]> C15.0 Cervical esophagus C15.1 Thoracic esophagus C15.2 Abdominal esophagus C15.3 Upper third of esophagus C15.4 Middle third of esophagus C15.5 Lower third of esophagus C15.8 Overlapping lesion of esophagus C15.9 Esophagus, NOS Note 2: There are two widely used but incompatible systems of dividing the esophagus into subsites, one using anatomic landmarks and the other using using thirds of the total length. Each of these two systems has been assigned topography codes in ICD-O-3; codes C15.0-C15.2 for the former, and C15.3-C15.5 for the latter. As explained on page 23 of ICD-O-3, "The terms cervical, thoracic, and abdominal are radiographic and intraoperative descriptors; upper, middle, and lower third are endoscopic and clinical descriptors." In actual practice by physicians, and in publications of UICC and AJCC, the terms and codes for the upper, middle, and lower thirds are often applied to sub-sections of the thoracic esophagus, and the abdominal portion can be considered part of the lower thoracic esophagus. Note 4: Effective with AJCC TNM 7th Edition, there are separate stage groupings for squamous cell carcinoma and adenocarcinoma. Since squamous cell carcinoma typically has a poorer prognosis than adenocarcinoma, a tumor of mixed histopathologic type or a type that is not otherwise specified should be classified as squamous cell carcinoma. CS Tumor Size Note: Code the specific tumor size as documented in the medical record. If tumor dimensions are stated, code the greatest dimension. If only one dimension is recorded, code this. For example, tumor is seen extending from 18 centimeter (cm) to 21 cm from the incisors: code 030 for a tumor length of 3 cm; tumor is 5.2 x 3.8 cm at 25 cm: code 052 because this is the greatest dimension. Code Description 000 No mass/tumor found 001-988 989 989 mm 990 Microscopic focus or foci only, and no size of focus given 991 Described as "less than 1 centimeter (cm)" 992 Described as "less than 2 cm," or "greater than 1 cm," or "between 1 cm and 2 cm" 993 Described as "less than 3 cm," or "greater than 2 cm," or "between 2 cm and 3 cm" 994 Described as "less than 4 cm," or "greater than 3 cm," or "between 3 cm and 4 cm" 995 Described as "less than 5 cm," or "greater than 4 cm," or "between 4 cm and 5 cm" 998 Circumferential 999 CS Extension Note 1: Ignore intraluminal extension to adjacent segment(s) of esophagus or to cardia of stomach and code depth of invasion or extra-esophageal spread as indicated. Note 2: The three layers of the mucosa (epithelium, lamina propria, and muscularis mucosae) may be called the m1, m2, and m3 layers. The submucosa may be described as having inner, middle, and outer thirds called sm1, sm2, and sm3. Note 3: For this schema, AJCC defines Tis as high-grade dysplasia, in which they include "all non-invasive neoplastic epithelium that was formerly called carcinoma in situ". Cancers stated to be noninvasive or in situ are classified as Tis. High grade dysplasia is generally not reportable in cancer registries; but if a registry does collect high grade dysplasia, code 000 should be used. Code Description TNM 7 Map TNM 6 Map SS77 Map SS2000 Map 000 In situ, intraepithelial, noninvasive; high grade dysplasia Tis Tis IS IS 100 T1a T1 L L 110 Invades lamina propria T1a T1 L L 120 Invades muscularis mucosae T1a T1 L L 130 Stated as T1a with no other information on extension T1a T1 L L 160 Invades submucosa T1b T1 L L 165 Stated as T1b with no other information on extension T1b T1 L L 170 T1NOS T1 L L 200 Muscularis propria invaded T2 T2 L L 210 Stated as T2 with no other information on extension T2 T2 L L 300 Localized, NOS T1NOS T1 L L 