]> C64.9 Kidney, NOS (Renal parenchyma) Note: Laterality must be coded for this site. CS Tumor Size Note 1: Code the tumor size as documented in the medical record. Code Description 000 No mass/tumor found 001-988 989 989 millimeters or larger 990 Microscopic focus or foci only and no size of focus given 991 Described as "less than 1 centimeter (cm)" 992 993 994 995 996 997 998 999 CS Extension Note 1: The parenchyma of the kidney includes the following structures: cortex (outer layer of kidney), renal columns; medulla, medullary rays, renal pyramids, and renal papillae; nephrons (renal corpuscle, loops of Henle, proximal and distal tubules, collecting duct); glomerulus and surrounding Bowman's capsule. The most common site for renal parenchymal cancer to develop is in the proximal convoluted tubule. Tumor extension from one of these structures into another is coded 100 in the absence of further involvement. Note 2: Gerota's fascia is a fibrous tissue sheath surrounding the kidney and suprarenal or adrenal gland. The perirenal fat, renal capsule, and renal parenchyma lie below the fascia. Note 3: Information about invasion beyond the capsule, venous involvement, and ipsilateral adrenal gland involvement is collected in this field for anatomic staging. This information is also collected in CS Site-Specific Factors 1, 2, and 3 as these factors may have an independent effect on prognosis. Note 4: AJCC considers "in situ carcinoma of the renal parenchyma" an impossible diagnosis. Any case so coded is mapped to TX for AJCC stage and in situ Summary Stage. Note 5: Use code 300 (Localized, NOS) only when no further information is available to assign code 100, 200, or 310-360. Note 6: The assignment of T1 and T2 categories for tumors limited to the kidney is based on tumor size. A physician's statement of the T category may be used to code CS Tumor Size and/or CS Extension if this is the only information in the medical record regarding one or both of these fields. However the two fields are coded independently: for example the record may document size but not extension, other than the physician's statement of the T category. Use codes 310-360, 605-625 or 810 as appropriate to code CS Extension based on a statement of T when no other extension information is available. Note 7: 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: contralateral kidney; contralateral ureter; liver from left kidney; spleen from right kidney. Code Description TNM 7 Map TNM 6 Map SS77 Map SS2000 Map 000 In situ, intraepithelial, noninvasive TX TX IS IS 100 Invasive cancer confined to kidney cortex and/or medulla ^ * L L 200 ^ * L L 300 Localized, NOS ^ * L L 310 Stated as T1a with no other information on extension ^ * L L 320 Stated as T1b with no other information on extension ^ * L L 330 Stated as T1 [NOS] with no other information on extension ^ * L L 340 Stated as T2a with no other information on extension ^ * L L 350 Stated as T2b with no other information on extension ^ * L L 360 Stated as T2 [NOS] with no other information on extension ^ * L L 390 ERROR ERROR ERROR ERROR 400 ERROR T3a RE RE 450 T3a T3a RE RE 460 T3a T3a RE RE 600 ERROR T3b RE RE 601 T3a T3b RE RE 