LIP AND ORAL CAVITY STAGING FORM – 8th ed. Tumor Size __________________ Laterality [ ] Bilateral [ ] Left [ ] Right CLINICAL STAGE CATEGORY OF DEFINITIONS PATHO- LOGIC PRIMARY TUMOR (T) ( ) Tx Primary tumor cannot be assessed ( ) Tx ( ) Tis Carcinoma in situ* ( ) Tis ( ) T1 Tumor ≤ 2 cm in greatest dimension, ≤ 5 mm depth of invasion (DOI not tumor thickness) ( ) T1 OR tumor > 2 cm but ≤ 4 cm, and ≤ 10 mm DOI ( ) T2 Tumor ≤ 2 cm, DOI > 5mm and ≤ 10 mm ( ) T2 OR tumor > 2 cm but ≤ 4 cm and ≤ 10 mm DOI ( ) T3 Tumor > 4 cm OR any tumor > 10 mm DOI ( ) T3 ( ) T4 Moderately advanced or very advanced local disease ( ) T4 ( ) T4a Moderately advanced local disease ( ) T4a (Lip) Tumor invades through cortical bone or involves the inferior alveolar nerve, floor of mouth, or skin of face, (i.e., chin or nose) (Oral Cavity) Tumor invades adjacent structures only (e.g., through cortical bone of the mandible or maxilla, or involves the maxillary sinus or skin of the face) Note: Superficial erosion of bone/tooth socket (alone) by a gingival primary is not sufficient to classify a tumor as T4 ( ) T4b Very advanced local disease ( ) T4b Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery CLINICAL REGIONAL LYMPH NODES (N) ENE – extranodal extension ( ) Nx Regional lymph nodes cannot be assessed ( ) N0 No regional lymph node metastasis ( ) N1 Metastasis in a single ipsilateral lymph node, 3 cm in greatest dimension and ENE ( – ) ( ) N2 Metastasis in a single ipsilateral lymph node, > 3 cm but 6 cm in greatest dimension and ENE ( – ); OR mets in multiple ipsilateral lymph nodes, 6 cm in greatest dimension and ENE ( – ); OR mets in bilateral or contralateral lymph nodes, 6 cm in greatest dimension and ENE ( – ) ( ) N2a Metastasis in single ipsilateral lymph node > 3 cm but 6 cm in greatest dimension and ENE ( – ) ( ) N2b Metastasis in multiple ipsilateral lymph nodes, 6 cm in greatest dimension and ENE ( – ) ( ) N2c Metastasis in bilateral or contralateral lymph nodes, 6 cm in greatest dimension and ENE ( – ) ( ) N3 Metastasis in a lymph node > 6 cm in greatest dimension and ENE ( – ); OR metastasis in any lymph node(s) with clinically overt ENE ( + ) ( ) N3a Metastasis in a lymph node > 6 cm in greatest dimension and ENE ( – ) ( ) N3b Metastasis in any lymph node(s) with clinically overt ENE ( + ) Patient Name: _________________________________________ Medical Record Number: ____________________ Financial Number: _________________________ North Kansas City Hospital American Joint Committee on Cancer, pub 2017 2800 Clay Edwards Drive AJCC Cancer Staging Manual, 8th edition North Kansas City, MO 64116 form revised by North Kansas City Hospital 2017 LIP and ORAL CAVITY STAGING FORM – page 2 PATHOLOGIC REGIONAL LYMPH NODES (N) ENE – extranodal extension Regional lymph nodes cannot be assessed ( ) Nx No regional lymph node metastasis ( ) N0 Metastasis in a single ipsilateral lymph node, 3 cm in greatest dimension and ENE ( – ) ( ) N1 Metastasis in a single ipsilateral lymph node, 3 cm in greatest dimension and ENE ( + ); ( ) N2 OR mets in single ipsilateral lymph node, > 3 cm but 6 cm in greatest dimension and ENE ( – ); OR mets in multiple ipsilateral lymph nodes, 6 cm in greatest dimension and ENE ( – ) OR mets in bilateral or contralateral lymph nodes, 6 cm in greatest dimension and ENE ( – ) Metastasis in single ipsilateral or contralateral lymph node < 3 cm in greatest dimension and ENE ( + ); ( ) N2a OR metastasis in a single ipsilateral node, > 3 cm but 6 cm in greatest dimension and ENE ( – ); Metastasis in multiple ipsilateral lymph nodes, 6 cm in greatest dimension and ENE ( – ) ( ) N2b Metastasis in bilateral or contralateral lymph nodes, 6 cm in greatest dimension and ENE ( – ) ( ) N2c Metastasis in a lymph node > 6 cm in greatest dimension and ENE ( – ); ( ) N3 OR metastasis in a single ipsilateral node > 3 cm and ENE ( + ); OR metastasis in multiple ipsilateral, contralateral, or bilateral lymph node(s) and any with ENE (+) Metastasis in a lymph node > 6 cm in greatest dimension and ENE ( – ) ( ) N3a Metastasis in a single ipsilateral node > 3 cm and ENE ( + ); ( ) N3b OR metastasis in multiple ipsilateral, contralateral, or bilateral lymph node(s) and any with ENE (+) CLINICAL DISTANT METASTASIS (M) PATHOLOGIC ( ) M0 No distant metastasis (no pathologic M0; use clinical M to complete stage group) ( ) M1 Distant metastasis ( ) M1 AJCC PROGNOSTIC STAGE GROUPS CLINICAL T N M PATHOLOGIC GROUP GROUP ( ) 0 Tis N0 M0 ( ) 0 ( ) I T1 N0 M0 ( ) I ( ) II T2 N0 M0 ( ) II ( ) III T3 N0 M0 ( ) III T1, T2, T3 N1 M0 ( ) IVA T4a N0, N1 M0 ( ) IVA T1, T2, T3, T4a N2 M0 ( ) IVB T4b Any N M0 ( ) IVB Any T N3 M0 ( ) IVC Any T Any N M1 ( ) IVC ( ) Stage unknown Physician signature Date & Time North Kansas City Hospital American Joint Committee on Cancer, pub 2017 2800 Clay Edwards Drive AJCC Cancer Staging Manual, 8th edition North Kansas City, MO 64116 form revised by North Kansas City Hospital 2017 .