ARCHETYPE pTNM stage (openEHR-EHR-OBSERVATION.tnm_stage-pathological.v0)

ARCHETYPE IDopenEHR-EHR-OBSERVATION.tnm_stage-pathological.v0
ConceptpTNM stage
DescriptionA framework for the postsurgical, histopathological classification and grading of malignancies using the TNM system.
UseUse to record the post-surgical, histopathological classification and grading of malignancies, and designated as 'pTNM'. This classification is based on evidence acquired before treatment, supplemented or modified by the additional evidence acquired from surgery and pathological examination. It is used as the basis for prognostic assessment and may also determine adjuvant treatment. Each malignancy has a unique TNM staging classification and it is expected that this archetype will be further constrained to reflect these individual requirements, using a specialisation or a template for each tumour and edition of the TNM classification.
MisuseNot to be used to record the pre-treatment, clinical TNM classification.
PurposeTo record the post-surgical, histopathological classification and grading of malignancies using the TNM classification.
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 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/., 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=9A4937B86D06BD9B51B172C86AD8EAEF, build_uid=27c9b20a-7f1e-45dc-8d6c-1bb5c3c7de9a, revision=0.0.1-alpha}
KeywordsTNM, cancer, tumour
Lifecyclein_development
UIDc6aba81c-33ed-425f-a290-154a5907e263
Language useden
Citeable Identifier1013.1.4191
Revision Number0.0.1-alpha
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Ian McNicoll, freshEHR Clinical Informatics Ltd. UK, originalLanguage=en, translators=, subjectOfData=unconstrained, archetypeTranslationTree=null, topLevelToAshis={identities=[], other_participations=[], credentials=[], description=[], relationships=[], ism_transition=[], activities=[], items=[], data=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0005], code=at0005, itemType=ELEMENT, level=4, text=Cancer type, description=The type of cancer being assessed., comment=Coding of the type of the cancer with a terminology is strongly preferred., 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=/data[at0001]/events[at0002]/data[at0003]/items[at0006], code=at0006, itemType=ELEMENT, level=4, text=Anatomical site, description=The anatomical site where the assessed cancer is situated., 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=/data[at0001]/events[at0002]/data[at0003]/items[at0007], code=at0007, itemType=ELEMENT, level=4, text=Anatomical subsite, description=The anatomical subsite where the assessed cancer is situated., 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=/data[at0001]/events[at0002]/data[at0003]/items[at0008.1], code=at0008.1, itemType=ELEMENT, level=4, text=Primary tumour (pT), description=Assessment of the primary tumour., comment=Designated as 'pT'. Coding with a TNM code appropriate for the identified 'Cancer type' and/or anatomical site is expected. For example: 'pT1'; or 'pT3'., 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=/data[at0001]/events[at0002]/data[at0003]/items[at0018.1], code=at0018.1, itemType=ELEMENT, level=4, 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: pT2(m) or pT2(4)., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of:
  •  Count
  •  Boolean
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0015.1], code=at0015.1, itemType=ELEMENT, level=4, 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: pT3(m, is) or pT2(3, is) or pT2(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=/data[at0001]/events[at0002]/data[at0003]/items[at0009.1], code=at0009.1, itemType=ELEMENT, level=4, text=Regional lymph nodes (pN), description=Assessment of the regional lymph nodes., comment=Designated as 'pN'. Coding with a TNM code appropriate for the identified 'Cancer type' and/or anatomical site is expected. For example: 'pNX'; or 'pN2'., 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=/data[at0001]/events[at0002]/data[at0003]/items[at0.1], code=at0.1, itemType=ELEMENT, level=4, text=Sentinel node (sn), description=Presence of metastasis within one or more sentinel node(s)., comment=Record as true, designated by addition of the suffix 'sn'. For example: 'pN0(sn) No sentinel lymph node metastasis' or 'pN1(sn) Sentinel lymph node metastasis'., 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=/data[at0001]/events[at0002]/data[at0003]/items[at0.2], code=at0.2, itemType=ELEMENT, level=4, text=Micrometastases (mi), description=Presence of micrometastases in the regional lymph drainage area of the primary tumour., comment=Record as true, designated by addition of the suffix 'mi'. For example: 'pN1(mi)'., 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=/data[at0001]/events[at0002]/data[at0003]/items[at0.3], code=at0.3, itemType=ELEMENT, level=4, text=Regional lymph node ITC, description=Presence of isolated tumour cells (ITC) detected by H & E stains or immunohistochemistry in regional lymph nodes., comment=For example 'pN0(i-) No regional lymph node metastasis histologically, negative morphological findings for ITC'; 'pN0(mol+) No regional lymph node metastasis histologically, positive non morphological findings for ITC'; or 'pN0(i+)(sn) No sentinel lymph node metastasis histologically, positive morphological findings for ITC'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • i- [Negative morphological findings for ITC.]
