FEMALE GENITAL SYSTEM VULVA 8000-8040, 8042-8180, 8191-8246, 8248-8700, 9020, 9071 C510-C512, C518-C519 C510 Labium majus C511 Labium minus C512 Clitoris C518 Overlapping lesion of vulva C519 Vulva, NOS Note 1: The following sources were used in the development of this chapter • SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998) (https://seer.cancer.gov/archive/manuals/EOD10Dig.3rd.pdf) • SEER Summary Staging Manual-2000: Codes and Coding Instructions (https://seer.cancer.gov/tools/ssm/ssm2000/) • Collaborative Stage Data Collection System, version 02.05: https://cancerstaging.org/cstage/Pages/default.aspx • Chapter 50 Vulva, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois. Note 2: See the following chapters for the listed histologies • 8041, 8190, 8247: Merkel Cell Skin • 8710-8714, 8800-8934, 8940-9016, 9030-9070, 9072-9138, 9141-9582: Soft Tissue • 8720-8790: Melanoma Skin • 8935-8936: GIST • 9140: Kaposi Sarcoma • 9700-9701: Mycosis Fungoides Note 3: Basal and squamous cell carcinomas of the skin of the vulva are coded to C519 and are reportable; basal and squamous carcinomas of the skin of the perineum would be coded to C445 and would not be reportable. Note 4: Isolated tumor cells (ITCs) are defined as single tumor cells or small clusters not greater than 0.2 mm, usually detected by immunohistochemical (IHC) or molecular methods. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction). • Lymph nodes with ITCs only are not counted as positive nodes for Summary Stage September 2021 Summary Stage 2018 Coding Manual v2.1 1 SUMMARY STAGE 0 In situ: noninvasive, intraepithelial 1 Localized only (localized, NOS) • Invasive carcinoma WITH or WITHOUT stromal invasion confined to o Musculature o Submucosa o Vulva including skin FIGO Stage I (IA, IB, I NOS) 2 Regional by direct extension only • Adjacent perineal structures • Anus • Bladder wall or bladder, NOS excluding mucosa • Perianal skin • Rectal wall or rectum, NOS excluding mucosa • Urethra, NOS o Lower/distal third of urethra • Vagina, NOS • Vulva and perineum involved WITH or WITHOUT stromal invasion FIGO Stage II 3 Regional lymph node(s) involved only • Femoral • Inguinal, NOS o Inguinofemoral (groin) o Node of Cloquet or Rosenmuller (highest deep inguinal) o Superficial inguinal • Regional lymph node(s), NOS o Lymph node(s), NOS FIGO Stage III (IIIA, IIIB, IIIC, III NOS), IVA • Localized tumor WITH regional lymph node involvement September 2021 Summary Stage 2018 Coding Manual v2.1 2 4 Regional by BOTH direct extension AND regional lymph node(s) involved • Codes (2) + (3) 7 Distant site(s)/lymph node(s) involved • Distant site(s) (including further contiguous extension) o Bladder mucosa o Fixed to pubic bone (pelvic bone) o Perineal body o Rectal mucosa o Urethra: upper/proximal two-thirds • Distant lymph node(s), NOS o Pelvic, NOS o Iliac, NOS . Common . External . Internal (hypogastric) (obturator) o Paracervical o Parametrial o Sacral, NOS . Lateral (laterosacral) . Middle (promontorial) (Gerota's node) . Presacral . Uterosacral • Distant metastasis, NOS o Carcinomatosis o Distant metastasis WITH or WITHOUT distant lymph node(s) FIGO Stage IVA • NONE or UNKNOWN regional lymph node involvement FIGO Stage IVB, IV NOS 9 Unknown if extension or metastasis September 2021 Summary Stage 2018 Coding Manual v2.1 3 VAGINA 8000-8700, 8720-8790, 8933, 8980, 9071, 9110 C529 C529 Vagina, NOS Note 1: The following sources were used in the development of this chapter • SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998) (https://seer.cancer.gov/archive/manuals/EOD10Dig.3rd.pdf) • SEER Summary Staging Manual-2000: Codes and Coding Instructions (https://seer.cancer.gov/tools/ssm/ssm2000/) • Collaborative Stage Data Collection System, version 02.05: https://cancerstaging.org/cstage/Pages/default.aspx • Chapter 51 Vagina, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois. Note 2: See the following chapters for the listed histologies • 8710-8714, 8800-8932, 8934, 8940-8975, 8981-9070, 9072-9105, 9120-9138, 9141- 9582: Soft Tissue • 8935-8936: GIST • 9140: Kaposi Sarcoma • 9700-9701: Mycosis Fungoides Note 3: Isolated tumor cells (ITCs) are defined as single tumor cells or small clusters not greater than 0.2 mm, usually detected by immunohistochemical (IHC) or molecular methods. