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{
"id" : "path_n_dax",
"algorithm" : "tnm",
"version" : "1.6",
"name" : "Path N Rectum",
"title" : "Pathologic N",
"notes" : "**Note 1:** Histological examination of a regional lymphadenectomy specimen will ordinarily include 12 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met. classify as pN0. (1)\n\n**Note 2:** Code only regional nodes and nodes, NOS in this field. Note 4 specifies when to code certain tumor deposits (TD) here. Distant nodes are coded in M (distant metastasis).\n\n**Note 3:** Assign N1 if regional lymph nodes are involved but there is no indication of the number of nodes involved.\n\n**Note 4:** Per UICC, \"Tumor deposits (satellites), i.e., macroscopic or microscopic nests or nodules, in the pericolorectal adipose tissue's lymph drainage area of a primary carcinoma without histological evidence of residual lymph node in the nodule, may represent discontinuous spread, venous invasion with extravascular spread (V1/2) or a totally replaced lymph node (N1/2). If such deposits are observed with lesions that would otherwise be classified as T1 or T2, then the T classification is not changed, but the nodule(s) is recorded as N1c. If a nodule is documented by the pathologist to be a totally replaced lymph node (generally having a smooth contour), it should be recorded as a positive lymph node and not as a satellite, and each nodule should be counted separately as a lymph node in the final pN determination.\" (2)\n\n**Regional lymph nodes** \n\n**All sites** \n\n Haemorrhoidal (hemorrhoidal) (middle, superior) \n Inferior mesenteric \n Mesenteric [NOS] \n Perirectal \n Rectal (middle) \n Rectal [NOS] \n Rectal (superior) \n Rectosigmoid (paracolic/pericolic)\n Sigmoidal (sigmoid mesenteric)\n\n Regional lymph nodes, NOS\n Lymph nodes, NOS\n\n**Rectosigmoid (C199)** \n\n Colic, (NOS) \n Left colic\n \n**Rectum (C209)** \n\n Haemorrhoidal (hemorrhoidal) (inferior) \n Internal iliac (hypogastric) \n Lateral (laterosacral) \n Middle (promontorial) (Gerota's node) \n Obturator\n Presacral\n Rectal (inferior) \n Sacral (NOS)\n Sacral promontory",
"footnotes" : "(1) International Union Against Cancer (UICC) *TNM Classification of Malignant Tumors,* 7th ed., Sobin, LH, Gospodarowicz, M, Wittekind, CH, eds. New York: Wiley, 2009, pg., 104\n\n(2) International Union Against Cancer (UICC) *TNM Classification of Malignant Tumors,* 7th ed., Sobin, LH, Gospodarowicz, M, Wittekind, CH, eds. New York: Wiley, 2009, pg., 103",
"last_modified" : "2018-02-02T14:54:20.364Z",
"definition" : [ {
"key" : "path_n",
"name" : "Pathologic N",
"type" : "INPUT"
}, {
"key" : "path_n_display",
"name" : "Pathologic N Display",
"type" : "DESCRIPTION"
}, {
"key" : "description",
"name" : "Description",
"type" : "DESCRIPTION"
}, {
"key" : "notes",
"name" : "Registrar Notes",
"type" : "DESCRIPTION"
} ],
"rows" : [ [ "pX", "pNX", "Regional lymph nodes cannot be assessed", "Pathologic classification criteria met, evaluation done:\n Physician unable to assess N\n Surgical resection primary tumor, no regional lymph nodes removed\n Involvement of regional lymph nodes not documented\nPhysician assigns pNX, no other information available to determine N" ], [ "p0", "pN0", "No regional lymph node metastasis", "No tumor deposits (TD)" ], [ "p1", "pN1", "Metastasis in 1-3 regional lymph nodes", "Note: N1 has subcategories of N1a, N1b and N1c. Assign N1 only when there is no information available to assign one of the subcategories\n\nStated as N1 [NOS]" ], [ "p1A", "pN1a", "Metastasis in 1 regional lymph node", "Stated as N1a" ], [ "p1B", "pN1b", "Metastasis in 2-3 regional lymph nodes", "Stated as N1b" ], [ "p1C", "pN1c", "Tumor deposit(s), i.e., satellites in the subserosa, or in non-peritonealized pericolic or perirectal\nsoft tissue WITHOUT regional lymph node metastasis", "Tumor deposit(s), i.e., satellites, in the subserosa, or in non-peritonealized pericolic or perirectal soft tissue without regional lymph node metastasis\n(See Note 4)\n\nStated as N1c" ], [ "p2", "pN2", "Metastasis in 4 or more regional lymph nodes", "Note: N2 has subcategories of N2a and N2b. Assign N2 only when there is no information available to assign one of the subcategories\n\nStated as N2 [NOS]" ], [ "p2A", "pN2a", "Metastasis in 4-6 regional lymph nodes", "Stated as N2a" ], [ "p2B", "pN2b", "Metastasis in 7 or more regional lymph nodes", "Stated as N2b" ], [ "c0", "cN0", "Clinically: No regional lymph node metastasis", "Use only for TNM defined pTis cases where there is a resection of the primary and the nodes are not evaluated pathologically" ], [ "88", "88", "Not applicable", "Primary site/histology not TNM defined\nDeath certificate only (DCO) case" ], [ "", "BLANK", "See Registrar Notes", "Pathologic classification criteria not met \nNo surgical resection of primary tumor and there isn’t a positive biopsy of a structure in the highest T category and highest N category\nEvidence of metastatic disease (pM1), no other workup\nOnly Pathologic Stage Group documented (no T, N, or M information available)" ] ]
}
