SU._IMARY STAGING GUIDE
For
The Cancer Surveltt_nce, Epidemlotogy _n_
End Re_utts Reporting (SEER) Program
Apri[, 1977
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SUqMARY STAGING GUIDE
Edited by
Evetyn q. Shambaugh= M.A.Fietd Liaison Section= Biometry BranchNationat Cancer Institute
Bethe_da, Ma ry]Land
Mitdred A. Weiss, Bo ?_.
UCLA Tumor Registry
University of Catlfornla at Los Angetes
Los Angetes, Catlfornla
Littian _. Axtett, M.A.
End Resutts Section, Biometry BranchNationat Cancer Institute
Bethesda, MaPytand
_edicat Consuttants
Robert F. Ryan, M,D.= Chalrn_nDepartment of Surgery
Tutane University Schoot of Medicine
New Orteans= Louisiana
Chartes E. Ptatz= M.D.
Department of Pathotogy, Cortege of MedicineUniversity of Iowa
iowa City, Iowa
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FOREWARD
For ease in coding, the SEEP _rogram favors the expanded extent of
disease schemes. They act as a guide to comptete veportin_= and they
Indicate the usuat progression of disease patterns. Often, however,
comparisons are necessary with historicat or other series for which
onty generat staging categories are avaltable. Therefore, this staging
guide was devetoped which summarizes the expanded extent of disease cate-
gories into three generat staging groups (i.e., tocatized, reglonat, and
distant ). Sometimes a series is so smart that onty generat categories
produce enough cases for a meaningfut anatysis. Many conditions may" be
grouped together which may seem incongruous, but such groupings are
unavoidable if the extent of disease codes are to be summarized into
three or four staging categories. Stage categories are based on a
combination of ctinicat observations and operative-pathotogicat evat-
uations. The priority order is pathotogic, operative, ctinicat.
In order to make the staging groups, insofar as we are abte, con-
sistent with categories devetoped by the American Joint Committee for
Cancer Staging and End Resu[ts Reporting (AJC) and by the Internationat
Unioo Against Cancer (UICC) and to give cons|der_tion to the prognos-
tic significance (survivat probabitlty) of various factors, a groupin3
subdividing the tocattzed, regionat, and distant categories was neces-
sary. The subdivisions can atways be summarized into the three famitiar
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stage categories--tocatizedj regionalL, and distant, or other a]Lternstive
groupings. For exampte, for co[on and rectum "confined to the mucnss"
is coded L . These cases can then be lnctuded with either the "in situ w
1
or the "[)catized" stage of disease depending on the rutes o¢ the series
with which the comparison is being made. For metanoms, tocstized cases
are subdivided into four groups (L through L ) In order to indicate1 4
Ctark's revers of invasion. Sites considered to be distant invotvement
by direct extension are coded D as distinct from D or D which are1 2 3
reserved for metastatic Invotvement.
TABLE OF CONTENTS
FOR
SUMMARY STAGING GUIDE
Page
Organization of Summary Staging Guide
Site-Specific Staging Guides for:
Upper tip ( 400, 403 ) 9
Lower tlp ( 401, 404) 11
Commissure of tip (406) 13
Base of tongue (410) 15
Anterior 2/3 tongue (411-414, 416) 17
Parotid grand ( 420 ) 19
Submandtbutar gt_and (421) 21
Upper gum (430) 23
Lower gum and retromo_ar trigone (431, 436) 25
Ftoor of mouth (440, 441, 4¢8, 449) 27
Cheek m_cosa and vestlbute of mouth (450, 451 ) 31
lJard patate (452) 33
Soft palate and uvula (453, 454 ) 35
Oropharynx (460-469) 39
Nasopharynx ( 470-47.3, 478-479) 43
Hypopharynx (480-483,488-489) 0,5
Cervicat or upper esophagus ( 500, 503 ) 47
Thoracic or middte esophagus (501, 504) _9
- vi -
Pa_e
Abdominal or lower esophagus (502, 505) 51
Stomach s ( excluding cardioesophagea[ 53
Junction) (510-516, 518-519)
Duodenum (520) 57
JeJunum and [teum (521. 522) 61
Cecum (534) 63
Ascending co[on (536) 65
Transverse coton, intruding hepatic and 59sptenic ftexures (530, 531, 537)
Descending coton (532) 73
Slgmold coton (533) 75
Rectosigmoid Junction ( 540 ) 79
Rectum ( 541 ) _3
Ana[ canal and anus, NOS (542. 543 ) 87
Liver and lntrahepatic bite duct (550, 551 ) _8
a[tbtadder ( _60 ) 91
Extrahepatic bite duct ( 561, 562 ) 92
Head of pancreas (570) 93
Body and talt of pancreas (571, 572 ) 94
Larynx (610-612) 97
Bronchus and tung, extruding carina (622-625, 528-529) 99
Bone ( 700-709 ) 102
Matignant metanoma of skin (730-737, 84t-84_, 105
871 -872, 874 ; histotogy 872 thru 879 )
Skin other than metanoma (730-737) 107
Breast ( 740-749, 759 ) 111
Cervix uteri (800-801, 808-809) 115
Corpus uteri ( 820-821, 828 ) I I 7
Ovary (830) |19
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TABLE OF CONTENTS
Page
Fattopian tube (832) 120
Vagina (840) t21
Vutva. including skin of vutva (841-844) 123
Prostate (859) 125
Testis (850, 869 ) 129
Penis, inctuding skin of penis (871, 872, 874) 130
Bradder (880-886, 888-889 ) 133
Kidney (rena_) parenchyma (890) 135
Rena[ (kidney) pe[vis (891) 136
Ureter ( 892 ) 138
Thyroid grand (939) 139
Lymph nodes and tymphoid tissue (960-969, I @1
416, 460_, 471, 491, 640. 692;
histotogy 959 %hPu 969, 975 )
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OR_.ANIZATION OF SUMMARY STAGING GUIDE
I, Summary staging definitions
IN SITU: lntraepithetiat, noninvasive, nonlnfittr_ting
LOCALI ZF_DD: Within organ
_o Invaslve cancer confined to the organ
of origin
bo Intratumlnat extension where specified
For example, intratuminat extension to
immediatety contiguous segments of the
targe bower is coded L untess the3
invaded segment has an identitiabty
different pattern ot tymph node drain-
agee
RE_I_O_N_AL: Beyond the organ of orlgin
_. By direct extension to adjacent organs/tissues
bo To regional tymph nodes
c. (a) and (b)
DISTANT: Direct extension or metastasis
a. Direct continuity to organs other than above
b. Discontinuous metastasis
c. To distant lLymph nodes
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[[. Site definitions
The internatlona[ Classification of Diseases for Ontology (ICD-O)
codes are included at the top of the page for each scheme, how-
ever, the first digit (I) has been dropped in compliance with the
practice of the SEER program.
I[[. Summary stagJng guide
A o Site-Specific staging schemes ( See pages 8 thro_h 141 )
Bo Nonspecific staping scheme
In s|tu
Localized
Regional, direct extension only
Regional, nodes only
Regional s direct extension and reglonl [ nodes
Regional, NOS
Non-locall zed, NOS
Distant
Unsta@ed
Thls nonspecific sta_ing scheme applies to the fotIowin_ nri-
mary sites:
ICD-O
Number PRIMARY SITE CODE
405 Mucosa of llps, NOS
40.8 Two or more cate_ories of tip
409 Lips, NOS
415 Junctions[ zone of tonglte
a 18 Two or more categories of tongue
419 Tongue, NOS
4?2 Subt ingua[ gland
428 Two or more categories of major salivary glands
429 Major salivary gland, NOS
4-_8 Two or more categories of Rum
439 Gum, NOS
45_ Palate, WOS
45.8 Two or more cate__ories of other parts of mouth
459 Orat cavity
- 2 -
490 Pharynx, NOS
491 WaLdeyer*s rings NOS
498 NeopLasms of tip, oral cavity and pharynx whose
point of origin cannot be assigned to any one of
the categories 40 through 48
499 ILL-defined sites in [lp. oral cavity, and pharynx
508 Junctions of esophagus
509 Esophagus, NOS
510 CardloesophageaL Junction (excLuding cardia ofs tomach )
523 Mecket*s diverticulum
528 _wo or more categories of the small intestine
529 S_,aLt intestine, bIOS
535 Appendix
538 ;wo or Lore categories of co£on
539 Coton, NOS
548 Other parts of rectum
568 Too or Bore categories of gaLLbLadder andextrahepatic bile ducts
569 BiLiary tract, NOS
573 Pancreatic duct
574 IsLets of Langerhans
578 two or more categories of pancreas
579 Pancreas, NOS
580 Retroperttoneum
588 _pecl£1ed parts of peritoneum
589 Peritoneum, NOS
590 Intestinal tract
598 Neoplasms of dl_estive organs and peritoneum whosepointe of origin cannot be assigned to any one of
the categories 50- through 58--
599 Gastrointestinal tract. NOS
600-605, 608, 609
Nas_[ cavities, accessory sinuses, middle ear sinner ear
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613 Laryngeal cartilage
618 Two or more categories of Larynx
619 Larynxs NOS
620 Trachea
622 Carina ( excluding main bronchus )
630 Parietal pleura
631 Visceral pleura
638 1[wo or more categories o£ pleura
639 PLeura • NOS
640--643. _48_ 649
Thymus and mediastinum (excLuding histology 959thru 969 )
650• 658o 65_
Other and iLt--defLned sites within respiratory
system and intrathoracic organs
690--691, 699
BLood• bone marrow (hematopoietic system)
692 SpLeen (excluding histology 959 thru 969. 975 )
693 Retlcutoendotbe_lat system• NOS
710• 712-719Connective tissue and other soft tissue
738 Two or more categories of skin (metanoticand nonmeLanotic)
739 Skin, NCS (meLanottc and nonmeLanotic)
799 Uterus• NOS
819 P_Lacenta
833 Broad Ligament834 Parame trium
835 Round Ligament838 Other uterine adnexa
839 Uterlne adnexa
848 Two or mope categories of other and unspecified
lemate genital organs
849 FemaLe genital tract, NOS
873 Body of penis
875 Epididymls
876 Spe rmatic cord
877 Scrotums NOS
878 Other parts of maLe genital organs
879 MaLe genital tract, NOS
- 4 -
887 Urachu_
893 Urethra
894 Paraurethra[ grand
898 Two or more categories of other urinary organs
899 grlnary system, NOS
900-909
Eye and [acrimat grand
910-919
Brain
920-923, 928, 929Other and unspecified parts of nervous system
940, 941, 943-946, 948, 949
Other endocrine glands
950-955, 958 Other it]L-defined sites
909 Unknown primary site
- 5 -
IV, Definition of Anatomic Sites Within The Orat Cavity
&ccordtng To The American Joint Committee on Cancer Sta_tng
LIPS, upper and tower, form the upper and tower anterior watt of the _rat
cavity. They consist of an exposed surface of modified epidermis coamon[y
referred to as the vermitton surface, which extends from commissure to
commissure and the mucous membrane tining the inner surface of the tips.
COMMISSURE OF LIP is the point of union of upper and tower tips (coraerof mouth).
POSTERiOR ONE-THIRD OF TONGUE (base of tongue) consists of the tess mohlte
portion of the tongue which extends infertorty from the fine of circum-
vattate papittae to the base of the epigtottis, the pharyngoeplgtottlc andgtossoepigtottic fords (which bound the vatfecuta).
ANTERIOR TWO-THiRDS OF TONGUE consists of the freety movabte portion of the
ton_n_e which extends anteriorty from the fine of c ircumvattate papitta_ to the
root of the tongue st the Junction of the ftoor of the mouth. It is composed
of fnur areas: ( 1 ) Tip, ( 2 ) Laterat borders, ( 3 ) Dorsum, _nd ( • ) Un:[ersurface(non-vlttous surface).
FLOOR OF MOUTH consists of a semitunar shaped space over the mytohyold and
hypo_tossus musctes, extending from the inner surface of the tower stv_otar
ridge to the root of the tongue. Its posterior boundary is the base of the
anterior pittsr of the tonsit. It is divided into two sides by the fr_nutum
of the tongue and contains the ostia of the submaxittary and tinguat sativary
gt ands.
LOWER _[N_,IVA intrudes the atveotar process of the mandibte and its covering
mucosa, which extends from the fine of attachment of mucosa in the buccat
gutter to the fine of free mucosa of the ftoor of the mouth. Posteriorty" it
extends to the ascending taBUS of the mandibte (retromotar trigone)o
UPPF. R _[N_IVA is the covering mucosa of the upper atveotar ridge, extending
from the fine of attachment of mucosa in the upper ginglvat buccat gutter
to the Junction with the hard patate. Its posterior margin is the
upper end of the pterygopaTatine arch.
BUC_.._L _[UCOSA inctudes aft the mucous membrane tining the inner surface ofthe c heek°
I{ARD P_LATE consists of the semitunar are_ between the upper atveoLar rLdges
and the mucous membrane covering the patatine process of maxtttary pststine
bones. It extends from the inner surface of the superior atveo|ar ridge
to the posterior edge of the palatine bone°
SOFT P&LATE consists of mucosa covering the orat cavity sl_e of the patatlne
muscles and extends from the posterior edge of the hard pstate to the free
border of the soft patate and inctudes the -,vuta. Its superior taterat
margin is the pterygomandibutar raphe. The Inferior taterat m_rgincomptetes the fauciat arch (gtossoDatatine arch) and inct-des the anterior
surface of the anterior tonsittar plttar.
- 6 -
NASODH&RYNX
Posterior Superior Watt (vautt) extends from the superior border of thechoana to the fever of the free border of the soft patateo The t_tera[
timtt is the _roove between the taterat watt and the base of the skutt.
Laterat Watt extends from the base of the skutt on each side to the revel
of the free border of the soft patate. It intrudes Rosenmutter's fossae
( pharynges t recesses).
