CS Extension

Notes

**Note 1**: Changes such as dimpling of the skin, tethering, and nipple retraction are caused by tension on Cooper's ligament(s), not by actual skin involvement. They do not alter the classification. **Note 2**: Consider adherence, attachment, fixation, induration, and thickening as clinical evidence of extension to skin or subcutaneous tissue, code 200. **Note 3**: Consider fixation, NOS as involvement of pectoralis muscle, code 300. **Note 4**: If CS Extension code is 000, then Behavior code must be 2; if CS Extension code is 050 or 070, then Behavior code may be 2 or 3; and if CS Extension code is 100, then Behavior code must be 3. **Note 5**: Inflammatory Carcinoma: AJCC includes the following text in the Cancer Staging Manual 7th Edition: "Inflammatory carcinoma is a clinicopathologic entity characterized by diffuse erythema and edema (peau d'orange) of the breast, often without an underlying palpable mass. These clinical findings should involve the majority of the skin of the breast. Classically, the skin changes arise quickly in the affected breast. Thus the term of inflammatory carcinoma should not be applied to a patient with neglected locally advanced cancer of the breast presenting late in the course of her disease. On imaging, there may be a detectable mass and characteristic thickening of the skin over the breast. This clinical presentation is due to tumor emboli within dermal lymphatics, which may or may not be apparent on skin biopsy. The tumor of inflammatory carcinoma is classified T4d. It is important to remember that inflammatory carcinoma is primarily a clinical diagnosis. Involvement of the dermal lymphatics alone does not indicate inflammatory carcinoma in the absence of clinical findings. In addition to the clinical picture, however, a biopsy is still necessary to demonstrate cancer either within the dermal lymphatics or in the breast parenchyma itself." **Note 6**: For CS coding, the abstractor should record a stated diagnosis of inflammatory carcinoma, and also record any clinical statement of the character and extent of skin involvement in the text area. Code 600 should be used if there is a stated diagnosis of inflammatory carcinoma and a clinical description of the skin involvement is less than one-third (33%) of the skin of the breast. Code 725 should be used if there is a stated diagnosis of inflammatory carcinoma and a clinical description of the skin involvement is greater than or equal to one-third (33%) and less than or equal to one-half (50%) of the skin of the breast. Code 730 should be used if there is a stated diagnosis of inflammatory carcinoma and a clinical description of the skin involvement in more than one-half (50%) (majority or diffuse) of the skin of the breast. Cases with a stated diagnosis of inflammatory carcinoma but no such clinical description should be coded 750. A clinical description of inflammation, erythema, edema, peau d'orange, or other terms describing skin changes without a stated diagnosis of inflammatory carcinoma should be coded 512-585 depending on described extent of the condition.
Code Description AJCC 7 T AJCC 6 T Summary Stage 1977 T Summary Stage 2000 T
000 In situ: noninfiltrating; intraepithelial
Intraductal WITHOUT infiltration
Lobular neoplasia		 Tis Tis IS IS
050 Paget disease of nipple
WITHOUT underlying tumor		 Tis Tis Extension Behavior Extension Behavior
070 Paget Disease disease of nipple
WITHOUT underlying invasive carcinoma pathologically		 Tis Tis Extension Behavior Extension Behavior
100 Confined to breast tissue and fat including nipple and/or areola
Localized, NOS		 Extension Size Extension Size L L
110 Stated as T1mi with no other information on extension Extension Size Extension Size L L
120 Stated as T1a with no other information on extension Extension Size Extension Size L L
130 Stated as T1b with no other information on extension Extension Size Extension Size L L
140 Stated as T1c with no other information on extension Extension Size Extension Size L L
170 Stated as T1 [NOS] with no other information on extension or size T1NOS T1NOS L L
180 Stated as T2 with no other information on extension or size T2 T2 L L
190 Stated as T3 with no other information on extension or size T3 T3 L L
200 Invasion of subcutaneous tissue
Local infiltration of dermal lymphatics adjacent to primary tumor involving skin by direct extension
Skin infiltration of primary breast including skin of nipple and/or areola		 Extension Size Extension Size RE RE
300 Attachment or fixation to pectoral muscle(s) or underlying tissue
Deep fixation
Invasion of (or fixation to) pectoral fascia or muscle		 Extension Size Extension Size RE RE
380 OBSOLETE DATA CONVERTED V0203
See code 790

Stated as T4 [NOS] with no other information on extension		 ERROR: ERROR: ERROR: ERROR:
390 OBSOLETE DATA CONVERTED V0203
See code 410

Stated as T4a with no other information on extension		 ERROR: ERROR: ERROR: ERROR:
400 Invasion of (or fixation to):
Chest wall
Intercostal or serratus anterior muscle(s)
Rib(s)

See codes 610 (obsolete), 612-615, and 620 (obsolete) for combinations with this code		 T4a T4a RE RE
410 Stated as T4a with no other information on extension T4a T4a RE RE
510 OBSOLETE DATA RETAINED V0200

