**Note 1:** Grade Clinical must not be blank.
**Note 2:** Assign the highest grade from the primary tumor assessed during the clinical time frame.
**Note 3:** If there are multiple tumors with different grades abstracted as one primary, code the highest grade.
**Note 4:** The grading system for this chapter is based on histology
* Immature teratomas and serous carcinomas: Use codes L, H, or 9. This include the following ICD-O-3 codes: 8441/2, 8441/3, 8460/3, 8461/3, 8474/3, 9080/3
* All other histologies: Code 1-3 if a nuclear grade is documented, otherwise code 9
* If your registry collects ovarian borderline tumors (/1), code “B” for grade
**Note 5:** G3 includes anaplastic.
**Note 6:** Code 9 (unknown) when
* Grade from primary site is not documented
* Clinical work is not done (for example, cancer is an incidental finding during surgery for another condition)
* Grade checked "not applicable" on CAP Protocol (if available) and no other grade information is available
**Note 7:** If there is only one grade available and it cannot be determined if it is clinical or pathological, assume it is a Grade Clinical and code appropriately per Grade Clinical categories for that site, and then code unknown (9) for Grade Pathological, and blank for Grade Post Therapy Clin (yc) and Grade Post Therapy Path (yp).