h e s i s , e.g. (T2(5). Suc-
c e s s i v e tumours s h o u l d be c l a s s i f i e d independently.
VPH/CMO/~O.~O
page 13
CLINICAL STAGES (TNM) OF CANINE OR FELINE TUMOURS OF EPIDERMAL OR DERMAL

ORIGIN (EXCLUDING LYMPHOSARCOMA AND MASTOCYTOMA)
Case number .................... Name of owner ......................... Date ...............

Cat/Dog ........... Age .......... Sex ..... Breed ................... Body weight .... I b s
( 1 kg = 2.2 l b s ) .... kgs
Circle appropriate category

T: Primary Tumour
Tis Pre-invasive carcinoma (carcinoma i n s i t u )

TO No evidence of tumour
T1 Tumour <
2 cm. maximum diameter,
super£ i c i a l o r exophyt i c
T2 Tumour 2-5 cm. maximum diameter, o r w i t h
minimal i n v a s i o n i r r e s p e c t i v e of s i z e
T3 T u m o u r > 5 cm. maximumdiameter, o r w i t h
i n v a s i o n of t h e s u b c u t i s , i r r e s p e c t i v e
of s i z e
T4 Tumour invading o t h e r s t r u c t u r e s such as
f a s c i a muscle, bone o r c a r t i l a g e C i r c l e s i t e ( s ) involved
Tumours o c c u r r i n g simultaneously should have t h e a c t u a l number recorded. The tumour w i t h

t h e h i g h e s t T category i s s e l e c t e d and t h e number of tumours i n d i c a t e d i n p a r e n t h e s i s , e.g.
T2 (5). S u c c e s s i v e tumours should be c l a s s i f i e d independently.
N: Regional Lymph Nodes (RLN)*
NO No evidence of RLN involvement

N1 Movable i p s i l a t e r a l nodes
Nla Nodes n o t considered t o c o n t a i n growth**
Nlb Nodes considered t o c o n t a i n growth**
N2 Movable c o n t r a l a t e r a l o r b i l a t e r a l nodes
N2a Nodes n o t considered t o c o n t a i n growth*"
N2b Nodes considered t o c o n t a i n growth**
N3 Fixed nodes
M: Distant Metastasis
MO No evidence of d i s t a n t m e t a s t a s i s
M1 D i s t a n t m e t a s t a s i s detected*** - specify s i t e ( s ) ....................................
STAGE GROUPING: No s t a g e grouping is a t p r e s e n t recommended
Comments ......................................................................................
*For RLN s e e i n t r o d u c t i o n
(+) = h i s t o l o g i c a l l y p o s i t i v e
**(-)' = h i s t o l o g i c a l l y n e g a t i v e ,
***Including lymph nodes beyond t h e r e g i o n i n which t h e primary tumour i s s i t u a t e d
VPH/CM0/80.20
page 14
2. SKIN
(Mas tocytoma)
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l examination and radiography. The primary

tumour i s a s s e s s e d on s i z e , i n f i l t r a t i o n of s u b c u t i s o r involvement of o t h e r s t r u c t u r e s such a s
f a s c i a , muscle, bone o r c a r t i l a g e . The s i z e , t o b e recorded i n cm., nay b e measured by
calliper.
I n t h e c a s e of m u l t i p l e simultaneous tumours, t h e tumour w i t h t h e h i g h e s t T c a t e g o r y should

be i d e n t i f i e d and t h e number of s e p a r a t e tumours i n d i c a t e d i n p a r e n t h e s i s , e.g. T2(5). Succes-.
s i v e tumours should b e c l a s s i f i e d independently.
The p a t h o l o g i c a l grade of tumour should b e recorded when a v a i l a b l e b u t does not modify t h e

classification.
Systemic s i g n s i n c l u d e g a s t r i c and duodenal u l c e r a t i o n , p e r i t o n i t i s , c o a g u l a t i o n d e f e c t s

and glomerulonephri t i s . Because t h e s e tumours can b e p r e s e n t w i t h o r w i t h o u t systemic s i g n s
t h e TNM system i s n o t e n t i r e l y s u i t a b l e . The tumours can, however, b e c l i n i c a l l y s t a g e d i n t o
four categories.
~~~/CM0/80.20
page 15
CLINICAL STAGES OF CANINE MASTOCYTOMA
Case number .................... Name o f owner ......................... Date ...............

Age .......... Sex .......... Breed ................................. Body weight .... l b s
(1 kg = 2.2 lbs) .... kgs
C i r c l e a o o r o ~ r i a t ec a t e e o r v
Clinical Stage
I One tumour confined t o t h e dermis w i t h o u t r e g i o n a l lymph node involvement
Ia w i t h o u t systemic s i g n s
Ib with systemic signs
I1 One tumour confined t o dermis, w i t h r e g i o n a l lymph node involvement
IIa w i t h o u t systemic s i g n s
IIb w i t h systemic signs
I11 M u l t i p l e dermal tumours o r l a r g e i n f i l t r a t i n g tumour w i t h o r w i t h o u t

r e g i o n a l lymph node involvement
IIIa w i t h o u t systemic s i g n s
IIIb w i t h systemic s i g n s
IV Any tumour w i t h d i s t a n t m e t a s t a s i s o r r e c u r r e n c e w i t h m e t a s t a s i s *
Mu1 t i p l e tumours
Tumours o c c u r r i n g simultaneously should have t h e a c t u a l number recorded. The tumour w i t h

t h e h i g h e s t T category i s s e l e c t e d and t h e number of tumours i n d i c a t e d i n p a r e n t h e s i s , e.g.
T2(5). S u c c e s s i v e tumours should be c l a s s i f i e d independently.
*Including blood a n d / o r bone marrow involvement

jrPH/CM0/80.20
page 1 6
3. W Y GLANDS
The c l a s s i f i c a t i o n a p p l i e s o n l y t o carcinoma.
The e x t e n t o f d i s e a s e i s a s s e s s e d on c l i n i c a l examination and radiography of t h e t h o r a x .

The primary tumour i s a s s e s s e d on s i z e , and involvement of s k i n and underlying s t r u c t u r e s .
The s i z e , t o b e recorded i n cm., may be measured by c a l l i p e r .
The p o s i t i o n of t h e tumour i n t h e mammary gland should be recorded b u t has no b e a r i n g on

classification.
The p a t h o l o g i c a l grade of tumour should b e recorded when a v a i l a b l e b u t does n o t modify t h e

classification.
M u l t i p l e tumours should b e c l a s s i f i e d independently.
The r e g i o n a l lymph nodes a r e t h e a x i l l a r y and i n g u i n a l nodes.

VPH/CM0/80.20
page 17
CLINICAL STAGES (TNM) OF CANINE MAMMARY TUMOURS
Case number ................... Name of owner ....................... Date ..................

Age ............. Sex ..... Breed .................................. Body weight ....... l b s
( 1 kg = 2.2 l b s ) ....... kg S
Number of primary tumours :
Mammary g l a n d l o c a t i o n Right Chain L e f t Chain

of primary tumours: 1 2 3 4 5 1 2 3 4 5
Largest s i n g l e
diameter (cm) : ----------
SINGL E
MULTIPLE
(Mark \/ where a p p l i c a b l e )
3
C i r c l e a l l glands involved
The fol.lowing a r e t h e minimum r e q u i r ~ e n t sf o r a s s e s s i n g t h e T, N and M c a t e g 3 r i e s . (If these

cannot b e met t h e symbols TX, NX and MX should be used. )
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination
N c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination
M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of thorax
C i r c l e a p p r o p r i a t e category
T: Primary Tumour
TO No evidence o f tumour
Tl. Tumour < 3 cm. maximum diameter

Tla not fixed Tlc f i x e d t o muscle
Tlb fixed t o skin
T2 Tumour 3-5 cm. maximum diameter

T2a not fixed ~2~ f i x e d t o muscle
T2b fixed t o s k i n
T3 Tumour > 5 cm. maximum diameter

T3a not fixed T3c f i x e d t o muscle
T3b fixed t o skin
T4 Tumour any s i z e , i n f lamrnatory carcinoma*
M u l t i p l e tumours should be c l a s s i f i e d independently.