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction). • Lymph nodes with ITCs only are not counted as positive nodes for Summary Stage SUMMARY STAGE 0 In situ: noninvasive, intraepithelial 1 Localized only (localized, NOS) • Confined to vagina • Musculature involved • Submucosa (stroma) (vagina) FIGO Stage I September 2021 Summary Stage 2018 Coding Manual v2.1 4 2 Regional by direct extension only • Bladder wall or bladder, NOS (excluding mucosa) • Cervix • Cul de sac (rectouterine pouch) • Extension to lower third of the vagina (from proximal vagina) • "Frozen pelvis" (clinically diagnosed) • Hydronephrosis or nonfunctioning kidney • Parametrium • Paravaginal soft tissue • Pelvic wall o Fascia o Muscle o Neurovascular structures o Skeletal portions of bony pelvis • Rectal wall or rectum, NOS excluding mucosa • Rectovaginal septum • Vesicovaginal septum • Vulva FIGO Stage II FIGO Stage III WITHOUT lymph node involvement 3 Regional lymph node(s) involved only • Lower third of vagina (ipsilateral and bilateral) o Femoral o Inguinal, NOS . Inguinofemoral (groin) . Node of Cloquet or Rosenmuller (highest deep inguinal) . Superficial inguinal • Upper two thirds of vagina o Pelvic, NOS . Iliac, NOS . Common . External . Internal (hypogastric) (obturator) . Paracervical . Parametrial . Sacral, NOS . Lateral (laterosacral) . Middle (promontorial) (Gerota's node) . Presacral . Uterosacral • Regional lymph node(s), NOS September 2021 Summary Stage 2018 Coding Manual v2.1 5 o Lymph node(s), NOS FIGO Stage III • Localized tumor WITH regional lymph node involvement 4 Regional by BOTH direct extension AND regional lymph node(s) involved • Codes (2) + (3) 7 Distant site(s)/lymph node(s) involved • Distant site(s) (including further contiguous extension) o Bladder mucosa (excluding bullous edema) o Extension beyond true pelvis o Rectal mucosa o Urethra • Distant lymph node(s), NOS o All sites . Mediastinal . Para-aortic, NOS . Aortic . Lateral aortic/lateral lumbar . Periaortic . Retroperitoneal, NOS . Scalene o Lower third of vagina (ipsilateral and bilateral) . Pelvic, NOS . Iliac, NOS . Common . External . Internal (hypogastric) (obturator) . Paracervical . Parametrial . Sacral, NOS . Lateral (laterosacral) . Middle (promontorial) (Gerota's node) . Presacral . Uterosacral o Upper two thirds of vagina . Femoral . Inguinal, NOS . Inguinofemoral (groin) . Node of Cloquet or Rosenmuller (highest deep inguinal) September 2021 Summary Stage 2018 Coding Manual v2.1 6 . Superficial inguinal • Distant metastasis, NOS o Carcinomatosis o Distant metastasis WITH or WITHOUT distant lymph node(s) FIGO Stage IV (IVA, IVB, IV NOS) 9 Unknown if extension or metastasis September 2021 Summary Stage 2018 Coding Manual v2.1 7 CERVIX 8000-8700, 8710-8803, 8805, 8810-8814, 8816-8858, 8860-8900, 8902-8910, 8921-8941, 8951- 8976, 8980-8990, 8992-9016, 9030-9043, 9045-9111, 9121-9132, 9135-9138, 9141-9175, 9181- 9221, 9230, 9240-9365, 9370-9580, 9582 C530-C531, C538-C539 C530 Endocervix C531 Exocervix C538 Overlapping lesion of cervix C539 Cervix uteri Note 1: The following sources were used in the development of this chapter • SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998) (https://seer.cancer.gov/archive/manuals/EOD10Dig.3rd.pdf) • SEER Summary Staging Manual-2000: Codes and Coding Instructions (https://seer.cancer.gov/tools/ssm/ssm2000/) • Collaborative Stage Data Collection System, version 02.05: https://cancerstaging.org/cstage/Pages/default.aspx • Chapter 52 Cervix Uteri, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois. • Cervix Uteri, from the AJCC Cancer Staging System Version 9 (2020). Used with permission of the American College of Surgeons, Chicago, Illinois • Chapter 54 Corpus Uteri-Sarcoma, in the AJCC Cancer Staging Manual, Eight Edition (2017) published by Spring International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois Note 2: See the following chapters for the listed histologies • 8815, 8859, 8901, 8912, 8920, 8950, 9120, 9133, 9180, 9222, 9366-9368, 9581: Soft Tissue • 9140: Kaposi Sarcoma • 9700-9701: Mycosis Fungoides Note 3: Isolated tumor cells (ITCs) are defined as single tumor cells or small clusters not greater than 0.2 mm, usually detected by immunohistochemical (IHC) or molecular methods. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction). • Lymph nodes with ITCs only are not counted as positive nodes for Summary Stage Note 4: Para-aortic nodes are now regional instead of distant. September 2021 Summary Stage 2018 Coding Manual v2.1 8 SUMMARY STAGE 0 In situ, intraepithelial, noninvasive • Cancer in situ WITH endocervical gland involvement • Cervical intraepithelial neoplasia