Note 1: Direct extension to or other involvement of structures considered M1 in AJCC staging is coded in the data item CS Mets at DX. This includes: sternum; skeletal muscle; skin of chest; contralateral lung or mainstem bronchus; separate tumor nodule(s) in different lobe, same lung, or in contralateral lung.
Note 2: Distance from Carina. Assume tumor is greater than or equal to 2 cm from carina if lobectomy, segmental resection, or wedge resection is done.
Note 3: Opposite Lung. If no mention is made of the opposite lung on a chest x-ray, assume it is not involved.
Note 4: Bronchopneumonia. "Bronchopneumonia" is not the same thing as "obstructive pneumonitis" and should not be coded as such.
Note 5: Pulmonary Artery/Vein. An involved pulmonary
artery/vein in the mediastinum is coded to 70
(involvement of major blood vessel). However, if the involvement of the
artery/vein appears to be only within lung
tissue and not in the mediastinum, it would not be coded to 70.
Note 6: Pleural
Effusion.
A. Note from SEER manual: Ignore pleural effusion that is negative for
tumor. Assume that a pleural effusion is negative if a resection is done.
B. Note from AJCC manual: Most pleural effusions associated with lung cancers
are due to tumor. However, there are a few patients in whom multiple cytoopathologic
examinations of pleural fluid are negative for tumor. In these cases, fluid
is non-bloody and is not an exudate. When these elements and clinical judgement
dictate that the effusion is not related to the tumor, the effusion should
be excluded as a staging element and the patient should be staged T1, T2,
or T3.
Note 7: Vocal cord paralysis (resulting from involvement of recurrent branch of the vagus nerve), superior vena cava obstruction, or compression of the trachea or the esophagus may be related to direct extension of the primary tumor or to lymph node involvement. The treatment options and prognosis associated with these manifestations of disease extent fall within the T4-Stage IIIB category; therefore, generally use code 70 for these manifestations. HOWEVER, if the primary tumor is peripheral and clearly unrelated to vocal cord paralysis, vena cava obstruction, or compression of the trachea or the esophagus, code these manifestations as mediastinal lymph node involvement (code 20) in CS Lymph Nodes unless there is a statement of involvement by direct extension from the primary tumor.
Code | Description | TNM | SS77 | SS2000 |
00 | In situ; noninvasive; intraepithelial | Tis | IS | IS |
10 | Tumor confined to one lung, WITHOUT extension or conditions described in codes 20-80 (excluding primary in main stem bronchus) (EXCLUDES superficial tumor as described in code 11) |
* | L | L |
11 | Superficial tumor of any size with invasive component
limited to bronchial wall, WITH or WITHOUT proximal extension to the
main stem bronchus |
T1 | L | L |
20 | Extension from other parts of lung to main stem bronchus,
NOS (EXCLUDES superficial tumor as described in code 11) Tumor involving main stem bronchus greater than or equal to 2.0 cm from carina (primary in lung or main stem bronchus) |
T2 | L | L |
21 | Tumor involving main stem bronchus, NOS (distance from
carina not stated and no surgery as described in Note 2) |
T2 | L | L |
23 | Tumor confined to hilus |
* | L | L |
25 | Tumor confined to the carina | * | L | L |
30 | Localized, NOS | T1 | L | L |
40 | Atelectasis/obstructive pneumonitis that extends to the
hilar region but does not involve the entire lung (or atelectasis/obstructive
pneumonitis, NOS) WITHOUT pleural effusion |
T2 | RE | RE |
45 | Extension to: Pleura, visceral or NOS (WITHOUT pleural effusion) Pulmonary ligament (WITHOUT pleural effusion) |
T2 | RE | RE |
50 | Tumor of/involving main stem bronchus less than 2.0 cm from carina |
T3 | L | RE |
52 | (40) + (50) | T3 | RE | RE |
53 | (45) + (50) | T3 | RE | RE |
55 | No evidence of primary tumor | T3 | RE | RE |
56 | Parietal pericardium or pericardium, NOS | T3 | RE | RE |
59 | Invasion of phrenic nerve | T3 | RE | RE |
60 | Direct extension to: Brachial plexus, inferior branches or NOS, from superior sulcus Chest (thoracic) wall Diaphragm Pancoast tumor (superior sulcus syndrome), NOS Parietal pleura Note: For separate lesion in chest wall or diaphragm, see CS Mets at DX. |
T3 | D | RE |
61 | Superior sulcus tumor WITH encasement of subclavian vessels OR WITH unequivocal involvement of superior branches of brachial plexus (C8 or above) |
T4 | D | RE |
65 | Multiple masses/separate tumor nodule(s) in the SAME lobe "Satellite nodules" in SAME lobe |
T4 | L | RE |
70 | Blood vessel(s), major (EXCEPT aorta and inferior vena
cava, see codes 74 and 77) Azygos vein Pulmonary artery or vein Superior vena cava (SVC syndrome) Carina from lung/mainstem bronchus Compression of esophagus or trachea not specified as direct extension Esophagus Mediastinum, extrapulmonary or NOS Nerve(s): Cervical sympathetic (Horner's syndrome) Recurrent laryngeal (vocal cord paralysis) Vagus Trachea |
T4 | RE | RE |
71 | Heart Visceral pericardium |
T4 | D | D |
72 | Malignant pleural effusion Pleural effusion, NOS |
T4 | D | D |
73 | Adjacent rib | T3 | D | D |
74 | Aorta | T4 | D | RE |
75 | Vertebra(s) Neural foramina |
T4 | D | D |
76 | Pleural tumor foci separate from direct pleural invasion | T4 | D | D |
77 | Inferior vena cava | T4 | D | D |
79 | Pericardial effusion, NOS; malignant pericardial effusion | T4 | D | D |
80 | Further contiguous extension (except to structures specified
in CS Mets at DX) |
T4 | D | D |
95 | No evidence of primary tumor | T0 | U | U |
98 | Tumor proven by presence of malignant cells in sputum
or bronchial washings but not visualized by imaging or bronchoscopy; "occult" carcinoma |
TX | U | U |
99 | Unknown extension Primary tumor cannot be assessed Not documented in patient record |
TX | U | U |
*For Extension codes 10, 23, and 25 ONLY, the T category
is assigned based on the value of tumor size, as shown
in the Extension Size table for this site.