GISTEsophagus - CS Mets at DX

Note 1: Liver metastasis implies the presence of tumor inside the liver parenchyma as one or more nodules. Adherence to the liver capsule, even if extensive, should not be considered liver metastasis.
Note 2: Lymph nodes from the supraclavicular region down to the celiac region previously considered to be distant are now regional.
Note 3: When a patient has more than one area of GIST, it is important to try to distinguish between intra-abdominal metastasis and tumor multiplicity. Distant metastases are relatively rare in GISTs, but they are increasingly detected with sophisticated radiological studies. Intra-abdominal metastasis will present as tumor involvement in the abdominal cavity outside the main tumor mass, in the peritoneum, omentum, serosae of organs, and the cul-de-sac, among other areas. Code this form of metastasis in CS Mets at DX.

Tumor multiplicity, in contrast, will present with anatomically separate, multiple tumors of different sizes arising independently in the GI tract. This form of tumor multiplicity usually will be seen in patients with neurofibromatosis type 1 or familial GIST syndrome, but in rare instances may be seen in patients without these conditions. This form of multiplicity should not be coded as metastasis, but the presence of multiple tumors should be coded in CS Site-Specific Factor 10, Tumor Multiplicity.

When a solitary omental or mesenteric tumor mass is found with a primary GIST elsewhere, do not code this as a metastasis. Code it as multiple tumors in CS Site-Specific Factor 10, Tumor Multiplicity.

When multiple tumor areas are present and it is not stated whether these are metastases or independent tumors, consult with a physician if possible to determine how to code them. If a decision cannot be made, code as 99.

Code	Description	TNM 7 Map	TNM 6 Map	SS77 Map	SS2000 Map
00	No distant metastasis	M0	NA	NONE	NONE
10	Distant lymph node(s), NOS	M1	NA	D	D
11	OBSOLETE DATA RETAINED V0200 Considered regional in AJCC 7th Edition See CS Lymph Nodes code 250 Upper thoracic esophagus only: Cervical lymph nodes Lower thoracic (abdominal) esophagus only: Celiac lymph nodes	ERROR	NA	D	D
12	OBSOLETE DATA RETAINED V0200 Considered regional in AJCC 7th Edition staging EXCEPT for common hepatic and splenic lymph nodes which are still considered distant and are included in code 15 See CS Lymph Nodes code 265 Specified distant lymph node(s), other than code 11, including: Cervical esophagus only: Common hepatic Diaphragmatic Pulmonary ligament Splenic Intrathoracic esophagus, upper or middle, only: Common hepatic Diaphragmatic Splenic Lower thoracic (abdominal) esophagus only: Aortopulmonary Pulmonary ligament	ERROR	NA	D	D
15	Common hepatic (18) Splenic (19)	M1	NA	D	D
40	Distant metastasis except distant lymph node(s) Carcinomatosis	M1	NA	D	D
50	OBSOLETE DATA REVIEWED AND CHANGED V0203 See codes 40 and 55 40 + any of (10 to 12) Distant lymph node(s) plus other distant metastases	ERROR	ERROR	ERROR	ERROR
55	40 + (10 or 15) Distant metastasis plus distant lymph node(s)	M1	NA	D	D
60	Distant metastasis, NOS Stated as M1 with no other information on distant metastasis	M1	NA	D	D
99	Unknown; distant metastasis not stated Distant metastasis cannot be assessed Not documented in patient record	M0	NA	U	U