KCR Spring Training T,N,M Case Examples Tonya Brandenburg
Colon Case – Clinical Staging Clinical T cTX – The biopsy tissue from the colonoscopy wasn’t adequate to assess depth of invasion Clinical N cNX – There was no imaging to assess lymph nodes Clinical M cM0 – No mets signs or symptoms on H&P Clinical Stage - 99
Colon Case – Pathological Staging Pathological T pTX – Nothing to assess depth of invasion Pathological N pN2b – More than 7 regional lymph nodes involved Pathological M pM1a – Para-aortic lymph nodes positive (not regional for ascending colon, so distant lymph nodes) Pathological Stage - IVA
Lung Case – Clinical Staging Clinical T cT4 – Tumor in the main bronchus that involves the trachea Clinical N cN3 – Positive scalene node biopsy Clinical M cM0 – No mets signs or symptoms on H&P Clinical Stage - IIIB
Lung Case – Pathological Staging Pathological T pT Pathological N pN Pathological M pM Pathological Stage – 99 This patient did not meet the criteria for pathological staging
Bladder Case – Clinical Staging Clinical T cT1(m) – Stromal invasion = submucosa. Multiple distinct tumors with the same histology get the m modifier Clinical N cN0 – CT scan was negative Clinical M cM0 – No mets signs or symptoms on H&P Clinical Stage - I
Bladder Case – Pathological Staging Pathological T ypT2a(m) – Superficial muscle invasion (muscularis propria) Pathological N ypN0 – Negative nodes Pathological M cM0 – No mets signs or symptoms on H&P Pathological Stage – y II
Kidney Case – Clinical Staging Clinical T cT2b – 12 cm tumor in the left lower pole Clinical N cN0 – CT scan was negative for nodes Clinical M cM0 – No mets signs or symptoms on H&P Clinical Stage - II
Kidney Case – Pathological Staging Pathological T pT3a – 10 cm tumor extending into renal vein Pathological N pNX – No nodes examined Pathological M cM0 – No mets signs or symptoms on H&P Pathological Stage – III – The nodal status doesn’t play a role in T3 tumors