Collaborative Staging Manual and Coding Instructions Part I General Instructions

COLLABORATIVE STAGING MANUAL AND CODING INSTRUCTIONS version 1.0

Collaborative Staging Task Force of the American Joint Committee on Cancer

NIH Publication Number 04-5496 U.S. Department of Health and Human Services National Institutes of Health National Cancer Institute

Version date: January 1, 2004 i Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

COPYRIGHT INFORMATION All material in this manual is in the public domain and may be reproduced or copied without permission. However, citation as to source is requested.

SUGGESTED CITATION Collaborative Staging Task Force of the American Joint Committee on Cancer. Collaborative Staging Manual and Coding Instructions, version 1.0. Jointly published by American Joint Committee on Cancer (Chicago, IL) and U.S. Department of Health and Human Services (Bethesda, MD), 2004. NIH Publication Number 04-5496.

Collaborative Staging (CS) Task Force Members Member Representing Stephen Edge, MD, Chair American Joint Committee on Cancer Gayle Clutter, RT, CTR National Program of Cancer Registries, Centers for Disease Control and Prevention Lynda Douglas, CTR American College of Surgeons; Central Registry April Fritz, BA, RHIT, CTR Surveillance, Epidemiology, and End Results Program, National Cancer Institute Missy Jamison National Program of Cancer Registries, Centers for Disease Control and Prevention Vencine Kelly, BA, CTR National Cancer Registrars Association Karen McCracken, CTR National Cancer Registrars Association Tom Rawson National Program of Cancer Registries, Centers for Disease Control and Prevention Lynn Ries, MS Surveillance, Epidemiology, and End Results Program, National Cancer Institute Nancy Schlag, BS, CTR North American Association of Central Cancer Registries Jennifer Seiffert, MLIS, CTR National Program of Cancer Registries, Centers for Disease Control and Prevention

American Joint Committee on Cancer Staff Connie Bura Susan Burkhardt Valerie Vesich, CTR

Physician Advisors to the Task Force James Armitage, MD Mark Arredondo, MD Laura Fajardo, MD Gini Fleming, MD Mary Gospodarowicz, MD Frederick Greene, MD Maureen MacIntyre, MD William MacKillop, MD David Page, MD Jatin Shah, MD

Questions regarding this document and Collaborative Staging in general should be directed to: Valerie Vesich, CTR [email protected] 312-202-5435 American Joint Committee on Cancer 633 North Saint Clair Street Chicago, IL 60611

Version date: January 1, 2004 ii Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

TABLE OF CONTENTS

PART I. INTRODUCTION AND GENERAL INSTRUCTIONS

INTRODUCTION 1 Changes in Abstracting Rules 2 How the Collaborative Staging System Works 4 Mapping and the Computer Algorithm 4 Table 1. Allowable Values and Format for Collaborative Staging Data Items 5 Figure 1. Schematic Diagram of Relationships of Inputs and Outputs 7 for Collaborative Staging How Mapping Was Determined 8

GENERAL INSTRUCTIONS General Instructions for Using the Collaborative Staging System: 11 Codes and Coding Instructions Table 2. Site Specific Factors Used For Primary Site/Histology Schemas 13 Structure and Format of Site/Histology-Specific Code Schemas 14 Coding “None” Vs. “Unknown” in the Collaborative Staging System, TNM 14 and Summary Stage Choosing the Correct Coding Schema for a Case 15 Table 3. Histology-specific Coding Schemas 15 Table 4. Schemas Where Tumor Size Is Required for AJCC Staging 16 Table 5. Schemas That Do Not Use Tumor Size for AJCC Staging 17 Table 6. Schemas for Which TNM Is Not Applicable 18 Death Certificate Only Cases 18 Use of Autopsy Information in Collaborative Staging 18 Definitions of Adjacent Tissues, Structures, and Organs 19 Ambiguous Terminology 20 How to Code the Collaborative Staging System Data Elements 21

INDIVIDUAL DATA FIELD CODING GUIDELINES CS Tumor Size 25 CS Extension 28 CS Tumor Size/Ext Eval 30 CS Lymph Nodes 33 Coding Regional Lymph Nodes for Head and Neck Sites 35 Figure 2. Layout of Site-Specific Factors for Head and Neck Sites 36 Definitions of Levels for Head and Neck Sites 37 CS Reg Nodes Eval 39 Regional Nodes Positive 41 Regional Nodes Examined 42 CS Mets at Dx 43 CS Mets Eval 45 CS Site-Specific Factor 1 47 CS Site-Specific Factor 2 49 CS Site-Specific Factor 3 51 CS Site-Specific Factor 4 53 CS Site-Specific Factor 5 55 CS Site-Specific Factor 6 57

Version date: January 1, 2004 iii Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Table of Contents, continued

Additional Collaborative Staging Tables 59 Figure 3. Example of “Extension Size Table” for Breast Schema 60

APPENDICES Appendix 1. Determining Descriptive Tumor Size 62 Appendix 2. Output Values, Storage Codes, and Display String Description String a. Allowable T Codes 63 b. Allowable N Codes 64 c. Allowable M Codes 65 d. Allowable Stage Codes 65 e. Allowable Summary Stage Codes 67 Appendix 3. Summary Stage Conversion Algorithm for All Schemas 68 Appendix 4. Site Specific Factors 72 Appendix 5. Histology Exclusion Groups 77

INDEX TO PART I 80

PART II. PRIMARY SITE SCHEMA

HEAD AND NECK Colon 271 Lip, Upper 87 Rectosigmoid, Rectum 279 Lip, Lower 95 Anus 285 Lip, Other 103 Liver and Intrahepatic Bile Ducts 289 Base of Tongue, Lingual Tonsil 111 Gallbladder 295 Anterior 2/3 of Tongue 119 Extrahepatic Bile Ducts 299 Gum, Upper 127 Ampulla of Vater 303 Gum, Lower, and Retromolar Area 135 Other Biliary and Biliary, NOS 307 Gum, NOS 143 Pancreas: Head 311 Floor of Mouth 151 Pancreas: Body and Tail 315 Hard Palate 159 Pancreas: Other and Unspecified 319 Soft Palate, Uvula 167 Other and Ill-Defined Digestive Other Mouth 175 Organs 323 Cheek (Buccal) Mucosa, Vestibule 183 Parotid Gland 191 Submandibular Gland 199 RESPIRATORY AND INTRATHORACIC Other and Unspecified Major Nasal Cavity 327 Salivary Glands 207 Middle Ear 335 Tonsil, Oropharynx 215 Maxillary Sinus 343 Anterior Surface of Epiglottis 223 Ethmoid Sinus 351 Nasopharynx 231 Accessory (Paranasal) Sinuses 359 Pyriform Sinus, Hypopharynx 239 Larynx, Glottic 367 Pharynx, NOS, and Other Larynx, Supraglottic 375 Ill-Defined Oral Cavity 247 Larynx, Subglottic 383 Larynx, Overlapping Lesion or NOS 391 Trachea 399 GASTROINTESTINAL Lung 403 Esophagus 253 Heart, Mediastinum 411 Stomach 259 Pleura 415 Small Intestine 265 Other and Ill-Defined Respiratory Sites and Intrathoracic Organs 419

Version date: January 1, 2004 iv Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Table of Contents, continued

MUSCULOSKELETAL EYE Bone 423 Conjunctiva 563 Skin 427 Melanoma of Conjunctiva 567 Skin of Eyelid 431 Cornea, Retina, Choroid, Ciliary Melanoma of Skin 435 Body, Eyeball, Overlapping Mycosis Fungoides and Sezary and Other Eye 571 Disease 443 Melanoma of Iris and Ciliary Body 575 Peripheral Nerves and Autonomic Melanoma of Choroid 581 Nervous System; Connective, Melanoma of Other Eye 585 Subcutaneous and Other Lacrimal Gland 589 Soft Tissues 447 Orbit 593 Retroperitoneum, Peritoneum 453 Retinoblastoma 597

BREAST AND FEMALE GENITAL CENTRAL NERVOUS Breast 457 Brain and Cerebral Meninges 603 Vulva 467 Other Parts of Central Nervous Vagina 471 System 607 Cervix 475 Corpus 481 Ovary 487 ENDOCRINE Fallopian Tube 493 Thyroid Gland 611 Broad and Round Ligaments, Thymus, Adrenal Gland, and Other Parametrium and Other Adnexa 499 Endocrine Glands 615 Other and Unspecified Female Genital Organs 503 Placenta 507 KAPOSI SARCOMA of All Sites 619

MALE GENITAL HEMATOPOIETIC AND LYMPHOID Penis 513 Hodgkin and Non-Hodgkin Prostate 517 Lymphoma 623 Testis 527 Hematopoietic, Reticuloendothelial, Other and Unspecified Male Immunoproliferative and Genital Organs 533 Myeloproliferative Neoplasms 629 Scrotum 537 Kidney 541 OTHER Renal Pelvis, Ureter 545 Other and Ill-Defined Sites, Unknown Bladder 549 Primary Site 633 Urethra 555 Paraurethral Gland, Overlapping STANDARD TABLES 637 Lesion and Unspecified Urinary Organs 559

INDEX OF SCHEMA BY ICD-O-3 PRIMARY SITE CODE 641

ALPHABETIC INDEX TO PART II: SITE SCHEMA 646

Version date: January 1, 2004 v Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Page left blank.

Version date: January 1, 2004 vi Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

INTRODUCTION

The Collaborative Staging Task Force, formed in 1998, was convened to address the issue of discrepancies in staging guidelines among the three major staging systems used in the United States. This project is sponsored by the American Joint Committee on Cancer (AJCC) in collaboration with the National Cancer Institute Surveillance, Epidemiology and End Results Program (NCI-SEER); Centers for Disease Control and Prevention National Program of Cancer Registries (CDC/NPCR); National Cancer Registrars Association (NCRA); North American Association of Central Cancer Registries (NAACCR); American College of Surgeons Commission on Cancer (CoC), and Canadian Cancer Society / National Cancer Institute of Canada (CCS-NCIC).

The initial focus of the Task Force was to develop a translation or other method of conversion between the TNM staging system of the AJCC and the SEER Summary Staging System. Such a translation would eliminate duplicate data collection by registrars reporting to clinical (facility-based) and epidemiologic (population-based central) registries, address the concerns of clinicians for more clinically relevant data as well as the public health sector’s concerns about data reproducibility over time, and provide a higher degree of compatibility between the systems that would expand data-sharing opportunities.

The Collaborative Staging System is a carefully selected set of data items that describe how far a cancer has spread at the time of diagnosis. Most of the data items have traditionally been collected by cancer registries, including tumor size, extension, lymph node status, and metastatic status. New items were created to collect information necessary for the conversion algorithms, including the evaluation fields that describe how the collected data were determined, and site/histology-specific factors that are necessary to derive the final stage grouping for certain primary cancers. In addition to the items coded by the registrar, this unified data set also includes several data items derived from the computer algorithms that classify each case in multiple staging systems: the sixth edition of the AJCC TNM system (TNM), Summary Stage 1977 (SS77), and SEER Summary Stage 2000 (SS2000).

AJCC TNM staging provides forward flexibility and clinical utility for individual cancer cases. TNM is dynamic and is changed periodically to meet the decision-making needs of clinicians regarding appropriate treatment methods and the evaluation of their results. The AJCC TNM staging system uses three basic descriptors that are then grouped into stage categories. The first component is “T,” which describes the extent of the primary tumor. The next component is “N,” which describes the absence or presence and extent of regional lymph node metastasis. The third component is “M,” which describes the absence or presence of distant metastasis. The final stage groupings (determined by the different permutations of “T,” “N,” and “M”) range from Stage 0 through Stage IV. The stage group is generated when specific criteria are met in the TNM system, for example, prostate cancer stage grouping will only be generated for adenocarcinomas. When a case does not meet the criteria for stage grouping, the result will be reported as Not Applicable. An example of this type of case is leiomyosarcoma of the uterus, which is specifically excluded from TNM staging in both the uterus and the soft tissue sarcoma chapter. The Collaborative Staging System is based on, and compatible with, the terminology and staging in the sixth edition of the AJCC Cancer Staging Manual,1 published in 2002. The general rules of the TNM system have been incorporated into the general rules for Collaborative Staging.

Summary Staging provides a measure for cancer surveillance with longitudinal stability for population- based cancer registries. Summary staging is a single digit system and has only eight categories: in situ, local, regional to lymph nodes, regional by direct extension, both regional lymph nodes and regional extension, regional not otherwise specified, distant, and unknown. It is less complex than other staging systems and was developed for registrars and epidemiologists who want some information on stage but did not wish to collect the more detailed EOD or TNM system. Summary Staging can be useful when a series of cases is so small that only general categories produce enough data for meaningful analysis. The

Version date: January 1, 2004 1 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions version of Summary Staging commonly used dates from 19772; the site-specific sections were revised and updated in a new edition published in 20013.

The Collaborative Staging System uses a modified EOD format to collect information about each case. The SEER Extent of Disease (EOD)4 coding system provided longitudinal stability for epidemiological and cancer control studies. More detailed than the Summary Staging System, EOD was developed to assure consistency over time as other staging systems changed. EOD also allows collected data to be collapsed into different and previous staging systems. SEER EOD is a five-field, 10 digit system: tumor size (3 digits), extension of the primary tumor (2 digits), regional lymph node involvement (highest specific lymph node chain involved by tumor) (1 digit), the number of pathologically reviewed regional lymph nodes that are positive (2 digits), and the number of pathologically examined regional lymph nodes (2 digits).

CHANGES IN ABSTRACTING RULES

Note: This introductory discussion refers to schemas based on primary site when in fact some schemas, such as melanoma and lymphoma, are based on histologic type. The schemas are referred to as site-specific for the sake of brevity.

Agreement among the participating organizations has resulted in resolution of the rule for timing of data collection and the development of standardized coding rules so that a single format can be used to collect stage information. The timing rule effective 1/1/2004 for Collaborative Staging is: “use all information gathered through completion of surgery(ies) in first course of treatment, or all information available within four months of the date of diagnosis in the absence of disease progression, whichever is longer.” This timing rule change allows the CS Data Set to derive a “best stage” using pathologic data supplemented by clinical data.

Disease progression is defined as further direct extension or distant metastasis known to have developed after the diagnosis was established. Information about tumor extension, lymph node involvement, or distant metastasis obtained after disease progression is documented should be excluded from the Collaborative Staging fields. Collaborative Staging represents the aggregate information obtained during the period of diagnosis and work-up, not just the initial contact with the patient. For example, within the limits of the timing rule, if further diagnostic tests show more precise extension or a more precise tumor size, this revised information is not considered disease progression. In other words, Collaborative Staging does not consider as disease progression a change from lack of evidence of disease (status unknown) to known status of disease (negative or positive). However, a change from negative status to positive, is disease progression. Take, for example, an asymptomatic patient who is treated surgically. She then develops bone pain and is found to have osseous metastases within a few weeks of surgery. This would be considered disease progression because she was asymptomatic at the time her treatment decisions were made. Furthermore, if the treatment plan is discontinued or changed due to a revised disease status, this is progression of disease and collection of Collaborative Staging information stops at this point.

Other rule modifications have been made and are printed in the site/histology-specific chapters.

In the process of bringing together the principles of Summary Stage, the TNM categories and stage groupings, and the SEER Extent of Disease coding structure, the Collaborative Staging System has also attempted to update abstracting rules to deal with the contemporary health care environment, in which completeness of staging documentation in the medical record has become an issue. In many circumstances, a patient’s insurance will not pay for an imaging study or lab test that is expected to be negative but may otherwise be considered part of an ‘ideal’ cancer staging workup. Similarly, the content of clinician notes has changed over time to simply report any symptomatic, suspicious, or involved areas rather than chronicle every body part that is normal. This change in documentation is a source of

Version date: January 1, 2004 2 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions frustration to data collectors who rely on statements of normalcy or negativity to establish the boundaries of how far the cancer has spread.

When clinical practice changes and data collection guidelines do not, the completeness of the data is affected. The implementation of the Collaborative Staging System introduces a paradigm shift in the collection of information documenting the extent of disease, particularly in the collection of information about regional lymph nodes or distant metastases for primary sites not easily examined by palpation, observation, physical examination, or other clinical methods. These ‘inaccessible’ primary sites include (but are not limited to) bladder, kidney, prostate, esophagus, stomach, lung, liver, corpus uteri, and ovary.

The Collaborative Staging System allows data collectors to record regional lymph nodes as negative (based on clinical evaluation) rather than unknown when there is no mention of regional lymph node involvement in the physical examination, pre-treatment diagnostic testing or surgical exploration, and the patient receives what would be usual treatment to the primary site (treatment appropriate to the stage of disease as determined by the physician). The basis for this shift in the approach to information missing from the medical record is that typically the clinician reports positive findings and tends to remain silent on some or all negative findings. This new coding guideline also allows data collectors to record distant metastasis clinically as none rather than unknown (again, based on clinical evaluation) when the clinician proceeds with usual treatment of the primary site, since this action presumes the absence of distant metastasis that would otherwise change the treatment approach.

These guidelines apply primarily to localized or early (T1, T2) stage in the TNM system for inaccessible primary sites such as those mentioned previously. The code(s) for unknown information can and should be used in situations where there is reasonable doubt that the tumor is no longer localized. An example would be when there is clinical evidence that a prostate cancer has penetrated through the capsule into the surrounding tissues (regional direct extension/T3a) and regional lymph node involvement is not mentioned.

By coding regional lymph nodes as negative and/or coding distant metastasis as none rather than coding these fields as unknown, the Collaborative Staging System computer algorithms will be able to derive a stage group that includes the best information.

For accessible primary sites that can be observed, palpated or examined without instruments, such as breast, oral cavity, skin, salivary gland, thyroid, and other organs, there should be some description of the regional lymph nodes. A statement such as “remainder of examination negative” is sufficient to code regional lymph nodes as clinically negative.

In summary, the developers of the CS model believe that it will improve the quality of data being collected by the cancer registry community. Uniform rules and standardized training will make it easier for cancer registry personnel to complete staging tasks.

Version date: January 1, 2004 3 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

HOW THE COLLABORATIVE STAGING SYSTEM WORKS

For each cancer case, the data collector determines the site of origin or general histology for the cancer. The data items specific to that cancer site/histology are extracted from the medical record and coded in the Collaborative Staging System fields. When data collection is complete, the data collector activates the computer algorithms to derive the values for the items in the TNM system and Summary Stage (both 1977 and 2000). These algorithms are provided in portable platform-independent form by the Task Force. The classification or stage of each tumor is actually determined by the computer in a consistent and accurate manner (see Mapping and the Computer Algorithm, below).

Table 1 lists the individual Collaborative Staging data items, both input and derived, together with their NAACCR item number, length and other information, as published in the NAACCR Standards Volume II Version 10.1, Chapter X, Data Descriptor Table (revised November 2003).

Mapping and the Computer Algorithm

Once the data collector has coded all of the Collaborative Staging System elements for a case (the input values), the coded values are passed to a computer program that generates the correct stage for the case in three systems: AJCC TNM, 6th edition; SEER Summary Stage 1977; and SEER Summary Stage 2000. The program returns a set of values for the set of output items included in Table 1. A schematic diagram of the relationship between the inputs and outputs is shown in Figure 1.

The output values are returned as a set of numeric codes designed for storage in the computerized abstract. Each of the numeric codes is also provided with a display value, or English language character string showing the meaning of the code. For example, a returned value of 12 for T means T1a, and a 15 means T1b. Appendix 2 shows all of the output values and their display strings.

The computer algorithm that generates the stages is based on the values in the mapping columns for each of the Collaborative Staging System data elements. Mapping is provided from each code to the appropriate category in TNM and each summary stage. Some schemas require reference to two or more tables to determine the appropriate category. The mapping column either contains the category or a pointer to a further table where the category can be determined. Once each of the categories is determined, a further step is performed to generate the final stage groups. An example of the type of reference table used in this final step is shown in Appendix 3 for converting the results of the individual CS Extension, CS Lymph Nodes and CS Mets at Dx field to Summary Stage 1977 and Summary Stage 2000. For TNM stage grouping, the tables are schema-specific. Although the data collector does not code the stage groups directly, the rules by which the stages are derived are explicit in all of the tables, and the logic that the computer program follows should be fully evident from the tables available to the data collector.

As part of the output of the CS algorithm, two additional fields should be stored by the computer in the CS data base: CS Version 1st and CS Version Latest. CS Version 1st is the number of the version initially used to code CS fields and may be updated if cases are recoded, for example for a special study, using a later version of the Collaborative Staging manual. Depending on the structure of the registry software, CS Version 1st could be stored automatically by the computer or entered manually by the abstractor. The meaning and interpretation of CS Version 1st will be dependent on vendor implementation and local practices. This field should be interpreted with caution in a dataset where the actual coding procedures are unknown. CS Version Latest is the number of the version of the CS algorithm used most recently to derive the CS output fields and should be updated by the computer (rather than manually) every time the CS Derived items are re-computed.

Version date: January 1, 2004 4 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Table 1. Allowable Values and Format for Collaborative Staging Data Items

INPUT ITEMS Data Item Name NAACCR Char- Allowable Values Right Blanks: NAACCR Data Item acter (site-specific Justified, Yes or Ver 10.1 Number Length unless otherwise Zero filled No Column # stated) CS Tumor Size 2800 3 000-999 Yes No 629-631 CS Extension 2810 2 00-99 Yes No 632-633 CS Tumor 2820 1 0-9 N/A No 634-634 Size/Ext Eval CS Lymph Nodes 2830 2 00-99 Yes No 635-636 CS Reg Nodes 2840 1 0-9 N/A No 637-637 Eval Regional Nodes 830 2 00-90, 95, 96, 97, Yes No 541-542 Examined 98, 99 (all sites) Regional Nodes 820 2 00-90, 95, 97, 98, Yes No 539-540 Positive 99 (all sites) CS Mets At Dx 2850 2 00-99 Yes No 638-639 CS Mets Eval 2860 1 0-9 N/A No 640-640 CS Site-Specific 2880 3 000-999 Yes No 641-643 Factor 1 CS Site-Specific 2890 3 000-999 Yes No 644-646 Factor 2 CS Site-Specific 2900 3 000-999 Yes No 647-649 Factor 3 CS Site-Specific 2910 3 000-999 Yes No 650-652 Factor 4 CS Site-Specific 2920 3 000-999 Yes No 635-655 Factor 5 CS Site-Specific 2930 3 000-999 Yes No 656-658 Factor 6

Version date: January 1, 2004 5 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Table 1 continued. Allowable Values and Format for Collaborative Staging Data Items OUTPUT ITEMS Data Item Name NAACCR Char- Allowable Values Right Blanks: NAACCR Data Item acter Justified, Yes or Ver 10.1 Number Length Zero No Column # filled Derived AJCC T 2940 2 00, 01, 05, 06, 07, N/A N/A 659-660 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 29, 30, 31, 32, 33, 39, 40, 41, 42, 43, 44, 49, 88, 99 Derived AJCC N 2960 2 00, 01, 02, 03, 04, N/A N/A 662-663 09, 10, 11, 12, 13, 18, 19, 20, 21, 22, 23, 29, 30, 31, 32, 33, 39, 88, 99 Derived AJCC M 2980 2 00, 10, 11, 12, 13, N/A N/A 665-666 19, 88, 99 Derived AJCC T 2950 1 c, p, a, y N/A N/A 661-661 Descriptor Derived AJCC N 2970 1 c, p, a, y N/A N/A 664-664 Descriptor Derived AJCC M 2990 1 c, p, a, y N/A N/A 667-667 Descriptor Derived AJCC 3000 2 00, 01, 02, 10, 11, N/A N/A 668-669 Stage Group 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 70, 71, 72, 73, 74, 88, 90, 99 Derived AJCC 3030 1 Blank, 1, 2 N/A Yes 672-672 Flag Derived SS1977 3010 1 Blank, 0, 1, 2, 3, N/A Yes 670-670 4, 5, 7, 8, 9 Derived SS1977 3040 1 Blank, 1, 2 N/A Yes 673-673 Flag Derived SS2000 3020 1 Blank, 0, 1, 2, 3, N/A Yes 671-671 4, 5, 7, 8, 9 Derived SS2000 3050 1 Blank, 1, 2 N/A Yes 674-674 Flag CS Version 1st 2935 6 000000-999999 N/A No 705-710 CS Version 2936 6 000000-999999 N/A No 711-716 Latest

Version date: January 1, 2004 6 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Figure 1 Schematic Diagram of Relationships of Inputs and Outputs for Collaborative Staging

CS Tumor Size AJCC T Other input items always used: Histology, Behavior T Descriptor C/P CS Extension AJCC N CS TS/Ext Eval AJCC Stage N Descriptor C/P Group CS Lymph Nodes AJCC M Other input items occasionally Regional Nodes Positive used: Age, Grade M Descriptor C/P Regional Nodes Exam. SS77 Ext SEER Summary CS Reg Nodes Eval Stage 1977 SS2000 Ext CS Mets at DX SS77 Nodes SEER Summary CS Mets Eval Stage 2000 SS2000 Nodes CS Site-Spec Factors 1-6 SS77 Mets CS Version 1st

Always used SS2000 Mets Sometimes used CS Version Latest

Inputs Interim (Temporary) Outputs Final Outputs

Version date: January 1, 2004 7 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

How Mapping Was Determined

The Collaborative Staging Task Force based its codes for the extension, lymph nodes, and metastases fields on SEER’s Extent of Disease, which had been designed to accommodate collapsing into TNM 3rd edition and the SEER Summary Stages. Some fundamental restructuring of the EOD codes was necessary to accommodate the sixth edition of TNM with its greater detail and supplementary prognostic information. For example, in EOD, all lymph node involvement (regional and distant) was coded in the lymph nodes field. In Collaborative Staging, regional lymph node involvement is coded in the CS lymph node field, and distant lymph node involvement is coded with other distant metastases. In each table, codes were added or combined where necessary to accommodate the 6th edition of TNM. The following rules and procedures were used to determine the correct mapping to TNM 6th edition:

• Downstaging rule. The Collaborative Staging Task Force applied the stated rule from the AJCC manual, “If there is doubt concerning the T, N, or M classification to which a particular case should be assigned, then the lower (less advanced) category should be assigned.” When a mapping could be made to more than one classification, for example, T1 or T2, the mapping was always made to the lower or less extensive category. Occasionally this rule did not seem to apply, for example, when a lower category seemed to provide an exclusive list, while the higher category was more general. The downstaging rule was not applied to the assignment of stage group, only to the assignment of T, N, and M classification.

• Use of NOS. The Collaborative Staging Task Force added NOS (not otherwise specified) to some of its T, N, M, and stage group categories for clarity and ease of processing. The NOS is added when a further breakdown of the T, N, and M permutations into subsets is available, but the correct subset cannot be determined. NOS can appear in both the descriptions of codes and the mapping. This NOS terminology is not official AJCC usage. The NOS can safely be ignored in reports and analyses when it is not a useful distinction. In addition, the data collector should only code to a category such as “Stated as T1 NOS” when the appropriate subset (e.g., T1a or T1b) cannot be determined.

Example. For glottic larynx, T1 means “Tumor limited to the vocal cord(s) . . .” T1a means tumor limited to one vocal cord, and T1b means tumor involves both vocal cords. In Collaborative Staging, the subgroup of T1 NOS is designated for use when the tumor is known to be limited to the vocal cords, but it cannot be determined whether one or both cords are involved. In Collaborative Staging, the category T1 would be used to mean all of the T1’s, including the T1a’s, T1b’s, and T1 NOS’s.

REFERENCES

1. Greene FL, Page DL, Fleming ID et al. AJCC Cancer Staging Manual, sixth edition. American Joint Committee on Cancer. New York: Springer-Verlag, 2002. 2. Shambaugh EM and Weiss MA. SEER Summary Staging Guide 1977. Bethesda, MD: National Cancer Institute, NIH Publication Number 98-2313, reprinted December 1997. 3. Young JL, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA (eds). Summary Staging Manual 2000: Codes and Coding Instructions. Bethesda, MD: National Cancer Institute, NIH Publication Number 01-4969, 2001 4. Fritz AG and Ries LAG (eds). SEER Extent of Disease Coding, 1998: Codes and Coding Instructions, Third Edition. Bethesda, MD: National Cancer Institute, NIH Publication Number 98-1999, April 1998.

Version date: January 1, 2004 8 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

General Rules and Instructions

Version date: January 1, 2004 9 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Page left blank.

Version date: January 1, 2004 10 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

General Instructions for Using the Collaborative Staging System Codes and Coding Instructions

The Collaborative Staging System schemas consist of the 15 data fields necessary to derive T, N, M, and Stage Group according to the sixth edition of the AJCC Cancer Staging Manual; Summary Stage 1977; and SEER Summary Stage 2000.

This manual provides codes and coding instructions for the process of data entry. In order to derive the desired T, N, M, and Stage Group in the TNM system or the Summary Stage(s), the computer algorithms described in the introduction must be used. This manual provides the logic of the computer algorithms in table format for each schema, but is not intended to be used for generating the stages manually, because for some sites, additional tables are necessary to determine T, N, M, or Stage Group. These additional tables are available for review on the Collaborative Staging web site, http://www.cancerstaging.org

These schemas apply to cases diagnosed January 1, 2004 and later. Do NOT use these schemas for cases diagnosed prior to January 1, 2004; cases diagnosed prior to 01/01/2004 should be coded to whatever coding system was in effect at the time of diagnosis.

General Guidelines

Note: These general instructions refer to schemas based on primary site when, in fact, some schemas, such as melanoma and lymphoma, are based on histologic type. The schemas are referred to as site-specific for the sake of brevity.

1. Collaborative Staging is collected on all cases regardless of whether they are microscopically confirmed. A description of the type of diagnostic confirmation is collected in a separate data item. The diagnostic confirmation field can be used to exclude non-microscopically confirmed cases during analysis as necessary, since the AJCC Cancer Staging Manual states that “all cases should be microscopically confirmed. Cases not microscopically confirmed should be coded from the schema for the site/histology the clinician considers most likely to be the primary.”

2. Collaborative Staging is collected on all sites/histologies. Summary Stage 1977 and Summary Stage 2000 are generated for all sites and histologies. The TNM elements and stage group are only generated for cases that meet the TNM criteria. For example, there is no TNM schema for brain. a. The Collaborative Staging System consists of 94 schemas, most of which are site-specific. Some malignancies that can develop in many parts of the body are coded according to the histology of the case. For example, all lymphomas are coded according to the lymphoma schema, regardless of the organ in which the lymphoma develops.

3. All schemas apply to all histologies unless otherwise noted. Summary Stage 1977 and Summary Stage 2000 are generated for all histologies. The computer algorithms for determining the final TNM stage group take into account any histologies that are excluded from TNM staging. For example, the TNM schema for prostate applies only to adenocarcinomas. For excluded histologies, the computer algorithm returns values representing “Not Applicable,” meaning that AJCC T, N, M, and Stage Group are not generated for that site-histology combination.

Version date: January 1, 2004 11 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

4. Timing of Data Collection: The data collected in the Collaborative Staging System are limited to • information gathered through completion of surgery(ies) in first course of treatment, OR • all information available within four months of the date of diagnosis in the absence of disease progression (metastasis known to have developed after the diagnosis was established should be excluded) • whichever is longer.

5. Site-specific and histology-specific guidelines take precedence over general guidelines. Always read the notes pertaining to a specific site or histology schema.

6. For each field, code the highest applicable number. (Exception: codes for Unknown, Not Applicable, and NOS categories such as Localized, NOS do not take priority over more specific codes with lower numbers.) The codes are ordered in a hierarchy so that increasing numbers generally indicate increasing degrees of tumor involvement. The hierarchies are not the same for the different staging systems, and Collaborative Staging generally follows the hierarchies of the TNM system. a. Combination codes (for example, code 35 for “25 plus 30”) have been assigned when using the higher number does not result in the appropriate mapping for all three stage groups. Combination codes have been omitted when use of a higher number results in correct mapping for all three staging systems.

7. For the fields CS Tumor Size, CS Extension, CS Lymph Nodes, and CS Mets at DX, Collaborative Staging records the greatest extent of disease based on combined clinical and operative/pathological assessment. a. Gross observations at surgery are particularly important when all malignant tissue is not removed. In the event of a discrepancy between pathology and operative reports concerning excised tissue, priority is given to the pathology report. b Clinical information, such as a description of skin involvement for breast cancer and size of the primary lesion and distant lymph nodes for any site, can change the stage. Clinical information should be reviewed carefully to assure accurate recording of the Collaborative Staging data set.

8. When the patient does not receive preoperative treatment and the operative/pathology information disproves the clinical information, code the operative/pathology information.

9. When the patient does receive preoperative treatment, the greatest extent of disease prior to the beginning of treatment should be recorded. Preoperative, or neoadjuvant, treatment is defined as systemic (chemotherapy, hormone therapy, or immunotherapy) treatment or radiation therapy that is administered as an attempt to shrink the tumor, improve resectability, or control symptoms before the patient undergoes surgery. In the infrequent situation where post-operative disease is more extensive despite neoadjuvant treatment, this can be coded in the method of evaluation field for extension, regional lymph nodes or metastases at diagnosis.

10. The fields Reg LN Pos and Reg LN Exam are based on pathologic (microscopic) information only.

11. The fields CS Tumor Size/Ext Eval, CS Reg Nodes Eval, and CS Mets Eval document how the most extensive tumor was established as well as whether the patient received preoperative treatment.

12. Site-Specific Factors (SSFs) are included in every schema. They are incorporated into the staging algorithms when additional information is necessary to derive tumor (T), lymph node (N), metastasis (M), or TNM stage group, or where the factor is considered to be of clinical or prognostic importance. Information formerly coded as tumor markers, such as estrogen receptor assay or progesterone receptor assay for breast, is coded in site-specific factors. For sites/histologies where some or all site specific factors are not used, they are coded 888, not applicable. Table 2 lists the schemas that require one or more Site Specific Factors. Appendix 4 lists the names of each site specific factor for each schema.

Version date: January 1, 2004 12 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Table 2. Site Specific Factors Used For Primary Site/Histology Schemas SSF Sites/histologies where used 1 head and neck* mycosis fungoides melanoma/iris and colon breast ciliary body rectum ovary retinoblastoma liver placenta brain pleura prostate other cns melanoma testis thyroid melanoma/conjunctiva other endocrine melanoma/choroid Kaposi sarcoma lymphoma 2 head and neck*, liver, melanoma, breast, prostate, testis, lymphoma 3 head and neck*, melanoma, breast, prostate, testis, lymphoma 4 head and neck*, melanoma, breast, prostate, testis 5 head and neck*, breast, prostate, testis 6 head and neck*, breast, prostate

* head and neck includes the following schemas: upper lip; lower lip; other lip; base of tongue; anterior tongue; upper gum; lower gum and retromolar trigone; other gum; floor of mouth; hard palate; soft palate/uvula; other mouth; buccal mucosa; parotid gland; submandibular gland; other salivary glands; oropharynx; anterior surface of epiglottis; nasopharynx; pyriform sinus/hypopharynx; other pharynx; nasal cavity; middle ear; maxillary sinus; ethmoid sinus; other sinus; glottic larynx; supraglottic larynx; subglottic larynx; other larynx

13. Metastasis known to have developed after the initial extent of disease was established (in other words, disease progression) should be excluded when determining the farthest extent of disease at the time of diagnosis.

14. Autopsy reports are used in coding the Collaborative Staging System in the same way as are pathology reports, applying the same rules for inclusion and exclusion.

15. The extent of disease may be described only in terms of T (tumor), N (node), and M (metastasis) characteristics. In such cases, assign the code in the appropriate field that corresponds to the TNM information. If there is a discrepancy between documentation in the medical record and the physician’s assignment of TNM, the documentation takes precedence. Cases of this type should be discussed with the physician who assigned the TNM.

Version date: January 1, 2004 13 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

STRUCTURE AND FORMAT OF SITE/HISTOLOGY-SPECIFIC CODE SCHEMAS

The schemas in this manual are listed according to the order of the first ICD-O-3 primary site code to which a schema applies. Schemas for which there is no TNM classification are included in ICD-O-3 sequence in the manual. Some of the histology-based schemas appear in site code order (for example, melanoma of the skin is with other skin schemas), and others are at the end of the list. Two indices to the schemas are provided at the end of this manual, one by ICD-O-3 code and the other by common primary site and histology terms.

Within the schemas themselves, the code structures for the various organs, lymph nodes, and other tissues are organized according to the T, N, and M categories (T1, then T2, then T3, for example). As such, they may not be sequential for Summary Stage definitions. Regardless of the relative order of the codes in the schemas, the staging algorithms will properly account for the information.

The categories of TNM are the basis for the CS Extension, CS Lymph Nodes and CS Mets at DX fields. Tissues categorized under T in the TNM system are listed in CS Extension and tissues categorized under M are listed in the CS Mets at DX field. However, for the Summary Staging (1977 and/or 2000) algorithms, there may be codes in the CS Extension field that map to regional direct extension or distant stage, and there may be codes in CS Mets at DX that map to regional or even localized disease. The details of the case should be coded in the fields where they are listed; the computer algorithm is designed to generate the correct stage. It should also be noted that information in fields other than CS Extension may be used to derive the T, N, M and Stage Group, for example tumor size and various site-specific factors.

CODING “NONE” VS. “UNKNOWN” IN THE COLLABORATIVE STAGING SYSTEM, TNM AND SUMMARY STAGE

As noted in the introduction, cancers of certain primary sites are not easily examined by palpation, observation, physical examination, or other clinical methods. These ‘inaccessible’ primary sites include, but are not limited to, bladder, kidney, prostate, esophagus, stomach, lung, liver, corpus uteri and ovary.

A new coding rule in the Collaborative Staging System applies to these inaccessible sites, primarily for localized or early (T1, T2) stage cancers. The Collaborative Staging System allows data collectors to record regional lymph nodes as negative (based on clinical evaluation) rather than unknown when there is no mention of regional lymph node involvement in the physical examination, pre-treatment diagnostic testing or surgical exploration, and the patient receives what would be usual treatment to the primary site (treatment appropriate to the stage of disease as determined by the physician).

This new coding guideline also permits data collectors to record distant metastasis clinically as none rather than unknown (again, based on clinical evaluation) when the clinician proceeds with usual treatment of the primary site, since this action presumes that there are no distant metastasis that would otherwise change the treatment approach.

The code(s) for unknown information can and should be used in situations where there is reasonable doubt that the tumor is no longer localized. For example, when there is clinical evidence that a prostate cancer has penetrated through the capsule into the surrounding tissues (regional direct extension/T3a) and regional lymph node involvement is not mentioned, it would be correct to code lymph node involvement and metastases at diagnosis as unknown in the absence of any specific information regarding nodes or distant metastases.

For accessible primary sites that can be observed, palpated or examined without instruments, such as breast, oral cavity, skin, salivary gland, thyroid, and other organs, there should be some description of the

Version date: January 1, 2004 14 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions regional lymph node status. A statement such as “remainder of examination negative” is sufficient to code regional lymph nodes as clinically negative.

CHOOSING THE CORRECT CODING SCHEMA FOR A CASE

Most of the Collaborative Staging System schemas apply to cases defined by their primary site codes in ICD-O-3. A few of the schemas apply to cases defined by their histologic type codes in ICD-O-3, and these schemas take precedence over the schema for the site. The histologically defined schemas are shown in Table 3.

TABLE 3. HISTOLOGY-SPECIFIC CODING SCHEMAS

Melanoma (ICD-O-3 morphology codes 8720-8790) Kaposi sarcoma (9140) Retinoblastoma (9510-9514) Lymphoma (9590-9699 and 9702-9729) Mycosis Fungoides (9700-9701) Hematopoietic and reticuloendothelial system (9731-9989)

A case with one of these ICD-O-3 histologic types must be coded using the schema for the histologic type group.

Melanomas are further broken down by primary site code, as follows: Malignant melanoma of the skin, vulva, penis and scrotum (C44.0-C44.9, C51.0-C51.2, C51.8- C51.9, C60.0-C60.1, C60.8-C60.9, C63.2) Malignant melanoma of conjunctiva (C69.0) Malignant melanoma of iris and ciliary body (C69.4) Malignant melanoma of choroid (C69.3) Malignant melanoma of other eye (C69.1, C69.2, C69.5, C69.8-C69.9)

For cases with all other histologic types, the correct schema to use is determined by the primary site code.

Each schema clearly states the applicable primary site codes and histologic type codes at the beginning of the schema.

Note: The appropriate site or histology schema to use for coding surgical treatment(s) may be different from the site or histology schema used for coding the Collaborative Staging data set. For example, an extralymphatic lymphoma of the stomach treated surgically would use the lymphoma schema in this manual to code Collaborative Staging, but surgery would be coded using the stomach codes for surgery of primary site. Refer to the treatment coding rules in the SEER Program coding manual or the FORDS manual for more details.

Version date: January 1, 2004 15 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Schemas Where Tumor Size is Necessary for AJCC Staging

In order to classify the T category for certain sites/histologies, it is necessary to know the size of the primary tumor, usually for T1 - T3. For the following sites/histologies, the size of the primary tumor must be recorded in order to assign the T category and derive a stage group. Tumor size is not necessary to assign Summary Stage. The name of the Collaborative Staging schema and its website file name (shown in parentheses) are double indented under the TNM chapter and subsite names. (See Table 4.)

TABLE 4. SCHEMAS WHERE TUMOR SIZE IS NECESSARY FOR AJCC STAGING

Lip and oral cavity Lung Lip Lung (Lung) Upper Lip (LipUpper) Bone Lower Lip (LipLower) Bone (Bone) Other Lip (OthLip) Soft tissue sarcoma Oral Cavity Heart and Mediastinum Anterior Tongue (AntTongue) (HeartMediastinum) Upper Gum (GumUpper) Soft Tissue (SoftTissue) Lower Gum (GumLower) Peritoneum (Peritoneum) Other Gum (OthGum) Carcinoma of the Skin Floor of Mouth (FOM) Skin, Vulva, Penis, Scrotum–Carcinoma Hard Palate (HardPalate) (Skin) Buccal Mucosa (BuccalMucosa) Carcinoma of the Eyelid Other Mouth (OthMouth) Skin of Eyelid–Carcinoma (SkinEyelid) Pharynx Breast Oropharynx Breast (Breast) Oropharynx (Oropharynx) Vulva Base of Tongue (BaseTongue) Vulva (Vulva) Soft Palate (SoftPalate) Cervix Uteri Hypopharynx Cervix (Cervix) Hypopharynx (Hypopharynx) Kidney Major Salivary Glands Kidney (Kidney) Parotid Gland (ParotidGland) Carcinoma of the Conjunctiva Submandibular Gland Conjunctiva–Carcinoma (Conjunctiva) (SubmandibularGland) Malignant Melanoma of the Uvea Other Salivary Gland (OthSalivary) Iris and Ciliary Body–Melanoma (ciliary Thyroid body only) (MelanomaIrisCiliary) Thyroid (Thyroid) Choroid–Melanoma (MelanomaChoroid) Anal Canal Carcinoma of the Lacrimal Gland Anus (Anus) Lacrimal gland–Carcinoma Liver including Intrahepatic Bile Ducts (LacrimalGland) Liver and intrahepatic bile ducts (Liver) Sarcoma of the Orbit Exocrine Pancreas Orbit (Orbit) Pancreas Head (PancreasHead) Pancreas Body and Tail (PancreasBodyTail) Other Pancreas (OthPancreas)

Version date: January 1, 2004 16 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Schemas That Do Not Use Tumor Size for AJCC Staging

In order to classify both summary stage and the AJCC T category for certain sites/histologies, it is necessary to know how far the tumor has extended in a contiguous, continuous or direct manner from its point of origin. For the following sites/histologies, the extension of the primary tumor must be recorded in order to assign the T category and derive a stage group. The name of the Collaborative Staging schema and its website file name (in parentheses) are double indented under the TNM chapter and subsite names. (See Table 5.)

TABLE 5. SCHEMAS THAT DO NOT USE TUMOR SIZE FOR AJCC STAGING

Pharynx Melanoma of the Skin Nasopharynx Skin, Vulva, Penis Scrotum–Melanoma Nasopharynx (Nasopharynx) (Melanoma) Larynx Vagina Other Larynx (OthLarynx) Vagina (Vagina) Glottic Larynx Corpus uteri Glottic Larynx (GlotticLarynx) Corpus uteri (Corpus) Supraglottic Larynx Ovary Supraglottic Larynx (SupraLarynx) Ovary (Ovary) Anterior Surface of Epiglottis Fallopian Tube (AntEpiglottis) Fallopian tube (FallopianTube) Subglottic Larynx Gestational trophoblastic tumor Subglottic Larynx (SubLarynx) Placenta (Placenta) Nasal Cavity and Paranasal Sinuses Penis Nasal Cavity (NasalCavity) Penis (Penis) Maxillary Sinus (MaxillarySinus) Prostate Ethmoid Sinus (EthmoidSinus) Prostate (Prostate) Esophagus Testis Esophagus (Esophagus) Testis (Testis) Stomach Renal Pelvis and Ureter Stomach (Stomach) Renal Pelvis and Ureter (RenalPelvis) Small Intestine Urinary Bladder Small intestine (SmallIntestine) Bladder (Bladder) Colon and rectum Urethra Colon (Colon) Urethra (Urethra) Rectum (Rectum) Malignant Melanoma of the Conjunctiva Gallbladder Conjunctiva–Melanoma Gallbladder (Gallbladder) (MelanomaConjunctiva) Extrahepatic bile ducts Malignant Melanoma of the Uvea Extrahepatic bile ducts Iris and Ciliary Body–Melanoma (iris (ExtraHepaticDucts) only) (MelanomaIrisCiliary) Other Biliary and Biliary, NOS Retinoblastoma (OthBiliary) Retinoblastoma (Retinoblastoma) Ampulla of Vater Lymphoid neoplasms Ampulla (Ampulla) Mycosis Fungoides (MF) Pleural mesothelioma Malignant Lymphoma (Lymphoma) Pleura (Pleura)

Version date: January 1, 2004 17 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

TABLE 6. SCHEMAS FOR WHICH AJCC STAGING IS NOT APPLICABLE

For the following schemas, TNM is not applicable. The name of the Collaborative Staging schema and its website file name (in parentheses) are shown below.

Other pharynx (OthPharynx) Other endocrine (OthEndocrine) Other digestive (OthDigestive) Other eye (OthEye) Middle ear (MiddleEar) Melanoma of Other Eye (MelanomaOthEye) Other sinus (OthSinus) Kaposi sarcoma (KS) Trachea (Trachea) Hematopoietic, Reticuloendothelial, Other respiratory (OthRespiratory) Immunoproliferative and Other adnexa (OthAdnexa) Myeloproliferative Neoplasms Other female genital (OthFemaleGen) (HemeRetic) Other male genital (OthMaleGen) Other Ill-defined and Unknown Primary Other urinary (OthUrinary) Sites (OthIllDef) Brain (Brain) Other CNS (OthCNS)

DEATH CERTIFICATE ONLY CASES

Death Certificate only cases are coded as unknown (usually 9, 99, 999, etc.) or not applicable (usually 8, 88, 888, etc.) in all Collaborative Staging fields. Although there may be some site/histology-specific exceptions, the usual pattern for coding Death Certificate Only cases is as follows:

CS Tumor Size 999 CS Site-Specific Factor 1 888 CS Extension 99 CS Site-Specific Factor 2 888 CS Tumor Size/Ext Eval 9 CS Site-Specific Factor 3 888 CS Lymph Nodes 99 CS Site-Specific Factor 4 888 CS Reg Nodes Eval 9 CS Site-Specific Factor 5 888 Reg LN Pos 99 CS Site-Specific Factor 6 888 Reg LN Exam 99 CS Mets at DX 99 CS Mets Eval 9

USE OF AUTOPSY INFORMATION IN COLLABORATIVE STAGING

Information obtained from autopsy may be used in either of two ways in the Collaborative Staging System. The evaluation fields must then be coded correctly to indicate how the autopsy information is to be interpreted. If a patient with a suspected diagnosis of cancer dies and an autopsy is performed, extent of disease information obtained from the autopsy may be included along with other clinical and pathologic information, if it meets the timing rules for inclusion. In this case, the computer algorithm will assign the T, N, or M to “p” (pathologic) classification. If cancer is not suspected at the time of autopsy, the extent of disease information from the autopsy is included, but the algorithm will assign the T, N, and M to the autopsy (a) classification of the TNM system rather than to clinical or pathologic evaluation. Each of the evaluation field schemas has appropriate codes to allow this distinction.

Version date: January 1, 2004 18 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

DEFINITIONS OF ADJACENT TISSUES, STRUCTURES, AND ORGANS

Adjacent connective tissue Some of the Collaborative Staging System schemas for ill-defined or non-specific sites in this manual contain a code for adjacent connective tissue, which is defined here as the unnamed tissues that immediately surround an organ or structure containing a primary cancer. Use this code when a tumor has invaded past the outer border (capsule, serosa, or other edge) of the primary organ into the organ’s surrounding supportive structures but has not invaded into larger structures or adjacent organs.

The structures identified in ICD-O-3 as connective tissue include the following: adipose tissue; aponeuroses; arteries; blood vessels; bursa; connective tissue, NOS; fascia; fatty tissue; fibrous tissue; ganglia; ligaments; lymphatic channels (not nodes); muscle; nerves (spinal, sympathetic and peripheral); skeletal muscle; subcutaneous tissue; synovia; tendons; tendon sheaths; veins; and vessels, NOS. In general, these tissues do not have specific names. These tissues form the framework of many organs, provide support to hold organs in place, bind tissues and organs together, and serve as storage sites for nutrients. Blood, cartilage and bone are sometimes considered connective tissues, but in this manual they would be listed separately.

Adjacent organs Organs are anatomic structures with specific physiologic functions other than (or in addition to) support and storage. Continuous tumor growth from one organ into an organ anatomically next to the primary would be coded to the appropriate code for ‘adjacent organs/structures’ in the Collaborative Staging schemas for ill-defined and non-specific sites.

Adjacent structures Connective tissues large enough to be given a specific name would be considered adjacent structures. For example, the brachial artery has a name, as does the broad ligament. Continuous tumor growth from one organ into an adjacent named structure would be coded to the appropriate code for ‘adjacent organs/structures’ in the Collaborative Staging for ill-defined or non-specific sites.

Version date: January 1, 2004 19 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

AMBIGUOUS TERMINOLOGY Interpreting Ambiguous Terminology for Collaborative Staging

Determination of the cancer stage is both a subjective and objective assessment of how far the cancer has spread. Sometimes the clinician is hesitant to commit to a definite statement that a particular organ or tissue is involved by the cancer and uses what data collectors refer to as “ambiguous terminology.” The following lists can generally be used to interpret the intent of the clinician; however, if individual clinicians use these terms differently, the clinician’s definitions and choice of therapy should be recognized. If a term used in a diagnostic statement is not listed below, consult the clinician to determine the intent of the statement.

Consider as involvement DO NOT Consider as Involvement adherent abuts apparent(ly) approaching appears to approximates comparable with attached compatible with cannot be excluded/ruled out consistent with efface/effacing/effacement contiguous/continuous with encased/encasing encroaching upon* encompass(ed) extension to, into, onto, out onto entrapped features of equivocal fixation to another structure** extension to without invasion/ fixed** involvement of impending perforation of kiss/kissing impinging upon matted (except for lymph nodes) impose/imposing on possible incipient invasion questionable induration reaching infringe/infringing rule out into* suggests intrude very close to invasion to into, onto, out onto worrisome most likely onto* overstep presumed probable protruding into (unless encapsulated) suspected suspicious to* up to

* interpreted as involvement whether the description is clinical or operative/ pathological ** interpreted as involvement of other organ or tissue

Version date: January 1, 2004 20 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

HOW TO CODE THE COLLABORATIVE STAGING SYSTEM DATA ELEMENTS A one page summary of how to code using this manual

Note: This procedure focuses on only the Collaborative Staging data fields and assumes other registry operations such as case finding, completion of text fields and other data fields, edit checking and case submission are also being performed appropriately.

1. Before you begin to code using the Collaborative Staging System, read completely the general rules in this manual.

2. Read the medical record carefully to determine the primary site and histology and identify the correct ICD-O-3 codes. While you are reviewing the record, make mental notes about the tissues and lymph nodes that are involved by tumor.

3. If the histology is melanoma (8720-8790), Kaposi sarcoma (9140), retinoblastoma (9510-9514), lymphoma (9590-9699 and 9702-9729), mycosis fungoides (9700-9701), or hematopoietic and reticuloendothelial system (9731-9989), use the histology-specific schema for the appropriate histology-site combination.

4. Otherwise, turn to the correct site-specific schema in the Part II of this manual. Schemas are in ICD-O-3 order by the first code that uses the schema. Verify that you are in the correct chapter by confirming that the code is in the list at the beginning of the schema.

5. Begin assigning codes for the 15 fields in the Collaborative Staging System. Be sure to read the notes and follow the site/histology-specific instructions at the beginning of each data field. Some schemas may have site-specific factors associated with extension, lymph nodes or metastasis; keep these in mind as you assign the codes. a. Code the tumor size in the CS Tumor Size field. b. Code how far the tumor has directly spread in the CS Extension field. c. Code how the farthest tumor spread was determined in the CS Tumor Size/Ext Eval field. d. Code whether regional lymph nodes are involved in the CS Lymph Nodes field. e. Code how the farthest regional node spread was determined in the CS Reg Node Eval field. f. Code the number of positive regional lymph nodes from the pathology report in the Reg Nodes Pos field. g. Code the number of regional lymph nodes examined by the pathologist in the Reg Nodes Exam field. h. Code the farthest distant metastasis (including distant lymph nodes) in the CS Mets at Dx field. i. Code how the distant metastasis was determined in the CS Mets Eval field. j. Code the six site-specific factors. If the first site-specific factor is listed as “Not Applicable,” code 888 in all site specific factors. Otherwise, code the specific information requested for each site specific factor. When the next site-specific factor is 888 Not Applicable, all the remaining site-specific factors will also be 888.

Congratulations! You have collected all the facts about the case and the codes are ready for the computer to convert into the T, N, M, Stage Group, Summary Stage 1977 and Summary Stage 2000. Depending on your software system, the final stage information may be derived now, when the case is saved, or prior to exiting the case. Finish the rest of the abstract, edit check it and save it.

When the computer derives the final stage information, the program will check the histology code and other coded information to determine whether T, N, M and Stage Group will be generated for the case. If the histology code is on the computer’s exceptions list for that site, the T, N, M, and Stage Group will be reported as “Not Applicable.” Summary Stage is generated for every case. The computer algorithm will also record which version of the Collaborative Staging System was used to derive the final stages.

Version date: January 1, 2004 21 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Page left blank.

Version date: January 1, 2004 22 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

Coding Instructions for Collaborative Staging Data Elements

Version date: January 1, 2004 23 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

Page left blank.

Version date: January 1, 2004 24 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS TUMOR SIZE Item Length: 3 NAACCR Item #2800

Description Records the largest dimension or diameter of the primary tumor, and is always recorded in millimeters. To convert centimeters to millimeters, multiply the dimension by 10. If tumor size is given in tenths of millimeters, round down if between .1 and .4 mm, and round up if between .5 and .9 mm.

Code Description 000 Indicates no mass or no tumor found; for example, when a tumor of a stated primary site is not found, but the tumor has metastasized. 001–988 Exact size in millimeters. 989 989 millimeters or larger. 990 Microscopic focus or foci only; no size of focus is given. 991 Described as less than 1 cm 992 Described as less than 2 cm 993 Described as less than 3 cm 994 Described as less than 4 cm 995 Described as less than 5 cm SITE-SPECIFIC CODES WHERE NEEDED 999 Unknown; size not stated; not stated in patient record.

Examples: Mammogram shows 2.5 cm breast malignancy Code as 025 (2.5 cm = 25 millimeters) CT of chest shows 4 cm mass in RUL Code as 040 (4 cm = 40 mm) Thyroidectomy specimen yields 8 mm carcinoma Code as 008 Prostate needle biopsy shows 0.6 mm carcinoma Code as 001 (round up six-tenths of mm)

For schemas that do not use tumor size:

Code Description 888 Not applicable

Instructions for Coding 1. Refer to general guidelines for Collaborative Staging for timing rules for data collection.

2. Refer to site/histology-specific instructions for additional information. Site/histology-specific instructions replace or over-ride general instructions. Where there are no site/histology-specific instructions, these general instructions apply.

3. Record tumor size information in the following order: a. Record tumor size from the pathology report, if it is available, when the patient receives no radiation or systemic treatment prior to surgery.

Version date: January 1, 2004 25 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Tumor Size, continued Example: Chest x-ray shows 3.5 cm mass; the pathology report from the surgery states that the same mass is malignant and measures 2.8 cm. Record tumor size as 028. b. If the patient receives preoperative (neoadjuvant) systemic therapy (chemotherapy, hormone therapy, immunotherapy) or radiation therapy, code the largest size of tumor prior to treatment. Example: Patient has a 2.2 cm mass in the oropharynx; fine needle aspiration of mass confirms squamous cell carcinoma. Patient receives course of neoadjuvant combination chemotherapy. Pathologic size of tumor after total resection is 0.8 cm. Record tumor size as 022. c. Information on size from imaging/radiographic techniques can be used to code size when there is no more specific size information from a pathology or operative report, but it should be taken as low priority, just above a physical exam. d. If there is a difference in reported tumor size among imaging and radiographic techniques, record the largest size of tumor reported in the record. e. In the infrequent event that the tumor does not respond to neoadjuvant treatment and is, in fact, more extensive after preoperative treatment as determined by the operative or pathology report, code the farthest extension and code CS Tumor Size/Ext Eval as 6, based on pathology/operative report after treatment.

4. Record the exact size of the primary tumor for all sites/histologies except those for which it is stated to be not applicable. If no size is given, code as 999. a. Always code the size of the primary tumor, not the size of the polyp, ulcer, cyst, or distant metastasis. However, if the tumor is described as a “cystic mass,” and only the size of the entire mass is given, code the size of the entire mass, since the cysts are part of the tumor itself. b. Record the largest dimension or diameter of tumor, whether it is from an excisional biopsy specimen or the complete resection of the primary tumor. Example A 3.3 cm tumor would be 33 millimeters and would be coded as 033. Example Tumor is described as 2.4 x 5.1 x 1.8 cm in size. Record tumor size as 051. c. Record the size of the invasive component, if given. d. If both an in situ and an invasive component are present and the invasive component is measured, record the size of the invasive component even if it is smaller. Example Tumor is mixed in situ and invasive adenocarcinoma, total 3.7 cm in size, of which 1.4 cm is invasive. Record tumor size as 014. e. Additional rule for breast primaries: If the size of the invasive component is not given, record the size of the entire tumor from the surgical report, pathology report, radiology report or clinical examination. Example Infiltrating duct carcinoma with extensive in situ component; total size 2.3 cm. Record tumor size as 023. Example Duct carcinoma in situ covering a 1.9 cm area with focal areas of invasive ductal carcinoma. Record tumor size as 019. Note: For breast cancer, document how the size of the tumor was determined in Site Specific Factor field 6. Information from the pathology report can be used to identify in situ versus invasive tumor even if exact size is not given. If tumor size is a clinical measurement only in the range 001-989, Site Specific Factor 6 must be coded as 888. f. For purely in situ lesions, code the size as stated. g. Microscopic residual tumor does not affect overall tumor size. h. Do not add pieces or chips together to create a whole; they may not be from the same location, or they may represent only a very small portion of a large tumor. However, if the pathologist states an aggregate or composite size (determined by fitting the tumor pieces together and measuring the total size), record that size. i. If an excisional biopsy is performed and residual tumor at time of resection of the primary is found to be larger than the excisional biopsy, code the size of the residual tumor.

Version date: January 1, 2004 26 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Tumor Size, continued j. For an incisional needle biopsy, code tumor size as 999. Do not code the tumor size from a needle biopsy unless no residual tumor is found on further resection. k. Record tumor size (lateral dimension) for malignant melanoma. Depth of invasion is coded in a site-specific factor.

5. Special codes a. Tumor dimension is to be recorded for all schemas, except as noted below. Other information collected in this field in previous staging systems, such as depth of invasion for melanoma, has been moved to Site-Specific Factors for those sites/histologies. b. If size is not reported, code as 999, which means unknown size, not applicable, or not documented in the patient record. c. The descriptions in code 998 take precedence over any mention of size. Code 998 is used only for the following sites: Esophagus (C15.0-C15.5, C15.8-C15.9): Entire circumference Stomach (C16.0-C16.6, C16.8-C16.9): Diffuse, widespread—¾ or more, linitis plastica Colorectal (M-8220/8221 with /2 or /3): Familial/multiple polyposis Lung and main stem bronchus (C34.0-C34.3, C34.8-C34.9): Diffuse, entire lobe or lung Breast (C50.0-C50.6, C50.8-C50.9): Inflammatory carcinoma; Diffuse, widespread—¾ or more of breast. d. Code 990, Microscopic focus or foci only; no size is given, should be used when no gross tumor is seen and tumor is only identified microscopically. Note: the terms microscopic focus, microfocus, and microinvasion are NOT the same as [macroscopic] focal or focus. A macroscopic focus or foci indicates a very small or isolated area, pinpoint, or spot of tumor that may be visible grossly. Only tumor identified microscopically should be coded to 990. Example Ovary specimen: extensive cystic disease with focal areas of tumor seeding. Disregard “focal” and code tumor size to 999 unknown. Example Cervix conization: severe dysplasia with focal areas of microinvasion. Code tumor size as 990 microscopic focus, no size given. e. Codes 991 through 995 are non-specific size descriptions that, for some sites, could still be used to determine a T category. However, if a specific size is given, the more precise size should be coded in the range 001-989. f. Other special codes in the range 996 to 997 are used on a site-specific basis. See the individual site/histology schemas for further information and definitions. g. Note: For the following diagnoses and/or primary sites, size is not applicable. Record as code 888. Disseminated Langerhans cell histiocytosis (Letterer-Siwe disease) Hematopoietic neoplasms Immunoproliferative diseases Leukemia Malignant lymphoma (Hodgkin lymphoma and non-Hodgkin lymphoma) Mast cell tumors Multiple myeloma and other plasma cell tumors Myelodysplastic syndromes Myeloproliferative diseases Unknown and ill-defined primary sites (C76.0–C76.5, C76.7–C76.8, C80.9) h. The source of the tumor size (radiographs, endoscopy, pathology specimen, etc.) is documented in the CS Tumor Size/Ext Eval field.

6. It is strongly recommended that the choice of tumor size codes be documented in a related text field on the abstract.

Version date: January 1, 2004 27 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS EXTENSION Item Length: 2 NAACCR Item #2810

Description Identifies contiguous growth (extension) of the primary tumor within the organ of origin or its direct extension into neighboring organs. For certain sites such as ovary, discontinuous metastasis is coded in the CS Extension field. See site-specific schemas for detailed codes and coding instructions.

Code Description TNM SS77 SS2000 Mapping Mapping Mapping 00 In situ; non-invasive Tis IS IS SITE/HISTOLOGY-SPECIFIC CODES 80 Further contiguous extension 95 No evidence of primary tumor T0 U U 99 Unknown extension; primary tumor cannot be TX U U assessed; not stated in patient record

Instructions for Coding 1. Code the farthest documented extension of the primary tumor. Do not include discontinuous metastases to distant sites (these are coded in CS Mets at Dx) except for ovary and corpus uteri (see 2e below).

2. Record extension information in the following order: a. Record extension from the pathology report, if it is available, when the patient receives no radiation or systemic treatment prior to surgery. b. If the patient receives preoperative (neoadjuvant) systemic therapy (chemotherapy, hormone therapy, immunotherapy) or radiation therapy, code the farthest extension identified prior to treatment (clinically). Example Patient has rectal mass firmly attached to pelvic wall (clinically T4, extension code 60). Patient undergoes preoperative radiation therapy. The pathology report from the low anterior resection shows residual tumor outside the rectum in perimuscular tissue (pathologically T3, extension code 40). Code extension as 60, because the preoperative treatment apparently “shrank” the tumor away from the pelvic wall. c. In the infrequent event that the tumor does not respond to neoadjuvant treatment and is, in fact, more extensive after preoperative treatment as determined by the operative or pathology report, code the farthest extension and code CS Tumor Size/Ext Eval as 6, based on pathology/operative report after treatment. Example Patient found to have an obstructing central lung tumor very close to the main stem bronchus (clinically T2, extension code 20). Patient undergoes six weeks of intensive chemotherapy. At thoracotomy, tumor was observed directly extending into trachea (pathologically T4, extension code 70). Code extension as 70, because the tumor was noted to be more extensive after the preoperative treatment. Example Patient has a 5.5 cm hard, moveable mass in the right breast (clinically T3, extension code 10) and receives preoperative chemotherapy. The pathology report from the modified radical mastectomy shows residual 2.8 cm mass with infiltration of the deep subcutaneous tissues over the mass (pathologically T2, extension code 20). Code extension as 20, because although the chemotherapy “shrank” the tumor, the residual tumor was found to be more extensive than the clinical presentation.

Version date: January 1, 2004 28 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Extension, continued d. Information on extent of disease from imaging/radiographic techniques can be used to code extension when there is no more specific extension information from a pathology or operative report, but it should be taken as low priority, just above a physical exam. e. If an involved organ or tissue is not mentioned in the schema, approximate the location and code it with listed organs or tissues in the same anatomic area. f. With the exception of corpus uteri and ovary, all codes represent contiguous (direct) extension of tumor from the site of origin to the organ/structure/tissue represented in the code. Example Carcinoma of the prostate with extension to pubic bone would be coded 60. Carcinoma of the prostate with metastases to thoracic spine would be coded in CS Extension to the appropriate code for tumor extension and the metastases to the thoracic spine would be coded in the CS Mets at Dx field.

3. Refer to general guidelines for Collaborative Staging for timing rules for data collection.

4. Refer to the ambiguous terminology section for terms that constitute tumor involvement or extension.

5. If the information in the medical record is ambiguous or incomplete regarding the extent to which the tumor has spread, the extent of disease may be inferred from the T category stated by the physician.

6. If the only indication of extension in the record is the physician’s statement of a T category from the TNM staging system or a stage from a site-specific staging system, such as Dukes’ C, record the numerically lowest equivalent extension code for that T category.

7. Some site or histology schemas include designations such as T1, NOS; T2, NOS; Localized, NOS; and other non-specific categories. The NOS is added when there is further breakdown of the category into subsets (such as T1a, T1b, T1c), but the correct subset cannot be determined. The NOS designation, which can appear in both the descriptions of codes and the mapping, is not official AJCC descriptive terminology. The NOS should be disregarded in reports and analyses when it is not a useful distinction. The data collector should only code to a category such as “Stated as T1 NOS” when the appropriate subset (e.g., T1a or T1b) cannot be determined.

8. Distant metastases must be coded in the CS Mets at Dx field.

9. Do not code CS Extension as in situ if there is any evidence of nodal or metastatic involvement; use the code for Localized, NOS, if there is no better information. Example Excisional biopsy of breast tumor shows extensive DCIS. Sentinel node biopsy reveals one positive axillary node. Code CS Extension as 10, localized, NOS, because an in situ tumor theoretically cannot metastasize and apparently an area of invasion was missed by the pathologist.

10. The presence of microscopic residual disease or positive tumor margins does not increase the extension code.

11. It is strongly recommended that the choice of extension codes be documented in a related text field on the abstract.

Version date: January 1, 2004 29 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS TUMOR SIZE/EXT EVAL Item Length: 1 NAACCR Item #2820

Description Records how the codes for the two items “CS Tumor Size” and “CS Extension” were determined, based on the diagnostic methods employed.

Note: This field is used primarily to describe whether the staging basis for the T category in the TNM system is clinical or pathological.

Code Description Staging Basis 0 No surgical resection done. Evaluation based on physical examination, imaging c examination, or other non-invasive clinical evidence. No autopsy evidence used. 1 No surgical resection done. Evaluation based on endoscopic examination, c* diagnostic biopsy, including fine needle aspiration biopsy, or other invasive techniques. No autopsy evidence used. Does not meet criteria for AJCC pathologic staging. 2 No surgical resection done, but evidence derived from autopsy (tumor was p suspected or diagnosed prior to autopsy) 3 Surgical resection performed WITHOUT pre-surgical systemic treatment or p radiation OR surgical resection performed, unknown if pre-surgical systemic treatment or radiation performed Meets criteria for AJCC pathologic staging. Evaluation based on evidence acquired before treatment, supplemented or modified by the additional evidence acquired during and from surgery, particularly from pathologic examination of the resected specimen 5 Surgical resection performed WITH pre-surgical systemic treatment or radiation; c tumor size/extension based on clinical evidence 6 Surgical resection performed WITH pre-surgical systemic treatment or radiation, y BUT tumor size/extension based on pathologic evidence 8 Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to a autopsy) 9 Unknown if surgical resection done c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record For sites with no TNM schema: not applicable

* For some primary sites, code 1 may be a pathologic staging basis, as determined by the site-specific chapter in the AJCC Cancer Staging Manual, sixth edition.

Version date: January 1, 2004 30 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Tumor Size/Ext Eval, continued Instructions for Coding 1. Select the CS Tumor Size/Ext Eval code that documents the report or procedure from which the information about the farthest extension or size of the primary tumor was obtained; this may not be the numerically highest Eval code. Example Fine needle aspiration biopsy (Eval code 2) confirms adenocarcinoma of prostate. CT scan of pelvis (Eval code 1) shows tumor extension through the prostatic capsule into adjacent connective tissues. Code CS Tumor Size/Ext Eval as 1 because the CT scan showed more extensive tumor than the biopsy.

2. For primary sites/histologies where tumor size is not a factor in determining the T category in TNM (see Table 5 in the General Instructions), code CS Tumor Size/Ext Eval on the basis of the CS extension field only.

3. For primary sites where both tumor size and extension determine the T category in TNM (see Table 4 in the General Instructions), select the code that best explains how the information in the CS Tumor Size and CS Extension fields were determined. a. If there is a difference between the derived category for the tumor size and the CS extension, select the evaluation code that reflects how the worse or higher category was determined. Example Tumor size for a breast cancer biopsy is 020 (maps to T1). There is ulceration of the skin (extension code 50, maps to T4). Code CS Tumor Size/Ext Eval field as 0, physical examination, because the ulceration information from the physical examination results in a higher T category. b. If the patient had no surgery, use code 0, 1, or 9. Example Patient has a chest x-ray showing an isolated 4 cm tumor in the right upper lobe. Patient opts for radiation therapy. Code this field as 0. Staging algorithm would identify information as clinical (c). Example Colon cancer with colonoscopy and biopsy confirming cancer. Code this field as 1. Staging algorithm would identify information as clinical (c). The biopsy does not meet the criteria for pathologic staging. Example Endoscopies for cervix or bladder would be coded as 1 in this field and the staging algorithm would identify the information as clinical (c). Exception Lung cancer with mediastinoscopy showing direct extension into mediastinum. Code this field as 1. Staging algorithm would identify information as pathologic (p), because mediastinoscopy is defined as a pathologic procedure in TNM.. c. If the patient had surgery followed by other treatment(s), use code 3 or 9. d. If the size or extension of the tumor determined prior to treatment was the basis for neoadjuvant therapy, use code 5. e. If the size or extension of the tumor was greater after presurgical treatment than before treatment, use code 6. This code is likely to be used infrequently and maps to the “y” intercurrent treatment staging basis. f. If the patient had an autopsy, use code 2 if the diagnosis was known or suspected prior to death. Use code 8 if the malignancy was not known or suspected prior to death.

4. For sites/histologies where there is no TNM schema, this field may be coded 9, not applicable. (See Table 6 in the General Instructions.)

5. Code 0 includes imaging studies such as standard radiography, special radiographic projections, tomography, computerized tomography (CT), ultrasonography, lymphography, angiography, scintigraphy (nuclear scans), ultrasonography, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, spiral scanning (CT or MRI) and other non-invasive methods of examining tissues.

Version date: January 1, 2004 31 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Tumor Size/Ext Eval, continued 6. Codes 0-3 are oriented to the AJCC staging basis. In general, Code 1 includes microscopic analysis of tissue that is insufficient to meet the requirements for pathologic staging in the TNM system. However, pathologic staging requirements vary by site; for some site schemas, code 1 may be classified as pathologic. For specific classification rules, refer to the AJCC Cancer Staging Manual, sixth edition. For example, a total cystectomy is required to pathologically stage a bladder cancer. Any tissue removed during another procedure, such as a transurethral resection of a bladder tumor, would not meet the requirements for pathologic staging and should be coded to 1 in this field. Code 1 also includes observations at surgery, such as an exploratory laparotomy in which unresectable pancreatic cancer is identified, where further tumor extension is not biopsied.

7. Code 3 is considered pathologic staging across all sites. Use code 3 for a biopsy of tumor extension that meets the requirements for pathologic staging basis. In other words, according to TNM rules, if the biopsy documents the highest T category, the biopsy meets the requirements for pathologic staging basis and the CS Tumor Size/Ext Eval field should be coded to 3. For example, if a prostate cancer patient has a biopsy of the rectum that shows microscopic involvement of the rectal wall (T4), according to the AJCC Cancer Staging Manual sixth edition that patient meets the requirements for pathologic staging in the T category.

Version date: January 1, 2004 32 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS LYMPH NODES Item Length: 2 NAACCR Item #2830

Description Identifies the regional lymph nodes involved with cancer at the time of diagnosis.

Code Description TNM SS77 SS2000 Mapping Mapping Mapping 00 None; no regional lymph node involvement N0 None None SITE/HISTOLOGY-SPECIFIC CODES 80 Lymph nodes, NOS NX RN RN 90 Unknown; regional lymph nodes cannot be NX U U assessed; not stated in patient record

For schemas that do not use the CS Lymph Nodes field:

Code Description 88 Not applicable

Instructions for Coding 1. Record the specific regional lymph node chain farthest from the primary site that is involved by tumor either clinically or pathologically. a. Regional lymph nodes are listed for each site/histology. In general, the regional lymph nodes in the chain(s) closest to the primary site have the lower codes. Nodes farther away from the primary or in farther lymph node chains have higher codes. Record the highest applicable code. Exception The higher codes for ‘Regional lymph nodes, NOS’; ‘Lymph nodes, NOS’; ‘Stated as N1, no other information’; ‘Stated a N2a, no other information’, and so forth, should only be used when there is no available information as to the name(s) of the regional nodes involved. Example Peribronchial lymph nodes are positive on fine needle aspiration biopsy. Contralateral mediastinal mass noted on CT scan but not biopsied. Patient chooses radiation therapy as primary treatment. Use the code for contralateral mediastinal lymph node involvement as it is higher than the code for peribronchial lymph nodes. b. Record involved regional lymph nodes from the pathology report, if it is available, when the patient receives no radiation or systemic treatment prior to surgery. c. If there is a discrepancy between clinical information and pathologic information about the same lymph nodes, the pathologic information takes precedence if no preoperative treatment was administered. Example Axillary lymphadenopathy stated as “suspicious for involvement” noted on physical exam. After axillary dissection, all lymph nodes are negative. Code CS Lymph Nodes as 0, no regional lymph node involvement. d. For inaccessible sites, primarily for localized or early stage (T1, T2) cancers: record regional lymph nodes as negative rather than unknown (based on clinical evaluation) when there is no mention of regional lymph node involvement in the physical examination, pre-treatment diagnostic testing or surgical exploration, and the patient receives what would be usual treatment to the primary site (see general rules for further discussion).

Version date: January 1, 2004 33 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Lymph Nodes, continued e. If there is direct extension of the primary tumor into a regional lymph node, record the involved node in this field. f. If the patient receives preoperative (neoadjuvant) systemic therapy (chemotherapy, hormone therapy, immunotherapy) or radiation therapy, code the farthest involved regional lymph nodes, based on information prior to surgery. Example Patient has a hard matted mass in the axilla (code 50) and a needle biopsy of the breast that confirms ductal carcinoma. Patient receives three months of chemotherapy. The pathology report from the modified radical mastectomy shows only scar tissue in the axilla with no involvement of axillary lymph nodes (Negative, code 00). Code CS Lymph Nodes as 50 because the chemotherapy apparently “sterilized” the lymph nodes. g. In the infrequent event that clinically involved regional lymph nodes do not respond to neoadjuvant treatment and are, in fact, more extensively involved after preoperative treatment as determined by the operative or pathology report, code the farthest extension and code CS Reg Nodes Eval as 6, based on pathology/operative report after treatment. Example Patient has needle biopsy-proven prostate cancer with no mention of involved lymph nodes on physical examination (Negative, code 00). He receives Lupron while deciding whether to undergo a radical prostatectomy. At the time of surgery, a laparoscopic pelvic node biopsy is reported to show metastases (Regional nodes involved, code 10) to lymph nodes and the prostatectomy is canceled. Code CS Lymph Nodes as 10 because the preoperative treatment (Lupron) had no effect on the lymph nodes.

2. Use code 00 for lymph node involvement when the CS Extension is coded in situ, even if no lymph nodes are removed, since “in situ” by definition means noninvasive. If there is evidence of nodal involvement associated with a tumor described as in situ, it would indicate that an area of invasion was missed and the primary tumor is not an in situ lesion, so lymph nodes can be coded as appropriate for the case.

3. For solid tumors, the terms “fixed” or “matted” and “mass in the hilum, mediastinum, retroperitoneum, and/or mesentery” (with no specific information as to tissue involved) are considered involvement of lymph nodes. a. Any other terms, such as “palpable,” “enlarged,” “visible swelling,” “shotty,” or “lymph- adenopathy” should be ignored, unless there is a statement of involvement by the clinician. Exception The terms adenopathy, enlargement, and mass in the hilum or mediastinum should be coded as involvement for lung primaries only. b. For lymphomas, any positive mention of lymph nodes indicates involvement of those lymph nodes. c. Regional lymph nodes are not palpable for inaccessible sites such as bladder, kidney, prostate, esophagus, stomach, lung, liver, corpus uteri and ovary. The best description concerning regional lymph nodes will be on imaging studies or in the surgeon's evaluation at the time of exploratory surgery or definitive surgery. If regional lymph nodes for these inaccessible sites are not mentioned on imaging or exploratory surgery, they are presumed to be clinically negative. d. The terms “homolateral,” “ipsilateral,” and “same side” are used interchangeably. e. Any unidentified nodes included with the resected primary site specimen are to be coded as regional lymph nodes, NOS. f. Where more specific categories are provided, the codes for “regional lymph node(s), NOS”; “lymph nodes, NOS”; and “Stated as N_, no additional information” should be used only after an exhaustive search for more specific information.

Version date: January 1, 2004 34 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Lymph Nodes, continued 4. When size of involved regional lymph nodes is required, code from pathology report, if available. a. Code the size of the metastasis, not the entire node, unless otherwise stated in site-specific schemas. The size of the metastasis within the lymph node can be inferred if the size for the entire node falls within one of the codes; for example, a single involved node 1.5 cm in size can be coded to “single lymph node # 2 cm” because the metastasis cannot be larger than 1.5 cm.

5. If the only indication of lymph node involvement in the record is the physician’s statement of an N category from the TNM staging system or a stage from a site-specific staging system, such as Dukes’ C, record the numerically lowest equivalent CS Lymph Nodes code for that N category. a. If there is a discrepancy between documentation in the medical record and the physician’s assignment of TNM, the documentation takes precedence. Cases of this type should be discussed with the physician who assigned the TNM. b. If the information in the medical record is ambiguous or incomplete regarding the extent to which the tumor has spread, lymph node involvement may be inferred from the N category stated by the physician.

6. Some site or histology schemas include designations such as N1, NOS; N2, NOS, and other non- specific categories. The NOS is added when there is further breakdown of the category into subsets (such as N1a, N1b, N1c), but the correct subset cannot be determined. The NOS designation, which can appear in both the descriptions of codes and the mapping, is not official AJCC descriptive terminology. The NOS should be disregarded in reports and analyses when it is not a useful distinction. The data collector should only code to a category such as “Stated as N1 NOS” when the appropriate subset (e.g., N1a or N1b) cannot be determined.

7. For colon, rectosigmoid and rectum primaries, if there is a statement about tumor nodule(s) in the pericolic or perirectal fat, use the following guidelines for coding regional lymph node involvement: Code as regional lymph node involvement if the nodule has a smooth contour. Code as tumor extension if the nodule has an irregular contour.

8. It is strongly recommended that the choice of regional lymph node codes be documented in a related text field on the abstract.

CODING REGIONAL LYMPH NODES FOR HEAD AND NECK SITES

For head and neck sites, regional lymph node information is coded in several fields. The CS Lymph Nodes field contains information about the nodes involved, their number and laterality. Site-Specific Factors 1 and 2 are used to code the size of involved lymph nodes and the presence of extracapsular extension. Site-Specific Factors 3 through 6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I- III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. See Figure 2a for the layout of Site-Specific Factors 3 through 6 and Figure 2b for the interpretation of a coded example.

