CS Extension

Notes

**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 contralateral lung. **Note 2**: Distance from Carina: Assume tumor is greater than or equal to 2 centimeters (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. Bronchopneumonia is an acute inflammation of the walls of the bronchioles, usually a result of spread of infection from the upper to the lower respiratory tract. Obstructive pneumonitis is a combination of atelectasis, bronchiectasis with mucous plugging, and parenchymal inflammation that develops distal to an obstructing endobronchial lesion. **Note 5**: Pulmonary Artery/Vein: An involved pulmonary artery/vein in the mediastinum is coded to 700 (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 is not coded to 700. **Note 6**: Vocal cord paralysis (resulting from involvement of recurrent branch of the vagus nerve), superior vena cava (SVC) 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 700 for these manifestations. However, if the primary tumor is peripheral and clearly unrelated to vocal cord paralysis, SVC obstruction, or compression of the trachea or the esophagus, code these manifestations as mediastinal lymph node involvement (code 200) in CS Lymph Nodes, unless there is a statement of involvement by direct extension from the primary tumor. **Note 7**: Pleural effusion and pericardial effusion are coded in CS Mets at DX. **Note 8**: In some cases, the determination of the T category for TNM 6 or 7 staging is based on this field, CS Tumor Size, CS Mets at DX, and CS Site-Specific Factor 1. **Note 9**: Code to the highest applicable code for CS Extension and then code the absence or presence of separate ipsilateral tumor nodules in CS Site-Specific Factor 1, Separate Tumor Nodules/Ipsilateral lung. Code separate tumor nodules in contralateral lung in CS Mets at DX. **Note 10**: Specific information about visceral pleura invasion is captured in codes 410-430 and CS Site-Specific Factor 2, Visceral Pleural Invasion (VPI)/Elastic Layer. Elastic layer involvement has prognostic significance for lung cancer.
Code Description AJCC 7 T AJCC 6 T Summary Stage 1977 T Summary Stage 2000 T
000 In situ, intraepithelial, noninvasive Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value Determine Correct Table for SS 1977 T Determine Correct Table for SS 2000 T
100 Tumor confined to one lung
WITHOUT extension or conditions described in codes 200-800
EXCLUDING primary in main stem bronchus
EXCLUDING superficial tumor as described in code 110		 Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
110 Superficial tumor of any size with invasive component limited to bronchial wall, with or without proximal extension to the main stem bronchus Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
115 Stated as T1a with no other information on extension Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
120 Stated as T1b with no other information on extension Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
125 Stated as T1[NOS] with no other information on extension Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
200 Extension from other parts of lung to main stem bronchus, NOS
EXCLUDING superficial tumor as described in code 110
Tumor involving main stem bronchus greater than or equal to 2.0 cm from carina (primary in lung or main stem bronchus)		 Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
210 Tumor involving main stem bronchus, NOS
(Distance from carina not stated and no surgery as described in Note 2)		 Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
220 Direct tumor invasion into an adjacent ipsilateral lobe Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
230 Tumor confined to hilus Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
250 OBSOLETE DATA CONVERTED V0204
See code 680

Tumor confined to carina		 ERROR: Determine Correct Table for AJCC 6 T,M - T value ERROR: Determine Correct Table for SS 2000 T
300 Localized, NOS Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
400 Atelectasis/obstructive pneumonitis that extends to the hilar region but does not involve the entire lung
Or atelectasis/obstructive pneumonitis, NOS		 Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
410 Extension to but not into pleura, including invasion of elastic layer
BUT not through the elastic layer.		 Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
420 Invasion of pleura, including invasion through the elastic layer Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
430 Invasion of pleura, NOS Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
440 Pulmonary ligament Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
450 OBSOLETE DATA RETAINED V0200

Extension to:
Pleura, visceral or NOS (WITHOUT pleural effusion)
Pulmonary ligament 		ERROR: Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
455 Stated as T2a with no other information on extension Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
460 Stated as T2b with no other information on extension Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
465 Stated as T2 [NOS] with no other information on size or extension Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
500 Tumor of/involving main stem bronchus less than 2.0 cm from carina Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
520 500 + 400 Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
530 OBSOLETE DATA RETAINED V0200

450 + 500		 ERROR: Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
540 500 + any of (410-440) Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
550 Atelectasis/obstructive pneumonitis involving entire lung Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
560 Parietal pericardium or pericardium, NOS Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
570 Stated as T3 with no other information on extension Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
590 Invasion of phrenic nerve Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
600 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.		 Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value D Determine Correct Table for SS 2000 T
610 Superior sulcus tumor WITH encasement of subclavian vessels
OR WITH unequivocal involvement of superior branches of brachial plexus (C8 or above)		 T4 Determine Correct Table for AJCC 6 T,M - T value D Determine Correct Table for SS 2000 T
650 OBSOLETE DATA RETAINED V0200
Separate tumor nodules reclassified in AJCC 7th Edition, coded in CS Site-Specific Factor 1

