Nasal Cavity CS Tumor Size (Revised: 02/03/2010)

Transcription

1 Nasal Cavity C30.0 C30.0 Nasal cavity (excludes nose, NOS C76.0) Note: Laterality must be coded for this site, except subsites Nasal cartilage and Nasal septum, for which laterality is coded 0. CS Tumor Size CS Extension CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval Reg LN Pos Reg LN Exam CS Mets at DX CS Mets Eval CS Site-Specific Factor 1 Size of Lymph Nodes CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head and Neck CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular Lymph Nodes, Lymph Nodes for Head and Neck CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and Neck CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head and Neck CS Site-Specific Factor 10 HPV (Human Papilloma Virus) Status CS Site-Specific Factor 11 Measured Thickness (Depth) CS Site-Specific Factor 12 CS Site-Specific Factor 13 CS Site-Specific Factor 14 CS Site-Specific Factor 15 CS Site-Specific Factor 16 CS Site-Specific Factor 17 CS Site-Specific Factor 18 CS Site-Specific Factor 19 CS Site-Specific Factor 20 CS Site-Specific Factor 21 CS Site-Specific Factor 22 CS Site-Specific Factor 23 CS Site-Specific Factor 24 CS Site-Specific Factor 25 The following tables are available at the collaborative staging website: Histology Inclusion Table AJCC 7th ed. Histology Exclusion Table AJCC 6th ed. AJCC TNM 7 Stage AJCC TNM 6 Stage Summary Stage Lymph Nodes Size Table Nasal Cavity CS Tumor Size (Revised: 02/03/2010) 000 No mass/tumor found millimeters (code exact size in millimeters) 29 April 2010 Part II - Upper Respiratory - 1 Version

2 millimeters or larger 990 Microscopic focus or foci only and no size of focus given 991 Described as "less than 1 cm" 992 Described as "less than 2 cm," or "greater than 1 cm," or "between 1 cm and 2 cm" 993 Described as "less than 3 cm," or "greater than 2 cm," or "between 2 cm and 3 cm" 994 Described as "less than 4 cm," or "greater than 3 cm," or "between 3 cm and 4 cm" 995 Described as "less than 5 cm," or "greater than 4 cm," or "between 4 cm and 5 cm" 999 Unknown; size not stated Nasal Cavity CS Extension (Revised: 10/12/2009) Note 1: The bones of the lateral wall of the nasal cavity include the maxilla, the perpendicular plate of the palatine bone, the medial pterygoid plate, the labyrinth and inferior concha of the ethmoid. The roof of the nasal cavity is formed by the nasal bone. The floor of the nasal cavity, which forms the roof of the mouth, is composed of the bones of the hard palate: the horizontal plate of the palatine bone posteriorly and the palatine process of the maxilla anteriorly. Note 2: "Bony invasion" does not include extension to palate, cribriform plate, or pterygoid plates. Extension to these structures is coded separately. Note 3: Base of skull NOS only if no information is available to code to more specific bony structures in the skull. Note 4: In code 700, "minimal extension to anterior cranial fossa" implies tumor pushing through the cribriform plate, but without invasion of the dura or brain. Note 5: Use code 300 for localized tumor ONLY if no information Is available to assign codes 100, 110, 200, or 410. Note 6: Use code 110, 410, 680, 725, 810, or 815 if the physician's assignment of T category is the ONLY information available about the extent of the tumor. TNM 7 TNM 6 SS77 SS In situ; non-invasive Tis Tis IS IS 100 Invasive tumor confined to one of the following subsites: Septum Floor Lateral wall, including meatus (superior, middle, inferior) and nasal conchae (superior, middle, inferior) Vestibule (edge of naris to mucocutaneous junction) WITHOUT bony invasion 105 Invasive tumor confined to one subsite listed in code 100 WITH bony invasion T1 T1 L L T1 T1 RE RE 29 April 2010 Part II - Upper Respiratory - 2 Version

3 TNM 7 TNM 6 SS77 SS Confined to nasal cavity NOS Stated as T1 with no further information on extension 200 Invasive tumor confined to two or more subsites listed in code 100 WITHOUT bony invasion 205 Invasive tumor confined to two or more subsites listed in code 100 WITH bony invasion T1 T1 L L T2 T2 L L T2 T2 RE RE 300 Localized, NOS T1 T1 L L 400 Extending to adjacent region within the nasoethmoidal complex: Nasolacrimal duct Ethmoid sinus Choana WITH or WITHOUT bony invasion T2 T2 RE RE 410 Stated as T2 with no further information on extension T2 T2 RE RE 600 Adjacent organs/structures including: Base of skull NOS (see Note 3) Palate Note: Choana moved to code 400 to correct AJCC mapping T3 T3 RE RE 650 Cribiform plate T3 T3 RE RE 660 Maxillary sinus T3 T3 RE RE 670 Medial wall or floor of the orbit T3 T3 RE RE 680 Stated as T3 with no other information on extension T3 T3 RE RE 690 Frontal sinus Pterygoid plates 700 Tumor invades: Anterior orbital contents Skin of nose Skin of cheek Anterior cranial fossa (minimal extension) Sphenoid sinus T4a T4a RE RE T4a T4a D D 29 April 2010 Part II - Upper Respiratory - 3 Version