Version date: January 1, 2004 35 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

Figure 2a. Layout of Site-Specific Factors for Head and Neck Sites

SSF 3 Levels I-III ______I II III

SSF 4 Levels IV-V, ______retropharyngeal (RP) IV V RP

SSF 5 Levels VI-VII, ______Facial (F) VI VII F

SSF 6 Other groups ______Parapharyngeal (PP), PP PA S Parotid (PA), Suboccipital (S)

Figure 2b. Example and Interpretation of Site-Specific Factors for Head and Neck Sites

Example: Left Radical Neck Dissection: 2 positive parotid node (< 3 cm with extra-capsular extension), 1 positive buccal (facial) node (2 cm), and 1 positive 2 cm submandibular node.

SSF 3 Levels I-III _1__0__0_ I II III

SSF 4 Levels IV-V, _0__0__0_ retropharyngeal (RP) IV V RP

SSF 5 Levels VI-VII, _0__0__1_ Facial (F) VI VII F

SSF 6 Other groups _0__1__0_ Parapharyngeal (PP), PP PA S Parotid (PA), Suboccipital (S)

Stored in database as Interpretation SSF 3 100 Level 1 only SSF 4 000 All nodes neg SSF 5 001 Facial nodes only SSF 6 010 Parotid nodes only

CS Lymph Nodes, continued Unknown In Site-Specific Factors 3-6 for lymph node levels, use code 9 only when it is unknown if lymph nodes are involved. Within each of the Site-Specific Factors 3-6, do not code 9 in some positions and 0 or 1 in other positions. If specific information is available about the positive or negative status of some but not all nodes in any one level or group, assume that the rest of the nodes in the same Site-Specific Factor are negative and code accordingly.

Version date: January 1, 2004 36 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

NOS When the only information available is “Regional nodes, NOS” or “Cervical nodes, NOS” or “Internal jugular lymph nodes, NOS” or “Lymph nodes, NOS,” code 0 in all digits of Site-Specific Factors 3-6. Example 1 A carcinoma of the base of tongue involves bilateral submandibular nodes and left upper, mid-, and lower jugular nodes, the largest measuring 4 cm. There is no extracapsular extension. These are level I, II, III, and IV lymph nodes according to AJCC definitions. CS Lymph Nodes is coded 40 (bilateral or contralateral nodes). Site-Specific Factor 1 is coded 040 indicating the largest size. Site-Specific Factor 2 is coded 000 for no extracapsular extension. Site-Specific Factor 3 is coded 111, to show that levels I, II, and III are involved. Site-Specific Factor 4 is coded 100 to show that level IV is involved. Site-Specific Factors 5 and 6 are each coded 000, since no other nodes are involved. Example 2 Laryngeal biopsy with squamous cell carcinoma, no other information available. CS Lymph Nodes is coded 99. Site-Specific factors 1-6 are each coded 999, since no information is available regarding lymph node involvement. Example 3 Patient diagnosed elsewhere with carcinoma of oropharynx with cervical lymph node involvement. No other information available. CS Lymph Nodes is coded 50 (regional nodes, NOS, not stated if ipsilateral, bilateral, or contralateral, or if single or multiple). Site-specific Factors 1 and 2 are each coded 999. Site-Specific Factors 3-6 are each coded 000.

Definitions of Levels for Head and Neck Sites The definitions of the levels and the lymph node chains included in each level are as follows:

Level I contains the submental and submandibular triangles bounded by the anterior and posterior bellies of the digastric muscle, and the hyoid bone inferiorly, and the body of the mandible superiorly. Submandibular Submaxillary Submental

Level II contains the upper jugular lymph nodes and extends from the level of the skull base superiorly to the hyoid bone inferiorly. Jugulodigastric Upper deep cervical Upper jugular (subdigastric)

Level III contains the middle jugular lymph nodes from the hyoid bone superiorly to the level of the lower border of the cricoid cartilage inferiorly. Middle deep cervical Mid-jugular

Level IV contains the lower jugular lymph nodes from the level of the cricoid cartilage superiorly to the clavicle inferiorly. Jugulo-omohyoid Lower deep cervical Lower jugular (supraomohyoid)

Level V contains the lymph nodes in the posterior triangle bounded by the anterior border of the trapezius muscle posteriorly, the posterior border of the sternocleidomastoid muscle anteriorly, and the clavicle inferiorly. For descriptive purposes, Level V may be further subdivided into upper, middle, and lower levels corresponding to the superior and inferior planes that define Levels II, III, and IV. Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower, corresponding to the levels that define upper, middle, and lower jugular nodes)

Version date: January 1, 2004 37 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

Level VI contains the lymph nodes of the anterior central compartment from the hyoid bone superiorly to the suprasternal notch inferiorly. On each side, the lateral boundary is formed by the medial border of the carotid sheath. Anterior deep cervical Paratracheal Pretracheal Laterotracheal Prelaryngeal (Delphian) Recurrent laryngeal Paralaryngeal

Level VII contains the lymph nodes inferior to the suprasternal notch in the superior mediastinum. Upper mediastinal

Other groups Buccinator (facial) Periparotid and Retropharyngeal Nasolabial intraparotid Sub-occipital Parapharyngeal Preauricular

Version date: January 1, 2004 38 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS REG NODES EVAL Item Length: 1 NAACCR Item #2840

Description Records how the code for the item “CS Lymph Nodes” was determined, based on the diagnostic methods employed.

Code Description Staging Basis 0 No regional lymph nodes removed for examination. Evaluation based on physical c examination, imaging, or other non-invasive clinical evidence. No autopsy evidence used. 1 No regional lymph nodes removed for examination. Evaluation based on c endoscopic examination, diagnostic biopsy including fine needle aspiration of lymph node(s) or other invasive techniques. No autopsy evidence used. Does not meet criteria for AJCC pathologic staging. 2 No regional lymph nodes removed for examination, but evidence derived from p autopsy (tumor was suspected or diagnosed prior to autopsy). 3 Regional lymph nodes removed for examination (removal of at least 1 lymph p node) WITHOUT pre-surgical systemic treatment or radiation OR lymph nodes removed for examination, unknown if pre-surgical systemic treatment or radiation performed Meets criteria for AJCC pathologic staging. 5 Regional lymph nodes removed for examination WITH pre-surgical systemic c treatment or radiation, and lymph node evaluation based on clinical evidence. 6 Regional lymph nodes removed for examination WITH pre-surgical systemic y treatment or radiation, BUT lymph node evaluation based on pathologic evidence. 8 Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy. a 9 Unknown if lymph nodes removed for examination c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record For sites that have no TNM staging: Not applicable

Instructions for Coding 1. Select the CS Reg Nodes Eval code that documents the report or procedure from which the information about the farthest involved regional lymph nodes was obtained; this may not be the numerically highest eval code. Example Modified radical neck dissection for hypopharyngeal cancer shows one lower jugular node involved (CS Reg LN code 10, Eval code 3). Physical exam shows hard, matted scalene (transverse cervical) node presumed to contain metastasis (CS Reg LN code 32, Eval code 0). Code CS Reg Nodes Eval as 0 since the scalene node involvement was determined clinically rather than by examination of tissue.

2. For sites/histologies where there is no TNM schema (see Table 5 in the General Instructions), CS Reg Node Eval may be coded 9 (not applicable).

Version date: January 1, 2004 39 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Reg Nodes Eval, continued 3. Select the code that best explains how the information in the CS Lymph Nodes field was determined. a. If the patient had no removal of lymph node(s), use code 0, 1, or 9. Example Prostate cancer with laparoscopic lymph node biopsy showing involved nodes; radical prostatectomy canceled. Code CS Reg Node Eval as 3. Staging algorithm would identify information as pathologic (p). According to AJCC, a positive biopsy of one or more regional lymph nodes is sufficient to meet the pathologic staging basis for prostate cancer. Example Lung cancer with CT scan or MRI showing involved contralateral mediastinal nodes. Code CS Reg Node Eval as 1. Staging algorithm would identify information as clinical (c). b. If the patient had removal of lymph node(s) surgery followed by other treatment(s), use code 3 or 9. c. If the patient receives preoperative (neoadjuvant) systemic therapy (chemotherapy, hormone therapy, immunotherapy) or radiation therapy, the clinical status of lymph nodes takes precedence (code 5). d. If the size, number or extension of regional lymph node involvement determined prior to treatment was the basis for neoadjuvant therapy, use code 5. However, if more extensive tumor is during lymph node examination after neoadjuvant therapy, use code 6. e. If the patient had an autopsy, use code 2 if the diagnosis was known or suspected prior to death. Use code 8 if the malignancy was not known or suspected prior to death.

4. Code 0 includes imaging studies such as standard radiography, special radiographic projections, tomography, computerized tomography (CT), ultrasonography, lymphography, angiography, scintigraphy (nuclear scans), ultrasonography, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, spiral scanning (CT or MRI) and other non-invasive methods of examining tissues.

5. Codes 0-3 are oriented to the AJCC staging basis. Code 1 includes microscopic analysis of tissue insufficient to meet the requirements for pathologic staging in the TNM system. For example, a needle biopsy of an axillary lymph node will document that a lymph node is involved by breast cancer, but does not meet the requirement for removal of a sufficient number of lymph nodes so that the highest N stage can be assessed. Pathologic staging requirements vary by site; for some site schemas, code 1 may be classified as pathologic. For specific classification rules, refer to the AJCC Cancer Staging Manual, sixth edition. Code 1 also includes observations at surgery, such as abdominal exploration at the time of a colon resection, where regional lymph nodes are not biopsied.

6. Code 3 maps to pathologic staging across all sites. Use code 3 if the lymph node procedure meets the requirements for pathologic staging basis of regional lymph nodes. The requirements vary among sites as to the location and number of lymph nodes involved, the size of the involved nodes, and other characteristics. For prostate cancer, a positive biopsy of a single regional lymph node is sufficient to assign CS Reg Nodes Eval code 3 to the case.

Version date: January 1, 2004 40 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

REGIONAL NODES POSITIVE Item Length: 2 NAACCR Item #820

Description Records the exact number of regional lymph nodes examined by the pathologist and found to contain metastases.

Code Description 00 All nodes examined are negative. 01–89 1–89 nodes are positive. (Code exact number of nodes positive) 90 90 or more nodes are positive. 95 Positive aspiration of lymph node(s) was performed. 97 Positive nodes are documented, but the number is unspecified. 98 No nodes were examined. 99 It is unknown whether nodes are positive; not applicable; not stated in patient record.

Instructions for Coding 1. Record information about only regional lymph nodes in this field. Involved distant lymph nodes should be coded in the “CS Mets at Dx” field.

2. Rules for coding Regional Nodes Positive are the same for both in situ and invasive cases.

3. This field is based on pathologic information only. If no lymph nodes were removed for examination, or if a lymph node drainage area was removed but no lymph nodes were found, code as 98.

4. Record the total number of regional lymph nodes removed and found to be positive by pathologic examination. a. The number of regional lymph nodes positive is cumulative from all procedures that removed lymph nodes through the completion of surgeries in the first course of treatment. b. This field is to be recorded regardless of whether the patient received preoperative treatment.

5. Any combination of positive aspirated, biopsied, sampled or dissected lymph nodes should be coded to 97 if the number of involved nodes cannot be determined on the basis of cytology or histology.

6. For the following primary sites and histologies, the Regional Nodes Positive field is always coded as 99. Placenta Brain and Cerebral Meninges Other Parts of Central Nervous System Hodgkin and non-Hodgkin Lymphoma Hematopoietic, Reticuloendothelial, Immunoproliferative and Myeloproliferative Neoplasms Other and Ill-Defined Primary Sites Unknown Primary Site

Version date: January 1, 2004 41 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

REGIONAL NODES EXAMINED Item Length: 2 NAACCR Item #830

Description Records the total number of regional lymph nodes that were removed and examined by the pathologist. Code Description 00 No nodes were examined. 01–89 1–89 nodes were examined. (Code the exact number of regional lymph nodes examined.) 90 90 or more nodes were examined. 95 No regional nodes were removed, but aspiration of regional nodes was performed. 96 Regional lymph node removal was documented as a sampling, and the number of nodes is unknown/not stated. 97 Regional lymph node removal was documented as a dissection, and the number of nodes is unknown/not stated. 98 Regional lymph nodes were surgically removed, but the number of lymph nodes is unknown/not stated and not documented as a sampling or dissection; nodes were examined, but the number is unknown. 99 It is unknown whether nodes were examined; not applicable or negative; not stated in patient record.

Instructions for Coding 1. Record information about only regional lymph nodes in this field. Distant lymph node information should be coded in the “CS Mets at Dx” field.

2. Rules for coding Regional Nodes Examined are the same for in situ and invasive cases.

3. This field is based on pathologic information only. If no lymph nodes were removed for examination, or if a lymph node drainage area was removed but no lymph nodes were found, code as 00. If it is unknown whether nodes were removed or examined, code as 99.

4. Record the total number of regional lymph nodes removed and examined by the pathologist. a. The number of regional lymph nodes examined is cumulative from all procedures that removed lymph nodes through the completion of surgeries in the first course of treatment. b. If lymph nodes are aspirated and other lymph nodes are removed, use code 98. c. This field is to be recorded regardless of whether the patient received preoperative treatment.

5. If a lymph node biopsy was performed, code the number of nodes removed, if known. If the number of nodes removed by biopsy is not known, use code 96.

6. For the following primary sites and histologies, the Regional Nodes Examined field is always coded as 99. Brain and Cerebral Meninges Hematopoietic, Reticuloendothelial, Immunoproliferative and Myeloproliferative Neoplasms Hodgkin and non-Hodgkin Lymphoma Other and Ill-Defined Primary Sites Other Parts of Central Nervous System Placenta Unknown Primary Site

Version date: January 1, 2004 42 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS METS AT DX Item Length: 2 NAACCR Item #2850

Description Identifies the distant site(s) of metastatic involvement at time of diagnosis.

Code Description TNM SS77 SS2000 Mapping Mapping Mapping 00 No; none M0 None None 10 Distant lymph node(s) M1 D D 40 Distant metastases except code 10 M1 D D Distant metastasis, NOS Carcinomatosis SITE/HISTOLOGY-SPECIFIC CODES WHERE NEEDED 50 (40) + (10) M1 D D 99 Unknown; distant metastasis cannot be assessed; MX U U not stated in patient record

For schemas that do not use the CS Mets at Dx field:

Code Description 88 Not applicable

Instructions for Coding 1. This field represents distant metastases (the TNM M component or distant stage in Summary Staging) at the time of diagnosis. In other words, when the patient was diagnosed, tumor had already spread indirectly (through vascular or lymph channels) to a site remote from the primary tumor.

Note: The structure of the CS Mets at Dx field is based on the M category of TNM. In some schemas, there may be additional items in CS Extension or CS Lymph Nodes that map to distant stage in Summary Staging (77 and/or 2000) and there may be some items in CS Mets at Dx that map to regional stage in Summary Staging. Regardless of where such items are recorded, the staging algorithms will properly account for the information.

2. Assign the highest applicable code for metastasis at diagnosis, whether the determination was clinical or pathological and whether or not the patient had any preoperative systemic therapy.

3. Metastasis known to have developed after the extent of disease was established (also referred to as progression of disease) should not be recorded in the CS Mets at Dx field.

4. Record CS Mets at Dx as Code 00 (None) rather than Code 99 (Unknown) when the clinician proceeds with standard treatment of the primary site for localized or early (T1, T2) stage disease, since this action presumes that there are no distant metastasis that would otherwise alter the treatment approach. Code 99 can and should be used in situations where there is reasonable doubt that the tumor is no longer localized and there is no documentation of distant metastases. Version date: January 1, 2004 43 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Mets at Dx, continued 5. If the only indication of extension in the record is the physician’s statement of an M category from the TNM staging system or a stage from a site-specific staging system, such as Dukes’ D, record the numerically lowest equivalent extension code for that M category. In most cases, this will be 40, Distant metastasis, NOS.

6. If the information in the medical record is ambiguous or incomplete regarding the extent to which the tumor has spread, the extent of disease may be inferred from the M category stated by the physician.

7. Some site or histology schemas include a designation of M1, NOS. The NOS is added when there is further breakdown of the category into subsets (such as M1a, M1b, M1c), but the correct subset cannot be determined. The NOS designation, which can appear in both the descriptions of codes and the mapping, is not official AJCC descriptive terminology. The NOS should be disregarded in reports and analyses when it is not a useful distinction. The data collector should only code to a category such as “Stated as M1 NOS” when the appropriate subset (such as M1a or M1b) cannot be determined.

8. It is strongly recommended that the choice of distant lymph nodes and/or distant metastasis codes be documented in a related text field on the abstract.

Version date: January 1, 2004 44 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS METS EVAL Item Length: 2 NAACCR Item #2860

Description Records how the code for the item “CS Mets at Dx” was determined based on the diagnostic methods employed.

Code Description Staging Basis 0 No pathologic examination of metastatic tissue performed. Evaluation of distant c metastasis based on physical examination, imaging examination, and/or other non-invasive clinical evidence. No autopsy evidence used. 1 No pathologic examination of metastatic tissue performed. Evaluation of distant c metastasis based on endoscopic examination or other invasive technique. No autopsy evidence used. Does not meet criteria for AJCC pathologic staging of distant metastasis. 2 No pathologic examination of metastatic tissue done prior to death, but evidence p derived from autopsy (tumor was suspected or diagnosed prior to autopsy). 3 Pathologic examination of metastatic tissue performed WITHOUT pre-surgical p systemic treatment or radiation OR pathologic examination of metastatic tissue performed, unknown if pre- surgical systemic treatment or radiation performed Meets criteria for AJCC pathologic staging of distant metastasis. 5 Pathologic examination of metastatic tissue performed WITH pre-surgical c systemic treatment or radiation, and metastasis based on clinical evidence. 6 Pathologic examination of metastatic tissue performed WITH pre-surgical y systemic treatment or radiation, BUT metastasis based on pathologic evidence. 8 Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy. a 9 Not assessed; cannot be assessed c Unknown if assessed Not documented in patient record For sites with no TNM staging: Not applicable

Instructions for Coding 1. Select the CS Mets Eval code that documents the report or procedure from which the information was obtained about metastatic involvement farthest from the primary site; this may not be the numerically highest eval code. Example Liver palpated and reported as normal during laparotomy for stomach cancer (Eval code 1). CT scan of brain shows multiple metastatic nodules (Eval code 0). Code CS Mets Eval as 0; the brain would be reported as involved but the liver would not be reported as involved..

2. For primary sites/histologies where there is no TNM schema (Table 6), this field may be coded as 9 (not applicable).

3. Select the code that best explains how the information in the CS Metastases field was determined. a. If the patient had no examination of metastatic tissue, use code 0, 1, or 9.

Version date: January 1, 2004 45 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Mets Eval, continued Example Patient has diagnosis of colon cancer by biopsy. CT scan shows liver metastasis. Code this field as 0. Staging algorithm will indicate information is clinical (c). Example Lung cancer with endoscopy of contralateral lung showing involvement of contralateral mainstem bronchus. Code this field as 1. Staging algorithm will indicate information is clinical (c). Example Prostate cancer with enlarged scalene node confirmed as cancer on needle biopsy. Code this field as 3. Staging algorithm will indicate information is pathologic (p), since the biopsy of the metastatic site confirms M1 disease. b. If the patient had removal of presumed metastatic tissue (even though the pathology report was negative), use code 3. c. Code the method of evaluation for the site(s) farthest from the primary. Example Colon cancer patient has CT scan showing normal lungs. During the resection, the surgeon palpates the liver and finds it to be normal. Code this field as 0, since the CT scan shows that potential metastatic sites outside the surgical field are negative. d. If the patient had an autopsy, use code 2 if the diagnosis was known or suspected prior to death. Use code 8 if the malignancy was not known or suspected prior to death.

4. If the patient receives preoperative (neoadjuvant) systemic therapy (chemotherapy, hormone therapy, immunotherapy) or radiation therapy, the clinical status of metastases at diagnosis takes precedence (code 5).

5. If the patient has biopsies of some metastases while others are visible only on imaging, use code 6 to indicate if, after preoperative treatment, the biopsy is negative for metastasis but there is still evidence of clinical metastasis.

6. Code 0 includes imaging studies such as standard radiography, special radiographic projections, tomography, computerized tomography (CT), ultrasonography, lymphography, angiography, scintigraphy (nuclear scans), ultrasonography, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, spiral scanning (CT or MRI) and other non-invasive methods of examining tissues.

7. Any positive biopsy or resection of distant metastasis meets the requirement for pathologic staging basis and should be coded to CS Mets Eval code 3.

8. Code 1 includes endoscopy and observations at surgery, such as abdominal exploration at the time of a colon resection, where distant metastasis is not biopsied.

Version date: January 1, 2004 46 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS SITE-SPECIFIC FACTOR 1 Item Length: 3 NAACCR Item #2880

Description Identifies additional information needed to generate stage, or prognostic factors that have an effect on stage or survival.

Code Description 000 None SITE/HISTOLOGY-SPECIFIC CODES 999 Unknown; [site-specific title] cannot be assessed; Not documented in patient record

For schemas that do not use this site-specific factor:

Code Description 888 Not applicable for this site

Instructions for Coding 1. If there is no site/histology-specific factor for a schema, code 888.

2. The following primary sites/histologies use Site Specific Factor 1 to code information. See the site- specific schemas for acceptable codes and their definitions.

Site/Histology Factor Head and neck* Size of Lymph Nodes Colon Carcinoembryonic Antigen (CEA) Rectosigmoid, rectum Carcinoembyronic Antigen (CEA) Liver Alpha Fetoprotein (AFP) Pleura Pleural Effusion Malignant Melanoma of Skin, Vulva, Penis, Scrotum Measured Thickness (Depth), Breslow’s Measurement Mycosis Fungoides Peripheral Blood Involvement Breast Estrogen Receptor Assay (ERA) Ovary Carbohydrate Antigen 125 (CA-125) Placenta Prognostic Scoring Index Prostate Prostate Specific Antigen Laboratory Value (PSA Lab Value) Testis Alpha Fetoprotein (AFP) Thyroid Single vs. Multiple Nodules ______* Head and neck includes the following schemas: upper lip; lower lip; other lip; base of tongue; anterior tongue; upper gum; lower gum and retromolar trigone; other gum; floor of mouth; hard palate; soft palate/uvula; other mouth; buccal mucosa; parotid gland; submandibular gland; other salivary glands; oropharynx; anterior surface of epiglottis; nasopharynx; pyriform sinus/ hypopharynx; other pharynx; nasal cavity; middle ear; maxillary sinus; ethmoid sinus; other sinus; glottic larynx; supraglottic larynx; subglottic larynx; other larynx

Version date: January 1, 2004 47 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Site-Specific Factor 1, continued Site/Histology Factor Melanoma of Conjunctiva Measured Thickness (Depth), Breslow’s Measurement Melanoma of Choroid Measured Thickness (Depth), Breslow’s Measurement Melanoma of Iris and Ciliary Body Measured Thickness (Depth), Breslow’s Measurement Retinoblastoma Extension Evaluated at Enucleation Brain WHO Grade Other CNS WHO Grade Thyroid Solitary vs. Multifocal Other Endocrine WHO Grade Kaposi Sarcoma Associated with HIV/AIDS Lymphoma Associated with HIV/AIDS

3. Code 000 Not done is used when there is a statement in the record that a test was not performed. a. If there is no report of a lab test in the patient record, code as 999 Unknown; Not documented in patient record. b. For Kaposi sarcoma, if AIDS status is not documented, code as 999 Unknown rather than 002, Not Present.

Version date: January 1, 2004 48 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS SITE-SPECIFIC FACTOR 2 Item Length: 3 NAACCR Item #2890

Description Identifies additional information needed to generate stage, or prognostic factors that have an effect on stage or survival.

Code Description 000 None SITE/HISTOLOGY-SPECIFIC CODES 999 Unknown; [site-specific title] cannot be assessed; Not documented in patient record

For schemas that do not use this site-specific factor:

Code Description 888 Not applicable for this site

Instructions for Coding 1. If there is no site/histology-specific factor for a schema, code 888.

2. The following primary sites use Site Specific Factor 2 to code information. See the site-specific schemas for acceptable codes and their definitions.

Site/Histology Factor Head and neck* Extracapsular Extension, Lymph Nodes for Head and Neck Liver Fibrosis Score Malignant Melanoma of Skin, Vulva, Penis, Scrotum Ulceration Breast Progesterone Receptor Assay (PRA) Prostate Prostate Specific Antigen (PSA) Testis Human Chorionic Gonadotropin (HCG) Hodgkin and non-Hodgkin Lymphoma Symptoms at Diagnosis

______* Head and neck includes the following schemas: upper lip; lower lip; other lip; base of tongue; anterior tongue; upper gum; lower gum and retromolar trigone; other gum; floor of mouth; hard palate; soft palate/uvula; other mouth; buccal mucosa; parotid gland; submandibular gland; other salivary glands; oropharynx; anterior surface of epiglottis; nasopharynx; pyriform sinus/ hypopharynx; other pharynx; nasal cavity; middle ear; maxillary sinus; ethmoid sinus; other sinus; glottic larynx; supraglottic larynx; subglottic larynx; other larynx

Version date: January 1, 2004 49 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Site-Specific Factor 2, continued 3. Code 000 Not done is used when there is a statement in the record that a test was not performed. a. If there is no report of a lab test in the health record, code as 999 Unknown; Not documented in patient record. b. For malignant melanoma of skin, if ulceration is not mentioned in the pathology report, code as 000 No ulceration present.

Version date: January 1, 2004 50 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS SITE-SPECIFIC FACTOR 3 Item Length: 3 NAACCR Item #2900

Description Identifies additional information needed to generate stage, or prognostic factors that have an effect on stage or survival.

Code Description 000 None SITE/HISTOLOGY-SPECIFIC CODES 999 Unknown; [site-specific title] cannot be assessed; Not documented in patient record

For schemas that do not use this site-specific factor:

Code Description 888 Not applicable for this site

Instructions for Coding 1. If there is no site/histology-specific factor for a schema, code 888.

2. The following primary sites use Site Specific Factor 3 to code information. See the site-specific schemas for acceptable codes and their definitions.

Site/Histology Factor Head and Neck* Levels I-III, Lymph Nodes of Head and Neck Malignant Melanoma of Skin, Vulva, Penis, Scrotum Clinical Status of Lymph Node Mets Breast Number of Positive Ipsilateral Axillary Lymph Nodes Prostate CS Extension - Pathologic Extension Testis LDH (Lactate Dehydrogenase) Lymphoma International Prognostic Index (IPI) Score

______* Head and neck includes the following schemas: upper lip; lower lip; other lip; base of tongue; anterior tongue; upper gum; lower gum and retromolar trigone; other gum; floor of mouth; hard palate; soft palate/uvula; other mouth; buccal mucosa; parotid gland; submandibular gland; other salivary glands; oropharynx; anterior surface of epiglottis; nasopharynx; pyriform sinus/ hypopharynx; other pharynx; nasal cavity; middle ear; maxillary sinus; ethmoid sinus; other sinus; glottic larynx; supraglottic larynx; subglottic larynx; other larynx

3. Code 000 Not done is used when there is a statement in the record that a test was not performed. a. If there is no report of a lab test in the health record, code as 999 Unknown; Not documented in patient record. b. For the lymphomas, if the IPI score is not stated in the record, code as 999 Unknown; Not documented in patient record. It is not necessary to calculated the IPI score from other information in the record.

Version date: January 1, 2004 51 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Site-Specific Factor 3, continued For head and neck sites only: 4. Use code 9 only when it is unknown if lymph nodes are involved. Within the Site-Specific Factors, do not code 9 in some positions and 0 or 1 in other positions. If specific information is available about the positive or negative status of some but not all nodes in any one level or group, assume that the rest of the nodes in the same Site-Specific Factor are negative and code accordingly.

5. When the only information available is “Regional nodes, NOS” or “Cervical nodes, NOS” or “Internal jugular lymph nodes, NOS” or “Lymph nodes, NOS,” code 0 in all digits of Site-Specific Factors 3-6.

6. See “Coding Regional Lymph Nodes for Head and Neck Sites” under CS Lymph Nodes for further information about the regional nodes of the head and neck, including definitions of the levels.

Version date: January 1, 2004 52 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS SITE-SPECIFIC FACTOR 4 Item Length: 3 NAACCR Item #2910

Description Identifies additional information needed to generate stage, or prognostic factors that have an effect on stage or survival.

Code Description 000 None SITE/HISTOLOGY-SPECIFIC CODES 999 Unknown; [site-specific title] cannot be assessed; Not documented in patient record

For schemas that do not use this site-specific factor:

Code Description 888 Not applicable for this site

Instructions for Coding 1. If there is no site/histology-specific factor for a schema, code 888.

2. The following primary sites use Site Specific Factor 4 to code information. See the site-specific schemas for acceptable codes and their definitions.

Site/Histology Factor Head and Neck* Levels IV-V, Lymph Nodes of Head and Neck Malignant Melanoma of Skin, Vulva, Penis, Scrotum Lactate Dehydrogenase (LDH) Breast Immunohistochemistry (IHC) of Regional Lymph Nodes Prostate Prostatic Acid Phosphatase (PAP) Testis Radical Orchiectomy Performed

______* Head and neck includes the following schemas: upper lip; lower lip; other lip; base of tongue; anterior tongue; upper gum; lower gum and retromolar trigone; other gum; floor of mouth; hard palate; soft palate/uvula; other mouth; buccal mucosa; parotid gland; submandibular gland; other salivary glands; oropharynx; anterior surface of epiglottis; nasopharynx; pyriform sinus/ hypopharynx; other pharynx; nasal cavity; middle ear; maxillary sinus; ethmoid sinus; other sinus; glottic larynx; supraglottic larynx; subglottic larynx; other larynx

3. Code 000 Not done is used when there is a statement in the record that a test was not performed. a. If there is no report of a lab test in the health record, code as 999 Unknown; Not documented in patient record.

Version date: January 1, 2004 53 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Site-Specific Factor 4, continued For head and neck sites only: 4. Use code 9 only when it is unknown if lymph nodes are involved. Within the Site-Specific Factors, do not code 9 in some positions and 0 or 1 in other positions. If specific information is available about the positive or negative status of some but not all nodes in any one level or group, assume that the rest of the nodes in the same Site-Specific Factor are negative and code accordingly.

5. When the only information available is “Regional nodes, NOS” or “Cervical nodes, NOS” or “Internal jugular lymph nodes, NOS” or “Lymph nodes, NOS,” code 0 in all digits of Site-Specific Factors 3-6.

6. See “Coding Regional Lymph Nodes for Head and Neck Sites” under CS Lymph Nodes for further information about the regional nodes of the head and neck, including definitions of the levels.

Version date: January 1, 2004 54 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS SITE-SPECIFIC FACTOR 5 Item Length: 3 NAACCR Item #2920

Description Identifies additional information needed to generate stage, or prognostic factors that have an effect on stage or survival.

Code Description 000 None SITE/HISTOLOGY-SPECIFIC CODES 999 Unknown; [site-specific title] cannot be assessed; Not documented in patient record

For schemas that do not use this site-specific factor:

Code Description 888 Not applicable for this site

Instructions for Coding 1. If there is no site/histology-specific factor for a schema, code 888.

2. The following primary sites use Site Specific Factor 5 to code information. See the site-specific schemas for acceptable codes and their definitions.

Site/Histology Factor Head and Neck* Levels VI-VIII, Lymph Nodes of Head and Neck Breast Molecular Studies of Regional Lymph Nodes Prostate Gleason’s Primary and Secondary Patterns Testis Size of Metastasis in Lymph Nodes

______* Head and neck includes the following schemas: upper lip; lower lip; other lip; base of tongue; anterior tongue; upper gum; lower gum and retromolar trigone; other gum; floor of mouth; hard palate; soft palate/uvula; other mouth; buccal mucosa; parotid gland; submandibular gland; other salivary glands; oropharynx; anterior surface of epiglottis; nasopharynx; pyriform sinus/ hypopharynx; other pharynx; nasal cavity; middle ear; maxillary sinus; ethmoid sinus; other sinus; glottic larynx; supraglottic larynx; subglottic larynx; other larynx

3. Code 000 Not done is used when there is a statement in the record that a test was not performed. a. If there is no report of a lab test in the health record, code as 999 Unknown; Not documented in patient record.

For head and neck sites only: 4. Use code 9 only when it is unknown if lymph nodes are involved. Within the Site-Specific Factors, do not code 9 in some positions and 0 or 1 in other positions. If specific information is available about the positive or negative status of some but not all nodes in any one level or group, assume that the rest of the nodes in the same Site-Specific Factor are negative and code accordingly.

Version date: January 1, 2004 55 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Site-Specific Factor 5, continued 5. When the only information available is “Regional nodes, NOS” or “Cervical nodes, NOS” or “Internal jugular lymph nodes, NOS” or “Lymph nodes, NOS,” code 0 in all digits of Site-Specific Factors 3-6.

6. See “Coding Regional Lymph Nodes for Head and Neck Sites” under CS Lymph Nodes for further information about the regional nodes of the head and neck, including definitions of the levels.

Version date: January 1, 2004 56 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS SITE-SPECIFIC FACTOR 6 Item Length: 3 NAACCR Item #2930

Description Identifies additional information needed to generate stage, or prognostic factors that have an effect on stage or survival.

Code Description 000 None SITE/HISTOLOGY-SPECIFIC CODES 999 Unknown; [site-specific title] cannot be assessed; Not documented in patient record

For schemas that do not use this site-specific factor:

Code Description 888 Not applicable for this site

Instructions for Coding 1. If there is no site/histology-specific factor for a schema, code 888.

2. The following primary sites use Site Specific Factor 6 to code information. See the site-specific schemas for acceptable codes and their definitions.

Site/Histology Factor Head and Neck* Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Breast Size of Tumor--Invasive Component Prostate Gleason’s Score

______* Head and neck includes the following schemas: upper lip; lower lip; other lip; base of tongue; anterior tongue; upper gum; lower gum and retromolar trigone; other gum; floor of mouth; hard palate; soft palate/uvula; other mouth; buccal mucosa; parotid gland; submandibular gland; other salivary glands; oropharynx; anterior surface of epiglottis; nasopharynx; pyriform sinus/ hypopharynx; other pharynx; nasal cavity; middle ear; maxillary sinus; ethmoid sinus; other sinus; glottic larynx; supraglottic larynx; subglottic larynx; other larynx

3. Code 000 Not done is used when there is a statement in the record that a test was not performed. a. If there is no report of a lab test in the health record, code as 999 Unknown; Not documented in patient record.

Version date: January 1, 2004 57 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Site-Specific Factor 6, continued

For head and neck sites only: 4. Use code 9 only when it is unknown if lymph nodes are involved. Within the Site-Specific Factors, do not code 9 in some positions and 0 or 1 in other positions. If specific information is available about the positive or negative status of some but not all nodes in any one level or group, assume that the rest of the nodes in the same Site-Specific Factor are negative and code accordingly.

5. When the only information available is “Regional nodes, NOS” or “Cervical nodes, NOS” or “Internal jugular lymph nodes, NOS” or “Lymph nodes, NOS,” code 0 in all digits of Site-Specific Factors 3-6.

6. See “Coding Regional Lymph Nodes for Head and Neck Sites” under CS Lymph Nodes for further information about the regional nodes of the head and neck, including definitions of the levels.

Version date: January 1, 2004 58 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

ADDITIONAL COLLABORATIVE STAGING TABLES

In addition to the tables of codes for each of the Collaborative Staging System data items, it was necessary to develop reference tables that the computer algorithm uses to assure that the output data items (T, N, M, Stage Group, SS77 and SS2000) are accurately derived. These tables are not printed in this manual, usually because of their length. Any reference tables that have been developed for individual schema are listed at the top of the schema in Part II of this manual but are not printed in the manual. They are available for reference on the Collaborative Staging website, www.cancerstaging.org.

AJCC STAGE TABLE The allowable storage codes for derived T, N, M and Stage Group are shown in Appendix 2 with their output character strings. The AJCC stage tables are site-specific and are not included in this manual due to their length. The data collector or researcher can access the AJCC stage table associated with each schema under the appropriate site-specific section of the Collaborative Staging website, www.cancerstaging.org.

SUMMARY STAGE TABLE The summary stage conversion table is shown in Appendix 3. This table evaluates the CS Extension, CS Lymph Nodes, and CS Mets at Dx fields to determine the final Summary Stage 77 and Summary Stage 2000 output (Appendix 2e). The Summary Stage Table applies to all schemas and lists all possible combinations, including Not Applicable, Unstagable and Error situations. The algorithm takes the highest (most extensive value) from any of the three input fields as the output value. For example, if the Extension code maps to regional direct extension, the Lymph Nodes code maps to regional lymph nodes, and no distant metastases are coded in the Mets at Dx field, the output value will be RE+RN, regional extension and nodes.

HISTOLOGY EXCLUSION TABLES It has been previously noted that not all cases will have T, N, M, and Stage Group categories derived by the computer algorithm. This is because certain histologies are excluded from some chapters of the AJCC Cancer Staging Manual, sixth edition. In order that the Collaborative Staging System could accurately derive the components of the TNM system only for the histologies allowed in the AJCC manual, tables of allowable and excluded ICD-O-3 histology have been developed with the cooperation of the AJCC. These lists are shown in Appendix 5 of this manual. The nine major categories of cancers are shown with their associated three-digit morphology code ranges.

For example, in TNM staging, carcinoids are specifically excluded from the colon cancer chapter. If a malignant carcinoid case is abstracted, all of the 10 data items for colon should be recorded (9 basic data items plus one site-specific factor for colon). The computer algorithm will look at the recorded ICD-O-3 morphology coded and match it to the exclusions table for colon. Because carcinoid (M-8240/3) is on the exclusions list, the algorithm will not generate a T, N, M or Stage Group, but will generate both Summary Stage 1977 and 2000.

SITE-SPECIFIC EXTRA TABLES In the introduction to this manual it was noted that some schemas require additional reference tables in order for the computer algorithm to determine the final derived T, N, M, or Stage Group output. The need for these extra tables arises when additional information is needed to differentiate, for example, a T1a from a T1b, or when the tumor size is a significant factor in determining the T category.

Version date: January 1, 2004 59 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

For example, it is necessary to combine information from both the tumor size table and the extension table in order to derive the T category for breast cancer. If the tumor extension is purely in situ, the derived T is Tis; if the tumor extension involves the skin or chest wall, the derived T is one of the T4 subcategories. But if the tumor extension is in the range of 10-30, it is necessary to know the exact size of the tumor. The computer algorithm looks at the “Extension Size Table” for breast to determine the correct output. In the table below, if the Extension code is 10 and the tumor size is coded 018 (1.8 cm), the computer algorithm will read the sixth line of the table and output a T1c. If the extension code is 20 and the tumor size is coded 055, the computer algorithm will read the eighth line of the table and output a T3.

Figure 3. Example of “Extension Size Table” for Breast Schema Note: For Extension codes 10, 20, and 30 ONLY, the T category is assigned based on value of CS Tumor Size, as follows: From To T Code Comment Tumor Tumor Size Size 000 000 ERROR Tumor size 000 should only be used with Extension 95. 001 001 T1mic 002 005 T1a 006 010 T1b 011 020 T1c 021 050 T2 051 989 T3 990 990 T1mic 991 991 T1b 992 992 T1c 993 995 T2NOS 996 996 T1NOS 997 997 ERROR Tumor size 997 should only be used with Extension code 05 or 07. 998 998 T3 999 999 TX

As another example, the patient’s age and histology must be known in order to stage a thyroid cancer. Several additional tables on the thyroid schema are used by the computer algorithm to determine the TNM Stage Group when the patient is under or over age 45 and the histology is papillary/follicular, medullary or anaplastic.

Version date: January 1, 2004 60 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Appendices

1. Determining Descriptive Tumor Size

2. Output Values, Storage Codes, and Display String Descriptions for T, N, M, Stage Group and Summary Stage

3. Summary Stage Conversion Algorithm for All Schemas

4. Site Specific Factors

5. Histology Exclusion Groups

Version date: January 1, 2004 61 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Appendix 1. Determining Descriptive Tumor Size Millimeter Equivalents for Descriptive Terms Fruits mm Miscellaneous Food mm Apple 070 Doughnut 090 Apricot 040 Egg 050 Cherry 020 Bantam 040 Date 040 Goose 070 Fig (dried) 040 Hen 030 Grape 020 Pigeon 030 Grapefruit 100 Robin 020 Kumquat 050 Lentil 991 Lemon 080 Millet 991 Olive 020 Orange 090 Money Peach 060 Dime 010 Pear 090 Dollar, half 030 Plum 030 Dollar, silver 040 Tangerine 060 Nickel 020 Penny 010 Nuts Quarter 020 Almond 030 Chestnut 040 Chestnut, horse 040 Other Hazel 020 Ball, golf 040 Hickory 030 Ball, ping-pong 030 Peanut 010 Ball, tennis 060 Pecan 030 Baseball 070 Walnut 030 Eraser on pencil 991 Fist 090 Vegetables Marble 010 Bean 010 Matchhead 991 Bean, lima 020 Pea 991 Microscopic focus 990 Pea, split 991 Described as less than 1 cm. 991 Described as between 1 and 2 cm 992 Described as between 2 and 3 cm 993 Described as between 3 and 4 cm 994 Described as between 4 and 5 cm 995

SIZES IN CENTIMETERS, MILLIMETERS, INCHES 10 millimeters (mm) = 1 centimeter (cm) 1 millimeter (mm) = 1/10 centimeter (cm) 2.5 centimeters (cm) = 1 inch (in) 1 centimeter (cm) = .394 inch (in)

Version date: January 1, 2004 62 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

APPENDIX 2. ALLOWABLE VALUES

Appendix 2a. T Allowable Codes This table shows the allowable values for the generated Collaborative Stage data items. The Storage Code is the value to be stored in the field of a NAACCR record. The Storage Codes are designed for analysis. The Display String is the corresponding label that should be displayed on the screen or in a report. The meaning of these strings will be clear to the registrar or physician user.

Storage Code Display String* Display String Description 99 TX TX 00 T0 T0 01 Ta Ta 05 Tis Tis 06 Tispu Tispu (Urethra only) 07 Tispd Tispd (Urethra only) 10 T1 T1 11 T1mic T1mic 12 T1a T1a 13 T1a1 T1a1 14 T1a2 T1a2 15 T1b T1b 16 T1b1 T1b1 17 T1b2 T1b2 18 T1c T1c 19 T1NOS T1 NOS 20 T2 T2 29 T2NOS T2 NOS 21 T2a T2a 22 T2b T2b 23 T2c T2c 30 T3 T3 39 T3NOS T3 NOS 31 T3a T3a 32 T3b T3b 33 T3c T3c 40 T4 T4 49 T4NOS T4 NOS 41 T4a T4a 42 T4b T4b 43 T4c T4c 44 T4d T4d 88 NA Not applicable

* T_ with no subscript indicates that there is only one choice for that category T_ NOS indicates that there are additional choices for the category but a more specific code cannot be determined.

Version date: January 1, 2004 63 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Appendix 2b. N Allowable Codes This table shows the allowable values for the generated Collaborative Stage data items. The Storage Code is the value to be stored in the field of a NAACCR record. The Storage Codes are designed for analysis. The Display String is the corresponding label that should be displayed on the screen or in a report. The meaning of these strings will be clear to the registrar or physician user.

Storage Code Display String* Display String Description 99 NX NX 00 N0 N0 09 N0NOS N0 NOS 01 N0(i-) N0(i-) 02 N0(i+) N0(i+) 03 N0(mol-) N0(mol-) 04 N0(mol+) N0(mol+) 10 N1 N1 19 N1NOS N1 NOS 11 N1a N1a 12 N1b N1b 13 N1c N1c 18 N1mi N1mi 20 N2 N2 29 N2NOS N2 NOS 21 N2a N2a 22 N2b N2b 23 N2c N2c 30 N3 N3 39 N3NOS N3 NOS 31 N3a N3a 32 N3b N3b 33 N3c N3c 88 NA Not applicable

* N_ with no subscript indicates that there is only one choice for that category N_ NOS indicates that there are additional choices for the category but a more specific code cannot be determined.

Version date: January 1, 2004 64 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Appendix 2c. M Allowable Codes This table shows the allowable values for the generated Collaborative Stage data items. The Storage Code is the value to be stored in the field of a NAACCR record. The Storage Codes are designed for analysis. The Display String is the corresponding label that should be displayed on the screen or in a report. The meaning of these strings will be clear to the registrar or physician user.

Storage Code Display String* Display String Description 99 MX MX 00 M0 M0 10 M1 M1 11 M1a M1a 12 M1b M1b 13 M1c M1c 19 M1NOS M1 NOS 88 NA Not applicable * M_ with no subscript indicates that there is only one choice for that category M_ NOS indicates that there are additional choices for the category but a more specific code cannot be determined.

Appendix 2d. Stage Allowable Codes This table shows the allowable values for the generated Collaborative Stage data items. The Storage Code is the value to be stored in the field of a NAACCR record. The Storage Codes are designed for analysis. The Display String is the corresponding label that should be displayed on the screen or in a report. The meaning of these strings will be clear to the registrar or physician user.

Storage Code Display String* Display String Description 00 0 Stage 0 01 0a Stage 0a 02 0is Stage 0is 10 I Stage I 11 INOS Stage I NOS 12 IA Stage IA

13 IA1 Stage IA1 14 IA2 Stage IA2 15 IB Stage IB 16 IB1 Stage IB1 17 IB2 Stage IB2 18 IC Stage IC 19 IS Stage IS 23 ISA Stage ISA (lymphoma only)

24 ISB Stage ISB (lymphoma only)

20 IEA Stage IEA (lymphoma only)

21 IEB Stage IEB (lymphoma only) 22 IE Stage IE (lymphoma only) 30 II Stage II

Version date: January 1, 2004 65 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Appendix 2d continued Display String Display String Description Storage Code 31 IINOS Stage II NOS

32 IIA Stage IIA

33 IIB Stage IIB 34 IIC Stage IIC 35 IIEA Stage IIEA (lymphoma only) 36 IIEB Stage IIEB (lymphoma only) 37 IIE Stage IIE (lymphoma only) 38 IISA Stage IISA (lymphoma only) 39 IISB Stage IISB (lymphoma only)

40 IIS Stage IIS (lymphoma only) 41 IIESA Stage IIESA (lymphoma only) 42 IIESB Stage IESB (lymphoma only) 43 IIES Stage IIES (lymphoma only) 50 III Stage III 51 IIINOS Stage III NOS

52 IIIA Stage IIIA 53 IIIB Stage IIIB 54 IIIC Stage IIIC 55 IIIEA Stage IIIEA (lymphoma only) 56 IIIEB Stage IIIEB (lymphoma only) 57 IIIE Stage IIIE (lymphoma only) 58 IIISA Stage IIISA (lymphoma only) 59 IIISB Stage IIISB (lymphoma only) 60 IIIS Stage IIIS (lymphoma only) 61 IIIESA Stage IIIESA (lymphoma only) 62 IIIESB Stage IIIESB (lymphoma only) 63 IIIES Stage IIIES (lymphoma only) 70 IV Stage IV 71 IVNOS Stage IV NOS

72 IVA Stage IVA 73 IVB Stage IVB 74 IVC Stage IVC 88 NA Not applicable 90 OCCULT Stage Occult 99 UNK Stage Unknown

* A stage group with no subscript indicates that there is only one choice for that category A stage group NOS indicates that there are additional choices for the category but a more specific code cannot be determined.

Version date: January 1, 2004 66 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Appendix 2e. Summary Stage Allowable Codes This table shows the allowable values for the generated Collaborative Stage data items. The Storage Code is the value to be stored in the field of a NAACCR record. The Storage Codes are designed for analysis. The Display String is the corresponding label that should be displayed on the screen or in a report. The meaning of these strings will be clear to the registrar or physician user.

Storage Code Display String Display String Description ERROR Processing error (no storage code needed) NONE None (internal use only, no storage code needed) 0ISIn situ 1 L Localized 2 RE Regional, direct extension 3 RN Regional, lymph nodes only 4 RE+RN Regional, extension and nodes 5 RNOS Regional, NOS 7 D Distant 8 NA Not applicable 9 U Unknown/Unstaged

Version date: January 1, 2004 67 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Appendix 3. Summary Stage Conversion Algorithm for All Schemas

* In situ implies no involvement outside Extension LN SS77 Mets SS77 Final SS77 Extension LN SS77 Mets SS77 Final SS77 the primary site. SS77 or or or SS2000 or SS2000 SS77 or or or SS2000 or SS2000 SS2000 SS2000 result result SS2000 SS2000 result result result result result result Extension LN SS77 Mets Final SS77 SS77 or or SS77 or or SS2000 IS * D RE+RN ERROR L RN RE RE+RN SS2000 SS2000 SS2000 result IS * D D ERROR L RN RN RN result result result IS * D NA ERROR L RN RE+RN RE+RN IS * NONE NONE IS IS * D U ERROR L RN D D IS * NONE L ERROR IS NA NONE IS L RN NA RN IS * NONE RE ERROR IS * NA L ERROR L RN U RN IS * NONE RN ERROR IS * NA RE ERROR L RE+RN NONE RE+RN IS * NONE RE+RN ERROR IS * NA RN ERROR L RE+RN L RE+RN IS * NONE D ERROR IS * NA RE+RN ERROR L RE+RN RE RE+RN IS NONE NA IS IS * NA D ERROR L RE+RN RN RE+RN IS NONE U IS IS NA NA IS L RE+RN RE+RN RE+RN IS * RE NONE ERROR IS NA U IS L RE+RN D D IS * RE L ERROR IS * U NONE IS L RE+RN NA RE+RN IS * RE RE ERROR IS * U L ERROR L RE+RN U RE+RN IS * RE RN ERROR IS * U RE ERROR L D NONE D IS * RE RE+RN ERROR IS * U RN ERROR L D L D IS * RE D ERROR IS * U RE+RN ERROR L D RE D IS * RE NA ERROR IS * U D ERROR L D RN D IS * RE U ERROR IS U NA IS L D RE+RN D IS * RN NONE ERROR IS U U IS L D D D IS * RN L ERROR L NONE NONE L L D NA D IS * RN RE ERROR L NONE L L L D U D IS * RN RN ERROR L NONE RE RE L NA NONE L IS * RN RE+RN ERROR L NONE RN RN L NA L L IS * RN D ERROR L NONE RE+RN RE+RN L NA RE RE IS * RN NA ERROR L NONE D D L NA RN RN IS * RN U ERROR L NONE NA L L NA RE+RN RE+RN IS * RE+RN NONE ERROR L NONE U L L NA D D IS * RE+RN L ERROR L RE NONE RE L NA NA L IS * RE+RN RE ERROR L RE L RE L NA U L IS * RE+RN RN ERROR L RE RE RE L U NONE L IS * RE+RN RE+RN ERROR L RE RN RE+RN L U L L IS * RE+RN D ERROR L RE RE+RN RE+RN L U RE RE IS * RE+RN U ERROR L RE D D L U RN RN IS * D NONE ERROR L RE NA RE L U RE+RN RE+RN IS * D L ERROR L RE U RE L U D D IS * D RE ERROR L RN NONE RN L U NA L IS * D RN ERROR L RN L RN L U U L

Version date: January 1, 2004 68 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Extension LN SS77 Mets SS77 Final SS77 Extension LN SS77 Mets SS77 Final SS77 Extension LN SS77 Mets SS77 Final SS77 SS77 or or or SS2000 or SS2000 SS77 or or or SS2000 or SS2000 SS77 or or or SS2000 or SS2000 SS2000 SS2000 result result SS2000 SS2000 result result SS2000 SS2000 result result result result result result result result RE NONE NONE RE RE NA NONE RE RNOS RE+RN NONE RNOS RE NONE L RE RE NA L RE RNOS RE+RN L RNOS RE NONE RE RE RE NA RE RE RNOS RE+RN RE RNOS RE NONE RN RE+RN RE NA RN RE+RN RNOS RE+RN RN RNOS RE NONE RE+RN RE+RN RE NA RE+RN RE+RN RNOS RE+RN RE+RN RNOS RE NONE D D RE NA D D RNOS RE+RN D D RE NONE NA RE RE NA NA RE RNOS RE+RN NA RNOS RE NONE U RE RE NA U RE RNOS RE+RN U RNOS RE RE NONE RE RE U NONE RE RNOS D NONE D RE RE L RE RE U L RE RNOS D L D RE RE RE RE RE U RE RE RNOS D RE D RE RE RN RE+RN RE U RN RE+RN RNOS D RN D RE RE RE+RN RE+RN RE U RE+RN RE+RN RNOS D RE+RN D RE RE D D RE U D D RNOS D D D RE RE NA RE RE U NA RE RNOS D NA D RE RE U RE RE U U RE RNOS D U D RE RN NONE RE+RN RNOS NONE NONE RNOS RNOS NA NONE RNOS RE RN L RE+RN RNOS NONE L RNOS RNOS NA L RNOS RE RN RE RE+RN RNOS NONE RE RNOS RNOS NA RE RNOS RE RN RN RE+RN RNOS NONE RN RNOS RNOS NA RN RNOS RE RN RE+RN RE+RN RNOS NONE RE+RN RNOS RNOS NA RE+RN RNOS RE RN D D RNOS NONE D D RNOS NA D D RE RN NA RE+RN RNOS NONE NA RNOS RNOS NA NA RNOS RE RN U RE+RN RNOS NONE U RNOS RNOS NA U RNOS RE RE+RN NONE RE+RN RNOS RE NONE RNOS RNOS U NONE RNOS RE RE+RN L RE+RN RNOS RE L RNOS RNOS U L RNOS RE RE+RN RE RE+RN RNOS RE RE RNOS RNOS U RE RNOS RE RE+RN RN RE+RN RNOS RE RN RNOS RNOS U RN RNOS RE RE+RN RE+RN RE+RN RNOS RE RE+RN RNOS RNOS U RE+RN RNOS RE RE+RN D D RNOS RE D D RNOS U D D RE RE+RN NA RE+RN RNOS RE NA RNOS RNOS U NA RNOS RE RE+RN U RE+RN RNOS RE U RNOS RNOS U U RNOS RE D NONE D RNOS RN NONE RNOS D NONE NONE D RE D L D RNOS RN L RNOS D NONE L D RE D RE D RNOS RN RE RNOS D NONE RE D RE D RN D RNOS RN RN RNOS D NONE RN D RE D RE+RN D RNOS RN RE+RN RNOS D NONE RE+RN D RE D D D RNOS RN D D D NONE D D RE D NA D RNOS RN NA RNOS D NONE NA D

RE D U D RNOS RN U RNOS D NONE U D

Version date: January 1, 2004 69 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Extension LN SS77 Mets SS77 Final SS77 Extension LN SS77 Mets SS77 Final SS77 Extension LN SS77 Mets SS77 Final SS77 SS77 or or or SS2000 or SS2000 SS77 or or or SS2000 or SS2000 SS77 or or or SS2000 or SS2000 SS2000 SS2000 result result SS2000 SS2000 result result SS2000 SS2000 result result result result result result result result D RE NONE D D U NONE D NA D NONE D D RE L D D U L D NA D L D D RE RE D D U RE D NA D RE D D RE RN D D U RN D NA D RN D D RE RE+RN D D U RE+RN D NA D RE+RN D D RE D D D U D D NA D D D D RE NA D D U NA D NA D NA D D RE U D D U U D NA D U D D RN NONE D NA NONE NONE U NA NA NONE U D RN L D NA NONE L L NA NA L L D RN RE D NA NONE RE RE NA NA RE RE D RN RN D NA NONE RN RN NA NA RN RN D RN RE+RN D NA NONE RE+RN RE+RN NA NA RE+RN RE+RN D RN D D NA NONE D D NA NA D D D RN NA D NA NONE NA U NA NA NA NA D RN U D NA NONE U U NA NA U U D RE+RN NONE D NA RE NONE RE NA U NONE U D RE+RN L D NA RE L RE NA U L L D RE+RN RE D NA RE RE RE NA U RE RE D RE+RN RN D NA RE RN RE+RN NA U RN RN D RE+RN RE+RN D NA RE RE+RN RE+RN NA U RE+RN RE+RN D RE+RN D D NA RE D D NA U D D D RE+RN NA D NA RE NA RE NA U NA U D RE+RN U D NA RE U RE NA U U U D D NONE D NA RN NONE RN U NONE NONE U D D L D NA RN L RN U NONE L L D D RE D NA RN RE RE+RN U NONE RE RE D D RN D NA RN RN RN U NONE RN RN D D RE+RN D NA RN RE+RN RE+RN U NONE RE+RN RE+RN D D D D NA RN D D U NONE D D D D NA D NA RN NA RN U NONE NA U D D U D NA RN U RN U NONE U U D NA NONE D NA RE+RN NONE RE+RN U RE NONE RE D NA L D NA RE+RN L RE+RN U RE L RE D NA RE D NA RE+RN RE RE+RN U RE RE RE D NA RN D NA RE+RN RN RE+RN U RE RN RE+RN D NA RE+RN D NA RE+RN RE+RN RE+RN U RE RE+RN RE+RN D NA D D NA RE+RN D D U RE D D D NA NA D NA RE+RN NA RE+RN U RE NA RE D NA U D NA RE+RN U RE+RN U RE U RE

Version date: January 1, 2004 70 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Extension LN SS77 Mets SS77 Final SS77 Extension LN SS77 Mets SS77 Final SS77 SS77 or or or SS2000 or SS2000 SS77 or or or SS2000 or SS2000 SS2000 SS2000 result result SS2000 SS2000 result result result result result result U RN NONE RN U D RE+RN D U RN L RN U D D D U RN RE RE+RN U D NA D U RN RN RN U D U D U RN RE+RN RE+RN U NA NONE U U RN D D U NA L L U RN NA RN U NA RE RE U RN U RN U NA RN RN U RE+RN NONE RE+RN U NA RE+RN RE+RN U RE+RN L RE+RN U NA D D U RE+RN RE RE+RN U NA NA U U RE+RN RN RE+RN U NA U U U RE+RN RE+RN RE+RN U U NONE U U RE+RN D D U U L L U RE+RN NA RE+RN U U RE RE U RE+RN U RE+RN U U RN RN U D NONE D U U RE+RN RE+RN U D L D U U D D U D RE D U U NA U U D RN D

Version date: January 1, 2004 71 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Appendix 4. Site Specific Factors

Schema SSF1 SSF2 SSF3 SSF4 SSF5 SSF6

LipUpper Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

LipLower Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

OthLip Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

BaseTongue Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

AntTongue Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

GumUpper Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

GumLower Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

OthGum Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

FOM Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

HardPalate Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

SoftPalate Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

OthMouth Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

BuccalMucosa Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

ParotidGland Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

Submandibular Gland Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

OthSalivary Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

Version date: January 1, 2004 72 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Schema SSF1 SSF2 SSF3 SSF4 SSF5 SSF6

Oropharynx Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

AntEpiglottis Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

Nasopharynx Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

Hypopharynx Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

OthPharynx Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

Esophagus none

Stomach none

SmallIntestine none

Colon Carcino- embryonic Antigen (CEA)

Rectosigmoid, Rectum Carcino- embryonic Antigen (CEA)

Anus none

Liver Alpha Fibrosis Score Fetoprotein (AFP)

Gallbladder none

OthBiliary none

ExtraHepaticDucts none

Ampulla none

PancreasHead none

PancreasBodyTail none

OthPancreas none

OthDigestive none

NasalCavity Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

MiddleEar Size of LNs Extracaps. H&N LN H&N LN H&N LN Otn LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VII Levels H&N

MaxillarySinus Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

Version date: January 1, 2004 73 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Schema SSF1 SSF2 SSF3 SSF4 SSF5 SSF6

EthmoidSinus Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

OthSinus Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

GlotticLarynx Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

SupraLarynx Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

SubLarynx Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

OthLarynx Size of LNs Extracaps. H&N LN H&N LN H&N LN Oth LN Group Exten. LN for Levels I-III Levels IV-V Levels VI-VIII Levels H&N

Trachea none

Lung none

HeartMediastinum none

Pleura Pleural Effusion

OthRespiratory none

Bone none

Skin none

SkinEyelid none

Melanoma (of Skin, Measured Ulceration Clinical LDH Vulva, Penis, Scrotum) Thickness Status of LN (depth) Mets Breslow’s

MF Peripheral Blood Involvement

SoftTissue none

Peritoneum none

Breast ERA PRA # Pos. Ipsilat IHC of LNs Molecular Size of Tumor Ax LNs Studies Reg Invasive LNs Component

Vulva none

Vagina none

Cervix none

Corpus none

Ovary CA-125

FallopianTube none

Version date: January 1, 2004 74 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Schema SSF1 SSF2 SSF3 SSF4 SSF5 SSF6

OthAdnexa none

OthFemaleGen none

Placenta Prognostic Scoring Index

Penis none

Prostate PSA Lab PSA CS Path PAP Gleason’s Gleason’s Value Extension Prim and 2nd Score Patterns

Testis AFP HCG LDH Radical Size of Mets Orchiectomy in LNs

OthMaleGen none

Scrotum none

Kidney none

RenalPelvis none

Bladder none

Urethra none

OthUrinary none

Conjunctiva none

Melanoma Conjunctiva Measured Thickness (depth) Breslow’s

OthEye none

MelanomaChoroid Measured Thickness (depth) Breslow’s

MelamonaIrisCiliary Measured Thickness (depth) Breslow’s

MelanomaOthEye none

LacrimalGland none

Orbit none

Retinoblastoma Extension Evaluated at Enucleation

Brain WHO grade

OthCNS WHO grade

Thyroid Solitary vs Multifocal

OthEndocrine WHO grade

Version date: January 1, 2004 75 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Schema SSF1 SSF2 SSF3 SSF4 SSF5 SSF6

KS Assoc w/ HIV/AIDS

Lymphoma Assoc w/ Symptoms at IPI score HIV/AIDS Diagnosis

HemeRetic none

OthIllDef none

Version date: January 1, 2004 76 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Appendix 5. Histology Exclusion Groups based on ICD-O-3 Morphology Codes

Histology Code Groupings for Collaborative Staging Carcinomas 800-823, 825-867; 894 Carcinoids 824 Melanomas 872-879 Sarcomas 871; 880-892; 899; 904; 912-913; 915-925; 937; 954-958 Other specified 868-870; 893; 895-898; 900-903; 906-911; 926-936; 938-953 cancers Mesotheliomas 905 Kaposi sarcoma 914 Lymphomas 959-972 Hematopoietic 973-976; 976; 980-996; 997; 998

In the following table, ‘x’ in a cell means that category of cancer is excluded from AJCC staging for that site. The CS algorithm will output T-NA, N-NA, M-NA, Stage Group-NA. Conversely, an empty cell means that all histologies in that code grouping will generate (output) T, N, M, and Stage Group. A schema name marked with an asterisk (*) means that there is no TNM staging scheme in the sixth edition. For these sites, all histologies are included and only Summary Stage will be generated.

Schema Carci- Carci- Mela- Sar- Other Mesothe- Kaposi Lym- Hema- Other noma noid noma coma specified lioma sarcoma phoma topoi- exclu- cancers etic sions Lip: Upper; Lower; xxxx x x xx Other Base of Tongue x x x x x x x x Anterior 2/3 of xxxx x x xx Tongue Gum: Upper; Lower; xxxx x x xx NOS Floor of Mouth x x x x x x x x Hard Palate x x x x x x x x Soft Palate x x x x x x x x Other Mouth x x x x x x x x Buccal Mucosa x x x x x x x x Parotid Gland x x x x x x x x Submandibular Gland x x x x x x x x Other Salivary Gland x x x x x x x x Tonsil, Oropharynx x x x x x x x x Anter Surface of xxxx x x xx Epiglottis Nasopharynx x x x x x x x x Pyriform Sinus; xxxx x x xx Hypopharynx Other Pharynx* Esophagus x x x x x x x x Stomach x x x x x x x x Small Intestine x x x x x x x x Colon x x x x x x x x Rectosigmoid; xxxx x x xx Rectum Anus xxxx x x xx Liver, intrahepatic xxxx x x xx ducts Gallbladder x x x x note 1 x x x x Extrahepatic Ducts x x x x x x x x Ampulla of Vater x x x x x x x x 8013; 8041; 8246; 8247; 8574

Version date: January 1, 2004 77 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Schema Carci- Carci- Mela- Sar- Other Mesothe- Kaposi Lym- Hema- Other noma noid noma coma specified lioma sarcoma phoma topoi- exclu- cancers etic sions Other Biliary x x x x x x x x Pancreas: Head x x x x x x x x 815_ Pancreas: Body, Tail x x x x x x x x 815_ Other Pancreas x x x x x x x x 815_ Other Digestive* Nasal Cavity x x x x x x x x Middle Ear* Maxillary Sinus x x x x x x x x Ethmoid Sinus x x x x x x x x Other Sinus* Glottic Larynx x x x x x x x x Supraglottic Larynx x x x x x x x x Subglottic Larynx x x x x x x x x Other Larynx x x x x x x x x Trachea* Lung x x x x x x x Heart, Mediastinum x x x x x x x x Pleura x x x x x x x x Other Respiratory* Bone x x x x note 2 x x x x Skin (Carcinoma) x x x x x x x x Eyelid (Carcinoma) x x x x x x x Skin (Melanoma) x x x x x x x x Mycosis Fungoides x x x x x x x x note 3 x Soft Tissue x x x x note 4 x x x x Retroperitoneum, x x x x note 4 x x x x Peritoneum Breast xxxx x x xx Vulva xxxx x x xx Vagina x x x x x x x x Cervix x x x x x x x x Corpus x x x x note 5 x x x x Ovary x x x x note 6 x x x x Fallopian Tube x x x x x x x x Ligaments, Other Adnexa* Other Female Genital* Placenta x x x x x note 7 x x x x Penis x x x x x x x x Prostate x x x x x x x x 813_ Testis x note 8 x x x x note 8 x x x x Other Male Genital* Scrotum x x x x x Kidney x x x x x x x x Renal pelvis, Ureter x x x x x x x x Urinary Bladder x x x x x x x x Urethra x x x x x x x x Other Urinary* Conjunctiva xxxx x x xx (Carcinoma) Conjunctiva xx x x x x xx (Melanoma) Melanoma of uvea x x x x x x x x Other Eye* Iris, Ciliary Body xx x x x x xx (Melanoma) Choroid (Melanoma) x x x x x x x x Other Eye xx x x x x xx (Melanoma)

Version date: January 1, 2004 78 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Schema Carci- Carci- Mela- Sar- Other Mesothe- Kaposi Lym- Hema- Other noma noid noma coma specified lioma sarcoma phoma topoi- exclu- cancers etic sions Lacrimal gland xxxx x x xx (Carcinoma) Orbit (Sarcoma) x x x x x x x x Retinoblastoma x x x x x note 9 x x x x Brain* Other CNS* Thyroid x x x x x x x x Other Endocrine* Kaposi Sarcoma–all xxxxx x xx sites* Lymphoma–all sites x x x x x x x x Hematopoietic, Retic* Other, Ill-Defined Sites*

Note 1: For gallbladder, 8980 is included for TNM Staging. Note 2: For bone, codes 9260-9342 are included for TNM Staging Note 3: For mycosis fungoides and Sezary disease, all histologies other than 9700 and 9701 are excluded. Note 4: For soft tissue and retroperitoneum/peritoneum, codes 8936 and 9473 are included for TNM Staging. Note 5: For corpus, 8951 is included for TNM Staging. Note 6: For ovary, morphology codes 906-909 are included for TNM Staging. Note 7: For placenta, 910 is included for TNM Staging. Note 8: For testis, 859-865 and 906-909 are included for TNM Staging. Note 9: For retinoblastoma, all histologies other than 951 are excluded.

Version date: January 1, 2004 79 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Index to Part I

A Coding rules summary ...... 21 Abstracting rules...... 2 Collaborative Staging Task Force ...... 1 Accessible primary sites...... 3, 14 Collaborative Staging web site ...... 11 Breast ...... 3, 14 Colon Lymph node involvement ...... 3, 14 CEA...... 47 Oral cavity...... 3, 14 CS Lymph Nodes ...... 35 Salivary gland ...... 3, 14 CS Site-Specific Factor 1...... 47 Skin...... 3, 14 Site-Specific Factors...... 13 Thyroid...... 3, 14 Tumor size...... 27 AFP...... 47 Combination codes ...... 12 Aggregate tumor size ...... 26 Composite tumor size ...... 26 AIDS/HIV ...... 48 Computer Algorithm ...... 4, 11, 21 AJCC Cancer Staging Manual ...... 1, 11 Contiguous (direct) extension AJCC stage allowable values ...... 65 CS Extension...... 29 AJCC Stage Table ...... 59 Corpus uteri AJCC staging not applicable...... 18 Discontinuous metastasis ...... 28 AJCC TNM staging...... 1, 11 Inaccessible primary site...... 3 Output from Collaborative Staging ...... 4 CS Extension Algorithm, computer...... 4, 11 Allowable Values...... 5 Allowable Values and Format for Collaborative Coding instructions ...... 28 Staging Data Items...... 5 In situ cancer...... 29 Alpha fetoprotein ...... 47 CS Extension - Pathologic Extension for prostate 51 Ambiguous terminology ...... 20 CS Lymph Nodes American Joint Committee on Cancer (AJCC).... 1 Allowable values ...... 5 Autopsy reports Coding instructions ...... 33 CS Mets Eval...... 45 None vs. unknown ...... 33 CS Reg Nodes Eval ...... 39, 40 Physician staging...... 35 CS Tumor Size/Ext Eval ...... 30, 31 CS Mets At Dx use of...... 13, 18, 30 Allowable values ...... 5 Coding instructions ...... 43 B None vs. unknown ...... 43 Bladder CS Mets Eval Inaccessible primary site...... 3 Allowable values ...... 5 Brain Coding instructions ...... 45 CS Site-Specific Factor 1...... 48 CS Reg Nodes Eval ...... 34 Regional Nodes Examined ...... 42 Allowable values ...... 5 Regional Nodes Positive ...... 41 Coding instructions ...... 39 Site-Specific Factors...... 13 CS Site-Specific Factor 1 WHO grade...... 48 Allowable values ...... 5 Breast Coding instructions ...... 47 Accessible primary site ...... 3, 14 None vs. unknown ...... 48 CS Site-Specific Factor 1...... 47 CS Site-Specific Factor 2 CS Site-Specific Factor 2...... 49 Allowable values ...... 5 CS Site-Specific Factor 3...... 51 Coding instructions ...... 49 CS Site-Specific Factor 4...... 53 None vs. unknown ...... 50 CS Site-Specific Factor 5...... 55 CS Site-Specific Factor 3 CS Site-Specific Factor 6...... 57 Allowable values ...... 5 ERA...... 47 Coding instructions ...... 51 Inflammatory carcinoma ...... 27 None vs. unknown ...... 52 Number of positive axillary nodes ...... 51 CS Site-Specific Factor 4 PRA...... 49 Allowable values ...... 5 Site-Specific Factors...... 13 Coding instructions ...... 53 Tumor size...... 26, 27, 57 None vs. unknown ...... 53, 54 Breslow’s Measurement...... 47, 48 CS Site-Specific Factor 5 Allowable values ...... 5 C Coding instructions ...... 55 CA-125...... 47 None vs. unknown ...... 55 Canadian Cancer Society ...... 1 CS Site-Specific Factor 6 Carbohydrate antigen 125 ...... 47 Allowable values ...... 5 Carcinoembryonic Antigen ...... 47 Coding instructions ...... 57 Carcinoids histology exclusion group ...... 77 None vs. unknown ...... 57, 58 Carcinomas histology exclusion group...... 77 CS TS/Ext Eval...... 26 CEA ...... 47 CS Tumor Size Centers for Disease Control and Prevention ...... 1 Allowable values ...... 5 Central nervous system Coding instructions ...... 25 CS Site-Specific Factor 1...... 48 CS Tumor Size/Ext Eval...... 27, 28 Regional Nodes Examined ...... 42 Allowable values ...... 5 Regional Nodes Positive ...... 41 Coding instructions ...... 30 WHO grade...... 48 CS Version 1st...... 4, 6, 21 Chips or pieces, tumor size...... 26 CS Version Latest...... 4, 6, 21 Clinical assessment ...... 12 Cyst size, use of for tumor size...... 26 Clinical information, use of ...... 12 Cystic mass size, use of for tumor size...... 26 Clinical staging basis ...... 30, 39, 45

Version date: January 1, 2004 80 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

D Imaging studies Death certificate only cases ...... 18 CS Extension...... 29 Derived fields, allowable values ...... 6 CS Lymph Nodes ...... 34 Diagnostic confirmation ...... 11 CS Mets Eval...... 46 Diagram of Inputs and Outputs ...... 7 CS Reg Nodes Eval ...... 40 Discontinuous metastasis ...... 28 CS Tumor Size/Ext Eval ...... 31 Corpus uteri...... 28 Tumor size...... 26 CS Extension...... 28 Immunohistochemistry (IHC) of lymph nodes for Ovary...... 28 breast...... 53 Disease progression...... 2, 12, 13 Immunoproliferative diseases CS Mets at DX...... 43 Regional Nodes Examined ...... 42 Display strings for Collaborative Staging ...... 4 Regional Nodes Positive ...... 41 Distant metastases...... 29 Tumor size...... 27 Downstaging rule ...... 8 Implementation date of 1/1/04 ...... 11 Endocrine, other In situ tumor CS Site-Specific Factor 1...... 48 CS Extension...... 29 Enucleation for retinoblastoma ...... 48 CS Lymph Nodes ...... 34 Regional Nodes Examined ...... 42 E Regional Nodes Positive ...... 41 ERA ...... 47 Tumor size...... 26 Esophagus Inaccessible primary sites...... 3, 14 Inaccessible primary site...... 3 Bladder ...... 3 Tumor size...... 27 Corpus uteri...... 3 Estrogen receptor assay ...... 47 CS Lymph Nodes ...... 33, 34 Extension Size Table, example...... 60 Esophagus ...... 3 Extra tables...... 59 Kidney ...... 3 Extracapsular extension, lymph nodes ...... 35, 49 Liver...... 3 Lung ...... 3 F New coding rule...... 14 Familial polyposis ...... 27 None vs. unknown ...... 14 Fibrosis Score for liver ...... 49 Ovary...... 3 Fixed lymph nodes ...... 34 Prostate...... 3 Fruit and nut size equivalents ...... 62 Stomach ...... 3 Inflammatory carcinoma...... 27 G International Prognostic Index (IPI) Score for General Guidelines ...... 11 lymphoma ...... 51 Gestational trophoblastic tumor ...... 17 Invasive component Gleason’s patterns/score ...... 55, 57 Tumor size...... 26, 57 Grade, WHO ...... 48 IPI score for lymphoma ...... 51 H K HCG...... 49 Kaposi sarcoma Head and neck AIDS/HIV...... 48 CS Site-Specific Factor 1...... 47 CS Site-Specific Factor 1...... 13, 48 CS Site-Specific Factor 2...... 49 Histology-specific coding schema...... 15, 21 CS Site-Specific Factor 3...... 51, 52 HIV/AIDS...... 48 CS Site-Specific Factor 4...... 53, 54 Site-Specific Factors...... 13 CS Site-Specific Factor 5...... 55 Kaposi sarcoma histology exclusion group ...... 77 CS Site-Specific Factor 6...... 58 Kidney Extracapsular extension, lymph nodes ..... 49 Inaccessible primary site...... 3 Lymph node levels ...... 51, 53, 55, 57 Regional lymph nodes ...... 35 L Schemas included ....13, 47, 49, 51, 53, 55, 57 Lactate dehydrogenase ...... 53 Site-Specific Factors...... 13, 36 Langerhans cell histiocytosis, disseminated Size of lymph nodes ...... 47 Tumor size...... 27 Head and neck lymph node levels ...... 37, 55, 57 LDH ...... 51, 53 Coding instructions ...... 51, 53 Letterer-Siwe disease Hematopoietic and reticuloendothelial system Tumor size...... 27 Histology-specific coding schema...... 15, 21 Leukemia Regional Nodes Examined ...... 42 Regional Nodes Examined ...... 42 Regional Nodes Positive ...... 41 Regional Nodes Positive ...... 41 Hematopoietic histology exclusion group ...... 77 Tumor size...... 27 Hierarchy of codes ...... 12 Levels of head and neck lymph nodes ...... 55 Histologies excluded from TNM staging ...... 11 Coding instructions ...... 51, 53 Histology Exclusion Tables...... 59 Liver Histology Exclusion Groups, Names of ...... 77 AFP...... 47 Histology-specific schemas...... 15, 21 CS Site-Specific Factor 1...... 47 HIV/AIDS ...... 48 CS Site-Specific Factor 2...... 49 Human chorionic gonadotropin ...... 49 Fibrosis score ...... 49 Inaccessible primary site...... 3 I Site-Specific Factors...... 13 IHC of lymph nodes for breast ...... 53 Lung Ill-defined primary sites Adenopathy ...... 34 Regional Nodes Examined ...... 42 Hilar mass ...... 34 Regional Nodes Positive ...... 41 Inaccessible primary site...... 3 Mediastinal mass...... 34 Tumor size...... 27

Version date: January 1, 2004 81 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Lymph nodes N Axillary, number positive for breast ...... 51 N allowable values ...... 64 Clinical status for melanoma ...... 51 Names of Site-Specific Factors...... 72 Direct extension into ...... 34 National Cancer Institute of Canada ...... 1 Enlarged ...... 34 National Cancer Institute Surveillance, Epidemiology Extracapsular extension ...... 35 and End Results ...... 1 Fixed...... 34 National Cancer Registrars Association (NCRA) . . 1 Levels in head and neck ...... 35, 51, 53, 57 NCRA ...... 1 Matted...... 34 Needle biopsy, tumor size ...... 27 Palpable ...... 34 Neoadjuvant therapy ...... 12 Shotty ...... 34 CS Extension...... 28 Size...... 35 CS Lymph Nodes ...... 33, 34 Size of metastasis for testis...... 55 CS Mets at DX...... 43 Visible swelling ...... 34 CS Mets Eval...... 45, 46 Lymphadenopathy ...... 34 CS Reg Nodes Eval ...... 39, 40 Lymphoma CS Tumor Size ...... 26, 31 AIDS/HIV...... 48 CS Tumor Size/Ext Eval ...... 30, 31 CS Site-Specific Factor 1...... 48 Regional Nodes Examined ...... 42 CS Site-Specific Factor 2...... 49 Regional Nodes Positive ...... 41 CS Site-Specific Factor 3...... 51 Tumor size...... 26 Histology-specific coding schema...... 15, 21 Nodule(s) in pericolic fat ...... 35 HIV/AIDS...... 48 None vs. unknown ...... 3, 14 IPI score ...... 51 CS Lymph Nodes ...... 33 Lymph node involvement ...... 34 CS Mets at DX...... 43 Regional Nodes Examined ...... 42 CS Site-Specific Factor 1...... 48 Regional Nodes Positive ...... 41 CS Site-Specific Factor 2...... 50 Site-Specific Factors...... 13 CS Site-Specific Factor 3...... 51, 52 Symptoms at diagnosis ...... 49 CS Site-Specific Factor 4...... 53, 54 Tumor size...... 27 CS Site-Specific Factor 5...... 55 Lymphoma histology exclusion group ...... 77 CS Site-Specific Factor 6...... 57, 58 NOS, Use of...... 8 M CS Extension...... 29 M allowable values...... 65 CS Lymph Nodes ...... 34 Mapping CS Mets at DX...... 44 Columns in Collaborative Staging tables ..... 4 CS Site-Specific Factor 3...... 52 How it was determined ...... 8 CS Site-Specific Factor 4...... 54 Margins, positive CS Site-Specific Factor 5...... 56 CS Extension...... 29 CS Site-Specific Factor 6...... 58 Mass, NOS, and lymph nodes ...... 34 Use of for head and neck lymph nodes ..... 36 Mast cell tumors, tumor size...... 27 Not applicable Matted lymph nodes ...... 34 using code(s) for ...... 12 Melanoma NPCR...... 1 Breslow's measurement...... 47, 48 Clinical status of lymph node mets ...... 51 O CS Site-Specific Factor 1...... 47 Operative assessment ...... 12 CS Site-Specific Factor 2...... 49 Operative reports CS Site-Specific Factor 3...... 51 CS Reg Nodes Eval ...... 34 CS Site-Specific Factor 4...... 53 CS Tumor Size/Ext Eval ...... 26, 28 Histology-specific coding schema...... 15, 21 Oral cavity LDH...... 53 Accessible primary site ...... 3, 14 Site breakdown for...... 15 Orchiectomy, radical...... 53 Site-Specific Factors...... 13 Other endocrine Thickness (depth) ...... 47, 48 CS Site-Specific Factor 1...... 48 Tumor size...... 27 WHO grade...... 48 Ulceration ...... 49, 50 Other specified histology exclusion group...... 77 Melanomas histology exclusion group ...... 77 Ovary Mesotheliomas histology exclusion group...... 77 CA-125 ...... 47 Microscopic confirmation ...... 11 CS Site-Specific Factor 1...... 47 Microscopic focus or foci ...... 27 Discontinuous metastasis ...... 28 Tumor size...... 27 Inaccessible primary site...... 3 Missing information, coding guideline...... 3 Site-Specific Factors...... 13 Molecular studies of regional lymph nodes for breast ...... 55 P Multiple myeloma, tumor size...... 27 PAP ...... 53 Multiple polyposis...... 27 Pathological assessment ...... 12 Multiple vs. single nodules for thyroid ...... 47 Pathological staging basis ...... 30, 39, 45 Mycosis fungoides Pathology reports CS Site-Specific Factor 1...... 47 CS Extension...... 28 Histology-specific coding schema...... 15, 21 CS Lymph Nodes ...... 33, 35 Peripheral blood involvement ...... 47 CS Reg Nodes Eval ...... 34 Site-Specific Factors...... 13 CS Tumor Size/Ext Eval ...... 26, 28 Myelodysplastic syndromes Priority of...... 12 Tumor size...... 27 Size of lymph nodes ...... 35 Myeloproliferative diseases Tumor size...... 25 Regional Nodes Examined ...... 42 Peripheral blood involvement in MF ...... 47 Regional Nodes Positive ...... 41 Physician staging Tumor size...... 27 CS Extension...... 29 CS Lymph Nodes ...... 35 CS Mets at DX...... 44

Version date: January 1, 2004 82 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Physician-assigned TNM ...... 29 Residual disease CS Extension...... 29 CS Extension...... 29 CS Lymph Nodes ...... 35 Residual tumor ...... 26 CS Mets at DX...... 44 Reticuloendothelial system use of...... 13 Histology-specific coding schema...... 15, 21 Pieces or chips, tumor size ...... 26 Regional Nodes Examined ...... 42 Placenta Regional Nodes Positive ...... 41 CS Site-Specific Factor 1...... 47 Retinoblastoma Prognostic Scoring Index ...... 47 CS Site-Specific Factor 1...... 48 Regional Nodes Examined ...... 42 Extension at enucleation ...... 48 Regional Nodes Positive ...... 41 Histology-specific coding schema...... 15, 21 Site-Specific Factors...... 13 Site-Specific Factors...... 13 Pleura Rules CS Site-Specific Factor 1...... 47 Downstaging ...... 8 Pleural effusion ...... 47 Summary, one-page ...... 21 Site-Specific Factors...... 13 Timing...... 2 Pleural effusion...... 47 Polyp size, use of for tumor size...... 26 S Polyposis, familial or multiple ...... 27 Salivary gland PRA ...... 49 Accessible primary site ...... 3, 14 Preoperative treatment ...... 12 Sarcomas histology exclusion group...... 77 CS Extension...... 28 SEER Program ...... 1 CS Lymph Nodes ...... 33, 34 SEER Summary Stage ...... 11 CS Mets at DX...... 43 Output from Collaborative Staging ...... 4 CS Mets Eval...... 45, 46 Shotty lymph nodes ...... 34 CS Reg Nodes Eval ...... 39, 40 Site-Specific Extra Tables...... 59 CS Tumor Size ...... 26 Site-Specific Factors (SSFs) CS Tumor Size/Ext Eval ...... 30 Brain ...... 13 Regional Nodes Examined ...... 42 Breast ...... 13 Regional Nodes Positive ...... 41 Colon...... 13 Tumor size...... 26 Head and neck ...... 13 Presurgical treatment Kaposi sarcoma ...... 13 CS Tumor Size ...... 31 Liver...... 13 CS Tumor Size/Ext Eval ...... 31 Lymphoma ...... 13 Primary sites, inaccessible...... 3 Melanoma ...... 13 Progesterone receptor assay ...... 49 Mycosis fungoides ...... 13 Prognostic Scoring Index for placenta ...... 47 Names of...... 72 Progression of disease...... 2, 12, 13 Ovary...... 13 CS Mets at DX...... 43 Placenta...... 13 Prostate Pleura ...... 13 CS Extension - Pathologic Extension ...... 51 Prostate...... 13 CS Reg Nodes Eval ...... 40 Purpose of...... 12 CS Site-Specific Factor 1...... 47 Rectum ...... 13 CS Site-Specific Factor 2...... 49 Retinoblastoma ...... 13 CS Site-Specific Factor 3...... 51 Schemas using ...... 13 CS Site-Specific Factor 4...... 53 Testis...... 13 CS Site-Specific Factor 5...... 55 Thyroid...... 13 Gleason's patterns...... 55 Size of lymph nodes ...... 35, 47 Gleason's score...... 57 Skin Inaccessible primary site...... 3 Accessible primary site ...... 3, 14 PAP...... 53 Solitary vs. multifocal for thyroid...... 47, 48 PSA...... 49 Staging basis ...... 30, 39, 45 PSA lab value ...... 47 CS Mets Eval...... 45 Site-Specific Factors...... 13 CS Reg Nodes Eval ...... 39, 40 Prostate specific antigen...... 49 CS Tumor Size/Ext Eval ...... 30-32 Prostatic acid phosphatase ...... 53 Start date of 1/1/04...... 11 PSA ...... 47, 49 Stomach Inaccessible primary site...... 3 R Tumor size...... 27 Radical orchiectomy...... 53 Storage codes for Collaborative Staging ...... 4 Rectosigmoid Summary Stage ...... 11 CEA...... 47 Allowable values ...... 67 CS Lymph Nodes ...... 35 Conversion algorithm for all schemas...... 68 CS Site-Specific Factor 1...... 47 Output from Collaborative Staging ...... 4 Tumor size...... 27, 47 Summary Stage Table ...... 59, 68 Rectum Summary Staging...... 1, 2 CEA...... 47 Surgery coding schemas ...... 15 CS Lymph Nodes ...... 35 Surgical observations CS Site-Specific Factor 1...... 47 use of...... 12 Site-Specific Factors...... 13 Symptoms at diagnosis for lymphoma ...... 49 Tumor size...... 27 References...... 8 Regional Nodes Examined Allowable values ...... 5 Coding instructions ...... 42 Regional Nodes Positive Allowable values ...... 5 Coding instructions ...... 41

Version date: January 1, 2004 83 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

T U T allowable values ...... 63 Ulcer size, use of for tumor size...... 26 Testis Ulceration for melanoma ...... 49 AFP...... 47 Unknown CS Site-Specific Factor 1...... 47 use of for head and neck lymph nodes ..... 36 CS Site-Specific Factor 2...... 49 using code(s) for ...... 3 CS Site-Specific Factor 3...... 51 Unknown and ill-defined primary sites CS Site-Specific Factor 4...... 53 Regional Nodes Examined ...... 42 CS Site-Specific Factor 5...... 55 Regional Nodes Positive ...... 41 HCG ...... 49 Tumor size...... 27 LDH...... 51 Unknown vs. none ...... 3, 14 Radical orchiectomy ...... 53 Site-Specific Factors...... 13 W Size of metastasis in lymph nodes ...... 55 Web site, Collaborative Staging ...... 11 Text field on abstract ...... 27 WHO grade...... 48 CS Extension...... 29 CS Lymph Nodes ...... 35 Y CS Mets at DX...... 44 Y staging basis...... 31 CS Tumor Size ...... 27 Thickness (depth) of melanoma ...... 47, 48 Thyroid Accessible primary site ...... 3, 14 CS Site-Specific Factor 1...... 47 Single vs. multiple nodules ...... 47 Site-Specific Factors...... 13 Solitary vs. multifocal...... 48 Timing rules ...... 2, 12 TNM, physician-assigned use of...... 13 Tumor markers...... 12 Tumor size Aggregate ...... 26 Breast ...... 26, 27, 57 Chips or pieces ...... 26 Composite...... 26 Descriptive...... 62 Fruit and nuts equivalents ...... 62 In situ cancer...... 26 In situ component ...... 26 Invasive component ...... 26, 57 Melanoma ...... 27 Microscopic focus or foci...... 27 Not applicable ...... 27 Pieces or chips ...... 26 Schemas not using for AJCC...... 17 Schemas requiring for AJCC ...... 16 Unknown...... 27

Version date: January 1, 2004 84 Version 1.0 COLLABORATIVE STAGING MANUAL AND CODING INSTRUCTIONS Version 1.0

Part II

Version date: January 1, 2004 85 Version 1.0 Page left blank.

