Summary Stage 2018: Oropharynx
Summary Stage 2018
Notes
**Oropharynx**
C019, C024, C051-C052, C090-C091, C098-C099, C100, C102-C104, C108-C109 (8000-8700, 9700-9701)
C111 and Schema Discriminator 1: Nasopharynx/PharyngealTonsil: 2 (8000-8700, 9700-9701)
C019, C024, C051-C052, C090-C091, C098-C099, C100, C102-C104, C108-C109, C111
C019 Base of tongue, NOS
C024 Lingual tonsil
C051 Soft palate, NOS
C052 Uvula
C090 Tonsillar fossa
C091 Tonsillar pillar
C098 Overlapping lesion of tonsil
C099 Tonsil, NOS
C100 Vallecula
C102 Lateral wall of oropharynx
C103 Posterior wall of oropharynx
C104 Branchial cleft (site of neoplasm)
C108 Overlapping lesion of oropharynx
C109 Oropharynx, NOS
C111 Pharyngeal tonsil
**Note 1:** The following sources were used in the development of this chapter
* SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998) (https://seer.cancer.gov/archive/manuals/EOD10Dig.3rd.pdf)
* SEER Summary Staging Manual-2000: Codes and Coding Instructions (https://seer.cancer.gov/tools/ssm/)
* Collaborative Stage Data Collection System, version 02.05: https://cancerstaging.org/cstage/Pages/default.aspx
* Chapter 10 *HPV-Mediated (p16+) Oropharyngeal Cancer*, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois.
* Chapter 11 *Oropharynx (p16-) and Hypopharynx*, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois.
**Note 2:** See the following chapters for the listed histologies
* C111 and Schema Discriminator 1: Nasopharynx/PharyngealTonsil:1 (8000-8700, 9700-9701): *Nasopharynx*
* 8710-8714, 8800-8934, 8940-9137, 9141-9582: *Soft Tissue*
* 8720-8790: *Melanoma Head and Neck*
* 8935-8936: *GIST*
* 9140: *Kaposi Sarcoma*
**Note 3:** The intrinsic muscles of tongue are four paired muscles within the tongue which control its shape. The extrinsic muscles originate from structures outside the tongue and control its positioning.
**Note 4:** Parapharyngeal involvement (pharyngeal space invasion) (code 7) denotes postero-lateral infiltration of tumor beyond the pharyngobasilar fascia. The pharyngobasilar fascia is the fibrous layer of the pharyngeal wall between the mucosa and the muscular layer, attached superiorly to the basilar part of the occipital bone and diminishing in thickness as it descends.
**Note 5:** The masticator space (code 7) primarily consists of the muscles of mastication, the medial and lateral pterygoid, masseter, and temporalis muscles. The space also includes the ramus of the mandible and the third division of cranial nerve V as it passes through the foramen ovale into the suprahyoid neck.
SS2018 |
Description |
0 |
In situ: noninvasive, intraepithelial |
1 |
Localized only (localized, NOS)
- All sites
+ Confined to site of origin
+ Epiglottis, lingual surface
- Oropharynx (C090-C091, C098-C099, C100, C102-C104, C108-C109)
+ Tonsil (palatine, NOS)
+ Tonsillar pillar/fossa
+ Wall (anterior [including vallecular], lateral, posterior)
- Pharyngeal Tonsil (C111)
+ Adenoid
+ Nasopharynx (inferior wall, superior surface of soft palate)
+ Pharyngeal tonsil (nasopharyngeal tonsil)
+ Posterior superior wall (vault)
- Soft Palate (C051, C052)
+ Lamina propria, submucosa, musculature
+ Tumor crosses midline
- Tongue Base (C019, C024)
+ Lamina propria, submucosa, musculature (intrinsic)
+ Tumor crosses midline |
2 |
Regional by direct extension only
- All sites
+ Epiglottis, lingual surface plus both lateral walls through soft palate or base of tongue
+ Epiglottis WITH fixation
- Oropharynx (C090-C091, C098-C099, C100, C102-C104, C108-C109)
+ Base of tongue (including lingual tonsil)
+ Buccal mucosa
+ Floor of mouth
+ Gum (gingiva)
+ Hypopharynx
+ Larynx, NOS
+ Lateral walls (both) through soft palate or base of tongue
+ Posterior surface of epiglottis
+ Prevertebral fascia/muscle
+ Pyriform sinus
+ Soft palate (inferior surface including uvula, superior [nasopharyngeal] surface, NOS)
+ Soft tissue of neck
- Pharyngeal Tonsil (C111)
+ Hard palate
+ Mandible
+ Nasal cavity
+ Oropharynx
+ Paranasal sinuses
+ Pterygopalatine fossa
+ Soft palate, inferior surface including uvula
- Soft Palate (C051, C052)
+ Buccal mucosa (inner cheek)
+ Gum (gingiva), upper
+ Hard palate
+ Lateral pharyngeal wall
+ Mandible
+ Tonsils, including tonsillar pillars and fossae