Extensive skin involvement, including:
Satellite nodule(s) in skin of primary breast
Ulceration of skin of breast
Any of the following conditions described as involving not more than 50% of the breast, or amount or percent of involvement not stated:
Edema of skin
En cuirasse
Erythema
Inflammation of skin
Peau d'orange ("pigskin")		 ERROR: T4b RE RE
512 Extensive skin involvement, including:
Satellite nodule(s) in skin of primary breast
Ulceration of skin of breast		 T4b T4b RE RE
514 Any of the following conditions described as involving less than one-third (33%) of the breast
WITHOUT a stated diagnosis of inflammatory carcinoma
WITH or WITHOUT dermal lymphatic infiltration:
Edema of skin
En cuirasse
Erythema
Inflammation of skin
Peau d'orange ("pigskin")		 T4b T4b RE RE
516 514 + 512 T4b T4b RE RE
518 Any of the following conditions described as involving one third (33%) or more but less than or equal to half (50%) of the breast
WITHOUT a stated diagnosis of inflammatory carcinoma
WITH or WITHOUT dermal lymphatic infiltration:
Edema of skin
En cuirasse
Erythema
Inflammation of skin
Peau d'orange ("pigskin")		 T4b T4b RE RE
519 518 + 512 T4b T4b RE RE
520 Any of the following conditions described as involving more than 50% of the breast
WITHOUT a stated diagnosis of inflammatory carcinoma
WITH or WITHOUT dermal lymphatic infiltration:
Edema of skin
En cuirasse
Erythema
Inflammation of skin
Peau d'orange ("pigskin")		 T4b T4b RE RE
575 520 + 512 T4b T4b RE RE
580 Any of the following conditions with amount or percent of breast involvement not stated and
WITHOUT a stated diagnosis of inflammatory carcinoma
WITH or WITHOUT dermal lymphatic infiltration:
Edema of skin
En cuirasse
Erythema
Inflammation of skin
Peau d'orange ("pigskin")		 T4b T4b RE RE
585 580 + 512 T4b T4b RE RE
590 OBSOLETE DATA CONVERTED V0203
See code 605

Stated as T4b with no other information on extension		 ERROR: ERROR: ERROR: ERROR:
600 Diagnosis of inflammatory carcinoma
WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving less than one-third (33%) of the skin of the breast,
WITH or WITHOUT dermal lymphatic infiltration		 T4b T4d RE RE
605 Stated as T4b with no other information on extension T4b T4b RE RE
610 OBSOLETE DATA RETAINED V0200

(400) + (510)		 ERROR: T4c RE RE
612 Any of (512-516) + 400 T4c T4c RE RE
613 Any of (518-519) + 400 T4c T4c RE RE
615 Any of (520-585) + 400 T4c T4c RE RE
620 OBSOLETE DATA RETAINED V0200

(400) + (520)		 ERROR: T4c RE RE
680 Stated as T4c with no other information on extension T4c T4c RE RE
710 OBSOLETE DATA RETAINED V0200

Diagnosis of inflammatory carcinoma
WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving not more than 50% of the skin of the breast,
WITH or WITHOUT dermal lymphatic infiltration
Inflammatory carcinoma, NOS

Previous wording (V0100):
Diagnosis of inflammatory carcinoma
WITHOUT a clinical description of inflammation, erythema, edema, peau d'orange, etc., of more than 50% of the breast,
WITH or WITHOUT dermal lymphatic infiltration
Inflammatory carcinoma, NOS		 ERROR: T4d RE RE
715 OBSOLETE DATA RETAINED V0202

Diagnosis of inflammatory carcinoma
WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving not more than one-third (33%) of the skin of the breast,
WITH or WITHOUT dermal lymphatic infiltration		 T4b T4d RE RE
720 OBSOLETE DATA CONVERTED V0102

Description: Diagnosis of inflammatory carcinoma
WITH a clinical diagnosis of inflammation, erythema, edema, peau d'orange, etc., of not more than 50% of the breast,
WITH or WITHOUT dermal lymphatic infiltration
Inflammatory carcinoma, NOS
NOTE: Code 720 has been combined with code 710.
Any cases coded to 720 should be re-coded to code 710.

Previous wording (V0100):
Diagnosis of inflammatory carcinoma
WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc. of LESS THAN OR EQUAL TO 50% of the breast, WITH or WITHOUT dermal lymphatic infiltration		 ERROR: ERROR: ERROR: ERROR:
725 Diagnosis of inflammatory carcinoma
WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving one-third (33%) or more but less than or equal to one-half (50%) of the skin of the breast,
WITH or WITHOUT dermal lymphatic infiltration		 T4d T4d RE RE
730 Diagnosis of inflammatory carcinoma
WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving more than one-half (50%) of the skin of the breast,
WITH or WITHOUT dermal lymphatic infiltration		 T4d T4d RE RE
750 Diagnosis of inflammatory carcinoma
WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., but percent of involvement not stated,
WITH or WITHOUT dermal lymphatic infiltration.

Note: If percentage is known, code to 600, 725, or 730.

Diagnosis of inflammatory carcinoma
WITHOUT a clinical description of inflammation, erythema, edema, peau d'orange, etc.,
WITH or WITHOUT dermal lymphatic infiltration

Inflammatory carcinoma, NOS		 T4d T4d RE RE
780 Stated as T4d with no other information on extension T4d T4d RE RE
790 Stated as T4 [NOS] with no other information on extension T4NOS T4NOS RE RE
950 No evidence of primary tumor T0 T0 U U
999 Unknown; extension not stated
Primary tumor cannot be assessed
Not documented in patient record		 TX TX U U
- For CS Extension codes 100-140, 200, and 300 ONLY, the T category is assigned based on value of CS Tumor Size as shown in the Extension Size Table for this schema. - For CS Extension codes 100-140, 200, and 300 ONLY, the T category is assigned based on value of CS Tumor Size as shown in the Extension Size Table for this schema. - For CS Extension codes 050 and 070 ONLY, Summary Stage 1977 and Summary Stage 2000 are assigned based on the value of Behavior Code ICD-O-3 as shown in the Extension Behavior Table for this schema.