CS Extension
Notes
**Note 1**: The two main types of bladder cancer are the flat (sessile) variety and the papillary type. The flat (sessile) variety is called in situ when tumor has not penetrated the basement membrane. Papillary tumor that has not penetrated the basement membrane is called noninvasive. * A. Definite statements of noninvasion for papillary transitional cell carcinomas (code 010) include: Noninfiltrating Noninvasive No evidence of invasion No extension into lamina propria No stromal invasion No extension into underlying supporting tissue Negative lamina propria and superficial muscle Negative muscle and (subepithelial) connective tissue No infiltrative behavior/component * B. Inferred descriptions of noninvasion for papillary transitional cell carcinomas (code 030) include: No involvement of muscularis propria and no mention of subepithelium/submucosa No statement of invasion (microscopic description present) (Underlying) Tissue insufficient to judge depth of invasion No invasion of bladder wall No involvement of muscularis propria Benign deeper tissue Microscopic description problematic (noninvasion versus superficial invasion) Frond surfaced by transitional cell No mural infiltration No evidence of invasion (no sampled stroma) Confined to mucosa (see also Note 3 if tumor is not described as papillary) **Note 3**: Noninvasive (in situ) flat transitional cell carcinoma: Careful attention must be given to the use of the term "confined to mucosa" for flat bladder carcinomas. Historically, carcinomas described as "confined to mucosa" were coded as localized. However, pathologists use this designation for noninvasion as well. Pathologists also vary in their use of the terms "invasion of mucosa, grade 1" and "invasion of mucosa, grade 2" to distinguish between noninvasive and invasive carcinomas. In order to accurately code tumors described as "confined to mucosa", abstractors should determine: * If the tumor is confined to the epithelium: then it is noninvasive (code 060). * If the tumor has penetrated the basement membrane to invade the lamina propria: then it is invasive (code 155). The lamina propria and submucosa tend to merge when there is no muscularis mucosa, so these terms may be used interchangeably, along with stroma and subepithelial connective tissue. * If the distinction between involvement of the epithelium and lamina propria cannot be made, then the tumor should be coded as "confined to mucosa, NOS" (code 100). Statements meaning confined to mucosa, NOS for flat transitional cell carcinomas include: * Confined to mucosal surface * Limited to mucosa, no invasion of submucosa and muscularis * No infiltration/invasion of fibromuscular and muscular stroma * Superficial, NOS **Note 4**: In case of multifocal noninvasive Ta and Tis tumors, use code 060 or 100 in preference to 010 or 030. **Note 5**: Use code 230 if the only description of extension is through full thickness of bladder wall, and there is no clear statement as to whether or not the cancer has extended into fat. If there is documentation that tumor has breached the wall, including invasion into fat or beyond, use code 411 or higher. **Note 6**: An associated in situ component of tumor extending into the prostatic ducts, prostatic glands, or ureter without invasion is disregarded in staging classification. Use the code that best describes depth of bladder wall invasion. **Note 7**: Direct invasion of the distal ureter is classified by the depth of greatest invasion in the bladder or ureter for AJCC staging. Use codes 165, 215, 235, and 245 for extension from bladder directly into distal ureter. The distal ureter is defined as below the iliac vessel, within the pelvic brim. **Note 8**: Extension from bladder into subepithelial tissue of prostatic urethra should be coded 160 and not code 600. **Note 9**: If CS Extension code is 010-060, Behavior ICD-O-3 must be coded as 2. If CS Extension code is 100, Behavior ICD-O-3 may be coded as 2 or 3. If CS Extension code is 155 or greater, Behavior ICD-O-3 must be coded as 3.| Code | Description | AJCC 7 T | AJCC 6 T | Summary Stage 1977 T | Summary Stage 2000 T |
|---|---|---|---|---|---|
| 010 | Papillary: Papillary transitional cell carcinoma, stated to be noninvasive Papillary non-infiltrating (See Note 2A) Stated as Ta with no other information on extension (See Notes 1 and 2) |
Ta | Ta | IS | IS |
| 030 | Papillary: Papillary transitional cell carcinoma, with inferred description of noninvasion (See Note 2B) |
Ta | Ta | IS | IS |
| 060 | Nonpapillary: Sessile (flat) (solid) carcinoma in situ Carcinoma in situ, NOS Transitional cell carcinoma in situ Stated as Tis with no other information on extension |
Tis | Tis | IS | IS |
| 100 | Confined to mucosa, NOS (See Note 3) |
Tis | Tis | L | L |
| 150 | OBSOLETE DATA RETAINED V0200 See codes 155 and 170 Invasive tumor confined to subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma) TNM/AJCC T1 Jewett-Strong-Marshall Stage A |
ERROR: | T1 | L | L |
| 155 | Subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma) of bladder only | T1 | T1 | L | L |