OROPHARY_IX
Posterior WaLL extends from the free borders of the soft palate to the
tip of the epigtottis.
Laterat Watt intrudes the tonsittar pittars, tonslttar fossae, and tonsilSo
Anterior Watt consists of the tinguat (anterior) surface of the epigtot-
tis, and the pharyn_oeplgtotttic and gtossoeplgiottic fords which boundthe vat recurs.
HYPOPHA RYNX
Pyriform Slaus extends from the pharyngoepigtottic ford to the upper e_ge
of the esophagus, between the inner surface of the thyroid cartltage andthe posterior t_terat surface of the arytenoid and crtcoid cartl[ageSo
Post-Crlc_ld Area extends from the posterior surface of the arytenoid
cartltages and their connecting fo]Lds to the Inferior surface of the
crtcoid° The t_terst margin Is the anterior part of the pyriform sinus.
Posterior Pharyngeat Walt extends from the fever of the tip of the epi-
gtottis to the inferior margin of the crlcoid cartttage, and tateratty
to the posterior margins of the pyriform sinus.
- 7 -
VERMILION SURFACE OF UPPER LIP
Vermil ion surface-___.
,Subcutaneous tissue
,___Commissure )_-- MuscleSkin _-Labial mucosa'"----"--- ''"Lower lip
_ _Gingiva
-8-
UPPER LIP Aprl(, 1977
400, 403
IN SITU; nontnvaslve
LOCALIZED ([nva.qion, but not to muscle)
Vermttlon surface
Skin of tipLabiat m_cos_ ( inner lip)
Muttlpte foot but confined to vermition surface,
t_blat mucosa and/or skin
Locat ized, NOS
REG_I[._O_NAL, Direct Extension
R if:
l
Commissure(s) of tlps
L_wer tipMusc ttta ture
R if:2
Bucca[ muc6s_ (inner cheek)
Gtnglv_ _ upper
R if:3
Maxttta
Nose
I_GION_AL, Lymph Nodes
Facial: bucc Inator
Parot|d.- In _ra-aurtcut_r, preaur| cul _rSubment at
Submandlbutar (submaxittary)
DISTANT, Direct Extension or Metastasis
D[ST&NT, Lymph Nodes
Internat Jugula r
Upper cervicat (inctudtng cervtcat, NOS)
Supractavtcutar ( transverse cervicat )Other distant nodes
- 9 -
LOWER LIP
___--Vermil ion surface
REGIONAL NODES
1. Facial
2. Submental=
3. Submandibular
I 3
Mandible
Subcutaneous tissue/ Muscle/
Labial mucosa ( _ Upper lipSkin _ CommissureLower gingiva
\ -10-
LOWER LIP Apri[, 1977
401 , 404
IN _!_; noninvasive
LOCALIZED ( Invasion, but not to muscle )
Verm[ tion surface
Skin of tip
Labiat mucosa ( inner tip)
Ilultipte fool but confined to vermition surface,tabiat mucosa and/or skin
Locatlzeds NOS
BE__!Q_NAL, Direct Extension
R If:
1
Commlgsure(s ) of tlp.g
Upper [IpMuscuta ture
R if:?
Buccat mucosa (inner cheek)
Glngiva , tower
R if:
3
Mandl hte
_EG[ONAL, Lymph Nodes
Faciat: mandibutar
Subm en t at
Sub_andlbutar (_ubmaxlttary)
_DIST&NT, Direct Extension or Metastasis
DfSTA_/T__, Lymph Node._
Internat Juguta r
Upper cervicat (Intruding cervlcat, NOS)Supractavlcutar { transverse cervicat)Other distant nodes
- 11 -
COMMISSURE OF LIPS
Commissure
REGIONAL NODES
1. Facial
2. Parotid
3. Submental
4. Submandibular M_ 2
Mandible 4
.Subcutaneous tissue/ Muscle
)///Labial mucosa
Skin @_Upper gingiva
_--Lower gingiva
Vermil ion .___Upper lip
Surface ___kower lip
-12--
COMMISSURE 3F LIP &prt t, 1977406
IN SITU; noninv_sive
LOCALIZED
Vermitton surface
Skin of tip
Labl_t mucosa (inner tip)
Loca[ lzed, NOS
R_EEG_IO_NA_L, Direct Extension
if:1
Both tlpsMusc u ta ture
R if:
2
Bt_ccat mucosa (inner cheek)
GI ngiva
R if:3
Msxl tta
Mandlb[e
Nose
REGIONAL, Lymph Nodes
F_ciat: mandibutar
Paro rid: in fra-aurl cutar, pre_uri cut arSubment at
Sttb_andlbutar ( submsx|ILtary )
D__S!_A_NT, Direct Extension or Metastasis
DfST&NT, Lymph Nodes
Internat Jugutar
Upper cervtc_t (inctuding cervicat, NOS)Supractavlcutar ( transverse cervtcat)Other distant nodes
- 13 -
BASE OF TONGUE
Epiglottis
Glossoepiglottic fold/__ Vallecula
_ __] (__/-Pa latinePharyng°epigl°tticfold_
"5 tonsil _1 Lateral
_Tonsillar fossa 1" Pharyngealm_ _o_///-Glossopharyngeal sulcusl Wall
-- o° _'°Oo /_ Tonsillar pillar J
< Midline \ Soft palate,
-Uvula /
Epiglottis_Mandible -Hypo-
REGIONAL NODES pharynx
1. Submandibular
2. Upper cervical
3. Internal jugular
_ Upper g0ngtvi___!_o FloorSublingual f Mouth
gland_Lower gingiva
BASE OF TONGUE ApriL. 1977410
IN SITU; noninvastve
LO_AL!_ZE_DL if:
l
Confined to posterior 1/3 of tongue on one side
L if:2
Mldtine tumor; tumor has crossed mtdtine
L if:
x
LocaLized, NOS
R_E_G[O_NAL, Direct Extension
R if:1
Anterlor 2/3 of tongue
GI ngiva, bower
Subt i ngua t gland
R if:
2
Vattecuta, including pharyngoeptgtottic and gtossoepigtottic folds
Epiglottis, ltn&nutat (pharyngeal) surfaceFloor of mouth
Lateral pharyngeal walt ( tonsittar plTtar-q, tonsittar fossae,tonslls )
REGIONAL, Lymph Nodes
Submandlbutar (submaxillary)
Internal jugular: subdt gast tic
Upper cervlcat (IncLuding cervlcat j NOS)
DISTANTj Direct Extension or Metastasis
D if extension to:
I
Ma nd Ib I e
Larynx
F[Ypopha rynx
Soft palate, including uvula
D if:
2
Other distant invotvement
DISTANT, Lymph Nodes
Supractavtcutar ( transverse cervtcat )Other distant nodes
- 15 -
ANTERIOR % OF TONGUE
Palatine tonsil '_); ).y Glossopha_ngeal sulcusTonsillar fossa
Tonsillar pillar - .('/.Base of tongue_,nterior % of tongue
REGIONAL NODES Midline __1. Submandibular
2. Submental _- ___
3. Upper cervical _
4. Internal jugular
5. Sublingual
_Upper gingiva Hard
Ventral " ! 1_/ SoftpalPtleai- t
surface_ .--_-- I _ \
< '_ j// J _) Uvula / iSublingual __JFIoorofmouth }(
gland f \ _ _ /surface_, /fLower gingiva Dorsal
-16 -
ANTERIOR 2/3 OF TONGUE _prit, 19"77411-414o 416
IN_SI TU; nonlnva slve
LO_AL!_Z_E__L If:
l
Confined to anterior 1/3 of tongue on one sidewith or without Invasion of muscutature
L If:2
Mldtine tumor; tumor has crossed mldtine
L if:X
Local ized, NON
REGIO_NA_L, Direct Extension
R if:1
Ftoor of mouth
Base of tongue
Subtlngtm t gland
R If:
2
Gingiva, tower
R If:3
Mahdi bt e
REGION&L, Lymph Nodes
Submandtbutar (submaxillary)Submen t at
Internal JuguLar: subdigastric, supraomohyoidUpper cervicat (lnctuding cervlcat, NON)
Suht Inguat
DIST&NT, Direct Extension or Metastasis
D if extension to:
1
Lateral pharyngeal watt (tonslltar pillars, tonsittar fossae, tonsils)
Soft patate, Inctudlng uvuta
Maxi tta
D if:
2
Other distant tnvotvement
D!S_TANT_ , Lymph Nodes
Supractavicutar ( transverse cevvlcat )Other distant nodes
- 17 -
PAROTID GLAND
___ _Preauricular area\J/ ,_,'_---- External auditory meatus
Pgl_°tid_-= _--_ M_M astoid process
__f.Subauricular area _ ,oid
_-__Submandibular gland(q _muscte
\ Mandible DigaStcle_ ;te_rnocleidomastoid
scle
'terygoidmuscle
Facial nerve
__1_ _ __ Facial
aSScteer Maxillary ar
Carotid arte_ __Jugular v_in-
_,18-
PAROTID GLAND Apvit, 1977420
[N SITU; noninvasive
L_CALIZED
Fntirely within benign tumor capsute
Substance of parotid grand invaded
Muttipte loci but confined to substance of parotid grand
Locat ized, SOS
REGIONAL, Direct Extension
R If:
1
Perigtandular soft tissue
Nerve{ ._): faclat s auricular, spinal accessory
Ske[etat muscle(s)- digastric, sternocteidomastoid, masseter,
pie rygold, stytoidPerio.qteum of mandibte
Pharyngeal mucosa
Submandlbutar (_ubmaxittary) grand
R If:
2
Sk In
R if:3
Mandib[ e
,Major blood vessel(s): carotid artery, faciat artery or vein,
maxitLary artery, Jugutsr veln
Mastoid process
Externat auditory meatusSkut I
REG_ [ON?L L, Lymph Nodes
Parotid: Intra-parotid, infra-auricutar, preaurlcutarSub=andlbutar (submaxl ttary)
D_[S_T__N!_ , Direct Extension or Metastasis
DISTANT, Lymph Nodes
Upper cervlcat (including cervicat= NOS)
Supraciavicutar ( transverse cervicat )Other distant nodes
- 19 -
SUBMANDIBULAR GLAND
Submandibular MUSCLESgland
Pterygoid\ _ S_Stylohyoi dStyloglossus__
Digastric -_'_Z'__
Hy°gl°ssus /
\
1 _ Facial nerveParotid gland
Sublingual gland --- __
Facia/iartery _-__ -/ _ _T_ Lingual nerve
.oo s, . . _ ne 1. Submandibular
Maxilla_ _ 2. Submental
Mandible " -,,_ar_uryI 3. Cervical, NOS4. Upper jugular- 20 -
SUBMANDIBULAR GLAND ApriL, 1977(Sut_naxittary GLand)421
IN SITU; noninvasi ve
LOCALIZED
EntireLy within benign tumor capsule
Substance of parotid gland invaded
MuLtipLe foci but confined to substance of submandib_tar gland
Local lzed, NOS
_RE_O_I_O_N_AL,Direct Extension
R If:1
Perigtandutar soft tissue
SkeLetaL muscte(s ): digastric, mytohoid, stytohyoid, hyogtossus,
stytogt ossus; pterygoi dPertosteum of mandible
Parotid gland
Subtinguat gland
l_ If:
2
Nerve( s )
Major blood vesseL(s): facial artery or vein, maxillary _rteryMandibLe
REGIONAL, Lymph Nodes
Subment a t
Sub_andlbutar (submaxilLary)
Internal JuguLar (subdigastrlc)
Upper cervical ( including cervicaL, NOS )
DI_T__&_N_T, Direct Extension or Metastasis
DISTANT, Lymph Nodes
SupractavtcuLar (transverse cervicaL)Other distant nodes
- 21 -
UPPER GUM (GINGIVA)
Upper gingiva
Hard palate
t __Soft palate Muscle_'_- Uvula Submucosa
Buccal mucosa _/Gjngival
Upper gingiva mucosa
'_'--Labial mucosa
4. Internal jugular
5. Upper cervical
-22 ..
UPPER GUM (G[NG][VA) ApriL, 1977430
IN SLTU; nonlnvastve
LOCALIZED
L If:
I
Confined to mucosa
L if Invading:2
Lamina propria (mucoperiosteum)
L If:
x
Localized_ NOS
REG][ONAL, Direct Extension
R If:1
Ma x i t la
_ard and/or soft palateBuccat mucosa ( Inner cheek)
Labial mucosa, upper tip
R If:2
Lateral pharyngeal waiL[ ( tonsittar pillars, tonsittar fossae, tonsils )Soft tissue of face
REGIONAL, Lymph Nodes
FaciaL: mandlbutar
Sabmandtbular (submaxitlary)
Re tropharyngea t
Internal JugularUpper cervical (Including cervical, NOS)
DI_IAN'r , Direct Extension or Metastasis
D if extension to:1
Skin
Nasat cavity
Maxillary antrum (sinus)
Skutt, including ftoor of orbit
D if:2
Other distant |nvotvement
D[ST&NT, Lymph Nodes
Supraclavicutar (transver._e cervicat)Other distant nodes
- 23 -
LOWER GUM (GINGIVA)
Buccal mucosa
Mucosand -
Sublingual gla __ Floor of mouthSubmucosa Lower gingivaLabial mucosa
r_ ' _A_" ___ Palatine tonsil
oi_oo_ _ Tonsillar fossao t o%° )__Tonsillar pillar
i /
REGIONAL NODES1. Facial
2. Submandibular
3. Submental54. Internal
;"ljuuu,ar Mandible ___ .
