Summary Stage 2018: Colon and Rectum
Summary Stage 2018
Notes
**Colon and Rectum**
8000-8700, 8720-8790, 9700-9701
C180, C182-C189, C199, C209
C180 Cecum
C182 Ascending colon
C183 Hepatic flexure of colon
C184 Transverse colon
C185 Splenic flexure of colon
C186 Descending colon
C187 Sigmoid colon
C188 Overlapping lesion of colon
C189 Colon, NOS
C199 Rectosigmoid junction
C209 Rectum, NOS
**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 20 *Colon and Rectum*, 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.
* Chapter 33 *Neuroendocrine Tumors of the Colon and Rectum*, 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:** See the following chapters for the listed histologies
* 8710-8714, 8800-8934, 8940-9137, 9141-9582: *Soft Tissue*
* 8935-8936: *GIST*
* 9140: *Kaposi Sarcoma*
**Note 3:** Code 0 (behavior code 2) includes cancer cells confined within the glandular basement membrane (intraepithelial), or described as in situ.
**Note 4:** For the following, AJCC 8th edition stages these as in situ tumors. SS2018 stages these as localized (behavior code 3)
* Intramucosal, NOS
* Lamina propria
* Mucosa, NOS
* Confined to, but not through muscularis mucosa
**Note 5:** Ignore intraluminal extension to adjacent segment(s) of colon/rectum or to the ileum from the cecum; code depth of invasion or extracolonic spread as indicated.
**Note 6:** Tumor that is adherent to other organs or structures, macroscopically, is coded as regional (code 2) or distant (code 7). However, if no tumor is present in the adhesion, microscopically, the classification should be coded to localized (code 1) or regional (code 2).
**Note 7:** Tumors characterized by involvement of the serosal surface (visceral peritoneum) by direct extension or perforation in which the tumor cells are continuous with the serosal surface through inflammation are coded to regional (code 2).
| SS2018 |
Description |
| 0 |
In situ, intraepithelial, noninvasive |
| 1 |
Localized only (localized, NOS)
- Confined to colon, rectum, rectosigmoid, NOS
- Extension through wall, NOS
- Intraluminal extension to colon and/or anal canal/anus (rectum only)
- Invasion of
+ Intramucosal, NOS
+ Lamina propria
+ Mucosa, NOS
+ Muscularis mucosae
+ Muscularis, NOS
+ Muscularis propria
+ Submucosa (superficial invasion)
- Non-peritonealized pericolic tissues invaded
- Perimuscular tissue invaded
- Polyp (head, stalk, NOS)
- Subserosal tissue/(sub)serosal fat invaded
- Transmural, NOS
- Wall, NOS |
| 2 |
Regional by direct extension only
- All sites
+ Abdominal wall
+ Adherent to other organs or structures clinically with no microscopic examination
+ Adjacent (connective) tissue(s), NOS
+ Fat, NOS
+ Mesentery (including mesenteric fat, mesocolon)
+ Mesothelium
+ Pericolic fat
+ Perirectal fat
+ Retroperitoneum (excluding fat)
+ Serosa
+ Small intestine
+ Tumor found in adhesion(s) if microscopic examination performed
+ Tunica serosa
+ Visceral peritoneum
- Ascending colon (C182)
+ Kidney, right
+ Liver, right lobe
+ Retroperitoneal fat
+ Ureter, right
- Transverse colon and flexures (C183, C184, C185)
+ Bile ducts
+ Gallbladder
+ Gastrocolic ligament
+ Greater omentum
+ Kidney
+ Liver
+ Pancreas
+ Spleen
+ Stomach
- Descending colon (C186)
+ Kidney, left
+ Pelvic wall
+ Retroperitoneal fat
+ Spleen
+ Ureter, left
- Sigmoid colon (C187)
+ Pelvic wall
- Rectosigmoid (C199)