605 T3a T3a RE RE 610 T3b T3b RE RE 620 T3c T3c RE RE 625 T3NOS T3NOS RE RE 630 T4 T3a RE RE 640 T4 T3b RE RE 645 T4 T3c RE RE 650 T4 T4 RE RE 660 Retroperitoneal soft tissue T4 T4 RE RE 665 660 + any of (460, 601, 610, 620, 625, 630, 640, 645, 650) T4 T4 RE RE 670 T4 T4 D RE 700 Ribs T4 T4 D D 750 T4 T4 D D 800 T4 T4 D D 801 T4 T4 D D 810 Stated as T4 with no other information on extension T4 T4 RE RE 950 T0 T0 U U 999 TX TX U U ^ For CS Extension codes 100-360 ONLY, the T category for AJCC 7 is assigned based on the value of CS Tumor Size, as shown in the Extension Size AJCC 7 Table for this site. * For CS Extension codes 100-360 ONLY, the T category for AJCC 6 is assigned based on the value of CS Tumor Size, as shown in the Extension Size AJCC 6 Table for this site. &generalcstsexteval; CS Lymph Nodes Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: Regional nodes include unilateral, bilateral or contralateral involvement of named node(s). Code Description TNM 7 Map TNM 6 Map SS77 Map SS2000 Map 000 No regional lymph node involvement N0 N0 NONE NONE 100 N1 N1 RN RN 110 N1 N1 D RN 150 ERROR ERROR ERROR ERROR 200 MULTIPLE regional lymph nodes listed in code 100 N1 N2 RN RN 210 N1 N2 D RN 400 N1 N2 D RN 700 N1 N1 RN RN 800 Lymph nodes, NOS N1 N1 RN RN 999 NX NX U U &generalregnodeseval; &generalreglnpos; &generalreglnexam; CS Mets at DX Code Description TNM 7 Map TNM 6 Map SS77 Map SS2000 Map 00 No distant metastasis M0 M0 NONE NONE 10 Distant lymph node(s) M1 M1 D D 20 M1 M1 D D 40 M1 M1 D D 50 ERROR ERROR ERROR ERROR 55 M1 M1 D D 60 M1 M1 D D 99 M0 MX U U &generalmetseval; CS Site-Specific Factor 1 Invasion Beyond Capsule Note 1: Information about invasion beyond the capsule is collected in CS Extension as an element in anatomic staging. It is also collected in this field as it may have an independent effect on prognosis. Note 2: Record the location of invasion beyond capsule as documented in the pathology report. Assign code 000 if surgical resection of the primary site is performed, the pathology report is available for review, and invasion beyond capsule is not mentioned. Code Description 000 Invasion beyond capsule not present/not identified 010 020 030 888 988 991 Invasion beyond capsule, NOS 998 999 CS Site-Specific Factor 2 Vein Involvement Note 1: Information about vein involvement is collected in CS Extension as an element in anatomic staging. It is also collected in this field as it may have an independent effect on prognosis. Note 2: Record the involvement of specific named veins as documented in the pathology report. Do not code invasion of small unnamed vein(s) of the type collected as lymph-vascular invasion. Lymph-vascular invasion is usually only seen microscopically. Assign code 000 if surgical resection of the primary site is performed, the pathology report is available for review, and involvement of these specified veins is not mentioned. Code Description 000 Vein involvement not present/not identified 010 Involvement of renal vein only 020 Involvement of inferior vena cava (IVC) below the diaphragm only 030 Involvement of IVC above the diaphragm only 040 Involvement of IVC, NOS only 050 060 070 080 090 888 988 998 