CL.ASSIFICATION OF TUMOURS I M

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WORLD

HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA S A N T ~

CL.ASSIFICATION OF TUMOURS I M

DOMESTIC ANIMALS

ED I TED BY

L,

N ,

OWEN

F i r s t E d i t i o n Geneva

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^{1 9 8 0}

The issue of this document does not constitute formal publication. It shouid not be reviewed, abstracted or quoted without the agreement of rhe World Health Organization. Authors alone are responsible for views expressed in signed articles.

Ce document ne constitue pas irne publication.

11 ne doit faire I'objei d'aucun compte rendu ou rCsum6 ni d'aucune citation sans I'autorisaticn de I'Organisation Mondiale de la Sante. Les opinions exprirnees dans Ies articles signes n'engagent que leurs auteurs.

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VPH/CMO/~O. 20 page 3

C O N T E N T S

Preface

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Participants

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Introduction

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The T N

M

system

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The anatomical sites

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Skin (excluding lymphosarcoma and mastocytoma) Skin

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mastocytoma

Mammary glands

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Head and neck

Alimentary system, pancreas, liver

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Urological system

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Genital system

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Bones and joints

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Lymphoid and haemopoietic tissues (including lymphosarcoma of skin)

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Respiratory system

Endocrine glands (thyroid, adrenal)

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Page 4 5 6 6

11 12 14 16 21 26 32 35 4 3 46 48 5 1

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PREFACE

An International Histological Classification of Tumours of Domestic Animals complementing the classification of tumours of man was comp eted in 1975 and

t

published in the Bulletin of the World Health Organization. Since that time great advances have been made in other aspects of comparative oncology, notably in prognosis and therapy.

The TNM Classification of Malignant Tumours in man was first published in 1968 by the International Union against Cancer (UICC). As part of the WHO Programme on Comparative Oncology this method of classification has now been adapted as closely as possible for many of the tumours occurring in domestic animals, allowing for the many anatomical and pathological differences. This was done at two consultations held in Geneva on 18-20 April 1978 and 13-15 March

1979, and the participants who formulated the TNM Classification of Tumours in Domestic Animals are listed on page 5.

The TNM system for domestic animal tumours should be of great value in recording clinical cases and it is proving particularly useful in planning

international clinical trials on comparative oncology, some of which (e.g. canine mammary carcinoma) are already in progress.

Like the histological classification, the domestic animal TNM system reflects the present state of knowledge and will require modification in the future but it should provide some essential groundwork in clinical veterinary oncology.

In ~articular, this classification records the manv malignant tumours in

domestic animals which have already proved to be useful models for cancer research in man.

'Bull. Wld Hlth Org. 1976, 50, (1-2)

I I II II

"

1976, 53, (2-3)

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Participants in WHO consultations in 1978 and 1979 who formulated the

TNM

Classification of Tumours in Domestic Animals:

Dr R.S. Brodey, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pa 19104, United States of America

Dr E.L. Gillette, Colorado State University, Comparative Oncology Unit, Room 100, Veterinary Science, Fort Collins, Colorado 80523, United States of America

Dr V.N. Milouchine, formerly Veterinary Public Health Unit, WHO, Geneva, Switzerland Dr W. Misdorp, Nederlands Kanker Instituut, Antoni van Leeuwenhoek Ziekenhuis,

Plesmanlaan 121, Amsterdam

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Slotervaart, The Netherlands

Dr L.N. Owen, WHO Collaborating Centre for Comparative Oncology, Dept of Clinical Veterinary Medicine, Madingley Road, Cambridge CB3 OES, United Kingdom

Professor A.-L. Parodi, Ecole national vgtgrinaire, 94701 Alfort, France Dr A.B. Syrkin, Laboratory of Pharmacology, Cancer Research Centre (AMS/USSR),

Kashirskoje SH. 6, Moscow 115478, USSR

Dr G.H. Theilen, University of California School of Veterinary Medicine, Davis 95616, California, United States of America

The participants are pleased to acknowledge the technical assistance of Miss P.C. Botton, Veterinary Public Health, WHO, in the preparation and editing of this classification.

l I

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INTRODUCTION

THE PURPOSE OF CLASSIFICATION

The p r a c t i c e of d i v i d i n g c a n c e r c a s e s i n t o groups a c c o r d i n g t o " s t a g e s " has a l r e a d y been e s t a b l i s h e d f o r tumours of man.* The system a r o s e from t h e f a c t t h a t s u r v i v a l r a t e s were h i g h e r f o r c a s e s i n which t h e d i s e a s e was l o c a l i z e d t h a n f o r t h o s e i n which t h e d i s e a s e had extended beyond t h e organ of o r i g i n . These groups were o f t e n r e f e r r e d t o a s " e a r l y c a s e s ' ' and

" l a t e c a s e s " implying some r e g u l a r p r o g r e s s i o n w i t h time. The s t a g e of d i s e a s e a t t h e t i m e of d i a g n o s i s may b e a r e f l e c t i o n , n o t only of t h e r a t e of growth and e x t e n s i o n of t h e neoplasm, b u t a l s o of t h e t y p e of tumour, t h e tumour-host r e l a t i o n s h i p and t h e i n t e r v a l between r e c o g n i - t i o n of t h e f i r s t symptom o r s i g n and t h e d i a g n o s i s o r t r e a t m e n t .

The p r i n c i p a l purpose of i n t e r n a t i o n a l agreement on c l a s s i f i c a t i o n of c a n c e r c a s e s by e x t e n t of d i s e a s e i s t o provide a method of conveying one p e r s o n ' s c l i n i c a l o b s e r v a t i o n s t o o t h e r s w i t h o u t ambiguity.

The v e t e r i n a r y c l i n i c i a n ' s t a s k i s t o make a p r o v i s i o n a l p r o g n o s i s and a d e c i s i o n on t h e most e f f e c t i v e c o u r s e of t r e a t m e n t . These r e q u i r e , among o t h e r t h i n g s , an o b j e c t i v e a s s e s s - ment of t h e a n a t o m i c a l e x t e n t of t h e d i s e a s e .

The o b j e c t i v e s of s t a g i n g animal tumours a r e :

1. t o a i d t h e v e t e r i n a r y c l i n i c i a n i n p l a n n i n g t r e a t m e n t 2. t o g i v e some i n d i c a t i o n of p r o g n o s i s

3. t o a s s i s t i n e v a l u a t i o n of t r e a t m e n t r e s u l t s

4. t o f a c i l i t a t e t h e exchange of i n f o r m a t i o n between t r e a t m e n t c e n t r e s 5. t o c o n t r i b u t e t o t h e c o n t i n u i n g i n v e s t i g a t i o n of animal cancer

6. t o c o n t r i b u t e i n f o r m a t i o n t h a t i s of comparative v a l u e between man and animal.

To meet t h e s e o b j e c t i v e s a system of c l a s s i f i c a t i o n i s r e q u i r e d (1) i n which t h e b a s i c p r i n c i p l e s a r e a p p l i c a b l e t o a l l s i t e s , r e g a r d l e s s of t r e a t m e n t and (2) which may b e supple- mented l a t e r by i n f o r m a t i o n t h a t becomes a v a i l a b l e from h i s t o p a t h o l o g y o r s u r g e r y .

The TNM system meets t h e s e requirements. It p r o v i d e s an e s s e n t i a l communication and i n f o r m a t i o n exchange d e v i c e and a u s e f u l guide f o r p r o g n o s i s and t h e r a p y .

THE TNM SYSTEM The TNM system i s based on t h e assessment o f :

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t h e e x t e n t of t h e primary tumour T

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t h e c o n d i t i o n of t h e r e g i o n a l lymph nodes N

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t h e a b s e n c e l p r e s e n c e of d i s t a n t m e t a s t a s e s M

The a d d i t i o n of numbers t o t h e s e t h r e e components ( e . g . T 1 , T2

...

e t c . , NO, N 1

...

e t c . , MO, M 1

...

e t c . ) i n d i c a t e s t h e e x t e n t of t h e m a l i g n a n t d i s e a s e .