4 TNM 7 TNM 6 SS77 SS OBSOLETE DATA CONVERTED V0200 See code 760 T4b T4b D D Further contiguous extension including: Orbital apex Dura Brain Middle cranial fossa Cranial nerves (other than V2, maxillary division of trigeminal nerve) Nasopharynx Clivus 725 Stated as T4a with no other information on extension T4a T4a RE RE 760 Further contiguous extension including: Orbital apex Dura Brain Middle cranial fossa Cranial nerves (other than V2, maxillary division of trigeminal nerve) Nasopharynx Clivus T4b T4b D D 810 Stated as T4b with no other information on extension T4b T4b D D 815 Stated as T4 NOS with no other information on extension T4NOS T4NOS RE RE 950 No evidence of primary tumor T0 T0 U U 999 Unknown extension Primary tumor cannot be assessed TX TX U U Nasal Cavity CS Tumor Size/Ext Eval (Revised: 08/10/2009) Staging Basis 0 Does not meet criteria for AJCC pathologic staging: c No surgical resection done. Evaluation based on physical examination, imaging examination, or other non-invasive clinical evidence. No autopsy evidence used. 1 Does not meet criteria for AJCC pathologic staging: c No surgical resection done. Evaluation based on endoscopic examination, diagnostic biopsy, including fine needle aspiration biopsy, or other invasive techniques, including surgical observation without biopsy. No autopsy evidence used. 29 April 2010 Part II - Upper Respiratory - 4 Version

5 Staging Basis 2 Meets criteria for AJCC pathologic staging: p No surgical resection done, but evidence derived from autopsy (tumor was suspected or diagnosed prior to autopsy) 3 Either criteria meets AJCC pathologic staging: p Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation OR surgical resection performed, unknown if pre-surgical systemic treatment or radiation performed AND Evaluation based on evidence acquired before treatment, supplemented or modified by the additional evidence acquired during and from surgery, particularly from pathologic examination of the resected specimen. No surgical resection done. Evaluation based on positive biopsy of highest T classification. 5 Does not meet criteria for AJCC y-pathologic (yp) staging: c Surgical resection performed AFTER neoadjuvant therapy and tumor size/extension based on clinical evidence, unless the pathologic evidence at surgery (AFTER neoadjuvant) is more extensive (see code 6). 6 Meets criteria for AJCC y-pathologic (yp) staging: yp Surgical resection performed AFTER neoadjuvant therapy AND tumor size/extension based on pathologic evidence, because pathologic evidence at surgery is more extensive than clinical evidence before treatment. 8 Meets criteria for autopsy (a) staging: a Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy) 9 Unknown if surgical resection done Not assessed; cannot be assessed Unknown if assessed c 29 April 2010 Part II - Upper Respiratory - 5 Version

6 Nasal Cavity CS Lymph Nodes (Revised: 09/02/2009) Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: 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 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Note 4: 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, consider them as Level V nodes. Note 5: The description of lymph nodes has been standardized across the head and neck schemas. All lymph node levels and groups listed here are considered regional nodes for AJCC staging. Summary Stage 1977 and Summary Stage 2000 divide these nodes into regional and distant groups. TNM 7 TNM 6 SS77 SS None; no regional lymph node involvement N0 N0 NONE NONE 100 Single positive ipsilateral regional node: Level I node Level IA - Submental Level IB - Submandibular (submaxillary) Level II node - Upper jugular Jugulodigastric (subdigastric) Upper deep cervical Other groups: Retropharyngeal Cervical, NOS Deep cervical, NOS Internal jugular, NOS Regional lymph node, NOS ^ * RN RN 29 April 2010 Part II - Upper Respiratory - 6 Version

7 TNM 7 TNM 6 SS77 SS Single positive ipsilateral regional node: Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Level V node Posterior triangle group Posterior cervical Level VA - Spinal accessory Level VB - Transverse cervical, supraclavicular Level VI node - Anterior compartment group Laterotracheal Paralaryngeal Paratracheal - above suprasternal notch Perithyroidal Precricoid (Delphian) Prelaryngeal Pretracheal - above suprasternal notch Recurrent laryngeal Level VII node - Superior mediastinal group (for other mediastinal nodes see CS Mets at DX) Esophageal groove Paratracheal - below suprasternal notch Pretracheal - below suprasternal notch Other groups: Facial: Buccinator (buccal) Mandibular Nasolabial Parotid: Infraauricular Intraparotid Periparotid Preparotid Parapharyngeal Retroauricular Sublingual Suboccipital ^ * D D 180 Stated as N1, no other information N1 N1 RN RN 190 Stated as N2a, no other information N2a N2a RN RN 200 Multiple positive ipsilateral nodes, listed in code 100 ^ * RN RN 220 Multiple positive ipsilateral nodes, any listed in code 120 (WITH or WITHOUT nodes listed in code 100) ^ * D D 290 Stated as N2b, no other information N2b N2b RN RN 29 April 2010 Part II - Upper Respiratory - 7 Version