* Locally invading s k i n without i n f e c t i o n o r trauma a s t h e cause.

VPH/CMO/~O.Z
page 18
N: Regional Lymph Nodes (RLN) :**

Mark l/ where a p p l i c a b l e
RLN e v a l u a t e d Method of RLN e v a l u a t i o n
Inguinal Axillary Clinical Histological***
NO - no evidence of RLN
involvement
N1 - i p s i l a t e r a l RLN involved
Nla n o t f i x e d
~ l bf i x e d
NZ - b i l a t e r a l RLN involved
N2a n o t f i x e d
N2b f i x e d
M: Distant ~ e t a s t a s i s
Mark \/ where applicable
C i r c l e a p p r o p r i a t e category Method of M E v a l u a t i o n
Clinical Radiographic Histological
MO - no evidence of distant
metastasis
M1 - d i s t a n t metastasis including
d i s t a n t nodes
Specify s i t e ( s ) .....................................................................
STAGE GROUPING :
T
I11 Any T 3
Any T
F i n a l C l i n i c a l Stage:
T N M
TNM Evaluation - Stage ...............B..
Comments: .....................................................................................
** The RLN a r e t h e a x i l l a r y and i n g u i n a l nodes

*** (-) = ' h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e
VPH/CMO/~~.~O
page 1 9
CLINICAL STAGES (TNM) OF FELINE MAMWWY TUMOURS
Case number .................. Name of owner .......................... Date ................

Age ............ Sex ..... Breed ..................................... Body weight ..... l b s
( 1 kg = 2.2 l b s ) ..... kgs
Number of primary tumours:
Mammary gland l o c a t i o n Right Chain L e f t Chain

of primary tumours: 1 2 3 4 1 2 3 4
Largest s i n g l e
d i a m e t e r (cm) : - - - - - - - -
SINGLE
MULTIPLE E3 (Mark l/ where a p p l i c a b l e )
C i r c l e a l l glands involved
Ir
The following a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . (If these

cannot b e met t h e syinbols TX, NX and MX should b e used.)
*
C i r c l e a p p r o p r i a t e Category
Primary Tumour
T1 Tumour < 1 cm. maximum diameter

Tla not fixed TIC f i x e d t o muscle
Tlb fixed t o skin

T2b fixed t o skin
T3 Tumour >3 cm. maximum diameter

T3b f i x e d t o skin
T4 Tumour any s i z e , i n £ lammatory carcinoma*
* Locally invading s k i n without i n f e c t i o n o r trauma a s t h e cause.

Y Y H / C M O / ~ O . 20
page 20
Pi: Regional Lymph Nodes (RLN):**

Mark l/ where a p p l i c a b l e
RLN e v a l u a t e d Method of RLN e v a l u a t i o n
C i r c l e appropriate category
Inguinal Axillary Clinical -
Histological***
NO - no evidence of RLN
involvement
N1 - i p s i l a t e r a l RLN i n v o l v e d
Nla n o t f i x e d
N2 -
Nlb f i x e d
b i l a t e r a l RLN involved
U n
N2a n o t f i x e d U 0 0 0
N2b f i x e d
n n C1 n
Mark \/ where applicable
C i r c l e appropriate category Method of M E v a l u a t i o n
Clinical Radiographic Histological
MO - no evidence of d i s t a n t
metastasis
M1 - d i s t a n t metastasis including
d i s t a n t nodes
Specify s i t e ( s ) ....................................................................
STAGE GROUPING:
T N
I11 Any T3 Any N

Any T Any Nb
F i n a l C l i n i c a l Stage:
TNM E v a l u a t i o n - - Stage ..................
Comments: .....................................................................................
** The RLN a r e t h e a x i l l a r y and i n g u i n a l nodes

*** (-) = h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e
VP~/CM0/80.20
page 21
4. HEAD AND NECK
(excluding larynx)
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l examination, radiography of t h e thorax aad

endoscopy . Radiographic examinat i o n i s mandatory.
The r e g i o n a l lymph nodes a r e t h e c e r v i c a l , t h e submandibular and t h e p a r o t i d nodes.
LIPS
1. Lower l i p
2. Upper l i p
3. Connnissures
The o r a l c a v i t y i n c l u d e s t h e a n t e r i o r two-thirds of t h e tongue, f l o o r of mouth, b u c c a l

mucosa, t h e a l v e o l i and t h e hard p a l a t e .
1. Buccal mucosa
2. Lower a l v e o l u s and g i n g i v a
3. Upper a l v e o l u s and g i n g i v a
4. Hard p a l a t e
5. Tongue: (a) d o r s a l s u r f a c e and l a t e r a l b o r d e r s ( a n t e r i o r two-thirds); (b) inferior
surface
6. F l o o r of mouth
In t h e c a s e of m u l t i p l e tumours, t h e symbol (m) i s added t o t h e a p p r o p r i a t e T category.
OROPHARYNX
The oropharynx extends from t h e j u n c t i o n of t h e hard and s o f t p a l a t e s t o t h e l e v e l of t h e

f l o o r of t h e g l o s s o e p i g l o t t i c f o l d s .
1. A n t e r i o r w a l l ( g l o s s o e p i g l o t t i c a r e a ) : ( a ) tongue ( p o s t e r i o r t h i r d ) ; (b) glosso-

e p i g l o t t i c f o l d s ; ( c ) a n t e r i o r ( l i n g u a l ) s u r f a c e of e p i g l o t t i s
2. L a t e r a l w a l l and t o n s i l s
3. P o s t e r i o r oropharyngeal w a l l
4. Superior w a l l - i n f e r i o r s u r f a c e of s o f t p a l a t e and uvula
The hypo pharynx i s included w i t h t h e oropharynx .

It extends from t h e pharyngoepiglo t t i c
f o l d t o t h e upper end of t h e oesophagus and p o s t e r i o r pharyngeal w a l l .
In t h e c a s e of m u l t i p l e tumours, t h e symbol (m) i s added t o t h e a p p r o p r i a t e T category.

VPH/CMO/~O.~O
page 22
CLINICAL STAGES ( T N M ) OF CANINE / FELINE TUMOURS OF THE LIPS
Case number .................... Name of owner ......................... Date ................

Cat/Dog ..... Age .......... Sex ..... Breed .......................... Body weight ..... l b s
( 1 kg = 2.2 l b s ) ..... &S
The following a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . ( I f these

cannot be met t h e symbols TX, NX and MX should b e used. )
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examinat i o n
M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography o f t h o r a x
T: Primary Tumour .
Tis P r e i n v a s i v e carcinoma (carcinoma
T1 Tumour <2 cm. maximum diameter, s u p e r f i c i a l o r exophytic
T2 Tumour < 2 cm. maximum diameter, with minimal i n v a s i o n i n depth
T3 Tumour > 2 cm. diameter o r with deep i n v a s i o n i r r e s p e c t i v e of s i z e
T4 Tumour invading bone

Nla Nodes n o t considered t o c o n t a i n growth**
Nlb Nodes considered t o c o n t a i n growth**
N2a Nodes n o t considered t o c o n t a i n growth**
N3 Fixed nodes
M1 - s p e c i f y s i t e ( s ) ..............
D i s t a n t m e t a s t a s i s ( i n c l u d i n g d i s t a n t nodes) d e t e c t e d
......................................................................................
