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TNM
Supplement
Companion website
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 Union for International Cancer Control

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TNM
Supplement
A Commentary on Uniform Use
F i fth E d i tion

EDITED BY
Christian Wittekind
Leipzig, Germany

James D. Brierley
Toronto, ON, Canada

Anne Lee
Hong Kong, China

Elisabeth van Eycken

Brussels, Belgium
This edition first published 2019 © 2019 UICC
Published 2019 by John Wiley & Sons Ltd

This work is a co‐publication between the UICC and John Wiley & Sons, Ltd

Edition History
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ISBN 978‐1‐4443‐3243‐8 John Wiley & Sons, Ltd Oxford 2012

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Library of Congress Cataloging‐in‐Publication Data

Names: Wittekind, Ch. (Christian), editor. | Brierley, James, editor. | Lee, A. W. M. (Anne W. M.), editor. |
Eycken, E. van, editor. | Union for International Cancer Control, issuing body.
Title: TNM supplement : a commentary on uniform use / edited by Ch. Wittekind,
J.D. Brierley, Anne Lee, Elisabeth van Eycken.
Other titles: Tumour-node-metastasis supplement
Description: Fifth edition. | Hoboken, NJ : Wiley-Blackwell ; [Geneva, Switzerland] : UICC, 2019. |
Includes bibliographical references and index. |
Identifiers: LCCN 2019003455 (print) | LCCN 2019005429 (ebook) | ISBN 9781119263944
(Adobe PDF) | ISBN 9781119263920 (ePub) | ISBN 9781119263937 (pbk.)
Subjects: | MESH: Neoplasms–classification
Classification: LCC RC258 (ebook) | LCC RC258 (print) | NLM QZ 15 | DDC 616.99/40012–dc23
LC record available at https://lccn.loc.gov/2019003455

Cover image: © UICC

Cover design by Wiley

Set in 9.25/13 pt Frutiger Light by SPi Global, Pondicherry, India

10 9 8 7 6 5 4 3 2 1
CONTENTS

Preface, viii
Organizations Associated with the TNM System, xiii
National Committees, xiii
Acknowledgements, xv
Abbreviations, xvi

Chapter 1 EXPLANATORY NOTES – GENERAL

The General Rules of the TNM System, 1
The TNM Clinical and Pathological Classifications, 7
Residual Tumour (R) Classification, 15
Additional Descriptors, 20
Optional Descriptors, 24
Unknown Primary, 25
Staging of Tumours for Which No TNM Classification is Provided, 25
Histopathological Grading, 26
References, 28

Chapter 2 EXPLANATORY NOTES – SPECIFIC

ANATOMICAL SITES
Head and Neck Tumours, 34
Digestive System Tumours, 54
Lung, Pleural and Thymic Tumours, 85
Bone Tumours, 104
Soft Tissue Tumours, 106
Gastrointestinal Stromal Tumour (GIST), 108
Skin Tumours, 110
Breast Tumours, 118
Gynaecological Tumours, 122
Urological Tumours, 131
Ophthalmic Tumours, 142
Hodgkin and Non‐Hodgkin Lymphomas, 149
References, 150

v
vi CONTENTS

Chapter 3 SITE‐SPECIFIC REQUIREMENTS

FOR pT AND pN
Introduction, 157
Head and Neck Tumours, 160
Digestive System Tumours, 166
Lung and Pleural Tumours, 173
Tumours of Bone and Soft Tissues, 176
Skin Tumours, 179
Breast Tumours, 183
Gynaecological Tumours, 185
Urological Tumours, 188
Adrenal Cortex Tumours, 192
Ophthalmic Tumours, 193
Hodgkin and Non‐Hodgkin Lymphomas, 195
References, 196

Chapter 4 NEW TNM CLASSIFICATIONS RECOMMENDED

FOR TESTING AND OTHER CLASSIFICATIONS
Introduction, 198
General, 198
Specific, 198
Non Upper Aerodigestive Tract Mucosal Melanoma, 199
Primary Liver Carcinoma of Infants and Children/Hepatoblastoma, 200
Primary Cutaneous Lymphomas, 202
Cutaneous T‐Cell Lymphomas, 202
Primary Cutaneous Lymphomas, 203
Histopathologic Staging of Lymph Nodes in Mycosis Fungoides and Sézary
Syndrome, 204
Primary Cutaneous B‐Cell/T‐Cell Lymphoma (Non‐MF/SS Lymphoma), 206
Multiple Myeloma, 207
Leukaemia, 208
References, 208

Chapter 5 OPTIONAL PROPOSALS FOR TESTING NEW

SUBCATEGORIES OF TNM
All Tumour Sites, 210
Head and Neck Tumours, 210
Digestive System Tumours, 211
Lung Tumours, 213
Breast Tumours (ICD‐0‐3 C50), 214
 CONTENTS vii

Gynaecological Tumours, 215

Urological Tumours, 215
References, 216

Chapter 6 FREQUENTLY ASKED QUESTIONS

General Questions, 218
Site‐Specific Questions, 229
References, 289

Index, 291
Plate section facing p. 48
PREFACE

First published in 1987 [1], and revised in 1992 [2], the fourth edition of the
TNM Classification of Malignant Tumours was the result of a push from all
national TNM committees towards the establishment of a uniform classification
system that could be used worldwide. It was, therefore, the first edition of the
text in which the featured classification criteria were identical to those detailed
in the fourth edition of the AJCC’s Manual for Staging of Cancer of the American
Joint Committee on Cancer [3].
Although the classification system was, by 1987, widely accepted, medical
professionals had pointed out that some of its definitions and rules for staging
were imprecise and could lead to inconsistency in its application. Discrepant
understandings of organ classifications, general rules and, in particular, the
requirements of pathological classification (pT, pN) were all potential risks.
In an effort to address these concerns, the TNM Project Committee of the
UICC collected and reviewed criticisms and suggestions from the national TNM
committees, as well as from registries, oncological associations and individual
users. The solution that they found was to complement the fourth edition of the
TNM Classification [1, 2] with the publication of a new book: the TNM
Supplement [4]. Designed to provide guidance on the uniform use of the clas-
sification system, the first edition of this new text was published in 1993.
By 1997, the TNM Classification was in its fifth edition [5], though most
descriptions of tumour sites had remained largely unchanged, with only minor
additions made so as to reflect new data on prognosis and new methods of
outcome assessment. The TNM Project Committee of the UICC was aware that
not all classification proposals and updates received could be included in this
fifth edition and so the decision was made to produce another TNM Supplement
within which they may be accommodated [6]. The second edition of the TNM
Supplement therefore comprised, for the most part, of the first edition’s con-
tents, amended to include a number of new items.
Retaining much of its predecessor’s content, the sixth edition of the TNM
Classification [7] again featured only small revisions but was elaborated upon in
a third edition of the TNM Supplement [8].
The TNM Classification’s seventh edition [9] saw the inclusion of several novel
tumour classifications. While comments on the new entities and modifications
concerned had been published elsewhere [10], it was nevertheless deemed

viii
 Preface ix

important to highlight and examine these with a fourth edition of the TNM
Supplement [11].
In the current, eighth edition of the TNM Classification [12], the featured tumour
sites are much the same as those found in the book’s previous edition. Some hitherto
unexamined tumour entities and anatomic sites have, however, been introduced,
while others have seen their analyses modified and revised to take account of new
data on prognosis and prognosis assessment [13]. This strategy is in accord with the
core philosophy of maintaining the classification system’s stability over time.
A new approach was adopted in the TNM Classification’s seventh edition [9]
that helped to distinguish stages from prognostic groupings. This has been
expanded upon in the eighth edition, which introduces new clinical and patho-
logical stages for some tumour entities. Additionally, a helpful overview of prog-
nostic factors for different tumour entities has been given. These prognostic
factor grids are based on former publications of the UICC and have been
expanded to reflect new data [14–16].
This fifth edition of the TNM Supplement contains a number of changes.
While the previous edition’s contents have been largely preserved, feedback
from users of the TNM classification and the TNM Help Desk (https://www.uicc.
org/tnm‐help‐desk) has helped to refine and clarify certain elements. Two chap-
ters of ‘Explanatory Notes’ have, for example, been reworked so that anatomical
sites and subsites, regional lymph nodes, and T, N and M categories are more
precisely defined. Elsewhere, a chapter discussing ‘Pending Questions and
Problems’ has been added, while the minimum requirements for the pathologi-
cal classification of individual tumour sites and entities are now described in a
chapter on ‘Site‐Specific Requirements for pT and pN’.
Since the publication of the eighth edition of the TNM Classification, the UICC
TNM Project Committee has reviewed several recommended changes and
amendments, the details of which are outlined in this TNM Supplement’s fourth
and fifth chapters, entitled ‘New TNM Classifications Recommended for Testing
and Other Classifications’ and ‘Optional Proposals for Testing New Subcategories
of TNM’, respectively. Relevant references have been included wherever data
exist to support these recommendations. Where they do not, it may be assumed
that such proposals are based on either anecdotal experience or more general
considerations. All proposals included are based on the principle of ramification,
whereby the T, N and M categories featured in the TNM Classification, eighth
edition, remain unchanged but optional subdivisions are provided within spe-
cific categories. After classifying according to these subdivisions, one may deter-
mine to what extent a change of the present categories improves the classification
process with respect to prognostic statements or the choice of treatment.
x Preface

