SU._IMARY
STAGING
GUIDE
For
The
Cancer
End
Re_utts
Surveltt_nce,
Epidemlotogy
Reporting
(SEER)
_n_
Program
Apri[,
-
t
-
1977
SUqMARY
Edited
STAGING
by
Evetyn
q.
Shambaugh=
M.A.
Fietd
Liaison
Section=
Nationat
Cancer
Institute
Bethe_da,
Biometry
Littian
_.
End
Resutts
Nationat
Angetes
Branch
Consuttants
Robert
F.
Ryan,
Department
of
Tutane
University
Orteans=
City,
Los
MaPytand
_edicat
iowa
at
Axtett,
M.A.
Section,
Biometry
Cancer
Institute
Bethesda,
Chartes
E.
Department
University
Branch
Ma ry]Land
Mitdred
A.
Weiss,
Bo ?_.
UCLA
Tumor
Registry
University
of
Catlfornla
Los
Angetes,
Catlfornla
New
GUIDE
M,D.=
Chalrn_n
Surgery
Schoot
of
Medicine
Louisiana
Ptatz=
of
of
M.D.
Pathotogy,
Iowa
Cortege
Iowa
-
lit
-
of
Medicine
FOREWARD
For
ease
disease
in
coding,
schemes.
Indicate
They
the
usuat
comparisons
are
onty
generat
guide
was
into
three
distant
).
Sometimes
together
unavoidable
combination
uations.
In
sistent
with
Cancer
Staging
Unioo
tic
and
the
Cancer
Resu[ts
(survivat
the
subdivisions
to
(AJC)
can
give
and
be
-
iv
groupings
are
summarized
into
be
may"
based
on
various
distant
summarized
-
a
evat-
ctinicat.
we
by
cons|der_tion
of
atways
categories
such
Joint
and
and
conditions
as
American
cate-
Many
are
insofar
the
regionat,
disease
reglonat,
operative,
Reporting
and
to
staging
operative-pathotogicat
groups,
by
of
generat
categories
probabitlty)
tocattzed,
are
pathotogic,
staging
(UICC)
but
and
is
onty
they
which
this
tocatized,
that
Stage
devetoped
End
(i.e.,
codes
for
extent
of
however,
series
expanded
incongruous,
disease
order
Often,
anatysis.
observations
make
significance
The
of
and
Therefore,
smart
meaningfut
extent
veportin_=
other
avaltable.
categories.
categories
Against
subdividing
sary.
to
or
so
expanded
patterns.
groups
seem
the
comptete
the
is
may
extent
priority
order
are
a
ctinicat
The
to
historicat
series
for
favors
disease
staging
a
staging
of
guide
summarizes
generat
the
_rogram
of
with
which
four
a
categories
cases
if
or
three
as
which
gories
grouped
act
necessary
devetoped
enough
SEEP
progression
staging
produce
the
abte,
con-
Committee
the
to
factors,
categories
into
are
Internationat
the
prognosa
was
the
for
three
groupin3
necesfamitiar
be
stage
categories--tocatizedj
groupings.
is
For
coded
L
.
regionalL,
exampte,
These
cases
for
co[on
can
and
and
then
be
distant,
rectum
or
other
"confined
lnctuded
with
to
either
a]Lternstive
the
mucnss"
the
"in
situ
1
or
the
with
"[)catized"
which
are
stage
the
comparison
subdivided
into
four
of
disease
is
depending
being
groups
made.
(L
through
1
Ctark's
by
direct
revers
of
extension
invasion.
are
Sites
coded
D
reserved
for
metastatic
Invotvement.
For
the
rutes
metanoms,
L
)
In
o¢
the
tocstized
order
to
series
cases
indicate
4
considered
as
1
on
distinct
to
from
be
distant
D
or
2
invotvement
D
which
3
are
w
TABLE
OF
CONTENTS
FOR
SUMMARY
STAGING
GUIDE
Page
Organization
of
Site-Specific
Summary
Staging
Staging
Guides
Upper
tip
( 400,
403
Lower
tlp
( 401,
404)
Commissure
Base
of
of
tip
tongue
Anterior
)
9
11
(406)
13
15
tongue
grand
(411-414,
( 420
Submandtbutar
Upper
gum
(430)
Lower
gum
and
Ftoor
of
Cheek
m_cosa
416)
17
)
19
gt_and
(421)
21
23
retromo_ar
mouth
(440,
and
lJard
patate
(452)
Soft
palate
and
Oropharynx
for:
(410)
2/3
Parotid
Guide
trigone
441,
(431,
4¢8,
449)
of
mouth
vestlbute
436)
27
(450,
uvula
(453,
( 470-47.3,
Hypopharynx
(480-483,488-489)
upper
Thoracic
or
middte
)
31
454
)
35
39
Nasopharynx
or
451
33
(460-469)
Cervicat
25
478-479)
43
0,5
esophagus
( 500,
esophagus
(501,
-
vi
-
503
)
504)
47
_9
Pa_e
Abdominal
or
lower
esophagus
Stomach
s
Junction)
( excluding
(510-516,
Duodenum
(520)
JeJunum
and
Cecum
53
(521.
522)
61
(534)
63
Transverse
sptenic
coton,
ftexures
Descending
(536)
coton
( 541
canal
Liver
and
and
and
73
75
( 540
anus,
NOS
lntrahepatic
Extrahepatic
Body
59
)
79
_3
( _60
of
and
)
a[tbtadder
Head
hepatic
537)
(532)
Junction
Ana[
531,
(533)
Rectosigmoid
Rectum
65
intruding
(530,
coton
Slgmold
bite
pancreas
(542.
bite
543
duct
)
87
(550,
551
)
_8
)
91
duct
562
( 561,
)
92
(570)
talt
of
93
pancreas
(571,
572
)
94
97
(610-612)
Bronchus
and
tung,
( 700-709
Matignant
871 -872,
Skin
51
cardioesophagea[
518-519)
[teum
co[on
Bone
505)
57
Ascending
Larynx
(502,
extruding
(622-625,
)
than
528-529)
99
102
metanoma
of
874 ; histotogy
other
carina
skin
(730-737)
metanoma
879
84t-84_,
)
105
107
Breast
( 740-749,
Cervix
uteri
(800-801,
808-809)
115
Corpus
uteri
( 820-821,
828
I I7
Ovary
759
(730-737,
872
thru
)
111
)
|19
(830)
-
vii
-
TABLE
OF
CONTENTS
Page
Fattopian
tube
Vagina
(840)
Vutva.
including
Prostate
skin
of
vutva
(841-844)
123
(859)
(850,
Penis,
inctuding
125
869
)
129
skin
(880-886,
Kidney
(rena_)
Rena[
(kidney)
Ureter
( 892
Thyroid
120
t21
Testis
Bradder
(832)
888-889
penis
pe[vis
(871,
)
parenchyma
872,
874)
130
133
(890)
135
136
(891)
)
138
grand
Lymph
nodes
416,
460_,
histotogy
of
139
(939)
and
471,
959
tymphoid
tissue
491,
640.
692;
%hPu
969,
975 )
-
vlii
(960-969,
-
I @1
OR_.ANIZATION
I,
Summary
IN
staging
SUMMARY
STAGING
GUIDE
definitions
SITU:
LOCALI
OF
lntraepithetiat,
ZF_DD:
noninvasive,
Within
_o
organ
Invaslve
of
bo
nonlnfittr_ting
cancer
confined
to
the
organ
origin
Intratumlnat
extension
For
intratuminat
example,
immediatety
targe
where
extension
contiguous
bower
is
specified
segments
coded
L
untess
to
of
the
the
3
invaded
segment
different
has
pattern
an
ot
identitiabty
tymph
node
drain-
agee
RE_I_O_N_AL:
DISTANT:
Beyond
the
organ
_.
By
direct
bo
To
regional
c.
(a)
and
Direct
orlgin
of
extension
tymph
Direct
b.
Discontinuous
c.
To
or
organs/tissues
nodes
metastasis
continuity
distant
adjacent
(b)
extension
a.
to
to
metastasis
lLymph
-
1
nodes
-
organs
other
than
above
[[.
Site
definitions
The
internatlona[
codes
are
ever,
the
practice
I[[.
Classification
included
at
first
of
digit
the
SEER
stagJng
Summary
A o
Site-Specific
Bo
Nonspecific
of
the
top
of
(I)
has
been
Diseases
the
for
page
for
dropped
Ontology
each
in
(ICD-O)
how-
scheme,
compliance
with
the
program.
guide
staging
schemes
staping
In
( See
pages
8
thro_h
141
)
scheme
s|tu
Localized
Regional,
direct
Regional,
nodes
Regional
s
extension
direct
Regional,
NOS
Non-locall
Distant
zed,
only
only
extension
and
reglonl
[
nodes
to
fotIowin_
NOS
Unsta@ed
Thls
nonspecific
mary
sites:
sta_ing
scheme
PRIMARY
SITE
applies
the
ICD-O
Number
of
405
Mucosa
40.8
Two
409
Lips,
415
Junctions[
a 18
Two
419
Tongue,
4?2
Subt
ingua[
428
Two
or
429
Major
4-_8
Two
439
Gum,
45_
Palate,
45.8
Two
459
Orat
or
llps,
more
CODE
NOS
cate_ories
of
tip
NOS
zone
or
more
of
tonglte
categories
of
tongue
of
major
NOS
gland
more
categories
salivary
or
more
gland,
salivary
glands
NOS
categories
of
Rum
cate__ories
of
other
NOS
WOS
or
more
cavity
-
2
-
parts
of
mouth
nri-
490
491
498
499
Pharynx,
NOS
WaLdeyer*s
rings
NOS
NeopLasms
of
tip,
oral
cavity
and
pharynx
whose
point
of
origin
cannot
be
assigned
to
any
one
of
the
categories
40
through
48
ILL-defined
sites
in
[lp.
oral
cavity,
and
pharynx
508
509
Junctions
Esophagus,
510
CardloesophageaL
s tomach
)
523
Mecket*s
528
529
_wo
S_,aLt
535
538
539
Appendix
;wo
or
Coton,
548
Other
568
Too
or
Bore
extrahepatic
569
BiLiary
573
Pancreatic
duct
574
578
579
IsLets
two
or
Pancreas,
of
Langerhans
more
categories
NOS
580
588
589
Retroperttoneum
_pecl£1ed
Peritoneum,
590
Intestinal
598
Neoplasms
pointe
of
the
categories
Gastrointestinal
599
600-605,
or
608,
Nas_[
inner
of
esophagus
NOS
(excLuding
Junction
cardia
of
diverticulum
more
intestine,
Lore
NOS
parts
categories
bIOS
of
the
categories
of
co£on
of
gaLLbLadder
of
pancreas
of
intestine
rectum
categories
bile
ducts
tract,
small
and
NOS
parts
NOS
of
peritoneum
tract
609
cavities,
ear
of
dl_estive
organs
and
origin
cannot
be
assigned
50through
58-tract.
NOS
accessory
-
sinuses,
3 -
peritoneum
to
any
middle
one
ear
whose
of
s
613
618
619
Laryngeal
Two
or
Larynxs
more
NOS
cartilage
categories
of
620
Trachea
622
Carina
630
631
638
639
Parietal
pleura
Visceral
pleura
1[wo or more
categories
PLeura
• NOS
640--643.
_48_
649
Thymus
and
thru
969
)
650•
( excluding
658o
65_
Other
and
system
and
o£
692
SpLeen
(excluding
693
Retlcutoendotbe_lat
sites
marrow
pleura
histology
(hematopoietic
histology
tissue
and
738
Two
or
more
categories
and
nonmeLanotic)
739
Skin,
799
Uterus•
819
P_Lacenta
833
834
Broad
Parame
Ligament
trium
835
838
839
Round
Other
Uterlne
Ligament
uterine
adnexa
848
849
Two
or
lemate
FemaLe
873
875
876
877
878
Body
of
penis
Epididymls
Spe rmatic
cord
Scrotums
NOS
Other
parts
of
879
MaLe
(meLanottc
system)
959
of
and
thru
969.
NOS
other
soft
tissue
(metanotic
skin
nonmeLanotic)
NOS
mope
genital
genital
genital
adnexa
categories
organs
tract,
maLe
tract,
-
4
of
NOS
-
other
NOS
genital
959
respiratory
within
organs
system•
712-719
Connective
)
(excLuding
iLt--defLned
intrathoracic
bone
NCS
bronchus
mediastinum
690--691,
699
BLood•
710•
main
Larynx
organs
and
unspecified
975
)
887
Urachu_
893
Urethra
894
898
Paraurethra[
Two
or
more
899
grlnary
grand
categories
system,
of
other
urinary
organs
NOS
900-909
Eye
and
[acrimat
grand
910-919
Brain
920-923,
928,
Other
940,
950-955,
909
941,
Other
929
and
unspecified
943-946,
endocrine
958
Unknown
948,
Other
parts
949
glands
it]L-defined
primary
site
-
5
of
-
sites
nervous
system
IV,
Definition
&ccordtng
of
To
The
Anatomic
American
Sites
Joint
Within
Committee
The
on
Orat
Cavity
Cancer
Sta_tng
LIPS,
upper
and
tower,
form
the
upper
and
tower
anterior
watt
of
the
_rat
cavity.
They
consist
of
an
exposed
surface
of
modified
epidermis
coamon[y
referred
to
as
the
vermitton
surface,
which
extends
from
commissure
to
commissure
and
the
mucous
membrane
tining
the
inner
surface
of
the
tips.
COMMISSURE
of
mouth).
POSTERiOR
portion
OF
of
LIP
is
ONE-THIRD
the
tongue
vattate
papittae
gtossoepigtottic
areas:
OF
point
of
union
TONGUE
(base
which
extends
to
the
fords
ANTERIOR
TWO-THiRDS
ton_n_e
which
extends
root
of
the
tongue
of
fnur
(non-vlttous
the
base
(which
Tip,
of
the
bound
( 2 )
upper
of
tongue)
infertorty
and
Laterat
tower
consists
from
the
epigtottis,
the
vatfecuta).
OF TONGUE
consists
anteriorty
from
st
the
Junction
of
( 1 )
surface).
of
the
tips
of
fine
(coraer
the
of
tess
mohlte
circum-
pharyngoeplgtottlc
of
the
the
fine
the
ftoor
freety
movabte
of
c ircumvattate
of
the
mouth.
borders,
( 3 )
Dorsum,
and
portion
papitta_
It
is
_nd
( • )
of
the
to
the
composed
Un:[ersurface
FLOOR
OF MOUTH
consists
of
a semitunar
shaped
space
over
the
mytohyold
and
hypo_tossus
musctes,
extending
from
the
inner
surface
of
the
tower
stv_otar
ridge
to
the
root
of
the
tongue.
Its
posterior
boundary
is
the
base
of
the
anterior
pittsr
of
the
tonsit.
It
is
divided
into
two
sides
by
the
fr_nutum
of
the
tongue
and
contains
the
ostia
of
the
submaxittary
and
tinguat
sativary
gt ands.
LOWER
mucosa,
gutter
extends
_[N_,IVA
which
to
the
to
the
UPPF. R _[N_IVA
from
the
fine
to
the
Junction
upper
end
of
BUC_.._L
_[UCOSA
the
c heek°
intrudes
extends
fine
of
ascending
is
of
the
the
from
free
atveotar
process
of
the
fine
of
attachment
mucosa
of
the
ftoor
taBUS
of
the
mandibte
the
covering
mucosa
attachment
of
mucosa
with
the
hard
patate.
pterygopaTatine
arch.
inctudes
aft
the
of
mucous
the
mandibte
of
mucosa
of
the
mouth.
(retromotar
the
upper
in
the
upper
Its
posterior
membrane
atveotar
ginglvat
margin
tining
the
and
its
covering
in
the
buccat
Posteriorty"
trigone)o
ridge,
buccat
is
the
inner
extending
gutter
surface
of
I{ARD
P_LATE
consists
of
the
semitunar
are_
between
the
upper
atveoLar
rLdges
and
the
mucous
membrane
covering
the
patatine
process
of
maxtttary
pststine
bones.
It
extends
from
the
inner
surface
of
the
superior
atveo|ar
ridge
to
the
posterior
edge
of
the
palatine
bone°
SOFT
P&LATE
consists
muscles
and
extends
border
of
the
soft
margin
comptetes
surface
is
the
the
of
the
of
from
patate
mucosa
the
and
pterygomandibutar
fauciat
arch
anterior
covering
posterior
inctudes
the
edge
the
raphe.
