Clinical N

This input is used for staging

Notes

**Note 1:** Code only regional lymph nodes and lymph nodes, NOS in this field. Distant lymph nodes are coded in M (distant metastasis). **Note 2:** Assign N1 if regional lymph nodes are involved but there is no indication of the number of nodes involved. **Note 3:** 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 **Note 4:** Imaging studies often refer to involved nodes in the gastrohepatic ligament or at the gastrohepatic level for esophageal primaries. Code as left gastric nodes if there is no more specific information. **Regional Lymph Nodes for Esophagus (including contralateral or bilateral)** **All esophagus subsites** Anterior mediastinal (6) Mediastinal, NOS Peri-/paraesophageal (8L, 8M) Regional lymph nodes, NOS Lymph nodes, NOS **Cervical esophagus (C150)** Anterior deep cervical (laterotracheal) (recurrent laryngeal) Anterior mediastinal (6) Aortopulmonary (5) Cervical, NOS Cervical (deep), NOS Diaphragmatic (15) Internal jugular, NOS Jugulodigastric (subdigastric) Mediastinal, NOS Para-aortic (ascending aorta or phrenic) Paratracheal (2R, 2L, 4R, 4L) Posterior mediastinal (3P) Pulmonary ligament (9) Scalene (inferior deep cervical) (1) Subaortic Supraclavicular (transverse cervical) (1) Superior mediastinal **Upper thoracic esophagus (C151, C153)** Cervical lymph nodes **Lower thoracic (abdominal) esophagus (C152, C155)** Aortopulmonary (5) Diaphragmatic (15) Celiac lymph nodes (20) Left gastric (superior gastric) (17): cardiac (cardial), lesser curvature, perigastric, NOS Para-aortic (ascending aorta or phrenic) Paratracheal (2R, 2L, 4R, 4L) Posterior mediastinal (3P) (tracheoesophageal) Pulmonary ligament (9) Subaortic Superior mediastinal **Intrathoracic esophagus, upper (C153) or middle (C154)** Aortopulmonary (5) Carinal (tracheobronchial) (10R,10L) (tracheal bifurcation) Cervical: deep (NOS), lower (NOS), middle (NOS), upper (NOS) Diaphragmatic (15) Hilar (bronchopulmonary) (proximal lobar) (pulmonary root) Internal jugular, NOS Intrabronchial, NOS Jugulo-omohyoid (supraomohyoid) Jugulodigastric (subdigastric) Left gastric (superior gastric) (17): cardiac (cardial), lesser curvature, perigastric (NOS) Para-aortic (ascending aorta or phrenic) Peritracheal Posterior mediastinal (tracheoesophageal) Pulmonary ligament (9) Superior mediastinal

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
c1	cN1	Metastasis in 1-2 regional lymph nodes	Stated as N1
c2	cN2	Metastasis in 3-6 regional lymph nodes	Stated as N2
c3	cN3	Metastasis in 7 or more regional lymph nodes	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)