Version date: January 1, 2004 86 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

COLLABORATIVE STAGING MANUAL AND CODING INSTRUCTIONS

Collaborative Staging Task Force of the American Joint Committee on Cancer

Part I version 01.00.00 incorporating minor page corrections through July 15, 2005

NIH Publication Number 04-5496 U.S. Department of Health and Human Services National Institutes of Health National Cancer Institute

Version date: January 1, 2004 i Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

COPYRIGHT INFORMATION All material in this manual is in the public domain and may be reproduced or copied without permission. However, citation as to source is requested.

SUGGESTED CITATION Collaborative Staging Task Force of the American Joint Committee on Cancer. Collaborative Staging Manual and Coding Instructions, version 1.0. Jointly published by American Joint Committee on Cancer (Chicago, IL) and U.S. Department of Health and Human Services (Bethesda, MD), 2004. NIH Publication Number 04-5496.

Collaborative Staging (CS) Task Force Members Member Representing Stephen Edge, MD, Chair American Joint Committee on Cancer Gayle Clutter, RT, CTR National Program of Cancer Registries, Centers for Disease Control and Prevention Lynda Douglas, CTR American College of Surgeons; Central Registry April Fritz, BA, RHIT, CTR Surveillance, Epidemiology, and End Results Program, National Cancer Institute Missy Jamison National Program of Cancer Registries, Centers for Disease Control and Prevention Vencine Kelly, BA, CTR National Cancer Registrars Association Karen McCracken, CTR National Cancer Registrars Association Tom Rawson National Program of Cancer Registries, Centers for Disease Control and Prevention Lynn Ries, MS Surveillance, Epidemiology, and End Results Program, National Cancer Institute Nancy Schlag, BS, CTR North American Association of Central Cancer Registries Jennifer Seiffert, MLIS, CTR National Program of Cancer Registries, Centers for Disease Control and Prevention

American Joint Committee on Cancer Staff Connie Bura Susan Burkhardt Valerie Vesich, CTR

Physician Advisors to the Task Force James Armitage, MD Mark Arredondo, MD Laura Fajardo, MD Gini Fleming, MD Mary Gospodarowicz, MD Frederick Greene, MD Maureen MacIntyre, MD William MacKillop, MD David Page, MD Jatin Shah, MD

Questions regarding this document and Collaborative Staging in general should be directed to: Valerie Vesich, CTR [email protected] 312-202-5435 American Joint Committee on Cancer 633 North Saint Clair Street Chicago, IL 60611

Version date: January 1, 2004 ii Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

page edited July 2005 OBSOLETE CODES

From time to time, it is necessary to revise Collaborative Staging (CS) coding tables by reassigning concepts from one code to another to maintain the underlying structure and rules for code assignment. This can occur when a single code needs to be split into more than one code, or when a structure needs to be move from one table to another (for example, a lymph node being moved from CS Lymph Nodes to CS Mets at Dx). Codes in CS tables will not be deleted while users have data coded with those codes. Instead, the codes will be marked as OBSOLETE in their descriptions, and instructions will be provided for handling previously coded data.

In some cases, it may be possible to perform global corrections on prior data without manual review. In other cases, such as when a code is being split, it will be necessary to manually review abstracts and recode them. Guidance for handling each instance of OBSOLETE will be provided when the change is published.

The designation of OBSOLETE is an official part of the description of the code, and it should be displayed to users, for example, in pick lists for coding new data so that the codes are not used into the future, and in translation of codes in displays or printouts of abstracts.

Table 1. Allowable Values and Format for Collaborative Staging Data Items

INPUT ITEMS Data Item Name NAACCR Char- Allowable Values Right Blanks: NAACCR Data Item acter (site-specific Justified, Yes or Ver 10.x Number Length unless otherwise Zero filled No Column # stated) CS Tumor Size 2800 3 000-999 Yes No 629-631 CS Extension 2810 2 00-99 Yes No 632-633 CS Tumor 2820 1 0-9 N/A No 634-634 Size/Ext Eval CS Lymph Nodes 2830 2 00-99 Yes No 635-636 CS Reg Nodes 2840 1 0-9 N/A No 637-637 Eval Regional Nodes 830 2 00-90, 95, 96, 97, Yes No 541-542 Examined 98, 99 (all sites) Regional Nodes 820 2 00-90, 95, 97, 98, Yes No 539-540 Positive 99 (all sites) CS Mets At Dx 2850 2 00-99 Yes No 638-639 CS Mets Eval 2860 1 0-9 N/A No 640-640 CS Site-Specific 2880 3 000-999 Yes No 641-643 Factor 1 CS Site-Specific 2890 3 000-999 Yes No 644-646 Factor 2 CS Site-Specific 2900 3 000-999 Yes No 647-649 Factor 3 CS Site-Specific 2910 3 000-999 Yes No 650-652 Factor 4 CS Site-Specific 2920 3 000-999 Yes No 653-655 Factor 5 CS Site-Specific 2930 3 000-999 Yes No 656-658 Factor 6

Version date: January 1, 2004 5 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I General Instructions

Table 1 continued. Allowable Values and Format for Collaborative Staging Data Items OUTPUT ITEMS Data Item Name NAACCR Char- Allowable Values Right Blanks: NAACCR Data Item acter Justified, Yes or Ver 10.x Number Length Zero No Column # filled Derived AJCC T 2940 2 00, 01, 05, 06, 07, N/A N/A 659-660 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 29, 30, 31, 32, 33, 39, 40, 41, 42, 43, 44, 49, 88, 99 Derived AJCC N 2960 2 00, 01, 02, 03, 04, N/A N/A 662-663 09, 10, 11, 12, 13, 18, 19, 20, 21, 22, 23, 29, 30, 31, 32, 33, 39, 88, 99 Derived AJCC M 2980 2 00, 10, 11, 12, 13, N/A N/A 665-666 19, 88, 99 Derived AJCC T 2950 1 c, p, a, y N/A N/A 661-661 Descriptor Derived AJCC N 2970 1 c, p, a, y N/A N/A 664-664 Descriptor Derived AJCC M 2990 1 c, p, a, y N/A N/A 667-667 Descriptor Derived AJCC 3000 2 00, 01, 02, 10, 11, N/A N/A 668-669 Stage Group 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 70, 71, 72, 73, 74, 88, 90, 99 Derived AJCC 3030 1 Blank, 1, 2 N/A Yes 672-672 Flag Derived SS1977 3010 1 Blank, 0, 1, 2, 3, N/A Yes 670-670 4, 5, 7, 8, 9 Derived SS1977 3040 1 Blank, 1, 2 N/A Yes 673-673 Flag Derived SS2000 3020 1 Blank, 0, 1, 2, 3, N/A Yes 671-671 4, 5, 7, 8, 9 Derived SS2000 3050 1 Blank, 1, 2 N/A Yes 674-674 Flag CS Version 1st 2935 6 000000-999999 N/A No 705-710 CS Version 2936 6 000000-999999 N/A No 711-716 Latest

Version date: January 1, 2004 6 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS TUMOR SIZE Item Length: 3 NAACCR Item #2800 page edited March 2004 Description Records the largest dimension or diameter of the primary tumor, and is always recorded in millimeters. To convert centimeters to millimeters, multiply the dimension by 10. If tumor size is given in tenths of millimeters, record size as 001 if largest dimension or diameter of tumor is between 0.1 and 0.9 mm.

Code Description 000 Indicates no mass or no tumor found; for example, when a tumor of a stated primary site is not found, but the tumor has metastasized. 001–988 Exact size in millimeters. 989 989 millimeters or larger. 990 Microscopic focus or foci only; no size of focus is given. 991 Described as less than 1 cm 992 Described as less than 2 cm 993 Described as less than 3 cm 994 Described as less than 4 cm 995 Described as less than 5 cm SITE-SPECIFIC CODES WHERE NEEDED 999 Unknown; size not stated; not stated in patient record.

Examples: Mammogram shows 2.5 cm breast malignancy Code as 025 (2.5 cm = 25 millimeters) CT of chest shows 4 cm mass in RUL Code as 040 (4 cm = 40 mm) Thyroidectomy specimen yields 8 mm carcinoma Code as 008 Prostate TURP shows 0.6 mm carcinoma Code as 001 (round up six-tenths of mm)

For schemas that do not use tumor size:

Code Description 888 Not applicable

Instructions for Coding 1. Refer to general guidelines for Collaborative Staging for timing rules for data collection.

2. Refer to site/histology-specific instructions for additional information. Site/histology-specific instructions replace or over-ride general instructions. Where there are no site/histology-specific instructions, these general instructions apply.

3. Record tumor size information in the following order: a. Record tumor size from the pathology report, if it is available, when the patient receives no radiation or systemic treatment prior to surgery.

Version date: January 1, 2004 25 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Tumor Size, continued Example: Chest x-ray shows 3.5 cm mass; the pathology report from the surgery states that the same mass is malignant and measures 2.8 cm. Record tumor size as 028. b. If the patient receives preoperative (neoadjuvant) systemic therapy (chemotherapy, hormone therapy, immunotherapy) or radiation therapy, code the largest size of tumor prior to treatment. Example: Patient has a 2.2 cm mass in the oropharynx; fine needle aspiration of mass confirms squamous cell carcinoma. Patient receives course of neoadjuvant combination chemotherapy. Pathologic size of tumor after total resection is 0.8 cm. Record tumor size as 022. c. Information on size from imaging/radiographic techniques can be used to code size when there is no more specific size information from a pathology or operative report, but it should be taken as low priority, just above a physical exam. d. If there is a difference in reported tumor size among imaging and radiographic techniques, record the largest size of tumor reported in the record. e. In the infrequent event that the tumor does not respond to neoadjuvant treatment and is, in fact, more extensive after preoperative treatment as determined by the operative or pathology report, code the farthest extension and code CS Tumor Size/Ext Eval as 6, based on pathology/operative report after treatment.

4. Record the exact size of the primary tumor for all sites/histologies except those for which it is stated to be not applicable. If no size is given, code as 999. a. Always code the size of the primary tumor, not the size of the polyp, ulcer, cyst, or distant metastasis. However, if the tumor is described as a “cystic mass,” and only the size of the entire mass is given, code the size of the entire mass, since the cysts are part of the tumor itself. b. Record the largest dimension or diameter of tumor, whether it is from an excisional biopsy specimen or the complete resection of the primary tumor. Example A 3.3 cm tumor would be 33 millimeters and would be coded as 033. Example Tumor is described as 2.4 x 5.1 x 1.8 cm in size. Record tumor size as 051. c. Record the size of the invasive component, if given. d. If both an in situ and an invasive component are present and the invasive component is measured, record the size of the invasive component even if it is smaller. Example Tumor is mixed in situ and invasive adenocarcinoma, total 3.7 cm in size, of which 1.4 cm is invasive. Record tumor size as 014. e. Additional rule for breast primaries: If the size of the invasive component is not given, record the size of the entire tumor from the surgical report, pathology report, radiology report or clinical examination. Example Infiltrating duct carcinoma with extensive in situ component; total size 2.3 cm. Record tumor size as 023. Example Duct carcinoma in situ covering a 1.9 cm area with focal areas of invasive ductal carcinoma. Record tumor size as 019. Note: For breast cancer, document how the size of the tumor was determined in Site Specific Factor field 6. Information from the pathology report can be used to identify in situ versus invasive tumor even if exact size is not given. If tumor size is a clinical measurement only in the range 001-989, Site Specific Factor 6 must be coded as 888. f. For purely in situ lesions, code the size as stated. g. Microscopic residual tumor does not affect overall tumor size. h. Do not add pieces or chips together to create a whole; they may not be from the same location, or they may represent only a very small portion of a large tumor. However, if the pathologist states an aggregate or composite size (determined by fitting the tumor pieces together and measuring the total size), record that size. i. If an excisional biopsy is performed and residual tumor at time of resection of the primary is found to be larger than the excisional biopsy, code the size of the residual tumor.

Version date: January 1, 2004 26 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

page edited May 2004 CS Tumor Size, continued j. For an incisional needle biopsy, code tumor size as 999. Do not code the tumor size from a needle biopsy unless no residual tumor is found on further resection. k. Record tumor size (lateral dimension) for malignant melanoma. Depth of invasion is coded in a site-specific factor.

5. Special codes a. Tumor dimension is to be recorded for all schemas, except as noted below. Other information collected in this field in previous staging systems, such as depth of invasion for melanoma, has been moved to Site-Specific Factors for those sites/histologies. b. If size is not reported, code as 999, which means unknown size, not applicable, or not documented in the patient record. c. The descriptions in code 998 take precedence over any mention of size. Code 998 is used only for the following sites: Esophagus (C15.0-C15.5, C15.8-C15.9): Entire circumference Stomach (C16.0-C16.6, C16.8-C16.9): Diffuse, widespread—¾ or more, linitis plastica Colorectal (M-8220/8221 with /2 or /3): Familial/multiple polyposis Lung and main stem bronchus (C34.0-C34.3, C34.8-C34.9): Diffuse, entire lobe or lung Breast (C50.0-C50.6, C50.8-C50.9): Diffuse d. Code 990, Microscopic focus or foci only; no size is given, should be used when no gross tumor is seen and tumor is only identified microscopically. Note: the terms microscopic focus, microfocus, and microinvasion are NOT the same as [macroscopic] focal or focus. A macroscopic focus or foci indicates a very small or isolated area, pinpoint, or spot of tumor that may be visible grossly. Only tumor identified microscopically should be coded to 990. Example Ovary specimen: extensive cystic disease with focal areas of tumor seeding. Disregard “focal” and code tumor size to 999 unknown. Example Cervix conization: severe dysplasia with focal areas of microinvasion. Code tumor size as 990 microscopic focus, no size given. e. Codes 991 through 995 are non-specific size descriptions that, for some sites, could still be used to determine a T category. However, if a specific size is given, the more precise size should be coded in the range 001-989. f. Other special codes in the range 996 to 997 are used on a site-specific basis. See the individual site/histology schemas for further information and definitions. g. Note: For the following diagnoses and/or primary sites, size is not applicable. Record as code 888. Disseminated Langerhans cell histiocytosis (Letterer-Siwe disease) Hematopoietic neoplasms Immunoproliferative diseases Leukemia Malignant lymphoma (Hodgkin lymphoma and non-Hodgkin lymphoma) Mast cell tumors Multiple myeloma and other plasma cell tumors Myelodysplastic syndromes Myeloproliferative diseases h. The source of the tumor size (radiographs, endoscopy, pathology specimen, etc.) is documented in the CS Tumor Size/Ext Eval field.

6. It is strongly recommended that the choice of tumor size codes be documented in a related text field on the abstract.

Version date: January 1, 2004 27 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS EXTENSION Item Length: 2 NAACCR Item #2810

Description Identifies contiguous growth (extension) of the primary tumor within the organ of origin or its direct extension into neighboring organs. For certain sites such as ovary, discontinuous metastasis is coded in the CS Extension field. See site-specific schemas for detailed codes and coding instructions.

Code Description TNM SS77 SS2000 Mapping Mapping Mapping 00 In situ; non-invasive Tis IS IS SITE/HISTOLOGY-SPECIFIC CODES 80 Further contiguous extension 95 No evidence of primary tumor T0 U U 99 Unknown extension; primary tumor cannot be TX U U assessed; not stated in patient record

Instructions for Coding 1. Code the farthest documented extension of the primary tumor. Do not include discontinuous metastases to distant sites (these are coded in CS Mets at Dx) except for ovary and corpus uteri (see 2e below).

2. Record extension information in the following order: a. Record extension from the pathology report, if it is available, when the patient receives no radiation or systemic treatment prior to surgery. b. If the patient receives preoperative (neoadjuvant) systemic therapy (chemotherapy, hormone therapy, immunotherapy) or radiation therapy, code the farthest extension identified prior to treatment (clinically). Example Patient has rectal mass firmly attached to pelvic wall (clinically T4, extension code 60). Patient undergoes preoperative radiation therapy. The pathology report from the low anterior resection shows residual tumor outside the rectum in perimuscular tissue (pathologically T3, extension code 40). Code extension as 60, because the preoperative treatment apparently “shrank” the tumor away from the pelvic wall. c. In the infrequent event that the tumor does not respond to neoadjuvant treatment and is, in fact, more extensive after preoperative treatment as determined by the operative or pathology report, code the farthest extension and code CS Tumor Size/Ext Eval as 6, based on pathology/operative report after treatment. Example Patient found to have an obstructing central lung tumor very close to the main stem bronchus (clinically T2, extension code 20). Patient undergoes six weeks of intensive chemotherapy. At thoracotomy, tumor was observed directly extending into trachea (pathologically T4, extension code 70). Code extension as 70, because the tumor was noted to be more extensive after the preoperative treatment. Example Patient has a 5.5 cm hard, moveable mass in the right breast (clinically T3, extension code 10) and receives preoperative chemotherapy. The pathology report from the modified radical mastectomy shows residual 2.8 cm mass with infiltration of the deep subcutaneous tissues over the mass (pathologically T2, extension code 20). Code extension as 20, because although the chemotherapy “shrank” the tumor, the residual tumor was found to be more extensive than the clinical presentation.

Version date: January 1, 2004 28 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

page edited March 2004 CS Tumor Size/Ext Eval, continued Instructions for Coding 1. Select the CS Tumor Size/Ext Eval code that documents the report or procedure from which the information about the farthest extension or size of the primary tumor was obtained; this may not be the numerically highest Eval code. Example Fine needle aspiration biopsy (Eval code 1) confirms adenocarcinoma of prostate. CT scan of pelvis (Eval code 0) shows tumor extension through the prostatic capsule into adjacent connective tissues. Code CS Tumor Size/Ext Eval as 0 because the CT scan showed more extensive tumor than the biopsy.

2. For primary sites/histologies where tumor size is not a factor in determining the T category in TNM (see Table 5 in the General Instructions), code CS Tumor Size/Ext Eval on the basis of the CS extension field only.

3. For primary sites where both tumor size and extension determine the T category in TNM (see Table 4 in the General Instructions), select the code that best explains how the information in the CS Tumor Size and CS Extension fields were determined. a. If there is a difference between the derived category for the tumor size and the CS extension, select the evaluation code that reflects how the worse or higher category was determined. Example Tumor size for a breast cancer biopsy is 020 (maps to T1). There is ulceration of the skin (extension code 50, maps to T4). Code CS Tumor Size/Ext Eval field as 0, physical examination, because the ulceration information from the physical examination results in a higher T category. b. If the patient had no surgery, use code 0, 1, or 9. Example Patient has a chest x-ray showing an isolated 4 cm tumor in the right upper lobe. Patient opts for radiation therapy. Code this field as 0. Staging algorithm would identify information as clinical (c). Example Colon cancer with colonoscopy and biopsy confirming cancer. Code this field as 1. Staging algorithm would identify information as clinical (c). The biopsy does not meet the criteria for pathologic staging. Example Endoscopies for cervix or bladder would be coded as 1 in this field and the staging algorithm would identify the information as clinical (c). Exception Lung cancer with mediastinoscopy showing direct extension into mediastinum. Code this field as 1. Staging algorithm would identify information as pathologic (p), because mediastinoscopy is defined as a pathologic procedure in TNM.. c. If the patient had surgery followed by other treatment(s), use code 3 or 9. d. If the size or extension of the tumor determined prior to treatment was the basis for neoadjuvant therapy, use code 5. e. If the size or extension of the tumor was greater after presurgical treatment than before treatment, use code 6. This code is likely to be used infrequently and maps to the “y” intercurrent treatment staging basis. f. If the patient had an autopsy, use code 2 if the diagnosis was known or suspected prior to death. Use code 8 if the malignancy was not known or suspected prior to death.

4. For sites/histologies where there is no TNM schema, this field may be coded 9, not applicable. (See Table 6 in the General Instructions.)

5. Code 0 includes imaging studies such as standard radiography, special radiographic projections, tomography, computerized tomography (CT), ultrasonography, lymphography, angiography, scintigraphy (nuclear scans), ultrasonography, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, spiral scanning (CT or MRI) and other non-invasive methods of examining tissues.

Version date: January 1, 2004 31 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Tumor Size/Ext Eval, continued 6. Codes 0-3 are oriented to the AJCC staging basis. In general, Code 1 includes microscopic analysis of tissue that is insufficient to meet the requirements for pathologic staging in the TNM system. However, pathologic staging requirements vary by site; for some site schemas, code 1 may be classified as pathologic. For specific classification rules, refer to the AJCC Cancer Staging Manual, sixth edition. For example, a total cystectomy is required to pathologically stage a bladder cancer. Any tissue removed during another procedure, such as a transurethral resection of a bladder tumor, would not meet the requirements for pathologic staging and should be coded to 1 in this field. Code 1 also includes observations at surgery, such as an exploratory laparotomy in which unresectable pancreatic cancer is identified, where further tumor extension is not biopsied.

7. Code 3 is considered pathologic staging across all sites. Use code 3 for a biopsy of tumor extension that meets the requirements for pathologic staging basis. In other words, according to TNM rules, if the biopsy documents the highest T category, the biopsy meets the requirements for pathologic staging basis and the CS Tumor Size/Ext Eval field should be coded to 3. For example, if a prostate cancer patient has a biopsy of the rectum that shows microscopic involvement of the rectal wall (T4), according to the AJCC Cancer Staging Manual sixth edition that patient meets the requirements for pathologic staging in the T category.

Version date: January 1, 2004 32 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS LYMPH NODES Item Length: 2 NAACCR Item #2830 page updated April 2004 Description Identifies the regional lymph nodes involved with cancer at the time of diagnosis.

Code Description TNM SS77 SS2000 Mapping Mapping Mapping 00 None; no regional lymph node involvement N0 None None SITE/HISTOLOGY-SPECIFIC CODES 80 Lymph nodes, NOS NX RN RN 99 Unknown; regional lymph nodes cannot be NX U U assessed; not stated in patient record

For schemas that do not use the CS Lymph Nodes field:

Code Description 88 Not applicable

Instructions for Coding 1. Record the specific regional lymph node chain farthest from the primary site that is involved by tumor either clinically or pathologically. a. Regional lymph nodes are listed for each site/histology. In general, the regional lymph nodes in the chain(s) closest to the primary site have the lower codes. Nodes farther away from the primary or in farther lymph node chains have higher codes. Record the highest applicable code. Exception The higher codes for ‘Regional lymph nodes, NOS’; ‘Lymph nodes, NOS’; ‘Stated as N1, no other information’; ‘Stated a N2a, no other information’, and so forth, should only be used when there is no available information as to the name(s) of the regional nodes involved. Example Peribronchial lymph nodes are positive on fine needle aspiration biopsy. Contralateral mediastinal mass noted on CT scan but not biopsied. Patient chooses radiation therapy as primary treatment. Use the code for contralateral mediastinal lymph node involvement as it is higher than the code for peribronchial lymph nodes. b. Record involved regional lymph nodes from the pathology report, if it is available, when the patient receives no radiation or systemic treatment prior to surgery. c. If there is a discrepancy between clinical information and pathologic information about the same lymph nodes, the pathologic information takes precedence if no preoperative treatment was administered. Example Axillary lymphadenopathy stated as “suspicious for involvement” noted on physical exam. After axillary dissection, all lymph nodes are negative. Code CS Lymph Nodes as 0, no regional lymph node involvement. d. For inaccessible sites, primarily for localized or early stage (T1, T2) cancers: record regional lymph nodes as negative rather than unknown (based on clinical evaluation) when there is no mention of regional lymph node involvement in the physical examination, pre-treatment diagnostic testing or surgical exploration, and the patient receives what would be usual treatment to the primary site (see general rules for further discussion).

Version date: January 1, 2004 33 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Lymph Nodes, continued e. If there is direct extension of the primary tumor into a regional lymph node, record the involved node in this field. f. If the patient receives preoperative (neoadjuvant) systemic therapy (chemotherapy, hormone therapy, immunotherapy) or radiation therapy, code the farthest involved regional lymph nodes, based on information prior to surgery. Example Patient has a hard matted mass in the axilla (code 50) and a needle biopsy of the breast that confirms ductal carcinoma. Patient receives three months of chemotherapy. The pathology report from the modified radical mastectomy shows only scar tissue in the axilla with no involvement of axillary lymph nodes (Negative, code 00). Code CS Lymph Nodes as 50 because the chemotherapy apparently “sterilized” the lymph nodes. g. In the infrequent event that clinically involved regional lymph nodes do not respond to neoadjuvant treatment and are, in fact, more extensively involved after preoperative treatment as determined by the operative or pathology report, code the farthest extension and code CS Reg Nodes Eval as 6, based on pathology/operative report after treatment. Example Patient has needle biopsy-proven prostate cancer with no mention of involved lymph nodes on physical examination (Negative, code 00). He receives Lupron while deciding whether to undergo a radical prostatectomy. At the time of surgery, a laparoscopic pelvic node biopsy is reported to show metastases (Regional nodes involved, code 10) to lymph nodes and the prostatectomy is canceled. Code CS Lymph Nodes as 10 because the preoperative treatment (Lupron) had no effect on the lymph nodes.

2. Use code 00 for lymph node involvement when the CS Extension is coded in situ, even if no lymph nodes are removed, since “in situ” by definition means noninvasive. If there is evidence of nodal involvement associated with a tumor described as in situ, it would indicate that an area of invasion was missed and the primary tumor is not an in situ lesion, so lymph nodes can be coded as appropriate for the case.

3. For solid tumors, the terms “fixed” or “matted” and “mass in the hilum, mediastinum, retroperitoneum, and/or mesentery” (with no specific information as to tissue involved) are considered involvement of lymph nodes. a. Any other terms, such as “palpable,” “enlarged,” “visible swelling,” “shotty,” or “lymph- adenopathy” should be ignored, unless there is a statement of involvement by the clinician. Exception The terms adenopathy, enlargement, and mass in the hilum or mediastinum should be coded as involvement for lung primaries only. b. For lymphomas, any positive mention of lymph nodes indicates involvement of those lymph nodes. c. Regional lymph nodes are not palpable for inaccessible sites such as bladder, kidney, prostate, esophagus, stomach, lung, liver, corpus uteri and ovary. The best description concerning regional lymph nodes will be on imaging studies or in the surgeon's evaluation at the time of exploratory surgery or definitive surgery. If regional lymph nodes for these inaccessible sites are not mentioned on imaging or exploratory surgery, they are presumed to be clinically negative. d. The terms “homolateral,” “ipsilateral,” and “same side” are used interchangeably. e. Any unidentified nodes included with the resected primary site specimen are to be coded as regional lymph nodes, NOS. f. Where more specific categories are provided, the codes for “regional lymph node(s), NOS”; “lymph nodes, NOS”; and “Stated as N_, no additional information” should be used only after an exhaustive search for more specific information.

Version date: January 1, 2004 34 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS REG NODES EVAL Item Length: 1 NAACCR Item #2840

Description Records how the code for the item “CS Lymph Nodes” was determined, based on the diagnostic methods employed.

Code Description Staging Basis 0 No regional lymph nodes removed for examination. Evaluation based on physical c examination, imaging, or other non-invasive clinical evidence. No autopsy evidence used. 1 No regional lymph nodes removed for examination. Evaluation based on c endoscopic examination, diagnostic biopsy including fine needle aspiration of lymph node(s) or other invasive techniques. No autopsy evidence used. Does not meet criteria for AJCC pathologic staging. 2 No regional lymph nodes removed for examination, but evidence derived from p autopsy (tumor was suspected or diagnosed prior to autopsy). 3 Regional lymph nodes removed for examination (removal of at least 1 lymph p node) WITHOUT pre-surgical systemic treatment or radiation OR lymph nodes removed for examination, unknown if pre-surgical systemic treatment or radiation performed Meets criteria for AJCC pathologic staging. 5 Regional lymph nodes removed for examination WITH pre-surgical systemic c treatment or radiation, and lymph node evaluation based on clinical evidence. 6 Regional lymph nodes removed for examination WITH pre-surgical systemic y treatment or radiation, BUT lymph node evaluation based on pathologic evidence. 8 Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy. a 9 Unknown if lymph nodes removed for examination c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record For sites that have no TNM staging: Not applicable

Instructions for Coding 1. Select the CS Reg Nodes Eval code that documents the report or procedure from which the information about the farthest involved regional lymph nodes was obtained; this may not be the numerically highest eval code. Example Modified radical neck dissection for hypopharyngeal cancer shows one lower jugular node involved (CS Reg LN code 10, Eval code 3). Physical exam shows hard, matted scalene (transverse cervical) node presumed to contain metastasis (CS Reg LN code 32, Eval code 0). Code CS Reg Nodes Eval as 0 since the scalene node involvement was determined clinically rather than by examination of tissue.

2. For sites/histologies where there is no TNM schema (see Table 5 in the General Instructions), CS Reg Node Eval may be coded 9 (not applicable).

Version date: January 1, 2004 39 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

page edited March 2004 CS Reg Nodes Eval, continued 3. Select the code that best explains how the information in the CS Lymph Nodes field was determined. a. If the patient had no removal of lymph node(s), use code 0, 1, or 9. Example Prostate cancer with laparoscopic lymph node biopsy showing involved nodes; radical prostatectomy canceled. Code CS Reg Node Eval as 3. Staging algorithm would identify information as pathologic (p). According to AJCC, a positive biopsy of one or more regional lymph nodes is sufficient to meet the pathologic staging basis for prostate cancer. Example Lung cancer with CT scan or MRI showing involved contralateral mediastinal nodes. Code CS Reg Node Eval as 0. Staging algorithm would identify information as clinical (c). b. If the patient had removal of lymph node(s) surgery followed by other treatment(s), use code 3 or 9. c. If the patient receives preoperative (neoadjuvant) systemic therapy (chemotherapy, hormone therapy, immunotherapy) or radiation therapy, the clinical status of lymph nodes takes precedence (code 5). d. If the size, number or extension of regional lymph node involvement determined prior to treatment was the basis for neoadjuvant therapy, use code 5. However, if more extensive tumor is found during lymph node examination after neoadjuvant therapy, use code 6. e. If the patient had an autopsy, use code 2 if the diagnosis was known or suspected prior to death. Use code 8 if the malignancy was not known or suspected prior to death.

4. Code 0 includes imaging studies such as standard radiography, special radiographic projections, tomography, computerized tomography (CT), ultrasonography, lymphography, angiography, scintigraphy (nuclear scans), ultrasonography, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, spiral scanning (CT or MRI) and other non-invasive methods of examining tissues.

5. Codes 0-3 are oriented to the AJCC staging basis. Code 1 includes microscopic analysis of tissue insufficient to meet the requirements for pathologic staging in the TNM system. For example, a needle biopsy of an axillary lymph node will document that a lymph node is involved by breast cancer, but does not meet the requirement for removal of a sufficient number of lymph nodes so that the highest N stage can be assessed. Pathologic staging requirements vary by site; for some site schemas, code 1 may be classified as pathologic. For specific classification rules, refer to the AJCC Cancer Staging Manual, sixth edition. Code 1 also includes observations at surgery, such as abdominal exploration at the time of a colon resection, where regional lymph nodes are not biopsied.

6. Code 3 maps to pathologic staging across all sites. Use code 3 if the lymph node procedure meets the requirements for pathologic staging basis of regional lymph nodes. The requirements vary among sites as to the location and number of lymph nodes involved, the size of the involved nodes, and other characteristics. For prostate cancer, a positive biopsy of a single regional lymph node is sufficient to assign CS Reg Nodes Eval code 3 to the case.

Version date: January 1, 2004 40 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS SITE-SPECIFIC FACTOR 1 Item Length: 3 NAACCR Item #2880

Description Identifies additional information needed to generate stage, or prognostic factors that have an effect on stage or survival.

Code Description 000 None SITE/HISTOLOGY-SPECIFIC CODES 999 Unknown; [site-specific title] cannot be assessed; Not documented in patient record

For schemas that do not use this site-specific factor:

Code Description 888 Not applicable for this site

Instructions for Coding 1. If there is no site/histology-specific factor for a schema, code 888.

2. The following primary sites/histologies use Site Specific Factor 1 to code information. See the site- specific schemas for acceptable codes and their definitions.

Site/Histology Factor Head and neck* Size of Lymph Nodes Colon Carcinoembryonic Antigen (CEA) Rectosigmoid, rectum Carcinoembyronic Antigen (CEA) Liver Alpha Fetoprotein (AFP) Pleura Pleural Effusion Malignant Melanoma of Skin, Vulva, Penis, Scrotum Measured Thickness (Depth), Breslow’s Measurement Mycosis Fungoides Peripheral Blood Involvement Breast Estrogen Receptor Assay (ERA) Ovary Carbohydrate Antigen 125 (CA-125) Placenta Prognostic Scoring Index Prostate Prostate Specific Antigen Laboratory Value (PSA Lab Value) Testis Alpha Fetoprotein (AFP) Thyroid Single vs. Multiple Nodules ______* Head and neck includes the following schemas: upper lip; lower lip; other lip; base of tongue; anterior tongue; upper gum; lower gum and retromolar trigone; other gum; floor of mouth; hard palate; soft palate/uvula; other mouth; buccal mucosa; parotid gland; submandibular gland; other salivary glands; oropharynx; anterior surface of epiglottis; nasopharynx; pyriform sinus/ hypopharynx; other pharynx; nasal cavity; middle ear; maxillary sinus; ethmoid sinus; other sinus; glottic larynx; supraglottic larynx; subglottic larynx; other larynx

Version date: January 1, 2004 47 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

page edited March 2004 CS Site-Specific Factor 1, continued Site/Histology Factor Melanoma of Conjunctiva Measured Thickness (Depth), Breslow’s Measurement Melanoma of Choroid Measured Thickness (Depth), Breslow’s Measurement Melanoma of Iris and Ciliary Body Measured Thickness (Depth), Breslow’s Measurement Retinoblastoma Extension Evaluated at Enucleation Brain WHO Grade Other CNS WHO Grade Other Endocrine WHO Grade Kaposi Sarcoma Associated with HIV/AIDS Lymphoma Associated with HIV/AIDS

3. Code 000 Not done is used when there is a statement in the record that a test was not performed. a. If there is no report of a lab test in the patient record, code as 999 Unknown; Not documented in patient record. b. For Kaposi sarcoma, if AIDS status is not documented, code as 999 Unknown rather than 002, Not Present.

Version date: January 1, 2004 48 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS SITE-SPECIFIC FACTOR 4 Item Length: 3 NAACCR Item #2910

Description Identifies additional information needed to generate stage, or prognostic factors that have an effect on stage or survival.

Code Description 000 None SITE/HISTOLOGY-SPECIFIC CODES 999 Unknown; [site-specific title] cannot be assessed; Not documented in patient record

For schemas that do not use this site-specific factor:

Code Description 888 Not applicable for this site

Instructions for Coding 1. If there is no site/histology-specific factor for a schema, code 888.

2. The following primary sites use Site Specific Factor 4 to code information. See the site-specific schemas for acceptable codes and their definitions.

Site/Histology Factor Head and Neck* Levels IV-V, Lymph Nodes of Head and Neck Malignant Melanoma of Skin, Vulva, Penis, Scrotum Lactate Dehydrogenase (LDH) Breast Immunohistochemistry (IHC) of Regional Lymph Nodes Prostate Prostate Apex Involvement (effective as of version 1.02.00) [Prostatic Acid Phosphatase (PAP)–OBSOLETE as of version 1.02.00] Testis Radical Orchiectomy Performed

______* Head and neck includes the following schemas: upper lip; lower lip; other lip; base of tongue; anterior tongue; upper gum; lower gum and retromolar trigone; other gum; floor of mouth; hard palate; soft palate/uvula; other mouth; buccal mucosa; parotid gland; submandibular gland; other salivary glands; oropharynx; anterior surface of epiglottis; nasopharynx; pyriform sinus/ hypopharynx; other pharynx; nasal cavity; middle ear; maxillary sinus; ethmoid sinus; other sinus; glottic larynx; supraglottic larynx; subglottic larynx; other larynx

3. Code 000 Not done is used when there is a statement in the record that a test was not performed. a. If there is no report of a lab test in the health record, code as 999 Unknown; Not documented in patient record.

Version date: January 1, 2004 53 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Instructions for Data Items

CS Site-Specific Factor 4, continued For head and neck sites only: 4. Use code 9 only when it is unknown if lymph nodes are involved. Within the Site-Specific Factors, do not code 9 in some positions and 0 or 1 in other positions. If specific information is available about the positive or negative status of some but not all nodes in any one level or group, assume that the rest of the nodes in the same Site-Specific Factor are negative and code accordingly.

5. When the only information available is “Regional nodes, NOS” or “Cervical nodes, NOS” or “Internal jugular lymph nodes, NOS” or “Lymph nodes, NOS,” code 0 in all digits of Site-Specific Factors 3-6.

6. See “Coding Regional Lymph Nodes for Head and Neck Sites” under CS Lymph Nodes for further information about the regional nodes of the head and neck, including definitions of the levels.

Version date: January 1, 2004 54 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Schema SSF1 SSF2 SSF3 SSF4 SSF5 SSF6

OthAdnexa none

OthFemaleGen none

Placenta Prognostic Scoring Index

Penis none

Prostate PSA Lab PSA CS Path [PAP- Gleason’s Gleason’s Value Extension obsolete] Prim and Score Prostate Apex 2nd Patterns Involvement*

Testis AFP HCG LDH Radical Size of Mets Orchiectomy in LNs

OthMaleGen none

Scrotum none

Kidney none

RenalPelvis none

Bladder none

Urethra none

OthUrinary none

Conjunctiva none

Melanoma Conjunctiva Measured Thickness (depth) Breslow’s

OthEye none

MelanomaChoroid Measured Thickness (depth) Breslow’s

MelamonaIrisCiliary Measured Thickness (depth) Breslow’s

MelanomaOthEye none

LacrimalGland none

Orbit none

Retinoblastoma Extension Evaluated at Enucleation

Brain WHO grade

OthCNS WHO grade

Thyroid Solitary vs Multifocal

OthEndocrine WHO grade

Version date: January 1, 2004 75 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Schema SSF1 SSF2 SSF3 SSF4 SSF5 SSF6

KS Assoc w/ HIV/AIDS

Lymphoma Assoc w/ Symptoms at IPI score HIV/AIDS Diagnosis

HemeRetic none

OthIllDef none

* name and content of field changed as of version 1.02 (April 2005)

Version date: January 1, 2004 76 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

D Imaging studies Death certificate only cases ...... 18 CS Extension...... 29 Derived fields, allowable values ...... 6 CS Lymph Nodes ...... 34 Diagnostic confirmation ...... 11 CS Mets Eval...... 46 Diagram of Inputs and Outputs ...... 7 CS Reg Nodes Eval ...... 40 Discontinuous metastasis ...... 28 CS Tumor Size/Ext Eval ...... 31 Corpus uteri...... 28 Tumor size...... 26 CS Extension...... 28 Immunohistochemistry (IHC) of lymph nodes for Ovary...... 28 breast...... 53 Disease progression...... 2, 12, 13 Immunoproliferative diseases CS Mets at DX...... 43 Regional Nodes Examined ...... 42 Display strings for Collaborative Staging ...... 4 Regional Nodes Positive ...... 41 Distant metastases...... 29 Tumor size...... 27 Downstaging rule ...... 8 Implementation date of 1/1/04 ...... 11 In situ tumor E CS Extension...... 29 Endocrine, other CS Lymph Nodes ...... 34 CS Site-Specific Factor 1...... 48 Regional Nodes Examined ...... 42 Enucleation for retinoblastoma ...... 48 Regional Nodes Positive ...... 41 ERA ...... 47 Tumor size...... 26 Esophagus Inaccessible primary sites...... 3, 14 Inaccessible primary site...... 3 Bladder ...... 3 Tumor size...... 27 Corpus uteri...... 3 Estrogen receptor assay ...... 47 CS Lymph Nodes ...... 33, 34 Extension Size Table, example...... 60 Esophagus ...... 3 Extra tables...... 59 Kidney ...... 3 Extracapsular extension, lymph nodes ...... 35, 49 Liver...... 3 Lung ...... 3 F New coding rule...... 14 Familial polyposis ...... 27 None vs. unknown ...... 14 Fibrosis Score for liver ...... 49 Ovary...... 3 Fixed lymph nodes ...... 34 Prostate...... 3 Fruit and nut size equivalents ...... 62 Stomach ...... 3 Inflammatory carcinoma...... 27 G International Prognostic Index (IPI) Score for General Guidelines ...... 11 lymphoma ...... 51 Gestational trophoblastic tumor ...... 17 Invasive component Gleason’s patterns/score ...... 55, 57 Tumor size...... 26, 57 Grade, WHO ...... 48 IPI score for lymphoma ...... 51 H K HCG...... 49 Kaposi sarcoma Head and neck AIDS/HIV...... 48 CS Site-Specific Factor 1...... 47 CS Site-Specific Factor 1...... 13, 48 CS Site-Specific Factor 2...... 49 Histology-specific coding schema...... 15, 21 CS Site-Specific Factor 3...... 51, 52 HIV/AIDS...... 48 CS Site-Specific Factor 4...... 53, 54 Site-Specific Factors...... 13 CS Site-Specific Factor 5...... 55 Kaposi sarcoma histology exclusion group ...... 77 CS Site-Specific Factor 6...... 58 Kidney Extracapsular extension, lymph nodes ..... 49 Inaccessible primary site...... 3 Lymph node levels ...... 51, 53, 55, 57 Regional lymph nodes ...... 35 L Schemas included ....13, 47, 49, 51, 53, 55, 57 Lactate dehydrogenase ...... 53 Site-Specific Factors...... 13, 36 Langerhans cell histiocytosis, disseminated Size of lymph nodes ...... 47 Tumor size...... 27 Head and neck lymph node levels ...... 37, 55, 57 LDH ...... 51, 53 Coding instructions ...... 51, 53 Letterer-Siwe disease Hematopoietic and reticuloendothelial system Tumor size...... 27 Histology-specific coding schema...... 15, 21 Leukemia Regional Nodes Examined ...... 42 Regional Nodes Examined ...... 42 Regional Nodes Positive ...... 41 Regional Nodes Positive ...... 41 Hematopoietic histology exclusion group ...... 77 Tumor size...... 27 Hierarchy of codes ...... 12 Levels of head and neck lymph nodes ...... 55 Histologies excluded from TNM staging ...... 11 Coding instructions ...... 51, 53 Histology Exclusion Groups, Names of ...... 77 Liver Histology Exclusion Tables...... 59 AFP...... 47 Histology-specific schemas...... 15, 21 CS Site-Specific Factor 1...... 47 HIV/AIDS ...... 48 CS Site-Specific Factor 2...... 49 Human chorionic gonadotropin ...... 49 Fibrosis score ...... 49 Inaccessible primary site...... 3 I Site-Specific Factors...... 13 IHC of lymph nodes for breast ...... 53 Lung Ill-defined primary sites Adenopathy ...... 34 Regional Nodes Examined ...... 42 Hilar mass ...... 34 Regional Nodes Positive ...... 41 Inaccessible primary site...... 3 Mediastinal mass...... 34 Tumor size...... 27

Version date: January 1, 2004 81 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Lymph nodes N Axillary, number positive for breast ...... 51 N allowable values ...... 64 Clinical status for melanoma ...... 51 Names of Site-Specific Factors...... 72 Direct extension into ...... 34 National Cancer Institute of Canada ...... 1 Enlarged ...... 34 National Cancer Institute Surveillance, Epidemiology Extracapsular extension ...... 35 and End Results ...... 1 Fixed...... 34 National Cancer Registrars Association (NCRA) . . 1 Levels in head and neck ...... 35, 51, 53, 57 NCRA ...... 1 Matted...... 34 Needle biopsy, tumor size ...... 27 Palpable ...... 34 Neoadjuvant therapy ...... 12 Shotty ...... 34 CS Extension...... 28 Size...... 35 CS Lymph Nodes ...... 33, 34 Size of metastasis for testis...... 55 CS Mets at DX...... 43 Visible swelling ...... 34 CS Mets Eval...... 45, 46 Lymphadenopathy ...... 34 CS Reg Nodes Eval ...... 39, 40 Lymphoma CS Tumor Size ...... 26, 31 AIDS/HIV...... 48 CS Tumor Size/Ext Eval ...... 30, 31 CS Site-Specific Factor 1...... 48 Regional Nodes Examined ...... 42 CS Site-Specific Factor 2...... 49 Regional Nodes Positive ...... 41 CS Site-Specific Factor 3...... 51 Tumor size...... 26 Histology-specific coding schema...... 15, 21 Nodule(s) in pericolic fat ...... 35 HIV/AIDS...... 48 None vs. unknown ...... 3, 14 IPI score ...... 51 CS Lymph Nodes ...... 33 Lymph node involvement ...... 34 CS Mets at DX...... 43 Regional Nodes Examined ...... 42 CS Site-Specific Factor 1...... 48 Regional Nodes Positive ...... 41 CS Site-Specific Factor 2...... 50 Site-Specific Factors...... 13 CS Site-Specific Factor 3...... 51, 52 Symptoms at diagnosis ...... 49 CS Site-Specific Factor 4...... 53, 54 Tumor size...... 27 CS Site-Specific Factor 5...... 55 Lymphoma histology exclusion group ...... 77 CS Site-Specific Factor 6...... 57, 58 NOS, Use of...... 8 M CS Extension...... 29 M allowable values...... 65 CS Lymph Nodes ...... 34 Mapping CS Mets at DX...... 44 Columns in Collaborative Staging tables ..... 4 CS Site-Specific Factor 3...... 52 How it was determined ...... 8 CS Site-Specific Factor 4...... 54 Margins, positive CS Site-Specific Factor 5...... 56 CS Extension...... 29 CS Site-Specific Factor 6...... 58 Mass, NOS, and lymph nodes ...... 34 Use of for head and neck lymph nodes ..... 36 Mast cell tumors, tumor size...... 27 Not applicable Matted lymph nodes ...... 34 using code(s) for ...... 12 Melanoma NPCR...... 1 Breslow's measurement...... 47, 48 Clinical status of lymph node mets ...... 51 O CS Site-Specific Factor 1...... 47 Obsolete, meaning of ...... 5 CS Site-Specific Factor 2...... 49 Operative assessment ...... 12 CS Site-Specific Factor 3...... 51 Operative reports CS Site-Specific Factor 4...... 53 CS Reg Nodes Eval ...... 34 Histology-specific coding schema...... 15, 21 CS Tumor Size/Ext Eval ...... 26, 28 LDH...... 53 Oral cavity Site breakdown for...... 15 Accessible primary site ...... 3, 14 Site-Specific Factors...... 13 Orchiectomy, radical...... 53 Thickness (depth) ...... 47, 48 Other endocrine Tumor size...... 27 CS Site-Specific Factor 1...... 48 Ulceration ...... 49, 50 WHO grade...... 48 Melanomas histology exclusion group ...... 77 Other specified histology exclusion group...... 77 Mesotheliomas histology exclusion group...... 77 Ovary Microscopic confirmation ...... 11 CA-125 ...... 47 Microscopic focus or foci ...... 27 CS Site-Specific Factor 1...... 47 Tumor size...... 27 Discontinuous metastasis ...... 28 Missing information, coding guideline...... 3 Inaccessible primary site...... 3 Molecular studies of regional lymph nodes for breast Site-Specific Factors...... 13 ...... 55 Multiple myeloma, tumor size...... 27 P Multiple polyposis...... 27 PAP ...... 53 Multiple vs. single nodules for thyroid ...... 47 Pathological assessment ...... 12 Mycosis fungoides Pathological staging basis ...... 30, 39, 45 CS Site-Specific Factor 1...... 47 Pathology reports Histology-specific coding schema...... 15, 21 CS Extension...... 28 Peripheral blood involvement ...... 47 CS Lymph Nodes ...... 33, 35 Site-Specific Factors...... 13 CS Reg Nodes Eval ...... 34 Myelodysplastic syndromes CS Tumor Size/Ext Eval ...... 26, 28 Tumor size...... 27 Priority of...... 12 Myeloproliferative diseases Size of lymph nodes ...... 35 Regional Nodes Examined ...... 42 Tumor size...... 25 Regional Nodes Positive ...... 41 Peripheral blood involvement in MF ...... 47 Tumor size...... 27 Physician staging CS Extension...... 29 CS Lymph Nodes ...... 35 CS Mets at DX...... 44

Version date: January 1, 2004 82 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

Physician-assigned TNM ...... 29 Regional Nodes Positive CS Extension...... 29 Allowable values ...... 5 CS Lymph Nodes ...... 35 Coding instructions ...... 41 CS Mets at DX...... 44 Residual disease use of...... 13 CS Extension...... 29 Pieces or chips, tumor size ...... 26 Residual tumor ...... 26 Placenta Reticuloendothelial system CS Site-Specific Factor 1...... 47 Histology-specific coding schema...... 15, 21 Prognostic Scoring Index ...... 47 Regional Nodes Examined ...... 42 Regional Nodes Examined ...... 42 Regional Nodes Positive ...... 41 Regional Nodes Positive ...... 41 Retinoblastoma Site-Specific Factors...... 13 CS Site-Specific Factor 1...... 48 Pleura Extension at enucleation ...... 48 CS Site-Specific Factor 1...... 47 Histology-specific coding schema...... 15, 21 Pleural effusion ...... 47 Site-Specific Factors...... 13 Site-Specific Factors...... 13 Rules Pleural effusion...... 47 Downstaging ...... 8 Polyp size, use of for tumor size...... 26 Summary, one-page ...... 21 Polyposis, familial or multiple ...... 27 Timing...... 2 PRA ...... 49 Preoperative treatment ...... 12 S CS Extension...... 28 Salivary gland CS Lymph Nodes ...... 33, 34 Accessible primary site ...... 3, 14 CS Mets at DX...... 43 Sarcomas histology exclusion group...... 77 CS Mets Eval...... 45, 46 SEER Program ...... 1 CS Reg Nodes Eval ...... 39, 40 SEER Summary Stage ...... 11 CS Tumor Size ...... 26 Output from Collaborative Staging ...... 4 CS Tumor Size/Ext Eval ...... 30 Shotty lymph nodes ...... 34 Regional Nodes Examined ...... 42 Site-Specific Extra Tables...... 59 Regional Nodes Positive ...... 41 Site-Specific Factors (SSFs) Tumor size...... 26 Brain ...... 13 Presurgical treatment Breast ...... 13 CS Tumor Size ...... 31 Colon...... 13 CS Tumor Size/Ext Eval ...... 31 Head and neck ...... 13 Primary sites, inaccessible...... 3 Kaposi sarcoma ...... 13 Progesterone receptor assay ...... 49 Liver...... 13 Prognostic Scoring Index for placenta ...... 47 Lymphoma ...... 13 Progression of disease...... 2, 12, 13 Melanoma ...... 13 CS Mets at DX...... 43 Mycosis fungoides ...... 13 Prostate Names of...... 72 CS Extension - Pathologic Extension ...... 51 Ovary...... 13 CS Reg Nodes Eval ...... 40 Placenta...... 13 CS Site-Specific Factor 1...... 47 Pleura ...... 13 CS Site-Specific Factor 2...... 49 Prostate...... 13 CS Site-Specific Factor 3...... 51 Purpose of...... 12 CS Site-Specific Factor 4...... 53 Rectum ...... 13 CS Site-Specific Factor 5...... 55 Retinoblastoma ...... 13 CS Site-Specific Factor 6...... 57 Schemas using ...... 13 Gleason's patterns...... 55 Testis...... 13 Gleason's score...... 57 Thyroid...... 13 Inaccessible primary site...... 3 Size of lymph nodes ...... 35, 47 PAP...... 53 Skin PSA...... 49 Accessible primary site ...... 3, 14 PSA lab value ...... 47 Solitary vs. multifocal for thyroid...... 47, 48 Site-Specific Factors...... 13 Staging basis ...... 30, 39, 45 Prostate apex involvement ...... 53 CS Mets Eval...... 45 Prostate specific antigen...... 49 CS Reg Nodes Eval ...... 39, 40 Prostatic acid phosphatase ...... 53 CS Tumor Size/Ext Eval ...... 30-32 PSA ...... 47, 49 Start date of 1/1/04...... 11 Stomach R Inaccessible primary site...... 3 Radical orchiectomy...... 53 Tumor size...... 27 Rectosigmoid Storage codes for Collaborative Staging ...... 4 CEA...... 47 Summary Stage ...... 11 CS Lymph Nodes ...... 35 Allowable values ...... 67 CS Site-Specific Factor 1...... 47 Conversion algorithm for all schemas...... 68 Tumor size...... 27, 47 Output from Collaborative Staging ...... 4 Rectum Summary Stage Table ...... 59, 68 CEA...... 47 Summary Staging...... 1, 2 CS Lymph Nodes ...... 35 Surgery coding schemas ...... 15 CS Site-Specific Factor 1...... 47 Surgical observations Site-Specific Factors...... 13 use of...... 12 Tumor size...... 27 Symptoms at diagnosis for lymphoma ...... 49 References...... 8 Regional Nodes Examined Allowable values ...... 5 Coding instructions ...... 42

Version date: January 1, 2004 83 Version 1.0 Collaborative Staging Manual and Coding Instructions Part I Additional Tables and Appendices

T U T allowable values ...... 63 Ulcer size, use of for tumor size...... 26 Testis Ulceration for melanoma ...... 49 AFP...... 47 Unknown CS Site-Specific Factor 1...... 47 use of for head and neck lymph nodes ..... 36 CS Site-Specific Factor 2...... 49 using code(s) for ...... 3 CS Site-Specific Factor 3...... 51 Unknown and ill-defined primary sites CS Site-Specific Factor 4...... 53 Regional Nodes Examined ...... 42 CS Site-Specific Factor 5...... 55 Regional Nodes Positive ...... 41 HCG ...... 49 Tumor size...... 27 LDH...... 51 Unknown vs. none ...... 3, 14 Radical orchiectomy ...... 53 Site-Specific Factors...... 13 W Size of metastasis in lymph nodes ...... 55 Web site, Collaborative Staging ...... 11 Text field on abstract ...... 27 WHO grade...... 48 CS Extension...... 29 CS Lymph Nodes ...... 35 Y CS Mets at DX...... 44 Y staging basis...... 31 CS Tumor Size ...... 27 Thickness (depth) of melanoma ...... 47, 48 Thyroid Accessible primary site ...... 3, 14 CS Site-Specific Factor 1...... 47 Single vs. multiple nodules ...... 47 Site-Specific Factors...... 13 Solitary vs. multifocal...... 48 Timing rules ...... 2, 12 TNM, physician-assigned use of...... 13 Tumor markers...... 12 Tumor size Aggregate ...... 26 Breast ...... 26, 27, 57 Chips or pieces ...... 26 Composite...... 26 Descriptive...... 62 Fruit and nuts equivalents ...... 62 In situ cancer...... 26 In situ component ...... 26 Invasive component ...... 26, 57 Melanoma ...... 27 Microscopic focus or foci...... 27 Not applicable ...... 27 Pieces or chips ...... 26 Schemas not using for AJCC...... 17 Schemas requiring for AJCC ...... 16 Unknown...... 27

Version date: January 1, 2004 84 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lip, Upper Lip (Vermilion or Labial Mucosa) C00.0, C00.3 C00.0 External upper lip C00.3 Mucosa of upper lip Note: AJCC includes labial mucosa (C00.3) with buccal mucosa (C06.0)

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Lip, Upper CS Tumor Size SEE STANDARD TABLE

Lip, Upper CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to: * L L Labial mucosa (inner lip) Lamina propria Multiple foci Submucosa (superficial invasion) Vermilion surface Superficial extension to: Skin of lip Subcutaneous soft tissue of lip

20 Musculature * L L

30 Localized, NOS * L L

50 Buccal mucosa (inner cheek) * RE RE Commissure Opposite (both) lip(s)

51 Gingiva * RE RE

70 Maxilla T4 RE RE

Version date: January 1, 2004 87 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

74 Upper lip/commissure: Nose T4 RE D

75 Tongue T4 D D

76 Skin of face/neck T4 D D

77 Cortical bone (other than code 70) T4 D D Floor of mouth Inferior alveolar nerve

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10, 20, 30, 50, and 51 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Lip, Upper CS TS/Ext-Eval SEE STANDARD TABLE

Lip, Upper CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Other groups Facial Buccinator (buccal) Nasolabial Parotid Infra-auricular Intraparotid Periparotid Preauricular Regional lymph node, NOS

11 Single positive ipsilateral regional node: * D RN Level I node Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular

Version date: January 1, 2004 88 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

11, Level III node cont’d Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Parapharyngeal Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

Version date: January 1, 2004 89 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Lip, Upper CS Reg Nodes Eval SEE STANDARD TABLE

Lip, Upper Reg LN Pos SEE STANDARD TABLE

Lip, Upper Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 90 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lip, Upper CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Lip, Upper CS Mets Eval SEE STANDARD TABLE

Lip, Upper CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 91 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lip, Upper CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Lip, Upper CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 92 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lip, Upper CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Lip, Upper CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 93 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Lip, Upper CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 94 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lip, Lower Lip (Vermilion or Labial Mucosa) C00.1, C00.4, C00.6 C00.1 External lower lip C00.4 Mucosa of lower lip C00.6 Commissure of lip Note: AJCC includes labial mucosa (C00.4) with buccal mucosa (C06.0)

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Histology Exclusion Table CS Reg Nodes Eval Nodes for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels CS Mets Eval IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Lip, Lower CS Tumor Size SEE STANDARD TABLE

Lip, Lower CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to: * L L Labial mucosa (inner lip) Lamina propria Multiple foci Submucosa (superficial invasion) Vermilion surface Superficial extension to: Skin of lip Subcutaneous soft tissue of lip

20 Musculature * L L

30 Localized, NOS * L L

50 Buccal mucosa (inner cheek) * RE RE Commissure Opposite (both) lip(s)

51 Gingiva * RE RE

Version date: January 1, 2004 95 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

70 Mandible T4 RE RE

74 Nose T4 RE D

75 Tongue T4 D D

76 Skin of face/neck T4 D D

77 Cortical bone (other than code 70) T4 D D Floor of mouth Inferior alveolar nerve

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10, 20, 30, 50, and 51 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Lip, Lower CS TS/Ext-Eval SEE STANDARD TABLE

Lip, Lower CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Other groups Facial: Mandibular Regional lymph node, NOS

11 Single positive ipsilateral regional node: * D RN Level II node Upper deep cervical Upper jugular Level III node Middle deep cervical Mid-jugular Level IV node Jugulo-omohyoid (supraomohyoid)

Version date: January 1, 2004 96 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

11, Lower deep cervical cont’d Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

Version date: January 1, 2004 97 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Lip, Lower CS Reg Nodes Eval SEE STANDARD TABLE

Lip, Lower Reg LN Pos SEE STANDARD TABLE

Lip, Lower Reg LN Exam SEE STANDARD TABLE

Lip, Lower CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

Version date: January 1, 2004 98 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Lip, Lower CS Mets Eval SEE STANDARD TABLE

Lip, Lower CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 99 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lip, Lower CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Lip, Lower CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 100 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lip, Lower CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Lip, Lower CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 101 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Lip, Lower CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 102 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Lip Lip (Vermilion or Labial Mucosa) C00.2, C00.5, C00.8-C00.9 C00.2 External lip, NOS C00.5 Mucosa of lip, NOS C00.8 Overlapping lesion of lip C00.9 Lip, NOS (excludes skin of lip C44.0) Note: AJCC includes labial mucosa (C00.5) with buccal mucosa (C06.0)

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Other Lip CS Tumor Size SEE STANDARD TABLE

Other Lip CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to: * L L Labial mucosa (inner lip) Lamina propria Multiple foci Submucosa (superficial invasion) Vermilion surface Superficial extension to: Skin of lip Subcutaneous soft tissue of lip

20 Musculature * L L

30 Localized, NOS * L L

50 Buccal mucosa (inner cheek) * RE RE Commissure Opposite (both) lip(s)

51 Gingiva * RE RE

Version date: January 1, 2004 103 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

75 Tongue T4 D D

76 Skin of face/neck T4 D D

77 Cortical bone T4 D D Floor of mouth Inferior alveolar nerve

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10, 20, 30, 50, and 51 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Other Lip CS TS/Ext-Eval SEE STANDARD TABLE

Other Lip CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Regional lymph node, NOS

11 Single positive ipsilateral regional node: * D RN Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS

12 Single positive ipsilateral regional node: * D D Level V node

Version date: January 1, 2004 104 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral

Version date: January 1, 2004 105 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Other Lip CS Reg Nodes Eval SEE STANDARD TABLE

Other Lip Reg LN Pos SEE STANDARD TABLE

Other Lip Reg LN Exam SEE STANDARD TABLE

Other Lip CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Other Lip CS Mets Eval

Version date: January 1, 2004 106 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

SEE STANDARD TABLE

Other Lip CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Other Lip CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 107 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Lip CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Other Lip CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

Version date: January 1, 2004 108 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Other Lip CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 109 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Lip CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 110 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Base of Tongue, Lingual Tonsil C01.9, C02.4 C01.9 Base of tongue, NOS C02.4 Lingual tonsil Note: AJCC includes base of tongue (C01.9) with oropharynx (C10._).

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Base of Tongue, Lingual Tonsil CS Tumor Size SEE STANDARD TABLE

Base of Tongue, Lingual Tonsil CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor on one side confined to posterior 1/3 of tongue: * L L Lamina propria Submucosa

20 Musculature, intrinsic or NOS * L L

30 Localized, NOS * L L Midline tumor

40 Tumor crosses midline * L L

50 Anterior 2/3 of tongue for base of tongue * RE RE Base of tongue for lingual tonsil Floor of mouth Lower gingiva

53 Sublingual gland * RE RE

60 Epiglottis, lingual (pharyngeal) surface * RE RE Glossoepiglottic fold Glossopharyngeal fold Lateral pharyngeal wall

Version date: January 1, 2004 111 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60, Pharyngoepiglottic fold cont’d Tonsillar pillars and fossae Tonsils Vallecula

62 Soft palate, inferior surface or NOS * D RE

71 Mandible for lingual tonsil T4a RE D

72 Mandible for base of tongue T4a D D

74 Medial pterygoid T4a D D Hard palate

75 Musculature, extrinsic: T4a D D Genioglossus Geniohyoid Hyoglossus Mylohyoid Palatoglossus Styloglossus

77 Larynx T4a D D

78 Skin T4b D D

80 Contiguous extension to: T4b D D Base of skull Carotid artery Hypopharynx Lateral nasopharynx Lateral pterygoid muscle Pterygoid plates Uvula

82 Further contiguous extension T4b D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10, 20, 30, 40, 50, 53, 60, and 62 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Base of Tongue, Lingual Tonsil CS TS/Ext-Eval SEE STANDARD TABLE

Version date: January 1, 2004 112 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Base of Tongue, Lingual Tonsil CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Sublingual Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Regional lymph node, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

Version date: January 1, 2004 113 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 49, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Base of Tongue, Lingual Tonsil CS Reg Nodes Eval SEE STANDARD TABLE

Base of Tongue, Lingual Tonsil Reg LN Pos SEE STANDARD TABLE

Base of Tongue, Lingual Tonsil Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 114 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Base of Tongue, Lingual Tonsil CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Base of Tongue, Lingual Tonsil CS Mets Eval SEE STANDARD TABLE

Base of Tongue, Lingual Tonsil CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 115 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Base of Tongue, Lingual Tonsil CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Base of Tongue, Lingual Tonsil CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 116 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Base of Tongue, Lingual Tonsil CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Base of Tongue, Lingual Tonsil CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 117 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Base of Tongue, Lingual Tonsil CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 118 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS C02.0-C02.3, C02.8-C02.9 C02.0 Dorsal surface of tongue, NOS C02.1 Border of tongue C02.2 Ventral surface of tongue, NOS C02.3 Anterior 2/3 of tongue, NOS C02.8 Overlapping lesion of tongue C02.9 Tongue, NOS

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Histology Exclusion Table CS Reg Nodes Eval Nodes for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels CS Mets Eval IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Tumor Size SEE STANDARD TABLE

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor on one side confined to: * L L Lamina propria Submucosa

20 Musculature, intrinsic or NOS * L L

30 Localized, NOS * L L Midline tumor

40 Tumor crosses midline * L L

50 Base of tongue * RE RE Floor of mouth Gingiva, lower Retromolar trigone

53 Sublingual gland * RE RE

Version date: January 1, 2004 119 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60 Lateral pharyngeal wall * D RE Soft palate, inferior surface Tonsillar pillars and fossae Tonsils

70 Mandible T4a RE D

72 (60) + (70) T4a D D

74 Maxilla T4a D D Maxillary sinus

75 Musculature, extrinsic: T4a D D Genioglossus Geniohyoid Hyoglossus Mylohyoid Palatoglossus Styloglossus

80 Further contiguous extension T4b D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For codes 10, 20, 30, 40, 50, 53, and 60 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS TS/Ext-Eval SEE STANDARD TABLE

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Sublingual Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node

Version date: January 1, 2004 120 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Middle deep cervical cont’d Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Regional lymph node, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

Version date: January 1, 2004 121 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 49, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Reg Nodes Eval SEE STANDARD TABLE

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS Reg LN Pos SEE STANDARD TABLE

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS Reg LN Exam SEE STANDARD TABLE

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Version date: January 1, 2004 122 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Mets Eval SEE STANDARD TABLE

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph nodes cannot be assessed Not documented in patient record

Version date: January 1, 2004 123 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

Version date: January 1, 2004 124 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Anterior 2/3 of Tongue, Tip, Border, and Tongue, NOS CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

Version date: January 1, 2004 125 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 126 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, Upper C03.0 C03.0 Upper gum

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Gum, Upper CS Tumor Size SEE STANDARD TABLE

Gum, Upper CS Extension Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to code as bone involvement. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to lamina propria (mucoperiosteum) * L L (stroma)

30 Localized, NOS * L L

50 Buccal mucosa (inner cheek) * RE RE Floor of mouth Labial mucosa (inner lip), lip Tongue

55 Facial muscle, NOS * RE RE Subcutaneous soft tissue of face

60 Lateral pharyngeal wall (tonsillar pillars and fossae, tonsils) * RE RE

70 Maxilla T4a RE RE

72 Deep muscle of tongue: T4a RE RE Genioglossus Hyoglossus Palatoglossus Styloglossus

Version date: January 1, 2004 127 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

74 Maxillary antrum (sinus) T4a D D Nasal cavity

76 Skin T4a D D

79 Skull T4b D D

80 Further contiguous extension, including: T4b D D Masticator space Pterygoid plates Skull base Encases internal carotid artery

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For codes 10, 30, 50, 55, 60, and 65 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Gum, Upper CS TS/Ext-Eval SEE STANDARD TABLE

Gum, Upper CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Retropharyngeal, NOS Regional lymph node, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX)

Version date: January 1, 2004 128 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

12, Other groups cont’d Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 49, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Version date: January 1, 2004 129 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, Upper CS Reg Nodes Eval SEE STANDARD TABLE

Gum, Upper Reg LN Pos SEE STANDARD TABLE

Gum, Upper Reg LN Exam SEE STANDARD TABLE

Gum, Upper CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Gum, Upper CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 130 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, Upper CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Gum, Upper CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 131 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, Upper CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Gum, Upper CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

Version date: January 1, 2004 132 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Gum, Upper CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 133 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, Upper CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 134 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, Lower and Retromolar Area Retromolar gingiva (trigone) C03.1, C06.2 C03.1 Lower gum C06.2 Retromolar area

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I-III, Extension Size Table Reg LN Exam Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Gum, Lower and Retromolar Area CS Tumor Size SEE STANDARD TABLE

Gum, Lower and Retromolar Area CS Extension Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to code as bone involvement (code 70). Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to lamina propria * L L (mucoperiosteum)(stroma)

30 Localized, NOS * L L

50 Buccal mucosa (inner cheek) * RE RE Floor of mouth Labial mucosa (inner lip), lip Tongue

55 Facial muscle, NOS * RE RE Subcutaneous soft tissue of face

60 Lateral pharyngeal wall (tonsillar pillars and fossae, tonsils) * RE RE

65 Soft palate including uvula * RE RE

70 Mandible T4a RE RE

Version date: January 1, 2004 135 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

72 Deep muscle of tongue: T4a RE RE Genioglossus Hyoglossus Palatoglossus Styloglossus

76 Skin T4a D D

79 Skull T4b D D

80 Further contiguous extension, including: T4b D D Masticator space Pterygoid plates Skull base Encases internal carotid artery

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For codes 10, 30, 50, 55, 60, and 65 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Gum, Lower and Retromolar Area CS TS/Ext-Eval SEE STANDARD TABLE

Gum, Lower and Retromolar Area CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular

Version date: January 1, 2004 136 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Other groups cont’d Facial: Buccinator (buccal) Nasolabial Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Regional lymph node, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

Version date: January 1, 2004 137 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 49, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Gum, Lower and Retromolar Area CS Reg Nodes Eval SEE STANDARD TABLE

Gum, Lower and Retromolar Area Reg LN Pos SEE STANDARD TABLE

Gum, Lower and Retromolar Area Reg LN Exam SEE STANDARD TABLE

Gum, Lower and Retromolar Area CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Gum, Lower and Retromolar Area CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 138 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, Lower and Retromolar Area CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Gum, Lower and Retromolar Area CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 139 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, Lower and Retromolar Area CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Gum, Lower and Retromolar Area CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

Version date: January 1, 2004 140 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Gum, Lower and Retromolar Area CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Gum, Lower and Retromolar Area CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

Version date: January 1, 2004 141 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 142 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, NOS C03.9 C03.9 Gum, NOS

CS Tumor Size CS Site-Specific Factor 1 - Size The following tables are CS Extension of Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Histology Exclusion Table CS Reg Nodes Eval Nodes for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Extension Size Table Reg LN Exam Levels I-III, Lymph Nodes for Lymph Nodes Size Table CS Mets at DX Head and Neck CS Mets Eval CS Site-Specific Factor 4 - Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Gum, NOS CS Tumor Size SEE STANDARD TABLE

Gum, NOS CS Extension Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to code as bone involvement. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to lamina propria mucoperiosteum) * L L (stroma)

30 Localized, NOS * L L

50 Buccal mucosa (inner cheek) * RE RE Labial mucosa (inner lip), lip

55 Facial muscle, NOS * RE RE Subcutaneous soft tissue of face

60 Lateral pharyngeal wall (tonsillar pillars and * RE RE fossae, tonsils)

72 Deep muscle of tongue: T4a RE RE Genioglossus Hyoglossus Palatoglossus Styloglossus

76 Skin T4a D D

Version date: January 1, 2004 143 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

79 Skull T4b D D

80 Further contiguous extension, including: T4b D D Masticator space Pterygoid plates Skull base Encases internal carotid artery

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For codes 10, 30, 50, 55, 60, and 65 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Gum, NOS CS TS/Ext-Eval SEE STANDARD TABLE

Gum, NOS CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Other groups Facial: Buccinator (buccal) Nasolabial Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Regional lymph node, NOS

Version date: January 1, 2004 144 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

Version date: January 1, 2004 145 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 20, 30, 40, 49, 50 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph nodes, using the extra table, Lymph Nodes Size Table for this site.

