CS Extension: Breast Cancer

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
  • Intraductal without infiltration
  • Lobular neoplasia
 Tis IS IS
15 Paget Disease of nipple (without underlying tumor) Tis ** **
07 Paget Disease of nipple (without underlying invasive carcinoma pathologically) Tis ** **
10 Confined to breast tissue and fat including nipple and/or areola
Localized, NOS		 * L L
20
  • Invasion of subcutaneous tissue
  • 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
 * RE RE
30
  • Attached or fixation to pectoral muscle(s) or underlying tissue
  • Deep fixation
  • Invasion of (or fixation to) pectoral fascia or muscle
 * RE RE
40 Invasion of (or fixation to):
  • Chest wall
  • Intercostal or serratus anterior muscle(s)
  • Rib(s)
 T4a RE RE
51
  • Extensive skin involvement, including:
    • 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")
 T4b RE RE
52 Any of the following conditions described as involving more than 50% of the breast without a stated diagnosis of inflammatory carcinoma:
  • Edema of skin
  • En cuirasse
  • Erythema
  • Inflammation of skin
  • Peau d'orange ("pigskin")
 T4b RE RE
61 (40) + (51) T4c RE RE
62 (40) + (52) T4b RE RE
71
  • Diagnosis of inflammatory carcinoma 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
 T4b RE RE
72 Diagnosis of inflammatory carcinoma 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 T4b RE RE
73 Diagnosis of inflammatory carcinoma 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 T4d RE RE
95 No evidence of primary tumor T0 U U
99
  • Unknown extension
  • Primary tumor cannot be assessed
  • Not documented in patient record
 TX U U

* 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.

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