In light of the development of new techniques in molecular biology, the most

important and widely used methods of enhancing the accuracy of the TNM clas-
sification system have also been presented here. Furthermore, several authors
have emphasized that, in the current era of evidence‐based medicine, future
amendments must be substantiated with data [13, 17]. Others have raised ques-
tions regarding the use and interpretation of TNM in specific situations. These,
along with informative answers, can be found in the sixth chapter of this sup-
plement: ‘Frequently Asked Questions’.
The present stage groupings – as defined in the TNM Classification, eighth
edition [12] – are generally based on the anatomical extent of disease, repre-
sented by T, N and M or pT, pN and pM. For some tumour sites or entities,
however, additional factors are included. These are as follows:

Histologic type Thyroid

Age Thyroid
Grade Gastrointestinal neuroendocrine tumours
Appendix carcinoma
Bone
Soft tissues
Mitotic rate GIST
Tumour markers Testis

●● For oesophageal carcinoma (excluding the anatomical stage), an additional

prognostic grouping is provided to encompass squamous cell carcinoma and
adenocarcinoma. This group takes into account grade and – for squamous
cell carcinoma – location.
●● For gestational trophoblastic tumours, a prognostic grouping is provided that
considers T/pT, M/pM and relevant risk factors.
●● As more non‐anatomic prognostic factors become available, this approach
may provide a means of separating extent‐of‐disease staging from prognostic
grouping.

Both the AJCC and the TNM Project Committee of the UICC recognize that,
in addition to the anatomical extent of disease pre‐ and post‐initial treatment,
the residual tumour status after treatment – i.e. the R (residual tumour) classifi-
cation – and other non‐anatomical factors (e.g. host factors, biochemical mark-
ers, DNA analysis, oncogenes, oncogene products) may be important when
estimating outcome. TNM and R aside, these prognostic factors are currently
under investigation and it can be assumed that their roles in treatment planning,
analysis of treatment and design of future clinical trials will grow.
 Preface xi

The eighth edition of the TNM Classification [12] contains rules of classification
and staging that correspond to those in the eighth edition of 2017’s AJCC Cancer
Staging Manual [18] and have approval of all national TNM committees.
Institutions and physicians interested in the further development of the TNM
system are encouraged to test the recommendations included in this supple-
ment. These may concern the ramification of existing classifications or the clas-
sification of new tumour sites and entities. Equally, they may concern methods
of enhancing the accuracy of the TNM system over the years to come. Publication
of both retrospective and prospective studies is desired. The TNM Project
Committee would appreciate receiving relevant information and is available to
provide further details and consultation.
The TNM Prognostic Factors Project welcomes comments from TNM users.

Union for International Cancer Control (UICC)

31–33 Avenue Giuseppe Motta, CH‐1202 Geneva, Switzerland
F: +41 22 809 1810    http://www.uicc.org

Christian Wittekind, Leipzig, Germany

James D. Brierley, Toronto, Canada
Anne Lee, Hong Kong, China
Elisabeth van Eycken, Brussels, Belgium

References

[1] UICC (International Union Against Cancer) TNM Classification of Malignant Tumours,
4th edn, Hermanek P, Sobin LH (eds). Berlin, Heidelberg, New York: Springer; 1987.
[2] UICC (International Union Against Cancer) TNM Classification of Malignant Tumours,
4th edn, 2nd revision, Hermanek P, Sobin LH (eds). Berlin, Heidelberg, New York:
Springer; 1992.
[3] American Joint Committee on Cancer (AJCC) AJCC Manual for Staging of Cancer, 4th
edn, Beahrs OH, Henson DE, Hutter RVP, et al. (eds). Philadelphia: Lippincott; 1992.
[4] UICC (International Union Against Cancer) TNM Supplement 1993: A Commentary
on Uniform Use, Hermanek P, Henson DE, Hutter RVP, Sobin LH (eds). Berlin,
Heidelberg, New York: Springer; 1993.
[5] UICC (International Union Against Cancer) TNM Classification of Malignant Tumours,
5th edn, Sobin LH, Wittekind Ch (eds). New York: Wiley; 1997.
[6] UICC (International Union Against Cancer) TNM Supplement 2001: A Commentary
on Uniform Use, 2nd edn, Wittekind C, Henson DE, Hutter RVP, Sobin LH (eds).
New York: Wiley; 2001.
[7] UICC (International Union Against Cancer) TNM Classification of Malignant Tumours,
6th edn, Sobin LH, Wittekind Ch. (eds). New York: Wiley; 2002.
xii Preface

[8] UICC (International Union Against Cancer) TNM Supplement: A Commentary on

Uniform Use, 3rd edn, Wittekind C, Henson DE, Hutter RVP, Sobin LH (eds). New
York: Wiley; 2003.
[9] Sobin LH, Gospodarowicz MK, Wittekind C (eds), TNM Classification of Malignant
Tumours, 7th edn. Oxford: Blackwell Publishing Ltd; 2010.
[10] Sobin LH, Compton CC. TNM seventh edition: what’s new, what’s changed. Cancer
2010; 116:5336–5339.
[11] UICC (Union for International Cancer Control) TNM Supplement: A Commentary
on Uniform Use, 4th edn, Wittekind C, Compton CC, Brierley J, Sobin LH (eds).
Oxford: Wiley‐Blackwell; 2012.
[12] UICC (Union for International Cancer Control) TNM Classification of Malignant
Tumours, 8th edn, Brierley JD, Gospodarowicz MK, Wittekind C (eds). Oxford:
Wiley‐Blackwell; 2017.
[13] Gospodarowicz MK, Miller D, Groome PA, et al. The process for continuous
improvement of the TNM classification. Cancer 2004; 100:1–5.
[14] UICC (Union for International Cancer Control) Prognostic Factors in Cancer,
Hermanek P, Gospodarowicz MK, Henson DE, et al. (eds). Berlin, Heidelberg, New
York: Springer; 1995.
[15] UICC (Union for International Cancer Control) Prognostic Factors in Cancer, 2nd
edn, Gospodarowicz MK, Henson DE, Hutter RVP, et al. (eds). New York: Wiley;
2001.
[16] UICC (Union for International Cancer Control) Prognostic Factors in Cancer, 3rd
edn, Gospodarowicz MK, O’Sullivan B, Sobin LH (eds). New York: Wiley; 2006.
[17] Quirke P, Cuvelier C, Ensari A, et al. Evidence‐based medicine: the time has come to
set standards for staging. J Pathol 2010; 221:357–360, correspondence 361–362.
[18] American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 8th edn,
Amin MB, Edge SB, Greene FL, et al. (eds). New York: Springer; 2017.
ORGANIZATIONS ASSOCIATED
WITH THE TNM SYSTEM

CDC Centers for Disease Control and Prevention (USA)

FIGO International Federation of Gynaecology and Obstetrics
IACR International Association of Cancer Registries
IARC International Agency for Cancer Research
IASLC International Association for the Study of Lung Cancer
ICCR International Collaboration on Cancer Reporting
WHO World Health Organization

