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Thyroid gland
Miscellaneous
TNM Staging of carcinomas

Reviewer: Shahidul Islam, M.D., Ph.D. (see Reviewers page)
Revised: 31 March 2013, last major update March 2009
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

Clinical staging
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Pathologic staging
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Primary tumor (T)
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TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
T1: Limited to thyroid, 2 cm or less in greatest dimension
T1a: Limited to thyroid, 1 cm or less
T1b: Limited to thyroid, more than 1 cm but not more than 2 cm
T2: Limited to thyroid, greater than 2 cm, but not more than 4 cm
T3: Limited to thyroid and > 4 cm OR any tumor with minimal extrathyroid extension (e.g. extension to sternothyroid muscle or perithyroid soft tissues)
T4a: Moderately advanced disease
Tumor of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus or recurrent laryngeal nerve
T4b: Very advanced disease
Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels

Anaplastic carcinoma - all are considered T4 tumors
T4a: Intrathyroidal anaplastic carcinoma
T4b: Anaplastic carcinoma with gross extrathyroid extension

Regional lymph nodes (N)
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NX: Regional lymph nodes cannot be assessed
N0: No regional lymph node metastasis
N1: Regional lymph node metastasis
N1a: Metastasis to Level VI (pretracheal, paratracheal and prelaryngeal/Delphian lymph nodes)
N1b: Metastasis to unilateral, bilateral or contralateral cervical (Levels I, II, III, IV or V) or retropharyngeal or superior mediastinal lymph nodes (Level VII)

Notes:
Clinical images / diagrams
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Central compartment
Cervical lymph node levels

Distant metastasis (M)
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M0: No distant metastasis
M1: Distant metastasis

Stage grouping
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Papillary or follicular:
Under 45 years 45 years or older
Stage I any T   any N   M0     T1 N0 M0
Stage II any T any N M1 T2 N0 M0
Stage III T3 N0 M0
T1-3 N1a M0
Stage IVA T4a N0-1a M0
T1-4a N1b M0
Stage IVB T4b any N M0
Stage IVC     Any T   any N   M1

Medullary carcinoma:
Stage I T1 N0 M0
Stage II T2-3 N0 M0
Stage III T1-3 N1a M0
Stage IVA T4a N0-1a M0
T1-4a N1b M0
Stage IVB T4b any N M0
Stage IVC     Any T   any N   M1

Anaplastic carcinoma
(all cases are Stage IV):

Stage IVA     T4a any N M0
Stage IVB T4b any N M0
Stage IVC Any T   any N   M1

Additional references
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End of Thyroid gland > Miscellaneous > TNM Staging of carcinomas


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