Appendix carcinoma TNM staging AJCC UICC version 9

Primary tumor (T)^*
T category	T criteria
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ (intramucosal carcinoma; invasion of the lamina propria or extension into but not through the muscularis mucosae)
Tis(LAMN)	Low-grade appendiceal mucinous neoplasm confined to the muscularis propria; Acellular mucin or mucinous epithelium may invade into the muscularis propria. T1 and T2 are not applicable to LAMN; Acellular mucin or mucinous epithelium that extends into the subserosa or serosa should be classified as T3 or T4a, respectively.
T1	Tumor invades the submucosa (through the muscularis mucosa but not into the muscularis propria)
T2	Tumor invades the muscularis propria
T3	Tumor invades through the muscularis propria into the subserosa or the mesoappendix
T4	Tumor invades the visceral peritoneum, including acellular mucin or mucinous epithelium involving the serosa of the appendix or mesoappendix, and/or directly invades adjacent organs or structures
T4a	Tumor invades the visceral peritoneum, including acellular mucin or mucinous epithelium involving the serosa of the appendix or serosa of the mesoappendix
T4b	Tumor directly invades or adheres to adjacent organs or structures
Primary tumor suffix (m) Multiple synchronous primary tumors
Regional lymph nodes (N)^*
N category	N criteria
NX	Regional lymph nodes cannot be assessed
N0	No tumor involvement of regional lymph node(s)
N1	Tumor involvement of one to three regional lymph nodes (tumor in lymph node measuring greater than or equal to 0.2 mm) or any number of tumor deposits is present with no tumor involvement in all identifiable lymph nodes
N1a	Tumor involvement of one regional lymph node
N1b	Tumor involvement of two or three regional lymph nodes
N1c	No tumor involvement of regional lymph nodes, but there are tumor deposits in the subserosa or mesentery
N2	Tumor involvement of four or more regional lymph nodes
Regional lymph nodes suffix (sn) Sentinel node procedure (f) FNA or core biopsy
Distant metastasis (M)^*
M category	M criteria
cM0	No distant metastasis
cM1	Distant metastasis
cM1c	Metastasis to sites other than peritoneum
pM1	Microscopic confirmation of distant metastasis
pM1a	Intraperitoneal acellular mucin, without identifiable tumor cells in the disseminated peritoneal mucinous deposits
pM1b	Intraperitoneal metastasis only, including peritoneal mucinous deposits containing tumor cells
pM1c	Microscopic confirmation of metastasis to sites other than peritoneum
NOTE: For specimens containing acellular mucin without identifiable tumor cells, efforts should be made to obtain additional tissue for thorough histologic examination to evaluate for cellularity.
Histologic grade (G)^*
G	G definition
GX	Grade cannot be assessed
G1	Well differentiated
G2	Moderately differentiated
G3	Poorly differentiated
NOTE: In rare cases of discordance in primary and metastatic histological grade, the grade of metastatic disease is utilized for stage group assignment.
AJCC prognostic stage group is assigned based on the stage classification and categories chosen.^*
Prognostic stage groups
When T is...	And N is...	And M is...	And grade is...	Then the stage group is...
Tis	N0	M0	Any	0
Tis(LAMN)	N0	M0	Any	0
T1	N0	M0	Any	I
T2	N0	M0	Any	I
T3	N0	M0	Any	IIA
T4a	N0	M0	Any	IIB
T4b	N0	M0	Any	IIC
T1	N1	M0	Any	IIIA
T2	N1	M0	Any	IIIA
T3	N1	M0	Any	IIIB
T4	N1	M0	Any	IIIB
Any T	N2	M0	Any	IIIC
Any T	Any N	M1a	Any	IVA
Any T	Any N	M1b	G1	IVA
Any T	Any N	M1b	G2, G3, or GX	IVB
Any T	Any N	M1c	Any G	IVC

AJCC: American Joint Committee on Cancer; TNM: tumor, node, metastasis; UICC: Union for International Cancer Control.

* AJCC data elements required for staging are identified with an asterisk.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging System: Appendix, Version 9 (2022), published by the American College of Surgeons (ACS).

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Appendix carcinoma TNM staging AJCC UICC version 9