archetype (adl_version=1.4)
	openEHR-EHR-CLUSTER.tnm_staging-lung_cancer.v1
specialise
	openEHR-EHR-CLUSTER.tnm_staging.v1

concept
	[at0000.1]	-- TNM staging - Lung cancer (Sixth Edition)
language
	original_language = <[ISO_639-1::en]>
description
	original_author = <
		["name"] = <"Dr Ian McNicoll">
		["organisation"] = <"Ocean Informatics, UK">
		["email"] = <"ian.mcnicoll@oceaninformatics.com">
		["date"] = <"27/07/2009">
	>
	details = <
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record the TNM staging classification for lung cancer (Sixth Edition).">
			use = <"Use only for the Sixth edition of TNM lung cancer classification.">
			keywords = <"tumour", "TNM", "malignancy", "cancer", "staging", "classification", "lung", "bronchial", "lymph node", "metastasis">
			misuse = <"Not to be used for pleural mesothelioma, sarcoma or other rare lung tumours.
Not to be used for other editions of TNM classification.">
			copyright = <"copyright (c) 2009 openEHR Foundation">
		>
	>
	lifecycle_state = <"AuthorDraft">
	other_contributors = <"Heather Leslie,Ocean Informatics. Australia", "Cathy Richardson, NEHTA, Australia", "David McKillop, NEHTA, Australia", "Koray Atalag, University of Auckland, New Zealand">
	other_details = <
		["MD5-CAM-1.0.1"] = <"E03215CDA1A9A90A2730E3949D0B36F7">
		["references"] = <"Greene FL, Page DL, Fleming ID. et al, eds, for the American Joint Committee on Cancer. AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer-Verlag; 2002. 

American Joint Committee on Cancer. TNM schema files [Internet]. [cited 2009 Jul 27 ] 
Available from: http://www.cancerstaging.org/education/tnmschema/tnmschema.html
">
	>

definition
	CLUSTER[at0000.1] matches {	-- TNM staging - Lung cancer (Sixth Edition)
		items cardinality matches {0..*; unordered} matches {
			CLUSTER[at0002] occurrences matches {0..1} matches {	-- Clinical (cTNM)
				items cardinality matches {0..*; unordered} matches {
					ELEMENT[at0003] occurrences matches {0..1} matches {	-- Primary tumour (T)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.14, 	-- Tx
									at0.15, 	-- T0
									at0.16, 	-- Tis
									at0.17, 	-- T1
									at0.18, 	-- T2
									at0.19, 	-- T3
									at0.20]	-- T4
								}
							}
						}
					}
					ELEMENT[at0004] occurrences matches {0..1} matches {	-- Regional lymph nodes (N)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.21, 	-- NX
									at0.22, 	-- N0
									at0.23, 	-- N1
									at0.24, 	-- N2
									at0.25]	-- N3
								}
							}
						}
					}
					ELEMENT[at0005] occurrences matches {0..1} matches {	-- Distant metastasis (M)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.26, 	-- MX
									at0.27, 	-- M0
									at0.28]	-- M1
								}
							}
						}
					}
					ELEMENT[at0025] occurrences matches {0..1} matches {	-- Residual tumour (R)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0026, 	-- RX
									at0027, 	-- RO
									at0028, 	-- R1
									at0029]	-- R2
								}
							}
						}
					}
					ELEMENT[at0010] occurrences matches {0..1} matches {	-- Clinical stage grouping
						value matches {
							DV_TEXT matches {*}
						}
					}
					ELEMENT[at0014] occurrences matches {0..1} matches {	-- Clinical staging
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.33, 	-- Stage 0
									at0.34, 	-- Stage IA
									at0.54, 	-- Stage IIA
									at0.35, 	-- Stage IB
									at0.36, 	-- Stage IIB
									at0.37, 	-- Stage IIIA
									at0.38]	-- Stage IIIB
								}
							}
						}
					}

					ELEMENT[at0012] occurrences matches {0..1} matches {	-- Comment
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
			CLUSTER[at0006] occurrences matches {0..1} matches {	-- Pathological (pTNM)
				items cardinality matches {0..*; unordered} matches {
