CS Extension: Lymphoma

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 Stage I	*	L	L
11	Localized involvement of a single extralymphatic organ/ site in the absence of any lymph node involvement Multifocal involvement of one extralymphatic organ/site Stage IE	*	L	L
12	Involvement of spleen only Stage IS	*	L	L
20	Involvement of two or more lymph node regions on the SAME side of the diaphragm Stage II	*	RNOS	RNOS
21	Localized involvement of a single extralymphatic organ/site 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	*	RNOS	RNOS
22	Involvement of spleen PLUS lymph node(s) BELOW the diaphragm Stage IIS	*	RNOS	RNOS
23	Involvement of spleen PLUS involvement of a single extralymphatic organ/site BELOW the diaphragm with or without involvement of lymph node(s) BELOW the diaphragm Stage IIES	*	RNOS	RNOS
30	Involvement of lymph node regions on BOTH sides of the diaphragm Stage III	*	D	D
31	Involvement of an extralymphatic organ/site PLUS involvement of lymph node(s) on the OPPOSITE side of the diaphragm Stage IIIE	*	D	D
32	Involvement of the spleen PLUS lymph node(s) ABOVE the diaphragm Stage IIIS	*	D	D
33	(31) + (32) 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	*	D	D
80	Diffuse or disseminated (multifocal) involvement of ONE OR 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	*	D	D
99	Unknown extension Primary tumor cannot be assessed Not documented in patient record	*	U	U

* 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.