Gum, NOS CS Reg Nodes Eval SEE STANDARD TABLE

Gum, NOS Reg LN Pos SEE STANDARD TABLE

Gum, NOS Reg LN Exam SEE STANDARD TABLE

Gum, NOS CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Gum, NOS CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 146 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, NOS CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Gum, NOS CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 147 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gum, NOS CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Gum, NOS CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

Version date: January 1, 2004 148 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Gum, NOS CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Gum, NOS CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

Version date: January 1, 2004 149 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 150 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Floor of Mouth C04.0-C04.1, C04.8-C04.9 C04.0 Anterior floor of mouth C04.1 Lateral floor of mouth C04.8 Overlapping lesion of floor of mouth C04.9 Floor of mouth, NOS

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Floor of Mouth CS Tumor Size SEE STANDARD TABLE

Floor of Mouth CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor on one side confined to: * L L Lamina propria Submucosa

30 Localized, NOS * L L

40 Tumor crosses midline * L L

50 Anterior 2/3 of tongue * RE RE Base of tongue Gingiva (alveolar ridge), lower

53 Sublingual gland, including ducts * RE RE Submandibular (submaxillary) glands, including ducts

60 Epiglottis * RE RE Glossoepiglottic fold Glossopharyngeal sulcus Lateral pharyngeal wall Pharyngeal (lingual) surface Pharyngoepiglottic fold

Version date: January 1, 2004 151 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60, Tonsillar pillars and fossae cont’d Tonsils Vallecula

62 Extension to deep extrinsic muscle of tongue: T4a L L Genioglossus Geniohyoid Hyoglossus Mylohyoid Palatoglossus Styloglossus

63 (62) + any of [(50) or (53) or (60)] T4a RE RE

64 Subcutaneous soft tissue of chin/neck T4a RE RE

70 Mandible T4a RE RE

76 Skin of undersurface of chin/neck T4a RE RE

77 Further contiguous extension: T4a D D Maxillary sinus

80 Further contiguous extension: T4b D D Base of skull Masticator space Pterygoid plates

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *Note: For Extension codes 10, 20, 30, 40, 50, 53, and 60 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Floor of Mouth CS TS/Ext-Eval SEE STANDARD TABLE

Floor of Mouth CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemes, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental

Version date: January 1, 2004 152 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Level II node cont’d Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Sublingual Regional lymph node, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

Version date: January 1, 2004 153 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 20, 30, 40, 49, 50 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Floor of Mouth CS Reg Nodes Eval SEE STANDARD TABLE

Floor of Mouth Reg LN Pos SEE STANDARD TABLE

Floor of Mouth Reg LN Exam SEE STANDARD TABLE

Floor of Mouth CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

Version date: January 1, 2004 154 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Floor of Mouth CS Mets Eval SEE STANDARD TABLE

Floor of Mouth CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 155 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Floor of Mouth CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Floor of Mouth CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 156 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Floor of Mouth CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Floor of Mouth CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 157 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Floor of Mouth CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 158 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hard Palate C05.0 C05.0 Hard palate

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Histology Exclusion Table CS Reg Nodes Eval Nodes for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels CS Mets Eval IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Hard Palate CS Tumor Size SEE STANDARD TABLE

Hard Palate CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor on one side confined to mucoperiosteum (stroma) * L L

30 Localized, NOS * L L

40 Tumor crosses midline * L L

50 Buccal mucosa (inner cheek) * RE RE Gingiva, upper Glossopalatine arch Pharyngopalatine arch Soft palate Uvula

70 Maxillary bone T4a RE RE Palatine bone

74 Deep muscle of tongue T4a D D Floor of nose Maxillary antrum (sinus) Nasal cavity Nasopharynx Skin of face Sphenoid bone

Version date: January 1, 2004 159 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

76 Pterygoid plate T4b D D

80 Further contiguous extension T4b D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10, 30, 40, and 50 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Hard Palate CS TS/Ext-Eval SEE STANDARD TABLE

Hard Palate CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Retropharyngeal Regional lymph node, NOS

11 Single positive ipsilateral regional node: * D RN Level I node Submental

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical

Version date: January 1, 2004 160 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

12, Posterior triangle (spinal accessory and transverse cervical) cont’d (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Parapharyngeal Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

Version date: January 1, 2004 161 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Hard Palate CS Reg Nodes Eval SEE STANDARD TABLE

Hard Palate Reg LN Pos SEE STANDARD TABLE

Hard Palate Reg LN Exam SEE STANDARD TABLE

Hard Palate CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Hard Palate CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 162 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hard Palate CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Hard Palate CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 163 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hard Palate CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Hard Palate CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

Version date: January 1, 2004 164 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Hard Palate CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Hard Palate CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

Version date: January 1, 2004 165 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 166 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Soft Palate, Uvula C05.1-C05.2 C05.1 Soft Palate, NOS C05.2 Uvula Note 1: AJCC includes inferior surface of the soft palate (C05.1) and uvula (C05.2) with oropharynx (C09._, C10._). Note 2: Soft palate excludes nasopharyngeal (superior) surface of soft palate (C11.3).

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Soft Palate, Uvula CS Tumor Size SEE STANDARD TABLE

Soft Palate, Uvula CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor on one side confined to: * L L Lamina propria Submucosa

20 Musculature invaded * L L

30 Localized, NOS * L L

40 Tumor crosses midline * L L

50 Buccal mucosa (inner cheek) * RE RE Gum (gingiva), upper

60 Lateral pharyngeal wall * RE RE Tonsillar pillars and fossae Tonsils

65 Hard palate T4a RE RE

Version date: January 1, 2004 167 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

70 Mandible T4a D D Maxilla Palatine bone (bone of hard palate)

71 Pterygoid muscle, medial or NOS T4a D D

72 Tongue T4a D D Deep extrinsic muscle of tongue

73 Larynx T4a D D

74 Maxillary antrum (sinus) T4b D D Nasopharynx, lateral or NOS

77 Nasal cavity T4a RE D

78 Pterygoid muscle, lateral T4b RE D Pterygoid plates Note: For medial pterygoid muscle or pterygoid muscle, NOS, see code 71

79 [(77) or (78)] with any of [(70) to (76)] T4b D D

80 Further contiguous extension T4b D D Carotid artery Skull base

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10, 20, 40, 50, and 60 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Soft Palate, Uvula CS TS/Ext-Eval SEE STANDARD TABLE

Soft Palate, Uvula CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric)

Version date: January 1, 2004 168 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Upper deep cervical cont’d Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Regional lymph node, NOS

11 Single positive ipsilateral regional node: * D RN Other groups Retropharyngeal

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Parapharyngeal Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

Version date: January 1, 2004 169 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Soft Palate, Uvula CS Reg Nodes Eval SEE STANDARD TABLE

Soft Palate, Uvula Reg LN Pos SEE STANDARD TABLE

Soft Palate, Uvula Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 170 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Soft Palate, Uvula CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Soft Palate, Uvula CS Mets Eval SEE STANDARD TABLE

Soft Palate, Uvula CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 171 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Soft Palate, Uvula CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Soft Palate, Uvula CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 172 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Soft Palate, Uvula CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Soft Palate, Uvula CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 173 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Soft Palate, Uvula CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 174 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Mouth C05.8-C05.9, C06.8-C06.9 C05.8 Overlapping lesion of palate C05.9 Palate, NOS C06.8 Overlapping lesion of other and unspecified parts of mouth C06.9 Mouth, NOS

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Histology Exclusion Table CS Reg Nodes Eval Nodes for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels CS Mets Eval IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Other Mouth CS Tumor Size SEE STANDARD TABLE

Other Mouth CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to: * L L Lamina propria Submucosa

20 Musculature invaded * L L

30 Localized, NOS * L L

50 Adjacent oral cavity * RE RE

60 Extension to oropharynx: * RE RE Inferior surface of soft palate Lateral pharyngeal wall Lingual surface of epiglottis Vallecula

70 Extension to adjacent structures: T4a D D Mandible Maxilla Maxillary antrum (sinus) Nasal cavity Skin of face/neck Tongue

Version date: January 1, 2004 175 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

71 Deep extrinsic muscle of tongue T4a D D

72 Skull T4b D D

75 Base of skull T4b D D Encases internal carotid artery Masticator space Pterygoid plates

80 Further contiguous extension T4b D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10, 20, 30, 50, and 60 ONLY, the T category is assigned based on the value of Tumor Size, as shown in the Extension Size Table for this site.

Other Mouth CS TS/Ext-Eval SEE STANDARD TABLE

Other Mouth CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Regional lymph node, NOS

Version date: January 1, 2004 176 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

Version date: January 1, 2004 177 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 49, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Other Mouth CS Reg Nodes Eval SEE STANDARD TABLE

Other Mouth Reg LN Pos SEE STANDARD TABLE

Other Mouth Reg LN Exam SEE STANDARD TABLE

Other Mouth CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Other Mouth CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 178 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Mouth CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Other Mouth CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 179 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Mouth CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Other Mouth CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

Version date: January 1, 2004 180 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Other Mouth CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Other Mouth CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

Version date: January 1, 2004 181 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 182 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Cheek (Buccal) Mucosa, Vestibule C06.0-C06.1 C06.0 Cheek mucosa C06.1 Vestibule of mouth

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Cheek (Buccal) Mucosa, Vestibule CS Tumor Size SEE STANDARD TABLE

Cheek (Buccal) Mucosa, Vestibule CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to: * L L Lamina propria Submucosa

20 Musculature (buccinator) * RE L

30 Localized, NOS * L L

50 Lip(s) including commissure * RE RE

51 Gingiva * RE RE

60 Lateral pharyngeal wall * RE RE Tonsillar pillars and fossae Tonsils

65 Subcutaneous soft tissue of cheek T4a RE RE

66 Skin of cheek (WITH or WITHOUT ulceration) T4a RE D

67 Maxillary sinus T4a D D

Version date: January 1, 2004 183 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

70 Bone (cortical): T4a D D Mandible Maxilla

73 Skull T4b D D

75 Tongue T4a D D Deep extrinsic muscle of tongue

79 Other contiguous extension: T4b D D Base of skull Encases internal carotid artery Masticator space Pterygoid plates

80 Further contiguous extension: T4b D D Hard palate Soft palate

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10, 20, 30, 50, 51, and 60 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Cheek (Buccal) Mucosa, Vestibule CS TS/Ext-Eval SEE STANDARD TABLE

Cheek (Buccal) Mucosa, Vestibule CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical

Version date: January 1, 2004 184 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Lower jugular cont’d Other groups Facial: Buccinator (buccal) Nasolabial Parotid, NOS Infra-auricular Preauricular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Regional lymph node, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple or regional

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

Version date: January 1, 2004 185 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 49, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Cheek (Buccal) Mucosa, Vestibule CS Reg Nodes Eval SEE STANDARD TABLE

Cheek (Buccal) Mucosa, Vestibule Reg LN Pos SEE STANDARD TABLE

Cheek (Buccal) Mucosa, Vestibule Reg LN Exam SEE STANDARD TABLE

Cheek (Buccal) Mucosa, Vestibule CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Version date: January 1, 2004 186 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Cheek (Buccal) Mucosa, Vestibule CS Mets Eval SEE STANDARD TABLE

Cheek (Buccal) Mucosa, Vestibule CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Cheek (Buccal) Mucosa, Vestibule CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

Version date: January 1, 2004 187 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Cheek (Buccal) Mucosa, Vestibule CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Cheek (Buccal) Mucosa, Vestibule CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

Version date: January 1, 2004 188 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Cheek (Buccal) Mucosa, Vestibule CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 189 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Cheek (Buccal) Mucosa, Vestibule CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 190 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Parotid Gland C07.9 C07.9 Parotid gland Note: Laterality must be coded for C07.9.

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Histology Exclusion Table CS Reg Nodes Eval Nodes for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels CS Mets Eval IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Parotid Gland CS Tumor Size SEE STANDARD TABLE

Parotid Gland CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

10 Invasive tumor confined to gland/duct of origin * L L Multiple foci confined to substance of parotid gland

30 Localized, NOS * L L

35 Microscopic extraparenchymal extension ONLY * RE RE

40 Another major salivary gland (submaxillary, sublingual) * RE RE Periglandular soft/connective tissue including macroscopic extraparenchymal extension Pharyngeal mucosa Skeletal muscle: Digastric Masseter Pterygoid Sternocleidomastoid Stylohyoid

42 External auditory meatus T4a RE RE Skin overlying gland

45 Periosteum of mandible T4a RE RE

Version date: January 1, 2004 191 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 Auricular nerve T4a RE RE Mandible Mastoid

70 Facial (7th) nerve T4a RE D

72 Spinal accessory nerve T4a RE D

75 Major blood vessel(s): T4b RE RE Carotid artery Facial artery or vein Jugular vein Maxillary artery

76 Base of skull T4b RE D Skull, NOS

77 Pterygoid plates T4b D D

80 Further contiguous extension T4b D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10, 30, 35, and 40 ONLY, the T category is assigned based on the value of CS Tumor Size as shown in the Extension by Size Table for this site.

Parotid Gland CS TS/Ext-Eval SEE STANDARD TABLE

Parotid Gland CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Parotid nodes Infra-auricular Intraparotid Preauricular Cervical, NOS Deep cervical, NOS Internal jugular Mandibular, NOS Regional lymph node, NOS

Version date: January 1, 2004 192 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

11 Single positive ipsilateral regional node: * D RN Level II node Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Lower deep cervical Lower jugular

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

Version date: January 1, 2004 193 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes,using the extra table, Lymph Nodes Size table, for this site.

Parotid Gland CS Reg Nodes Eval SEE STANDARD TABLE

Parotid Gland Reg LN Pos SEE STANDARD TABLE

Parotid Gland Reg LN Exam SEE STANDARD TABLE

Parotid Gland CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Supraclavicular (transverse cervical)

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

Version date: January 1, 2004 194 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Parotid Gland CS Mets Eval SEE STANDARD TABLE

Parotid Gland CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 195 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Parotid Gland CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Parotid Gland CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 196 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Parotid Gland CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Parotid Gland CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 197 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Parotid Gland CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 198 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Submandibular Gland C08.0 C08.0 Submandibular Gland Note: Laterality must be coded for C08.0.

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Histology Exclusion Table CS Reg Nodes Eval Nodes for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels CS Mets Eval IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Submandibular Gland CS Tumor Size SEE STANDARD TABLE

Submandibular Gland CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

10 Invasive tumor confined to gland/duct of origin * L L

30 Localized, NOS * L L

35 Microscopic extraparenchymal extension ONLY * RE RE

40 Another major salivary gland (parotid, sublingual) * RE RE Periglandular soft/connective tissue including macroscopic extraparenchymal extension Skeletal muscle: Digastric Genioglossus Geniohyoid Hyoglossus Mylohyoid Palatoglossus Pterygoid Styloglossus Stylohyoid

45 Periosteum of mandible T4a RE RE

Version date: January 1, 2004 199 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 Mandible T4a RE RE Nerves: Facial (7th) Lingual

51 External auditory meatus T4a D D

52 Major blood vessels: T4b RE RE Carotid artery Facial artery or vein Maxillary artery

71 Base of skull T4b RE D Skull, NOS

72 Spinal accessory nerve T4a RE D

77 Pterygoid plates T4b D D

80 Further contiguous extension T4b D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10, 30, 35, and 40 ONLY, the T category is assigned based on value of CS Tumor Size as shown in the Extension Size Table for this site.

Submandibular Gland CS TS/Ext-Eval SEE STANDARD TABLE

Submandibular Gland CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Cervical, NOS

Version date: January 1, 2004 200 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Deep cervical, NOS cont’d Internal jugular, NOS Mandibular, NOS Regional lymph node, NOS

12 Single positive ipsilateral regional node: * D D Level IV node Lower deep cervical Lower jugular Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

Version date: January 1, 2004 201 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 49, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Submandibular Gland CS Reg Nodes Eval SEE STANDARD TABLE

Submandibular Gland Reg LN Pos SEE STANDARD TABLE

Submandibular Gland Reg LN Exam SEE STANDARD TABLE

Submandibular Gland CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Supraclavicular (transverse cervical)

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Submandibular Gland CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 202 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Submandibular Gland CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Submandibular Gland CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 203 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Submandibular Gland CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Submandibular Gland CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

Version date: January 1, 2004 204 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Submandibular Gland CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Submandibular Gland CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

Version date: January 1, 2004 205 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 206 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Unspecified Major Salivary Glands C08.1, C08.8-C08.9 C08.1 Sublingual gland C08.8 Overlapping lesion of major salivary glands C08.9 Major salivary gland, NOS Note: Laterality must be coded for C08.1.

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Histology Exclusion Table CS Reg Nodes Eval Nodes for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels CS Mets Eval IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Other and Unspecified Major Salivary Glands CS Tumor Size SEE STANDARD TABLE

Other and Unspecified Major Salivary Glands CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

10 Invasive tumor confined to gland/duct of origin * L L

30 Localized, NOS * L L

35 Microscopic extraparenchymal extension ONLY * RE RE

40 Extension to: T3 RE RE Another major salivary gland (parotid, submandibular) Periglandular soft/connective tissue including extraparenchymal extension Skeletal muscle: Digastric Pterygoid Stylohyoid

45 Periosteum of mandible T4a RE RE

51 Mandible T4a RE RE Nerves: Facial (7th) Lingual

Version date: January 1, 2004 207 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60 Skin T4a D D

62 External auditory meatus T4a D D

65 Blood vessel(s): T4b RE RE Carotid artery Facial artery or vein Maxillary artery

71 Base of skull T4b RE D Skull, NOS

72 Spinal accessory nerve T4a RE D

79 Pterygoid plates T4b D D

80 Further contiguous extension T4b D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10, 30, and 35 ONLY, the T category is assigned based on value of CS Tumor Size as shown in the Extension Size Table for this site.

Other and Unspecified Major Salivary Glands CS TS/Ext-Eval SEE STANDARD TABLE

Other and Unspecified Major Salivary Glands CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Cervical, NOS Mandibular, NOS Regional lymph node, NOS

12 Single positive ipsilateral regional node: * D D Level II node Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular

Version date: January 1, 2004 208 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

12, Level IV node cont’d Lower deep cervical Lower jugular Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

Version date: January 1, 2004 209 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 49, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Other and Unspecified Major Salivary Glands CS Reg Nodes Eval SEE STANDARD TABLE

Other and Unspecified Major Salivary Glands Reg LN Pos SEE STANDARD TABLE

Other and Unspecified Major Salivary Glands Reg LN Exam SEE STANDARD TABLE

Other and Unspecified Major Salivary Glands CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Supraclavicular (transverse cervical)

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Other and Unspecified Major Salivary Glands CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 210 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Unspecified Major Salivary Glands CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Other and Unspecified Major Salivary Glands CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 211 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Unspecified Major Salivary Glands CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Other and Unspecified Major Salivary Glands CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

Version date: January 1, 2004 212 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Other and Unspecified Major Salivary Glands CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Other and Unspecified Major Salivary Glands CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

Version date: January 1, 2004 213 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 214 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Tonsil, Oropharynx C09.0-C09.1, C09.8-C09.9, C10.0, C10.2-C10.4, C10.8-C10.9 C09.0 Tonsillar fossa C09.1 Tonsillar pillar C09.8 Overlapping lesion of tonsil C09.9 Tonsil, NOS (excludes lingual tonsil C02.4) C10.0 Vallecula C10.2 Lateral wall of oropharynx C10.3 Posterior wall of oropharynx C10.4 Branchial cleft (site of neoplasm) C10.8 Overlapping lesion of oropharynx C10.9 Oropharynx, NOS Note 1: Laterality must be coded for C09.0, C09.1, C09.8, and C09.9. Note 2: AJCC includes base of tongue (C01.9) with oropharynx (C09._, C10._).

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Tonsil, Oropharynx CS Tumor Size SEE STANDARD TABLE

Tonsil, Oropharynx CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to one of the following subsites: * L L Anterior wall (including vallecula and lingual (anterior) surface of epiglottis) One lateral wall Posterior wall

20 Involvement of two or more subsites: * L L Posterior, anterior or lateral wall(s)

30 Localized, NOS * L L

40 Soft palate, inferior surface including uvula, or soft palate, NOS * RE RE

41 Hypopharynx NOS * RE RE

Version date: January 1, 2004 215 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pyriform sinus

42 Soft palate, superior (nasopharyngeal) surface * RE RE

50 Base of tongue * RE RE Buccal mucosa (inner cheek) Floor of mouth Gum (gingiva)

55 Any extension coded in 10-50 WITH fixation * RE RE

60 Prevertebral fascia or muscle * RE RE Soft tissue of neck

62 Nasopharynx, lateral, or NOS T4b RE RE

65 Larynx, NOS T4a RE RE Medial pterygoid muscle, or pterygoid muscle, NOS Posterior surface of epiglottis

70 Deep extrinsic muscles of tongue: T4a D D Genioglossus Geniohyoid Hyoglossus Mylohyoid Palatoglossus Styloglossus Hard palate Mandible

72 Lateral pterygoid muscle T4b D D Pterygoid plates

75 Bone of skull T4b D D

76 Bone T4b D D

77 Carotid artery T4b D D

80 Further contiguous extension: T4b D D Anterior 2/3 of tongue Parotid gland

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For codes 10, 20, 40, 41, 42, 50, 55, and 60 ONLY, the T category is assigned based on the value of CS Tumor Size as shown in the Extension Size Table for this site.

Tonsil, Oropharynx CS TS/Ext-Eval SEE STANDARD TABLE

Version date: January 1, 2004 216 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Tonsil, Oropharynx CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular Regional lymph node, NOS

11 Single positive ipsilateral regional node: * D RN Level I node Submandibular (submaxillary) Submental

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

Version date: January 1, 2004 217 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Tonsil, Oropharynx CS Reg Nodes Eval SEE STANDARD TABLE

Version date: January 1, 2004 218 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Tonsil, Oropharynx Reg LN Pos SEE STANDARD TABLE

Tonsil, Oropharynx Reg LN Exam SEE STANDARD TABLE

Tonsil, Oropharynx CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Tonsil, Oropharynx CS Mets Eval SEE STANDARD TABLE

Tonsil, Oropharynx CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

Version date: January 1, 2004 219 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Tonsil, Oropharynx CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Tonsil, Oropharynx CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

Version date: January 1, 2004 220 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Tonsil, Oropharynx CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Tonsil, Oropharynx CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

Version date: January 1, 2004 221 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Tonsil, Oropharynx CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 222 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Anterior Surface of Epiglottis C10.1 C10.1 Anterior surface of epiglottis Note: AJCC includes lingual (anterior) surface of epiglottis (C10.1) with larynx. SEER Extent of Disease included it with oropharynx.

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Lymph Nodes Size Table Reg LN Exam III, Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Anterior Surface of Epiglottis CS Tumor Size SEE STANDARD TABLE

Anterior Surface of Epiglottis CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to anterior surface of epiglottis with T1 L L normal vocal cord mobility

20 Mucosa of adjacent subsite(s) of oropharynx T2 L L

30 Localized, NOS T1 L L

31 Vallecula without fixation of larynx T2 L L

32 Mucosa of adjacent subsite(s) of supraglottis (including posterior T2 RE RE surface of epiglottis) without fixation of larynx

33 Larynx, glottic or NOS, without fixation of larynx T2 RE RE

34 Pyriform sinus, medial wall or NOS, without fixation of larynx T2 RE RE

35 Mucosa of base of tongue without fixation of larynx T2 RE RE

36 Any of (10) to (35) with vocal cord fixation T3 RE RE

37 Paraglottic space T3 RE RE Pre-epiglottic tissues

38 Minor thyroid cartilage erosion (inner cortex) (see also code 67) T3 D D

Version date: January 1, 2004 223 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

39 Hypopharynx, NOS T3 RE RE Postcricoid area Pyriform sinus except medial wall (see code 34)

43 (38) + (39) T3 D D

45 Soft palate, inferior surface including uvula, or soft palate, NOS T4a RE RE

47 Nasopharynx, NOS T4a RE RE Soft palate, superior (nasopharyngeal) surface

50 Base of tongue, except mucosa (see code 35) T4a RE RE Buccal mucosa (inner cheek) Floor of mouth Gum (gingiva)

62 Soft tissues of neck T4a RE RE

65 Pterygoid muscle T4a RE RE

66 [(38) or (43)] + any of [(45) to (65)] T4a D D

67 Invasion through thyroid cartilage (see also code 38) T4a D D Thyroid cartilage, NOS

68 Trachea T4a D D

69 Esophagus T4a D D Strap muscles Thyroid

70 Extrinsic muscles of tongue: T4a D D Genioglossus Geniohyoid Hyoglossus Mylohyoid Palatoglossus Styloglossus

75 Prevertebral fascia or muscle T4b RE RE Prevertebral space

77 (75) + any of [(66) to (70)] T4b D D

80 Further contiguous extension, including: T4b D D Anterior 2/3 of tongue Bone Encases carotid artery Hard palate Mandible Mediastinal structures Parotid gland

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Version date: January 1, 2004 224 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Anterior Surface of Epiglottis CS TS/Ext-Eval SEE STANDARD TABLE

Anterior Surface of Epiglottis CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Lower deep cervical Lower jugular Retropharyngeal Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular Regional lymph node, NOS

11 Single positive ipsilateral regional node: * D RN Level I node Submandibular (submaxillary) Submental

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid

Version date: January 1, 2004 225 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

12, Parapharyngeal cont’d Periparotid Retropharyngeal Sub-occipital Supraclavicular fossa

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph nodes, using the extra table, Lymph Nodes Size Table for this site.

Version date: January 1, 2004 226 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Anterior Surface of Epiglottis CS Reg Nodes Eval SEE STANDARD TABLE

Anterior Surface of Epiglottis Reg LN Pos SEE STANDARD TABLE

Anterior Surface of Epiglottis Reg LN Exam SEE STANDARD TABLE

Anterior Surface of Epiglottis CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), including mediastinal M1 D D

40 Distant metastases except distant lymph node(s) (codes 08 -10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Anterior Surface of Epiglottis CS Mets Eval SEE STANDARD TABLE

Anterior Surface of Epiglottis CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

Version date: January 1, 2004 227 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Anterior Surface of Epiglottis CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Anterior Surface of Epiglottis CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

Version date: January 1, 2004 228 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Anterior Surface of Epiglottis CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Anterior Surface of Epiglottis CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

Version date: January 1, 2004 229 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Anterior Surface of Epiglottis CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 230 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Nasopharynx C11.0-C11.3, C11.8-C11.9 C11.0 Superior wall of nasopharynx C11.1 Posterior wall of nasopharynx C11.2 Lateral wall of nasopharynx C11.3 Anterior wall of nasopharynx C11.8 Overlapping lesion of nasopharynx C11.9 Nasopharynx, NOS

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Lymph Nodes Size Table Reg LN Exam III, Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Nasopharynx CS Tumor Size SEE STANDARD TABLE

Nasopharynx CS Extension Note: Parapharyngeal involvement denotes postero-lateral infiltration of tumor beyond the pharyngobasilar fascia. Involvement of the masticator space denotes extension of tumor beyond the anterior surface of the lateral pterygoid muscle, or lateral extension beyond the postero-lateral wall of the maxillary antrum, pterygo-maxillary fissure. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to one of the following subsites: T1 L L Inferior wall (superior surface of soft palate) One lateral wall Posterior superior wall (vault)

20 Involvement of two or more subsites: T1 L L Lateral wall extending into eustachian tube/middle ear Posterior, inferior, or lateral wall(s)

30 Confined to nasopharynx T1 L L Localized, NOS

40 Oropharynx T2a RE RE Soft palate, inferior surface

50 Nasal cavity T2a RE RE

Version date: January 1, 2004 231 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

55 Any extension coded in 10-50 WITH fixation or tumor T4 RE RE Described only as FIXED

56 Any extension coded in 10-50 WITH parapharyngeal extension T2b RE RE

57 Hard palate T4 D RE

58 Pterygopalatine fossa T4 RE RE

60 Bone, including skull T3 RE RE

62 Paranasal sinus T3 D RE

65 Orbit T4 RE D

70 Brain T4 D D Cranial nerves Hypopharynx Infratemporal fossa Orbit Intracranial extension, NOS

75 Masticator space T4 D D

80 Further contiguous extension T4 D D Soft tissues of the neck

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Nasopharynx CS TS/Ext-Eval SEE STANDARD TABLE

Nasopharynx CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular

Version date: January 1, 2004 232 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Level IV node cont’d Lower deep cervical Lower jugular Retropharyngeal Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular Regional lymph node, NOS

11 Single positive ipsilateral regional node: * D RN Level I node Submandibular (submaxillary) Submental

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital Supraclavicular fossa

18 Stated as N1, no other information N1 RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

Version date: January 1, 2004 233 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, no other information N2 RN RN

70 Stated as N3, NOS N3NOS RN RN

75 Regional lymph nodes in the supraclavicular fossa: N3b D D Inferior deep cervical (scalene) Spinal accessory (posterior cervical) Supraclavicular (transverse cervical)

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table, for this site.

Nasopharynx CS Reg Nodes Eval SEE STANDARD TABLE

Nasopharynx Reg LN Pos SEE STANDARD TABLE

Nasopharynx Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 234 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Nasopharynx CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Nasopharynx CS Mets Eval SEE STANDARD TABLE

Nasopharynx CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 235 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Nasopharynx CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Nasopharynx CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 236 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Nasopharynx CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Nasopharynx CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 237 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Nasopharynx CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 238 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pyriform Sinus, Hypopharynx, Laryngopharynx C12.9, C13.0-C13.2, C13.8-C13.9 C12.9 Pyriform sinus C13.0 Postcricoid region C13.1 Hypopharyngeal aspect of aryepiglottic fold C13.2 Posterior wall of hypopharynx C13.8 Overlapping lesion of hypopharynx C13.9 Hypopharynx, NOS

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Histology Exclusion Table CS Reg Nodes Eval Nodes for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Extension Size Table Reg LN Exam III, Lymph Nodes for Head and Neck Lymph Nodes Size Table CS Mets at DX CS Site-Specific Factor 4 - Levels CS Mets Eval IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Tumor Size SEE STANDARD TABLE

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Extension Note: If fixation of hemilarynx or larynx code to 55 not 51. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to one of the following subsites: * L L Laryngopharynx Postcricoid area Posterior pharyngeal wall Pyriform sinus

20 Tumor involves adjacent subsite(s) (listed in code 10) WITHOUT * L L fixation

30 Localized, NOS * L L

40 Oropharynx * RE RE

50 Larynx * RE RE

51 Any of codes 10-40 WITH fixation of tumor or fixation, NOS * RE RE

55 Fixation of hemilarynx or larynx T3 RE RE

Version date: January 1, 2004 239 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60 Soft tissues of neck including T4a RE RE Prelaryngeal strap muscles and subcutaneous fat

61 Esophagus T4a RE RE

62 Thyroid gland T4a D RE

63 Cricoid cartilage T4a D RE Thyroid cartilage

64 Prevertebral fascia/muscle(s) T4b RE RE

65 Carotid artery T4b D RE

66 Hyoid bone T4a D D

70 Mediastinal structures T4b D D

80 Further contiguous extension T4b D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10, 20, 30, 40, 50, and 51 ONLY, the T category is assigned based on value of CS Tumor Size as shown in the Extension Size Table for this site.

Pyriform Sinus, Hypopharynx, Laryngopharynx CS TS/Ext-Eval SEE STANDARD TABLE

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Lower deep cervical Lower jugular Retropharyngeal

Version date: January 1, 2004 240 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Cervical, NOS cont’d Deep cervical, NOS Internal jugular, NOS Mandibular Regional lymph node, NOS

11 Single positive ipsilateral regional node: * D RN Level I node Submandibular (submaxillary) Submental Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX)

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

Version date: January 1, 2004 241 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Reg Nodes Eval SEE STANDARD TABLE

Pyriform Sinus, Hypopharynx, Laryngopharynx Reg LN Pos SEE STANDARD TABLE

Pyriform Sinus, Hypopharynx, Laryngopharynx Reg LN Exam SEE STANDARD TABLE

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

Version date: January 1, 2004 242 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Mets Eval SEE STANDARD TABLE

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 243 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 244 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 245 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Pyriform Sinus, Hypopharynx, Laryngopharynx CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 246 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites C14.0, C14.2, C14.8 C14.0 Pharynx, NOS C14.2 Waldeyer ring C14.8 Overlapping lesion of lip, oral cavity Note: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 - Size of Lymph The following tables are CS Extension Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - Extracapsular staging website: CS Lymph Nodes Extension, Lymph Nodes for Head and Neck Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 3 - Levels I-III, AJCC Stage Reg LN Pos Lymph Nodes for Head and Neck Reg LN Exam CS Site-Specific Factor 4 - Levels IV-V and CS Mets at DX Retropharyngeal Lymph Nodes for Head and CS Mets Eval Neck CS Site-Specific Factor 5 - Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Tumor Size SEE STANDARD TABLE

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Extension Note: Definition of Adjacent Structures: Connective tissues large enough to be given a specific name would be considered adjacent structures. For example, the brachial artery has a name, as does the broad ligament. Continuous tumor growth from one organ into an adjacent named structure would be coded to less than 60 in the schemes for ill- defined or non-specific sites. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial NA IS IS

10 Invasive tumor confined to site of origin NA L L

30 Localized, NOS NA L L

40 More than one region of pharynx involved (oropharynx, NA RE RE nasopharynx, hypopharynx)

50 Pharynx and oral cavity involved NA RE RE

55 Any of codes 10-50 WITH fixation NA RE RE

60 Extension to adjacent structures (See note) NA RE RE

80 Further contiguous extension NA D D

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Version date: January 1, 2004 247 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Regional lymph node(s) bilateral and/or contralateral: NA RN RN Cervical, NOS Internal jugular, NOS Deep cervical, NOS: Lower, NOS Jugulo-omohyoid (supraomohyoid) Middle Upper, NOS: Jugulodigastric (subdigastric) Mandibular, NOS Submandibular (submaxillary) Submental Paratracheal Recurrent laryngeal nerve chain Prelaryngeal Delphian node Retropharyngeal Regional lymph node(s), NOS

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites Reg LN Pos SEE STANDARD TABLE

Version date: January 1, 2004 248 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites Reg LN Exam SEE STANDARD TABLE

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), including: NA D D Mediastinal Supraclavicular (transverse cervical)

40 Distant metastasis, NOS NA D D Distant metastases except distant lymph node(s) (code 10) Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Distant metastasis cannot be assessed Not documented in patient record

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

Version date: January 1, 2004 249 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

Version date: January 1, 2004 250 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

Version date: January 1, 2004 251 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial)nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Pharynx, NOS, and Other Ill-Defined Oral Cavity Sites CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 252 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Esophagus C15.0-C15.5, C15.8-C15.9 C15.0 Cervical esophagus C15.1 Thoracic esophagus C15.2 Abdominal esophagus C15.3 Upper third of esophagus C15.4 Middle third of esophagus C15.5 Lower third of esophagus C15.8 Overlapping lesion of esophagus C15.9 Esophagus, NOS Anatomic Limits of Esophagus: Cervical Esophagus (C15.0): From the lower border of the cricoid cartilage to the thoracic inlet (suprasternal notch), about 18 cm from the incisors. Intrathoracic (including abdominal esophagus) (C15.1 - C15.5): Upper thoracic portion (C15.3): From the thoracic inlet to the level of the tracheal bifurcation (18-24 cm). Mid-thoracic portion (C15.4): From the tracheal bifurcation midway to the gastroesophageal (GE) junction (24-32 cm). Lower thoracic portion (C15.5: From midway between the tracheal bifurcation and the gastroesophageal junction to the GE junction, including the abdominal esophagus (C15.2) between 32-40 cm.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Esophagus CS Tumor Size Note: For esophagus, this field is used for size of tumor/length of involved esophagus. Code Description

000 No mass/tumor found

001-988 001 - 988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

998 Circumferential

999 Unknown; size not stated Not documented in patient record

Version date: January 1, 2004 253 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Esophagus CS Extension Note: Ignore intraluminal extension to adjacent segment(s) of esophagus or to cardia of stomach and code depth of invasion or extra-esophageal spread as indicated. Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

10 Invasive tumor confined to mucosa, NOS (including intramucosal, T1 L L NOS)

11 Invades lamina propria T1 L L

12 Invades muscularis mucosae T1 L L

16 Invades submucosa T1 L L

20 Muscularis propria invaded T2 L L

30 Localized, NOS T1 L L

40 Adventitia and/or soft tissue invaded T3 RE RE Esophagus is described as "FIXED"

60 Tumor invades adjacent structures T4 RE RE Cervical esophagus: Blood vessel(s): Carotid artery Jugular vein Subclavian artery Thyroid gland Intrathoracic, upper or mid-portion, esophagus: Blood vessel(s), major: Aorta Azygos vein Pulmonary artery/vein Vena cava Carina Diaphragm Main stem bronchus Trachea Intrathoracic, lower portion (abdominal), esophagus: Blood vessel(s): Aorta Gastric artery/vein Vena cava Diaphragm, not fixed, or NOS Stomach, cardia (via serosa)

65 Cervical esophagus: T4 RE RE Carina Cervical vertebra(e) Hypopharynx Larynx Trachea Intrathoracic esophagus: Lung via bronchus Mediastinal structure(s), NOS Pleura

Version date: January 1, 2004 254 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

65, Rib(s) cont’d Thoracic vertebra(e)

78 Thoracic/middle esophagus: T4 RE D Pericardium

80 Further contiguous extension: T4 D D Cervical/upper esophagus: Lung Main stem bronchus Pleura Abdominal/lower esophagus: Diaphragm fixed

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Esophagus CS TS/Ext-Eval SEE STANDARD TABLE

Esophagus CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s) (including contralateral or bilateral) N1 RN RN For all subsites: Peri-/paraesophageal Cervical esophagus only: Cervical, NOS Anterior deep cervical (laterolateral) (recurrent laryngeal) Internal jugular, NOS: Deep cervical, NOS: Upper, NOS: Jugulodigastric (subdigastric) Intrathoracic esophagus, upper or middle, only: Internal jugular, NOS: Deep cervical, NOS: Lower, NOS: Jugulo-omohyoid (supraomohyoid) Middle Upper cervical, NOS: Jugulodigastric (subdigastric) Intrabronchial: Carinal (tracheobronchial) (tracheal bifurcation) Hilar (bronchopulmonary) (proximal lobar) (pulmonary root) Peritracheal Left gastric (superior gastric): Cardiac (cardial) Lesser curvature

Version date: January 1, 2004 255 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Perigastric, NOS cont’d Posterior mediastinal (tracheoesophageal) Intrathoracic esophagus, lower (abdominal) only: Left gastric (superior gastric): Cardiac (cardial) Lesser curvature Perigastric, NOS Posterior mediastinal (tracheoesophageal)

20 Cervical Esophagus only: N1 D RN Scalene (inferior deep cervical) Supraclavicular (transverse cervical)

22 Intrathoracic, upper thoracic or middle, only: N1 D RN Superior mediastinal

30 All esophagus subsites: N1 RN RN Anterior mediastinal Mediastinal, NOS Cervical esophagus only: Aortopulmonary Paratracheal Posterior mediastinal Superior mediastinal Intrathoracic esophagus,upper or middle, only: Aortopulmonary Pulmonary ligament Intrathoracic esophagus, lower (abdominal) only: Common hepatic Diaphragmatic Paratracheal Splenic Superior mediastinal

50 Regional lymph node(s), NOS N1 RN RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Esophagus CS Reg Nodes Eval SEE STANDARD TABLE

Esophagus Reg LN Pos SEE STANDARD TABLE

Esophagus Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 256 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Esophagus CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), NOS M1NOS D D

11 Upper thoracic esophagus only: M1a D D Cervical lymph node(s) Lower thoracic (abdominal) esophagus only: Celiac lymph node(s)

12 Specified distant lymph node(s), other than code 11, including: M1NOS D D 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

40 Distant metastases except distant lymph node(s) (codes 10 - 12) M1b D D Distant metastasis, NOS Carcinomatosis

50 (40) + any of [(10) to (12)] M1b D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Esophagus CS Mets Eval SEE STANDARD TABLE

Esophagus CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Esophagus CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Version date: January 1, 2004 257 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Esophagus CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Esophagus CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Esophagus CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Esophagus CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 258 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Stomach C16.0-C16.6, C16.8-C16.9 C16.0 Cardia, NOS C16.1 Fundus of stomach C16.2 Body of stomach C16.3 Gastric antrum C16.4 Pylorus C16.5 Lesser curvature of stomach, NOS C16.6 Greater curvature of stomach, NOS C16.8 Overlapping lesion of stomach C16.9 Stomach, NOS

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Lymph Nodes Number Positive Reg LN Exam Table CS Mets at DX CS Mets Eval

Stomach CS Tumor Size Code Description

000 No mass/tumor found

001-988 001 - 988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

998 Diffuse; widespread; 3/4's or more: linitis plastica

999 Unknown; size not stated Not documented in patient record

Version date: January 1, 2004 259 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Stomach CS Extension Note 1: INTRALUMINAL or INTRAMURAL extension to esophagus and duodenum is classified by the depth of greatest invasion in any of these sites, including stomach. (For extension to esophagus or duodenum via serosa, see code 60.) Note 2: If the diagnosis states "linitis plastica" and no other information regarding extension is available, use code 35. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

05 (Adeno)carcinoma in a polyp, noninvasive Tis IS IS

10 Invasive tumor confined to mucosa, NOS (including intramucosal, T1 L L NOS)

11 Invades lamina propria T1 L L

12 Invades muscularis mucosae T1 L L

13 Confined to head of polyp T1 L L Extension to stalk

14 Confined to stalk of polyp T1 L L

15 Tumor in polyp, NOS T1 L L

16 Invades submucosa (superficial invasion) T1 L L

20 Invades into but not through muscularis propria T2a L L

30 Localized, NOS T1 L L Implants inside stomach

35 Linitis plastica (see Note 2) and no other information regarding T2a RE L extension is available.

40 Invasion through muscularis propria or muscularis, NOS T2b L L Extension through wall, NOS Perimuscular tissue invaded Subserosal tissue/(sub)serosal fat invaded

45 Extension to adjacent (connective) tissue T2b RE RE WITHOUT perforation of visceral peritoneum: Gastric artery Ligaments: Gastrocolic Gastrohepatic Gastrosplenic Omentum, NOS Greater Lesser Perigastric fat

50 Invasion of/through serosa (mesothelium) T3 RE RE (tunica serosa) (visceral peritoneum), including perforation of visceral peritoneum covering the gastric ligaments or the omentum WITHOUT invasion of adjacent structures

Version date: January 1, 2004 260 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

55 (45) + (50) T3 RE RE

60 Diaphragm T4 RE RE Duodenum via serosa or NOS Esophagus via serosa Ileum Jejunum Liver Pancreas Small intestine, NOS Spleen Transverse colon (including flexures)

70 Abdominal wall T4 D D Adrenal gland Kidney Retroperitoneum

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Stomach CS TS/Ext-Eval SEE STANDARD TABLE

Stomach CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): * RN RN Left gastric (superior gastric), NOS: Cardial Cardioesophageal Gastric, left Gastropancreatic, left Lesser curvature Lesser omental Paracardial Pancreaticosplenic (pancreaticolienal) Pancreatoduodenal Perigastric, NOS Peripancreatic Right gastric (inferior gastric), NOS: Gastrocolic Gastroduodenal Gastroepiploic (gastro-omental), right or NOS Gastrohepatic Greater curvature

Version date: January 1, 2004 261 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Greater omental cont’d Pyloric, NOS Infrapyloric (subpyloric) Suprapyloric Splenic (lienal), NOS: Gastroepiploic (gastro-omental), left Splenic hilar Nodule(s) in perigastric fat

40 Celiac * D RN Hepatic (excluding gastrohepatic, [see code 10] and hepatoduodenal [see code 42])

42 For lesser curvature only: * D D Hepatoduodenal

50 Regional lymph node(s), NOS * RN RN

80 Lymph node(s), NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-80 ONLY, the N category is assigned based on the value of the Reg LN Pos using the Lymph Nodes Number Positive table for this site.

Stomach CS Reg Nodes Eval SEE STANDARD TABLE

Stomach Reg LN Pos SEE STANDARD TABLE

Stomach Reg LN Exam SEE STANDARD TABLE

Stomach CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s): M1 D D For all subsites: Inferior mesenteric Para-aortic Porta hepatis (portal) (hilar) (in hilus of liver) Retropancreatic Retroperitoneal Superior mesenteric or mesenteric, NOS For all subsites EXCEPT lesser curvature Hepatoduodenal

Version date: January 1, 2004 262 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Stomach CS Mets Eval SEE STANDARD TABLE

Stomach CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Stomach CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Stomach CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Stomach CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 263 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Stomach CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Stomach CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 264 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Small Intestine C17.0-C17.3, C17.8-C17.9 C17.0 Duodenum C17.1 Jejunum C17.2 Ileum (excludes ileocecal valve C18.0) C17.3 Meckel diverticulum (site of neoplasm) C17.8 Overlapping lesion of small intestine C17.9 Small intestine, NOS

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Small Intestine CS Tumor Size SEE STANDARD TABLE

Small Intestine CS Extension Note 1: Ignore intraluminal or lateral extension to adjacent segment(s) of small intestine and code depth of invasion or spread outside the small intestine as indicated. Note 2: The nonperitonealized perimuscular tissue is, for jejunum and ileum, part of the mesentery and, for duodenum in areas where serosa is lacking, part of the retroperitoneum. Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

05 (Adeno)carcinoma in a polyp, noninvasive Tis IS IS

10 Invasive tumor confined to mucosa, NOS, including intramucosal, T1 L L NOS

11 Invasion of lamina propria T1 L L

12 Invasion of muscularis mucosae T1 L L

13 Confined to head of polyp T1 L L

14 Confined to stalk of polyp T1 L L

15 Invasion of polyp, NOS T1 L L

16 Invasion of submucosa (superficial invasion) T1 L L

20 Muscularis propria invaded T2 L L

30 Localized, NOS T1 L L Intraluminal spread to other segments of small intestine or cecum

40 Invasion through muscularis propria or muscularis, NOS T3 L L

Version date: January 1, 2004 265 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Extension through wall, NOS Subserosal tissue/(sub) serosal fat invaded Transmural, NOS

42 Fat, NOS T3 RE RE

45 Adjacent connective tissue T3 RE RE Mesentery, including mesenteric fat, invaded less than or equal to 2 cm in depth or NOS Nonperitonealized perimuscular tissue invaded less than or equal to 2 cm in depth or NOS Retroperitoneum invaded less than or equal to 2 cm in depth or NOS

50 Invasion of/through serosa(mesothelium)(tunica serosa) (visceral T4 L RE peritoneum)

55 (50) + [(42) or (45)] T4 RE RE

60 For duodenum primary only: T4 RE RE Ampulla of Vater Diaphragm Extrahepatic bile ducts Gallbladder Pancreas Pancreatic duct

65 For duodenum primary only: T4 RE RE Blood vessel(s), major: Aorta Gastroduodenal artery Portal vein Renal vein Superior mesenteric artery or vein Vena cava Greater omentum Hepatic flexure Kidney, NOS Kidney, right Liver, NOS Liver, quadrate lobe Liver, right lobe Omentum, NOS Transverse colon Ureter, right For jejunum or ileum primary only: Colon, including appendix

66 For duodenum primary only: T4 RE RE Stomach

67 For all small intestine sites: T4 RE RE Abdominal wall Mesentery invaded greater than 2 cm in depth Non-peritonealized perimuscular tissue invaded greater than 2 cm in depth Retroperitoneum invaded greater than 2 cm in depth

68 For all small intestine sites: T4 RE RE

Version date: January 1, 2004 266 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other segments of the small intestine via serosa

70 For jejunum or ileum primary only: T4 D D Bladder Fallopian tube Ovary Uterus

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Small Intestine CS TS/Ext-Eval SEE STANDARD TABLE

Small Intestine CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN For duodenum primaries only: Duodenal Gastroduodenal Hepatic Infrapyloric (subpyloric) Pancreaticoduodenal Pyloric For jejunum or ileum primaries only: Ileocolic for terminal ileum primary Mesenteric, NOS Posterior cecal (retrocecal) for terminal ileum primary Superior mesenteric

20 Regional lymph node(s) for duodenum primaries only: N1 D RN Pericholodochal (common bile duct) Superior mesenteric (See code 11 in CS Mets at DX for other lymph nodes of of small intestine)

30 Regional lymph node(s), NOS N1 RN RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Small Intestine

Version date: January 1, 2004 267 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

CS Reg Nodes Eval SEE STANDARD TABLE

Small Intestine Reg LN Pos SEE STANDARD TABLE

Small Intestine Reg LN Exam SEE STANDARD TABLE

Small Intestine CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), other than those listed M1 D D in code 11 including celiac lymph node(s) Distant lymph node(s), NOS

11 For jejunum and ileum primaries only: M1 D RN Pericholodochal (For duodenal primary, see Lymph Nodes field)

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (40) + any of [(10) or (11)] M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Small Intestine CS Mets Eval SEE STANDARD TABLE

Small Intestine CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Version date: January 1, 2004 268 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Small Intestine CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Small Intestine CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Small Intestine CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Small Intestine CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Small Intestine CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 269 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 270 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Colon C18.0-C18.9 C18.0 Cecum C18.1 Appendix C18.2 Ascending colon C18.3 Hepatic flexure of colon C18.4 Transverse colon C18.5 Splenic flexure of colon C18.6 Descending colon C18.7 Sigmoid colon C18.8 Overlapping lesion of colon C18.9 Colon, NOS

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Carcinoembryonic Antigen (CEA) available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 4 AJCC Stage Reg LN Pos CS Site-Specific Factor 5 Lymph Nodes Number Positive Reg LN Exam CS Site-Specific Factor 6 Table CS Mets at DX CS Mets Eval

Colon CS Tumor Size Code Description

000 No mass/tumor found

001-988 001 - 988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

998 Familial/multiple polyposis (M-8220/8221)

999 Unknown; size not stated Not documented in patient record

Version date: January 1, 2004 271 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Colon CS Extension Note 1: Ignore intraluminal extension to adjacent segment(s) of colon/rectum or to the ileum from the cecum; code depth of invasion or extracolonic spread as indicated. Note 2: A tumor nodule in the pericolic adipose tissue of a primary carcinoma without histologic evidence of residual lymph node in the nodule is classified as a regional lymph node metastasis if the nodule has the form and smooth contour of a lymph node, or if the contour is not described. If the nodule has an irregular contour, it should be coded in CS Extension as code 45. Note 3: Codes 60-80 are used for contiguous extension from the site of origin. Discontinuous involvement is coded in CS Mets at DX. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

05 (Adeno)carcinoma in a polyp or adenoma, noninvasive Tis IS IS

10 Invasive tumor confined to mucosa, NOS (including intramucosal, Tis L L NOS)

11 Lamina propria, including lamina propria in the stalk of a polyp T1 L L

12 Muscularis mucosae, including muscularis mucosae in the stalk of a T1 L L polyp

13 Confined to head of polyp, NOS T1 L L

14 Confined to stalk of polyp, NOS T1 L L

15 Invasive tumor in polyp, NOS T1 L L

16 Invades submucosa (superficial invasion), including submucosa in T1 L L the stalk of a polyp

20 Muscularis propria invaded T2 L L

30 Localized, NOS T1 L L Confined to colon, NOS

40 Extension through wall, NOS T3 L L Invasion through muscularis propria or muscularis, NOS Non-peritonealized pericolic tissues invaded Perimuscular tissue invaded Subserosal tissue/(sub)serosal fat invaded Transmural, NOS

42 Fat, NOS T3 RE RE

45 Extension to: T3 RE RE All colon sites: Adjacent tissue(s), NOS Connective tissue Mesenteric fat Mesentery Mesocolon Pericolic fat Ascending and descending colon Retroperitoneal fat Transverse colon/flexures Gastrocolic ligament Greater omentum

Version date: January 1, 2004 272 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

46 Adherent to other organs or structures, but no microscopic tumor T3 RE RE found in adhesion(s)

50 Invasion of/through serosa (mesothelium) (visceral peritoneum) T4 RE RE

55 Any of [(42) to (45)] + (50) T4 RE RE

57 Adherent to other organs or structures, NOS T4 RE RE

60 All colon sites: T4 RE RE Small intestine Cecum and appendix: Greater omentum Ascending colon: Greater omentum Liver, right lobe Tranverse colon and flexures: Gallbladder/bile ducts Kidney Liver Pancreas Spleen Stomach Descending colon: Greater omentum Pelvic wall Spleen Sigmoid colon: Greater omentum Pelvic wall

65 All colon sites: T4 RE RE Abdominal wall Retroperitoneum (excluding fat)

66 Ascending colon: T4 RE RE Right kidney Right ureter Descending colon: Left kidney Left ureter

70 Cecum, appendix, ascending, descending and sigmoid colon: T4 D D Fallopian tube Ovary Uterus

75 All colon sites unless otherwise stated above: T4 D D Adrenal (suprarenal) gland Bladder Diaphragm Fistula to skin Gallbladder Other segment(s) of colon via serosa

80 Further contiguous extension: T4 D D Cecum and appendix: Kidney Liver Ureter

Version date: January 1, 2004 273 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

80, Transverse colon and flexures: cont’d Ureter Sigmoid colon: Cul de sac (rectouterine pouch) Ureter Other contiguous extension

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Colon CS TS/Ext-Eval SEE STANDARD TABLE

Colon CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: A tumor nodule in the pericolic adipose tissue of a primary carcinoma without histologic evidence of residual lymph node in the nodule is classified as a regional lymph node metastasis if the nodule has the form and smooth contour of a lymph node, or if the contour is not described. If the nodule has an irregular contour, it should be coded in CS Extension as code 45. Note 3: Inferior mesenteric nodes are coded in CS Mets at DX for cecum, appendix, ascending colon, transverse colon, and hepatic flexure. Superior mesenteric nodes are coded in CS Mets at DX for all colon sites. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s) for all colon sites: * RN RN Colic (NOS) Epicolic (adjacent to bowel wall) Mesocolic (NOS) Paracolic/pericolic Nodule(s) or foci in pericolic fat/adjacent mesentery/ mesocolic fat

20 Regional lymph node(s), for specific subsites: * RN RN Cecum and appendix: Cecal: anterior (prececal), posterior (retrocecal); NOS Ileocolic Right colic Ascending colon: Ileocolic Middle colic Right colic Transverse colon and flexures: Inferior mesenteric for splenic flexure only Left colic for splenic flexure only Middle colic Right colic for hepatic flexure only Descending colon: Inferior mesenteric Left colic Sigmoid

Version date: January 1, 2004 274 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

20, Sigmoid colon: cont’d Inferior mesenteric Sigmoidal (sigmoid mesenteric) Superior hemorrhoidal Superior rectal

30 Regional lymph node(s) for all colon sites: * RN RN Mesenteric, NOS Regional lymph node(s), NOS

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-80 ONLY, the N category is assigned based on the value of Reg LN Pos, using the Lymph Nodes Number Positive Table for this site.

Colon CS Reg Nodes Eval SEE STANDARD TABLE

Colon Reg LN Pos SEE STANDARD TABLE

Colon Reg LN Exam SEE STANDARD TABLE

Colon CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

08 Cecum, appendix, ascending, hepatic flexure and transverse colon: M1 RN D Superior mesenteric lymph node(s)

10 Distant lymph node(s) other than code 08 M1 D D For all colon sites: Common iliac Distant lymph node(s), NOS External iliac Para-aortic Retroperitoneal For cecum, appendix, ascending colon, transverse colon, and hepatic flexure: Inferior mesenteric For splenic flexure, descending colon, and sigmoid colon: Superior mesenteric

40 Distant metastases except distant lymph node(s) (codes 08-10) M1 D D Distant metastasis, NOS Carcinomatosis

Version date: January 1, 2004 275 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 (40) + [(08) or (10)] M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Colon CS Mets Eval SEE STANDARD TABLE

Colon CS Site-Specific Factor 1 Carcinoembryonic Antigen (CEA) Code Description

000 Test not done

010 Positive/elevated

020 Negative/normal; within normal limits

030 Borderline; undetermined whether positive or negative

080 Ordered, but results not in chart

999 Unknown or no information Not documented in patient record

Colon CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Colon CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Colon CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 276 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Colon CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Colon CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 277 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 278 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Rectosigmoid, Rectum C19.9, C20.9 C19.9 Rectosigmoid junction C20.9 Rectum, NOS

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Carcinoembryonic Antigen (CEA) available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 4 AJCC Stage Reg LN Pos CS Site-Specific Factor 5 Lymph Nodes Number Positive Reg LN Exam CS Site-Specific Factor 6 Table CS Mets at DX CS Mets Eval

Rectosigmoid, Rectum CS Tumor Size Code Description

000 No mass/tumor found

001-988 001 - 988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only; no size given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

998 Familial/multiple polyposis (M-8220/8221)

999 Unknown; size not stated Not documented in patient record

Version date: January 1, 2004 279 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Rectosigmoid, Rectum CS Extension Note 1: Ignore intraluminal extension to adjacent segment(s) of colon/rectum and code depth of invasion or extracolonic spread as indicated. Note 2: A tumor nodule in the pericolic adipose tissue of a primary carcinoma without histologic evidence of residual lymph node in the nodule is classified as a regional lymph node metastasis if the nodule has the form and smooth contour of a lymph node, or if the contour is not described. If the nodule has an irregular contour, it should be coded in CS Extension as code 45. Note 3: Codes 60-80 are used for contiguous extension from the site of origin. Discontinuous involvement is coded in CS Mets at DX. Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

05 (Adeno)carcinoma in a polyp or adenoma, noninvasive Tis IS IS

10 Invasive tumor confined to mucosa, NOS, including intramucosal, Tis L L NOS

11 Lamina propria, including lamina propria in the stalk of a polyp Tis L L

12 Muscularis mucosae, including muscularis mucosae in the stalk of a T1 L L polyp

13 Confined to head of polyp, NOS T1 L L

14 Confined to stalk of polyp, NOS T1 L L

15 Invasive tumor in polyp, NOS T1 L L

16 Submucosa (superficial invasion), including submucosa in the stalk T1 L L of a polyp

20 Muscularis propria invaded T2 L L

30 Localized, NOS TX L L Confined to rectum, NOS

40 Extension through wall, NOS T3 L L Invasion through muscularis propria or muscularis, NOS Perimuscular tissue invaded Subserosal tissue/(sub)serosal fat invaded Non-peritonealized pericolic tissues invaded Transmural, NOS

42 Fat, NOS T3 RE RE

45 Adjacent (connective) tissue: T3 RE RE For all sites: Perirectal fat For rectosigmoid: Mesentery (including mesenteric fat, mesocolon) Pericolic fat For rectum: Extension to anus Rectovaginal septum

46 Adherent to other organs or structures but no tumor found in T3 RE RE adhesion(s)

50 Invasion of/through serosa (mesothelium) ( visceral peritoneum) T4 RE RE

Version date: January 1, 2004 280 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

55 (50) with [(42) or (45)] T4 RE RE

57 Adherent to other organs or structures, NOS T4 RE RE

60 Rectosigmoid: T4 RE RE Cul de sac (rectouterine pouch) Pelvic wall Small intestine Rectum: Bladder for males only Cul de sac (rectouterine pouch) Ductus deferens Pelvic wall Prostate Rectovesical fascia for male only Seminal vesicle(s) Skeletal muscle of pelvic floor Vagina

70 Rectosigmoid: T4 D D Bladder Colon via serosa Fallopian tube(s) Ovary(ies) Prostate Ureter(s) Uterus Rectum: Bladder for female only Bone(s) of pelvis Urethra Uterus

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Rectosigmoid, Rectum CS TS/Ext-Eval SEE STANDARD TABLE

Version date: January 1, 2004 281 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Rectosigmoid, Rectum CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: A tumor nodule in the perirectal adipose tissue of a primary carcinoma without histologic evidence of residual lymph node in the nodule is classified as a regional lymph node metastasis if the nodule has the form and smooth contour of a lymph node, or if the contour is not described. If the nodule has an irregular contour, it should be coded in CS Extension as code 45. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): * RN RN Rectosigmoid: Paracolic/pericolic Perirectal Rectal Nodule(s) or foci in pericolic fat/adjacent mesentery/mesocolic fat Rectum: Perirectal Rectal, NOS Nodule(s) or foci in perirectal fat

20 Regional lymph node(s): * RN RN Rectosigmoid: Colic, NOS Left colic Hemorrhoidal, superior or middle Inferior mesenteric Middle rectal Sigmoidal (sigmoid mesenteric) Superior rectal Rectum: Hemorrhoidal, superior, middle or inferior Inferior mesenteric Internal iliac (hypogastric) Obturator Rectal, superior, middle, or inferior Sacral, NOS Lateral (laterosacral) Middle (promontorial) (Gerota's node) Presacral Sacral promotory Sigmoidal (sigmoid mesenteric)

30 Mesenteric, NOS * RN RN Regional lymph node(s), NOS

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For Lymph Nodes codes 10-80 ONLY, the N category is assigned based on the value of Reg LN Pos, using the Lymph Nodes Number Positive Table for this site:

Version date: January 1, 2004 282 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Rectosigmoid, Rectum CS Reg Nodes Eval SEE STANDARD TABLE

Rectosigmoid, Rectum Reg LN Pos SEE STANDARD TABLE

Rectosigmoid, Rectum Reg LN Exam SEE STANDARD TABLE

Rectosigmoid, Rectum CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), NOS M1 D D

11 Rectosigmoid: M1 RN D Internal iliac (hypogastric) Obturator

12 Other distant lymph node(s), including M1 D D external iliac or common iliac

40 Distant metastases except distant lymph node(s) codes 10-12 M1 D D Distant metastasis, NOS Carcinomatosis

50 (40) + any of [(10) to (12)] M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Rectosigmoid, Rectum CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 283 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Rectosigmoid, Rectum CS Site-Specific Factor 1 Carcinoembryonic Antigen (CEA) Note: The Site-Specific Factors section includes factors that are needed to derive TNM or AJCC stage and also includes items that are considered important but are not needed for AJCC. This includes prognostic and predictive factors and tumor markers. There are many sites for which there are no Site-Specific Factors required at this time. Code Description

000 Test none done

010 Positive/elevated

020 Negative/normal; within normal limits

030 Borderline; undetermined whether positive or negative

080 Ordered, but results not in chart

999 Unknown or no information Not documented in patient record

Rectosigmoid, Rectum CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Rectosigmoid, Rectum CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Rectosigmoid, Rectum CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Rectosigmoid, Rectum CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Rectosigmoid, Rectum CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 284 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Anus Anal Canal; Anus, NOS; Other Parts of Rectum C21.0-C21.2, C21.8 C21.0 Anus, NOS (excludes skin of anus and perianal skin C44.5) C21.1 Anal canal C21.2 Cloacogenic zone C21.8 Overlapping lesion of rectum, anus and anal canal Note: Skin of anus is coded separately (C44.5).

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Anus CS Tumor Size SEE STANDARD TABLE

Anus CS Extension Note: Codes 60-80 are used for contiguous extension from the site of origin. Discontinuous involvement is coded in CS Mets at DX. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor confined to mucosa, NOS (including intramucosal, * L L NOS)

11 Invades lamina propria * L L

12 Invades muscularis mucosae * L L

16 Invades submucosa (superficial invasion) * L L

20 Invades muscularis propria (internal sphincter) * L L

30 Localized, NOS * L L

40 Ischiorectal fat/tissue * RE RE Perianal skin Perirectal skin Rectal mucosa or submucosa Rectal wall Skeletal muscles: Anal sphincter (external) Levator ani Subcutaneous perianal tissue

60 Perineum T4 RE RE Vulva

Version date: January 1, 2004 285 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

70 Bladder T4 D D Pelvic peritoneum Urethra Vagina

75 Broad ligament(s) T4 D D Cervix uteri Corpus uteri Prostate

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For codes 10-40 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Anus CS TS/Ext-Eval SEE STANDARD TABLE

Anus CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Unilateral and bilateral: N1 RN RN For all subsites: Anorectal Inferior hemorrhoidal Lateral sacral (laterosacral) Perirectal

20 Unilateral: N2 RN RN For anal canal: Internal iliac (hypogastric) Obturator

21 Unilateral: N2 D RN For anus: Internal iliac (hypogastric) Obturator

30 Unilateral: N2 RN RN For anal canal: Superficial inguinal (femoral)

31 Unilateral: N2 D RN For anus: Superficial inguinal (femoral)

40 (20) + (30) N2 RN RN

Version date: January 1, 2004 286 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

41 (10) + (30) N3 RN RN

42 (10) + (31) N3 D RN

50 Bilateral: N3 RN RN For anal canal: Internal iliac (hypogastric) Obturator Superficial inguinal (femoral)

51 Bilateral: N3 D RN For anus: Internal iliac (hypogastric) Obturator Superficial inguinal (femoral)

60 Regional lymph node(s), NOS N1 RN RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Anus CS Reg Nodes Eval SEE STANDARD TABLE

Anus Reg LN Pos SEE STANDARD TABLE

Anus Reg LN Exam SEE STANDARD TABLE

Anus CS Mets at DX SEE STANDARD TABLE

Anus CS Mets Eval SEE STANDARD TABLE

Anus CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Version date: January 1, 2004 287 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Anus CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Anus CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Anus CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Anus CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Anus CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 288 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Liver and Intrahepatic Bile Ducts C22.0-C22.1 C22.0 Liver C22.1 Intrahepatic bile duct

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Alpha Fetoprotein (AFP) available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Fibrosis Score Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 3 AJCC Stage Reg LN Pos CS Site-Specific Factor 4 Extension Size Table Reg LN Exam CS Site-Specific Factor 5 CS Mets at DX CS Site-Specific Factor 6 CS Mets Eval

Liver and Intrahepatic Bile Ducts CS Tumor Size SEE STANDARD TABLE

Liver and Intrahepatic Bile Ducts CS Extension Note 1: In codes 30, 40, and 65, "multiple (satellite) nodules/tumors" includes satellitosis, multifocal tumors, and intrahepatic metastases. Note 2: Major vascular invasion (code 63) is defined as invasion of the branches of the main portal vein (right or left portal vein, not including sectoral or segmental branches) or as invasion of one or more of the three hepatic veins (right, middle, or left). Invasion of hepatic artery or vein is coded to 66. Code Description TNM SS77 SS2000

10 Single lesion (one lobe) T1 L L WITHOUT intrahepatic vascular invasion, including vascular invasion not stated

20 Single lesion (one lobe) WITH intrahepatic vascular invasion T2 L L

30 Multiple (satellite) nodules/tumors (one lobe) * L L WITHOUT intrahepatic vascular invasion, including vascular invasion not stated

40 Multiple (satellite) nodules/tumors (one lobe) * L L WITH intrahepatic vascular invasion

50 Confined to liver, NOS T1 L L Localized, NOS

51 More than one lobe involved by contiguous growth (single lesion) T1 RE RE WITHOUT vascular invasion, including vascular invasion not stated

52 More than one lobe involved by contiguous growth (single lesion) T2 RE RE WITH vascular invasion

53 Extension to gallbladder, extent within liver not stated T1 RE RE

54 Single lesion with extension to gallbladder + [(10) or (51)] T1 RE RE

55 Single lesion with extension to gallbladder + [(20) or (52)] T2 RE RE

Version date: January 1, 2004 289 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

56 Extension to gallbladder + [(30) or (40)] * RE RE

58 Extrahepatic bile ducts T2 RE RE

63 Major vascular invasion: major branch(es) of portal or hepatic T3 RE RE vein(s) (see Note 2)

64 Direct extension/perforation of visceral peritoneum T4 RE RE

65 Multiple (satellite) nodules/tumors in more than one lobe of liver or * D RE on surface of parenchyma Satellite nodules, NOS

66 Extension to hepatic artery or vena cava T4 RE RE

70 Diaphragm T4 RE RE

75 Lesser omentum T4 RE RE Ligament(s): Coronary Falciform Round [of liver] Hepatoduodenal Hepatogastric Triangular Parietal peritoneum

76 (65) + any of [(64) or (66) or (70) or (75)] T4 D RE

80 Further contiguous extension: T4 D D Pancreas Pleura Stomach Other contiguous extension

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 30, 40, 56, and 65 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Liver and Intrahepatic Bile Ducts CS TS/Ext-Eval Code Description Staging Basis

0 No surgical resection done. Evaluation based on physical examination, imaging c examination, or other non-invasive clinical evidence. No autopsy evidence used.

1 No surgical resection done. Evaluation based on endoscopic examination, diagnostic p biopsy, including fine needle aspiration biopsy, or other invasive techniques including surgical observation without biopsy. No autopsy evidence used.

2 No surgical resection done, but evidence derived from autopsy (tumor was suspected or p diagnosed prior to autopsy)

Version date: January 1, 2004 290 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

3 Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation OR p surgical resection performed, unknown if pre-surgical systemic treatment or radiation performed. Evidence acquired before treatment, supplemented or modified by the additional evidence acquired during and from surgery, particularly from pathologic examination of the resected specimen

5 Surgical resection performed WITH pre-surgical systemic treatment or radiation, BUT c tumor size/extension based on clinical evidence

6 Surgical resection performed WITH pre-surgical systemic treatment or radiation; tumor y size/extension based on pathologic evidence

8 Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy) a

9 Unknown if surgical resection done c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record

Liver and Intrahepatic Bile Ducts CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Hepatic NOS: Hepatic artery Hepatic pedicle Inferior vena cava Porta hepatis (hilar) [in hilus of liver] Hepatoduodenal ligament Periportal Portal vein Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Liver and Intrahepatic Bile Ducts CS Reg Nodes Eval SEE STANDARD TABLE

Liver and Intrahepatic Bile Ducts Reg LN Pos SEE STANDARD TABLE

Liver and Intrahepatic Bile Ducts Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 291 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Liver and Intrahepatic Bile Ducts CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), NOS M1 D D

11 Distant lymph node(s): M1 RN D Cardiac Lateral (aortic) (lumbar) Pericardial (pericardiac) Posterior mediastinal (tracheoesophageal) including juxtaphrenic nodes Retroperitoneal, NOS

12 Distant lymph node(s): M1 RN D Coronary artery Renal artery

13 Distant lymph node(s): M1 D D Aortic (para-, peri-) Diaphragmatic, NOS Peripancreatic (near head of pancreas only)

15 Distant lymph node(s) other than codes 10-13, including inferior M1 D D phrenic nodes

40 Distant metastasis except distant lymph node(s) (codes 10-15) M1 D D Distant metastasis, NOS Carcinomatosis

50 (40) + any of [(10) or (11) or (15)] M1 D D Distant lymph node(s) plus other distant metastases

52 (40) + [(12) or (13)] M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Primary tumor cannot be assessed Not documented in patient record

Liver and Intrahepatic Bile Ducts CS Mets Eval SEE STANDARD TABLE

Liver and Intrahepatic Bile Ducts CS Site-Specific Factor 1 Alpha Fetoprotein (AFP) Code Description

000 Test not done

010 Positive/elevated

020 Negative/normal; within normal limits

030 Borderline; undetermined whether positive or negative

Version date: January 1, 2004 292 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

080 Ordered, but results not in chart

999 Unknown or no information Not documented in patient record

Liver and Intrahepatic Bile Ducts CS Site-Specific Factor 2 Fibrosis Score Note: AJCC classifies fibrosis scores 0-4 (none to moderate fibrosis) as F0, and fibrosis scores 5-6 (severe fibrosis or cirrhosis) as F1. Fibrosis score is also called Ishak score. Code Description

000 F0: Fibrosis score 0-4 (none to moderate fibrosis)

001 F1: Fibrosis score 5-6 (severe fibrosis or cirrhosis)

999 Fibrosis score not recorded Insufficient information Not documented in patient record

Liver and Intrahepatic Bile Ducts CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Liver and Intrahepatic Bile Ducts CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Liver and Intrahepatic Bile Ducts CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Liver and Intrahepatic Bile Ducts CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 293 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 294 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gallbladder C23.9 C23.9 Gallbladder

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Gallbladder CS Tumor Size SEE STANDARD TABLE

Gallbladder CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

10 Invasive tumor confined to: T1a L L Lamina propria Mucosa, NOS Submucosa (superficial invasion)

20 Muscularis propria T1b L L

30 Localized, NOS T1NOS L L

40 Perimuscular connective tissue T2 RE RE

50 Invasion of/through serosa (visceral peritoneum) T3 L RE

55 (40) + (50) T3 RE RE

60 Extension into liver, NOS T3 RE RE

61 Extension into liver less than or equal to 2 cm T3 RE RE

62 Extension to ONE of the following: T3 RE RE Ampulla of Vater Duodenum Extrahepatic bile duct(s) Omentum, NOS Greater Lesser Pancreas Small intestine, NOS

65 Extension to ONE of the following T3 RE RE WITHOUT extension to any structure in (62): Colon Stomach

Version date: January 1, 2004 295 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

66 Extension to cystic artery/vein T3 RE D WITHOUT extension to any structure in [(62) to (65)]

67 [(60) or (61)] PLUS extension to ONE structure in codes [(62) to T3 RE RE (65)]

68 (66) + [(60) or (61)] T3 RE D

71 Extension into liver greater than 2 cm T3 D D WITHOUT extension to any structure in codes [(62) to (66)]

72 Extension into liver greater than 2 cm T3 D D PLUS extension to ONE structure in codes [(62) to (66)]

73 Extension to two or more structures in codes [(62) to (66)], T4 D D WITH or WITHOUT extension into liver of any depth

75 Extension to: T4 RE D Hepatic artery Portal vein

78 (75) + any of [(60) to (73)] T4 D D

80 Further contiguous extension, including: T4 D D Abdominal wall Diaphragm

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Gallbladder CS TS/Ext-Eval SEE STANDARD TABLE

Gallbladder CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Also note that celiac and superior mesenteric nodes are listed in this field rather than Mets at DX, because AJCC classifies them as N1 and not M1. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Cystic duct (Calot's node) Node of foramen of Winslow (omental) (epiploic) Pericholedochal (common bile duct)

11 Regional lymph node(s): N1 D RN Porta hepatis (portal) (periportal) (hilar) (in hilus of liver)

20 Regional lymph node(s): N1 RN RN Pancreaticoduodenal

Version date: January 1, 2004 296 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

21 Regional lymph node(s): N1 D RN Periduodenal Peripancreatic (near head of pancreas only)

25 (11) + (20) N1 D RN

30 Regional lymph node(s), NOS N1 RN RN

50 Celiac lymph node(s) N1 D D

60 Superior mesenteric lymph node(s) N1 D D

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Gallbladder CS Reg Nodes Eval SEE STANDARD TABLE

Gallbladder Reg LN Pos SEE STANDARD TABLE

Gallbladder Reg LN Exam SEE STANDARD TABLE

Gallbladder CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), including: M1 D D Para-aortic Peripancreatic (along body and tail of pancreas only) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Version date: January 1, 2004 297 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Gallbladder CS Mets Eval SEE STANDARD TABLE

Gallbladder CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Gallbladder CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Gallbladder CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Gallbladder CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Gallbladder CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Gallbladder CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 298 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Extrahepatic Bile Duct(s) C24.0 C24.0 Extrahepatic bile duct

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Extrahepatic Bile Duct(s) CS Tumor Size SEE STANDARD TABLE

Extrahepatic Bile Duct(s) CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

10 Invasive tumor of extrahepatic bile duct(s) (choledochal, common, T1 L L cystic, and hepatic) confined to: Lamina propria Mucosa, NOS Submucosa (superficial invasion)

20 Muscularis propria T1 L L

30 Localized, NOS T1 L L

40 Beyond wall of bile duct T2 RE RE Periductal/fibromuscular connective tissue

60 Gallbladder T3 RE RE Liver, porta hepatis Pancreas

61 Unilateral branches of hepatic artery (right or left) T3 RE RE Unilateral branches of portal vein (right or left)

65 Colon, NOS T4 RE RE Transverse including flexure Duodenum, NOS Omentum, NOS Lesser Stomach, distal

66 Common hepatic artery T4 RE RE Hepatic artery, NOS Main main portal vein or its branches bilaterally Portal vein, NOS

Version date: January 1, 2004 299 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

70 Other parts of colon T4 D RE Greater omentum Stomach, proximal

75 Abdominal wall T4 D D

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Extrahepatic Bile Duct(s) CS TS/Ext-Eval SEE STANDARD TABLE

Extrahepatic Bile Duct(s) CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

15 Regional lymph node(s): N1 RN RN Cystic duct (node of the neck of the gallbladder) (Calot's node) Hepatic Hilar (in the hepatoduodenal ligament) Node of the foramen of Winslow (omental) (epiploic) Pancreaticoduodenal Pericholedochal (node around common bile duct) Periduodenal Peripancreatic (near head of pancreas only) Periportal Porta hepatis (portal) (hilar) (in hilus of liver) Regional lymph node(s), NOS

35 Regional lymph node(s): N1 D D Celiac Superior mesenteric

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Extrahepatic Bile Duct(s) CS Reg Nodes Eval SEE STANDARD TABLE

Extrahepatic Bile Duct(s) Reg LN Pos SEE STANDARD TABLE

Version date: January 1, 2004 300 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Extrahepatic Bile Duct(s) Reg LN Exam SEE STANDARD TABLE

Extrahepatic Bile Duct(s) CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) including: M1 D D Para-aortic Peripancreatic (along body and tail of pancreas only) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastases, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patientrecord

Extrahepatic Bile Duct(s) CS Mets Eval SEE STANDARD TABLE

Extrahepatic Bile Duct(s) CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Extrahepatic Bile Duct(s) CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Extrahepatic Bile Duct(s) CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Version date: January 1, 2004 301 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Extrahepatic Bile Duct(s) CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Extrahepatic Bile Duct(s) CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Extrahepatic Bile Duct(s) CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 302 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Ampulla of Vater C24.1 C24.1 Ampulla of Vater

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Ampulla of Vater CS Tumor Size SEE STANDARD TABLE

Ampulla of Vater CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

10 Invasive tumor confined/limited to ampulla of Vater or extending to T1 L L sphincter of Oddi

30 Localized, NOS T1 L L

42 Duodenal wall T2 RE RE

52 Pancreas T3 RE RE

62 Common bile duct T4 RE RE

65 Extrahepatic bile ducts other than common bile duct or sphincter of T4 RE RE Oddi

70 Extension to other adjacent organs or tissues: T4 RE RE Blood vessels(major): Hepatic artery Portal vein Gallbladder Hepatic flexure Lesser omentum Liver including porta hepatis Peripancreatic soft tissues Stomach, NOS: Distal Transverse colon

75 Stomach, proximal T4 RE D

80 Further contiguous extension T4 D D Other adjacent organs

Version date: January 1, 2004 303 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Ampulla of Vater CS TS/Ext-Eval SEE STANDARD TABLE

Ampulla of Vater CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: Splenic lymph nodes and those located at the tail of the pancreas are not considered regional and should be coded under Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Hepatic Hepatic artery Node of the foramen of Winslow (epiploic) (omental) Pancreaticoduodenal Peripancreatic (except at tail of pancreas, see CS Mets at DX) Periportal Lymph node(s): Anterior to the ampulla of Vater Inferior to the ampulla of Vater Posterior to the ampulla of Vater Superior to the ampulla of Vater Regional lymph node(s), NOS

11 Regional lymph node(s): N1 D RN Celiac Infrapyloric (subpyloric) Lateral aortic (lumbar) Proximal mesenteric Retroperitoneal Superior mesenteric

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Ampulla of Vater CS Reg Nodes Eval SEE STANDARD TABLE

Ampulla of Vater Reg LN Pos SEE STANDARD TABLE

Version date: January 1, 2004 304 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Ampulla of Vater Reg LN Exam SEE STANDARD TABLE

Ampulla of Vater CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Node(s) at the tail of the pancreas Para-aortic Splenic lymph node(s) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Carcinomatosis Distant metastasis, NOS (Includes seeding of peritoneum, even if limited to the lesser sac region; positive peritoneal cytology)

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patientrecord

Ampulla of Vater CS Mets Eval SEE STANDARD TABLE

Ampulla of Vater CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Ampulla of Vater CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Ampulla of Vater CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Version date: January 1, 2004 305 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Ampulla of Vater CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Ampulla of Vater CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Ampulla of Vater CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 306 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Biliary and Biliary, NOS C24.8-C24.9 C24.8 Overlapping lesion of biliary tract (neoplasms involving both intrahepatic and extrahepatic bile ducts) C24.9 Biliary tract, NOS

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Other Biliary and Biliary, NOS CS Tumor Size SEE STANDARD TABLE

Other Biliary and Biliary, NOS CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

10 Invasive tumor confined to: T1 L L Lamina propria Mucosa, NOS Submucosa (superficial invasion)

20 Muscularis propria T1 L L

30 Localized, NOS T1 L L Tumor confined to bile duct

40 Perimuscular connective tissue T2 RE RE Tumor invades beyond the wall of the bile duct

50 Invasion of/through serosa T2 L RE

55 (40) + (50) T2 RE RE

60 Extension into liver, NOS T3 RE RE

61 Extension into liver less than or equal to 2 cm T3 RE RE

62 Extension to ONE of the following: T3 RE RE Ampulla of Vater Omentum, NOS Greater Lesser Pancreas Small intestine, NOS

63 Gallbladder T3 RE RE Unilateral branches of the right or left portal vein Unilateral branches of the right or left hepatic artery

Version date: January 1, 2004 307 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

65 Extension to ONE of the following: T4 D D Colon Stomach

66 Abdominal wall T4 RE RE Duodenum

70 Extension into liver greater than 2 cm T3 D D Extension to two or more adjacent organs listed in codes [(60) to (63)]

71 Extension to two or more adjacent organs any of which are in codes T4 D D [(65) to (66)]

75 Common hepatic artery T4 RE D Cystic artery/vein Hepatic artery, NOS Portal vein or its branches bilaterally Portal vein, NOS

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Other Biliary and Biliary, NOS CS TS/Ext-Eval SEE STANDARD TABLE

Other Biliary and Biliary, NOS CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Cystic duct (Calot's node) Node of foramen of Winslow (epiploic) (omental) Pericholedochal (common bile duct)

