Friday, December 11, 2015

Breast Cancer TNM Staging mnemonic

Hello. This was requested by someone and I thought I'll post a few tips that help me remember the staging of breast cancer.
We're using the TNM classification in this post and I'll be talking about T & N only.
Let's get started!

Tx: Tumor can not be assessed.
How to remember: X looks like a cross. Cross out things you can't assess.

T0: No evidence of primary tumor.
How to remember: Zero has no value.

Tis: Carcinoma in situ
How to remember: IS - In Situ, duh!

T1: Tumor ≤ 2 cm in greatest dimension
How to remember: 1 is followed by 2. Consecutive numbers. T1 - 2 cm.

T1a: Tumor > 0.1 cm but ≤ 0.5 cm in greatest dimension
T1b:Tumor > 0.5 cm but ≤ 1 cm in greatest dimension
T1c:Tumor > 1 cm but ≤ 2 cm in greatest dimension
How to remember: Double the number. 0.5 + 0.5 = 1 + 1 = 2

T2:Tumor > 2 cm but ≤ 5 cm in greatest dimension
T3:Tumor > 5 cm in greatest dimension
How to remember: Two, Three, High Five! :D

T4:Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules)
How to remember: When you're four, size won't bore.

T4a: Extension to chest wall, not including only pectoralis muscle adherence/invasion
T4b: Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d’orange) of the skin, which do not meet the criteria for inflammatory carcinoma
T4c: Both T4a and T4b
T4d: Inflammatory carcinoma
How to remember:
CUSBI
T4a: Chest wall
T4b: Ulceration, skin changes, satellite nodules
T4c: Both of the above
T4d: Inflammatory

Now let's go to N!

Nx: Regional lymph nodes cannot be assessed (eg, previously removed)
Mnemonic: X looks like a cross. Cross out things you can't assess.

N0: No regional lymph node metastasis
Mnemonic: Zero has no value.

N1: Metastasis to movable ipsilateral level I, II axillary lymph node(s)
N2: Metastases in ipsilateral level I, II axillary lymph nodes that are clinically fixed or matted or in clinically detected ipsilateral internal mammary nodes in the absence of clinically evident axillary lymph node metastasis
N3: Metastases in ipsilateral infraclavicular (level III axillary) lymph node(s), with or without level I, II axillary node involvement, or in clinically detected ipsilateral internal mammary lymph node(s) and in the presence of clinically evident level I, II axillary lymph node metastasis; or metastasis in ipsilateral supraclavicular lymph node(s), with or without axillary or internal mammary lymph node involvement
Mnemonic: MFI (Mother Fucking Insane!) - Movable, Fixed, Ipsilateral IMS

N2a: Metastases in ipsilateral level I, II axillary lymph nodes fixed to one another (matted) or to other structures
N2b: Metastases only in clinically detected ipsilateral internal mammary nodes and in the absence of clinically evident level I, II axillary lymph node metastases.
Mnemonic:
Axillary present in A
Axillary absent in B

N3a: Metastasis in ipsilateral infraclavicular lymph node(s)
N3b: Metastasis in ipsilateral internal mammary lymph node(s) and axillary lymph node(s)
N3c: Metastasis in ipsilateral supraclavicular lymph node(s)
Mnemonic: IMS - Infraclavicular, Mammary, Supraclavicular

That's all!
All men are created equal, but some work harder pre-season.
-IkaN

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