For example, a v e t e r i n a r i a n f a m i l i a r w i t h t h e system might d e s c r i b e a dog w i t h c a n c e r of t h e mammary g l a n d a s "T3b N2 MO". This would i n d i c a t e t h a t t h e tumour was of a c e r t a i n s i z e (more t h a n 3 cm i n d i a m e t e r ) w i t h f i x a t i o n t o t h e u n d e r l y i n g f a s c i a o r muscle; t h a t e i t h e r t h e a x i l l a r y o r i n g u i n a l lymph nodes were p a l p a b l e and f i x e d ; and t h a t t h e r e was no c l i n i c a l e v i - dence of d i s t a n t m e t a s t a s e s .

I n o t h e r words it i s a kind of shorthand n o t a t i o n f o r t h e d e s c r i p t i o n of a malignant

,

tumour.

*UICC TNM C l a s s i f i c a t i o n of Malignant Tumours, Ed. M. Harmer, 3rd e d . , Geneva, 1978.

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General r u l e s

The g e n e r a l r u l e s a p p l i c a b l e t o a l l s i t e s a r e a s follows:

1. I n a l l c a s e s confirmation of malignancy by h i s t o l o g i c a l o r c y t o l o g i c a l examination i s o b l i g a t o r y . Any c a s e s n o t s o proved must b e recorded s e p a r a t e l y .

A t many s i t e s s e v e r a l d i s t i n c t types of c a n c e r may occur, d i f f e r i n g n o t only i n t h e i r h i s t o l o g i c a l p a t t e r n b u t a l s o i n t h e i r c l i n i c a l behaviour. It would c l e a r l y b e wrong t o con- s i d e r a l l such types t o g e t h e r .

An example i s cancer of t h e mammary gland of t h e dog. W e l l d i f f e r e n t i a t e d t u b u l a r adeno- carcinomas have a good prognosis following mastectomy b u t a n a p l a s t i c carcinomas have a poor prognosis.

2 . A l l c a s e s a r e i d e n t i f i e d by T , N and M c a t e g o r i e s , which must b e determined and recorded p r i o r t o d e f i n i t i v e t r e a t m e n t . They remain unchanged although t h e y may b e q u a l i f i e d by addi- t i o n a l h i s t o p a t h o l o g i c a l o r s u r g i c a l information.

The reason f o r t h i s i s c l e a r . The c o n d i t i o n of many animals w i t h cancer p r e c l u d e s surgery when they f i r s t a t t e n d f o r t r e a t m e n t . Consequently they would be excluded from a u n i v e r s a l c l a s s i f i c a t i o n i f evidence o b t a i n e d only a t o p e r a t i o n w e r e r e q u i r e d .

The TNM system i n man d e s c r i b e s two c l a s s i f i c a t i o n s f o r each s i t e : (a) pre-treatment, c l i n i c a l c l a s s i f i c a t i o n

(b) p o s t - s u r g i c a l h i s t o p a t h o l o g i c a l c l a s s i f i c a t i o n d e s i g n a t e d pTNbf

For most tumours t h e pTNM c a t e g o r i e s correspond t o t h e TNM c a t e g o r i e s b u t d i f f e r e n c e s have been noted and a d d i t i o n s made f o r t h y r o i d , b r e a s t , oesophagus, stomach, b l a d d e r , p r o s t a t e and melanoma. This dual c l a s s i f i c a t i o n h a s n o t been attempted a t t h i s s t a g e f o r tumours i n domes- t i c animals. It i s t h e pre-treatment c l i n i c a l TNM c l a s s i f i c a t i o n which i s of paramount

importance f o r purposes of r e p o r t i n g and e v a l u a t i o n .

It i s recognized, however, e s p e c i a l l y i n t h e a l l o c a t i o n of animals w i t h c e r t a i n tumours i n c l i n i c a l t r i a l s , t h a t d e t a i l e d h i s t o p a t h o l o g i c a l information supplementing t h e c l i n i c a l diagnosis i s e s s e n t i a l , e.g. grading of mastocytomas, i n v a s i o n o r l a c k of i n v a s i o n by mammary t u b u l a r adenocarcinoma.

3. I n t h e c l i n i c a l assessment of an animal tumour numerous i n v e s t i g a t i o n s may b e done. It i s important t o d i s t i n g u i s h o b l i g a t o r y i n v e s t i g a t i o n s from t h o s e which add refinement t o t h e diag- n o s i s of t h e e x t e n t of t h e malignant d i s e a s e . For each s i t e minimum c r i t e r i a f o r TNM

c l a s s i f i c a t i o n a r e l i s t e d . The r e g i o n a l lymph nodes f o r each s i t e a r e d e f i n e d .

4 . A f t e r a s s i g n i n g T, N and M c a t e g o r i e s (with d e g r e e of e x t e n s i o n ) t h e s e may b e grouped i n t o a number of c l i n i c a l s t a g e s f o r c e r t a i n tumours.

It i s obvious t h a t tumours of some s i t e s l e n d themselves more e a s i l y and s a t i s f a c t o r i l y t o c l a s s i f i c a t i o n t h a n o t h e r s . These a r e t h e a c c e s s i b l e s i t e s where eye and hand can a s s e s s by d i r e c t v i s i o n , p a l p a t i o n and measurement t h e primary tumour and i t s r e g i o n a l lymph nodes. The mammary gland, t h e upper a i r and food p a s s a g e s , t h e s k i n and long bones a r e examples. The

l e a s t s a t i s f a c t o r y s i t e s f o r c l a s s i f i c a t i o n of t h e i r tumours a r e t h e deep-seated v i s c e r a , e.g.

stomach, colon, kidney and ovary.

It i s necessary t h e r e f o r e t h a t , although t h e r u l e s of t h e TNM system s h o u l d be r i g i d l y observed, t h e r e must b e , f o r any p a r t i c u l a r s i t e , some method f o r t h e i d e n t i f i c a t i o n and recording of a d d i t i o n a l i n f o r m a t i o n considered e s s e n t i a l f o r t h a t s i t e . The f o l l o w i n g i s a n example of such a d d i t i o n a l informat i o n .

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Most dogs w i t h mammary c a n c e r o f p o s t e r i o r g l a n d s have a mastectomy, which u s u a l l y means t h e i n g u i n a l lymph node i s removed and examined h i s t o l o g i c a l l y . I f mobile nodes a r e p a l p a b l e c l i n i c a l l y b e f o r e o p e r a t i o n t h e d e s i g n a t i o n N 1 i s a p p l i e d t o t h e c a s e . I f t h e s e nodes a r e found on h i s t o l o g i c a l examination t o b e tumour-free, t h e c y p h e r (-) (minus) i s added, t h u s : NI(-). I f t h e y c o n t a i n tumour d e p o s i t s , t h e cypher (+) ( p l u s ) i s added, t h u s : NI(+).

PRIMARY TUMOUR ( T )

T1, T 2 , T3, T 4 i n d i c a t e i n c r e a s i n g d e g r e e s of e x t e n t of t h e primary tumour. The number of t h e s e T c a t e g o r i e s may v a r y a c c o r d i n g t o t h e p a r t i c u l a r s i t e b u t i t i s recommended t h a t i n g e n e r a l t h e r e s h o u l d be f o u r . F o r each s i t e t h e i d e a l s i t u a t i o n i s when tumours can b e accu- r a t e l y d e f i n e d , a c c u r a t e l y a s s e s s e d on c l i n i c a l examination and have p r e c i s e "boundariest', such a s a s i z e - l i m i t a t i o n o r a "yes o r no" d i s t i n c t i o n , e.g. movable o r f i x e d .

1. The tumours e a s i e s t t o c l a s s i f y a r e t h o s e which a r i s e i n a s i n g l e organ. I n t h e s e t h e tumour can b e s i m p l y d e s c r i b e d i n terms of i t s a n a t o m i c a l e x t e n t .

I n t h e mannnary g l a n d of t h e dog f o r i n s t a n c e , t h e t h r e e main q u a l i t i e s w h i c h . d e t e m i n e t h e T c a t e g o r y a r e s i z e , involvement o f s k i n and involvement of u n d e r l y i n g t i s s u e s . There a r e f o u r degrees of T and any agreed c l i n i c a l f e a t u r e can determine t h e degree of T, as i n d i c a t e d i n t h e f o l l o w i n g s i m p l i f i e d t a b l e :

It i s n o t known i f t h e l o c a l i z a t i o n of t h e tumour w i t h i n t h e mammary g l a n d ( s ) i s as impor- t a n t i n a n i m a l s a s it i s i n women. However, a l t h o u g h p o s i t i o n i s n o t included i n t h e T

d e f i n i t i o n s , t h e r e i s no d i f f i c u l t y i n comparing, f o r example, a group of T 3 o u t e r h a l f c a s e s and a group o f T3 i n n e r h a l f c a s e s , p r o v i d e d t h i s i n f o r m a t i o n i s recorded i n t h e animal's h o s p i t a l c h a r t .