NATIONAL COMMITTEES

Australia and New Zealand: National TNM Committee

Austria, Germany, Switzerland: Deutschsprachiges TNM‐Komitee
Belgium: National TNM Committee
Brazil: National TNM Committee
Canada: National Staging Steering Committee
China: National TNM Cancer Staging Committee of
China
Denmark: National TNM Committee
Gulf States: TNM Committee
India: National TNM Committee
Israel: National Cancer Staging Committee
Italy: Italian Prognostic Systems Project
Japan: Japanese Joint Committee
Latin America and Caribbean: Sociedad Latinoamericana y del Caribe de
Oncología Médica
Netherlands: National Staging Committee
Poland: National Staging Committee
Singapore: National Staging Committee
Spain: National Staging Committee
South Africa: National Staging Committee
Turkey: Turkish National Cancer Staging Committee
United Kingdom: National Staging Committee
United States of America: American Joint Committee on Cancer

xiii
xiv National Committees

Members of UICC Committees Associated

with the TNM System

In 1950, the UICC appointed a Committee on Tumour Nomenclature and

Statistics. In 1954, this committee became known as the Committee on Clinical
Stage Classification and Applied Statistics and, in 1966, it was renamed the
Committee on TNM Classification. With new prognostic factors taken into
consideration, the committee was renamed twice more, becoming the TNM
Prognostic Factors Project Committee in 1994 and then the TNM Prognostic
Factors Core Group in 2003.

UICC TNM Prognostic Factors Core Group: 2018

Asamura, H. Japan
Brierley, J.D. Canada
Brookland, R.K. USA
Gospodarowicz, M.K. Canada
Lee, A. China
Mason, M. UK
O’Sullivan, B. Canada
Van Eycken, E. Belgium
Wittekind, Ch. Germany
ACKNOWLEDGEMENTS

The editors appreciate the advice and assistance received from the members of
the UICC TNM Prognostic Factors Core Group, the national TNM Committees
and the Surveillance, Epidemiology and End Results (SEER) Program of the
National Cancer Institute (USA).
We thank Professor Patti Groome and Ms Colleen Webber for supervising
and performing the literature watch from its inception until 2015 and 2016,
respectively and subsequently Dr. Malcolm Mason and Ms. Bernadette Coles.
The fifth edition of the TNM Supplement is the result of a number of consulta-
tive meetings organized and supported by the UICC and AJCC secretariats.
This publication was made possible by grants 1U58DP001818 and
1U58DP004965 from the Centers for Disease Control and Prevention (CDC)
(USA). Its contents are solely the responsibility of the authors and do not
­necessarily represent the official views of the CDC.
The authors are grateful for comments, additions and questions from Ramon
Rami‐Porta, Mary Gospodarowicz and Brian O’Sullivan.
The Union for International Cancer Control (UICC) provided encourage-
ment and support and its secretariat arranged meetings and facilitated
communications.

xv
ABBREVIATIONS

a autopsy, p. 23
c clinical, p. 1
G histopathological grading, p. 26
ICD‐O International Classification of Diseases for Oncology, 3rd edition, 2000
ITC isolated tumour cells, p. 10
L lymphatic invasion, p. 24
m multiple tumours, pp. 5 and 20
M distant metastasis, p. 11
N regional lymph node metastasis, p. 9
p pathological, p. 1
Pn perineural invasion, p. 24
r recurrent tumour, p. 21
R residual tumour after treatment, p. 15
sn sentinel lymph node, p. 11
Stage anatomical Stage, p. 13
T extent of primary tumour, p. 7
V venous invasion, p. 24
y classification after initial multimodality treatment, p. 20

Substantial changes in the 2019 fifth edition compared with the 2012
fourth edition are marked by a bar at the left‐hand side of the page.

xvi
chapter 1

EXPLANATORY NOTES – GENERAL

The General Rules of the TNM System

General Rule No. 1

All cases should be confirmed microscopically as malignant tumours
including histological type. Any cases not so proved must be reported
separately.
Microscopically unconfirmed cases can be staged, but should be analysed
separately.

Examples
Microscopic confirmation of choriocarcinoma is not required if the serum/urine βHCG
level is abnormally elevated.
Microscopic confirmation of hepatocellular carcinoma is not required if the serum AFP
level is abnormally elevated in the presence of characteristic radiological appearance.

General Rule No. 2 (Table 1.1)

Two classifications are described for each site, namely:
(a) Clinical classification: the pre‐treatment clinical classification designated TNM
(or cTNM) is used to select and evaluate therapy. This is based on evidence
acquired before treatment. Such evidence is based on physical examination,
imaging, endoscopy, biopsy, surgical exploration and other relevant
examinations.
(b) Pathological classification: the post‐surgical histopathological classification,
designated pTNM, is used to guide adjuvant therapy and provides additional
data to estimate prognosis and calculate end results. This is based on evi-
dence acquired before treatment, supplemented or modified by additional
evidence acquired from surgery and from pathological examination.

TNM Supplement: A Commentary on Uniform Use, Fifth Edition.

Edited by Christian Wittekind, James D. Brierley, Anne Lee and Elisabeth van Eycken.
© 2019 UICC. Published 2019 by John Wiley & Sons Ltd.

1
2 TNM Supplement

Table 1.1 Definitions of various TNM terms

Definitions

1. Cancer stage (a noun) – ‘the stage’

The UICC has defined the term ‘stage’ as the anatomical extent of disease
(UICC 8th edition [2, 3]).

2. Cancer staging (a verb) – ‘to stage’

It refers to the process of deriving the ‘stage’. This includes the investigational
work‐up, most usually examination and imaging studies, or, alternatively, verifying
or consulting the T, N and M category definitions and combinations.

3. Stage migration
The term ‘stage migration’ describes a change in the proportion of T, N or M
­categories following introduction of new means of assessing disease extent in
populations of patients rather than in individual patients.

4. Stage shift
The term ‘stage shift’ describes a change in the pattern of stage distribution within
a defined population to a lower stage following the introduction of early detection
or screening programs, or to a higher stage when access to care becomes limited.

5. Downstaging/downsizing/upstaging/understaging
●● The term ‘downstaging’ is used to describe a reduction in the T or N category

after neoadjuvant therapy.

●● The term ‘downsizing’ is used to describe a reduction in size of the tumour after

neoadjuvant therapy.
●● The terms ‘upstaging’ and ‘understaging’ are occasionally used, and typically

relate to different diagnostic accuracy of various staging investigations. We do

not recommend their use.

The pathological assessment of the regional lymph nodes (pN) entails removal
of at least one lymph node to validate the absence or presence of cancer. It is
not necessary to pathologically confirm the status of the highest N category to
assign the pN. The assignment of the regional lymph nodes (pN) requires
­pathological assessment of the primary tumour (pT), except in cases of an
unknown primary (T0).
An excisional biopsy of a lymph node without assessment of the pT category
is insufficient to fully evaluate the pN category and is considered a clinical
classification.

Example
The examination of axillary lymph nodes (sentinel lymph node or non‐sentinel
lymph nodes) with only a biopsy diagnosis of the primary tumour in the breast
is classified as cN, e.g. cN1, if there are metastases in movable ipsilateral level I, II
axillary lymph node(s).
 Explanatory Notes – General 3

The pathological assessment of distant metastasis (pM1) entails micro-

scopic examination.
TNM is a dual system that includes a clinical (pre‐treatment or after neoadju-
vant radio‐/chemo‐/radiochemotherapy but before surgery) and a pathological
(post‐surgical histopathological) classification. It is imperative to differentiate
between them since they are based on different methods of examination and
serve different purposes. The clinical classification is designated TNM or cTNM;
the pathological, pTNM. When TNM is used without a prefix, it implies the
­clinical classification (cTNM). Microscopic confirmation does not in itself justify
the use of pT. The requirements for pathological classification are described in
Chapter 3 on page 157.
Biopsy provides the diagnosis, including histological type and grade
(if ­possible). The clinical assessment of tumour size should not be based on
the biopsy.
In general, the cTNM is the basis for the choice of treatment and the pTNM is
the basis for prognostic assessment. In addition, the pTNM determines adjuvant
treatment. Comparison between cTNM and pTNM can help in evaluating the
accuracy of the clinical and imaging methods used to determine the cTNM.
Therefore, it is important to retain the clinical as well as the pathological
­classification in the medical record.
A tumour is primarily described by the clinical classification before treatment
or before the decision not to treat. In addition, a pathological classification is
performed if specific requirements are met (see Chapter 3, page 157). Therefore,
for an individual patient there should be a clinical classification, e.g. cT2cN1cM0
and a pathological classification pT2pN2cM0.
Note.
The various T, N and M categories as well as the categories of optional classifications
like R, L, V, G should be written as common Arabic numerals, not as subscripts, e.g. T1
(not T1) and N3 (not N3). Stages are designated by Roman numerals.