8 TNM 7 TNM 6 SS77 SS Regional lymph nodes listed in code 100: Positive ipsilateral node(s), not stated if single or multiple or regional 320 Regional lymph nodes listed in code 120: Positive ipsilateral node(s), not stated if single or multiple 400 Regional lymph nodes as listed in code 100: Positive bilateral or contralateral nodes 420 Regional lymph nodes, any listed in code 120: Positive bilateral or contralateral nodes (WITH or WITHOUT nodes listed in code 100) ^ * RN RN ^ * D D ^ * RN RN ^ * D D 490 Stated as N2c, no other information N2c N2c RN RN 500 Regional lymph nodes listed in code 100: Positive node(s), not stated if ipsilateral, or bilateral, or contralateral, AND not stated if single or multiple 520 Regional lymph nodes listed in code 120: Positive node(s), not stated if ipsilateral, or bilateral, or contralateral, AND not stated if single or multiple ^ * RN RN ^ * D D 600 Stated as N2, NOS N2NOS N2NOS RN RN 700 Stated as N3, no other information N3 N3 RN RN 800 Lymph nodes, NOS ^ * RN RN 999 Unknown; not stated Regional lymph nodes cannot be assessed NX NX U U ^ For codes 100, 120, 200, 220, 300, 320, 400, 420, 500, 520 and 800 ONLY, the N category for AJCC 7th Edition staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site. * For codes 100, 120, 200, 220, 300, 320, 400, 420, 500, 520 and 800 ONLY, the N category for AJCC 6th Edition staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site. 29 April 2010 Part II - Upper Respiratory - 8 Version

9 Nasal Cavity CS Lymph Nodes Eval (Revised: 10/26/2009) Note 1: This field is used primarily to derive the staging basis for the N category in the TNM system. It records how the code for the item "CS Lymph Nodes" was determined based on the diagnostic methods employed and their intent. Note 2: In the 7th edition of the AJCC manual, the clinical and pathologic classification rules for the N category were changed to reflect current medical practice. The N is designated as clinical or pathologic based on the intent (workup versus treatment) matching with the assessment of the T classification. When the intent is workup, the staging basis is clinical, and when the intent is treatment, the staging basis is pathologic. A. Microscopic assessment including biopsy of regional nodes or sentinel nodes if being performed as part of the workup to choose the treatment plan, is therefore part of the clinical staging. When it is part of the workup, the T category is clinical, and there has not been a resection of the primary site adequate for pathologic T classification (which would be part of the treatment). B. Microscopic assessment of regional nodes if being performed as part of the treatment is therefore part of the pathologic staging. When it is part of the treatment, the T category is pathologic, and there has been a resection of the primary site adequate for pathologic T classification (all part of the treatment). Note 3: Microscopic assessment of the highest N category is always pathologic (code 3). Note 4: If lymph node dissection is not performed after neoadjuvant therapy, use code 0 or 1. Note 5: Only codes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy. Staging Basis 0 Does not meet criteria for AJCC pathologic staging: c No regional lymph nodes removed for examination. Evidence based on physical examination, imaging examination, or other non-invasive clinical evidence. No autopsy evidence used. 1 Does not meet criteria for AJCC pathologic staging based on at least one of the following criteria: c No regional lymph nodes removed for examination. Evidence based on endoscopic examination, or other invasive techniques including surgical observation, without biopsy. No autopsy evidence used. OR Fine needle aspiration, incisional core needle biopsy, or excisional biopsy of regional lymph nodes or sentinel nodes as part of the diagnostic workup, WITHOUT removal of the primary site adequate for pathologic T classification (treatment). 2 Meets criteria for AJCC pathologic staging: p No regional lymph nodes removed for examination, but evidence derived from autopsy (tumor was suspected or diagnosed prior to autopsy). 3 Meets criteria for AJCC pathologic staging based on at least one of the following criteria: p Any microscopic assessment of regional nodes (including FNA, incisional core needle bx, excisional bx, sentinel node bx or node resection), WITH removal of the primary site adequate for pathologic T classification (treatment) or biopsy assessment of the highest T category. OR Any microscopic assessment of a regional node in the highest N category, regardless of the T category information. 29 April 2010 Part II - Upper Respiratory - 9 Version

10 Staging Basis 5 Does not meet criteria for AJCC y-pathologic (yp) staging: c Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph node evaluation based on clinical evidence, unless the pathologic evidence at surgery (AFTER neoadjuvant) is more extensive (see code 6). 6 Meets criteria for AJCC y-pathologic (yp) staging: yp Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph node evaluation based on pathologic evidence, because the pathologic evidence at surgery is more extensive than clinical evidence before treatment. 8 Meets criteria for AJCC autopsy (a) staging: a Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy. 9 Unknown if lymph nodes removed for examination Not assessed; cannot be assessed Unknown if assessed c Nasal Cavity Reg LN Pos (Revised: 03/30/2009) Note: Record this field even if there has been preoperative treatment. 00 All nodes examined negative nodes positive (code exact number of nodes positive) or more nodes positive 95 Positive aspiration or core biopsy of lymph node(s) 97 Positive nodes - number unspecified 98 No nodes examined 99 Unknown if nodes are positive; not applicable Nasal Cavity Reg LN Exam (Revised: 03/02/2009) 00 No nodes examined nodes examined (code exact number of regional lymph nodes examined) or more nodes examined 29 April 2010 Part II - Upper Respiratory - 10 Version