2 . A second group of tumours o c c u r s i n s i t u a t i o n s which a r e n o t s o circumscribed and i n which t h e s i z e and e x t e n t cannot b e s o e a s i l y a s c e r t a i n e d , e.g. tumours of t h e b l a d d e r a r e a s s e s s e d on cystoscopy, r a d i o g r a p h y , manual examination under a n a e s t h e s i a and t h e e x t e n t of p e n e t r a t i o n of t h e b l a d d e r w a l l by t h e tumour ( a s i n d i c a t e d by t h e m i c r o s c o p i c examination of t i s s u e removed f o r b i o p s y ) .

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S i z e

l

3 . ^At h i r d t y p e cannot b e diagnosed a t a l l w i t h o u t t a k i n g o p e r a t i v e f i n d i n g s i n t o a c c o u n t , e.g.

laparotomy i n o v a r i a n tumours and s u r g i c o - p a t h o l o g i c a l f i n d i n g s i n colon and bone tumours.

T

M u l t i p l e tumours have t o be c o n s i d e r e d under s e v e r a l h e a d i n g s : Skin

F a s c i a , Muscle and T h o r a c i c w a l l

T 1 Less t h a n 3 cm

T 3 T 2

3-5 cm

T 4

More than 5 cm

Minor involvement

w i t h o r w i t h o u t f a s c i a o r muscle f i x a t i o n

Major involvement

4

T h o r a c i c o r abdominal w a l l f i x a t i o n

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( a ) t h o s e o c c u r r i n g s i m u l t a n e o u s l y i n p a i r e d organs ( e . g . c h a i n of mammary g l a n d s ) s h o u l d b e c l a s s i f i e d i n d e p e n d e n t l y .

(b) t h o s e o c c u r r i n g s i m u l t a n e o u s l y i n t h e s k i n s h o u l d have t h e a c t u a l number r e c o r d e d . The tumour w i t h t h e h i g h e s t T c a t e g o r y i s s e l e c t e d and t h e number of tumours i n d i c a t e d i n paren- t h e s i s , t h u s T2(5).

( c ) t h o s e o c c u r r i n g i n hollow v i s c e r a o r c a v i t i e s , e . g . b l a d d e r , vagina, p e n i s , and i n which t h e e x a c t number i s i m m a t e r i a l , a r e denoted by a d d i t i o n o f t h e s u f f i x (m) t h u s : T3(m). This may a l s o b e a p p l i e d t o t h e h i s t o p a t h o l o g i c a l c l a s s i f i c a t i o n , t h u s : P2(m)

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s e e " H i s t o p a t h o l o g i - c a l e x t e n t and g r a d i n g , page

.

I n a d d i t i o n t o t h e degrees ,of T needed t o d e s c r i b e t h e l o c a l e x t e n t of a tumour, o t h e r T symbols r e q u i r e mention:

TO means "no e v i d e n c e of primary tumour". This c a t e g o r y i s necessary t o cover c a s e s where l y m p h a t i c o r blood-borne m e t a s t a s e s o c c u r w h i l e t h e primary neoplasm remains o c c u l t .

TX means t h a t i t i s impossible t o a s s e s s f u l l y t h e e x t e n t of t h e primary tumour.

T i s i s r e s e r v e d e x c l u s i v e l y f o r carcinoma i n s i t u ( p r e i n v a s i v e carcinoma).

--

This i s a n e s s e n t i a l c a t e g o r y i n some s i t e s , e . g . cornea and s c l e r a , e y e l i d s and nose.

REGIONAL LYMPH NODES (NI

N 1 , N2, N3 i n d i c a t e t h e c h a r a c e r i s t i c s of lymph nodes, which may be a s s e s s e d by p a l p a t i o n , lymphangiography o r o t h e r p r o c e d u r e s . The number of t h e s e c a t e g o r i e s v a r i e s a c c o r d i n g t o s i t e . E x a m ~ l e of N c l a s s i f i c a t i o n : o r a l c a v i t v

NO No p a l p a b l e r e g i o n a l lymph nodes, i . e . no r e g i o n a l lymph nodes a r e p a l p a b l e o r t h e y a p p e a r t o be normal on o t h e r d i a g n o s t i c p r o c e d u r e s

N 1 Movable r e g i o n a l i p s i l a t e r a l lymph nodes N2 Movable c o n t r a l a t e r a l o r b i l a t e r a l lymph nodes N3 F i x e d lymph nodes

H i s t o l o g i c a l i n f o r m a t i o n c o n c e r n i n g t h e s t a t e of t h e lymph nodes o b t a i n e d from a b i o p s y o r f o l l o w i n g o p e r a t i o n may b e added t o any N c a t e g o r y by t h e u s e of t h e cyphers ^(-) (minus) o r (+) ( p l u s ) , i n d i c a t i n g t h e absence o r p r e s e n c e o f m e t a s t a t i c involvement. This i s a l s o a p p l i c a b l e t o NX, t h u s : NX- o r NX+.

When r e g i o n a l lymph nodes a r e p a l p a b l e t h e y must b e c l a s s i f i e d a s N 1 o r N2 b u t an examining c l i n i c i a n may wish t o i n c l u d e h i s assessment of whether a lymph node c o n t a i n s m e t a s t a t i c tumour o r n o t . Thus f o r a l l lymph nodes d r a i n i n g head and neck tumours t h e d e f i n i t i o n s a r e :

N 1 Movable r e g i o n a l nodes

N l a nodes n o t c o n s i d e r e d t o c o n t a i n growth Nlb nodes c o n s i d e r e d t o c o n t a i n growth N2 Movable i p s i l a t e r a l o r b i l a t e r a l nodes

N2a nodes n o t c o n s i d e r e d t o c o n t a i n growth N2b nodes c o n s i d e r e d t o c o n t a i n growth DISTANT FIETASTASES (M)

The absence o r p r e s e n c e of m e t a s t a s e s i s i n d i c a t e d by t h e l e t t e r M.

MO No m e t a s t a s e s a r e d e t e c t e d c l i n i c a l l y

M 1 M e t a s t a s i s o t h e r than t o r e g i o n a l lymph nodes i s p r e s e n t

(9)

VPH/CM0/80.20 page 10

I f n e c e s s a r y M 1 may be s u b d i v i d e d i n t o f u r t h e r c a t e g o r i e s t o i n d i c a t e t h e t y p e of m e t a s t a s i s , e . g . t o bone, l i v e r , l u n g e t c .

MX I m p o s s i b l e t o a s s e s s t h e p r e s e n c e o f m e t a s t a s e s . H i s t o p a t h o l o g i c a l e x t e n t (P) and g r a d i n g ( G )

I n f o r m a t i o n o b t a i n e d a t o p e r a t i o n i s n o t g e n e r a l l y c o n s i d e r e d a d m i s s i b l e f o r c l i n i c a l c l a s s i f i c a t i o n b u t may b e used a s an a d d i t i o n . Two a s p e c t s of h i s t o p a t h o l o g y may be r e c o r d e d . The symbol P r e f e r s t o t h e depth of i n f i l t r a t i o n o f t h e tumour w i t h i n t h e organ o r t i s s u e , w h i l e t h e symbol G r e f e r s t o t h e p a t h o l o g i c a l g r a d i n g o f t h e tumour,

For example, f o r tumours of some hollow o r g a n s t h e h i s t o p a t h o l o g i c a l e x t e n t i s e x p r e s s e d i n f o u r d e g r e e s of P:

P1 Tumour c o n f i n e d t o t h e mucosa

P2 Tumour i n v o l v e s t h e mucosa and t h e submucosa and e x t e n d s t o o r i n t o t h e s e r o s a , b u t does n o t p e n e t r a t e through t h e s e r o s a

P3 Tumour p e n e t r a t e s through t h e s e r o s a w i t h o r w i t h o u t i n v a s i o n of contiguous s t r u c t u r e s P 4 Tumour d i f f u s e l y i n v o l v e s t h e e n t i r e t h i c k n e s s of t h e organ w a l l w i t h o u t obvious

b o u n d a r i e s .

