Advanced Abstracting
Issues for the Lung Cancer
Diagnosis
Judy Andrews, CTR
Metropolitan Regional Coordinator
Georgia Center for Cancer Statistics
GATRA Fall Meeting 2004
ICD-O-3 CODES
ICD-0-3 TERM
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
Anatomy
Related adjectives: Lung= pneumo-, pulmono-,
broncho-, bronchiolo-, alveolar, hilar
Breathing= -pnea (difficulty with
breathing=dyspnea)
Paired organ
Subsites:
Right lobe: 3 lobes
Left Lobe: 2 lobes
Lung Anatomy
Carina
Upper Lobe
Oblique
Fissure
Middle
Lobe
Lower
Lobe
Lung Anatomy: Key Words
Apex
Hilum
Carina
Lingula
Cardiac Notch
Pleural Cavity
Chest Wall
Mediastinum
Base
ICD-O-3 Morphology Codes
Small cell lung cancers include ICD-O-3 morphology
codes M-80413, M-80423, M-80433, M-80443, and
M80453
Common non-small cell lung cancer histologies
Squamous or epidermoid (807_3)
Adenocarcinoma (814_3)
Bronchioloalveolar (82503)
Large cell carcinoma (80123)
Other subtypes of adenocarcinoma are acinar, papillary,and
mucinous
Adenosquamous carcinoma (85603)
Mesothelioma (905_3)
Bronchogenic carcinoma IS NOT a specific cell type
Regional Lymph Nodes for the
Lung
The regional lymph nodes for the lung are
all above the diaphragm
Intrathoracic nodes include mediastinal
and intrapulmonary nodes
Scalene and supraclavicular nodes are
also considered regional nodes for staging
Regional Lymph Nodes for the
Lung
Intrathoracic
Pulmonary
12 Peribronchial
11 Intrapulmonary
10 Hilar
13 Segmental
Superior mediastinal
1 Superior Mediastinal
3 Pretracheal,retrotracheal
2 Paratracheal
4 Lower paratracheal,
azygos
Intrathoracic
Aortic
5 Subaortic (aortic
window)
6 Para-aortic (ascending
aorta or phrenic)
Inferior mediastinal
7 Carinal, subcarinal
8 Paraesophageal
9 Pulmonary ligament
Regional Lymph Nodes for the
Lung
Extrathoracic
Scalene
Supraclavicular or transverse cervical
Common Metastatic Sites for
the Lung
Lymphatic Spread
Cervical Lymph Nodes
Contralateral Lung
Contralateral Mediastinum
Hematogenic Spread
Brain
Bone
Liver
Adrenal glands
Contralateral Lung
Extent of Disease Evaluation
for the Lung
Diagnostic Studies: Physical Exam
Signs and Symptoms
Palpable lymph nodes or organs
Pancoast Tumor
Horner’s Syndrome
Extent of Disease Evaluation
for the Lung
Diagnostic Studies: Imaging
Chest X-ray
CAT Scan
MRI Scan
PET Scan
Bone Scan
Extent of Disease Evaluation
for the Lung
Diagnostic Studies: Endoscopies
Bronchoscopy
Mediastinoscopy
Thoracoscopy
Extent of Disease Evaluation
for the Lung
Diagnostic Studies: Pathological
Closed Chest Needle Biopsy
Cytology (Thoracentesis)
Sputum Cytology
Bronchial Washings
Bone Marrow Biopsy
Extent of Disease Evaluation
for the Lung
Diagnostic Studies: Tumor Markers
Neuron Specific Enolase (NSE)
Squamous Cell Carcinoma Antigen
DNA Studies
Adrenocorticotropic Hormone (ACTH)
Carcinoembryonic Antigen (CEA)
Calcitonin
Tissue Polypeptide Antigen (TPA)
Staging Systems for Lung
SEER Extent of Disease 3rd Edition
(Diagnosis year 1988-2003)
SEER Summary Staging 2000
(Diagnosis year 2001-2003)
American Joint Committee on Cancer (AJCC)
TNM 6th Edition
(Diagnosis year 2003 forward)
Collaborative Staging
(Diagnosis year 2004 forward)
Staging Systems for Lung
SEER EOD
Size
Extent
Regional Lymph Nodes
Reg LN Positive
Reg LN Examined
AJCC TNM 6th Edition
cT,pT: Extent of primary tumor
cN,pN: Absence or presence &
Ext of regional lymph nodes
cM,pM: Absence/presence of
metastasis
[Clinical (c) and pathologic (p)]
SEER Summary Stage 2000
In Situ
Localized
Reg by Direct Ext
Reg Ipsilateral LN only
Reg by Direct & Ipsilateral Reg LN
Reg, Nos
Distant Site/Node Involv
Collaborative Stage
CS Tumor Size
CS Tumor Size/Ext Eval
CS Lymph Nodes
CS Lymph Nodes Eval
CS Mets at Dx
CS Mets Eval
CS Site Specific Factors 1-6
Collaborative Stage
General Guidelines
Timing Rule
Site-specific guidelines
Highest applicable number for each field
Greatest extent of disease
Collaborative Stage for Bronchus
and Lung
General Guidelines continued:
CS Tumor Size/Ext
CS Tumor Size/Ext Eval
CS Regional LN
CS Reg Nodes Eval
CS Mets
CS Mets Eval
Regional LN Pos/Regional LN Exam
Site Specific Factors
Collaborative Stage for Bronchus
and Lung
CS Tumor Size
000
001-998
989
990
991
992-995
996
997
998
999
No mass/tumor found
001-998 millimeters (exact size)
989 millimeters or larger
Microscopic focus or foci only, no
size of focus given
Described as less than 1 cm
Described as less than (2,3,4,5 cm)
Malignant cells in bronchopulmonary
secretions, but no tumor is seen
