CS Extension: Lung

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.

  1. Note from SEER manual: Ignore pleural effusion that is negative for tumor. Assume that a pleural effusion is negative if a resection is done.
  2. 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, without extension or conditions described in codes 20-80
(excluding primary in main stem bronchus)
(EXCLUDES superficial tumor as described in code 11)		 * L L
11 Superficial tumor of any size with invasive component limited to bronchial wall, with or without proximal extension to the main stem bronchus T1 L L
20 Extension from other parts of lung to main stem bronchus, NOS
(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)		 T2 L L
21 Tumor involving main stem bronchus, NOS (distance from carina not stated and no surgery as described in Note 2) T2 L L
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 but does not involve the entire lung (or atelectasis/obstructive pneumonitis, NOS) without pleural effusion T2 RE RE
45 Extension to:
  • Pleura, visceral or NOS (without pleural effusion)
  • Pulmonary ligament (without pleural effusion)
 T2 RE RE
50 Tumor of/involving main stem bronchus less than 2.0 cm from carina T3 L RE
52 (40) + (50) T3 RE RE
53 (45) + (50) T3 RE RE
55 No evidence of primary tumor T3 RE RE
56 Parietal pericardium or pericardium, NOS T3 RE RE
59 Invasion of phrenic nerve T3 RE RE
60 Direct extension to:
  • Brachial plexus, inferior branches or NOS, from superior sulcus
  • Chest (thoracic) wall
  • Diaphragm
  • Pancoast tumor (superior sulcus syndrome), NOS
  • Parietal pleura
Note: For separate lesion in chest wall or diaphragm, see CS Mets at DX.		 T3 D RE
61 Superior sulcus tumor with encasement of subclavian vessels OR with unequivocal involvement of superior branches of brachial plexus (C8 or above) T4 D RE
65 Multiple masses/separate tumor nodule(s) in the SAME lobe
"Satellite nodules" in SAME lobe		 T4 L RE
70
  • Blood vessel(s), major (EXCEPT aorta and inferior vena cava, see 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
 T4 RE RE
71
  • Heart
  • Visceral pericardium
 T4 D D
72
  • Malignant pleural effusion
  • Pleural effusion, NOS
 T4 D D
73 Adjacent rib T3 D D
74 Aorta T4 D RE
75
  • Vertebra(s)
  • Neural foramina
 T4 D D
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 Mets at DX) T4 D D
95 No evidence of primary tumor T0 U U
98 Tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy;
"occult" carcinoma		 TX U U
99
  • Unknown extension
  • Primary tumor cannot be assessed
  • Not documented in patient record
 TX U U

* 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.

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