11 95 No regional nodes removed, but aspiration or core biopsy of regional nodes performed 96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated 97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated 98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not documented as sampling or dissection; nodes examined, but number unknown 99 Unknown if nodes were examined; not applicable or negative Nasal Cavity CS Mets at DX (Revised: 12/08/2009) TNM 7 TNM 6 SS77 SS No; none M0 M0 NONE NONE 10 Distant lymph node(s) M1 M1 D D 40 Distant metastases except distant lymph node(s) (code 10) Carcinomatosis 50 (10) + (40) Distant lymph node(s) plus other distant metastases 60 Distant metastasis, NOS Stated as M1, NOS 99 Unknown if distant metastasis Distant metastasis cannot be assessed M1 M1 D D M1 M1 D D M1 M1 D D M0 MX U U Nasal Cavity CS Mets Eval (Revised: 08/10/2009) Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the diagnostic methods employed. Staging Basis 0 Does not meet criteria for AJCC pathologic staging of distant metastasis: c Evaluation of distant metastasis based on physical examination, imaging examination, and/or other non-invasive clinical evidence. No pathologic examination of metastatic tissue performed or pathologic examination was negative. 29 April 2010 Part II - Upper Respiratory - 11 Version

12 Staging Basis 1 Does not meet criteria for AJCC pathologic staging of distant metastasis: c Evaluation of distant metastasis based on endoscopic examination or other invasive technique, including surgical observation without biopsy. No pathologic examination of metastatic tissue performed or pathologic examination was negative. 2 Meets criteria for AJCC pathologic staging of distant metastasis: p No pathologic examination of metastatic specimen done prior to death, but positive metastatic evidence derived from autopsy (tumor was suspected or diagnosed prior to autopsy). 3 Meets criteria for AJCC pathologic staging of distant metastasis: p Specimen from metastatic site microscopically positive WITHOUT pre-surgical systemic treatment or radiation OR specimen from metastatic site microscopically positive, unknown if pre-surgical systemic treatment or radiation performed OR specimen from metastatic site microscopically positive prior to neoadjuvant treatment. 5 Does not meet criteria for AJCC y-pathologic (yp) staging of distant metastasis: c Specimen from metastatic site microscopically positive WITH pre-surgical systemic treatment or radiation, BUT metastasis based on clinical evidence. 6 Meets criteria for AJCC y-pathologic (yp) staging of distant metastasis: Specimen from metastatic site microscopically positive WITH pre-surgical systemic treatment or radiation, BUT metastasis based on pathologic evidence. 8 Meets criteria for AJCC autopsy (a) staging of distant metastasis: yp a Evidence from autopsy based on examination of positive metastatic tissue AND tumor was unsuspected or undiagnosed prior to autopsy. 9 Not assessed; cannot be assessed Unknown if assessed c Nasal Cavity CS Site-Specific Factor 1 Size of Lymph Nodes (Revised: 12/01/2009) Note: the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. 000 No involved regional nodes millimeters (code exact size in millimeters) millimeters or larger 29 April 2010 Part II - Upper Respiratory - 12 Version

13 OBSOLETE DATA CONVERTED V0200 See code millimeters 989 OBSOLETE DATA CONVERTED V0200 See code millimeters or larger 990 Microscopic focus or foci only, no size of focus given 991 Described as "less than 1cm" 992 Described as "less than 2cm" or "greater than 1cm" or "between 1cm and 2cm" 993 Described as "less than 3cm" or "greater than 2cm" or "between 2cm and 3cm" 994 Described as "less than 4cm" or "greater than 3cm" or "between 3cm and 4cm" 995 Described as "less than 5cm" or "greater than 4cm" or "between 4cm and 5cm" 996 Described as "less than 6cm" or "greater than 5cm" or "between 5cm and 6cm" 997 Described as "more than 6cm" 999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Nasal Cavity CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head and Neck (Revised: 12/30/2009) Note 1: This CS Site-Specific Factor is obsolete beginning with CS Version 2 (codes and notes). Old data are retained, but new cases are not coded with this Factor. Use code 988 for this field. Note 2: the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in this field. Note 3: A statement of the presence or absence of extracasular extension in a pathology report takes priority over clinical assessment. However, if the pathology report contains no statement about extracapsular extension, either positive or negative, the clinical assessment should be coded. If nodes are involved but there is neither a clinical assessment of extranodal extension nor a statement about it in the pathology report, use code 999. Note 4: According to AJCC (page 24), "Imaging studies showing amorphous speculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Note 5: CS Site-Specific Factor 2 is obsolete beginning with CS Version 2 (codes and notes). Old data are retained, but new cases are not coded with this Factor. Use code 988 for this field. 000 OBSOLETE DATA RETAINED V0200 No extracapsular extension 29 April 2010 Part II - Upper Respiratory - 13 Version

14 001 OBSOLETE DATA RETAINED V0200 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically 005 OBSOLETE DATA RETAINED V0200 Extracapsular extension present pathologically 888 OBSOLETE DATA CONVERTED V0200 See code 987 Not applicable; no lymph node involvement 987 OBSOLETE DATA CONVERTED AND RETAINED V0200 Data converted from code 888 Not applicable; no lymph node involvement 988 Not applicable: Information not collected for this case 999 OBSOLETE DATA RETAINED V0200 Unknown if regional lymph node(s) involved, not stated Regional lymph nodes cannot be assessed Nasal Cavity CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. 000 No lymph node involvement in Levels I, II, or III 100 Level I lymph node(s) involved 010 Level II lymph node(s) involved 001 Level III lymph node(s) involved 110 Level I and II lymph nodes involved 101 Level I and III lymph nodes involved 011 Level II and III lymph nodes involved 111 Level I, II and III lymph nodes involved 29 April 2010 Part II - Upper Respiratory - 14 Version