11 Regional lymph node(s): N1 D RN Porta hepatis (portal) (hilar) [in hilus of liver]

20 Regional lymph node(s): N1 RN RN Pancreaticoduodenal Periportal

21 Regional lymph node(s): N1 D RN Periduodenal Peripancreatic (near head of pancreas only)

30 Regional lymph node(s), NOS N1 RN RN

50 Celiac N1 D D

Version date: January 1, 2004 308 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60 Superior mesenteric N1 D D

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Other Biliary and Biliary, NOS CS Reg Nodes Eval SEE STANDARD TABLE

Other Biliary and Biliary, NOS Reg LN Pos SEE STANDARD TABLE

Other Biliary and Biliary, NOS Reg LN Exam SEE STANDARD TABLE

Other Biliary and Biliary, NOS CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) including: M1 D D Para-aortic

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastases, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Other Biliary and Biliary, NOS CS Mets Eval SEE STANDARD TABLE

Other Biliary and Biliary, NOS CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Version date: January 1, 2004 309 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Biliary and Biliary, NOS CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Other Biliary and Biliary, NOS CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Other Biliary and Biliary, NOS CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Other Biliary and Biliary, NOS CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Other Biliary and Biliary, NOS CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 310 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pancreas: Head C25.0 C25.0 Head of pancreas Note: For tumors of the islet cells, determine which subsite of the pancreas is involved and use that primary site code and the corresponding Collaborative Stage scheme. If the subsite cannot be determined, use the general code for Islets of Langerhans, C25.4, and use the Collaborative Stage scheme for Pancreas, Other and Unspecified.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Pancreas: Head CS Tumor Size SEE STANDARD TABLE

Pancreas: Head CS Extension Note 1: Islets of Langerhans are distributed throughout the pancreas, and therefore any extension code can be used. Note 2: Codes 40-80 are used for contiguous extension of tumor from the site of origin. Discontinuous involvement is coded in CS Mets at DX. Code Description TNM SS77 SS2000

00 In situ; non-invasive Tis IS IS PanIn III Pancreatic Intraepithelial Neoplasia III

10 Confined to pancreas * L L

30 Localized, NOS * L L

40 Extension to peripancreatic tissue, NOS T3 RE RE Fixation to adjacent structures, NOS

44 Ampulla of Vater T3 RE RE Duodenum Extrahepatic bile duct(s)

50 Adjacent stomach T3 RE RE Stomach, NOS

54 Blood vessel(s) (major): T3 RE RE Gastroduodenal artery Hepatic artery Pancreaticoduodenal artery Portal vein Superior mesenteric artery Transverse colon, including hepatic flexure

55 Mesenteric fat T3 RE D Mesentery Mesocolon Peritoneum

Version date: January 1, 2004 311 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

57 Gallbladder T3 RE D

58 Body of stomach T3 D RE

59 (58) + [(55) or (57)] T3 D D

60 Tumor is inseparable from the superior mesenteric artery T4 RE RE Superior mesenteric artery

61 Omentum T4 RE D

63 Liver (including porta hepatis) T4 RE D

65 (60) + [(55) or (57)] T4 RE D

66 (60) + (58) T4 D RE

67 (60 + 59) T4 D D OR any of [(61 to 65)] + [(58) or (59)] OR (66) + any of [(55) or (57) or (59) or (61) or (63) or (65)]

68 Tumor is inseparable from the celiac axis T4 D D Aorta Celiac artery

69 Colon (other than transverse colon including hepatic flexure) T4 D D Spleen

78 Adrenal (suprarenal) gland T4 D D Ileum Jejunum Kidney Retroperitoneum Ureter

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10 and 30 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Pancreas: Head CS TS/Ext-Eval SEE STANDARD TABLE

Pancreas: Head CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Celiac

Version date: January 1, 2004 312 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Gastroepiploic (gastro-omental), left cont’d Hepatic Infrapyloric (subpyloric) Lateral aortic (lumbar) Peripancreatic, NOS: Anterior, NOS: Anterior pancreaticoduodenal Anterior proximal mesenteric Pyloric Inferior to the head and body of pancreas Posterior, NOS: Pericholedochal (common bile duct) Posterior pancreaticoduodenal Posterior proximal mesentery Superior to the head and body of pancreas Retroperitoneal Superior mesenteric Regional lymph node(s), NOS

20 Pancreaticosplenic (pancreaticolienal) N1 D D Splenic (lienal), NOS Superior hilum Suprapancreatic

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Pancreas: Head CS Reg Nodes Eval SEE STANDARD TABLE

Pancreas: Head Reg LN Pos SEE STANDARD TABLE

Pancreas: Head Reg LN Exam SEE STANDARD TABLE

Pancreas: Head CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS (includes seeding of peritoneum, even if limited to the lesser sac region; positive peritoneal cytology) Carcinomatosis

Version date: January 1, 2004 313 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Pancreas: Head CS Mets Eval SEE STANDARD TABLE

Pancreas: Head CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Pancreas: Head CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Pancreas: Head CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Pancreas: Head CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Pancreas: Head CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Pancreas: Head CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 314 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pancreas: Body and Tail C25.1-C25.2 C25.1 Body of pancreas C25.2 Tail of pancreas Note: For tumors of the islet cells, determine which subsite of the pancreas is involved and use that primary site code and corresponding the Collaborative Stage scheme. If the subsite cannot be determined, use the general code for Islets of Langerhans, C25.4, and use the Collaborative Stage scheme for Pancreas, Other and Unspecified.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Pancreas: Body and Tail CS Tumor Size SEE STANDARD TABLE

Pancreas: Body and Tail CS Extension Note 1: Islets of Langerhans are distributed throughout the pancreas, and therefore any extension code can be used. Note 2: Codes 40-80 are used for contiguous extension of tumor from the site of origin. Discontinuous involvement is coded in CS Mets at DX. Code Description TNM SS77 SS2000

00 In situ; non-invasive Tis IS IS PanIn III Pancreatic Intraepithelial Neoplasia III

10 Confined to pancreas * L L

30 Localized, NOS * L L

40 Extension to peripancreatic tissue, NOS T3 RE RE Fixation to adjacent structures, NOS

44 Duodenum T3 RE RE

48 Ampulla of Vater T3 RE RE Extrahepatic bile duct(s)

50 Spleen T3 RE RE

56 Blood vessel(s): T3 RE RE Hepatic artery Portal vein Splenic artery/vein Superior mesenteric vein Splenic flexure of colon

57 Kidney, NOS T3 RE D Left adrenal (suprarenal) gland Left kidney Left ureter

Version date: January 1, 2004 315 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

58 Mesenteric fat T3 RE D Mesentery Mesocolon Peritoneum

59 Retroperitoneal soft tissue (retroperitoneal space) T3 D D

60 Tumor is inseparable from the celiac axis or superior mesenteric T4 RE RE artery Aorta Celiac artery Superior mesenteric artery

62 Stomach T4 RE RE

70 [(60) or (62)] + [(57) or (58)] T4 RE D

71 Ileum T4 RE D Jejunum

73 Gallbladder T4 RE D Liver (including porta hepatis)

75 (59) + any of [(60) or (62) or (71) or (73)] T4 D D

77 Colon (other than splenic flexure) T4 D D

78 Diaphragm T4 D D Right adrenal (suprarenal) gland Right kidney Right ureter

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10 and 30 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Pancreas: Body and Tail CS TS/Ext-Eval SEE STANDARD TABLE

Pancreas: Body and Tail CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Hepatic Lateral aortic (lumbar) Pancreaticosplenic (pancreaticolienal)

Version date: January 1, 2004 316 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Peripancreatic, NOS: cont’d Anterior, NOS: Anterior pancreaticoduodenal Anterior proximal mesenteric Pyloric Inferior to the head and body of pancreas Posterior, NOS: Pericholedochal (common bile duct) Posterior pancreaticoduodenal Posterior proximal mesentery Superior to the head and body of pancreas Retroperitoneal Splenic (lienal) Gastroepiploic Splenic hilum Suprapancreatic Superior mesenteric Regional lymph node(s), NOS

20 Regional lymph node(s): N1 D D Celiac Infrapyloric (subpyloric)

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Pancreas: Body and Tail CS Reg Nodes Eval SEE STANDARD TABLE

Pancreas: Body and Tail Reg LN Pos SEE STANDARD TABLE

Pancreas: Body and Tail Reg LN Exam SEE STANDARD TABLE

Pancreas: Body and Tail CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS (includes seeding of peritoneum, even if limited to the lesser sac region; positive peritoneal cytology) Carcinomatosis

Version date: January 1, 2004 317 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Pancreas: Body and Tail CS Mets Eval SEE STANDARD TABLE

Pancreas: Body and Tail CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Pancreas: Body and Tail CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Pancreas: Body and Tail CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Pancreas: Body and Tail CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Pancreas: Body and Tail CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Pancreas: Body and Tail CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 318 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pancreas: Other and Unspecified C25.3-C25.4, C25.7-C25.9 C25.3 Pancreatic duct C25.4 Islets of Langerhans C25.7 Other specified parts of pancreas C25.8 Overlapping lesion of pancreas C25.9 Pancreas, NOS Note: For tumors of the islet cells, determine which subsite of the pancreas is involved and use that primary site code and the corresponding Collaborative Stage scheme. If the subsite cannot be determined, use the general code for Islets of Langerhans, C25.4, and use the Collaborative Stage scheme for Pancreas, Other and Unspecified.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Pancreas: Other and Unspecified CS Tumor Size SEE STANDARD TABLE

Pancreas: Other and Unspecified CS Extension Note 1: Islets of Langerhans are distributed throughout the pancreas, and, therefore, any extension code can be used. Note 2: Codes 40-80 are used for contiguous extension of tumor from the site of origin. Discontinuous involvement is coded in CS Mets at DX. Code Description TNM SS77 SS2000

00 In situ; non-invasive Tis IS IS PanIn III Pancreatic intraepithelial neoplasia III

10 Confined to pancreas * L L

30 Localized, NOS * L L

40 Peripancreatic tissue T3 RE RE

45 Ampulla of Vater T3 RE RE Duodenum Extra hepatic bile duct(s)

50 Adjacent large vessel(s) (except as listed in code 60) T3 RE RE Colon Spleen Stomach

60 Tumor is inseparable from the celiac axis or superior mesenteric T4 RE RE artery Aorta Celiac artery Superior mesenteric artery

Version date: January 1, 2004 319 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10 and 30 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Pancreas: Other and Unspecified CS TS/Ext-Eval SEE STANDARD TABLE

Pancreas: Other and Unspecified CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Celiac Hepatic Infrapyloric (subpyloric) Lateral aortic (lumbar) Pancreaticosplenic (pancreaticolienal) Peripancreatic, NOS: Anterior, NOS: Anterior pancreaticoduodenal Anterior proximal mesenteric Pyloric Inferior to the head and body of pancreas Posterior, NOS: Pericholedochal (common bile duct) Posterior pancreaticoduodenal Posterior proximal mesentery Superior to the head and body of pancreas Retroperitoneal Splenic (lienal), NOS Gastroepiploic (gastro-omental), left Splenic hilum Suprapancreatic Superior mesenteric Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Pancreas: Other and Unspecified CS Reg Nodes Eval SEE STANDARD TABLE

Version date: January 1, 2004 320 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pancreas: Other and Unspecified Reg LN Pos SEE STANDARD TABLE

Pancreas: Other and Unspecified Reg LN Exam SEE STANDARD TABLE

Pancreas: Other and Unspecified CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS (includes seeding of peritoneum, even if limited to the lesser sac region; positive peritoneal cytology) Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Pancreas: Other and Unspecified CS Mets Eval SEE STANDARD TABLE

Pancreas: Other and Unspecified CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Pancreas: Other and Unspecified CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Pancreas: Other and Unspecified CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Version date: January 1, 2004 321 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pancreas: Other and Unspecified CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Pancreas: Other and Unspecified CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Pancreas: Other and Unspecified CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 322 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Ill-Defined Digestive Organs C26.0, C26.8-C26.9 C26.0 Intestinal tract, NOS C26.8 Overlapping lesion of digestive system C26.9 Gastrointestinal tract, NOS Note: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Other and Ill-Defined Digestive Organs CS Tumor Size SEE STANDARD TABLE

Other and Ill-Defined Digestive Organs CS Extension Note 1: Definition of Adjacent Connective Tissue: Some of the schemes for ill-defined or non-specific sites in this manual contain a code 40, adjacent connective tissue, which is defined here as the unnamed tissues that immediately surround an organ or structure containing a primary cancer. Use this code when a tumor has invaded past the outer border (capsule, serosa, or other edge) of the primary organ into the organ's surrounding supportive structures but has not invaded into larger structures or adjacent organs. Note 2: Definition of Adjacent Structures: Connective tissues large enough to be given a specific name would be considered adjacent structures. For example, the brachial artery has a name, as does the broad ligament. Continuous tumor growth from one organ into an adjacent named structure would be coded to 60 in the schemes for ill-defined or non-specific sites. Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial NA IS IS

10 Invasion of submucosa NA L L

30 Localized, NOS NA L L

40 Adjacent connective tissue (see Note 1) NA RE RE

60 Adjacent organs/structures (see Note 2) NA RE RE

80 Further contiguous extension NA D D

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Version date: January 1, 2004 323 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Ill-Defined Digestive Organs CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Ill-Defined Digestive Organs CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Regional lymph node(s) NA RN RN Intra-abdominal Paracaval Pelvic Subdiaphragmatic Regional lymph node(s), NOS

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Other and Ill-Defined Digestive Organs CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Ill-Defined Digestive Organs Reg LN Pos SEE STANDARD TABLE

Other and Ill-Defined Digestive Organs Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 324 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Ill-Defined Digestive Organs CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Other and Ill-Defined Digestive Organs CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Ill-Defined Digestive Organs CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Other and Ill-Defined Digestive Organs CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Other and Ill-Defined Digestive Organs CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Other and Ill-Defined Digestive Organs CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 325 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Ill-Defined Digestive Organs CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Other and Ill-Defined Digestive Organs CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 326 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Nasal Cavity C30.0 C30.0 Nasal cavity (excludes nose, NOS C76.0) Note: Laterality must be coded for this site, except subsites Nasal cartilage and Nasal septum, for which laterality is coded 0.

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Lymph Nodes Size Table Reg LN Exam III, Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Nasal Cavity CS Tumor Size SEE STANDARD TABLE

Nasal Cavity CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive Tis IS IS

10 Invasive tumor confined to site of origin T1 L L Meatus (superior, middle, inferior) Nasal chonchae (superior, middle, inferior) Septum Tympanic membrane

30 Localized, NOS T1 L L

40 Extending to adjacent connective tissue within the nasoethomoidal T2 RE RE complex Nasolacrimal duct

60 Adjacent organs/structures including: T3 RE RE Bone of skull Choana Frontal sinus Hard palate Nasopharynx

65 Cribriform plate T3 RE RE

66 Maxillary sinus T3 RE RE

Version date: January 1, 2004 327 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

67 Medial wall or floor of the orbit T3 RE RE

70 Tumor invades: T4a D D Anterior orbital contents Skin of cheek Skin of nose Minimal extension to: Anterior cranial fossa Pterygoid plates Sphenoid or frontal sinuses

71 Tumor invades: T4b D D Orbital apex Dura Brain Middle cranial fossa Cranial nerves other than (V2), nasopharynx, or clivus

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Nasal Cavity CS TS/Ext-Eval SEE STANDARD TABLE

Nasal Cavity CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of nvolved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Sublingual Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Retropharyngeal Regional lymph node, NOS

Version date: January 1, 2004 328 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

12 Single positive ipsilateral regional node: * D D Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotrachea Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple or regional

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

Version date: January 1, 2004 329 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Nasal Cavity CS Reg Nodes Eval SEE STANDARD TABLE

Nasal Cavity Reg LN Pos SEE STANDARD TABLE

Nasal Cavity Reg LN Exam SEE STANDARD TABLE

Nasal Cavity CS Mets at DX SEE STANDARD TABLE

Nasal Cavity CS Mets Eval SEE STANDARD TABLE

Nasal Cavity CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

Version date: January 1, 2004 330 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Nasal Cavity CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Nasal Cavity CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

Version date: January 1, 2004 331 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Nasal Cavity CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 332 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Nasal Cavity CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Nasal Cavity CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

Version date: January 1, 2004 333 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 334 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Middle Ear C30.1 C30.1 Middle ear Note 1: Laterality must be coded for this site. Note 2: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I-III, Reg LN Exam Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Middle Ear CS Tumor Size SEE STANDARD TABLE

Middle Ear CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive NA IS IS

10 Invasive tumor confined to: NA L L Cochlea Incus Malleus Semicircular ducts, NOS: Ampullae Saccule Utricle Septum Stapes Tympanic membrane

30 Localized, NOS NA L L

40 Adjacent connective tissue: NA RE RE Auditory tube Nerve(s) Pharyngotympanic tube

60 Adjacent organs/structures: NA RE RE External auditory meatus Internal carotid artery 60, Mastoid antrum

Version date: January 1, 2004 335 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

cont’d Nasopharynx Temporal bone

80 Further contiguous extension NA D D Meninges

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Middle Ear CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Middle Ear CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Single positive ipsilateral regional node: NA RN RN Level I node Sublingual Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Retropharyngeal Regional lymph node, NOS

12 Single positive ipsilateral regional node: NA D D Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular 12, Level V node

Version date: January 1, 2004 336 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

cont’d Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotrachea Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Middle Ear CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Middle Ear Reg LN Pos SEE STANDARD TABLE

Middle Ear Reg LN Exam SEE STANDARD TABLE

Middle Ear CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

Version date: January 1, 2004 337 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Middle Ear CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Middle Ear CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 338 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Middle Ear CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Middle Ear CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 339 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Middle Ear CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Middle Ear CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 340 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Middle Ear CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 341 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 342 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Maxillary Sinus C31.0 C31.0 Maxillary sinus Note: Laterality must be coded for this site.

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I- Lymph Nodes Size Table Reg LN Exam III, Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Maxillary Sinus CS Tumor Size SEE STANDARD TABLE

Maxillary Sinus CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

10 Invasive tumor confined to mucosa of maxillary antrum (sinus) T1 L L without erosion or destruction of bone

30 Localized, NOS T1 L L

40 Invasion of infrastructure: T2 RE RE Hard palate except extension to posterior wall of sinus pterygoid plates (code 68) Middle nasal meatus, except extension to posterior wall of sinus and pterygoid plates (code 68) Nasal cavity (floor, lateral wall, septum, turbinates) Palatine bone Tumor causing bone erosion or destruction, except for the posterior antral wall

60 Invasion of suprastructure: T3 RE RE Ethmoid sinus, anterior Floor or medial wall of orbit Floor or posterior wall of maxillary sinus Subcutaneous tissues

65 Bone of the posterior wall of maxillary sinus T3 RE RE Invasion of maxilla, NOS

Version date: January 1, 2004 343 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

66 Ethmoid sinus T3 RE RE Posterior ethmoid, NOS Pterygoid sinus

68 Anterior orbital contents T4a RE RE Cribriform plate Frontal sinus Infratemporal fossa Pterygoid plates Skin of cheek Sphenoid sinus

70 Base of skull T4b RE RE Nasopharynx Orbital contents, including eye Pterygomaxillary or temporal fossa Soft palate

75 Brain T4b RE RE Clivus Cranial nerves other than (V2) Dura Middle cranial fossa Nasopharynx Orbital apex

80 Further contiguous extension T4NOS D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Maxillary Sinus CS TS/Ext-Eval SEE STANDARD TABLE

Maxillary Sinus CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular

Version date: January 1, 2004 344 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Level III node cont’d Middle deep cervical Mid jugular Level IV node Jugulo-omohoyoid (supramohyoid) Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Regional lymph node, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple or regional

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

Version date: January 1, 2004 345 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Maxillary Sinus CS Reg Nodes Eval SEE STANDARD TABLE

Maxillary Sinus Reg LN Pos SEE STANDARD TABLE

Maxillary Sinus Reg LN Exam SEE STANDARD TABLE

Maxillary Sinus CS Mets at DX SEE STANDARD TABLE

Maxillary Sinus CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 346 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Maxillary Sinus CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Maxillary Sinus CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 347 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Maxillary Sinus CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Maxillary Sinus CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

Version date: January 1, 2004 348 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Maxillary Sinus CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Maxillary Sinus CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

Version date: January 1, 2004 349 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 350 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Ethmoid Sinus C31.1 C31.1 Ethmoid sinus

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I-III, Lymph Nodes Size Table Reg LN Exam Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV-V CS Mets Eval and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Ethmoid Sinus CS Tumor Size SEE STANDARD TABLE

Ethmoid Sinus CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial Tis IS IS

12 Invasive tumor confined to left or right ethmoid sinus without bone T1 L L erosion

14 Confined to both ethmoid sinuses without bone erosion T2 L L

16 Confined to ethmoid, NOS without bone erosion T1 L L

22 Invasive tumor confined to either left or right ethmoid with bone T1 L L erosion (cribriform plate)

24 Confined ethmoid sinuses with bone erosion (cribriform plate) T1 L L

26 Confined ethmoid, NOS with bone erosion (cribriform plate) T1 L L

30 Localized, NOS T1 L L

40 More than one ethmoid sinus invaded WITH or WITHOUT bony T2 RE RE involvement: Nasal cavity, NOS Floor Lateral wall Nasal vestibule Septum Turbinates

Version date: January 1, 2004 351 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

65 Maxillary sinus T3 RE RE

66 Cribriform plate T3 D D Palate

70 Anterior orbit T4a RE RE Base of skull Frontal sinus Intracranial extension Minimum extension to anterior cranial fossa Nasopharynx Orbital extension including apex Pterygoid plate Skin of external nose or cheek Sphenoid

72 (66) + (70) T4a D D

76 Brain T4b RE RE Clivus Cranial nerves other than (V2) Dura Middle cranial fossa Nasopharynx Orbital extension including apex

78 (66) + (76) T4b D D

80 Further contiguous extension T4NOS D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Ethmoid Sinus CS TS/Ext-Eval SEE STANDARD TABLE

Ethmoid Sinus CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level I node Submandibular (submaxillary) Submental

Version date: January 1, 2004 352 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Level II node cont’d Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Regional lymph node, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral nodes(s), not stated if single or multiple or regional

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

Version date: January 1, 2004 353 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *For codes 10, 12, 20, 22, 30, 32, 40, 42, 50, 52 and 80 ONLY, the N category is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Ethmoid Sinus CS Reg Nodes Eval SEE STANDARD TABLE

Ethmoid Sinus Reg LN Pos SEE STANDARD TABLE

Ethmoid Sinus Reg LN Exam SEE STANDARD TABLE

Ethmoid Sinus CS Mets at DX SEE STANDARD TABLE

Ethmoid Sinus CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 354 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Ethmoid Sinus CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Ethmoid Sinus CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 355 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Ethmoid Sinus CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Ethmoid Sinus CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

Version date: January 1, 2004 356 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Ethmoid Sinus CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Ethmoid Sinus CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

Version date: January 1, 2004 357 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 358 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Accessory (Paranasal) Sinuses C31.2-C31.3, C31.8-C31.9 C31.2 Frontal sinus C31.3 Sphenoid sinus C31.8 Overlapping lesion of accessor sinuses C31.9 Accessory sinus, NOS Note 1: Laterality must be coded for Frontal sinus, C31.2 Note 2: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histologies for Which AJCC CS Reg Nodes Eval for Head and Neck Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 3 - Levels I-III, AJCC Stage Reg LN Exam Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Accessory (Paranasal) Sinuses CS Tumor Size SEE STANDARD TABLE

Accessory (Paranasal) Sinuses CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial NA IS IS

10 Invasive tumor confined to mucosa of one of the following: NA L L Frontal sinus Sphenoid sinus

30 Localized, NOS NA L L

40 More than one accessory sinus invaded NA RE RE Destruction of bony wall of sinus

50 Palate NA RE RE Nasal cavity, NOS: Floor Lateral wall Septum Turbinates

60 Bone: NA RE RE Facial bones Maxilla Orbital structures

Version date: January 1, 2004 359 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60, Pterygoid fossa cont’d Zygoma

70 Brain NA RE RE Cranial nerves Muscles: Masseter Pterygoid Nasopharynx Orbital contents, including eye Soft tissue Skin

80 Further contiguous extension NA D D

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Accessory (Paranasal) Sinuses CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Accessory (Paranasal) Sinuses CS Lymph Nodes Note 1: For head and neck schemes, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemes, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Single positive ipsilateral regional node: NA RN RN Level I node Sublingual Submandibular (submaxillary) Submental Level II node Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Cervical, NOS Deep cervical, NOS Internal jugular, NOS Mandibular, NOS Retropharyngeal Regional lymph node, NOS

Version date: January 1, 2004 360 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

12 Single positive ipsilateral regional node: NA D D Level III node Middle deep cervical Mid jugular Level IV node Jugulo-omohoyoid (supramohyoid) Lower deep cervical Lower jugular Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VI node Anterior deep cervical Laterotrachea Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Retropharyngeal Sub-occipital

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Accessory (Paranasal) Sinuses CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Accessory (Paranasal) Sinuses Reg LN Pos SEE STANDARD TABLE

Accessory (Paranasal) Sinuses Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 361 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Accessory (Paranasal) Sinuses CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Accessory (Paranasal) Sinuses CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Accessory (Paranasal) Sinuses CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 362 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Accessory (Paranasal) Sinuses CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Accessory (Paranasal) Sinuses CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 363 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Accessory (Paranasal) Sinuses CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Accessory (Paranasal) Sinuses CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 364 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Accessory (Paranasal) Sinuses CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 365 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 366 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Glottic Larynx C32.0 C32.0 Glottis

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I-III, Lymph Nodes Size Table Reg LN Exam Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Glottic Larynx CS Tumor Size SEE STANDARD TABLE

Glottic Larynx CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor with normal vocal cord mobility T1NOS L L Confined to glottis, NOS; intrinsic larynx; laryngeal commisure(s) anterior, posterior; vocal cord(s), NOS, true vocal cord(s), true cord(s)

11 One vocal cord T1a L L

12 Both vocal cords T1b L L

30 Tumor involves adjacent regions(s) of larynx: T2 L L Subglottis Supraglottis False vocal cord (s)

35 Impaired vocal cord mobility T2 L L

40 Tumor limited to larynx WITH vocal cord fixation T3 L L Involvement of intrinsic muscle(s): Aryepiglottic: Corniculate tubercle Cuneiform tubercle Arytenoid Cricoarytenoid Cricothyroid

Version date: January 1, 2004 367 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

40, Thyroarytenoid cont’d Thyroepiglottic Vocalis

45 Localized, NOS T1NOS L L

51 Paraglottic space T3 RE RE

52 Minor thyroid cartilage erosion (e.g., inner cortex) T3 RE D

60 Base of tongue T4a RE RE Hypopharynx, NOS Postcricoid area Pre-epiglottic tissues Pyriform sinus Vallecula

68 Extension to/through T4a RE D Cricoid cartilage Thyroid cartilage except minor erosion, see code 52

70 Extension to/through tissues beyond larynx: T4a D D Extrinsic (strap) muscles: Omohyoid Sternohyoid Sternothyroid Thryohyoid Oropharynx Skin Soft tissue of neck Thyroid gland Trachea

71 Cervical esophagus T4a D D

73 Deep extrinsic muscle(s) of tongue T4a D D

80 Further contiguous extension, including: T4b D D Mediastinal structures Prevertebral space Tumor encases carotid artery

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Glottic Larynx CS TS/Ext-Eval SEE STANDARD TABLE

Version date: January 1, 2004 368 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Glottic Larynx CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level II Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III Middle deep cervical Mid-jugular Level IV Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Level VI Anterior deep cervical Delphian node Laterotracheal Paralaryngeal Paratracheal Prelaryngeal (Delphian) Pretracheal Recurrent laryngeal Cervical, NOS Deep cervical, NOS Internal jugular NOS: Regional lymph node, NOS Stated as N1, NOS

11 Single positive ipsilateral regional node: * D RN Level I Submandibular (submaxillary) Submental Other groups Retropharyngeal Mandibular, NOS

12 Single positive ipsilateral regional node: * D RN Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Sub-occipital

Version date: January 1, 2004 369 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Glottic Larynx CS Reg Nodes Eval SEE STANDARD TABLE

Version date: January 1, 2004 370 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Glottic Larynx Reg LN Pos SEE STANDARD TABLE

Glottic Larynx Reg LN Exam SEE STANDARD TABLE

Glottic Larynx CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Glottic Larynx CS Mets Eval SEE STANDARD TABLE

Glottic Larynx CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

Version date: January 1, 2004 371 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Glottic Larynx CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Glottic Larynx CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

Version date: January 1, 2004 372 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Glottic Larynx CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Glottic Larynx CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

Version date: January 1, 2004 373 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Glottic Larynx CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 374 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Supraglottic Larynx C32.1 C32.1 Supraglottis Note: Excludes Anterior Surface of Epiglottis - see separate schema (C10.1).

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I-III, Lymph Nodes Size Table Reg LN Exam Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Supraglottic Larynx CS Tumor Size SEE STANDARD TABLE

Supraglottic Larynx CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor with normal vocal cord mobility confined to: T1 L L Supraglottis (one subsite): Aryepiglottic fold Arytenoid cartilage Corniculate cartilage Cuneiform cartilage Epilarynx, NOS False cords Ventricular bands Ventricular cavity Ventricular fold Infrahyoid epiglottis Laryngeal cartilage, NOS Laryngeal (posterior) surface of epiglottis Suprahyoid epiglottis (including tip, lingual {anterior} and laryngeal surfaces)

20 Tumor involves more than one subsite of supraglottis T2 L L WITHOUT fixation or NOS

30 Tumor involves adjacent regions(s) of larynx T2 L L

35 Impaired vocal cord mobility T2 L L

Version date: January 1, 2004 375 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

40 Tumor limited to larynx WITH vocal cord fixation T3 L L

45 Localized, NOS T1 L L

52 Paraglottic space T3 RE RE

60 Tumor involves region outside the supraglottis T2 RE RE WITHOUT fixation, including: Medial wall of pyriform sinus Mucosa of base of tongue Vallecula

62 Code 60 WITH fixation T3 RE RE

65 Hypopharynx, NOS T3 RE RE Postcricoid area Pre-epiglottic tissues

66 Deep base of tongue T3 RE RE

67 Cricoid cartilage T3 RE RE

68 Minor thyroid cartilage erosion (e.g., inner cortex) T3 RE D

70 Extension to/through: T4a D D Esophagus Oropharynx Soft tissues of neck Thyroid cartilage (except minor erosion, see code 68) Thyroid gland

72 Extension to/through: T4a D D Extrinsic (strap) muscle(s) Omohyoid Sternohyoid Sternothyroid Thyrohyoid Skin

73 Extension to/through: T4a D D Deep extrinsic muscle of tongue Trachea

80 Further contiguous extension, including: T4b D D Mediastinal structures Prevertebral space Tumor encases carotid artery

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Supraglottic Larynx CS TS/Ext-Eval SEE STANDARD TABLE

Version date: January 1, 2004 376 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Supraglottic Larynx CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level II Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III Middle deep cervical Mid-jugular Level VI Anterior deep cervical Delphian node Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Cervical, NOS Deep cervical, NOS Internal jugular, NOS: Regional lymph node, NOS Stated as N1, NOS

11 Single positive ipsilateral regional node: * D RN Level I Submandibular (submaxillary) Submental Other groups Retropharyngeal Mandibular, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Sub-occipital

18 Stated as N1, no other information N1 RN RN

Version date: January 1, 2004 377 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Supraglottic Larynx CS Reg Nodes Eval SEE STANDARD TABLE

Version date: January 1, 2004 378 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Supraglottic Larynx Reg LN Pos SEE STANDARD TABLE

Supraglottic Larynx Reg LN Exam SEE STANDARD TABLE

Supraglottic Larynx CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Supraglottic Larynx CS Mets Eval SEE STANDARD TABLE

Supraglottic Larynx CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

Version date: January 1, 2004 379 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Supraglottic Larynx CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Supraglottic Larynx CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

Version date: January 1, 2004 380 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Supraglottic Larynx CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Supraglottic Larynx CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

Version date: January 1, 2004 381 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Supraglottic Larynx CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 382 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Subglottic Larynx C32.2 C32.2 Subglottis

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I-III, Lymph Nodes Size Table Reg LN Exam Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Subglottic Larynx CS Tumor Size SEE STANDARD TABLE

Subglottic Larynx CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Invasive tumor with normal vocal cord mobility confined to T1 L L subglottis

30 Tumor involves adjacent regions(s) of larynx T2 L L Vocal cords with normal or impaired mobility

40 Tumor limited to larynx WITH vocal cord fixation T3 L L

45 Localized, NOS T1 L L

60 Base of tongue T4a RE RE Hypopharynx, NOS Postcricoid area Pre-epiglottic tissues Pyriform sinus (pyriform fossa) Vallecula

68 Extension to/through cricoid cartilage or thyroid cartilage T4a RE D

70 Extension to/through: T4a D D Cervical esophagus Deep extrinsic muscles of tongue Extrinsic (strap) muscles Omohyoid

Version date: January 1, 2004 383 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

70, Sternohyoid cont’d Sternothyroid Thyrohyoid Oropharynx Skin Soft tissues of neck Thyroid gland Trachea

73 Contiguous extension to other tissues beyond larynx not specified T4a D D in codes 70 or 80

80 Further contiguous extension: T4b D D Mediastinal structures Prevertebral space Tumor encases carotid artery

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Subglottic Larynx CS TS/Ext-Eval SEE STANDARD TABLE

Subglottic Larynx CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level II Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III Middle deep cervical Mid-jugular Level VI Anterior deep cervical Delphian node Laterotracheal Paralaryngeal Paratracheal Prelaryngeal Pretracheal

Version date: January 1, 2004 384 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Recurrent laryngeal cont’d Cervical, NOS Deep cervical, NOS Internal jugular, NOS: Regional lymph node, NOS Stated as N1, NOS

11 Single positive ipsilateral regional node: * D RN Level I Submandibular (submaxillary) Submental Other groups Retropharyngeal Mandibular, NOS

12 Single positive ipsilateral regional node: * D D Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

Version date: January 1, 2004 385 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Subglottic Larynx CS Reg Nodes Eval SEE STANDARD TABLE

Subglottic Larynx Reg LN Pos SEE STANDARD TABLE

Subglottic Larynx Reg LN Exam SEE STANDARD TABLE

Subglottic Larynx CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

Version date: January 1, 2004 386 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Subglottic Larynx CS Mets Eval SEE STANDARD TABLE

Subglottic Larynx CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 387 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Subglottic Larynx CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Subglottic Larynx CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 388 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Subglottic Larynx CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Subglottic Larynx CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 389 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Subglottic Larynx CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 390 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Larynx, Overlapping Lesion or Not Otherwise Specified C32.3, C32.8-C32.9 C32.3 Laryngeal cartilage C32.8 Overlapping lesion of larynx C32.9 Larynx, NOS

CS Tumor Size CS Site-Specific Factor 1 - Size of The following tables are CS Extension Lymph Nodes available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - staging website: CS Lymph Nodes Extracapsular Extension, Lymph Nodes Histology Exclusion Table CS Reg Nodes Eval for Head and Neck AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - Levels I-III, Lymph Nodes Size Table Reg LN Exam Lymph Nodes for Head and Neck CS Mets at DX CS Site-Specific Factor 4 - Levels IV- CS Mets Eval V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 - Levels VI- VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 - Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck

Larynx, Overlapping Lesion or Not Otherwise Specified CS Tumor Size SEE STANDARD TABLE

Larynx, Overlapping Lesion or Not Otherwise Specified CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive Tis IS IS

10 Invasive tumor confined to site of origin T1 L L

20 Tumor involves more than one subsite, T2 L L WITHOUT fixation or NOS

30 Tumor involves adjacent regions(s) of larynx T2 L L

35 Impaired vocal cord mobility T2 L L

40 Tumor limited to larynx T3 L L WITH vocal cord fixation

45 Localized, NOS T1 L L

60 Hypopharynx, NOS T3 RE RE Postcricoid area Pre-epiglottic tissues Pyriform sinus (pyriform fossa) Vallecula

68 Extension to/through cricoid cartilage and thyroid cartilage T4a RE D

Version date: January 1, 2004 391 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

70 Extension to/through: T4a D D Cervical esophagus Deep muscle of tongue Extrinsic (strap) muscles Omohyoid Sternohyoid Sternothyroid Thyrohyoid Oropharynx Skin Soft tissues of neck Thyroid gland Trachea

80 Further contiguous extension, including: T4b D D Mediastinal structures Prevertebral space Tumor encases carotid artery

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Larynx, Overlapping Lesion or Not Otherwise Specified CS TS/Ext-Eval SEE STANDARD TABLE

Larynx, Overlapping Lesion or Not Otherwise Specified CS Lymph Nodes Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by AJCC. The complete definitions are provided in the General Instructions. Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, and levels involved) is coded in Site-Specific Factors 1-6. Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered ipsilateral. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Single positive ipsilateral regional node: * RN RN Level II Jugulodigastric (subdigastric) Upper deep cervical Upper jugular Level III Middle deep cervical Mid-jugular Level IV Jugulo-omohyoid (supraomohyoid) Lower deep cervical Lower jugular Level VI Anterior deep cervical Delphian node

Version date: January 1, 2004 392 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Laterotracheal cont’d Paralaryngeal Paratracheal Prelaryngeal Pretracheal Recurrent laryngeal Cervical, NOS Deep cervical, NOS Internal jugular, NOS Regional lymph node, NOS Stated as N1, NOS

11 Single positive ipsilateral regional node: * D RN Level I Submandibular (submaxillary) Submental Other groups Retropharyngeal Mandibular, NOS

12 Single positive ipsilateral regional node: * D RN Level V node Posterior cervical Posterior triangle (spinal accessory and transverse cervical) (upper, middle, and lower corresponding to the levels that define upper, middle, and lower jugular nodes) Level VII node Upper mediastinum (for other mediastinal nodes see CS Mets at DX) Other groups Intraparotid Parapharyngeal Periparotid Sub-occipital

18 Stated as N1, no other information N1 RN RN

19 Stated as N2a, no other information N2a RN RN

20 Multiple positive ipsilateral nodes listed in code 10 * RN RN

21 Multiple positive ipsilateral nodes listed in code 11 * D RN

22 Multiple positive ipsilateral nodes listed in code 12 * D D

29 Stated as N2b, no other information N2b RN RN

30 Regional lymph nodes as listed in code 10: * RN RN Positive ipsilateral node(s), not stated if single or multiple

31 Regional lymph nodes as listed in code 11: * D RN Positive ipsilateral node(s), not stated if single or multiple

32 Regional lymph nodes as listed in code 12: * D D Positive ipsilateral node(s), not stated if single or multiple

40 Regional lymph nodes as listed in code 10: * RN RN Positive bilateral or contralateral nodes

41 Regional lymph nodes as listed in code 11: * D RN Positive bilateral or contralateral nodes

Version date: January 1, 2004 393 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

42 Regional lymph nodes as listed in code 12: * D D Positive bilateral or contralateral nodes

49 Stated as N2c, no other information N2c RN RN

50 Regional lymph nodes as listed in code 10: * RN RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

51 Regional lymph nodes as listed in code 11: * D RN Positive node(s) not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

52 Regional lymph nodes as listed in code 12: * D D Positive node(s), not stated if ipsilateral, or bilateral, or contralateral AND not stated if single or multiple

60 Stated as N2, NOS N2NOS RN RN

70 Stated as N3, no other information N3 RN RN

80 Lymph nodes, NOS, no other information * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10-12, 20-22, 30-32, 40-42, 50-52, and 80 ONLY, the N category is assigned based on the value of Site- Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph Nodes Size Table for this site.

Larynx, Overlapping Lesion or Not Otherwise Specified CS Reg Nodes Eval SEE STANDARD TABLE

Larynx, Overlapping Lesion or Not Otherwise Specified Reg LN Pos SEE STANDARD TABLE

Larynx, Overlapping Lesion or Not Otherwise Specified Reg LN Exam SEE STANDARD TABLE

Larynx, Overlapping Lesion or Not Otherwise Specified CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mediastinal Supraclavicular (transverse cervical) Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

Version date: January 1, 2004 394 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Larynx, Overlapping Lesion or Not Otherwise Specified CS Mets Eval SEE STANDARD TABLE

Larynx, Overlapping Lesion or Not Otherwise Specified CS Site-Specific Factor 1 Size of Lymph Nodes Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph node(s). Do not code the size of any nodes coded in CS Mets at DX. Code Description

000 No involved regional nodes

001-988 001-988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Described as less than 6 cm

997 Described as more than 6 cm

999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved Not documented in patient record

Version date: January 1, 2004 395 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Larynx, Overlapping Lesion or Not Otherwise Specified CS Site-Specific Factor 2 Extracapsular Extension, Lymph Nodes for Head and Neck Note 1: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code the status of any nodes coded in CS Mets at DX. Pathologic assessment takes priority over clinical assessment. Note 2: According to AJCC (page 24), "Imaging studies showing amorphous spiculated margins of involved nodes or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular (extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such disease." Code Description

000 No extracapsular extension

001 Extracapsular extension clinically, not assessed pathologically Nodes described as "fixed", not assessed pathologically

005 Extracapsular extension present pathologically

888 Not applicable; no lymph node involvement

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Larynx, Overlapping Lesion or Not Otherwise Specified CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels I, II, or III

100 Level I lymph node(s) involved

010 Level II lymph node(s) involved

001 Level III lymph node(s) involved

110 Level I and II lymph nodes involved

101 Level I and III lymph nodes involved

011 Level II and III lymph nodes involved

111 Level I, II and III lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 396 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Larynx, Overlapping Lesion or Not Otherwise Specified CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels IV or V or retropharyngeal

100 Level IV lymph node(s) involved

010 Level V lymph node(s) involved

001 Retropharyngeal nodes involved

110 Level IV and V lymph nodes involved

101 Level IV and retropharyngeal nodes involved

011 Level V and retropharyngeal nodes involved

111 Level IV and V and retropharyngeal lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Larynx, Overlapping Lesion or Not Otherwise Specified CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No lymph node involvement in Levels VI or VII or facial nodes

100 Level VI lymph node(s) involved

010 Level VII lymph node(s) involved

001 Facial (buccinator, nasolabial) lymph node(s) involved

110 Level VI and VII lymph nodes involved

101 Level VI and facial (buccinator, nasolabial) nodes involved

011 Level VII and facial (buccinator, nasolabial) nodes involved

Version date: January 1, 2004 397 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

111 Level VI and VII and facial (buccinator, nasolabial) lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Larynx, Overlapping Lesion or Not Otherwise Specified CS Site-Specific Factor 6 Parapharyngeal, Parotid, Preauricular, and Sub-Occipital Lymph Nodes, Lymph Nodes for Head and Neck Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7 different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved. Code Description

000 No parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), or sub-occipital lymph node involvement

100 Parapharyngeal lymph node(s) involved

010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved

001 Sub-occipital lymph node(s) involved

110 Parapharyngeal and parotid (preauricular, periparotid, and/or intraparotid) lymph nodes involved

101 Parapharyngeal and sub-occipital lymph nodes involved

011 Parotid (preauricular, periparotid, and/or intraparotid) and sub-occipital lymph nodes involved

111 Parapharyngeal, parotid (preauricular, periparotid, and/or intraparotid), and sub-occipital lymph nodes involved

999 Unknown if regional lymph node(s) involved, not stated Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 398 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Trachea C33.9 C33.9 Trachea Note: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Trachea CS Tumor Size SEE STANDARD TABLE

Trachea CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial NA IS IS

10 Invasive tumor confined to trachea NA L L

30 Localized, NOS NA L L

40 Adjacent connective tissue NA RE RE Arch of aorta Azygos vein, right Brachiocephalic vein Carotid sheath Common carotid artery(ies) Jugular arch Phrenic nerves Pretracheal fascia Recurrent laryngeal nerve Subclavian artery(ies) Vagus nerve

60 Adjacent organs/structures NA RE RE Cricoid cartilage Esophagus Pleura Right and left main bronchi Sternum Thymus Thyroid gland Vertebral column

80 Further contiguous extension NA D D

Version date: January 1, 2004 399 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Trachea CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Trachea CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Regional lymph node(s): NA RN RN Mediastinal, NOS: Posterior (tracheoesophageal) Paratracheal Pretracheal Tracheal, NOS Regional lymph node(s), NOS

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Trachea CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Trachea Reg LN Pos SEE STANDARD TABLE

Trachea Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 400 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Trachea CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Trachea CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Trachea CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Trachea CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Trachea CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Trachea CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 401 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Trachea CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Trachea CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 402 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lung C34.0-C34.3, C34.8-C34.9 C34.0 Main bronchus C34.1 Upper lobe, lung C34.2 Middle lobe, lung C34.3 Lower lobe, lung C34.8 Overlapping lesion of lung C34.9 Lung, NOS Note: Laterality must be coded for this site (except carina).

CS Tumor Size CS Site-Specific Factor 1 The following tables are available CS Extension CS Site-Specific Factor 2 at the collaborative staging CS TS/Ext-Eval CS Site-Specific Factor 3 website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam Mets Size Table for Mets at DX 00 CS Mets at DX Mets Size Table for Mets at DX 99 CS Mets Eval

Lung CS Tumor Size Note: Do not code size of hilar mass unless primary is stated to be in the hilum. Code Description

000 No mass/tumor found

001-988 001 - 988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

996 Malignant cells present in bronchopulmonary secretions, but no tumor seen radiographically or during bronchoscopy; "occult" carcinoma

997 Diffuse (entire lobe)

998 Diffuse (entire lung or NOS)

999 Unknown; size not stated Not documented in patient record

Version date: January 1, 2004 403 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

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 different lobe, same lung, or 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 70 (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 70. Note 6: Pleural Effusion. A. Note from SEER manual: Ignore pleural effusion that is negative for tumor. Assume that a pleural effusion is negative if a resection is done. B. Note from AJCC manual: Most pleural effusions associated with lung cancers are due to tumor. However, there are a few patients in whom multiple cytoopathologic examinations of pleural fluid are negative for tumor. In these cases, fluid is non-bloody and is not an exudate. When these elements and clinical judgement dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient should be staged T1, T2, or T3. Note 7: 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 70 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 20) in CS Lymph Nodes unless there is a statement of involvement by direct extension from the primary tumor. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Tumor confined to one lung, * L L WITHOUT extension or conditions described in codes 20-80 (excluding primary in main stem bronchus) (EXCLUDES superficial tumor as described in code 11)

11 Superficial tumor of any size with invasive component limited to T1 L L bronchial wall, WITH or WITHOUT proximal extension to the main stem bronchus

20 Extension from other parts of lung to main stem bronchus, NOS T2 L L (EXCLUDES superficial tumor as described in code 11) Tumor involving main stem bronchus greater than or equal to 2.0 cm from carina (primary in lung or main stem bronchus)

21 Tumor involving main stem bronchus, NOS (distance from carina T2 L L not stated and no surgery as described in Note 2)

23 Tumor confined to hilus * L L

25 Tumor confined to the carina * L L

30 Localized, NOS T1 L L

40 Atelectasis/obstructive pneumonitis that extends to the hilar region T2 RE RE but does not involve the entire lung (or atelectasis/obstructive pneumonitis, NOS) WITHOUT pleural effusion

Version date: January 1, 2004 404 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

45 Extension to: T2 RE RE Pleura, visceral or NOS (WITHOUT pleural effusion) Pulmonary ligament (WITHOUT pleural effusion)

50 Tumor of/involving main stem bronchus less T3 L RE than 2.0 cm from carina

52 (40) + (50) T3 RE RE

53 (45) + (50) T3 RE RE

55 Atelectasis/obstructive pneumonitis involving entire lung T3 RE RE

56 Parietal pericardium or pericardium, NOS T3 RE RE

59 Invasion of phrenic nerve T3 RE RE

60 Direct extension to: T3 D RE 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.

61 Superior sulcus tumor T4 D RE WITH encasement of subclavian vessels OR WITH unequivocal involvement of superior branches of brachial plexus (C8 or above)

65 Multiple masses/separate tumor nodule(s) in the SAME lobe T4 L RE "Satellite nodules" in SAME lobe

70 Blood vessel(s), major (EXCEPT aorta and inferior vena cava, see T4 RE RE codes 74 and 77) 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

71 Heart T4 D D Visceral pericardium

72 Malignant pleural effusion T4 D D Pleural effusion, NOS

73 Adjacent rib T3 D D

74 Aorta T4 D RE

Version date: January 1, 2004 405 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

75 Vertebra(s) T4 D D Neural foramina

76 Pleural tumor foci separate from direct pleural invasion T4 D D

77 Inferior vena cava T4 D D

79 Pericardial effusion, NOS; malignant pericardial effusion T4 D D

80 Further contiguous extension (except to structures specified in CS T4 D D Mets at DX)

95 No evidence of primary tumor T0 U U

98 Tumor proven by presence of malignant cells in sputum or TX U U bronchial washings but not visualized by imaging or bronchoscopy; "occult" carcinoma

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10, 23, and 25 ONLY, the T category is assigned based on the value of tumor size, as shown in the Extension Size table for this site.

Lung CS TS/Ext-Eval Code Description Staging Basis

0 No surgical resection done. Evaluation based on physical examination, imaging c examination, or other non-invasive clinical evidence. No autopsy evidence used.

1 No surgical resection done. Evaluation based on endoscopic examination, diagnostic p biopsy, including fine needle aspiration biopsy, or other invasive techniques including surgical observation without biopsy. No autopsy evidence used.

2 No surgical resection done, but evidence derived from autopsy (tumor was suspected or p diagnosed prior to autopsy)

3 Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation OR p surgical resection performed, unknown if pre-surgical systemic treatment or adiation performed. Evidence acquired before treatment, supplemented or modified by the additional evidence acquired during and from surgery, particularly from pathologic examination of the resected specimen

5 Surgical resection performed WITH pre-surgical systemic treatment or radiation, BUT c tumor size/extension based on clinical evidence.

6 Surgical resection performed WITH pre-surgical systemic treatment or radiation; tumor y size/extension based on pathologic evidence

8 Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy) a

9 Unknown if surgical resection done c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record

Version date: January 1, 2004 406 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lung CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: If at mediastinoscopy/x-ray, the description is "mass", "adenopathy", or "enlargement" of any of the lymph nodes named in Regional Lymph Nodes, assume that at least regional lymph nodes are involved. Note 3: The words "no evidence of spread" or "remaining examination negative" are sufficient information to consider regional lymph nodes negative in the absence of any statement about nodes. Note 4: 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 70 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 20) in CS Lymph Nodes unless there is a statement of involvement by direct extension from the primary tumor. Code Description TNM SS77 SS2000 00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s), ipsilateral: N1 RN RN Bronchial Hilar (bronchopulmonary) (proximal lobar) (pulmonary root) Intrapulmonary nodes, including involvement by direct extension: Interlobar Lobar Segmental Subsegmental Peri/parabronchial

20 Regional lymph node(s), ipsilateral: N2 RN RN Aortic [above diaphragm], NOS: Peri/para-aortic, NOS: Ascending aorta (phrenic) Subaortic (aortico-pulmonary window) Carinal (tracheobronchial) (tracheal bifurcation) Mediastinal, NOS: Anterior Posterior (tracheoesophageal) Pericardial Peri/paraesophageal Peri/paratracheal, NOS: Azygos (lower peritracheal) Pre- and retrotracheal, NOS: Precarinal Pulmonary ligament Subcarinal

50 Regional lymph node(s), NOS N1 RN RN

60 Contralateral/bilateral hilar (bronchopulmonary) (proximal lobar) N3 D D (pulmonary root) Contralateral/bilateral mediastinal Scalene (inferior deep cervical), ipsilateral or contralateral Supraclavicular (transverse cervical), ipsilateral or contralateral

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 407 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lung CS Reg Nodes Eval Note: This item reflects the validity of the classification of the item CS Lymph Nodes only according to diagnostic methods employed. Code Description Staging Basis

0 No regional lymph nodes removed for examination. Evidence based on physical c examination, imaging examination, or other non-invasive clinical evidence. No autopsy vidence used.

1 No regional lymph nodes removed for examination. Evidence based on endoscopic p examination, diagnostic biopsy including fine needle aspiration of lymph node(s) or ther invasive techniques, including surgical observation without biopsy. No autopsy evidence used.

2 No regional lymph nodes removed for examination, but evidence derived from autopsy p (tumor was suspected or diagnosed prior to autopsy)

3 Regional lymph nodes removed for examination (removal of at least 1 lymph node) p WITHOUT pre-surgical systemic treatment or radiation OR lymph nodes removed for xamination, unknown if pre-surgical systemic treatment or radiation performed

5 Regional lymph nodes removed for examination WITH pre-surgical systemic treatment or c radiation, BUT lymph node evaluation based on clinical evidence.

6 Regional lymph nodes removed for examination WITH pre-surgical systemic treatment or y radiation, and lymph node evaluation based on pathologic evidence

8 Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy a

9 Unknown if lymph nodes removed for examination c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record

Lung Reg LN Pos SEE STANDARD TABLE

Lung Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 408 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lung CS Mets at DX Code Description TNM SS77 SS2000

00 No; none * NONE NONE

10 Distant lymph node(s), including cervical nodes M1 D D

35 Separate tumor nodule(s) in different lobe, same lung M1 L D

37 Extension to: M1 D D Sternum Skeletal muscle Skin of chest

39 Extension to: M1 D D Contralateral lung Contralateral main stem bronchus Separate tumor nodule(s) in contralateral lung

40 Abdominal organs M1 D D Distant metastases except distant lymph node(s) (code 10) except those specified in codes 35 to 39, including separate lesion in chest wall or diaphragm Distant metastasis, NOS Carcinomatosis

50 Distant metastases + Distant node(s) M1 D D (10) + any of [(35) to (40)]

99 Unknown if distant metastasis ** U U Distant metastasis cannot be assessed Not documented in patient record *For CS Mets at DX code 00 only, the M category is assigned based on the value of CS Tumor Size, using the Mets Size Table for Mets at DX code 00 for this site. **For CS Mets at DX code 99 only, the M category is assigned on the valueof CS Tumor Size, using the Mets Size Table for Mets at DX code 99 for this site.

Lung CS Mets Eval SEE STANDARD TABLE

Lung CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Lung CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Version date: January 1, 2004 409 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lung CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Lung CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Lung CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Lung CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 410 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Heart, Mediastinum C38.0-C38.3, C38.8 C38.0 Heart C38.1 Anterior mediastinum C38.2 Posterior mediastinum C38.3 Mediastinum, NOS C38.8 Overlapping lesion of heart, mediastinum and pleura

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Heart, Mediastinum CS Tumor Size SEE STANDARD TABLE

Heart, Mediastinum CS Extension Note: Sarcomas of the heart and mediastinum are classified as deep tumors. A deep tumor is located either exclusively beneath the superficial fascia, superficial to the fascia with invasion of or through the fascia, or both superficial yet beneath the fascia. Code Description TNM SS77 SS2000

10 Invasive tumor confined to site of origin * L L

30 Localized, NOS * L L

40 Adjacent connective tissue: * RE RE Heart: Visceral pericardium (epicardium) (See note in General Instructions on adjacent connective tissue)

60 Adjacent organs/structures: * RE RE Heart: Ascending aorta Parietal pericardium Vena cava Mediastinum: Descending aorta Esophagus Large (named) artery(ies) Large (named) vein(s) Pericardium, NOS Parietal Visceral (epicardium) Phrenic nerve(s) Pleura, NOS Parietal pleura Visceral pleura of lung Sternum

Version date: January 1, 2004 411 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60, Sympathetic nerve trunk(s) cont’d Thoracic duct Thymus Trachea, parietal pleura Vertebra(e)

80 Further contiguous extension * D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10-80 ONLY, the T category is assigned based on value of CS Tumor Size from the Extension Size Table for this site.

Heart, Mediastinum CS TS/Ext-Eval SEE STANDARD TABLE

Heart, Mediastinum CS Lymph Nodes Note 1: Regional lymph nodes are defined as those in the vicinity of the primary tumor. Note 2: Regional lymph node involvement is rare. For this schema, if there is no mention of lymph node involvement clinically, assume that lymph nodes are negative (code 00). Use code 99 (Unknown) only when there is no available information on the extent of the patient's disease, for example, when a lab-only case is abstracted from a biopsy report and no clinical history is available. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Aortic (above diaphragm), NOS: Peri/para-aortic, NOS Ascending aorta (phrenic) Subaortic (aortico-pulmonary window) Carinal (tracheobronchial) (tracheal bifurcation) Mediastinal, NOS: Anterior Posterior (tracheoesophageal) Pericardial Peri/paraesophageal Peri/paratracheal, NOS: Azygos (lower peritracheal) Pre- and retrotracheal, NOS: Precarinal Pulmonary ligament Subcarinal Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown (see Note 2) NX U U

Version date: January 1, 2004 412 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Heart, Mediastinum CS Reg Nodes Eval SEE STANDARD TABLE

Heart, Mediastinum Reg LN Pos SEE STANDARD TABLE

Heart, Mediastinum Reg LN Exam SEE STANDARD TABLE

Heart, Mediastinum CS Mets at DX SEE STANDARD TABLE

Heart, Mediastinum CS Mets Eval SEE STANDARD TABLE

Heart, Mediastinum CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Heart, Mediastinum CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Heart, Mediastinum CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Heart, Mediastinum CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 413 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Heart, Mediastinum CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Heart, Mediastinum CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 414 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pleura C38.4 C38.4 Pleura, NOS

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Pleural Effusion available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 4 AJCC Stage Reg LN Pos CS Site-Specific Factor 5 Pleural Effusion Extension Table Reg LN Exam CS Site-Specific Factor 6 CS Mets at DX CS Mets Eval

Pleura CS Tumor Size SEE STANDARD TABLE

Pleura CS Extension Note: Pleural effusion does not affect the coding of the CS Extension field, but is coded as Site-Specific Factor 1. Code Description TNM SS77 SS2000

10 Invasive tumor (mesothelioma) confined to pleura, NOS T1NOS * *

12 Ipsilateral parietal pleura, including mediastinal or diaphragmatic T1a * * pleura, WITHOUT involvement of visceral pleura

14 Ipsilateral parietal pleura, including mediastinal or diaphragmatic T1b * * pleura, WITH focal involvement of visceral pleura

16 Ipsilateral parietal pleura, including mediastinal or diaphragmatic T1NOS * * pleura, involvement of visceral pleura not stated

20 Ipsilateral pleura WITH nodule(s) beneath visceral pleural surface T2 * * Ipsilateral pleural surface with confluent visceral pleural tumor (including fissure)

30 Localized, NOS T1NOS * *

42 Diaphragm (diaphragmatic muscle) T2 * *

50 Mesothelioma nodule(s) which have broken through the visceral T2 * * pleural surface to the lung surface Lung parenchyma, or lung involvement, NOS

52 Adjacent connective tissue: T3 * * Endothoracic fascia Pericardium, non-transmural or NOS

61 Chest wall, solitary focus of tumor ONLY T3 * * Mediastinal tissues, mediastinal fat

63 Diffuse or multifocal invasion of soft tissues of chest wall T4 * * Heart muscle, myocardium Medistinal organs Rib

Version date: January 1, 2004 415 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

65 Extension to internal surface of pericardium T4 * *

69 Pericardial effusion with positive cytology T4 * *

78 Contralateral pleura (For contralateral lung, see CS Mets at DX) T4 * *

80 Further contiguous extension: T4 * * Brachial plexus Cervical tissues Intra-abdominal organs Peritoneum Spine

95 No evidence of primary tumor T0 * *

99 Unknown extension TX * * Primary tumor cannot be assessed Not documented in patient record * The mapping to Summary Stage 1977 and Summary Stage 2000 depends on the value of Site-Specific Factor 1, Pleural Effusion. See the extra table, Extension Pleural Effusion Table, for details.

Pleura CS TS/Ext-Eval SEE STANDARD TABLE

Pleura CS Lymph Nodes Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s), ipsilateral, intrapulmonary: N1 RN RN Hilar: Bronchopulmonary Proximal lobar Pulmonary root Intrapulmonary: Interlobar Lobar Segmental Subsegmental Peri/parabronchial

20 Regional lymph node(s), ipsilateral, mediastinal: N2 RN RN Aortic [above diaphragm], NOS: Aorto-pulmonary window Ascending aorta Peri/para-aortic Phrenic Subaortic Carinal: Tracheobronchial Tracheal bifurcation Internal mammary (parasternal) Mediastinal, NOS: Anterior Posterior (tracheoesophageal) Pericardial

Version date: January 1, 2004 416 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

20, Peri/paraesophageal [below carina] cont’d Peri/paratracheal, NOS: Lower peritracheal (azygos) Upper paratracheal Pretracheal and retrotracheal, NOS: Precarinal Prevascular Pulmonary ligament Subcardial Subcarinal

50 Regional lymph node(s), NOS N1 RN RN

70 Contralateral or bilateral nodes specified in codes 10 or 20 N3 D D Ipsilateral, contralateral or bilateral nodes: Scalene (inferior deep cervical) Supraclavicular (transverse cervical)

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Pleura CS Reg Nodes Eval SEE STANDARD TABLE

Pleura Reg LN Pos SEE STANDARD TABLE

Pleura Reg LN Exam SEE STANDARD TABLE

Pleura CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), including cervical nodes M1 D D

35 Direct extension to contralateral lung M1 D D

40 Distant metastases, except code [(10) or (35)] M1 D D Distant metastasis, NOS (includes discontinuous involvement of contralateral pleura/chest wall) Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Version date: January 1, 2004 417 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Pleura CS Mets Eval SEE STANDARD TABLE

Pleura CS Site-Specific Factor 1 Pleural Effusion Code Description

000 No pleural effusion

010 Pleural effusion, non-malignant

020 Pleural effusion, malignant

030 Pleural effusion, NOS

999 Unknown if pleural effusion

Pleura CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Pleura CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Pleura CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Pleura CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Pleura CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 418 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs C39.0, C39.8-C39.9 C39.0 Upper respiratory tract, NOS C39.8 Overlapping lesion of respiratory system and intrathoracic organs C39.9 Ill-defined sites within respiratory system Note: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Tumor Size SEE STANDARD TABLE

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial NA IS IS

10 Invasive tumor confined to site of origin NA L L

30 Localized, NOS NA L L

40 Adjacent connective tissue NA RE RE

60 Adjacent organs/structures NA RE RE Descending aorta Esophagus Large (named) artery(ies) Large (named) vein(s) Pericardium, NOS Parietal Visceral (epicardium) Phrenic nerve(s) Pleura, NOS Parietal Visceral Sternum Sympathetic nerve trunk(s) Thoracic duct Thymus Trachea Vertebra(e) Visceral pleura of lung

80 Further contiguous extension NA D D

Version date: January 1, 2004 419 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Regional lymph nodes: NA RN RN Aortic [above diaphragm], NOS: Peri/para-aortic, NOS: Ascending aorta (phrenic) Subaortic (aortico-pulmonary window) Carinal (tracheobronchial) (tracheal bifurcation) Hilar (bronchopulmonary) (proximal lobar) (pulmonary root) Intrapulmonary, NOS: Interlobar Lobar Segmental Subsegmental Mediastinal, NOS: Anterior Posterior (tracheoesophageal) Peri/parabronchial Pericardial Peri/paraesophageal Peri/paratracheal, NOS: Azygos (lower peritracheal) Pre- and retrotracheal, NOS: Precarinal Pulmonary ligament Subcarinal Regional lymph node(s), NOS

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Version date: January 1, 2004 420 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs Reg LN Pos SEE STANDARD TABLE

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs Reg LN Exam SEE STANDARD TABLE

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Distant metastasis cannot be assessed Not documented in patient record

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Version date: January 1, 2004 421 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Other and Ill-Defined Respiratory Sites and Intrathoracic Organs CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 422 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Bone C40.0-C40.3, C40.8-C40.9, C41.0-C41.4, C41.8-C41.9 C40.0 Long bones of upper limb, scapula and associated joints C40.1 Short bones of upper limb and associated joints C40.2 Long bones of lower limb and associated joints C40.3 Short bones of lower limb and associated joints C40.8 Overlapping lesion of bones, joints and articular cartilage of limbs C40.9 Bone of limb, NOS C41.0 Bones of skull and face and associated joints (excludes mandible C41.1) C41.1 Mandible C41.2 Vertebral column (excludes sacrum and coccyx C41.4) C41.3 Rib, sternum, clavicle and associated joints C41.4 Pelvic bones, sacrum, coccyx and associated joints C41.8 Overlapping lesion of bones, joints and articular cartilage C41.9 Bone, NOS Note: Laterality must be coded for C40.0-C40.3, and C41.3-C41.4. For sternum, sacrum, coccyx, and symphysis pubis, laterality is coded 0.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Bone CS Tumor Size SEE STANDARD TABLE

Bone CS Extension Note: The cortex of a bone is the dense outer shell that provides strength to the bone; the spongy center of a bone is the cancellous portion. The periosteum of the bone is the fibrous membrane covering of a bone that contains the blood vessels and nerves; the periosteum is similar to the capsule on a visceral organ. Code Description TNM SS77 SS2000

10 Invasive tumor confined to cortex of bone * L L

20 Extension beyond cortex to periosteum (no break in periosteum) * L L

30 Localized, NOS * L L

40 Extension beyond periosteum to surrounding tissues, including * RE RE adjacent skeletal muscle(s)

60 Adjacent bone/cartilage * RE RE

70 Skin * D D

80 Further contiguous extension * D D

82 Skip metastases or discontinuous tumors in the same bone T3 D D

Version date: January 1, 2004 423 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For codes 10, 20, 30, 40, 60, 70, and 80 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Bone CS TS/Ext-Eval SEE STANDARD TABLE

Bone CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: Regional lymph nodes are defined as those in the vicinity of the primary tumor. Note 3: Regional lymph node involvement is rare. If there is no mention of lymph node involvement clinically, assume that lymph nodes are negative. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s) N1 RN RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Bone CS Reg Nodes Eval SEE STANDARD TABLE

Bone Reg LN Pos SEE STANDARD TABLE

Bone Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 424 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Bone CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1b D D

30 Distant metastasis to lung only M1a D D

40 Distant metastases except distant lymph node(s) or lung M1b D D Distant metastasis, NOS Carcinomatosis

50 (10) + [(30) + 40)] M1b D D Distant lymph node(s) plus other distant metastases

55 Stated as M1, NOS M1NOS D D

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Bone CS Mets Eval SEE STANDARD TABLE

Bone CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Bone CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Bone CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Bone CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 425 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Bone CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Bone CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 426 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] C44.0, C44.2-C44.9 C44.0 Skin of lip, NOS C44.2 External ear C44.3 Skin of ear and unspecified parts of face C44.4 Skin of scalp and neck C44.5 Skin of trunk C44.6 Skin of upper limb and shoulder C44.7 Skin of lower limb and hip C44.8 Overlapping lesion of skin C44.9 Skin, NOS Note: Laterality must be coded for C44.2-C44.3 and C44.5-C44.7. For codes C44.3 and C44.5, if the tumor is midline (e.g., chin), code as 9, midline, in the laterality field.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Tumor Size SEE STANDARD TABLE

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Extension Note 1: In the case of multiple simultaneous tumors, code the tumor with greatest extension. Note 2: Skin ulceration does not alter the Collaborative Stage classification. Note 3: Skin of genital sites is not included in this schema. These sites are skin of vulva (C51.0-C51.2, C51.8- C51.9), skin of penis (C60.0-C60.1, C60.8, C60.9) and skin of scrotum (C63.2). Code Description TNM SS77 SS2000

00 In situ: noninvasive; intraepidermal; Bowen disease Tis IS IS

10 Lesion(s) confined to dermis * L L

40 Localized, NOS * L L

50 Subcutaneous tissue (through entire dermis) * L L

70 Underlying cartilage, bone, skeletal muscle T4 D RE

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

Version date: January 1, 2004 427 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10, 40 and 50 ONLY, the T category is assigned based on value of CS Tumor Size from Extension Size Table for this site.

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS TS/Ext-Eval SEE STANDARD TABLE

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s) by primary site (includes bilateral or N1 RN RN contralateral nodes for head, neck, and trunk) Head and Neck: All subsites: Cervical Lip: Mandibular, NOS: Submandibular (submaxillary) External ear/auditory canal: Mastoid (post-/retro-auricular) (occipital) Preauricular Face, Other (cheek, chin, forehead, jaw, nose and temple): Facial, NOS: Buccinator (buccal) Nasolabial Mandibular, NOS: Submandibular (submaxillary) Parotid, NOS: Infra-auricular Preauricular Scalp: Mastoid (post-/retro-auricular) (occipital) Parotid, NOS: Infra-auricular Preauricular Spinal accessory (posterior cervical) Neck: Axillary Mandibular, NOS Mastoid (post-/retro-auricular) (occipital) Parotid, NOS: Infra-auricular Preauricular Spinal accessory (posterior cervical) Supraclavicular (transverse cervical) Upper Trunk: Axillary Cervical

Version date: January 1, 2004 428 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Internal mammary (parasternal) cont’d Supraclavicular (transverse cervical) Lower Trunk: Femoral (superficial inguinal) Arm/Shoulder: Axillary Epitrochlear for hand/forearm Spinal accessory for shoulder Leg/Hip: Femoral (superficial inguinal) Popliteal for heel and calf All sites: Regional lymph node(s), NOS

20 Head and Neck: N1 D RN Lip: Facial, NOS: Buccinator (buccal) Nasolabial Submental Parotid, NOS: Infra-auricular Preauricular Face, Other (cheek, chin, forehead, jaw, nose, and temple): Submental Neck: Submental

30 (10) + (20) N1 D RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Reg Nodes Eval SEE STANDARD TABLE

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] Reg LN Pos SEE STANDARD TABLE

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] Reg LN Exam SEE STANDARD TABLE

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Mets at DX SEE STANDARD TABLE

Version date: January 1, 2004 429 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Mets Eval SEE STANDARD TABLE

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Skin [excl. Skin of Eyelid] [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 430 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Skin of Eyelid C44.1 C44.1 Eyelid Note: Laterality must be coded for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage for TNM sites with Reg LN Pos CS Site-Specific Factor 6 no stage groupings Reg LN Exam Extension Size Table CS Mets at DX CS Mets Eval

Skin of Eyelid CS Tumor Size SEE STANDARD TABLE

Skin of Eyelid CS Extension Note 1: In the case of multiple simultaneous tumors, code the tumor with greatest extension. Note 2: Skin ulceration does not alter the Collaborative Stage classification. Note 3: Presence of tumor at eyelid margin takes priority over depth of invasion in dermis/tarsal plate; i.e., code 25 takes priority over codes 10-20. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS Bowen disease; intraepidermal

10 Lesion(s) confined to dermis T1 L L Minimal infiltration of dermis (not invading tarsal plate)

20 Infiltrates deeply into dermis (invading tarsal plate) T2 L L

25 Tumor at eyelid margin * L L

30 Involves full eyelid thickness T3 L L

40 Localized, NOS T1 L L

50 Subcutaneous tissue (through entire dermis) T3 L L

60 Adjacent structures, including T4 D RE Bulbar conjunctiva Globe Perineural space Sclera Soft tissues of orbit

70 Bone/periosteum of orbit T4 D RE Skeletal muscle Underlying cartilage

72 Nasal cavity T4 D D Paranasal sinuses

Version date: January 1, 2004 431 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

74 Central nervous system T4 D D

75 Metastatic skin lesion(s) T4 D D

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension code 25 ONLY, the T category is assigned based on value of CS Tumor Size as shown in Extension Size Table. Tumors 5mm or less are T1, tumors 6-10mm are T2, and tumors more than 10mm are T3.

Skin of Eyelid CS TS/Ext-Eval SEE STANDARD TABLE

Skin of Eyelid CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s) N1 RN RN Cervical, NOS Facial, NOS: Buccinator (buccal) Nasolabial Mandibular, NOS: Submandibular (submaxillary) Submental Parotid, NOS: Infra-auricular Preauricular Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Skin of Eyelid CS Reg Nodes Eval SEE STANDARD TABLE

Skin of Eyelid Reg LN Pos SEE STANDARD TABLE

Version date: January 1, 2004 432 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Skin of Eyelid Reg LN Exam SEE STANDARD TABLE

Skin of Eyelid CS Mets at DX SEE STANDARD TABLE

Skin of Eyelid CS Mets Eval SEE STANDARD TABLE

Skin of Eyelid CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Skin of Eyelid CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Skin of Eyelid CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Skin of Eyelid CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 433 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Skin of Eyelid CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Skin of Eyelid CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 434 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Skin, Vulva, Penis, Scrotum C44.0-C44.9, C51.0-C51.2, C51.8-C51.9, C60.0-C60.2, C60.8-C60.9, C63.2 (M-8720-8790) C44.0 Skin of lip, NOS C44.1 Eyelid C44.2 External ear C44.3 Skin of ear and unspecified parts of face C44.4 Skin of scalp and neck C44.5 Skin of trunk C44.6 Skin of upper limb and shoulder C44.7 Skin of lower limb and hip C44.8 Overlapping lesion of skin C44.9 Skin, NOS C51.0 Labium majus C51.1 Labium minus C51.2 Clitoris C51.8 Overlapping lesion of vulva C51.9 Vulva, NOS C60.0 Prepuce C60.1 Glans penis C60.2 Body of penis C60.8 Overlapping lesion of penis C60.9 Penis C63.2 Scrotum, NOS Note 1: Laterality must be coded for C44.1-C44.3, and C44.5-C44.7. For codes C44.3 and C44.5, if the tumor is midline (e.g., chin), code as 9, midline, in the laterality field. Note 2: For melanoma of sites other than those above, use the site-specific schema for the appropriate site. Note 3: The level of invasion, as defined by Dr. Wallace Clark, is used when defining subcategories of T1 melanomas, but not for thicker melanoma (i.e, T2, T3 or T4).

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Measured Thickness (Depth), available at the collaborative CS TS/Ext-Eval Breslow's Measurement staging website: CS Lymph Nodes CS Site-Specific Factor 2 - Histologies for Which AJCC CS Reg Nodes Eval Ulceration Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 3 - AJCC Stage Reg LN Exam Clinical Status of Lymph Node Thickness and Ulceration CS Mets at DX Mets Extension and Ulceration CS Mets Eval CS Site-Specific Factor 4 - LDH CS Reg Nodes Positive CS Site-Specific Factor 5 Clinical Status Code for Lymph CS Site-Specific Factor 6 Node (N1) Clinical Status Code for Lymph Node Category N (N2) Mets at DX and LDH

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Tumor Size Note: Record the size of the tumor in the CS Tumor Size table below, not depth or thickness. Depth or thickness is recorded in Site-Specific Factor 1 in the Measured Thickness (Depth), Breslow's Measurement table. Code Description

000 No mass/tumor found

001-988 001 - 988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

Version date: January 1, 2004 435 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

999 Unknown; size not stated Not documented in patient record

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Extension Note 1: If there is a discrepancy between the Clark level and the pathologic description of extent, use the higher (more extensive) code. Note 2: Satellite or in-transit metastasis are coded under CS Lymph Nodes. Note 3: If there is no documentation of ulceration in the pathology report, assume ulceration is not present. Note 4: Ulceration is determined by histopathological examination and not on clinical evaluation. Code Description TNM SS77 SS2000

00 In situ: noninvasive; intraepidermal Tis IS IS Clark's level I Basement membrane of the epidermis is intact

10 Papillary dermis invaded * L L Clark's level II

20 Papillary-reticular dermal interface invaded * L L Clark's level III

30 Reticular dermis invaded * L L Clark's level IV

40 Skin/dermis, NOS * L L Localized, NOS

50 Subcutaneous tissue invaded (through entire dermis) * L RE Clark's level V

80 Further contiguous extension: * D D Underlying cartilage, bone, skeletal muscle

95 No evidence of primary tumor T0 U U

99 Unknown extension * U U Primary tumor cannot be assessed (e.g., shave biopsy or regressed melanoma) Not documented in patient record * For Extension codes 10 - 80, and 99 ONLY, the T category is assigned based on value the of CS Site-Specific Factor 1, Measured Thickness and CS Site-Specific Factor 2, Ulceration, as well as Extra Table 1, Thickness and Ulceration and Extra Table 2, Extension and Ulceration.

Version date: January 1, 2004 436 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS TS/Ext-Eval SEE STANDARD TABLE

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: Satellite or in-transit metastasis are coded under CS Lymph Nodes. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s) by primary site: * RN RN (includes bilateral or contralateral nodes for head, neck, and trunk) Head and Neck - All subsites: Cervical, NOS Lip: Mandibular, NOS: Submandibular(submaxillary) Eyelid/canthus: Facial, NOS: Buccinator (buccal) Nasolabial Mandibular, NOS: Submandibular (submaxillary) Parotid, NOS: Infra-auricular External ear/auditory canal: Mastoid (post-/reto-auricular) (occipital) Preauricular Face, Other (cheek, chin forehead, jaw, nose and temple): Facial, NOS: Buccinator (buccal) Nasolabial Mandibular, NOS: Submandibular (submaxillary) Parotid, NOS: Infra-auricular Preauricular Scalp: Mastoid (post-/retro-auricular) (occipital) Parotid, NOS: Infra-auricular Preauricular Spinal accessory (posterior cervical) Neck: Axillary Mandibular, NOS Mastoid (post-/retro-auricular) Parotid, NOS: Infra-auricular Preauricular Spinal accessory (posterior cervical) Supraclavicular (transverse cervical) Upper Trunk: Axillary Cervical

Version date: January 1, 2004 437 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Internal mammary cont’d Supraclavicular Lower Trunk: Superficial inguinal (femoral) Arm/Shoulder: Axillary Epitrochlear for hand/forearm Spinal accessory (posterior cervical) for shoulder Leg/hip: Popliteal for heel and calf Superficial inguinal (femoral) Vulva/penis/scrotum: Deep inguinal: Rosenmuller or Cloquet node Superficial inguinal (femoral) All sites: Regional lymph node(s), NOS

12 Regional lymph node(s) by primary site: * D RN Head and Neck Sites: Lip: Facial, NOS Buccinator (buccal) Nasolabial Mandibular, NOS Submental Parotid, NOS Infra-auricular Preauricular Eyelid/canthus: Facial, NOS: Mandibular, NOS Submental Face, Other (cheek, chin, forehead, jaw, nose, and temple) Mandibular, NOS Submental Neck: Mandibular, NOS Submental

13 Only satellite nodule(s), NOS, with regional nodes not stated * RN RN

14 Only satellite nodule(s),less than or equal to 2 cm from primary * RN RN tumor with regional nodes not stated

15 Intralymphatic metastases (in-transit metastases between the N3 RN RN primary melanoma and the regional lymph nodes)

20 Satellite nodule(s) and regional lymph node(s) N3 RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record *Mapping of N depends on the values in Reg LN Pos and the Site-Specific Factor 3 Table, Clinical Status of Lymph Node Mets.

Version date: January 1, 2004 438 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Reg Nodes Eval SEE STANDARD TABLE

Malignant Melanoma of Skin, Vulva, Penis, Scrotum Reg LN Pos Note 1: Record this field even if there has been preoperative treatment. Note 2: Although satellite nodules and in-transit metastasis are coded under CS Lymph Nodes, DO NOT count as Reg LN Pos in this field. Code Description

00 All nodes examined negative.

01-89 01 - 89 nodes positive (code exact number of nodes positive)

90 90 or more nodes positive

95 Positive aspiration of lymph node(s)

97 Positive nodes - number unspecified

98 No nodes examined

99 Unknown if nodes are positive; not applicable Not documented in patient record

Malignant Melanoma of Skin, Vulva, Penis, Scrotum Reg LN Exam Note: Although satellite nodules and in-transit metastasis are coded under CS Lymph Nodes, DO NOT count as Reg LN Exam in this field. Code Description

00 No nodes examined

01-89 01 - 89 nodes examined (code exact number of regional lymph nodes examined)

90 90 or more nodes examined

95 No regional nodes removed, but aspiration of regional nodes performed

96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated

97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated

98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not documented as sampling or dissection; nodes examined, but number unknown

99 Unknown if nodes were examined; not applicable or negative Not documented in patient record

Version date: January 1, 2004 439 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

05 Underlying cartilage, bone, skeletal muscle * D D

10 Distant lymph node(s) * D D

40 Distant metastasis, NOS * D D

42 Metastatases to skin or subcutaneous tissue beyond regional lymph * D D nodes

43 Lung * D D

44 Other distant metastases M1c D D

52 (10) + (42) * D D

53 (10) + (43) * D D

54 (10) + (44) M1c D D

99 Unknown MX U U Distant metastasis cannot be assessed Not documented in patient record *For codes 05, 10, 40, 42, 43, 52 and 53 ONLY, the M category is assigned based on the status of serum LDH as coded in Site-Specific Factor 4 LDH table and shown in the Special Mets at DX and LDH table.

