Note 1 Grade Pathological must not be blank.

Note 2 Assign the highest grade from the primary tumor.

Note 3 If there are multiple tumors with different grades abstracted as one primary, code the highest grade.

Note 4 Use the grade from the clinical work up from the primary tumor in different scenarios based on behavior or surgical resection

• Behavior

• Tumor behavior for the clinical and the pathological diagnoses are the same AND the clinical grade is the highest grade
• Tumor behavior for clinical diagnosis is invasive, and the tumor behavior for the pathological diagnosis is in situ

• Surgical Resection

• Surgical resection is done of the primary tumor and there is no grade documented from the surgical resection
• Surgical resection is done of the primary tumor and there is no residual cancer

• No surgical resection

• Surgical resection of the primary tumor has not been done, but there is positive microscopic confirmation of distant metastases during the clinical time frame

Note 5 Code 9 (unknown) when

• Grade from primary site is not documented
• No resection of the primary site (see exception in Note 4, Surgical resection, last bullet)
• Neo-adjuvant therapy is followed by a resection (see Grade Post Therapy Path (yp))
• Grade checked "not applicable" on CAP Protocol (if available) and no other grade information is available
• Clinical case only (see Grade Clinical)
• There is only one grade available and it cannot be determined if it is clinical, pathological, post therapy clinical or post therapy pathological