15 999 Unknown if regional lymph node(s) involved, not stated Regional lymph nodes cannot be assessed Nasal Cavity CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. 000 No lymph node involvement in Levels IV or V or retropharyngeal 100 Level IV lymph node(s) involved 010 Level V lymph node(s) involved 001 Retropharyngeal nodes involved 110 Level IV and V lymph nodes involved 101 Level IV and retropharyngeal nodes involved 011 Level V and retropharyngeal nodes involved 111 Level IV and V and retropharyngeal lymph nodes involved 999 Unknown if regional lymph node(s) involved, not stated Regional lymph nodes cannot be assessed Nasal Cavity CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note 1: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Note 2: Facial nodes including buccinator, mandibular, and nasolabial lymph nodes. 000 No lymph node involvement in Levels VI or VII or facial nodes 29 April 2010 Part II - Upper Respiratory - 15 Version

16 100 Level VI lymph node(s) involved 010 Level VII lymph node(s) involved 001 Facial lymph node(s) involved 110 Level VI and VII lymph nodes involved 101 Level VI and facial nodes involved 011 Level VII and facial nodes involved 111 Level VI and VII and facial lymph nodes involved 999 Unknown if regional lymph node(s) involved, not stated Regional lymph nodes cannot be assessed Nasal Cavity CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular Lymph Nodes, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. 000 No involvement of any group: Parapharyngeal lymph nodes Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes Suboccipital/retroauricular lymph nodes 100 Parapharyngeal lymph node(s) involved 010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved 001 Suboccipital/retroauricular lymph node(s) involved 110 Involvement of two groups: Parapharyngeal lymph nodes Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes 101 Involvement of two groups: Parapharyngeal lymph nodes Suboccipital/retroauricular lymph nodes 011 Involvement of two groups: Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes Suboccipital lymph nodes 29 April 2010 Part II - Upper Respiratory - 16 Version

17 111 Involvement of three groups: Parapharyngeal lymph nodes Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes, Suboccipital/retroauricular lymph nodes 999 Unknown if regional lymph node(s) involved, not stated Regional lymph nodes cannot be assessed Nasal Cavity CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels (Revised: 03/30/2009) Note 1: AJCC requires that nodes be designated as involving upper or lower levels within the neck. The boundary between upper and lower levels is the lower border of the cricoid cartilage. Note 2: Nodes in Levels I, II, and III are upper level nodes. Nodes in Level IV and VII are lower level nodes. Level VA nodes are upper level nodes, and Level VB are lower level nodes. Level VI nodes span both upper and lower levels. Nodes included in "Other groups" (Facial, Parotid, Parapharyngeal, Retropharyngeal, Retroauricular, and Suboccipital) are all upper level nodes. Note 3: the location of nodal involvement in relation to the lower border of the cricoid cartilage of all involved nodes, whether assessed clinically or pathologically, as stated by a physician. Note 4: If there is no physician statement of upper and/or lower level nodal involvement, assign levels I, II, III, and VA nodes to upper level. Assign level IV, VB, and VII to lower level. If Level V (A and B not specified) and/or Level VI nodes are involved with no further information about location, use code 040. Note 5: A description of "mid neck" requires clarification with the physician. 040, unknown level, if "mid neck" is the only information available. 000 No lymph nodes involved 010 Upper level lymph nodes involved (all involved nodes above the lower border of the cricoid cartilage) 020 Lower level lymph nodes involved (all involved nodes below the lower border of the cricoid cartilage) 030 Upper and lower level lymph nodes involved (all involved nodes both above and below the lower border of the cricoid cartilage) 040 Unknown level lymph nodes involved (unable to determine if involved nodes above or below the lower border of the cricoid cartilage) 988 Not applicable: Information not collected for this case 999 Unknown if regional lymph node(s) involved, not stated 29 April 2010 Part II - Upper Respiratory - 17 Version

18 Nasal Cavity CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and Neck (Revised: 10/16/2009) Note 1: the status of extracapsular extension accessed clinically for any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extensio in any nodes coded in CS Mets at DX in this field. Note 2: If nodes are involved clinically, and documentation of physical examination or imaging is available without a statement of extracapsular extension, use code 010. Note 3: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular extension, use code 030. Note 4: If there is no information about clinical assessment of nodes, use code 999. Note 5: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS can be diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence of cranial nerve tissue. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and stranding of the perinodal soft tissue in previously untreated patients." 000 No lymph nodes involved clinically 010 Nodes involved clinically, no extracapsular extension clinically 020 Nodes involved clinically, extracapsular extension clinically (nodes described as fixed or matted) 030 Nodes involved clinically, unknown if extracapsular extension 988 Not applicable: Information not collected for this case 997 Clinical examination of lymph nodes performed, unknown results 998 No clinical examination of lymph nodes 999 Unknown if regional lymph node(s) involved clinically, not stated Regional lymph nodes cannot be accessed Nasal Cavity CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note 1: the status of extracapsular extension assessed pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in this field. Note 2: If nodes are involved pathologically but there is no statement of extranodal extension in the pathology report, use code 010. Note 3: "microscopic" or "macroscropic" extranodal extension as stated in the final diagnosis. If not stated in the final diagnosis, code "microscopic" if extranodal extension is described only in the microscopic section of the pathology report and "macroscopic" if extranodal extension is described in the gross section of the pathology report. Note 4: "Macroscopic" extension takes priority over "microscopic" extension. Note 5: Use code 040 if pathologic extracapsular extension is described with no further information and the pathology report is not available for review. Note 6: Use code 050 if nodes involved pathologically with no further information about extracapsular extension. 000 No lymph nodes involved pathologically 29 April 2010 Part II - Upper Respiratory - 18 Version