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Mets Eval SEE STANDARD TABLE

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 1 Measured Thickness (Depth), Breslow's Measurement Note: Code MEASURED THICKNESS (Depth) of tumor (Breslow's measurement), not size. Record actual thickness measurement in hundreths of millimeters from the pathology report. Code Description

000 No mass/tumor found

001-988 0.01 - 9.88 millimeters Code exact measurement in HUNDREDTHS of millimeters. Examples: Code Measured thickness 001 0.01 millimeter 002 0.02 millimeters 010 0.1 millimeter 074 0.74 millimeters 100 1 millimeters 105 1.05 millimeters 988 9.88 millimeters

989 9.89 millimeters or larger

Version date: January 1, 2004 440 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

990 Microinvasion; microscopic focus or foci only; no size given

999 Unknown; measured thickness not stated Not documented in patient record

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 2 Ulceration Note 1: Melanoma ulceration is the absence of an intact epidermis overlying the primary melanoma based upon histopathological examination. NOte 2: If the pathology report does not mention ulceration in diagnosis, No Ulceration Present, code 000. Code Description

000 No ulceration present

001 Ulceration present

999 Unknown Not stated Not documented in patient record

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 3 Clinical Status of Lymph Node Mets Code Description

000 No lymph node metastases

001 Clinically occult (microscopic) lymph node metastases only

002 Clinically apparent (macroscopic) lymph node metastases

999 Unknown Not stated Not documented in patient record

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 4 LDH Note: Per AJCC, "An elevated serum LDH should be used only when there are 2 or more determinations obtained more than 24 hours apart, because an elevated serum LDH on a single determination can be falsely positive as a result of hemolysis or other factors unrelated to melanoma metastases." Code Description

000 Test not done, test was not ordered and was not performed

002 Within normal limits

004 Range 1 less than 1.5 x upper limit of normal for LDH assay

005 Range 2 1.5 - 10 x upper limit of normal for LDH assay

006 Range 3 more than 10 x upper limit of normal for LDH assay

008 Ordered, but results not in chart

999 Unknown Not stated Not documented in patient record

Version date: January 1, 2004 441 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Malignant Melanoma of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 442 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum (M-9700-9701) C44.0-C44.9, C51.0-C51.2, C51.8-C51.9, C60.0-C60.2, C60.8-C60.9, C63.2 C44.0 Skin of lip, NOS C44.1 Eyelid C44.2 External ear C44.3 Skin of ear and unspecified parts of face C44.4 Skin of scalp and neck C44.5 Skin of trunk C44.6 Skin of upper limb and shoulder C44.7 Skin of lower limb and hip C44.8 Overlapping lesion of skin C44.9 Skin, NOS C51.0 Labium majus C51.1 Labium minus C51.2 Clitoris C51.8 Overlapping lesion of vulva C51.9 Vulva, NOS C60.0 Prepuce C60.1 Glans penis C60.2 Body of penis C60.8 Overlapping lesion of penis C60.9 Penis C63.2 Scrotum, NOS Note 1: Laterality must be coded for C44.1-C44.3 and C44.5-C44.7. For codes C44.3 and C44.5, if the tumor is midline (e.g., chin), code as 9 (midline) in the laterality field. Note 2: Source: Developed by the Mycosis Fungoides Cooperative Group (MFCG)

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Peripheral Blood Involvement available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 4 AJCC Stage Reg LN Pos CS Site-Specific Factor 5 Reg LN Exam CS Site-Specific Factor 6 CS Mets at DX CS Mets Eval

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Tumor Size SEE STANDARD TABLE

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Extension Note 1: In approximating body surface, the palmar surface of the hand, including digits, is about 1%. Note 2: Use code 25 when skin involvement is present but only a general location/site is mentioned (i.e., face, legs, torso, arms). Use code 30 when there is skin involvement but there is no mention of location/site. Code Description TNM SS77 SS2000

10 Plaques, papules, or erythematous patches plaque stage"): T1 L L Less than 10% of skin surface, no tumors Limited plaques/patches MFCG Stage I

Version date: January 1, 2004 443 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

20 Plaques, papules, or erythematous patches ("plaque stage"): T2 L L Greater than or equal to 10% of skin surface, no tumors Generalized plaques/patches MFCG Stage II

25 Plaques, papules, or erythematous patches ("plaque stage"): T2 L L % or body surface not stated, no tumors

30 Skin involvement, NOS: T1 L L Extent not stated, no tumors Localized, NOS

50 One or more tumors (tumor stage) T3 RE RE Cutaneous tumors

70 Generalized erythroderma (greater than 50% of body involved with T4 RE RE diffuse redness) Sezary syndrome/Sezary disease MFGC Stage III

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS TS/Ext-Eval SEE STANDARD TABLE

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Lymph Nodes Note: For this site, code ALL lymph node (regional and distant) involvement in this field. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Clinically enlarged palpable lymph node(s) (adenopathy), and either N1 RN RN pathologically negative nodes or no pathological statement

20 No clinically enlarged palpable lymph node(s) (adenopathy); N2 RN RN pathologically positive lymph node(s)

30 Both clinically enlarged palpable lymph node(s) (adenopathy) and N3 RN RN pathologically positive lymph node(s)

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Reg Nodes Eval SEE STANDARD TABLE

Version date: January 1, 2004 444 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum Reg LN Pos SEE STANDARD TABLE

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum Reg LN Exam SEE STANDARD TABLE

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Mets at DX Note: For this site, code ALL lymph node (regional and distant) involvement in the CS Lymph Nodes field. Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

40 Visceral (non-cutaneous, extra nodal) involvement: M1 D D MFCG Stage IV Carcinomatosis Distant metastasis, NOS

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Mets Eval SEE STANDARD TABLE

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 1 Peripheral Blood Involvement Code Description

000 No peripheral blood involvement Less than 1000 Sezary cells

001 Atypical circulating cells in peripheral blood: Less than 5% Greater than or equal to 1000 Sezary cells

002 Atypical circulating cells in peripheral blood: Greater than 5%

003 % not stated

999 Insufficient information Not documented in patient record

Version date: January 1, 2004 445 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Mycosis Fungoides and Sezary Disease of Skin, Vulva, Penis, Scrotum CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 446 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues C47.0-C47.6, C47.8-C47.9, C49.0-C49.6, C49.8-C49.9 C47.0 Peripheral nerves and autonomic nervous system of head, face and neck C47.1 Peripheral nerves and autonomic nervous system of upper limb and shoulder C47.2 Peripheral nerves and autonomic nervous system of lower limb and hip C47.3 Peripheral nerves and autonomic nervous system of thorax C47.4 Peripheral nerves and autonomic nervous system of abdomen C47.5 Peripheral nerves and autonomic nervous system of pelvis C47.6 Peripheral nerves and autonomic nervous system of trunk, NOS C47.8 Overlapping lesion of peripheral nerves and autonomic nervous system C47.9 Autonomic nervous system, NOS C49.0 Connective, subcutaneous and other soft tissues of head, face, and neck C49.1 Connective, subcutaneous and other soft tissues of upper limb and shoulder C49.2 Connective, subcutaneous and other soft tissues of lower limb and hip C49.3 Connective, subcutaneous and other soft tissues of thorax C49.4 Connective, subcutaneous and other soft tissues of abdomen C49.5 Connective, subcutaneous and other soft tissues of pelvis C49.6 Connective, subcutaneous and other soft tissues of trunk C49.8 Overlapping lesion of connective, subcutaneous and other soft tissues C49.9 Connective, subcutaneous and other soft tissues, NOS Note 1: Laterality must be coded for C47.1-C47.2 and C49.1-C49.2. Note 2: Soft tissue sarcomas of the heart and mediastinum (C38.0-C38.3 and C38.9) use the Heart, Mediastinum schema.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Special Extension Size Table 1 Reg LN Exam Special Extension Size Table 2 CS Mets at DX Special Extension Size Table 3 CS Mets Eval

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Tumor Size SEE STANDARD TABLE

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Extension Note 1: Connective tissue includes adipose tissue; aponeuroses; arteries; blood vessels; bursa; connective tissue, NOS; fascia; fatty tissue; fibrous tissue; ligaments; lymphatic channels (not nodes); muscle; skeletal muscle; subcutaneous tissue; synovia; tendons; tendon sheaths; veins; and vessels, NOS. Peripheral nerves and autonomic nervous system includes: ganglia, nerve, parasympathetic nervous system, peripheral nerves, spinal nerves, sympathetic nervous system. Note 2: If a vessel has a name, for example, brachial artery or recurrent laryngeal nerve, consider it a structure (code 60). Note 3: For tumors of the extremities and trunk ONLY, superficial lesions are defined as those not involving the superficial muscular fascia. Deep lesions are those that involve or are beneath the superficial fascia. Note 4: According to AJCC, "All intraperitoneal visceral lesions, retroperitoneal lesions, and intrathoracic lesions, and the majority of head and neck tumors are considered deep." For coding extension of soft tissue tumors in these sites (C47.0, C47.3-5, C49.0, C49.3-5), use only codes 12, 32, 42, 62, 80, 95, or 99.

Version date: January 1, 2004 447 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Note 5: Definition of Adjacent Connective Tissue: Some of the schemes for ill-defined or non-specific sites in this manual contain a code 40, adjacent connective tissue, which is defined here as the unnamed tissues that immediately surround an organ or structure containing a primary cancer. Use this code when a tumor has invaded past the outer border (capsule, serosa, or other edge) of the primary organ into the organ's surrounding supportive structures but has not invaded into larger structures or adjacent organs. In general, these tissues do not have specific names. These tissues form the framework of many organs, provide support to hold organs in place, bind tissues and organs together, and serve as storage sites for nutrients. Blood, cartilage and bone are sometimes considered connective tissues, but in this manual they are listed separately. Code Description TNM SS77 SS2000

10 Invasive tumor confined to site/tissue of origin, NOS *** L L

11 Superficial invasive tumor confined to site/tissue of origin (lesion * L L does not involve superficial fascia)

12 Deep tumor confined to site/tissue of origin ** L L

30 Localized, NOS *** L L

31 Superficial: localized tumor, NOS * L L

32 Deep: localized tumor, NOS ** L L

40 Adjacent connective tissue (see Note 5) *** RE RE

41 Superficial tumor involving adjacent connective tissue * RE RE

42 Deep tumor involving adjacent connective tissue ** RE RE

60 Adjacent organs/structures including bone/cartilage (including *** RE RE major vessel invasion) (see Note 5)

61 Superficial tumor involving adjacent organs/structures including * RE RE bone/cartilage (including major vessel invasion) (see Note 5)

62 Deep tumor involving adjacent organs/structures including ** RE RE bone/cartilage (including major vessel invasion) (see Note 5)

80 Further contiguous extension ** D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 11, 31, 41, and 61 ONLY, the T category is assigned based on the value of CS Tumor Size as shown in the Special Extension Size Table 1 for this site. ** For Extension codes 12, 32, 42, 62 and 80 ONLY, the T category is assigned based on the value of CS Tumor Size as shown in the Special Extension Size Table 2 for this site. *** For Extension codes 10, 30, 40, and 60 ONLY, the T category is assigned based on the value of CS Tumor Size as shown in the Special Extension Size Table 3 for this site.

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS TS/Ext-Eval SEE STANDARD TABLE

Version date: January 1, 2004 448 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Lymph Nodes Note 1: Regional lymph nodes are defined as those in the vicinity of the primary tumor. Note 2: Regional lymph node involvement is rare. For this schema, if there is no mention of lymph node involvement clinically, assume that lymph nodes are negative (code 00). Use code 99 (Unknown) only when there is no available information on the extent of the patient's disease, for example, when a lab-only case is abstracted from a biopsy report and no clinical history is available. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s) by primary site (bilateral or contralateral N1 RN RN for head, neck, trunk) Head and Neck: All subsites: Cervical, NOS Lip: Facial, NOS: Buccinator (buccal) Nasolabial Mandibular, NOS: Submandibular (submaxillary) Submental Parotid, NOS: Infra-auricular Preauricular Eyelid/canthus: Facial, NOS: Buccinator (buccal) Nasolabial Mandibular, NOS: Submandibular (submaxillary) Submental Parotid, NOS: Infra-auricular External ear and auditory canal: Mastoid (posterior, retro-auricular) (occipital) Preauricular Face, Other (cheek, chin, forehead, jaw, nose and temple): Facial, NOS: Buccinator (buccal) Nasolabial Mandibular, NOS: Submandibular (submaxillary) Submental Parotid, NOS: Infra-auricular Preauricular Scalp: Mastoid (posterior, retro-auricular) (occipital) Parotid, NOS: Infra-auricular Preauricular Spinal accessory (posterior cervical) Neck: Axillary Mastoid (posterior, retro-auricular) (occipital) Mandibular, NOS: Parotid, NOS:

Version date: January 1, 2004 449 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Infra-auricular cont’d Preauricular Spinal accessory (posterior cervical) Supraclavicular (transverse cervical) Arm/shoulder: Axillary Spinal accessory for shoulder Epitrochlear for hand/forearm Leg/hip: Femoral (superficial inguinal) Popliteal for heel and calf Thorax: Hilar (bronchopulmonary) (proximal lobar) (pulmonary root) Mediastinal Abdomen: Celiac Iliac Para-aortic Pelvis: Deep inguinal, NOS: Rosenmuller or Cloquet node Superficial inguinal (femoral) Upper trunk: Axillary Cervical Internal mammary Supraclavicular (transverse cervical) Lower trunk: Superficial inguinal (femoral) All sites: Regional lymph node(s), NOS

12 Submental nodes for neck primary only (bilateral or contralateral) N1 D RN

15 Neck primary only: (10) + (12) N1 D RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown (see Note 2) NX U U

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Reg Nodes Eval SEE STANDARD TABLE

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues Reg LN Pos SEE STANDARD TABLE

Version date: January 1, 2004 450 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues Reg LN Exam SEE STANDARD TABLE

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Mets at DX SEE STANDARD TABLE

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Mets Eval SEE STANDARD TABLE

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 451 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Peripheral Nerves and Autonomic Nervous System; Connective, Subcutaneous, and Other Soft Tissues CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 452 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Retroperitoneum and Peritoneum C48.0-C48.2, C48.8 C48.0 Retroperitoneum C48.1 Specified parts of peritoneum (including omentum and mesentery) C48.2 Peritoneum, NOS C48.8 Overlapping lesion of retroperitoneum and peritoneum Note: AJCC includes these sites with soft tissue sarcomas (C47.0-C48.9)

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Retroperitoneum and Peritoneum CS Tumor Size SEE STANDARD TABLE

Retroperitoneum and Peritoneum CS Extension Note: For AJCC TNM staging, all retroperitoneal lesions are considered deep lesions. Code Description TNM SS77 SS2000

10 Tumor confined to site of origin * L L

30 Localized, NOS * L L

40 Adjacent connective tissue see definition of adjacent connective * RE RE tissue in General Instructions.

60 Adjacent organs/structures including bone/cartilage * RE RE Retroperitoneum: Adrenal(s) (suprarenal gland(s)) Aorta Ascending colon Descending colon Kidney(s) Pancreas Vena cava Vertebra Peritoneum: Colon (except ascending and descending colon) Esophagus Gallbladder Liver Small intestine Spleen Stomach

80 Further contiguous extension, including: * D D For retroperitoneum: extension to colon other than ascending or descending For peritoneum: extension to ascending or descending colon

Version date: January 1, 2004 453 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For codes 10-80 ONLY, the T category is assigned based on value of CS Tumor Size, as shown in the Extension Size Table for this site.

Retroperitoneum and Peritoneum CS TS/Ext-Eval SEE STANDARD TABLE

Retroperitoneum and Peritoneum CS Lymph Nodes Note 1: Regional lymph nodes are defined as those in the vicinity of the primary tumor. Note 2: Regional lymph node involvement is rare. For this schema, if there is no mention of lymph node involvement clinically, assume that lymph nodes are negative (code 00). Use code 99 (Unknown) only when there is no available information on the extent of the patient's disease, for example, when a lab-only case is abstracted from a biopsy report and no clinical history is available. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Intra-abdominal Paracaval Pelvic Subdiaphragmatic Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown (see Note 2) NX U U

Retroperitoneum and Peritoneum CS Reg Nodes Eval SEE STANDARD TABLE

Retroperitoneum and Peritoneum Reg LN Pos SEE STANDARD TABLE

Retroperitoneum and Peritoneum Reg LN Exam SEE STANDARD TABLE

Retroperitoneum and Peritoneum CS Mets at DX SEE STANDARD TABLE

Version date: January 1, 2004 454 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Retroperitoneum and Peritoneum CS Mets Eval SEE STANDARD TABLE

Retroperitoneum and Peritoneum CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Retroperitoneum and Peritoneum CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Retroperitoneum and Peritoneum CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Retroperitoneum and Peritoneum CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Retroperitoneum and Peritoneum CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Retroperitoneum and Peritoneum CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 455 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 456 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Breast C50.0-C50.6, C50.8-C50.9 C50.0 Nipple C50.1 Central portion of breast C50.2 Upper-inner quadrant of breast C50.3 Lower-inner quadrant of breast C50.4 Upper-outer quadrant of breast C50.5 Lower-outer quadrant of breast C50.6 Axillary Tail of breast C50.8 Overlapping lesion of breast C50.9 Breast, NOS Note: Laterality must be coded for this site.

CS Tumor Size CS Site-Specific Factor 1 - Estrogen The following tables are CS Extension Receptor Assay (ERA) available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - Progesterone staging website: CS Lymph Nodes Receptor Assay (PRA) Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 3 - Number of AJCC Stage Reg LN Pos Positive Ipsilateral Axillary Lymph Extension Size Table Reg LN Exam Nodes Extension Behavior Table CS Mets at DX CS Site-Specific Factor 4 - Lymph Nodes Positive Axillary CS Mets Eval Immunohistochemistry (IHC) of Regional Nodes Table Lymph Nodes IHC MOL Table CS Site-Specific Factor 5 - Molecular Studies of Regional Lymph Nodes CS Site-Specific Factor 6 - Size of Tumor--Invasive Component

Breast CS Tumor Size Note 1: For tumor size, some breast cancers cannot be sized pathologically. Note 2: When coding pathologic size, code the measurement of the invasive component. For example, if there is a large in situ component (e.g., 4 cm) and a small invasive component see Site-Specific Factor 6 to code more information about the reported tumor size. If the size of invasive component is not given, code the size of the entire tumor and record what it represents in Site-Specific Factor 6. Note 3: Microinvasion is the extension of cancer cells beyond the basement membrane into the adjacent tissues with no focus more than 0.1 cm in greatest dimension. When there are multiple foci of microinvasion, the size of only the largest focus is used to classify the microinvasion. (Do not use the sum of all the individual foci.) Code Description

000 No mass/tumor found

001-988 001 - 988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

Version date: January 1, 2004 457 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

996 Mammographic/xerographic diagnosis only, no size given; clinically not palpable

997 Paget's Disease of nipple with no demonstrable tumor

998 Diffuse

999 Unknown; size not stated Not documented in patient record

Breast CS Extension Note 1: Changes such as dimpling of the skin, tethering, and nipple retraction are caused by tension on Cooper's ligament(s), not by actual skin involvement. They do not alter the classification. Note 2: Consider adherence, attachment, fixation, induration, and thickening as clinical evidence of extension to skin or subcutaneous tissue, code '20'. Note 3: Consider "fixation, NOS" as involvement of pectoralis muscle, code '30'. Note 4: If extension code is 00, then Behavior code must be 2; if extension code is 05 or 07, then behavior code may be 2 or 3; and, if extension code is 10, then behavior code must be 3. Note 5: Inflammatory Carcinoma. AJCC includes the following text in the 6th edition Staging Manual (p. 225-6), "Inflammatory carcinoma is a clinicopathologic entity characterized by diffuse erythema and edema (peau d'orange) of the breast, often without an underlying palpable mass. These clinical findings should involve the majority of the skin of the breast. Classically, the skin changes arise quickly in the affected breast. Thus the term of inflammatory carcinoma should not be applied to a patient with neglected locally advanced cancer of the breast presenting late in the course of her disease. On imaging, there may be a detectable mass and characteristic thickening of the skin over the breast. This clinical presentation is due to tumor emboli within dermal lymphatics, which may or may not be apparent on skin biopsy. The tumor of inflammatory carcinoma is classified T4d. It is important to remember that inflammatory carcinoma is primarily a clinical diagnosis. Involvement of the dermal lymphatics alone does not indicate inflammatory carcinoma in the absence of clinical findings. In addition to the clinical picture, however, a biopsy is still necessary to demonstrate cancer either within the dermal lymphatics or in the breast parenchyma itself." Note 6: For Collaborative Staging, the abstractor should record a stated diagnosis of inflammatory carcinoma, and also record any clinical statement of the character and extent of skin involvement in the text area. Code 72 should be used if there is a stated diagnosis of inflammatory carcinoma and a clinical description of the skin involvement in more than 50% of the breast. All other cases with a stated diagnosis of inflammatory carcinoma but no such clinical description should be coded 71. A clinical description of inflammation, erythema, edema, peau d'orange, etc. without a stated diagnosis of inflammatory carcinoma should be coded 51 or 52, depending on described extent of the condition. Code Description TNM SS77 SS2000

00 In situ: noninfiltrating; intraepithelial Tis IS IS Intraductal WITHOUT infiltration Lobular neoplasia

05 Paget Disease of nipple (WITHOUT underlying tumor) Tis ** **

07 Paget Disease of nipple (WITHOUT underlying invasive carcinoma Tis ** ** pathologically)

10 Confined to breast tissue and fat including nipple and/or areola * L L Localized, NOS

20 Invasion of subcutaneous tissue * RE RE Local infiltration of dermal lymphatics adjacent to primary tumor involving skin by direct extension Skin infiltration of primary breast including skin of nipple and/or areola

Version date: January 1, 2004 458 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

30 Attached or fixation to pectoral muscle(s) or underlying tissue * RE RE Deep fixation Invasion of (or fixation to) pectoral fascia or muscle

40 Invasion of (or fixation to): T4a RE RE Chest wall Intercostal or serratus anterior muscle(s) Rib(s)

51 Extensive skin involvement, including: T4b RE RE Satellite nodule(s) in skin of primary breast Ulceration of skin of breast Any of the following conditions described as involving not more than 50% of the breast, or amount or percent of involvement not stated: Edema of skin En cuirasse Erythema Inflammation of skin Peau d'orange ("pigskin")

52 Any of the following conditions described as involving more than T4b RE RE 50% of the breast WITHOUT a stated diagnosis of inflammatory carcinoma: Edema of skin En cuirasse Erythema Inflammation of skin Peau d'orange ("pigskin")

61 (40) + (51) T4c RE RE

62 (40) + (52) T4b RE RE

71 Diagnosis of inflammatory carcinoma T4b RE RE WITHOUT a clinical description of inflammation, erythema, edema, peau d'orange,etc., of more than 50% of the breast, WITH or WITHOUT dermal lymphatic infiltration Inflammatory carcinoma, NOS

72 Diagnosis of inflammatory carcinoma T4b RE RE WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc. of LESS THAN OR EQUAL TO 50% of the breast, WITH or WITHOUT dermal lymphatic infiltration

73 Diagnosis of inflammatory carcinoma T4d RE RE WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., of more than 50% of the breast, WITH or WITHOUT dermal lymphatic infiltration

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10, 20, and 30 ONLY, the T category is assigned based on value of CS Tumor Size as shown in the Extension Size Table for this site. ** For codes 05 and 07 ONLY, summary stage is assigned based on the value of Behavior Code ICD-0-3 as shown in the Extension Behavior Table for this site.

Version date: January 1, 2004 459 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Breast CS TS/Ext-Eval SEE STANDARD TABLE

Breast CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2 mm and code the lymph nodes as positive in this field. Use code 60 in the absence of other information about regional nodes. Note 3: If no lymph nodes were removed surgically, then use only the following codes for clinical evaluation of axillary nodes: 00 - Clinically negative 50 - Fixed/matted nodes, 60 - Clinically positive axillary nodes 99 - Unknown/not stated. Note 4: If pre-surgical therapy was given and there is a clinical evaluation (positive or negative) of lymph nodes, then use only the following codes for clinical evaluation of axillary nodes: 00 - Clinically negative 50 - Fixed/matted nodes 60 - Clinically positive axillary nodes AND Code a '5' in the nodes evaluation field. If there is no clinical evaluation of nodes, use the information from the pathologic evaluation and code a '6' in the nodes evaluation field. Note 5: Isolated tumor cells (ITC) are defined as single tumor cells or small clusters not greater than 0.2 mm, usually detected only by immunohistochemical (IHC) or molecular methods but which may be verified on H and E stains. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction). Lymph nodes with ITCs only are not considered positive lymph nodes. Note 6: Codes 13-50 are used for positive axillary nodes without internal mammary nodes. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement, including ITCs * NONE NONE detected by immunohistochemistry or molecular methods ONLY. (See Note 5 and Site-specific Factors 4 and 5.)

05 Regional lymph node(s) with (ITCs) detected on routine H and E N0(i+) NONE NONE stains. (See Note 5)

13 Axillary lymph node(s), ipsilateral, micrometastasis ONLY N1mi RN RN detected by immunohistochemical (IHC) means ONLY (at least one micrometastasis greater than 0.2 mm and all micrometastases less than or equal to 2 mm)

15 Axillary lymph node(s), ipsilateral, micrometastasis ONLY N1mi RN RN detected or verified on H&E (at least one micrometastasis greater than 0.2 mm and all micrometastases less than or equal to 2 mm) Micrometastasis, NOS

25 Movable axillary lymph node(s), ipsilateral, positive with more than ** RN RN micrometastasis (i.e., at least one metastasis greater than 2 mm)

26 Stated as N1, NOS ** RN RN

28 Stated as N2, NOS ** RN RN

50 Fixed/matted ipsilateral axillary nodes, positive with more than ** RN RN micrometastasis (i.e., at least one metastasis greater than 2 mm) Fixed/matted ipsilateral axillary nodes, NOS

60 Axillary/regional lymph node(s), NOS ** RN RN Lymph nodes NOS

71 Internal mammary node(s), ipsilateral, positive on sentinel nodes ** RN RN but not clinically apparent (no positive imaging or clinical exam) WITHOUT axillary lymph node(s), ipsilateral

Version date: January 1, 2004 460 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

72 Internal mammary node(s), ipsilateral, positive on sentinel nodes ** RN RN but not clinically apparent (no positive imaging or clinical exam) WITH axillary lymph node(s), ipsilateral

73 Internal mammary node(s), ipsilateral, positive on sentinel nodes ** RN RN but not clinically apparent (no positive imaging or clinical exam) UNKNOWN if positive axillary lymph node(s), ipsilateral

74 Internal mammary node(s), ipsilateral, clinically apparent (on N2b RN RN imaging or clinical exam) WITHOUT axillary lymph node(s), ipsilateral

75 Infraclavicular lymph node(s) (subclavicular) N3a D RN

76 Internal mammary node(s), ipsilateral, clinically apparent (on N3b RN RN imaging or clinical exam) WITH axillary lymph node(s), ipsilateral, codes 15 to 60 WITH or WITHOUT infraclavicular lymph node(s)

77 Internal mammary node(s), ipsilateral, clinically apparent (on N2b RN RN imaging or clinical exam) UNKNOWN if positive axillary lymph node(s), ipsilateral

78 (75) + (77) N3a D RN

79 Stated as N3, NOS N3NOS RN RN

80 Supraclavicular node(s) N3c D D

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For code 00 ONLY, the N category is assigned based on the coding of Site-Specific Factors 4 and 5 using the IHC MOL Table for this site. **For codes 25, 26, 28, 50, 60, 71, 72, and 73 ONLY, the N category is assigned based on the value of Site-Specific Factor 3, Number of Positive Ipsilateral Axillary LymphNodes. See Lymph Nodes Positive Axillary Nodes Table.

Breast CS Reg Nodes Eval SEE STANDARD TABLE

Breast Reg LN Pos Note 1: Record this field even if there has been preoperative treatment. Note 2: Lymph nodes with only isolated tumor cells (ITCs) are NOT counted as positive lymph nodes. Only lymph nodes with metastases greater than 0.2mm (micrometastases or larger) should be counted as positive. If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastastases are > 0.2mm and code the lymph nodes as positive in this field. Note 3: Record all positive regional lymph nodes in this field. Record the number of positive regional axillary nodes separately in the appropriate Site-Specific Factor field. Code Description

00 All nodes examined negative.

01-89 1 - 89 nodes positive (code exact number of nodes positive)

90 90 or more nodes positive

Version date: January 1, 2004 461 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 Positive aspiration of lymph node(s)

97 Positive nodes - number unspecified

98 No nodes examined

99 Unknown if nodes are positive; not applicable Not documented in patient record

Breast Reg LN Exam SEE STANDARD TABLE

Breast CS Mets at DX Note: Supraclavicular (transverse cervical) is moved to CS Lymph Nodes. Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Cervical, NOS Contralateral/bilateral axillary and/or internal mammary Other than above Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

42 Further contiguous extension: M1 D D Skin over: Axilla Contralateral (opposite) breast Sternum Upper abdomen

44 Metastasis: M1 D D Adrenal (suprarenal) gland Bone, other than adjacent rib Contralateral (opposite) breast - if stated as metastatic Lung Ovary Satellite nodule(s) in skin other than primary breast

50 (10) + any of [(40) to (44)] M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Breast CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 462 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Breast CS Site-Specific Factor 1 Estrogen Receptor Assay (ERA) Code Description

000 Test not done (test was not ordered and was not performed)

010 Positive/elevated

020 Negative/normal; within normal limits

030 Borderline; undetermined whether positive or negative

080 Ordered, but results not in chart

999 Unknown or no information Not documented in patient record

Breast CS Site-Specific Factor 2 Progesterone Receptor Assay (PRA) Code Description

000 Test not done (test was not ordered and was not performed

010 Positive/elevated

020 Negative/normal; within normal limits

030 Borderline, undetermined whether positive or negative

080 Ordered, but results not in chart

999 Unknown or no information Not documented in patient record

Breast CS Site-Specific Factor 3 Number of Positive Ipsilateral Axillary Lymph Nodes Note 1: Record this field even if there has been preoperative treatment. Note 2: Lymph nodes with only isolated tumor cells (ITCs) are NOT counted as positive lymph nodes. Only lymph nodes with metastases greater than 0.2 mm (micrometastases or larger) should be counted as positive. If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2 mm and code the lymph nodes as positive in this field. Code Description

000 All ipsilateral axillary nodes examined negative

001-089 1 - 89 nodes positive (code exact number of nodes positive)

090 90 or more nodes positive

095 Positive aspiration of lymph node(s)

097 Positive nodes - number unspecified

098 No axillary nodes examined

099 Unknown if axillary nodes are positive; not applicable Not documented in patient record

Version date: January 1, 2004 463 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Breast CS Site-Specific Factor 4 Immunohistochemistry (IHC) of Regional Lymph Nodes Note 1: Use codes 000-009 only to report results of IHC on otherwise histologically negative lymph nodes on routine H and E stains., i.e., only when CS Lymph Nodes is coded 00. Otherwise code 888 in this field. Note 2: Isolated tumor cells (ITC) are defined as single tumor cells or small clusters 0.2 mm, usually detected only by immunohistochemical (IHC) or molecular methods (RT-PCR: Reverse Transcriptase Polymerase Chain Reaction) but which may be verified on H and E stains. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction.) Note 3: If it is unstated whether or not IHC tests were done, assume they were not done. Code Description

000 Regional lymph nodes negative on H and E, no IHC studies done or unknown if IHC studies done Nodes clinically negative, not examined pathologically

001 Regional lymph nodes negative on H and E, IHC studies done, negative for tumor

002 Regional lymph nodes negative on H and E, IHC studies done, positive for ITCs (tumor cell clusters not greater than 0.2mm)

009 Regional lymph nodes negative on H and E, positive for tumor detected by IHC, size of tumor cell clusters or metastases not stated

888 Not applicable CS Lymph Nodes not coded 00 or 05

Breast CS Site-Specific Factor 5 Molecular Studies of Regional Lymph Nodes Note 1: Use codes 000-002 only to report results of molecular studies on otherwise histologically negative lymph nodes on routine H and E stains., i.e., only when CS Lymph Nodes is coded 00. Otherwise code 888 in this field. Note 2: Isolated tumor cells (ITC) are defined as single tumor cells or small clusters less than or equal to 0.2 mm, usually detected only by immunohistochemical (IHC) or molecular methods (RT-PCR: Reverse Transcriptase Polymerase Chain Reaction) but which may be verified on H and E stains. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction.) Note 3: If it is not stated whether molecular tests were done, assume they were not done. Code Description

000 Regional lymph nodes negative on H and E, no RT-PCR molecular studies done or unknown if RT- PCR studies done Nodes clinically negative, not examined pathologically

001 Regional lymph nodes negative on H and E, RT-PCR molecular studies done, negative for tumor

002 Regional lymph nodes negative on H and E, RT-PCR molecular studies done, positive for tumor

888 Not applicable CS Lymph Nodes not coded 00

Version date: January 1, 2004 464 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Breast CS Site-Specific Factor 6 Size of Tumor--Invasive Component Note 1: Record the code that indicates how the tumor size coded in CS Tumor Size was determined. Note 2: For this field, "mixed" indicates a tumor with both invasive and in situ components. Such a "mixed" tumor may be a single histology such as mixed infiltrating ductal and ductal carcinoma in situ or combined histology such as mixed infiltrating ductal and lobular carcinoma in situ. "Pure" indicates a tumor that contains only invasive or only in situ tumor. Note 3: This information is collected for analytic purposes and does not affect the stage grouping algorithm. Different codes in this field may explain differences in outcome for patients in the same T category or stage group. Example: Patient 1 has a "mixed" (see Note 2) tumor measuring 2.5 cm with extensive areas of in situ tumor, and the size of the invasive component is not stated. This would be coded 025 in CS Tumor Size, and would be classified as T2. It would be coded 040 in Site-Specific Factor 6. Patient 2 has a purely invasive tumor measuring 2.5 cm. This would also be coded 025 in CS Tumor Size and would also be classified as T2. However, it would be coded 000 in Site-Specific Factor 6. Patient 1's tumor would probably have a better survival than Patient 2's tumor, since it would more likely be a T1 lesion if the true dimensions of the invasive component were known. Code Description

000 Entire tumor reported as invasive (no in situ component reported)

010 Entire tumor reported as in situ (no invasive component reported)

020 Invasive and in situ components present, size of invasive component stated and coded in CS Tumor Size

030 Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated AND in situ described as minimal (less than 25%)

040 Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated AND in situ described as extensive (25% or more)

050 Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated AND proportions of in situ and invasive not known

060 Invasive and in situ components present, unknown size of tumor (CS Tumor Size coded 999)

888 Unknown if invasive and in situ components present, unknown if tumor size represents mixed tumor or a "pure" tumor. (See Note 2.)

Version date: January 1, 2004 465 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 466 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Vulva (incl. Skin of Vulva) [excl. Melanoma of Vulva, Kaposi Sarcoma of vulva, Mycosis Fungiodes of vulva, Sezary Disease of vulva, and Other Lymphomas of vulva] C51.0-C51.2, C51.8-C51.9 C51.0 Labium majus C51.1 Labium minus C51.2 Clitoris C51.8 Overlapping lesion of vulva C51.9 Vulva, NOS Note: This schema is NOT used for Malignant Melanoma, Kaposi's Sarcoma, Mycosis Fungoides, Sezary Disease, or Other Lymphomas. Each of these diseases has a separate schema.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Special Extension Size Table 1 Reg LN Exam Special Extension Size Table 2 CS Mets at DX Special Extension Size Table 3 CS Mets Eval

Vulva (incl. Skin of Vulva) CS Tumor Size SEE STANDARD TABLE

Vulva (incl. Skin of Vulva) CS Extension Note 1: FIGO Stage 1, 1A and 1B are defined by size of tumor (less than or equal to 2 cm), involvement of vulva or vulva and perineum, and depth of stromal invasion as defined in codes 10, 11, 12, 30, 40, 41, and 42. FIGO Stage II is greater than 2 cm, but would be coded in the same range of codes. Note 2: The depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion. Code Description TNM SS77 SS2000

00 In situ: Tis IS IS Noninvasive; intraepithelial Bowen's disease, intraepidermal; preinvasive carcinoma FIGO Stage 0

10 Invasive cancer confined to: * L L Musculature Submucosa Vulva including skin

11 Vulva only: Stromal invasion less than or equal to 1 mm ** L L

12 Vulva only: Stromal invasion greater than 1 mm *** L L

30 Localized, NOS * L L

40 Vulva and perineum, level of invasion in mm not stated * RE RE

41 Vulva and perineum, stromal invasion less than or equal to 1 mm ** RE RE

42 Vulva and perineum, stromal invasion greater than 1 mm *** RE RE

Version date: January 1, 2004 467 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60 Anus T3 RE RE Perianal skin Urethra (See code 75 for upper urethral mucosa) Vagina FIGO Stage III

62 Bladder wall or bladder, NOS excluding mucosa T3 D RE Rectal wall or rectum, NOS excluding mucosa

70 Perineal body T4 D D Rectal mucosa

75 Bladder mucosa T4 D RE Fixed to pubic bone Upper urethral mucosa FIGO Stage IVA

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10, 30, and 40 ONLY, the T category is assigned based on the value of CS Tumor Size as shown in the Special Extension Size Table 1 for this site. ** For Extension codes 11 and 41 ONLY, the T category is assigned based on the value of CS Tumor Size as shown in the Special Extension Size Table 2 for this site. *** For Extension codes 12 and 42 ONLY, the T category is assigned based on the value of CS Tumor Size as shown in the Special Extension Size Table 3 for this site.

Vulva (incl. Skin of Vulva) CS TS/Ext-Eval SEE STANDARD TABLE

Vulva (incl. Skin of Vulva) CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Unilateral regional lymph nodes: N1 RN RN Inguinal, NOS: Deep inguinal, NOS: Node of Cloquet or Rosenmuller (highest deep inguinal) Superficial inguinal (femoral) Regional lymph node(s), NOS (unilateral) FIGO Stage III

50 Bilateral or contralateral regional lymph nodes: N2 RN RN Inguinal, NOS: Deep inguinal, NOS: Node of Cloquet or Rosenmuller (highest deep inguinal) Superficial inguinal (femoral) Regional lymph node(s), NOS (bilateral or contralateral) FIGO Stage IVA

Version date: January 1, 2004 468 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60 Regional lymph node(s), NOS (not stated if unilateral, N1 RN RN bilateral or contralateral)

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Vulva (incl. Skin of Vulva) CS Reg Nodes Eval SEE STANDARD TABLE

Vulva (incl. Skin of Vulva) Reg LN Pos SEE STANDARD TABLE

Vulva (incl. Skin of Vulva) Reg LN Exam SEE STANDARD TABLE

Vulva (incl. Skin of Vulva) CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), NOS M1 D D

11 Distant lymph node(s): M1 RN D External iliac

12 Distant lymph node(s): M1 D D Internal iliac (hypogastric) Obturator Pelvic, NOS

13 Distant lymph node(s) other than code 11 and 12, including M1 D D common iliac

40 Distant metastases other than distant lymph node(s) (codes 10 to M1 D D 13) Distant metastasis, NOS Carcinomatosis

50 (40) + any of [(10) to (13)] M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Version date: January 1, 2004 469 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Vulva (incl. Skin of Vulva) CS Mets Eval SEE STANDARD TABLE

Vulva (incl. Skin of Vulva) CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Vulva (incl. Skin of Vulva) CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Vulva (incl. Skin of Vulva) CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Vulva (incl. Skin of Vulva) CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Vulva (incl. Skin of Vulva) CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Vulva (incl. Skin of Vulva) CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 470 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Vagina C52.9 C52.9 Vagina, NOS

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Vagina CS Tumor Size SEE STANDARD TABLE

Vagina CS Extension Note: According to AJCC, pelvic wall is defined as muscle, fascia, neurovascular structures, or skeletal portions of the bony pelvis. Code Description TNM SS77 SS2000

00 In situ: Noninvasive; intraepithelial Tis IS IS FIGO Stage 0

10 Invasive cancer confined to T1 L L Submucosa (stroma) (vagina) FIGO Stage I

20 Musculature involved T1 L L

30 Localized, NOS T1 L L

40 Cervix T2 RE RE Paravaginal soft tissue Rectovaginal septum Vesicovaginal septum Vulva FIGO Stage II

50 Cul de sac (rectouterine pouch) T2 RE RE FIGO Stage II

52 Extension to bladder wall or bladder, NOS excluding mucosa T3 D RE Rectal wall or rectum, NOS excluding mucosa

60 Extension to pelvic wall T3 D RE Described clinically as "frozen pelvis", NOS FIGO Stage III

70 Extension to bladder mucosa (excluding bullous edema) T4 D D or rectal mucosa FIGO Stage IVA

Version date: January 1, 2004 471 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

80 Extension beyond true pelvis T4 D D Extension to urethra FIGO Stage IVA, not further specified

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Vagina CS TS/Ext-Eval SEE STANDARD TABLE

Vagina CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 All parts of vagina, regional nodes: N1 RN RN Pelvic lymph nodes: Iliac, NOS: Common External Internal (hypogastric) Obturator Middle sacral (promontorial) (Gerota's node)

20 Lower third of vagina, regional nodes: N1 D RN Ipsilateral: Inguinal, NOS: Superficial inguinal (femoral)

30 Lower third of vagina, regional nodes: N1 D RN Bilateral: Inguinal, NOS: Superficial inguinal (femoral)

40 Upper two-thirds of vagina, regional nodes: N1 D RN Pelvic lymph node(s), NOS

50 Regional lymph node(s), unknown whether primary is in upper or N1 RN RN lower vagina Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Vagina CS Reg Nodes Eval SEE STANDARD TABLE

Version date: January 1, 2004 472 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Vagina Reg LN Pos SEE STANDARD TABLE

Vagina Reg LN Exam SEE STANDARD TABLE

Vagina CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), NOS M1 D D

11 Distant lymph node(s): M1 D D Aortic, NOS: Lateral (lumbar) Para-aortic Periaortic Inguinal (for primary in upper two-thirds of vagina only) Retroperitoneal, NOS

12 Distant lymph node(s) other than code 11 M1 D D

40 Distant metastases except distant lymph node(s) (codes 10 to 12) M1 D D FIGO Stage IVB Distant metastasis, NOS Carcinomatosis

50 (40) + any of [(10) to (12)] M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Vagina CS Mets Eval SEE STANDARD TABLE

Vagina CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Version date: January 1, 2004 473 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Vagina CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Vagina CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Vagina CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Vagina CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Vagina CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 474 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Cervix Uteri C53.0-C53.1, C53.8-C53.9 C53.0 Endocervix C53.1 Exocervix C53.8 Overlapping lesion of cervix C53.9 Cervix uteri

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Cervix Uteri CS Tumor Size SEE STANDARD TABLE

Cervix Uteri CS Extension Note: Involvement of anterior and/or posterior septum is coded as involvement of the vaginal wall. Code Description TNM SS77 SS2000

00 In situ: Preinvasive; noninvasive; intraepithelial Tis IS IS Cancer in situ WITH endocervical gland involvement FIGO Stage 0

01 CIN (Cervical intraepithelial neoplasia) Grade III Tis IS IS

11 Minimal microscopic stromal invasion less than or equal to 3 mm in T1a1 L L depth and less than or equal to 7 mm in horizontal spread FIGO Stage IA1

12 "Microinvasion" T1a2 L L Tumor WITH invasive component greater than 3 mm and less than or equal to 5 mm in depth, taken from the base of the epithelium, and less than or equal to 7 mm in horizontal spread FIGO Stage IA2

20 Invasive cancer confined to cervix and tumor larger than that in * L L code 12 FIGO Stage IB

25 Invasive cancer confined to cervix and clinically visible lesion * L L

30 Localized, NOS * L L Confined to cervix uteri or uterus, NOS, except corpus uteri, NOS (Not clinically visible or unknown if clinically visible.)

31 FIGO Stage I, not further specified * L L

Version date: January 1, 2004 475 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

35 Corpus uteri, NOS T1NOS RE RE

36 (35) + (11) T1a1 RE RE

37 (35) + (12) T1a2 RE RE

38 (35) + [(20) or (25)] * RE RE

39 (35) + [(30) or (31)] * RE RE

40 Extension to: T2a RE RE Cul de sac (rectouterine pouch) Upper 2/3's of vagina including fornices Vagina, NOS Vaginal wall, NOS FIGO Stage IIA FIGO Stage II, NOS

50 Extension to: T2b RE RE Ligament(s): Broad Cardinal Uterosacral Parametrium (paracervical soft tissue) FIGO Stage IIB

60 Extension to: T3a RE RE Bladder wall Bladder, NOS excluding mucosa Bullous edema of bladder mucosa Lower 1/3 of vagina Rectal wall Rectum, NOS excluding mucosa FIGO Stage IIIA

62 Extension to: T3a D RE Ureter, intra- and extramural Vulva FIGO Stage IIIA

63 Tumor causes hydronephrosis or nonfunctioning kidney T3b RE RE FIGO Stage IIIB

65 Extension to pelvic wall(s) T3b D RE (Described clinically as "frozen pelvis", NOS) FIGO Stage IIIB

68 Extension to: T3NOS D RE Fallopian tube Ovary(ies) Urethra

70 Extension to rectal or bladder mucosa T4 D D (Note: for bullous edema of bladder mucosa, see code 60.) FIGO Stage IVA

80 Further contiguous extension beyond true pelvis T4 D D Sigmoid colon Small intestine FIGO Stage IVA, not further specified

Version date: January 1, 2004 476 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 20, 25, 30, 31, 38 and 39, the T category is assigned based on the CS Tumor Size, as shown in the Extension Size Table for this site.

Cervix Uteri CS TS/Ext-Eval SEE STANDARD TABLE

Cervix Uteri CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: If the clinician says "adnexa palpated" but doesn't mention lymph nodes, assume lymph nodes are not involved. Note 3: If either exploratory or definitive surgery is done with no mention of lymph nodes, assume nodes are negative, code 00. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Iliac, NOS: Common External Internal (hypogastric) Obturator Paracervical Parametrial Pelvic, NOS Sacral, NOS: Lateral (laterosacral) Middle (promontorial) (Gerota's node) Presacral Uterosacral Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Cervix Uteri CS Reg Nodes Eval SEE STANDARD TABLE

Cervix Uteri Reg LN Pos SEE STANDARD TABLE

Version date: January 1, 2004 477 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Cervix Uteri Reg LN Exam SEE STANDARD TABLE

Cervix Uteri CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) including: M1 D D Aortic (para-, peri-, lateral) Inguinal (femoral) Mediastinal Distant lymph node(s), NOS FIGO Stage IV

40 Distant metastases, except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Cervix Uteri CS Mets Eval SEE STANDARD TABLE

Cervix Uteri CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Cervix Uteri CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Cervix Uteri CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Version date: January 1, 2004 478 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Cervix Uteri CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Cervix Uteri CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Cervix Uteri CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 479 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 480 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Corpus Uteri; Uterus, NOS (excluding Placenta) C54.0-C54.3, C54.8-C54.9, C55.9 C54.0 Isthmus uteri C54.1 Endometrium C54.2 Myometrium C54.3 Fundus uteri C54.8 Overlapping lesion of corpus uteri C54.9 Corpus uteri C55.9 Uterus, NOS

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Tumor Size SEE STANDARD TABLE

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Extension Note 1: According to the AJCC, extension to the bowel or bladder mucosa must be proven by biopsy in order to rule out bullous edema. Note 2: Since "cancer cells in ascites or in peritoneal washings" was not specifically categorized in the 1977 Summary Stage Guide, is unclear to which stage previous cases may have been coded. Code Description TNM SS77 SS2000

00 In situ: preinvasive; noninvasive; intraepithelial Tis IS IS Cancer in situ FIGO Stage 0

10 FIGO Stage I not further specified T1NOS L L Invasive cancer confined to corpus uteri

11 Confined to endometrium (stroma) T1a L L FIGO Stage IA

12 Tumor invades less than one-half of myometrium T1b L L Invasion of inner half of myometrium FIGO Stage IB

13 Tumor invades one-half or more of myometrium T1c L L Invasion of outer half of myometrium FIGO Stage IC

14 Invasion of myometrium, NOS T1NOS L L

16 Serosa of corpus (tunica serosa) T1NOS L L

40 Localized, NOS T1NOS L L

Version date: January 1, 2004 481 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 Cervix uteri, NOS, but not beyond uterus T2NOS RE RE FIGO Stage II, NOS

51 Endocervical glandular involvement only T2a RE RE FIGO Stage IIA

52 Cervical stromal invasion T2b RE RE FIGO Stage IIB

60 Extension or metastasis within true pelvis: T3a RE RE Adnexa Fallopian tube(s) Ligaments: Broad, round, uterosacral Ovary(ies) Parametrium Pelvic serosa Tunica serosa FIGO Stage IIIA FIGO Stage III, NOS

61 Cancer cells in ascites T3a RE RE Cancer cells in peritoneal washings FIGO Stage IIIA

62 Ureter and vulva T3a D RE

64 Extension or metastasis to vagina T3b D RE FIGO Stage IIIB

65 Extension or metastasis to pelvic wall(s) T3b RE RE Described clinically as "frozen pelvis", NOS FIGO Stage IIIB

66 Extension or metastasis to: T3b RE RE Bladder wall Bladder, NOS excluding mucosa Rectal wall Rectum, NOS excluding mucosa FIGO Stage IIIB

67 [(65) or (66)] and [(62) or (64)] T3b D RE

70 Extension to bowel mucosa or T4 D D bladder mucosa (excluding bullous edema) FIGO Stage IVA FIGO Stage IVNOS

80 Further contiguous extension T4 D D Abdominal serosa (peritoneum) Cul de sac Sigmoid colon Small intestine

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Version date: January 1, 2004 482 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Corpus Uteri; Uterus, NOS (excluding Placenta) CS TS/Ext-Eval SEE STANDARD TABLE

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: If the clinician says "adnexa palpated" but doesn't mention lymph nodes, assume lymph nodes are not involved. Note 3: If either exploratory/definitive surgery is done with no mention of lymph nodes, assume nodes are negative. Note 4: Regional nodes includes bilateral and contralateral involvement of named nodes. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Iliac, NOS: Common External Internal (hypogastric) Obturator Paracervical Parametrial Pelvic, NOS Sacral, NOS: Lateral (laterosacral) Middle (promontorial) (Gerota's node) Presacral Uterosacral

20 Regional lymph node(s): N1 RN RN Aortic, NOS: Lateral (lumbar) Para-aortic Periaortic

50 Regional lymph node(s): N1 RN RN FIGO Stage IIIC, NOS

80 Regional lymph node(s), NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Reg Nodes Eval SEE STANDARD TABLE

Corpus Uteri; Uterus, NOS (excluding Placenta) Reg LN Pos SEE STANDARD TABLE

Version date: January 1, 2004 483 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Corpus Uteri; Uterus, NOS (excluding Placenta) Reg LN Exam SEE STANDARD TABLE

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

11 Distant lymph node(s): M1 RN D Superficial inguinal

12 Distant lymph node(s) other than code 11: M1 D D Deep inguinal, NOS: Node of Cloquet or Rosenmuller (highest deep inguinal) Distant lymph node(s), NOS

40 Distant metastases, except distant lymph node(s) (codes 11-12) M1 D D Distant metastasis, NOS Carcinomatosis Stage IVB Stage IV, NOS

50 (40) + any of [(11) or (12)] M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Mets Eval SEE STANDARD TABLE

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Version date: January 1, 2004 484 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Corpus Uteri; Uterus, NOS (excluding Placenta) CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 485 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 486 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Ovary C56.9 C56.9 Ovary Note: Laterality must be coded for this site.

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Carbohydrate Antigen 125 (CA-125) available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 4 AJCC Stage Reg LN Pos CS Site-Specific Factor 5 Reg LN Exam CS Site-Specific Factor 6 CS Mets at DX CS Mets Eval

Ovary CS Tumor Size SEE STANDARD TABLE

Ovary CS Extension Note 1: Ascites WITH malignant cells changes FIGO stages I and II to IC and IIC, respectively. Ascites, NOS is considered negative. Note 2: "Both extension to and discontinuous metastasis to any of the following pelvic organs is considered FIGO Stage II and coded in the range 50-65: adnexae, NOS; bladder, bladder serosa; broad ligament (mesovarium); cul- de-sac; fallopian tubes; parametrium; pelvic peritoneum; pelvic wall; rectum; sigmoid colon; sigmoid mesentery; ureter; uterus; uterine serosa. Note 3: Peritoneal implants outside the pelvis (codes 70-73) must be microscopically confirmed. Peritoneal implants may also be called seeding, salting, talcum powder appearance, or studding. Note 4: If implants are mentioned, determine whether they are in the pelvis or in the abdomen and code appropriately (60-64) or (70-73). If the location is not specified, code as 75. Note 5: Both extension to and discontinuous metastasis to any of the following abdominal organs is considered FIGO Stage III and coded in the range 70-75: abdominal mesentery; diaphragm; gallbladder; infracolic omentum; kidneys; large intestine except rectum and sigmoid colon; liver (peritoneal surface); omentum; pancreas; pericolic gutter; peritoneum, NOS; small intestine; spleen; stomach; ureters. Note 6: Excludes parenchymal liver nodules, which are coded in CS Mets at DX Note 7: Since "cancer cells in ascites or in peritoneal washings" was not specifically categorized in the 1977 Summary Stage Guide, it is unclear to which stage previous cases may have been coded. Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial; preinvasive Tis IS IS

10 Tumor limited to one ovary, capsule intact, no tumor on ovarian T1a L L surface, no malignant cells in ascites or peritoneal washings FIGO Stage IA

20 Tumor limited to both ovaries, capsule(s) intact, no tumor on T1b L L ovarian surface, no malignant cells in ascites or peritoneal washings FIGO Stage IB

30 Tumor limited to ovaries, unknown if capsule(s) ruptured or if one T1NOS L L or both ovaries involved Localized, NOS FIGO Stage I, NOS

Version date: January 1, 2004 487 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

35 Tumor limited to ovary(ies), capsule(s) ruptured T1c L RE FIGO Stage 1C

36 Tumor on ovarian surface T1c D RE FIGO Stage 1C

41 Tumor limited to ovary(ies) WITH malignant cells in ascites or T1c RE RE peritoneal washings FIGO Stage IC

43 (35) + (41) T1c RE RE FIGO Stage IC

44 (36) + any of [(35) or (41)] T1c D RE FIGO Stage 1C

50 Extension to or implants on (but no malignant cells in ascites or T2a RE RE peritoneal washings): Adnexa, NOS, ipsilateral or NOS Fallopian tube(s), ipsilateral or NOS FIGO Stage IIA

52 Extension to or implants on (but no malignant cells in ascites or T2a D RE peritoneal washings): Adnexa, NOS, contralateral Fallopian tube(s), contralateral Uterus FIGO Stage IIA

60 Extension to or implants on other pelvic structures (but no T2b RE RE malignant cells in ascites or peritoneal washings): Pelvic tissue: Adjacent peritoneum Ligament(s): Broad, ipsilateral, NOS Ovarian Round Suspensory Mesovarium, ipsilateral, NOS Pelvic wall FIGO Stage IIB

61 Extension to or implants on other pelvic structures (but no T2b D RE malignant cells in ascites or peritoneal washings): Broad ligament(s), contralateral Mesovarium, contralateral FIGO Stage IIB

62 WITH malignant cells in ascites or peritoneal washings [(50) and/or T2c RE RE (60)] FIGO Stage IIC

63 WITH malignant cells in ascites or peritoneal washings [(52) and/or T2c D RE (61)] FIGO Stage IIC

64 (61) WITH malignant cells in ascites or peritoneal washings T2c D RE FIGO IIC

65 Tumor involves one or both ovaries with pelvic extension, NOS T2NOS RE RE FIGO Stage II, NOS

Version date: January 1, 2004 488 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

70 Microscopic peritoneal implants beyond pelvis, including peritoneal T3a D D surface/capsule of liver FIGO Stage IIIA (See Note 5)

71 Macroscopic peritoneal implants beyond pelvis, less than or equal T3b D D to 2 cm in diameter, including peritoneal surface of liver FIGO Stage IIIB (See Note 5)

72 Peritoneal implants beyond pelvis, greater than 2 cm in diameter, T3c D D including peritoneal surface of liver (liver capsule) FIGO Stage IIIC (See Note 5)

73 Tumor involves one or both ovaries with microscopically confirmed T3NOS D D peritoneal metastasis outside the pelvis, NOS FIGO Stage III, NOS (See Note 5)

75 Peritoneal implants, NOS (See Note 5) T3NOS D D

80 Further contiguous extension T3NOS D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Ovary CS TS/Ext-Eval SEE STANDARD TABLE

Ovary CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: If the clinician says "adnexa palpated" but doesn't mention lymph nodes, assume lymph nodes are not involved, code "00". Note 3: If either exploratory/definitive surgery is done with no mention of lymph nodes, assume nodes are negative. Note 4: Regional nodes includes bilateral and contralateral involvement of named nodes. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Iliac, NOS: Common External Internal (hypogastric), NOS Obturator Pelvic, NOS

12 Regional lymph node(s): N1 D RN Lateral sacral (laterosacral)

20 Regional lymph node(s): N1 RN RN Aortic (para-, peri-, lateral) Retroperitoneal, NOS

Version date: January 1, 2004 489 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

30 Regional lymph node(s): N1 D RN Inguinal

40 (10) + (20) N1 RN RN

42 [(12) or (30)] + [(10) or (20)] N1 D RN

50 Regional lymph node(s), NOS N1 RN RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Ovary CS Reg Nodes Eval SEE STANDARD TABLE

Ovary Reg LN Pos SEE STANDARD TABLE

Ovary Reg LN Exam SEE STANDARD TABLE

Ovary CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), NOS M1 D D

40 Distant metastases, except distant lymph node(s) (code 10), M1 D D including: Liver parenchymal metastasis Pleural effusion WITH positive cytology Distant metastasis, NOS Carcinomatosis Stage IV, NOS

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Ovary CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 490 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Ovary CS Site-Specific Factor 1 Carbohydrate Antigen 125 (CA-125) Code Description

000 Test None Done

010 Positive/elevated

020 Negative/normal; within normal limits

030 Borderline; undetermined whether positive or negative

080 Ordered, but results not in chart

999 Not documented in patient record Unknown or no information

Ovary CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Ovary CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Ovary CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Ovary CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Ovary CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 491 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 492 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Fallopian Tube C57.0 C57.0 Fallopian tube Note: Laterality must be coded for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Fallopian Tube CS Tumor Size SEE STANDARD TABLE

Fallopian Tube CS Extension Note 1: Positive regional lymph nodes (FIGO Stage IIIC) are coded in the CS Lymph Nodes field. Note 2: Codes 13 and 71: Since "malignant ascites or malignant peritoneal washings" was not specifically categorized in the 1977 Summary Staging Guide, it is unclear to which stage previous cases may have been coded. Note 3: Liver capsule metastases are coded to 75-78 in the Extension field; liver parenchymal metastases are coded in the Mets at DX field. Code Description TNM SS77 SS2000

00 In situ: noninvasive, intraepithelial Tis IS IS Limited to tubal mucosa FIGO Stage 0

10 Confined to fallopian tube, NOS T1NOS L L FIGO Stage I

11 Confined to one fallopian tube T1a L L WITHOUT penetrating serosal surface; no ascites FIGO Stage IA

12 Confined to both fallopian tubes T1b L L WITHOUT penetrating serosal surface; no ascites FIGO Stage IB

13 Extension onto or through tubal serosa T1c L L Malignant ascites Malignant peritoneal washings FIGO Stage IC

30 Localized, NOS T1NOS L L FIGO Stage 1

35 Pelvic extension, NOS with no malignant cells in T2NOS RE RE peritoneal washings FIGO Stage II

Version date: January 1, 2004 493 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

40 Extension or metastasis to: T2a RE RE Corpus uteri Ovary, ipsilateral Uterus, NOS FIGO Stage IIA

50 Extension or metastasis to: T2b RE RE Broad ligament, ipsilateral Mesosalpinx, ipsilateral Peritoneum FIGO Stage IIB

60 Ovary, contralateral T2a D RE FIGO Stage IIA

65 Extension or metastasis to: T2b D RE Cul de sac (rectouterine pouch) Rectosigmoid Sigmoid Small intestine FIGO IIB

70 Extension or metastasis to: T2b D RE Omentum FIGO Stage IIB

71 Pelvic extension (codes 35 to 70) T2c D RE WITH malignant cells in ascites or peritoneal washings FIGO Stage IIC

75 Peritoneal implants outside the pelvis, NOS T3NOS D D FIGO Stage III

76 Microscopic peritoneal metastasis outside the pelvis T3a D D FIGO Stage IIIA

77 Macroscopic peritoneal metastasis less than or equal to 2 cm T3b D D outside the pelvis FIGO Stage IIIB

78 Peritoneal metastases greater than 2 cm T3c D D FIGO Stage IIIC

80 Further contiguous extension T3NOS D D FIGO Stage III

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Fallopian Tube CS TS/Ext-Eval SEE STANDARD TABLE

Version date: January 1, 2004 494 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Fallopian Tube CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: If the clinician says "adnexa palpated" but doesn't mention lymph nodes, assume lymph nodes are not involved. Note 3: If either exploratory/definitive surgery is done with no mention of lymph nodes, assume nodes are negative. Note 4: Regional nodes includes bilateral and contralateral involvement of named nodes. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s): N1 RN RN Iliac, NOS: Common External Internal (hypogastric) Obturator Pelvic, NOS

12 Regional lymph node(s): N1 D RN Lateral sacral (laterosacral) Presacral

20 Regional lymph node(s): N1 RN RN Aortic, NOS: Lateral (lumbar) Para-aortic Periaortic Retroperitoneal, NOS

22 (12) + (20) N1 D RN

30 Regional lymph node(s): N1 D RN Inguinal

50 Regional lymph node(s), NOS N1 RN RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Fallopian Tube CS Reg Nodes Eval SEE STANDARD TABLE

Fallopian Tube Reg LN Pos SEE STANDARD TABLE

Fallopian Tube Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 495 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Fallopian Tube CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s), NOS M1 D D

40 Distant metastases, except distant lymph node(s) (code 10), M1 D D including: Liver parenchymal metastasis Pleural effusion WITH positive cytology Distant metastasis, NOS Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Fallopian Tube CS Mets Eval SEE STANDARD TABLE

Fallopian Tube CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Fallopian Tube CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Fallopian Tube CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Fallopian Tube CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 496 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Fallopian Tube CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Fallopian Tube CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 497 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 498 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Broad and Round Ligaments, Parametrium, Uterine Adnexa C57.1-C57.4 C57.1 Broad ligament C57.2 Round ligament C57.3 Parametrium C57.4 Uterine adnexa Note: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Tumor Size SEE STANDARD TABLE

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial NA IS IS

10 Confined to tissue or organ of origin NA L L

30 Localized, NOS NA L L

40 Corpus uteri NA RE RE Ovary, ipsilateral Uterus, NOS

50 Fallopian tube for ligaments NA RE RE Mesosalpinx, ipsilateral Peritoneum

70 Cervix uteri NA D D Cul de sac (rectouterine pouch) Omentum Ovary, contralateral Rectosigmoid Sigmoid Small intestine

80 Further contiguous extension NA D D

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Version date: January 1, 2004 499 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Regional lymph node(s): NA RN RN Aortic, NOS: Lateral (lumbar) Para-aortic Periaortic Iliac, NOS: Common External Internal (hypogastric): Obturator Inguinal Lateral sacral (laterosacral) Pelvic, NOS Retroperitoneal, NOS Regional lymph node(s), NOS

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Broad and Round Ligaments, Parametrium, Uterine Adnexa Reg LN Pos SEE STANDARD TABLE

Broad and Round Ligaments, Parametrium, Uterine Adnexa Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 500 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Version date: January 1, 2004 501 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Broad and Round Ligaments, Parametrium, Uterine Adnexa CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 502 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Unspecified Female Genital Organs C57.7-C57.9 C57.7 Other specified parts of female genital organs C57.8 Overlapping lesion of female genital organs C57.9 Female genital tract, NOS Note: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Other and Unspecified Female Genital Organs CS Tumor Size SEE STANDARD TABLE

Other and Unspecified Female Genital Organs CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial NA IS IS

10 Confined to site of origin NA L L

30 Localized, NOS NA L L

40 Adjacent connective tissue (See definition in General Instructions) NA RE RE

60 Adjacent organs/structures: NA RE RE Female genital organs: Adnexa Broad ligament(s) Cervix uteri Corpus uteri Fallopian tube(s) Ovary(ies) Parametrium Round ligament(s) Uterus, NOS Vagina

80 Further contiguous extension: NA D D Other organs of pelvis

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Version date: January 1, 2004 503 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Unspecified Female Genital Organs CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Unspecified Female Genital Organs CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement NA NONE NONE

10 Regional lymph node(s), NOS NA RN RN

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Other and Unspecified Female Genital Organs CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Unspecified Female Genital Organs Reg LN Pos SEE STANDARD TABLE

Other and Unspecified Female Genital Organs Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 504 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Unspecified Female Genital Organs CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Other and Unspecified Female Genital Organs CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Unspecified Female Genital Organs CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Other and Unspecified Female Genital Organs CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Other and Unspecified Female Genital Organs CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Other and Unspecified Female Genital Organs CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 505 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Unspecified Female Genital Organs CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Other and Unspecified Female Genital Organs CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 506 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Placenta C58.9 C58.9 Placenta Note 1: This schema correlates to the AJCC's Gestational Trophoblastic Tumors scheme. In most cases, gestational trophoblastic tumors (ICD-O-3 morphology codes 9100-9105) are coded to placenta, C58.9. Note 2: If a trophoblastic tumor is not associated with a pregnancy and arises in another site, such as ovary, use the primary site code and Collaborative Staging schema for that site.

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Prognostic Scoring Index Table 1 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histology Exclusion Table Reg Nodes Eval CS Site-Specific Factor 4 AJCC Stage Reg LN Pos CS Site-Specific Factor 5 Reg LN Exam CS Site-Specific Factor 6 CS Mets at DX CS Mets Eval

Placenta CS Tumor Size SEE STANDARD TABLE

Placenta CS Extension Note 1: Substaging of gestational trophoblastic tumors are determined by the value coded in the Prognostic Scoring Index Table, using Site Specific Factor 1. See note in Site Specific Factor 1, Prognostic Index Table to determine the prognostic index score. Note 2: For this schema, according to AJCC, involvement of genital structures may be either by direct extension or metastasis and is still T2. For Collaborative Staging, metastasis to genital structures should be coded 70 in CS Extension and not coded in CS Mets at DX. Code Description TNM SS77 SS2000

00 In situ: Noninvasive; intraepithelial Tis IS IS FIGO Stage 0

10 Confined to placenta T1 L L FIGO Stage I

30 Localized, NOS T1 L L FIGO Stage 1

40 Adjacent connective tissue, NOS T2 RE RE FIGO Stage II

60 Other genital structures by direct extension or NOS: T2 RE RE Broad ligament Cervix Corpus uteri Fallopian tube(s) Genital structures, NOS Ovary(ies) Uterus, NOS Vagina FIGO Stage II

70 Other genital structures, by metastasis: T2 D D

Version date: January 1, 2004 507 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Broad ligament Cervix Corpus uteri Fallopian tube(s) Genital structures, NOS Ovary(ies) Uterus, NOS Vagina FIGO Stage II

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record Note: For codes 10 - 80, the substaging is determined by using the Risk Scores in the Prognostic Scoring Index in Site Specific Factor 1 Table.

Placenta CS TS/Ext-Eval SEE STANDARD TABLE

Placenta CS Lymph Nodes Code Description TNM SS77 SS2000

88 Not applicable NA U U

Placenta Reg Nodes Eval Code Description

9 Does not apply NA

Placenta Reg LN Pos Code Description

99 Does not apply

Placenta Reg LN Exam Code Description

99 Does not apply

Version date: January 1, 2004 508 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Placenta CS Mets at DX Note 1: All lymph node involvement is considered M1 in TNM, so all lymph node involvement, whether regional or distant nodes, is coded in the field Mets at DX. Note 2: According to AJCC, metastasis to genital structures is considered T2 and not M1 for GTT. For this Collaborative Staging schema, metastasis to genital structures is coded 70 in CS Extension and not coded in CS Mets at DX. Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Metastasis to lung(s) only, NOS M1a D D FIGO III

20 Regional lymph nodes: M1b RN RN Iliac, NOS: Common External Internal (hypogastric), NOS Obturator Parametrial Pelvic, NOS Sacral, NOS: Lateral Presacral Promontory (Gerota's) Uterosacral

30 Regional lymph nodes: M1b RN RN Aortic, NOS: Lateral Para-aortic Periaortic

35 (20) + (30) M1b RN RN

40 Regional lymph node(s), NOS M1b RN RN

50 Distant lymph node(s), NOS M1b D D

51 Distant lymph node(s): Superficial inguinal (femoral) M1b D D

52 Specified distant lymph node(s) other than in code 51 M1b D D

60 Lymph nodes, NOS M1b D D

70 Distant metastases, other than lymph node(s) or lung M1b D D Distant metastasis, NOS Carcinomatosis

80 (70) + any of [(10) to (60)] M1b D D

99 Unknown MX U U Distant metastasis cannot be assessed Not documented in patient record

Placenta CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 509 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Placenta CS Site-Specific Factor 1 Prognostic Scoring Index Table 1 Note: Clinician scoring is recommended. If any one of the factors is unknown, stop trying to assign score, unless you have already determined with the factors you have - low risk or high risk. The score on the Prognostic Scoring Index is used to substage patients. Substage A (low risk) and Substage B (high risk) are assigned on the basis of a non-anatomic risk factor scoring system: AGE [Score 0: age less than or equal to 40; Score 1: age 40 or more] ANTECEDENT PREG [Score 0: Hydatidiform mole; Score 1: Abortion; Score 2: Term pregnancy] MONTHS FROM INDEX PREG [Score 0: less than 4; Score 1: 4 months and less than 7 months; Score 2: 7 months to 12 months; Score 4: More than 12 months] PRETREATMENT SERUM hCG(IU/ml) [Score 0: <10 to 3rd power, (1,000); Score 1: 10-3rd power to 10-4th power (1,000 to less than 10,000); Score 2: 10-4th power to less than 10-5th power (10,000 to less than 100,000); Score 4: greater than or equal to 10-5th power (100,000 or greater)] LARGEST TUMOR SIZE, INCLUDING UTERUS [Score 0: < 3 cm; Score 1: 3-<5 cm; Score 2: greater than or equal to 5 cm] SITES OF METS [Score 0: Lung only or None; Score 1: Spleen, kidney; Score 2: Gastrointestinal tract; Score 4: Liver, brain] NUMBER OF METS [Score 0: 0; Score 1: 1-4; Score 2: 5-8; Score 4: >8] PREVIOUS FAILED CHEMOTHERAPY [Score 2: Single drug; Score 4: 2 or more drugs]. Sum the score of each prognostic risk factor(s) to determine the final Prognostic Scoring Index in the table below: Code Description

000 Clinician stated no risk factors

001 Clinician stated low risk (sum score of 7 or less) Stated to be substage A, but score not specified

002 Clinician stated high risk (sum score of 8 or greater or NOS) Stated to be substage B, but score not specified

200 Clinician stated to have risk factors, but unknown whether low or high risk.

999 Unknown Risk factors cannot be assessed Not documented in patient record

Placenta CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Placenta CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Placenta CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 510 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Placenta CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Placenta CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 511 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 512 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] C60.0-C60.2, C60.8-C60.9 C60.0 Prepuce C60.1 Glans penis C60.2 Body of penis C60.8 Overlapping lesion of penis C60.9 Penis, NOS Note: This schema is NOT used for Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, or Other Lymphomas. Each of these diseases has a separate schema.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Tumor Size SEE STANDARD TABLE

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Extension Code Description TNM SS77 SS2000

00 In situ: noninvasive; Bowen disease; intraepithelial Tis IS IS

05 Noninvasive verrucous carcinoma Ta IS IS

10 Invasive tumor limited to subepithelial connective tissue, but not T1 L L involving corpus spongiosum or cavernosum If primary is skin: invasive tumor limited to skin of penis, prepuce (foreskin) and/or glans

30 Localized, NOS T1 L L

35 For body of penis ONLY: T2 L L Corpus cavernosum Corpus spongiosum Tunica albuginea of corpus spongiosum

40 Corpus cavernosum except for tumor in body of penis T2 RE RE Corpus spongiosum except for tumor in body of penis Tunica albuginea of corpus spongiosum except for tumor in body of penis

50 Satellite nodule(s) on prepuce or glans T1 RE RE

Version date: January 1, 2004 513 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60 Urethra T3 RE RE Prostate

70 Adjacent structures: T4 RE RE Muscle, NOS: Bulbospongiosus Ischiocavernosus Superficial transverse perineal Skin: Abdominal Perineum Pubic Scrotal

80 Further contiguous extension T4 D D Testis

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS TS/Ext-Eval SEE STANDARD TABLE

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: If the clinician says "adnexa palpated" but doesn't mention lymph nodes, assume lymph nodes are not involved. Note 3: If either exploratory/definitive surgery is done with no mention of lymph nodes, assume nodes are negative. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 SINGLE superficial inguinal (femoral) regional lymph node N1 RN RN

20 Multiple OR bilateral superficial inguinal (femoral) regional lymph N2 RN RN nodes

30 Regional lymph nodes: N3 RN RN Deep inguinal, NOS: Node of Cloquet or Rosenmuller (highest deep inguinal)

40 Regional lymph nodes: N3 RN RN External iliac Internal iliac (hypogastric) Obturator Pelvic nodes, NOS

50 Regional Lymph Node(s), NOS N1 RN RN

Version date: January 1, 2004 514 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Reg Nodes Eval SEE STANDARD TABLE

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] Reg LN Pos SEE STANDARD TABLE

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] Reg LN Exam SEE STANDARD TABLE

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Mets at DX SEE STANDARD TABLE

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Mets Eval SEE STANDARD TABLE

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Version date: January 1, 2004 515 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Penis [excl Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease and Other Lymphomas] CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 516 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Prostate C61.9 C61.9 Prostate gland Note: Transitional cell carcinoma of the prostatic urethra is to be coded to primary site C68.0, Urethra, and assigned Collaborative Stage codes according to the urethra scheme.

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension-Clinical Extension Prostatic Specific Antigen (PSA) available at the collaborative CS TS/Ext-Eval Lab Value staging website: CS Lymph Nodes CS Site-Specific Factor 2 - Histology Exclusion Table CS Reg Nodes Eval Prostatic Specific Antigen (PSA) AJCC Stage Reg LN Pos CS Site-Specific Factor 3 - CS Reg LN Exam Extension - Pathologic Extension CS Mets at DX CS Site-Specific Factor 4 - CS Mets Eval Prostatic Acid Phosphatase (PAP) CS Site-Specific Factor 5 - Gleason's Primary Pattern and Secondary Pattern Value CS Site-Specific Factor 6 - Gleason's Score

Prostate CS Tumor Size SEE STANDARD TABLE

Prostate CS Extension-Clinical Extension Note 1: Information from prostatectomy is EXCLUDED from this field. See Site-Specific Factor 3, CS Extension - Pathologic Extension. Note 2: A. Codes 10-15: 1) CODES 10 to 15 are used only for clinically inapparent tumor not palpable or visible by imaging and incidentally found microscopic carcinoma (latent, occult) in one or both lobes. Within this range, give priority to codes 13-15 over code 10. 2) When tumor is found in one lobe or in both lobes by needle biopsy but is not palpable or visible by imaging, use code 15. B. CODES 20 to 24 are used only for clinically/radiographically apparent tumor, i.e., that which is palpable or visible by imaging. Codes 21 and 22 have precedence over code 20. Code 20 has precedence over code 24. C. CODE 30 is used for localized cancer when it is unknown if clinically or radiographically apparent. An example would be when a diagnosis is made prior to admission for a prostatectomy with no details provided on clinical findings prior to admission. D. CODES 33 and 34 have precedence over code 31. E. CODES 41 to 49 are used for extension beyond the prostate. Note 3: Use codes 13-14 when a TURP is done, not for a biopsy only. Do not use code 15 when a TURP is done. Note 4: Involvement of the prostatic urethra does not alter the extension code. Note 5: "Frozen pelvis" is a clinical term which means tumor extends to pelvic sidewall(s). In the absence of a more detailed statement of involvement, assign this to code 60. Note 6: AUA stage. Some of the American Urological Association (AUA) stages A-D are provided as guidelines for coding in the absence of more specific information in the medical record. If physician-assigned AUA stage D1- D2 is based on involvement of lymph nodes only, code under CS Lymph Nodes or CS Mets at DX, not CS Extension. Note 7: This schema includes evaluation of other pathologic tissue such as a biopsy of the rectum. Note 8: For this site, the T category and its associated c, p. y, or a indicator are assigned based on the values in CS Extension, CS TS/Ext Eval, and Site-Specific Factor 3. If the value of Site-Specific Factor 3 is less than 096 (i.e., prostatectomy was done and extension information is available for staging), the T category is taken from the Site- Specific Factor 3 mapping, and identified as a pT. Otherwise (i.e., Site-Specific Factor 3 code is 096 or greater, meaning that prostatectomy was not performed, or it was performed but the information is not usable for staging), the T category is taken from the CS Extension mapping, and the c, p, y, or a indicator is taken from the TS/Ext Eval mapping.

Version date: January 1, 2004 517 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Prostate CS Extension-Clinical Extension, continued Code Description TNM SS77 SS2000

00 In situ: noninvasive; intraepithelial Tis IS IS

10 Clinically inapparent tumor, number of foci or percent involved T1NOS L L tissue not specified Stage A, NOS

13 Incidental histologic finding in 5% or less of tissue resected T1a L L (clinically inapparent)

14 Incidental histologic finding more than 5% of tissue resected T1b L L (clinically inapparent)

15 Tumor identified by needle biopsy, e.g., for elevated PSA T1c L L (clinically inapparent)

20 Involvement in one lobe, NOS (clinically apparent only) T2NOS L L

21 Involves one half of one lobe or less (clinically apparent only) T2a L L

22 Involves more than one half of one lobe, but not both lobes T2b L L (clinically apparent only)

23 Involves both lobes (clinically apparent only) T2c L L

24 Clinically apparent tumor confined to prostate, NOS T2NOS L L Stage B, NOS

30 Localized, NOS T2NOS L L Confined to prostate, NOS Intracapsular involvement only Not stated if Stage A or B, T1 or T2, clinically apparent or inapparent

31 Into prostatic apex/arising in prostatic apex, NOS T2NOS L L

33 Arising in prostatic apex T2NOS L L

34 Extending into prostatic apex T2NOS L L

41 Extension to periprostatic tissue (Stage C1) T3NOS RE RE Extracapsular extension (beyond prostatic capsule), NOS Through capsule, NOS

42 Unilateral extracapsular extension T3a RE RE

43 Bilateral extracapsular extension T3a RE RE

45 Extension to seminal vesicle(s) (Stage C2) T3b RE RE

49 Periprostatic extension, NOS T3NOS RE RE (Unknown if seminal vesicle(s) involved) Stage C, NOS

50 Extension to or fixation to adjacent structures T4 RE RE other than seminal vesicles: Bladder neck Bladder, NOS

Version date: January 1, 2004 518 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50, Fixation, NOS cont’d Rectovesical (Denonvillier's) fascia Rectum; external sphincter

52 Levator muscles T4 D RE Skeletal muscle, NOS Ureter(s)

60 Extension to or fixation to pelvic wall or pelvic bone T4 D D "Frozen pelvis", NOS (See Note 5)

70 Further contiguous extension (Stage D2) including to: T4 D D Bone Other organs Penis Sigmoid colon Soft tissue other than periprostatic

95 No evidence of primary tumor T0 U U

99 Extension unknown TX U U Primary tumor cannot be assessed Not documented in patient record

Prostate CS TS/Ext-Eval Note 1: For this site, use this item to evaluate the coding of tumor size and extension as coded in both CS Extension (clinical for prostate) and Site-Specific Factor 3, Pathologic Extension if prostatectomy was performed. Note 2: The codes for this item for prostate differ from the codes used for most other sites. AJCC allows pathologic staging to be assigned on the basis of some biopsies without resection. According to the AJCC manual, "In general, total prostatoseminal-vesiculectomy, including regional node specimen, and histologic confirmation are required for pathologic T classification. However, under certain circumstances, pathologic T classification can be determined with other means. For example, (1) positive biopsy of the rectum permits a pT4 classification without prostatoseminal-vesiculectomy, and (2) a biopsy revealing carcinoma in extraprostatic soft tissue permits a pT3 classification, as does a biopsy revealing adenocarcinoma infiltrating the seminal vesicles." (P. 310) Note 3: For this site, the T category and its associated c, p, y, or a indicator are assigned based on the values in CS Extension, CS TS/Ext Eval, and Site-Specific Factor 3. For details, see Note 7 under CS Extension. Note 4: According to AJCC, staging basis for transurethral resection of prostate (TURP) is clinical and is recorded as CS TS/Ext-Eval "1" (c).