5. Upper cervical i,_i_,- 2_- _
LOWEI_ GUM (GIHGIVA) April., 1977AND RETROMOLAR TRIGONE
431 • 456
IN SITU; noninvaslve
LOCALIZED
L if:
1
Confined to mucosa
L if invading:2
Lamina propria (mucoperiosteum)
L if:
x
Localized, NOS
___Q_I_O_NA_L,Direct Extens ion
R if:1
Mandible; periosteum of mandtbteFloor of mouth
Buccat mucosa ( inner cheek )
Labiat mucosa• tower lip
Tongue
R If:2
Lateral pharyngeal watt ( tonsittar pillars, tonsittar fossae, tonstts )
Soft palate, including uvulaSof_ tissue of face
REGIONAL, Lymph Nodes
FaciaL: mandibular
Subaandlhutar (submaxlttary)Subm ent _t
Internal Jugular= suhd[ gastric• supraomohyold
Upper cervical (including cervicat_ NOS)
DISTANT, Direct Extension or Metastasis
D if extension to:1
Skln
Skutt
D if:
2
Other distant involvement
DIS__A_b__, Lymph Nodes
Supractavicutar ( transverse cervical )
Other distant nodes
- 25 -
FLOOR OF MOUTH
__ Alveolar ridgeLower gingiva --_/'___Mucosa
//,,_//:J__ SubmucosaMandible _): _Sublingual gland
_._ __ -Submandibular gland
Epiglottis/ Glossoepiglottic fold
= _/--__jVallecula
/_ _) _'_j____ Phan/ngoepiglottic fold /_ _(o ;_ II
"6 Palatine tonsil _j=_ _,_[.._-_ Tonsillar Tossa _ _'a,a_e
\\___ _Glossopharyngeal sulcusnnIv _oU._ /f/_T ...... \ _ ..........
oOO I %'_ Ionsmarp.lar )-- ...............t
I | Soft PalateI / Glossopalatine archf_-_\
\ I / / -uvu ,"E
= _ 'l _ Phan/ngopalatine" archMidline
REGIONAL NODES ....
1. Submental ______ ff_
2. Submandibular _ _:3, Sublingual
4. Internal jugular
5. Cervical. NOS
- 26 -
FLOOR OF MOUTR ApriL, 1977
440,441,448,449
IN SITU; nonlnvaslve
LOCAL I ZED
L If:
1
Confined to mucosa on one side
L if:
2
Confined to one side:
Submuco s a invadedMuscu[s ture i nvsded
L if:3
Mld[lne tumor; tumor has crossed midLlne
L if:
x
Locat tzed, NOS
RE_G_!_O_NA_L, Direct Extension
R If:1
Gingiva, towerAnterior 2[3 of tongue
Submandibutar (submaxittary) gtand(s )
Subt lngua t grandPeriosteum of mandlbte
R If:2
Mandl_t e
Base of tongue
Vattecuta, intruding pharyngoepigtottlc and gtossoeoigtottic fords
R if:3
F_Dtgtottls, pharyngeal ( tingual ) surface
Laterat pharyngeat watt (tonstttar pittars, tonsittsr fossae, tonsits)Undertytng soft tissues
R if:4
Skin
- 27 -
FLOOI_ OF MOUTH ApeLL, 1977
440 j 441 • 448,449
RE__GI[ONA L, Lymph Nodes
Sub_andtbutar ( submaxi ttary)
Subment at
SabL ingua 1.
Internal. Jugutar: subdigastrlcs supraomohyo|d
Upper cervlcat ( including cePvicaI s NOS)
DISTlkNT, Direct Extension or Metastasis
D IST_A_N_T, Lymph Nodes
Supractavicutar ( transverse cervicat)Other distant nodes
- 28 -
CHEEK (BUCCAL) MUCOSA
Vermillion II pper gingivasurface_P---_/'"_ Labial mucosa
,, . ._..Hardpalate /_'k-_, _,
_uccal - "_ "S°'tpalate i_
mucosa_ _ _Uvula _
' °1N_, o
SKULL \ Tonsillar pillar
Z_gomo_ ___i__
(--/--/ Maxilla
NAL NODES _ _-___--
1. Facial 4. Submental_\
2. Parotid 5. Internal jugular
3. Submandibular 6. Upper cervical
- 30 -.
CHEEK (Buccat) MUCOSA &prlt, 197 'VESTIBULE OF M_UT_
450_451
IN SI_TU; nontnvaslve
LOCAL I ZED
L if:1
Confined to mucosa
Submucosa invaded
Loca¢ ized, NOS
REGIONAL, Direct Extension
R If:
1
Soft tissue of cheek ([nctudtng muscte)
Glngiva
Lip(s)Laterat pharyngeat walt (tonsittar pittars, tonsittar tossae, tonslts)
R If:
2
Skin
R_EG_IONAL. j Lymph Nodes
Faciat: buccina tor, mandibutar
Paro tid: preauricutar j infra-auricut arSubmandibutar (submax[tl.ary)
Internat Jugutar : subdI _ast tic
Upper cervicat ([nc[udlng cervicat, NOS)
DIST&NT, Direct Extension or Metastasis
D If extension to:1
Base or anterior 2/3 of tongue
Rued or soft palate
Bone: maxitta, mandibte, skutt
D if:
2
Other distant Invotvement
D_S__A_N'r, Lymph Nodes j
Supractavicutav ( transverse cervicat )Other distant nodes
- 31 -
HARD PALATE
f Har0kpa,ate
....................., _ NasalW PalatineUpper gingiva
Soft palate
\ Uvula
./_. Palatine tonsilonsilla r fossa
oOOo'_'%Oo./_--L-Tonsillar pillar
REGIONAL NODES Maxillary antrum _lvla_xill_//_1. Submandibular
2. Retropharyngeal
3. Internal jugular
4. Cervical, NOS-32 ,-
HARD PALATE April, 1977452
IN SITU; noninvasive
LOCALIZED
L if:1
Confined to mucosa on one side
L if:2
Midline tumor; tumor has crossed midline
L if:
X
Loca l ized, NOS
REG_IONA_L, Direct Extension
R if:
1
Soft palate, Including uvula
Gingiva, upperPalatine hone
Maxi tta
R if:2
Buccal mttcosa (inner cheek)
REGIONAL s Lymph Nodes
Submandibular (submaxillary)
Re teopharyngeal
Internal Jugular: subdi gastricUpper cervical (Including ceevica1 s NOS)
DIST&NT_ Direct Extension or Metastasis
D if extension to:1
Nasal cavity; floor of no-qe
Maxillary antrum ( sinus )
Na sopha rynx
D if:2
Other distant involvement
_D_I_S___I__, Lymph Nodes
Supraclavlcutar (transverse cervical)Other distant nodes
- 33 -
SOFT PALATE AND UVULA
Pa,ateSoft Palate
_k__._ Nasal cavity"Uvula floor
Palatine bone pharynx
Lower gingiva
Floor of mouth
Mandible
_ _/Upper gingiva _._
______Tonsillar fossa /}__ j (/
BuccalmUTonsillarcosa___,_,, _._'_f=:- _._- _- Palatine tonsil S__pillar _-__/ REGIONAL NODE 2
\\ i _/ 1. Submandibular _ 4
i _ 2. Retropharyngeal \ ,3. Internal jugular / 44. Upper cervical
- 34 -
SOFT PALATE April, 1977AND UVULA
lt53, 454
I N_ S_]_TO ; non invasl ve
LOCALIZED
L If:
!
Confflned to mucosa on one side
L if=2
Submucosa and�or muscutature invaded on one side
L if:
3
Mid]Line tu_or; t_mor has crossed mid[lne
L if:
x
Locat ized, NOS
RE_ION_A_L, Direct Extension
R If:
1
H_rd patate, mucosa
Gingiva, upper
Laterst pharyngeat watt (tonsittar pittar._, tonsittsr foss_e,tonsi ts )
R If:
2
Buccat mucosa (inner cheek)
N_sat cavity ¢1oor
REGIONAL, Lymph Nodes
S_bmandibuta r ( submaxl ttary)
Re tropharyngea[
lnterna[ Jugut_r: subdi gast tic
Upper cervicat (including cervical, NOS)
- 35 -
SOFT PALATE April, 1977AND UVULA
4539 454
I)_I_STA_N_T. Direct Extension or Metastasis
D if extension to:1
To ngue
NasopharynxPalatine bone
Max| t[ a
Maxtttary antrum (sinus)Mandibte
D lf:2
Other distant lnwo[vement
D[ST&NT, Lymph Nodes
Supraclavicu[ar (transverse cervlcat)
Other distant nodes
- 36 -
OROPHARYNX
Hard palateSoft palate
Nasopharynx
Prevertebral fascia
Oropharynx
Floor of mouth Hypopharynx
Mandible Pyriform sinus
Anterior 2/3Tongue
Base
Naso - .,.-"__l_l_
/_ • phary.-n--x--__Anterior wall/_L_J /) ,""l_ '_ -_ _t__ Posterior wall
,, j J / Oropharynxlll t'__ ,_Uvula] _T_r-_/ { "". [, ,__ Base of tongue_._/ J ""__:_- Lateral wall
REGIONAL NODES/'_- _/- Hy-o-ha- d'x\_f ";PT_."""eta' ill, /-1. Retropharynge_l_ .._!; ,:_}l'i lt_l
• ,uou,ar i_. c2:n:alJ, NOS I'_
PHARYNX (from behind)
-tR--
OROPHARY_X April, 1977460-469
IN SITU; nonlnvastve
LOCALIZED (Tumor Is not fixed)
L If confined to:
1
Posterior wail
One taterat watt
Anterior watt ( intruding taryngea[ (anterior) surface of epigtottis,
vattecuta eptgtottts, and junctionat region of oroph_rynx)
L if tumor lnvotves:2
Lateral watt( s ) and posterior ( or anterior) _tt
L if:X
Locat ized, NOS
REGIONAL, Direct Extension
R if:1
Tumor is not fixed, hut extends into:
Soft tissue of neck
Preyer tebrat fascia
Base of tongue
Larynx
Pyri form sinus
Hypopharynx, NOS
Soft patate, intruding uvuta
Na_opha rynxFront of mouth
Gum (gingiva), posteriorRuccat mucosa (inner cheek)
R if:2
Tltmor Is de._qcribed as "fixed to adjacent tissues"
REGIONA_L, Lymph Nodes
Re t ropharyngea [
Internal ,jugutar- subdlgastrlc, supraomohyold
Upper cervicat (inctudlng cervlcat, NOS)
- 39 -
OROPHARY._ X _,prt t s 1977460 -469
D][ST&NT_, Direct Extension or Metastasis
D if extension to:1
Both taterat watts lnvotved via soft pa]Late or base of tongu_eAnterior 2/3 of tongue
qard pa rateMandlbt e
Parotid grand
D If:
2
Other distant involvement
DISTANT s Lymph Nodes
Submandlbuta r
SupPactav[cutar ( transverse cervlcat )Other distant nodes
- 40 -
NASOPHARYNX
an tube
Nasopharynx
Nasal Posterior wallLateral wallAnterior wall
ropharynxSoft palate
Uvu _ Hypopharynx
SKULL
/_ 1./Frontal sinus_J_ F Iph°rn°',d r,b'ntus ,
1. Retropharyngeal \ _
2. Internal jugular ....
3. Cervical, NOS
- q2 "'
NASOPHARYNX April. 1977
(470-473. 478-479)
IN SITU; nontnvastve
LOCALIZED (Tumor is not fixed)
L If confined to:
1
Posterior superior wall (vault)
One lateral walt (including aryepigtotttc fold, NOS)
L if tumor Involves-
2
Posterior superior watt (vault) and lateral watt(s )
Lateral wall Into eustachian tube/ middle ear
L if:X
LocaLized, NOS
_RE__Q! _ON A _L, Direct Extension
R If:
I
Tumor Ls n_o__tfixed, but extends into:
Oropharynx; nasal cavity
Skull, including floor of orbit
Pterygopa tatI ne fossa
Soft palate, including uvula
R If:
2
Tumor is described as *fixed to adjacent tissues n
REG[ONA_L= Lymph Nodes
Ret r o_haryngea t
Internal JuguLar
Upper cervical (including cervical, NOS)
DIST___N!_. Direct Extension or Metastasis
D if extension to:1
Brain, including cranial nerves
Accessory sinus: maxillary, _Phenoid , ethmoid, frontalHard palate
Hypopharynx
Soft tissues of neck
D If:
2
Other distant involvement
DISTANt_, Lymph Nodes
Supraclavlcutar (transverse cervical)
Subm andlbu[ ar
Other distant nodes- 43 -
HYPOPHARYNX
Nasopharynx
Prevertebral muscles
Oro- Posterior wallphar_ Hypopharynx
Larynx Pyriform sinusCricoid -- Postcricoid area
cartilage / Esophagus
Nasopharynx
OropharynxBase of tongue-
HypopharynxPosteriorPyriform sinus
Esophagus-
PHARYNX (posterior view)REGIONAL NODES _
1. Retropharynge
2. Internal jugular -\ _Z
3. Cervical, NOS _ 3
-40,-
HYPOP_ARYNX Aprlt, 19r 7
480-483, 488-489
][.N__SI__U; non[nvasive
LOCALIZED (Tumor is not flxed)
L if confined to:
1
Pyriform sinusPostcricoid area
Posterior pharyngeat walt
L if tumor lnvotves:
2
Pyriform sinus and postcricoid area
Pyriform sinus and posterior pharyngeat watt
Postcrlcoid area and posterior pharyngeat watt
Pyriform sinus, postcricoid area and posterior pharyngeat wa_t
L if:
x
Locat lzed, NOS
REGIONAL, Direct Extension
P lf:
1
Tumor is not .fixed_ but extends into'.Oropha rynx ; ta rynxSoft tissues of neck
Prevertebrat muscle(s)
Upper esophagus
R if:
2
Tumor is described as "fixed to adjacent tissues"
REGIONA_L, Lymph Nodes
RetroDharyngea t
Internat Jugtttar: subdlgastrlc, supraomohyoid
Upper cervicat (intruding cervicat, NOS)
DI_S_T_b_NT, Direct Extension or Metastasis
D if extension to:1
Na sopha rynx
Base of tongueFtoor of mouth
D if:
2
Other distant Invotvemen_
D[ST?_NT, Lymph Nodes
SupractavIcutar ( transverse cervlcat )Other distant nodes
- 45 -
UPPER OR CERVICAL ESOPHAGUS
__- U_hagus
iddle esophagus _
LarYn"-_ i_._ _Vertebra\e
Thyroid___ _x
Mucosa_
Submucosa_-_'__.(_llth_ J" Circularm
FIuscul ari s l, Longitudinalm_!___)i] t
Trac Aorta '____/_
,_ _ina Lumen'_-f_ _r"
Esophagus
LYMPH NODES_Upper deep iugular-_--_.. /Upper cervical--_¢ (,_Lower " __1 L)I_
Sup. mediastinal_
o hageal
-- 46 -.