STAGE GROUPING: No s t a g e grouping i s a t present recommended
Comments: ......................................................................................
................................................................................................
................................................................................................
* The RLN a r e t h e c e r v i c a l , submandibular and p a r o t i d nodes
** (-1 = h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e
V~~/CM0/80.20
page 23
CLINICAL STAGES (TNM) OF CANINE/FELINE TUMOURS OF THE OWL CAVITY (BUCCAL CAVITY)
Case n~lrnber .................... Name of owner ......................... Date ................

Cat/Dog ..... Age .......... Sex ..... Breed ......................... Body weight ..... l b s
( 1 kg = 2.2 l b s ) ..... kg s
This c l a s s i f i c a t i o n a p p l i e s t o t h e a n t e r i o r two-thirds of t h e tongbe, f l o o r of mouth, b u c c a l
mucosa, t h e a l v e o l i and t h e hard p a l a t e .
The f o l l o w i n g a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . (If these

cannot be met t h e symbols TX, NX and MX should be used.)
M categories : C l i n i c a l and s u r g i c a l examination, radiography of thorax
T: Primary Tumour
Tis P r e i n v a s i v e carcinoma (carcinoma i n s i t u )
T1 Tumour < 2 cm. maximum diameter

Tla w i t h o u t bone i n v a s i o n Tlb w i t h bone i n v a s i o n

T2a without bone i n v a s i o n T2b w i t h bone i n v a s i o n
T3 Tumour > 4 cm. maximum diameter

T3a without bone i n v a s i o n T3bb w i t h bone i n v a s i o n
The symbol (m) added t o t h e a p p r o p r i a t e T category i n d i c a t e s m u l t i p l e tumours
N: Regional Lymph Nodes (RIB)*
Nla Nodes n o t considered t o c o n t a i n growth* Nlb Nodes considered t o c o n t a i n growth**
H2 Movable c o n t r a l a t e r a l o r b i l a t e r a l nodes
N2a Nodes n o t considered t o c o n t a i n growth** N2b Nodes considered t o c o n t a i n growthk*
N3 Fixed nodes
M1 ..............
D i s t a n t m e t a s t a s i s ( i n c l u d i n g d i s t a n t nodes) d e t e c t e d - specify s i t e ( s )
......................................................................................
~~H/CM0/80.20
p a g e 24
STAGE GROUPING :
N M
NO, Nla o r N2a MO
II T2 NO, Nla o r N2a MO
III*** T3 NO, Nla o r N2a MO

Any T Nlb
IV Any T Any N2b o r N3 MO

Any T Any N M1
Comments: .....................................................................................
* The RLN a r e t h e c e r v i c a l , submandibular and p a r o t i d nodes

** (-) = h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e
*** Any bone involvement
VPH/CM0/80.20
page 25
CLINICAL STAGES (TNM) OF CANINE/FELINE/EQUINE TUMOURS OF THE OROPHARYNX*

Species .......... Age ........ Sex .... Breed ....................... Body weight .... l b s
( 1 kg = 2.2 l b s ) .... kgs
The following c l a s s i f i c a t i o n a p p l i e s from t h e junction of t h e hard and s o f t p a l a t e s t o the l e v e l
of the f l o o r of t h e g l o s s o e p i g l o t t i c f o l d s .
The following a r e the minimum requirements f o r assessing t h e T, N and M categories. ( I f these

T c a t e g o r i e s : C l i n i c a l , s u r g i c a l and.radiologica1 examination, endoscopy
T: Primary Tumour
Tis Preinvas i v e carcinoma (carcinoma --

i n Si t u )
TO No evidence of primary tumour
T1 Tumour s u p e r f i c i a l o r exophytic
Tla without systemic s i g n s Tlb with systemic signs
T2 Tumour w i t h invasion of t o n s i l only

T2a without systemic signs T2b with systemic s i g n s
T3 Tumour with invasion of surrounding t i s s u e

T3a without systemic s i g n s T3b with systemic signs
4
The symbol (m) added t o t h e appropriate T category i n d i c a t e s m u l t i p l e tumours.
N: Regional Lymph Nodes ( m ) * *
Nla nodes n o t considered t o contain growth***
Nlb nodes considered t o contain growth***
N2a nodes n o t considered t o contain growth***
N2b nodes considered t o contain growth***
N3 Fixed nodes
M1 D i s t a n t m e t a s t a s i s (including d i s t a n t nodes) detected - specify site(s) :. .............

STAGE GROUPING: No s t a g e grouping i s a t present reconrmended.
Comments: ......................................................................................
*Mainly t o n s i l l a r carcinoma; **The RLN a r e the c e r v i c a l , submandibular and p a r o t i d nodes
t ***(-l - h;-tfil--;,,ll~ p p p n + i ~ r p ,,p> h i s t n l T ~ i S a l . l b 7 L n a ~ ~ ~ ~ 3 1 e , ,
VPH/CMO/80.20
page 26
OESOPHAGUS
Tunours of t h e oesophagus a r e r a r e i n animals except i n geographic a r e a s where t h e canine

oesophageal p a r a s i t e S p i r o c e r c a l u p i e x i s t s and where herbivorous animals have a h i g h i n t a k e of
bracken f e r n (Pteridium aquilinum) .
The e x t e n t of d i s e a s e i s a s s e s s e d by c l i n i c a l examination, radiography of t h e t h o r a x and
endos copy.
STOMACH
I n single-stomached animals t h e r e a r e two r e g i o n s and t h e tumour i s assigned t o t h a t r e g i o n

i n which t h e bulk o f it i s s i t u a t e d .
(a) anterior half

(b) posterior half
I n h e r b i v o r e s t h e anatomical s i t e i s recorded e.g. rumen, abomasum.
The e x t e n t of d i s e a s e i s a s s e s s e d by c l i n i c a l examination, radiography of t h e t h o r a x and

endoscopy o r laparotomy.
The r e g i o n a l lymph nodes a r e t h e g a s t r i c and s p l e n i c nodes.
PANCREAS
The e x t e n t of d i s e a s e i s a s s e s s e d by laparotomy o r laparoscopy, and radiography of t h e

thorax.
The r e g i o n a l lymph nodes a r e t h e s p l e n i c and h e p a t i c nodes.
LIVER
The e x t e n t of d i s e a s e i s a s s e s s e d by c l i n i c a l examination, radiography of t h e t h o r a x ,

and laparotomy o r laparoscopy.
The r e g i o n a l lymph nodes are t h e h e p a t i c and diaphragmatic nodes.
INTESTINES
The e x t e n t of d i s e a s e i s a s s e s s e d by c l i n i c a l examination, radiography of t h e t h o r a x

and subsequent laparotomy.
The r e g i o n a l lymph nodes a r e t h e mesenteric, c a e c a l , c o l i c and r e c t a l nodes.
*With t h e exception of tumours of t h e p a n c r e a s , i n t h e c a s e of m u l t i p l e tumours t h e symbol

(m) i s added t o t h e a p p r o p r i a t e T category.
VPH/CMO/~~.~O
page 27
CLINICAL STAGES (TNM) OF TUMOURS OF THE OESOPHAGUS (ALL SPECIES)
Case number .................... Name of owner ......................... ...............

Date
( 1 kg = 2.2 l b s ) .... kgs

cannot be met t h e symbols TX, NX and MX should b e used.)
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, endoscopy

T: Primary Tumour
T1 Tumour confined t o t h e oesophagus
T2 Tumour invading neighbouring s t r u c t u r e s
The symbol (m) added t o t h e a p p r o p r i a t e T category i n d i c a t e s m u l t i p l e tumours.
NO No evidence of EUN involvement

N1 RLN involved
l
MO No evidence o f d i s t a n t m e t a s t a s i s
M1 Distant metastasis detected - specify site(s): ........................................