No surgical resection of primary site 999 CS Site-Specific Factor 3 Ipsilateral Adrenal Gland Involvement Note 1: Information about contiguous ipsilateral adrenal gland involvement is collected in CS Extension, and noncontiguous ipsilateral adrenal gland involvement is collected in CS Mets as DX, as elements in anatomic staging. This information is also collected in this field as it may have an independent effect on prognosis. Note 2: Record ipsilateral adrenal gland involvement as documented in the pathology report. Assign code 000 if histologic examination of a specimen including tissue from the adrenal gland is performed, the pathology report is available for review, and involvement of the adrenal gland is not mentioned. Code Description 000 Ipsilateral adrenal gland involvement not present/not identified 010 Contiguous involvement of ipsilateral adrenal gland 020 Noncontiguous involvement of ipsilateral adrenal gland 030 040 Involvement of ipsilateral adrenal gland, not stated whether contiguous or noncontiguous 888 988 998 No histologic examination to determine ipsilateral adrenal gland involvement 999 CS Site-Specific Factor 4 Sarcomatoid Features Note 1: Sarcomatoid morphology may be manifested by any renal cell carcinoma. The presence of sarcomatoid component in a renal cell carcinoma may be prognostically important. Note 2: Record the presence or absence of sarcomatoid features as documented anywhere in the pathology report. Assign code 000 if pathologic examination of the primary site is performed, the pathology report is available for review, and sarcomatoid features are not mentioned. Code Description 000 Sarcomatoid features not present/not identified 010 Sarcomatoid features present/identified 888 987 988 998 No pathologic examination of primary site 999 CS Site-Specific Factor 5 Histologic Tumor Necrosis Note 1: Tumor necrosis is an independent predictor of outcome for renal cell carcinoma. Note 2: Record the presence or absence of tumor necrosis as documented in the pathology report. Assign code 000 if histologic examination of primary site is performed, the pathology report is available for review, and histologic tumor necrosis is not mentioned. Code Description 000 Histologic tumor necrosis not present/not identified 010 Histologic tumor necrosis present/identified 888 988 998 No histologic examination of primary site 999 CS Site-Specific Factor 6 Fuhrman Nuclear Grade Note 1: Fuhrman nuclear grade is a four-grade system based on nuclear diameter and shape, the prominence of nucleoli, and the presence of chromatin clumping in the highest grade. Note 2: Record the Fuhrman nuclear grade as documented in the pathology report. Code Description 010 Grade 1 020 Grade 2 030 Grade 3 040 Grade 4 888 987 988 998 No histologic examination of primary site 999 CS Site-Specific Factor 7 Size of Metastasis in Lymph Nodes Note: Code the size of the largest metastasis in a lymph node as documented in the pathology report, not the size of the lymph node. If the size of the metastasis is not documented in the pathology report, code the size of the largest involved lymph node as documented pathologically or clinically with pathology taking