TNM Classification | Anal Carcinoma

TNM Classification

The TNM classification is used to classify cancers. It is an abbreviation for the three criteria tumor, mode and metastases. Tumor stands for the size and spread of the anal carcinoma from T1 (smaller than 2 cm) to T3 (larger than 5 cm).

Stage T4 is present regardless of size if the tumor grows into neighboring organs such as the bladder or vagina. The classification from N0 to N3 is based on the lymph nodes that may be affected by cancer cells (N for Latin: Nodus lypmhoideus = lymph node). In M1 the tumour has already spread to other organs (metastasised), in M0 there are no metastases. The individually determinable TNM classification can on the one hand help to determine the appropriate therapy and on the other hand be helpful in assessing the prognosis.

Associated symptoms

The anal carcinoma can make itself felt through various accompanying symptoms, which are however quite unspecific and can therefore also occur in various harmless diseases. Especially in the early stages, however, the disease can also progress without symptoms. Later, there are often hard to feel and painless skin changes at the bowel outlet.

Bleeding is typical and alarming. Even if harmless diseases such as haemorrhoids or anal eczema are often the cause, a doctor should always be consulted for examination if there is blood on the anus or in the stool. Other possible accompanying symptoms of anal carcinoma can be a feeling of pressure or alienation as well as pain, especially during bowel movements. Another symptom that can occur is itching. In most cases, fecal incontinence (= uncontrolled excretion of stool) can only occur at an advanced stage of the disease.


Pain is a very unspecific symptom and the extent to which it occurs in anal carcinoma varies from case to case. Often the early stages of the disease are completely painless and free of symptoms. Sudden severe pain is more likely to indicate a malignant disease and can be triggered by an infection, for example.

As the disease progresses, the narrowing growth of the tumour often initially causes only pain that occurs during or after bowel movements. However, the cause of pain during defecation is very rarely anal carcinoma. Benign symptoms such as constipation are also much more common. A medical clarification should be carried out in any case. Persistent pain due to anal carcinoma usually occurs at a very late stage, when the tumour has already grown very large.


For anal carcinoma there are various options available for therapy. The options for treatment depend primarily on the size and spread of the tumour. However, other factors such as age and concomitant diseases and, in particular, the patient’s wishes are also decisive.

Smaller tumours that have not grown deeply into the tissue and do not affect the sphincter muscle are usually removed surgically. For larger tumours, a combined treatment of radiation and chemotherapy has proven to be the treatment with the best chances of success. Both forms of therapy have a particular effect on fast-dividing cells and thus especially on cancer cells. Nevertheless, healthy cells are also damaged and side effects such as urination problems and diarrhoea often occur, which subside after a few weeks. However, patients are spared the side effects of the combined therapy, such as the creation of an artificial bowel outlet, a usually radical surgical removal of larger tumours.