California Cancer Reporting System Standards Volume I: Abstracting and Coding Procedures
This data item records the size of a solid primary tumor that has been resected. It is an important prognostic indicator and is valuable for both clinical practice and for research on surgically treated patients.
Code the tumor size from the largest invasive component of the primary tumor measured at surgical resection when the surgery is administered as first course treatment.
Record the largest dimension or diameter of tumor, whether it is from an excisional biopsy specimen or the complete resection of the primary tumor.
The pathologic tumor size is recorded from the surgical resection specimen when surgery (including after neoadjuvant therapy) is administered as part of the first course of treatment.
Use final diagnosis, microscopic or gross examination, in that order, when only a pathology report is available.
Do not add the size of pieces or chips together to create a whole.
Code the size from the synoptic report (CAP protocol) when there is a discrepancy among the various sections of the pathology report.
Example:
Chest x-ray shows 2.5 cm mass; the pathology report from the surgery states that the same mass is malignant and measures 1.8 cm. Record tumor size as 018 (18mm).
Record the size of the invasive component, even if it is smaller, when both in situ and invasive components are measured.
Code the size of the primary tumor, not the size of the polyp, ulcer, cyst, or distant metastasis.
Record the size of the entire tumor from the operative report or pathology report when the size of the invasive component is not given.
Record the size as stated for purely in situ lesions.
Disregard microscopic residual or positive margins.
Code the size of the largest invasive tumor, or the largest in situ tumor when the tumor is multi-focal or multicentric.
Tumor size noted in a resection operative report is a clinical tumor size, not a pathologic tumor size.
Tumor size is the largest dimension of the tumor, not necessarily the depth or thickness of the tumor.
Record tumor size only in millimeters (mm). Convert to millimeters when the size of tumor is measured in centimeters.
Tumor Size Less than or Greater than:
Record the tumor size as 1 mm less when tumor size is reported as “less than x mm” or “less than x cm”.
Examples:
Code as 009 when stated <10 mm; or 009 when stated as < 1 cm.
Code 001 when stated as less than 1 mm.
Record the tumor size as 1 mm more when tumor size is reported as “more than x mm” or “more than x cm”.
Example:
Code as 010 when stated > 9 mm; or 011 when stated as > 1 cm.
When size stated is between 2 sizes, for example, “between 3 and 4 cm”, code to the midpoint: 3.5.
Rounding:
Round tenths of millimeters in the 1-4 range down to the nearest whole millimeter.
Round tenths of millimeters in the 5-9 range up to the nearest whole millimeter when tumor size is greater than 1 millimeter.
Examples:
Lung cancer described as 6.5 millimeters in size. Round up to 7 mm and code as 007.
Cancer in a polyp described as 1.3 millimeters in size. Round down to 1 mm and code as 001.
Code 999 is used when size is unknown or not applicable.
Sites/morphologies where tumor size is not applicable are listed here:
Hematopoietic, Reticuloendothelial, and Myeloproliferative neoplasms (Histology codes 9590-9992)
Kaposi Sarcoma
Melanoma Choroid
Melanoma Ciliary Body
Melanoma Iris
Unknown primary site (C809)
The CCR requires text documentation to support the Tumor Size Pathologic code.
Code |
Description |
000 |
No mass/tumor found |
001 |
1 mm or described as less than 1 mm |
002-988 |
Exact size in millimeters (2 mm to 988 mm) |
989 |
989 millimeters or larger |
990 |
Microscopic focus or foci only and no size of focus is given |
998-Site Specific Codes |
Alternate descriptions of tumor size for specific sites: Familial/multiple polyposis: Rectosigmoid and rectum (C19.9, C20.9) Colon (C18.0, C18.2-C18.9) If no size is documented: Circumferential: Esophagus (C15.0 C15.5, C15.8 C15.9) Diffuse; widespread: 3/4s or more; linitis plastica: Stomach and Esophagus GE Junction (C16.0 C16.6, C16.8 C16.9) Diffuse, entire lung or NOS: Lung and main stem bronchus (C34.0 C34.3, C34.8 C34.9) Diffuse: Breast (C50.0 C50.6, C50.8 C50.9) |
999 |
Unknown; size not stated; Not documented in patient record; Size of tumor cannot be assessed; Not applicable |