P a t h o l o g i c a l g r a d i n g i s e x p r e s s e d i n t h r e e d e g r e e s : G 1 Low grade malignancy

G2 Medium g r a d e malignancy G3 High g r a d e malignancy

A d d i t i o n a l p a t h o l o g i c a l c a t e g o r i e s may be used i n c e r t a i n s i t e s , f o r example, t o r e c o r d i n v a s i o n of lymphatics o r v e i n s i n u r o l o g i c a l s i t e s . These a r e d e s i g n a t e d L and V.

Thus f o r tumours o f t h e b l a d d e r t h e d e f i n i t i o n s a r e : L0 No l y m p h a t i c i n v a s i o n

L1 S u p e r f i c i a l l y m p h a t i c s invaded L2 Deep l y m p h a t i c s invaded

For tumours of t h e kidney t h e d e f i n i t i o n s a r e : V0 The v e i n s do n o t c o n t a i n tumour

V 1 Renal v e i n c o n t a i n s tumour V2 Vena cava c o n t a i n s tumour S t a g e grouping

A s s t a t e d e a r l i e r t h e " s t a g i n g " of tumours h a s b e e n p r a c t i s e d f o r many y e a r s i n m e d i c i n e , and t h e system can b e a p p l i e d e q u a l l y w e l l t o animal tumours. C l a s s i f i c a t i o n by T, N and M aims a t a more p r e c i s e r e c o r d i n g of t h e a p p a r e n t e x t e n t of t h e d i s e a s e and t h e c a s e s can t h e n be grouped a c c o r d i n g t o c r i t e r i a t h a t a r e s t a t i s t i c a l l y p r e d i c t i v e . I n a tumour w i t h f o u r p o s s i b l e d e g r e e s of T, f o u r d e g r e e s of N and two d e g r e e s of M , t h e number o f groups. e x t e n d i n g from T I NO MO a t one end of t h e s c a l e t o T 4 N 3 M 1 a t t h e o t h e r . i s 32. To r e c o r d i n d i v i d u a l c a s e s i n t h e s e groups i s simple; t o reproduce t a b l e s c o n t a i n i n g t h a t number i s i m p r a c t i c a l

* e x c e p t f o r v e r y l a r g e s e r i e s .

(10)

V P H / C M ~ / 80.20 page 11

A t h e o r e t i c a l example may c o n t a i n t h e f o l l o w i n g stage-grouping:

TNM Groups C l i n i c a l S t a g e No of Groups p e r

Stage

Any TN symbols

+

M 1 I V 16

I t w i l l be s e e n t h a t t h e 1 2 TNM groups i n S t a g e 111 span a range from T1 NZ MO t o T4 N 3 MO.

The one-year s u r v i v a l of t h e f i r s t group may b e a b o u t 60% w h i l e of t h e l a s t group o n l y 15%.

This shows t h e l i m i t a t i o n of s t a g i n g where it i n c l u d e s such d i s s i m i l a r groups and demonstrates a t t h e same time t h e advantage of TNM c a t e g o r i e s .

THE ANATOMICAL SITES

The s i t e s now c l a s s i f i e d cover t h e g r e a t e r p a r t of t h e v e t e r i n a r y f i e l d f o r dogs and c a t s and most a r e s u i t a b l e f o r o t h e r animals. Each s i t e i s c o n s i d e r e d i n t h e same g e n e r a l manner, t h e f o l l o w i n g d e t a i l s b e i n g s e t o u t i n s h o r t i n t r o d u c t o r y remarks:

1. D e s c r i p t i o n of t h e s i t e and r e g i o n s

2 . D e f i n i t i o n of t h e r e g i o n a l and, where a p p l i c a b l e , t h e j u x t a - r e g i o n a l lymph nodes f o r each s i t e

3. Where n e c e s s a r y , t h e c l i n i c a l and s u r g i c a l methods recommended f o r e s t a b l i s h i n g t h e TNM c a t e g o r i e s .

The s i t e s a r e grouped under 11 headings:

1. S k i n ( e x c l u d i n g lymphosarcoma and mas tocytoma)

2. Skin (mastocytoma)

3. Mammary g l a n d s

I

4. Head and neck

5. Alimentary system, i n c l u d i n g p a n c r e a s , l i v e r 6 . U r o l o g i c a l s y s tem

7. G e n i t a l system 8. Bones and j o i n t s

9 . Lymphoid and h a e m a t o p o i e t i c t i s s u e s ( i n c l u d i n g lymphosarcoma of s k i n ) 10. R e s p i r a t o r y system

11. Endocrine g l a n d s ( t h y r o i d , a d r e n a l )

Tumours of t h e eye, CNS, h e a r t and e n d o c r i n e g l a n d s ( o t h e r t h a n a d r e n a l and t h y r o i d ) a r e n o t i n c l u d e d because i t is d i f f i c u l t t o c l a s s i f y them c l i n i c a l l y a t t h e p r e s e n t time and many of t h i s group a r e only l o c a l l y i n v a s i v e .

(11)

VPH/CM0/80.20 page 12

1. S K I N

( e x c l u d i n g lymphosarcoma and mastocytoma)

The c l a s s i f i c a t i o n a p p l i e s t o primary tumours of t h e s k i n . There must be h i s t o l o g i c a l v e r i f i c a t i o n t o p e r m i t grouping of c a s e s by h i s t o l o g i c a l t y p e .

The c l a s s i f i c a t i o n i s b a s e d on d i v i s i o n i n t o s i x r e g i o n s .

I n d e f i n i n g t h e lymph nodes f o r each r e g i o n , t h e body i s d i v i d e d v e r t i c a l l y a t t h e u m b i l i c u s .

The r e g i o n s and r e g i o n a l nodes a r e a s follows:

Regions Regional nodes

( a ) e y e l i d , e a r and n o s e c e r v i c a l ( b i l a t e r a l ) ( b ) f a c e ( e x c l u d i n g " a " ) ,

s c a l p and neck

c e r v i c a l ( b i l a t e r a l ) submandibular ( b i l a t e r a l ) a u r i c u l a r ( b i l a t e r a l )

( c ) upper limb a x i l l a r y and p r e s c a p u l a r ( i p s i l a t e r a l ) (d) t r u n k a n t e r i o r t o t h e

u m b i l i c u s

( e ) t r u n k p o s t e r i o r t o t h e u m b i l i c u s

a x i l l a r y ( b i l a t e r a l ) p r e s c a p u l a r ( b i l a t e r a l ) i n g u i n a l ( b i l a t e r a l )

( f ) lower limb i n g u i n a l and p o p l i t e a l ( i p s i l a t e r a l )

The e x t e n t of t h e d i s e a s e i s a s s e s s e d on c l i n i c a l examination and radiography. The primary tumour i s a s s e s s e d on s i z e , i n f i l t r a t i o n of s u b c u t i s o r involvement of o t h e r s t r u c t u r e s such a s f a s c i a , muscle, bone o r c a r t i l a g e . The s i z e , t o b e recorded i n cm., may be measured by c a l - l i p e r .

The p a t h o l o g i c a l g r a d e o f tumour should b e r e c o r d e d when a v a i l a b l e b u t does n o t modify t h e c l a s s i f i c a t i o n .

TO = no e v i d e n c e of tumour. Use f o r r e c h e c k s f o r malignancy a f t e r s u r g i c a l removal of primary tumour.

M u l t i p l e tumours

I n t h e c a s e o f m u l t i p l e simultaneous tumours, t h e tumour w i t h t h e h i g h e s t T c a t e g o r y should be i d e n t i f i e d and t h e number of s e p a r a t e tumours i n d i c a t e d i n p a r e n t h e s i s , e . g . (T2(5). Suc- c e s s i v e tumours s h o u l d be c l a s s i f i e d i n d e p e n d e n t l y .

(12)

V P H / C M O / ~ O . ~ O page 13 CLINICAL STAGES (TNM) OF CANINE OR FELINE TUMOURS OF EPIDERMAL OR DERMAL

ORIGIN (EXCLUDING LYMPHOSARCOMA AND MASTOCYTOMA)

Case number

...

Name of owner

...

^Date

...

Cat/Dog

...

^Age

...

^Sex

...

^Breed

...

Body weight

....

I b s

....