CERVICAL OR UPPER kprit, 1977ESOPHAGUS
500, 503
!_N S!I_U% nontnvasive
LOCAL [ZE_
L If confined to:1
Mucosa of upper esophagus
Mucosa but extends to middle esophagus
L If tumor invades--2
Muscut aria
L if:x
Local [zed, NOS
REGIONAL, Direct Extension
R if:
I
Adventitia and/or soft tissues of neck
Major brood vesseL(s): carotid artery, subclavian artery,
JuguLar veinThyroid gland
Esophagus is described as "fixed"
R if:2
HF popha rynx ; [arynx
Tr achea_ including cap lnaCervical vertebra(e)
REGIONAL t Lymph Nodes
Paraegophagea [
Internal JuguLar
Anterior deep cervicaL: taterotracheat ( recurrent )
Upper cervica% (including cervicaL, NOS)
D[STAN_T, Direct Extension or Metastasls
D if extension to:
I
Main stem bronchus
Lung and/or pleura
D if:
2
Other distant invotvement
_D[_S_TAN_T. Lymph Nodes
Posterior medlastina 1
Supractavicu[ar (transverse cervicaL)
Other distant nodes
- 47 -
MIDDLE OR THORACIC ESOPHAGUS
"!',, esophagus /____r_ Submucosa
/_ _Long
HilarC:_neaS_
Perib,onchia_odes_' -Bronchii_ _'_
2Ribs
_Pleura gus_Esopha
DiaphragmV,
_ Ao,toi
__. / n°des _
-g8 _'
THORACIC OR MIDDLE Aprtt, • 1977ESOPHAGUS
501 • 504
IN SITU; nonlnvasive
LOCAL!ZE_
L if confined to:1
Mucosa of middte esophagus
Mucosa but extends to upper and/or tower esophagus
L if tumor invotves:2
Muscutaris
L if:X
Locat Ized, SOS
REGIONAL, Direct Extension
R if:
1
Adventiti_ andfor soft tissues
Major brood vesset(s): aorta, putmonary artery or Vein, vena cav_Trachea
Carlna
Main stem bronchus
Esophagus is described as WfixedH
R if:
2
Lung via bronchusPt eura
Pericardium
Mediastinal structure(s) NOSRib(s)
Thoracic vertebra(e)
Diaphragm
I__G-_ION'AL, Lymph Nodes
Pa raesophagea
Tracheobronchiat: peritracheat, carinal (bifurcation), hitar
(pulmonary roots )Posterior mediastinat
Internat JuguTar
Left gastric: cardiac, teaser curvature
Upper cervicat (lnctudlng cervtcat, NOS)
DISTA_NT, Direct Extension or Metastasis
D I__T_AN__• Lymph Nodes
Supractavicutar (transverse cervicat)Other distant nodes
- 49 -
LOWER OR DISTAL ESOPHAGUS
_ .,.....---_
L,vert _ Lowerlesophogus __Mucoso
_Submucosa
'_ --S_:_:eCh _/1_ __ Longitudinal Muscle; ruarue
Thyroid gland
oresss/ \\ \ Aor,a
_/_'e-'l_ _..----"_ PuJm° narY artery _,_, _.)
/n°des
D'aP:odeso___-_ _Stomach
lessercurvature)
-50
ABDOMINAL OR LOWER &prlt, 1977ESOPHAGUS
502• 505
_S[ T U; nonl nvas[ ve
LO_C_AL!_g__
L if confined to:I
Mucosa of ]Lower esophagus
Mucosa but extends to midd]Le esophagus
L If tumor involves:
2
Muscutar is
L It:x
Loca]L ized• NOS
RE_G_[O_NAL . Direct Extension
R lfz1
Adventitia and/or soft tissues
Esophagus is described as nfixede
R if:
2
Di aphr agmCardia of stomach
Major b]Lood vesse]L(s ).- aorta• gastric artery or vein• vena cava
REG!_ON_AL • Lymph Nodes
Pa ra esophagea ]L
Left Eastric: cardiac• ]Lesser curvature, perigastric, NOSPosterior meal lastI na ]L
D!ST_AN__, Direct Extension or Metastasis
D If:
1
WD|aphragm is fixed" ( Indicates phrenic nerve involved by tumor)
D if:
2Other distant involvement
DiSC_ANT• Lymph Nodes
Ce]Liac
Para-ao rt lc
Other distant nodes
- 51 -
STOMACH
rocjm Loweresophagus_ \Stomach ......." '_ ......
__. __Spleen _ Lesse:vatur__ _ _
_"il_Sma'l intestine _I n°d_ _"->":--"_::_ 1
! Pancreas__ I Stomach _pleen
. Du°denum'_C__od_s of
l_ y _ _ IGreat::lemc h,lumcurvature
_Mucosa
". ,Submucosa
_"I("__ I,,-_ Circular muscle} Muscularis_._,, .';",)_--Loncjitudinal
"%"...._ Serosa
i __r omentum. :. _.( omentum Left lobe
Greater __ A_, __'__: _4"_ ; (
//_Transverse colon
-"_...______r" Hepatic -.______flexureS,_ Splenic flexure
Small intestine_ . '
- 52 --.
STOMACH ( exc t,_I n_ April = 1977
cardioesophageat Janctlon)
510-516, 518-519
IN SITU; noninvaslve
LOCALIZED
L if:
l
Confined to mucosa (lamina propria or muscularls mucosae; lntra_uc_sat )
L If:
2
Submucosa invaded (thru m_scutarls mucosae)
S_atk invaded { if polyp)
Superficial invasion
L if:
3
Muscutaris propria Invaded
invasion through muscutarls propria
Suhserosa[ tissue Invaded {including extension through the salt, ._OS)
L lf:4
Implants inside the stomach
L If:
x
Local ized, NOS
RE__ON_AL, Direct Extension
R if extension to:
1
Perigastric fatLesser omentum
Ligaments: gastrocotic, gastrohepatic, gastrosp]LenlcGastric artery
R If:
2
Invasion of (through) serosa_Diffuse involvement of entire thickness of stomach watt
(tlnttts ptasttca)
R If extension to:
3
Esophagus (intra_umlnat)Duodenum ( intratuminal )
R if extension to:
4
SpleenOmentum (greater)
Transverse colon (including hepatic and splenic flexures)
D I aphra gm
_Invasion of serosa may be considered tocallzed In historlcal comparisons.
- 53 -
STOMACH ( exc1_dlng April, 1977
cardloesophageal J_nction)
510-516. 518-519
R if extension to'.5
EsophaGuS via serosaDuodenum via serosa
Liver
Pancreas
Jejunum, ileum
REGIONAL s Lymph Nodes
Inferior gastric: Superior gastric:
Gast rocotic Cardiac
_astroeptptoic, right or NOS Cardioesophsgea[
Greater curvature Gastrohepatic
Greater omentum Left gastricIn frapytorlc Lesser curvature
Py lorlc Lesser oment_m
Subpy¢ortc P_rac ar di al
Splenic hilar: Perigastrtc, NOS
Left gastroepiptoic Nodu[e(s) In perigastric tatPancreat lcotienat
Peripanc reat ic
Spten ic
D__.[SI_AN!, Direct Extension or Metastasis
D if extension to=1
Left Kidney
Adrenal Grand(s)RetroperltoneumKbdomina _ wa[]L
Ovary ( Krukenber G tumor )
D if:2
Other distant involvement
D!STAN! , Lymph Nodes
Cetiac
Repat ic
Wesenteric, superior or inferiorPara-aor t ic
Portat
RetroperltoneatOther distant nodes
DUODENUM
- $6 -
DUODENUM lprit, 1977
52O
IN SI__U; noninvasive
LOCALIZED
L if:1
Invasive cancer confined to a polypConfined to stlbmueosa
L If:
2
Muscutaris and/or serosa Invaded
L if."3
Intrat_mlnat to Jejunum
L if.*x
Locat tzed, NOS
REG_!O_NAL, Direct Extension
R if:
1
Pe ri duodena t tissue
Mesentery s intruding mesenteric fatStomach
Extrahepatic bite duct(s), Intruding ampulla of Vater
Pancreas, Intruding pancreatic duct
R if:
Gr eatep omentum
Major brood vesset(s): aorta, superior aesenteric artery or vein,
vena cava, portat vein# renat vein s g_stro-duodenat artery
R If:3
Smart intestine via sePosm
Transverse coton, intruding hepatlc ftexure
Right and/or quadrate robe of tiLverGait bt adder
Right kidney
Right ureter
D 1 ap hra gmAbdominat watt
Retroperitoneum
- 57 -
DUODENUM Ap_It, 197752O
_REGI_O_NAL. Lymph Nodes
Hepatic: pancreatlcoduodena[, infvapytoric, gastrod_xodenat
D_[I_S_T_A_NT,Direct Extension ov Metastasis
DISTANT, Lymph Nodes
Superior mesente ticOther distant nodes
- 58 -
,JEJUNUM 8L ILEUM
OuoenumIIi _ J_v(_,_---_ Jejunum }Smoll intestine
b
valve_/__ _ LumenS'_ _\_ '_,, ;)'i_RAppendix/ Largeintestine Muco___/_/) _ erosa
Circularmuscle\Longitudinai
mtoneum
wall
Fallopiantube
Over
Bladder U
.._ Bladder
- 60 -
JEJUNUM AND ILEUM Aprlt, 1977
521, 522
IN SITU; nonlnvasive
LOCAL_!__E_D
L if:
I
Invaslve cancer confined to a potyp
Conflned to submucosa
L If:
2
Muscutaris and/or serosa invaded
L if:
3
Intratuminat to l[eocecat vatve or cecum from lteum
Intratumlnat to duodenum from jejunum
L if:x
Loca]L ized, NOS
____G__I_O_NA _L, Direct Extension
R if:
I
Mesentery, inctudlng mesenterlc fat
R If:2
Abdomlnat wat[
Ret roperitoneumSma|t intestine via serosa
Large intestine, including appendix
R EEGIO_N_A_L, Lymph Nodes
Posterior cecal (termlna[ Iteum onty)
Iteocotic ( %erminat lteum onty)
Superior mesente ric
.DIST&N-T, Direct Extension or Metastasis
Bradder
Uterus
Ovary
Fatt opi an tube
Other distant lnvotvement
DIST_N__, Lymph Nodes
- 61 -
CECUM 8 ASCI='NDING COLON
clingco
Cecum/ _ Transversecolon
Y
Ascending Descendingcolon
Iliocolic
Cecum
A intestine
Fallopian
Ov_
- 62 -
CECUM Aprlt, 1977534
iN SITU; nonlnvasive
LOCAL I ZED
L if:1
Confined to mucosa (lamina proprla or muscutar|s ._ucosae;t ntramucosa t )
L if:2
Stgbmucosa invaded (thru muscutaris mucosae)
Stark invaded (if polyp)
Superficia I i nvaslon
L if:3
Muscu_arts proprla invaded
Invasion through muscutaris proprla
S_bserosat tissue invaded (Intruding extension through th_ watt, $3_)
L If:4
Iatratuminat to appendix, cecum or |teocecat vatve, iteum, ascend-
ing cotonImptants inside the cecum
L if:
x
Locat ized, N'OS
R EG_IONAL, Direct Extension
R I f e xtenslon to :
1
Mesentery, Including mesentertc fat
Perlcolic (pericecat) fat
&d,Jacent tissue(s), NOS
R If:
2
Invasion of (through) serosa_
R if extension to=
3
Greater omentum
Re trope ri toneumAbdomi nat watt
Smart intestine, other than iteum
_Invaslon of serosa may be considered tocatized In histor|cat comparisons.
- 63 -
CECUM Aprl[, 1977534
REGIONAL, Lymph Nodes
EpicoticPa rac ot [c
Cecat
I t eoc ot ic
Right cotic (lnctudlng cotlc, NOS)Mesenteric, superior or NOS
Nodute(s) in perlcotic fat
DISTANT, Direct Extension or Metastasig
D if extension to:1
Uterus
Ov ar y
Fair opian tube
Urinary bladder
Ga llbtadder
Right kidney or ureterLiver
Other segment of coton via serosa
2
Other distant invotvement
DISTANT, Lymph Nocfes
Inferior mesente ticPaPa-aortlc
Re t rope ri tonea
Other distant nodes
- 64 -
ASCENDING CDLgN Apri i, 1977536
iN SIT U; noninvaslwe
LO_CA_LI_Z_E_D
L if:
I
Confined to mucosa (]Lamina propria or _uscutaris mucosae;|ntramucosal)
L It:
2
Submucosa invaded ( thru muscularis mucosae )
Stetik invaded (If polyp)
Superficial invasion
L if:
3
MuscuLaris propria invaded
Invasion through muscularis proDria
SuLbserosal tissue lnwaded (including extension through the
wall, NOS )
L if:
4
Intralumina[ to cecum, appendix, |leoeecaL waive, transverse colon
Implants inside the ascending colon
L if:
x
Locaiized, NOS
REGIONAL, Direct Extension
R if extension to:
1Perlcol lc fat
Re troperltonea[ Cat
Adjacent tissue(s), NOS
R if:2
Invasion of (through) serosa_
R if extension to:
3
Greater oment um
Re trowe ri to neumAbdominal wall[
Small intestine
Right ureter
Right kidney
Liwer, right lobe
wInvasion of serosa may be considered Localized in hlstoric_i _ompsrisons.