19 010 Nodes involved pathologically, no extracapsular extension pathologically 020 Nodes involved pathologically, MICROSCOPIC extracapsular extension pathologically 030 Nodes involved pathologically, MACROSCOPIC extracapsular extension pathologically 040 Nodes involved pathologically, extracapsular extension pathologically, unknown if microscopic or macroscopic 050 Nodes involved pathologically, unknown if extracapsular extension 988 Not applicable: Information not collected for this case 997 Pathologic examination of lymph nodes performed, results not available 998 No pathologic examination of lymph nodes 999 Unknown if regional lymph node(s) involved pathologically, not stated Nasal Cavity CS Site-Specific Factor 10 HPV (Human Papilloma Virus) Status (Revised: 10/12/2009) Note 1: There is evidence that human papilloma virus (HPV) plays a role in the pathogenesis of some cancers. Note 2: Record the results of any HPV testing performed on pathologic specimens from the primary tumor or a metastatic site, including regional nodes. HPV testing may be performed for prognostic purposes; testing may also be performed on metastatic sites to aid in the determination of the primary site. Note 3: The highest risk HPV types are types 16 and 18. Other high risk types are 31, 33, 35, 36, 45, 51, 52, 56, 58, 59, 68, 26, 53, 66, 67, 69, 70, 73, 82, 85 Low risk types are 6, 11, 32, 34, 40, 42, 44, 54, 61, 62, 64, 71, 72, 74, 81, 83, 84, 87, 89. The HPV vaccine is designed to protect against types 16 and 18 (associated with cervical cancer) and types 6 and 11 (associated with genital warts). Note 4: High risk may be abbreviated "hrhpv" or "HR-HPV". Note 5: Some tests for HPV, such as a hybrid capture test, only report negative or positive for high risk HPV without identifying types; use codes 025 and 050, respectively to report those test results. 000 HPV test negative; not positive for any HPV types Negative, NOS 010 LOW RISK positive (all positive type(s) are low risk) 020 HIGH RISK positive, specified type(s) other than types 16 or 18, WITH or WITHOUT positive results for low risk type(s) 030 HIGH RISK positive for HPV 16 WITHOUT positive results for HPV 18 or positivity of HPV 18 unknown, WITH or WITHOUT positive results for other high-risk types, WITH or WITHOUT positive results for low risk type(s) 040 HIGH RISK positive for HPV 18 WITHOUT positive results for HPV 16 or positivity of HPV 16 unknown, WITH or WITHOUT positive results for other high-risk types, WITH or WITHOUT positive results for low risk type(s) 29 April 2010 Part II - Upper Respiratory - 19 Version

20 050 HIGH RISK positive for HPV 16 AND HPV 18, WITH or WITHOUT positive results for other high-risk types, WITH or WITHOUT positive results for low risk type(s) 060 HIGH RISK positive, NOS, type(s) not specified 070 Positive, NOS, risk and type(s) not stated 988 Not applicable: Information not collected for this case 997 Test ordered, results not in chart 998 Test not done (test was not ordered and was not performed), including no pathologic specimen available for HPV testing 999 Unknown or no information Nasal Cavity CS Site-Specific Factor 11 Measured Thickness (Depth) (Revised: 11/15/2009) Note 1: MEASURED THICKNESS (Depth) of the invasive tumor not size, diameter, or any other measurement. Record the actual measurement in tenths of millimeters as stated on the pathology repot. Do not record the measurement from a radiographic report. Note 2: Record the measurement labeled specifically as thickness or depth of tumor. In the absence of a label,use the "cut surface" dimension, or the third dimension from a description of 3 dimensions (N1 x N2 x N3). For example, from a tumor size recorded as 2cm x 1cm x 0.5cm, record No mass/tumor found Exact thickness in tenths of millimeters Examples: millimeter millimeter millimeters millimeters, 1 centimeter millimeters millimeters or larger 987 Not applicable, in situ carcinoma 988 Not applicable: Information not collected for this case 990 Microinvasion Microscopic focus or foci only; no depth given 998 No surgical specimen 999 Unknown, thickness not stated 29 April 2010 Part II - Upper Respiratory - 20 Version