( 1 kg = 2.2 l b s ) kgs C i r c l e a p p r o p r i a t e c a t e g o r y

T: Primary Tumour

T i s P r e - i n v a s i v e carcinoma (carcinoma i n s i t u ) TO No e v i d e n c e of tumour

T1 Tumour

<

²cm. maximum d i a m e t e r , s u p e r £ i c i a l o r exophyt i c

T2 Tumour 2-5 cm. maximum diameter, o r w i t h minimal i n v a s i o n i r r e s p e c t i v e of s i z e T3 T u m o u r > 5 cm. maximumdiameter, o r w i t h

i n v a s i o n of t h e s u b c u t i s , i r r e s p e c t i v e o f s i z e

T4 Tumour i n v a d i n g o t h e r s t r u c t u r e s such as

f a s c i a muscle, bone o r c a r t i l a g e C i r c l e s i t e ( s ) involved

Tumours o c c u r r i n g s i m u l t a n e o u s l y should have t h e a c t u a l number recorded. The tumour w i t h t h e h i g h e s t T c a t e g o r y i s s e l e c t e d and t h e number of tumours i n d i c a t e d i n p a r e n t h e s i s , e.g.

T2 (5). S u c c e s s i v e tumours should be c l a s s i f i e d i n d e p e n d e n t l y . N: Regional Lymph Nodes (RLN)*

NO No evidence of RLN involvement N 1 Movable i p s i l a t e r a l nodes

Nla Nodes n o t considered t o c o n t a i n growth**

Nlb Nodes c o n s i d e r e d t o c o n t a i n growth**

N2 Movable c o n t r a l a t e r a l o r b i l a t e r a l nodes N2a Nodes n o t c o n s i d e r e d t o c o n t a i n growth*"

N2b Nodes c o n s i d e r e d t o c o n t a i n growth**

N 3 Fixed nodes M: D i s t a n t M e t a s t a s i s

MO No e v i d e n c e of d i s t a n t m e t a s t a s i s

M 1 D i s t a n t m e t a s t a s i s detected***

-

s p e c i f y s i t e ( s )

...

STAGE GROUPING: No s t a g e grouping is a t p r e s e n t recommended

Comments

...

*For RLN s e e i n t r o d u c t i o n

**(-)' = h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e

***Including lymph nodes beyond t h e r e g i o n i n which t h e primary tumour i s s i t u a t e d

(13)

VPH/CM0/80.20 page 14

2. SKIN

(Mas tocytoma)

The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l e x a m i n a t i o n and r a d i o g r a p h y . The primary tumour i s a s s e s s e d on s i z e , i n f i l t r a t i o n of s u b c u t i s o r involvement of o t h e r s t r u c t u r e s such a s f a s c i a , muscle, bone o r c a r t i l a g e . The s i z e , t o b e r e c o r d e d i n cm., nay b e measured by

c a l l i p e r .

I n t h e c a s e of m u l t i p l e simultaneous tumours, t h e tumour w i t h t h e h i g h e s t T c a t e g o r y should be i d e n t i f i e d and t h e number of s e p a r a t e tumours i n d i c a t e d i n p a r e n t h e s i s , e . g . T 2 ( 5 ) . Succes-.

s i v e tumours should b e c l a s s i f i e d i n d e p e n d e n t l y .

The p a t h o l o g i c a l grade of tumour s h o u l d b e r e c o r d e d when a v a i l a b l e b u t does n o t modify t h e c l a s s i f i c a t i o n .

Systemic s i g n s i n c l u d e g a s t r i c and duodenal u l c e r a t i o n , p e r i t o n i t i s , c o a g u l a t i o n d e f e c t s and glomerulonephri t i s

.

Because t h e s e tumours can b e p r e s e n t w i t h o r w i t h o u t s y s t e m i c s i g n s t h e TNM system i s n o t e n t i r e l y s u i t a b l e . The tumours can, however, b e c l i n i c a l l y s t a g e d i n t o f o u r c a t e g o r i e s .

(14)

~ ~ ~ / C M 0 / 8 0 . 2 0 page 15

CLINICAL STAGES OF CANINE MASTOCYTOMA

Case number

...

Name o f owner

...

^Date

...

....

Age

...

^Sex

...

^Breed

...

Body weight l b s (1 kg = 2 . 2 l b s )

....

^kgs

C i r c l e a o o r o ~ r i a t e c a t e e o r v C l i n i c a l S t a g e

I One tumour c o n f i n e d t o t h e dermis w i t h o u t r e g i o n a l lymph node involvement I a w i t h o u t s y s t e m i c s i g n s

Ib w i t h s y s t e m i c s i g n s

I1 One tumour confined t o dermis, w i t h r e g i o n a l lymph node involvement I I a w i t h o u t s y s t e m i c s i g n s

I I b w i t h s y s t e m i c s i g n s

I11 M u l t i p l e dermal tumours o r l a r g e i n f i l t r a t i n g tumour w i t h o r w i t h o u t r e g i o n a l lymph node involvement

I I I a w i t h o u t s y s t e m i c s i g n s I I I b w i t h s y s t e m i c s i g n s

I V Any tumour w i t h d i s t a n t m e t a s t a s i s o r r e c u r r e n c e w i t h m e t a s t a s i s *

Mu1 t i p l e tumours

Tumours o c c u r r i n g s i m u l t a n e o u s l y s h o u l d have t h e a c t u a l number recorded. The tumour w i t h t h e h i g h e s t T c a t e g o r y i s s e l e c t e d and t h e number of tumours i n d i c a t e d i n p a r e n t h e s i s , e . g . T2(5). S u c c e s s i v e tumours should be c l a s s i f i e d independently.

* I n c l u d i n g blood a n d / o r bone marrow involvement

(15)

jrPH/CM0/80.20 page 1 6

3 . W Y GLANDS

The c l a s s i f i c a t i o n a p p l i e s o n l y t o carcinoma.

The e x t e n t o f d i s e a s e i s a s s e s s e d on c l i n i c a l examination and radiography of t h e t h o r a x . The primary tumour i s a s s e s s e d on s i z e , and involvement of s k i n and u n d e r l y i n g s t r u c t u r e s . The s i z e , t o b e r e c o r d e d i n cm., may be measured by c a l l i p e r .

The p o s i t i o n of t h e tumour i n t h e mammary g l a n d s h o u l d be r e c o r d e d b u t h a s no b e a r i n g on c l a s s i f i c a t i o n .

The p a t h o l o g i c a l g r a d e of tumour s h o u l d b e r e c o r d e d when a v a i l a b l e b u t does n o t modify t h e c l a s s i f i c a t i o n .

M u l t i p l e tumours should b e c l a s s i f i e d independently.

The r e g i o n a l lymph nodes a r e t h e a x i l l a r y and i n g u i n a l nodes.

(16)

VPH/CM0/80.20 page 17 CLINICAL STAGES (TNM) OF CANINE MAMMARY TUMOURS

... ... ...

Case number Name of owner Date

Age

...

^Sex

...

^Breed

...

Body w e i g h t

...

^{l b s}

( 1 kg = 2.2 l b s )

...

^kg^S

Number of primary tumours :

Mammary g l a n d l o c a t i o n Right Chain L e f t Chain

of primary tumours: 1 2 3 4 5 1 2 3 4 5

L a r g e s t s i n g l e

d i a m e t e r (cm) :

---

S INGL E

MULTIPLE (Mark

\/

where a p p l i c a b l e )

3

C i r c l e a l l g l a n d s i n v o l v e d

The fol.lowing a r e t h e minimum r e q u i r ~ e n t s f o r a s s e s s i n g t h e T, N and M c a t e g 3 r i e s . ( I f t h e s e cannot b e met t h e symbols TX, NX and MX should be used. )

T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination N c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of t h o r a x C i r c l e a p p r o p r i a t e c a t e g o r y

T: Primary Tumour

TO No evidence o f tumour

Tl. Tumour

<

³^cm. maximum d i a m e t e r

T l a n o t f i x e d T l c f i x e d t o muscle Tlb f i x e d t o s k i n

T2 Tumour 3-5 cm. maximum d i a m e t e r

T2a n o t f i x e d ~2~ f i x e d t o muscle

T2b f i x e d t o s k i n

T3 Tumour

>

⁵^cm.maximum d i a m e t e r

T3a n o t f i x e d T3c f i x e d t o muscle

T4 Tumour any s i z e , i n f lamrnatory carcinoma*

M u l t i p l e tumours should be c l a s s i f i e d independently.

