KidneyParenchyma - CS Extension

Note 1: The parenchyma of the kidney includes the following structures: cortex (outer layer of kidney), renal columns; medulla, medullary rays, renal pyramids, and renal papillae; nephrons (renal corpuscle, loops of Henle, proximal and distal tubules, collecting duct); glomerulus and surrounding Bowman's capsule. The most common site for renal parenchymal cancer to develop is in the proximal convoluted tubule. Tumor extension from one of these structures into another is coded 100 in the absence of further involvement.
Note 2: Gerota's fascia is a fibrous tissue sheath surrounding the kidney and suprarenal or adrenal gland. The perirenal fat, renal capsule, and renal parenchyma lie below the fascia.
Note 3: Information about invasion beyond the capsule, venous involvement, and ipsilateral adrenal gland involvement is collected in this field for anatomic staging. This information is also collected in CS Site-Specific Factor 1, CS Site-Specific Factor 2, and CS Site-Specific Factor 3, as these factors may have an independent effect on prognosis.
Note 4: AJCC considers "in situ carcinoma of the renal parenchyma" an impossible diagnosis. Any case so coded is mapped to TX for AJCC stage and in situ Summary Stage.
Note 5: Use code 300 (Localized, NOS) only when no further information is available to assign code 100, 200, or 310-360.
Note 6: The assignment of T1 and T2 categories for tumors limited to the kidney is based on tumor size. A physician's statement of the T category may be used to code CS Tumor Size and/or CS Extension if this is the only information in the medical record regarding one or both of these fields. However the two fields are coded independently: for example the record may document size but not extension, other than the physician's statement of the T category. Use codes 310-360, 605-625 or 810 as appropriate to code CS Extension based on a statement of T when no other extension information is available.
Note 7: Direct extension to or other involvement of structures considered M1 in AJCC staging is coded in the data item CS Mets at DX. This includes: contralateral kidney; contralateral ureter; liver from left kidney; spleen from right kidney.

^ For CS Extension codes 100-360 ONLY, the T category for AJCC 7 is assigned based on the value of CS Tumor Size, as shown in the Extension Size AJCC 7 Table for this site.
* For CS Extension codes 100-360 ONLY, the T category for AJCC 6 is assigned based on the value of CS Tumor Size, as shown in the Extension Size AJCC 6 Table for this site.

Code	Description	TNM 7 Map	TNM 6 Map	SS77 Map	SS2000 Map
000	In situ, intraepithelial, noninvasive	TX	TX	IS	IS
100	Invasive cancer confined to kidney cortex and/or medulla	^	*	L	L
200	Invasion of renal capsule Renal pelvis or calyces involved Separate focus of tumor in renal pelvis/calyx	^	*	L	L
300	Localized, NOS	^	*	L	L
310	Stated as T1a with no other information on extension	^	*	L	L
320	Stated as T1b with no other information on extension	^	*	L	L
330	Stated as T1 [NOS] with no other information on extension	^	*	L	L
340	Stated as T2a with no other information on extension	^	*	L	L
350	Stated as T2b with no other information on extension	^	*	L	L
360	Stated as T2 [NOS] with no other information on extension	^	*	L	L
390	OBSOLETE DATA CONVERTED V0200 See code 625 Stated as T3, NOS	ERROR	ERROR	ERROR	ERROR
400	OBSOLETE DATA RETAINED V0200 Adrenal (suprarenal gland), ipsilateral reclassified in AJCC 7; see codes 450 and 630 Adrenal (suprarenal) gland, ipsilateral Perirenal (perinephric) tissue/fat Renal (Gerota's) fascia Renal sinus fat Retroperitoneal soft tissue	ERROR	T3a	RE	RE
450	OBSOLETE DATA REVIEWED V0203 See codes 460 and 660 Perirenal (perinephric) tissue/fat Renal (Gerota's) fascia Renal sinus fat Retroperitoneal soft tissue	T3a	T3a	RE	RE
460	Perirenal (perinephric) tissue/fat Renal (Gerota's) fascia Renal sinus fat	T3a	T3a	RE	RE
600	OBSOLETE DATA RETAINED V0200 Blood vessels reclassified in AJCC 7th Edition; see codes 601 and 610 Blood vessels: Extrarenal portion of renal vein or segmental (muscle containing) branches Hilar blood vessel Inferior vena cava below diaphragm Perirenal vein Renal artery Renal vein, NOS Tumor thrombus in a renal vein, NOS	ERROR	T3b	RE	RE
601	Blood vessels: Extrarenal portion of renal vein or segmental (muscle containing) branches Hilar blood vessel Perirenal vein Renal artery Renal vein, NOS Tumor thrombus in a renal vein, NOS	T3a	T3b	RE	RE
605	Stated as T3a with no other information on extension	T3a	T3a	RE	RE
610	Inferior vena cava (IVC) below diaphragm Stated as T3b with no other information on extension	T3b	T3b	RE	RE
620	IVC above diaphragm or invades wall of IVC Stated as T3c with no other information on extension	T3c	T3c	RE	RE
625	IVC, NOS Stated as T3 [NOS] with no other information on extension	T3NOS	T3NOS	RE	RE
630	Ipsilateral adrenal (suprarenal) gland (Noncontiguous ipsilateral adrenal gland involvement coded in CS Mets at DX)	T4	T3a	RE	RE
640	630 + (601 and/or 610) Ipsilateral adrenal gland plus blood vessels listed in code 601 and/or IVC below diaphragm	T4	T3b	RE	RE
645	630 + 620 Ipsilateral adrenal gland plus IVC above diaphragm or wall of IVC	T4	T3c	RE	RE
650	Extension beyond Gerota's fascia to: Ascending colon from right kidney Descending colon from left kidney Diaphragm Duodenum from right kidney Peritoneum Tail of pancreas Ureter, including implant(s), ipsilateral Beyond Gerota's fascia, NOS	T4	T4	RE	RE
660	Retroperitoneal soft tissue	T4	T4	RE	RE
665	660 + any of (460, 601, 610, 620, 625, 630, 640, 645, 650)	T4	T4	RE	RE
670	Extension beyond Gerota's fascia to: Psoas muscle Quadratus lumborum muscle	T4	T4	D	RE
700	Ribs	T4	T4	D	D
750	Liver from right kidney Spleen from left kidney Stomach	T4	T4	D	D
800	OBSOLETE DATA RETAINED AND REVIEWED V0203 See codes 460, 601, 610-750, 801, CS Mets at DX codes 20, 55 Further contiguous extension: Aorta Other direct extension	T4	T4	D	D
801	Further contiguous extension: Aorta Other direct extension (except to structures specified in CS Mets at DX code 20)	T4	T4	D	D
810	Stated as T4 with no other information on extension	T4	T4	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