General Rule No. 3

After assigning cT, cN and cM and/or pT, pN and pM categories, these
may be grouped into stages. The TNM classification and stages, once
established, must remain unchanged in the medical records. The clinical
stage is essential to select and evaluate therapy, while the pathological
stage provides the most precise data to estimate prognosis and calculate
end results.
The rule that the TNM classification, once established, must remain unchanged
in the patient’s record applies to the definitive TNM classification determined
just before initiation of treatment or before making the decision not to treat.
4 TNM Supplement

If, for instance, the initial classification cT2cN0cM0 is made in one hospital and
is later updated to cT2cN1cM0 after the patient is referred to another center
where special imaging techniques are available, then the latter classification,
based on a special examination, is considered the definitive one.
Following two surgical procedures for a single lesion, the pTNM classification
should be a composite of the histological examination of the specimens from
both operations.

Example
Initial endoscopic polypectomy of a carcinoma of the ascending colon is classified
pT1pNXcM0; the subsequent right hemicolectomy contains two regional lymph nodes
with tumour and a suspicious metastatic focus in the liver, later found to be a haeman-
gioma, is excised: pT0pN1cM0. The definitive pTNM classification consists of the results
of both operative specimens: pT1pN1bcM0 (Stage IIIA).
If an initial local excision of a rectal carcinoma is performed and the margins are posi-
tive the stage may be pT1pNXcM0, R1.
If radiotherapy is given, followed by anterior resection and there is no residual dis-
ease, the stage is ypT0pN0cM0, R0.
The definitive classification is ypT0pN0cM0, R0.
Note.
Assignment of the ‘y’ as an additional descriptor for cases involving multimodality
­therapy is described on page 20.

For an estimation of the final stage, clinical and pathological data may be
­combined when only partial information is available in either the pathological
classification or the clinical classification. See examples below.
It is important to note that the category is defined by whether it is determined
clinically or pathologically. Stage should not be assigned as is not clinical or
pathological.
However, for surveillance purposes stage data are lost if clinical and pathologi-
cal data are not combined when only partial information is available either in the
clinical classification or pathological classification. The term harmonized stage,
hTNM, has been proposed.

Example
A CT scan reveals a bladder cancer but there is no evidence of lymph node metastasis
and the clinical stage is cT3bcN0cM0, cStage IIIA. A cystectomy is performed and the
pT category is pT2 but there are no lymph nodes in the specimen so the pN category is
pNX. The stage is therefore pT2bpNXcM0 and a pathological stage cannot be assigned
but a combined harmonized stage group can be assigned as hStage II.

‘X’ denotes the absence or uncertainty of assigning a given category (T or N)

when all reasonable clinical or pathological methods of assessment have been
 Explanatory Notes – General 5

used or are unavailable to assess the patient. ‘X’ should not be used to simply fill
in the blanks when data are unavailable to one individual on the assessment
team. For further discussion on the meaning and application of X (e.g. NX)
see Greene et al. [1].

General Rule No. 4

If there is doubt concerning the correct T, N or M category to which a
particular case should be allotted, then the lower (i.e. less advanced)
category should be chosen. This will also be reflected in the stages.

Example
Sonography of the liver: suspicious lesion but no definitive evidence of metastasis ‐
assign cM0 (not cM1).

If there are conflicting results from different methods, the classification should
be based on the most reliable method of assessment.

Example
Colorectal carcinoma, pre‐operative examination of the liver: sonography, suspicious,
but no evidence of metastasis; CT, evidence of metastasis. The results of CT deter-
mine the classification: cM1. If a biopsy is performed and metastases are confirmed,
then it would be classified as pM1. However, if CT were negative, the case would be
classified cM0.

General Rule No. 5

In the case of multiple simultaneous tumours in one organ, the tumour
with the highest T category should be classified and the multiplicity or
the number of tumours should be indicated in parentheses, e.g. T2(5)
or T2(m). In simultaneous bilateral cancers of paired organs, each tumour
should be classified independently. In tumours of the liver (HCC),
­intrahepatic bile ducts (ICC) as well as ovary and fallopian tube, multi-
plicity is a criterion of T classification.
The following apply to grossly recognizable multiple primary simultaneous
carcinomas at the same site. They do not apply to one grossly detected tumour
associated with multiple separate microscopic foci.

1. Multiple synchronous tumours in one organ may be:

a) Multiple non‐invasive tumours
b) Multiple invasive tumours
c) Multiple invasive tumours with associated non‐invasive tumours
(­carcinoma in situ)
6 TNM Supplement

d) A single invasive tumour with an associated non‐invasive tumour

(­carcinoma in situ)

For (a) the multiplicity should be indicated by the suffix ‘(m)’, e.g. Tis(m).
For (b) and (c) the tumour with the highest T category is classified and the
multiplicity or the number of invasive tumours is indicated in parentheses,
e.g. T2(4) or T2(m).
For (c) and (d) the presence of an associated carcinoma in situ may be
­indicated by the suffix ‘(is)’, e.g. T3(m, is) or T2(3, is) or T2(is).

2. For classification of multiple simultaneous tumours in ‘one’ organ, the

tumours at these sites with the highest T category should be classified and
the multiplicity of the number of tumours should be indicated in parentheses,
e.g. T2(5) or T2(m).
Combining multiple carcinomas of skin should be done only with subsites
(C44.5‐7 or C63.2) [3]. Carcinomas of the skin of the head and neck should
only be combined with carcinomas of the skin of the head and neck. A carci-
noma of the skin in subsite C44.3 and a synchronous one in subsites C44.6
and C44.7 should be classified as synchronous tumours.

Examples of sites for separate classifications of two tumours are:

●● Oropharynx and hypopharynx
●● Submandibular gland and parotid gland

●● Urinary bladder and urethra (separate tumours)

●● Skin carcinoma of the eyelid and skin carcinoma of the head and neck,

since both have their own classifications

Examples for classification of the tumour with the highest T category and
indication of multiplicity (m symbol) or numbers of tumours:
●● Two separate tumours of the hypopharynx

●● Skin carcinoma of the abdominal wall and the back (both part of the

trunk)

Cancer Registries have their own rules to decide on multiple tumours in order
to improve comparability and uniformity in cancer incidence reporting. These
rules should be clearly documented when reporting.
For tumours of the colon or rectum in different localizations it is
­recommended to classify those tumours separately; e.g. a carcinoma of the
ascending colon and one of the sigmoid colon should be classified separately,
particularly because the regional lymph nodes are defined differently
(see TNM Classification of Malignant Tumours, 8th edition [2], pages 73–74).
 Explanatory Notes – General 7

Second or subsequent primary cancers occurring in the same organ or in

­ifferent organs after initial treatment are staged independently and are
d
known as metachronuous primary tumours. Such cancers are not staged
using the prefix ‘y’.
For systemic or multicentric cancers potentially involving many discrete
organs, four histological groups – malignant lymphomas, leukemias, Kaposi
sarcoma and mesothelioma – are included. They are counted only once in any
individual.
A tumour in the same organ with a different histologic type is counted as a
new tumour, e.g. lung carcinomas (see page 88).