*

L o c a l l y i n v a d i n g s k i n w i t h o u t i n f e c t i o n o r trauma a s t h e cause.

(17)

VPH/CMO/~O.Z page 18

N: Regional Lymph Nodes (RLN)

:**

Mark l/ where a p p l i c a b l e

RLN e v a l u a t e d Method of RLN e v a l u a t i o n C i r c l e a p p r o p r i a t e c a t e g o r y

I n g u i n a l A x i l l a r y C l i n i c a l Histological***

NO

-

no evidence of RLN involvement

N 1

-

i p s i l a t e r a l RLN involved Nla n o t f i x e d

~ l b f i x e d

NZ

-

b i l a t e r a l RLN involved N2a n o t f i x e d

N2b f i x e d M: D i s t a n t ~ e t a s t a s i s

Mark

\/

where a p p l i c a b l e Method of M E v a l u a t i o n C i r c l e a p p r o p r i a t e c a t e g o r y

C l i n i c a l Radiographic H i s t o l o g i c a l MO

-

no evidence of d i s t a n t

m e t a s t a s i s

M 1

-

d i s t a n t m e t a s t a s i s i n c l u d i n g d i s t a n t nodes

S p e c i f y s i t e ( s )

...

STAGE GROUPING : T

I11 Any T 3

Any T

F i n a l C l i n i c a l S t a g e :

T N M

TNM E v a l u a t i o n

-

S t a g e

...B..

Comments:

...

**

The RLN a r e t h e a x i l l a r y and i n g u i n a l nodes

***

^(-) = ' h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e

(18)

V P H / C M O / ~ ~ . ~ O page 1 9

CLINICAL STAGES (TNM) OF FELINE MAMWWY TUMOURS

Case number

...

Name of owner

...

^Date

...

Age

...

^Sex ^Breed Body weight l b s

...

( 1 kg = 2.2 l b s ) kgs

Number of primary tumours:

Mammary g l a n d l o c a t i o n Right Chain L e f t Chain

of primary tumours: 1 2 3 4 1 2 3 4

L a r g e s t s i n g l e

d i a m e t e r (cm) :

- - -

SINGLE

MULTIPLE

E3

^(Mark ^l/where a p p l i c a b l e )

C i r c l e a l l g l a n d s involved

Ir

The f o l l o w i n g a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . ( I f t h e s e cannot b e met t h e syinbols TX, NX and MX should b e used.)

T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination

*

N c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of t h o r a x C i r c l e a p p r o p r i a t e Category

Primary Tumour

TO No evidence o f tumour

T1 Tumour

<

1 cm. maximum d i a m e t e r

T l a n o t f i x e d TIC f i x e d t o muscle

Tlb f i x e d t o s k i n

T2 Tumour 1-3 cm. maximum d i a m e t e r

T2a n o t f i x e d T2c f i x e d t o muscle

T3 Tumour

>

³ ^cm.maximum d i a m e t e r T3a n o t f i x e d

T3c f i x e d t o muscle

T4 Tumour any s i z e , i n £ lammatory carcinoma*

M u l t i p l e tumours should be c l a s s i f i e d independently.

*

L o c a l l y invading s k i n w i t h o u t i n f e c t i o n o r trauma a s t h e cause.

(19)

Y Y H / C M O / ~ O . 20 page 2 0

Pi: R e g i o n a l Lymph Nodes (RLN):**

Mark l/ where a p p l i c a b l e

RLN e v a l u a t e d Method of RLN e v a l u a t i o n C i r c l e a p p r o p r i a t e c a t e g o r y

I n g u i n a l A x i l l a r y C l i n i c a l H i s t o l o g i c a l * * *

-

NO

-

no e v i d e n c e of RLN involvement

N 1

-

i p s i l a t e r a l RLN i n v o l v e d Nla n o t f i x e d

Nlb f i x e d

U n

N2

-

b i l a t e r a l RLN i n v o l v e d N2a n o t f i x e d

N2b f i x e d

U 0 0 0

n n ^C1 n

M: D i s t a n t M e t a s t a s i s

Mark

\/

where a p p l i c a b l e C i r c l e a p p r o p r i a t e c a t e g o r y Method of M E v a l u a t i o n

C l i n i c a l R a d i o g r a p h i c H i s t o l o g i c a l MO

-

no e v i d e n c e of d i s t a n t

m e t a s t a s i s

M 1

-

d i s t a n t m e t a s t a s i s i n c l u d i n g d i s t a n t nodes

S p e c i f y s i t e ( s )

...

STAGE GROUPING:

T N

I11 Any T3

Any T

Any N Any Nb

F i n a l C l i n i c a l S t a g e :

...

TNM E v a l u a t i o n

- -

S t a g e

Comments:

...

**

The RLN a r e t h e a x i l l a r y and i n g u i n a l nodes

***

^{(-) =}h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e

(20)

VP~/CM0/80.20 page 21

4. HEAD AND NECK ( e x c l u d i n g l a r y n x )

The e x t e n t of d i s e a s e i s a s s e s s e d on c l i n i c a l examination, radiography of t h e thorax aad endoscopy

.

Radiographic examinat i o n i s mandatory.

The r e g i o n a l lymph nodes a r e t h e c e r v i c a l , t h e submandibular and t h e p a r o t i d nodes.

LIPS 1. Lower l i p

2. Upper l i p 3. Connnissures

The o r a l c a v i t y i n c l u d e s t h e a n t e r i o r two-thirds of t h e tongue, f l o o r of mouth, b u c c a l mucosa, t h e a l v e o l i and t h e hard p a l a t e .

1. Buccal mucosa

2. Lower a l v e o l u s and g i n g i v a 3 . Upper a l v e o l u s and g i n g i v a 4. Hard p a l a t e

5. Tongue: (a) d o r s a l s u r f a c e and l a t e r a l b o r d e r s ( a n t e r i o r t w o - t h i r d s ) ; ( b ) i n f e r i o r s u r f a c e

6 . F l o o r of mouth

In t h e c a s e of m u l t i p l e tumours, t h e symbol (m) i s added t o t h e a p p r o p r i a t e T category.

OROPHARYNX

The oropharynx e x t e n d s from t h e j u n c t i o n of t h e hard and s o f t p a l a t e s t o t h e l e v e l of t h e f l o o r of t h e g l o s s o e p i g l o t t i c f o l d s .

1. A n t e r i o r w a l l ( g l o s s o e p i g l o t t i c a r e a ) : ( a ) tongue ( p o s t e r i o r t h i r d ) ; ( b ) glosso- e p i g l o t t i c f o l d s ; ( c ) a n t e r i o r ( l i n g u a l ) s u r f a c e of e p i g l o t t i s

2. L a t e r a l w a l l and t o n s i l s 3. P o s t e r i o r oropharyngeal w a l l

4. S u p e r i o r w a l l

-

i n f e r i o r s u r f a c e of s o f t p a l a t e and u v u l a

The hypo pharynx i s included w i t h t h e oropharynx

.

^{I t}e x t e n d s from t h e pharyngoepiglo t t i c f o l d t o t h e upper end of t h e oesophagus and p o s t e r i o r pharyngeal w a l l .

In t h e c a s e of m u l t i p l e tumours, t h e symbol (m) i s added t o t h e a p p r o p r i a t e T category.

(21)

V P H / C M O / ~ O . ~ O page 22

CLINICAL STAGES ( T N M ) OF CANINE

/

FELINE TUMOURS OF THE LIPS

Case number

...

Name of owner

...

Date

...

... ...

... ... ...

Cat/Dog Age Sex Breed Body w e i g h t l b s

( 1 kg = 2.2 l b s )

...

^&S

The f o l l o w i n g a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . ( I f t h e s e cannot be met t h e symbols TX, NX and MX should b e used. )

T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examinat i o n N c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, r a d i o g r a p h y o f t h o r a x C i r c l e a p p r o p r i a t e c a t e g o r y

T: Primary Tumour

.