- 65 -
ASCENDING COL_N kprit. 1977536
_G___Q_QNAL, Lymph Nodes
EpicoticParacot lc
It eocot lc
Right cotic (lnctudlng cotlc, NOS)Middte cottc
Mesenteric, superior or NOS
Nodute(s) in pericotic fat
DIST_A_N_T, Direct Extension or Metastasis
D If extension to:
1
Uterus
Ovary
Fatt opi an tube
Urinary bladderGaltbtadder
Other segment of co[on via serosa
D if:2
Other distant invotvement
_I_&_N__, Lymph Nodes
Inferior me sentertc
Para- ao r t lc
Re fro pert tonea tOther distant nodes
- 66 -
HEPATIC FLEXURE,
TRANSVERSE COLON & Splenicflexure8PLF..N IC FLEXURE colon
___,S Middlecolic
pleen
•-__ L._"_./-S_lentc-_)anc flexure Hepatic
- -. nodes
__. _ ;;_C_'9..\ _ :¢"("TransverseRightcQ
/
Small
TRANSVERSE C3LON &prIt, 1977
( Inct,adlng ftexures )
530_ 531 , 53"7IN SITU; non|nvaslve
LOCAL [ZED
L if:
1
Confined to mucosa (tamlna proprla or muscutarls mucosae;l. nt ramucosa t )
L If."
2
Submucosa invaded ( thru muscutaris mucosae )
Stark invaded (if potyp)
Superficiat invasion
L If.*3
Muscutaris proprta invaded
Invasion through muscutaris propr|a
Subserosat tissue Invaded (|nctuding extension through the
waI I, NOS )
L if:
4
Intratuminat to ascending oc descending coton
L if;
X
Locatized s NOS
RE_G_IO_N_A_L, Direct Extension
R if extension to"
I
Mesentery ( Including mesenter|c fat ); mesocolon
Perlcot ic fat
Greater omentum; gastrocotic tlgament
AdJacent tlssue(s ), NOS
R if.*
2
Invasion of (through) serosa_
R if extension to:
3
St omach
Smart intestine
Liver
SpteenPancreas
We t rope r I toneum
Gallbladder/ bite ducts
Kidney
bbdomina t walt
_Invaslon of serosa may be considered locatlzed In historical comparisons.- 69 -
TRANSVERSE C_L_N Aprit s 1977( Inctudlng ftexure9 )
530s 531s 537
__EG_gN_AL , Lymph Nodes
Eplcotic
Paracot Ic
Right cotJc for hepatic ftexure ontyMi ddte cotic
Cotic, NOS
Left cotic for sptenIc ftexuve onty
Inferior mesenteric for sptenic flexure on[y
Superior mesenteric for hepatic ftexure and transverse
co to n onty
Mesenteric, NOS
Nodute(s) in pericotic tat
DISTANT, Direct Extension or Metastasis
O if exten_ion to:1
Other segment of coton via serosa
DiaphragmUre te r
Adrenat gland
Ova ry
D if:
2
Other distant Involvement
DI_S_T_ANT_, Lymph Nodes
Para-ao rt Ic or re trope rl toneat
Inferior mesenteric for hepatic flexure _nd transverse colon onty
Superior mesenterlc _or sptenic ftexure onty
- 70 -
DESCENDING COLON
D ooo.
_._,_ >Spleen
"" IDescending
colon
colic
Mesenter nodesSigmoid colon
mes_ntericnodes
Smallintestine.
tes
_F_lopion tube
_ _ _! _OvaryBIpar_r:rt_--- _ Xl_._ ,uterus
-72-
DESCEND [ NG COLON Aprit, 1977532
_IN SI._TU; noninvasive
LOCAL I ZED
L if:!
Confined to mucosa (tamina proprLa or muscutaris mucosae)
L if."2
Submucosa invaded (thru n_scutaris mucosae)
Stark invaded (if polyp)Super¢iciat [ nvasion
L if:
3
Muscutaris propria invaded
Invasion through muscutaPis proprla
Subserosat tissue invaded (Intruding extension through th_
watt, NOS )
L if:
4
[ntra[umlna[ to splenic flexure, transverse colon, slgmold colon
L if:X
Loca 1. ized, NOS
REGIONAL, Direct Extension
I_ if extension to:
1
Pericotlc fat, NOSRe troperl tonea[ fat
Adjacent tissue(s), NOS
R If:
2
Invasion of (through) serosa_
R if extension to:3
Smart intestine
Re trope r i toneumGreater ome ntum
Abdominat or petvlc watt
Left ureter
Left kl dney
Spteen
_[nvasion of serosa may be considered tocatized in historicat comparisons.
- 73 -
DESCENDING C3LON ApriL, 1977532
RE I_O_.N_A_L.Lymph Nodes
Epicotlc
Paracot tc
Left cntlc ( Including co_Icj NOS)
Mesenterlc, inferior or NOS
Nodute(s) In perlcotic fat
DISTANT. Direct Extension or Metastasis
D if extension to:
1Uterus
Ovary
Faltoptan tube
Other segment of coton via serosa
D If:
2
Other distant lnvotvement
I)[_S_TA_N_T, Lymph Nodes
Para-aortlc
Ret roper i toneal
Superior mesente rlc
Other distant nodes
- 74 -
S IGMO ID C_)LON Apri t, 1977533
SITU; non invastve
LOCALIZED
L if:1
Confined to mucosa (lamina propria or muscularis m_cosae;I ntramuc osa [ )
L if:2
Submucosa invaded ( thru muscularis mucosae )
St at k invaded ( I f po lyp )
Superficial invasion
L If:3
Muscutarls propria invaded
Invasion through muscularis propria
Subserosal tissue invaded (including extension through the
wail, SOS )
L if:4
Intraluminal to descending colon, rectoslgmoid, or rectum
L if:
X
Localized, NOS
REGIONAL, Direct Extension
R If extension to:
1
Mesentery ( including mesenterlc fat ); megosLgmoidPericot ic fat
AdJacent tissue(s ), NOS
R if:2
InvaSion of (through) serosa_
R if extension to:3
Greater omentum
Abdominal or pelvic wall
Small Intestine
_Invas£on of sero.qa may be considered localized in historical comparisons.
- 75 -
S [GMOID C_LON April, 1977533
REGIONAL, Lymph Nodes
EpicolicParacol Ic
Colic, NOS
SigmoidatSuperior hemorrhoidal
Superior rectal
Mesenterlc, inferior or NOS
Nodule(s) in pericolic fat
DIST&NT, Direct Extension or Metastasis
D lie ex%ension to:
1
Uterus
Cub de sac ( rectouterine pouch)
Ovary
Fail opl an tubeUreter
Urinary btadder
Other segment of colon via serosa
D if:2
Other distant involvement
DIST&NT, Lymph Nodes
Para-aortic
Re troveri toneat
Superior mesente rlc
Other distant nodes
- 76 -
RIECTO Sl GMOI D
.)L/ _.Spleen
_Y \_' .s_j''
Wectosigmoid LIIBT21
t
Mesentery
nodes
Bladd
Prost Rectummoid-
mesentericnodes
intestine ?erirectal nodes
--/8 -
RECTOSIGMOID April, 1977540
iN S[_TU; nonlnvasive
LOCAL !_Z_E_D
L if:
I
Confined to mu_osa (Lamina propria or muscutaris mucosae;i ntramucosa t )
L if:
2
Sabmucosa invaded ( thru muscularIs mucosae )
Stalk invaded (if polyp)Superflci_t invasion
L if:
3
Muscutarls propria invaded
Invasion throuEh muscutarls pro_)ria
Sabserosat tissue invaded (including through the watt, N:)_ )
L if:
4
[ntratuminal to sigmoid colon or rectum
L if:
X
LocaLized, NOS
REGIONAL, Direct Extension
R if extension to:
1
Me_entery, including me.qenteric fatPerico[ |c (perirecta[) fat
AdJacent tissue(s), NOS
R If:
2
Invasion of (through) serosa_
R if extension to:
3
Small intestine
Cut de sac (rectoaterine pouch)
PeLvic waLL/ pelvic plexuses
_Invasion of serosa may be considered LocaLized in historical comparisons.
- 79 -
RHC'['OS ][GMO [ D Aprl. L, 1977540
REG[ONALs Lymph Nodes
Paracotic ( inctudin_ colic, NOS)Pararecta[
Hemorrhoidal, superior or middle
Sigmoidat
Internat lilac (hypogastrlc)
_esenteric, inferior or NOS
Nodute(s) in pericotic fat
DISTANT= Direct Extension or _[etastasis
D if extension to:
t
Uterus
Vagi na
Urinary bradder and/or ureterProstate
Sketetat mu_ctes of petrie ftoor
Fattopi an tubeOvary
Other segment of colon via sros_
D if:2
Other dlst_nt lnvotvement
DISY&NT, Lymph Node_
Para-aort ic
Re troper ltoneat
Superior mesentertcOther distant nodes
- 80 -
RECTUM
colon l
escending Left colic IiRectumI " ' Sigmoid J
Sigmoidmesenteric ' /t /
Perirectalnodes _/_Prostate
_ladder
+,,Seminalvesicle _ _-_Rectum
• • _ _Bladder
_Ductus deferens
Rectum Pel_:_nes _--J I /t_I_
__Perirectal fat Pelvicbones
Rectum_Fallopian_\_ _ \
Urethra Uteru '
Uterus__jj. _'_/ ] I Ik'o/'odligament Bladder
/ /
Urel_ra____ /Vagina,/ Cervix/ _Perirectalfat - 82 -
RECTUM Aprit, 1977541
IN SITU; noninvasive
LOCAL IZEV_
L if:1
P.onfined to mucosa (lamina propria or muscutarls mucosae)
L if:2
Submucosa invaded ( thru muscutarls mucosae)
Stalk invaded ( i f po[vD)
Superficial invasion
L If:
3
MuscuLaris proprla invaded
Invasion through muscu[aris proDrla ( Including extension
through watt, WOS)
L If:
X
Loca lized, NOS
_RE_GI___O_N_A__L,Direct Extension
R If extension %0:
I
Perirectat fat
Rectovagina[ s eptum
Adjacent tissue(s). NOS
if:
2
invasion of ( through ) serosa_t
R If extension to:
3
[ntra[umina[ to rectoslgmoid or mnus
R if extension to:
4
Colon, anus ( except tntratuminal )
Vm _i na
Cut de sac ( rectouterine pouch)
_Invasion of serosa may be considered [ocatlzed in historlca[ comp_risonso
- 83 -
RECTUM Aprlt s 1977541
R if extension %o:
5
Urinary btadder/rectovesicat fascia, mateProstate
Semln a_ veslcte
Ductus deferens
Sketeta[ muscte of pe|vic ftoor
Petrie watt
REGIONAL, Lymph Nodes
Pararectat
Hemorrhoida[, superior or middle
Sacrat
SI gmo t d at
Mesenteric, Inferior or NOS
[nternat it lac ( hypogastric )
Nodu[e( s ) in perlrecta[ fat
DISTANT, Direct Extension or Metastasis
D if extension to:
I
Uterus
Urinary b[ adder, femate
Sacrum
Sacra[ pt exus
Bones of petvls
Ovary
Urethra
Per[neum; perJTLana[ skin
D if:
2
Other dl_t ant invotv ement
DISTANT LYMPH _N_ODE_S
Para-aort ic
Re t rope r i ton e at
Superior mesente TiC
I nguLnat
Other distant nodes
- 84 -
ANUS, ANAL CANAL &
ANAL MUCO6A
_,ood _ _
Urethra-""T...-_"_/-AkS_X _;/Anus" Anal mucosa Vulva_
Vagina /Cerv,x _e,,_o;
Mucoso__
Submuc_\osa------'-___' / -; Blodde__ " iiProstate ectum
Serosa Urethra Per,anal skin
f
I
Iliacnodes
Rectum / _"_ _
/ \I _
Brood hgament ladder
ANAL CANkL April, 1977
&NUS, N3S54:>. 543
IN SX_.T_._.U;noninvasive
t.OCAL!Z_ED
L If:
I
Incidental finding of mat|gnancy In hemorrhoidInvasive cancer confined to submucosa
L If:
2
MuscutarI8 {internal sphincter)
L if:
x
Local ized, NOS
REG[ONA_L, Direct Extension
R If:I
Rectal mucosa or suhmucosa
Perianat skin
Skeletal muscte(s ): anal sphincter ( external ], tevator ani[schiorectat fat/t issue
R if:2
Perineum
Vu tva
REGIONAL, Lymph Nodes
Anorectat ; pararec tat
Interat lilac (hypogastrlc) for anal canal onlyLateral sacral for anal canal only
Superficial inguinal for anus only
D_][_T&__T, Direct Extension or Metastasis
D if extension to:
1
Pros tat e
Peritoneum o¢ pelvic floorBladder
Urethra
Va gi na
D if:
2
Other distant involvement
DIST_AN_T, Lymph Nodes
NOTE: Melanoma of the anus is classified according to the staging
scheme for RtelanotRa.- 87 -
LIVER Aprit, 1977INTRAHEPAT[= BILE DU2TS
550, 551
LOC A L I ZED
Confined to one robe
Satellite nodule(s) confined to one _obe
Loca t lzed, NOS
REGIONAL, Direct Extension
R if:
1
More than one lobe invotved by contiguou_ growth
Oattbtadder from right robe of river
R if:
2
Extrahepatic blood veg._e[( s): hepatic artery, vena cave, portal vein
Extrahepatic bi_e duct( ._ )
D Iap hra gmPeri toneum
Llgament(s )5 fatciform, coronary_ triangular, hepatogagtPic,hepa t oduode na [
Lesser omentum
REGIONAL_ Lymph Nodes
Cardiac
Diaphragmatic: pericardia[
Posterior mediastinat
Hepatic: hepatic pedicte, inferior vena cava, hepatic artery
Laterat aortic (retroperitonea[) : coronary, penat artery
DISTAl_T, Direct F.xtension oll Metastasig
D if:
1
Satettite nodutes in more than one robe of river, _qurface or parenchyma[
D i f extension to:
2
P [ eu ra
Pancreas
St omac h
D if:
3
Other distant lnvotvement
DISTANT, Lymph Nodes
- 88 -
LYMPHATICS OF THE GALLBLADDER
Gallbladder
•. Bile ducts
Hepatic artery
Pancreatic duct
Duodenum
Fig 504 Schematic re rcsentation of the lymphatics of tho gallbladder showing the path-. • p
ways to, 1, cystic node; 2, node of anterior border of fornmen of Winslow; and, 3, superiorn,tro-l_:mcrcatic od uodenal node.