radiographically or during bronchoscopy
Diffuse (entire lobe)
Diffuse (entire lung)
Unknown; size not stated
Not documented in patient record
Collaborative Stage for Bronchus
and Lung
CS Extension
Primary Tumor extension
DO NOT CODE DISCONTINOUS METASTASES IN
THIS FIELD
Priority order for extension
Notes 1-7: Read carefully
Collaborative Stage for Bronchus
and Lung
CS TS/EXT EVAL
Evaluates source for “CS Tumor Size” and
“CS Extension”
Describes clinical or pathological staging
of the tumor
Collaborative Stage for Bronchus
and Lung
CS TS/EXT EVAL
Code 0, 1, 9
Code 2
Code 3
Code 5
Code 6
Code 8
Code 9
No surgery
Autopsy (diagnosis suspected)
Surgery followed by other therapy
Determined prior to neoadjuvant
therapy
Determined after neoadjuvant
therapy
Autopsy (diagnosis unsuspected)
Unknown, Not assessed, Not stated
Collaborative Stage for
Bronchus and Lung
CS Lymph Nodes
Regional Nodes and Nodes, NOS only
Highest Applicable Code
Exception (NOS)
New Rule for Inaccessible Site
Lung
Notes 1-4: Read carefully
Collaborative Stage for
Bronchus and Lung
CS Reg Nodes Eval
Code 0, 1, 9
Code 2
Code 3
Code 5
Code 6
Code 8
Code 9
No LN(s) removal
Autopsy (diagnosis suspected)
LN(s) surgery followed by other
therapy
LN(s) status determined prior to
neoadjuvant therapy
LN(s) status determined after
neoadjuvant therapy
Autopsy (diagnosis unsuspected)
Unknown, Not assessed, Not stated
Collaborative Stage for Bronchus
and Lung
Regional Nodes Positive
00
All nodes examined negative
01-89
1-89 nodes positive
90
90 or more nodes positive
95
Positive aspiration of LN(s)
was performed
97
Positive nodes documented,
number unspecified
98
No nodes examined
99
Unknown if nodes positive,
not applicable, not stated in
record
Regional Nodes Examined
00
No nodes examined
01-89
1-89 nodes examined
90
90 or more nodes examined
95
No Reg LN removed, Aspiration
of Reg LN performed
96
Reg LN removal documented as
sampling, number unknown/not
stated
97
Reg LN removal documented as
dissection, number unknown/not
stated
98
Reg LN surgically removed,
number of LNs unknown/not
stated, not documented as
sampling or dissection; nodes
examined, number unknown
99
Unknown, not applicable, not
stated in record
Collaborative Stage for
Bronchus and Lung
CS Mets at Dx
00
10
35
37
39
40
50
99
No; none
Distant Lymph Nodes (s), including cervical nodes
Separate tumor nodules (s) in different lobe, same lung
Extension to sternum, skeletal muscle, skin of chest
Extension to contralateral lung, contralateral main stem
bronchus, separate tumor nodule(s) in contralateral lung
Abdominal organs, distant metastasis except to distant
lymph nodes (code 10), distant mets, NOS, carcinomatosis
Distant mets + distant node(s)
(10) + any [35-40]
Unknown; distant metastasis cannot be assessed, not
documented in patient record.
Collaborative Stage for
Bronchus and Lung
CS Mets Eval
Code 0, 1, 9
Code 2
Code 3
Code 5
Code 6
Code 8
Code 9
No surgery
Autopsy (diagnosis suspected)
Surgery followed by other
therapy
Determined prior to
neoadjuvant therapy
Determined after
neoadjuvant therapy
Autopsy (diagnosis unsuspected)
Unknown, Not assessed, Not stated
Collaborative Stage for
Bronchus and Lung
CS Site Specific Factors
SSF 1
SSF 2
SSF 3
SSF 4
SSF 5
SSF 6
Code 888
Code 888
Code 888
Code 888
Code 888
Code 888
Treatment for Bronchus and
Lung
Surgery
Non-small cell carcinoma: Stage I and II (Localized)
Small cell carcinoma: Not recommended
Radiation
Non-small cell carcinoma: Inoperable, Advanced
Small cell carcinoma: Recommended
Systemic Therapy
Non-small cell carcinoma: Chemotherapy
Small cell carcinoma: Combination chemotherapy
Hormonal & Endocrine
Not proven to be useful
Treatment for Bronchus and
Lung
Surgery Codes
Primary Site
Scope of Regional Lymph Node
Surgical Procedure of Other Site
Treatment for Bronchus and
Lung
Surgery Codes continued
Primary Site
Scope of Regional Lymph Node
Surgical Procedure of Other Site
Treatment for Bronchus and
Lung
Surgery Codes continued
Primary Site
Scope of Regional Lymph Node
Surgical Procedure of Other Site
Treatment for Bronchus and
Lung
Radiation
Treatment Volume
Treatment Modality
Regional Dose
Boost Modality
Boost Dose
Prophylactic Cranial Radiation (PCI)
Treatment for Bronchus and
Lung
Chemotherapy
Non-Small Cell Carcinoma
Small Cell Carcinoma
Hormones
Immunotherapy
Other
Endoscopic Photodynamic Therapy
Keys to Abstracting
Organization
Dates
Procedure Documentation
Resources
Diagnosis year
Text
Pertinent
Acronyms