**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:** Codes 1-3 take priority over A-D.
**Note 5:** For this grading system, the CAP Checklist refers to this as “histologic type,” instead of grade.
**Note 6:** Code 9 (unknown) when
* Grade from primary site is not documented
* Clinical workup 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).