(gtossoDatatine
tonsittar
The
plttar.
-
6
-
orat
cavity
of
the
hard
-,vuta.
Its
Inferior
arch)
and
sl_e
pstate
superior
taterat
inct-des
of
the
to
the
taterat
m_rgin
the
patatlne
free
anterior
it
NASODH&RYNX
Posterior
choana
timtt
to
is
Laterat
of
the
( pharynges
Superior
the
fever
the
_roove
Watt
free
t
Watt
(vautt)
of
the
free
between
the
extends
border
recesses).
of
from
the
the
soft
extends
border
taterat
base
of
of
from
the
watt
the
patate.
the
soft
and
skutt
It
superior
patateo
the
base
on
each
intrudes
border
The
of
the
side
to
of
the
t_tera[
skutt.
the
Rosenmutter's
revel
fossae
OROPHARY_IX
Posterior
tip
of
Laterat
WaLL
extends
epigtottis.
the
Watt
Anterior
Watt
tis,
and
the
the
vat
recurs.
HYPOPHA
Pyriform
of
the
intrudes
from
the
consists
of
pharyn_oeplgtotttic
the
tonsittar
the
Posterior
gtottis
to
the
borders
of
pittars,
tinguat
and
the
soft
tonslttar
(anterior)
gtossoeplgiottic
palate
to
fossae,
surface
of
fords
and
the
which
the
tonsilSo
epigtotbound
RYNX
Slaus
extends
from
the
esophagus,
between
the
posterior
t_terat
surface
Post-Crlc_ld
cartltages
crtcoid°
free
the
pharyngoepigtottic
inner
of
the
surface
arytenoid
Area
extends
from
the
posterior
and
their
connecting
fo]Lds
to
the
The
t_terst
margin
Is
the
anterior
Pharyngeat
Walt
extends
from
to
the
inferior
margin
of
the
posterior
margins
of
the
pyriform
-
7
ford
of
the
and
surface
Inferior
part
of
the
fever
of
crlcoid
cartttage,
sinus.
-
to
thyroid
crtcoid
the
upper
e_ge
cartltage
cartl[ageSo
and
of
the
arytenoid
surface
of
the
the
pyriform
sinus.
the
tip
and
of
the
tateratty
epi-
VERMILION
SURFACE
OF
UPPER
LIP
Vermil ion surface-___.
,Subcutaneous
,___Commissure
'"----"--- ''"Lower
Skin
)_--
lip
_
-8-
_-Labial
Muscle
_Gingiva
tissue
mucosa
UPPER
400,
IN
SITU;
nontnvaslve
LOCALIZED
([nva.qion,
Vermttlon
Skin
Labiat
not
to
muscle)
surface
of
tip
m_cos_
ized,
REG_I[._O_NAL,
( inner
lip)
foot
but
confined
mucosa
and/or
skin
Muttlpte
t_blat
Locat
but
to
vermition
surface,
NOS
Direct
Extension
R
if:
l
Commissure(s)
L_wer
tip
Musc ttta ture
of
R
tlps
if:
2
Bucca[
muc6s_
Gtnglv_
_
(inner
cheek)
upper
R
if:
3
Maxttta
Nose
I_GION_AL,
Facial:
Parot|d.Subment
Lymph
Nodes
bucc
Inator
In _ra-aurtcut_r,
preaur|
cul
_r
at
Submandlbutar
DISTANT,
Direct
D[ST&NT,
Lymph
(submaxittary)
Extension
or
Metastasis
Nodes
Internat
Jugula
r
Upper
cervicat
(inctudtng
Supractavtcutar
( transverse
Other
distant
nodes
NOS)
)
cervtcat,
cervicat
-
9
-
LIP
403
Aprl(,
1977
LOWER LIP
___--Vermil
ion surface
REGIONAL NODES
1. Facial
2. Submental
=
3. Submandibular
I
3
Mandible
Subcutaneous
/ Muscle
tissue
/
Labial mucosa
Skin _( _
\
Commissure
Lower gingiva
-10-
Upper lip
LOWER
LIP
401 ,
404
IN
noninvasive
_!_;
( Invasion,
LOCALIZED
Verm[
tion
Skin
of
Labiat
Ilultipte
tabiat
not
to
muscle
)
surface
tip
mucosa
fool
mucosa
Locatlzeds
BE__!Q_NAL,
but
( inner
tip)
but
confined
and/or
skin
to
vermition
surface,
NOS
Direct
Extension
R
If:
1
Commlgsure(s
Upper
[Ip
Muscuta
ture
) of
R
tlp.g
if:
?
Buccat
mucosa
Glngiva
,
(inner
cheek)
tower
R
if:
3
Mandl
_EG[ONAL,
hte
Lymph
Nodes
Faciat:
mandibutar
Subm en t at
Sub_andlbutar
(_ubmaxlttary)
_DIST&NT,
Direct
DfSTA_/T__,
Lymph
Internat
Extension
Metastasis
Node._
Juguta
Upper
cervicat
Supractavlcutar
Other
distant
or
r
(Intruding
{ transverse
nodes
cervlcat,
cervicat)
-
NOS)
11
-
Apri[,
1977
COMMISSURE
OF LIPS
Commissure
REGIONAL NODES
1. Facial
2. Parotid
3. Submental
4. Submandibular
M_
2
Mandible
.Subcutaneous
/
Muscle
)///Labial
Skin @_Upper
_--Lower
4
tissue
mucosa
gingiva
gingiva
lip
Vermil ion .___Upper
Surface ___kower
-12--
lip
COMMISSURE
406
IN
SITU;
noninv_sive
LOCALIZED
Vermitton
surface
Skin
Labl_t
of
tip
mucosa
Loca[
lzed,
(inner
tip)
NOS
R_EEG_IO_NA_L
, Direct
Extension
if:
1
Both
Musc
tlps
u ta ture
R
if:
2
Bt_ccat
mucosa
(inner
cheek)
GI ngiva
R
if:
3
Msxl tta
Mandlb[e
Nose
REGIONAL,
Lymph
F_ciat:
Paro
rid:
Subment
Nodes
mandibutar
in fra-aurl
cutar,
pre_uri
cut
ar
at
( submsx|ILtary
Sttb_andlbutar
D__S!_A_NT,
Direct
DfST&NT,
Lymph
Extension
)
or
Metastasis
Nodes
Internat
Jugutar
Upper
cervtc_t
Supractavlcutar
Other
distant
(inctuding
( transverse
nodes
cervicat,
cervtcat)
-
NOS)
13
-
3F
LIP
&prt
t,
1977
BASE OF TONGUE
Epiglottis
/__
Glossoepiglottic
Vallecula
"5
fold
tonsil
_1 Lateral
_Tonsillar
fossa
1"
_o_///-Glossopharyngeal
sulcusl
__] (__/-Pa
latinePharyng°epigl°ttic
fold_
o° _'°Oo /_ Tonsillar pillar
J
m_
_
--
<
Pharyngeal
Wall
Midline
\
Soft palate,
-Uvula
Mandible
REGIONAL NODES
/
Epiglottis_
-Hypopharynx
1. Submandibular
2. Upper cervical
3. Internal jugular
_
Upper g0ngtvi_
Sublingual
__!_o
gland_
Lower gingiva
fFloor
Mouth
BASE
410
IN
SITU;
OF
TONGUE
ApriL.
noninvastve
LO_AL!_ZE_D
L
if:
l
Confined
to
L
posterior
1/3
of
tongue
on
one
side
if:
2
Mldtine
tumor;
L
tumor
has
crossed
mtdtine
if:
x
LocaLized,
NOS
R_E_G[O_NAL,
Extension
Direct
R
if:
1
Anterlor
GI ngiva,
Subt
i ngua
2/3
of
bower
t gland
R
tongue
if:
2
Vattecuta,
Epiglottis,
Floor
of
including
ltn&nutat
mouth
Lateral
tonslls
REGIONAL,
pharyngeal
)
Lymph
Direct
D
plTtar-q,
Nodes
Extension
if
extension
gast
or
tic
cervlcat
j
NOS)
Metastasis
to:
I
Ma nd Ib I e
Larynx
F[Ypopha
rynx
Soft
palate,
D
Other
DISTANT,
2
distant
Lymph
Supractavtcutar
Other
distant
including
uvula
if:
invotvement
Nodes
( transverse
nodes
gtossoepigtottic
folds
surface
( tonsittar
walt
Submandlbutar
(submaxillary)
Internal
jugular:
subdt
Upper
cervlcat
(IncLuding
DISTANTj
and
pharyngoeptgtottic
(pharyngeal)
cervtcat
-
)
15
-
tonsittar
fossae,
1977
ANTERIOR % OF TONGUE
Palatine tonsil
Tonsillar fossa
'_)
; ).y Glossopha_ngeal
sulcus
.('/.Base of tongue
_,nterior % of tongue
Tonsillar pillar -
REGIONAL
NODES
1. Submandibular
Midline
_
2. Submental
_-
4. Internal jugular
3.
cervical
5. Upper
Sublingual
_
_Upper
surface_ .--_-- I
gingiva
___
Hard
_ \
< '_"
j//! 1_/
J _)
Ventral
Sublingual __JFIoorofmouth
gland f \ _
Uvula / i
SoftpalPtleai-
Lower gingiva
-16
-
_
Dorsal surface_,
t
}(
/
/f
ANTERIOR
411-414o
IN_SI
TU;
nonlnva
2/3
416
OF
TONGUE
_prit,
slve
LO_AL!_Z_E__
L
If:
l
Confined
to
with
anterior
without
or
L
1/3
of
Invasion
tongue
on
one
of
muscutature
side
If:
2
Mldtine
tumor;
L
tumor
has
crossed
mldtine
if:
X
Local
ized,
REGIO_NA_L,
NON
Direct
R
Extension
if:
1
Ftoor
of
mouth
Base
of
Subtlngtm
tongue
t gland
R
If:
2
tower
Gingiva,
R
If:
3
bt e
Mahdi
REGION&L,
Lymph
Nodes
Submandtbutar
Submen
t at
(submaxillary)
Internal
JuguLar:
Upper
cervicat
Suht I nguat
Direct
DIST&NT,
D
subdigastric,
supraomohyoid
(lnctuding
cervlcat,
NON)
Extension
if
extension
or
Metastasis
to:
1
Lateral
pharyngeal
watt
Soft
patate,
Inctudlng
Maxi tta
D
2
distant
Other
D!S_TANT_
,
Lymph
Supractavicutar
Other
distant
(tonslltar
uvuta
pillars,
if:
tnvotvement
Nodes
( transverse
nodes
cevvlcat
-
)
17
-
tonsittar
fossae,
tonsils)
19"77
PAROTID GLAND
\J/
___
,_,'_---External auditory meatus
_Preauricular
area
Pgl_°tid_-= _--_ M_M astoid process
__f.Subauricular
area
_-__Submandibular
\ Mandible
_
gland(q
,oid
_muscte
D igaStcle_
;te_rnocleidomastoid
scle
'terygoid
muscle
Facial nerve
__1_
_
__
aSSc
teer
Facial
Maxillary ar
_,18-
Jugular v_inCarotid arte_ __
PAROTID
420
[N
SITU;
GLAND
Apvit,
noninvasive
L_CALIZED
Fntirely
Substance
Muttipte
Locat
within
of
loci
ized,
REGIONAL,
benign
tumor
parotid
grand
but
confined
capsute
invaded
to
substance
of
parotid
grand
SOS
Direct
Extension
R
If:
1
soft
Perigtandular
Nerve{
Ske[etat
._):
faclat
muscle(s)-
tissue
auricular,
spinal
accessory
digastric,
sternocteidomastoid,
pie rygold,
stytoid
s
Perio.qteum
of
Pharyngeal
Submandlbutar
mucosa
(_ubmaxittary)
masseter,
mandibte
R
grand
If:
2
Sk In
R
if:
3
Mandib[
,Major
e
blood
Mastoid
Externat
Skut
I
vessel(s):
process
auditory
REG_ [ON?L L,
Lymph
Parotid:
Sub=andlbutar
D_[S_T__N!_ ,
Direct
DISTANT,
Lymph
carotid
maxitLary
faciat
Jugutsr
artery
veln
meatus
Nodes
Intra-parotid,
(submaxl
Upper
cervlcat
Supraciavicutar
Other
distant
artery,
artery,
infra-auricutar,
preaurlcutar
ttary)
Extension
or
Metastasis
Nodes
(including
( transverse
nodes
cervicat=
cervicat
-
NOS)
)
19
-
or
vein,
1977
SUBMANDIBULAR
GLAND
Submandibular
gland
MUSCLES
Pterygoid\ _
Styloglossus__
S_Stylohyoi d
Digastric -_'_Z'__
Hy°gl°ssus
/
\
1
_
Facial nerve
Parotid gland
Sublingual gland
Facia/i artery _-__
/
_ _T_
,
Maxilla_
Mandible
. .
---
Lingual nerve
_
ne
_
"
__
.oo s
1. Submandibular
2. Submental
-,,_ar_uryI
3.
NOS
4. Cervical,
Upper jugular
- 20 -
SUBMANDIBULAR
(Sut_naxittary
421
IN
SITU;
noninvasi
GLAND
GLand)
ApriL,
ve
LOCALIZED
EntireLy
Substance
MuLtipLe
Local
within
benign
tumor
capsule
of
parotid
gland
invaded
foci
but
confined
to
substance
lzed,
of
submandib_tar
gland
NOS
_RE_O_I_O_N_AL, Direct
Extension
R
If:
1
Perigtandutar
SkeLetaL
soft
muscte(s
Pertosteum
of
Parotid
Subtinguat
):
tissue
digastric,
stytogt
mytohoid,
pterygoi
ossus;
stytohyoid,
d
hyogtossus,
mandible
gland
gland
l_
If:
2
Nerve(
s )
Major
MandibLe
blood
REGIONAL,
Subment
Lymph
vesseL(s):
facial
artery
or
vein,
Nodes
a t
Sub_andlbutar
(submaxilLary)
Internal
JuguLar
(subdigastrlc)
Upper
cervical
( including
DI_T__&_N_T,
Direct
DISTANT,
Lymph
SupractavtcuLar
Other
distant
Extension
or
cervicaL,
NOS
Metastasis
Nodes
(transverse
nodes
cervicaL)
-
21
-
)
maxillary
_rtery
1977
UPPER GUM (GINGIVA)
Upper gingiva
Hard palate
t
__Soft
_'_-
palate
Uvula
Muscle
Submucosa
Upper gingiva
mucosa
'_'--Labial mucosa
_/Gjngival
Buccal mucosa
4. Internal jugular
5. Upper cervical
-22
..
