Tumor Size Pathologic

Field length: 3

Code the size of the primary tumor that has been resected.

Coding Instructions

Note: Record tumor size only in millimeters (mm). Convert to millimeters from centimeters when size of tumor is measured in centimeters (cm). Often measurements are given in centimeters and must be

converted to millimeters, such as < 1 cm, code as 009; or < 2 cm , code as 019.

Coding Instructions

1. Record the size of the resected or excised tumor. The tumor size may differ from the size of the specimen.

Note: An incisional biopsy that removed the whole tumor is actually an excisional biopsy. Record excisional biopsy tumor size in Tumor Size--Pathologic.

Example: A breast biopsy revealed a 1.3 cm ductal carcinoma. There was no residual carcinoma found in the partial mastectomy specimen. The biopsy removed the whole tumor which makes it an excisional biopsy. Code the clinical tumor size as 999 and the path tumor size as 013.

2. Record the size of the invasive component, if given

a. Record the size of the invasive component, even if it is smaller, when both an in situ and an invasive component are present and the invasive component is measured

Example: Tumor is mixed in situ and invasive adenocarcinoma, total 3.7 cm in size, of which 1.4 cm is invasive. Record tumor size as 014 (1.4 cm or 14 mm).

b. Record the size of the entire tumor from the surgical report or pathology report when the size of the invasive component is not given

Example 1: A breast tumor with infiltrating duct carcinoma with extensive in situ component; total size 2.3 cm. Record tumor size as 023 (2.3 cm or 23 mm).

Example 2: Duct carcinoma in situ measuring 1.9 cm with an area of invasive ductal carcinoma. Record tumor size as 019 (1.9 cm = 19 mm).

c. Record the size of the primary tumor, including contiguous tumor tissue extension, at the time of diagnosis

3. Code the largest size of the primary tumor measured on the surgical resection specimen when surgery is administered as part of the first definitive treatment

Note: Do not use pathologic tumor size from surgery when neoadjuvant therapy has been administered.

a. Code the size from the synoptic report (also known as CAP protocol or pathology report checklist) when there is a discrepancy among tumor size measurements in the various sections of the pathology report

b. Use final diagnosis, microscopic, or gross examination, in that order, when no synoptic report is available

Example 1: Chest x-ray shows 3.5 cm mass. The pathology report from the lobectomy states RUL lung mass: 2.8 cm adenocarcinoma. Record pathologic tumor size as 028 (28 mm).

Example 2: Pathology report states lung carcinoma is 2.1 cm x 3.2 cm x 1.4 cm. Record pathologic tumor size as 032 (32 mm).

4. Tumor size is the largest dimension of the tumor, not the depth or thickness of the tumor

5. Record the largest dimension or diameter of tumor, whether it is from an excisional biopsy specimen or the complete resection of the primary tumor

Example 1: Tumor is described as 2.4 x 5.1 x 1.8 cm in size. Record tumor size as 051 (51 mm).

Example 2: Anal canal tumor is 2.5 cm from proximal to distal (3.5 cm in circumference). Record tumor size as 035. The circumferential measurement is the largest measurement in this example. In this case, the pathologist usually cuts the anus and rectum open like a tube; the circumference is measured flat.

6. Include pathologic information obtained through completion of definitive surgery when the surgery is part of the first course of treatment

7. Do not use information on size from imaging/radiographic techniques to code Tumor Size--Pathologic

8. Pathologic tumor size follows the timing rules for AJCC pathological staging. For pathologic tumor size, take into consideration what the physician would use to assign pathological stage. Refer to AJCC TNM guidelines to determine the sources of information that pertain to the pathological staging timeframe.

Example: Lumpectomy and mastectomy pertain to the pathological timeframe. A size from lumpectomy or mastectomy would be used for the pathologic tumor size.

Note: Do not infer the tumor size from the T category.

9. Always code the size of the primary tumor, not the size of the polyp, ulcer, cyst, or distant metastasis. The tumor size may differ from the size of the specimen. However, when the tumor is described as a “cystic mass” or “polypoid mass” and only the size of the entire mass is given, code the size of the entire mass, since the cysts or polyps are part of the tumor itself.

10. Code the size of the largest focus when there is microinvasion. Code 990 when there is microinvasion and no size given.

11. Record the size as stated for purely in situ lesions

12. Disregard microscopic residual or positive surgical margins when coding tumor size. Microscopic residual tumor does not affect overall tumor size. The status of primary tumor margins may be recorded in a separate data item.

13. Multifocal/multicentric tumors: Code the size of the largest invasive tumor, or the largest in situ tumor if all tumors are in situ, when the tumor is multi-focal or when multiple tumors are reported as a single primary.

14. Record tumor size only in millimeters (mm). Convert to millimeters from centimeters when size of tumor is measured in centimeters (cm). Often measurements are given in centimeters and must be converted to millimeters, such as < 1 cm, code as 009; or < 2 cm, code as 019.

