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Clinical staging and the TNM classification

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Abstract

The principles of clinical staging are of paramount importance in general clinical practice, where knowledge of the likely behaviour of different tumour types forms the basis for selection of clinical investigations. This chapter covers tumour biology; tumour behaviour; features of malignancy; clinical staging of cancer; TNM classification; other investigations; example of a clinical staging system.

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Figures

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3.1 Tumour growth and clinical detection.
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3.3 Invasion and metastasis.
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3.4 Microscopic comparison of well defined invasive tumours. Well defined complex mammary adenoma from an 8-year-old female Staffordshire Bull Terrier. The black arrows show the clear demarcation between tumour and surrounding normal tissue. The red arrow shows normal mammary gland. An invasive anal sac gland carcinoma from a 6-year-old Cocker Spaniel. In contrast to (a), there is no clear boundary between tumour and normal tissue, and lobules of tumour cells are seen invading the adjacent connective tissue (black arrows). (H&E, original magnification X40) (Images courtesy of Dr Fernando Constantino-Casas, Department of Veterinary Medicine, University of Cambridge)
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3.6 Ultrasound image of a bladder tumour (arrowed) showing layers of the bladder wall.
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3.7 MRI transverse and sagittal sections of the brain in a dog with pituitary macroadenoma.
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3.8 T1 and T2 weighted dorsal sections from a dog with a nasal tumour invading the maxillary bone.
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3.9 Principal lymph nodes and lymphatic drainage in the dog.
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3.10 CT transverse section of canine thorax, showing multiple pulmonary metastases. (Image courtesy of Paddy Mannion, Cambridge Radiology Referrals)
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3.12 Clinical staging of SCC of the nasal planum in a cat. Tis: pre-invasive carcinoma . T1: superficial/exophytic, <2 cm). T3: invasion of the subcutis. T4: invading other structures.

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