Bladder - CS Extension

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 noninvasion; however, noninvasion can be inferred from the microscopic description.
    A. Definite statements of noninvasion for papillary transitional cell carcinomas (code 010) 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
    B. Inferred descriptions of noninvasion for papillary transitional cell carcinomas (code 030) 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 (noninvasion versus superficial invasion)
        Frond surfaced by transitional cell
        No mural infiltration
        No evidence of invasion (no sampled stroma)
        Confined to mucosa (see also Note 3 if tumor is not described as papillary)
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 noninvasion 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 (code 060).
    If the tumor has penetrated the basement membrane to invade the lamina propria: then it is invasive (code 155). 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" (code 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 Ta and Tis tumors, use code 060 or 100 in preference to 010 or 030.
Note 5: Use code 230 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. If there is documentation that tumor has breached the wall, including invasion into fat or beyond, use code 411 or higher.
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. Use 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 for AJCC staging. Use codes 165, 215, 235, and 245 for extension from bladder directly into distal ureter. The distal ureter is defined as below the iliac vessel, within the pelvic brim.
Note 8: Extension from bladder into subepithelial tissue of prostatic urethra should be coded 160 and not code 600.
Note 9: If CS Extension code is 010-060, Behavior ICD-O-3 must be coded as 2. If CS Extension code is 100, Behavior ICD-O-3 may be coded as 2 or 3. If CS Extension code is 155 or greater, Behavior ICD-O-3 must be coded as 3.

Code	Description	TNM 7 Map	TNM 6 Map	SS77 Map	SS2000 Map
010	Papillary: Papillary transitional cell carcinoma, stated to be noninvasive Papillary non-infiltrating (See Note 2A) Stated as Ta with no other information on extension (See Notes 1 and 2)	Ta	Ta	IS	IS
030	Papillary: Papillary transitional cell carcinoma, with inferred description of noninvasion (See Note 2B)	Ta	Ta	IS	IS
060	Nonpapillary: Sessile (flat) (solid) carcinoma in situ Carcinoma in situ, NOS Transitional cell carcinoma in situ Stated as Tis with no other information on extension	Tis	Tis	IS	IS
100	Confined to mucosa, NOS (See Note 3)	Tis	Tis	L	L
150	OBSOLETE DATA RETAINED V0200 See codes 155 and 170 Invasive tumor confined to subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma) TNM/AJCC T1 Jewett-Strong-Marshall Stage A	ERROR	T1	L	L
155	Subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma) of bladder only	T1	T1	L	L
160	Subepithelial connective tissue of prostatic urethra	T1	T1	L	L
165	Extension to distal ureter: Subepithelial connective tissue of bladder and/or distal ureter (See Note 7)	T1	T1	RE	RE
170	Stated as T1 with no other information on extension	T1	T1	L	L
200	OBSOLETE DATA CONVERTED V0200 See code 240 Muscle (muscularis propria) invaded, NOS	ERROR	ERROR	ERROR	ERROR
210	Muscle (muscularis propria) of bladder only: Superficial muscle - inner half Stated as T2a with no other information on extension	T2a	T2a	L	L
215	Extension to distal ureter: Superficial muscle of bladder and/or distal ureter (See Note 7)	T2a	T2a	RE	RE
220	Muscle (muscularis propria) of bladder only: Deep muscle--outer half Stated as T2b with no other information on extension	T2b	T2b	L	L
230	Extension through full thickness of bladder wall BUT still contained within bladder wall (see Note 5)	T2b	T2b	L	L
