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Cancer Staging Systems

Staging of Thyroid Cancer

TNM definition

Primary tumor (T)

• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• T1: Tumor 1 cm or less in greatest dimension limited to the thyroid
• T2: Tumor more than 1 cm but not more than 4 cm in greatest dimension limited to the thyroid
• T3: Tumor more than 4 cm in greatest dimension limited to the thyroid
• T4: Tumor of any size extending beyond the thyroid capsule

Regional lymph nodes (N)

Regional lymph nodes are the cervical and upper mediastinal lymph nodes.

• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Regional lymph node metastasis
  • N1a: Metastasis in ipsilateral cervical lymph node(s)
  • N1b: Metastasis in bilateral, midline, or contralateral cervical or mediastinal lymph node(s)

Distant metastases (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

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Stage grouping

Papillary or follicular

Under 45 years

• Stage I
  • Any T, any N, M0
• Stage II
  • Any T, any N, M1

45 years and older

• Stage I
  • T1, N0, M0
• Stage II
  • T2, N0, M0
  • T3, N0, M0
• Stage III
  • T4, N0, M0
  • Any T, N1, M0
• Stage IV
  • Any T, any N, M1

Medullary

• Stage I
  • T1, N0, M0
• Stage II
  • T2, N0, M0
  • T3, N0, M0
  • T4, N0, M0
• Stage III
  • Any T, N1, M0
• Stage IV
  • Any T, any N, M1

Undifferentiated (anaplastic)

All cases are stage IV

• Stage IV
  • Any T, any N, any M

References

1. Thyroid Gland. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 5th ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1997, pp 59-64.

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