pTNM

pTNM, or pathological TNM, is a cancer staging notation that describes the extent of cancer based on histopathologic examination of tissue removed during surgery. The prefix 'p' indicates that the T, N, and M components are assigned from microscopic or gross analysis of surgical specimens, rather than from clinical assessment alone. This contrasts with cTNM (clinical staging, based on imaging and examination) and ypTNM (post-neoadjuvant pathologic staging).

T describes the extent of the primary tumor as determined in surgical specimens: tumor size or depth of invasion and spread to adjacent structures, according to site-specific criteria. N describes regional lymph node involvement, based on the number and location of lymph nodes with tumor involvement. M describes distant metastasis, defined by the presence of cancer in distant organs or tissues, which may be confirmed pathologically or inferred from imaging in conjunction with histology. In practice, the M component can be based on pathologic findings when available, or on clinical evidence when not.

pTNM is used to assign an overall stage group (Stage 0-IV) according to cancer-specific staging tables in guidelines such as the AJCC/UICC Cancer Staging Manual. Stage grouping integrates T, N, and M values and varies by cancer type. Notable nuance: the prefix 'p' is distinct from 'yp' used after neoadjuvant therapy; 'p' indicates pathology after surgery without prior systemic therapy, while 'yp' accounts for therapy effects on the tumor. Example: pT2 N1 M0 indicates a moderately advanced primary tumor with regional lymph node involvement but no distant metastasis, with exact stage depending on cancer type.