ARCHETYPE TNM clinical classification (openEHR-EHR-CLUSTER.tnm.v0)

ARCHETYPE IDopenEHR-EHR-CLUSTER.tnm.v0
ConceptTNM clinical classification
DescriptionA framework for the clinical classification and stage grouping of malignancies using the TNM system.
UseUse to record the clinical classification, designated as TNM or cTNM, and stage grouping of malignancies. This archetype has been designed to be nested inside an ENTRY archetype which will provide a clinical context for the TNM record - for example: the 'Specific details' SLOT within the EVALUATION.problem_diagnosis archetype. Each cancer has a set of unique TNM classification values. It is expected that this archetype will be further constrained to reflect the unique requirements for each tumour and edition of the TNM classification, using either an archetype specialisation or a template. With certain types of tumours, such as Hodgkin and other non-Hodgkin lymphomas, a different system for designating the extent of disease and prognosis is used. In these circumstances only the stage group is defined.
MisuseNot to be used to record the TNM pathological classification - use the CLUSTER.tnm-pathological archetype for this purpose.
PurposeTo record the clinical classification and stage grouping of malignancies using the TNM system.
ReferencesBrierley JD, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours, 8th Edition. Wiley-Springer; 2016. 272 p.

Principles of Cancer Staging. AJCC American Joint Committee on Cancer; [cited 2019 03 15]. Available at: https://facs.groupdropbox.com/share/ac03e57b3ea913ab7d728f5a9f621e84/download?file_ids[]=13911553.

TNM Classification Help (Manual for Cancer Staging); [cited 2019 10 04]. Available at: http://cancerstaging.blogspot.com/.
Copyright© openEHR Foundation
AuthorsAuthor name: Heather Leslie
Organisation: Atomica Informatics
Email: heather.leslie@atomicainformatics.com
Date originally authored: 2016-08-26
Other Details LanguageAuthor name: Heather Leslie
Organisation: Atomica Informatics
Email: heather.leslie@atomicainformatics.com
Date originally authored: 2016-08-26
OtherDetails Language Independent{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/., custodian_organisation=openEHR Foundation, references=Brierley JD, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours, 8th Edition. Wiley-Springer; 2016. 272 p. Principles of Cancer Staging. AJCC American Joint Committee on Cancer; [cited 2019 03 15]. Available at: https://facs.groupdropbox.com/share/ac03e57b3ea913ab7d728f5a9f621e84/download?file_ids[]=13911553. TNM Classification Help (Manual for Cancer Staging); [cited 2019 10 04]. Available at: http://cancerstaging.blogspot.com/., current_contact=Heather Leslie, Atomica Informatics, heather.leslie@atomicainformatics.com, original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=D4ABCF465DF1E7C6E494FF68736C84FB, build_uid=b1430253-1c6e-4925-838c-a55478eb8e8c, revision=0.0.1-alpha}
KeywordsTNM, cancer, tumour, cTNM, grading, staging, malignancy, classification, grouping, stage, neoplasia
Lifecyclein_development
UID3f7445bf-9910-4354-a54e-34ee2f39af6c
Language useden
Citeable Identifier1246.145.831
Revision Number0.0.1-alpha
AllArchetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=A framework for the clinical classification and stage grouping of malignancies using the TNM system., archetypeConceptComment=Designated as TNM or cTNM., otherContributors=Vebjørn Arntzen, Oslo University Hospital, Norway (openEHR Editor)
Silje Ljosland Bakke, Nasjonal IKT HF, Norway (openEHR Editor)
Hildegard Franke, freshEHR Clinical Informatics Ltd. UK
Sergey Kovalenko, Chelyabinsk Regional Children Hospital, Russia
Sabine Leh, Haukeland University Hospital, Department of Pathology, Norway (openEHR Editor)
Miha Lenic, Marand, Slovenia
Heather Leslie, Atomica Informatics, Australia (openEHR Editor)
Ian McNicoll, freshEHR Clinical Informatics Ltd. UK
SARA PRETE, Abinsula, Italy
Natalia Strauch, Medizinische Hochschule Hannover, Germany
Norwegian Review Summary, Nasjonal IKT HF, Norway
John Tore Valand, Helse Bergen, Norway (openEHR Editor), originalLanguage=en, translators=German: Natalia Strauch, Medizinische Hochschule Hannover, Strauch.Natalia@mh-hannover.de
Norwegian Bokmål: Vebjørn Arntzen, Sabine Leh, Oslo University Hospital HF, Helse Bergen HF, varntzen@ous-hf.no
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  • RX [Presence of residual tumour cannot be assessed.]
