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:** For nasopharynx, unilateral and bilateral retropharyngeal nodes are mapped to N1, and nodes in the supraclavicular fossa are mapped to N3b. The supraclavicular fossa is defined by 3 points: the superior margin of the sterna end of the clavicle, the superior margin of the lateral end of the clavical, and the point where the neck meets the shoulder. **Note 3:** 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 4:** 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 5:** 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 6:** 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 node(s) 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
c1	cN1	Unilateral metastasis, in cervical lymph nodes(s), and/or unilateral or bilateral metastasis in retropharyngeal lymph nodes, 6 cm or less in greatest dimension, above the supraclavicular fossa	Positive lymph nodes, not stated if unilateral or bilateral Positive lymph nodes, size not stated Stated as N1
c2	cN2	Bilateral metastasis in cervical lymph node(s), 6 cm or less in greatest dimension, above the supraclavicular fossa	Positive bilateral nodes, NOS Stated as N2
c3	cN3	Metastasis in cervical lymph node(s) greater than 6 cm in dimension or in the supraclavicular fossa	Note: N3 has subcategories of N3a and N3b. Assign N3 only when there is no information available to assign one of the subcategories. Stated as N3 [NOS]
c3A	cN3a	Greater than 6 cm in dimension	Stated as N3a
c3B	cN3b	Extension in the supraclavicular fossa	Unilateral or bilateral positive regional node(s): Level IV - Lower jugular: Jugulo-omohyoid (supraomohyoid) Lower deep cervical Virchow node Level VB - Transverse cervical, supraclavicular Level VII - Superior mediastinal group Esophageal groove Paratracheal - below suprasternal notch Pretracheal - below suprasternal notch Stated as N3b
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)