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/ssm2000/)
* 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:** Invasion into "pericolonic/ pericolorectal tissue" can be either Localized or Regional, depending on the primary site. Some sites are entirely peritonealized; some sites are only partially peritonealized or have no peritoneum. Localized may not be used for sites that are entirely peritonealized (cecum, transverse colon, sigmoid colon, rectosigmoid colon, upper third of rectum).
+ Localized
- Invasion through muscularis propria or muscularis, NOS
- Non-peritonealized pericolic/perirectal tissues invaded [Ascending Colon/Descending Colon/Hepatic Flexure/Splenic Flexure: Posterior surface; Middle third of rectum: Anterior surface; Lower third of rectum]
- Subserosal tissue/(sub)serosal fat invaded
+ Regional
- Mesentery
- Peritonealized pericolic/perirectal tissues invaded [Ascending Colon/Descending Colon/Hepatic Flexure/Splenic Flexure: anterior and lateral surfaces; Cecum; Sigmoid Colon; Transverse Colon; Rectosigmoid; Rectum: middle third anterior surface]
- Pericolic/Perirectal fat
+ If the pathologist does not further describe the “pericolic/perirectal tissues” as either “non-peritonealized pericolic/perirectal tissues” vs “peritonealized pericolic/perirectal tissues” fat and the gross description does not describe the tumor relation to the serosa/peritoneal surface, and it cannot be determined whether the tumor arises in a peritonealized portion of the colon, code Localized.
**Note 7:** 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 8:** 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).
(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