  • i+ [Positive morphological findings for ITC.]
  • mol- [Negative non-morphological findings for ITC.]
  • mol+ [Positive non-morphological findings for ITC.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0010.1], code=at0010.1, itemType=ELEMENT, level=4, text=Distant metastasis (pM), description=Assessment of distant metastasis., comment=Designated as 'pM'. Coding with a TNM code appropriate for the identified 'Cancer type' and/or anatomical site is expected. For example: 'pM1'; or 'pM0'., uncommonOntologyItems=null, occurencesFormal=0..3, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0.8], code=at0.8, itemType=ELEMENT, level=4, text=Distant metastasis ITC, description=Presence of isolated tumour cells (ITC) detected by H & E stains or immunohistochemistry in distant metastases, such as bone marrow., comment=For example: 'pM0(i+)' or 'pM0(mol+)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • i- [Negative morphological findings for ITC.]
  • i+ [Positive morphological findings for ITC.]
  • mol- [Negative non-morphological findings for ITC.]
  • mol+ [Positive non-morphological findings for ITC.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0011], code=at0011, itemType=ELEMENT, level=4, text=Histopathological grade (G), description=Histopathological grading of the tumour., comment=Coding with a TNM code appropriate for the identified 'Cancer type' and/or anatomical site is expected. For example: 'GX'; 'high grade' or 'low grade'., 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=/data[at0001]/events[at0002]/data[at0003]/items[at0012], code=at0012, itemType=ELEMENT, level=4, text=Residual tumour (R), description=Assessment of the presence of residual tumour after treatment., comment=For example: 'R1 (Microscopic residual tumour)'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • RX [Presence of residual tumour cannot be assessed.]
  • R0 [No residual tumour.]
  • R1 [Microscopic residual tumour.]
  • R2 [Macroscopic residual tumour.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0013], code=at0013, itemType=ELEMENT, level=4, 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=/data[at0001]/events[at0002]/data[at0003]/items[at0014], code=at0014, itemType=ELEMENT, level=4, 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=/data[at0001]/events[at0002]/data[at0003]/items[at0035], code=at0035, itemType=ELEMENT, level=4, 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=/data[at0001]/events[at0002]/data[at0003]/items[at0019], code=at0019, itemType=ELEMENT, level=4, 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=/data[at0001]/events[at0002]/data[at0003]/items[at0020], code=at0020, itemType=ELEMENT, level=4, 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=/data[at0001]/events[at0002]/data[at0003]/items[at0021], code=at0021, itemType=ELEMENT, level=4, text=Autopsy (a), description=Assessment is performed by postmortem examination after the death of the patient., 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=/data[at0001]/events[at0002]/data[at0003]/items[at0016.1], code=at0016.1, itemType=ELEMENT, level=4, text=pTNM assessment, description=Concatenation of 'pT', 'pN' and 'pM' 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=/data[at0001]/events[at0002]/data[at0003]/items[at0017], code=at0017, itemType=ELEMENT, level=4, text=Stage grouping, description=The staging of the TNM 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]], capabilities=[], state=[], context=[], events=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002], code=at0002, itemType=POINT_EVENT, level=2, text=Point in time event, description=Default, unspecified point in time which may be explicitly defined in a template or at run-time., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=POINT_EVENT, bindings=null, values=null, extendedValues=null]], source=[], content=[], target=[], details=[], provider=[], protocol=[ResourceSimplifiedHierarchyItem [path=/protocol[at0004]/items[at0023], code=at0023, itemType=ELEMENT, level=2, text=TNM Edition, description=The edition of the TNM classification system used for the assessment., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0004]/items[at0022], code=at0022, itemType=SLOT, level=2, text=Extension, description=Additional information required to capture local content or to align with other reference models/formalisms., comment=For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
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