1. KCR Spring Training T,N,M Case Examples Tonya Brandenburg

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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