+ Cul de sac (rectouterine pouch)
+ Pelvic wall
+ Small intestine
- Rectum (C209)
+ Anus
+ Bladder (males only)
+ Cul de sac (rectouterine pouch)
+ Ductus deferens
+ Pelvic wall
+ Prostate
+ Rectovaginal septum
+ Rectovesical fat (males only)
+ Seminal vesicle(s)
+ Skeletal muscles of pelvic floor
+ Vagina |
| 3 |
Regional lymph node(s) involved only
- All sites
+ Colic, NOS
+ Epicolic (adjacent to bowel wall)
+ Mesenteric, NOS
+ Mesocolic, NOS
+ Paracolic
+ Pericolic
+ Tumor deposits (TD) in the subserosa, mesentery, mesorectal or nonperitonealized pericolic or perirectal tissues WITHOUT regional nodal metastasis
+ Regional lymph node(s), NOS
* Lymph node(s), NOS
- Cecum (C180)
+ Cecal, NOS
* Anterior cecal (prececal)
* Posterior cecal (retrocecal)
+ Colic (right)
+ Ileocolic
+ Periappendiceal
- Ascending colon (C182)
+ Colic (middle-right branch, right)
+ Ileocolic
- Hepatic flexure (C183)
+ Colic (middle, right)
+ Ileocolic
- Transverse colon (C184)
+ Colic (middle)
- Splenic flexure (C185)
+ Colic (left, middle)
+ Mesenteric (inferior)
- Descending colon (C186)
+ Colic (left)
+ Mesenteric (inferior)
+ Sigmoid
- Sigmoid colon (C187)
+ Colic (left)
+ Mesenteric (inferior)
+ Rectal (superior) (hemorrhoidal)
+ Rectosigmoid
+ Sigmoid (sigmoidal) (sigmoid mesenteric)
+ Superior rectal (hemorrhoidal)
- Rectosigmoid (C199)
+ Hemorrhoidal (middle, superior)
+ Mesenteric (inferior)
+ Mesorectal
+ Pericolic
+ Perirectal
+ Rectal (middle, superior)
+ Sigmoid (mesenteric)
- Rectum (C209)
+ Hemorrhoidal (middle, superior)
+ Iliac (internal) (hypogastric) (obturator)
+ Mesenteric (inferior)
+ Mesorectal
+ Perirectal
+ Rectal (inferior)
+ Sacral, NOS
* Lateral sacral (laterosacral)
* Middle sacral (promontorial) (Gerota’s node)
* Presacral
+ Sigmoidal (sigmoid mesenteric) |
| 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)
+ All sites
* Adrenal (suprarenal) gland
* Bladder
* Diaphragm
* Fallopian tube
* Fistula to skin
* Gallbladder
* Other segment(s) of colon via serosa
* Ovary(ies)
* Uterus
+ Cecum (C180)
* Kidney, right
* Liver
* Ureter, right
+ Transverse colon and flexures (C183-C185)
* Ureter
+ Sigmoid colon (C187)
* Cul de sac (rectouterine pouch)
* Ureter
+ Rectosigmoid (C199)
* Bladder
* Colon via serosa
* Fallopian tube
* Ovary
* Prostate
* Skeletal muscles of pelvic floor
* Ureter
* Vagina
+ Rectum (C209)
* Bladder (for females only)
* Bone(s) of pelvis
* Cervix
* Perineum, perianal skin
* Sacral plexus
* Sacrum
* Ureter
* Urethra
* Uterus
- Distant lymph node(s), NOS
+ Colon
* Iliac (common, external)
* Inferior mesenteric (cecum, ascending colon, hepatic flexure, transverse colon)
* Para-aortic
* Retroperitoneal
* Superior mesenteric
+ Rectosigmoid/Rectum
* Colic (left) (rectum)
* Hemorrhoidal, inferior (rectosigmoid)
* Iliac (common, external)
* Internal iliac (hypogastric), NOS (rectosigmoid)
* Obturator (rectosigmoid)
* Rectal, inferior (rectosigmoid)
* Superior mesenteric
- Distant metastasis, NOS
+ Carcinomatosis
+ Peritoneal surface metastasis (peritoneum)
+ 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) Jessup, J.M., Goldberg, R.M., et al. **Colon and Rectum**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 251-274
(6) Shi, C., Woltering, E.A., Washington, M.K., et al. **Neuroendocrine Tumors of the Colon and Rectum**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 395-406
