Summary Stage 2018: Pleural Mesothelioma
Summary Stage 2018
Notes
**Pleural Mesothelioma**
9050-9053
C340-C343, C348-C349, C384
C340 Main bronchus
C341 Upper lobe, lung
C342 Middle lobe, lung
C343 Lower lobe, lung
C348 Overlapping lesion of lung
C349 Lung, NOS
C384 Pleura
**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 37 *Malignant Pleural Mesothelioma*, 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:** Code 0 is not applicable for this chapter.
**Note 3:** Most pleural effusions are due to tumor. When the cytopathological examinations of pleural fluid are negative for tumor, the effusion should be excluded as a staging element and the tumor should not be classified as metastasis.
* The physician statement of pleural effusion can be used to code this data item
* If the physician feels the pleural effusion is due to tumor, despite negative cytology, the physician's assessment can be used.
* If pleural fluid cytology is described as suspicious/suspicious for mesothelioma, code 7
| SS2018 |
Description |
| 1 |
Localized only (localized, NOS)
- Confined to pleura, NOS
- Invasive tumor (mesothelioma) confined to pleura, NOS
- Ipsilateral parietal pleura WITH or WITHOUT involvement of
+ Diaphragmatic pleural
+ Mediastinal pleura
+ Parietal pleura
+ Visceral pleura |
| 2 |
Regional by direct extension only
- Adjacent (connective) tissue, NOS
- Chest wall
- Confluent visceral pleural tumor (including any involvement of interlobar fissure)
- Diaphragmatic muscle
- Endothoracic fascia
- Ipsilateral pleural surfaces all involved
+ Diaphragmatic, parietal, mediastinal, and visceral
- Lung parenchyma, or lung involvement, NOS
- Mediastinal fat (mediastinal tissues)
- Mediastinal organs (direct extension)
- Nodule(s) beneath visceral pleural surface (ipsilateral pleura)
- Pericardium (extension through the internal surface) (non-transmural, NOS) WITHOUT pericardial effusion
- Pulmonary parenchyma (visceral pleural extension)
- Rib |
| 3 |
Regional lymph node(s) involved only
- Aortic (above diaphragm), NOS
+ Ascending aorta (phrenic)
+ Peri/para-aortic
+ Subaortic (aortico-pulmonary window)
- Carinal (tracheobronchial) (tracheal bifurcation)
- Hilar (ipsilateral)
+ Bronchopulmonary
+ Proximal lobar
+ Pulmonary root
- Intercostal
- Internal mammary (parasternal)
- Intrapulmonary
+ Interlobar
+ Lobar
+ Segmental
+ Subsegmental
- Mediastinal, NOS (ipsilateral)
+ Anterior
+ Posterior (tracheoesophageal)
- Pericardial
- Peri/parabronchial
- Peri/paraesophageal (below carina)
- Peri/paratracheal (lower [azygos], upper, NOS)
- Pretracheal and retrotracheal (precarinal), NOS
- Prevascular
- Pulmonary ligament
- Subcardial
- Subcarinal
- 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)
+ Brachial plexus
+ Cervical (neck) tissues
+ Contralateral lung
+ Contralateral pleura (direct contiguous extension)
+ Contralateral pleura/chest wall (discontinuous involvement)
+ Heart muscle
+ Intra-abdominal organs
+ Mediastinal organs (discontinuous involvement)
+ Mesothelioma WITH malignant pleural fluid
+ Pericardial effusion, malignant
+ Pericardium WITH pericardial effusion
+ Peritoneum (direct transdiaphragmatic extension of tumor)
+ Peritoneum (discontinuous extension of tumor)
+ Pleural effusion (see Note 3)
+ Spine
- Distant lymph node(s), NOS
+ Hilar (contralateral, bilateral)
* Bronchopulmonary
* Proximal lobar
* Pulmonary root
+ Mediastinal (contralateral, bilateral)
* Anterior
* Posterior (tracheoesophageal)
+ Peridiaphragmatic (ipsilateral, contralateral)
* Mediastinal
+ Scalene (ipsilateral, contralateral)
* Inferior deep cervical
+ Supraclavicular (ipsilateral or contralateral)
* Transverse cervical
- 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) Rusch, V.W., et al. **Malignant Plural Mesothelioma**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 457-468