UPPER
430
IN
SLTU;
GUM
(G[NG][VA)
ApriL,
1977
tonsils
)
nonlnvastve
LOCALIZED
L
If:
I
Confined
to
mucosa
L
if
Invading:
2
Lamina
propria
(mucoperiosteum)
L
If:
x
Localized_
REG][ONAL,
NOS
Direct
Extension
R
If:
1
Ma x i t la
_ard
and/or
soft
palate
Buccat
mucosa
( Inner
cheek)
Labial
mucosa,
upper
R
tip
If:
2
Lateral
Soft
tissue
pharyngeal
of
Lymph
REGIONAL,
FaciaL:
pillars,
Nodes
mandlbutar
Sabmandtbular
Re tropharyngea
Internal
Jugular
Upper
cervical
DI_IAN'r
( tonsittar
waiL[
face
,
Direct
(submaxitlary)
t
(Including
Extension
D
if
cervical,
or
extension
NOS)
Metastasis
to:
1
Skin
Nasat
Maxillary
Skutt,
cavity
antrum
including
D
(sinus)
ftoor
of
orbit
if:
2
Other
D[ST&NT,
distant
Lymph
Supraclavicutar
Other
distant
|nvotvement
Nodes
(transver._e
nodes
cervicat)
-
23
-
tonsittar
fossae,
LOWER GUM (GINGIVA)
Buccal mucosa
Mucosa
nd
-
Sublingual
gla __
Submucosa
r_
'
Floor of
mouth
Lower
gingiva
Labial mucosa
oi_oo_
_
Tonsillar fossa
o t o%° )__Tonsillar
pillar
_A_"
___
Palatine tonsil
i /
1. FacialNODES
REGIONAL
2. Submandibular
3. Submental
4. Internal
5
;"ljuuu,ar
5. Upper cervical
Mandible
- 2_-
___ .
i,_i_,
_
LOWEI_ GUM (GIHGIVA)
April.,
AND RETROMOLAR
TRIGONE
431
IN
SITU;
1977
• 456
noninvaslve
LOCALIZED
L
if:
1
Confined
mucosa
to
L
if
invading:
2
Lamina
propria
(mucoperiosteum)
L
if:
x
Localized,
NOS
___Q_I_O_NA_L,
Direct
Extens
R
ion
if:
1
Mandible;
Floor
Buccat
Labiat
Tongue
of
periosteum
mouth
mucosa
( inner
of
cheek
mucosa•
lip
tower
R
mandtbte
)
If:
2
Lateral
Soft
Sof_
REGIONAL,
palate,
tissue
pharyngeal
including
of
face
Lymph
FaciaL:
DISTANT,
( tonsittar
uvula
pillars,
Nodes
mandibular
(submaxlttary)
Subaandlhutar
Subm ent _t
Internal
Upper
watt
Jugular=
cervical
Direct
suhd[
(including
Extension
D
if
gastric•
cervicat_
or
extension
supraomohyold
NOS)
Metastasis
to:
1
Skln
Skutt
D
if:
2
Other
DIS__A_b__,
distant
Lymph
Supractavicutar
Other
distant
involvement
Nodes
( transverse
nodes
cervical
-
)
25
-
tonsittar
fossae,
tonstts
)
FLOOR OF MOUTH
__
Lower gingiva --_/'___Mucosa
//,,_//:J__
Mandible _):
_Sublingual
_._
__
=
Epiglottis
/
Glossoepiglottic fold
_/--__jVallecula
o
;/_ _) __'_j____
"6
_
=
nn
=
Submucosa
gland
-Submandibular gland
Pha n/ngoepiglottic
fold
Palatine tonsil
_,_[.._-_
Tonsillar Tossa
\\___
_Glossopharyngeal
sulcus
Iv _oU._ /f/_T
......
oOO I %'_ t
Ionsmarp.lar
I
I
\
"E
Alveolar ridge
\
|
/
I /
_
'l _
/_
II
_(
_j
_
_'a,a_e
\ _ ..........
)-- ...............
Soft Palate
Glossopalatine archf_-_
/
-uvu ,
Phan/ngopalatine" arch
Midline
REGIONAL NODES
....
1. Submental ____
__
2.
3, Submandibular
Sublingual
4. Internal jugular
5. Cervical. NOS
- 26 -
ff_
_
_:
FLOOR
OF MOUTR
440,441,448,449
IN
SITU;
LOCAL
ApriL,
1977
nonlnvaslve
I ZED
L
If:
1
Confined
to
mucosa
L
on
one
side
if:
2
Confined
Submuco
Muscu[s
to
one
side:
s a invaded
ture
i nvsded
L
if:
3
Mld[lne
tumor;
tumor
L
has
crossed
midLlne
if:
x
Locat
tzed,
RE_G_!_O_NA_L,
NOS
Direct
Extension
R
If:
1
Gingiva,
Anterior
Submandibutar
tower
2[3
Subt
lngua
Periosteum
t
of
tongue
(submaxittary)
gtand(s
)
grand
of
mandlbte
R
If:
2
Mandl_t
Base
of
Vattecuta,
e
tongue
intruding
R
pharyngoepigtottlc
and
gtossoeoigtottic
fords
if:
3
F_Dtgtottls,
Laterat
Undertytng
pharyngeal
pharyngeat
watt
soft
tissues
R
( tingual
(tonstttar
)
surface
pittars,
if:
4
Skin
-
27
-
tonsittsr
fossae,
tonsits)
FLOOI_
OF MOUTH
440 j 441 • 448,449
RE__GI[ONA L,
Lymph
Nodes
Sub_andtbutar
Subment
at
( submaxi
SabL
ingua
1.
Internal.
Jugutar:
Upper
cervlcat
DISTlkNT,
Direct
D IST_A_N_T,
Lymph
Supractavicutar
Other
distant
ttary)
subdigastrlcs
( including
cePvicaI
Extension
or
supraomohyo|d
s NOS)
Metastasis
Nodes
( transverse
nodes
cervicat)
-
28
-
ApeLL,
1977
CHEEK (BUCCAL)
MUCOSA
Vermillion
II
surface_P---_/'"
_
,,
.
mucosa_
_uccal
pper gingiva
Labial mucosa
._..Hardpalate
_
- "_
/_'k-_,
_Uvula
'
_
°1 i_
"S°'tpalate
_,
N
SKULL
\
(--/--/
_,
o
Tonsillar pillar
Maxilla
Z_gomo_ ___i__
NAL
NODES
_
1. Facial
4. Submental_\
2. Parotid
5. Internal jugular
3. Submandibular
6. Upper cervical
-
30 -.
_-___--
CHEEK
(Buccat)
VESTIBULE
OF
MUCOSA
M_UT_
&prlt,
450_451
IN
SI_TU;
LOCAL
nontnvaslve
I ZED
L
if:
1
Confined
Submucosa
Loca¢
to
mucosa
invaded
ized,
REGIONAL,
NOS
Direct
Extension
R
If:
1
Soft
tissue
Glngiva
Lip(s)
Laterat
of
cheek
pharyngeat
R
muscte)
([nctudtng
walt
(tonsittar
pittars,
If:
2
Skin
R_EG_IONAL. j
Faciat:
Paro tid:
Submandibutar
Internat
Upper
DIST&NT,
Nodes
Lymph
buccina
tor,
mandibutar
preauricutar
j infra-auricut
(submax[tl.ary)
:
subdI
([nc[udlng
Jugutar
cervicat
Direct
Extension
If
D
_ast
tic
cervicat,
or
extension
ar
NOS)
Metastasis
to:
1
Base
or
Rued
Bone:
or
anterior
of
2/3
soft
palate
maxitta,
mandibte,
D
tongue
skutt
if:
2
Other
D_S__A_N'r,
distant
Lymph
Supractavicutav
Other
distant
Invotvement
Nodes
j
( transverse
nodes
cervicat
-
)
31
-
tonsittar
tossae,
tonslts)
197
'
HARD PALATE
f Har0
k
pa,ate
W
Palatine
Nasalgingiva
Upper
....................., _
Soft palate
\ Uvula
onsilla r fossa
./_. Palatine tonsil
oOO
o'_'%Oo./_--L-Tonsilla
r pillar
REGIONAL NODES
1. Submandibular
Maxillary antrum _lvla_xill_//_
2. Retropharyngeal
3. Internal jugular
4. Cervical, NOS
-32
,-
HARD
452
IN
SITU;
noninvasive
LOCALIZED
L
if:
1
Confined
to
mucosa
L
on
one
side
if:
2
tumor;
Midline
tumor
L
has
crossed
midline
if:
X
Loca
l ized,
REG_IONA_L,
NOS
Direct
Extension
R
if:
1
Soft
palate,
Gingiva,
upper
Palatine
hone
Maxi
tta
Including
R
REGIONAL
if:
2
mttcosa
Buccal
s
(inner
Lymph
cheek)
Nodes
Submandibular
(submaxillary)
Re teopharyngeal
Internal
Jugular:
Upper
cervical
DIST&NT_
uvula
Direct
subdi
(Including
Extension
D
if
extension
floor
of
( sinus
gastric
ceevica1
or
s
NOS)
Metastasis
to:
1
Nasal
Maxillary
Na sopha
cavity;
antrum
no-qe
)
rynx
D
if:
2
Other
_D_I_S___I__,
distant
Lymph
Supraclavlcutar
Other
distant
involvement
Nodes
(transverse
nodes
cervical)
-
33
-
PALATE
April,
1977
SOFT PALATE AND UVULA
Pa,ate
Soft Palate
_k__._
Nasal cavity
floor
"Uvula
Palatine bone
pharynx
Lower gingiva
Floor of mouth
Mandible
_
_/Upper
______Tonsillar
gingiva
fossa
_._
/}__
j
(/
pillar _-__/
REGIONAL NODE
Buccal
mUTonsillarcosa___,_,,
_'_f=:- _._- _.
_- Palatine tonsil
S__
\\
i
_/
1. Submandibular _
i
_
2. Retropharyngeal
3. Internal jugular
4. Upper cervical
- 34 -
2
4
\
,
/
4
SOFT
PALATE
AND UVULA
lt53,
I N_ S_]_TO ;
non
invasl
April,
454
ve
LOCALIZED
L
If:
!
Confflned
to
mucosa
L
on
one
side
if=
2
Submucosa
andor
muscutature
L
invaded
on
one
side
if:
3
Mid]Line
tu_or;
t_mor
L
has
crossed
mid[lne
if:
x
Locat
RE_ION_A_L,
ized,
NOS
Direct
Extension
R
If:
1
H_rd
patate,
mucosa
Gingiva,
upper
Laterst
pharyngeat
tonsi
ts )
R
watt
(tonsittar
pittar._,
If:
2
Buccat
N_sat
REGIONAL,
mucosa
cavity
Lymph
(inner
¢1oor
cheek)
Nodes
S_bmandibuta
r ( submaxl
ttary)
Re tropharyngea[
lnterna[
Jugut_r:
subdi
gast
tic
Upper
cervicat
(including
cervical,
NOS)
-
35
-
tonsittsr
foss_e,
1977
SOFT
PALATE
AND
UVULA
4539
I)_I_STA_N_T. Direct
Extension
D
if
or
extension
Metastasis
to:
1
To ngue
Nasopharynx
Palatine
Max| t[ a
bone
Maxtttary
Mandibte
(sinus)
antrum
lf:
D
2
Other
D[ST&NT,
distant
Lymph
Supraclavicu[ar
Other
distant
lnwo[vement
Nodes
(transverse
nodes
cervlcat)
-
36
-
454
April,
1977
OROPHARYNX
Hard palate
Soft palate
Nasopharynx
Prevertebral fascia
Oropharynx
Floor of mouth
Mandible
Anterior
Tongue
Hypopharynx
Pyriform sinus
2/3
Base
,, j
] _T_r-_/
_._/
REGIONAL NODES/'_1. Retropharynge_l_
/_ •
/_L_J /)
J
/
{
J
_/-
Naso - .,.-"__l_l_
phary.-n--x--__Anterior
wall
,""l_ '_ -_ _t__
Posterior wall
Oropharynxlll t'__
,_Uvula
"". [, ,__
Base of tongue
""__:_Lateral wall
Hy-o-ha-
.._!;
• ,uou,ar
_. c2:n:alJ,
NOS
d'x\_f ";PT_."""eta' ill, /,:_}l'i
lt_l
I'_
PHARYNX
-tR--
i
(from behind)
IN
SITU;
OROPHARY_X
460-469
April,
surface
of
of
oroph_rynx)
epigtottis,
nonlnvastve
LOCALIZED
(Tumor
Is
not
fixed)
L
If
confined
to:
1
wail
watt
Posterior
One
taterat
Anterior
vattecuta
( intruding
eptgtottts,
watt
L
if
taryngea[
and
junctionat
tumor
(anterior)
region
lnvotves:
2
Lateral
watt(
s )
L
and
posterior
( or
anterior)
_tt
if:
X
Locat
ized,
REGIONAL,
NOS
Direct
Extension
R
if:
1
Tumor
is
Soft
Preyer
not
fixed,
tissue
tebrat
Base
of
Larynx
Pyri
form
of
hut
extends
into:
neck
fascia
tongue
sinus
Hypopharynx,
NOS
Soft
patate,
intruding
Na_opha
rynx
Front
of
mouth
Gum
(gingiva),
Ruccat
mucosa
uvuta
posterior
(inner
cheek)
if:
R
2
Tltmor
REGIONA_L,
Is
de._qcribed
Lymph
as
"fixed
to
adjacent
Nodes
Re t ropharyngea
[
Internal
,jugutarsubdlgastrlc,
Upper
cervicat
(inctudlng
cervlcat,
-
supraomohyold
NOS)
39
-
tissues"
1977
OROPHARY._
460 -469
D][ST&NT_,
Direct
Extension
D
if
or
extension
X
Metastasis
to:
1
Both
taterat
Anterior
2/3
qard
pa rate
Mandlbt
e
Parotid
watts
lnvotved
of
tongue
via
soft
pa]Late
grand
D
If:
2
Other
DISTANT
distant
s
Lymph
Submandlbuta
SupPactav[cutar
Other
distant
involvement
Nodes
r
( transverse
nodes
)
cervlcat
-
40
-
or
base
of
tongu_e
_,prt
t s
1977
NASOPHARYNX
an tube
Nasopharynx
Nasal
Posterior wall
Lateral wall
Anterior wall
ropharynx
Soft palate
Uvu
_
Hypopharynx
SKULL
/_
1./Frontal sinus
_J_
F Iph°rn°',d r,b'ntus
,
1. Retropharyngeal
2. Internal jugular
3. Cervical, NOS
- q2 "'
\
_
....
NASOPHARYNX
(470-473.
IN
SITU;
nontnvastve
(Tumor
LOCALIZED
L
is
not
If
confined
fixed)
to:
1
Posterior
One
lateral
superior
walt
wall
(including
L
tumor
if
(vault)
aryepigtotttc
fold,
NOS)
Involves-
2
Posterior
Lateral
wall
superior
Into
L
watt
(vault)
and
lateral
eustachian
tube/
middle
watt(s
)
ear
if:
X
LocaLized,
_RE__Q! _ON A _L,
NOS
Direct
Extension
R
If:
I
Tumor
Ls n_o__tfixed,
but
extends
into:
Oropharynx;
nasal
cavity
Skull,
including
floor
of
orbit
Pterygopa
tatI
ne fossa
Soft
palate,
including
uvula
R
If:
2
Tumor
REG[ONA_L=
is
described
Lymph
as
*fixed
adjacent
tissues
n
Nodes
Ret r o_haryngea
t
Internal
JuguLar
Upper
cervical
(including
DIST___N!_.
to
Direct
Extension
D
if
cervical,
or
extension
NOS)
Metastasis
to:
1
Brain,
including
Accessory
sinus:
Hard
palate
Hypopharynx
Soft
tissues
of
D
cranial
maxillary,
nerves
_Phenoid
,
neck
If:
2
Other
DISTANt_,
distant
Lymph
involvement
Nodes
Supraclavlcutar
Subm andlbu[
ar
Other
distant
(transverse
cervical)
nodes
-
43
-
ethmoid,
frontal
April.
478-479)
1977
HYPOPHARYNX
Nasopharynx
Prevertebral muscles
Orophar_
Larynx
Cricoid
Posterior wall
Hypopharynx
Pyriform sinus
-- Postcricoid area
cartilage /
Esophagus
Nasopharynx
Oropharynx
Base of tongueHypopharynx
Posterior
Pyriform sinus
Esophagus-
PHARYNX
REGIONAL NODES
_
1. Retropharynge
2. Internal jugular
-\
3. Cervical, NOS
_
_Z
3
-40,-
(posterior view)
HYPOP_ARYNX
480-483,
][.N__SI__U;
Aprlt,
488-489
non[nvasive
LOCALIZED
(Tumor
L
is
not
if
confined
flxed)
to:
1
Pyriform
Postcricoid
sinus
area
Posterior
pharyngeat
L
if
walt
tumor
lnvotves:
2
Pyriform
Pyriform
Postcrlcoid
Pyriform
sinus
sinus
and
and
area
sinus,
L
postcricoid
posterior
and
posterior
postcricoid
area
pharyngeat
watt
pharyngeat
watt
area
and
posterior
if:
x
Locat
lzed,
REGIONAL,
NOS
Direct
Extension
P
lf:
1
Tumor
is
not
.fixed_
but
Oropha
rynx
; ta rynx
Soft
tissues
of
neck
Prevertebrat
muscle(s)
Upper
extends
into'.
esophagus
R
if:
2
Tumor
REGIONA_L,
is
described
Lymph
as
to
"fixed
adjacent
Nodes
RetroDharyngea
t
Internat
Jugtttar:
subdlgastrlc,
Upper
cervicat
(intruding
cervicat,
DI_S_T_b_NT,
Direct
Extension
D
if
or
extension
supraomohyoid
NOS)
Metastasis
to:
1
Na sopha
rynx
Base
of
tongue
Ftoor
of
mouth
D
if:
2
Other
D[ST?_NT,
distant
Lymph
SupractavIcutar
Other
distant
Invotvemen_
Nodes
( transverse
nodes
cervlcat
-
45
)
-
tissues"
pharyngeat
wa_t
19r 7
UPPER
OR
CERVICAL
__-
ESOPHAGUS
U_hagus
iddle esophagus
_
LarYn"-_
i_._
Thyroid___
_Vertebra\e
_x
Mucosa_
Trac.(_llth_
,_
FIuscul ari s l, Longitudinalm_!___)i]
Submucosa_-_'__
Aorta
J" Circularm '____/_
_ina
t
Lumen'_-f_
_r"
LYMPH NODES_
Upper deep iugular-_--_.. /
Upper cervical--_¢
(,_
Lower
" __1
L)I_
Esophagus
Sup. mediastinal_
o hageal
-- 46 -.