400 T3 T3 RE RE 450 Stated as T3 with no other information on extension T3 T3 RE RE 600 ERROR T4 RE RE 610 ERROR ERROR ERROR ERROR 615 T4a T4 RE RE 650 ERROR T4 RE RE 660 T4a T4 RE D 680 T4a T4 D D 700 ERROR ERROR ERROR ERROR 710 Stated as T4a with no other information on extension T4a T4 RE RE 720 T4b T4 RE RE 725 720 + 615 T4b T4 RE RE 728 720 + 660 T4b T4 RE D 730 T4b T4 RE RE 740 T4b T4 D D 745 T4b T4 D D 750 T4b T4 D D 780 ERROR T4 RE D 800 ERROR T4 D D 810 T4b T4 D D 815 T4NOS T4 RE RE 820 T4b T4 D D 950 No evidence of primary tumor T0 T0 U U 999 TX TX U U &generalcstsexteval; CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS in this field. Distant nodes are coded in CS Mets at DX. Note 2: Regional lymph nodes for any part of the esophagus fall in the range from periesophageal/cervical to the celiac region. Contralateral and bilateral cervical, supraclavicular, and mediastinal lymph nodes are included. Note 3: Celiac nodes are coded in CS Lymph Nodes for lower thoracic (abdominal) esophagus; they are coded in CS Mets at DX for cervical and intrathoracic (upper and middle) esophagus. Cervical nodes, NOS are coded in CS Lymph Nodes for cervical esophagus; they are coded in CS Mets at DX for intrathoracic esophagus. Note 4: Lymph node stations/groups are listed in parentheses when applicable. See Figure 10.3 in the AJCC Cancer Staging Manual 7th Edition or Handbook for illustrations. Note 6: The number of positive regional nodes is required to calculate the correct N category for this schema. Use codes 560, 610 or 710 when the pathology report assigns an N1, N2 or N3 category but does not specify the number of nodes involved, or the record identifies an N1, N2 or N3 category but the specific information about number of nodes involved is not available. Use codes (100-255, 265-280 and 305-500) rather than codes 560, 610 or 710 when information about the number of positive nodes is available, or when nodes are clinically positive but not removed for examination. Code Description TNM 7 Map TNM 6 Map SS77 Map SS2000 Map 000 No regional lymph node involvement N0 N0 NONE NONE 100 ^ N1 RN RN 200 ^ N1 D RN 220 ^ N1 D RN 250 ^ N0 D D 255 250 + any of (100, 200, 220) ^ N1 D D 260 ERROR ERROR ERROR ERROR 265 ^ N0 D D 270 265 + any of (100, 200, 220) ^ N1 D D 275 265 + 250 ^ N0 D D 280 275 + any of (100, 200, 220) ^ N1 D D 300 ERROR ERROR ERROR ERROR 305 ^ N1 D D 310 305 + (250 or 255) ^ N1 D D 320 305 + (265 or 275) ^ N1 D D 330 305 + (275 or 280) ^ N1 D D 500 Regional lymph node(s), NOS ^ N1 RN RN 560 Stated as pathologic N1 with no other pathologic information on regional lymph nodes N1 N1 RN RN 600 OBSOLETE DATA CONVERTED V0203 See code 500 Stated as clinical N2 (clinical assessment; no lymph nodes removed) ERROR ERROR ERROR ERROR 610 Stated as pathologic N2 with no other pathologic information on regional lymph nodes N2 N1 RN RN 700 ERROR ERROR ERROR ERROR 710 Stated as pathologic N3 with no other pathologic information on regional lymph nodes N3 N1 RN RN 800 N1 N1 RN RN 999 NX NX U U ^ For CS Lymph Nodes codes 100-255, 265-280, and 305-500 ONLY, the N category for AJCC 7 staging is assigned based on the number of positive lymph nodes. When CS Lymph Nodes Eval is 0, 1, 5, or 9, the N category is assigned from the Lymph Nodes Clinical Evaluation AJCC 7 Table, using Regional Nodes Positive and CS Site-Specific Factor 1; when CS Lymph Nodes Eval is 2, 3, 6, 8, or not coded, the N category is determined from the Lymph Nodes Pathologic Evaluation AJCC 7 Table using Regional Nodes Positive. &generalregnodeseval; &commonreglnpos_active; &generalreglnexam; CS Mets at DX Note 1: Lymph nodes extending from