  • R0 [No residual tumour.]
  • R1 [Microscopic residual tumour.]
  • R2 [Macroscopic residual tumour.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0012], code=at0012, itemType=ELEMENT, level=1, text=Lymphatic invasion (L), description=Assessment of invasion into the lymphatic system., comment=For example: 'L0 (No lymphatic invasion)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • LX [Lymphatic invasion cannot be assessed.]
  • L0 [No lymphatic invasion.]
  • L1 [Lymphatic invasion.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0016], code=at0016, itemType=ELEMENT, level=1, text=Venous invasion (V), description=Assessment of invasion into the venous system., comment=For example: 'V1 (Microscopic venous invasion)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • VX [Venous invasion cannot be assessed.]
  • V0 [No venous invasion.]
  • V1 [Microscopic venous invasion.]
  • V2 [Macroscopic venous invasion.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0021], code=at0021, itemType=ELEMENT, level=1, text=Perineural invasion (Pn), description=Assessment of invasion into the space surrounding nerves., comment=For example: 'Pn0 (No perineural invasion)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • PnX [Perineural invasion cannot be assessed.]
  • Pn0 [No perineural invasion.]
  • Pn1 [Perineural invasion.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0025], code=at0025, itemType=ELEMENT, level=1, text=Multiple primary tumours (m), description=Presence of multiple simultaneous primary tumours at a single site., comment=Designated as a suffix, either as the letter 'm' or the number of primary tumours. For example: 'T2(m)' or 'T2(4)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of:
  •  Count
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, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0026], code=at0026, itemType=ELEMENT, level=1, text=Multimodality therapy (y), description=Assessment is performed during or following initial multimodality therapy., comment=Record as true, designated by addition of the prefix 'y'. For example: 'yTNM'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0027], code=at0027, itemType=ELEMENT, level=1, text=Recurrent (r), description=Assessment is performed for a recurring cancer after a disease-free interval., comment=Record as true, designated by addition of the prefix 'r'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0028], code=at0028, itemType=ELEMENT, level=1, text=Autopsy (a), description=Assessment is performed at postmortem examination., comment=Record as true, designated by addition of the prefix 'a'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0029], code=at0029, itemType=ELEMENT, level=1, text=Carcinoma in situ (is), description=Presence of carcinoma in situ associated with the primary tumour., comment=Record as true, designated by addition of the suffix 'is'. For example: 'T3(m, is)' or 'T2(3, is)' or 'T2(is)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0030], code=at0030, itemType=ELEMENT, level=1, text=TNM assessment, description=Concatenation of 'T', 'N' and 'M' assessments plus any optional assessments of 'G', 'R', 'L', 'V', prefixes and/or suffixes, as applicable., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0031], code=at0031, itemType=ELEMENT, level=1, text=Stage grouping, description=The categorisation of the anatomical stage of the tumour, usually based on TNM assessment., comment=For example: carcinoma in situ is categorised as stage 0; or tumours with distant metastasis are categorised as stage IV., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0032], code=at0032, itemType=ELEMENT, level=1, text=TNM Edition, description=The edition of the TNM classification system used for the assessment., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null]], protocol=[], ism_transition=[], contacts=[], activities=[], context=[], other_participations=[], state=[], details=[], description=[], source=[]}, topLevelItems={items=ResourceSimplifiedHierarchyItem [path=ROOT_/, code=at0000, itemType=CLUSTER, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=1..*, cardinalityText=, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=null, extendedValues=null]}, addHierarchyItemsTo=items, currentHierarchyItemsForAdding=[ResourceSimplifiedHierarchyItem [path=/items[at0001], code=at0001, itemType=ELEMENT, level=1, text=Anatomical site, description=The anatomical site where the assessed tumour is situated., comment=For example: stomach; or small intestine., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0002], code=at0002, itemType=ELEMENT, level=1, text=Anatomical subsite, description=The anatomical subsite where the assessed tumour is situated., comment=For example: cardia, fundus, corpus, antrum and pylorus (stomach); or duodenum, jejunum or ileum (small intestine)., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0003], code=at0003, itemType=ELEMENT, level=1, text=Primary tumour (T), description=Assessment of the primary tumour., comment=Designated as 'T' or 'cT'. Coding with a T code appropriate for the tumour type and anatomical site is expected. For example: 'T1'; or 'T3'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0004], code=at0004, itemType=ELEMENT, level=1, text=Regional lymph nodes (N), description=Assessment of the regional lymph nodes., comment=Designated as 'N' or 'cN'. Coding with an N code appropriate for the tumour type and anatomical site is expected. For example: 'NX'; or 'N2'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0005], code=at0005, itemType=ELEMENT, level=1, text=Distant metastasis (M), description=Assessment of distant metastasis., comment=Designated as 'M' or 'cM'. Coding with an M code appropriate for the tumour type and anatomical site is expected. For example: 'M1'; 'M1a'; 'M1 PUL'; or 'M0'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0006], code=at0006, itemType=ELEMENT, level=1, text=Histopathological grade (G), description=Histopathological grading of the tumour., comment=Pretreatment histopathological assessment may be determined from a limited biopsy prior to formal resection. Coding with a G code appropriate for the identified tumour type and anatomical site is expected. 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  • RX [Presence of residual tumour cannot be assessed.]
