TNM Classification of Malignant Tumors (TNM) is the cancer staging system developed and is maintained by the Union for International Cancer Control (UICC). It is also used by the American Joint Committee on Cancer (AJCC) and the International Federation of Gynecology and Obstetrics (FIGO). In 1987, the UICC and AJCC staging systems were unified into the single TNM staging system. Nevertheless, there are still some differences between the two systems. The TNM-classification is developed for solid tumors. TNM is a notation system that describes the stage of a cancer, which originates from a solid tumor, using alphanumeric codes; T describes the size of the original (primary) tumor and whether it has invaded nearby tissue, N describes nearby (regional) lymph nodes that are involved, and M describes distant metastasis (spread of cancer from one part of the body to another). In addition to T, N and M, the classification also contains other parameters that may be relevant.
TNM classification is a major determinant of appropriate treatment and prognosis. Stage is an increasingly important component of cancer surveillance and cancer control and an endpoint for the evaluation of the population-based screening and early detection efforts. The TNM staging system is the common language in which oncology health professionals can communicate on the cancer extent for individual patients as a basis for decision making on treatment management and individual prognosis but can also be used, to inform and evaluate treatment guidelines, national cancer planning and research. The objectives of the TNM classification are the following:
The TNM classification is a unified standard. It goes beyond clinician practice and constitutes vital information for policy-makers developing or implementing cancer control and prevention plans.
From a generic TNM Classification towards a disease-specific TNM Classification Development or implementation of a tumor-specific information model of the TNM Classification standard requires insight into how values sets can be restricted, expanded, and applied. Restriction of a value list means either leaving out items or making items more specific by choosing other terms within the official code system. The aim for the future is to have available ready-to-use value sets per type of malignancy. Codes systems This clinical model uses 2 international code systems:
For items where neither of these 2 code systems were considered useful or satisfactory, we chose to manage the value sets as part of the management of the HCIMs (Health and Care Information Models). When a unique and international reference to the TNM Classification standard as codesystem and the valuesets becomes availble these can be amended in a next version of the HCIM . Starting points from the perspective of the TNM Classification standard
Use of the ****UICC (http://www.uicc.org/resources/tnm) ****/ ****AJCC (http://cancerstaging.org/references-tools/deskreferences/Pages/default.aspx** )**** version of the TNM Classification of Malignant Tumours.**
Prefix and suffix are integrated in value sets Although it would be possible to create separate value sets for the potential prefixes and suffixes associated with the T, N, and M items, we chose to facilitate the use of the model by integrating them in the T, N, and M value sets. This decision is based on the current insight that it prevents the creation of invalid combinations. **Prefix **
Adult patients with a solid tumor on which the TNM-classifications can be applied. Issues Usability of this HCIM as well as disease-specific code lists are created in the first pilot(s), planned in the summer of 2020. During these projects, IKNL will provide the maintenance for these code lists. When these pilot projects are completed, the findings will be included as change requests in the regular maintenance process of the HCIM center.
|Definition||Base definition for all elements in a resource.|
|Definition||Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.|
|Definition||May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.|
|Alias||extensions, user content|
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
|Slicing||Unordered, Open, by url(Value)|
|Definition||Root concept of the TNMTumorClassification information model.This root concept contains all data elements of the TNMTumorClassification information model.|
|[Concept name ]||[example value]|
// example of NameInformation
## Example instances | NameInformation | | |----------------------|-------------------| | FirstNames | Johanna Petronella Maria | Initials | J.P.M. | GivenName | Jo | NameUsage | Geslachtsnaam partner gevolgd door eigen geslachtsnaam | LastName.Prefix | van | LastName.LastName | Putten | LastNamePartner.PartnerPrefix | van der | LastNamePartner.PartnerLastName | Giessen | Titles |
zib [zib name + version](https://zibs.nl/wiki/[zib name + version(release)]) difference
||[category of change]||[Description of change]([Reference to ticket/issue/zulip chat using MarkDown link])|