EOD Primary Tumor
Notes
**Note 1:** The two main types of bladder cancer are the flat (sessile) variety and the papillary type. The flat (sessile) variety is called in situ when tumor has not penetrated the basement membrane. Papillary tumor that has not penetrated the basement membrane is called noninvasive. **Note 2:** Noninvasive papillary transitional carcinoma: Pathologists use many different descriptive terms for noninvasive papillary transitional cell carcinoma. Frequently, the pathology report does not contain a definite statement of non-invasion; however, non-invasion can be inferred from the microscopic description. **Definite statements of non-invasion for papillary transitional cell carcinomas (Ta) include** - Noninfiltrating - Noninvasive - No evidence of invasion - No extension into lamina propria - No stromal invasion - No extension into underlying supporting tissue - Negative lamina propria and superficial muscle - Negative muscle and (subepithelial) connective tissue - No infiltrative behavior/component **Inferred descriptions of non-invasion for papillary transitional cell carcinomas include** - No involvement of muscularis propria and no mention of subepithelium/submucosa - No statement of invasion (microscopic description present) - (Underlying) Tissue insufficient to judge depth of invasion - No invasion of bladder wall - No involvement of muscularis propria - Benign deeper tissue - Microscopic description problematic (non-invasion versus superficial invasion) - Frond surfaced by transitional cell - No mural infiltration - No evidence of invasion (no sampled stroma) - Confined to mucosa **Note 3:** Noninvasive (in situ) flat transitional cell carcinoma: Careful attention must be given to the use of the term "confined to mucosa" for flat bladder carcinomas. Historically, carcinomas described as "confined to mucosa" were coded as localized. However, pathologists use this designation for non-invasion as well. Pathologists also vary in their use of the terms "invasion of mucosa, grade 1" and "invasion of mucosa, grade 2" to distinguish between noninvasive and invasive carcinomas. In order to accurately code tumors described as "confined to mucosa", abstractors should determine - If the tumor is confined to the epithelium: then it is noninvasive (000). - If the tumor has penetrated the basement membrane to invade the lamina propria: then it is invasive and coded to 100 for localized. The lamina propria and submucosa tend to merge when there is no muscularis mucosa, so these terms may be used interchangeably, along with stroma and subepithelial connective tissue. - If the distinction between involvement of the epithelium and lamina propria cannot be made, then the tumor should be coded as "confined to mucosa, NOS" (100). - Statements meaning confined to mucosa, NOS for flat transitional cell carcinomas include + Confined to mucosal surface + Limited to mucosa, no invasion of submucosa and muscularis + No infiltration/invasion of fibromuscular and muscular stroma + Superficial, NOS **Note 4:** In case of multifocal noninvasive, code 000. **Note 5:** Code 300 if the only description of extension is through full thickness of bladder wall, and there is no clear statement as to whether or not the cancer has extended into fat. **Note 6:** An associated in situ component of tumor extending into the prostatic ducts, prostatic glands, or ureter without invasion is disregarded in staging classification. Assign the code that best describes depth of bladder wall invasion. **Note 7:** Direct invasion of the distal ureter is classified by the depth of greatest invasion in the bladder or ureter. Code 100 if the distal ureter is defined as below the iliac vessel, within the pelvic brim is involved. **Note 8:** Code 130 when there is extension from the bladder into the subepithelial tissue of prostatic urethra.| Code | Description | SS2018 T |
|---|---|---|
| 000 | Papillary - Non-infiltrating - Transitional cell carcinoma, stated to be non-invasive - Transitional cell carcinoma, with inferred description of non-invasion | IS |
| 050 | Nonpapillary - Carcinoma in situ, NOS - Sessile (flat) (solid) carcinoma in situ - Transitional cell carcinoma in situ | IS |
| 100 | Confined to mucosa, NOS | L |
| 130 | Lamina propria Stroma Subepithelial connective tissue Submucosa Subserosa Tunica propria | L |
| 150 | Localized, NOS | L |
| 170 | Extension to distal ureter - Subepithelial connective tissue of bladder and/or distal ureter | RE |
| 200 | Muscle (muscularis propria) of bladder only - Superficial muscle - inner half | L |
| 250 | Extension to distal ureter - Superficial muscle of bladder and/or distal ureter | RE |
| 300 | Muscle (muscularis propria) of bladder only - Deep muscle--outer half Extension through full thickness of bladder wall BUT still contained within bladder wall | L |
| 350 | Extension to distal ureter - Deep muscle or extension through wall of bladder and/or distal ureter | RE |
| 370 | Muscle (muscularis propria) invaded, NOS of bladder only | L |
| 400 | Extension to distal ureter - Muscle (muscularis propria) invaded, NOS of bladder and/or distal ureter | RE |
| 450 | Extension to perivesical fat/tissues (MICROSCOPIC) including - Adventitia - Distal periureteral tissue - Periprostatic tissue - Peritoneum - Serosa (mesothelium) (to/through) - Tunica serosa (to/through) | RE |
| 500 | Extravesical mass Extension to perivesical fat/tissues (MACROSCOPIC) including - Adventitia - Distal periureteral tissue - Periprostatic tissue - Peritoneum - Serosa (mesothelium) (to/through) - Tunica serosa (to/through) | RE |
| 550 | Extension to perivesical fat/tissues, NOS, including - Adventitia - Distal periureteral tissue - Periprostatic tissue - Peritoneum - Serosa (mesothelium) (to/through) - Tunica serosa (to/through) | RE |
| 600 | Extravesical tumor with extension to - Parametrium - Prostate, NOS - Prostatic stroma - Rectovesical/Denonvilliers' fascia - Seminal vesicle - Ureter (excluding distal ureter) - Urethra (including prostatic urethra) - Uterus - Vagina - Vas deferens | RE |
| 650 | Extravesical tumor with extension to - Large intestine - Rectum (male) - Small intestine | D |
| 700 | Bladder is "fixed" | RE |
| 720 | Extravesical tumor with extension to - Abdominal wall - Bone - Colon - Pelvic wall - Pubic bone - Rectum (female) Further contiguous extension | D |
| 750 | Extravesical tumor, NOS | 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 |