STAGE GROUPING: No s t a g e grouping is a t p r e s e n t reconmended
Comments: .....................................................................................
*The U a r e :
- f o r t h e c e r v i c a l oesophagus, t h e c e r v i c a l and p r e s c a p u l a r nodes

- f o r t h e t h o r a c i c oesophagus, t h e m e d i a s t i n a l nodes
VPH/CM0/80.20
page 28

( 1 kg = 2 . 2 l b s ) .... kgs
cannot be m e t t h e symbols TX, NX and MX should b e used. )
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination (laparotomy o r laparoscopy, endoscopy)

N c a t e g o r i e s : S u r g i c a l examination (laparotomy, laparoscopy)
T: Primarv Tumour
T1 Tumour n o t invading s e r o s a
T2 Tumour invading s e r o s a
N: Regional Lymph Nodes (m)*

N1 RLN involved
N2 D i s t a n t LN involved+
M: D i s t a n t Metastasis
M1 Distant metastasis detected - specify s i t e ( s ) : ......................................
STAGE GROUPING: No s t a g e grouping i s a t p r e s e n t recommended
Comments: .....................................................................................
...............................................................................................
*The RLN a r e t h e g a s t r o s p l e n i c nodes
I
VPH/CMO/80.20
page 29
CLINICAL STAGES (TNM) OF TUMOURS OF THE PANCREAS

(ALL SPECIES)
Case number .................... ........................

N a m e o f owner Date ................
Species .......... Age ........ Sex .... Breed ...................... Body weight ..... l b s
( 1 kg = 2.2 l b s ) ..... kgs

cannot be met t h e sjrmbels TX, XX and MX should be used.)
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination (laparotomy o r laparoscopy)

N c a t e g o r i e s : S u r g i c a l examination (laparotomy , laparoscopy)
T: Primary Tumour
T1 Tumour p r e s e n t - state anatomical s i t e :
N: Regional Lymph Nodes ( m ) *
NO No evidence of RLN involvanent

NI RLN involved
I
N2 D i s t a n t LN involved
K: Distant Metastasis
M1 Distant metastasis detected - specify site(s): ......................................
STAGE GROUPING: No s t a g e grouping is a t p r e s e n t recommended.
Comments: .....................................................................................
P-
*The RLN a r e t h e s p l e n i c and h e p a t i c nodes

VPH/CM0/80.20
page 30
CLINICAL STAGES (TNM) OF TUMOIJElS OF THE LIVER

(ALL SPECIES)

( 1 kg = 2.2 l b s ) .... kgs
The following a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . (If t h e s e


M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of t h o r a x
T: Primary Tumour
T1 Tumour i n v o l v i n g one l o b e
T2 Tumour i n v o l v i n g more than one l o b e
NO No evidence o f RLN involvement

N1 RLNinvolved
STAGE GROWING: No s t a g e grouping i s a t p r e s e n t recommended
Comments: .....................................................................................
...............................................................................................
...............................................................................................
*The RLN a r e t h e h e p a t i c and diaphragmatic nodes

VPH/CM0/80.20
page 31
CLINICAL STAGES (TNM) OF TUMOURS OF THE INTESTINES

(ALL SPECIES)
1 Case number .................... Name of owner ........................ Date ...............

( 1 kg = 2.2 l b s ) .... kgs
The following a r e t h e minimum requirements f o r a s s e s s i n g the T, N and M categories. ( I f these


N c a t e g o r i e s : Surgical examination (laparotomy, laparoscopy)
M categories : C l i n i c a l and s u r g i c a l examination, radiography of thorax
T: Primary Tumour
T1 Tumour not invading s e r o s a
T2 Tumour invading serosa
The symbol (m) added t o t h e appropriate T category i n d i c a t e s multiple tumours.

N1 RLN involved t
N2 Distant LN involved
M1 Distant m e t a s t a s i s detected - specify s i t e ( s ) : ......................................
STAGE GROUPING: No s t a g e grouping is a t present reconmended
Comments: .....................................................................................
*The E&N a r e t h e mesenteric, caecal, c o l i c and r e c t a l nodes

VPH/CMO/~O.
20
page 32
6. UROLOGICAL SYSTEM
KIDNEY AND BLADDER
As w e l l a s c l i n i c a l examination, radiography of t h e t h o r a x and laparotomy, techniques such

a s lymphangiography o r a r t e r i o g r a p h y may b e h e l p f u l i n t h e assessment of t h e s e tumours. For
b l a d d e r tumours cystoscopy, urography and cystography a r e of c o n s i d e r a b l e v a l u e . It i s recog-
n i z e d t h a t f a c i l i t i e s f o r t h e s e techniques a r e n o t uniformly a v a i l a b l e and v e t e r i n a r y c l i n i c i a n s
who do n o t have them cannot c l a s s i f y t h e s e tumours according t o t h e system proposed.
I n t h e c a s e o f m u l t i p l e tumours of t h e b l a d d e r , t h e symbol (m) i s added t o t h e a p p r o p r i a t e

T category.
The r e g i o n a l lymph nodes f o r t h e kidney a r e t h e lumbar nodes and f o r t h e b l a d d e r , t h e

e x t e r n a l and i n t e r n a l i l i a c lymph nodes.
VPH/CM0/80.20
page 33
Case number ..................... Name of owner ........................ Date ................

Age .......... Sex ..... Breed ........................................ Body weight ..... l b s
( 1 kg = 2.2 l b s ) ..... kgs
The following a r e t h e minimum requirements f o r ass.essing t h e T, N and M c a t e g o r i e s . ( I f these

cannot b e met, t h e symbols TX. NX and MX should b e used. )

T: Primary Tumour
TO No evidence of tumour T3 Tumour invading p e r i n e p h r i c s t r u c t u r e s

(peritoneum) andlor p e l v i s , u r e t e r a n d l o r
T1 Small tumour w i t h o u t deformation r e n a l blood v e s s e l s ( r e n a l v e i n )
of t h e kidney
T2 S o l i t a r y tumour with deformation
a n d l o r enlargement of t h e kidney
N: Regional Lymph Nodes (RLN)* I
NO No evidence of. RLN involvement NZ B i l a t e r a l RLN involved
N1 I p s i l a t e r a l RLN involved N3 Other LN involved (abdominal and p e l v i c LN)
M1 Distant metastasis detected - specify Mla S i n g l e m e t a s t a s i s i n one organ

site(s) ............................ Mlb M u l t i p l e m e t a s t a s e s i n one organ
.................................... Mlc M u l t i p l e m e t a s t a s e s i n v a r i o u s organs
STAGE GROUPING: No s t a g e grouping i s a t p r e s e n t recommended.
--- - ~
Comments: .....................................................................................
.................................................................................................
*The RLN a r e t h e lumbar nodes

V P H / C M O / ~ O . 20
page 34
CLINICAL STAGES (TNM) OF CANINE TUMOUPS OF THE URINARY BLADDER
Case number .................... Name of owner ........................ Date ................

Age .......... Sex ..... Breed ....................................... Body weight ..... l b s
( 1 kg = 2.2 l b s ) ..... kgs

cannot b e met, t h e symbols TX, NX and MX should b e used.)
T c a t e g o r i e s : C l i n i c a l examination, cystoscopy, urography o r cystography, laparotomy.

N c a t e g o r i e s : S u r g i c a l examination (laparotomy o r laparoscopy)
M c a t e g o r i e s : C l i n i c a l examination, radiography of thorax, laparotomy
Primary Tumour
Tis Carcinoma --
in situ T2 Tumour invading t h e b l a d d e r w a l l , with
induration
T3 Tumour invading neighbouring organs
T1 S u p e r f i c i a l p a p i l l a r y tumour ( p r o s t a t e , u t e r u s , vagina, a n a l c a n a l )
N: Regional Lymph Nodes (W)*
NO No evidence of RLN involvement N2: RLN and l u x t a RLN involved
N1 RLN involved
M1 Distant metastasis detected - specify s i t e ( s ) : ....................................