the supraclavicular region to the celiac region previously considered to be distant are now classified as regional nodes. Involvement of these nodes is coded in CS Lymph Nodes. Note 2: Lymph node stations/groups are listed in parentheses where applicable. See Figure 10.3 in the AJCC Cancer Staging Manual 7th Edition or Handbook for illustrations. Code Description TNM 7 Map TNM 6 Map SS77 Map SS2000 Map 00 No distant metastasis M0 * NONE NONE 10 M1 M1NOS D D 11 ERROR M1a D D 12 ERROR ERROR ERROR ERROR 15 M1 M1b D D 40 M1 M1b D D 50 M1 M1b D D 60 M1 M1NOS D D 99 M0 * U U * For CS Mets at DX codes 00 or 99, the N and M categories for AJCC 6 staging are assigned based on the coding of CS Lymph Nodes as shown in the Lymph Nodes Mets at DX AJCC 6 Table. &generalmetseval; &commonssf1esophagus; CS Site-Specific Factor 2 Specific Location of Tumor Note 1: The location of a primary squamous cell carcinoma of the esophagus is a staging element for AJCC 7 staging. The location of the primary cancer site is defined by AJCC as the position of the upper (proximal) edge of the tumor in the esophagus. The location of the tumor in the esophagus provides important information about the tumor's relation to adjacent structures. The location of the proximal edge of the tumor within the esophagus may be described based on imaging, esophagoscopy, or surgical results. Note 2: As described in the AJCC 7th Edition and used in this Site-Specific Factor, the cervical esophagus is bordered superiorly by the hypopharynx and inferiorly by the thoracic inlet at the level of the sternal notch. The upper thoracic esophagus is bordered inferiorly by the lower border of the azygos vein. The middle thoracic esophagus is bordered inferiorly by the inferior pulmonary veins. The lower thoracic esophagus is bordered inferiorly by the stomach. The abdominal esophagus extends from the esophagogastric junction to 5 centimeters (cm) below the junction in the proximal stomach. Note 3: Code the specific location of the primary tumor according to the term(s) found in the medical record. If multiple terms are used, give priority to codes 010- 060 over 070-090. Code Description 010 Stated as cervical esophagus 020 Stated as upper thoracic esophagus 030 Stated as middle thoracic esophagus 040 050 Stated as lower thoracic esophagus 060 Stated as abdominal esophagus 070 Stated as upper third 080 Stated as middle third 090 Stated as lower third 100 888 988 999 Unknown; Esophagus, NOS &commonssf3esophagus; &commonssf4esophagus; &commonssf5esophagus; ¬appssfactor6; ¬appnewssf7; ¬appnewssf8; ¬appnewssf9; ¬appnewssf10; ¬appnewssf11; ¬appnewssf12; ¬appnewssf13; ¬appnewssf14; ¬appnewssf15; ¬appnewssf16; ¬appnewssf17; ¬appnewssf18; ¬appnewssf19; ¬appnewssf20; ¬appnewssf21; ¬appnewssf22; ¬appnewssf23; ¬appnewssf24; ¬appnewssf25; &commonhistinclusioncarcinoma; &commonhistologyexclusions1; &commonstageesophagus_notapptnm7; AJCC TNM 6 Stage T N M Stage T0 N0 M0 ERROR T0 N1 M0 IIB T0 NX M0 UNK T0 N0 M1NOS IVNOS T0 N1 M1NOS IVNOS T0 NX M1NOS IVNOS T0 N0 M1a IVA T0 N1 M1a IVA T0 NX M1a IVA T0 N0 M1b IVB T0 N1 M1b IVB T0 NX M1b IVB T0 N0 MX UNK T0 N1 MX UNK T0 NX MX UNK Tis N0 M0 0 Tis N1 M0 ERROR Tis NX M0 0 Tis N0 M1NOS ERROR Tis N1 M1NOS ERROR Tis NX M1NOS ERROR Tis N0 M1a ERROR Tis N1 M1a ERROR Tis NX M1a ERROR Tis N0 M1b ERROR Tis N1 M1b ERROR Tis NX M1b ERROR Tis N0 MX 0 Tis N1 MX ERROR Tis NX MX 0 T1 N0 M0 I T1 N1 M0 IIB T1 NX M0 UNK T1 N0 M1NOS IVNOS T1 N1 M1NOS IVNOS T1 NX M1NOS IVNOS T1 N0 M1a IVA T1 N1 M1a IVA T1 NX M1a IVA T1 N0 M1b IVB T1 N1 M1b IVB T1 NX M1b IVB T1 N0 MX UNK T1 N1 MX UNK T1 NX MX UNK T2 N0 M0 IIA T2 N1 M0 IIB T2 NX M0 UNK T2 N0 M1NOS IVNOS