Anal Cancer Staging
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The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classification and staging system for anal cancer are provided below. [1, 2] Note that these are based on the AJCC Cancer Staging Manual, 7th Edition (2010). Although the 8th edition has been published, implementation of the new system has been delayed until January 1, 2018. The AJCC advises that, “All newly diagnosed cases through December 31st 2017 should be staged with the 7th edition.” [3]
Table 1. TNM Classification for Anal Cancer (Open Table in a new window)
Primary tumor (T)
TX
Primary tumor cannot be assessed
T0
No evidence of primary tumor
Tis
Carcinoma in situ (Bowen disease, high-grade squamous intraepithelial lesion [HSIL], anal intraepithelial neoplasia II-III (AIN II-III)
T1
Tumor 2 cm or less in greatest dimension
T2
Tumor more than 2 cm but not more than 5 cm in greatest dimension
T3
Tumor more than 5 cm in greatest dimension
T4
Tumor of any size invades adjacent organ(s) (eg, vagina, urethra, bladder);direct invasion of the rectal wall, perirectal skin, subcutaneous tissue, or the sphincter muscle(s) is not classified as T4
Regional lymph nodes (N)
NX
Regional lymph nodes cannot be assessed
N0
No regional lymph node metastasis
N1
Metastasis in perirectal lymph node(s)
N2
Metastasis in unilateral internal iliac and/or inguinal lymph node(s)
N3
Metastasis in perirectal and inguinal lymph nodes and/or bilateral internal iliac and/or inguinal lymph nodes
Distant metastasis (M)
M0
No distant metastasis
M1
Distant metastasis
Table 2. Anatomic stage/prognostic group (Open Table in a new window)
Stage
T
N
M
0
Tis
N0
M0
I
T1
N0
M0
II
T2
N0
M0
T3
N0
M0
IIIA
T1
N1
M0
T2
N1
M0
T3
N1
M0
T4
N0
M0
IIIB
T4
N1
M0
Any T
N2
M0
Any T
N3
M0
IV
Any T
Any N
M1
How Is Anal Cancer Staged?. American Cancer Society. Available at http://www.cancer.org/cancer/analcancer/overviewguide/anal-cancer-overview-staging. Accessed: January 4, 2017.
NCCN Clinical Practice Guidelines in Oncology: Anal Carcinoma. National Comprehensive Cancer Network. Available at https://www.nccn.org/professionals/physician_gls/pdf/anal.pdf. Version 1.2017 — November 23, 2016; Accessed: January 4, 2017.
Implementation of AJCC 8th Edition Cancer Staging System. American Joint Committee on Cancer. Available at https://cancerstaging.org/About/news/Pages/Implementation-of-AJCC-8th-Edition-Cancer-Staging-System.aspx. Accessed: January 4, 2017.
Primary tumor (T)
TX
Primary tumor cannot be assessed
T0
No evidence of primary tumor
Tis
Carcinoma in situ (Bowen disease, high-grade squamous intraepithelial lesion [HSIL], anal intraepithelial neoplasia II-III (AIN II-III)
T1
Tumor 2 cm or less in greatest dimension
T2
Tumor more than 2 cm but not more than 5 cm in greatest dimension
T3
Tumor more than 5 cm in greatest dimension
T4
Tumor of any size invades adjacent organ(s) (eg, vagina, urethra, bladder);direct invasion of the rectal wall, perirectal skin, subcutaneous tissue, or the sphincter muscle(s) is not classified as T4
Regional lymph nodes (N)
NX
Regional lymph nodes cannot be assessed
N0
No regional lymph node metastasis
N1
Metastasis in perirectal lymph node(s)
N2
Metastasis in unilateral internal iliac and/or inguinal lymph node(s)
N3
Metastasis in perirectal and inguinal lymph nodes and/or bilateral internal iliac and/or inguinal lymph nodes
Distant metastasis (M)
M0
No distant metastasis
M1
Distant metastasis
Stage
T
N
M
0
Tis
N0
M0
I
T1
N0
M0
II
T2
N0
M0
T3
N0
M0
IIIA
T1
N1
M0
T2
N1
M0
T3
N1
M0
T4
N0
M0
IIIB
T4
N1
M0
Any T
N2
M0
Any T
N3
M0
IV
Any T
Any N
M1
Jeffrey B VanDeusen, MD, PhD Fellow, Department of Hematology/Oncology, Duke University School of Medicine
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital; Medical Director, Deaconess Hospital Outpatient Infusion Centers; Chairman, Deaconess Hospital Cancer Committee
Christopher D Braden, DO is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology
Disclosure: Nothing to disclose.
N Joseph Espat, MD, MS, FACS Harold J Wanebo Professor of Surgery, Assistant Dean of Clinical Affairs, Boston University School of Medicine; Chairman, Department of Surgery, Director, Adele R Decof Cancer Center, Roger Williams Medical Center
N Joseph Espat, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Clinical Oncology, Americas Hepato-Pancreato-Biliary Association, Association for Academic Surgery, Central Surgical Association, Chicago Medical Society, International Hepato-Pancreato-Biliary Association, Pancreas Club, Sigma Xi, Society for Leukocyte Biology, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Society of University Surgeons, Southeastern Surgical Congress, Southern Medical Association, Surgical Infection Society
Disclosure: Nothing to disclose.
Anal Cancer Staging
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