Major Vein Involvement
Description
Major vein involvement pertains to the invasion of the kidney tumor into major veins.
Involvement of veins from a renal cancer has prognostic implications because tumor cells can more easily disseminate through the bloodstream. This data item records information about the presence and level of involvement of specific major blood vessels. Do not code microscopically identified involvement of small unnamed blood vessels within the kidney; this information is coded in the field Lymph-Vascular Invasion (LVI). The tumor may be described as a thrombus, a cluster of tumor cells presents in the center of the vein but not attached to the wall of the vein. Tumor spread may resemble mud extruding along the inside of a pipe. Direct tumor invasion of the wall of the inferior vena cava is not coded in this field.
Record the code that best describes involvement of the renal vein and/or inferior vena cava (IVC) as described in the pathology report. Do not include clinical findings in this field.
Rationale
Involvement of major veins for Kidney is a Registry Data Collection Variable in AJCC. It was previously collected as Kidney, CS SSF #2.
Additional Info
**Source documents:** surgical pathology report
For further information, refer to the **Kidney** cancer protocol published by the College of American Pathologists for the AJCC Staging System *Kidney*
Notes
**Note 1:** **Physician Statement**
* Physician statement of Major Vein Involvement can be used to code this data item when no other information is available.
* The major veins include the renal vein or its segmental branches, and the inferior vena cava.
**Note 2:** **Relevance to Staging**
* Information about major vein involvement beyond the kidney is collected in primary tumor as an element in anatomic staging. It is also collected in this field as it may have an independent effect on prognosis.
**Note 3:** **Major Vein Involvement**
* Record the involvement of specific named veins as documented in the pathology report. Do not code invasion of small unnamed vein(s) of the type collected as lymph-vascular invasion. Lymph-vascular invasion is usually only seen microscopically.
Coding Guidelines
**1)** Record major vein involvement as documented in the surgical pathology report
* **a.** Surgical resection of primary site must be done
* **b.** Do not use imaging findings to code this data item.
**2)** **Code 0**: There is no involvement of the major veins
* **a.** If surgical resection is done and tumor is “confined to kidney” and staging is based on size, then there is no involvement of major veins
**3)** **Code 1**: Involvement of the renal vein or segmental branches
**4)** **Code 2**: Involvement of the inferior vena cava (IVC)
**5)** **Code 3**: Involvement of major veins, but not specified which one (renal vein, segmental branches, or inferior vena cava (IVC))
**6)** **Code 4**: Involvement of more than one vein (any combination of codes 1-3)
**7)** **Code 9** when
* **a.** There is no documentation in the medical record
* **b.** Clinical diagnosis only
* **c.** Evaluation of major vein involvement not done or unknown if done
* **d.** Surgical resection of the primary site is performed and there is no mention of major vein involvement
Default
8
Metadata
SSDI
| Code |
Description |
| 0 |
Major vein involvement not present/not identified |
| 1 |
Renal vein or its segmental branches |
| 2 |
Inferior vena cava (IVC) |
| 3 |
Major vein invasion, NOS |
| 4 |
Any combination of codes 1-3 |
| 8 |
Not applicable: Information not collected for this case
(If this information is required by your standard setter, use of code 8 may result in an edit error.) |
| 9 |
Not documented in medical record
Vein involvement not assessed or unknown if assessed
No surgical resection of primary site is performed |
