Summary Stage 2018: Appendix

Summary Stage 2018

Notes

**Appendix** 8000-8700, 8720-8790 C181 C181 Appendix **Note 1:** **Sources 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 19 *Appendix - Carcinoma*, 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 32 *Neuroendocrine Tumors of the Appendix*, 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. * *Appendix*, from the AJCC Cancer Staging System Version 9 (2022). Used with permission of the American College of Surgeons, Chicago, Illinois. * *Neuroendocrine Tumors of the Appendix*, from the AJCC Cancer Staging System Version 9 (2023). Used with permission of the American College of Surgeons, Chicago, Illinois. **Note 2:** **Other Summary Stage Chapters with Appendix sites** * **GIST**: 8935-8936 * **Kaposi Sarcoma**: 9140 * **Mycosis Fungoides**: 9700-9701 * **Soft Tissue**: 8710-8714, 8800-8934, 8940-9138, 9141-9582 **Note 3:** **LAMN tumor: Behavior** * LAMN tumors (8480) can be either in situ (behavior 2) or malignant (behavior 3). * If the tumor is confined to the muscularis propria, it is an in-situ tumor (behavior 2) * If the tumor extends beyond the muscularis propria, it is a malignant tumor (behavior 3) **Note 4:** **LAMN tumor: Localized tumor** * Code 1 (Localized) for LAMN's when the only statement is "Tumor invades through the muscularis propria into subserosa or mesoappendix but does not extend to serosal surface" and there isn't enough information to clarify subserosa versus mesoappendix. **Note 5:** **LAMN tumor: Regional nodal metastasis** * Nodal metastasis is very rare in low-grade appendiceal neoplasms (LAMN). * If there is no mention of lymph nodes in the pathology report for a LAMN, assume that there are no nodal metastasis.

NAACCR Item

NAACCR #764

SS2018	Description
0	In situ, intraepithelial, noninvasive - Acellular mucin or mucinous epithelium may invade into the muscularis propria - (Adeno) carcinoma, noninvasive, in a polyp or adenoma - Low-grade appendiceal mucinous neoplasm confined by the muscularis propria (LAMN) (in situ) - High-grade appendiceal mucinous neoplasm confined by the muscularis propria (HAMN) (in situ)
1	Localized only (localized, NOS) - Confined to appendix, NOS - Confined to polyp, NOS - Extension through wall, NOS - Invasion through muscularis propria - Lamina propria - Mucosa (intramucosal, NOS) - Muscularis mucosae - Non-peritonealized pericolic tissues invaded - Perimuscular tissue invaded - Submucosa - Subserosa - Includes acellular mucin or mucinous epithelium that extends into the subserosa (LAMN tumors) - Transmural, NOS - Wall, NOS
2	Regional by direct extension only - Abdominal wall - Adherent to other organs or structures - Adjacent tissue(s), NOS - Connective tissue - Fat, NOS - Greater omentum - Mesenteric fat - Mesentery - Mesoappendix - Includes acellular mucin or mucinous epithelium that extends into the mesoappendix - WITH or WITHOUT involvement of the serosa (LAMN tumors) - Pericolic fat - Retroperitoneum - Serosa (mesothelium) (visceral peritoneum) - Small intestine - Tumor found in adhesion(s) if microscopic examination performed
3	Regional lymph node(s) involved only - Tumor deposits (TD) in subserosa or mesentery WITHOUT regional lymph node metastases - Cecal + Anterior (prececal) + Posterior (retrocecal) + Right colic - Colic, NOS - Epicolic (adjacent to bowel wall) - Ileocolic - Mesenteric, NOS - Mesocolic, NOS - Paracolic/pericolic - 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) + Adrenal (suprarenal) gland + Bladder + Diaphragm + Fallopian tube + Fistula to skin + Gallbladder + Intraperitoneal spread/peritoneal metastasis (peritoneal carcinomastosis) + WITH or WITHOUT peritoneal mucinous deposits containing tumor cells + Includes peritoneal spread with LAMN tumors + Kidney + Liver + Other segment(s) of colon/rectum via serosa + Ovary + Ureter + Uterus - Distant lymph node(s), NOS + Inferior mesenteric + Superior mesenteric - 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) Overman, M.J., Jessup, J.M., et al. **Appendix - Carcinoma**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017 (6) Woltering, E.A., Bergsland, E.K., et al. **Neuroendocrine Tumors of the Appendix**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017 (7) **Appendix**, from the AJCC Cancer Staging System Version 9 (2022). Used with permission of the American College of Surgeons, Chicago, Illinois. (8) **Neuroendocrine Tumors of the Appendix**, from the AJCC Cancer Staging System Version 9 (2023). Used with permission of the American College of Surgeons, Chicago, Illinois.

SS2018	Description
0	In situ, intraepithelial, noninvasive - Acellular mucin or mucinous epithelium may invade into the muscularis propria - (Adeno) carcinoma, noninvasive, in a polyp or adenoma - Low-grade appendiceal mucinous neoplasm confined by the muscularis propria (LAMN) (in situ) - High-grade appendiceal mucinous neoplasm confined by the muscularis propria (HAMN) (in situ)
1	Localized only (localized, NOS) - Confined to appendix, NOS - Confined to polyp, NOS - Extension through wall, NOS - Invasion through muscularis propria - Lamina propria - Mucosa (intramucosal, NOS) - Muscularis mucosae - Non-peritonealized pericolic tissues invaded - Perimuscular tissue invaded - Submucosa - Subserosa - Includes acellular mucin or mucinous epithelium that extends into the subserosa (LAMN tumors) - Transmural, NOS - Wall, NOS
2	Regional by direct extension only - Abdominal wall - Adherent to other organs or structures - Adjacent tissue(s), NOS - Connective tissue - Fat, NOS - Greater omentum - Mesenteric fat - Mesentery - Mesoappendix - Includes acellular mucin or mucinous epithelium that extends into the mesoappendix - WITH or WITHOUT involvement of the serosa (LAMN tumors) - Pericolic fat - Retroperitoneum - Serosa (mesothelium) (visceral peritoneum) - Small intestine - Tumor found in adhesion(s) if microscopic examination performed
3	Regional lymph node(s) involved only - Tumor deposits (TD) in subserosa or mesentery WITHOUT regional lymph node metastases - Cecal + Anterior (prececal) + Posterior (retrocecal) + Right colic - Colic, NOS - Epicolic (adjacent to bowel wall) - Ileocolic - Mesenteric, NOS - Mesocolic, NOS - Paracolic/pericolic - 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) + Adrenal (suprarenal) gland + Bladder + Diaphragm + Fallopian tube + Fistula to skin + Gallbladder + Intraperitoneal spread/peritoneal metastasis (peritoneal carcinomastosis) + WITH or WITHOUT peritoneal mucinous deposits containing tumor cells + Includes peritoneal spread with LAMN tumors + Kidney + Liver + Other segment(s) of colon/rectum via serosa + Ovary + Ureter + Uterus - Distant lymph node(s), NOS + Inferior mesenteric + Superior mesenteric - Distant metastasis, NOS + Carcinomatosis + Distant metastasis WITH or WITHOUT distant lymph node(s)
9	Unknown if extension or metastasis