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©2013 UpToDate ® Print Email TNM staging for anal cancer Primary tumor (T) TX Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ (Bowen's disease, high-grade squamous intraepithelial lesion (HSIL), anal intraepithelial neoplasia II-III (AIN II-III)) T1 Tumor 2 cm or less in greatest dimension T2 Tumor more than 2 cm but not more than 5 cm in greatest dimension T3 Tumor more than 5 cm in greatest dimension T4 Tumor of any size invades adjacent organ(s), eg, vagina, urethra, bladder* Regional lymph nodes (N) NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in perirectal lymph node(s) N2 Metastasis in unilateral internal iliac and/or inguinal lymph node(s) N3 Metastasis in perirectal and inguinal lymph nodes and/or bilateral internal iliac and/or inguinal lymph nodes Distant metastasis (M) M0 No distant metastasis M1 Distant metastasis Anatomic stage/prognostic groups 0 Tis N0 M0 I T1 N0 M0 II T2 N0 M0 T3 N0 M0 IIIA T1 N1 M0 T2 N1 M0 T3 N1 M0 T4 N0 M0 IIIB T4 N1 M0 Any T N2 M0 Any T N3 M0 IV Any T Any N M1 Note: cTNM is the clinical classification, pTNM is the pathologic classification. * Direct invasion of the rectal wall, perirectal skin, subcutaneous tissue, or the sphincter muscle(s) is not classified as T4. Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer New York, Inc.