Clinical N

This input is used for staging


**Note 1:** Code only regional nodes and nodes, NOS in this field. Note 2 specifies when to code certain tumor deposits (TD) here. Distant nodes are coded in M (distant metastasis). **Note 2:** Per UICC, "Tumor deposits (satellites), i.e., macroscopic or microscopic nests or nodules, in the pericolorectal adipose tissue's lymph drainage area of a primary carcinoma without histological evidence of residual lymph node in the nodule, may represent discontinuous spread, venous invasion with extravascular spread (V1/2) or a totally replaced lymph node (N1/2). If such deposits are observed with lesions that would otherwise be classified as T1 or T2, then the T classification is not changed, but the nodule(s) is recorded as N1c. If a nodule is documented by the pathologist to be a totally replaced lymph node (generally having a smooth contour), it should be recorded as a positive lymph node and not as a satellite, and each nodule should be counted separately as a lymph node in the final pN determination." (1) **Note 3:** Assign N1 if regional lymph nodes are involved but there is no indication of the number of nodes involved. **Regional lymph nodes** **All sites** Haemorrhoidal (hemorrhoidal) (middle, superior) Inferior mesenteric Mesenteric [NOS] Perirectal Rectal (middle) Rectal [NOS] Rectal (superior) Rectosigmoid (paracolic/pericolic) Sigmoidal (sigmoid mesenteric) Regional lymph nodes, NOS Lymph nodes, NOS **Rectosigmoid (C199)** Colic, (NOS) Left colic **Rectum (C209)** Hemorrhoidal (inferior) Internal iliac (hypogastric) Lateral (laterosacral) Middle (promontorial) (Gerota's node) Obturator Presacral Rectal (inferior) Sacral (NOS) Sacral promontory


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 1-3 regional lymph nodes Note: N1 has subcategories of N1a, N1b and N1c. Assign N1 only when there is no information available to assign one of the subcategories

Stated as N1 [NOS]
c1A cN1a Metastasis in 1 regional lymph node Stated as N1a
c1B cN1b Metastasis in 2-3 regional lymph nodes Stated as N1b
c1C cN1c Tumor deposit(s), i.e., satellites, in the subserosa, or in non-peritonealized pericolic or perirectal soft tissue without regional lymph node metastasis Tumor deposits (TD) in the subserosa, mesentery, or nonperitonealized pericoic or perirectal tissues WITHOUT regional lymph node metastasis

Stated as N1c
c2 cN2 Metastasis in 4 or more regional lymph nodes Note: N2 has subcategories of N2a and N2b. Assign N2 only when there is no information available to assign one of the subcategories

Stated as N2 [NOS]
c2A cN2a Metastasis in 4-6 regional lymph nodes Stated as N2a
c2B cN2b Metastasis in 7 or more regional lymph nodes Stated as N2b
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)
(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., 103