SS2018: Bone
Summary Stage 2018
Notes
**Bone**
8000-8934, 8940-9138, 9141-9582
C400-C403, C408-C414, C418-C419
C400 Long bones of upper limb, scapula and associated joints
C401 Short bones of upper limb and associated joints
C402 Long bones of lower limb and associated joints
C403 Short bones of lower limb and associated joints
C408 Overlapping lesion of bones, joints and articular cartilage of limbs
C409 Bone of limb, NOS
C410 Bones of skull and face and associated joints (excludes mandible C411)
C411 Mandible
C412 Vertebral column
C413 Rib, sternum, clavicle, and associated joints
C414 Pelvic bones, sacrum, coccyx and associated joints
C418 Overlapping lesion of bones, joints and articular cartilage
C419 Bone, 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 38 *Bone*, 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
* 8935-8936: *GIST*
* 9140: *Kaposi Sarcoma*
* 9700-9701: *Mycosis Fungoides*
**Note 3:** Code 0 is not applicable for this chapter.
**Note 4:** The cortex of a bone is the dense outer shell that provides strength to the bone; the spongy center of a bone is the cancellous portion. The periosteum of the bone is the fibrous membrane covering of a bone that contains the blood vessels and nerves; the periosteum is similar to the capsule on a visceral organ.
**Note 5:** For the spinal tumors (C412), if only the number of adjacent vertebral segments below are involved, this would be localized (code 1). Any other vertebral segments involved (non-adjacent) would be regional (code 2).
* Body (left)
* Body (right)
* Pedicle (left)
* Pedicle (right)
* Posterior element
**Note 6:** For the pelvic tumors (C414), both the number of pelvic segments involved by the primary tumor and the presence or absence of extraosseous extension determine the correct Summary Stage 2018 for localized and regional pelvic bone primaries. The four pelvic segments used in these codes are:
* Acetabulum
* Iliac wing
* Pubic ramus/Symphysis/Ischium
* Sacrum
**Note 7:** Regional lymph nodes are defined as those in the vicinity of the primary tumor.
**Note 8:** Regional lymph node involvement is rare. If there is no mention of lymph node involvement clinically, assume that lymph nodes are negative.
| SS2018 |
Description |
| 1 |
Localized only (localized, NOS)
- Appendicular (C400-C403, C408-C411, C413, C418-C419)
+ Confined to cortex of bone
+ Extension beyond cortex to periosteum (no break in periosteum)
- Spine (C412)
+ Confined to spine, NOS (number of segments involved not known)
+ Involvement of single or multiple adjacent vertebral segment(s)
- Pelvis (C414)
+ Confined to pelvis, NOS (number of segments involved not known and WITHOUT or UNKNOWN if extraosseous extension)
+ One to four pelvic segments involved WITHOUT or UNKNOWN if extraosseous extension |
| 2 |
Regional by direct extension only
- All sites
+ Extraosseous extension (beyond periosteum to surrounding tissues, including adjacent skeletal muscle(s))
- Appendicular (C400-C403, C408-C411, C413, C418-C419)
+ Adjacent bone/cartilage
- Spine (C412)
+ Involvement of multiple non-adjacent vertebral segments
+ Spinal canal
- Pelvis (C414)
+ One to four pelvic segments involved WITH extraosseous extension |
| 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)
+ All bone sites
* Bone (other than primary site)
* Lung
+ Appendicular (C400-C403, C408-C411, C413, C418-C419)
* Discontinuous tumors in the primary bone site ("skip" metastasis)
* Skin
+ Spine (C412)
* Gross vascular invasion
* Tumor thrombus in great vessels
+ Pelvis (C414)
* Encasement of external iliac vessels
* Gross tumor thrombus in major pelvic vessels
* Sacral neuroforamen
* Sacroiliac joint
- 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
(5) Kneisl, J.S., Rosenberg, A.E., et al. **Bone**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017
