The TNM staging system: A stable value in the battle against cancer. A brief historical overview
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The TNM Staging System: A Stable Value in the Battle Against Cancer. A Brief Historical Overview Nomikos IN Cancer staging is the way in which cancer is communicated. It defines prognosis, determines appropriate treatment, evaluates the results of treatment and sets the basis for clinical and translational cancer research. Before treatment is commenced for any patient with cancer, three essential factors should be known: the site of origin, the histological type (including the grade) and the extent or stage of the cancer. The globally accepted method for describing the extent of cancer is the anatomically based Tumor, Node, Metastasis (TNM) staging system, which classifies the cancer according to its local, regional and distant extent. Developed in France in the 1940s by Pierre Denoix, the TNM classification has become the accepted basis of cancer staging. The general rules of the TNM system change as new technologies in cancer diagnosis and treatment are developed. The initial work on the clinical classification of cancer was instituted by the League of Nations Health Organization (1929), the International Commission on Stage Grouping and Presentation of Results (ICPR) of the International Congress of Radiology (1953), and the International Union Against Cancer (UICC). The latter organization became most active in the field through its Committee on Clinical Stage Classification and Applied Statistics. This committee was later known as the UICC TNM Committee. Staging cancer is a never-ending process. The American Joint Committee on Cancer (AJCC), which has led this effort in the USA since 1959, published its first cancer staging
Nomikos IN, MD, FACS Director and Chairman, Department of Surgery, “Metaxa” Memorial Cancer Hospital, Piraeus Greece Corresponding author: Iakovos N Nomikos, 55 Psarron St., Korydallos, 18120 Piraeus Greece e-mail: [email protected]
Hellenic Journal of Surgery 89
manual in 1977. Since the 1980s the work of UICC and AJCC has been coordinated, resulting in the simultaneous publication of the TNM Classification of Malignant Tumors by the UICC and AJCC Cancer Staging Manual. The revision cycle is 6-8 years, a time frame that provides the accommodations to the advances in cancer care while allowing cancer registry systems to maintain stable operation. Currently (October 2017) the seventh edition of Cancer Staging Manual is in use [1]. In order to ensure that the cancer care community has the necessary infrastructure in place for documenting the 8th Edition stage, the AJCC Executive Committee, in dialogue with the National Cancer Institute (NCI-SEER), Centers for Disease Control and Prevention (CDC), the College of American Pathologists (CAP), the National Comprehensive Cancer Network (NCCN, the National Cancer Data Base (NCDB), and the Commission on Cancer (CoC), made the decision to delay the implementation of the 8th Edition Cancer Staging System to January 1, 2018.
Reference 1. Edge SB, Byrd DR, Compton CC, et al. Purposes and principles of cancer staging. In: AJCC cancer sta
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