CERVICAL
ESOPHAGUS
500,
!_N S!I_U%
LOCAL
OR
UPPER
503
nontnvasive
[ZE_
L
If
confined
to:
1
Mucosa
Mucosa
of
but
upper
extends
L
esophagus
to
If
middle
tumor
esophagus
invades--
2
aria
Muscut
L
if:
x
Local
[zed,
REGIONAL,
NOS
Direct
Extension
R
Adventitia
if:
I
and/or
soft
Major
brood
vesseL(s):
JuguLar
vein
Thyroid
gland
Esophagus
is
described
R
tissues
of
as
neck
artery,
carotid
subclavian
artery,
"fixed"
if:
2
HF popha
Tr achea_
Cervical
REGIONAL
t
rynx
; [arynx
including
vertebra(e)
Lymph
cap
lna
Nodes
Paraegophagea
[
Internal
JuguLar
Anterior
deep
cervicaL:
Upper
cervica%
(including
D[STAN_T,
Direct
Extension
D
Main
stem
Lung
and/or
if
I
bronchus
taterotracheat
cervicaL,
or
extension
( recurrent
NOS)
Metastasls
to:
pleura
D
if:
2
Other
_D[_S_TAN_T.
distant
Lymph
invotvement
Nodes
Posterior
medlastina
1
Supractavicu[ar
(transverse
Other
distant
nodes
cervicaL)
-
47
-
)
kprit,
1977
MIDDLE
OR
THORACIC
"!',,
ESOPHAGUS
esophagus
/____r_
/_
Submucosa
_Long
Perib,onchia_ode
s_'
-
2Ribs
HilarC:_neaS_
Bronchii_
_'_
_Pleura
Diaphragm
Esopha
_
gus
V,
i
_
Ao,to
__.
/
-g8
_'
n°des _
THORACIC
ESOPHAGUS
501
IN
SITU;
•
OR
MIDDLE
Aprtt,
504
nonlnvasive
LOCAL!ZE_
L
if
confined
to:
1
Mucosa
Mucosa
of
but
middte
extends
esophagus
to
upper
L
tumor
if
and/or
tower
esophagus
invotves:
2
Muscutaris
L
if:
X
Locat
Ized,
REGIONAL,
SOS
Direct
Extension
R
if:
1
andfor
Adventiti_
soft
Major
brood
Trachea
Carlna
Main
stem
bronchus
Esophagus
is
tissues
vesset(s):
aorta,
described
R
as
putmonary
artery
or
Vein,
vena
WfixedH
if:
2
Lung
via
Pt eura
Pericardium
bronchus
Mediastinal
Rib(s)
Thoracic
NOS
structure(s)
vertebra(e)
Diaphragm
I__G-_ION'AL,
Lymph
Nodes
Pa raesophagea
Tracheobronchiat:
peritracheat,
(pulmonary
Posterior
Internat
Left
Upper
roots
carinal
)
mediastinat
JuguTar
gastric:
cervicat
DISTA_NT,
Direct
D I__T_AN__•
Lymph
Supractavicutar
Other
distant
cardiac,
(lnctudlng
Extension
teaser
curvature
cervtcat,
NOS)
or
Metastasis
Nodes
(transverse
nodes
cervicat)
-
49
-
(bifurcation),
hitar
cav_
• 1977
LOWER
OR DISTAL
ESOPHAGUS
_ .,.....---_
_Submucosa
L,vert
;
_
'_
Lowerlesophogus
--S_:_:eCh
_/1_
__Mucoso
__
ruaru
e
Longitudinal
Muscle
Thyroid gland
/
\\
or
ess
s
\ Aor,a
_/_'e-'l_ _..----"_
PuJm° narY artery
_,_,
_.)
/n°des
D'aP:odes
o___-_
lessercurvature)
-50
_Stomach
ABDOMINAL
ESOPHAGUS
502•
_S[
nonl
T U;
nvas[
OR
LOWER
&prlt,
vein•
vena
cava
505
ve
LO_C_AL!_g__
L
if
confined
to:
I
Mucosa
Mucosa
of
but
]Lower
esophagus
extends
to
L
If
midd]Le
tumor
esophagus
involves:
2
Muscutar
is
L
It:
x
Loca]L
ized•
RE_G_[O_NAL .
NOS
Direct
Extension
R
lfz
1
Adventitia
and/or
Esophagus
is
tissues
soft
described
R
as
nfixede
if:
2
Di aphr
Cardia
agm
of
Major
b]Lood
REG!_ON_AL •
vesse]L(s
Lymph
Pa ra esophagea
Left
Eastric:
Posterior
D!ST_AN__,
stomach
).-
aorta•
gastric
artery
]Lesser
curvature,
or
Nodes
]L
cardiac•
meal lastI
na ]L
Direct
Extension
or
perigastric,
NOS
Metastasis
If:
D
1
WD|aphragm
is
D
fixed"
( Indicates
phrenic
nerve
if:
2
Other
distant
DiSC_ANT•
Lymph
involvement
Nodes
Ce]Liac
Para-ao
Other
rt lc
distant
nodes
-
51
-
involved
by
tumor)
1977
STOMACH
Loweresophagus_ \
......."
rocjm
Stomach
__.
__Spleen
_ Lesse:vatur__
!
Pancreas__
.
'_ ......
__
I Stomach _pleen
Du°denum'_C__od_s
_"il_Sma'l
l_
y
intestine
_I n°d_ _
of
_
_"->":--"_:
:_ 1h,lum
IGreat::lemc
curvature
_Mucosa
_"I("__
_._,,
I,,-_
Circular
muscle} Muscularis
.'
;",
)_-Loncjitudinal
Serosa
"%"...._
". ,Submucosa
. i
Greater
:.
__r
_.( omentum
omentum
__ A_, __'__: _4"_ ;
Left lobe
(
//_Transverse
colon
Small intestine_ . '
Hepatic
flexureS, _ -.______
-"_..._
_____r"
- 52 --.
Splenic flexure
STOMACH
( exc t,_I
cardioesophageat
510-516,
518-519
IN
SITU;
n_
April
Janctlon)
=
1977
noninvaslve
LOCALIZED
L
if:
l
Confined
to
mucosa
L
(lamina
propria
or
muscularls
mucosae;
lntra_uc_sat
)
If:
2
Submucosa
invaded
S_atk
invaded
Superficial
(thru
m_scutarls
mucosae)
{ if polyp)
invasion
L
if:
3
Muscutaris
invasion
Suhserosa[
propria
through
tissue
Invaded
muscutarls
Invaded
propria
{including
extension
through
the
salt,
lf:
L
4
Implants
inside
L
the
stomach
If:
x
Local
ized,
RE__ON_AL,
NOS
Extension
Direct
R
if
extension
to:
1
Perigastric
Lesser
omentum
fat
Ligaments:
Gastric
artery
gastrocotic,
R
gastrohepatic,
gastrosp]Lenlc
If:
2
Invasion
Diffuse
of
(through)
involvement
(tlnttts
serosa_
entire
of
thickness
of
stomach
watt
ptasttca)
R
If
extension
to:
3
Esophagus
Duodenum
(intra_umlnat)
( intratuminal
R
)
extension
if
to:
4
Spleen
Omentum
Transverse
D I aphra
_Invasion
(greater)
colon
(including
hepatic
and
splenic
flexures)
gm
of
serosa
may
be
considered
tocallzed
-
53
-
In
historlcal
comparisons.
._OS)
STOMACH
( exc1_dlng
cardloesophageal
510-516.
518-519
R
if
extension
April,
J_nction)
1977
to'.
5
EsophaGuS
Duodenum
Liver
Pancreas
via
via
Jejunum,
ileum
REGIONAL
s
serosa
serosa
Lymph
Inferior
Nodes
gastric:
Gast
Superior
rocotic
Cardiac
_astroeptptoic,
Greater
curvature
Greater
omentum
In frapytorlc
Py lorlc
Subpy¢ortc
Splenic
right
or
NOS
hilar:
D__.[SI_AN!,
Direct
reat
Nodu[e(s)
ic
Extension
D
if
or
Metastasis
extension
to=
1
Left
Kidney
Adrenal
Grand(s)
Retroperltoneum
Kbdomina
_ wa[]L
Ovary
( Krukenber
G
tumor
)
if:
D
2
Other
D!STAN!
,
distant
Lymph
involvement
Nodes
Cetiac
Repat
ic
Wesenteric,
Para-aor
Portat
Cardioesophsgea[
Gastrohepatic
Left
gastric
Lesser
curvature
Lesser
oment_m
P_rac
ar di al
Perigastrtc,
Left
gastroepiptoic
Pancreat
lcotienat
Peripanc
Spten
ic
gastric:
superior
t ic
Retroperltoneat
Other
distant
nodes
or
inferior
NOS
In
perigastric
tat
DUODENUM
- $6 -
DUODENUM
52O
IN
SI__U;
lprit,
1977
noninvasive
LOCALIZED
L
if:
1
Invasive
Confined
cancer
confined
to
stlbmueosa
L
to
a
polyp
If:
2
Muscutaris
and/or
L
serosa
Invaded
if."
3
to
Intrat_mlnat
L
Jejunum
if.*
x
Locat
tzed,
REG_!O_NAL,
NOS
Direct
Extension
R
Pe ri
duodena
Mesentery
Stomach
if:
1
t
s
tissue
intruding
Extrahepatic
Pancreas,
bite
Intruding
Major
duct(s),
pancreatic
fat
Intruding
duct
ampulla
Vater
omentum
brood
vesset(s):
R
aorta,
superior
vena
cava,
portat
duodenat
artery
If:
3
Smart
of
if:
R
Gr eatep
mesenteric
intestine
Transverse
Right
and/or
Gait bt adder
via
sePosm
coton,
intruding
quadrate
robe
of
hepatlc
tiLver
ftexure
Right
kidney
Right
ureter
D 1 ap hra gm
Abdominat
watt
Retroperitoneum
-
57
-
aesenteric
vein#
artery
renat
vein
or
vein,
s g_stro-
DUODENUM
52O
_REGI_O_NAL.
Lymph
Hepatic:
Nodes
pancreatlcoduodena[,
D_[I_S_T_A_NT,Direct
DISTANT,
Superior
Other
Lymph
Extension
infvapytoric,
ov
Metastasis
Nodes
mesente
distant
tic
nodes
-
58
-
gastrod_xodenat
Ap_It,
1977
,JEJUNUM
IIi _
8L
ILEUM
J_v(_,_---_ Jejunum }Smoll intestine
Ouoenum
b
valve_/__
_
Appendix
/
Largeintestine
LumenS'_
Muco___/_/)
_\_ '_,, ;)'i_R
_
erosa
Circular
\
Longitudinaimuscle
mtoneum
wall
Fallopiantube
Over
Bladder
U
.._
Bladder
- 60 -
JEJUNUM
AND
521,
522
IN
SITU;
nonlnvasive
LOCAL_!__E_D
L
if:
I
Invaslve
Conflned
cancer
confined
to submucosa
L
to
a
potyp
If:
2
and/or
Muscutaris
L
invaded
serosa
if:
3
Intratuminat
to
l[eocecat
Intratumlnat
to
duodenum
L
or
vatve
from
cecum
jejunum
if:
x
Loca]L
ized,
NOS
____
G__I_O_NA _L, Direct
Extension
R
if:
I
Mesentery,
mesenterlc
inctudlng
R
fat
If:
2
Abdomlnat
wat[
Ret roperitoneum
Sma|t
intestine
Large
via
intestine,
R EEGIO_N_A_L,
Lymph
Posterior
Iteocotic
Superior
including
appendix
Nodes
cecal
(termlna[
( %erminat
lteum
mesente
ric
Direct
.DIST&N-T,
serosa
Extension
or
Iteum
onty)
onty)
Metastasis
Bradder
Uterus
Ovary
Fatt
Other
DIST_N__,
opi
an
tube
distant
Lymph
lnvotvement
Nodes
-
61
-
from
lteum
ILEUM
Aprlt,
1977
CECUM
8
ASCI='NDING
COLON
clingco
Cecum/
_
Transversecolon
Y
Ascending
Descending
colon
Iliocolic
Cecum
A
intestine
Fallopian
Ov_
- 62 -
CECUM
534
iN
SITU;
Aprlt,
1977
nonlnvasive
LOCAL I ZED
L
if:
1
Confined
to
t ntramucosa
mucosa
t )
L
(lamina
proprla
or
muscutar|s
._ucosae;
if:
2
Stgbmucosa
invaded
(thru
Stark
invaded
(if
polyp)
Superficia
I i nvaslon
L
muscutaris
mucosae)
if:
3
Muscu_arts
proprla
Invasion
S_bserosat
invaded
through
tissue
muscutaris
invaded
L
proprla
(Intruding
extension
through
th_
watt,
If:
4
Iatratuminat
to
ing
coton
Imptants
inside
appendix,
the
L
cecum
or
|teocecat
vatve,
tocatized
In
iteum,
ascend-
cecum
if:
x
Locat
N'OS
ized,
R EG_IONAL,
Direct
Extension
R
I f
e xtenslon
1
Including
(pericecat)
Mesentery,
Perlcolic
&d,Jacent
to :
mesentertc
fat
tissue(s),
fat
NOS
R
If:
2
of
Invasion
(through)
R
serosa_
if
extension
to=
3
Greater
omentum
Re trope
Abdomi
ri
nat
Smart
intestine,
_Invaslon
of
toneum
watt
serosa
other
may
than
be
iteum
considered
-
63
-
histor|cat
comparisons.
$3_)
CECUM
534
REGIONAL,
Epicotic
Pa rac
Cecat
I t eoc
Lymph
ot
[c
ot
ic
Nodes
Right
cotic
Mesenteric,
Nodute(s)
DISTANT,
(lnctudlng
superior
in
Direct
or
cotlc,
NOS
perlcotic
fat
Extension
or
D
if
extension
NOS)
Metastasig
to:
1
Uterus
Ov ar y
Fair opian
tube
Urinary
bladder
Ga llbtadder
Right
Liver
kidney
Other
segment
Other
distant
or
of
ureter
coton
via
serosa
2
DISTANT,
Lymph
Inferior
PaPa-aortlc
invotvement
Nocfes
mesente
tic
Re t rope ri tonea
Other
distant
nodes
-
64
-
Aprl[,
1977
ASCENDING
536
iN
SIT U;
CDLgN
Apri
i,
1977
noninvaslwe
LO_CA_LI_Z_E_D
L
if:
I
Confined
to
|ntramucosal)
mucosa
L
invaded
( thru
(If
Superficial
propria
or
_uscutaris
mucosae;
It:
2
invaded
Submucosa
Stetik
(]Lamina
muscularis
mucosae
)
polyp)
invasion
L
if:
3
MuscuLaris
propria
Invasion
SuLbserosal
wall,
through
tissue
NOS )
invaded
muscularis
lnwaded
L
proDria
(including
extension
through
the
if:
4
Intralumina[
Implants
to
inside
cecum,
appendix,
|leoeecaL
the
ascending
colon
L
waive,
transverse
colon
if:
x
Locaiized,
REGIONAL,
NOS
Extension
Direct
R
if
to:
extension
1
Perlcol
fat
lc
Re troperltonea[
Adjacent
tissue(s),
Cat
NOS
R
if:
2
Invasion
of
(through)
R
Greater
oment
if
serosa_
extension
to:
3
um
Re trowe
ri to neum
Abdominal
wall[
Small
intestine
Right
Right
ureter
kidney
Liwer,
right
wInvasion
of
lobe
serosa
may
be
considered
Localized
-
65
-
in
hlstoric_i
_ompsrisons.
