Pathologic Staging (pTNM) CAP Approved Head and Neck – Nasal Cavity and Paranasal Sinuses 4.0.0.0 (AJCC 8th ed.)

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y ( posttreatment)

 

For All Carcinomas  

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pTis: Carcinoma in situ

For the Maxillary Sinus

___ pT1:   Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone

___ pT2:   Tumor causing bone erosion or destruction including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of maxillary sinus and pterygoid plates

___ pT3:   Tumor invades any of the following: bone of the posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid sinuses

___ pT4:   Moderately advanced or very advanced local disease

___ pT4a:  Moderately advanced local disease. Tumor invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses

___ pT4b:  Very advanced local disease. Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

For the Nasal Cavity and Ethmoid Sinus

___ pT1:   Tumor restricted to any one subsite, with or without bone invasion

___ pT2:   Tumor invading two subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with our without bony invasion ___ pT3:   Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate

___ pT4:   Moderately advanced or very advanced local disease

___ pT4a:  Moderately advanced local disease. Tumor invades any of the following:  anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses

___ pT4b:  Very advanced local disease. Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

Regional Lymph Nodes (pN) (Note F) 

___ pNX:  Regional lymph nodes cannot be assessed

___ pN0:  No regional lymph node metastasis

___ pN1:  Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(-)

___ pN2: Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(+);  or larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(-);  or metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(-);  or in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension and ENE(-)

___ pN2a:  Metastasis in single ipsilateral node 3 cm or less in greatest dimension and  ENE(+); or a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(-)

___ pN2b:   Metastasis in multiple ipsilateral nodes, none larger than 6 cm in greatest dimension and ENE(-) 

___ pN2c:  Metastasis in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension and ENE(-)

___ pN3: Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(-); or metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+);  or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE(+); or a single contralateral node 3 cm or smaller and ENE(+)

___ pN3a:  Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(-) ___ pN3b:   Metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+);   or multiple ipsilateral, contralateral or bilateral nodes any with ENE(+);  or a single contralateral node 3 cm or smaller and ENE(+) # Midline nodes are considered ipsilateral nodes. Note: Pathological ENE should be recorded as ENE(-) or ENE(+). Note: Measurement of the metastatic focus in the lymph nodes is based on the largest metastatic deposit size, which may include matted or fused lymph nodes.

Distant Metastasis (pM) (required only if confirmed pathologically in this case)

___ pM1:  Distant metastasis  Specify site(s) if known: ________________________

For Mucosal Melanoma Primary Tumor (pT)

___ pT3: Tumors limited to the mucosa and immediately underlying soft tissue, regardless of thickness or greatest dimension; for example, polypoid nasal disease, pigmented or nonpigmented lesions of the oral cavity, pharynx, or larynx

___ pT4:  Moderately advanced or very advanced disease

___ pT4a: Moderately advanced disease. Tumor involving deep soft tissue, cartilage, bone, or overlying skin

___ pT4b: Very advanced disease. Tumor involving brain, dura, skull base, lower cranial nerves (IX, X, XI, XII), masticator space, carotid artery, prevertebral space, or mediastinal structures

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed

___ pN0: No regional lymph node metastases

___ pN1: Regional lymph node metastases present

Distant Metastasis (pM) (required only if confirmed pathologically in this case)

___ pM1: Distant metastasis present  Specify site(s), if known: _________________________

Nasal Cavity and Paranasal Sinuses CAP 4.0.0.0 summary of TNM changes AJCC 7th to 8th edition

- pN stage now incorporates presence or absence of extranodal extension

- minor wording changes in pT stage

Head & Neck

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