Reproduced with permission from de[ Regato, Juan A., and
SpJut, Hartan J o: Ackerman and de[ Regato's Cancer, ed. 5,
St. Louis, 197_, The C. V. Mosby Co.
- 90-
GALLBLADDER ApriL, 1977560
IN SITU; noninvasive
LOCAL I ZED
L if'.
1
Invasive c_ncer confined to submucosa
L If:
2
Muscutavis and/or serosa invaded
L if:x
Local tzed, NOS
R_H_GIO_N_A_L, Direct Extension
R tf:
1
Right Lobe of liver
Gallbladder is replaced by tumor (indicate extension to liver)
Extrahepatic bile duct(s), including ampulla of V_ter
R if:
2
BLood vessels: cystic artery/vein, hepatic artery, port_t vein
Pancreas via extrahepatic bile ductsGreater omentum
Lesser omentum
DtLode num
REG_[_ONAL, Lymph Nodes
Cyst ic ( node of the neck of the gsttbtadder)Node of the toramen of WinsLow
Rep_tic : pe riportaL, panc reaticoduodenat
D__ST_A__, Direct Extension or Metastasis
D if extension to:1
Pancreas (other than above)
Large intestineStomach
D If:2
Other distant lnvol.vement
D[_S_T_ANT, Lymph Nodes
Mesent eric
Para-aor tlc
Other distant nodes
- 91 -
EXTRAHEPATIC BILE DUCT kprit, 1977IMPULLA OF VAYER
561, 562
IN SITU; noninvaslve
LOCAL IZED
Confined to bite duct(s)'- cystic s hepatic, common, amp_lta o¢ Vater
Loca t ized, NOS
REGIONAL, Direct Extension
R If:1
Du odenum
Gattb_adder
Pa nc rea s
Liver, porta hepatisLesser ome ntum
R If:
2
Transverse coton, intruding hepatic ftexureDistat stomach
Brood vessets: portat vein, hepatic artery
REGIONAL, Lymph Nodes
Cystic (node of the neck of the gattbtadder)Node of the foramen o¢ Win. tow
Repatic : pe rlportat, panc tea ticoduo denat
DISTANT, Direct Extension or _Metastasis
DISTANT, Lymph Nodes
Mesente ric
Para-aort ic
Other distant nodes
- 92 -
READ OF PANCREAS April, 197757O
LOCAL [_ZED
Confined to head of pancreas
Body of pancreas involved
With obstructionj but no invasions of extrahepatic bite duct{s)
LocaLized, NOS
REGION&L, Direct Extension
R if:1
Extrahepatic bite duct(s), including ampulla of ValetDuodenum
Stomach adjacent to head of pancreas, including stomach NDS
R If--
2
Liver
Major blood vessel( s ): hepatic, pancreaticoduodenat and/or gastro-
duodenal arteries, superior mesenteric artery or vein, portal vein
Transverse colon, including hepatic flexurePeri ton eum
Mesentery, mesocoton, mesenteric fatGreater and/or lesser omentum
Gallbladder
R if:3
Tumor is described as "fixed to adJacent tissues"
R__E_G!_ON___L, Lymph Nodes
Pe rlpanc tea t ic
Repatic: pancreaticoduodena[, infrapylor|c ( subpytorlc )Superior mesenter ic
Lateral aortic (retroperltoneat)Celiac
D[STANT, Direct Extension or Metastasis
D if extension to:
1
Body of stomachKidneyUreter
Adrenat gland
Re trope r i toneum
Je ju hum[teum
D if:
2
Other distant involvement
DIST&N_T, Lymph Nodes- 93 -
BODY AND YAIL
OF PANCREAS Apr[t, 1977
57 t , 572
LOCALIZEO
Confined to body and/or tait of pancreas
Read of pancreas invotved
Locatized, NOS
R_EE.GIONAL, Direct Extension
R lf:
1
Left kidneyLeft ureter
Le_t sdrenat grand
Retroperitoneat soft tissues (retroperltoneat space )
R if:
2
SpteenSt omac h
Liver_ ports hepat isGatthtsdder
Smart intestine
Sptenic ftexurePert ton eum
Mesentery, mesocoton, mesenteric fat
Major blood vesset(s ): aorta, cetiac artery, hepstic srtery, sptvntc
artery or vein, superior mesenteric artery or
vein, portat vein
REGIONA_L, Lymph Nodes
Sptenic: suprapancreattc, sptenlc httum, pancreat icotlenst
Superior mesenteric
Laterat aortic (retroperitoneat)
D_[STA_NI, Direct Extension or Metastasis
D if extension to:
I
Right kidney
Right ureter
Right adrenat gland
Diaphragm
Large Intestine (other than sptenic ftexure)
D if:2
Other distant invotvement
DISTANT , Lymph Nodes
- 94 -
LYMPHNODESOF THE PELVIS ANDABDOMEN
Cehac Axis Nodes CeliacAxis
£uper_r Me,enteric Nodes RenalArtery
RenalNodes _ SupermrMesentedcAdery
Spermabc Nodes _. Spermalic/lurlery
Inferio¢Me,enteric Nodes InferioqMesentericklery
Source: Taylor, G. W., Lymph Node Metastases, p. 44
-95-
DEFINITION OF ANATOMICAL LIMITS OF THE LARYNX A_C_)RDING
TO T_E AMERICAN JOINT COMMITTEE ON CANCER STAGING
Anterior Limit is constituted by the anterior or tinguaI surface of the
suprmhyoid epigtottts, thyrohyoid membrane, the _nterior commissure s srtd
the _nterior w_tt of the subgtottic region, which is composed of the thy-
roid cartilage, the cricothyroid membrane s and the anterlor arch of the
crico Id cart i rage.
Posterior Lateral Limits inctude the aryepigtottic fords, the arytenold re-
gions the |nterarytenoid space s and the posterior surface of the sub==t_ttlc
space represented by the mucous membrane covering the cricold cartilage.
_pertor _atera_ Limits are constituted by the tip and the Lateral border of
the epiglottis.
Inferior LL_t_s are constituted by a plane passing through the inferior edge
of the cricoid cartitage.
The Larynx Is divided Into the fottowing anatomica[ regions and sites:
Regio_ St te
SupragLottic VentricuLar bands (fatse cords), right and tett
Arytenoids, right and teft
Eplgtottis (both tinguat and [sryngeat aspects)
Suprahyold epigtottis
I nfrahyo id epiglottis
Aryepigtottic folds
Gtottic True voca[ cords, right and Left
Anterior and posterior comm|ssures
Subgtottlc Right and Left watts of the subglottls, excLu-sive of the undersurface of the cords
- 96 -
LARYNX &prlt. 1977
( Exc tuding cartilage )
610o612. 618j 619
IN SITU; nonlnvasive
LOCAL!_Z__D
L if:1
Tumor _imited to one area within a region
SuDr agtot t ic regionLaryngeal (posterior) surface of epiglottis
&rytenoldAryepiglottlc fold
Ventricutar band (false cord. vestibular fold)
Ventric_tar cavity
Gtottic region ( normal mobility)
Vocal cord, one _ldeComml ssure
Subgtottlc region on one side
L If:
2
T_mor extends to adjacent area(s) within a region
Su_ragtott ic regionMore than one of the above areas
Gtottic region (normal mobility)Cord and commissure
Both voca_ cords
Subgtottic region on both sides
L if:
3
Gtottic region: Fixation of cord(s)
L if:4
Tumor Involves adjacent reglon(s)
Supragtott lc region
Gtottic region (with or without fixation)
Sub,tort ic region
Involves Intrinsic muscle(s): aryepigtottic, arytenold, cricoarytenoid.
cricothyro|d, thyroeplgtottic, thyroarytea_i:vocatis
L if:
X
Loca tized, NOS
- 97 -
LARYNX Aprit, 1977
( Exctuding cartilage)
610-612, 618, 619
REGIONAL, Direct Extension
R if:1
Pyriform sinusPostcrico td area
Hypopha rynx NOS
Vattecuta, Intruding pharyngoep|gtottic and g_ossoepigtottic fords
Base of tongue from _aryn_eat surface of epigtottis
R if:
2
Extends into crlcoid and�or thyroid cartitage
_RE_G[_O_N_A_L, Lymph Nodes
Internat Jugutar : subdi gast tic
Anterior deep cervical: p.retaryngeat, pretrachea[, taterotracheat( recurrent )
Cervlca t, NOS
D_STAN_T, Direct Extension or Metastasis
D if extension to:
1
Extrinsic muscte( s): omohyoid, sternohyoid, sternothyroid, thyrohFoid( strap musctes)
Soft tissues of neck
ThyroidSkln
Tr ac hea
Upper esophagus
D If:
2
Other distant lnvotvement
DIST_AI__, Lymph Nodes
Supract av tcutarSu bm an dl but ar
Other distant nodes
- 98 -
BRONCO/US AND LUNG Aprlt, 1977
(Exctudlng car|na)
622-625j 628-629
[_ S__IT UU; non i nvets ire
LOCAL [ ZED
Singte tumor _> 2 era. from carlna and confined to one tungand/or main stem bronchus
L if:
1
Tumor size is 3.0 cm. or tess
L i f:
2
Tumor size • 3.0 cm.
L if:3
Tumor size is unknown
L if:4
Single tumor of any size < 2 cm. from carina and confined to one
tung and/or main stem bronchus
L if:
5
guttipte masses confined to one tung and/or main stem bronchus
L if:
x
Locat i zed, NOS
- 99 -
BRONCHUS AND LUNG Aprit, 1977(Exctudlng carlna )
522-625, 628-629
REGIO_N_A_L, Direct Extension
R if extension to:
I
Pt eura s visce ra_/NOS
Pericardium, p_rietat/NOSPu tmona ry t lgament
P if tumor tnvotves:2
Carina
Tr ac he a
Esophagus
Nerve( s ):
Recurrent ta ryngea l
VagusPhrenlc
Cervical sympathetic (Horner°s syndrome)
Major brood vesset(_ )."
Putmonary artery or vein
Azygos veinSuperior vena cava
R if:x
Extrapulmonary medtastinal extension, NOS
R EGION_A_L, Lymph Nodes
I n tra put mona ry
H|]LaLr (bronchiaL; parabronchia[; putntonary root)
Subca ri nat ; carina_
Mediastlna[ (paratracheobronchia[_ paratrachea[; perlcard[at ;
para-esophageat; para-aortlc-above diaphragm)
- 100 -
BRONCHUS AND LUNG Aprit, 1977(Exctudlng carina)
622-6259 628-629
DISTANTj Direct Extension or Metastasis
D if extension to:1
Brachia[ plexus from superior sutcus or Oancoast tumor
Lung and/or main stem bronchus, contrataterat
Pericardium, visceralHe art
Pteura, parietal
O if extension to."2
l_[b, sternum, vertebraChest ( thoracic ) wattSketetat muscte
Skin of chest
D[ ap hr agm
Kbdom[ nat organs
D If:
3
Other distant tnvotvement
DI_?*NT, Lymph Nodes
Contratatera[ hitar or medtastina[ (Intruding bItatera[)
Suprac[awlcu[ar ( transverse cervical. )
Scatene
Cervl cat , NOSOther distant nodes
- 101 -
BONE Aprtt, 1977700 -709
.[_..OC_AL [ZED
Confined to bone
Tumor has broken through peeiosteum but not beyond
Abnormat configuration o_ bone
Locat ized, NOS
REGIONALj Direct Extension
Surrounding tissues, intruding skeletat muscte(s)
Adjacent hone
REGIONAL 9 Lymph Nodes
First chain o¢ nodes lnvotved in the area of the
tumor
DIST&NT, Direct Extension or Metastasis
SkinOther dtstent lnvotvement
D!_!AN__, Lymph Nodes
- 102 -
LYMPHATICSOF THE SKIN
Fig. qO0Lymphalics of the skin of the face and upper and lower ext_mili¢_
Reproduced with permission from del Regato, Juun &.. _nd
SpJut, llarlan J.: AcRorman and deL ke_.,.atoSs Cancerm @do 5 ISt, Lou[8, 1977, The C. V. _4osby Co,
- lOq -
MALIGN._NT MELANOMA OF SKIN April, 1977
730-737j 8tt- I --8/-_ 4 _ 871-872, 874
HISTOLOGY: 872 thru 879
IN SITU; intraepidermaI (Clark's Level I )
LOCAL I ZE_
L if ¢umor Invades:
1
Papil. lary dermis (Clark's Level 2)
L if tumor invades'.