STAGE GROUPING: No s t a g e grouping i s a t p r e s e n t recommended.
Comments: ......................................................................................
*The PLN a r e t h e i n t e r n a l and e x t e r n a l i l i a c nodes. The j u x t a RLN a r e the lumbar nodes

VPH/CM0/80.20
page 35
7(a). FEMALE G E N I T A L SYSTEM
OVARY
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l examination and t h e f i n d i n g s a t o p e r a t i o n ,

b u t b e f o r e d e f i n i t i v e treatment i s commenced. Radiography of t h e thorax i s mandatory. It i s
recognized t h a t some c a s e s w i l l remain u n c l a s s i f i e d .
The r e g i o n a l lymph nodes a r e r h e lumbar nodes.
UTERUS
C e r v i c a l tumours a r e v e r y r a r e i n animals and no s t a g i n g c l a s s i f i c a t i o n i s provided. Uterine

tumours a r e i n f r e q u e n t.
There a r e two a r e a s c f t h e u t e r u s , t h e body and horns.
The e x t e n t of d i s e a s e i s a s s e s s e d by c l i n i c a l examination, radiography of t h e t h o r a x

and laparoscopy o r laparotomy.
I n t h e c a s e of m u l t i p l e tumours, t h e symbol (m) i s added t o t h e a p p r o p r i a t e T c a t e g o r y .
The r e g i o n a l lymph nodes a r e t h e i n t e r n a l and e x t e r n a l i l i a c and sub-lumbar and s a c r a l nodes
VAGINA AND VULVA
Tumours of t h e v u l v a a r e c l a s s i f i e d a s t h o s e of s k i n . Tumours p r e s e n t i n t h e vagina a s

secondary growths from e i t h e r g e n i t a l o r e x t r a - g e n i t a l s i t e s should b e excluded.
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l examination and/or f o l l o w i n g s u r g i c a l

exposure, and radiography o f t h e thorax is r e q u i r e d .
I
I n t h e c a s e of m u l t i p l e tumours, t h e symbol (m) i s added t o t h e a p p r o p r i a t e T category.
The r e g i o n a l lymph nodes a r e t h e s u p e r f i c i a l i n g u i n a l , s a c r a l and i n t e r n a l i l i a c nodes.

VP~/~~0/80.20
page 36
CLINICAL STAGES (TNM) OF CANINE TUMOURS OF THE OVARY*

Breed ................................. Body weight .... l b s
( 1 kg = 2.2 l b s ) .... kgs
The f o l l o w i n g a r e t h e minimum requirements f o r a s s e s s i n g t h e T , N and M c a t e g o r i e s . ( I f these
cannot be met, t h e symbols TX, NX and MX should be used.)
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examinat i o n (laparotomy , laparoscopy)

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination (laparotorny) and radiography of t h o r a x
T: Primary Tumour
TO No evidence of tumour T3 Tumour invading t h e o v a r i a n b u r s a

T1 Tumour l i m i t e d t o one ovary T4 Tumour invading neighbouring
structures
T2 Tumours l i m i t e d t o both o v a r i e s
N: Regional Lymph Nodes (m)**

N1 RLN involved
M1 Evidence of i m p l a n t a t i o n ( s ) o r o t h e r
metastases:
Mla i n t h e peritoneal cavity
Mlb beyond t h e p e r i t o n e a l c a v i t y - s p e c i f y s i t e ( s ) :
Mlc both p e r i t o n e a l c a v i t y and beyond
Comments: .....................................................................................
*General p r i n c i p l e s apply t o a l l s p e c i e s
**The RLN a r e t h e lumbar nodes
VpH/CMO/ 80.20
page 37
Case number .................... Name or' owner ......................... Date ...............

Species ................ Age .......... Breed ......................... Body weight .... l b s
( 1 kg = 2.2 l b s ) .... kgs

cannot be met, t h e symbols TX, M( and MX should be used.)
T categories : C l i n i c a l and s u r g i c a l examination (laparotomy o r laparoscopy)

N c a t e g o r i e s : Surgical examination (laparotomy o r laparoscopy)
- - -
T: Primary Tumour
T1 Small non-invasive tumour
T2 Large o r i n v a s i v e tumour
The symbol (m) added t o t h e appropriate T category i n d i c a t e s m u l t i p l e tumours

N1 P e l v i c RLN involved
N2 Para-aortic RLN involved
M: D i s t a n t Metastasis
M1 Evidence of m e t a s t a s i s :
Mla i n t h e peritonea1 cavity
Mlb beyond t h e peritonea1 c a v i t y - s p e c i f y s i t e ( s ) : ................................
Mlc i n and beyond t h e p e r i t o n e a l c a v i t y
STAGE GROUPING: No s t a g e grouping i s a t present recommended
Comments: .....................................................................................
*The RLN a r e the p e l v i c nodes d i s t a l t o t h e b i f u r c a t i o n of t h e common i l i a c a r t e r i e s and

intra-abdominal para-aortic nodes proximal t o t h e b i f u r c a t i o n of t h e common i l i a c
arteries.
VPH/~M0/80.20
page 38

Age ............... Breed ......................... Body weight .... l b s
( 1 kg = 2.2 l b s ) .... kgs

cannot be met, t h e symbols TX, NX and MX should b e used.)
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examinat i o n
N c a t e g o r i e s : S u r g i c a l examination
M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography o f thorax
T: Primary Tumour
T1 Tumour 1 cm maximum diameter, s u p e r f i c i a l
T2 Tumour 1-3 cm maximum diameter, w i t h minimal i n v a s i o n
T3 Tumour ) 3 cm o r every tumour w i t h deep i n v a s i o n
T4 Tumour invading neighbouring s t r u c t u r e s ( s k i n , perineum, u r e t h r a , ~ a r a v a ~ i n w a la l l ,
anal canal)
The symbol (m) added t o t h e a p p r o p r i a t e T c a t e g o r y i n d i c a t e s m u l t i p l e tumours
N: Regional Lymph Nodes (RLN)**

N1 Movable, i p s i l a t e r a l nodes
N2 Movable, b i l a t e r a l nodes
N3 Fixed nodes
Comments: .....................................................................................
...............................................................................................
*Tumours p r e s e n t i n t h e vagina a s secondary growths from e i t h e r g e n i t a l o r e x t r a g e n i t a l
s i t e s should be excluded.
**The RLN a r e the s u p e r f i c i a l i n g u i n a l , s a c r a l and i n t e r n a l i l i a c nodes, except t h a t f o r
t h e c r a n i a l p a r t of t h e vagina they a r e only t h e i n t e r n a l i l i a c nodes.
VPH/CM0/80.20
page 34
7 (b ) . MALE GENITAL SYSTEM
TESTIS
Tumours of t h e t e s t i s may b e i n t h e descended t e s t i c l e (scrotum) o r undescended t e s t i c l e

(abdomen o r i n g u i n a l ).
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l examination, radiography of t h e t h o r a x
and ( f o r abdominal t e s t i c l e ) laparotomy.
The r e g i o n a l lymph nodes a r e t h e sub-lumbar, i n g u i n a l nodes.
PENIS
There a r e t h r e e anatomical r e g i o n s :
(a) preputium o r prepuce
(b) glans
(c) s h a f t of p e n i s
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l examination and radiography of t h e

thorax.
The r e g i o n a l l y q h nodes a r e t h e s u p e r f i c i a l i n g u i n a l nodes.
PROSTATE
While h y p e r p l a s i a of t h e p r o s t a t e i s common i n t h e dog malignant p r o s t a t i c tumours i n t h i s

and o t h e r domestic animal s p e c i e s a r e unconnnon.