| 160 | Subepithelial connective tissue of prostatic urethra | T1 | T1 | L | L |
| 165 | Extension to distal ureter: Subepithelial connective tissue of bladder and/or distal ureter (See Note 7) |
T1 | T1 | RE | RE |
| 170 | Stated as T1 with no other information on extension | T1 | T1 | L | L |
| 200 | OBSOLETE DATA CONVERTED V0200 See code 240 Muscle (muscularis propria) invaded, NOS |
ERROR: | ERROR: | ERROR: | ERROR: |
| 210 | Muscle (muscularis propria) of bladder only: Superficial muscle - inner half Stated as T2a with no other information on extension |
T2a | T2a | L | L |
| 215 | Extension to distal ureter: Superficial muscle of bladder and/or distal ureter (See Note 7) |
T2a | T2a | RE | RE |
| 220 | Muscle (muscularis propria) of bladder only: Deep muscle--outer half Stated as T2b with no other information on extension |
T2b | T2b | L | L |
| 230 | Extension through full thickness of bladder wall BUT still contained within bladder wall (see Note 5) |
T2b | T2b | L | L |
| 235 | Extension to distal ureter: Deep muscle or extension through wall of bladder and/or distal ureter (See Note 7) |
T2b | T2b | RE | RE |
| 240 | Muscle (muscularis propria) invaded, NOS of bladder only Stated as T2 [NOS] with no other information on extension |
T2NOS | T2NOS | L | L |
| 245 | Extension to distal ureter: Muscle (muscularis propria) invaded, NOS of bladder and/or distal ureter (See Note 7) |
T2NOS | T2NOS | RE | RE |
| 300 | Localized, NOS | T1 | T1 | L | L |
| 400 | OBSOLETE DATA CONVERTED V0200 See code 430 Adventitia Extension to/through serosa (mesothelium) Peritoneum Periureteral fat/tissue Perivesical fat/tissue, NOS |
ERROR: | ERROR: | ERROR: | ERROR: |
| 410 | OBSOLETE DATA CONVERTED V0203 See code 411 Extension to perivesical fat/tissues (microscopic) |
ERROR: | ERROR: | ERROR: | ERROR: |
| 411 | Extension to perivesical fat/tissues (microscopic) including: Adventitia Serosa (mesothelium) Peritoneum Periprostatic tissue Distal periureteral tissue Stated as T3a with no other information on extension |
T3a | T3a | RE | RE |
| 415 | OBSOLETE DATA CONVERTED V0203 See code 411 Stated as T3a with no other information on extension |
ERROR: | ERROR: | ERROR: | ERROR: |
| 420 | OBSOLETE DATA CONVERTED V0203 See code 421 Extension to perivesical fat/tissues (macroscopic) Extravesical mass Stated as T3b with no other information on extension |
ERROR: | ERROR: | ERROR: | ERROR: |
| 421 | Extension to perivesical fat/tissues (macroscopic) including: Adventitia Serosa (mesothelium) Peritoneum Periprostatic tissue Distal periureteral tissue Extravesical mass Stated as T3b with no other information on extension |
T3b | T3b | RE | RE |
| 430 | OBSOLETE DATA REVIEWED V0203 See codes 411, 421, 431 Adventitia Extension to/through serosa (mesothelium) Peritoneum Periureteral fat/tissue (see Note 10) Perivesical fat/tissue, NOS Stated as T3 [NOS] with no other information on extension |
T3NOS | T3NOS | RE | RE |
| 431 | Extension to perivesical fat/tissues, NOS (unknown if microscopic or macroscopic), including: Adventitia Serosa (mesothelium) Peritoneum Periprostatic tissue Distal periureteral tissue Stated as T3 [NOS] with no other information on extension |
T3NOS | T3NOS | RE | RE |
| 450 | OBSOLETE DATA CONVERTED V0200 See code 810 Stated as T4 [NOS] |
ERROR: | ERROR: | ERROR: | ERROR: |
| 600 | OBSOLETE DATA RETAINED AND REVIEWED V0203 See codes 165, 215, 235, 245, and 630 Prostatic stroma Prostate, NOS Ureter Urethra, including prostatic urethra (excluding subepithelial connective tissue, see code 160) |
T4a | T4a | RE | RE |
| 630 | Prostatic stroma Prostate, NOS Ureter (excluding distal ureter) Urethra, including prostatic urethra (excluding subepithelial connective tissue, see code 160) |
T4a | T4a | RE | RE |
| 650 | Parametrium Rectovesical/Denonvilliers' fascia Seminal vesicle Vas deferens |
T4a | T4a | RE | RE |
| 670 | Uterus Vagina |
T4a | T4a | RE | RE |
| 673 | Rectum, male | T4a | T4a | RE | D |
| 677 | Large intestine including rectum, female (excluding rectum, male) Small intestine |
T4a | T4a | D | D |
| 680 | Stated as T4a with no other information on extension | T4a | T4a | RE | RE |
| 700 | Bladder is "fixed" | T4b | T4b | RE | RE |
| 710 | Pubic bone | T4b | T4b | RE | D |
| 715 | 700 + 673 | T4b | T4b | RE | D |
| 720 | (710 or 700) + 677 | T4b | T4b | D | D |
| 730 | OBSOLETE DATA REVIEWED V0203 See codes 673, 710, 715, and 720 Rectum, male Pubic bone |
T4b | T4b | RE | D |
| 750 | Abdominal wall Pelvic wall |
T4b | T4b | D | D |
| 800 | OBSOLETE DATA RETAINED V0200 See codes 730 and 801 Further contiguous extension, including: Pubic bone Rectum, male Sigmoid |
ERROR: | T4b | D | D |
| 801 | OBSOLETE DATA REVIEWED V0203 See codes 677, 720, and 802 Further contiguous extension including: Rectum, female Sigmoid |
T4b | T4b | D | D |
| 802 | Further contiguous extension | T4b | T4b | D | D |
| 805 | Stated as T4b with no other information on extension | T4b | T4b | RE | RE |
| 810 | 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 |