Code Description Staging Basis

0 No surgical resection done. Evaluation based on physical examination, imaging c examination, or other non-invasive clinical evidence. No autopsy evidence used.

1 No surgical resection done. Evaluation based on endoscopic examination, diagnostic c biopsy, including fine needle aspiration biopsy, or other invasive techniques including surgical observation without biopsy. No autopsy evidence used. Does not meet criteria for AJCC pathological T staging.

2 No surgical resection done, but positive biopsy of extraprostatic tissue allows assignment to p CS Extension Codes [(41) to (70)] (see Note 2)

3 No surgical resection done, but evidence derived from autopsy (tumor was suspected or p diagnosed prior to autopsy)

Version date: January 1, 2004 519 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

4 Surgical resection performed p WITHOUT pre-surgical systemic treatment or radiation OR surgical resection performed, unknown if pre-surgical systemic treatment or radiation performed. Evidence acquired before treatment, supplemented or modified by the additional evidence acquired during and from surgery, particularly from pathologic examination of the resected specimen. Meets criteria for AJCC pathologic T staging.

5 Surgical resection performed c WITH pre-surgical systemic treatment or radiation, BUT tumor size/extension based on clinical evidence

6 Surgical resection performed y WITH pre-surgical systemic treatment or radiation; BUT tumor size/extension based on pathologic evidence

8 Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy) a

9 Unknown if surgical resection done c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record

Prostate CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional nodes, including contralateral or bilateral lymph nodes: N1 RN RN Iliac, NOS External Internal (hypogastric), NOS: Obturator Pelvic, NOS Periprostatic Sacral, NOS Lateral (laterosacral) Middle (promontorial) (Gerota's node) Presacral Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed

Prostate CS Reg Nodes Eval SEE STANDARD TABLE

Prostate Reg LN Pos SEE STANDARD TABLE Prostate

Version date: January 1, 2004 520 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Reg LN Exam SEE STANDARD TABLE

Prostate CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

11 Distant lymph node(s), NOS M1a RN D Common iliac

12 Distant lymph node(s): M1a D D Aortic, NOS: Lateral (lumbar) Para-aortic Periaortic Cervical Inguinal, NOS Deep, NOS Node of Coquet or Rosenmuller (highest deep inguinal) Superficial (femoral) Retroperitoneal, NOS Scalene (inferior deep cervical) Supraclavicular (transverse cervical) Distant lymph node(s), NOS

30 Metastasis in bone(s) M1b D D

35 (30) + [(11) or (12)] M1b D D

40 Distant metastasis, other than distant lymph node(s) (codes 11 or M1c D D 12) or bone(s) Carcinomatosis

45 Distant metastasis, NOS M1NOS D D Stage D2, NOS

50 (40) + any of [(11) or (12)] M1c D D

55 (40) + any of [(30) or (35)] M1c D D

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Prostate CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 521 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Prostate CS Site-Specific Factor 1 Prostatic Specific Antigen (PSA) Lab Value Note 1: Record the highest PSA lab value prior to diagnostic biopsy or treatment. For example, a pretreatment PSA of 20.0 ng/ml would be recorded as 200. Note 2: Lab values for SSFs 1 and 2 should be from the same laboratory test. Code Description

000 Test not done (test was not ordered and was not performed)

001 0.1 or less ng/ml (actual value with implied decimal point)

002-899 0.2 - 89.9 ng/ml (actual value with implied decimal point)

990 99.0 or greater ng/ml (actual value with implied decimal point)

999 Unknown or no information Not documented in patient record

Prostate CS Site-Specific Factor 2 Prostatic Specific Antigen (PSA) Note 1: Use the highest PSA lab value prior to diagnostic biopsy or treatment. Note 2: Lab values for SSFs 1 and 2 should be from the same laboratory test. Code Description

000 Test not done (test was not ordered and was not performed)

010 Positive/elevated

020 Negative/normal; within normal limits

030 Borderline; undetermined whether positive or negative

080 Ordered, but results not in chart

999 Unknown or no information Not documented in patient record

Prostate CS Site-Specific Factor 3 CS Extension - Pathologic Extension Note 1: Include information from prostatectomy in this field and not in CS Extension - Clinical Extension. Use all histologic information including the prostatectomy if it was done within the first course of treatment. Code 097 if there was no prostatectomy performed within the first course of treatment. Note 2: Limit information in this field to first course of treatment in the absence of disease progression. Note 3: Involvement of the prostatic urethra does not alter the extension code. Note 4: When the apical margin, distal urethral margin, bladder base, or bladder neck margin is involved and there is no extracapsular extension, use code 040. Note 5: When prostate cancer is an incidental finding during a prostatectomy for other reasons (for example, a cystoprostatectomy for bladder cancer), use the appropriate code for the extent of disease found (for example, one lobe, or both lobes, or more). Note 6: "Frozen pelvis" is a clinical term which means tumor extends to pelvic sidewall(s). In the absence of a more detailed statement of involvement, assign this to code 060. Note 6: AUA stage. Some of the American Urological Association (AUA) stages A-D are provided as guidelines for coding in the absence of more specific information in the medical record. If physician-assigned AUA stage D1- D2 is based on involvement of lymph nodes only, code under CS Lymph Nodes or CS Mets at DX, not CS Extension - Pathologic Extension. Note 7: For this site, the T category and its associated c, p. y, or a indicator are assigned based on the values in CS Extension, CS TS/Ext Eval, and Site-Specific Factor 3. For details, see Note 7 under CS Extension.

Version date: January 1, 2004 522 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Prostate CS Site-Specific Factor 3 CS Extension - Pathologic Extension, continued Code Description TNM SS77 SS2000

000 In situ; non-invasive; intraepithelial Tis IS IS

020 Involvement in one lobe, NOS T2NOS L L

021 Involves one half of one lobe or less T2a L L

022 Involves more than one half of one lobe, but not both lobes T2b L L

023 Involves both lobes T2c L L

030 Localized, NOS T2NOS L L Confined to prostate, NOS Intracapsular involvement only Stage B, NOS

031 Into prostatic apex/arising in prostatic apex, NOS (see also codes T2NOS L L 033 and 034)

032 Invasion into (but not beyond) prostatic capsule T2NOS L L

033 Arising in prostatic apex T2NOS L L

034 Extending into prostatic apex T2NOS L L

040 No extracapsular extension but margins involved (See Note 4) T3NOS L RE

041 Extension to periprostatic tissue (Stage C1): T3a RE RE Extracapsular extension (beyond prostatic capsule), NOS Through capsule, NOS

042 Unilateral extracapsular extension T3a RE RE

043 Bilateral extracapsular extension T3a RE RE

045 Extension to seminal vesicle(s) (Stage C2) T3b RE RE

048 Extracapsular extension and margins involved T3NOS RE RE

050 Extension to or fixation to adjacent structures other than seminal T4 RE RE vesicles: Bladder neck Bladder, NOS Fixation, NOS Rectovesical (Denonvillier's) fascia Rectum; external sphincter

052 Levator muscle T4 D RE Skeletal muscle, NOS Ureter

060 Extension to or fixation to pelvic wall or pelvic bone T4 D D "Frozen pelvis", NOS (See Note 6)

070 Further contiguous extension (Stage D2) including to: T4 D D Bone Penis Sigmoid colon

Version date: January 1, 2004 523 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

70, Soft tissue other than periprostatic tissue cont’d Other organs

095 No evidence of primary tumor T0 U U

096 Unknown if prostatectomy done TX U U

097 No prostatectomy done within first course of treatment TX U U

098 Prostatectomy was done within first course of treatment, TX U U but there was disease progression

099 Prostatectomy done: TX U U Extension unknown Primary tumor cannot be assessed Not documented in patient record

Prostate CS Site-Specific Factor 4 Prostatic Acid Phosphatase (PAP) Code Description

000 Test not done (test was not ordered and was not performed)

010 Positive/elevated

020 Negative/normal; within normal limits

030 Borderline; undetermined whether positive or negative

080 Ordered, but results not in chart

999 Unknown or no information Not documented in patient record

Prostate CS Site-Specific Factor 5 Gleason's Primary Pattern and Secondary Pattern Value Note: If only one number is given and it is less than or equal to 5, assume that it describes a pattern and uses the number as the primary pattern and code the secondary as '9'. Code Description

000 Test not done (test was not ordered and was not performed)

011 Primary pattern 1, secondary pattern 1

012 Primary pattern 1, secondary pattern 2

013 Primary pattern 1, secondary pattern 3

014 Primary pattern 1, secondary pattern 4

015 Primary pattern 1, secondary pattern 5

019 Primary pattern 1, secondary pattern 9

021 Primary pattern 2, secondary pattern 1

022 Primary pattern 2, secondary pattern 2

Version date: January 1, 2004 524 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

023 Primary pattern 2, secondary pattern 3

024 Primary pattern 2, secondary pattern 4

025 Primary pattern 2, secondary pattern 5

029 Primary pattern 2, secondary pattern unknown

031 Primary pattern 3, secondary pattern 1

032 Primary pattern 3, secondary pattern 2

033 Primary pattern 3, secondary pattern 3

034 Primary pattern 3, secondary pattern 4

035 Primary pattern 3, secondary pattern 5

039 Primary pattern 3, secondary pattern unknown

041 Primary pattern 4, secondary pattern 1

042 Primary pattern 4, secondary pattern 2

043 Primary pattern 4, secondary pattern 3

044 Primary pattern 4, secondary pattern 4

045 Primary pattern 4, secondary pattern 5

049 Primary pattern 4, secondary pattern unknown

051 Primary pattern 5, secondary pattern 1

052 Primary pattern 5, secondary pattern 2

053 Primary pattern 5, secondary pattern 3

054 Primary pattern 5, secondary pattern 4

055 Primary pattern 5, secondary pattern 5

059 Primary pattern 5, secondary pattern unknown

099 Primary pattern unknown

999 Unknown or no information Not documented in patient record

Version date: January 1, 2004 525 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Prostate CS Site-Specific Factor 6 Gleason's Score Note 1: Usually prostate cancers are graded using Gleason's score or pattern. Gleason's grading for prostate primaries is based on a 5-component system (5 histologic patterns). Prostatic cancer generally shows two main histologic patterns. The primary pattern-that is, the pattern occupying greater than 50% of the cancer-is usually indicated by the first number of the Gleason's grade and the secondary pattern is usually indicated by the second number. These two numbers are added together to create a pattern score, ranging from 2 to 10. If the pathologist gives only one number and it is less than or equal to 5, assume that it describes a pattern. If only one number is given and it is greater than 5, assume that it is a score. If there are two numbers, assume that they refer to two patterns (the first number being the primary and the second number being the secondary) and sum them to obtain the score. Note 2: Record the Gleason's score based on the addition of the primary and secondary pattern. Code Description

000 Test not done (test was not ordered and was not performed)

002-010 Gleason's Score (See Notes 1 and 2)

999 Unknown or no information Not documented in patient record

Version date: January 1, 2004 526 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Testis C62.0-C62.1, C62.9 C62.0 Undescended testis C62.1 Descended testis C62.9 Testis, NOS

CS Tumor Size CS Site-Specific Factor 1 - Alpha The following tables are CS Extension Fetoprotein (AFP) available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - Human staging website: CS Lymph Nodes chorionic gonadotropin (hCG) Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 3 - LDH AJCC Stage Reg LN Pos CS Site-Specific Factor 4 - Radical Serum Marker S Value Table Reg LN Exam Orchiectomy Performed Extension Orchiectomy Table CS Mets at DX CS Site-Specific Factor 5 - Size of Number Positive Lymph Nodes CS Mets Eval Metastasis in Lymph Nodes and Size of Metastasis in Lymph CS Site-Specific Factor 6 Nodes

Testis CS Tumor Size SEE STANDARD TABLE

Testis CS Extension Note 1: Laterality must be coded for this site. Note 2: According to AJCC, "Except for pTis and pT4, extent of primary tumor for TNM is classified by radical orchiectomy. TX is used for other categories in the absence of radical orchiectomy." For Collaborative Staging, this means that the categories of T1, T2, and T3 are derived only when Site Specific Factor 4 indicates that a radical orchiectomy was performed. See the Extension Orchiectomy table for details. Code Description TNM SS77 SS2000

00 In situ: noninvasive; intraepithelial Tis IS IS Intratubular germ cell neoplasia

10 Invasive tumor WITHOUT vascular/lymphatic invasion, or * L L presence of vascular/lymphatic invasion or NOS Body of testis Rete testis Tunica albuginea

15 Invasive tumor WITH vascular/lymphatic invasion * L L Body of testis Rete testis Tunica albuginea

20 Tunica vaginalis involved * L L Surface implants

30 Localized, NOS * L L

31 Tunica, NOS TX L L

40 Epididymis involved WITHOUT vascular/lymphatic invasion, or * RE RE presence of vascular/lymphatic invasion not stated

45 Epididymis involved WITH vascular/lymphatic invasion * RE RE

Version date: January 1, 2004 527 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

50 Spermatic cord, ipsilateral * RE RE Vas deferens

60 Dartos muscle, ipsilateral T4 RE RE Scrotum, ipsilateral

70 Extension to scrotum, contralateral T4 D D Ulceration of scrotum

75 Penis T4 D D

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For extension codes 10, 15, 20, 30, 40, 45, and 50, the T category is assigned based on the values of CS Extension and Site-Specific Factor 4 (Radical Orchiectomy Performed), using the Extension/Orchiectomy extra table.

Testis CS TS/Ext-Eval SEE STANDARD TABLE

Testis CS Lymph Nodes Note 1: Regional nodes in codes 10-30 include contralateral and bilateral nodes. Note 2: Involvement of inguinal, pelvic, or external iliac lymph nodes in the absence of previous scrotal or inguinal surgery is coded in CS Mets at DX, as distant lymph node involvement. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph node(s) (bilateral and contralateral): * RN RN Aortic, NOS: Lateral (lumbar) Para-aortic Periaortic Preaortic Retroaortic Retroperitoneal, NOS Spermatic vein Regional lymph node(s), NOS

20 Regional lymph node(s) (bilateral and contralateral): * D RN Pericaval, NOS: Interaortocaval Paracaval Precaval Retrocaval

30 Regional lymph node(s) (bilateral and contralateral): * RN RN Pelvic, NOS External iliac WITH previous scrotal or inguinal surgery

Version date: January 1, 2004 528 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

40 Inguinal nodes, NOS: * D D Deep, NOS Node of Cloquet or Rosenmuller (highest deep inguinal) Superficial (femoral) WITH previous scrotal or inguinal surgery

50 Regional lymph node(s), NOS * RN RN

80 Lymph nodes, NOS * RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record * For codes 10, 20, 30, 40, 50, and 80 the N category is assigned from the Number Positive Lymph Nodes and Size of Metastasis in Lymph Nodes extra table using the values of Site Specific Factor 5 (Size of Metastasis in Lymph Nodes) and Reg LN Pos.

Testis CS Reg Nodes Eval SEE STANDARD TABLE

Testis Reg LN Pos SEE STANDARD TABLE

Testis Reg LN Exam SEE STANDARD TABLE

Testis CS Mets at DX Note: Involvement of inguinal, pelvic, or external iliac lymph nodes after previous scrotal or inguinal surgery is coded under CS Lymph Nodes, as regional node involvement. Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

11 Distant lymph node(s): M1a RN RN Pelvic, NOS External iliac WITHOUT previous scrotal or inguinal surgery, or unknown if previous scrotal or inguinal surgery

12 Distant lymph node(s): M1a D D Inguinal nodes, NOS: Deep, NOS Node of Cloquet or Rosenmuller (highest deep inguinal) Superficial (femoral) WITHOUT previous scrotal or inguinal surgery, or unknown if previous scrotal or inguinal surgery

13 Specified distant lymph node(s), other than code (11) or (12) M1a D D Distant lymph node(s), NOS

Version date: January 1, 2004 529 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

20 Distant metastasis to lung M1a D D

25 Distant metastases to lung and lymph node(s) (20) + any of [(11) to M1a D D (13)]

40 Metastasis to other distant sites (WITH or WITHOUT metastasis to M1b D D lung and/or distant lymph node(s)) Carcinomatosis

45 Distant metastasis, NOS M1NOS D D

99 Unknown MX U U Distant metastasis cannot be assessed Not documented in patient record

Testis CS Mets Eval SEE STANDARD TABLE

Testis CS Site-Specific Factor 1 Alpha Fetoprotein (AFP) Code Description

000 Test not done (SX)

020 Within normal limits (S0)

040 Range 1 (S1) less than 1,000 ng/ml

050 Range 2 (S2) 1,000 -10,000 ng/ml

060 Range 3 (S3) greater than 10,000 ng/ml

080 Ordered, but results not in chart

999 Unknown or no information Not documented in patient record

Testis CS Site-Specific Factor 2 Human Chorionic Gonadotropin (hCG) Code Description

000 Test not done (SX)

020 Within normal limits (S0)

040 Range 1 (S1) less than 5,000 mIU/ml

050 Range 2 (S2) 5,000 - 50,000 mIU/ml

060 Range 3 (S3) greater than 50,000 mIU/ml

080 Ordered, but results not in chart

999 Unknown or no information Not documented in patient record

Version date: January 1, 2004 530 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Testis CS Site-Specific Factor 3 LDH (Lactate Dehydrogenase) Code Description

000 Test not done (SX)

020 Within normal limits (S0)

040 Range 1 (S1) 1.5 x N (N equals the upper limit of normal for LDH)

050 Range 2 (S2) 1.5 - 10 x N (N equals the upper limit of normal for LDH)

060 Range 3 (S3) greater than 10 x N (N equals the upper limit of normal for LDH)

080 Ordered, but results not in chart

999 Unknown or no information Not documented in patient record

Testis CS Site-Specific Factor 4 Radical Orchiectomy Performed Code Description

000 Radical orchiectomy not performed

001 Radical orchiectomy performed

999 Unknown if radical orchiectomy performed

Testis CS Site-Specific Factor 5 Size of Metastasis in Lymph Nodes Note: For CS Lymph Nodes codes 10, 20, 30, 40 and 50, the N category is assigned based on the values in the Site Specific Factor 5 Table below and the Number Lymph Nodes Positive and Size of Lymph Node Metastasis Extra Table. Code Description

000 No lymph node metastasis

001 Lymph node metastasis mass 2 cm or less in greatest dimension No extranodal extension of tumor

002 Lymph node metastasis mass more than 2 cm but not more than 5 cm in greatest dimension Extranodal extension of tumor

003 Lymph node metastasis mass more than 5 cm in greatest dimension

998 Regional lymph node(s) involved, size of lymph node mass, number of positive lymph nodes and extranodal extension status not stated

999 Unknown if regional nodes involved Not documented in patient record

Version date: January 1, 2004 531 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Testis CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 532 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) C63.0-C63.1, C63.7-C63.9 C63.0 Epididymis C63.1 Spermatic cord C63.7 Other specified parts of male genital organs C63.8 Overlapping lesion of male genital organs C63.9 Male genital organs, NOS Note 1: AJCC does not define TNM staging for this site. Note 2: Laterality must be coded for C63.0-C63.1. Note 3: Carcinoma of the scrotum is included in the scrotum schema. Melanoma (M-8720-8790) of scrotum is included in the melanoma skin schema. Mycosis fungoides (M-9700) or Sezary disease (M-9701) of scrotum is included in the mycosis fungoides schema. Melanoma, mycosis fungoides, or Sezary disease of any other site listed is coded using this schema. Kaposi sarcoma of all sites is included in the Kaposi sarcoma schema, and lymphomas of all sites are included in the lymphoma schema.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Tumor Size SEE STANDARD TABLE

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Extension Code Description TNM SS77 SS2000

00 In situ: noninvasive; intraepithelial NA IS IS

10 Confined to site of origin NA L L

30 Localized, NOS NA L L

40 Adjacent connective tissue NA RE RE (See definition of connective tissue in the general instructions)

60 Adjacent organs/structures: NA RE RE Male genital organs: Penis Prostate Testis Sites in this schema which are not the primary

80 Further contiguous extension NA D D Other organs and structures in male pelvis: Bladder Rectum Urethra

Version date: January 1, 2004 533 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Regional lymph node(s) NA RN RN Iliac, NOS: External Internal (hypogastric), NOS: Obturator Inguinal, NOS: Deep inguinal, NOS: Node of Cloquet or Rosenmuller (highest deep inguinal) Superficial inguinal (femoral) Pelvic, NOS Regional lymph node(s), NOS

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) Reg LN Pos SEE STANDARD TABLE

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 534 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 535 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Other and Unspecified Male Genital Organs (excluding: Kaposi Sarcoma and Lymphoma) CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 536 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] C63.2 Scrotum, NOS Note: Melanoma (M-8720-8790) of scrotum is included in the melanoma schema. Mycosis Fungoides (M-9700) or Sezary disease (M-9701) of scrotum is included in the Mycosis Fungoides schema. Kaposi sarcoma of the scrotum is included in the Kaposi Sarcoma schema. Lymphoma of the scrotum is included in the lymphoma schema.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Tumor Size SEE STANDARD TABLE

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepidermal Tis IS IS

10 Confined to scrotum * L L

30 Localized, NOS * L L

40 Adjacent connective tissue * RE RE (See definition of connective tissue in general instructions)

60 Adjacent organs/structures T4 RE RE Male genital organs: Epididymis Penis Prostate Spermatic cord Testis

80 Further contiguous extension T4 D D Other organs and structures in male pelvis: Bladder Rectum Urethra

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For CS Extension codes 10, 30 and 40 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size table for this site.

Version date: January 1, 2004 537 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS TS/Ext-Eval SEE STANDARD TABLE

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph nodes N1 RN RN Iliac, NOS: External Internal (hypogastric), NOS: Obturator Inguinal, NOS: Deep inguinal, NOS Node of Cloquet or Rosenmuller (highest deep inguinal) Superficial inguinal (femoral) Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Reg Nodes Eval SEE STANDARD TABLE

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] Reg LN Pos SEE STANDARD TABLE

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] Reg LN Exam SEE STANDARD TABLE

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Mets at DX SEE STANDARD TABLE

Version date: January 1, 2004 538 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Mets Eval SEE STANDARD TABLE

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Scrotum [excl. Malignant Melanoma, Kaposi Sarcoma, Mycosis Fungoides, Sezary Disease, and Other Lymphomas] CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 539 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 540 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Kidney (Renal Parenchyma) C64.9 C64.9 Kidney, NOS (Renal parenchyma) Note: Laterality must be coded for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Kidney (Renal Parenchyma) CS Tumor Size SEE STANDARD TABLE

Kidney (Renal Parenchyma) CS Extension Note: The parenchyma of the kidney includes the following structures: cortex (outer layer of kidney) and renal columns; medulla, medullary rays, renal pyramids, and renal papillae; nephrons (renal corpuscle, loops of Henle, proximal and distal tubules, collecting duct), glomerulus, and 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 would be coded to 10 unless there were further signs of involvement. Code Description TNM SS77 SS2000

00 In situ Tis IS IS

10 Invasive cancer confined to kidney cortex and/or medulla * L L

20 Invasion of renal capsule * L L Renal pelvis or calyces involved Separate focus of tumor in renal pelvis/calyx

30 Localized, NOS * L L

39 Stated as T3, NOS T3NOS RE RE

40 Adrenal (suprarenal) gland, ipsilateral T3a RE RE Perirenal (perinephric) tissue/fat Renal (Gerota's) fascia Renal sinus fat Retroperitoneal soft tissue

60 Blood vessels: T3b RE RE Extrarenal portion of renal vein or segmental branches Hilar blood vessel Inferior vena cava below diaphragm Perirenal vein Renal artery Renal vein, NOS Tumor thrombus in a renal vein, NOS

62 Vena cava above diaphragm or invades the wall of the vena cava T3c RE RE

Version date: January 1, 2004 541 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

65 Extension beyond Gerota's fascia to: T4 RE RE Ascending colon from right kidney Descending colon from left kidney Diaphragm Duodenum from right kidney Peritoneum Tail of pancreas Ureter, including implant(s), ipsilateral

67 Extension beyond Gerota's fascia to: T4 D RE Psoas muscle

70 Ribs T4 D D

75 Liver T4 D D Spleen Stomach

80 Further contiguous extension T4 D D Aorta Contralateral Adrenal (suprarenal) gland Kidney Ureter Other direct extension

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For codes 10, 20, and 30 ONLY, the T category is assigned based on the value of tumor size, as shown in the Extension Size Table for this site.

Kidney (Renal Parenchyma) CS TS/Ext-Eval SEE STANDARD TABLE

Kidney (Renal Parenchyma) CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Single regional lymph node: N1 RN RN Aortic, NOS: Lateral (lumbar) Para-aortic Periaortic Renal hilar Retroperitoneal, NOS Regional lymph node(s), NOS

11 Single regional lymph node: N1 D RN Paracaval

Version date: January 1, 2004 542 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

15 (10) + (11) including: N2 D RN Single regional lymph node as specified in code 10 PLUS single paracaval node

40 More than one regional lymph node (including contralateral or N2 D RN bilateral nodes) other than as defined in code 15

70 Regional lymph node(s), NOS N1 RN RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Kidney (Renal Parenchyma) CS Reg Nodes Eval SEE STANDARD TABLE

Kidney (Renal Parenchyma) Reg LN Pos SEE STANDARD TABLE

Kidney (Renal Parenchyma) Reg LN Exam SEE STANDARD TABLE

Kidney (Renal Parenchyma) CS Mets at DX SEE STANDARD TABLE

Kidney (Renal Parenchyma) CS Mets Eval SEE STANDARD TABLE

Kidney (Renal Parenchyma) CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Kidney (Renal Parenchyma) CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Version date: January 1, 2004 543 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Kidney (Renal Parenchyma) CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Kidney (Renal Parenchyma) CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Kidney (Renal Parenchyma) CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Kidney (Renal Parenchyma) CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 544 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Renal Pelvis and Ureter C65.9, C66.9 C65.9 Renal pelvis C66.9 Ureter Note: Laterality must be coded for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Renal Pelvis and Ureter CS Tumor Size SEE STANDARD TABLE

Renal Pelvis and Ureter CS Extension Note: If CS Extension code is 00 or 05, Behavior Code must be 2. If CS Extension code is 10, Behavior Code must be 3. Code Description TNM SS77 SS2000

00 Carcinoma in situ, NOS Tis IS IS Non-invasive, intraepithelial

05 Papillary noninvasive carcinoma Ta IS IS

10 Subepithelial connective tissue (lamina propria, submucosa) T1 L L invaded

20 Muscularis invaded T2 L L

30 Localized, NOS T1 L L

40 Extension to adjacent (connective) tissue: T3 RE RE Peripelvic/periureteric tissue Retroperitoneal soft/connective tissue

60 For renal pelvis only: T3 RE RE Ipsilateral kidney parenchyma and kidney, NOS

62 Ureter from renal pelvis T4 RE RE

63 Psoas muscle from ureter T4 RE RE

65 Extension to bladder from ureter T4 RE RE Implants in ureter

66 Extension to major blood vessel(s): T4 RE RE Aorta Renal artery/vein Vena cava (inferior) Tumor thrombus in a renal vein, NOS

Version date: January 1, 2004 545 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

67 Adrenal (suprarenal) gland from renal pelvis T4 RE RE

68 Duodenum from right renal pelvis or right ureter T4 RE RE

70 Extension to: T4 D D Ascending colon from right renal pelvis Bladder (wall or mucosa) from renal pelvis Colon, NOS Descending colon from left renal pelvis Ipsilateral kidney parenchyma from ureter Liver Pancreas Perinephric fat via kidney Spleen

75 Ascending colon from right ureter T4 RE D Descending colon from left ureter

80 Further contiguous extension, including: T4 D D For ureter: Prostate Uterus

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Renal Pelvis and Ureter CS TS/Ext-Eval SEE STANDARD TABLE

Renal Pelvis and Ureter CS Lymph Nodes Note: Measure the size of the metastasis in the lymph node to determine codes 10-30, not the size of the lymph node itself. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Single regional lymph node, less than or equal to 2 cm: N1 RN RN Renal pelvis: Aortic, NOS: Lateral (lumbar) Para-aortic Periaortic Paracaval Renal hilar Retroperitoneal, NOS Regional lymph node(s), NOS Ureter: Iliac, NOS: Common External Internal (hypogastric), NOS Obturator

Version date: January 1, 2004 546 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

10, Lateral aortic (lumbar) cont’d Paracaval Pelvic, NOS Periureteral Renal hilar Retroperitoneal, NOS Regional lymph node(s), NOS

20 Regional lymph nodes as listed in code 10 N2 RN RN Single regional lymph node greater than 2 - 5 cm OR multiple regional nodes, none greater than 5 cm

30 Regional lymph nodes as listed in code 10 N3 RN RN Regional lymph node(s), at least one greater than 5 cm

50 Regional lymph node(s), NOS (size and/or number not stated) N1 RN RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Renal Pelvis and Ureter CS Reg Nodes Eval SEE STANDARD TABLE

Renal Pelvis and Ureter Reg LN Pos SEE STANDARD TABLE

Renal Pelvis and Ureter Reg LN Exam SEE STANDARD TABLE

Renal Pelvis and Ureter CS Mets at DX SEE STANDARD TABLE

Renal Pelvis and Ureter CS Mets Eval SEE STANDARD TABLE

Renal Pelvis and Ureter CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Version date: January 1, 2004 547 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Renal Pelvis and Ureter CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Renal Pelvis and Ureter CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Renal Pelvis and Ureter CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Renal Pelvis and Ureter CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Renal Pelvis and Ureter CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 548 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Bladder C67.0-C67.9 C67.0 Trigone of bladder C67.1 Dome of bladder C67.2 Lateral wall of bladder C67.3 Anterior wall of bladder C67.4 Posterior wall of bladder C67.5 Bladder neck C67.6 Ureteric orifice C67.7 Urachus C67.8 Overlapping lesion of bladder C67.9 Bladder, NOS

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Bladder CS Tumor Size SEE STANDARD TABLE

Bladder CS Extension 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. 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." For Bladder Cases Only, Definite Statements of Non-invasion (Extension code 01) 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'. For Bladder Cases Only, Inferred Descriptions of Non- invasion (Extension code 03) 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 cells'; 'No mural infiltration'; 'No evidence of invasion (no sampled stroma)'. Note 2: The lamina propria and submucosa tend to merge when there is no muscularis mucosae, so these terms will be used interchangeably.

Version date: January 1, 2004 549 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Note 3: 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 4: If Extension code is 00-06, Behavior Code must be 2. If Extension code is 10, Behavior Code may be 2 or 3. If Extension code is 15 or greater, Behavior Code must be 3. Note 5: Statements meaning Confined to Mucosa, NOS (code 10): Confined to mucosal surface Limited to mucosa, no invasion of submucosa and muscularis No infiltration/invasion of fibromuscular and muscular stroma Superficial, NOS. Note 6: If a tumor is described as confined to mucosa (or the equivalents in Note 5) AND as papillary, use extension code 01 or 03. Use code 10 (confined to mucosa) only if the tumor is described as confined to mucosa but is not described as papillary. Note 7: Periureteral in code 40 refers only to that portion of the ureter that is intramural to the bladder. All other periureteral involvement would be coded to 60. Code Description TNM SS77 SS2000

01 PAPILLARY transitional cell carcinoma, stated to be noninvasive Ta IS IS Papillary non-infiltrating Jewett-Strong-Marshall Stage 0 TNM/AJCC Ta (See Note 1.)

03 PAPILLARY transitional cell carcinoma, with inferred description Ta IS IS of non-invasion (See Note 1.)

06 Sessile (flat) (solid) carcinoma in situ Tis IS IS Carcinoma in situ, NOS Transitional cell carcinoma in situ TNM/AJCC Tis Jewett-Strong-Marshall CIS

10 Confined to mucosa, NOS Tis L L

15 Invasive tumor confined to subepithelial connective tissue (tunica T1 L L propria, lamina propria, submucosa, stroma) TNM/AJCC T1 Jewett-Strong-Marshall Stage A

20 Muscle (muscularis) invaded, NOS T2NOS L L

21 Muscle (muscularis) invaded: T2a L L Superficial muscle--inner half

22 Muscle (muscularis) invaded: T2b L L Deep muscle--outer half

23 Extension through full thickness of bladder wall T3a L L

30 Localized, NOS T1 L L

40 Adventitia T3NOS RE RE Perivesical fat/tissue, NOS Periureteral fat/tissue Extension to/through serosa (mesothelium) Peritoneum

41 Extension to perivesical fat (microscopic) T3a RE RE

42 Extension to perivesical fat (macroscopic) T3b RE RE Extravesical mass

45 Stated as T4, NOS T4NOS RE RE

Version date: January 1, 2004 550 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60 Prostate T4a RE RE Urethra, including prostatic urethra Ureter

65 Vas deferens; seminal vesicle T4a RE RE Rectovesical/Denonvilliers' fascia Parametrium

67 Uterus T4a RE RE Vagina

70 Bladder is FIXED T4b RE RE

75 Pelvic wall T4b D D Abdominal wall

80 Further contiguous extension, including: T4b D D Rectum, male Pubic bone Sigmoid

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Bladder CS TS/Ext-Eval Note: According to AJCC, staging basis for transurethral resection of bladder tumor (TURBT) is clinical and is recorded as CS TS/Ext-Eval "1" (c). Code Description Staging Basis

0 No surgical resection done. Evaluation based on physical examination, imaging c examination, or other non-invasive clinical evidence. No autopsy evidence used.

1 No surgical resection done. Evaluation based on endoscopic examination, diagnostic c biopsy, including fine needle aspiration biopsy, or other invasive techniques including surgical observation without biopsy. No autopsy evidence used.

2 No surgical resection done, but evidence derived from autopsy (tumor was suspected or p diagnosed prior to autopsy).

3 Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation p OR surgical resection performed, unknown if pre-surgical systemic treatment or radiation performed. Evidence acquired before treatment, supplemented or modified by the additional evidence acquired during and from surgery, particularly from pathologic examination of the resected specimen.

5 Surgical resection performed WITH pre-surgical systemic treatment or radiation, c BUT tumor size/extension based on clinical evidence.

6 Surgical resection performed WITH pre-surgical systemic treatment or radiation; y tumor size/extension based on pathologic evidence.

Version date: January 1, 2004 551 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

8 Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy). a

9 Unknown if surgical resection done c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record

Bladder CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: Measure the size of the metastasis in the lymph node to determine codes 10-30, not the size of the lymph node itself. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph nodes (including contralateral or bilateral nodes): N1 RN RN Perivesical Iliac: Internal (hypogastric) Obturator External Iliac, NOS Sacral (lateral, presacral, sacral promontory (Gerota's), or NOS) Pelvic, NOS Regional lymph node(s), NOS Single regional lymph node less than or equal to 2 cm

20 Single regional lymph node greater than 2 cm and less than or equal N2 RN RN to 5 cm OR multiple regional nodes, none greater than 5 cm

30 Regional lymph node(s), at least one greater than 5 cm N3 RN RN

50 Regional lymph node(s), NOS (size and/or number not stated) N1 RN RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Bladder CS Reg Nodes Eval SEE STANDARD TABLE

Bladder Reg LN Pos SEE STANDARD TABLE

Bladder Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 552 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Bladder CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s): Common iliac M1 D D

11 Distant lymph node(s), NOS M1 D D Specified distant lymph node(s) other than code (10)

40 Distant metastases, except distant lymph node(s) (code 10 or 11) M1 D D Distant metastasis, NOS Carcinomatosis

50 (40) + any of [(10) or (11)] M1 D D

99 Unknown MX U U Distant metastasis cannot be assessed Not documented in patient record

Bladder CS Mets Eval SEE STANDARD TABLE

Bladder CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Bladder CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Bladder CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Bladder CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 553 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Bladder CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Bladder CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 554 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Urethra C68.0 C68.0 Urethra Note: Transitional cell carcinoma of the prostatic ducts and prostatic urethra are to be coded to urethra (C68.0) according to this schema.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Reg LN Exam CS Mets at DX CS Mets Eval

Urethra CS Tumor Size SEE STANDARD TABLE

Urethra CS Extension Note: If CS Extension code is 00 or 05, Behavior Code must be 2. If CS Extension code is 10, Behavior Code must be 3. Code Description TNM SS77 SS2000

00 Carcinoma in situ, NOS Tis IS IS

01 Carcinoma in situ, involvement of prostatic urethra Tispu IS IS

02 Carcinoma in situ, involvement of prostatic ducts Tispd IS IS

05 Noninvasive papillary, polypoid, or verrucous carcinoma Ta IS IS Note: Code 05 does not apply to transitional cell carcinoma of prostatic urethra or prostatic ducts

10 Subepithelial connective tissue (lamina propria, submucosa) T1 L L invaded

20 Muscularis invaded T2 L L

30 Localized, NOS T1 L L

40 Corpus spongiosum T2 RE RE Periurethral muscle (sphincter) Prostate

60 Beyond the prostatic capsule T3 RE RE Bladder neck Corpus cavernosum Vagina, anterior or NOS

70 Other adjacent organs, including T4 D D Bladder (excluding bladder neck) Seminal vesicle(s)

80 Further contiguous extension T4 D D

Version date: January 1, 2004 555 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Urethra CS TS/Ext-Eval SEE STANDARD TABLE

Urethra CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: Measure the size of the metastasis in the lymph node to determine codes 10-30, not the size of the lymph node itself. Code Description TNM SS77 SS2000

00 No regional lymph node involvement N0 NONE NONE

10 Regional lymph nodes (including contralateral or bilateral nodes): N1 RN RN Iliac, NOS: Common External Internal (hypogastric), NOS: Obturator Inguinal, NOS: Deep Node of Cloquet or Rosenmuller (highest deep inguinal) Superficial (femoral) Pelvic, NOS Sacral, NOS Presacral Regional lymph node(s), NOS Single regional lymph node less than or equal to 2 cm

20 Single regional lymph node greater than 2 - 5 cm N2 RN RN OR multiple regional nodes, none greater than 5 cm

30 Regional lymph node(s), at least one greater than 5 cm N2 RN RN

50 Regional lymph node(s), NOS (size and/or number not stated) N1 RN RN

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Urethra CS Reg Nodes Eval SEE STANDARD TABLE

Version date: January 1, 2004 556 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Urethra Reg LN Pos SEE STANDARD TABLE

Urethra Reg LN Exam SEE STANDARD TABLE

Urethra CS Mets at DX SEE STANDARD TABLE

Urethra CS Mets Eval SEE STANDARD TABLE

Urethra CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Urethra CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Urethra CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Urethra CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 557 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Urethra CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Urethra CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 558 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs C68.1, C68.8-C68.9 C68.1 Paraurethral gland C68.8 Overlapping lesion of urinary organs C68.9 Urinary system, NOS Note: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Tumor Size SEE STANDARD TABLE

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Extension Note: If CS Extension code is 00 or 05, Behavior code must be 2. If CS Extension code is 10, Behavior Code must be 3. Code Description TNM SS77 SS2000

00 Carcinoma in situ, NOS (See Note) NA IS IS

05 Noninvasive papillary, polypoid, or verrucous carcinoma (See NA IS IS Note)

10 Subepithelial connective tissue (lamina propria, submucosa) NA L L invaded (See Note)

20 Muscularis invaded NA L L

30 Localized, NOS NA L L

40 Corpus spongiosum NA RE RE Periurethral muscle (sphincter) Prostate

60 Beyond the prostatic capsule NA RE RE Bladder neck Corpus cavernosum Vagina, anterior or NOS

70 Other adjacent organs, including NA D D Bladder (excluding bladder neck) Seminal vesicle(s)

80 Further contiguous extension NA D D

Version date: January 1, 2004 559 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 No regional lymph node involvement NA NONE NONE

10 Regional lymph nodes (including contralateral or bilateral nodes): NA RN RN Iliac, NOS: Common External Internal (hypogastric), NOS: Obturator Inguinal, NOS: Deep Node of Cloquet or Rosenmuller (highest deep inguinal) Superficial (femoral) Pelvic, NOS Sacral, NOS Presacral Regional lymph node(s), NOS

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Version date: January 1, 2004 560 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs Reg LN Pos SEE STANDARD TABLE

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs Reg LN Exam SEE STANDARD TABLE

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Version date: January 1, 2004 561 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Paraurethral Gland, Overlapping Lesion of Urinary Organs, and Unspecified Urinary Organs CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 562 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] C69.0 C69.0 Conjunctiva Note: Laterality must be coded for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Tumor Size SEE STANDARD TABLE

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Tumor confined to conjunctiva * L L

30 Localized, NOS * L L

40 Intraocular extension T3 L L

50 Adjacent extraocular extension, excluding orbit T3 RE RE Eyelid

70 Orbit, NOS T4NOS RE RE

71 Orbital soft tissues without bone invasion T4a RE RE

72 Bone of orbit T4b RE RE

78 Adjacent paranasal sinuses T4c RE RE

79 Brain T4d D D

80 Further contiguous extension T4NOS D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10 and 30 ONLY, T category is assigned based on value of CS Tumor Size, as shown in Extension Size Table. Tumors 5mm or less are T1. Tumors more than 5mm are T2.

Version date: January 1, 2004 563 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS TS/Ext-Eval SEE STANDARD TABLE

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Lymph Nodes Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph nodes N1 RN RN Cervical Mandibular, NOS: Submandibular (submaxillary) Parotid, NOS: Infra-auricular Preauricular Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Reg Nodes Eval SEE STANDARD TABLE

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] Reg LN Pos SEE STANDARD TABLE

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] Reg LN Exam SEE STANDARD TABLE

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Mets at DX SEE STANDARD TABLE

Version date: January 1, 2004 564 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Mets Eval SEE STANDARD TABLE

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Conjunctiva [excl. Retinoblastoma, Malignant Melanoma, Kaposi Sarcoma, and Lymphoma] CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 565 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 566 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Conjunctiva C69.0 (M-8720-8790) C69.0 Conjunctiva Note: Laterality must be coded for this site.

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Measured Thickness (Depth), available at the collaborative CS TS/Ext-Eval Breslow's Measurement staging website: CS Lymph Nodes CS Site-Specific Factor 2 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 3 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 4 AJCC Stage for TNM sites with Reg LN Exam CS Site-Specific Factor 5 no stage groupings CS Mets at DX CS Site-Specific Factor 6 CS Mets Eval

Malignant Melanoma of Conjunctiva CS Tumor Size Note: Record the size of the tumor in the CS Tumor Size table below, not depth or thickness. Depth or thickness is recorded in Site Specific Factor 1 in the Measured Thickness (Depth), Breslow's Measurement table. Code Description

000 No mass/tumor found

001-988 001 - 988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

999 Unknown; size not stated Not documented in patient record

Malignant Melanoma of Conjunctiva CS Extension Code Description TNM SS77 SS2000

00 In situ Tis IS IS

10 Tumor(s) of bulbar conjunctiva confined to the epithelium T1 L L occupying more one quadrant or less

12 Tumor(s) of bulbar conjunctiva confined to the epithelium T1 L L occupying more than one quadrant

Version date: January 1, 2004 567 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

15 Tumor(s) of bulbar conjunctiva, NOS T1 L L

30 Localized, NOS T1 L L

40 Tumor of bulbar conjunctiva, thickness not stated, WITH T2 RE RE invasion of substantia propria (or with corneal extension, NOS)

41 Tumor of bulbar conjunctiva, not more than 0.8 mm in thickness, T2 RE RE WITH invasion of substantia propria (or with corneal extension, NOS)

42 Tumor of bulbar conjunctiva, more than 0.8 mm in thickness, T3 RE RE WITH invasion of substantia propria (or with corneal extension, NOS)

44 Tumor involves: T3 L L Caruncle Conjunctival fornix Palpebral conjunctiva

46 (44) + any of [(40) or (42)] T3 RE RE

70 Extension to: T4 RE RE Eyelid Globe Orbit

80 Further contiguous extension, including: T4 D D Central nervous system Sinuses

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Malignant Melanoma of Conjunctiva CS TS/Ext-Eval SEE STANDARD TABLE

Malignant Melanoma of Conjunctiva CS Lymph Nodes Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph nodes N1 RN RN Cervical Mandibular, NOS: Submandibular (submaxillary) Parotid, NOS: Infra-auricular Preauricular Regional lymph node(s), NOS

Version date: January 1, 2004 568 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Malignant Melanoma of Conjunctiva CS Reg Nodes Eval SEE STANDARD TABLE

Malignant Melanoma of Conjunctiva Reg LN Pos SEE STANDARD TABLE

Malignant Melanoma of Conjunctiva Reg LN Exam SEE STANDARD TABLE

Malignant Melanoma of Conjunctiva CS Mets at DX SEE STANDARD TABLE

Malignant Melanoma of Conjunctiva CS Mets Eval SEE STANDARD TABLE

Malignant Melanoma of Conjunctiva CS Site-Specific Factor 1 Measured Thickness (Depth), Breslow's Measurement Note: Code MEASURED THICKNESS (Depth) of tumor (Breslow's measurement), not size. Record actual measurement in millimeters from the pathology report. Code Description

000 No mass/tumor found

001-988 0.01 - 9.88 millimeters Code exact measurement in HUNDREDTHS of millimeters. Examples: 001 0.01 millimeter 002 0.02 millimeters 010 0.1 millimeter 074 0.74 millimeters 100 1 millimeters 105 1.05 millimeters 988 9.88 millimeters

989 9.89 millimeters or larger

990 Microinvasion; microscopic focus or foci only; no size given

999 Unknown; size not stated Not documented in patient record

Version date: January 1, 2004 569 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Conjunctiva CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Malignant Melanoma of Conjunctiva CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Malignant Melanoma of Conjunctiva CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Malignant Melanoma of Conjunctiva CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Malignant Melanoma of Conjunctiva CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 570 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] C69.1-C69.4, C69.8-C69.9 C69.1 Cornea, NOS C69.2 Retina C69.3 Choroid C69.4 Ciliary body C69.8 Overlapping lesion of eye and adnexa C69.9 Eye, NOS Note 1: Laterality must be coded for this site. Note 2: AJCC does not define TNM staging for this site. Note 3: AJCC includes primary site C69.8 (Overlapping lesions of eye and adnexa) in its chapter 46, Sarcoma of the Orbit. Collaborative Staging excludes melanomas and retinoblastomas from this schema. All other histologies are included with this schema.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Tumor Size SEE STANDARD TABLE

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Extension Code Description TNM SS77 SS2000

00 In situ NA IS IS

10 Tumor confined to site of origin NA L L

30 Localized, NOS NA L L

40 Intraocular extension NA L L

70 Adjacent extraocular extension: NA RE RE Eyelid Orbit

80 Further contiguous extension NA D D

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Version date: January 1, 2004 571 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Regional lymph nodes NA RN RN Cervical Mandibular, NOS: Submandibular (submaxillary) Parotid, NOS: Infra-auricular Preauricular Regional lymph node(s), NOS

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] Reg LN Pos SEE STANDARD TABLE

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 572 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Version date: January 1, 2004 573 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Cornea, Retina, Choroid, Ciliary Body (Iris, Lens, Sclera, Uveal Tract), Eyeball, Overlapping and Other Eye [Excluding Melanoma and Retinoblastoma] CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 574 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Iris and Ciliary Body C69.4 (M-8720-8790) C69.4 Ciliary Body and Iris Note: Laterality must be coded for these sites

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Measured Thickness (Depth), available at the collaborative CS TS/Ext-Eval Breslow's Measurement staging website: CS Lymph Nodes CS Site-Specific Factor 2 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 3 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 4 AJCC Stage Reg LN Exam CS Site-Specific Factor 5 CS Mets at DX CS Site-Specific Factor 6 CS Mets Eval

Malignant Melanoma of Iris and Ciliary Body CS Tumor Size SEE STANDARD TABLE

Malignant Melanoma of Iris and Ciliary Body CS Extension Note 1: AJCC 6th Edition states that when basal dimension and apical height do not fit this classification, the largest diameter should be used for classification. In clinical practice the tumor base may be estimated in optic disc diameters (dd) (average: 1 dd = 1.5mm). The elevation may be estimated in diopters (average: 3 diopters = 1 mm). Other techniques, such as ultrasonography and computerized stereometry, may provide a more accurate measurement. Note 2: Iris and ciliary body are both included in the ICD-O-3 site code of C69.4, so they are in the same Collaborative Staging schema. However, they are staged with different criteria by AJCC. Many of the extension codes below are marked as applicable to either iris or ciliary body only. Any code not so marked may be used for either site. Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 FOR IRIS PRIMARY ONLY: T1NOS L L Confined to iris, NOS

11 FOR IRIS PRIMARY ONLY: T1a L L Limited to iris not more than 3 clock hours in size, WITHOUT melanomalytic glaucoma, or not stated if melanomalytic glaucoma

13 FOR IRIS PRIMARY ONLY: T1b L L Limited to iris more than 3 clock hours in size, WITHOUT melanomalytic glaucoma, or not stated if melanomalytic glaucoma

14 FOR IRIS PRIMARY ONLY: T1c L L Limited to iris WITH melanomalytic glaucoma

21 FOR CILIARY BODY PRIMARY ONLY: T1NOS L L Tumor 10 mm or less in greatest diameter and 2.5 mm or less in greatest height (thickness), not stated if extraocular extension present (See Note 1.)

Version date: January 1, 2004 575 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

22 FOR CILIARY BODY PRIMARY ONLY: T1a L L Tumor 10 mm or less in greatest diameter and 2.5 mm or less in greatest height (thickness), WITHOUT microscopic or macroscopic extraocular extension. (See Note 1.)

23 FOR CILIARY BODY PRIMARY ONLY: T1b L L Tumor 10 mm or less in greatest diameter and 2.5 mm or less in greatest height (thickness), WITH microscopic extraocular extension. (See Note 1.)

24 FOR CILIARY BODY PRIMARY ONLY: T1c L L Tumor 10 mm or less in greatest diameter and 2.5 mm or less in greatest height (thickness), WITH macroscopic extraocular extension. (See Note 1.)

30 Localized, NOS T1NOS L L Diameter and/or thickness in clock hours or mm not stated

41 FOR IRIS PRIMARY ONLY: T2NOS L L Tumor confluent with or extending into the ciliary body and/or choroid WITHOUT melanomalytic glaucoma, or not stated if melanomalytic glaucoma

42 FOR IRIS PRIMARY ONLY: T2a L L Tumor confluent with or extending into the ciliary body and/or choroid WITH melanomalytic glaucoma

51 FOR CILIARY BODY PRIMARY ONLY: T2NOS L L Tumor greater than 10 mm but not more than 16 mm in greatest basal diameter and between 2.5 mm and 10 mm in maximum height (thickness), not stated if extraocular extension present (See Note 1.)

52 FOR CILIARY BODY PRIMARY ONLY: T2a L L Tumor greater than 10 mm but not more than 16 mm in greatest basal diameter and between 2.5 mm and 10 mm in maximum height (thickness), WITHOUT microscopic or macroscopic extraocular extension present. (See Note 1.)

53 FOR CILIARY BODY PRIMARY ONLY: T2b RE RE Tumor greater than 10 mm but not more than 16 mm in greatest basal diameter and between 2.5 mm and 10 mm in maximum height (thickness), WITH microscopic extraocular extension present. (See Note 1.)

54 FOR CILIARY BODY PRIMARY ONLY: T2c RE RE Tumor greater than 10 mm but not more than 16 mm in greatest basal diameter and between 2.5 mm and 10 mm in maximum height (thickness), WITH macroscopic extraocular extension present. (See Note 1.)

60 FOR IRIS PRIMARY ONLY: T3NOS L L Tumor confluent with or extending into the ciliary body and/or choroid WITH scleral extension, WITHOUT melanomalytic glaucoma, or not stated if melanomalytic glaucoma

Version date: January 1, 2004 576 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

61 FOR IRIS PRIMARY ONLY: T3a L L Tumor confluent with or extending into the ciliary body and/or choroid WITH scleral extension, AND melanomalytic glaucoma

65 FOR IRIS PRIMARY ONLY: T4 RE RE Extraocular extension

71 FOR CILIARY BODY PRIMARY ONLY: T3NOS L L Tumor more than 16 mm in greatest basal diameter and/or greater than 10 mm in maximum height (thickness), WITHOUT extraocular extension or not stated if extraocular extension present. (See Note 1.)

75 FOR CILIARY BODY PRIMARY ONLY: T4 RE RE Tumor more than 16 mm in greatest basal diameter and/or greater than 10 mm in maximum height (thickness), WITH extraocular extension. (See Note 1.)

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Malignant Melanoma of Iris and Ciliary Body CS TS/Ext-Eval SEE STANDARD TABLE

Malignant Melanoma of Iris and Ciliary Body CS Lymph Nodes Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph nodes N1 RN RN Cervical Parotid (preauricular) Submandibular Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Malignant Melanoma of Iris and Ciliary Body CS Reg Nodes Eval SEE STANDARD TABLE

Version date: January 1, 2004 577 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Iris and Ciliary Body Reg LN Pos SEE STANDARD TABLE

Malignant Melanoma of Iris and Ciliary Body Reg LN Exam SEE STANDARD TABLE

Malignant Melanoma of Iris and Ciliary Body CS Mets at DX SEE STANDARD TABLE

Malignant Melanoma of Iris and Ciliary Body CS Mets Eval SEE STANDARD TABLE

Malignant Melanoma of Iris and Ciliary Body CS Site-Specific Factor 1 Measured Thickness (Depth), Breslow's Measurement Note: Code MEASURED THICKNESS (Depth) of tumor (Breslow's measurement), not size. Record actual measurement in millimeters from the pathology report. Code Description

000 No mass/tumor found

001-988 0.01 - 9.88 millimeters Code exact measurement in HUNDREDTHS of millimeters. Examples: 001 0.01 millimeter 002 0.02 millimeters 010 0.1 millimeter 074 0.74 millimeters 100 1 millimeters 105 1.05 millimeters 988 9.88 millimeters

989 9.89 millimeters or larger

990 Microinvasion; microscopic focus or foci only; no size given

999 Unknown; size not stated Not documented in patient record

Malignant Melanoma of Iris and Ciliary Body CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Version date: January 1, 2004 578 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Iris and Ciliary Body CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Malignant Melanoma of Iris and Ciliary Body CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Malignant Melanoma of Iris and Ciliary Body CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Malignant Melanoma of Iris and Ciliary Body CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 579 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 580 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Choroid C69.3 (M-8720-8790) C69.3 Choroid Note: Laterality must be coded for these sites

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Measured Thickness (Depth), available at the collaborative CS TS/Ext-Eval Breslow's Measurement staging website: CS Lymph Nodes CS Site-Specific Factor 2 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 3 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 4 AJCC Stage Reg LN Exam CS Site-Specific Factor 5 CS Mets at DX CS Site-Specific Factor 6 CS Mets Eval

Malignant Melanoma of Choroid CS Tumor Size SEE STANDARD TABLE

Malignant Melanoma of Choroid CS Extension Note: AJCC 6th Edition states that when basal dimension and apical height do not fit this classification, the largest diameter should be used for classification. In clinical practice the tumor base may be estimated in optic disc diameters (dd) (average: 1 dd = 1.5mm). The elevation may be estimated in diopters (average: 3 diopters = 1 mm). Other techniques, such as ultrasonography and computerized stereometry, may provide a more accurate measurement. Code Description TNM SS77 SS2000

00 In situ Tis IS IS

22 Tumor 10 mm or less in greatest diameter and 2.5 mm or less in T1NOS L L greatest height (thickness), AND extraocular invasion unknown

24 Tumor 10 mm or less in greatest diameter and 2.5 mm or less in T1a L L greatest height (thickness), WITHOUT microscopic extraocular extension

26 Tumor 10 mm or less in greatest diameter and 2.5 mm or less in T1b L L greatest height (thickness), WITH microscopic extraocular extension

28 Tumor 10 mm or less in greatest diameter and 2.5 mm or less in T1c L L greatest height (thickness), WITH macroscopic extraocular extension

30 Localized, NOS T1NOS L L

42 Tumor greater than 10 mm but not more than 16 mm in greatest T2NOS L L basal diameter and between 2.5 mm and 10 mm in maximum height (thickness), AND extraocular invasion unknown

44 Tumor greater than 10 mm but not more than 16 mm in greatest T2a L L

Version date: January 1, 2004 581 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

basal diameter and between 2.5 mm and 10 mm in maximum height (thickness), WITHOUT microscopic extraocular invasion

46 Tumor greater than 10 mm but not more than 16 mm in greatest T2b RE RE basal diameter and between 2.5 mm and 10 mm in maximum height (thickness), WITH microscopic extraocular invasion

48 Tumor greater than 10 mm but not more than 16 mm in greatest T2c RE RE basal diameter and between 2.5 mm and 10 mm in maximum height (thickness), WITH macroscopic extraocular invasion

66 Tumor greater than 16 mm in greatest diameter and/or greater than T3 RE RE 10 mm in maximum height (thickness) WITH microscopic extraocular extension

68 Tumor greater than 16 mm in greatest diameter and/or greater than T4 RE RE 10 mm in maximum height (thickness) WITH macroscopic extraocular extension

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record

Malignant Melanoma of Choroid CS TS/Ext-Eval SEE STANDARD TABLE

Malignant Melanoma of Choroid CS Lymph Nodes Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph nodes N1 RN RN Cervical Parotid (preauricular) Submandibular Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Malignant Melanoma of Choroid CS Reg Nodes Eval SEE STANDARD TABLE Malignant Melanoma of Choroid

Version date: January 1, 2004 582 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Reg LN Pos SEE STANDARD TABLE

Malignant Melanoma of Choroid Reg LN Exam SEE STANDARD TABLE

Malignant Melanoma of Choroid CS Mets at DX SEE STANDARD TABLE

Malignant Melanoma of Choroid CS Mets Eval SEE STANDARD TABLE

Malignant Melanoma of Choroid CS Site-Specific Factor 1 Measured Thickness (Depth), Breslow's Measurement Note: Code MEASURED THICKNESS (Depth) of tumor (Breslow's measurement), not size. Record actual measurement in millimeters from the pathology report. Code Description

000 No mass/tumor found

001-988 0.01 - 9.88 millimeters Code exact measurement in HUNDREDTHS of millimeters. Examples: 001 0.01 millimeter 002 0.02 millimeters 010 0.1 millimeter 074 0.74 millimeters 100 1 millimeters 105 1.05 millimeters 988 9.88 millimeters

989 9.89 millimeters or larger

990 Microinvasion; microscopic focus or foci only; no size given

999 Unknown; size not stated Not documented in patient record

Malignant Melanoma of Choroid CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Version date: January 1, 2004 583 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Choroid CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Malignant Melanoma of Choroid CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Malignant Melanoma of Choroid CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Malignant Melanoma of Choroid CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 584 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Other Eye C69.1, C69.2, C69.5, C69.8-C69.9 (M-8720-8790) C69.1 Cornea C69.2 Retina C69.5 Lacrimal gland C69.8 Overlapping lesion of eye and adnexa C69.9 Eye, NOS Excludes 69.0 Conjunctiva, C69.3 Choroid, and C69.4 Ciliary Body Note 1: Laterality must be coded for these sites Note 2: AJCC includes primary site C69.8 (Overlapping lesions of eye and adnexa) in its chapter 46, Sarcoma of the Orbit. This schema includes only melanomas of the sites listed above.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Malignant Melanoma of Other Eye CS Tumor Size SEE STANDARD TABLE

Malignant Melanoma of Other Eye CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial NA IS IS

10 Tumor limited to other part of eye NA L L WITH or WITHOUT intraocular extension

30 Localized, NOS NA L L

70 Adjacent extraocular extension NA RE RE

80 Further contiguous extension NA D D

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Malignant Melanoma of Other Eye CS TS/Ext-Eval SEE STANDARD TABLE

Version date: January 1, 2004 585 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Other Eye CS Lymph Nodes Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Regional lymph nodes NA RN RN Cervical Parotid (preauricular) Submandibular Regional lymph node(s), NOS

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Malignant Melanoma of Other Eye CS Reg Nodes Eval SEE STANDARD TABLE

Malignant Melanoma of Other Eye Reg LN Pos SEE STANDARD TABLE

Malignant Melanoma of Other Eye Reg LN Exam SEE STANDARD TABLE

Malignant Melanoma of Other Eye CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Malignant Melanoma of Other Eye CS Mets Eval SEE STANDARD TABLE

Version date: January 1, 2004 586 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Malignant Melanoma of Other Eye CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Malignant Melanoma of Other Eye CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Malignant Melanoma of Other Eye CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Malignant Melanoma of Other Eye CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Malignant Melanoma of Other Eye CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Malignant Melanoma of Other Eye CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 587 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 588 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lacrimal Gland C69.5 C69.5 Lacrimal gland Note: Laterality must be coded for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam Extension Size Table 2 CS Mets at DX CS Mets Eval

Lacrimal Gland CS Tumor Size SEE STANDARD TABLE

Lacrimal Gland CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Tumor confined to lacrimal gland/duct * L L

30 Localized, NOS * L L

40 Invading periosteum of fossa of lacrimal gland/duct ** RE RE

60 Extension to any of the following WITHOUT bone invasion: T4 RE RE Globe (eyeball) Optic nerve Orbital soft tissues

70 Adjacent bone T4 RE RE

75 Brain T4 D D

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension codes 10 and 30 ONLY, the T category is assigned based on the value of CS Tumor Size as shown in Extension Size Table. Tumors 2.5 cm or less are T1, and tumors between 2.5 and 5 cm are T2. **For Extension code 40 ONLY, the T category is assigned based on the value of CS Tumor Size as shown in Extension Size Table 2. Tumors 5 cm or less are T3a, and tumors more than 5 cm are T3b.

Lacrimal Gland CS TS/Ext-Eval SEE STANDARD TABLE

Version date: January 1, 2004 589 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lacrimal Gland CS Lymph Nodes Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph nodes N1 RN RN Cervical Mandibular, NOS: Submandibular (submaxillary) Parotid, NOS: Infra-auricular Preauricular Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Lacrimal Gland CS Reg Nodes Eval SEE STANDARD TABLE

Lacrimal Gland Reg LN Pos SEE STANDARD TABLE

Lacrimal Gland Reg LN Exam SEE STANDARD TABLE

Lacrimal Gland CS Mets at DX SEE STANDARD TABLE

Lacrimal Gland CS Mets Eval SEE STANDARD TABLE

Lacrimal Gland CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Version date: January 1, 2004 590 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Lacrimal Gland CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Lacrimal Gland CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Lacrimal Gland CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Lacrimal Gland CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Lacrimal Gland CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 591 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 592 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Orbit C69.6 C69.6 Orbit, NOS Note 1: Laterality must be coded for this site. Note 2: AJCC uses this scheme only for sarcomas of the orbit.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 5 AJCC Stage Reg LN Pos CS Site-Specific Factor 6 Extension Size Table Reg LN Exam CS Mets at DX CS Mets Eval

Orbit CS Tumor Size SEE STANDARD TABLE

Orbit CS Extension Code Description TNM SS77 SS2000

00 In situ; noninvasive; intraepithelial Tis IS IS

10 Tumor confined to orbit * L L Localized, NOS

40 Diffuse invasion of orbital tissues and/or bony walls T3 RE RE

60 Extension to: T4 RE RE Adjacent paranasal sinuses Cranium

70 Central nervous system T4 D D

80 Further contiguous extension T4 L L

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record *For Extension code 10 ONLY, the T category is assigned based on the value of CS Tumor Size, as shown in the Extension Size Table for this site.

Orbit CS TS/Ext-Eval SEE STANDARD TABLE

Version date: January 1, 2004 593 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Orbit CS Lymph Nodes Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph nodes N1 RN RN Cervical Mandibular, NOS: Submandibular (submaxillary) Parotid, NOS: Infra-auricular Preauricular Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Orbit CS Reg Nodes Eval SEE STANDARD TABLE

Orbit Reg LN Pos SEE STANDARD TABLE

Orbit Reg LN Exam SEE STANDARD TABLE

Orbit CS Mets at DX SEE STANDARD TABLE

Orbit CS Mets Eval SEE STANDARD TABLE

Orbit CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Version date: January 1, 2004 594 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Orbit CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Orbit CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Orbit CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Orbit CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Orbit CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 595 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 596 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Retinoblastoma C69.0-C69.6, C69.8-C69.9 (9510-9514) C69.0 Conjunctiva C69.1 Cornea, NOS C69.2 Retina C69.3 Choroid C69.4 Ciliary Body C69.5 Lacrimal Gland C69.6 Orbit, NOS C69.8 Overlapping lesion of eye and adnexa C69.9 Eye, NOS Note 1: Laterality must be coded for this site. Note 2: Code all retinoblastomas using this scheme, including conjunctiva, uvea and other parts of eye.

CS Tumor Size CS Site-Specific Factor 1 - Extension The following tables are CS Extension Evaluated at Enucleation available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 4 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 5 AJCC Stage for TNM sites with Reg LN Exam CS Site-Specific Factor 6 no stage groupings CS Mets at DX CS Mets at DX, CS Mets Eval CS Mets Eval

Retinoblastoma CS Tumor Size SEE STANDARD TABLE

Retinoblastoma CS Extension Code Description TNM SS77 SS2000

11 Any eye in which the largest tumor is less than or equal to 3 mm in T1a L L height AND no tumor is located closer than 1 DD (1.5 mm) to the optic nerve or fovea

13 All other eyes in which the tumor(s) are confined to retina T1b L L regardless of location or size (up to half the volume of the eye) AND no vitreous seeding AND no retinal detachment or subretinal fluid greater than 5 mm from the base of the tumor

31 Tumor confined to retina (no vitreous seeding or significant T1NOS L L retinal detachment), NOS

41 Minimal tumor spread to vitreous and/or subretinal space. T2a L L Fine local or diffuse vitreous seeding and/or serous retinal detachment up to total detachment may be present but no clumps, lumps, snowballs, or avascular masses are allowed in the vitreous or subretinal space. Calcium flecks in the vitreous or subretinal space are allowed. Tumor may fill up to 2/3 the volume of the eye.

43 Massive tumor spread to vitreous and/or subretinal space. T2b L L

Version date: January 1, 2004 597 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Vitreous seeding and/or subretinal implantation may consist of lumps, clumps, snowballs, or avascular tumor masses. Retinal detachment may be total. Tumor may fill up to 2/3 the volume of the eye.

45 Unsalvageable intraocular disease. T2c L L Tumor fills more than 2/3 the eye No possibility of visual rehabilitation. One or more of the following are present: Tumor-associated glaucoma, either neovascular or angle closure Anterior segment extension of tumor Ciliary body extension of tumor Hyphema (significant) Massive vitreous hemorrhage Tumor in contact with lens Orbital cellulitis-like clinical presentation

47 Tumor with contiguous spread to adjacent tissues or spaces T2NOS L L (vitreous or subretinal space), NOS

59 Invasion of optic nerve and/or optic coats, NOS T3 RE RE

75 Extraocular tumor T4 RE RE

80 Further contiguous extension T4 D D

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record Note: If enucleation done (i.e., SSF1 code 030 to 080) the T category is derived from Site-Specific Factor 1 and assigned "pT". If no enucleation done, the T category is derived from CS Extension and assigned based on CS TS/Ext-Eval field.

Retinoblastoma CS TS/Ext-Eval Note: This item reflects the validity of the classification of the Tumor Size and CS Extension were determined based on the diagnostic methods employed. Code Description Staging Basis

0 No surgical resection done. Evaluation based on physical examination, imaging c examination, or other non-invasive clinical evidence. No autopsy evidence used.

1 No surgical resection done. Evaluation based on endoscopic examination, diagnostic c biopsy, including fine needle aspiration biopsy, or other invasive techniques including surgical observation without biopsy. No autopsy evidence used. Does not meet criteria for AJCC pathological T staging.

2 No surgical resection done, but evidence derived from autopsy (tumor was suspected or p diagnosed prior to autopsy).

3 Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation p OR surgical resection performed, unknown if pre-surgical systemic treatment or radiation performed.

3, Evidence acquired before treatment, supplemented or modified by the additional evidence

Version date: January 1, 2004 598 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

cont’d acquired during and from surgery, particularly from pathologic examination of the resected specimen. Meets criteria for AJCC pathological T staging.

5 Surgical resection performed WITH pre-surgical systemic treatment or radiation, c BUT tumor size/extension based on clinical evidence.

6 Surgical resection performed WITH pre-surgical systemic treatment or radiation; tumor y size and/or extension based on pathologic evidence.

8 Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy). a

9 Unknown if surgical resection done c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record

Retinoblastoma CS Lymph Nodes Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Regional lymph nodes N1 RN RN Submandibular Parotid (preauricular) Cervical Regional lymph node(s), NOS

80 Lymph nodes, NOS N1 RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Retinoblastoma CS Reg Nodes Eval SEE STANDARD TABLE

Retinoblastoma Reg LN Pos SEE STANDARD TABLE

Retinoblastoma Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 599 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Retinoblastoma CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) * D D

30 Distant metastasis to bone marrow only * D D

40 Distant metastasis except distant lymph node(s) (10) or bone * D D marrow (30) Distant metastasis, NOS Carcinomatosis

50 (10) + any of [(30) or (40)] * D D Distant lymph node(s) plus other distant metastases

55 Stated as M1, NOS * D D

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record * For Mets at DX codes 10, 30, 40, 50, and 55 ONLY, the M category is assigned based on the value of CS Mets at DX, as shown in the table CS Mets, Mets Eval for this site.

Retinoblastoma CS Mets Eval SEE STANDARD TABLE

Retinoblastoma CS Site-Specific Factor 1 Extension Evaluated at Enucleation Note: If no enucleation has been performed, code 000. Code Description TNM SS77 SS2000

000 No enucleation performed TX U U

030 Tumor(s) confined to retina, NOS T1 L L

041 Tumor cells in the vitreous body T1 L L

043 Tumor(s) confined to subretinal space. T1 L L No optic nerve or choroidal invasion

044 Tumor invades optic nerve up to, but not through, level of lamina T2a L L cribrosa

046 Tumor invades choroid focally T2b L L

047 Tumor invades optic nerve up to, but not through, level of lamina T2c L L cribrosa AND invades the choroid focally

048 Optic nerve as far as lamina cribrosa, NOS T2NOS L L

049 Minimal invasion of optic nerve and/or optic coats, NOS T2NOS L L

Version date: January 1, 2004 600 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

054 Tumor invades optic nerve through the level of lamina T3a RE RE cribrosa but not to line of resection

056 Tumor massively invades choroid T3b RE RE

057 Tumor invades optic nerve through level of lamina cribrosa but not T3c RE RE to line and resection AND massively invades choroid

059 Significant invasion of optic nerve and/or optic coats, NOS T3NOS RE RE

072 Extraocular extension including: T4 RE RE Both anteriorly or posteriorly into orbit Optic nerve to line of resection Orbit through sclera Extension into subarachnoidal space of optic nerve Extension to apex of orbit

074 Extraocular extension including into: T4 D D Brain Brain beyond the chiasm

075 Other adjacent extraocular extension T4 RE RE

080 Further contiguous extension T4 D D

095 No evidence of primary tumor T0 U U

096 Unknown if enucleation done TX U U

999 Enucleation done: TX U U Extension unknown

Retinoblastoma CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Retinoblastoma CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Retinoblastoma CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 601 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Retinoblastoma CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Retinoblastoma CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 602 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Brain and Cerebral Meninges C70.0, C71.0-C71.9 C70.0 Cerebral meninges C71.0 Cerebrum C71.1 Frontal lobe C71.2 Temporal lobe C71.3 Parietal lobe C71.4 Occipital lobe C71.5 Ventricle, NOS C71.6 Cerebellum, NOS C71.7 Brain stem C71.8 Overlapping lesion of brain C71.9 Brain, NOS Note 1: This scheme is compatible with the AJCC fourth edition scheme TNM for brain. The AJCC opted not to recommend a TNM scheme in the sixth edition. Note 2: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 - WHO The following tables are CS Extension Grade Classification available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 4 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 5 AJCC Stage Reg LN Exam CS Site-Specific Factor 6 CS Mets at DX CS Mets Eval

Brain and Cerebral Meninges CS Tumor Size SEE STANDARD TABLE

Brain and Cerebral Meninges CS Extension Note: C71.0 is SUPRAtentorial, except the following subsites coded to C 71.0 are INFRAtentorial: hypothalamus, pallium, thalamus. C71.1-C71.5 are SUPRAtentorial. C71.6-C71.7 are INFRAtentorial. The following subsites coded to C71.8 are SUPRAtentorial: corpus callosum, tapetum. The following sites coded to C71.9 are SUPRAtentorial: anterior cranial fossa, middle cranial fossa, suprasellar. The following subsites coded to C71.9 are INFRAtentorial: posterior cranial fossa. Code Description TNM SS77 SS2000

05 Benign or borderline brain tumors NA NA NA

10 Supratentorial tumor confined to: NA L L CEREBRAL HEMISPHERE (cerebrum) or MENINGES of CEREBRAL HEMISPHERE on one side: Frontal lobe Occipital lobe Parietal lobe Temporal lobe

11 Infratentorial tumor confined to: NA L L CEREBELLUM or MENINGES of CEREBELLUM on one side: Vermis: Lateral lobes Median lobe of cerebellum

Version date: January 1, 2004 603 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

12 Infratentorial tumor confined to: NA L L BRAIN STEM or MENINGES of BRAIN STEM on one side: Medulla oblongata Midbrain (mesencephalon) Pons Hypothalamus Thalamus

15 Confined to brain, NOS NA L L Confined to meninges, NOS

20 Infratentorial tumor: NA L L Both cerebellum and brain stem involved with tumor on one side

30 Confined to ventricles NA L L Tumor invades or encroaches upon ventricular system

40 Tumor crosses the midline NA RE RE Tumor involves contralateral hemisphere Tumor involves corpus callosum (including splenium)

50 Supratentorial tumor extends infratentorially to involve cerebellum NA RE RE or brain stem

51 Infratentorial tumor extends supratentorially to involve cerebrum NA RE RE (cerebral hemisphere)

60 Tumor invades: NA RE RE Bone (skull) Major blood vessel(s) Meninges (dura) Nerves, NOS Cranial nerves Spinal cord/canal

70 Circulating cells in cerebral spinal fluid (CSF) NA D D Nasal cavity Nasopharynx Posterior pharynx Outside central nervous system (CNS)

80 Further contiguous extension NA D D

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Brain and Cerebral Meninges CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site. NA

Version date: January 1, 2004 604 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Brain and Cerebral Meninges CS Lymph Nodes Code Description TNM SS77 SS2000

88 Not applicable NA U U

Brain and Cerebral Meninges CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site. NA

Brain and Cerebral Meninges Reg LN Pos Code Description

99 Not applicable.

Brain and Cerebral Meninges Reg LN Exam Code Description

99 Not applicable.

Brain and Cerebral Meninges CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant metastases NA D D

85 "Drop" metastases NA D D

99 Unknown NA U U Distant metastasis cannot be assessed Not documented in patient record

Brain and Cerebral Meninges CS Mets Eval Code Description Staging Basis

9 Not applicable for this site. NA

Version date: January 1, 2004 605 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Brain and Cerebral Meninges CS Site-Specific Factor 1 WHO Grade Classification Note: Code the WHO Grade Classification as documented in the medical record. Code Description

010 Grade I

020 Grade II

030 Grade III

040 Grade IV

999 Clinically diagnosed/grade unknown Not documented in medical record Grade unknown, NOS

Brain and Cerebral Meninges CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Brain and Cerebral Meninges CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Brain and Cerebral Meninges CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Brain and Cerebral Meninges CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Brain and Cerebral Meninges CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 606 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Parts of Central Nervous System C70.1, C70.9, C72.0-C72.5, C72.8-C72.9 C70.1 Spinal meninges C70.9 Meninges, NOS C72.0 Spinal cord C72.1 Cauda equina C72.2 Olfactory nerve C72.3 Optic nerve C72.4 Acoustic nerve C72.5 Cranial nerve, NOS C72.8 Overlapping lesion of brain and central nervous system C72.9 Nervous system, NOS Note: This schema is compatible with the AJCC fourth edition TNM for spinal cord. AJCC does not define TNM staging for this site in the sixth edition.

CS Tumor Size CS Site-Specific Factor 1 - WHO The following tables are CS Extension Grade Classification available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 4 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 5 AJCC Stage Reg LN Exam CS Site-Specific Factor 6 CS Mets at DX CS Mets Eval

Other Parts of Central Nervous System CS Tumor Size SEE STANDARD TABLE

Other Parts of Central Nervous System CS Extension Code Description TNM SS77 SS2000

05 Benign or borderline brain tumors NA NA NA

10 Tumor confined to tissue or site of origin NA L L

30 Localized, NOS NA L L

40 Meningeal tumor infiltrates nerve NA RE RE Nerve tumor infiltrates meninges (dura)

50 Adjacent connective/soft tissue NA RE RE Adjacent muscle

60 Brain, for cranial nerve tumors NA RE RE Major blood vessel(s) Sphenoid and frontal sinuses (skull)

70 Brain except for cranial nerve tumors NA D D Bone, other than skull Eye

80 Further contiguous extension NA D D

Version date: January 1, 2004 607 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Other Parts of Central Nervous System CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Other Parts of Central Nervous System CS Lymph Nodes Code Description TNM SS77 SS2000

88 Not applicable NA U U

Other Parts of Central Nervous System CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Other Parts of Central Nervous System Reg LN Pos Code Description

99 Not applicable.

Other Parts of Central Nervous System Reg LN Exam Code Description

99 Not applicable.

Version date: January 1, 2004 608 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Parts of Central Nervous System CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Other Parts of Central Nervous System CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Other Parts of Central Nervous System CS Site-Specific Factor 1 WHO Grade Classification Note: Code the WHO Grade Classification as documented in the medical record for sites C70.1 and C70.9 only. Code Description

010 Grade I

020 Grade II

030 Grade III

040 Grade IV

999 Clinically diagnosed/grade unknown Not documented in medical record Grade unknown, NOS

Other Parts of Central Nervous System CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Version date: January 1, 2004 609 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other Parts of Central Nervous System CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Other Parts of Central Nervous System CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Other Parts of Central Nervous System CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Other Parts of Central Nervous System CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 610 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Thyroid Gland C73.9 C73.9 Thyroid gland

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Solitary vs Multifocal available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histology Exclusion Table CS Reg Nodes Eval CS Site-Specific Factor 4 AJCC Stage-Thyroid: Papillary Reg LN Pos CS Site-Specific Factor 5 and Follicular - Age less than 45 Reg LN Exam CS Site-Specific Factor 6 Extension Size Table CS Mets at DX Histologies-Thyroid CS Mets Eval AJCC Stage-Thyroid: Papillary and Follicular - Age 45 and older AJCC Stage-Thyroid: Medullary AJCC Stage-Thyroid: Anaplastic

Thyroid Gland CS Tumor Size SEE STANDARD TABLE

Thyroid Gland CS Extension Note: AJCC considers all anaplastic carcinomas to be T4. Collaborative Staging has implemented this as follows: If histology is equal to 8020 or 8021 and if CS Extension is equal to 00, 10, 20, 30, 40, 45, or 48, then T category is equal to T4a. For these histologies, if CS Extension is equal to 50, 52, 60, 62, 70, 72, or 80, then T category is equal to T4b. If CS Extension is equal to 95 or 99, the T category is T4NOS. For all other histologies, follow the rules as shown in the tables. Code Description TNM SS77 SS2000

00 In situ; non-invasive Tis IS IS

10 Single invasive tumor confined to thyroid * L L

20 Multiple foci confined to thyroid * L L

30 Localized, NOS * L L

40 Into thyroid capsule, but not beyond * L L

45 Minimal extrathyroid extension including: T3 RE RE Strap muscle(s): Omohyoid Sternohyoid Sternothyroid

48 Pericapsular soft/connective tissue T3 RE RE

50 Parathyroid T4a RE RE Nerves: Recurrent laryngeal Vagus

52 Cricoid cartilages T4a RE RE Esophagus Larynx Sternocleidomastoid muscle

Version date: January 1, 2004 611 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

60 Thyroid cartilage T4b RE RE Tumor is described as "FIXED to adjacent tissues"

62 Blood vessel(s) (major): T4b RE RE Carotid artery Jugular vein Thyroid artery or vein

70 Bone T4b D D Skeletal muscle, other than strap or sternocleidomastoid muscle

72 Trachea T4a D D

80 Further contiguous extension T4b D D Mediastinal tissues Prevertebral fascia

95 No evidence of primary tumor T0 U U

99 Unknown extension TX U U Primary tumor cannot be assessed Not documented in patient record * For Extension codes 10, 20, 30, and 40 ONLY, the T category is assigned based on value of CS Tumor Size from Extension Size Table.

