EOD Mets
Notes
**Note 1:** **Pleural and pericardial effusions**
* Most pleural and pericardial effusions with lung cancer are due to tumor
* In a few patients, however, multiple cytopathological examinations of pleural and/or pericardial fluid are negative for tumor, and the fluid is non-bloody and is not an exudate. Where these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element.
* Code 00 in the absence of any other metastasis.
**Note 2:** **Extrathoracic metastasis**
* Organs
* Abdominal organs
* Adjacent rib (noncontiguous involvement only) (see *EOD Primary Tumor* for contiguous involvement)
* Skin of chest
* Separate lesion in chest wall or diaphragm
* Distant lymph node(s)
- Cervical
- Distant lymph node(s), NOS
* Carcinomatosis
* Distant metastasis WITH or WITHOUT distant lymph node(s)
| Code |
Description |
SS2018 M |
| 00 |
No distant metastasis
Unknown if distant metastasis |
NONE |
| 10 |
Pericardial effusion or pleural effusion (malignant)
* Ipsilateral, contralateral, bilateral, NOS)
Pleural tumor foci or nodules on ipsilateral lung (separate from direct extension) or contralateral lung
Pericardial nodules
Contralateral lung/main stem bronchus
Separate tumor nodule(s) in contralateral lung |
D |
| 20 |
Single distant lymph node involved
- Cervical
- Distant lymph node, NOS
WITH or WITHOUT metastasis listed in code 10 |
D |
| 30 |
Single extrathoracic metastasis in a single organ
* WITH or WITHOUT metastasis listed in code 10 |
D |
| 40 |
Multiple extrathoracic metastases in a single organ system
*Example: The skeleton is considered one organ. Several metastases in a single bone OR
several metastases in several bones are classified as M1c1.*
* WITH or WITHOUT metastasis listed in code 10 |
D |
| 45 |
Multiple extrathoracic metastases in multiple organs system
*Example: Liver and distant lymph nodes*
WITH or WITHOUT metastasis listed in code 10 |
D |
| 50 |
Multiple extrathoracic metastases, unknown if single or multiple organ systems |
D |
| 70 |
Distant metastasis, NOS |
D |
| 99 |
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) **Lung**, from the AJCC Cancer Staging System Version 9 (2025). Used with permission of the American College of Surgeons, Chicago, Illinois.
