EOD Primary Tumor

Notes

**Note 1:** Changes such as dimpling of the skin, tethering, and nipple retraction are caused by tension on Cooper’s ligament(s), not by actual skin involvement. They do not alter the classification. **Note 2:** Adherence, attachment, fixation, induration, and thickening are clinical evidence of extension to skin or subcutaneous tissue; assign code 200. **Note 3:** “Fixation, NOS” is involvement of pectoralis muscle; assign code 200. **Note 4:** For a clinical description of inflammation, erythema, edema, peau d’orange, or other terms describing skin changes without a stated diagnosis of inflammatory carcinoma, assign code 400.
Code Description SS2018 T
000 In situ: noninfiltrating; intraepithelial Intraductal WITHOUT infiltration Lobular neoplasia, grade 3 (LIN 3) IS
050 Paget disease of nipple WITHOUT underlying tumor Behavior with Primary Tumor for SS2018 T
070 Paget disease of nipple WITH underlying DCIS tumor Behavior with Primary Tumor for SS2018 T
100 Any size tumor Confined to breast tissue and fat including nipple and/or areola Localized, NOS EXCLUDES: skin invasion of breast, nipple and areola (see code 200) L
200 Any size tumor Attachment or fixation to pectoral muscle(s) or underlying tumor Deep fixation Invasion of - Pectoral fascia or muscle(s) - Subcutaneous tissue Local infiltration of dermal lymphatics adjacent to primary tumor involving skin by direct extension Skin infiltration of primary breast including skin of nipple and/or areola RE
300 Invasion of (or fixation to) - Chest wall - Intercostal or serratus anterior muscle(s) - Rib(s) RE
400 Extensive skin involvement WITHOUT a stated diagnosis of inflammatory carcinoma WITH or WITHOUT dermal lymphatic filtration - Edema of skin - En cuirasse - Erythema - Inflammation of skin - Lenticular nodule(s) - Peau d'orange ("pigskin") - Satellite nodule(s) - Skin edema - Ulceration of skin of breast RE
450 Diagnosis of inflammatory carcinoma WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving less than or equal to one-third (33%) of the skin of the breast or percentage not stated WITH or WITHOUT dermal lymphatic infiltration - En cuirasse - Satellite nodule(s) - Skin edema - Ulceration of skin of breast RE
500 300 + (400 OR 450) RE
600 Diagnosis of inflammatory carcinoma WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving greater than one-third (33%) or more of the skin of the breast WITH or WITHOUT dermal lymphatic infiltration - En cuirasse - Lenticular nodule(s) - Satellite nodule(s) - Ulceration of skin of breast RE
700 Stated as “Inflammatory carcinoma” with no other information RE
800 No evidence of primary tumor U
999 Unknown; extension not stated Primary tumor cannot be assessed Not documented in patient record Death Certificate Only U
(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: 3-30 (5) Hortobagyi, G.N., Giuliano, A., et al. **Breast**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 589-628