Clinical N

This input is used for staging


**Note 1:** If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are assigned as ipsilateral. **Note 2:** Size of the largest metastasis in a lymph node must be known to assign N. You may use a physician’s statement of the N category if this is the only information in the medical record. * If the size of the metastasis is not documented, determine the size of the largest involved lymph node as documented clinically * If the size of the lymph node(s) cannot be determined, assign N1 * Do not code the size of any node(s) assigned in M (distant metastasis) **Note 3:** The description of lymph nodes has been standardized across the head and neck schemas. All lymph node levels and groups listed here are assigned as regional nodes for TNM staging. **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 nodes see M [distant metastasis])** 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 nodes, NOS Lymph nodes, NOS **Note 4:** For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, levels involved, and location of involved nodes above or below the lower border of the cricoid cartilage) is coded in **Site-Specific Factors 1, 3-9**. **Note 5:** For head and neck cancers, if lymph nodes are described only as "supraclavicular", try to determine if they are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior triangle, inferior to the transverse cervical artery) and code appropriately. * If the specific level cannot be determined, assign them as Level V nodes


Clinical N Clinical N Display Description Registrar Notes
cX cNX Regional lymph nodes cannot be assessed Clinical classification criteria met, evaluation done:
Physician unable to assess N
Regional lymph node involvement cannot be determined or findings inconclusive
Physician assigns cNX, no other information available to determine N
c0 cN0 No regional lymph node metastasis No regional lymph node involvement
c1 cN1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension Positive ipsilateral lymph node, not stated if single or multiple
Positive lymph node, not stated if ipsilateral, bilateral, or contralateral

Positive lymph node, size not stated

Stated as N1
c2 cN2 Metastasis as described below Note: N2 has subcategories of N2a, N2b and N2c. Assign N2 only when there is no information available to assign one of the subcategories

Stated as N2 [NOS]
c2A cN2a Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension Stated as N2a
c2B cN2b Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension Multiple lymph nodes, not stated if ipsilateral, bilateral or contralateral

Stated as N2b
c2C cN2c Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension Bilateral lymph nodes, size not stated

Stated as N2c
c3 cN3 Metastasis in a lymph node more than 6 cm in greatest dimension Stated as N3
88 88 Not applicable Primary site/histology not TNM defined
Death certificate only (DCO) case
<BLANK> BLANK See Registrar Notes Clinical classification criteria not met
Clinical classification criteria met, evaluation done:
No information about diagnostic workup
Results not documented in record
Tumor first detected on surgical resection (no clinical workup)
Evidence of metastatic disease [(cM1) or (pM1)], no other workup
Only Clinical Stage Group documented (no T, N, or M information available)