Summary Stage 2018: Lung
Summary Stage 2018
Notes
**Lung**
8000-8700, 8720-8790, 8972, 8980
C340-C343, C348-C349
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).
| SS2018 |
Description |
| 0 |
In situ, intraepithelial, noninvasive
- Adenocarcinoma in situ (AIS): adenocarcinoma with pure lepidic pattern, less than or equal to 3 cm in greatest dimension
- Squamous cell carcinoma in situ (SCIS) |
| 1 |
Localized only (localized, NOS)
- Adjacent ipsilateral lobe
- Confined to carina, NOS
- Confined to hilus
- Confined to lung, NOS
- Main stem bronchus, NOS (without involvement of the carina)
+ Including extension from other part of lung
- Minimally invasive adenocarcinoma
+ Adenocarcinoma tumor WITH predominantly lepidic pattern (AIS) measuring less than or equal to 3 cm in greatest dimension
* WITH invasive component measuring less than or equal to 5 mm in greatest dimension
- Superficial tumor, WITH invasive component limited to bronchial wall
+ WITH or WITHOUT proximal extension to main stem bronchus |
| 2 |
Regional by direct extension only
- Atelectasis/obstructive pneumonitis
+ Extends to hilar region, involving part or all of lung
- Blood vessel(s) (major)
+ Aorta
+ Azygos vein
+ Pulmonary artery or vein
+ Superior vena cava (SVC syndrome)
- Brachial plexus
- Carina from lung
- Chest wall (thoracic wall)
- Compression of esophagus or trachea not specified as direct extension
- Diaphragm (separate lesion-see code 7)
- Esophagus
- Mediastinum, extrapulmonary or NOS
- Nerve(s)
+ Cervical sympathetic (Horner's syndrome)
+ Recurrent laryngeal (vocal cord paralysis)
+ Vagus
- Pancoast tumor (superior sulcus syndrome), NOS
- Parietal pericardium
- Parietal pleura (PL3)
- Pericardium, NOS
- Phrenic nerve
- Pleura, NOS
- Pulmonary ligament
- Separate tumor nodule(s) in the same lobe as the primary
- Visceral pleura invasion (PL1, PL2, or NOS)
- Trachea |
| 3 |
Regional lymph node(s) involved only
- IPSILATERAL nodes only
+ Bronchial
- Peri/parabronchial
+ Carinal (tracheobronchial) (tracheal bifurcation)
+ Hilar (bronchopulmonary) (proximal lobar) (pulmonary root)
+ Intrapulmonary
* Interlobar
* Lobar
* Segmental
* Subsegmental
+ Mediastinal, NOS
* Anterior
* Aortic (above diaphragm), NOS
- Peri/para-aortic, NOS
+ Ascending aorta (phrenic)
- Subaortic (aortic-pulmonary window)
* Inferior mediastinal
- Paraesophageal
- Pulmonary ligament
- Subcarinal
* Periesophageal
* Pericardial
* Posterior (tracheoesophageal)
* Precarinal
* Pretracheal, NOS
* Superior mediastinal
- Paratracheal (left, right, upper, low, NOS)
- Azygos (lower paratracheal)
- Prevascular
- Retrotracheal
+ 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)
+ Abdominal organs
+ Adjacent rib
+ Contralateral lung/main stem bronchus
+ Heart
+ Inferior vena cava
+ Neural foramina
+ Pericardial nodules or pleural effusion (malignant) (ipsilateral, contralateral, bilateral, NOS)
+ Pleural tumor foci or nodules on ipsilateral lung (separate from direct extension) or contralateral lung
+ Rib
+ Separate tumor nodule(s) in contralateral lung
+ Separate tumor nodule(s) in a different ipsilateral lobe
+ Skeletal muscle
+ Skin of chest
+ Sternum
+ Vertebra(e) (vertebral body)
+ Visceral pericardium
- Distant lymph node(s), NOS
+ IPSILATERAL or CONTRALATERAL
* Low cervical
* Proximal root
* Scalene (inferior deep cervical)
* Sternal notch
* Supraclavicular (transverse cervical)
+ CONTRALATERAL/BILATERAL nodes
* Bronchial
- Peri/parabronchial
* Carinal
* Hilar (bronchopulmonary) (proximal lobar) (pulmonary root)
- Intrapulmonary
- Interlobar
- Lobar
- Segmental
- Subsegmental
* Mediastinal
- Anterior
- Aortic (above diaphragm), NOS
+ Peri/para-aortic, NOS
* Ascending aorta (phrenic)
+ Subaortic (aortic-pulmonary window)
- Inferior mediastinal
+ Paraesophageal
+ Pulmonary ligament
+ Subcarinal
- Periesophageal
- Pericardial
- Posterior (tracheoesophageal)
- Precarinal
- Pretracheal
- Superior mediastinal
+ Paratracheal (left, right, upper, low, NOS)
- Azygos (lower paratracheal)
+ Prevascular
+ Retrotracheal
- 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) 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
