TNM Committee advances 9th edition staging revisions

The TNM Core Committee met on 1–2 May in a hybrid format to finalise the upcoming 9th edition of the TNM Classification of Malignant Tumours, due for publication in August 2025. The Committee is co-chaired by Dr Liesbet Van Eycken and Dr James Brierley, and includes staging experts and representatives from FIGO (International Federation of Gynecology and Obstetrics), IASLC (International Association for the Study of Lung Cancer), IARC, WHO, ICCR (International Collaboration on Cancer Reporting), IACR (International Association of Cancer Registries) and the AJCC (American Joint Committee on Cancer).

Key updates in the 9th edition of the TNM Classification from the previous 2016 edition include changes to staging criteria for salivary gland cancers, mesothelioma, and HPV-related cancers such as oropharyngeal tumours. The 9th edition also reflects a growing emphasis on personalised care, incorporating refinements in prognosis aimed at aligning staging with patient outcomes.

“The TNM Classification system aims to better reflect prognosis so that patients with aggressive disease can receive aggressive treatment, and those who don’t need it can avoid unnecessary side effects.”
– Dr James Brierley, Co-chair of the TNM Core Committee, and Emeritus Professor, Department of Radiation Oncology, University of Toronto, Canada

Key changes in 9th edition include:

• New staging for HPV-associated oropharyngeal cancers to better reflect their distinct behaviour and prognosis
• Revised criteria for salivary gland and nasopharyngeal cancers, based on updated imaging and anatomical features
• Anal canal tumours with larger T3 classifications now staged higher due to poorer outcomes

These updates are grounded in recent evidence and reflect input from cancer registries, clinical outcomes, and international collaboration with AJCC and disease-specific experts.

The Committee also explored how future TNM updates could be shared more flexibly. While some tumour site revisions, such as colorectal and oral cavity cancers, are still in development and planned for 2027, current publishing formats don’t yet support rolling updates.

Improving global cancer data collection

Stakeholders from across the cancer control field – clinicians, registrars, epidemiologists – identified consistent core data needs: tumour details, treatment information, and patient outcomes. Discussions focused on common barriers such as incomplete data, poor linkage between datasets, and privacy concerns.

“Gaps and poor linkage in data limit estimating outcomes and undermine progress in refining staging and prognosis. While technology can help address these issues, systems should be designed with interoperability in mind. More effective linkage with health systems is not only possible but also more cost-effective in the long run.”
– Dr Liesbet Van Eycken, Co-chair of the TNM Core Committee, and Director of the Belgian Cancer Registry

The findings also emphasised the growing importance of including molecular markers, social determinants of health, such as socioeconomic status and access to care, in cancer data systems.

Education remains a key priority. TNM pages are among the most visited area of the UICC website, and e-learning modules have been completed by thousands of professionals worldwide. New resources will be launched to support the 9th edition and ensure broad, effective implementation.

The TNM Classification of Malignant Tumours, developed and maintained by UICC in collaboration with international partners, offers a common language to describe the anatomical extent of cancer. It supports clinical decision-making, prognostic evaluation, cancer surveillance, and research

Discover more about the TNM classification system