- If the tumor is not staged according to the AJCC manual, leave this data item blank.
- Refer to the current AJCC Cancer Staging Manual for staging rules.
- Code AJCC T Suffix as (m) when there are multiple synchronous tumors
- Multifocal is different from synchronous primary tumors.
- The (m) suffix applies to multiple invasive cancers. It is not applicable to multiple foci of in situ cancer or a mixed invasive and in situ cancer.
- Thyroid
- Most all thyroid differentiated tumors should be designated as either (s) or (m).
- Thyroid is different and (m) is used if it is multifocal.
AJCC TNM N Suffix (Applicable for all cases)
- If the tumor is not staged according to the AJCC manual, leave this data item blank.
- Refer to the current AJCC Cancer Staging Manual for staging rules.
- If an FNA or a core biopsy is performed on lymph nodes as part of the diagnostic workup, the cN category should have the f suffix. (Doesn’t matter if the biopsy is negative or positive, the (f) just denotes it was done.)
- If SLN biopsy is performed as part of the diagnostic workup, the cN category should have the sn suffix. (No matter what site it is.)
- If a sentinel lymph node biopsy and regional node dissection are both performed, you leave the n suffix BLANK and do not code (sn), this is only coded when sentinel lymph node biopsy is done and no regional dissection.
- Sometimes when a SLN bx is done additional non-sentinel nodes can be taken during the same operative procedure. These additional non-sentinel nodes are palpably abnormal and selectively removed (or harvested) as part of the SLNBx procedure by the surgeon or may be discovered by the pathologist. Consider this just a SLN biopsy and not an axillary dissection, and code the (sn) suffix.
