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Staging of anal cancer

The TNM-classification is used to divide anal cancer into stages. TNM assesses the tumor (T), lymph nodes (N), and metastases (M), at the time of diagnosis.

Tumor infiltration (T)

  • Tis  carcinoma in situ
  • T1  Tumor ≤ 2 cm in diameter
  • T2  Tumor > 2 cm, but < 5 cm in diameter
  • T3  Tumor ≥ 5 cm in diameter


  • T4  Tumor infiltration into neighboring organs (vagina, urethra, bladder, prostate) irrespective of size. Infiltration of sphincter muscle alone is not classified as T4.


Lymph node status (N)

  • N0  No regional lymph nodes
  • N1  Metastases in peri- or mesorectal lymph nodes


  • N2  Metastases in unilateral internal iliac and/or inguinal lymph nodes


  • N3  Metastases in peri- or mesorectal and inguinal lymph nodes and/or bilateral internal iliac and/or inguinal lymph nodes


  • NX  Regional lymph nodes cannot be assessed

Metastases (M)

  • M0  No metastases
  • M1  Metastases

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