T2 N1 M1NOS IVNOS T2 NX M1NOS IVNOS T2 N0 M1a IVA T2 N1 M1a IVA T2 NX M1a IVA T2 N0 M1b IVB T2 N1 M1b IVB T2 NX M1b IVB T2 N0 MX UNK T2 N1 MX UNK T2 NX MX UNK T3 N0 M0 IIA T3 N1 M0 III T3 NX M0 UNK T3 N0 M1NOS IVNOS T3 N1 M1NOS IVNOS T3 NX M1NOS IVNOS T3 N0 M1a IVA T3 N1 M1a IVA T3 NX M1a IVA T3 N0 M1b IVB T3 N1 M1b IVB T3 NX M1b IVB T3 N0 MX UNK T3 N1 MX UNK T3 NX MX UNK T4 N0 M0 III T4 N1 M0 III T4 NX M0 III T4 N0 M1NOS IVNOS T4 N1 M1NOS IVNOS T4 NX M1NOS IVNOS T4 N0 M1a IVA T4 N1 M1a IVA T4 NX M1a IVA T4 N0 M1b IVB T4 N1 M1b IVB T4 NX M1b IVB T4 N0 MX UNK T4 N1 MX UNK T4 NX MX UNK TX N0 M0 UNK TX N1 M0 UNK TX NX M0 UNK TX N0 M1NOS IVNOS TX N1 M1NOS IVNOS TX NX M1NOS IVNOS TX N0 M1a IVA TX N1 M1a IVA TX NX M1a IVA TX N0 M1b IVB TX N1 M1b IVB TX NX M1b IVB TX N0 MX UNK TX N1 MX UNK TX NX MX UNK &commonsummarystage; &commonstageesophagus_squamoustnm7; &commonstageesophagus_adenocarcinomatnm7; Lymph Nodes Clinical Evaluation AJCC 7 Table Note: This table is used when CS Lymph Nodes is 100-500 and CS Regional Nodes Eval is 0, 1, 5, or 9. The N category for AJCC7 staging is determined based on the number of positive regional nodes in Regional Nodes Positive and the value of CS Site-Specific Factor 1, Clinical Assessment of Regional Lymph Nodes. Regional Nodes Positive CS SSF 1 000 0 CS SSF 1 100 100 CS SSF 1 200 200 CS SSF 1 300 300 CS SSF 1 400 400 CS SSF 1 888 888 CS SSF 1 988 988 CS SSF 1 999 999 00 N1 N1 N2 N3 N1 ERROR ERROR N1 01-02 N1 N1 N2 N3 N1 ERROR ERROR N1 03-06 N2 N2 N2 N2 N2 ERROR ERROR N2 07-90 N3 N3 N3 N3 N3 ERROR ERROR N3 95-97 N1 N1 N2 N3 N1 ERROR ERROR N1 98-99 N1 N1 N2 N3 N1 ERROR ERROR N1 Lymph Nodes Pathologic Evaluation AJCC 7 Table Also Used When CS Lymph Nodes Eval Is Not Coded Note: This table is used when CS Lymph Nodes is 100-500 and CS Lymph Nodes Eval is 2, 3, 6, 8, or not coded. The N category for AJCC 7 staging is determined based on the number of positive regional nodes in Regional Nodes Positive. Regional Nodes Positive N Category 00-02 N1 03-06 N2 07-90 N3 95-99 N1 Lymph Nodes Mets at DX Table AJCC 6 Note: When CS Mets at DX is coded 00 or 99, the N and M categories for AJCC 6 staging are determined by the CS Lymph Nodes code as shown in this table. CS Lymph Nodes CS Mets at DX 00 0 CS Mets at DX 99 99 000 M0 MX 100 M0 MX 200 M0 MX 220 M0 MX 250 M1a M1a 255 M1a M1a 260 ERROR ERROR 265 M1b M1b 270 M1b M1b 275 M1b M1b 280 M1b M1b 300 ERROR ERROR 305 M0 MX 310 M1a M1a 320 M1b M1b 330 M1b M1b 500 M0 MX 560 M0 MX 600 ERROR ERROR 610 M0 MX 700 ERROR ERROR 710 M0 MX 800 M0 MX 999 M0 MX Histologies Stage Table Note 1: The determination of the AJCC 7 stage group from T, N, M, and grade for esophagus depends further on histologic type. Since squamous cell carcinoma typically has a poorer prognosis than adenocarcinoma, a tumor of mixed histopathologic type (including a squamous component or NOS histology) or a type that is not otherwise specified should be staged as squamous cell carcinoma. Note 2: This table shows the selection of the appropriate version of the AJCC Stage table based on histology. In the table below, Squamous maps to the table AJCC TNM 7 Stage Squamous, and Adenocarcinoma maps to the table AJCC TNM 7 Stage Adenocarcinoma. ICD-O-3 histology code Stage Table 8000-8046 Squamous 8050 Adenocarcinoma 8051-8131 Squamous 8140-8147 Adenocarcinoma 8148-8157 Squamous 8160-8162 Adenocarcinoma 8170-8175 Adenocarcinoma 8180-8221 Adenocarcinoma 8230-8249 Squamous 8250-8507 Adenocarcinoma 8508 Squamous 8510-8513 Squamous 8514-8551 Adenocarcinoma 8560-8570 Squamous 8571-8574 Adenocarcinoma 8575 Squamous 8576 Adenocarcinoma 8940-8941 Adenocarcinoma 8950 Squamous 8980-8981 Squamous