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l exami~zation, supplemented by (T) urography,

endoscopy o r laparotomy and biopsy, (N) lymphography a n d / o r urography, laparotomy, (M) p e l v i c ,
t h o r a c i c and s k e l e t a l x-rays.
The r e g i o n a l lymph nodes a r e t h e e x t e r n a l and i n t e r n a l i l i a c lymph nodes.

VPH/CM0/80.20
page 40
CLINICAL STAGES (TNM) OF CANINE TUMOURS OF THE TESTIS
Case number .................... Name of owner ......................... Date...............

( 1 kg = 2.2 l b s ) .... kgs
Site : Mark /where applicable
Right t e s t i s
Both t e s t e s Feminization p r e s e n t D
cannot b e met, t h e symbols TX, NX and MX should be used.)
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination (laparotomy f o r abdominal t e s t i c l e only)
-
T: Primary Tumour
T1 Tumour r e s t r i c t e d t o t h e t e s t i s
T2 Tumour invading t h e t u n i c a albuginea
T3 Tumour invading t h e r e t e t e s t i s and/or t h e epididymis
T4 Tumour invading t h e s p e r m a t i c cord and/or t h e scrotum
I
N1 I p s i l a t e r a l RLN involved
N2 C o n t r a l a t e r a l o r b i l a t e r a l RLN involved
M1 Distant metastasis detected - specify s i t e ( s ) : .......................................
Comments: .....................................................................................
*The RLN a r e t h e sub-lumbar, i n g u i n a l nodes

f
V P H / C M O / ~ O .20
page 4 1
CLINICAL STAGES (TNM) OF CANINE TUMOURS OF THE PENIS

(PREFUCE AND GLANS)

( 1 kg = 2.2 l b s ) .... kgs

cannot b e met, t h e symbols TX, NX and MX s h o u l d b e used.)
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of t h o r a x

- - - -
T: Primary Tumour
T1 Tumour < 1 cm maximum diameter, s t r i c t l y superficial
T2 Tumour 1-3 cm maximum diameter w i t h minimal i n v a s i o n
T3 Tumour )3 cm -
o r every tumour w i t h deep i n v a s i o n
The symbol (m) added t o t h e a p p r o p r i a t e T c a t e g o r y i n d i c a t e s m u l t i p l e tumours.
N: Regional Lymph Nodes (UN)*

Movable i p s i l a t e r a l nodes
N2 Movable b i l a t e r a l nodes
N3 Fixed nodes
Comments: .....................................................................................
*The RLN a r e the s u p e r f i c i a l i n g u i n a l nodes

VPH/CMO/~O.ZO
page 42
CLINICAL STAGES (TNM) OF CANINE TUMOURS OF THE PROSTATE

( 1 kg = 2.2 l b s ) .... kgs
The following a r e t h e minimum requirements f o r a s s e s s i n g t h e T , N and M c a t e g o r i e s . (If these

cacnot be met, t h e symbols TX, NX and MX should b e used.
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, urography, endoscopy and biopsy

N c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, lymphography and/or urography
M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of p e l v i s , t h o r a x and s k e l e t o n
T: Primary Tumour
T1 I n t r a c a p s u l a r tumour, surrounded by normal g l a n d
T2 D i f f u s e i n t r a c a p s u l a r tumour
T3 Tumour extending beyond t h e capsule
T4 Tumour f i x e d , o r invading neighbouring s t r u c t u r e s

N1 RLN involved
N2 RLN and j u x t a RLN involved
Comments: .....................................................................................
- -
*The RLN a r e t h e e x t e r n a l and i n t e r n a l i l i a c nodes. The j u x t a RLN a r e t h e lumbar nodes

VPH/CMO/~O.~O
page 43
8. BONES AND JOINTS
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l and r a d i o g r a p h i c examination.

Radiographic examination of t h e a f f e c t e d bone o r j o i n t t o g e t h e r w i t h t h e t h o r a x ( f o r m e t a s t a s e s )
i s mandatory.

~~H/~M0/80.20
page 44
CLINICAL STAGES (TM) OF CANINE / FELINE TUMOURS OF THE BONE

Cat/Dog ..... Age .......... Sex .... Breed .......................... Body weight .... lbs
(1 kg = 2.2 lbs) .... kgs
Circle involved
The following are the minimum requirements for assessing the T and M categories. (If these
cannot be met, the symbols TX and MX should be used.)
T categories : Clinical, surgico-pathological and radiographic examination

M categories : Surgico-pathological examination, radiography of thorax
t
T: Primary Tumour

T1 Tumour confined within the medulla and cortex
T2 Tumour extends beyond the periosteum
Multiple tumours should be classified independently.
MO No evidence of distant metastasis

M1 Distant metastasis detected - specify site(s): ......................................
STAGE GROWING: No stage grouping is at present recommended
Comments: .....................................................................................
...............................................................................................
V~~/CM0/80.20
page 45
CLINICAL STAGES (TNM) OF CANINE AND FELINE TUMOURS OF JOINTS AND ASSOCIATED STRUCTURES
(TENDONS,TENDON SHEATHS ETC. )

Species ..... Age .......... Sex .... Breed ........................... Body weight .... l b s
( 1 kg = 2.2 l b s ) .... kg s
The following a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . (If t h e s e

cannot b e met t h e symbols TX, NX and MX should be used.
T c a t e g o r i e s : C l i n i c a l , s u r g i c o - p a t h o l o g i c a l and r a d i o g r a p h i c examination
N c a t e g o r i e s : C l i n i c a l and s u r g i c o - p a t h o l o g i c a l examination
M c a t e g o r i e s : Surgico-pathological examination, radiography of thorax
p - - - - -
T: Primary Tumour
T1 Tumour well-def ined, no i n v a s i o n of surrounding t i s s u e s
T2 Tumour invading s o f t t i s s u e s
T3 Tumour invading j o i n t s and/or bones
~ ut ilp l e tumours should be c l a s s i f i e d independently

I
l N1 RLN involved**
1 M: Distant Metastasis
M1 Distant metastasis detected - specify s i t e ( s ) : .......................................
Comments: .....................................................................................
kThe RLN a r e a s d e s c r i b e d i n t h e i n t r o d u c t i o n t o s k i n (page 1 2 )

**(-l = h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e .
VPH/CM0/80.20
page 46
9. LYMPHOID AND HAEMATOPOIETIC TISSUES
( i n c l u d i n g lymphosarcoma o f s k i n )
Lymphosarcoma i n most domestic mammals f a l l s i n t o d i s t i n c t anatomic t y p e s : g e n e r a l i z e d

lymphadenopathy, organs and nodes of t h e a l i m e n t a r y t r a c t , thymus, s k i n , t r u e lymphatic leukemia
and o c c a s i o n a l l y o t h e r s i t e s such a s r e n a l t i s s u e o r eye o n l y .
The TNM system cannot b e used. A h i s t o l o g i c a l c l a s s i f i c a t i o n i s e s s e n t i a l and a t t e m p t s

should be made t o t y p e t h e s e tumours immunologically a s w e l l .
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l , r a d i o g r a p h i c and haematological

examination and i s d e s c r i b e d a s w i t h o r without s y s t e m i c s i g n s e.g. dyspnoea, dysentery. The
recommended method f o r biopsy i n m u l t i c e n t r i c lymphosarcoma i s t o e x c i s e an e n t i r e node e.g.
p o p l i t e a l , prescapular ( s u p e r f i c i a l c e r v i c a l ) .
~PH/CM0/80.20
page 47
CLINICAL STAGES OF LYMPHOSARCOMA AND LYblFHOID LEUKAEMIA I N DOMESTIC MAEWLS*

( INCLUDING LYMPHOSMKOMA OF SKIN)
Case number ............... Name of owner ......................... Date .................
