Determining Lymph Node Involvement

Regional and distant lymph nodes are listed for each Summary Stage chapter.

• Assign the highest specific lymph node chain involved by tumor (this may be regional lymph node involvement or distant lymph node involvement).
• Regional lymph nodes are listed for each chapter in the Summary Stage manual.
• Ipsilateral nodes are on the same side of the primary.
• Contralateral nodes are on the opposite side of the primary.
  • Review each Summary Stage chapter to determine if contralateral nodes are regional or distant.
• Any unidentified nodes included within resected primary site are counted as “regional lymph nodes, NOS.”
• The following terms should be ignored when determining involvement (except for lung)
  • Enlarged
  • Lymphadenopathy
  • Palpable
  • Shotty
  • Visible swelling
• If a specific chain of lymph nodes is named, but not listed as regional, first determine if the name is synonymous for regional listed lymph nodes. Otherwise, assume distant lymph nodes are involved.

See the Summary Stage Manual for further information and guidelines on assigning lymph node involvement.

Updated: December 15, 2023