21 Nasal Cavity CS Site-Specific Factor 12 (Revised: 06/30/2008) Nasal Cavity CS Site-Specific Factor 13 (Revised: 06/30/2008) Nasal Cavity CS Site-Specific Factor 14 (Revised: 06/30/2008) Nasal Cavity CS Site-Specific Factor 15 (Revised: 06/30/2008) Nasal Cavity CS Site-Specific Factor 16 (Revised: 02/23/2009) Nasal Cavity CS Site-Specific Factor 17 (Revised: 02/23/2009) Nasal Cavity CS Site-Specific Factor 18 (Revised: 02/23/2009) 29 April 2010 Part II - Upper Respiratory - 21 Version

22 Nasal Cavity CS Site-Specific Factor 19 (Revised: 02/23/2009) Nasal Cavity CS Site-Specific Factor 20 (Revised: 02/23/2009) Nasal Cavity CS Site-Specific Factor 21 (Revised: 02/23/2009) Nasal Cavity CS Site-Specific Factor 22 (Revised: 02/23/2009) Nasal Cavity CS Site-Specific Factor 23 (Revised: 02/23/2009) Nasal Cavity CS Site-Specific Factor 24 (Revised: 02/23/2009) Nasal Cavity CS Site-Specific Factor 25 (Revised: 02/23/2009) 29 April 2010 Part II - Upper Respiratory - 22 Version

23 Malignant Melanoma of Nasal Cavity C30.0 M C30.0 Nasal cavity (excludes nose, NOS C76.0) Laterality must be coded for this site, except subsites Nasal cartilage and Nasal septum, for which laterality is coded 0. CS Tumor Size CS Extension CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval Reg LN Pos Reg LN Exam CS Mets at DX CS Mets Eval CS Site-Specific Factor 1 Size of Lymph Nodes CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head and Neck CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular Lymph Nodes, Lymph Nodes for Head and Neck CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and Neck CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head and Neck CS Site-Specific Factor 10 HPV (Human Papilloma Virus) Status CS Site-Specific Factor 11 Measured Thickness (Depth) CS Site-Specific Factor 12 CS Site-Specific Factor 13 CS Site-Specific Factor 14 CS Site-Specific Factor 15 CS Site-Specific Factor 16 CS Site-Specific Factor 17 CS Site-Specific Factor 18 CS Site-Specific Factor 19 CS Site-Specific Factor 20 CS Site-Specific Factor 21 CS Site-Specific Factor 22 CS Site-Specific Factor 23 CS Site-Specific Factor 24 CS Site-Specific Factor 25 The following tables are available at the collaborative staging website: Histology Inclusion Table AJCC 7th ed. Histology Exclusion Table AJCC 6th ed. AJCC TNM 7 Stage AJCC TNM 6 Stage Summary Stage Malignant Melanoma of Nasal Cavity CS Tumor Size (Revised: 02/03/2010) 000 No mass/tumor found 29 April 2010 Part II - Upper Respiratory - 23 Version

24 millimeters (code exact size in millimeters) millimeters or larger 990 Microscopic focus or foci only and no size of focus given 991 Described as "less than 1 cm" 992 Described as "less than 2 cm," or "greater than 1 cm," or "between 1 cm and 2 cm" 993 Described as "less than 3 cm," or "greater than 2 cm," or "between 2 cm and 3 cm" 994 Described as "less than 4 cm," or "greater than 3 cm," or "between 3 cm and 4 cm" 995 Described as "less than 5 cm," or "greater than 4 cm," or "between 4 cm and 5 cm" 999 Unknown; size not stated Malignant Melanoma of Nasal Cavity CS Extension (Revised: 01/10/2010) Note 1: AJCC does not include a Tis or TX category for melanoma of mucosa of head and neck sites. Extension codes of 000 and 999 will be mapped to NA and AJCC stage group will be derived as NA. Note 2: AJCC does not include a T1 or T2 category for mucosal melanoma of head and neck sites. Note 3: The bones of the lateral wall of the nasal cavity include the maxilla, the perpendicular plate of the palatine bone, the medial pterygoid plate, the labyrinth and inferior concha of the ethmoid. The roof of the nasal cavity is formed by the nasal bone. The floor of the nasal cavity, which forms the roof of the mouth, is composed of the bones of the hard palate: the horizontal plate of the palatine bone posteriorly and the palatine process of the maxilla anteriorly. Note 4: "Bony invasion" does not include extension to palate, cribriform plate, or pterygoid plates. Extension to these structures is coded separately. Note 5: Base of skull NOS only if no information is available to code to more specific bony structures in the skull. Note 6: Use code 300 for localized tumor ONLY if no information is available to assign code 105, 110, 200, or 350. Note 7: Use code 350, 725, 810, or 815 if the physician's assignment of T category is the ONLY information available about the extent of the tumor. TNM 7 TNM 6 SS77 SS In situ; non-invasive NA NA IS IS 100 OBSOLETE DATA RETAINED V0200 ERROR NA L L Invasive tumor confined to site of origin Meatus (superior, middle, inferior) Nasal chonchae (superior, middle, inferior) Septum Tympanic membrane 29 April 2010 Part II - Upper Respiratory - 24 Version

