EOD Primary Tumor
Notes
**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 is to be used only when the following criteria are met
* Minimally invasive adenocarcinoma (less than or equal to 3 cm)
* **WITH** predominantly **lepidic pattern** **AND**
* less than or equal to 5 mm invasion in greatest dimension
* If predominantly **lepidic pattern** is present and the size of the invasive component is unknown, see code 300
**Note 3:** Code 200 is to be used for **superficial spreading tumors** only. The pathology report must state that it is superficially spreading.
* These types of tumor are uncommon, and this code should be used very sparingly. If in doubt, do not use this code
**Note 4:** Code 300 is to be used for a localized cancer where size defines the extent of the primary tumor. It is not a predominantly lepidic pattern (code 100), or a superficial spreading tumor (code 200), and there is no involvement of adjacent structures or invasion of the pleural (codes 400 and above).
**Note 5:** 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 6:** Specific information about visceral pleura invasion is captured in codes 450 (PL1, PL2, or NOS) and 500 (PL3). Elastic layer involvement has prognostic significance for lung cancer.
**Note 7:** 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 8:** 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 9:** 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 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, PL2, or NOS) |
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 |
| 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 |
| 675 |
Any size tumor
- Adjacent rib
- Rib
- Skeletal muscle
- Sternum |
D |
| 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 |
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(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)
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