T i s P r e i n v a s i v e carcinoma (carcinoma TO No evidence of tumour

T1 Tumour

<

²cm. maximum diameter, s u p e r f i c i a l o r exophytic T2 Tumour

<

²cm. maximum diameter, w i t h minimal i n v a s i o n i n depth T3 Tumour

>

2 cm. d i a m e t e r o r w i t h deep i n v a s i o n i r r e s p e c t i v e of s i z e T4 Tumour invading bone

N: Regional Lymph Nodes (RLN)*

NO No e v i d e n c e of RLN involvement N 1 Movable i p s i l a t e r a l nodes

Nla Nodes n o t c o n s i d e r e d t o c o n t a i n growth**

Nlb Nodes c o n s i d e r e d t o c o n t a i n growth**

N2 Movable c o n t r a l a t e r a l o r b i l a t e r a l nodes N2a Nodes n o t c o n s i d e r e d t o c o n t a i n growth**

N2b Nodes c o n s i d e r e d t o c o n t a i n growth**

N 3 Fixed nodes M: D i s t a n t M e t a s t a s i s

MO No evidence of d i s t a n t m e t a s t a s i s

M 1 D i s t a n t m e t a s t a s i s ( i n c l u d i n g d i s t a n t nodes) d e t e c t e d

-

...

STAGE GROUPING: No s t a g e grouping i s a t present recommended

Comments:

...

*

The RLN a r e t h e c e r v i c a l , submandibular and p a r o t i d nodes

** (-1

= h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e

(22)

V ~ ~ / C M 0 / 8 0 . 2 0 page 23

CLINICAL STAGES (TNM) OF CANINE/FELINE TUMOURS OF THE OWL CAVITY (BUCCAL CAVITY) Case n~lrnber

...

Name of owner

...

^Date

...

... ...

Cat/Dog

...

^Age ^Sex ^Breed Body weight l b s

...

( 1 kg = 2.2 l b s ) kg s This c l a s s i f i c a t i o n a p p l i e s t o t h e a n t e r i o r two-thirds of t h e tongbe, f l o o r of mouth, b u c c a l mucosa, t h e a l v e o l i and t h e hard p a l a t e .

The f o l l o w i n g a r e t h e minimum r e q u i r e m e n t s f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . ( I f t h e s e cannot be met t h e symbols TX, NX and MX s h o u l d be u s e d . )

T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination N c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of thorax C i r c l e a p p r o p r i a t e c a t e g o r y

T: Primary Tumour

T i s P r e i n v a s i v e carcinoma (carcinoma i n s i t u ) TO No evidence of tumour

T1 Tumour

<

²cm. maximum diameter

T l a w i t h o u t bone i n v a s i o n Tlb w i t h bone i n v a s i o n T2 Tumour 2-4 cm. maximum d i a m e t e r

T2a w i t h o u t bone i n v a s i o n T2b w i t h bone i n v a s i o n T 3 Tumour

>

4 cm. maximum d i a m e t e r

T3a w i t h o u t bone i n v a s i o n T3bb w i t h bone i n v a s i o n

The symbol (m) added t o t h e a p p r o p r i a t e T c a t e g o r y i n d i c a t e s m u l t i p l e tumours N : Regional Lymph Nodes ( R I B ) *

NO No evidence of RLN involvement N 1 Movable i p s i l a t e r a l nodes

Nla Nodes n o t considered t o c o n t a i n growth* Nlb Nodes c o n s i d e r e d t o c o n t a i n growth**

H2 Movable c o n t r a l a t e r a l o r b i l a t e r a l nodes

N2a Nodes n o t considered t o c o n t a i n growth** N2b Nodes c o n s i d e r e d t o c o n t a i n growthk*

N3 Fixed nodes M: D i s t a n t M e t a s t a s i s

...

M 1 D i s t a n t m e t a s t a s i s ( i n c l u d i n g d i s t a n t nodes) d e t e c t e d

-

...

(23)

~ ~ H / C M 0 / 8 0 . 2 0 p a g e 24

STAGE GROUPING :

N M

NO, Nla o r N2a MO

I I T2 NO, Nla o r N2a MO

III*** T3 NO, Nla o r N2a MO

Any T Nlb

I V Any T Any N2b o r N3 MO

Any T Any N M 1

Comments:

...

*

The RLN a r e t h e c e r v i c a l , submandibular and p a r o t i d nodes

**

^{(-) =}h i s t o l o g i c a l l y n e g a t i v e , (+) = h i s t o l o g i c a l l y p o s i t i v e

***

Any bone involvement

(24)

VPH/CM0/80.20 page 25 CLINICAL STAGES (TNM) OF CANINE/FELINE/EQUINE TUMOURS OF THE OROPHARYNX*

...

Case number Name of owner

...

^Date

...

.... ... ....

Species

...

^Age

...

^Sex ^Breed Body weight l b s

....

( 1 kg = 2.2 l b s ) kgs The following c l a s s i f i c a t i o n a p p l i e s from t h e j u n c t i o n of t h e h a r d and s o f t p a l a t e s t o t h e l e v e l of t h e f l o o r of t h e g l o s s o e p i g l o t t i c f o l d s .

The following a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . ( I f t h e s e cannot be met t h e symbols TX, NX and MX should be used.)

T c a t e g o r i e s : C l i n i c a l , s u r g i c a l a n d . r a d i o l o g i c a 1 examination, endoscopy N c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of thorax C i r c l e a p p r o p r i a t e category

T: Primary Tumour

T i s Preinvas i v e carcinoma (carcinoma i n

--

S i t u ) TO No evidence of primary tumour

T1 Tumour s u p e r f i c i a l o r exophytic

Tla without systemic s i g n s Tlb with systemic s i g n s

T2 Tumour w i t h i n v a s i o n of t o n s i l only

T2a without systemic s i g n s T2b with systemic s i g n s

T3 Tumour with invasion of surrounding t i s s u e

T3a without systemic s i g n s T3b w i t h systemic s i g n s

4

The symbol (m) added t o t h e a p p r o p r i a t e T category i n d i c a t e s m u l t i p l e tumours.

N: Regional Lymph Nodes ( m ) * *

NO No evidence of RLN involvement N 1 Movable i p s i l a t e r a l nodes

Nla nodes n o t considered t o c o n t a i n growth***

Nlb nodes considered t o contain growth***

N2 Movable c o n t r a l a t e r a l o r b i l a t e r a l nodes N2a nodes n o t considered t o c o n t a i n growth***

N2b nodes considered t o contain growth***

N3 Fixed nodes M: D i s t a n t M e t a s t a s i s

M 1 D i s t a n t m e t a s t a s i s (including d i s t a n t nodes) d e t e c t e d

-

:. ...

STAGE GROUPING: No s t a g e grouping i s a t p r e s e n t reconrmended.

Comments:

...

*Mainly t o n s i l l a r carcinoma; **The RLN a r e the c e r v i c a l , submandibular and p a r o t i d nodes t ***(-l

-

h;-tfil--;,,ll~ p p p n + i ~ r p

,,p>

h i s t n l T ~ i S a l . l b 7 L n a ~ ~ ~ ~ 3 1 e , ,

(25)

VPH/CMO/80.20 page 26

OESOPHAGUS

Tunours of t h e oesophagus a r e r a r e i n animals e x c e p t i n g e o g r a p h i c a r e a s where t h e c a n i n e oesophageal p a r a s i t e S p i r o c e r c a l u p i e x i s t s and where h e r b i v o r o u s animals have a h i g h i n t a k e of bracken f e r n ( P t e r i d i u m aquilinum)

.

The e x t e n t of d i s e a s e i s a s s e s s e d by c l i n i c a l examination, radiography of t h e t h o r a x and endos copy.

STOMACH

I n single-stomached animals t h e r e a r e two r e g i o n s and t h e tumour i s a s s i g n e d t o t h a t r e g i o n i n which t h e b u l k o f it i s s i t u a t e d .

( a ) a n t e r i o r h a l f ( b ) p o s t e r i o r h a l f

I n h e r b i v o r e s t h e anatomical s i t e i s recorded e.g. rumen, abomasum.

The e x t e n t of d i s e a s e i s a s s e s s e d by c l i n i c a l examination, radiography of t h e t h o r a x and endoscopy o r laparotomy.

The r e g i o n a l lymph nodes a r e t h e g a s t r i c and s p l e n i c nodes.

PANCREAS

The e x t e n t of d i s e a s e i s a s s e s s e d by laparotomy o r l a p a r o s c o p y , and radiography of t h e thorax.

The r e g i o n a l lymph nodes a r e t h e s p l e n i c and h e p a t i c nodes.