					ELEMENT[at0007] occurrences matches {0..1} matches {	-- Primary tumour (pT)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.39, 	-- pT0
									at0.40, 	-- pTis
									at0.41, 	-- pT1
									at0.42, 	-- pT2
									at0.43, 	-- pT3
									at0.44, 	-- pT4
									at0.45]	-- pTx
								}
							}
						}
					}
					ELEMENT[at0008] occurrences matches {0..1} matches {	-- Regional lymph node (pN)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.46, 	-- pNX
									at0.47, 	-- pN0
									at0.48, 	-- pN1
									at0.49, 	-- pN2
									at0.50]	-- pN3
								}
							}
						}
					}
					ELEMENT[at0009] occurrences matches {0..1} matches {	-- Distant metastasis (pM)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.51, 	-- pMX
									at0.52, 	-- pM0
									at0.53]	-- pM1
								}
							}
						}
					}
					ELEMENT[at0030] occurrences matches {0..1} matches {	-- Residual tumour (pR)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0031, 	-- RX
									at0032, 	-- RO
									at0033, 	-- R1
									at0034]	-- R2
								}
							}
						}
					}
					ELEMENT[at0035] occurrences matches {0..1} matches {	-- Histopathological grading (G)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0038, 	-- GX
									at0039, 	-- G1
									at0040, 	-- G2
									at0041, 	-- G3
									at0042]	-- G4
								}
							}
						}
					}
					ELEMENT[at0011] occurrences matches {0..1} matches {	-- Pathological staging
						value matches {
							DV_TEXT matches {*}
						}
					}
					ELEMENT[at0015] occurrences matches {0..1} matches {	-- Pathological stage grouping
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.33, 	-- Stage 0
									at0.34, 	-- Stage IA
									at0.54, 	-- Stage IIA
									at0.35, 	-- Stage IB
									at0.36, 	-- Stage IIB
									at0.37, 	-- Stage IIIA
									at0.38]	-- Stage IIIB
								}
							}
						}
					}
					ELEMENT[at0013] occurrences matches {0..1} matches {	-- Comment
					value matches {
						DV_TEXT matches {*}
					}
					}
				}
			}
		}
	}

ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0.14"] = <
					text = <"Tx">
					description = <"Primary tumour cannot be assessed.">
				>
				["at0.15"] = <
					text = <"T0">
					description = <"No evidence of primary tumour.">
				>
				["at0.16"] = <
					text = <"Tis">
					description = <"Carcinoma in situ.">
				>
				["at0.17"] = <
					text = <"T1">
					description = <"Tumour ≤3cm in greatest dimension and completely surrounded by lung or visceral pleura and not involving a main bronchus.">
				>
				["at0.18"] = <
					text = <"T2">
					description = <"Tumour >3cm in greatest dimension;or, Involves main bronchus, 2cm or more distal to the carina;or, Invades the visceral pleura; or, Associated with atelectasis of obstructive pneumonia that extends to the hilar region but does not involve entire lung.">
				>
				["at0.19"] = <
					text = <"T3">
					description = <"Tumour of any size that directly invades chest wall, diaphragm, mediastinal pleura, parietal pericardium; or, Tumour in main bronchus <2cm from carina; or, Tumour with associated atelectasis or obstructive pneumonitis involving the entire lung.">
				>
				["at0.20"] = <
					text = <"T4">
					description = <"Tumour of any size that invades mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina; or, Separate tumour nodules in same lobe; or,Tumour with malignant pleural effusion.">
				>
				["at0.21"] = <
					text = <"NX">
					description = <"Regional nodes cannot be assessed.">
				>
				["at0.22"] = <
					text = <"N0">
					description = <"No metastasis to regional lymph nodes.">
				>
				["at0.23"] = <
					text = <"N1">
					description = <"Metastasis to ipsilateral intralobar, peribronchial and/or hilar nodes including nodes involved by direct extension of the primary tumour.">
				>
				["at0.24"] = <
					text = <"N2">
