Pathologic N

This input is used for staging


**Note 1:** Histological examination of a regional lymphadenectomy specimen will ordinarily include 6 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0. (1) **Note 2:** Code only regional lymph nodes and lymph nodes, NOS in this field. Distant lymph nodes are coded in M (distant metastasis). **Note 3:** Assign N1 if regional lymph nodes are involved but there is no indication of the number of nodes involved. **Note 4:** Regional lymph nodes for any part of the esophagus fall in the range from periesophageal/cervical to the celiac region. Contralateral and bilateral cervical, supraclavicular, and mediastinal lymph nodes are included. However, some nodal chains in this large area are partially regional and partially distant because they include both nodes that are close to the esophagus toward the body's midline and nodes that run laterally away from the esophagus or perpendicular to it. Regional nodes are those that lie in the bed of the esophagus. *Examples* Regional supraclavicular nodes (level 1) Regional pulmonary ligament nodes (level 9) Regional hilar tracheobronchial nodes (level 10) Regional diaphragmatic nodes (level 15) * These nodes are closest to the esophagus; nodes in these chains that are further from the esophagus are distant * Medical record terminology is unlikely to be so specific in describing involved node locations, so try to correlate involved node information with staging statements that indicate whether the nodes were classified as regional or distant by the physicians; lacking such physician guidance, presume regional nodes. If the record just indicates involvement of supraclavicular nodes, for example, and there is no further information available, presume that the involved nodes were close to the esophagus and regional **Regional lymph nodes for EsophagusGEJunction** Left gastric (superior gastric), NOS Cardiac Cardioesophageal Gastric, left (17) Gastropancreatic, left Lesser curvature Lesser omental Pericardial (16) Pancreaticosplenic (pancreaticolienal) Pancreatoduodenal Perigastric, NOS Peripancreatic Right gastric (inferior gastric), NOS Gastrocolic Gastroduodenal Gastroepiploic (gastro-omental), right or NOS Gastrohepatic Greater curvature Greater omental Pyloric, NOS Infrapyloric (subpyloric) Suprapyloric Splenic (lienal), NOS: Gastroepiploic (gastro-omental), left Splenic hilar Nodule(s) in perigastric fat Celiac Hepatic and hepatoduodenal Paraesophageal, NOS Periesophageal, NOS, including: Anterior mediastinal (6) Aortopulmonary (5) Diaphragmatic (15) Paraesophageal, lower (8l) Paraesophageal, middle (8m) Paratracheal, lower (4L, 4R) Paratracheal, upper (2L, 2R) Posterior mediastinal (3p) Pulmonary ligament (9) Subcarinal (tracheal carina) (7) Supraclavicular (1) Tracheobronchial (hilar) (10L, 10R) Regional lymph nodes, NOS Lymph nodes, NOS


Pathologic N Pathologic N Display Description Registrar Notes
pX pNX Regional lymph nodes cannot be assessed Pathologic classification criteria met, evaluation done:
Physician unable to assess N
Surgical resection primary tumor, no regional lymph nodes removed
Involvement of regional lymph nodes not documented
Physician assigns pNX, no other information available to determine N
p0 pN0 No regional lymph node metastasis
p1 pN1 Metastasis in 1-2 regional lymph nodes Stated as N1
p2 pN2 Metastasis in 3-6 regional lymph nodes Stated as N2
p3 pN3 Metastasis in 7 or more regional lymph nodes Stated as N3
c0 cN0 Clinically: No regional lymph node metastasis Use only for TNM defined pTis cases where there is a resection of the primary and the nodes are not evaluated pathologically
88 88 Not applicable Primary site/histology not TNM defined
Death certificate only (DCO) case
<BLANK> BLANK See Registrar Notes Pathologic classification criteria not met
No surgical resection of primary tumor and there isn’t a positive biopsy of a structure in the highest T category and highest N category
Evidence of metastatic disease (pM1), no other workup
Only Pathologic Stage Group documented (no T, N, or M information available)
(1) International Union Against Cancer (UICC) *TNM Classification of Malignant Tumors,* 7th ed., Sobin, LH, Gospodarowicz, M, Wittekind, CH, eds. New York: Wiley, 2009, pg., 69