EOD Primary Tumor


**Note 1:** Bronchopneumonia is not the same thing as obstructive pneumonitis and should not be coded as such. * Bronchopneumonia is an acute inflammation of the walls of the bronchioles, usually a result of spread of infection from the upper to the lower respiratory tract * Obstructive pneumonitis is a combination of atelectasis, bronchiectasis with mucous plugging, and parenchymal inflammation that develops distal to an obstructing endobronchial lesion **Note 2:** Code 100 only applies to predominantly lepidic pattern (AIS) tumors with a small focus of invasion. **Note 3:** 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 bed rest with shallow breathing. Sometimes called a collapsed lung. * For staging purposes, atelectasis must present with an obstructing tumor **Note 4:** Specific information about visceral pleura invasion is captured in codes 450 (PL1 and PL2) and 500 (PL3). Elastic layer involvement has prognostic significance for lung cancer. **Note 5:** Penetration of the visceral pleura indicates a progression of invasion, even in small (≤ 3cm) tumors, and indicates a less favorable prognosis. Visceral pleural invasion is considered present both in tumors that extend to the visceral pleural surface (type PL2 invasion), and in tumors that penetrate beyond the elastic layer of the visceral pleura (type PL1 invasion). Further invasion, which extends to the parietal pleura, is also described as type PL3 invasion. **Note 6:** Separate ipsilateral tumor nodules of the same histopathological type (intrapulmonary metastases) are coded either 500 (same lobe) or 700 (different ipsilateral lobe). Separate tumor nodules in the contralateral lung are assigned in EOD Mets. **Note 7:** Occult carcinoma occurs when tumor is proven by the presence of malignant cells or bronchial washings, but there is no other evidence of the tumor. In these cases, assign EOD Primary Tumor 980, EOD Regional Nodes 000, and EOD Mets 00.
Code Description SS2018 T
000 In situ, Noninvasive, intraepithelial Squamous cell carcinoma in situ (SCIS) Adenocarcinoma in situ (AIS): adenocarcinoma with pure lepidic pattern, less than or equal to 3 cm in greatest dimension IS
100 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 L
200 Superficial spreading tumor, any size - WITH invasive component limited to bronchial wall - WITH or WITHOUT proximal extension to main stem bronchus (these types of tumors are uncommon) L
300 Any size tumor - Confined to lung, NOS - Localized, NOS L
400 Any size tumor - Adjacent ipsilateral lobe (direct tumor invasion) - Confined to hilus - Main stem bronchus, NOS (without involvement of the carina) + Including extension from other part of lung L
450 Any size tumor - Atelectasis/obstructive pneumonitis + Extends to hilar region, involving part or all of lung - Pleura, NOS - Pulmonary ligament - Visceral pleura (PL1 or PL2) RE
500 Any size tumor - Brachial plexus, inferior branches or NOS - Chest wall (thoracic wall) (separate lesion-see EOD Mets) - Pancoast tumor (superior sulcus syndrome), NOS - Parietal pericardium - Parietal pleura (PL3) - Pericardium, NOS - Phrenic nerve Separate tumor nodule(s) in the same lobe as the primary RE
550 Any size tumor - Adjacent rib - Rib - Skeletal muscle - Sternum D
600 Tumor limited to the carina L
650 Blood vessel(s) (major) - Aorta - Azygos vein - Pulmonary artery or vein - Superior vena cava (SVC syndrome) Carina from lung Compression of esophagus or trachea not specified as direct extension Esophagus Mediastinum, extrapulmonary or NOS Nerve(s) - Cervical sympathetic (Horner’s syndrome) - Recurrent laryngeal (vocal cord paralysis) - Vagus Trachea RE
700 Heart Inferior vena cava Neural foramina Vertebra(e) (vertebral body) Visceral pericardium Separate tumor nodule(s) in a different ipsilateral lobe Further contiguous extension D
800 No evidence of primary tumor U
980 Tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy; "occult" carcinoma 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) 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: 431-456