					description = <"Metastasis to ipsilateral mediastinal and/or subcarinal nodes.">
				>
				["at0.25"] = <
					text = <"N3">
					description = <"Metastasis to contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular nodes.">
				>
				["at0.26"] = <
					text = <"MX">
					description = <"Distant metastasis cannot be assessed.">
				>
				["at0.27"] = <
					text = <"M0">
					description = <"No distant metastasis.">
				>
				["at0.28"] = <
					text = <"M1">
					description = <"Distant metastasis present.">
				>
				["at0.33"] = <
					text = <"Stage 0">
					description = <"Tis  N0  M0">
				>
				["at0.34"] = <
					text = <"Stage IA">
					description = <"T1  N0  M0">
				>
				["at0.35"] = <
					text = <"Stage IB">
					description = <"T2  N0  M0">
				>
				["at0.37"] = <
					text = <"Stage IIB">
					description = <"T2  N1  M0 ; T3  N0  M0">
				>
				["at0.38"] = <
					text = <"Stage IIIA">
					description = <"T1  N2  M0,  T2  N2  M0,  T3  N1  M0, T3 N2 M0">
				>
				["at0.54"] = <
					text = <"Stage IIIB">
					description = <"Any T  N3  M0, T4  Any N  M0">
				>
				["at0.40"] = <
					text = <"pT0">
					description = <"No evidence of primary tumour.">
				>
				["at0.41"] = <
					text = <"pTis">
					description = <"Carcinoma in situ.">
				>
				["at0.42"] = <
					text = <"pT1">
					description = <"Tumour ≤3cm in greatest dimension and completely surrounded by lung or visceral pleura and not involving a main bronchus.">
				>
				["at0.43"] = <
					text = <"pT2">
					description = <"Tumour >3cm in greatest dimension; or, Involves main bronchus, 2cm or more distal to the carina; or, Invades the visceral pleura; or, Associated with atelectasis of obstructive pneumonia that extends to the hilar region but does not involve entire lung.">
				>
				["at0.44"] = <
					text = <"pT3">
					description = <"Tumour of any size that directly invades chest wall, diaphragm, mediastinal pleura, parietal pericardium; or, Tumour in main bronchus <2cm from carina; or, Tumour with associated atelectasis or obstructive pneumonitis involving the entire lung.">
				>
				["at0.45"] = <
					text = <"pT4">
					description = <"Tumour of any size that invades mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina; or, Separate tumour nodules in same lobe; or, Tumour with malignant pleural effusion.">
				>
				["at0.39"] = <
					text = <"pTx">
					description = <"Primary tumour cannot be assessed.">
				>
				["at0.46"] = <
					text = <"pNX">
					description = <"Regional nodes cannot be assessed.">
				>
				["at0.47"] = <
					text = <"pN0">
					description = <"No metastasis to regional lymph nodes.">
				>
				["at0.48"] = <
					text = <"pN1">
					description = <"Metastasis to ipsilateral intralobar, peribronchial and/or hilar nodes including nodes involved by direct extension of the primary tumour.">
				>
				["at0.49"] = <
					text = <"pN2">
					description = <"Metastasis to ipsilateral mediastinal and/or subcarinal nodes.">
				>
				["at0.50"] = <
					text = <"pN3">
					description = <"Metastasis to contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular nodes.">
				>
				["at0.51"] = <
					text = <"pMX">
					description = <"Distant metastasis cannot be assessed.">
				>
				["at0.52"] = <
					text = <"pM0">
					description = <"No distant metastasis.">
				>
				["at0.53"] = <
					text = <"pM1">
					description = <"Distant metastasis present.">
				>
				["at0.36"] = <
					text = <"Stage IIA">
					description = <"T1  N1  M0">
				>
				["at0000"] = <
					text = <"Tumour - TNM Cancer staging">
					description = <"A framework for the classification and grading of malignancies. Primarily based on the TNM classification. Normally specialised for individual tumours.">
				>
				["at0000.1"] = <
					text = <"TNM staging - Lung cancer (Sixth Edition)">