- Tongue Base (posterior 1/3 of tongue) (C019, C024)
+ Anterior two-thirds of tongue for base of tongue
+ Base of tongue tumor crosses midline
+ Floor of mouth
+ Glossoepiglottic fold
+ Glossopharyngeal sulcus
+ Lateral pharyngeal wall
+ Lingual tonsil for base of tongue
+ Lower gingiva
+ Pharyngoepiglottic fold
+ Soft palate, inferior surface or NOS including uvula
+ Sublingual gland
+ Tonsil, tonsillar pillars and fossae |
3 |
Regional lymph node(s) involved only
- Level I
+ Level IA - Submental
+ Level IB - Submandibular (submaxillary), sublingual
- Level II - Upper jugular
+ Jugulodigastric (subdigastric)
+ Upper deep cervical
+ Level IIA - Anterior
+ Level IIB - Posterior
- Level III - Middle jugular
+ Middle deep cervical
- Level IV - Lower jugular
+ Jugulo-omohyoid (supraomohyoid)
+ Lower deep cervical
+ Virchow node
- Level V - Posterior triangle group
+ Posterior cervical
+ Level VA - Spinal accessory
+ Level VB - Transverse cervical, supraclavicular
- Level VI - Anterior compartment group
+ Laterotracheal
+ Paralaryngeal
+ Paratracheal - above suprasternal notch
+ Perithyroidal
+ Precricoid (Delphian)
+ Prelaryngeal
+ Pretracheal - above suprasternal notch
+ Recurrent laryngeal
- Level VII - Superior mediastinal group (for other mediastinal node(s), see code 7)
+ Esophageal groove
+ Paratracheal - below suprasternal notch
+ Pretracheal - below suprasternal notch
- Other groups
+ Cervical, NOS
+ Deep cervical, NOS
+ Facial
* Buccinator (buccal)
* Mandibular
* Nasolabial
+ Internal jugular, NOS
+ Parapharyngeal
+ Parotid
* Infraauricular
* Intraparotid
* Periparotid
* Preauricular
+ Retroauricular (mastoid)
+ Retropharyngeal
+ Suboccipital
- Regional lymph node(s), NOS
+ Lymph node(s), NOS |
4 |
Regional by BOTH direct extension AND regional lymph node(s) involved
- Codes (2) + (3) |
7 |
Distant site(s)/lymph node(s) involved
- Distant site(s) (including further contiguous extension)
+ All sites
* Carotid artery (encasing)
* Deep/extrinsic muscles of tongue
- Genioglossus
- Hyoglossus
- Palatoglossus
- Styloglossus
* Lateral nasopharynx
* Masseter muscle
* Masticator space
- Cranial nerve V-third division
- Muscles of mastication
- Pterygoid muscle (lateral, medial)
- Ramus of mandible
- Temporalis muscles
* Parapharyngeal extension (pharyngeal space invasion)
* Pterygoid plates
* Skull (base, bone, NOS)
+ Oropharynx (C090-C091, C098-C099, C100, C102-C104, C108-C109)
* Anterior 2/3 of tongue
* Hard palate
* Mandible
* Parotid gland
+ Pharyngeal Tonsil (C111)
* Brain
* Cranial nerve involvement
* Hypopharynx
* Infratemporal fossa/masticator space
* Orbit (floor, NOS)
* Paranasal sinus
* Soft tissues of neck
+ Soft palate (C051, C052)
* Hypopharynx
* Maxilla
* Maxillary sinus (antrum)
* Nasal cavity
* Nasopharynx (lateral, NOS)
* Palatine bone (bone of hard palate)
* Tongue
+ Tongue Base (posterior 1/3 of tongue) (C019, C024)
* Hard palate
* Hypopharynx
* Larynx
* Mandible
* Skin
- Distant lymph node(s)
+ Mediastinal (excluding superior mediastinal node(s), Level VII)
- Distant metastasis, NOS
+ Carcinomatosis
+ Distant mets WITH or WITHOUT distant lymph node(s) |
9 |
Unknown if extension or metastasis |
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(2) Young JL Jr, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA (eds.). **SEER Summary Staging Manual-2000: Codes and Coding Instructions**, National Cancer Institute, NIH Pub. No. 01-4969, Bethesda, MD, 2001.
(3) Collaborative Stage Work Group of the American Joint Committee on Cancer. **Collaborative Stage Data Collection System User Documentation and Coding Instructions, version 02.05**. American Joint Committee on Cancer (Chicago, IL)
(4) Gress, D.M., Edge, S.B., Gershenwald, J.E., et al. **Principles of Cancer Staging**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 3-30
(5) Lydiatt, W.M., Patel, S.G., Shah, J.P., et al. **Staging Head and Neck Cancers**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 55-65
(6) O’Sullivan, B., Lydiatt, W.M., Shah, J.P., et al. **HPV-Mediated (p16+) Oropharyngeal Cancer**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 113-121
(7) Lydiatt, W.M., Ridge, J.A., Shah, J.P., et al. **Oropharynx (p16-) and Hypopharynx**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 123-135