Summary Stage 2018: GIST
Summary Stage 2018
Notes
**Gastrointestinal Tumors (GIST)**
8935-8936 (C000-C539, C571-C809)
**Note 1:** The following sources were used in the development of this chapter
* 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 43 *Gastrointestinal Stromal Tumor*, 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:** GIST of the corpus, ovary and fallopian tube are collected in the following:
* C540-C549, C559: *Corpus Sarcoma*
* C569: *Ovary*
* C570: *Fallopian Tube*
**Note 3:** For GIST tumors arising in the tubular organs of the digestive system (Esophagus, Stomach, Small Intestine, Appendix, Colon and Rectum), any extension beyond the muscular wall (e.g. invasion beyond the muscularis propria/muscularis, NOS) into adjacent tissues, sites or organs is no longer considered confined to the site of origin (code 1).
* Extension through the wall, NOS, or through the muscularis propria/muscularis, NOS without further extension would be code 1 (confined to the site of origin).
* Extension through the wall, NOS or through the muscularis propria/muscularis, NOS with any further extension into underlying tissues/fat, organs or structures would be included code 2 or 7 (Adjacent (connective) tissue, NOS or Extension to organs/structures, NOS).
**Note 4:** See the chapter corresponding to the primary site for information about the site’s anatomy. The corresponding chapter can be used to help determine what the adjacent (connective) tissues, structures or organs are, but the site-specific chapter codes are not to be used to determine whether a GIST tumor is localized, regional or distant.
**Note 5:** For GIST tumors arising in the Retroperitoneum (C480-C482, C488), refer to the Summary Stage General Instructions for the definition of adjacent (connective) tissue. Refer to the General Instructions to determine whether the GIST tumor involves adjacent tissues, or is confined to the primary site.
**Note 6:** Nodal metastasis is very rare in gastrointestinal stromal tumors (GISTs) and surgeons generally agree that nodal dissection is not indicated. In the absence of information on regional lymph node status for a localized tumor, assume nodes are negative.
| SS2018 |
Description |
| 0 |
In situ, intraepithelial, noninvasive |
| 1 |
Localized only (localized, NOS)
- Confined to site of origin |
| 2 |
Regional by direct extension only
- Adjacent (connective) tissue, NOS |
| 3 |
Regional lymph node(s) involved only
- Regional lymph node(s), NOS
+ Lymph node(s), NOS |
| 4 |
Regional by BOTH direct extension AND regional lymph node(s) involved
- Codes (2) + (3) |
| 7 |
Distant site(s)/lymph node(s) involved
- Distant site(s) (including further contiguous extension)
+ Adherent to organs/structure, NOS
+ Extension to organs/structures, NOS
+ Liver parenchymal nodules
+ Peritoneal nodules
- Distant lymph node(s), NOS
- Distant metastasis, NOS
+ Carcinomatosis
+ Distant metastasis WITH or WITHOUT distant lymph node(s) |
| 9 |
Unknown if extension or metastasis |
(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) Pollock, R.E., Maki, R.G. **Introduction to Soft Tissue Sarcoma**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 489-497
(6) DeMatteo, R.P., Maki, R.G., Pollock, R.E., et al. **Gastrointestinal Stromal Tumor**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 523-529