priority. Do not code the size of any node(s) coded in CS Mets at DX. Code Description 000 No regional lymph node(s) involved 001-979 980 980 mm or larger 988 990 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" 996 Described as "less than 6 cm" or "greater than 5 cm" or "between 5 cm and 6 cm" 997 Described as "more than 6 cm" 998 999 CS Site-Specific Factor 8 Extranodal Extension of Regional Lymph Nodes Note 1: Code the status of extranodal extension whether assessed clinically or pathologically of any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extranodal extension in any nodes coded in CS Mets at DX field. Note 2: A statement of the presence or absence of extranodal extension in a pathology report takes priority over clinical assessment. Note 3: If nodes are involved but the clinical documentation and/or pathologic assessment does not indicate extranodal extension, assign code 010 (no extranodal extension documented on the available reports). Note 4: If the only documentation is a reference to clinically or pathologically involved nodes with no reference to extranodal extension, assign code 030 (no physical exam/imaging report and/or no pathology report available). Code Description 000 No regional lymph nodes involved 010 020 030 Regional nodes involved, unknown if extranodal extension 988 999 ¬appnewssf9; ¬appnewssf10; ¬appnewssf11; ¬appnewssf12; ¬appnewssf13; ¬appnewssf14; ¬appnewssf15; ¬appnewssf16; ¬appnewssf17; ¬appnewssf18; ¬appnewssf19; ¬appnewssf20; ¬appnewssf21; ¬appnewssf22; ¬appnewssf23; ¬appnewssf24; ¬appnewssf25; &commonhistinclusioncarcinoma; &commonhistologyexclusions1; AJCC TNM 7 Stage T N M Stage T0 N0 M0 ERROR T0 N1 M0 III T0 NX M0 UNK T1a N0 M0 I T1a N1 M0 III T1a NX M0 UNK T1b N0 M0 I T1b N1 M0 III T1b NX M0 UNK T1NOS N0 M0 I T1NOS N1 M0 III T1NOS NX M0 UNK T2a N0 M0 II T2a N1 M0 III T2a NX M0 UNK T2b N0 M0 II T2b N1 M0 III T2b NX M0 UNK T2NOS N0 M0 II T2NOS N1 M0 III T2NOS NX M0 UNK T3a N0 M0 III T3a N1 M0 III T3a NX M0 III T3b N0 M0 III T3b N1 M0 III T3b NX M0 III T3c N0 M0 III T3c N1 M0 III T3c NX M0 III T3NOS N0 M0 III T3NOS N1 M0 III T3NOS NX M0 III T4 N0 M0 IV T4 N1 M0 IV T4 NX M0 IV TX N0 M0 UNK TX N1 M0 UNK TX NX M0 UNK T0 N0 M1 IV T0 N1 M1 IV T0 NX M1 IV T1a N0 M1 IV T1a N1 M1 IV T1a NX M1 IV T1b N0 M1 IV T1b N1 M1 IV T1b NX M1 IV T1NOS N0 M1 IV T1NOS N1 M1 IV T1NOS NX M1 IV T2a N0 M1 IV T2a N1 M1 IV T2a NX M1 IV T2b N0 M1 IV T2b N1 M1 IV T2b NX M1 IV T2NOS N0 M1 IV T2NOS N1 M1 IV T2NOS NX M1 IV T3a N0 M1 IV T3a N1 M1 IV T3a NX M1 IV T3b N0 M1 IV T3b N1 M1 IV T3b NX M1 IV T3c N0 M1 IV T3c N1 M1 IV T3c NX M1 IV T3NOS N0 M1 IV T3NOS N1 M1 IV T3NOS NX M1 IV T4 N0 M1 IV T4 N1 M1 IV T4 NX M1 IV TX N0 M1 IV TX N1 M1 IV TX NX M1 IV AJCC TNM 6 Stage T N M Stage T0 N0 M0 ERROR T0 N1 M0 III T0 N2 M0 IV T0 NX M0 UNK T0 N0 M1 IV T0 N1 M1 IV T0 N2 M1 IV T0 NX M1 IV T0 N0 MX UNK T0 N1 MX UNK T0 N2 MX IV T0 NX MX UNK T1NOS N0 M0 I T1NOS N1 M0 III T1NOS N2 M0 IV T1NOS NX M0 UNK T1NOS N0 M1 IV T1NOS N1 M1 IV T1NOS N2 M1 IV T1NOS NX M1 IV T1NOS N0 MX UNK T1NOS N1 MX UNK T1NOS N2 MX IV T1NOS NX MX UNK T1a N0 M0 I T1a N1 M0 III T1a N2 M0 IV T1a NX M0 UNK T1a N0 M1 IV T1a N1 M1 IV T1a N2 M1 IV T1a NX M1 IV T1a N0 MX UNK