Lung - CS Extension

Note 1: 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: sternum; skeletal muscle; skin of chest; contralateral lung or mainstem bronchus; separate tumor nodule(s) in contralateral lung.
Note 2: Distance from Carina: Assume tumor is greater than or equal to 2 centimeters (cm) from carina if lobectomy, segmental resection, or wedge resection is done.
Note 3: Opposite Lung: If no mention is made of the opposite lung on a chest x-ray, assume it is not involved.
Note 4: Bronchopneumonia: 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 5: Pulmonary Artery/Vein: An involved pulmonary artery/vein in the mediastinum is coded to 700 (involvement of major blood vessel). However, if the involvement of the artery/vein appears to be only within lung tissue and not in the mediastinum, it is not coded to 700.
Note 6: Vocal cord paralysis (resulting from involvement of recurrent branch of the vagus nerve), superior vena cava (SVC) obstruction, or compression of the trachea or the esophagus may be related to direct extension of the primary tumor or to lymph node involvement. The treatment options and prognosis associated with these manifestations of disease extent fall within the T4-Stage IIIB category; therefore, generally use code 700 for these manifestations. However, if the primary tumor is peripheral and clearly unrelated to vocal cord paralysis, SVC obstruction, or compression of the trachea or the esophagus, code these manifestations as mediastinal lymph node involvement (code 200) in CS Lymph Nodes, unless there is a statement of involvement by direct extension from the primary tumor.
Note 7: Pleural effusion and pericardial effusion are coded in CS Mets at DX.
Note 8: In some cases, the determination of the T category for TNM 6 or 7 staging is based on this field, CS Tumor Size, CS Mets at DX, and CS Site-Specific Factor 1.
Note 9: Code to the highest applicable code for CS Extension and then code the absence or presence of separate ipsilateral tumor nodules in CS Site-Specific Factor 1, Separate Tumor Nodules/Ipsilateral lung. Code separate tumor nodules in contralateral lung in CS Mets at DX.
Note 10: Specific information about visceral pleura invasion is captured in codes 410-430 and CS Site-Specific Factor 2, Visceral Pleural Invasion (VPI)/Elastic Layer. Elastic layer involvement has prognostic significance for lung cancer.

^ For CS Extension codes 000-440, 455-520, 540-600, 730, and 950-999, the T category for AJCC 7 staging is assigned based on the values of CS Tumor Size, CS Extension, and CS Site Specific Factor 1, as shown in the Size Extension AJCC 7 Table for this schema.
* For CS Extension codes 000-999, the T category for AJCC 6 staging is assigned based on the values of CS Tumor Size, CS Extension, CS Mets at Dx and CS Site Specific Factor 1 as shown in the Size Extension Mets AJCC 6 Table for this schema.
# For CS Extension codes 000, 950, 980 and 999, Summary Stage 77 is assigned based on the values of CS Extension and Site Specific Factor 1 as shown in the Summary Stage 77 Table for this schema.
** For CS Extension codes 000-700, 740, 950-999, Summary Stage 2000 is assigned based on the values of CS Extension and Site Specific Factor 1 as shown in the Summary Stage 2000 Table for this schema.

