The evolution and transformation of cancer staging in the era of precision medicine

The TNM classification has served as the cornerstone of cancer staging for decades, guiding treatment decisions, 
prognostic assessment, and the standardization of clinical research. However, rapid advances in molecular biology, 
genomics, liquid biopsy, spatial biology, and digital technologies have fundamentally changed our understanding of 
cancer development. Current evidence indicates that carcinogenesis is a continuous biological process that begins long 
before a clinically detectable tumor is formed, whereas the TNM system describes only the anatomical extent of an already 
established malignancy. Objective: to analyze the limitations of the current anatomical TNM staging system in the era of 
molecular oncology and precision medicine and to substantiate the concept of shifting from tumor staging toward staging 
of carcinogenesis as a continuous biological process. This study was performed as a narrative analytical review with a 
conceptual analysis of current evidence in molecular oncology, cancer immunology, liquid biopsy, multi-omics technologies, 
and digital medicine. The analysis demonstrates that the T, N, and M categories do not always reflect tumor biology, molecular 
heterogeneity, or clonal evolution. Future staging systems are expected to integrate anatomical, molecular, immunological, 
and digital parameters into a unified biological framework. It is concluded that the future evolution of cancer staging will 
likely involve a transition from static anatomical assessment to dynamic biological characterization of carcinogenesis, with 
TNM remaining an essential but no longer exclusive component of comprehensive cancer evaluation.