LIVER

The e x t e n t of d i s e a s e i s a s s e s s e d by c l i n i c a l examination, radiography of t h e t h o r a x , and laparotomy o r laparoscopy.

The r e g i o n a l lymph nodes are t h e h e p a t i c and diaphragmatic nodes.

INTESTINES

The e x t e n t of d i s e a s e i s a s s e s s e d by c l i n i c a l examination, radiography of t h e t h o r a x and subsequent laparotomy.

The r e g i o n a l lymph nodes a r e t h e m e s e n t e r i c , c a e c a l , c o l i c and r e c t a l nodes.

*With t h e e x c e p t i o n of tumours of t h e p a n c r e a s , i n t h e c a s e of m u l t i p l e tumours t h e symbol (m) i s added t o t h e a p p r o p r i a t e T category.

(26)

V P H / C M O / ~ ~ . ~ O page 27

CLINICAL STAGES (TNM) OF TUMOURS OF THE OESOPHAGUS (ALL SPECIES)

Case number

...

Name of owner

...

^Date

...

Species

...

^Age

...

^Sex

....

^Breed

...

Body weight

....

^{l b s}

( 1 kg = 2.2 l b s )

....

^kgs

The f o l l o w i n g a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . ( I f t h e s e cannot be met t h e symbols TX, NX and MX s h o u l d b e used.)

T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, endoscopy N c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, r a d i o g r a p h y of t h o r a x

C i r c l e a p p r o p r i a t e c a t e g o r y T: Primary Tumour

TO No evidence of tumour

T1 Tumour confined t o t h e oesophagus T2 Tumour invading neighbouring s t r u c t u r e s

The symbol (m) added t o t h e a p p r o p r i a t e T c a t e g o r y i n d i c a t e s m u l t i p l e tumours.

NO No e v i d e n c e of EUN involvement N 1 RLN i n v o l v e d

M: D i s t a n t M e t a s t a s i s

MO No evidence o f d i s t a n t m e t a s t a s i s ^l

M 1 D i s t a n t m e t a s t a s i s d e t e c t e d

-

s p e c i f y s i t e ( s ) :

...

STAGE GROUPING: No s t a g e grouping is a t p r e s e n t reconmended

Comments:

...

*The U a r e :

-

f o r t h e c e r v i c a l oesophagus, t h e c e r v i c a l and p r e s c a p u l a r nodes

-

f o r t h e t h o r a c i c oesophagus, t h e m e d i a s t i n a l nodes

(27)

VPH/CM0/80.20 page 28

Case number

...

Name of owner

...

^Date

...

S p e c i e s

...

^Age

...

^Sex

....

^Breed

...

Body weight

....

^{l b s}

( 1 kg = 2 . 2 l b s )

....

^kgs

The f o l l o w i n g a r e t h e minimum r e q u i r e m e n t s f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . ( I f t h e s e cannot be m e t t h e symbols TX, NX and MX should b e used. )

T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination (laparotomy o r laparoscopy, endoscopy) N c a t e g o r i e s : S u r g i c a l examination (laparotomy, l a p a r o s c o p y )

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, r a d i o g r a p h y of t h o r a x C i r c l e a p p r o p r i a t e c a t e g o r y

T: Primarv Tumour

TO No e v i d e n c e of tumour T1 Tumour n o t i n v a d i n g s e r o s a T2 Tumour i n v a d i n g s e r o s a

T 3 Tumour i n v a d i n g n e i g h b o u r i n g s t r u c t u r e s

The symbol (m) added t o t h e a p p r o p r i a t e T c a t e g o r y i n d i c a t e s m u l t i p l e tumours

N: Regional Lymph Nodes

(m)*

NO No evidence of RLN involvement N 1 RLN i n v o l v e d

N2 D i s t a n t LN involved+

M: D i s t a n t Metastasis

MO No e v i d e n c e o f d i s t a n t m e t a s t a s i s

-

...

STAGE GROUPING: No s t a g e grouping i s a t p r e s e n t recommended

Comments:

...

*The RLN a r e t h e g a s t r o s p l e n i c nodes

I

(28)

VPH/CMO/80.20 page 29 CLINICAL STAGES (TNM) OF TUMOURS OF THE PANCREAS

(ALL SPECIES)

... ...

Case number N a m e o f owner

...

^Date

Species

...

^Age

...

^Sex

....

^Breed

...

Body weight

...

^{l b s}

...

( 1 kg = 2.2 l b s ) kgs

The following a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . ( I f t h e s e cannot be met t h e sjrmbels TX, XX and MX should be used.)

T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination (laparotomy o r laparoscopy) N c a t e g o r i e s : S u r g i c a l examination (laparotomy

,

laparoscopy)

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of thorax

T: Primary Tumour

TO No evidence of tumour

T1 Tumour p r e s e n t

-

s t a t e anatomical s i t e : N: Regional Lymph Nodes ( m ) *

NO No evidence of RLN involvanent N I RLN involved

I N2 D i s t a n t LN involved K: D i s t a n t M e t a s t a s i s

-

...

STAGE GROUPING: No s t a g e grouping is a t p r e s e n t recommended.

Comments:

...

P-

*The RLN a r e t h e s p l e n i c and h e p a t i c nodes

(29)

VPH/ CM0/80.20 page 30

CLINICAL STAGES (TNM) OF TUMOIJElS

OF

THE LIVER (ALL SPECIES)

...

Case number

...

Name of owner Date

.... ....

Species

...

^Age

...

^Sex ^Breed

...

Body weight l b s

( 1 kg = 2.2 l b s )

....

^kgs

The f o l l o w i n g a r e t h e minimum requirements f o r a s s e s s i n g t h e T, N and M c a t e g o r i e s . (If t h e s e cannot be met t h e symbols TX, NX and MX s h o u l d be u s e d . )

T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination (laparotomy o r l a p a r o s c o p y ) N c a t e g o r i e s : S u r g i c a l examination (laparotomy, laparoscopy)

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, r a d i o g r a p h y of t h o r a x C i r c l e a p p r o p r i a t e c a t e g o r y

T: Primary Tumour

TO No evidence of tumour T1 Tumour i n v o l v i n g one l o b e

T2 Tumour i n v o l v i n g more t h a n one l o b e T3 Tumour i n v a d i n g neighbouring s t r u c t u r e s

The symbol (m) added t o t h e a p p r o p r i a t e T c a t e g o r y i n d i c a t e s m u l t i p l e tumours N: Regional Lymph Nodes (RLN)*

NO No evidence o f RLN involvement N 1 RLNinvolved

N2 D i s t a n t LN i n v o l v e d M: D i s t a n t M e t a s t a s i s

M1 D i s t a n t m e t a s t a s i s d e t e c t e d

-

...

STAGE GROWING: No s t a g e grouping i s a t p r e s e n t recommended

Comments:

...

*The RLN a r e t h e h e p a t i c and d i a p h r a g m a t i c nodes

(30)

VPH/CM0/80.20 page 31

CLINICAL STAGES (TNM) OF TUMOURS OF THE INTESTINES (ALL SPECIES)

... ... ...

1

Case number Name of owner Date

Species

...

^Age

...

^Sex

....

^Breed

...

Body weight

....

^{l b s}

( 1 kg = 2.2 l b s )

....

^kgs

The following a r e t h e minimum requirements f o r a s s e s s i n g t h e T , N and M c a t e g o r i e s . ( I f t h e s e cannot be met t h e symbols TX, NX and MX should be used.)

T c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination (laparotomy o r laparoscopy) N c a t e g o r i e s : S u r g i c a l examination (laparotomy, laparoscopy)

M c a t e g o r i e s : C l i n i c a l and s u r g i c a l examination, radiography of thorax C i r c l e a p p r o p r i a t e category

T: Primary Tumour

TO No evidence of tumour T 1 Tumour n o t invading s e r o s a T2 Tumour invading s e r o s a

T3 Tumour invading neighbouring s t r u c t u r e s

The symbol (m) added t o t h e a p p r o p r i a t e T category i n d i c a t e s multiple tumours.

NO No evidence of RLN involvement

N1 RLN involved t

N2 D i s t a n t LN involved M: D i s t a n t M e t a s t a s i s

...

-

s p e c i f y s i t e ( s ) : STAGE GROUPING: No s t a g e grouping i s a t p r e s e n t reconmended

Comments:

...

*The E&N a r e t h e mesenteric, c a e c a l , c o l i c and r e c t a l nodes