T1a N1 MX UNK T1a N2 MX IV T1a NX MX UNK T1b N0 M0 I T1b N1 M0 III T1b N2 M0 IV T1b NX M0 UNK T1b N0 M1 IV T1b N1 M1 IV T1b N2 M1 IV T1b NX M1 IV T1b N0 MX UNK T1b N1 MX UNK T1b N2 MX IV T1b NX MX UNK T2 N0 M0 II T2 N1 M0 III T2 N2 M0 IV T2 NX M0 UNK T2 N0 M1 IV T2 N1 M1 IV T2 N2 M1 IV T2 NX M1 IV T2 N0 MX UNK T2 N1 MX UNK T2 N2 MX IV T2 NX MX UNK T3NOS N0 M0 III T3NOS N1 M0 III T3NOS N2 M0 IV T3NOS NX M0 UNK T3NOS N0 M1 IV T3NOS N1 M1 IV T3NOS N2 M1 IV T3NOS NX M1 IV T3NOS N0 MX UNK T3NOS N1 MX UNK T3NOS N2 MX IV T3NOS NX MX UNK T3a N0 M0 III T3a N1 M0 III T3a N2 M0 IV T3a NX M0 UNK T3a N0 M1 IV T3a N1 M1 IV T3a N2 M1 IV T3a NX M1 IV T3a N0 MX UNK T3a N1 MX UNK T3a N2 MX IV T3a NX MX UNK T3b N0 M0 III T3b N1 M0 III T3b N2 M0 IV T3b NX M0 UNK T3b N0 M1 IV T3b N1 M1 IV T3b N2 M1 IV T3b NX M1 IV T3b N0 MX UNK T3b N1 MX UNK T3b N2 MX IV T3b NX MX UNK T3c N0 M0 III T3c N1 M0 III T3c N2 M0 IV T3c NX M0 UNK T3c N0 M1 IV T3c N1 M1 IV T3c N2 M1 IV T3c NX M1 IV T3c N0 MX UNK T3c N1 MX UNK T3c N2 MX IV T3c NX MX UNK T4 N0 M0 IV T4 N1 M0 IV T4 N2 M0 IV T4 NX M0 IV T4 N0 M1 IV T4 N1 M1 IV T4 N2 M1 IV T4 NX M1 IV T4 N0 MX IV T4 N1 MX IV T4 N2 MX IV T4 NX MX IV TX N0 M0 UNK TX N1 M0 UNK TX N2 M0 IV TX NX M0 UNK TX N0 M1 IV TX N1 M1 IV TX N2 M1 IV TX NX M1 IV TX N0 MX UNK TX N1 MX UNK TX N2 MX IV TX NX MX UNK &commonsummarystage; Extension Size Table AJCC 6 Note: For CS Extension codes 100-360 ONLY, the T category for AJCC 6 staging is assigned based on the value of CS Tumor Size, as shown in this table. CS Extension CS Tumor Size 000 0 CS Tumor Size 001-040 1 40 CS Tumor Size 041-070 41 70 CS Tumor Size 071-989 71 989 CS Tumor Size 990-991 990 991 CS Tumor Size 992-994 992 994 CS Tumor Size 995 995 CS Tumor Size 996 996 CS Tumor Size 997-998 997 998 CS Tumor Size 999 999 100 ERROR T1a T1b T2 T1a T1a T1b T1NOS T2 TX 200 ERROR T1a T1b T2 T1a T1a T1b T1NOS T2 TX 300 ERROR T1a T1b T2 T1a T1a T1b T1NOS T2 TX 310 ERROR T1a T1b T2 T1a T1a T1b T1a T1a T1a 320 ERROR T1a T1b T2 T1a T1b T1b T1b T1b T1b 330 ERROR T1a T1b T2 T1a T1NOS T1b T1NOS T1NOS T1NOS 340 ERROR T1a T1b T2 T1a T2 T1b T2 T2 T2 350 ERROR T1a T1b T2 T1a T2 T1b T2 T2 T2 360 ERROR T1a T1b T2 T1a T2 T1b T2 T2 T2 Extension Size Table AJCC 7 Note: For CS Extension codes 100-360 ONLY, the T category for AJCC 7 staging is assigned based on the value of CS Tumor Size, as shown in this table. CS Extension CS Tumor Size 000 0 CS Tumor Size 001-040 1 40 CS Tumor Size 041-070 41 70 CS Tumor Size 071-100 71 100 CS Tumor Size 101-989 101 989 CS Tumor Size 990-991 990 991 CS Tumor Size 992-994 992 994 CS Tumor Size 995 995 CS Tumor Size 996 996 CS Tumor Size 997 997 CS Tumor Size 998 998 CS Tumor Size 999 999 100 ERROR T1a T1b T2a T2b T1a T1a T1b T1NOS T2NOS T2b TX 200 ERROR T1a T1b T2a T2b T1a T1a T1b T1NOS T2NOS T2b TX 300 ERROR T1a T1b T2a T2b T1a T1a T1b T1NOS T2NOS T2b TX 310 ERROR T1a T1b T2a T2b T1a T1a T1b T1a T1a T1a T1a 320 ERROR T1a T1b T2a T2b T1a T1b T1b T1b T1b T1b T1b 330 ERROR T1a T1b T2a T2b T1a T1NOS T1b T1NOS T1NOS T1NOS T1NOS 340 ERROR T1a T1b T2a T2b T1a T2a T1b T2a T2a T2a T2a 350 ERROR T1a T1b T2a T2b T1a T2b T1b T2b T2b T2b T2b 360 ERROR T1a T1b T2a T2b T1a T2NOS T1b T2NOS T2NOS T2NOS T2NOS