25 TNM 7 TNM 6 SS77 SS Tumor confined to mucosal of one of the following subsites: Septum Floor Lateral wall, including meatus (superior, middle, inferior) and nasal conchae (superior, middle, inferior) Vestibule (edge of naris to mucocutaneous junction) Without bony invasion 110 Confined to mucosa of nasal cavity NOS without bony invasion 200 Tumor confined to mucosa of two or more subsites listed in code 105 WITHOUT bony invasion T3 NA L L T3 NA L L T3 NA L L 300 Localized, NOS T3 NA L L 330 Extension to mucosa of adjacent regions: Ethmoid sinus Choana Frontal sinus Nasopharynx Without bony invasion 340 Extending to mucosa of further adjacent regions Maxillary sinus Sphenoid sinus WITHOUT bony invasion 350 Stated as T3 NOS with no otherinformation on extension 380 Involvement of deep tissues of any structure in code 105, 110, or T3 NA RE RE T3 NA D D T3 NA L L T4a NA L L T4a NA RE RE (Involvement of deep tissues of any structure in code 105, 110, or Mucosal involvement of any structure in code Involvement of any structure in code 105, 110, or 200 with bony invasion 400 Extending to adjacent connective tissue within the nasoethomoidal complex Nasolacrimal duct T4a NA RE RE T4a NA RE RE 450 Hard palate T4a NA RE RE 29 April 2010 Part II - Upper Respiratory - 25 Version

26 TNM 7 TNM 6 SS77 SS (385, 390, 400, or 450) T4a NA D D (Involvement of any structure in code 385, 390, 400, or Mucosal involvement of any structure in code Involvement of deep tissues or bony involvement of any structure in code OBSOLETE DATA RETAINED V0200 T4a NA D D ERROR NA RE RE Adjacent organs/structures including: Bone of skull Choana Frontal sinus Hard palate Nasopharynx 650 OBSOLETE DATA CONVERTED V0200 See code 750 ERROR ERROR ERROR ERROR Cribiform plate 660 OBSOLETE DATA RETAINED V0200 ERROR NA RE RE Maxillary sinus 670 Medial wall or floor of the orbit T4a NA D D 700 OBSOLETE DATA RETAINED V0200 ERROR NA D D Tumor invades: Anterior orbital contents Skin of nose Skin of cheek Minimal extension to: Anterior cranial fossa Pterygoid plates Sphenoid or frontal sinuses 705 Tumor invades Anterior orbital contents Skin of nose Skin of cheek Pterygoid plates 710 OBSOLETE DATA RETAINED V0200 T4a NA D D ERROR NA D D Tumor invades Orbital apex Dura Brain Middle cranial fossa Cranial nerves other than (V2),nasopharynx, or clivus 29 April 2010 Part II - Upper Respiratory - 26 Version

27 TNM 7 TNM 6 SS77 SS Stated as T4a with no other information on extension T4a NA L L 750 Anterior cranial fossa Cribriform plate Clivus Middle cranial fossa Skull base (705, 670, 340, or 500) T4b NA RE RE T4b NA D D (Involvement of structures in code Involvement of structures in code 705 or 670 or any involvement of structures in code 340) 800 Contiguous extension including Orbital apex Dura Brain Middle cranial fossa Cranial nerves (IX, X, XI, XII) 801 Further contiguous extension including Masticator space Carotid artery (encased) Prevertebral space Mediastinal structures T4b NA D D T4b NA D D 810 Stated as T4b with no other information on extension T4b NA D D 815 Stated as T4 NOS with no other information on extension 950 OBSOLETE DATA RETAINED V0200 No evidence of primary tumor 999 Unknown extension Primary tumor cannot be assessed T4NOS NA L L ERROR NA U U NA NA U U Malignant Melanoma of Nasal Cavity CS Tumor Size/Ext Eval (Revised: 11/13/2009) Staging Basis 7 Staging Basis 6 0 Does not meet criteria for AJCC pathologic staging: c No surgical resection done. Evaluation based on physical examination, imaging examination, or other non-invasive clinical evidence. No autopsy evidence used. 29 April 2010 Part II - Upper Respiratory - 27 Version

28 Staging Basis 7 Staging Basis 6 1 Does not meet criteria for AJCC pathologic staging: c No surgical resection done. Evaluation based on endoscopic examination, diagnostic biopsy, including fine needle aspiration biopsy, or other invasive techniques, including surgical observation without biopsy. No autopsy evidence used. 2 Meets criteria for AJCC pathologic staging: p No surgical resection done, but evidence derived from autopsy (tumor was suspected or diagnosed prior to autopsy) 3 Either criteria meets AJCC pathologic staging: p Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation OR surgical resection performed, unknown if pre-surgical systemic treatment or radiation performed AND Evaluation based on evidence acquired before treatment, supplemented or modified by the additional evidence acquired during and from surgery, particularly from pathologic examination of the resected specimen. No surgical resection done. Evaluation based on positive biopsy of highest T classification. 5 Does not meet criteria for AJCC y-pathologic (yp) staging: c Surgical resection performed AFTER neoadjuvant therapy and tumor size/extension based on clinical evidence, unless the pathologic evidence at surgery (AFTER neoadjuvant) is more extensive (see code 6). 6 Meets criteria for AJCC y-pathologic (yp) staging: yp Surgical resection performed AFTER neoadjuvant therapy AND tumor size/extension based on pathologic evidence, because pathologic evidence at surgery is more extensive than clinical evidence before treatment. 8 Meets criteria for autopsy (a) staging: a Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy) 9 Unknown if surgical resection done Not assessed; cannot be assessed Unknown if assessed c 29 April 2010 Part II - Upper Respiratory - 28 Version