ASCENDING
536
_G___Q_QNAL,
Lymph
Epicotic
Paracot
lc
It
lc
eocot
Right
Middte
cotic
cottc
(lnctudlng
Mesenteric,
cotlc,
superior
in
Nodute(s)
DIST_A_N_T,
Nodes
Direct
or
NOS
pericotic
fat
Extension
or
If
D
NOS)
extension
Metastasis
to:
1
Uterus
Ovary
Fatt
opi an
tube
Urinary
bladder
Galtbtadder
Other
segment
of
D
Other
_I_&_N__,
distant
Lymph
co[on
via
serosa
if:
2
invotvement
Nodes
Inferior
Para-
me sentertc
ao r t lc
Re fro
Other
pert
tonea
distant
t
nodes
-
66
-
COL_N
kprit.
1977
HEPATIC
FLEXURE,
TRANSVERSE
8PLF..N IC
COLON
&
FLEXURE
colon
Splenicflexure
pleen
•-__
_)anc
___,S
Middlecolic
L._"_./-S_lentcflexure
Hepatic
- -.
nodes
_ _. _ ;;_C_'9..\ _ :¢"("TransverseRightcQ
/
Small
TRANSVERSE
( Inct,adlng
530_
IN
SITU;
LOCAL
531
C3LON
ftexures
&prIt,
)
, 53"7
non|nvaslve
[ZED
L
if:
1
Confined
l. nt
to
ramucosa
mucosa
t )
L
invaded
proprla
or
muscutarls
mucosae;
If."
2
invaded
Submucosa
Stark
Superficiat
(tamlna
( thru
(if
invasion
L
muscutaris
)
mucosae
potyp)
If.*
3
Muscutaris
Invasion
Subserosat
waI
proprta
through
tissue
I,
NOS
invaded
muscutaris
Invaded
propr|a
(|nctuding
extension
through
the
)
L
if:
4
Intratuminat
to
ascending
L
if;
oc
descending
coton
X
Locatized
s
NOS
RE_G_IO_N_A_L, Direct
Extension
R
if
extension
to"
I
Mesentery
Perlcot
ic
Greater
AdJacent
( Including
fat
omentum;
tlssue(s
R
mesenter|c
gastrocotic
),
NOS
fat
);
mesocolon
tlgament
if.*
2
Invasion
of
(through)
R
if
serosa_
extension
to:
3
St omach
Smart
intestine
Liver
Spteen
Pancreas
We t rope
Gallbladder/
Kidney
bbdomina
_Invaslon
r I toneum
bite
t
of
ducts
walt
serosa
may
be
considered
-
69
locatlzed
-
In
historical
comparisons.
1977
TRANSVERSE
( Inctudlng
530s
__EG_gN_AL
,
Eplcotic
Paracot
Right
Mi ddte
Lymph
Aprit
)
colon
onty
537
Nodes
Ic
cotJc
cotic
for
hepatic
ftexure
Cotic,
NOS
Left
cotic
for
sptenIc
Inferior
mesenteric
for
Superior
mesenteric
for
co to n onty
Mesenteric,
NOS
in
Nodute(s)
DISTANT,
531s
C_L_N
ftexure9
Direct
ftexuve
sptenic
hepatic
pericotic
tat
Extension
or
O
onty
if
exten_ion
of
coton
onty
flexure
ftexure
on[y
and
transverse
Metastasis
to:
1
Other
segment
Diaphragm
Ure te r
via
serosa
gland
Adrenat
Ova ry
D
if:
2
Other
DI_S_T_ANT_,
Para-ao
Inferior
Superior
Involvement
distant
Lymph
rt
Ic
Nodes
or
mesenteric
mesenterlc
re trope
rl
for
_or
toneat
hepatic
sptenic
flexure
ftexure
-
70
_nd
onty
-
transverse
s
1977
DESCENDING
_._,_
COLON
D ooo.
>Spleen
"" IDescending
colon
colic
Mesenter
nodes
Sigmoid colon
mes_nteric
nodes
Smallintestine.
tes
BIpar_r:rt_-_
_
_!
-72-
_F_lopion
tube
_ Xl_._
,uterus
_Ovary
DESCEND
532
_IN
SI._TU;
LOCAL
[ NG
COLON
Aprit,
noninvasive
I ZED
L
if:
!
Confined
to
mucosa
L
(tamina
proprLa
or
muscutaris
mucosae)
if."
2
Submucosa
invaded
(thru
n_scutaris
mucosae)
(if
polyp)
[ nvasion
Stark
invaded
Super¢iciat
L
if:
3
Muscutaris
propria
Invasion
Subserosat
watt,
invaded
through
tissue
NOS )
L
muscutaPis
invaded
proprla
(Intruding
extension
through
th_
if:
4
to
splenic
L
if:
[ntra[umlna[
flexure,
transverse
colon,
slgmold
colon
X
Loca
1. ized,
NOS
Direct
REGIONAL,
Extension
I_
extension
if
to:
1
Pericotlc
Re troperl
fat,
tonea[
NOS
fat
Adjacent
tissue(s),
R
NOS
If:
2
Invasion
of
serosa_
(through)
R
if
extension
to:
3
Smart
intestine
Re trope
r i toneum
Greater
ome ntum
Abdominat
or
petvlc
Left
ureter
Left
watt
kl dney
Spteen
_[nvasion
of
serosa
may
be
considered
tocatized
-
73
-
in
historicat
comparisons.
1977
DESCENDING
532
RE
I_O_.N_A_L.Lymph
Epicotlc
Paracot
Left
Nodes
tc
cntlc
( Including
Mesenterlc,
inferior
Nodute(s)
DISTANT.
In
Direct
co_Icj
or
NOS
perlcotic
fat
Extension
or
D
NOS)
if
extension
of
coton
Metastasis
to:
1
Uterus
Ovary
Faltoptan
Other
tube
segment
D
via
serosa
If:
2
Other
I)[_S_TA_N_T,
distant
Lymph
lnvotvement
Nodes
Para-aortlc
Ret roper
i toneal
Superior
mesente
rlc
Other
distant
nodes
-
74
-
C3LON
ApriL,
1977
S IGMO
533
SITU;
non
ID
C_)LON
Apri
t,
invastve
LOCALIZED
L
if:
1
Confined
to
mucosa
I ntramuc
osa [ )
L
propria
(lamina
or
muscularis
m_cosae;
if:
2
Submucosa
invaded
St at k invaded
Superficial
( thru
(If
invasion
L
muscularis
po lyp
mucosae
)
)
If:
3
propria
through
tissue
SOS )
Muscutarls
Invasion
Subserosal
wail,
L
invaded
muscularis
invaded
propria
(including
extension
through
the
if:
4
Intraluminal
to
descending
L
if:
colon,
rectoslgmoid,
or
rectum
X
Localized,
REGIONAL,
NOS
Direct
Extension
extension
R
Mesentery
Pericot
If
1
( including
fat
ic
mesenterlc
tissue(s
AdJacent
),
R
to:
);
fat
megosLgmoid
NOS
if:
2
InvaSion
of
(through)
R
serosa_
if
extension
to:
3
Greater
omentum
Abdominal
or
Small
Intestine
_Invas£on
of
pelvic
sero.qa
may
wall
be
considered
localized
-
75
-
in
historical
comparisons.
1977
S [GMOID
533
REGIONAL,
Epicolic
Paracol
Colic,
Sigmoidat
Superior
Lymph
Ic
NOS
hemorrhoidal
Superior
Mesenterlc,
rectal
inferior
in
Nodule(s)
DIST&NT,
Nodes
Direct
or
NOS
pericolic
fat
Extension
or
D
lie
Metastasis
ex%ension
to:
1
Uterus
Cub
de
Ovary
Fail
opl
Ureter
Urinary
Other
sac
an
( rectouterine
tube
btadder
segment
of
D
Other
DIST&NT,
distant
Lymph
pouch)
colon
via
serosa
if:
2
involvement
Nodes
Para-aortic
Re troveri
toneat
Superior
mesente
Other
distant
rlc
nodes
-
76
-
C_LON
April,
1977
RIECTO Sl GMOI D
.)L/
_.Spleen
_Y
\_'
Wectosigmoid
.s_j''
LIIBT21
t
Mesentery
nodes
Bladd
Prost
moidmesenteric
nodes
intestine
?erirectal nodes
--/8
-
Rectum
RECTOSIGMOID
540
iN
S[_TU;
LOCAL
1977
April,
nonlnvasive
!_Z_E_D
L
if:
I
Confined
to
i ntramucosa
mu_osa
t )
L
(Lamina
propria
or
muscutaris
mucosae;
if:
2
Sabmucosa
invaded
Stalk
invaded
Superflci_t
( thru
muscularIs
mucosae
)
(if
polyp)
invasion
L
if:
3
Muscutarls
Invasion
Sabserosat
propria
throuEh
tissue
L
invaded
muscutarls
invaded
pro_)ria
(including
through
the
watt,
in
historical
N:)_
)
if:
4
to
[ntratuminal
sigmoid
L
or
colon
rectum
if:
X
LocaLized,
REGIONAL,
NOS
Direct
Extension
R
extension
if
to:
1
Me_entery,
Perico[
AdJacent
|c
including
(perirecta[)
tissue(s),
R
fat
me.qenteric
fat
NOS
If:
2
Invasion
(through)
of
serosa_
if
R
extension
to:
3
Small
Cut
de
PeLvic
_Invasion
intestine
sac
(rectoaterine
waLL/
pelvic
of
serosa
may
pouch)
plexuses
be
considered
LocaLized
-
79
-
comparisons.
RHC'['OS
540
REG[ONALs
Lymph
Paracotic
Pararecta[
Nodes
( inctudin_
Hemorrhoidal,
Sigmoidat
Internat
lilac
_esenteric,
Nodute(s)
DISTANT=
colic,
superior
or
(hypogastrlc)
inferior
or
in
Direct
NOS)
NOS
pericotic
fat
Extension
or
D
if
middle
extension
_[etastasis
to:
t
Uterus
Vagi
na
Urinary
Prostate
Sketetat
Fattopi
Ovary
Other
bradder
an
and/or
of
mu_ctes
tube
segment
of
D
Other
DISY&NT,
Para-aort
dlst_nt
Lymph
colon
ureter
ftoor
petrie
via
sros_
if:
2
lnvotvement
Node_
ic
Re troper
ltoneat
Superior
mesentertc
Other
distant
nodes
-
80
-
][GMO [ D
Aprl.
L,
1977
RECTUM
colon
l
escending
Rectum
I "'
Ii
Left colic
Sigmoid
J
Sigmoidmesenteric
't
Perirectalnodes
Prostate
_ladder
+,,Seminal
vesicle
•
_
_/_
_Ductus
__Perirectal
Pel_:_nes
_--J
_I_
Rectum_
Fallopian
_\_
fat
Urethra
deferens
It /
_
Uteru
Uterus__jj.
Urel_ra____
Vagina,/
_'_/
Cervix
/
] I
Ik'o/'odligament
/ /
/
_Perirectalfat
/
_-_Rectum
_
_Bladder
•
Rectum
/
- 82 -
\
Pelvicbones
'
Bladder
RECTUM
541
IN
SITU;
Aprit,
1977
noninvasive
LOCAL IZEV_
if:
L
1
P.onfined
to
mucosa
L
(lamina
propria
or
muscutarls
mucosae)
if:
2
Submucosa
invaded
Stalk
invaded
Superficial
( thru
muscutarls
mucosae)
( i f po[vD)
invasion
L
If:
3
proprla
through
MuscuLaris
Invasion
through
invaded
muscu[aris
proDrla
( Including
extension
WOS)
watt,
L
If:
X
Loca
lized,
NOS
_RE_GI___O_N_A__L,
Direct
Extension
R
If
extension
%0:
I
Perirectat
fat
Rectovagina[
Adjacent
s eptum
tissue(s).
NOS
if:
2
invasion
of
( through
If
R
)
serosa_t
extension
to:
3
[ntra[umina[
to
rectoslgmoid
or
R
if
to:
extension
mnus
4
Colon,
Vm _i na
Cut
de
_Invasion
anus
sac
of
( except
tntratuminal
( rectouterine
serosa
may
)
pouch)
be
considered
-
[ocatlzed
83
-
in
historlca[
comp_risonso
RECTUM
541
R
if
extension
%o:
5
Urinary
Prostate
btadder/rectovesicat
Semln
a_
mate
veslcte
Ductus
deferens
Sketeta[
Petrie
watt
muscte
of
Lymph
REGIONAL,
fascia,
pe|vic
ftoor
Nodes
Pararectat
superior
Hemorrhoida[,
Sacrat
SI
gmo
or
middle
t d at
Mesenteric,
Inferior
[nternat
it lac
Nodu[e(
s )
DISTANT,
in
or
NOS
( hypogastric
)
perlrecta[
Direct
fat
or
Extension
D
if
extension
Metastasis
to:
I
Uterus
Urinary
Sacrum
b[ adder,
Sacra[
pt
Bones
of
femate
exus
petvls
Ovary
Urethra
Per[neum;
perJTLana[
D
skin
if:
2
Other
DISTANT
dl_t
LYMPH
Para-aort
Re t rope
Superior
ant
invotv
ement
_N_ODE_S
ic
r i ton
e at
mesente
I nguLnat
Other
distant
TiC
nodes
-
84
-
Aprlt
s
1977
ANUS,
ANAL
ANAL
CANAL
&
MUCO6A
_,ood
Anus" Anal mucosa
_
_
Vulva_
Vagina
/
Urethra-""T...-_"_/-AkS_X
Cerv,x _;/_e,,_o;
Mucoso__
Submuc_\osa------'-__
_' /
Serosa
-;
Prostate
Blodde __
Urethra
ectum
"
ii
Per,anal skin
f
I
Iliacnodes
Rectum / _"_
/
_
\I _
Brood hgament
ladder
ANAL
&NUS,
54:>.
IN
CANkL
N3S
543
April,
SX_.T_._.U;noninvasive
t.OCAL!Z_ED
L
If:
I
Incidental
Invasive
finding
cancer
L
of
confined
mat|gnancy
In
to
submucosa
hemorrhoid
If:
2
MuscutarI8
{internal
L
sphincter)
if:
x
Local
ized,
REG[ONA_L,
NOS
Direct
Extension
R
If:
I
Rectal
Perianat
mucosa
skin
Skeletal
[schiorectat
or
muscte(s
fat/t
R
suhmucosa
):
anal
sphincter
( external
],
tevator
ani
issue
if:
2
Perineum
Vu tva
REGIONAL,
Lymph
Anorectat
Interat
Lateral
Nodes
; pararec
tat
lilac
(hypogastrlc)
sacral
for
anal
Superficial
for
inguinal
D_][_T&__T,
Direct
for
canal
Extension
D
if
anus
or
anal
canal
only
only
only
Metastasis
to:
extension
1
Pros
tat
e
Peritoneum
Bladder
Urethra
o¢
pelvic
floor
Va gi na
D
if:
2
Other
distant
DIST_AN_T,
Lymph
NOTE:
Melanoma
scheme
involvement
Nodes
of
for
the
anus
RtelanotRa.
is
classified
-
87
according
-
to
the
staging
1977
LIVER
Aprit,
INTRAHEPAT[=
550,
1977
BILE
DU2TS
551
LOC A L I ZED
Confined
Satellite
Loca
to
one
nodule(s)
t lzed,
REGIONAL,
robe
confined
to
one
_obe
NOS
Extension
Direct
if:
R
1
More
than
Oattbtadder
one
lobe
invotved
from
right
robe
by
of
contiguou_
river
growth
if:
R
2
Extrahepatic
Extrahepatic
D Iap hra gm
Peri
toneum
blood
bi_e
)5
Llgament(s
Lesser
veg._e[(
duct(
._ )
fatciform,
hepa t oduode
s):
hepatic
coronary_
na [
artery,
vena
cave,
portal
vein
hepatogagtPic,
triangular,
omentum
REGIONAL_
Lymph
Nodes
Cardiac
Diaphragmatic:
pericardia[
Posterior
mediastinat
Hepatic:
Laterat
DISTAl_T,
hepatic
pedicte,
aortic
(retroperitonea[)
Direct
F. xtension
D
oll
inferior
:
vena
coronary,
cava,
hepatic
artery
penat
artery
Metastasig
if:
1
Satettite
nodutes
D
in
i f
more
extension
than
one
robe
to:
2
P [ eu ra
Pancreas
St omac h
D
if:
3
Other
DISTANT,
distant
Lymph
lnvotvement
Nodes
-
88
-
of
river,
_qurface
or
parenchyma[
LYMPHATICS OF THE GALLBLADDER
Gallbladder
•.