2
Papillary-reticular dermal Interface (Clark's Level 3)
L i f tumor invades:3
.qetlcular dermis (Clark's Level 4)
L If:4
Skin utceration
Satellite nodule(s) within 2 cm. of outer border of
pr Iinary lesion
L if:x
Localized, NOS; confined to skin/dermis, NOS
_F,G IOWA L
R if tumor invades-.1
Subcutoneou._ tissue (through entire dermis) (Clark's Level 5)
P if:P
Satellite nodule(s) more than 2 cm, trom outer border
of nrimary lesion
- 105 -
MALIGNANT MELANOMA OF SKIN Aprl[= 1977
730-737, 841-844, 871 -872, _74
HISTOLOGY: 872 thru 879
PEGIONAL, Lymph Nodes (b.v primary site)
Parotid: preaurlcular, Infra-auri culav Axl llary
F o re head Arm
Temporal region _,and
.'Iat a r r ef_,ion Shoutder
Lateral half of eyelids Chest wall
Outer canthus Scapula (upper hack),Anterior half of ear below transverse llne
Sul_nandlbular (gubmaxiltary) Epltrochlear
Midllne of forehead Hand
Media[ half of eyelids ForearmInner canthus
Nose Superf ic |a [ inguinal
L [ps
Cheeks Lumbar region (lower back)Anterior abdominal wail
Cervical Lower extremities ( excludingheel )
Head and neck tumors, any location Perlneum
Scapula, above transverse llne Perianal region
Suprac|avlcu[ar ( transverse cervical ) Pop[iteal
Che_t wall Wee[
Neck Posterior leg
DISTANT., Direct Extension or Metastasis
D if extension to:
I
Undertyln_ cartilage, bone, muscle
D if:
2
Metastatic (generalized) skin lesions
D if:
3
Other distant involvement
DISTANT, Lymph Nodes
- 106 -
SKIN OTHER THAN MELANOMA AprJ [, ! 977730-737
NOTF: Skin of vutva use 8a1-844 schemes; nenis u_e 871= 872, 874 schemes
IN SI TU; i ntraepJdermal
LOCAL I ZED
Single lesion confined to dermis
Locatized, NOS
RF_IONAL, Direct Rxtenslon
_kin ulceration
Subcutaneous ti.._sues ( through entire dermis )
DISTANT, Direct Extension or Meta.q_tasis
D If extension to:
I
Underlying cartilage, bone, muscte
D if-.
2
__etastatic (generalized) skin lesions
_F.GIO_NA_L, Lymph Nodes (by primary site)
Parot id: preauric_itar, i n¢ ra-auri c,ttar Axittacy
Forehead Arm
TempoPa I region .Wand
Mater region Shoutde r
Latera_ half of eyetids Chest watt
Outer canthus Scaputa (u_per back),
Anterior half of ear below transverse tlne
Submandibu[ar (submaxittary) Epl trochtear
qi dl Ine of forehead Hand
Mediat half of eyetids Forearm[nneP canthus
Nose Superfic Jar InAgulnat
Lips
Cheeks Lumbar region (tower back)
Anterior abdominal wait
CervIcat Lower extremities ( exctudIng
beet )
Head and neck tumors, any tocatlon Perlneum
Scaputa, above transverse line PerIanat region
Supraclavicu[ar ( transverse cervical ) Popttteal
Chest watt ,_eet
Neck Poster|or te_.
- I07 -
SKIN OTHFR THAN MELANOMA Aprit, 1977730-737
DISTANT, Direct Extension or Metastasis
D if extension to:
1
Undertying c_rtil_ge_ bone s and muscle
D i_:
2
Metastatic (_ene_a_ized) ._ki_ _e-_ion._
D if:
3
r_fher distant involvement
D_I_AN_T, Lymph Nodes
- 108 -
LYMPHATICS OF THE BREAST
Fig. 669. ],ym|ihaiics of the breast leading 1o, 1, axiilary liO(]C_ which are distributed over alargo area from tile laleral aspecls of the breast pro|)<'r to the axiJlary vessels; 2. interl>ccloralchain leadiug to iilwrl_-'ci.ral node (circle dclail) end to high nodes in the axilia; 3, chain ofthe Interim[ mammary leading frequenLlv to node in second i,ltcrspace and to snpraclavicnlarand cervical nodes. The lymphal/c= of the breast may empty, into the opposite axillary nodc_.
Reproduced with pepmissLon .from (tel Regato, Ju&n A., and
SpJuts Hat, an J.: Ackerman and det Regato's Cancerj ed. 5_
St. Louiss 1977. The C. V. _osby Co.
- 1.10-
BREAST April, 1977
740-749 Female
759 Male
IN SITU (inctudlng noninfiltrating intraductal or tobutar)
LO_CALI_Z_E_D
Primary tumor involving:
Breast tissue only
(may be described ctinlcalty as fixation of tumor within
breast, but not to skin, skin dimpling, tethering, orretraction )
Nipple and/or areola
(may be described clinically as nlppte and/or areolar
attachment, thicRening, Induration, retraction, or
involvement, Paget's disease of nipple (Including
ulceration of nlppte ) )
L If tumor size Is <2 cm.
1
L if tumor size Is 2-4.9 cmo
2
L if tumor size its > 5 cm,
3
L If tumor size is unknown4
L Localized, NOS
x
RE_IOHA_L , Direct Extension
Primary tumor Invading:
Subcutaneous tissue
Skin of primary breast
(may be described clinically as: adherence, attachment,
fixation, induration, thickening of skin)
R if tumor size is <2 cm.1
R if %umor size is 2-4.9 cm.2
R t¢ tumor size is > 5 cmo
3
1_ if tumor slze is unknown
4
- 111 -
BREAST Aprit, 1977740-740 Fema_ e
759 Mat e
Primary tumor of any size with:
Skin edema, peau d°orange, "pigskin"
En curraise, tenticu%ar nodtltes
Inftammation of skin, erythemaUtceratlon of skin of breast
Satettite nodutes In skin of primary breast
Pectorat fascia or pectovat muscte invotvement (may be described
ct|nlcatty as undertying tissue fixation or attachment)
R If:5
Tumor of any size wlth above description
R if:5
Invasion of (or fixation to) chest watt, ribs, tnte_ostator serratus anterior musctes
RgG!__NAL, Lymph Nodes
Low axittary (adJacent to tait of breast)
Mid axit[ary: centraL, Interpectorat, iotter's node
High axtttary: subctavicutar, axiltary vein nodes, aplcat
Axlt tary, NOS
Internat mammary (parasternat)
Nodutes In axlttary fat
DISTANT, Direct Extension or Metastasis
D If
!
Skin over sternum, upper abdomen, axitta or opposi te breastSatetttte nodute(s) in adjacent skin
D if tumor Invotves:
2
Breast, cont rataterat
Adrenat grand
Ovary
D If:
3
Other distant invotvement
p__ST_ANT_, Lymph Nodes
I n frac tar lcu tar
Supractavicu[ar ( transverse cervlca[)
Cervical, NOS
Axittary and/or lnternalL mammary, contratatera[Other distant nodes
- 112 -
LYMPHATICSOF THE UTERUS
Fig. 619. ,_;chcm:ttic rcprcscntation of the ]ymt_hatics of Ihc ,teals qlowing, 1, the nitro-ovarian ['_dic'le; 2, [ho external i]iac Dcdic|c; al_d,3, Ihc round ligament pcdic|o]cading to IlKinguinal l)"mDh ncx]cs.
I?oproduced with permi._sion from dot Regato, Juan Ao, and
Sp.Jut, llaPlan Jo: Ackevm_n and det l_egsto's C_ncer, ed. 5,
Ste Loulsp 1977, The Co Vo _osby Co,
- -11q -
CERVIX UTER[ &pz'[ L, 19:
800-801, 808-609
XN S_T_U
Non-invasive, pre-lnv_sive, intraeplthetlatLeague of Nations Stage 0
LO__A_L!_Z_E_.
L if:
1
Minimal stroml invasion; "microlnvasion"
L If:
2
lnvaslve cancer confined to cervix
L if.*
x
League of Nations Stage [
REGIONAL. Direct Extension
R if extension to:1
Corpus uteri (body of uterus)
R If extension to:
2
Upper 2/3 of rag|hal wa]t (IncLuding fornices and vagina, NOS)Paramet r lure
Ligaments= broad, uterosacrat, cardinalLeague of Nations Stage [I
R If extension to:
3
Lower 1/3 of vaglnat wattPeLvic watt(s)
League of Nations Stage Ill
R if extension to:
4
Rectal and/or bladder walt (excluding mucosa)Buttous edema of bladder mucosa
Cut de sac ( rectouterlne pouch)
- 115 -
CERVIX UTERI Aprils 1977
800-801, 808- 809
RE_GIONA_L, Lymph Nodes
Hypogast ric
Itiac (common, internaL, externaL)Obtura tot
Parac er v l cat
Parametria t/pe tvlc, NOS
Sacral ( taterosacvat, presacrat, sacral promontory, uterosacrat)
DISTANT, Direct Extension or Metastasis
D If extension to:1
BLadder _m_c osa
Rectal _m__co_s aUreter
Ure th ra
Si gmoid colonSmatt Lntest Ine
Vu tva
Ovary and/or fa_l.oplan tube
D If:2
WFrozen pelvis N
D if:3
Other distant involvement
D If:X
League of Nations Stage IV
DISTANT, Lymph Nodes
Aortic (para-aortic, periaortlcj Lumbar)
InguI natOther distant nodes
- 116 --
CORPUS UTERI Aprt ts 1977
820-82|• 828
IN SITU, pre-lnvaslve, non-lnva.,_Ive
L if:
1
Invaslve cancer confined to endometrlum
L if:
2
Myometrlum/seroga (perimetrlum) invaded
Invastve cancer confined to corpus, cttntcatty:( Depth of Invasion unknown )
L if:
3
Sounding of uterine cavity Is < 8 cm. from cervlcat os
L if:4
Sounding of uterine cavity Is • 8 cm, from cervIcat os
L if'.x
Locattzed, NOS
REGION&_L_ Direct Extension
R if extension to:
1
Cervix uteri, inc'Luding endocervlx
R if extension to _.
2
Pa ramet rium
Ligaments: broad, round, uterosacra]L
R if extension to:3
Petvlc watt(s)
Ovary and/or fattoplan tube(_)
R if extension to:
4
Rectat and/or bradder watt (exctudlng mucosa)
- 117 -
CORPUS UTEPI &prt I, 1977
820-821 j 828
RE GI_O_NA_L, Lymph Nodes
Hypo_ast r ic
lilac ( common_ internal, externalL)Obtura tot
Paracervtca[
Parame t rialL/pe [vlc, NOS
Sacra[ ( lLaterosacra[, sacralL promontory, presacra]L, _terosRcrat )
Super f Ic is lL i ngui nat
Latera[ aort ic, preaortlc
D[[S!_A.NI, Direct Extension or Metastasis
D If extension to:
I
Va gi na
Vutva
CulL de sac. (rectouterine pouch)
Rectum or bladder mucosa
Ureter
Slgmold cotonSmall intestine
Serosa of abdominat organs
D If:
2
"Frozen petv|s"
D if:3
r_ther distant invotvement
DI_S__ANI, Lymph Nodes
- I18 -
OVARY April, 1977830
LOCAL I ZED
Confined to ovarian tissue--one ovary or, If not specified to be
metastatic, both ovaries
Local ized, NOS
REGIONAL, Direct Extension
Peritoneum (pelvic; immediately adjacent, not implants)
Broad t[gament, tpsitaterat
Mesovarlum, |psi Lateral
Fallopian tube, lpsltaterat
AcEnexa, ipsitater_l
RE_O_IONAL, Lymph Nodes
Aort lc ( lateral and preaorttc )
Hypo gas tr tc
Itiac (common, internal, external)Ohturator
Ret roper[ tonea t/pe trio, NOS
D[SIPA_I_NT, Direct Extension or Metastasis
D if extension to:
I
SI gmo idO_ en tum
Cut de sac (rectouterine pouch)Uterus
Rectosigmoidj rectumSmart intestine
Bt adder, ureter
D if:
2
Implants on ovary, fallopian tube, cub de sac (rectouterine potuch),
peritoneum, omentumMetastatic to contratateral ovary and/or fallopian tube
D if:3
Other distant involvement
DIS TA_N!P, Lymph Nodes
[nguAnatOther distant nodes
- 119 -
FALLOP [A_ TUBE Aprl[, 1977832
LOCALIZED
Confined to fattopian tube(s) (specify bitaterat invotvement )
Locat ized, NOS
REGIONA. L, Direct Extension
Peri toneum
Broad tigament, tpsitaterat
Mesosalpinx, ipsitaterat
Ovary, ipsi Late r_t
Uterus (endometrium), lpsitaterat
£EQI_O__AL, Lymph Nodes
Aort tc ( tater_t _nd pre_ortic )
ffypo g_str tc
Itiac (common, [nternat, externat)Obturat or
Re t rope ri toneat/pe 1vie, NOS
D[S_A_N_T. Direct Extension or MetastaSis
D if extension to:
I
Omentum
Cut de sac ( rectoutevine pouch)
Stgmoid
Rectoslgmo id
Ovary, cont_taterat
Smart intestine
D if:
2
Other distant Invotvement
D__I_S_T_A_r_,Lymph Nodes
I ngu tna tOther distant nodes
- 120 -
VAGINA April, 1977540
IN SITU; noninvaslve
LOCALIZED
L if:
I
Inv_slve c_ncer confined to submucosa (stroma)
L If-"2
Musculature Invaded
L IF:
x
Localized, NOS
REGIONAL, Direct Extension
Cervix
VUlv
Cut de s_c ( rectouterlne pouch)
Veslcovagina[ septum (paracystium)
Rectovaginst septum
REGIONAL, Lymph Nodes
External illac
Internat |liac (hypogastrlc)
Common lilac (sacrst promontory)
DISTA_N_T, Direct Extension or Metastas,is
D if extension to:1
Ur et hra
Bt adder
Rectum
D if:2
"Frozen pelvis"
D!ST_NT, Lymph Nodes
Inguina tPeriaortic
Other distant tymph nodes
- 121 -
LYMPHATICSOF THE VULVA
Reproduced with permission from deL Regato, Juan Ao s and
SpJuts Harlan J,: ._ckerman and det Regato_8 Cancerj edo 5sSt. Loulsm 1977 s The C. Vo Mo.q. by CO°
- 122 -
VULVA April, 1977
(including skin of v,_lva_)84 I -844
IN SITU; noninvaslve; BowenPs disease
LOC&L [ZED
Invasive cancer confined to submucosa
Confined to skin of vulv_
_[uscuta tuee Invaded
Localized, NOS
__EE__!_O_NAL,Direct Extension
Vaginal watt or orifice
Uret hrat orifice
Pevi neum
Pertanat skin
Anus
REGIONAL, Lymph Nodes
Supeefic ial Inguinal
Deep inguinal: Rosenmulter'9 or Cloquet's nodeExternal lliac
DISTA_N_, Direct Extension or Metastasis
D if extensl on to:
1
Perinea _ body
Rectal mucos a
D I_:
2Other distant involvement
DISTANTp Lymph Nodes
_Except melanomas which are classified accoeding to the
staging scheme for melanoma.