235	Extension to distal ureter: Deep muscle or extension through wall of bladder and/or distal ureter (See Note 7)	T2b	T2b	RE	RE
240	Muscle (muscularis propria) invaded, NOS of bladder only Stated as T2 [NOS] with no other information on extension	T2NOS	T2NOS	L	L
245	Extension to distal ureter: Muscle (muscularis propria) invaded, NOS of bladder and/or distal ureter (See Note 7)	T2NOS	T2NOS	RE	RE
300	Localized, NOS	T1	T1	L	L
400	OBSOLETE DATA CONVERTED V0200 See code 430 Adventitia Extension to/through serosa (mesothelium) Peritoneum Periureteral fat/tissue Perivesical fat/tissue, NOS	ERROR	ERROR	ERROR	ERROR
410	OBSOLETE DATA CONVERTED V0203 See code 411 Extension to perivesical fat/tissues (microscopic)	ERROR	ERROR	ERROR	ERROR
411	Extension to perivesical fat/tissues (microscopic) including: Adventitia Serosa (mesothelium) Peritoneum Periprostatic tissue Distal periureteral tissue Stated as T3a with no other information on extension	T3a	T3a	RE	RE
415	OBSOLETE DATA CONVERTED V0203 See code 411 Stated as T3a with no other information on extension	ERROR	ERROR	ERROR	ERROR
420	OBSOLETE DATA CONVERTED V0203 See code 421 Extension to perivesical fat/tissues (macroscopic) Extravesical mass Stated as T3b with no other information on extension	ERROR	ERROR	ERROR	ERROR
421	Extension to perivesical fat/tissues (macroscopic) including: Adventitia Serosa (mesothelium) Peritoneum Periprostatic tissue Distal periureteral tissue Extravesical mass Stated as T3b with no other information on extension	T3b	T3b	RE	RE
430	OBSOLETE DATA REVIEWED V0203 See codes 411, 421, 431 Adventitia Extension to/through serosa (mesothelium) Peritoneum Periureteral fat/tissue (see Note 10) Perivesical fat/tissue, NOS Stated as T3 [NOS] with no other information on extension	T3NOS	T3NOS	RE	RE
431	Extension to perivesical fat/tissues, NOS (unknown if microscopic or macroscopic), including: Adventitia Serosa (mesothelium) Peritoneum Periprostatic tissue Distal periureteral tissue Stated as T3 [NOS] with no other information on extension	T3NOS	T3NOS	RE	RE
450	OBSOLETE DATA CONVERTED V0200 See code 810 Stated as T4 [NOS]	ERROR	ERROR	ERROR	ERROR
600	OBSOLETE DATA RETAINED AND REVIEWED V0203 See codes 165, 215, 235, 245, and 630 Prostatic stroma Prostate, NOS Ureter Urethra, including prostatic urethra (excluding subepithelial connective tissue, see code 160)	T4a	T4a	RE	RE
630	Prostatic stroma Prostate, NOS Ureter (excluding distal ureter) Urethra, including prostatic urethra (excluding subepithelial connective tissue, see code 160)	T4a	T4a	RE	RE
650	Parametrium Rectovesical/Denonvilliers' fascia Seminal vesicle Vas deferens	T4a	T4a	RE	RE
670	Uterus Vagina	T4a	T4a	RE	RE
673	Rectum, male	T4a	T4a	RE	D
677	Large intestine including rectum, female (excluding rectum, male) Small intestine	T4a	T4a	D	D
680	Stated as T4a with no other information on extension	T4a	T4a	RE	RE
700	Bladder is "fixed"	T4b	T4b	RE	RE
710	Pubic bone	T4b	T4b	RE	D
715	700 + 673	T4b	T4b	RE	D
720	(710 or 700) + 677	T4b	T4b	D	D
730	OBSOLETE DATA REVIEWED V0203 See codes 673, 710, 715, and 720 Rectum, male Pubic bone	T4b	T4b	RE	D
750	Abdominal wall Pelvic wall	T4b	T4b	D	D
800	OBSOLETE DATA RETAINED V0200 See codes 730 and 801 Further contiguous extension, including: Pubic bone Rectum, male Sigmoid	ERROR	T4b	D	D
801	OBSOLETE DATA REVIEWED V0203 See codes 677, 720, and 802 Further contiguous extension including: Rectum, female Sigmoid	T4b	T4b	D	D
802	Further contiguous extension	T4b	T4b	D	D
805	Stated as T4b with no other information on extension	T4b	T4b	RE	RE
810	Stated as T4 [NOS] with no other information on extension	T4NOS	T4NOS	RE	RE
950	No evidence of primary tumor	T0	T0	U	U
999	Unknown; extension not stated Primary tumor cannot be assessed Not documented in patient record	TX	TX	U	U