Thyroid Gland CS TS/Ext-Eval SEE STANDARD TABLE

Thyroid Gland CS Lymph Nodes Note: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement N0 NONE NONE

10 Ipsilateral regional lymph nodes: N1a RN RN Anterior deep cervical (laterotracheal) (recurrent laryngeal): Paralaryngeal Paratracheal Prelaryngeal Pretracheal Cervical, NOS Internal jugular, NOS: Deep cervical, NOS: Lower, NOS Jugulo-omohyoid (supraomohyoid) Middle Retropharyngeal Spinal accessory (posterior cervical)

11 Regional lymph nodes: N1a D RN Delphian node Mediastinal, NOS Posterior mediastinal (tracheoesphageal) Upper anterior mediastinal Supraclavicular (transverse cervical)

Version date: January 1, 2004 612 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

20 Regional lymph nodes as listed in code 10 N1b RN RN Bilateral, contralateral, or midline cervical nodes

21 Regional lymph nodes as listed in code 11 N1b D RN Bilateral, contralateral, or midline cervical nodes

30 Tracheoesophageal (posterior mediastinal) N1b RN RN

31 Mediastinal, NOS N1b D RN Upper anterior mediastinal

50 Regional lymph node(s), NOS N1NOS RN RN

80 Lymph nodes, NOS N1NOS RN RN

99 Unknown; not stated NX U U Regional lymph node(s) cannot be assessed Not documented in patient record

Thyroid Gland CS Reg Nodes Eval SEE STANDARD TABLE

Thyroid Gland Reg LN Pos SEE STANDARD TABLE

Thyroid Gland Reg LN Exam SEE STANDARD TABLE

Thyroid Gland CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D Mandibular, NOS

11 Distant lymph node(s) M1 D D Submandibular (submaxillary) Submental

12 Distant lymph node(s) other than in code 10 or 11 M1 D D Distant lymph node(s), NOS

40 Distant metastases except distant lymph node(s) (code 10) M1 D D Distant metastasis, NOS Carcinomatosis

50 (40) + or any of [(10) to (12)] M1 D D Distant lymph node(s) plus other distant metastasis)

99 Unknown if distant metastasis MX U U Distant metastasis cannot be assessed Not documented in patient record

Version date: January 1, 2004 613 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Thyroid Gland CS Mets Eval SEE STANDARD TABLE

Thyroid Gland CS Site-Specific Factor 1 Solitary vs Multifocal Code Description

000 None

001 Solitary tumor

002 Multifocal tumor [AJCC descriptor (m)]

999 Insufficient information Not documented in patient record

Thyroid Gland CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Thyroid Gland CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Thyroid Gland CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Thyroid Gland CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Thyroid Gland CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 614 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands C37.9, C74.0-C74.1, C74.9, C75.0-C75.5, C75.8-C75.9 Note: Laterality must be coded for sites C74.0, C74.1, C74.9, and C75.4. C37.9 Thymus C74.0 Cortex of adrenal gland C74.1 Medulla of adrenal gland C74.9 Adrenal gland, NOS C75.0 Parathyroid gland C75.1 Pituitary gland C75.2 Craniopharyngeal duct C75.3 Pineal gland C75.4 Carotid body C75.5 Aortic body and other paraganglia C75.8 Overlapping lesion of endocrine glands and related structures C75.9 Endocrine gland, NOS Note: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 - WHO The following tables are CS Extension Grade Classification available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 4 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 5 AJCC Stage Reg LN Exam CS Site-Specific Factor 6 CS Mets at DX CS Mets Eval

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Tumor Size SEE STANDARD TABLE

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Extension Code Description TNM SS77 SS2000

00 In situ; non-invasive; intraepithelial NA IS IS

05 For C75.1 pituitary gland, C75.2 craniopharyngeal duct and C75.3 NA NA NA pineal gland ONLY: Benign or borderline tumors

10 Invasive carcinoma confined to gland of origin NA L L

30 Localized, NOS NA L L

40 Adjacent connective tissue (see definition in General Instructions) NA RE RE

60 Adjacent organs/structures NA RE RE Thymus and aortic body: Organs/structures in mediastinum Adrenal (suprarenal): Kidney Retroperitoneal structures Parathyroid Thyroid Thyroid cartilage 60, Pituitary and craniopharyngeal duct:

Version date: January 1, 2004 615 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

cont’d Cavernous sinus Infundibulum Pons Sphenoid body and sinuses Pineal: Infratentorial and central brain Carotid body: Upper neck

80 Further contiguous extension NA D D

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: Use code 99, not applicable, for the following sites: Pituitary gland (C75.1), Craniopharyngeal duct (C75.2), and Pineal gland (C75.3) Code Description TNM SS77 SS2000

00 None; no regional lymph node involvement NA NONE NONE

10 Regional lymph nodes NA RN RN Cervical for carotid body and parathyroid only Mediastinal for aortic body and thymus only Retroperitoneal for adrenal (suprarenal) gland only

80 Lymph nodes, NOS NA RN RN

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record For Pituitary gland (C75.1), Craniopharyngeal duct (C75.2), and Pineal gland (C75.3): Not applicable

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands Reg LN Pos

Version date: January 1, 2004 616 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

SEE STANDARD TABLE

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands Reg LN Exam SEE STANDARD TABLE

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Mets at DX Code Description TNM SS77 SS2000

00 No; none NA NONE NONE

10 Distant lymph node(s), NOS NA D D

40 Distant metastases except distant lymph node(s) (code 10) NA D D Distant metastasis, NOS Carcinomatosis

50 (10) + (40) NA D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis NA U U Cannot be assessed Not documented in patient record

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Site-Specific Factor 1 WHO Grade Classification Note 1: WHO grade applies only to C75.1 pituitary gland, C75.2 craniopharyngeal duct, C75.3 pineal gland. For all other sites in this schema, enter code 999. Note 2: Code the WHO Grade Classification as documented in the medical record. Code Description

010 Grade I

020 Grade II

030 Grade III

040 Grade IV

999 Clinically diagnosed/grade unknown Not documented in medical record Grade unknown, NOS

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Site-Specific Factor 2

Version date: January 1, 2004 617 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Code Description

888 Not applicable for this site

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 618 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Kaposi Sarcoma of All Sites (M-9140) Note: This scheme cannot be compared to either the Historic Stage or the 1977 Summary Stage schemes.

CS Tumor Size CS Site-Specific Factor 1 - The following tables are CS Extension Associated with HIV/AIDS available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 staging website: CS Lymph Nodes CS Site-Specific Factor 3 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 4 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 5 AJCC Stage Reg LN Exam CS Site-Specific Factor 6 CS Mets at DX CS Mets Eval

Kaposi Sarcoma of All Sites CS Tumor Size Code Description

888 Not applicable

Kaposi Sarcoma of All Sites CS Extension Code Description TNM SS77 SS2000

11 Single lesion: NA U L Skin

12 Single lesion: NA U L Mucosa (e.g., oral cavity, anus, rectum, vagina, vulva)

13 Single lesion: NA U L Viscera (e.g., pulmonary, gastrointestinal tract, spleen, other)

21 Multiple lesions: NA U L Skin

22 Multiple lesions: NA U L Mucosa (e.g., oral cavity, anus, rectum, vagina, vulva)

23 Multiple lesions: NA U L Viscera (e.g., pulmonary, gastrointestinal tract, spleen, other)

24 (21) + (22) NA U RE

25 (21) + (23) NA U RE

26 (22) + (23) NA U RE

27 (21) + (22) + (23) NA U D

29 Multiple lesions, NOS NA U U

95 No evidence of primary tumor NA U U

99 Unknown extension NA U U Primary tumor cannot be assessed Not documented in patient record

Version date: January 1, 2004 619 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Kaposi Sarcoma of All Sites CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Kaposi Sarcoma of All Sites CS Lymph Nodes Note: For this site, code ALL lymph node involvement in this field. Code Description TNM SS77 SS2000

00 No lymph node involvement (No clinical adenopathy and either NA U NONE pathologically negative or no pathological statement)

10 Clinically enlarged palpable lymph node(s) (adenopathy), and either NA U RN pathologically negative nodes or no pathological statement

20 No clinically enlarged palpable lymph node(s) (adenopathy) but NA U RN pathologically positive lymph node(s)

30 Both clinically enlarged palpable lymph node(s) (adenopathy) and NA U RN pathologically positive lymph node(s) Lymph nodes, NOS

99 Unknown; not stated NA U U Regional lymph node(s) cannot be assessed Not documented in patient record

Kaposi Sarcoma of All Sites CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Kaposi Sarcoma of All Sites Reg LN Pos SEE STANDARD TABLE

Kaposi Sarcoma of All Sites Reg LN Exam SEE STANDARD TABLE

Version date: January 1, 2004 620 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Kaposi Sarcoma of All Sites CS Mets at DX Code Description TNM SS77 SS2000

88 Not applicable NA U U

Kaposi Sarcoma of All Sites CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Kaposi Sarcoma of All Sites CS Site-Specific Factor 1 Associated with HIV/AIDS * HIV (Human Immunodificiency Virus) includes types I and II. Older terminology includes HTLV-3 and LAV. Code Description

001 Yes/Present

002 No/Not present

999 Unknown if present or not Insufficient information Not documented in patient record

Kaposi Sarcoma of All Sites CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Kaposi Sarcoma of All Sites CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Kaposi Sarcoma of All Sites CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Version date: January 1, 2004 621 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Kaposi Sarcoma of All Sites CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Kaposi Sarcoma of All Sites CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 622 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) (ICD-O-3 M-959-972 EXCEPT 9700/3 and 9701/3)

CS Tumor Size CS Site-Specific Factor 1 - Associated The following tables are CS Extension with HIV/AIDS available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 2 - Systemic staging website: CS Lymph Nodes Symptoms at Diagnosis Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 3 - IPI Score Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 4 AJCC Stage Reg LN Exam CS Site-Specific Factor 5 Extension Stage Table CS Mets at DX CS Site-Specific Factor 6 CS Mets Eval

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Tumor Size Code Description

888 Not applicable

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Extension Note 1: For Hodgkin Lymphoma an E lesion is defined as disease that involves extralymphatic site(s). Extralymphatic means other than lymph nodes and other lymphatic structures. These lymphatic structures include spleen, thymus gland, Waldeyer's ring (tonsils), Peyer's patches (ileum) and lymphoid nodules in the appendix. Any lymphatic structure is to be coded the same as a lymph node region. Note 2: S equals Spleen involvement. Note 3: If there is no mention of extranodal involvement but several diagnostic procedures were done, including laparotomy, interpret as no involvement. Note 4: Involvement of adjacent soft tissue does not alter the classification. Code Description TNM SS77 SS2000

10 Involvement of a single lymph node region * L L Stage I

11 Localized involvement of a single extralymphatic organ/ site in the * L L absence of any lymph node involvement Multifocal involvement of one extralymphatic organ/site Stage IE

12 Involvement of spleen only * L L Stage IS

20 Involvement of two or more lymph node regions on the SAME side * RNOS RNOS of the diaphragm Stage II

21 Localized involvement of a single extralymphatic organ/site * RNOS RNOS WITH involvement of its regional lymph node(s) or WITH or WITHOUT involvement of other lymph node(s) on the SAME side of the diaphragm Direct extension to adjacent organs or tissues Stage IIE

Version date: January 1, 2004 623 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

22 Involvement of spleen PLUS lymph node(s) BELOW the * RNOS RNOS diaphragm Stage IIS

23 Involvement of spleen PLUS involvement of a single * RNOS RNOS extralymphatic organ/site BELOW the diaphragm WITH or WITHOUT involvement of lymph node(s) BELOW the diaphragm Stage IIES

30 Involvement of lymph node regions on BOTH sides of the * D D diaphragm Stage III

31 Involvement of an extralymphatic organ/site * D D PLUS involvement of lymph node(s) on the OPPOSITE side of the diaphragm Stage IIIE

32 Involvement of the spleen PLUS lymph node(s) ABOVE the * D D diaphragm Stage IIIS

33 (31) + (32) * D D OR Involvement of the spleen PLUS a single extralymphatic site ABOVE the diaphragm WITH or WITHOUT involvement of lymph node(s) Involvement of the spleen PLUS involvement of lymph node region(s)ABOVE the diaphragm PLUS involvement of a single extralymphatic organ/site on either side of the diaphragm Stage IIIES

80 Diffuse or disseminated (multifocal) involvement of ONE OR * D D MORE extralymphatic organ(s)/site(s) WITH or WITHOUT associated lymph node involvement Multifocal involvement of MORE THAN ONE extralymphatic organ/site Involvement of isolated extralymphatic organ in absence of involvement of adjacent lymph nodes, but in conjunction with disease in distant sites Metastasis/involvement: Bone marrow Liver Nodular involvement of lung(s) Stage IV

99 Unknown extension * U U Primary tumor cannot be assessed Not documented in patient record * AJCC stage group for this site is derived directly from the extension code, as shown in the Extension Stage Table. For extension codes 10-80, the AJCC Stages Groups I-IV are subdivided into A and B based on presence or absence of symptoms as shown in the Symptom Stage Subgroup Table.

Version date: January 1, 2004 624 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS TS/Ext-Eval Note: According to AJCC, "The use of the term pathologic staging is reserved for patients who undergo staging laparotomy with an explicit intent to assess the presence of abdominal disease or to define histologic microscopic disease extent in the abdomen. Staging laparatomy and pathological staging have been essentially abandoned as useful procedures." (6th ed., page 396) Therefore, Collaborative Staging uses a modified evaluation scheme for lymphomas, and it applies to the CS TS/EXT-EVAL field only. The other EVAL fields are coded as "not applicable" for this schema Code Description Staging Basis

0 No staging laparotomy done. No autopsy evidence used. c

3 Staging laparotomy done. p

8 Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy) a

9 Unknown if staging laparotomy done c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Lymph Nodes Code Description TNM SS77 SS2000

88 Not applicable NA U U

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site. NA

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) Reg LN Pos Code Description

99 Not applicable for this site

Version date: January 1, 2004 625 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) Reg LN Exam Code Description

99 Not applicable for this site

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Mets at DX Code Description TNM SS77 SS2000

88 Not applicable NA U U

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Mets Eval Code Description Staging Basis

9 Not applicable for this site. NA

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Site-Specific Factor 1 Associated with HIV/AIDS Note: HIV (Human Immunodeficiency Virus) includes types I and II. Older terminology includes HTLV-3 and LAV. Code Description

001 Yes/Present

002 No/Not present

999 Unknown if present or not insufficient information Not documented in patient record

Version date: January 1, 2004 626 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Site-Specific Factor 2 Systemic Symptoms at Diagnosis Note 1. Each stage should be classified as either A or B according to the absence or presence of defined constitutional symptoms, such as: 1. Fevers: Unexplained fever with temperature above 38 degrees C; 2. Night sweats: Drenching sweats that require change of bedclothes; 3. Weight loss: Unexplained weight loss of more than 10% of the usual body weight in the 6 months prior to diagnosis. Note 2. Pruritus alone does not qualify for B classification, nor does alcohol intolerance, fatigue, or a short, febrile illness associated with suspected infections. Code Description Modifier

000 No B symptoms (Asymptomatic) A

010 Any B symptoms: B Night sweats Unexplained fever (above 38 degrees C) Unexplained weight loss (generally greater than 10% loss of body weight in the six months before admission) B symptoms, NOS

020 Pruritis (if recurrent and unexplained) B

030 (010) + (020) B

999 Unknown if symptoms; insufficient information BLANK Not documented in patient record The "A" or "B" is appended to the stage I-IV as determined in the data item CS Site-Specific Factor 2, Systemic Symptoms at Diagnosis.

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Site-Specific Factor 3 IPI Score Note: Record the IPI (International Prognostic Index) as stated in the medical record. Code Description Risk Group

000 0 points Low

001 1 point Low

002 2 points Low intermediate

003 3 points High intermediate

004 4 points High

005 5 points High 999 Unknown Insufficient information Not documented in patient record

Version date: January 1, 2004 627 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Hodgkin and Non-Hodgkin Lymphomas of All Sites (excl. Mycosis Fungoides and Sezary Disease) CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 628 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms (M-9731-9734, 9740-9742, 9750-9758, 9760-9762, 9764-9769, 9800-9801, 9805, 9820, 9823, 9826-9827, 9831- 9837, 9840, 9860-9861, 9863, 9866-9867, 9870-9876, 9891, 9895-9897, 9910, 9920, 9930-9931, 9940, 9945-9946, 9948, 9950, 9960-9964, 9970, 9975, 9980, 9982-9987, 9989) Note: This list includes only preferred terms from ICD-O-3 9866 Acute promyelocytic leukemia 9731 Plasmacytoma, NOS 9867 Acute myelomonocytic leukemia 9732 Multiple myeloma 9870 Acute basophilic leukemia 9733 Plasma cell leukemia 9871 Acute myeloid leukemia with abnormal 9734 Plasmacytoma, extramedullary marrow, eosinophils 9740 Mast cell sarcoma 9872 Acute myeloid leukemia, minimal 9741 Malignant mastocytosis differentiation 9742 Mast cell leukemia 9873 Acute myeloid leukemia without maturation 9750 Malignant histiocytosis 9874 Acute myeloid leukemia with maturation 9751 Langerhans cell histiocytosis, NOS* 9875 Chronic myelogenous leukemia, BCR/ABL 9752 Langerhans cell histiocytosis, unifocal* positive 9753 Langerhans cell histiocytosis, multifocal* 9876 Atypical chronic myeloid leukemia BCR/ABL 9754 Langerhans cell histiocytosis disseminated negative 9755 Histiocytic sarcoma 9891 Acute monocytic leukemia 9756 Langerhans cell sarcoma 9895 Acute myeloid leukemia with multilineage 9757 Interdigitating dendritic cell sarcoma dysplasia 9758 Follicular dendritic cell sarcoma 9896 Acute myeloid leukemia, t(8;21)(q22;q22) 9760 Immunoproliferative disease, NOS 9897 Acute myeloid leukemia, 11q23 abnormalities 9761 Waldenstrom macroglobulinemia 9910 Acute megakaryoblastic leukemia 9762 Heavy chain disease, NOS 9920 Therapy-related acute myeloid leukemia, NOS 9764 Immunoproliferative small intestinal disease 9930 Myeloid sarcoma 9765 Monoclonal gammopathy of undetermined 9931 Acute panmyelosis with myelofibrosis significance* 9940 Hairy cell leukemia 9766 Angiocentric immunoproliferative lesion* 9945 Chronic myelomonocytic leukemia, NOS 9767 Angioimmunoblastic lymphadenopathy* 9946 Juvenile myelomonocytic leukemia 9768 T-gamma lymphoproliferative disease* 9948 Aggressive NK-cell leukemia 9769 Immunoglobulin deposition disease* 9950 Polycythemia (rubra) vera 9800 Leukemia, NOS 9960 Chronic myeloproliferative disease, NOS 9801 Acute leukemia, NOS 9961 Myelosclerosis with myeloid metaplasia 9805 Acute biphenotypic leukemia 9962 Essential thrombocythemia 9820 Lymphoid leukemia, NOS 9963 Chronic neutrophilic leukemia 9823 B-cell chronic lymphocytic leukemia/small 9964 Hypereosinophilic syndrome lymphocytic lymphoma 9970 Lymphoproliferative disorder, NOS* 9826 Burkitt cell leukemia 9975 Myeloproliferative disease, NOS* 9827 Adult T-cell leukemia/lymphoma (HTLV-1 9980 Refractory anemia, NOS positive) 9982 Refractory anemia with sideroblasts 9831 T-cell large granular lymphocytic leukemia* 9983 Refractory anemia with excess blasts 9832 Prolymphocytic leukemia, NOS 9984 Refractory anemia with excess blasts in 9833 Prolymphocytic leukemia, B-cell type transformation 9834 Prolymphocytic leukemia, T-cell type 9985 Refractory cytopenia with multilineage 9835 Precursor cell lymphoblastic leukemia, NOS dysplasia 9836 Precursor B-cell lymphoblastic leukemia 9986 Myelodysplastic syndrome with 5q deletion 9837 Precursor T-cell lymphoblastic leukemia (5q-) syndrome 9840 Acute myeloid leukemia, M6 type 9987 Therapy-related myelodysplastic syndrome, 9860 Myeloid leukemia, NOS NOS 9861 Acute myeloid leukemia, NOS 9989 Myelodysplastic syndrome, NOS 9863 Chronic myeloid leukemia

*Usually considered of uncertain/borderline behavior

Version date: January 1, 2004 629 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms Note: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Tumor Size Code Description

888 Not applicable

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Extension Code Description TNM SS77 SS2000

10 Localized disease: (single/solitary/unifocal/isolated/mono-ostotic) NA L L may be coded for: Plasmacytoma, NOS (M-9731/3) (solitary myeloma) Mast cell sarcoma (M-9740) Malignant histiocytosis (M-9750) Histiocytic sarcoma (M-9755) Langerhans cell sarcoma (M-9756) Dendritic cell sarcoma (M-9757, M-9758) Myeloid sarcoma (M-9930)

80 Systemic disease (poly-ostotic): NA D D All histologies including those in 10

99 Unknown NA D D

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Version date: January 1, 2004 630 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Lymph Nodes Code Description TNM SS77 SS2000

88 Not applicable NA U U

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms Reg LN Pos Code Description

99 Not applicable.

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms Reg LN Exam Code Description

99 Not applicable.

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Mets at DX Code Description TNM SS77 SS2000

88 Not applicable NA U U

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Version date: January 1, 2004 631 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Hematopoietic, Reticuloendothelial, Immunoproliferative, and Myeloproliferative Neoplasms CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 632 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Ill-Defined Sites, Unknown Primary Site C42.0-C42.4, C76.0-C76.5, C76.7-C76.8, C77.0-C77.5, C77.8-C77.9, C80.9 Note: C42._ and C77._, Other than hematopoietic, reticuloendothelial, immunoproliferative and myeloproliferative neoplasms, Hodgkin and non-Hodgkin lymphomas, and Kaposi sarcoma C42.0 Blood C42.1 Bone marrow C42.2 Spleen C42.3 Reticuloendothelial system, NOS C42.4 Hematopoietic system, NOS C76.0 Head, face or neck, NOS C76.1 Thorax, NOS C76.2 Abdomen, NOS C76.3 Pelvis, NOS C76.4 Upper limb, NOS C76.5 Lower limb, NOS C76.7 Other ill-defined sites C76.8 Overlapping lesion of ill-defined sites C77.0 Head, face and neck C77.1 Intrathoracic C77.2 Intra-abdominal C77.3 Axilla or arm C77.4 Inguinal region or leg C77.5 Pelvis C77.8 Lymph nodes of multiple regions C77.9 Lymph nodes, NOS C80.9 Unknown primary site Note: AJCC does not define TNM staging for this site.

CS Tumor Size CS Site-Specific Factor 1 The following tables are CS Extension CS Site-Specific Factor 2 available at the collaborative CS TS/Ext-Eval CS Site-Specific Factor 3 staging website: CS Lymph Nodes CS Site-Specific Factor 4 Histologies for Which AJCC CS Reg Nodes Eval CS Site-Specific Factor 5 Staging Is Not Generated Reg LN Pos CS Site-Specific Factor 6 AJCC Stage Reg LN Exam CS Mets at DX CS Mets Eval

Other and Ill-Defined Sites, Unknown Primary Site CS Tumor Size SEE STANDARD TABLE

Other and Ill-Defined Sites, Unknown Primary Site CS Extension Code Description TNM SS77 SS2000

88 Not applicable for this site NA U U

Version date: January 1, 2004 633 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Ill-Defined Sites, Unknown Primary Site CS TS/Ext-Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Ill-Defined Sites, Unknown Primary Site CS Lymph Nodes Code Description TNM SS77 SS2000

88 Not applicable NA U U

Other and Ill-Defined Sites, Unknown Primary Site CS Reg Nodes Eval Code Description Staging Basis

9 Not applicable for this site NA

Other and Ill-Defined Sites, Unknown Primary Site Reg LN Pos Code Description

99 Not applicable.

Other and Ill-Defined Sites, Unknown Primary Site Reg LN Exam Code Description

99 Not applicable.

Other and Ill-Defined Sites, Unknown Primary Site CS Mets at DX Code Description TNM SS77 SS2000

88 Not applicable NA U U

Other and Ill-Defined Sites, Unknown Primary Site CS Mets Eval Code Description Staging Basis

9 Not applicable for this site NA

Version date: January 1, 2004 634 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Other and Ill-Defined Sites, Unknown Primary Site CS Site-Specific Factor 1 Code Description

888 Not applicable for this site

Other and Ill-Defined Sites, Unknown Primary Site CS Site-Specific Factor 2 Code Description

888 Not applicable for this site

Other and Ill-Defined Sites, Unknown Primary Site CS Site-Specific Factor 3 Code Description

888 Not applicable for this site

Other and Ill-Defined Sites, Unknown Primary Site CS Site-Specific Factor 4 Code Description

888 Not applicable for this site

Other and Ill-Defined Sites, Unknown Primary Site CS Site-Specific Factor 5 Code Description

888 Not applicable for this site

Other and Ill-Defined Sites, Unknown Primary Site CS Site-Specific Factor 6 Code Description

888 Not applicable for this site

Version date: January 1, 2004 635 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page left blank.

Version date: January 1, 2004 636 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Standard Tables ICD-O-3 Site Code, Histology, Behavior CS Tumor Size The following tables are CS TS/Ext-Eval available at the collaborative CS Reg Nodes Eval staging website: CS Mets Eval Summary Stage Reg LN Pos Valid ICD-O-3 Site Codes Reg LN Exam Valid ICD-O-3 Histology Codes CS Mets at DX T Allowable Codes N Allowable Codes M Allowable Codes Stage Allowable Codes Summary Stage Allowable Codes

Standard Tables CS Tumor Size Code Description

000 No mass/tumor found

001-988 001 - 988 millimeters (code exact size in millimeters)

989 989 millimeters or larger

990 Microscopic focus or foci only, no size of focus given

991 Described as less than 1 cm

992 Described as less than 2 cm

993 Described as less than 3 cm

994 Described as less than 4 cm

995 Described as less than 5 cm

999 Unknown; size not stated Not documented in patient record

Standard Tables CS TS/Ext-Eval Code Description Staging Basis

0 No surgical resection done. Evaluation based on physical examination, imaging c examination, or other non-invasive clinical evidence. No autopsy evidence used.

1 No surgical resection done. Evaluation based on endoscopic examination, diagnostic c biopsy, including fine needle aspiration biopsy, or other invasive techniques including surgical observation without biopsy. No autopsy evidence used. Does not meet criteria for AJCC pathological T staging.

2 No surgical resection done, but evidence derived from autopsy (tumor was suspected or p diagnosed prior to autopsy).

Version date: January 1, 2004 637 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

3 Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation p OR surgical resection performed, unknown if pre-surgical systemic treatment or radiation performed. Evidence acquired before treatment, supplemented or modified by the additional evidence acquired during and from surgery, particularly from pathologic examination of the resected specimen. Meets criteria for AJCC pathological T staging.

5 Surgical resection performed WITH pre-surgical systemic treatment or radiation, c BUT tumor size/extension based on clinical evidence.

6 Surgical resection performed WITH pre-surgical systemic treatment or radiation; tumor y size/extension based on pathologic evidence.

8 Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy). a

9 Unknown if surgical resection done c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record

Standard Tables CS Reg Nodes Eval Note: This item reflects the validity of the classification of the item CS Lymph Nodes only according to diagnostic methods employed. Code Description Staging Basis

0 No regional lymph nodes removed for examination. Evidence based on physical c examination, imaging examination, or other non-invasive clinical evidence. No autopsy evidence used.

1 No regional lymph nodes removed for examination. Evidence based on endoscopic c examination, diagnostic biopsy including fine needle aspiration of lymph node(s) or other invasive techniques, including surgical observation without biopsy. No autopsy evidence used.

2 No regional lymph nodes removed for examination, but evidence derived from autopsy p (tumor was suspected or diagnosed prior to autopsy).

3 Regional lymph nodes removed for examination (removal of at least 1 lymph node) p WITHOUT pre-surgical systemic treatment or radiation OR lymph nodes removed for examination, unknown if pre-surgical systemic treatment or radiation performed.

5 Regional lymph nodes removed for examination c WITH pre-surgical systemic treatment or radiation, BUT lymph node evaluation based on clinical evidence.

6 Regional lymph nodes removed for examination WITH pre-surgical systemic treatment or y radiation, and lymph node evaluation based on pathologic evidence.

8 Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy. a

9 Unknown if lymph nodes removed for examination c Not assessed; cannot be assessed Unknown if assessed Not documented in patient record

Version date: January 1, 2004 638 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Standard Tables Reg LN Pos Note: Record this field even if there has been preoperative treatment. Code Description

00 All nodes examined negative.

01-89 1 - 89 nodes positive (code exact number of nodes positive)

90 90 or more nodes positive

95 Positive aspiration of lymph node(s)

97 Positive nodes - number unspecified

98 No nodes examined

99 Unknown if nodes are positive; not applicable Not documented in patient record

Standard Tables Reg LN Exam Code Description

00 No nodes examined

01-89 1 - 89 nodes examined (code exact number of regional lymph nodes examined)

90 90 or more nodes examined

95 No regional nodes removed, but aspiration of regional nodes performed

96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated

97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated

98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not documented as sampling or dissection; nodes examined, but number unknown

99 Unknown if nodes were examined; not applicable or negative Not documented in patient record

Version date: January 1, 2004 639 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Standard Tables CS Mets at DX Code Description TNM SS77 SS2000

00 No; none M0 NONE NONE

10 Distant lymph node(s) M1 D D

40 Distant metastasis, NOS M1 D D Distant metastases except distant lymph node(s) (code 10) Carcinomatosis

50 (10) + (40) M1 D D Distant lymph node(s) plus other distant metastases

99 Unknown if distant metastasis MX U U Cannot be assessed Not documented in patient record

Standard Tables CS Mets Eval Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the diagnostic methods employed. Code Description Staging Basis

0 No pathologic examination of metastatic tissue performed. Evaluation based on physical c examination, imaging examination, and/or other non-invasive clinical evidence. No autopsy evidence used.

1 No pathologic examination of metastatic tissue performed. Evaluation of distant metastasis c based on endoscopic examination or other invasive technique, including surgical observation without biopsy. No autopsy evidence used.

2 No pathologic examination of metastatic tissue done prior to death, but evidence derived p from autopsy (tumor was suspected or diagnosed prior to autopsy).

3 Pathologic examination of metastatic tissue performed WITHOUT pre-surgical systemic p treatment or radiation OR pathologic examination of metastatic tissue performed, unknown if pre-surgical systemic treatment or radiation performed.

5 Pathologic examination of metastatic tissue performed WITH pre-surgical systemic c treatment or radiation, BUT metastasis based on clinical evidence.

6 Pathologic examination of metastatic tissue performed WITH pre-surgical systemic y treatment or radiation, and metastasis based on pathologic evidence.

8 Evidence from autopsy, and; tumor was unsuspected or undiagnosed prior to autopsy. a

9 Not assessed; cannot be assessed c Unknown if assessed Not documented in patient record

Version date: January 1, 2004 640 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

INDEX OF SCHEMA BY ICD-O-3 PRIMARY SITE CODE (excluding histology-based schemas for malignant lymphoma, Kaposi sarcoma, and the hematopoietic diseases)

Hematopoietic and reticuloendothelial system neoplasms of all sites page 629 (ICD-O-3 morphology codes: M-9731-9734, 9740-9742, 9750-9758, 9760-9762, 9764-69, 9800-9801, 9805, 9820, 9823, 9826-9827, 9831-9837, 9840, 9860-9861, 9863, 9866-9867, 9870-9876, 9891, 9895-9897, 9910, 9920, 9930-9931, 9940, 9945-9946, 9948, 9950, 9960-9964, 9970, 9975, 9980, 9982-9987, 9989) Hodgkin and non-Hodgkin lymphomas of all sites page 623 (ICD-O-3 morphology codes: M-9590-9591, 9596, 9650-9655, 9659, 9661-9665, 9667, 9670-9671, 9673, 9675, 9678-9680, 9684, 9687, 9689-9691, 9695, 9698-9699, 9705, 9708-9709, 9714, 9716-9719, 9727- 9729) Kaposi sarcoma of all sites (ICD-O-3 morphology code M-9140) page 619

Page Page C00.0 External upper lip (vermilion border) 87 C10.0 Vallecula 215 C00.1 External lower lip (vermilion border) 95 C10.1 Anterior surface of epiglottis 223 C00.2 External lip, NOS (vermilion border) 103 C10.2 Lateral wall of oropharynx 215 C00.3 Mucosa of upper lip 87 C10.3 Posterior wall of oropharynx 215 C00.4 Mucosa of lower lip 95 C10.4 Branchial cleft 215 C00.5 Mucosa of lip, NOS 103 C10.8 Overlapping lesion of oropharynx 215 C00.6 Commissure of lip 95 C10.9 Oropharynx, NOS 215 C00.8 Overlapping lesion of lip 103 C11.0 Superior wall of nasopharynx 231 C00.9 Lip, NOS (excludes skin of lip C44.0) 103 C11.1 Posterior wall of nasopharynx 231 C01.9 Base of tongue, NOS 111 C11.2 Lateral wall of nasopharynx 231 C02.0 Dorsal surface of tongue, NOS 119 C11.3 Anterior wall of nasopharynx 231 C02.1 Border of tongue 119 C11.8 Overlapping lesion of nasopharynx 231 C02.2 Ventral surface of tongue, NOS 119 C11.9 Nasopharynx, NOS 231 C02.3 Anterior two-thirds of tongue, NOS 119 C12.9 Pyriform sinus 239 C02.4 Lingual tonsil 111 C13.0 Postcricoid region 239 C02.8 Overlapping lesion of tongue 119 C13.1 Hypopharyngeal aspect of C02.9 Tongue, NOS 119 aryepiglottic fold 239 C03.0 Upper gum 127 C13.2 Posterior wall of hypopharynx 239 C03.1 Lower gum 135 C13.8 Overlapping lesion of hypopharynx 239 C03.9 Gum, NOS 143 C13.9 Hypopharynx, NOS 239 C04.0 Anterior floor of mouth 151 C13.9 Laryngopharynx 239 C04.1 Lateral floor of mouth 151 C14.0 Pharynx, NOS 247 C04.8 Overlapping lesion of floor of mouth 151 C14.2 Waldeyer ring 247 C04.9 Floor of mouth, NOS 151 C14.8 Overlapping lesion of lip, oral C05.0 Hard palate 159 cavity and pharynx 247 C05.1 Soft palate, NOS 167 C15.0 Cervical esophagus 253 C05.2 Uvula 167 C15.1 Thoracic esophagus 253 C05.8 Overlapping lesion of palate 175 C15.2 Abdominal esophagus 253 C05.9 Palate, NOS 175 C15.3 Upper third of esophagus 253 C06.0 Cheek mucosa 183 C15.4 Middle third of esophagus 253 C06.1 Vestibule of mouth 183 C15.5 Lower third of esophagus 253 C06.2 Retromolar area 135 C15.8 Overlapping lesion of esophagus 253 C06.8 Overlapping lesion of other and C15.9 Esophagus, NOS 253 unspecified parts of mouth 175 C16.0 Cardia, NOS 259 C06.9 Minor salivary gland, NOS 175 C16.1 Fundus of stomach 259 C06.9 Mouth, NOS 175 C16.2 Body of stomach 259 C07.9 Parotid gland 191 C16.3 Gastric antrum 259 C08.0 Submandibular gland 199 C16.4 Pylorus 259 C08.1 Sublingual gland 207 C16.5 Lesser curvature of stomach, NOS 259 C08.8 Overlapping lesion of major salivary C16.6 Greater curvature of stomach, NOS 259 glands 207 C16.8 Overlapping lesion of stomach 259 C08.9 Major salivary gland, NOS 207 C16.9 Stomach, NOS 259 C09.0 Tonsillar fossa 215 C17.0 Duodenum 265 C09.1 Tonsillar pillar 215 C17.1 Jejunum 265 C09.8 Overlapping lesion of tonsil 215 C17.2 Ileum (excludes ileocecal valve, C18.0) 265 C09.9 Tonsil, NOS 215

Version date: January 1, 2004 641 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page Page C17.3 Meckel diverticulum (as site of C34.2 Middle lobe of lung 403 neoplasm) 265 C34.3 Lower lobe of lung 403 C17.8 Overlapping lesion of small intestine 265 C34.8 Overlapping lesion of lung 403 C17.9 Small intestine, NOS 265 C34.9 Lung, NOS 403 C18.0 Cecum 271 C37.9 Thymus 615 C18.1 Appendix 271 C38.0 Heart 411 C18.2 Ascending (right) colon 271 C38.1 Anterior mediastinum 411 C18.3 Hepatic flexure of colon 271 C38.2 Posterior mediastinum 411 C18.4 Transverse colon 271 C38.3 Mediastinum, NOS 411 C18.5 Splenic flexure of colon 271 C38.4 Pleura, NOS (including visceral C18.6 Descending (left) colon 271 and parietal) 415 C18.7 Sigmoid colon 271 C38.8 Overlapping lesion of heart, C18.8 Overlapping lesion of colon 271 mediastinum and pleura 411 C18.9 Colon, NOS 271 C39.0 Upper respiratory tract, NOS 419 C19.9 Rectosigmoid junction 279 C39.8 Overlapping lesion of respiratory C20.9 Rectum, NOS 279 system and intrathoracic organs 419 C21.0 Anus, NOS 285 C39.9 Ill-defined sites within respiratory C21.1 Anal canal 285 system 419 C21.2 Cloacogenic zone 285 C40.0 Long bones of upper limb, scapula C21.8 Overlapping lesion of rectum, and associated joints 423 anus and anal canal 285 C40.1 Short bones of upper limb and C22.0 Liver 289 associated joints 423 C22.1 Intrahepatic bile duct 289 C40.2 Long bones of lower limb and C23.9 Gallbladder 295 associated joints 423 C24.0 Extrahepatic bile duct(s) (choledochal, C40.3 Short bones of lower limb and common, cystic, and hepatic bile associated joints 423 duct(s); sphincter of Oddi) 299 C40.8 Overlapping lesion of bones, joints C24.1 Ampulla of Vater 303 and articular cartilage of limbs 423 C24.8 Overlapping lesion of biliary tract 307 C40.9 Bone of limb, NOS 423 C24.9 Biliary tract, NOS 307 C41.0 Bones of skull and face and C25.0 Head of pancreas 311 associated joints 423 C25.1 Body of pancreas 315 C41.1 Mandible 423 C25.2 Tail of pancreas 315 C41.2 Vertebral column 423 C25.3 Pancreatic duct 319 C41.3 Rib, sternum, clavicle and C25.4 Islets of Langerhans 319 associated joints 423 C25.7 Other and unspecified parts of C41.4 Pelvic bones, sacrum, coccyx and pancreas (neck) 319 associated joints 423 C25.8 Overlapping lesion of pancreas 319 C41.8 Overlapping lesion of bones, joints C25.9 Pancreas, NOS 319 and articular cartilage 423 C26.0 Intestinal tract, NOS 323 C41.9 Bone, NOS (including articular C26.8 Overlapping lesion of digestive system 323 cartilage) 423 C26.9 Gastrointestinal tract, NOS 323 C41.9 Bone, NOS 423 C30.0 Nasal cavity (excludes nose, C42.0 Blood (other than hematopoietic, NOS C76.0) 327 reticuloendothelial, immuno- C30.1 Middle ear (tympanic cavity) 335 proliferative and myeloproliferative C31.0 Maxillary sinus (antrum) 343 neoplasms) 633 C31.1 Ethmoid sinus 351 C42.1 Bone marrow (other than C31.2 Frontal sinus 359 hematopoietic, reticuloendothelial, C31.3 Sphenoid sinus 359 immunoproliferative and myelo- C31.8 Overlapping lesion of accessory proliferative neoplasms) 633 sinuses 359 C42.2 Spleen (other than hematopoietic, C31.9 Accessory sinus, NOS 359 reticuloendothelial, immuno- C32.0 Glottis (vocal cord) 367 proliferative and myeloproliferative C32.1 Supraglottic larynx 375 neoplasms) 633 C32.2 Subglottic larynx 383 C42.3 Reticuloendothelial system, NOS 633 C32.3 Laryngeal cartilage 391 C42.4 Hematopoietic system, NOS 633 C32.8 Overlapping lesion of larynx 391 C44.0 Skin of lip, NOS (excluding vermilion C32.9 Larynx, NOS 391 surface C00._) (excluding melanoma, C33.9 Trachea 399 Kaposi sarcoma, mycosis fungoides, C34.0 Main bronchus, incl. carina, hilus 403 Sezary disease and other C34.1 Upper lobe of lung, incl. lingula 403 lymphomas) 427

Version date: January 1, 2004 642 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page Page C44.0 Skin of lip, NOS (excl. vermilion C44.8 Overlapping lesion of skin surface C00._) (melanoma) 435 (excluding melanoma, Kaposi C44.0 Skin of lip, NOS (excl. vermilion sarcoma, mycosis fungoides, surface C00._) (mycosis fungoides Sezary disease and other and Sezary disease) 443 lymphomas) 427 C44.1 Eyelid (excluding melanoma, Kaposi C44.8 Overlapping lesion of skin (melanoma) 435 sarcoma, mycosis fungoides, C44.8 Overlapping lesion of skin (mycosis Sezary disease and other fungoides and Sezary disease) 443 lymphomas) 431 C44.9 Skin, NOS (excluding melanoma, C44.1 Eyelid (melanoma) 435 Kaposi sarcoma, mycosis fungoides, C44.1 Eyelid (mycosis fungoides and Sezary disease and other Sezary disease) 443 lymphomas) 427 C44.2 External ear (excluding melanoma, C44.9 Skin, NOS (melanoma) 435 Kaposi sarcoma, mycosis fungoides, C44.9 Skin, NOS (mycosis fungoides and Sezary disease and other Sezary disease) 443 lymphomas) 427 C47.0 Peripheral nerves and autonomic C44.2 External ear (melanoma) 435 nervous system of head, face C44.2 External ear (mycosis fungoides and neck 447 and Sezary disease) 443 C47.1 Peripheral nerves and autonomic C44.3 Skin of other and unspecified parts nervous system of upper limb of face (excluding melanoma, and shoulder 447 Kaposi sarcoma, mycosis fungoides, C47.2 Peripheral nerves and autonomic Sezary disease and other nervous system of lower limb lymphomas) 427 and hip 447 C44.3 Skin of other and unspecified parts C47.3 Peripheral nerves and autonomic of face (melanoma) 435 nervous system of thorax 447 C44.3 Skin of other and unspecified parts C47.4 Peripheral nerves and autonomic of face (mycosis fungoides and nervous system of abdomen 447 Sezary disease) 443 C47.5 Peripheral nerves and autonomic C44.4 Skin of scalp and neck (excluding nervous system of pelvis 447 melanoma, Kaposi sarcoma, C47.6 Peripheral nerves and autonomic mycosis fungoides, Sezary disease nervous system of trunk, NOS 447 and other lymphomas) 427 C47.8 Overlapping lesion of peripheral C44.4 Skin of scalp and neck (melanoma) 435 nerves and autonomic nervous C44.4 Skin of scalp and neck (mycosis system 447 fungoides and Sezary disease) 443 C47.9 Autonomic nervous system, NOS 447 C44.5 Skin of trunk (excluding melanoma, C48.0 Retroperitoneum 453 Kaposi sarcoma, mycosis fungoides, C48.1 Specified parts of peritoneum Sezary disease and other (incl. omentum and mesentery) 453 lymphomas) 427 C48.2 Peritoneum, NOS 453 C44.5 Skin of trunk (melanoma) 435 C48.8 Overlapping lesion of C44.5 Skin of trunk (mycosis fungoides and retroperitoneum and peritoneum 453 Sezary disease) 443 C49.0 Connective, subcutaneous and other C44.6 Skin of upper limb and shoulder soft tissues of head, face and neck 447 (excluding melanoma, Kaposi C49.1 Connective, subcutaneous and other sarcoma, mycosis fungoides, soft tissues of upper limb and Sezary disease and other shoulder 447 lymphomas) 427 C49.2 Connective, subcutaneous and other C44.6 Skin of upper limb and shoulder soft tissues of lower limb and hip 447 (melanoma) 435 C49.3 Connective, subcutaneous and other C44.6 Skin of upper limb and shoulder soft tissues of thorax 447 (mycosis fungoides and Sezary C49.4 Connective, subcutaneous and other disease) 443 soft tissues of abdomen 447 C44.7 Skin of lower limb and hip (excluding C49.5 Connective, subcutaneous and other melanoma, Kaposi sarcoma, soft tissues of pelvis 447 mycosis fungoides, Sezary disease C49.6 Connective, subcutaneous and other and other lymphomas) 427 soft tissues of trunk, NOS 447 C44.7 Skin of lower limb and hip (melanoma) 435 C49.8 Overlapping lesion of connective, C44.7 Skin of lower limb and hip (mycosis subcutaneous and other soft tissues 447 fungoides and Sezary disease) 443 C49.9 Connective, subcutaneous and other soft tissue, NOS 447

Version date: January 1, 2004 643 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page Page C50.0 Nipple 457 C57.7 Other specified parts of female C50.1 Central portion of breast (subareolar) 457 genital organs 503 C50.2 Upper-inner quadrant of breast 457 C57.8 Overlapping lesion of female C50.3 Lower-inner quadrant of breast 457 genital organs 503 C50.4 Upper-outer quadrant of breast 457 C57.9 Female genital tract, NOS 503 C50.5 Lower-outer quadrant of breast 457 C58.9 Placenta 507 C50.6 Axillary tail of breast 457 C60.0 Prepuce (excluding melanoma, Kaposi C50.8 Overlapping lesion of breast 457 sarcoma, mycosis fungoides, Sezary C50.9 Breast, NOS 457 disease and other lymphomas) 513 C51.0 Labia majus (excluding melanoma, C60.0 Prepuce (melanoma) 435 Kaposi sarcoma, mycosis fungoides, C60.0 Prepuce (mycosis fungoides and Sezary disease and other Sezary disease) 443 lymphomas) 467 C60.1 Glans penis (excluding melanoma, C51.0 Labia majus (melanoma) 435 Kaposi sarcoma, mycosis fungoides, C51.0 Labia majus (mycosis fungoides and Sezary disease and other Sezary disease) 443 lymphomas) 513 C51.1 Labia minus (excluding melanoma, C60.1 Glans penis (melanoma) 435 Kaposi sarcoma, mycosis fungoides, C60.1 Glans penis (mycosis fungoides and Sezary disease and other Sezary disease) 443 lymphomas) 467 C60.2 Body of penis (excluding melanoma, C51.1 Labia minus (melanoma) 435 Kaposi sarcoma, mycosis fungoides, C51.1 Labia minus (mycosis fungoides and Sezary disease and other Sezary disease) 443 lymphomas) 513 C51.2 Clitoris (excluding melanoma, Kaposi C60.2 Body of penis (melanoma) 435 sarcoma, mycosis fungoides, Sezary C60.2 Body of penis (mycosis fungoides disease and other lymphomas) 467 and Sezary disease) 443 C51.2 Clitoris (melanoma) 435 C60.8 Overlapping lesion of penis (excluding C51.2 Clitoris (mycosis fungoides and melanoma, Kaposi sarcoma, Sezary disease) 443 mycosis fungoides, Sezary disease C51.8 Overlapping lesion of vulva (excluding and other lymphomas) 513 melanoma, Kaposi sarcoma, C60.8 Overlapping lesion of penis (melanoma) 435 mycosis fungoides, Sezary disease C60.8 Overlapping lesion of penis (mycosis and other lymphomas) 467 fungoides and Sezary disease) 443 C51.8 Overlapping lesion of vulva (melanoma) 435 C60.9 Penis, NOS (excluding melanoma, C51.8 Overlapping lesion of vulva (mycosis Kaposi sarcoma, mycosis fungoides, fungoides and Sezary disease) 443 Sezary disease and other C51.9 Vulva, NOS (excluding melanoma, lymphomas) 513 Kaposi sarcoma, mycosis fungoides, C60.9 Penis, NOS (melanoma) 435 Sezary disease and other C60.9 Penis, NOS (mycosis fungoides lymphomas) 467 and Sezary disease) 443 C51.9 Vulva, NOS (melanoma) 435 C61.9 Prostate 517 C51.9 Vulva, NOS (mycosis fungoides and C62.0 Undescended testis 527 Sezary disease) 443 C62.1 Descended testis 527 C52.9 Vagina, NOS 471 C62.9 Testis, NOS 527 C53.0 Endocervix 475 C63.0 Epididymis 533 C53.1 Exocervix 475 C63.1 Spermatic cord 533 C53.8 Overlapping lesion of cervix uteri 475 C63.2 Scrotum, NOS (excluding melanoma, C53.9 Cervix uteri 475 Kaposi sarcoma, mycosis fungoides, C54.0 Isthmus uteri 481 Sezary disease and other C54.1 Endometrium 481 lymphomas) 537 C54.2 Myometrium 481 C63.2 Scrotum, NOS (melanoma) 435 C54.3 Fundus uteri 481 C63.2 Scrotum, NOS (mycosis fungoides C54.8 Overlapping lesion of corpus uteri 481 and Sezary disease) 443 C54.9 Corpus uteri 481 C63.7 Other specified parts of male genital C55.9 Uterus, NOS 481 organs 533 C56.9 Ovary 487 C63.8 Overlapping lesion of male genital C57.0 Fallopian tube 493 organs 533 C57.1 Broad ligament 499 C63.9 Male genital organs, NOS 533 C57.2 Round ligament 499 C64.9 Kidney, NOS (renal parenchyma) 541 C57.3 Parametrium 499 C65.9 Renal pelvis 545 C57.4 Uterine adnexa 499 C66.9 Ureter 545

Version date: January 1, 2004 644 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page Page C67.0 Trigone of bladder 549 C71.0 Cerebrum 603 C67.1 Dome of bladder 549 C71.1 Frontal lobe 603 C67.2 Lateral wall of bladder 549 C71.2 Temporal lobe 603 C67.3 Anterior wall of bladder 549 C71.3 Parietal lobe 603 C67.4 Posterior wall of bladder 549 C71.4 Occipital lobe 603 C67.5 Bladder neck 549 C71.5 Ventricle, NOS 603 C67.6 Ureteric orifice 549 C71.6 Cerebellum, NOS 603 C67.7 Urachus 549 C71.7 Brain stem 603 C67.8 Overlapping lesion of bladder 549 C71.8 Overlapping lesion of brain 603 C67.9 Bladder, NOS 549 C71.9 Brain, NOS 603 C68.0 Urethra (incl. transitional cell carcinoma C72.0 Spinal cord 607 of prostatic urethra M-8120-8130) 555 C72.1 Cauda equina 607 C68.1 Paraurethral gland 559 C72.2 Olfactory nerve 607 C68.8 Overlapping lesion of urinary organs 559 C72.3 Optic nerve 607 C68.9 Urinary system, NOS 559 C72.4 Acoustic nerve 607 C69.0 Conjunctiva (excluding melanoma, C72.5 Cranial nerve, NOS 607 retinoblastoma, Kaposi sarcoma, C72.8 Overlapping lesion of brain and and lymphoma) 563 central nervous system 607 C69.0 Conjunctiva (melanoma) 567 C72.9 Nervous system, NOS 607 C69.0 Conjunctiva (retinoblastoma) 597 C73.9 Thyroid gland 611 C69.1 Cornea (excluding melanoma and C74.0 Adrenal (suprarenal) cortex 615 retinoblastoma) 571 C74.1 Adrenal (suprarenal) medulla 615 C69.1 Cornea (melanoma) 585 C74.9 Adrenal (suprarenal) gland, NOS 615 C69.1 Cornea (retinoblastoma) 597 C75.0 Parathyroid gland 615 C69.2 Retina (excluding melanoma and C75.1 Pituitary gland 615 retinoblastoma) 571 C75.2 Craniopharyngeal duct 615 C69.2 Retina (melanoma) 585 C75.3 Pineal gland 615 C69.2 Retina (retinoblastoma) 597 C75.4 Carotid body 615 C69.3 Choroid (excluding melanoma and C75.5 Aortic body and other paraganglia 615 retinoblastoma) 571 C75.8 Overlapping lesion of endocrine C69.3 Choroid (melanoma) 581 glands and related structures 615 C69.3 Choroid (retinoblastoma) 597 C75.9 Endocrine gland, NOS 615 C69.4 Ciliary body (iris, sclera, lens, C76.0 Other and ill-defined sites of head, eyeball) (excluding melanoma face or neck, NOS 633 and retinoblastoma) 571 C76.1 Other and ill-defined sites of C69.4 Ciliary body (iris, sclera, lens, thorax, NOS 633 eyeball) (melanoma) 575 C76.2 Other and ill-defined sites of C69.4 Ciliary body (iris, sclera, lens, abdomen, NOS 633 eyeball) (retinoblastoma) 597 C76.3 Other and ill-defined sites of C69.5 Lacrimal gland (excluding melanoma pelvis, NOS 633 and retinoblastoma) 589 C76.4 Other and ill-defined sites of C69.5 Lacrimal gland (melanoma) 585 upper limb, NOS 633 C69.5 Lacrimal gland (retinoblastoma) 597 C76.5 Other and ill-defined sites of C69.6 Orbit, NOS (excluding retinoblastoma) 593 lower limb, NOS 633 C69.6 Orbit, NOS (retinoblastoma) 597 C76.7 Other ill-defined sites 633 C69.8 Overlapping lesion of eye and C76.8 Overlapping lesion of ill-defined sites 633 adnexa (excluding melanoma C77.0 Head, face and neck, lymph nodes of 633 and retinoblastoma) 571 C77.1 Intrathoracic lymph nodes 633 C69.8 Overlapping lesion of eye and C77.2 Intra-abdominal lymph nodes 633 adnexa (melanoma) 585 C77.3 Axilla or arm, lymph nodes of 633 C69.8 Overlapping lesion of eye and C77.4 Inguinal region or leg, lymph nodes of 633 adnexa (retinoblastoma) 597 C77.5 Pelvic lymph nodes 633 C69.9 Eye, NOS (excluding melanoma and C77.8 Lymph nodes of multiple regions 633 retinoblastoma) 571 C77.9 Lymph node, NOS 633 C69.9 Eye, NOS (melanoma) 585 C80.9 Unknown primary site 633 C69.9 Eye, NOS (retinoblastoma) 597 C70.0 Cerebral meninges 603 C70.1 Spinal meninges 607 C70.9 Meninges, NOS 607

Version date: January 1, 2004 645 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

ALPHABETIC INDEX TO PART II: SITE SCHEMA Page references are to the schema and do not list every reference to an organ or structure in the codes

Page Page A Bone, NOS (including articular cartilage) 423 Abdomen, connective tissue of 447 Bone of limb, NOS 423 Abdomen, nervous system of 447 Bones of skull and face and associated joints 423 Abdomen, NOS , other and ill-defined sites of 633 Border of tongue 119 Abdominal esophagus 253 Brain, NOS 603 Accessory sinus, NOS 359 Brain stem 603 Acoustic nerve 607 Branchial cleft 215 Adnexa, uterine 499 Breast, NOS 457 Adrenal (suprarenal) cortex 615 Broad ligament 499 Adrenal (suprarenal) gland, NOS 615 Bronchus 403 Adrenal (suprarenal) medulla 615 Buccal mucosa 183 Ampulla of Vater 303 Anal canal 285 C Anterior floor of mouth 151 Canal, anal 285 Anterior mediastinum 411 Cardia, NOS 259 Anterior surface of epiglottis 223 Carotid body 615 Anterior two-thirds of tongue, NOS 119 Cartilage: articular 423 Anterior wall of bladder 549 Cartilage: laryngeal, arytenoid, cricoid, Anterior wall of nasopharynx 231 cuneiform, thyroid 391 Antrum, gastric 259 Cauda equina 607 Anus, NOS 285 Cecum 271 Aortic body and other paraganglia 615 Central nervous system, other parts of 607 Appendix 271 Central portion of breast (subareolar) 457 Articular cartilage 423 Cerebellum, NOS 603 Aryepiglottic fold 375 Cerebral meninges 603 Aryepiglottic fold, hypopharyngeal aspect of 239 Cerebrum 603 Aryepiglottic fold, laryngeal aspect of 375 Cervical esophagus 253 Arytenoid cartilage 391 Cervix uteri 475 Ascending (right) colon 271 Cheek mucosa 183 Autonomic nervous system, NOS 447 Choledochal bile duct(s) 299 Axilla or arm, Lymph nodes of 633 Choroid (excluding melanoma and Axillary tail of breast 457 retinoblastoma) 571 Choroid (melanoma) 581 B Choroid (retinoblastoma) 597 Base of tongue, NOS 111 Ciliary body (iris, sclera, lens, eyeball) Bile duct, intrahepatic 289 (excluding melanoma and retinoblastoma) 571 Bile duct(s): choledochal, common, cystic, Ciliary body (iris, sclera, lens, eyeball) and hepatic 299 (melanoma) 575 Biliary tract, NOS 307 Ciliary body (iris, sclera, lens, eyeball) Bladder neck 549 (retinoblastoma) 597 Bladder, NOS 549 Clavicle 423 Blood (other than hematopoietic, reticulo- Cleft, branchial 215 endothelial, immunoproliferative and Clitoris (excluding melanoma, Kaposi sarcoma, myeloproliferative neoplasms) 633 mycosis fungoides, Sezary disease and other Body of pancreas 315 lymphomas) 467 Body of penis (excluding melanoma, Kaposi Clitoris (melanoma) 435 sarcoma, mycosis fungoides, Sezary Clitoris (mycosis fungoides and Sezary disease and other lymphomas) 513 disease) 443 Body of penis (melanoma) 435 Cloacogenic zone 285 Body of penis (mycosis fungoides and Sezary Coccyx 423 disease) 443 Colon, NOS 271 Body of stomach 259 Column, vertebral 423 Bone marrow (other than hematopoietic, Commissure of lip 95 reticuloendothelial, immunoproliferative and Common bile duct(s) 299 myeloproliferative neoplasms) 633

Version date: January 1, 2004 646 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page Page Conjunctiva (excluding melanoma, retino- Epiglottis, anterior surface of 223 blastoma, Kaposi sarcoma, and lymphoma) 563 Esophagus, NOS 253 Conjunctiva (melanoma) 567 Ethmoid sinus 351 Conjunctiva (retinoblastoma) 597 Exocervix 475 Connective, subcutaneous and other soft External ear (excluding melanoma, Kaposi tissues, NOS 447 sarcoma, mycosis fungoides, Sezary Connective, subcutaneous and other soft disease and other lymphomas 427 tissues of abdomen 447 External ear (melanoma) 435 Connective, subcutaneous and other soft External ear (mycosis fungoides and Sezary tissues of head, face and neck 447 disease) 443 Connective, subcutaneous and other soft External lip, NOS (vermilion border) 103 tissues of lower limb and hip 447 External lower lip (vermilion border) 95 Connective, subcutaneous and other soft External upper lip (vermilion border) 87 tissues of pelvis 447 Extrahepatic bile duct(s) (choledochal, Connective, subcutaneous and other soft common, cystic, and hepatic bile duct(s); tissues of thorax 447 sphincter of Oddi) 299 Connective, subcutaneous and other soft Eye, NOS (excluding melanoma and tissues of trunk, NOS 447 retinoblastoma) 571 Connective, subcutaneous and other soft Eye, NOS (melanoma) 585 tissues of upper limb and shoulder 447 Eye, NOS (retinoblastoma) 597 Connective tissue 447 Eyeball (excluding melanoma and Cord, false 375 retinoblastoma) 571 Cord, spermatic 533 Eyeball (melanoma) 575 Cord, spinal 607 Eyeball (retinoblastoma) 597 Cord, vocal 367 Eyelid (excluding melanoma, Kaposi sarcoma, Cornea (excluding melanoma and mycosis fungoides, Sezary disease and retinoblastoma) 571 other lymphomas) 431 Cornea (melanoma) 585 Eyelid (melanoma) 435 Cornea (retinoblastoma) 597 Eyelid (mycosis fungoides and Sezary disease) 443 Corpus uteri 481 Eyelid, skin of (excluding melanoma, Kaposi Cranial nerve, NOS 607 sarcoma, mycosis fungoides, Sezary Craniopharyngeal duct 615 disease and other lymphomas) 431 Cricoid cartilage 391 Cul de sac 453 F Cuneiform cartilage 391 Fallopian tube 493 Cystic bile duct(s) 299 False cord 375 Female genital tract, NOS 503 D Floor of mouth, NOS 151 Descended testis 527 Fossa, tonsillar 215 Descending (left) colon 271 Frontal lobe 603 Digestive system, ill-defined site of 323 Frontal sinus 359 Digestive system, NOS 323 Fundus of stomach 259 Dome of bladder 549 Fundus uteri 481 Dorsal surface of tongue, NOS 119 Duct (choledochal, common, cystic, and G hepatic) 299 Gallbladder 295 Duct, bile, NOS 299 Gastric antrum 259 Duct, extrahepatic 299 Gastrointestinal tract, NOS 323 Duct, intrahepatic bile 289 Genital organs (male) 533 Duct, pancreatic 319 Genital tract (female) 503 Duodenum 265 Gingiva see Gum Gland, lacrimal (excluding melanoma and E retinoblastoma) 589 Ear (excluding melanoma, Kaposi sarcoma, Gland, lacrimal (melanoma) 585 mycosis fungoides, Sezary disease and Gland, lacrimal (retinoblastoma) 597 other lymphomas 427 Gland, major salivary, NOS 207 Ear (melanoma) 435 Gland, minor salivary, NOS 175 Ear, middle 335 Gland: parathyroid, pituitary, endocrine 615 Ear (mycosis fungoides and Sezary disease) 443 Gland, paraurethral 559 Endocervix 475 Gland, parotid 191 Endocrine gland, NOS 615 Gland, prostate 517 Endometrium 481 Gland, sublingual 207 Epididymis 533 Gland, submandibular 199 Epiglottis (posterior surface) 375 Gland, submaxillary 199 Epiglottis, NOS 375

Version date: January 1, 2004 647 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page Page Glans penis (excluding melanoma, Kaposi L sarcoma, mycosis fungoides, Sezary Labia majus (excluding melanoma, Kaposi disease and other lymphomas) 513 sarcoma, mycosis fungoides, Sezary Glans penis (melanoma) 435 disease and other lymphomas) 467 Glans penis (mycosis fungoides and Sezary Labia majus (melanoma) 435 disease) 443 Labia majus (mycosis fungoides and Sezary Glottis (vocal cord) 367 disease) 443 Greater curvature of stomach, NOS 259 Labia minus (excluding melanoma, Kaposi Gum, lower (gingiva) 135 sarcoma, mycosis fungoides, Sezary Gum, NOS (gingiva) 143 disease and other lymphomas) 467 Gum, upper (gingiva) 127 Labia minus (melanoma) 435 Labia minus (mycosis fungoides and Sezary H disease) 443 Hard palate 159 Lacrimal gland (excluding melanoma and Head of pancreas 311 retinoblastoma) 589 Head, face and neck, connective tissue of 447 Lacrimal gland (melanoma) 585 Head, face and neck, lymph nodes of 633 Lacrimal gland (retinoblastoma) 597 Head, face and neck, nervous system of 447 Langerhans, islets of, NOS 319 Head, face or neck, NOS, other and Laryngeal cartilage 391 ill-defined sites of 633 Laryngopharynx 239 Heart 411 Larynx: extrinsic 375 Heart, mediastinum and pleura: overlapping Larynx: glottis 367 lesion 411 Larynx: NOS 391 Hematopoietic system, NOS 633 Larynx: overlapping lesion 391 Hematopoietic, reticuloendothelial, immuno- Larynx: subglottis 383 proliferative, and myeloproliferative Larynx: supraglottis 375 neoplasms (all sites) 629 Lateral floor of mouth 151 Hepatic bile duct(s) 299 Lateral wall of bladder 549 Hepatic flexure of colon 271 Lateral wall of nasopharynx 231 Hilus of lung 403 Lateral wall of oropharynx 215 Hypopharyngeal aspect of aryepiglottic fold 239 Lens (excluding melanoma and Hypopharynx, NOS 239 retinoblastoma) 571 Lens (melanoma) 575 I Lens (retinoblastoma) 597 Ileum (excludes ileocecal valve, C18.0) 265 Lesser curvature of stomach, NOS 259 Ill-defined site, other 633 Ligament: broad, round 499 Ill-defined sites within respiratory system 419 Lingual tonsil 111 Immunoproliferative neoplasms (all sites) 629 Lip, lower (excludes skin of lip C44.0) 95 Inguinal region or leg, lymph nodes 633 Lip, NOS (excludes skin of lip C44.0) 103 Intestinal tract, NOS 323 Lip, upper (excludes skin of lip C44.0) 87 Intestine, large 271 Lip, oral cavity and pharynx, overlapping Intestine, small 265 lesion of 247 Intra-abdominal lymph nodes 633 Liver 289 Intrahepatic bile duct 289 Lobe: frontal, temporal, parietal, occipital Intrathoracic lymph nodes 633 (brain) 603 Iris (excluding melanoma and retinoblastoma) 571 Lobe: upper, middle, lower (lung) 403 Iris (melanoma) 575 Long bones of lower limb and associated joints 423 Iris (retinoblastoma) 597 Long bones of upper limb, scapula and Islets of Langerhans 319 associated joints 423 Isthmus uteri 481 Lower gum 135 Lower limb and hip, connective tissue of 447 J Lower limb and hip, nervous system of 447 Jejunum 265 Lower limb, NOS, other and ill-defined sites of 633 Joints 423 Lower lobe of lung 403 Lower third of esophagus 253 Junction, rectosigmoid 279 Lower-inner quadrant of breast 457 Lower-outer quadrant of breast 457 K Lung, NOS 403 Kaposi sarcoma of all sites (M-9140) 619 Lymph node, NOS 633 Kidney, NOS (renal parenchyma) 541 Lymph nodes of multiple regions 633 Lymphoma (all sites) 623 Lymphoma, Hodgkin (all sites) 623 Lymphoma, non-Hodgkin (all sites) 623

Version date: January 1, 2004 648 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page Page M O Main bronchus, incl. carina, hilus 403 Occipital lobe 603 Major salivary gland, NOS 207 Olfactory nerve 607 Male genital organs, NOS 533 Optic nerve 607 Mandible 423 Oral cavity, ill-defined, NOS 175 Maxillary sinus (antrum) 343 Orbit, NOS (excluding retinoblastoma) 593 Meckel diverticulum (as site of neoplasm) 265 Orbit, NOS (retinoblastoma) 597 Mediastinum, NOS 411 Organs, male genital 533 Melanoma of choroid 581 Oropharynx, NOS 215 Melanoma of ciliary body 575 Other and unspecified parts of pancreas (neck) 319 Melanoma of clitoris 435 Other ill-defined sites 633 Melanoma of conjunctiva 567 Other specified parts of female genital organs 503 Melanoma of cornea 585 Other specified parts of male genital organs 533 Melanoma of external ear 435 Ovary 487 Melanoma of eyeball 575 Overlapping lesion of accessory sinuses 359 Melanoma of eyelid 435 Overlapping lesion of biliary tract 307 Melanoma of glans penis 435 Overlapping lesion of bladder 549 Melanoma of iris 575 Overlapping lesion of bones, joints and Melanoma of labium majus 435 articular cartilage 423 Melanoma of labium minus 435 Overlapping lesion of bones, joints and Melanoma of lens 575 articular cartilage of limbs 423 Melanoma of penis 435 Overlapping lesion of brain and central Melanoma of prepuce 435 nervous system 607 Melanoma of retina 585 Overlapping lesion of brain 603 Melanoma of sclera 575 Overlapping lesion of breast 457 Melanoma of scrotum 435 Overlapping lesion of cervix uteri 475 Melanoma of skin 435 Overlapping lesion of colon 271 Melanoma of vulva 435 Overlapping lesion of connective, subcutan- Meninges: cerebral 603 eous and other soft tissues 447 Meninges, NOS 607 Overlapping lesion of corpus uteri 481 Meninges: spinal 607 Overlapping lesion of digestive system 323 Middle ear (tympanic cavity) 335 Overlapping lesion of endocrine glands and Middle lobe of lung 403 related structures 615 Middle third of esophagus 253 Overlapping lesion of esophagus 253 Minor salivary gland, NOS 175 Overlapping lesion of eye and adnexa, Mouth, floor of 151 (excluding melanoma and retinoblastoma) 571 Mouth, NOS 175 Overlapping lesion of eye and adnexa Mouth, vestibule 183 (melanoma) 585 Mucosa, cheek 183 Overlapping lesion of eye and adnexa Mucosa of lip, NOS 103 (retinoblastoma) 597 Mucosa of lower lip 95 Overlapping lesion of female genital organs 503 Mucosa of upper lip 87 Overlapping lesion of floor of mouth 151 Mycosis fungoides of clitoris 443 Overlapping lesion of heart, mediastinum Mycosis fungoides of ear 443 and pleura 411 Mycosis fungoides of eyelid 443 Overlapping lesion of hypopharynx 239 Mycosis fungoides of labia majus 443 Overlapping lesion of ill-defined sites 633 Mycosis fungoides of labia minus 443 Overlapping lesion of larynx 391 Mycosis fungoides of penis 443 Overlapping lesion of lip 103 Mycosis fungoides of prepuce 443 Overlapping lesion of lip, oral cavity and Mycosis fungoides of scrotum 443 pharynx 247 Mycosis fungoides of skin 443 Overlapping lesion of lung 403 Mycosis fungoides of vulva 443 Overlapping lesion of major salivary glands 207 Myeloproliferative neoplasms (all sites) 629 Overlapping lesion of male genital organs 533 Myometrium 481 Overlapping lesion of nasopharynx 231 Overlapping lesion of oropharynx 215 N Overlapping lesion of other and unspecified Nasal cavity (excludes nose, NOS C76.0) 327 parts of mouth 175 Nasopharynx, NOS 231 Overlapping lesion of palate 175 Nerve: olfactory, optic, acoustic, cranial 607 Overlapping lesion of pancreas 319 Nerves, peripheral 447 Overlapping lesion of penis (excluding Nervous system, NOS 607 melanoma, Kaposi sarcoma, mycosis Nipple 457 fungoides, Sezary disease and other lymphomas) 513

Version date: January 1, 2004 649 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page Page Overlapping lesion of penis (melanoma) 435 Peripheral nerves and autonomic nervous Overlapping lesion of penis (mycosis system of abdomen 447 fungoides and Sezary disease) 443 Peripheral nerves and autonomic nervous Overlapping lesion of peripheral nerves system of head, face and neck 447 and autonomic nervous system 447 Peripheral nerves and autonomic nervous Overlapping lesion of rectum, anus and system of lower limb and hip 447 anal canal 285 Peripheral nerves and autonomic nervous Overlapping lesion of respiratory system and system of pelvis 447 intrathoracic organs 419 Peripheral nerves and autonomic nervous Overlapping lesion of retroperitoneum and system of thorax 447 peritoneum 453 Peripheral nerves and autonomic nervous Overlapping lesion of skin (excluding system of trunk, NOS 447 melanoma, Kaposi sarcoma, mycosis Peripheral nerves and autonomic nervous fungoides, Sezary disease and other system of upper limb and shoulder 447 lymphomas) 427 Peritoneum, NOS 453 Overlapping lesion of skin (melanoma) 435 Pharynx, NOS 247 Overlapping lesion of skin (mycosis Pillar, tonsillar 215 fungoides and Sezary disease) 443 Pineal gland 615 Overlapping lesion of small intestine 265 Pituitary gland 615 Overlapping lesion of stomach 259 Placenta 507 Overlapping lesion of tongue 119 Pleura, NOS (including visceral and parietal) 415 Overlapping lesion of tonsil 215 Pleura: visceral, parietal 415 Overlapping lesion of urinary organs 559 Postcricoid region 239 Overlapping lesion of vulva (excluding Posterior mediastinum 411 melanoma, Kaposi sarcoma, mycosis Posterior wall of bladder 549 fungoides, Sezary disease and other Posterior wall of hypopharynx 239 lymphomas) 467 Posterior wall of nasopharynx 231 Overlapping lesion of vulva (melanoma) 435 Posterior wall of oropharynx 215 Overlapping lesion of vulva (mycosis Prepuce (excluding melanoma, Kaposi fungoides and Sezary disease) 443 sarcoma, mycosis fungoides, Sezary disease and other lymphomas) 513 P Prepuce (melanoma) 435 Palate, hard 159 Prepuce (mycosis fungoides and Sezary Palate, NOS 175 disease) 443 Prostate 517 Palate, soft 167 Pancreas: body, tail 315 Pylorus 259 Pancreas: head 311 Pyriform sinus 239 Pancreas: neck of 319 Pancreas: NOS 319 R Pancreas: other and unspecified part of 319 Rectosigmoid junction 279 Pancreas: overlapping lesion 319 Rectum, NOS 279 Pancreatic duct 319 Renal parenchyma 541 Parametrium 499 Renal pelvis 545 Paranasal sinus, NOS 359 Respiratory system, ill-defined sites 419 Parathyroid gland 615 Reticuloendothelial neoplasms (all sites) 629 Paraurethral gland 559 Reticuloendothelial system, NOS (other than Parenchyma, kidney (renal) 541 hematopoietic, reticuloendothelia, immuno- Parietal lobe 603 proliferative and myeloproliferative Parietal pleura 415 neoplasms) 633 Parotid gland 191 Retina (excluding melanoma and Pelvic bones, sacrum, coccyx and associated retinoblastoma) 571 joints 423 Retina (melanoma) 585 Pelvic lymph nodes 633 Retina (retinoblastoma) 597 Pelvic peritoneum 453 Retinoblastoma of eye 597 Pelvis, connective tissue of 447 Retinoblastoma of retina 597 Pelvis, nervous system of 447 Retromolar area 135 Pelvis, NOS, other and ill-defined sites of 633 Retroperitoneum 453 Pelvis, renal 545 Rib, sternum, clavicle and associated joints 423 Penis, NOS (excluding melanoma, Kaposi Round ligament 499 sarcoma, mycosis fungoides, Sezary disease and other lymphomas) 513 Penis, NOS (melanoma) 435 Penis, NOS (mycosis fungoides and Sezary disease) 443

Version date: January 1, 2004 650 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page Page S Skin of trunk (mycosis fungoides and Sezary Sacrum 423 disease) 443 Salivary gland (minor), NOS 175 Skin of upper limb and shoulder (excluding Salivary gland (major), NOS 207 melanoma, Kaposi sarcoma, mycosis Sclera (excluding melanoma and fungoides, Sezary disease and other retinoblastoma) 571 lymphomas) 427 Sclera (melanoma) 575 Skin of upper limb and shoulder (melanoma) 435 Sclera (retinoblastoma) 597 Skin of upper limb and shoulder (mycosis Scrotum, NOS (excluding melanoma, Kaposi fungoides and Sezary disease) 443 sarcoma, mycosis fungoides, Sezary Skin, NOS (excluding melanoma, Kaposi disease and other lymphomas) 537 sarcoma, mycosis fungoides, Sezary Scrotum, NOS (melanoma) 435 disease and other lymphomas) 427 Scrotum, NOS (mycosis fungoides and Skin, NOS (melanoma) 435 Sezary disease) 443 Skin, NOS (mycosis fungoides and Sezary Short bones of lower limb and associated joints 423 disease) 443 Short bones of upper limb and associated joints 423 Skin, overlapping lesion (excluding Sigmoid colon 271 melanoma, Kaposi sarcoma, mycosis Sinus, accessory, NOS 359 fungoides, Sezary disease and other Sinus, ethmoid 351 lymphomas) 427 Sinus, frontal 359 Skin, overlapping lesion (melanoma) 435 Sinus, maxillary 343 Skin, overlapping lesion (mycosis fungoides Sinus, paranasal, NOS 359 and Sezary disease) 443 Sinus, pyriform 239 Small intestine, NOS 265 Sinus, sphenoid 359 Soft palate, NOS 167 Skin (except eyelid) (excluding melanoma, Soft tissue, NOS 447 Kaposi sarcoma, mycosis fungoides, Specified parts of peritoneum (incl. omentum Sezary disease and other lymphomas) 427 and mesentery) 453 Skin of eyelid (excluding melanoma, Kaposi Spermatic cord 533 sarcoma, mycosis fungoides, Sezary Sphenoid sinus 359 disease and other lymphomas) 431 Sphincter of Oddi 299 Skin of lip, NOS (excl. vermilion surface Spinal cord 607 C00._) (excluding melanoma, Kaposi Spinal meninges 607 sarcoma, mycosis fungoides, Sezary Spleen (other than hematopoietic, reticulo- disease and other lymphomas) 427 endothelial, immunoproliferative and Skin of lip, NOS (excl. vermilion surface myeloproliferative neoplasms) 633 C00._) (melanoma) 435 Splenic flexure of colon 271 Skin of lip, NOS (excl. vermilion surface Stomach, NOS 259 C00._) (mycosis fungoides and Sezary Subcutaneous tissue, NOS 447 disease) 443 Subglottic larynx 383 Skin of lower limb and hip (excluding Sublingual gland 207 melanoma, Kaposi sarcoma, mycosis Submandibular gland 199 fungoides, Sezary disease and other Submaxillary gland 199 lymphomas) 427 Superior wall of nasopharynx 231 Skin of lower limb and hip (melanoma) 435 Supraglottic larynx 375 Skin of lower limb and hip (mycosis Supraglottis (false cord, epiglottis {posterior fungoides and Sezary disease) 443 surface}, aryepiglottic fold) 375 Skin of other and unspecified parts of face (excluding melanoma, Kaposi sarcoma, T mycosis fungoides, Sezary disease and Tail of pancreas 315 other lymphomas) 427 Temporal lobe 603 Skin of other and unspecified parts of face Testicle 527 (melanoma) 435 Testis, NOS 527 Skin of other and unspecified parts of face Testis: undescended, descended 527 (mycosis fungoides and Sezary disease) 443 Thoracic esophagus 253 Skin of scalp and neck (excluding melanoma, Thorax, connective tissue of 447 Kaposi sarcoma, mycosis fungoides, Thorax, nervous system of 447 Sezary disease and other lymphomas) 427 Thorax, NOS, other and ill-defined sites of 633 Skin of scalp and neck (melanoma) 435 Thymus 615 Skin of scalp and neck (mycosis fungoides Thyroid cartilage 391 and Sezary disease) 443 Thyroid gland 611 Skin of trunk (excluding melanoma, Kaposi Tongue, anterior 2/3 of 119 sarcoma, mycosis fungoides, Sezary disease Tongue, base of 111 and other lymphomas) 427 Tongue, NOS 119 Skin of trunk (melanoma) 435

Version date: January 1, 2004 651 Version 1.0 Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Page Page V Tonsil, NOS 215 Vagina, NOS 471 Tonsil, lingual 111 Vallecula 215 Tonsillar fossa 215 Vater, ampulla of 303 Tonsillar pillar 215 Ventral surface of tongue, NOS 119 Trachea 399 Ventricle, NOS 603 Tract, biliary, NOS 307 Vermilion border see Lip Tract, female genital 503 Vertebral column 423 Tract, gastrointestinal, NOS 323 Vestibule of mouth 183 Transverse colon 271 Visceral pleura 415 Trigone of bladder 549 Vocal cord 367 Trunk, NOS, connective tissue of 447 Vulva, NOS (excluding melanoma, Kaposi Trunk, NOS, nervous system of 447 sarcoma, mycosis fungoides, Sezary Tympanic cavity 335 disease and other lymphomas) 467 Vulva, NOS (melanoma) 435 U Vulva, NOS (mycosis fungoides and Sezary Undescended testis 527 disease) 443 Unknown primary site 633 Upper gum 127 W Upper-inner quadrant of breast 457 Waldeyer ring 247 Upper limb and shoulder, connective tissue of 447 Upper limb and shoulder, nervous system of 447 Z Upper limb, NOS, other and ill-defined sites of 633 Zone, cloacogenic 285 Upper lobe of lung, incl. lingula 403

Upper-outer quadrant of breast 457

Upper respiratory tract, NOS 419 Upper third of esophagus 253 Urachus 549 Ureter 545 Ureteric orifice 549 Urethra (incl. transitional cell carcinoma of prostatic urethra M-8120-8130) 555 Urinary bladder 549 Urinary system, NOS 559 Uteri, cervix 475 Uteri, corpus 481 Uteri, fundus 481 Uteri, isthmus 481 Uterine adnexa 499 Uterus, NOS 481 Uvea (excluding melanoma and retinoblastoma) 571 Uvea (melanoma) 575 Uvea (retinoblastoma) 597 Uvula 167

Version date: January 1, 2004 652 Version 1.0