pTNM

The TNM staging system is an internationally recognized way to describe how far cancer has developed and spread. It was created by the American Joint Committee on Cancer (AJCC). This system uses detailed information about three key factors:

• Tumour (T): The size of the primary tumour and how far it has grown into surrounding tissue.

• Lymph Nodes (N): Whether cancer has spread to nearby lymph nodes (small structures that help your body fight infections).

• Metastases (M): Whether the cancer has spread (metastasized) to distant parts of the body.

Together, these factors (T, N, and M) provide doctors with a clear picture of the cancer’s stage, which helps predict how the disease might behave and guides treatment decisions.

What do the letters “p” and “c” mean in pTNM and cTNM?

The TNM staging system uses additional letters to indicate how the information was obtained:

• pTNM (Pathologic TNM): The letter “p” means the stage was determined by a pathologist—a doctor who examines tissues under a microscope—after analyzing tissue removed through surgery or biopsy. This provides precise and detailed information about the tumour, lymph nodes, and metastases based on actual tissue examination.

• cTNM (Clinical TNM): The letter “c” indicates the clinical stage, determined by your treating doctors using medical history, physical examinations, imaging tests (like CT scans, MRIs, or X-rays), and other medical assessments. Clinical staging gives a general understanding of the cancer’s extent before treatment begins.

Why is TNM staging important?

The TNM staging system provides critical information that helps doctors:

• Understand how advanced the cancer is.

• Predict how the cancer might behave over time (prognosis).

• Choose the most appropriate and effective treatment options.

• Determine if additional treatments (like chemotherapy or radiation) are necessary.

Your overall treatment plan will typically incorporate both the detailed pathologic information (pTNM) from your pathology report and the clinical staging (cTNM) determined by your doctors based on tests and exams.

Questions to ask your doctor

If your pathology or clinical reports mention TNM staging, you may want to ask your doctor these questions:

• What is the TNM stage of my cancer, and what does this mean for my treatment?

• How was my stage determined, and is it based on clinical tests or a pathologic examination?

• What is the prognosis (expected outcome) associated with my specific TNM stage?

• Does my TNM stage suggest the need for additional tests, treatments, or follow-up care?

Understanding the TNM staging system can help you clearly understand your diagnosis, actively participate in your treatment decisions, and plan effectively for your care.