- 123 -
LYMPHATICSOF THE PROSTATE
l;'il_. 542. _cl,..mntie rel)resentati(m of ],,'nJpllatics (_" tile prostate .showing,, 1, extenm] Ili:ze]'a'dic.14..;9,-hvpc)_;z,.tric |_('(]icle; nncl 3, i)o_,tc.ri(_r l)L.dic.]c. The infc.rior l_--dicle whic'h I'_lhnvsa duwm_'ard (lir_:c.tio_ a,_(l e,_ds in hypo_astric _()d_:_ is n()t illustrate:el hen:.
Peproduced wLfh pe_missLon t'rom det Regato_ Juan Ao • and
SpOut• Ha_an Jo: Acke_man _nd deL l_eg_to'_ Cancer• edo _•
St° Louis• 1977_ The Ce Vo _dosby Co.
-- 12q -
PROSTATE Aprlt, 1 97785q
]IN SI_TU; noninvaslve
L_OC__Ak!_Z_ED
L If=
!
Invaslve cancer confined to prostatic capsule
(intra-capsutar)
L if:
2
Invasion of prostatic capsute
L If:3
Prostatic urethra lnvotved
L if:
x
Local Ized, NOS
REGIONAL, Direct F, xtension
R If extension:1
Periprostatlc tisguesSeminar veslcte(s)
R if:
2
Through prostatic capsute, including "fixation"
R if extension to:3
Rectove_ica[ (Denonviltler's) fascia
Bradder
Rectum
Extraprosta tic urethra (membranous urethra )
- 125 -
PROSTATE _kprl L, 1977859
REGION&_, Lymph Nodes
Hypogast ric
Itlac ( common, Internat, externat)
Ob turator
Periprostatlc/petvlc, NOS
Sacra[ ([aterat sacra[, sacral promontory, presacra[)
DISTANT, Direct Extension or Metastasis
D if extension to:
1
Sketeta[ musctes: I-eva, tot anl
Petvl c bone
Pe Lvlc watt
Ureter
Sl gmoid colonPenis
D if:2
"Frozen pe]Lvls"
D i_-
3
Other distant Invotvement
DISTANT, Lymph Nodes
Aortic ( para-aortLc, perlaortic, [ttmbar )Ing_Ina[
Other distant nodes
- 126 -
LYMPHATICSOF THE TESTIS
Fig. 562. St'ht.tl_tiit. r,.prc,,t..tafi.n (,f th(: hml_h.tit-, of tile te_,tis showing main drainage inIll,. ]'s.zra-aoutic' l',lZtl_b:itic_ aizd fiirlhi'r ]'_.qihatJ(. t.xi,.'n.,ion |)y way of the thorat.ic (|loct. "[lie i
1[('11[ sltpr:'lul.lvital{ar hi.l(, i,; [airh' Ire.ll..i.fly itiv.ivcd. The I)'ml_lla'[ics of tllc ep didymis drainillto the cxlL'r,al iliac i'_mph 1,_l,.,.,i.
i_eprocluced w|th permission from del Retz=too Ju-n A. ,, nnd
Sp.Jut, ll_rian J.: Ackorm-_n _nd deL Re_to's Cancer, ed, 5,
St. Louis. 1977. The C. Y. ._osby Co.
- 128 -
TESTIS April, 1977
860, 869
LOCAL_!_ZE_
Confined to tun[ca albuginea (enceLpsu[ated tumor)
Tun[ca va_Ina|.Is Involved
Local[zeal, NOS
REGIONAL, Direct Extension
Ep [Ld _Ldy ml s
Scrotum, [ps i[ateral
Spermatic cord, Ipsi lateral
Vas deferens
R__E_ [QNAL, Lymph Nodes
Aortic s below lewe[ of renal arteries
External iliac
Re t rope rl tone_ [/pe [vic s NOS
DISTANT, Direct Extension or Metastasis
D if extension to:
l
UILceration of scrotum
Scrotum, con t ra[t eraIL
Testis, bilateralPenis
Kidney
&drena ]L gland
We t rope rl toneum
D If:
2
Other distant involvement
D__[SI['&.I!__, Lymph Node s
Ingu inat
Other distant nodes
- 129 -
SKIN OF PENIS April, 197787 I. 872,874
IN_SIT_U; nonlnvasive (Bowen's Disease)
LOCALIZED
Invasive cancer confined to skin of penis, pt'epace and/or gtans
Lo catized, NOS
REGIONAL, Direct Extension
R if:
1
Corpus cavernosum
R if:
2
Ur et hra
Sateltite nodute(s) on prepuce or gtans
Skln: pubic, scrotat, abdominal, perlneum
RE_G!_O_NA_L, Lymph Nodes
F_xternat itiac
Interna[ itlac(hypogastrlc)
Superfic ia t I ngui nat
Deep inguinat: Rosenmutter's oP Cloquet's node
DIS_T_ANT, Direct Extension or Metastasis
Test is
Other distant invo]Lvement
DISTANT LYMPH NODE
_Rxcept melanomas which are ctaRslfied according to the
staging scheme for metanoma.
- 130 -
LYMPHATICSOFTHEBLADDER
Fig. 534'. Anatomic sketch of the lymphatics of the bladdcr drained mainly by, I, the cxcenmlLiliac nod¢_ but also by, 2, lt)'pogastric and, 3, common tliac nodes.
Reproduced with permissl.on from det Regatos J_an A.. and
Spdut, Hartan J.: Ackerman and clct Rega¢o's Cancer s ed. 5jSt. Louis, 1077p The C. Y. Mosby Co.
--132 -
BLADDER
880-886, 888-889
I__N _S_TU; noninvasive; intraepithetiat
LOCALIZED
L If:
1
Confined to mucosa
L if:
2
Submucosa (subepithetial connective tissue; tunica
propria; lamina propria) invaded
L if:3
Superficial muscte (tess than one hatf way throughthe muscle coat)
L if:4
Deep muscle (half-way or mope through the muscle coat )
L if:
x
[_catized, NOS_ no detaited information of above
REGIOh_L, Direct Extension
R if:1
Invasion of periveDicat fat
Invasion of (through) serosa_ peritoneum
Surrounding connective tissue (including periprostatic tissue);
adjacent tissue, NOS
R if extension to:
2
Prostate, including prostatic urethraUreter
Vas deferens
Seminal veslc te
Rectovesica[ (Denonvlllier's) fascia
R if extension to:
3
Rectum, m_teParametrlum and uterus, femaleBladder is nfixed"
VaginaPubic Bone
UrethPa• female
- 133 -
BLADDER AprllL, 1977
880-886, 888-889
REGIONA_L, Lymph Nodes
Perives icat
F[ypo gas tr l c
Itiac (common, lnternat, externat)Obturator
Sacrat (taterosacrat, presacrat, sacrat promontory)
Pe[vtc, NOS; regionat, NOS
I)!STA_NT , Direct Extension or Metastasis
D if extension to:
1
Tumor fixed to ( invading ) petvic wattAbdomln at watt
Rectum, fere_te
Bones, extruding pubic bone
S i gmo ld
D If:
2
Other distant tnvotvement
D IST_&NT, Lymph Nodes
&ortic (pava-aortic, pertaorttc, tumbar)
InguinatOther distant node(s)
- 134 -
KIDNEY (RENAL) &pr[ [, 1977PARE._/CF[YMA
89O
LOC_A__!_ZE_D
L if tumor confined to:l
Kidney cortex
Kidney medut t a
L if:
2
Renal pelvis or calyces involved
L if:
X
Local ized, NOS
REGIO_NAL, Direct Extension
R if:
l
Perirenal tissue (fat)
Reno. l. (Oerota's) fascia
Retroperitoneat soft tissues (retroperitoneat space )
Blood vessels: perirenat veins, extrarenat portion of renal
vein, aorta, renal artery, hilar blood vessels, vena vav_
Adrenal gland, ipsitaterat
Ureter, including implant{ s), ipsitateral
R if:2
Peri ton eum
O iap hra gmTail of pancreas
Ascending colon from right kidneyDescending colon from teCt kidney
Duodenum from right kidney
REGIONA_L, Lymph Nodes
Hi tar ( small nodes at renat pelvis )
Lateral aortic (retroperttoneat)
- 135 -
KIDNEY (RENAL) &prl_, 1977PARENCRYMA
890
DISTANTj Direct Extension or Metastasis
D if extension to:1
Kidney, _it_ ter_t
Ureter, cont ratat erat
Adrenat _t_nd, contratateratRib_
S t omsc h
Spteen
Liver
D If:
2
Other distant lnvotvement
DISTANT, Lymph Nodes
- 1 36 -
RENAL { KIDNEY)
PELVIS April, 1077
891
I_____S][TU; nontnvastve; lntraeptthettat
LOCAL!_Z_E__
Invasive cancer confined to:
Submucosa
Muscuta lure
Localized, NOS
__IONAL, Direct Extension
Peripetvic tissue
Retroperitonea[ soft tissue (retroperitoneat space )
Major blood vessel(s): aorta, renal artery or vein, vena cars
Ureter, including implants
Kidney pare nchyma
Adrenal gland
Duodenum from right renal pelvis
REG_][ON/L.L, Lymph Nodes
Httar (renal hitus)
Lateral aortic (retroperitoneat)
D][S1"_NT, Direct Extension or Metastasis
D if extension to:
1
Bladder
Sptee_
Pans teas
Live r
Descending colon
D if:2
Other distant involvement
D[_;T?_N_T, Lymph Nodes
- t37 -
URETER Aprtt, tO77892
[_NN SITU; noninv_sive; intraepithe_iat
LOCALIZED
InvasIve cancer confined to'.
Submu co s
Muscutature
Locat tzed, NOS
REGIONAL_. Direct Extension
Periure thera t tissue
Retroperltoneat soft tissue (retroperitonea[ space)Psoas muse te
Imptant{s) distat in ureterBt adder
Kidney, ipsitaterat
Duodenum from right ureter
Ascending coton from right ureter
Descending coton from teft ureter
EE_G_I_ONAL, Lymph Nodes
Periure tera t
Hypo gas tri c
Itiac (common_ lnternat, external}Laterat aortic
Retroperitoneat/petvic, NOS
DISTANt., Direct F_xtenston or Metastasis
D If extension to:I
Uterus
Panc teas
Imptants in bradder
Prostate
D if:2
Other distant tnvotvement
D__I_SIANI,Lymph Nodes
- 138 -
THYROID GLAND Apri[, _._977939
IN SITU; nonlnvasive
LOCALIZED
L if:
1
Confined to one robe and/or isthmus
L if"
2
Both Lobes invotved
Thyroid gland capsule |nvo|ved
Muttlp[e loci but confined to Thyroid gland
L if:
3
Through capsule Of grand, but not beyond
L if:
x
Loca t ized, NOS
R_gG_!_OHA_L,Direct Extension
P if'.
!
Pe rl capsu_a r %issue s
Strap muscte( s }: steenothy_'otd, omohyo|d, sternohyoid
Nerve( s ): recurrent %aryngeat, vagus
R If:
2
Major brood vesset(s}: carotid artery, thyroid artery or vein_
jugut ar veinSo ft t Issues of neck
Esophagus
Larynx, Inctudlng thyroid and crlcoLd cartltagesSt er noc]Leidomasto id muse lie
Tumor is described as "fixed to adjacent tissues"
RE_G][ONAL, Lymph No des
Anterior deep cemv|ca_: pretaryngea]L, pretracheaL, 1Laterotrachea]L(recurrent)
Internat Jugutav : subdi gast tic
Re tPopharyngea [
Cervlca _, NOS
-- 139 -
THYROID GLAND Aprtl, 1977939
DIST&__T, Direct Extension or Metastasis
D If extension to:
1
Tr ac hea
Medtssttna[ tissues
Sketetat muscte, other than strap musctes and sternoctetdomastotdBo ne
if:
2
Other distant invoiwement
D!_S_T_A_r_, Lymph Nodes
Subm_ndlb_tar (submmxi*_]Lary)Su bm en t at
Other distant nodes
- 140 -
LYMPH NODES AND LY_+PI+e) ID Aprlt, 1977
TISSUE
q60-96q) 416) 460,
_7| , 49| • 640, _92
Histology: 959 fhrtL 960) Q75
S%ase I (Localized)
Confined to one !ymmh_a_)_c region above or below
*he d iaDhragm
__%a_e I [ ( ,We_iona[ )
[nvo[ve_nen% of _ore than one [ymph_%tlc region on only
one _ide of %he diaphragm
S%a_e I[I (Distant )
I
Involvement of _ympha%ic regions on both Bides of %he
d| aoh raqm
._ta_e IV (Distant )
?
Bone
Po_e marrow
L:tn_ and/or pleura
Liver
K i dnev
Gastrointestlna[ tract (b,lt not pPimary G. I. )
Skin tes[ons or s_lbeutaneous nodu]es (btit not primary skin)
SYSTEMIC S YM"T(_M S
_i_ht sweats
Unexp[a ined fever
Oruri%Is
Unexplained weight ]loss
NOTE: Lymphoid tiss,*e includes spleen, []n_ua[ and palatine ton_i[s,
adenoids ( pharyngeal tonsl is )• thymus and Wa[deyer's ring, NOS.
- I_*I -