The TNM Clinical and Pathological Classifications

T/pT Classification
1. When size is a criterion for the T/pT category, it is a measurement of the
invasive component. If in the breast, for example, there is a large in situ
component (e.g. 4 cm) and a small invasive component (e.g. 0.5 cm),
­
the tumour is coded for the invasive component only, i.e. pT1a.
2. Neither in the TNM Classification nor in the 1st [5] to 4th edition [6–8] of
the TNM Supplement are there any statements concerning the way to
measure tumour size for pT classification. According to the AJCC Cancer
Staging Manual, 2017 [3], ‘pT is derived from the actual measurement of
the unfixed tumour in the surgical specimen. It should be noted, however,
that up to 30% shrinkage of soft tissues may occur in the resected
­specimen’. Thus, in cases of discrepancies of clinically and pathologically
measured tumour size, the clinical measurement should also be considered
for the pT classification.
In some cases, especially with those tumour entities where size is impor-
tant for the pT category, it may be necessary to correlate the macroscopic size
(fixed or infixed) with the microscopic size. A thorough calculation of the
latter should be the basis for the size calculation.
3. Penetration or perforation of visceral serosa is a criterion for the T classifica-
tion of some tumour sites, e.g. stomach, colon, rectum, liver (HCC and ICC),
gallbladder, lung, ovary. It may be confirmed by histological examination of
biopsies or resection specimens or by cytological examination of specimens
obtained by scraping the serosa overlying the primary tumour.
4. The microscopic presence of a tumour in lymphatic vessels or veins does not
qualify as local spread of the tumour and does not affect the cT/pT category
(except for liver (HCC and ICC), testis, kidney and penis). It can be recorded
separately (TNM Classification, 8th edition, page 10 [2]).
8 TNM Supplement

5. A tumour in perineural spaces at the primary site is considered part of the

T classification, but can also be recorded separately as Pn1 (TNM Classification,
8th edition, [2], page 10), as it may be an independent prognostic factor.

Example
In carcinoma of the uterine cervix, direct invasion beyond the myometrium of the
uterine cervix qualifies as parametrial invasion with T2a/b, but not if based only
on the discontinuous presence of tumour cells in lymphatics of the parametrium.
The L (lymphatic invasion) and V (venous invasion) symbols (TNM Classification, 8th
edition [2], page 10) can be used in this case to record lymphatic and venous
involvement.

6. Direct spread of tumour into an adjacent organ, e.g. the liver from a gastric
primary, is recorded in the T/pT classification and is not considered to be
­distant metastasis.
Direct spread of the primary tumour into regional lymph nodes is classified
as lymph node metastasis.
7. The very uncommon cases with direct extension into an adjacent organ
or structure not mentioned in the T definitions are classified as the highest
T category.
8. Tumour spillage during surgery is considered a criterion in the T classification of
tumours of ovary, Fallopian tube and primary peritoneal carcinoma. For all other
tumours, tumour spillage does not affect the TNM classification or stages.
Note.
In tumours of the uterus (endometrium) positive cytology should be reported
­separately without change of the stage.

Regional Lymph Nodes

1. If a tumour involves more than one site or subsite, e.g., contiguous extension
to another site or subsite, the regional lymph nodes include those of all
involved sites and subsites.

Example
Carcinoma of the sigmoid colon involving the small intestine (jejunum): the
regional lymph nodes are those for the sigmoid colon, i.e. the sigmoid, left colic,
superior rectal (haemorrhoidal), inferior mesenteric and rectosigmoid as well as
those for the small intestine, i.e. the mesenteric nodes including the superior
mesenteric nodes.

2. In rare cases, one finds no metastases in the regional lymph nodes, but only
in lymph nodes that drain an adjacent organ directly invaded by the primary
tumour. The lymph nodes of the invaded site are considered regional as those
of the primary site for N classification.
 Explanatory Notes – General 9

Example
Carcinoma of the stomach with direct extension into an adjacent small bowel loop:
perigastric lymph nodes are tumour‐free, but metastases of 0.5 cm size are found
in two mesenteric lymph nodes in the vicinity of the invaded small bowel – this is
classified as pT4bpN1M0 (Stage IIIC) for cancer of the stomach.

N/pN Classification
1. The clinical category N0 (‘no regional lymph node metastasis’) includes lymph
nodes not clinically suspicious for metastasis even if they are palpable or
­visualized with imaging techniques. The clinical category N1 (‘regional lymph
node metastasis’) is used when there is sufficient clinical evidence, such as firm-
ness, enlargement or specific imaging characteristics. The term ‘adenopathy’ is
not precise enough to indicate lymph node metastasis and should be avoided.
2. Size of lymph nodes: in advanced lymphatic spread, one often finds perinodal
tumour and the confluence of several lymph node metastases into one large
tumour conglomerate. In the definition of the N classification, the perinodal
component should be included in the size for isolated lymph node metasta-
sis; for conglomerates, the overall size of the conglomerate should be
­considered and not only the size of the individual lymph nodes.
3. Direct extension of the primary tumour into lymph nodes is classified as
lymph node metastasis.
4. Tumour deposits (satellites) are discrete macroscopic or microscopic nodules
of cancer in the lymph drainage area of a primary carcinoma that are discon-
tinuous from the primary carcinoma and without histological evidence of
residual lymph node or identifiable vascular or neural structures. If a vessel is
identifiable on H&E, elastic or other stains, it should be classified as venous
invasion (V1/2) or lymphatic invasion (L1). Similarly, if neural structures
are identifiable, the lesion should be classified as perineural invasion (Pn1).
The presence of tumour deposits does not change the T categories of the
primary tumour. This rule is to be followed particularly in tumours of the
colon and rectum as well as in tumours of the appendix and may be applicable
to other tumour sites.
5. The reliability of the pN classification depends on the number of histologically
examined regional lymph nodes. Thus, it is recommended to add the number
of examined and involved lymph nodes in parentheses to the pN category,
e.g. in colorectal tumours pN1b (3/15).
For the various organs the number of lymph nodes ordinarily included in
the lymph node dissection specimen is stated. If the lymph nodes are ­negative,
but the number ordinarily examined is not met, pN0 is classified. The addition
of the number of lymph nodes (in colon tumours, e.g. 0/4) characterizes the
reliability of the pN classification.
10 TNM Supplement

6. Metastasis in any lymph node other than regional is classified as a distant

metastasis. If there is doubt concerning the correct category to which a
particular case should be allotted, then the lower (i.e. less advanced)
­category should be chosen.
7. When size is a criterion for pN classification, measurement is made of the
metastasis, not of an entire lymph node. However, for the cN classification
only, the overall size of the lymph node should be considered.
8. Invasion of lymphatic vessels (tumour cells in endothelium‐lined channels,
so‐called lymphangiosis carcinomatosa or lymphangitic spread) in a distant
organ is coded as pM1, e.g. lymphangitic spread in the lung from prostate
carcinoma or liver cell carcinoma.
9. Cases with micrometastasis only, i.e. no metastasis larger than 0.2 cm, can
be identified by the addition of ‘(mi)’, e.g. pN1(mi) or pN2(mi). If deposits of
tumour cells are 0.2 mm or smaller they are likely to be considered isolated
tumour cells (see below).
10. Isolated tumour cells (ITC) are single tumour cells or small clusters of cells
not more than 0.2 mm in greatest extent that can be detected by routine H
and E stains or immunohistochemistry. An additional criterion has been pro-
posed to include a cluster of fewer than 200 cells in a single histological
cross‐section [10]. The same applies to cases with findings suggestive of
tumour cells or their components by non‐morphologic techniques such as
flow cytometry or DNA analysis. ITCs may be apparent with routine histo-
logical stains as well as with immunohistochemical methods. ITCs do not
typically show evidence of metastatic activity (e.g. proliferation or stromal
reaction) or penetration of lymphatic sinus walls.

The following classification of isolated tumour cells was published in the

6th edition of the TNM booklet [10] following a communication by the
UICC in 1999 [11]. These cases with ITC in regional lymph nodes should
be analysed separately since the prognostic importance of those ITC cases
is not yet clear.
Cases with ITC cells in lymph nodes or at distant sites should be classified
as cN0 or cM0. The exceptions are in malignant melanoma of the skin
[12, 13] and in Merkel cell carcinoma, where ITC in a lymph node are
­classified as N1/pN1 [3]. These cases should be analysed separately.
The classification is as follows:

(p)N0 No regional lymph node metastasis histologically, no exami-

nation for isolated tumour cells (ITC)
(p)N0(i–) No regional lymph node metastasis histologically, negative
morphological findings for ITC
 Explanatory Notes – General 11

(p)N0(i+)  No regional lymph node metastasis histologically, positive

morphological findings for ITC
(p)N0(mol‐) No regional lymph node metastasis histologically, negative
non‐morphological findings for ITC
(p)N0(mol+) No regional lymph node metastasis histologically, positive non‐
morphological findings for ITC
Note.
This approach is consistent with TNM General Rule No. 4.

