Data Last Updated: Sept. 13, 2023

Schema Discriminator 1: Occult Head and Neck Lymph Nodes

This input is used for staging

Notes

**Note 1:** This schema discriminator is used to discriminate between head and neck tumors with unknown primary site coded as C760. Some situations require that a more specific primary site be assigned. * **00060: Cervical Lymph Nodes and Unknown Primary** Occult head and neck tumor with cervical metastasis in Levels I-VII, and other group lymph nodes without a p16 immunostaining or with negative results and without an Epstein-Barr virus (EBV) encoded small RNAs (EBER) by in situ hybridization performed or with negative results are staged using the AJCC Cervical Lymph Nodes and Unknown Primary Tumors of the Head and Neck Staging System. **Assign primary site C760; code the schema discriminator accordingly.** * **00090: Nasopharynx** Occult head and neck tumors with cervical metastasis in Levels I-VII, and other group lymph nodes that is positive for Epstein-Barr virus (EBV+) (regardless of p16 status) encoded small RNAs (EBER) identified by in situ hybridization are staged using the AJCC Nasopharynx Staging System. **Assign primary site C119; do NOT code this discriminator.** * **00100: HPV-Mediated (p16+) Oropharyngeal Cancer** Occult head and neck tumors with cervical metastasis in Levels I-VII, and other group lymph nodes, p16 positive with histology consistent with HPV-mediated oropharyngeal carcinoma (OPC), are staged using the AJCC HPV-Mediated (p16+) Oropharyngeal Cancer Staging System. **Assign primary site C109; do NOT code this discriminator** * **99999: Ill-Defined Other** If the tumor is not occult or does not have cervical metastasis in Levels I-VII, and other group lymph nodes, it is not included in the AJCC Cervical Lymph Nodes and Unknown Primary Tumors of the Head and Neck Staging System and will be classified as Ill-Defined Other for Summary Staging **Note 2:** If there is no evidence of the primary tumor, yet the physician "suspects" a specific head and neck subsite, do not assign that primary site, but code C760 (see exceptions for EBV positive or p16 positive cancers.)
Code Description Schema ID #/Description
0 Not Occult 99999: Ill Defined Other
00459: Soft Tissue Other (8941/3 only)
1 Occult, Negative cervical nodes (regional head and neck nodes) 99999: Ill Defined Other
00459: Soft Tissue Other (8941/3 only)
2 Not tested for EBV or p16 in head and neck regional nodes (EBV and p16 both unknown) 00060: Cervical Lymph Nodes and Unknown Primary
3 Unknown EBV, p16 negative in head and neck regional nodes 00060: Cervical Lymph Nodes and Unknown Primary
4 Unknown p16, EBV negative in head and neck regional nodes 00060: Cervical Lymph Nodes and Unknown Primary
5 Negative for both EBV and p16 in head and neck regional nodes 00060: Cervical Lymph Nodes and Unknown Primary
<BLANK> Not C760, discriminator does not apply

Positive p16 in head and neck regional nodes, EBV unknown or negative
Assign primary site C109

Positive EBV in head and neck regional nodes, p16 positive, negative, or unknown
Assign primary site C119
Various

00010: Oropharynx HPV-Mediated (p16+)



00090: Nasopharynx