S IMARY STA - Surveillance, Epidemiology, and End Results · Duodenum (520) 57 JeJunum and [teum...

SU._IMARY STAGING GUIDE

For

The Cancer Surveltt_nce, Epidemlotogy _n_

End Re_utts Reporting (SEER) Program

Apri[, 1977

- t -

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

- lit -

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

- iv -

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

- vii -

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 )

- vlii -

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

- 1 -

[[. 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

- 3 -

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 )


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


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


Subment a t

Sub_andlbutar (submaxilLary)

Internal JuguLar (subdigastrlc)

Upper cervical ( including cervicaL, NOS )

DI_T__&_N_T, Direct Extension or Metastasis


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


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


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


FaciaL: mandibular

Subaandlhutar (submaxlttary)Subm ent _t

Internal Jugular= suhd[ gastric• supraomohyold

Upper cervical (including cervicat_ NOS)


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


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)


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


_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


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


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


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


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


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


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"


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


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


_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


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


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


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


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


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


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


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)


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


R if extension to:

1Perlcol lc fat

Re troperltonea[ Cat

Adjacent tissue(s), NOS

R if:2


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


_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


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


O if exten_ion to:1


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


I_ if extension to:

1

Pericotlc fat, NOSRe troperl tonea[ fat

Adjacent tissue(s), NOS

R If:

2


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


D If:

2


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 )


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


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


EpicolicParacol Ic

Colic, NOS

SigmoidatSuperior hemorrhoidal

Superior rectal

Mesenterlc, inferior or NOS

Nodule(s) in pericolic fat


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


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


R if extension to:

1

Me_entery, including me.qenteric fatPerico[ |c (perirecta[) fat

AdJacent tissue(s), NOS

R If:

2


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


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)


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


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


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


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


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


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



- 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


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


LOCAL IZED

Confined to bite duct(s)'- cystic s hepatic, common, amp_lta o¢ Vater

Loca t ized, NOS


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


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


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


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


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


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


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


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


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


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


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


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



- 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


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


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


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)


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


D If:X

League of Nations Stage IV


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


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


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


D__I_S_T_A_r_,Lymph Nodes

I ngu tna tOther distant nodes

- 120 -

VAGINA April, 1977540


LOCALIZED

L if:

I

Inv_slve c_ncer confined to submucosa (stroma)

L If-"2

Musculature Invaded

L IF:

x

Localized, NOS


Cervix

VUlv

Cut de s_c ( rectouterlne pouch)

Veslcovagina[ septum (paracystium)

Rectovaginst septum


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


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[)


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



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


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


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


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


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


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


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


Hi tar ( small nodes at renat pelvis )

Lateral aortic (retroperttoneat)

- 135 -

KIDNEY (RENAL) &prl_, 1977PARENCRYMA

890


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



- 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


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


D__I_SIANI,Lymph Nodes

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THYROID GLAND Apri[, _._977939


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

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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

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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 -

S IMARY STA - Surveillance, Epidemiology, and End Results · Duodenum (520) 57 JeJunum and [teum...

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Transcript of S IMARY STA - Surveillance, Epidemiology, and End Results · Duodenum (520) 57 JeJunum and [teum...