Species ............... Age .......... Sex .... Breed ................ Body weight ..... l b s
( 1 kg = 2.2 l b s ) .... kgs
The e x t e n t of d i s e a s e i s a s s e s s e d by c l i n i c a l , r a d i o g r a p h i c and haematological examination.
1. ANATOMI C TYPE
A. Generalized
B. Alimentary
C. Thymic
D. Skin
E. Leukaemia (True)**
F. Others ( i n c l u d i n g s o l i t a r y r e n a l )
2. STAGE GROUPING ( t o i n c l u d e anatomic t y p e )
I Involvement l i m i t e d t o a s i n g l e node o r lymphoid t i s s u e i n a s i n g l e organ***
I1 Involvement of many lymph nodes i n a r e g i o n a l a r e a (2 tonsils)
I11 Generalize6 lymph node involvement
IV L i v e r a n d l o r s p l e e n involvement '(2 Stage 111)
V M a n i f e s t a t i o n i n t h e blood and involvement of bone marrow and/or o t h e r organ

systems ( 2 Stages I-IV)
Each s t a g e i s s u b c l a s s i f i e d i n t o :
(a) w i t h o u t systemic s i g n s , o r (b) w i t h systemic s i g n s
Comments: .....................................................................................
...............................................................................................
...............................................................................................
"Excluding myeloma
**Only blood and bone marrow involved
***Excluding bone marrow
V ? H / ~ > l 0 / 8 0 . '20
page 48
10. RESPIRATORY SYSTEM
NASAL CHAMBER AND SINUSES
The n a s a l chamber e x t e n d s from t h e e x t e r n a l n o s e a n t e r i o r l y i n c l u d i n g t h e a l a e t o t h e

oropharynx p o s t e r i o r l y . P a r a n a s a l s i n u s e s i n c l u d e f r o n t a l and m a x i l l a r y i n a l l s p e c i e s , p l u s
s p h e n o p a l a t i n e and ethmoidal s i n u s e s i n t h e h o r s e .
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l and r a d i o g r a p h i c examination.
I n t h e c a s e o f m u l t i p l e tumours, t h e symbol (m) i s added t o t h e a p p r o p r i a t e T category.
The r e g i o n a l lymph nodes a r e t h e submandibular, a n t e r i o r c e r v i c a l and pharyngeal nodes.
LARYNX, TRACHEA AND LUNGS
Primary tumours of t h e l a r y n x , t r a c h e a and lungs a r e r a r e i n animals. I n some geographi-

c a l r e g i o n s t h e r e i s a h i g h i n c i d e n c e i n sheep of j a a g s i e k t e , a h o r i z o n t a l l y t r a n s m i s s i b l e
disease.
The e x t e n t of disease i s a s s e s s e d by c l i n i c a l examination, endoscopy and radiography of

t h e thorax.
Mu1t i p l e tumours of t h e lungs should be c l a s s i f i e d independent1y .

The r e g i o n a l lymph nodes a r e t h e a n t e r i o r c e r v i c a l and pharyngeal ( l a r y n x and a n t e r i o r
t r a c h e a ) and i n t r a t h o r a c i c nodes ( t r a c h e a , l u n g s ) .
VFH/CM0/80.20
page 49
CLINICAL STAGES (TNM) OF CANINE M D FELINE TUMOURS OF THE NASAL CHAMBER AND SINUSES
Case number .................... Name of owner ..................... ;... Date ...............

Species .......... Age .......... Sex ... Breed ....................... Body weight .... l b s
( 1 kg = 2.2 l b s ) .... kgs
cannot be m e t t h e symbols TX, NX and MX should b e used.)
T c a t e g o r i e s : C l i n i c a l , s u r g i c a l and r a d i o g r a p h i c examination , x i s
N c a t e g o r i e s : C l i n i c a l examinat i o n
M c a t e g o r i e s : C l i n i c a l examination, radiography of t h o r a x
Primary Tumour
T1 Tumour i p s i l a t e r a l , minimal o r no bone d e s t r u c t i o n
T2 Tumour b i l a t e r a l and/or moderate bone
destruction
T3 Tumour invading neighbouring t i s s u e s
The symbol (m) added t o t h e a p p r o p r i a t e T category

i n d i c a t e s mu1 t i p l e tumours
Regional Lymph Nodes (RLN)*

C i r c l e s i t e ( s ) involved
Nla Nodes n o t considered t o c o n t a i n growth*"
Nlb Nodes considered t o c o n t a i n growth*"
N2a Nodes n o t considered t o c o n t a i n growth**
N3 Fixed nodes
M1 D i s t a n t m e t a s t a s i s d e t e c t e d ( i n c l u d i n g d i s t a n t nodes) - specify site(s1 .............
STAGE GROUPING: No s t a g e grouping is a t p r e s e n t recommended
.............................
Comments: ....................................................................................
*The r e g i o n a l lymph nodes a r e t h e submandibular, a n t e r i o r c e r v i c a l and pharyngeal nodes

**(-) =' h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e
VPH/CM0/80.20
page 50

species ........ Age :......... Sex .... Breed ........................ Body weight .... l b s
( 1 kg = 2 . 2 l b s ) .... kgs
P - - -
The following a r e t h e minimum requirements f o r a s s e s s i n g t h e T , N and M c a t e g o r i e s . (If these

T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, endoscopy, bronchoscopy, radiography

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examinat ion, radiography o f thorax
T: Primary Tumour
TX Tumour proven by presence of malignant c e l l s i n bronchopulmonary s e c r e t i o n s b u t n o t
seen by radiography o r bronchoscopy
T1 S o l i t a r y tumour surrounded by lung o r v i s c e r a l p l e u r a
T2 M u l t i p l e tumours of any s i z e
T3 Tumour invading neighbouring t i s s u e s
Mu1 t i p l e tumours should b e c l a s s i f i e d independently ( a p p l i c a b l e t o l u n g s only)

N1 Bronchial LN involved
Comments: .....................................................................................
*Thelegional lymph nodes f o r t h e l a r y n x and a n t e r i o r t r a c h e a a r e t h e a n t e r i o r c e r v i c a l and

and pharyngeal nodes; f o r t h e t r a c h e a and lungs they a r e t h e i n t r a t h o r a c i c , nodes
VPH/CM0/80.20
page 5 1
11. ENDOCRINE GLANDS
THYROID GLAND
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l examination, radiography of the t h o r a x ,

endoscopy and r a d i o - i s o t o p e scanning. % e r e must b e h i s t o l o g i c a l v e r i f i c a t i o n .
The r e g i o n a l lymph nodes are t h e c e r v i c a l nodes.
ADRENAL GLANDS
The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l examination, radiography of t h e t h o r a x ,

endoscopy and hormonal a s s a y s .
l
The r e g i o n a l lymph nodes a r e t h e lumbar nodes.
VPH/CMO/ 80.20
page 52
CLINICAL STAGES (TNN) OF CANINE TUMOURS OF THE THYROID GLAND

Age .......... Sex ..... Breed ........................................ Body weight .... l b s
( 1 kg = 2.2 l b s ) .... kgs
LOCATION: * LEFT RIGHT BOTH
1
The f o l l o w i n g a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . ( I f these
cannot be met, t h e symbols TX, NX and MX should b e used.)
