]> M-8153, 8240-8242, 8246, 8249 C24.1 Ampulla of Vater Note 1: For this schema, AJCC only stages well-differentiated neuroendocrine tumors. Note that the "concept" of well-differentiated is reflected in the histology code. The grade code is not needed in order to select the correct schema, but does need to be coded. Note 2: This schema is also used for carcinoid tumors and malignant gastrinomas. CS Tumor Size Note: The assignment of the T1 and T2 categories for neuroendocrine tumors (NET) of ampulla of Vater is based on tumor size. A physician's statement of the T category may be used to code both 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. Use codes 991 and 992 as appropriate to code CS Tumor Size based on a statement of T when no other size information is available. Code Description 000 No mass/tumor found 001-988 989 989 mm or larger 990 Microscopic focus or foci only and no size of focus given 991 992 993 994 995 996 997 998 999 CS Extension Note 1: AJCC does not include a Tis category for Neuroendocrine Tumors (NET) of the ampulla of Vater. Extension code 000 is mapped to TX for AJCC stage and in situ Summary Stage. Note 2: The assignment of the T1 and T2 categories for NETs of ampulla of Vater is based on tumor size. A physician's statement of the T category may be used to code both 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. Use codes 310, 430, 600, and 810 as appropriate to code CS Extension based on a statement of T when no other extension information is available. Note 3: Use code 300 for localized tumor only if no information is available to assign code 100 or 430. Code Description TNM 7 Map TNM 6 Map SS77 Map SS2000 Map 000 TX Tis IS IS 100 ^ T1 L L 300 ^ T1 L L 310 Stated as T1 with no other information on extension ^ T1 RE RE 420 Duodenal wall ^ T2 RE RE 430 Stated as T2 with no other information on extension ^ T1 L L 520 Pancreas T3 T3 RE RE 550 T3 T3 D D 600 Stated as T3 with no other information on extension T3 T3 RE RE 610 Visceral peritoneum (serosa) T4 T4 RE RE 620 Common bile duct T4 T4 RE RE 650 T4 T4 RE RE 700 T4 T4 RE RE 750 Stomach, proximal T4 T4 RE D 760 (620 to 750) + 550 T4 T4 D D 780 ERROR ERROR ERROR ERROR 800 T4 T4 D D 810 T4 T4 RE RE 950 No evidence of primary tumor T0 T0 U U 999 TX TX U U ^ For CS Extension codes 100-430 ONLY, the T category for AJCC 7 staging is assigned based on the value of CS Tumor Size, as shown in the Extension Size AJCC 7 Table for this schema. &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: Splenic lymph nodes and those located at the tail of the pancreas are not considered regional and should be coded under CS Mets at DX. 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 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 M1 M1 D D 40 M1 M1 D D 50 M1 M1 D D 60 Distant metastasis, NOS Stated as M1with no other information on distant metastasis M1 M1 D D 99 M0 MX U U &generalmetseval; ¬appssfactor1; ¬appssfactor2; ¬appssfactor3; CS Site-Specific Factor 4 Mitotic Count Note 1: The mitotic count, the number of mitoses per 10 high-power fields (HPF), is an element in a proposed grading scheme for neuroendocrine tumors (NETs) of the gastrointestinal system. This site-specific factor presumes the denominator of 10 HPF, so just the numberator (the mitotic count) is coded here. For other schemas in which mitotic count is collected, the denominator may vary. Note 2: As described in the AJCC chapter on NETs, 10 HPF at a magnification objective of 40 (40x) are equivalent to 2 square millimeters (mm). Note 3: Record mitotic count to the nearest tenth as documented in the