Summary Stage 2018: Colon and Rectum
Summary Stage 2018
Notes
**Colon and Rectum**
8000-8700, 8720-8790
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.
* *Neuroendocrine Tumors of the Colon and Rectum*, from the AJCC Cancer Staging System Version 9 (2023). 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, 8940-9138, 9141-9582: *Soft Tissue*
* 8935-8936: *GIST*
* 9140: *Kaposi Sarcoma*
* 9700-9701: *Mycosis Fungoides*
**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:** The colon and rectum may be entirely peritonealized, partially peritonealized, or non-peritonealized. Use this list to help distinguish between localized and regional Tumors (See Note 7).
* Entirely peritonealized segments: Cecum, Transverse colon, Sigmoid colon, Rectosigmoid colon
* Segmental surfaces that are peritonealized: Anterior and lateral surfaces of: Ascending colon, Descending colon, Hepatic flexure, Splenic flexure, Upper third of rectum. Anterior surface: Middle third of rectum.
* Entirely non-peritonealized segment: Lower third of rectum
* Segmental surfaces that are non-peritonealized: Posterior surface of: Ascending colon, Descending colon, Hepatic flexure, Splenic flexure, Upper two-thirds of rectum
**Note 7:** Invasion into “pericolonic/pericolorectal tissue” can be either localized (code 1) or regional (code 2), depending on the primary site and whether it is peritonealized (fully or partially) or not. When extension is described as “pericolonic/pericolorectal tissue”
* Localized may NOT be used for entirely peritonealized sites (cecum, transverse colon, sigmoid colon, rectosigmoid colon), as this would be equivalent to peritonealized pericolic/perirectal tissue invasion (regional, code 2)
* Localized may ONLY be used for peritonealized sites (See Note 6) when the extension is described using other terms listed under localized (code 1) (ex. subserosal fat). If there are no other terms used to describe the extension, other than invasion of “pericolorectal tissue”, then assign regional (code 2)
* For partially peritonealized sites (See Note 6), “pericolonic/pericolorectal tissue” may indicate invasion of either non-peritonealized (localized, code 1) or peritonealized tissue (regional, code 2)
* Check for mention of serosa/peritoneum in the operative report and/or pathology report final diagnosis or gross description to determine the correct code. Again, if other descriptions besides “pericolonic/pericolorectal tissue” are used, assign localized (code 1) or regional (code 2) based on the terminology used
* If the pathologist does not further describe the “pericolic/perirectal tissues” as either “non-peritonealized pericolic/perirectal tissues” vs “peritonealized pericolic/perirectal tissues” and the operative report and/or 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 (code 1).
**Note 8:** 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 9:** 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)
All Sites
- Confined to colon, rectum, rectosigmoid, NOS
- Confined to polyp (head, stalk, 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
+ Rectum (C209): WITH or WITHOUT intraluminal extension to colon and/or anal canal/anus
- Perimuscular tissue invaded
- Submucosa (superficial invasion)
- Subserosal tissue/(sub)serosal fat invaded
- Transmural, NOS
- Wall, NOS
Non-peritonealized sites (See Notes 6 and 7) or UNKNOWN if peritonealized (for peritonealized sites, see code 2)
- Pericolic fat/tissues
- Perirectal fat/tissues |
| 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
+ Retroperitoneum (excluding fat)
+ Serosa
+ Small intestine
+ Tumor found in adhesion(s) if microscopic examination performed
+ Tunica serosa
+ Visceral peritoneum
Peritonealized sites (See Notes 6 and 7) (for non-peritonealized sites or UNKNOWN if peritonealized, see code 1)
+ Pericolic fat/tissues
+ Perirectal fat/tissues
Cecum (C180)
+ Greater omentum
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 (hypogastric, internal, obturator) (see code 7 for common, external, NOS)
+ 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, hypogastric, internal, obturator, NOS)
* Inferior mesenteric (cecum, ascending colon, hepatic flexure, transverse colon)
* Para-aortic
* Retroperitoneal
* Superior mesenteric
+ Rectosigmoid
* Hemorrhoidal, inferior (rectosigmoid)
* Iliac (common, external, hypogastric, internal, obturator, NOS)
* Rectal, inferior
* Superior mesenteric
+ Rectum
* Colic (left) (rectum)
* Iliac (common, external, NOS) (see code 3 for hypogastric, internal, obturator)
* 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 |
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(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)
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(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
(7) **Neuroendocrine Tumors of the Colon and Rectum**, from the AJCC Cancer Staging System Version 9 (2023). Used with permission of the American College of Surgeons, Chicago, Illinois.