Multiple masses/separate tumor nodule(s) in the SAME lobe
"Satellite nodules" in SAME lobe		 ERROR: Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
680 Tumor confined to carina T4 Determine Correct Table for AJCC 6 T,M - T value L Determine Correct Table for SS 2000 T
700 Blood vessel(s), major (EXCEPT aorta and inferior vena cava, see codes 740 and 770)
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 syndrome)
Recurrent laryngeal (vocal cord paralysis)
Vagus
Trachea		 T4 Determine Correct Table for AJCC 6 T,M - T value RE Determine Correct Table for SS 2000 T
705 700 + (600 or 610) T4 Determine Correct Table for AJCC 6 T,M - T value D D
710 Heart
Visceral pericardium		 T4 Determine Correct Table for AJCC 6 T,M - T value D D
720 OBSOLETE DATA RETAINED V0200
Pleural effusion reclassified as distant metastasis in AJCC 7th Edition, see CS Mets at DX code 15

Malignant pleural effusion
Pleural effusion, NOS		 ERROR: Determine Correct Table for AJCC 6 T,M - T value D D
730 Adjacent rib
See also code 785		 Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value D D
740 Aorta T4 Determine Correct Table for AJCC 6 T,M - T value D Determine Correct Table for SS 2000 T
745 740 + 710 T4 Determine Correct Table for AJCC 6 T,M - T value D D
748 740 + 730 T4 Determine Correct Table for AJCC 6 T,M - T value D D
750 Vertebra(e)
Neural foramina		 T4 Determine Correct Table for AJCC 6 T,M - T value D D
760 OBSOLETE DATA RETAINED V0200
Separate pleural tumor foci reclassified as distant metastasis in AJCC 7th Edition, see CS Mets at DX code 24

Pleural tumor foci separate from direct pleural invasion		 ERROR: Determine Correct Table for AJCC 6 T,M - T value D D
770 Inferior vena cava T4 Determine Correct Table for AJCC 6 T,M - T value D D
780 OBSOLETE DATA RETAINED V0200

730 plus any of (610-720) or (740-770)		 ERROR: Determine Correct Table for AJCC 6 T,M - T value D D
785 730 + (700 or 710) T4 Determine Correct Table for AJCC 6 T,M - T value D D
790 OBSOLETE DATA RETAINED V0200
Pericardial effusion reclassified as distant metastasis, see CS Mets at DX code 20

Pericardial effusion, NOS; malignant pericardial effusion		 ERROR: Determine Correct Table for AJCC 6 T,M - T value D D
795 OBSOLETE DATA CONVERTED V0204
See code 810

Stated as T4 with no other information on extension		 ERROR: Determine Correct Table for AJCC 6 T,M - T value ERROR: ERROR:
800 Further contiguous extension
(Except to structures specified in CS Mets at DX codes 23 and 37)		 T4 Determine Correct Table for AJCC 6 T,M - T value D D
810 Stated as T4 with no other information on extension T4 Determine Correct Table for AJCC 6 T,M - T value D D
950 No evidence of primary tumor Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value Determine Correct Table for SS 1977 T Determine Correct Table for SS 2000 T
980 Tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy; "occult" carcinoma Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value Determine Correct Table for SS 1977 T Determine Correct Table for SS 2000 T
999 Unknown; extension not stated
Primary tumor cannot be assessed
Not documented in patient record		 Determine Correct Table for AJCC 7 T Determine Correct Table for AJCC 6 T,M - T value Determine Correct Table for SS 1977 T Determine Correct Table for SS 2000 T
- For CS Extension codes 000-440, 455-520, 540-600, 730, and 950-999, the T category for AJCC 7 staging is assigned based on the values of CS Tumor Size, CS Extension, and CS Site Specific Factor 1, as shown in the Size Extension AJCC 7 Table for this schema. - For CS Extension codes 000-999, the T category for AJCC 6 staging is assigned based on the values of CS Tumor Size, CS Extension, CS Mets at Dx and CS Site Specific Factor 1 as shown in the Size Extension Mets AJCC 6 Table for this schema. - For CS Extension codes 000, 950, 980 and 999, Summary Stage 77 is assigned based on the values of CS Extension and Site Specific Factor 1 as shown in the Summary Stage 77 Table for this schema. - For CS Extension codes 000-700, 740, 950-999, Summary Stage 2000 is assigned based on the values of CS Extension and Site Specific Factor 1 as shown in the Summary Stage 2000 Table for this schema.