					description = <"TNM Staging classification for lung cancer (Sixth edition) .">
				>
				["at0002"] = <
					text = <"Clinical (cTNM)">
					description = <"Clinical TNM pre-treatment classification based on physical examination, imaging and biopsies.">
				>
				["at0003"] = <
					text = <"Primary tumour (T)">
					description = <"Clincal assessment of the primary tumour.">
				>
				["at0004"] = <
					text = <"Regional lymph nodes (N)">
					description = <"Clinical assessment of the regional lymph nodes.">
				>
				["at0005"] = <
					text = <"Distant metastasis (M)">
					description = <"Clinical assessment of distant metastasis.">
				>
				["at0006"] = <
					text = <"Pathological (pTNM)">
					description = <"Pathological staging. Based on the clinical staging, results of prrocedures and pathological histo-pathological assessment.">
				>
				["at0007"] = <
					text = <"Primary tumour (pT)">
					description = <"Pathological assessment of the primary tumour.">
				>
				["at0008"] = <
					text = <"Regional lymph node (pN)">
					description = <"Pathological assessment of the regional lymph nodes.">
				>
				["at0009"] = <
					text = <"Distant metastasis (pM)">
					description = <"Pathological assessment of distant metastases.">
				>
				["at0010"] = <
					text = <"Clinical staging">
					description = <"The overall Clinical staging derived from each T, N and M component e.g T1aM0NX. May include additional TNM descriptors.">
				>
				["at0011"] = <
					text = <"Pathological staging">
					description = <"The overall Pathological staging derived from each pT, pN and pM component. May include additional TNM descriptors.">
				>
				["at0012"] = <
					text = <"Comment">
					description = <"A text comment on the Clinical staging.">
				>
				["at0013"] = <
					text = <"Comment">
					description = <"A text comment on the Pathological staging.">
				>
				["at0014"] = <
					text = <"Clinical stage grouping">
					description = <"The TNM Clinical stage grouping.">
				>
				["at0015"] = <
					text = <"Pathological stage grouping">
					description = <"The TNM Pathological stage grouping.">
				>
				["at0025"] = <
					text = <"Residual tumour (R)">
					description = <"Clinical assessment of post-treatment residual tumour.">
				>
				["at0026"] = <
					text = <"RX">
					description = <"Presence of residual tumour cannot be assessed.">
				>
				["at0027"] = <
					text = <"RO">
					description = <"No residual tumour.">
				>
				["at0028"] = <
					text = <"R1">
					description = <"Microscopic residual tumour.">
				>
				["at0029"] = <
					text = <"R2">
					description = <"Macroscopic residual tumour.">
				>
				["at0030"] = <
					text = <"Residual tumour (pR)">
					description = <"Pathological assessment of post-treatment residual tumour.">
				>
				["at0031"] = <
					text = <"RX">
					description = <"Presence of residual tumour cannot be assessed. ">
				>
				["at0032"] = <
					text = <"RO">
					description = <"No residual tumour.">
				>
				["at0033"] = <
					text = <"R1">
					description = <"Microscopic residual tumour.">
				>
				["at0034"] = <
					text = <"R2">
					description = <"Macroscopic residual tumour.">
				>
				["at0035"] = <
					text = <"Histopathological grading (G)">
					description = <"TNM histopathological grading classification. ">
				>
				["at0038"] = <
					text = <"GX">
					description = <"Grade of differentiation cannot be assessed.">
				>
				["at0039"] = <
					text = <"G1">
					description = <"Well differentiated.">
				>
				["at0040"] = <
					text = <"G2">
					description = <"Moderately differentiated.">
				>
				["at0041"] = <
					text = <"G3">
					description = <"Poorly differentiated.">
				>
				["at0042"] = <
					text = <"G4">
					description = <"Undifferentiated.">
				>
			>
		>
	>