Bile ducts
Hepatic
artery
Pancreatic duct
Duodenum
Fig . 504 • Schematic re p rcsentation of the lymphatics of tho gallbladder showing the pathways to, 1, cystic node; 2, node of anterior border of fornmen of Winslow; and, 3, superior
n,tro-l_:mcrcatic od uodenal node.
Reproduced
SpJut,
St.
with
Hartan
Louis,
permission
J o:
Ackerman
197_,
The
C.
V.
- 90-
from
and
Mosby
de[
de[
Co.
Regato,
Regato's
Juan
A.,
Cancer,
and
ed.
5,
GALLBLADDER
560
IN
SITU;
LOCAL
ApriL,
noninvasive
I ZED
L
if'.
1
c_ncer
Invasive
confined
L
submucosa
If:
2
and/or
Muscutavis
to
L
serosa
invaded
if:
x
Local
tzed,
NOS
R_H_GIO_N_A_L, Direct
Extension
R
tf:
1
Right
Lobe
Gallbladder
Extrahepatic
of
liver
is
replaced
bile
duct(s),
R
by
tumor
including
(indicate
ampulla
extension
of
V_ter
to
liver)
if:
2
BLood
vessels:
cystic
Pancreas
via
extrahepatic
Greater
omentum
Lesser
omentum
DtLode num
REG_[_ONAL,
Cyst
Node
ic
of
Rep_tic
D__ST_A__,
Lymph
Nodes
( node
the
of
the
toramen
:
Large
Stomach
panc
Extension
D
if
1
(other
or
extension
than
hepatic
ducts
neck
of
the
of
WinsLow
pe riportaL,
Direct
Pancreas
artery/vein,
bile
gsttbtadder)
reaticoduodenat
Metastasis
to:
above)
intestine
D
If:
2
Other
D[_S_T_ANT,
distant
Lymph
lnvol.vement
Nodes
Mesent
eric
Para-aor
tlc
Other
distant
nodes
-
91
-
artery,
port_t
vein
1977
EXTRAHEPATIC
IMPULLA
OF
561,
IN
SITU;
LOCAL
BILE
VAYER
DUCT
kprit,
1977
562
noninvaslve
IZED
Confined
Loca
to
bite
t ized,
REGIONAL,
duct(s)'-
cystic
s
hepatic,
NOS
Direct
Extension
R
If:
1
Du odenum
Gattb_adder
Pa nc rea
s
Liver,
Lesser
porta
hepatis
ome ntum
R
If:
2
Transverse
Distat
Brood
coton,
vessets:
REGIONAL,
Cystic
Node
Repatic
portat
Lymph
of
(node
the
:
DISTANT,
Direct
DISTANT,
Lymph
Mesente
intruding
hepatic
ftexure
stomach
vein,
hepatic
artery
Nodes
of
the
foramen
pe rlportat,
Extension
neck
of
o¢
Win.
panc
or
the
tow
tea
gattbtadder)
ticoduo
denat
_Metastasis
Nodes
ric
Para-aort
ic
Other
distant
nodes
-
92
-
common,
amp_lta
o¢
Vater
READ
57O
LOCAL
OF
PANCREAS
April,
1977
[_ZED
Confined
Body
of
With
to
head
pancreas
of
pancreas
involved
obstructionj
but
LocaLized,
no
invasions
of
extrahepatic
bite
duct{s)
NOS
REGION&L,
Direct
Extension
if:
R
1
Extrahepatic
Duodenum
bite
Stomach
adjacent
duct(s),
to
R
including
head
of
of
ampulla
pancreas,
including
Valet
stomach
NDS
If-2
Liver
Major
blood
duodenal
Transverse
Peri
ton eum
Mesentery,
Greater
Gallbladder
vessel(
arteries,
colon,
s ):
hepatic,
pancreaticoduodenat
superior
mesenteric
artery
including
hepatic
flexure
mesocoton,
and/or
lesser
R
mesenteric
omentum
or
and/or
gastrovein,
portal
vein
fat
if:
3
Tumor
is
described
R__E_G!_ON___L
, Lymph
Pe rlpanc
Repatic:
Superior
Lateral
Celiac
"fixed
to
adJacent
tea t ic
pancreaticoduodena[,
mesenter
ic
aortic
(retroperltoneat)
Extension
D
if
extension
or
infrapylor|c
Metastasis
to:
1
Body
Kidney
Ureter
of
stomach
Adrenat
gland
Re trope
r i toneum
Je ju hum
[teum
D
if:
2
Other
distant
DIST&N_T,
Lymph
tissues"
Nodes
Direct
D[STANT,
as
involvement
Nodes
-
93
-
( subpytorlc
)
BODY
AND
YAIL
OF PANCREAS
57 t , 572
Apr[t,
1977
LOCALIZEO
Confined
Read
of
to
body
pancreas
Locatized,
and/or
invotved
tait
of
pancreas
NOS
R_EE.GIONAL,
Direct
Extension
R
lf:
1
Left
Left
kidney
ureter
Le_t
sdrenat
grand
Retroperitoneat
soft
R
tissues
(retroperltoneat
space
)
if:
2
Spteen
St omac
Liver_
Gatthtsdder
Smart
h
ports
hepat
is
intestine
Sptenic
Pert
ton
ftexure
eum
Mesentery,
Major
blood
REGIONA_L,
mesocoton,
vesset(s
Lymph
Sptenic:
Superior
Laterat
D_[STA_NI,
):
mesenteric
aorta,
artery
vein,
fat
cetiac
artery,
or
vein,
superior
portat
vein
Nodes
suprapancreattc,
mesenteric
aortic
(retroperitoneat)
Direct
Extension
D
or
extension
if
sptenlc
httum,
Metastasis
to:
I
Right
Right
Right
Diaphragm
Large
kidney
ureter
adrenat
gland
Intestine
(other
than
sptenic
ftexure)
if:
D
2
Other
DISTANT
distant
,
Lymph
hepstic
srtery,
mesenteric
invotvement
Nodes
-
94
-
pancreat
icotlenst
sptvntc
artery
or
LYMPHNODESOF THE PELVIS ANDABDOMEN
Cehac Axis Nodes
Celiac Axis
£uper_r Me,enteric Nodes
Renal Artery
Renal Nodes
_
Spermabc Nodes
_.
Inferio¢Me,enteric Nodes
Source:
Taylor,
SupermrMesentedcAdery
Spermalic/lurlery
InferioqMesentericklery
G.
W.,
Lymph
-95-
Node
Metastases,
p.
44
DEFINITION
TO
T_E
OF ANATOMICAL
AMERICAN
JOINT
Anterior
Limit
is
constituted
by
suprmhyoid
epigtottts,
thyrohyoid
the
_nterior
w_tt
of
the
subgtottic
roid
cartilage,
the
cricothyroid
crico
Id cart i rage.
Posterior
Lateral
Limits
gions
the
|nterarytenoid
space
represented
by
the
_pertor
_atera_
the
epiglottis.
Inferior
of
the
The
LL_t_s
cricoid
Larynx
Is
Limits
inctude
space
s
mucous
are
Into
the
anterior
membrane,
region,
membrane
s
constituted
by
the
THE
LARYNX
ON
CANCER
by
a
plane
the
tip
St
SupragLottic
VentricuLar
bands
(fatse
Arytenoids,
right
and
s
the
of
the
srtd
thythe
the
Lateral
through
the
regions
border
of
inferior
and
edge
sites:
te
True
voca[
Anterior
Right
sive
cords,
and
and
of
96
-
right
and
tett
teft
and
right
and
posterior
Left
watts
undersurface
the
-
cords),
(both
tinguat
epigtottis
id
epiglottis
folds
Eplgtottis
Suprahyold
I nfrahyo
Aryepigtottic
Subgtottlc
and
anatomica[
Regio_
Gtottic
of
fords,
the
arytenold
resurface
of
the
sub==t_ttlc
the
cricold
cartilage.
passing
fottowing
A_C_)RDING
STAGING
or
tinguaI
surface
the
_nterior
commissure
which
is
composed
of
and
the
anterlor
arch
the
aryepigtottic
and
the
posterior
membrane
covering
are
constituted
cartitage.
divided
LIMITS
OF
COMMITTEE
[sryngeat
aspects)
Left
comm|ssures
of
the
of
subglottls,
the
cords
excLu-
LARYNX
&prlt.
1977
( Exc tuding
cartilage
610o612.
618j
619
IN
SITU;
)
nonlnvasive
LOCAL!_Z__D
L
if:
1
Tumor
_imited
to
SuDr
agtot
Laryngeal
t ic
one
a
region
surface
of
epiglottis
fold
Ventricutar
Ventric_tar
(false
band
cavity
region
Vocal
Comml
within
region
(posterior)
&rytenold
Aryepiglottlc
Gtottic
area
( normal
cord,
ssure
Subgtottlc
one
vestibular
fold)
mobility)
_lde
region
L
cord.
on
side
one
If:
2
T_mor
extends
to
ic
adjacent
Su_ragtott
More
than
Gtottic
Cord
Both
region
(normal
and
commissure
voca_
cords
Subgtottic
region
one
of
region
L
area(s)
the
on
within
above
a
region
areas
mobility)
both
sides
if:
3
Gtottic
region:
L
of
Fixation
cord(s)
if:
4
Tumor
Involves
Supragtott
Gtottic
Sub,tort
Involves
adjacent
lc
region
region
(with
ic region
Intrinsic
reglon(s)
or
muscle(s):
without
fixation)
aryepigtottic,
cricothyro|d,
vocatis
L
if:
X
Loca
tized,
NOS
-
97
-
arytenold,
thyroeplgtottic,
cricoarytenoid.
thyroarytea_i:
LARYNX
( Exctuding
610-612,
REGIONAL,
Direct
Aprit,
1977
cartilage)
618,
619
Extension
if:
R
1
Pyriform
Postcrico
Hypopha
Vattecuta,
Base
of
sinus
td
area
rynx
NOS
Intruding
tongue
from
R
pharyngoep|gtottic
_aryn_eat
surface
and
g_ossoepigtottic
epigtottis
of
fords
if:
2
Extends
into
crlcoid
_RE_G[_O_N_A_L, Lymph
andor
D_STAN_T,
t,
cartitage
Nodes
Internat
Jugutar
:
subdi
Anterior
deep
cervical:
( recurrent
)
Cervlca
thyroid
gast
tic
p.retaryngeat,
pretrachea[,
taterotracheat
NOS
Direct
Extension
D
extension
if
or
Metastasis
to:
1
Extrinsic
( strap
Soft
tissues
muscte(
musctes)
of
s):
omohyoid,
sternohyoid,
neck
Thyroid
Skln
Tr ac hea
Upper
esophagus
D
If:
2
Other
distant
DIST_AI__,
Lymph
lnvotvement
Nodes
Supract
av tcutar
Su bm an dl but
ar
Other
distant
nodes
-
98
-
sternothyroid,
thyrohFoid
BRONCO/US
(Exctudlng
622-625j
[_
S__IT UU;
non
i nvets
AND
LUNG
car|na)
628-629
Aprlt,
ire
LOCAL [ ZED
Singte
and/or
tumor
main
_> 2 era.
from
stem
bronchus
L
carlna
and
confined
to
from
carina
and
one
tung
if:
1
Tumor
size
3.0
is
L
cm.
or
tess
i f:
2
Tumor
size
L
•
3.0
cm.
if:
3
Tumor
size
is
L
unknown
if:
4
Single
tung
tumor
and/or
of
any
main
L
size
stem
< 2 cm.
bronchus
confined
to
if:
5
guttipte
masses
confined
L
to
one
tung
and/or
if:
x
Locat
i zed,
NOS
-
99
-
main
stem
bronchus
one
1977
REGIO_N_A_L,
Direct
BRONCHUS
(Exctudlng
AND LUNG
carlna
)
522-625,
628-629
Aprit,
Extension
R
if
extension
to:
I
Pt eura
s
Pericardium,
Pu tmona
visce
ry
ra_/NOS
p_rietat/NOS
t lgament
P
if
tumor
tnvotves:
2
Carina
Tr ac he a
Esophagus
Nerve(
s ):
Recurrent
Vagus
Phrenlc
ta
Cervical
Major
ryngea
l
sympathetic
brood
Putmonary
Azygos
Superior
(Horner°s
vesset(_
)."
artery
or
vein
vena
cava
R
syndrome)
vein
if:
x
Extrapulmonary
R EGION_A_L,
Lymph
medtastinal
extension,
NOS
Nodes
I n tra put mona ry
H|]LaLr
(bronchiaL;
Subca
ri nat ; carina_
parabronchia[;
putntonary
Mediastlna[
(paratracheobronchia[_
para-esophageat;
para-aortlc-above
root)
paratrachea[;
diaphragm)
-
100
-
perlcard[at
;
1977
DISTANTj
Direct
Extension
D
if
or
Metastasis
extension
to:
BRONCHUS
(Exctudlng
AND
LUNG
carina)
622-6259
628-629
1
Brachia[
plexus
Lung
and/or
Pericardium,
He art
Pteura,
from
superior
main
stem
visceral
sutcus
bronchus,
or
Oancoast
tumor
contrataterat
parietal
O
if
extension
to."
2
l_[b,
sternum,
vertebra
Chest
( thoracic
) watt
Sketetat
muscte
Skin
of
chest
D[ ap hr agm
Kbdom[
nat
organs
D
If:
3
Other
DI_?*NT,
tnvotvement
distant
Lymph
Nodes
Contratatera[
Suprac[awlcu[ar
Scatene
Cervl
Other
cat
, NOS
distant
hitar
or
medtastina[
(Intruding
( transverse
cervical.
)
nodes
-
101
-
bItatera[)
Aprit,
1977
BONE
Aprtt,
700 -709
.[_..OC_A
L [ ZED
Confined
Tumor
has
Abnormat
Locat
ized,
through
9
peeiosteum
o_
but
tissues,
intruding
skeletat
muscte(s)
hone
Lymph
chain
Skin
Other
D!_!AN__,
beyond
Extension
Nodes
o¢
nodes
lnvotved
in
the
area
102
-
tumor
DIST&NT,
not
bone
NOS
Direct
Surrounding
Adjacent
First
broken
configuration
REGIONALj
REGIONAL
bone
to
Direct
dtstent
Lymph
Extension
or
Metastasis
lnvotvement
Nodes
-
of
the
1977
LYMPHATICSOF THE SKIN
Fig. qO0Lymphalics of the skin of the face and upper and lower ext_mili¢_
Reproduced
with
permission
SpJut,
llarlan
J.:
AcRorman
St,
Lou[8,
1977,
The
C. V.
from
del
Regato,
and
deL ke_.,.atoSs
_4osby Co,
- lOq -
Juun
&..
Cancerm
_nd
@do
5I
MALIGN._NT
730-737j
HISTOLOGY:
IN
SITU;
LOCAL
intraepidermaI
(Clark's
Level
MELANOMA
OF
SKIN
8tt- I --8/-_ 4 _ 871-872,
872
thru
879
April,
874
I)
I ZE_
L
if
¢umor
Invades:
1
Papil.
lary
dermis
(Clark's
L
if
tumor
Level
2)
invades'.
2
Papillary-reticular
dermal
L
i f
tumor
Interface
(Clark's
Level
3)
invades:
3
.qetlcular
dermis
(Clark's
L
Level
4)
If:
4
Skin
utceration
Satellite
pr Iinary
nodule(s)
within
2
cm.
of
outer
border
of
lesion
L
if:
x
Localized,
NOS;
confined
to
skin/dermis,
if
invades-.
