Summary Stage 2018: Lung
Summary Stage 2018
8000-8700, 8720-8790, 8972, 8980
C340 Main bronchus
C341 Upper lobe, lung
C342 Middle lobe, lung
C343 Lower lobe, lung
C348 Overlapping lesion of lung
C349 Lung, 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 36 *Lung*, 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, 8940-8971, 8973-8975, 8981-9045, 9054-9138, 9141-9582: *Soft Tissue*
* 8935-8936: *GIST*
* 9050-9053: *Pleural Mesothelioma*
* 9140: *Kaposi Sarcoma*
* 9700-9701: *Mycosis Fungoides*
**Note 3:** Ground glass opacities (GGO), ground glass nodules (GGN), and ground/glass lepidic (GG/L) are frequently observed on CT and are increasingly detected with the advancements in imaging and are described as an area of hazy increased lung opacity. GGO, GGN, and GG/L can be observed in both benign and malignant lung conditions along with pre-invasive lesions (adenocarcinoma in situ, minimally invasive adenocarcinoma, and lepidic carcinoma). They are often associated with early stage lung cancer but not necessarily malignancies themselves.
* For staging purposes, these are not to be counted as separate tumor nodules
**Note 4:** "Bronchopneumonia" is not the same thing as "obstructive pneumonitis" and should not be coded as such.
**Note 5:** Atelectasis is the failure of the lung to expand (inflate) completely. This may be caused by a blocked airway, a tumor, general anesthesia, pneumonia or other lung infections, lung disease, or long-term bedrest with shallow breathing. Sometimes called a collapsed lung.
* For staging purposes, atelectasis must present with an obstructing tumor (code 2)
**Note 6:** Specific information about visceral pleura invasion (PL1 or PL2) or parietal pleural invasion (PL3) are coded as regional (code 2). Elastic layer involvement has prognostic significance for lung cancer.
**Note 7:** Separate ipsilateral tumor nodules of the same histopathological type (intrapulmonary metastases) are coded either regional (code 2) for same lobe or distant (code 7) for different ipsilateral lobe or contralateral lung.
**Note 8:** "Vocal cord paralysis," "superior vena cava syndrome," and "compression of the trachea or the esophagus" are classified as either direct extension from the primary tumor or mediastinal lymph node involvement
* If these manifestations are caused by direct extension of the primary tumor, code as primary tumor involvement (code 2)
* If the primary tumor is peripheral and clearly unrelated to vocal cord paralysis, SVC obstruction, or compression of the trachea, or the esophagus, these manifestations are secondary to lymph node involvement; code as mediastinal lymph node involvement (code 3)
* If unable to determine if these manifestations are due to direct extension or mediastinal lymph node involvement, record as mediastinal lymph node involvement (code 3)
**Note 9:** Most pleural and pericardial effusions with lung cancer are due to tumor. In a few patients, however, multiple cytopathological examinations of pleural and/or pericardial fluid are negative for tumor, and the fluid is non-bloody and is not an exudate. Where these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element.
**Note 10:** Occult carcinoma occurs when tumor is proven by the presence of malignant cells in sputum or bronchial washings, but there is no other evidence of the tumor. These cases are coded as unknown (code 9).
(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
(5) Rami-Porta, R., Asamura, H., Travis, W.D., Rusch, V.W. **Lung**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017