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