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:** Ground glass opacities (GGO), ground glass nodules (GGN), and ground/glass lepidic (GG/L) are frequently observed on CT and are increasingly detected with the advancements in imaging and are described as an area of hazy increased lung opacity. GGO, GGN, and GG/L can be observed in both benign and malignant lung conditions along with pre-invasive lesions (adenocarcinoma in situ, minimally invasive adenocarcinoma, and lepidic carcinoma). They are often associated with early stage lung cancer but not necessarily malignancies themselves. * For staging purposes, these are not to be counted as separate tumor nodules **Note 3:** 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 4:** 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 5:** 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 6:** 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 7:** 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 8:** 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 determined to be 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 9:** "Vocal cord paralysis," "superior vena cava syndrome," and "compression of the trachea or the esophagus" are classified as either direct extension from the primary tumor or mediastinal lymph node involvement * If these manifestations are caused by direct extension of the primary tumor, code as primary tumor involvement (EOD Primary Tumor, code 650) * If the primary tumor is peripheral and clearly unrelated to vocal cord paralysis, SVC obstruction, or compression of the trachea, or the esophagus, these manifestations are secondary to lymph node involvement; code as mediastinal lymph node involvement (EOD Lymph Nodes, code 400) * If unable to determine if these manifestations are due to direct extension or mediastinal lymph node involvement, record as mediastinal lymph node involvement (EOD Lymph Nodes, code 400) **Note 10:** 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 11:** Occult carcinoma occurs when tumor is proven by the presence of malignant cells in sputum 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) - Diaphragm (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 Code 600 + (100-500) Carina with involvement of any other parts of lung Blood vessel(s) (major) - Aorta - Azygos vein - Pulmonary artery or vein - Superior vena cava (SVC syndrome) Compression of esophagus or trachea 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 U
999 Unknown; extension not stated Primary tumor cannot be assessed Not documented in medical 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 (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