Sentinel Lymph Node

Definition
The sentinel lymph node is the first lymph node to receive lymphatic drainage
from a primary tumour. If it contains metastatic tumour this indicates that other
lymph nodes may contain tumour. If it does not contain metastatic tumour,
other lymph nodes are unlikely to contain tumour. Occasionally, there is more
than one sentinel lymph node.
The following designations are applicable when sentinel lymph node assess-
ment is attempted following resection of the primary tumour:

(p)NX (sn) Sentinel lymph node could not be assessed

(p)N0 (sn) No sentinel lymph node metastasis
(p)N1 (sn) Sentinel lymph node metastasis

Excisional biopsy of a sentinel node, in the absence of assignment of a pT,

is classified as a clinical N, e.g. cN1(sn).
Cases with or examined for isolated tumour cells (ITC) in sentinel lymph nodes
can be classified as follows:

(p)N0 (i‐)(sn) No sentinel lymph node metastasis histologically, negative

morphological findings for ITC
(p)N0 (i+)(sn) No sentinel lymph node metastasis histologically, positive
morphological findings for ITC
(p)N0 (mol‐)(sn) No sentinel lymph node metastasis histologically, negative
non‐morphological findings for ITC
(p)N0 (mol+)(sn) No sentinel lymph node metastasis histologically, positive
non‐morphological findings for ITC

M Classification
The MX category is considered to be inappropriate in the clinical assessment
of TNM if metastasis can be evaluated based on physical examination alone.
(The use of MX may result in exclusion from staging [2, 3, 14].)
Another random document with
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BREEDING COCKERELS FALL OF 1911
 CHAPTER XXIV
Preparing Surplus Cockerels for Market
The growing cockerels, fed in the same way as the pullets up to
six or eight weeks of age, will be, in the majority of cases, in prime
condition to have the finishing touches applied to round them out into
the best possible weight at the age for market.
We, of course, do not go into the various liquid foods which are fed
with a pump, but simply the most inexpensive and rapid way of
putting the birds in a condition to return the most money in the
shortest possible time. Corn, in its different forms, is, perhaps, the
most fattening food which can be fed, and for the cockerels intended
for market, the grain ration consists of nothing but corn, and as much
of it as they will clean up.
If it is possible to give the time to it, the mash, fed three times a
day, will produce the finest quality flesh. A mash made from corn
meal, ground oats, gluten meal, middlings and bran, in equal parts,
with beef scrap, or green cut bone, equal to the total of the meals,
and moistened so that the birds can choke it down in large
quantities, will produce the result better, perhaps, than anything else.

Must Have Green Food

Green food, however, should be given the bird at the most
convenient hour in between the other feedings. If to save time in
feeding was an object, a very good schedule is to feed corn first
thing in the morning, green food at about ten o’clock, and, between
two and three, the exact quantity of mash as described. If mash
alone is fed, it is best to feed each time only what the birds will clean
up in from thirty to forty minutes, the troughs in which it is placed
then being removed.
NO. 3 LAYING HOUSE FILLED WITH 1500 PULLETS TWO WEEKS FROM THE
RANGE
 CHAPTER XXV
$6.41 Per Hen Per Year Corning Method and
Strain Enabling Others to Better $6.41
The figures at the head of this chapter have become famous, and,
perhaps, in the way of small things, represent as great a bone of
contention as has been squabbled over for many a year. And yet
there really was nothing so extraordinary in the profit. It represented
a large amount of careful work and study, a keen business
administration, a careful looking after of all the little details, the
preserving of all by-products and selling them at a figure which was
actually under their true value, as was proven in later years by better
prices obtained.
For instance, the fertilizer made on the Farm has been so handled
that its returns to the owners are much greater than when these
figures were given to the public. The Corning Egg Farm was very
much criticised in numerous statements made in the different papers
throughout the country as to the authenticity of these figures, and, to
put it in clear Anglo-Saxon, many writers indulged quite freely in the
word so much used by one of the distinguished Presidents of the
United States, and threw the lie indiscriminately at everything and
everybody connected with The Corning Egg Farm.
After a time the humor of the situation dawned upon those who
were being so adversely criticized. The fact is, the critics were
people who wanted to gauge everything in the World by their own
little yard stick. They did not themselves know how to make $6.41
per hen per year, and, therefore, they reasoned it out that the man
did not exist who could. One fact entirely overlooked by these
profound writers on poultry subjects was that two dollars of this profit
was made by the sale of the hen at the end of ten months of laying.
 In the last few years there have appeared in the advertising
columns of numerous publications, claims by a man selling a book in
which he asserts he made $120.00 per hen, in twelve months, in a
back-yard. Another individual blossomed forth with a statement of
ten dollars and fifty odd cents profit per hen per year, but these
statements did not excite widespread criticism. They were
statements of men who were doing a back-yard business, with from
ten to twenty hens, and were, therefore, simply looked upon as
ridiculous and not entitled to serious consideration.

$6.41 Not Extravagant Claim

But The Corning Egg Farm “$6.41 per hen, per year” was not an
extravagant claim, and the figures showing just exactly how it had
been accomplished were plainly set forth. It was not done with
twenty hens in a back-yard, but on a large, commercial scale, and an
extensive business was in active operation.
The methods were so entirely new, and the results so
unprecedented, that poultry writers and lecturers hastily declared
them fantastic, without the careful investigation to which they were
entitled, and proceeded to wholesale condemnation of the figures,
the methods, and everything else connected with the Farm.
However, later, the majority of our critics have visited The Corning
Egg Farm, and have seen what we have, what we are doing, and
satisfied themselves thoroughly that every statement made was well
within the facts.
It will be noticed that the profit of $6.41 was figured with the
cockerels selling at the live weight price of broilers, and when no
hatching eggs were sold.

Corning Farm Making More Than $6.41

At The Corning Egg Farm, to-day, the hen is making considerably
more than $6.41 per year. A large number of cockerels, which
formerly brought merely the live weight broiler price, are now being
reared and disposed of for breeders. Hatching eggs are sold in large
quantities, but, it must be remembered, before one can reach this
point, his Strain of birds must be brought to a high point of
perfection, he must establish his reputation, and his customers must
find his claims are substantiated. As an illustration, purchasers of
hatching eggs from The Corning Egg Farm, in the season of 1910,
came back with orders for the season of 1911 increased by the
multiple of ten, and these same customers are already booking large
orders in September and October, 1911, for the hatching season of
1912.
This chapter is written to emphasize our statement that anyone
possessed of the ordinary qualifications to succeed with poultry, can,
by following The Corning Egg Farm Method, surely build up a large
and profitable business.

THE WORK SHOP ON THE CORNING EGG FARM

 CHAPTER XXVI
The Buildings on the Corning Egg Farm
The Buildings on the The Corning Egg Farm, at the close of the
year 1911, were as follows:
No. 1 — Brooder House, with Incubator and Sprouted Oats
Cellars underneath.
No. 2 — Work Shop, Grain Bins, Egg Packing Room,
Refrigerator Room, and Quarters for the Resident
Foreman, all under one roof.
No. 3 — Breeding House.
No. 4 — Laying House No. 1.
No. 5 — Laying House No. 2.
No. 6 — Laying House No. 3.
No. 7 — Line Breeding House.
No. 8 — Breeding Cockerel House.
No. 9 — Horse Stable.
No. 10 — Wagon Shed.
No. 11 — 41 Colony Houses Scattered over the Range.
No. 12 — Office Building.
To give an idea of the magnitude of The Corning Egg Farm, there
are under roof 18,455 square feet of floor space.