Code	Description	TNM 7 Map	TNM 6 Map	SS77 Map	SS2000 Map
000	In situ, intraepithelial, noninvasive	^	*	#	**
100	Tumor confined to one lung WITHOUT extension or conditions described in codes 200-800 EXCLUDING primary in main stem bronchus EXCLUDING superficial tumor as described in code 110	^	*	L	**
110	Superficial tumor of any size with invasive component limited to bronchial wall, with or without proximal extension to the main stem bronchus	^	*	L	**
115	Stated as T1a with no other information on extension	^	*	L	**
120	Stated as T1b with no other information on extension	^	*	L	**
125	Stated as T1[NOS] with no other information on extension	^	*	L	**
200	Extension from other parts of lung to main stem bronchus, NOS EXCLUDING superficial tumor as described in code 110 Tumor involving main stem bronchus greater than or equal to 2.0 cm from carina (primary in lung or main stem bronchus)	^	*	L	**
210	Tumor involving main stem bronchus, NOS (Distance from carina not stated and no surgery as described in Note 2)	^	*	L	**
220	Direct tumor invasion into an adjacent ipsilateral lobe	^	*	L	**
230	Tumor confined to hilus	^	*	L	**
250	OBSOLETE DATA CONVERTED V0204 See code 680 Tumor confined to carina	ERROR	*	ERROR	**
300	Localized, NOS	^	*	L	**
400	Atelectasis/obstructive pneumonitis that extends to the hilar region but does not involve the entire lung Or atelectasis/obstructive pneumonitis, NOS	^	*	RE	**
410	Extension to but not into pleura, including invasion of elastic layer BUT not through the elastic layer.	^	*	RE	**
420	Invasion of pleura, including invasion through the elastic layer	^	*	RE	**
430	Invasion of pleura, NOS	^	*	RE	**
440	Pulmonary ligament	^	*	RE	**
450	OBSOLETE DATA RETAINED V0200 Extension to: Pleura, visceral or NOS (WITHOUT pleural effusion) Pulmonary ligament	ERROR	*	RE	**
455	Stated as T2a with no other information on extension	^	*	RE	**
460	Stated as T2b with no other information on extension	^	*	RE	**
465	Stated as T2 [NOS] with no other information on size or extension	^	*	RE	**
500	Tumor of/involving main stem bronchus less than 2.0 cm from carina	^	*	L	**
520	500 + 400	^	*	RE	**
530	OBSOLETE DATA RETAINED V0200 450 + 500	ERROR	*	RE	**
540	500 + any of (410-440)	^	*	RE	**
550	Atelectasis/obstructive pneumonitis involving entire lung	^	*	RE	**
560	Parietal pericardium or pericardium, NOS	^	*	RE	**
570	Stated as T3 with no other information on extension	^	*	RE	**
590	Invasion of phrenic nerve	^	*	RE	**
600	Direct extension to: Brachial plexus, inferior branches or NOS, from superior sulcus Chest (thoracic) wall Diaphragm Pancoast tumor (superior sulcus syndrome), NOS Parietal pleura Note: For separate lesion in chest wall or diaphragm, see CS Mets at DX.	^	*	D	**
610	Superior sulcus tumor WITH encasement of subclavian vessels OR WITH unequivocal involvement of superior branches of brachial plexus (C8 or above)	T4	*	D	**
650	OBSOLETE DATA RETAINED V0200 Separate tumor nodules reclassified in AJCC 7th Edition, coded in CS Site-Specific Factor 1 Multiple masses/separate tumor nodule(s) in the SAME lobe "Satellite nodules" in SAME lobe	ERROR	*	L	**
680	Tumor confined to carina	T4	*	L	**
700	Blood vessel(s), major (EXCEPT aorta and inferior vena cava, see codes 740 and 770) Azygos vein Pulmonary artery or vein Superior vena cava (SVC syndrome) Carina from lung/mainstem bronchus Compression of esophagus or trachea not specified as direct extension Esophagus Mediastinum, extrapulmonary or NOS Nerve(s): Cervical sympathetic (Horner syndrome) Recurrent laryngeal (vocal cord paralysis) Vagus Trachea	T4	*	RE	**
705	700 + (600 or 610)	T4	*	D	D
710	Heart Visceral pericardium	T4	*	D	D
720	OBSOLETE DATA RETAINED V0200 Pleural effusion reclassified as distant metastasis in AJCC 7th Edition, see CS Mets at DX code 15 Malignant pleural effusion Pleural effusion, NOS	ERROR	*	D	D
730	Adjacent rib See also code 785	^	*	D	D
740	Aorta	T4	*	D	**
745	740 + 710	T4	*	D	D
748	740 + 730	T4	*	D	D
750	Vertebra(e) Neural foramina	T4	*	D	D
760	OBSOLETE DATA RETAINED V0200 Separate pleural tumor foci reclassified as distant metastasis in AJCC 7th Edition, see CS Mets at DX code 24 Pleural tumor foci separate from direct pleural invasion	ERROR	*	D	D
770	Inferior vena cava	T4	*	D	D
780	OBSOLETE DATA RETAINED V0200 730 plus any of (610-720) or (740-770)	ERROR	*	D	D
785	730 + (700 or 710)	T4	*	D	D
790	OBSOLETE DATA RETAINED V0200 Pericardial effusion reclassified as distant metastasis, see CS Mets at DX code 20 Pericardial effusion, NOS; malignant pericardial effusion	ERROR	*	D	D
795	OBSOLETE DATA CONVERTED V0204 See code 810 Stated as T4 with no other information on extension	ERROR	*	ERROR	ERROR
800	Further contiguous extension (Except to structures specified in CS Mets at DX codes 23 and 37)	T4	*	D	D
810	Stated as T4 with no other information on extension	T4	*	D	D
950	No evidence of primary tumor	^	*	#	**
980	Tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy; "occult" carcinoma	^	*	#	**
999	Unknown; extension not stated Primary tumor cannot be assessed Not documented in patient record	^	*	#	**