Pathologic T

This input is used for staging


**Note 1:** Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to code as bone involvement. (1) **Note 2:** Periosteum is a fibrous membrane that wraps the outer surface of bones. Cortical bone is the dense compact outer layer of the bone. Trabecular, cancellous, or spongy bone (spongiosa) is a porous network of tissue filling the interior of bone, decreasing weight and allowing room for blood vessels and marrow. **Note 3:** Tumor size must be known to assign a value of T1, T2 or T3. You may use a physician’s statement of the T category if this is the only information in the medical record. * If the tumor appears to be in the T1, T2 or T3 categories, but no size or category is specified, assign TX **Note 4:** Assign the appropriate T category (T1-T3) based on the tumor size when the tumor involvement is limited to the cortical bone for the following descriptions Invasive tumor confined to lamina propria (mucoperiosteum) (stroma) Bone, NOS Buccal mucosa (inner cheek) Cartilage, NOS Cortical bone of maxilla Cortical bone, NOS Fascial muscle, NOS Floor of mouth Labial mucosa (inner lip), lower lip Labial mucosa (inner lip), lip, NOS Lateral pharyngeal wall Maxilla, NOS Soft palate including uvula Subcutaneous soft tissue of face Tongue mucosa Tonsillar pillars and fossae Tonsils Confined to upper gum Localized, NOS **Note 5:** Involvement through cortical bone is required for assignment of T4a.


Pathologic T Pathologic T Display Description Registrar Notes
pX pTX Primary tumor cannot be assessed Pathologic classification criteria met, evaluation done:
Physician unable to assess T
Surgical resection of primary tumor, extension not stated
Tumor size (TS) unknown for T categories where TS needed to determine T
Physician assigns pTX, no other information available to determine T
p0 pT0 No evidence of primary tumor
pIS pTis Carcinoma in situ Intraepithelial, noninvasive

Stated as Tis
p1 pT1 Tumor 2 cm or less in greatest dimension Stated as T1
p2 pT2 Tumor more than 2 cm but not more than 4 cm in greatest dimension Stated as T2
p3 pT3 Tumor more than 4 cm in greatest dimension Stated as T3
p4 pT4 Not defined by UICC*# Note: T4 has subcategories of T4a and T4b. Assign T4 only when there is no information available to assign one of the subcategories

Tumor invades bone, nerve or extrinsic deep muscles

Stated as T4[NOS]
p4A pT4a (lip) Tumor invades through:
Cortical bone
Floor of mouth
Inferior alveolar nerve
Skin (chin or nose)

(oral cavity) Tumor invades through:
Cortical bone
Into deep/extrinsic muscle of tongue:
Maxillary sinus
Skin of face
Deep (extrinsic) muscle of tongue:

Bone of mandible
Mandible, NOS
Maxillary (sinus) antrum
Nasal cavity
Skin of face
Trabecular bone of maxilla or palatine bone

Stated as T4a
p4B pT4b (lip and oral cavity) Tumor invades:
Masticator space
Pterygoid plates
Skull base

or Encases internal carotid artery
Labial mucosa (inner lip), lower lip
Mucosa lower lip

Specified bone

Masticator space
Pterygoid plates

Further contiguous extension, including:
Skull base
Internal carotid artery (encased)

Stated as T4b
88 88 Not applicable Primary site/histology not TNM defined
Death certificate only (DCO) case
<BLANK> BLANK See Registrar Notes Pathologic classification criteria not met
Pathologic classification criteria met, evaluation done:
Results not documented in patient record
No surgical resection of known primary tumor (not T0)
Resection insufficient for site-specific pathologic assessment
No surgical resection of primary tumor and there isn’t a positive biopsy of a structure in the highest T category and highest N category
Evidence of metastatic disease (pM1), no other workup
Only Pathologic 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., 27 \* T4 [NOS] is not defined by UICC in the 7th edition. Approval has been provided by UICC to use "Tumor invades bone, nerve or extrinsic deep muscles" as T4 [NOS]. \# T4 [NOS] is not defined in AJCC 7th edition.