No. 1. Brooder House, Incubator and Sprouted Oats Cellars

This building is 264 feet in length, and consists really of two
buildings. When this structure was first erected it was sixteen feet
wide and fifty feet in length. The Incubator Cellar is entirely of
concrete construction, with a Brooder House one story in height
above it. The floor joists were all beam filled, making the building rat
proof. The second year it became necessary to enlarge the Brooder
House, and an extension was built, sixty-eight feet in length, and set
up on cedar posts, with concrete filled in on top of the sills between
the floor joists, making this part of the building also rat-proof.
After using this Brooder House and Incubator Cellar for three
seasons a still further enlargement became an absolute necessity.
Sixteen feet has been, and still is, the standard width of Laying
Houses on The Corning Egg Farm. It has been found, however, with
the Brooder House, an additional width is desirable in order to give
the chicks more roomy runs when confined by bad weather to the
House alone. Mainly for this reason, the 1911 addition to the Brooder
House has been made twenty-two feet in width. This new building is
146 feet in length. It is joined on to the old building in such a way that
the alley-way merely widens at the point of connection, thus making
one continuous House.
The interior arrangement of a four foot alley-way, the entire length
of the building, along the north wall, greatly facilitates the feeding,
watering, and general care of the chicks, without disturbing them by
passing through the pens.
The raised hover floor starts at the south side of this alley-way,
and is raised about a foot so as to allow the passing underneath of
the hot water trunk line, with its perfect insulation. Attached to this
hover floor, by hinges, is an inclined runway, which is raised or
lowered by a cord running through pulley wheels and fastened by
cleats to the north wall.
The division wires between the pens are of inch mesh, four feet
high, brought down to a ten inch board which is securely fastened to
the floor.
The ventilation is acquired by the use of V-shaped window drops,
placed just under the plate, full detailed drawing of which is given in
the back of this Book. The bottom of the windows, on the south front
of the building, are three feet above the floors, and these windows
are forty-four inches in length and thirty-six inches in width. They are
hung at the top, and are opened and closed by the same sort of
device used in churches for the “Cathedral” window. The holes in the
fastening irons are about two inches apart, allowing the window to be
firmly held open to any degree desired.
There is a slide board at the back of the hover, which is easily
raised, materially assisting in the quick and perfect cleansing of the
hover floor. Hanging above this, and using the slide board as a sill, is
a gate which extends to the height of the wire division, and swings
out, giving the attendant ready access to the hover, drinking cups,
etc.
The whole Brooder House is heated by hot water coils, extending
along the entire length of the north wall of the building. These are of
two inch pipe, and in the sixteen feet part of the building there are
six, while in the twenty-two foot extension there are eight pipes.
As stated, the Brooder House is built over the Incubator and
Sprouted Oats Cellars. The Sprouted Oats Cellar is entirely of
concrete, and the floor slopes to one point, where drains carry off the
water, allowing the frames to slowly drain themselves, and
preventing the oats from rotting from an over supply of moisture.
Access is given to the Incubator Cellar by a vestibule in which are
located broad stairways, enabling one to go from the Cellar to the
Brooder House without going outdoors.
The heater room occupies the first 30 feet of this Cellar, and is
divided from the incubator room proper by an eight inch concrete
wall. In this heater room is the large hot water boiler which heats the
Brooder House, above. There are also two automatic heaters,
controlling the trunk line pipes for the heating of the air passing up
under the hovers in the Brooder House. The incubator heaters also
stand in this room, the pipes passing through the division wall,
connecting with the incubators on the other side.
The floor is smooth surface concrete, there being a gentle slope in
the heater room all to one corner, where a drain carries off the water
used in flushing the floor. This same arrangement exists also in the
Incubator Cellar proper, allowing the hose to be used in flooding the
floor twice a day to give the proper amount of moisture for
incubation.
The concrete blocks used in the construction of this Cellar are
what is known as rock faced, and the face is on the inside, pointed
up in black. The floor joists overhead are dressed lumber, and are
painted in the following manner: the priming coat is almost pure oil
with just enough lead to give it a whitish tinge; the next coat is dead
white, flat finish, and the third is white enamel of the best stock
obtainable. The incubators are finished in the same way, allowing the
whole Cellar to be literally scrubbed with a brush.
This Cellar has no duplicate, anywhere.

Building No. 2, Work Shop, etc.

The Work Shop proper is twenty by thirty feet, on a concrete
foundation, with a cement floor. The height from the floor to the
rafters is ten feet in the clear. In this room stands a ten horse power
Gasolene Engine, and a large Mixer, the second Mixer designed by
The Corning Egg Farm, which produces a mix in less time, and with
less power, than any other machine to-day on the market. With the
necessary meals and green cut bone, in seven minutes the juices
from the bone are so uniformly distributed throughout the entire
mass that it is almost impossible to believe that no water has been
added. The weight of a mix will average about five hundred pounds.
In experiments with beef scrap in The Corning Egg Farm Mash, in
ten minutes’ time the meals are completely coated with oils which
come from good beef scrap when properly mixed. This Mixer is now
being made by Wilson Bros., Easton, Pa., in different sizes, from
hand to horse power, to meet the needs of large and small plants.
The Bone Cutter is also made by Wilson Bros., and, in our opinion,
is the best Bone Cutter on the market, and we have tried all the
different designs. Wilson Bros. manufacture these cutters in all sizes,
from hand power up to the large one which they first built for The
Corning Egg Farm, and we have graduated in size, during the past
years from a hand power to the Large Cutter now in use.
There is also a large Clover Cutter, which will cut in various
lengths from a quarter of an inch to an inch and a half. The
necessary pulleys and hangers for this machine are placed in the
rafters above.
Built into the rear and sides of this room are the various grain bins,
compactly arranged to reduce the labor of handling to a minimum.
 In the Work Shop is also a bench, with vices, etc., and cupboards,
built into the walls, where complete kits of tools for carpentry,
plumbing, hot water fitting, etc., are kept, in order that the
mechanical work, so far as repairs and keeping up the efficiency of
the plant go, is done without calling in outside labor.
Back of the Shop, and connecting with it, is the Egg Packing
Room, with its necessary arrangement of shelves, tables, etc., for
the work carried on there.
To the rear of the Egg Packing Room, but having no connection
with it whatever, is the room in which the large Freezer stands, for
the preservation of green bone. The concrete floor in this room is
sloped to a drain so that it may be thoroughly cleansed every day
after the bone is taken out or put into the Freezer. The Freezer itself
has a capacity of 2500 lbs. of bone, but the room, under ordinary
conditions of weather, maintains such a temperature that there is no
difficulty in carrying bone in barrels, standing around the room, which
increases our storing capacity to more than double the quantity.
On the second floor of the Work Shop is a complete and modern
apartment in which the working foreman lives.

Building No. 9, Horse Stable

This is constructed on the general plan of all the buildings on the
Farm, with capacity for four horses, and with necessary room for
hay, etc., in the loft above.
A large shed is built at the rear of the stable, in which bins are
constructed for the carrying of grit and shell, and also for the storage
of packing crates for eggs.

Building No. 10, Wagon Shed

This is conveniently placed to the stable, and is twenty by forty
feet, with four sets of double doors, allowing the placing of vehicles
without interfering with those already inside.

Building No. 12, Office Building

 Conveniently arranged in three rooms covering a floor space of
nine hundred and twenty-five square feet, hot water heated, and with
electric lights.

THE CELEBRATED CORNING LARGE FLOCK LAYING HOUSE NO. 3

CARRYING 1500 PULLETS
 CHAPTER XXVII
Construction of Laying, Breeding, and Breeding
Cockerel Houses
The Breeding and Laying Houses, on The Corning Egg Farm, are
all built in the manner described in the remainder of this chapter, and
are each 160 feet long. The Breeding Cockerel House is 60 feet in
length. These Houses are all fifteen feet, nine inches, in width, the
drawing in of them being three inches for the purpose of making the
roof rafters, which are sixteen feet in length, readily reach out to the
end of the plates, on the slant which they carry. The height of the
buildings from the ground, over all, is twelve feet, two inches at the
back and fourteen feet, two inches in front.
The interior of these buildings is divided into 20 foot sections, by
partitions extending out from the north wall of the buildings, seven
feet, and forming the roosting closets. These partitions run from the
floor clear to the ceiling, breaking the draughts, which but for them,
would make the long Laying Houses utterly impracticable.
The north wall of the Laying House is five feet high in the clear, the
south wall being seven feet. This makes a sufficient height for
walking through the building without stooping, and, as the bottom of
the windows is carried up three feet from the floor, the window itself
going up to the plate under the roof, the Sun reaches every part of
the House of practically sixteen feet wide.

