An extreme trans-Neptunian object (ETNO) is a trans-Neptunian object orbiting the Sun well beyond Neptune (30 AU) in the outermost region of the Solar System. An ETNO has a large semi-major axis of at least 150–250 AU. Its orbit is much less affected by the known giant planets than all other known trans-Neptunian objects. They may, however, be influenced by gravitational interactions with a hypothetical Planet Nine, shepherding these objects into similar types of orbits. The known ETNOs exhibit a highly statistically significant asymmetry between the distributions of object pairs with small ascending and descending nodal distances that might be indicative of a response to external perturbations.