2. What is TNM? TNM is a system for classifying malignant tumours ! It is a cancer staging system, which describes the extent of a person's cancer ! Most medical facilities use this system as their main method for cancer reporting 1 ! Most types of cancer have TNM designations, but some do not 1 ! 1.National Cancer Institute, Cancer Staging, 2010

3. How does the TNM system work? The 3 parameters of the TNM system 1 : T = extent of the tumour N = the extent of spread to the lymph nodes M = presence of distant metastases A number is added to each letter to indicate 1 : the size or extent of the primary tumour the extent of cancer spread 1.National Cancer Institute, Cancer Staging, 2010

4. T = extent of primary tumour organ local tissues T0T1T2T3 T is classified as follows: 1 Tx: Primary tumour cannot be evaluated | T0: No evidence of primary tumour Tis: Carcinoma in situ (CIS) 2 | T1, T2, T3, T4: Size and/or extent of the primary tumour 1.National Cancer Institute, Cancer Staging, 2010 2.CIS – abnormal cells are present but have not spread to neighbouring tissue; although not cancer, CIS may become cancer and is sometimes called pre-invasive cancer

5. N = extent of spread to lymph nodes distant nodes local nodes N0 N is classified as follows 1 : Nx: Regional lymph nodes cannot be evaluated | N0: No local lymph node involvement N1: Tumour has spread to local lymph nodes | N2, N3: Involvement of local and distant lymph nodes (number of lymph nodes and/or extent of spread) 1.National Cancer Institute, Cancer Staging, 2010 N1 N2

6. M0 M = presence of distant metastases M is classified as follows 1 : Mx: Distant metastasis cannot be evaluated | M0: No distant metastasis M1: Distant metastasis is present 1.National Cancer Institute, Cancer Staging, 2010 bone lung liver M1Mx ?