  • R0 [No residual tumour.]
  • R1 [Microscopic residual tumour.]
  • R2 [Macroscopic residual tumour.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0012], code=at0012, itemType=ELEMENT, level=1, text=Lymphatic invasion (L), description=Assessment of invasion into the lymphatic system., comment=For example: 'L0 (No lymphatic invasion)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • LX [Lymphatic invasion cannot be assessed.]
  • L0 [No lymphatic invasion.]
  • L1 [Lymphatic invasion.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0016], code=at0016, itemType=ELEMENT, level=1, text=Venous invasion (V), description=Assessment of invasion into the venous system., comment=For example: 'V1 (Microscopic venous invasion)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • VX [Venous invasion cannot be assessed.]
  • V0 [No venous invasion.]
  • V1 [Microscopic venous invasion.]
  • V2 [Macroscopic venous invasion.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0021], code=at0021, itemType=ELEMENT, level=1, text=Perineural invasion (Pn), description=Assessment of invasion into the space surrounding nerves., comment=For example: 'Pn0 (No perineural invasion)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • PnX [Perineural invasion cannot be assessed.]
  • Pn0 [No perineural invasion.]
  • Pn1 [Perineural invasion.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0025], code=at0025, itemType=ELEMENT, level=1, text=Multiple primary tumours (m), description=Presence of multiple simultaneous primary tumours at a single site., comment=Designated as a suffix, either as the letter 'm' or the number of primary tumours. For example: 'T2(m)' or 'T2(4)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of:
  •  Count
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, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0026], code=at0026, itemType=ELEMENT, level=1, text=Multimodality therapy (y), description=Assessment is performed during or following initial multimodality therapy., comment=Record as true, designated by addition of the prefix 'y'. For example: 'yTNM'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0027], code=at0027, itemType=ELEMENT, level=1, text=Recurrent (r), description=Assessment is performed for a recurring cancer after a disease-free interval., comment=Record as true, designated by addition of the prefix 'r'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0028], code=at0028, itemType=ELEMENT, level=1, text=Autopsy (a), description=Assessment is performed at postmortem examination., comment=Record as true, designated by addition of the prefix 'a'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0029], code=at0029, itemType=ELEMENT, level=1, text=Carcinoma in situ (is), description=Presence of carcinoma in situ associated with the primary tumour., comment=Record as true, designated by addition of the suffix 'is'. For example: 'T3(m, is)' or 'T2(3, is)' or 'T2(is)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0030], code=at0030, itemType=ELEMENT, level=1, text=TNM assessment, description=Concatenation of 'T', 'N' and 'M' assessments plus any optional assessments of 'G', 'R', 'L', 'V', prefixes and/or suffixes, as applicable., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0031], code=at0031, itemType=ELEMENT, level=1, text=Stage grouping, description=The categorisation of the anatomical stage of the tumour, usually based on TNM assessment., comment=For example: carcinoma in situ is categorised as stage 0; or tumours with distant metastasis are categorised as stage IV., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0032], code=at0032, itemType=ELEMENT, level=1, text=TNM Edition, description=The edition of the TNM classification system used for the assessment., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null]], minIndents={}, termBindingRetrievalErrorMessage=null]