pathology report. For example, a mitotic count of 3/10 HPF would be coded as 030. Note 4: Code the specific mitotic count only per 10 HPF or 2 square mm; assume the denominator is 10 HPF or 2 square mm if not specified. Use code 996 only if the mitotic count is expressed with a specific denominator other than 10 HPF or 2 square mm. Code Description 000 001-008 009 010-500 510 888 988 990 991 992 995 996 997 998 999 CS Site-Specific Factor 5 Serum Chromogranin A (CgA) Lab Value Note 1: Chromoganins are a family of proteins in secretory granules found throughout the neuroendocrine system. Serum Chromogranin A (CgA) has been shown to be a useful marker for neuroendocrine tumors. Note 2: Record to the nearest nanogram/milliliter the highest CgA lab value documented in the medical record prior to treatment. For example, code a pretreatment CgA of 400 ng/ml as 400. Note 3: Code 000 is reserved for exactly 0.0 ng/ml (no measurable amount of CgA). Do not round tiny values down to 0 ng/ml; any measured value less than or equal to 1 ng/ml should be coded 001. For code 001, also round 1.1-1.4 ng/ml down to 1 ng/ml. For codes 002-979, round values to the nearest ng/ml. Note 4: For an uncertain value, record the stated closest value. For example, code a value stated as "less than 5 ng/ml" as 005. Code Description 000 0 ng/ml 001 1 or less ng/ml 002-979 002-979 ng/ml 980 980 or greater ng/ml 988 997 Test ordered, results not in chart 998 Test not done (test not ordered and not performed) 999 CS Site-Specific Factor 6 Urinary 5-HIAA Lab Value Note 1: Carcinoid tumors can release large amounts of serotonin. 5-Hydroxyindoleacetic acid (5-HIAA) is-a breakdown product of the hormone serotonin. The 5-HIAA test measures the amount of acid secreted in the urine over a 24-hour period. Note 2: Record to the nearest milligram (mg) the highest 5-HIAA lab value documented in the medical record prior to treatment. For example, code a pretreatment 5-HIAA of 550 mg over 24 hours as 550. Note 3: Code 000 is reserved for exactly 0 mg (no measurable amount of 5-HIAA). Do not round tiny values down to 0 ng/ml; any measured value less than or equal to 1 mg should be coded 001. For code 001, also round 1.1-1.4 mg down to 1 ng/ml. For codes 002-979, round values to the nearest mg. Note 4: For an uncertain value, record the stated closest value. For example, code a value stated as "less than 5 mg" as 005. Code Description 000 0 milligrams (mg)/24hours 001 1 or less mg/24hours 002-979 2-979 mg/24hours 980 980 or greater mg/24hours 988 997 Test ordered, results not in chart 998 Test not done (test not ordered and not performed) 999 ¬appnewssf7; ¬appnewssf8; ¬appnewssf9; ¬appnewssf10; ¬appnewssf11; ¬appnewssf12; ¬appnewssf13; ¬appnewssf14; ¬appnewssf15; ¬appnewssf16; ¬appnewssf17; ¬appnewssf18; ¬appnewssf19; ¬appnewssf20; ¬appnewssf21; ¬appnewssf22; ¬appnewssf23; ¬appnewssf24; ¬appnewssf25; &commonhistinclusionnet; &commonhistexclusionampulla; &commonstagenetsmallintestineampullatnm7; &commonstageampulla; &commonsummarystage; Extension Size AJCC 7 Table Note: CS Extension codes 100-300 only; the T category for AJCC 7 staging is assigned based on the value of Tumor Size from this table. CS Extension CS Tumor Size 000 0 CS Tumor Size 001-010 1 10 CS Tumor Size 011-989 11 989 CS Tumor Size 990 990 CS Tumor Size 991 991 CS Tumor Size 992 992 CS Tumor Size 993-995 993 995 CS Tumor Size 996-998 996 998 CS Tumor Size 999-999 999 100 ERROR T1 T2 T1 T1 T2 T2 ERROR TX 300 ERROR T1 T2 T1 T1 T2 T2 ERROR TX 310 ERROR T1 T2 T1 T1 T1 T2 ERROR T1 420 ERROR T1 T2 T1 T1 T2 T2 ERROR TX 430 ERROR T1 T2 T1 T1 T2 T2 ERROR T2