Clinical N

This input is used for staging

Notes

**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

NAACCR Item

NAACCR #950

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 In situ case but no pTis is defined by TNM 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)