T c a t e g o r i e s : C l i n i c a l , s u r g i c a l and r a d i o g r a p h i c examination, endoscopy, r a d i o - i s o t o p e

S canning
M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography. of thorax, r a d i o - i s o t o p e
S canning
T: Primary Tumour
T1 Tumour < 2 cm maximum diameter : T l a n o t f i x e d , Tlb f i x e d
T2 Tumour 2-5 cn: maximum diameter : T2a n o t f i x e d , t l b f i x e d
T3 Tumour ) 5 cm maximum diameter : T3a not fixed T3b fixed
N: Regional Lvm~hNodes (RLN)**

N1 I p s i l a t e r a l RLN ihvolved : Nla n o t fixed*** Nlb fixed***
N2 B i l a t e r a l U N involved : N2a n o t fixed*** N2b fixed***
Assessment: Clinical ...... Radiographic ....... Histological .......
STAGE GROUPING : T N
I Tla,b NO(-) o r Nla(-)
o r N2a(-)
I1 TO NI(+)
Tla,b N 1 (+)
T2a,b NO(+) o r Nla(+)
I11 Any T3 Any N
Any T Any Nb
IV Any T Any N
Comments: .......................................................................................
*When both glands a r e i n v o l v e d , s e p a r a t e s t a g i n g forms should be used f o r each

**The RLN a r e t h e c e r v i c a l nodes
***(-) = h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e
VPH/CMO/~G.EO
page 53
CLINICAL STAGES (TNM) OF CANINE TUMOURS OF THE ADRENAL GLANDS

Age .......... Sex ... Breed .......................................... Body weight .... lbs
( 1 kg = 2.2 l b s ) .... kgs
cannot be met, t h e symbols TX, NX and MX should be used.)
T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of primary s i t e , hormonal assays

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of t h o r a x , hcrmonal a s s a y s
Circle. appropriate category
T: Primary Tumour
T1 Well-defined tumour
T3 Tumour invading blood v e s s e l s

N1 RLN involved
I
Comments: .....................................................................................
*The RLN a r e t h e lumbar nodes

Guidilene Linfoma PDF

Uploaded by

Copyright:

Available Formats

You might also like

Guidilene Linfoma PDF

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Guidilene Linfoma PDF

Uploaded by

Copyright:

Available Formats

WORLD HEALTH ORGANIZATION

The anatomical sites . 11

Skin (excluding lymphosarcoma and mastocytoma) 12

Head and neck 21

Alimentary system, pancreas, liver . 26

Bones and joints . 43

Lymphoid and haemopoietic tissues (including lymphosarcoma of skin) . 46

Endocrine glands (thyroid, adrenal) . 51

An International Histological Classification of Tumours of Domestic Animals

The TNM Classification of Malignant Tumours in man was first published in

In ~articular,this classification records the manv malignant tumours in

'Bull. Wld Hlth Org. 1976, 50, (1-2)

Dr R.S. Brodey, University of Pennsylvania School of Veterinary Medicine, Philadelphia,

THE PURPOSE OF CLASSIFICATION

The p r a c t i c e of d i v i d i n g c a n c e r cases i n t o groups according t o " s t a g e s " has a l r e a d y been

The p r i n c i p a l purpose of i n t e r n a t i o n a l agreement on c l a s s i f i c a t i o n of cancer c a s e s by

The v e t e r i n a r y c l i n i c i a n ' s t a s k i s t o make a p r o v i s i o n a l prognosis and a d e c i s i o n on t h e

The o b j e c t i v e s of s t a g i n g animal tumours a r e :

To meet t h e s e o b j e c t i v e s a system of c l a s s i f i c a t i o n i s r e q u i r e d (1) i n which t h e b a s i c

The TNM system meets t h e s e requirements. It provides an e s s e n t i a l communication and

THE TNM SYSTEM

The TNM system i s based on t h e assessment o f :

The a d d i t i o n of numbers t o t h e s e t h r e e components (e.g. T 1 , T2 ... e t c . , NO, N 1 ... e t c . ,

For example, a v e t e r i n a r i a n f a m i l i a r w i t h t h e system might d e s c r i b e a dog w i t h cancer of

I n o t h e r words it i s a kind of shorthand n o t a t i o n f o r t h e d e s c r i p t i o n of a malignant

1. I n a l l c a s e s confirmation of malignancy by h i s t o l o g i c a l o r c y t o l o g i c a l examination is

A t many s i t e s s e v e r a l d i s t i n c t types of c a n c e r may occur, d i f f e r i n g n o t only i n t h e i r

An example i s cancer of t h e mammary gland of t h e dog. W e l l d i f f e r e n t i a t e d t u b u l a r adeno-

2. A l l c a s e s a r e i d e n t i f i e d by T , N and M c a t e g o r i e s , which must b e determined and recorded

The reason f o r t h i s i s c l e a r . The c o n d i t i o n of many animals w i t h cancer p r e c l u d e s surgery

The TNM system i n man d e s c r i b e s two c l a s s i f i c a t i o n s f o r each s i t e :

For most tumours t h e pTNM c a t e g o r i e s correspond t o t h e TNM c a t e g o r i e s b u t d i f f e r e n c e s have

It i s recognized, however, e s p e c i a l l y i n t h e a l l o c a t i o n of animals w i t h c e r t a i n tumours

3. I n t h e c l i n i c a l assessment of an animal tumour numerous i n v e s t i g a t i o n s may b e done. It i s

4. A f t e r a s s i g n i n g T, N and M c a t e g o r i e s (with d e g r e e of e x t e n s i o n ) t h e s e may b e grouped i n t o

It i s obvious t h a t tumours of some s i t e s l e n d themselves more e a s i l y and s a t i s f a c t o r i l y t o

It i s necessary t h e r e f o r e t h a t , although t h e r u l e s of t h e TNM system s h o u l d be r i g i d l y

PRIMARY TUMOUR (T)

T1, T2, T3, T 4 i n d i c a t e i n c r e a s i n g degrees of e x t e n t of t h e primary tumour. The number

1. The tumours e a s i e s t t o c l a s s i f y a r e t h o s e which a r i s e i n a s i n g l e organ. I n these the

I n t h e mannnary gland of t h e dog f o r i n s t a n c e , t h e t h r e e main q u a l i t i e s w h i c h . d e t e m i n e t h e

It i s n o t known i f t h e l o c a l i z a t i o n of t h e tumour w i t h i n t h e mammary g l a n d ( s ) i s as impor-

2. A second group of tumours o c c u r s i n s i t u a t i o n s which a r e n o t s o circumscribed and i n which

3. A t h i r d t y p e cannot b e diagnosed a t a l l w i t h o u t t a k i n g o p e r a t i v e f i n d i n g s i n t o account, e.g.

M u l t i p l e tumours have t o be c o n s i d e r e d under s e v e r a l headings:

TO means "no evidence of primary tumour". This category i s necessary t o cover c a s e s

TX means t h a t i t i s impossible t o a s s e s s f u l l y t h e e x t e n t of t h e primary tumour.

REGIONAL LYMPH NODES (NI

N 1 , N2, N3 i n d i c a t e t h e c h a r a c e r i s t i c s of lymph nodes, which may be a s s e s s e d by p a l p a t i o n ,

NO No p a l p a b l e r e g i o n a l lymph nodes, i . e . no r e g i o n a l lymph nodes a r e p a l p a b l e o r t h e y

H i s t o l o g i c a l information concerning t h e s t a t e of t h e lymph nodes obtained from a biopsy o r

When r e g i o n a l lymph nodes a r e p a l p a b l e they must b e c l a s s i f i e d a s N 1 o r N2 b u t an examining

DISTANT FIETASTASES (M)

The absence o r presence of m e t a s t a s e s i s i n d i c a t e d by t h e l e t t e r M.

H i s t o p a t h o l o g i c a l e x t e n t (P) and g r a d i n g (G)

For example, f o r tumours of some hollow organs t h e h i s t o p a t h o l o g i c a l e x t e n t i s expressed

P1 Tumour confined t o t h e mucosa