UICC World Cancer Congress 2006

Objectives: To be aware of the process by which the TNM Classification is reviewed and changed and to provide preliminary results. Methods: The seventh edition of the TNM Classification will be published in 2009. The UICC TNM project has been surveying the literature yearly since 2001 to detect peer-reviewed studies that may have a bearing on modifying the current classification. Relevant articles have been circulated among UICC TNM expert panels and AJCC task forces. Their analyses will influence the next TNM revision. Results: Most of the proposals involve minor changes, i.e., “tweaking” of categories, to maintain comparability of data between editions. The site that potentially could have major changes is the lung owing to a comprehensive review of the classification by the International Association for the Study of Lung Cancer (IASLC) which is analyzing 80,000 cases. Among the proposals for relatively minor changes at other sites are the following: adding subdivisions of existing categories to define more precisely the anatomic extent of the primary tumor, e.g., separating intramucosal from submucosal tumors of the esophagus and stomach; eliminating category subdivisions, e.g., the level of vena caval involvement above and below the diaphragm for renal cell carcinoma; changing break-points between categories, e.g., the size of the tumor in organ confined renal cell carcinoma; “downstaging” of categories, e.g., peau d'orange in breast tumors and external ear carcinomas that invade cartilage; “upstaging” of categories, e.g., renal cell carcinomas extending to the adrenal. In addition there were requests for: a classification of gastroesophageal carcinomas, especially in respect to the definition of regional lymph nodes; revision of the number of regional lymph nodes needed for adequate assessment at selected sites; and refinement of the criteria concerning isolated tumor cells in lymph nodes. These items may or may not be changed, but will certainly be given consideration.