Part of Cancer staging guidance sheets
Thyroid gland (ICD10 C73)
Introduction
This is the data sheet for TNM 8th edition staging of the thyroid gland (ICD10 C73).
For more detailed information regarding TNM staging, please see pages 51-54 of the UICC TNM 8 book or visit the Wiley and UICC website.
Stage groupings
Papillary and Follicular* under 55 years
|
Stage Group |
T stage |
N stage |
M stage |
|---|---|---|---|
|
Stage I |
Any T |
Any N |
M0 |
|
Stage II |
Any T |
Any N |
M1 |
Papillary or Follicular 55 years and older
|
Stage I |
T1a,T1b,T2 |
N0 |
M0 |
|---|---|---|---|
|
Stage II |
T3 |
N0 |
M0 |
|
T1,T2,T3 |
N1 |
M0 |
|
|
Stage III |
T4a |
Any N |
M0 |
|
Stage IVA |
T4b |
Any N |
M0 |
|
Stage IVB |
Any T |
Any N |
M1 |
Medullary carcinoma
|
Stage I |
T1a, T1b |
N0 |
M0 |
|---|---|---|---|
|
Stage II |
T2, T3 |
N0 |
M0 |
|
Stage III |
T1, T2, T3 |
N1a |
M0 |
|
Stage IVA |
T1, T2, T3 |
N1b |
M0 |
|
|
T4a |
Any N |
M0 |
|
Stage IVB |
T4b |
Any N |
M0 |
|
Stage IVC |
Any T |
Any N |
M1 |
Anaplastic/undifferentiated carcinoma - all are considered stage IV
|
Stage IVA |
T1,T2,T3a |
N0 |
M0 |
|---|---|---|---|
|
Stage IVB |
T1,T2,T3a |
N1 |
M0 |
|
Stage IVB |
T3b,T4a,T4b |
N0,N1 |
M0 |
|
Stage IVC |
Any T |
Any N |
M1 |
Note:
* Including papillary, follicular, poorly differentiated, and Hurthle cell carcinomas.
Clinical staging
This is mentioned for ease of reference as it may be discussed in the MDT meeting and in relation to clinical trials, but we recommend that pathology reports include only the pathological TNM staging. The translation of the pathological data into staging differs with the tumour type. In papillary and follicular carcinoma, there is evidence that prognosis is poorer in older patients and therefore different criteria are applied to patients under 55 years from those to patients aged 55 years and older. In medullary carcinoma, no age stratification applies. All undifferentiated/anaplastic tumours are regarded as categories within stage IV.
TNM clinical classification
T - primary tumour*
| T value | Description |
|---|---|
|
TX |
Primary tumour cannot be assessed |
|
T0 |
No evidence of primary tumour |
|
T1 |
Tumour 2 cm or less in greatest dimension, limited to the thyroid T1a - Tumour 1 cm or less in greatest dimension, limited to the thyroid T1b - Tumour more than 1 cm but not more than 2 cm in greatest dimension, limited to the thyroid |
|
T2 |
Tumour more than 2 cm but not more than 4 cm in greatest dimension, limited to the thyroid |
|
T3 |
Tumour more than 4 cm in greatest dimension, limited to the thyroid or with gross extrathyroidal extension invading only strap muscles (sternohyoid, sternothyroid, or omohyoid muscles) T3a - Tumour more than 4 cm in greatest dimension, limited to the thyroid T3b - Tumour of any size with gross extrathyroidal extension invading strap muscles (sternohyoid, sternothyroid, or omohyoid muscles) |
|
T4a |
Tumour extends beyond the thyroid capsule and invades any of the following: subcutaneous soft tissues, larynx, trachea, oesophagus, recurrent laryngeal nerve |
|
T4b |
Tumour invades prevertebral fascia, mediastinal vessels, or encases carotid artery |
Note:
*Including papillary, follicular, poorly differentiated, Hurthle cell and anaplastic carcinomas
N - regional lymph nodes
| N value | Description |
|---|---|
|
NX |
Regional lymph nodes cannot be assessed |
|
N0 |
No regional lymph node metastasis |
|
N1 |
Regional lymph node metastasis N1a - Metastasis in Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes) or upper/superior mediastinum N1b - Metastasis in other unilateral, bilateral or contralateral cervical (Levels I, II III, IV, or V) or retropharyngeal |
M - distant metastasis
| M value | Description |
|---|---|
|
M0 |
No distant metastasis |
|
M1 |
Distant Metastasis |
TNM pathological classification
pT - primary tumour
The pT categories correspond to the T categories as per above.
| pT value | Description |
|---|---|
|
pTX |
Primary tumour cannot be assessed |
|
pT0 |
No evidence of primary tumour |
|
pT1a |
≤10 mm, limited to thyroid |
|
pT1b |
≤20 mm but >10 mm, limited to thyroid |
|
pT2 |
>20 mm, ≤40 mm, limited to thyroid |
|
pT3a |
>40 mm, limited to thyroid |
|
pT3b |
Tumour of any size with gross extrathyroidal extension invading strap muscles (sternohyoid, sternothyroid or omohyoid muscles) |
|
pT4a |
Tumour invades beyond thyroid capsule and invades any of: subcutaneous soft tissues, larynx, trachea, oesophagus or recurrent laryngeal nerve |
|
pT4b |
Tumour invades prevertebral fascia, mediastinal vessels or encases carotid artery |
Note:
- UICC TNM 8 staging applies to carcinomas and includes papillary, follicular, poorly differentiated, Hurthle cell and anaplastic carcinomas.
- Multifocal tumours (≥2 foci) of all histological types should be designated (m), the largest focus determining the classification, e.g. pT2(m).
pN - regional lymph nodes
| pN value | Description |
|---|---|
|
pNX |
Cannot assess regional lymph nodes |
|
pN0 |
No regional nodes involved |
|
pN1a |
Metastasis in level VI (pretracheal, paratracheal and prelaryngeal/Delphian) lymph nodes |
|
pN1b |
Metastasis in other unilateral, bilateral or contralateral cervical (levels I, II, III, IV or V) or retropharyngeal or superior mediastinal lymph nodes |
M - distant mestasis
| M value | Description |
|---|---|
|
M0 |
No distant metastasis |
|
M1 |
Distant Metastasis |
R - residual primary tumour
| R value | Description |
|---|---|
|
RX |
Cannot assess presence of residual primary tumour |
|
R0 |
No residual primary tumour |
|
R1 |
Microscopic residual primary tumour |
|
R2 |
Macroscopic residual primary tumour |
Last edited: 29 December 2022 2:40 pm
