Collaborative Stage

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 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.
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 would not be coded to 700.
Note 6: Vocal cord paralysis (resulting from involvement of recurrent branch of the vagus nerve), superior vena cava 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, vena cava 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 under CS Mets at DX.
Note 8: In some cases, the determination of the T category for TNM 6th or 7th is based on this field and CS Mets at DX or SSF #1.
Note 9: Code to the highest applicable code for extension and then code the absence or presence of separate ipsilateral tumor nodules in SSF 1: Separate Tumor Nodules/Ipsilateral lung. Code separate tumor nodules in contralateral lung in Mets at Dx.
Note 10: The visceral pleura invasion Code 450 in CSv1 has been further defined in CSv2 in Codes 410-440. This is due to introduction of elastic layer involvement that was found to have prognostic factor in lung cancer cases per AJCC 7th edition.

* The T category is assigned based on the value of the tumor size, extension and Site Specific Factor #1, as shown in the extension size table for 6th edition.
^ The T category is assigned based on the value of the tumor size, extension and Site Specific Factor #1, as shown in the extension size table for 7th edition.

Code	Description	TNM 7 Map	TNM 6 Map	SS77 Map	SS2000 Map
000	In situ; noninvasive; intraepithelial	^	*	IS	IS
100	Tumor confined to one lung, WITHOUT extension or conditions described in codes 200-800 (excluding primary in main stem bronchus)(EXCLUDES superficial tumor as described in code 110)	^	*	L	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	L
115	Stated as T1a with no other information on extension	^	*	L	L
120	Stated as T1b with no other information on extension	^	*	L	L
125	Stated as T1[NOS] with no other information on extension	^	*	L	L
200	Extension from other parts of lung to main stem bronchus, NOS (EXCLUDES 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	L
210	Tumor involving main stem bronchus, NOS (distance from carina not stated and no surgery as described in Note 2)	^	*	L	L
230	Tumor confined to hilus	^	*	L	L
250	Tumor confined to the carina	^	*	L	L
300	Localized, NOS	^	*	L	L
400	Atelectasis/obstructive pneumonitis that extends to the hilar region but does not involve the entire lung (or atelectasis/obstructive pneumonitis, NOS) WITHOUT pleural effusion	^	*	RE	RE
410	Extension to (but not into) pleura, including invasion of elastic layer, but not through the elastic layer.	^	*	RE	RE
420	Invasion of pleura, including invasion through the elastic layer	^	*	RE	RE
430	Invasion of pleura, NOS	^	*	RE	RE
440	Pulmonary ligament	^	*	RE	RE
450	OBSOLETE DATA RETAINED V0200 Extension to: Pleura, visceral or NOS (WITHOUT pleural effusion) Pulmonary ligament (WITHOUT pleural effusion)	^	*	RE	RE
455	Stated as T2a with no other information on extension	^	*	RE	RE
460	Stated as T2b with no other information on extension	^	*	RE	RE
465	Stated as T2 [NOS] with no other information on size or extension	^	*	RE	RE
500	Tumor of/involving main stem bronchus less than 2.0 cm from carina	^	*	L	RE
520	(500) + (400)	^	*	RE	RE
530	OBSOLETE DATA RETAINED V0200 (450) + (500)	^	*	RE	RE
540	(500) + any of (410-440)	^	*	RE	RE
550	Atelectasis/obstructive pneumonitis involving entire lung	^	*	RE	RE
560	Parietal pericardium or pericardium, NOS	^	*	RE	RE
570	Stated as T3 [NOS] with no other information on extension	^	*	RE	RE
590	Invasion of phrenic nerve	^	*	RE	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	RE
610	Superior sulcus tumor WITH encasement of subclavian vessels OR WITH unequivocal involvement of superior branches of brachial plexus (C8 or above)	^	*	D	RE
650	OBSOLETE DATA RETAINED V0200 Separate tumor nodules now coded in SSF #1 in AJCC 7th Edition Multiple masses/separate tumor nodule(s) in the SAME lobe "Satellite nodules" in SAME lobe	^	*	L	RE
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's syndrome) Recurrent laryngeal (vocal cord paralysis) Vagus Trachea	^	*	RE	RE
710	Heart Visceral pericardium	^	*	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 Malignant pleural effusion Pleural effusion, NOS	^	*	D	D
730	Adjacent rib See also code 785	^	*	D	D
740	Aorta	^	*	D	RE
745	(740) + (710)	^	*	D	D
750	Vertebra(s) Neural foramina	^	*	D	D
760	OBSOLETE DATA RETAINED V0200 Pleural tumor foci separate reclassified as distant metastasis in AJCC 7th Edition, see CS Mets at DX code 24 Pleural tumor foci separate from direct pleural invasion	^	*	D	D
770	Inferior vena cava	^	*	D	D
780	OBSOLETE DATA RETAINED V0200 730 plus any of (610-720) or (740-770)	^	*	D	D
785	730 + (700 or 710)	^	*	D	D
790	OBSOLETE DATA RETAINED V0200 Pericardial effusion reclassified as distant metastasis in AJCC 7th Edition, see CS Mets at DX code 20 Pericardial effusion, NOS; malignant pericardial effusion	^	*	D	D
795	Stated as T4 [NOS] with no other information on extension	^	*	D	D
800	Further contiguous extension (except to structures specified in CS Mets at DX codes 23 and 37)	^	*	D	D
950	No evidence of primary tumor	^	*	U	U
980	Tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy; "occult" carcinoma	^	*	U	U
999	Unknown extension Primary tumor cannot be assessed Not documented in patient record	^	*	U	U

Lung

CS Extension