Leadership shift and global collaboration at the TNM Core Committee

The UICC TNM Classification is a method used worldwide to classify cancer based on three key factors: the size of the Tumour (T), whether it has spread to nearby lymph Nodes (N), and whether it has Metastasised (M) to other parts of the body. This system helps doctors decide on the best treatment and predict patient outcomes.

The system was developed by Pierre Denoix in the 1940s and adopted by UICC in the 1950s. It has undergone numerous revisions over the decades in response to new scientific knowledge as well as technological and treatment advancements. The system has played a foundational role in cancer documentation and decision-making.

Dr Mary Gospodarowicz is a University Professor at the University of Toronto and the past Medical Director at the Princess Margaret Cancer Centre. Her involvement with the UICC TNM project dates to the early 1990s. As a clinician and radiation oncologist, she emphasised the importance of obtaining the stage at which every cancer patient is diagnosed, for documentation and decision-making. Her journey began with her participation in the Canadian Committee on Cancer Staging in the late-1980s, which eventually led to her role as co-chair of the UICC TNM Core Committee.

One of Mary's significant contributions was the extension of the work to include the classification of prognostic factors in cancer as adjunct to the UICC TNM staging classification.

“Together with Professor Hermanek, in the 1990s, we published the first book on prognostic factors in cancer, acknowledging that factors such as tumour histopathologic and molecular characteristics, patient age, comorbidities, and treatment environment are also crucial in understanding the outcomes of cancer treatment.” 
– Dr Mary Gospodarowicz, University Professor at the University of Toronto and the past Medical Director at the Princess Margaret Cancer Centre; outgoing co-chair of the UICC TNM Core Committee.

Mary played a pivotal role in making the UICC TNM project more inclusive and globally representative. She noted, “We encouraged the formation of national cancer staging committees and included them in the UICC TNM Project Global Advisory Group (GAG). Today, we work with chairs of staging committees from Poland, Brazil, Italy, China, and many other countries.” This effort ensured that the TNM classification reflects a broader range of perspectives and experiences.

Another notable development under her tenure was the introduction of the Essential TNM, a shorter version designed for use in regions with less advanced medical infrastructure, ensuring broader applicability without diluting the classification’s core principles.

A radiation oncologist at Princess Margaret Cancer Centre, Dr James Brierley has worked with Mary and has contributed to the evolution of the TNM classification since 2001. Like Mary, Jim’s work has focused on expanding the work to include prognostic factors and securing global cooperation.

“TNM is really a description of the anatomical extent of disease. However, age, performance status, and molecular markers are also very important. In certain diseases, these factors can be as important as the anatomical extent of disease, as with triple-negative breast cancer, for instance. But it's still important to know if a cancer is localised or metastatic. UICC’s philosophy with TNM classification has in the past been to focus on the extent of disease but has been expanded to facilitate the collection of non anatomical prognostic factors important for patient care and decision making. In some low- and middle-income countries, the ability to assess all non-anatomical factors is often not available– but it is important that they are recorded when available. This approach ensures that the TNM classification remains relevant and applicable globally, facilitating cancer surveillance and control activities across diverse settings.”
– Dr James Brierley, Professor, Department of Radiation Oncology, University of Toronto; co-chair of the UICC TNM Core Committee.

Jim further highlights the important work that is done with other global organisations, such as the International Agency for Research on Cancer (IARC), the International Collaboration on Cancer Reporting (ICCR), and the American Joint Committee on Cancer (AJCC). “Closer collaboration and integration with organisations such as IARC and WHO have been crucial in maintaining the relevance and accuracy of the TNM classification,” he said.

Other critical milestones that Jim cites relate to technological advancements, and how they make staging more precise and relevant. “When TNM classification was first established, it was based on clinical examination” he explains. “Today, we use imaging with CT scans, MRIs, and PET-CTs that provide much more detailed disease extent.”

Dr Liesbet Van Eycken is Director of the Belgian Cancer Registry. She will be stepping in to replace Mary as co-chair of the UICC TNM Core Committee alongside Jim. Her initial training was as a radiation oncologist in the 1990s, which is when she began using TNM classification on a daily basis.

In 2001, Liesbet shifted her focus to cancer epidemiology and registration. A cancer registry is a systematic collection, storage, and management of data about cancer and tumour diseases. It includes comprehensive information on patient history, diagnosis, treatment, and status for every cancer patient. As member of the UICC TNM Core Committee since 2010, she handles the UICC TNM Helpdesk and is co-editor of the latest editions of the TNM atlas and Supplement.

“Cancer registries play a crucial role in tracking cancer cases, helping us understand patient outcomes, quality of life, survival rates, and how well treatments work. They also aid in research, healthcare planning, and public health efforts by keeping an eye on cancer trends and incidence over time.”
– Dr Liesbet Van Eycken, Director of the Belgian Cancer Registry

One of her first priorities when working in cancer epidemiology and registration was to ensure they included TNM stage, to help doctors determine optimal interventions. “This data is also crucial for comparing research results from different populations and closing the gap between clinical practice and cancer registries," she explains. “The description of this role of cancer registries, i.e. to record disease extent in the context of cancer control activities, appears for the first time in the 8th edition of the TNM Classification.”

Like Mary and Jim, Liesbet emphasises the need to ensure that the TNM Classification remains applicable in low- and middle-income countries while keeping up with technological advancements. She sees leveraging real-world evidence from cancer registries, clinical databases, and other sources as crucial for maintaining the TNM classification’s accuracy and relevance.

These interviews were conducted following the TNM annual meeting, which took place in Geneva in May and gathered cancer staging experts from several organisations: the American Joint Committee on Cancer (AJCC), the Centers for Disease Control and Prevention (CDC), The International Federation of Gynecology and Obstetrics (FIGO), the International Association of Cancer Registries (IACR), the International Agency for Research on Cancer (IARC), the International Collaboration on Cancer Reporting (ICCR), the World Health Organization (WHO), and representatives of the UICC TNM Global Advisory Group from Brazil, Italy, Poland, and Spain.