Summary Stage 2018: Breast
Summary Stage 2018
C501 Central portion of breast
C502 Upper-inner quadrant of breast
C503 Lower-inner quadrant of breast
C504 Upper-outer quadrant of breast
C505 Lower-outer quadrant of breast
C506 Axillary Tail of breast
C508 Overlapping lesion of breast
C509 Breast, NOS
**Note 1:** The following sources were used in the development of this schema
* SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998) (https://seer.cancer.gov/archive/manuals/EOD10Dig.3rd.pdf)
* SEER Summary Staging Manual-2000: Codes and Coding Instructions (https://seer.cancer.gov/tools/ssm/)
* Collaborative Stage Data Collection System, version 02.05: https://cancerstaging.org/cstage/Pages/default.aspx
* Chapter 48 *Breast*, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois.
**Note 2:** 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 3:** Adherence, attachment, fixation, induration, and thickening are clinical evidence of extension to skin or subcutaneous tissue; assign code 2 for regional extension.
**Note 4:** “Fixation, NOS” is involvement of pectoralis muscle; assign code 2 for regional extension.
**Note 5:** For a clinical description of inflammation, erythema, edema, peau d’orange, or other terms describing skin changes without a stated diagnosis of inflammatory carcinoma, assign code 2 for regional extension.
**Note 6:** Negative nodes with positive ITCs or positive molecular findings less than or equal to 0.2 mm are negative for lymph nodes in Summary Stage.
**Note 7:** If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2 mm and code the lymph nodes as positive in this field.
**Note 8:** Bone marrow micrometastasis, circulating tumor cells (CTCs) or disseminated tumor cells and clusters (DTCs) that are less than 0.2 mm are negative for metastasis in Summary Stage.
(1) Fritz AG, Ries LAG (eds). **SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998)**, National Cancer Institute, NIH Pub. No. 98-2313, Bethesda, MD, 1998
(2) Young JL Jr, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA (eds.). **SEER Summary Staging Manual-2000: Codes and Coding Instructions**, National Cancer Institute, NIH Pub. No. 01-4969, Bethesda, MD, 2001.
(3) Collaborative Stage Work Group of the American Joint Committee on Cancer. **Collaborative Stage Data Collection System User Documentation and Coding Instructions, version 02.05.** American Joint Committee on Cancer (Chicago, IL)
(4) Gress, D.M., Edge, S.B., Gershenwald, J.E., et al. **Principles of Cancer Staging.** In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 3-30
(5) Hortobagyi, G.N., Giuliano, A., et al. **Breast**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 589-628