Regional Lymph Node Involvement
Regional lymph nodes are listed for each site in the summary staging manual.
- Consider the highest specific lymph node chain that is involved by tumor.
- For lymphomas, any mention of lymph nodes is indicative of involvement and is used to determine the number and location of lymph node chains involved (see lymphoma scheme).
- For solid tumors, the terms "fixed" or "matted" and "mass in the mediastinum, retroperitoneum, and/or mesentery" (with no specific information as to tissue involved) are considered involvement of lymph nodes.
- Terms, such as "palpable," "enlarged," "visible swelling," "shotty," or "lymphadenopathy" should be ignored (except for lung primaries); look for a statement of involvement, either clinically or pathologically. For lung primaries, these terms are interpreted as regional lymph node involvement.
- The terms "homolateral" and "ipsilateral" are used interchangeably. Any unidentified nodes included with the resected primary site specimen are to be considered as "Regional Lymph Nodes, NOS."
- If the only indication of lymph node involvement in the record is the physician' statement of an N category from the TNM staging system or a stage from a site-specific staging system, such as "Duke's C," consider that information in determining regional lymph node involvement.
- If there is a discrepancy between documentation in the medical record and the physician's assignment of a TNM stage, the documentation takes precedence. Cases of this type should be discussed with the physician who assigned the TNM stage (see General Guideline 9).
- If a specific chain of lymph nodes is named, but not listed as regional, first determine if the name is synonymous for a listed lymph node. Otherwise, assume distant lymph node(s) are involved.
Note: Regional lymph nodes are not palpable for inaccessible sites such as bladder, kidney, prostate, esophagus, stomach, lung, liver, corpus uteri, and ovary. The best description concerning regional lymph nodes will be the surgeon's evaluation at the time of exploratory surgery or definitive surgery.