Nearly Six Feet from Ground

The buildings are all set on posts, three feet in the ground and five
feet above. The floor joists are ten inches in width and two inches
thick, and, instead of the usual sill, two by ten planks are spiked at
both ends of these floor joists resting on the posts which support the
building. This construction is much simpler than the ordinary sills,
and is also less expensive.
The posts are eight feet apart and well braced. They are cross tied
at the corners, and about every fifty feet throughout the building; they
are also braced at the ends.
The floor joists are placed three feet apart, and the uprights are
made of two by four joists, placed three feet apart. At the corners of
the House the upright supports are doubled, making the corner posts
equivalent to four by four.
The construction of these buildings without any projections over
the top of the roof has two advantages. First, there is a saving in the
quantity of lumber used and in labor expended; second, all the joints
of the roof and walls are made tighter, and the lapping of the roofing
over the edges of the building and cementing it make all joints
absolutely air and water tight.

LAYING HOUSE PREPARED TO RECEIVE 1500 PULLETS FROM RANGE

Double Floors
 The floors are all built double. The under floor may be of any kind
of rough boards, and carefully covered over with one ply roofing of
any good quality, the laps, as elsewhere in the building, being
carefully cemented and nailed down with large, flat headed,
galvanized nails made for the purpose. The upper floor should be of
a cheap quality of tongued and grooved boards, well driven up and
securely nailed. Preferably this upper flooring is laid crosswise of the
building.
The outside of these buildings is covered with any cheap, rough
boards obtainable. These should be securely nailed over the
studding of the building, and then covered with a good grade of two
ply roofing paper. On the sides and ends of the building the roofing
should be put on upright, but on the roof it is better to lay it
lengthwise of the building and lapped, on the plan of laying shingles,
the joints all being securely cemented and nailed down, and then the
joints and nails painted over with cement, to make sure against any
possible leaks.
The inside walls of the building are lined with one ply roofing, with
the joints carefully nailed and cemented, and then both walls and
ceiling are covered with matched flooring. This gives four inches of
dead air space to all the walls of the building, making them cooler in
Summer and warmer in Winter than any other known construction.
Owing to the roof rafters being ten inches in width, the dead air
space under the roof is of course ten inches.
The three outsides of the building, north, east and west, are
covered with roofing down to the ground, there being, of course, no
inner lining below the floor under the House. To the south the House
is entirely open from the floor to the ground. Each House, raised five
feet from the ground and open to the south, gets the sunlight
underneath clear to the back of the building, which eliminates all
dampness, and, being so open prevents rats and other vermin
making any attempt to get into the House.
The window openings are nine feet long by three and a half feet in
width. As the studding is three feet apart this permits the making of
the openings without cutting the studding, and so weakening any of
the supports under the roof. These openings are spaced off so that
their total length comes as near as may be to one-half the length of
the south front of the House.

Canvas Windows
Ventilators, one foot in width and occupying the space between
the window openings, have recently been constructed in these
Houses, which permit the closing of all canvas windows tight at
night, when the weather is very cold, letting the air come in through
these ventilators, at the top, without bringing any draughts down
upon the birds. Detailed plans of these ventilators will be found at the
end of this Book.

ONE OF THE BREEDING HOUSES IN 1911

The frames of the curtained windows are made of one by four inch
boards, with two center supports dividing the window frame into
three foot sections. These frames are covered with medium weight
cotton duck, from which the dust must be brushed at regular
intervals to permit the air to circulate through them freely.
 Outside of the Office, Brooder House, Work Shop, Stable and the
Resident Quarters, no glass is used in any of the buildings, with the
exception of one small pane in the door of each Laying House,
through which a view of the interior may be had.
A hood, extending out eight inches, is built over the windows and
ventilators, the whole length of the buildings. This prevents the rain
from southerly storms beating into the Houses.
The windows are hung on hinges, and open inward from the top,
and are fastened to the ceiling with wooden buttons.
The front of all of the window openings, on the outside, is covered
with one inch mesh wire netting, to prevent the birds from flying out,
and also to prevent sparrows and other birds from flying in to
consume the grain provided for the fowls.

Double Doors
There are double doors at both ends of each House, swinging
inward, the opening being six feet in width. These doors are made of
two thicknesses of matched boards, one side being vertical, and the
other diagonal, with a lining of roofing paper between. These are
kept closed only in cold and stormy weather.
A board, twelve inches wide, is fastened to the floor a little over
three feet back from the door opening. This board runs across the
width of the House for six feet, and at that point a board of the same
width, three feet long, is fastened to it and carried down to the end
wall of the House. This makes a clear space in which the doors can
be swung open without being blocked by the litter, which the hens
would otherwise be sure to bank up against the doors. A vestibule of
wire netting, on sectional frames, is fastened to the ceiling and
baseboard, with wire hooks and eyes. See details shown in drawing,
at the back of the Book.
The second pair of doors, which open outward, are covered with
inch mesh wire down to within three feet of the floor, and are used
during the Summer months and in mild weather in Winter.
A small glass window, about eight by ten, is placed in one of the
solid doors at a convenient height. This enables one to observe the
conditions in the Laying Houses without being obliged to open the
door.
At the west end of all the Laying Houses there is a flight of stairs
with a platform at the top, five feet square and with a hand rail
around it, giving easy access to the House through the end from
which the least number of violent storms comes. The east ends of
the Laying Houses do not have steps and platforms.
The dropping boards are placed three feet above the floor in all
the Houses, except in the Cockerel House, where they are thirty
inches from the floor, as we found the growing cockerels needed
additional space overhead to prevent injury to their combs. This
leaves abundance of room in the Laying Houses for the birds to work
in the litter, and is also of sufficient height to allow a man to get
under the dropping boards to search for the eggs which the hens
often deposit in the litter.
This height also gives the Sun an opportunity to reach every nook
and corner of the House at some time during the day.

Draught-Proof Roosting Closets

The partitions dividing the twenty foot sections of the roosting
closets, as previously explained, are seven feet in width, extending
out one foot beyond the dropping boards, which are six feet wide,
and thus giving absolute protection to the hen, sitting on the roost,
from any draughts which may be blowing through the House.
Two sets of roosts are placed in each roosting closet, each
consisting of five perches, of two by two spruce, nine feet, ten inches
long, rounded at the top and nailed to a cross piece of the same
material. The first perch stands nine inches from the back wall; the
others are thirteen inches from center to center. Birds larger than the
Leghorns require more space between perches than here specified.
The two sets of roosts are placed side by side, and are fastened at
the back with a bolt, as shown in the plans. When the dropping
boards are being cleaned, the roosts are raised up and fastened to
hooks suspended in the ceiling. They are supported in front by a
piece of joist one foot high securely nailed to the cross pieces of the
roosts.
 There are openings under the dropping boards in all the Houses
for the egress and ingress of the fowls, with a runway leading to the
ground underneath. These openings are securely boxed and are
covered at top and bottom to prevent any draughts. The detail of
these openings is shown in the plans at the back of the Book.
The nests are all made of boxes bought from grocers and other
dealers in the neighborhood, and are much cheaper and better than
any nests laid out and built by mechanics. They are put up in three
tiers, and fill up the spaces between the windows, as shown in the
detailed drawing.
The boxes are cut down to twelve by fourteen inches, which
makes the best sized nest.
In the floor of each Laying House there are three hatchways
dividing the length of the building into four equal parts. These
hatchways are for convenience in removing the litter, and greatly
facilitate the operation and reduce the necessary amount of labor,
because a wagon can be backed directly underneath. If the wagon
should be too high, shovel out a runway for the wheels.

THE CORNING COLONY HOUSE

 These hatchways are made of two thicknesses of boards with
roofing between and are rabbited and securely fastened.
The nesting material used is fine excelsior. This is better than
straw or shavings as it does not offer a convenient home for lice,
and, if the nests be thoroughly disinfected with Crude Carbolic and
Kerosene, there is no danger of having any.