Collaborative Stage

Note 1: DISTINGUISHING NONINVASIVE AND INVASIVE BLADDER CANCER. The two main types of bladder cancer are the flat (sessile) variety and the papillary type. Only 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 non-invasive, and 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. The more commonly used descriptions for noninvasion are listed below in Notes 2 and 3. Careful attention must be given to the use of the term "confined to mucosa" for urinary bladder. Historically, carcinomas described as "confined to mucosa" were coded as localized. However, pathologists use this designation for non-invasion as well. In order to rule out the possibility of coding noninvasive tumors in this category, abstractors should determine:
         1) If the tumor is confined to the epithelium, then it is noninvasive.
         2) If the tumor has penetrated the basement membrane to invade the lamina propria, then it is invasive. The terms lamina propria, submucosa, stroma, and subepithelial connective tissue are used interchangeably.
         3) Only if this distinction cannot be made should the tumor be coded to "confined to mucosa."
Note 2. For papillary transitional cell carcinomas of the bladder, definite statements of non-invasion (Extension code 010) include:
    Non-infiltrating
    Non-invasive
    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
Note 3.   For papillary transitional cell carcinomas of the bladder, inferred descriptions of non-invasion (Extension 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 for pathologist (non-invasion versus superficial invasion)
    Frond surfaced by transitional cell
    No mural infiltration
    No evidence of invasion (no sampled stroma)
Note 4: The lamina propria and submucosa tend to merge when there is no muscularis mucosae, so these terms will be used interchangeably.
Note 5: The meaning of the terms "invasion of mucosa, grade 1" and "invasion of mucosa, grade 2" varies with the pathologist who must be queried to determine whether the carcinoma is noninvasive" or "invasive."
Note 6: If Extension code is 010-060, Behavior Code must be 2. If Extension code is 100, Behavior Code may be 2 or 3. If Extension code is 160 or greater, Behavior Code must be 3.
Note 7: Statements meaning Confined to Mucosa, NOS (code 100):
    Confined to mucosal surface
    Limited to mucosa, no invasion of submucosa and muscularis
    No infiltration/invasion of fibromuscular and muscular stroma
    Superficial, NOS
Note 8: If a tumor is described as confined to mucosa (or the equivalents in Note 7) AND as papillary, use extension code 010 or 030. Use code 100 (confined to mucosa) only if the tumor is described as confined to mucosa but is not described as papillary.
Note 9: Assign 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 a code from 410 or higher.
Note 10: Periureteral in code 430 refers only to that portion of the ureter that is intramural to the bladder. All other periureteral involvement would be coded to 600.
Note 11: Extension from bladder into subepithelial tissue of prostatic urethra should be coded 160 and not code 600.

Code	Description	TNM 7 Map	TNM 6 Map	SS77 Map	SS2000 Map
010	PAPILLARY transitional cell carcinoma, stated to be noninvasive papillary non-infiltrating Stated as Ta with no other information on extension (See Notes 1 and 2) Jewett-Strong-Marshall Stage 0	Ta	Ta	IS	IS
030	PAPILLARY transitional cell carcinoma, with inferred description of non-invasion (See Note 3)	Ta	Ta	IS	IS
060	Sessile (flat) (solid) carcinoma in situ Carcinoma in situ, NOS Transitional cell carcinoma in situ Stated as Tis with no other information on extension Jewett-Strong-Marshall CIS	Tis	Tis	IS	IS
100	Confined to mucosa, NOS (see Notes 7 and 8)	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) Stated as T1 with no other information on extension Jewett-Strong-Marshall Stage A	ERROR	T1	L	L
155	Invasive tumor confined to subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma)	T1	T1	L	L
160	Subepithelial connective tissue of prostatic urethra	T1	T1	L	L
170	Stated as T1 with no other information on extension Jewett-Strong-Marshall Stage A	T1	T1	L	L
200	OBSOLETE DATA CONVERTED V0200 See code 240 Muscle (muscularis propria) invaded, NOS	T2NOS	T2NOS	L	L
210	Muscle (muscularis propria) invaded: Superficial muscle--inner half Stated as T2a with no other information on extension	T2a	T2a	L	L
220	Muscle (muscularis propria) invaded: 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 9)	T2b	T2b	L	L
240	Muscle (muscularis propria) invaded, NOS Stated as T2 [NOS] with no other information on extension	T2NOS	T2NOS	L	L
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	Extension to perivesical fat/tissues (microscopic)	T3a	T3a	RE	RE
415	Stated as T3a with no other information on extension	T3a	T3a	L	L
420	Extension to perivesical fat/tissues (macroscopic) Extravesical mass Stated as T3b with no other information on extension	T3b	T3b	RE	RE
430	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
450	OBSOLETE DATA CONVERTED V0200 See code 810 Stated as T4 [NOS]	ERROR	ERROR	ERROR	ERROR
600	Prostatic stroma Prostate, NOS Ureter Urethra, including prostatic urethra (excluding subepithelial connective tissue, see code 160)	T4a	T4a	RE	RE
650	Parametrium Rectovesical/Denonvilliers' fascia Vas deferens; seminal vesicle	T4a	T4a	RE	RE
670	Uterus Vagina	T4a	T4a	RE	RE
680	Stated as T4a with no other information on extension	T4a	T4a	RE	RE
700	Bladder is FIXED	T4b	T4b	RE	RE
730	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	Further contiguous extension including: Rectum, female Sigmoid	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 Primary tumor cannot be assessed Not documented in patient record	TX	TX	U	U

Bladder

CS Extension