Anal cancer TNM staging AJCC UICC version 9

Primary tumor (T)^*
T category	T criteria
TX	Primary tumor not assessed
T0	No evidence of primary tumor
T1	Tumor less than or equal to 2 cm in greatest dimension
T2	Tumor greater than 2 cm but less than or equal to 5 cm in greatest dimension
T3	Tumor greater than 5 cm in greatest dimension
T4	Tumor of any size invading adjacent organ(s), such as the vagina, urethra, or bladder
Primary tumor suffix (m) Multiple synchronous primary tumors
Regional lymph nodes (N)^*
N category	N criteria
NX	Regional lymph nodes cannot be assessed
N0	No tumor involvement of regional lymph node(s)
N1	Tumor involvement of regional lymph node(s)
N1a	Tumor involvement of inguinal, mesorectal, superior rectal, internal iliac, or obturator lymph node(s)
N1b	Tumor involvement of external iliac lymph node(s)
N1c	Tumor involvement of N1b (external iliac) with any N1a node(s)
Regional lymph nodes suffix (sn) Sentinel node procedure (f) FNA or core needle biopsy
Distant metastasis (M)^*
M category	M criteria
cM0	No distant metastasis
cM1	Distant metastasis
pM1	Microscopic confirmation of distant metastasis
AJCC prognostic stage group is assigned based on the stage classification and categories chosen.^*
Prognostic stage groups
When T is...	And N is...	And M is...	Then the stage group is...
T1	N0	M0	I
T2	N0	M0	IIA
T1-T2	N1	M0	IIB
T3	N0-N1	M0	IIIA
T4	N0	M0	IIIB
T4	N1	M0	IIIC
Any T	Any N	M1	IV

AJCC: American Joint Committee on Cancer; TNM: tumor, node, metastasis; UICC: Union for International Cancer Control.

* AJCC data elements required for staging are identified with an asterisk.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging System: Anus, Version 9 (2022), published by the American College of Surgeons (ACS).

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Anal cancer TNM staging AJCC UICC version 9