NOS
_F,G IOWA L
R
tumor
1
Subcutoneou._
tissue
P
(through
entire
dermis)
(Clark's
if:
P
Satellite
nodule(s)
of
nrimary
lesion
more
than
2
cm,
-
105
trom
-
outer
border
Level
5)
1977
MALIGNANT
730-737,
HISTOLOGY:
PEGIONAL,
Lymph
Parotid:
Nodes
(b.v
primary
preaurlcular,
Infra-auri
culav
Arm
_,and
Shoutder
Chest
wall
Sul_nandlbular
Midllne
Media[
Inner
eyelids
of
Epltrochlear
forehead
of
Hand
eyelids
Forearm
Nose
L [ps
Superf
Cheeks
Cervical
Lower
heel
neck
above
Suprac|avlcu[ar
Che_t
tumors,
any
transverse
( transverse
location
llne
cervical
Perlneum
Perianal
)
wall
Extension
D
if
or
Metastasis
extension
to:
bone,
muscle
I
Undertyln_
cartilage,
D
if:
2
Metastatic
(generalized)
D
Other
distant
Lymph
region
(lower
back)
abdominal
wail
extremities
)
region
Pop[iteal
Posterior
Direct
inguinal
Wee[
Neck
DISTANT.,
ic |a [
Lumbar
Anterior
Head
and
Scapula,
(upper
hack),
transverse
llne
Scapula
below
ear
(gubmaxiltary)
half
canthus
1977
Axl llary
Temporal
region
.'I
at a r r ef_,ion
Lateral
half
of
of
Aprl[=
_74
site)
F o re head
Outer
canthus
Anterior
half
DISTANT,
MELANOMA
OF
SKIN
841-844,
871 -872,
872
thru
879
skin
lesions
if:
3
involvement
Nodes
-
106
-
leg
( excluding
SKIN
730-737
NOTF:
Skin
IN
SI TU;
LOCAL
of
vutva
use
8a1-844
schemes;
OTHER
nenis
THAN
MELANOMA
u_e
871=
AprJ
872,
874
[,
! 977
schemes
i ntraepJdermal
I ZED
Single
lesion
confined
RF_IONAL,
Direct
_kin
to
dermis
NOS
Locatized,
Rxtenslon
ulceration
Subcutaneous
DISTANT,
Direct
ti.._sues
( through
Extension
or
Meta.q_tasis
extension
to:
D
If
entire
dermis
)
I
Underlying
cartilage,
bone,
D
muscte
if-.
2
__etastatic
(generalized)
_F.GIO_NA_L,
Lymph
Parot
id:
skin
Nodes
(by
primary
preauric_itar,
lesions
site)
i n¢ ra-auri
c,ttar
Axittacy
Forehead
Arm
TempoPa
I
Mater
Shoutde
region
Latera_
half
Outer
Anterior
of
canthus
half
Submandibu[ar
qi
.Wand
region
eyetids
of
Scaputa
below
ear
(submaxittary)
of
dl Ine
Mediat
[nneP
Epl
forehead
half
canthus
of
r
watt
Chest
(u_per
transverse
back),
tlne
trochtear
Hand
Forearm
eyetids
Nose
Superfic
Jar
InAgulnat
Lips
Cheeks
Lumbar
region
Anterior
CervIcat
Lower
beet
Head
and
Scaputa,
above
Supraclavicu[ar
Chest
neck
tumors,
transverse
( transverse
any
tocatlon
Perlneum
line
PerIanat
cervical
)
watt
extremities
)
region
Popttteal
,_eet
Neck
Poster|or
-
I07
-
(tower
abdominal
te_.
back)
wait
( exctudIng
SKIN
OTHFR
730-737
DISTANT,
Direct
Extension
D
if
or
Metastasis
extension
to:
1
Undertying
c_rtil_ge_
D
bone
s
and
muscle
i_:
2
Metastatic
(_ene_a_ized)
D
r_fher
D_I_AN_T,
distant
Lymph
._ki_
_e-_ion._
if:
3
involvement
Nodes
-
108
-
THAN
MELANOMA
Aprit,
1977
LYMPHATICS OF THE BREAST
Fig. 669. ],ym|ihaiics of the breast leading 1o, 1, axiilary liO(]C_ which are distributed over a
largo area from tile laleral aspecls of the breast pro|)<'r to the axiJlary vessels; 2. interl>ccloral
chain leadiug to iilwrl_-'ci.ral node (circle dclail) end to high nodes in the axilia; 3, chain of
the Interim[ mammary leading frequenLlv to node in second i,ltcrspace and to snpraclavicnlar
and cervical nodes. The lymphal/c= of the breast may empty, into the opposite axillary nodc_.
Reproduced
SpJuts
Hat,
St.
Louiss
with
pepmissLon
an J.:
Ackerman
1977.
The
C.
V.
.from
and
_osby
- 1.10-
(tel
det
Co.
Regato,
Regato's
Ju&n
A.,
Cancerj
and
ed.
5_
BREAST
740-749
759
Male
IN
SITU
(inctudlng
noninfiltrating
intraductal
or
April,
Female
tobutar)
LO_CALI_Z_E_D
Primary
tumor
Breast
involving:
tissue
(may
be
breast,
retraction
only
described
but
not
)
to
ctinlcalty
skin,
skin
as
fixation
dimpling,
Nipple
and/or
areola
(may
be described
clinically
as
attachment,
thicRening,
Induration,
involvement,
Paget's
disease
of
ulceration
of
nlppte
))
L
nlppte
of
tumor
tethering,
and/or
retraction,
nipple
(Including
If
tumor
size
Is
<2
if
tumor
size
Is
2-4.9
if
tumor
size
its >
If
tumor
size
is
within
or
areolar
or
cm.
1
L
cmo
2
L
5
cm,
3
L
unknown
4
L
Localized,
NOS
x
RE_IOHA_L
,
Direct
Primary
tumor
Extension
Invading:
Subcutaneous
tissue
Skin
of
primary
breast
(may
be
described
clinically
as:
fixation,
induration,
thickening
R
adherence,
of
skin)
if
tumor
size
is
<2
cm.
if
%umor
size
is
2-4.9
t¢
tumor
size
is
>
if
tumor
slze
is
unknown
1
R
cm.
2
R
5
cmo
3
1_
4
-
111
-
attachment,
1977
BREAST
740-740
759
Mat
Primary
tumor
of
Skin
edema,
En
curraise,
Inftammation
Utceratlon
any
size
Aprit,
Fema_
e
with:
peau
d°orange,
"pigskin"
tenticu%ar
nodtltes
of
skin,
erythema
of
skin
of
breast
Satettite
Pectorat
ct|nlcatty
nodutes
fascia
as
In
skin
or
pectovat
undertying
R
of
primary
muscte
tissue
breast
invotvement
fixation
or
(may
be
attachment)
described
If:
5
Tumor
of
any
size
R
wlth
above
description
to)
musctes
chest
if:
5
Invasion
of
or
serratus
RgG!__NAL,
(or
Lymph
fixation
anterior
watt,
In
DISTANT,
tnte_ostat
Nodes
Low
axittary
(adJacent
to
tait
of
breast)
Mid
axit[ary:
centraL,
Interpectorat,
High
axtttary:
subctavicutar,
axiltary
Axlt
tary,
NOS
Internat
mammary
(parasternat)
Nodutes
ribs,
axlttary
Direct
iotter's
vein
node
nodes,
aplcat
fat
Extension
D
or
Metastasis
If
!
Skin
over
Satetttte
sternum,
nodute(s)
if
D
upper
in
abdomen,
adjacent
tumor
Invotves:
axitta
skin
or
2
Breast,
Adrenat
Ovary
cont
grand
rataterat
D
If:
3
Other
p__ST_ANT_,
I n frac
distant
invotvement
Lymph
Nodes
tar
tar
lcu
Supractavicu[ar
Cervical,
NOS
Axittary
and/or
Other
distant
( transverse
lnternalL
nodes
cervlca[)
mammary,
contratatera[
-
112
-
opposi
te
breast
1977
e
LYMPHATICSOF THE UTERUS
Fig. 619. ,_;chcm:ttic rcprcscntation of the ]ymt_hatics of Ihc ,teals qlowing, 1, the nitroovarian ['_dic'le; 2, [ho external i]iac Dcdic|c; al_d,3, Ihc round ligament pcdic|o ]cading to IlK
inguinal l)"mDh ncx]cs.
I?oproduced
with
permi._sion
Sp.Jut,
llaPlan
Jo:
Ackevm_n
Ste
Loulsp
1977,
The
Co Vo
from
and
_osby
- -11q -
dot
det
Co,
Regato,
l_egsto's
Juan
Ao,
C_ncer,
and
ed.
5,
CERVIX
800-801,
UTER[
&pz'[ L,
808-609
XN S_T_U
Non-invasive,
League
pre-lnv_sive,
Nations
Stage
of
intraeplthetlat
0
LO__A_L!_Z_E_.
L
if:
1
Minimal
stroml
invasion;
L
"microlnvasion"
If:
2
lnvaslve
cancer
confined
L
to
cervix
if.*
x
League
of
REGIONAL.
Nations
Direct
[
Stage
Extension
R
if
extension
to:
1
Corpus
uteri
(body
R
If
uterus)
of
extension
to:
2
Upper
Paramet
2/3
of
r lure
Ligaments=
League
rag|hal
broad,
Nations
of
R
If
wa]t
(IncLuding
uterosacrat,
Stage
fornices
cardinal
[I
extension
to:
3
Lower
PeLvic
1/3
of
watt(s)
League
vaglnat
of
R
Nations
if
watt
Ill
Stage
extension
to:
4
Rectal
Buttous
and/or
edema
Cut
sac
de
bladder
of
bladder
( rectouterlne
walt
(excluding
mucosa
mucosa)
pouch)
-
115
-
and
vagina,
NOS)
19:
CERVIX
800-801,
RE_GIONA_L,
Lymph
Nodes
Hypogast
ric
Itiac
(common,
Obtura
tot
Parac
er v l cat
Parametria
Sacral
DISTANT,
internaL,
t/pe
tvlc,
( taterosacvat,
Direct
externaL)
NOS
presacrat,
Extension
D
or
If
sacral
Metastasis
extension
to:
1
BLadder
Rectal
Ureter
Ure
_m_c osa
_m__co_s a
th ra
Si gmoid
colon
Smatt
Lntest
Vu tva
Ovary
Ine
and/or
fa_l.oplan
D
tube
If:
2
WFrozen
pelvis
N
D
if:
3
Other
distant
involvement
D
If:
X
League
DISTANT,
Aortic
InguI
Other
of
Lymph
UTERI
808-
Nations
Stage
IV
Nodes
(para-aortic,
nat
distant
periaortlcj
Lumbar)
nodes
-
116
--
promontory,
uterosacrat)
Aprils
809
1977
CORPUS
820-82|•
IN
SITU,
pre-lnvaslve,
UTERI
828
non-lnva.,_Ive
L
if:
1
Invaslve
cancer
confined
to
endometrlum
if:
L
2
Myometrlum/seroga
Invastve
( Depth
(perimetrlum)
cancer
confined
of
Invasion
L
invaded
to
unknown
corpus,
)
cttntcatty:
if:
3
Sounding
of
uterine
L
cavity
Is
<
8
cm.
from
cervlcat
os
cavity
Is
•
8
cm,
from
cervIcat
os
if:
4
Sounding
of
uterine
L
if'.
x
Locattzed,
REGION&_L_
NOS
Extension
Direct
R
if
extension
to:
1
Cervix
inc'Luding
uteri,
R
if
endocervlx
extension
to
_.
2
Pa ramet
rium
broad,
Ligaments:
R
uterosacra]L
round,
if
extension
to:
3
Petvlc
Ovary
watt(s)
and/or
fattoplan
R
tube(_)
if
extension
to:
4
Rectat
and/or
bradder
watt
(exctudlng
-
mucosa)
117
-
Aprt
ts
1977
CORPUS
820-821
RE GI_O_NA_L,
Lymph
internal,
Direct
Extension
D
If
or
extension
promontory,
Metastasis
to:
I
Va gi na
Vutva
Slgmold
Small
Serosa
sac.
(rectouterine
or bladder
mucosa
pouch)
coton
intestine
of
abdominat
D
organs
If:
2
"Frozen
petv|s"
D
if:
3
r_ther
distant
DI_S__ANI,
Lymph
I,
externalL)
Parame
t rialL/pe [vlc,
NOS
Sacra[
( lLaterosacra[,
sacralL
Super
f Ic is lL i ngui nat
Latera[
aort ic,
preaortlc
CulL de
Rectum
Ureter
&prt
Nodes
Hypo_ast
r ic
lilac
( common_
Obtura
tot
Paracervtca[
D[[S!_A.NI,
UTEPI
j 828
invotvement
Nodes
-
I18
-
presacra]L,
_terosRcrat
)
1977
OVARY
830
April,
1977
LOCAL I ZED
Confined
metastatic,
Local
to
ized,
REGIONAL,
ovarian
both
Lymph
lc
gas
Ret
immediately
tpsitaterat
Lateral
lpsltaterat
and
(common,
roper[
If
not
specified
to
be
adjacent,
not
implants)
sac
(rectouterine
Nodes
( lateral
tr tc
Itiac
Ohturator
or,
Extension
Peritoneum
(pelvic;
Broad
t[gament,
Mesovarlum,
|psi
Fallopian
tube,
AcEnexa,
ipsitater_l
Aort
Hypo
ovary
NOS
Direct
RE_O_IONAL,
tissue--one
ovaries
preaorttc
internal,
tonea
D[SIPA_I_NT, Direct
t/pe
D
if
external)
trio,
Extension
)
NOS
or
extension
Metastasis
to:
I
SI gmo id
O_ en tum
Cut
de
Uterus
sac
(rectouterine
Rectosigmoidj
Smart
intestine
Bt adder,
pouch)
rectum
ureter
D
if:
2
Implants
on ovary,
fallopian
peritoneum,
omentum
Metastatic
to contratateral
D
tube,
ovary
cub
de
and/or
if:
3
Other
DIS TA_N!P,
[nguAnat
Other
distant
Lymph
distant
involvement
Nodes
nodes
-
119
-
fallopian
tube
potuch),
FALLOP
832
[A_
TUBE
Aprl[,
LOCALIZED
Confined
to
Locat
REGIONA.
Peri
ized,
L,
fattopian
tube(s)
(specify
bitaterat
NOS
Direct
Extension
toneum
Broad
tigament,
tpsitaterat
Mesosalpinx,
ipsitaterat
Ovary,
ipsi
Late
r_t
Uterus
(endometrium),
£EQI_O__AL,
Lymph
Nodes
Aort
tc
( tater_t
ffypo g_str
tc
Itiac
(common,
Obturat
or
Re t rope
D[S_A_N_T.
ri
lpsitaterat
_nd
pre_ortic
[nternat,
toneat/pe
Direct
D
externat)
1vie,
Extension
if
extension
)
NOS
or
MetastaSis
to:
I
Omentum
Cut
de
sac
( rectoutevine
Stgmoid
Rectoslgmo
id
Ovary,
cont_taterat
Smart
intestine
D
pouch)
if:
2
Other
distant
D__I_S_T_A_r_,
Lymph
I ngu
Other
tna
t
distant
Invotvement
Nodes
nodes
-
120
-
invotvement
)
1977
VAGINA
540
IN
SITU;
noninvaslve
LOCALIZED
L
if:
I
Inv_slve
c_ncer
L
confined
to
submucosa
(stroma)
If-"
2
Musculature
Invaded
L
IF:
x
Localized,
REGIONAL,
NOS
Direct
Extension
Cervix
VUlv
Cut
de
s_c
Veslcovagina[
Rectovaginst
REGIONAL,
Lymph
External
Internat
Common
DISTA_N_T,
( rectouterlne
septum
septum
pouch)
(paracystium)
Nodes
illac
|liac
(hypogastrlc)
lilac
(sacrst
promontory)
Direct
Extension
D
if
or
extension
Metastas,is
to:
1
Ur et hra
Bt adder
Rectum
D
if:
2
"Frozen
D!ST_NT,
Inguina
Periaortic
Other
pelvis"
Lymph
Nodes
t
distant
tymph
nodes
-
121
-
April,
1977
LYMPHATICSOF THE VULVA
Reproduced
with
permission
SpJuts
Harlan
J,:
._ckerman
St.
Loulsm
1977
s The
C.