15. Record the size stated when tumor size is described as “at least” a certain size. Record 003 for a tumor size of at least 3mm.

16. Record ‘less than’ OR ‘greater than’ tumor size

a. Record the tumor size as one mm less than stated when tumor size is reported as “less than x mm” or “less than x cm”

Example: Size is < 10 mm, code size as 009.

i. Often measurements are given in centimeters and must be converted to millimeters, such as < 1 cm, code as 009; or < 2 cm, code as 019

ii. Code 001 when stated as less than 1 mm

b. Record the tumor size as one mm more than stated when tumor size is reported as “more than x mm” or “more than x cm”

Example: Size is > 10 mm, code size as 011.

i. Often measurements are given in centimeters and must be converted to millimeters, such as > 1 cm, code as 011; or > 2 cm, code as 021

c. Code 989 when tumor size is greater than 989 mm (98.9 cm)

17. Record “between” tumor sizes as the midpoint between the two measurements when tumor size is reported to be between two sizes; i.e., add the two sizes together and divide by two

Note: The word “between” must be stated to use this instruction.

Example: Tumor size is “between 2 and 3 cm.” Code size as 025 since 2 + 3 =5 divided by 2 = 2.5 (or 025 mm).

18. Record the higher tumor size when stated as a range

Example: Tumor size is 8-10 mm or tumor size is 8 to 10 mm. Code size as 010 since 10 mm is the higher of the values in the range.

19. Round decimals: Round the tumor size only if it is described in fractions of millimeters.

a. When tumor size is greater than 1 millimeter, round tenths of millimeters in the 1-4 range down to the nearest whole millimeter and round tenths of millimeters in the 5-9 range up to the nearest whole millimeter. See Exception for breast cancer.

b. Do not round tumor size expressed in centimeters to the nearest whole centimeter; rather, convert the measurement to millimeters by moving the decimal point one space to the right

Note 1: Record tumor size as 001 (do not round down to 000) when the largest dimension of a tumor is less than 1 millimeter (between 0.1 and 0.9 mm).

Note 2: Code 001 when tumor size is 1 mm.

Exception to rounding rules for BREAST primaries: Round tumor sizes greater than 1.0 mm and up to 2.4 mm to 2 mm (002). The purpose of this exception is so that the size recorded in the Tumor Size data item will derive the correct AJCC TNM Primary Tumor (T) category for breast primaries. Do not apply this instruction to any other site.

Examples:

• Breast cancer described as 6.5 millimeters in size. Round up to 7 mm and code as 007.
• Breast cancer described as 1.3 mm in size. Round up to 2 mm and code as 002.
• 2.3 millimeters cancer in a polyp. Round down to 2 mm and code 002.
• Hypopharynx: Focus of cancer described as 1.4 mm in size. Round down to 1 mm and code as 001.
• 5.2 cm breast cancer. Convert to millimeters and code 052.
• 2.5 cm rectal cancer. Do not round, record as 025 millimeters.

20. Assign code 000 when

a. No residual tumor is found

i. Neoadjuvant therapy has been administered and the resection shows no residual tumor

b. Schema is Cervical Lymph Nodes and Unknown Primary 00060

c. EOD Primary Tumor is coded 800 (No evidence of primary tumor) for any schema except for those listed in Coding Instruction 22

21. Assign tumor size for benign and borderline tumors in the schemas Brain, CNS Other, Intracranial Gland, and Medulloblastoma when provided; do not default to 999

22. Assign code 999 when

a. Pathologic tumor size is unknown

b. There is no excisional biopsy or tumor resection

c. The only measurement describes pieces or chips. Do not add the size of pieces or chips together to create a whole; they may not be from the same location, or they may represent only a very small portion of a large tumor.

However, when the pathologist states an aggregate or composite size (determined by fitting the tumor pieces together and measuring the total size), record that size.

d. Neoadjuvant therapy has been administered. Do not use a post-neoadjuvant size to code path tumor size.

e. For the following sites and schemas/schema IDs

i. Any case coded to primary site C420, C421, C423-C424, C770-C779, or C809

ii. HemeRetic 00830

1. Excluding Spleen (C422)

iii. Kaposi Sarcoma 00458

iv. Lymphoma 00790

v. Lymphoma-CLL/SLL 00795

vi. Melanoma Choroid and Ciliary Body 00672

vii. Melanoma Iris 00671

viii. Plasma Cell Disorders 00822

ix. Plasma Cell Myeloma 00821

23. Document the information to support coded pathologic tumor size in the appropriate text field of the abstract

Tumor size is important for staging of tumors in the following table of schemas. For more information about schemas and schema IDs, go to the SSDI Manual, Appendix A.

Table. Schemas for which Tumor Size Affects Staging