Vo
from
deL
Regato,
and
det
Regato_8
Mo.q. by
CO°
- 122 -
Juan
Ao s
Cancerj
and
edo
5s
VULVA
(including
84 I -844
IN
SITU;
noninvaslve;
BowenPs
skin
disease
LOC&L [ZED
Invasive
Confined
_[uscuta
cancer
confined
to
skin
of
vulv_
tuee
Invaded
Localized,
to
submucosa
NOS
__EE__!_O_NAL,
Direct
Extension
Vaginal
watt
or
Uret hrat
orifice
Pevi
neum
Pertanat
skin
orifice
Anus
REGIONAL,
Supeefic
Deep
External
DISTA_N_,
Lymph
Nodes
ial
Inguinal
inguinal:
Rosenmulter'9
lliac
Direct
or
Extension
D
if
or
node
Metastasis
on
extensl
Cloquet's
to:
1
Perinea
Rectal
_ body
mucos
a
D
I_:
2
Other
DISTANTp
_Except
staging
distant
Lymph
involvement
Nodes
melanomas
scheme
which
for
are
classified
accoeding
melanoma.
-
123
-
to
the
April,
of
1977
v,_lva_)
LYMPHATICSOF THE PROSTATE
l;'il_. 542. _cl,..mntie rel)resentati(m
of ],,'nJpllatics (_" tile prostate .showing,, 1, extenm] Ili:ze
]'a'dic.14..;9,-hvpc)_;z,.tric |_('(]icle; nncl 3, i)o_,tc.ri(_r l)L.dic.]c. The infc.rior l_--dicle whic'h I'_lhnvs
a duwm_'ard (lir_:c.tio_ a,_(l e,_ds in hypo_astric _()d_:_ is n()t illustrate:el hen:.
Peproduced
SpOut•
St°
Louis•
wLfh
Ha_an
Jo:
1977_
pe_missLon
Acke_man
The
Ce
t'rom
_nd
Vo
_dosby
det
deL
Co.
-- 12q -
Regato_
l_eg_to'_
Juan
Ao •
Cancer•
and
edo
_•
PROSTATE
85q
]IN
SI_TU;
noninvaslve
L_OC__Ak!_Z_E
D
L
If=
!
Invaslve
cancer
confined
to
prostatic
capsule
(intra-capsutar)
L
if:
2
Invasion
of
prostatic
L
capsute
If:
3
Prostatic
urethra
L
lnvotved
if:
x
Local
Ized,
REGIONAL,
NOS
Direct
F, xtension
R
If
extension:
1
Periprostatlc
Seminar
tisgues
veslcte(s)
R
if:
2
Through
prostatic
R
capsute,
if
extension
including
"fixation"
to:
3
(Denonviltler's)
Rectove_ica[
Bradder
Rectum
Extraprosta
tic
urethra
fascia
(membranous
-
urethra
125
-
)
Aprlt,
1 977
PROSTATE
859
REGION&_,
Lymph
Nodes
Hypogast
ric
Itlac
( common,
Ob turator
Internat,
Periprostatlc/petvlc,
NOS
([aterat
Sacra[
DISTANT,
Direct
sacra[,
Extension
D
Sketeta[
Petvl
c
Pe Lvlc
Ureter
if
1
musctes:
bone
watt
Sl gmoid
Penis
externat)
sacral
or
presacra[)
Metastasis
extension
I-eva,
promontory,
to:
tot
anl
colon
if:
D
2
"Frozen
pe]Lvls"
i_-
D
3
Other
DISTANT,
distant
Lymph
Invotvement
Nodes
Aortic
( para-aortLc,
Ing_Ina[
Other
distant
nodes
perlaortic,
[ttmbar
-
126
-
)
_kprl L,
1977
LYMPHATICSOF THE TESTIS
Fig. 562. St'ht.tl_tiit.
r,.prc,,t..tafi.n
(,f th(: hml_h.tit-,
of tile te_,tis showing
main drainage
in
Ill,. ]'s.zra-aoutic' l',lZtl_b:itic_ aizd fiirlhi'r ]'_.qihatJ(. t.xi,.'n.,ion |)y way of the thorat.ic (|loct. "[lie i
1[('11[
illto
sltpr:'lul.lvital{ar hi.l(, i,; [airh' Ire.ll..i.fly
the cxlL'r,al iliac i'_mph 1,_l,.,.,i.
i_eprocluced
Sp.Jut,
St.
w|th
ll_rian
Louis.
Ackorm-_n
The
The
from
permission
J.:
1977.
itiv.ivcd.
C.
_nd
Y.
._osby
- 128 -
I)'ml_lla'[ics of tllc ep didymis
del
Retz=too
deL
Re_to's
Co.
drain
Ju-n
Cancer,
A.
,,
nnd
ed,
5,
TESTIS
860,
LOCAL_!_ZE_
Confined
to
Tun[ca
tun[ca
Local[zeal,
REGIONAL,
Ep
albuginea
va_Ina|.Is
(enceLpsu[ated
Involved
NOS
Direct
Extension
[Ld _Ldy ml s
Scrotum,
[ps
Spermatic
Vas
deferens
R__E_ [QNAL,
i[ateral
cord,
Lymph
Aortic
External
s
Re t rope
DISTANT,
Ipsi
lateral
Nodes
below
iliac
lewe[
rl tone_
of
[/pe
Direct
[vic
renal
s
Extension
D
if
extension
arteries
NOS
or
Metastasis
to:
l
Scrotum,
con
Testis,
Penis
scrotum
of
UILceration
t ra[t
eraIL
bilateral
Kidney
&drena
]L
We t rope
gland
rl toneum
D
If:
2
Other
D__[SI['&.I!__,
Ingu
Other
distant
Lymph
inat
distant
involvement
Node
s
nodes
-
129
-
tumor)
April,
869
1977
SKIN
87 I.
IN_SIT_U;
nonlnvasive
(Bowen's
OF PENIS
872,874
Disease)
LOCALIZED
Invasive
cancer
confined
to
skin
of
penis,
pt'epace
and/or
NOS
Lo catized,
REGIONAL,
Direct
Extension
R
if:
1
Corpus
cavernosum
R
if:
2
Ur et hra
Sateltite
Skln:
nodute(s)
pubic,
RE_G!_O_NA_L,
Lymph
F_xternat
on
scrotat,
prepuce
abdominal,
Test
Other
gtans
perlneum
Nodes
itiac
Interna[
itlac(hypogastrlc)
Superfic
ia t
I ngui
nat
Deep
inguinat:
Rosenmutter's
DIS_T_ANT,
or
Direct
Extension
or
oP
Cloquet's
node
Metastasis
is
distant
DISTANT
LYMPH
_Rxcept
staging
melanomas
scheme
invo]Lvement
NODE
which
are
for
metanoma.
ctaRslfied
according
-
130
-
to
the
gtans
April,
1977
LYMPHATICS
OF THEBLADDER
Fig. 534'. Anatomic sketch of the lymphatics of the bladdcr drained mainly by, I, the cxcenmlL
iliac nod¢_ but also by, 2, lt)'pogastric and, 3, common tliac nodes.
Reproduced
with
permissl.on
Spdut,
Hartan
J.:
Ackerman
St.
Louis,
1077p
The
C.
Y.
from
and
Mosby
--132 -
det
clct
Co.
Regatos
Rega¢o's
J_an
A..
Cancer
s
and
ed.
5j
BLADDER
880-886,
I__N _S_TU;
888-889
intraepithetiat
noninvasive;
LOCALIZED
L
Confined
If:
1
mucosa
to
L
if:
2
Submucosa
propria;
(subepithetial
lamina
L
connective
invaded
propria)
tissue;
tunica
if:
3
Superficial
the
muscte
coat)
muscle
L
(tess
than
one
hatf
mope
through
way
through
if:
4
Deep
muscle
(half-way
L
or
the
muscle
coat
)
if:
x
[_catized,
NOS_
REGIOh_L,
Direct
detaited
no
information
of
above
Extension
R
if:
1
Invasion
Invasion
Surrounding
adjacent
of
of
periveDicat
(through)
connective
tissue,
R
if
fat
serosa_
tissue
peritoneum
(including
periprostatic
NOS
extension
to:
2
Prostate,
including
Ureter
Vas
deferens
Seminal
veslc
te
Rectovesica[
prostatic
urethra
(Denonvlllier's)
R
if
extension
fascia
to:
3
Rectum,
Parametrlum
Bladder
Vagina
Pubic
UrethPa•
m_te
is
and
nfixed"
uterus,
female
Bone
female
-
133
-
tissue);
BLADDER
880-886,
REGIONA_L,
Perives
Lymph
Nodes
icat
F[ypo gas tr l c
Itiac
(common,
Obturator
Sacrat
Pe[vtc,
I)!STA_NT ,
lnternat,
(taterosacrat,
NOS;
regionat,
Direct
presacrat,
NOS
Extension
D
externat)
or
promontory)
Metastasis
extension
if
sacrat
to:
1
Tumor
Abdomln
fixed
at
to
watt
( invading
Rectum,
fere_te
Bones,
extruding
S i gmo ld
pubic
D
)
petvic
watt
bone
If:
2
Other
D IST_&NT,
&ortic
Inguinat
Other
distant
Lymph
tnvotvement
Nodes
(pava-aortic,
distant
pertaorttc,
tumbar)
node(s)
-
134
-
AprllL,
888-889
1977
KIDNEY
(RENAL)
PARE._/CF[YMA
89O
LOC_A__!_ZE_D
L
if
tumor
confined
to:
l
Kidney
Kidney
cortex
medut
t a
L
if:
2
Renal
pelvis
or
L
calyces
involved
if:
X
Local
ized,
REGIO_NAL,
NOS
Direct
Extension
R
if:
l
Perirenal
tissue
Reno. l. (Oerota's)
(fat)
fascia
Retroperitoneat
Blood
vein,
Adrenal
Ureter,
soft
vessels:
aorta,
gland,
including
tissues
perirenat
renal
artery,
ipsitaterat
implant{
R
(retroperitoneat
veins,
hilar
s),
space
extrarenat
blood
ipsitateral
if:
2
Peri
ton
eum
O iap
Tail
hra
of
gm
pancreas
Ascending
Descending
Duodenum
REGIONA_L,
Hi tar
Lateral
colon
colon
from
Lymph
( small
aortic
from
from
right
right
teCt
kidney
kidney
kidney
Nodes
nodes
at
renat
(retroperttoneat)
pelvis
)
-
135
-
portion
vessels,
)
of
vena
renal
vav_
&pr[
[,
1977
KIDNEY
(RENAL)
PARENCRYMA
890
DISTANTj
Direct
Extension
if
D
extension
or
Metastasis
to:
1
Kidney,
Ureter,
Adrenat
Rib_
S t omsc
_it_
ter_t
cont
ratat
erat
_t_nd,
contrataterat
h
Spteen
Liver
D
If:
2
Other
DISTANT,
distant
Lymph
lnvotvement
Nodes
-
1 36
-
&prl_,
1977
RENAL
PELVIS
891
I_____S][TU;
nontnvastve;
{ KIDNEY)
April,
lntraeptthettat
LOCAL!_Z_E__
Invasive
cancer
Submucosa
Muscuta
lure
Localized,
confined
to:
NOS
__IONAL,
Direct
Extension
Peripetvic
tissue
Retroperitonea[
soft
tissue
(retroperitoneat
Major
blood
vessel(s):
aorta,
renal
artery
Ureter,
including
implants
Kidney
pare
nchyma
Adrenal
gland
Duodenum
from
right
renal
pelvis
REG_][ON/L.L,
Httar
Lymph
(renal
hitus)
aortic
Lateral
D][S1"_NT,
Nodes
(retroperitoneat)
Direct
Extension
D
if
extension
or
Metastasis
to:
1
Bladder
Sptee_
Pans teas
Live r
Descending
colon
D
if:
2
Other
D[_;T?_N_T,
distant
Lymph
involvement
Nodes
-
t37
-
space
vein,
or
)
vena
cars
1077
URETER
892
[_NN SITU;
intraepithe_iat
noninv_sive;
LOCALIZED
InvasIve
Submu
cancer
co s
confined
to'.
Muscutature
Locat
tzed,
NOS
REGIONAL_.
Direct
Periure
thera
Extension
t
Retroperltoneat
Psoas
muse
soft
in
distat
Kidney,
tissue
(retroperitonea[
space)
te
Imptant{s)
Bt adder
ureter
ipsitaterat
Duodenum
Ascending
Descending
from
right
ureter
coton
from
right
coton
from
teft
Lymph
EE_G_I_ONAL,
Periure
Hypo
tissue
Nodes
tera
t
gas tri
Itiac
Laterat
c
(common_
aortic
lnternat,
Retroperitoneat/petvic,
DISTANt.,
ureter
ureter
external}
NOS
F_xtenston
Direct
D
If
extension
or
Metastasis
to:
I
Uterus
Panc teas
Imptants
Prostate
in
bradder
D
if:
2
Other
distant
D__I_SIANI,
Lymph
tnvotvement
Nodes
-
138
-
Aprtt,
tO77
THYROID
939
IN
SITU;
GLAND
nonlnvasive
LOCALIZED
if:
L
1
Confined
to
L
Both
Lobes
Thyroid
Muttlp[e
one
robe
and/or
isthmus
if"
2
invotved
gland
loci
capsule
|nvo|ved
but
confined
to
L
Thyroid
gland
if:
3
Through
Of
capsule
L
grand,
not
but
beyond
if:
x
Loca
t ized,
NOS
R_gG_!_OHA_L,Direct
Extension
P
if'.
!
%issue
s }:
recurrent
Pe rl capsu_a
Strap
muscte(
Nerve(
s ):
r
R
s
steenothy_'otd,
%aryngeat,
omohyo|d,
vagus
sternohyoid
If:
2
Major
brood
vesset(s}:
jugut
ar vein
So ft
t Issues
of
neck
Esophagus
Larynx,
Inctudlng
St er noc]Leidomasto
Tumor
RE_G][ONAL,
is
Anterior
deep
Internat
Jugutav
Re tPopharyngea
Cervlca
thyroid
id
muse
described
Lymph
_,
carotid
as
and
artery,
thyroid
crlcoLd
artery
or
vein_
cartltages
lie
"fixed
to
adjacent
tissues"
No des
cemv|ca_:
:
subdi
pretaryngea]L,
(recurrent)
gast
pretracheaL,
tic
[
NOS
-- 139
-
1Laterotrachea]L
Apri[,
_. _977
THYROID
939
DIST&__T,
Direct
Extension
D
If
or
extension
GLAND
Metastasis
to:
1
Tr ac hea
Medtssttna[
Sketetat
Bo ne
tissues
muscte,
other
than
strap
musctes
if:
2
Other
D!_S_T_A_r_,
distant
Lymph
Subm_ndlb_tar
Su bm en t at
Other
distant
invoiwement
Nodes
(submmxi*_]Lary)
nodes
-
140
-
and
sternoctetdomastotd
Aprtl,
1977
LYMPH
NODES
AND
LY_+PI+e)
ID
Aprlt,
1977
TISSUE
q60-96q)
_7|
,
416)
49|
•
460,
640,
Histology:
I
S%ase
to
*he
960)
Q75
!ymmh_a_)_c
one
region
above
or
below
d iaDhragm
I [
( ,We_iona[
[nvo[ve_nen%
one
)
of
_ide
I[I
S%a_e
fhrtL
(Localized)
Confined
__%a_e
_92
959
of
_ore
%he
(Distant
than
one
[ymph_%tlc
region
on
only
diaphragm
)
I
of
Involvement
d| aoh
._ta_e
_ympha%ic
regions
on
both
Bides
of
%he
raqm
IV
(Distant
)
?
Bone
Po_e
marrow
L:tn_
and/or
pleura
Liver
K i dnev
Gastrointestlna[
Skin
tes[ons
SYSTEMIC
S YM"T(_M
_i_ht
tract
or
(b,lt
s_lbeutaneous
not
pPimary
nodu]es
G.
(btit
I.
not
)
primary
skin)
S
sweats
Unexp[a
ined
fever
Oruri%Is
Unexplained
NOTE:
weight
]loss
Lymphoid
tiss,*e
adenoids
( pharyngeal
includes
spleen,
tonsl
is
-
)•
[]n_ua[
thymus
I_*I
-
and
and
palatine
Wa[deyer's
ton_i[s,
ring,
NOS.