V.4.1.3 Tumor Size Summary

This data item records the most accurate measurement of a solid primary tumor, usually measured on the surgical resection specimen. Tumor size is one indication of the extent of disease and is therefore used by clinicians and researchers. Tumor size that is independent of stage is also useful for quality assurance efforts.

Coding Instructions:

• Tumor size is the diameter of the tumor, not the depth or thickness of the tumor.

• All measurements should be in millimeters (mm).

• Use tumor size measurement from the surgical resection specimen, when no pre-surgical treatment is administered.

• If there is a discrepancy among tumor size measurements in the various sections of the pathology report, code the size from the synoptic report.

• If only a path text report is available, use: final diagnosis, microscopic, or gross examination, in that order.

• Microscopic residual or positive surgical margins should be disregarded when coding tumor size. The status of primary tumor margins may be recorded in a separate data field.

• If no surgical resection, record the size prior to any other form of treatment

• Code the largest tumor measurement in the following priority order:

• Imaging

• Physical exam

• Other diagnostic procedures

• Priority of imaging/radiographic techniques should be taken as low priority, over a physical exam

• If there is a difference in reported tumor size among imaging and radiographic techniques, unless the physician specifies which imaging is most accurate, record the largest size in the record, regardless of which imaging technique reports it.

• Always code the size of the primary tumor, not the size of the polyp, ulcer, cyst, or distant metastasis.

• However, if the tumor is described as a "cystic mass," and only the size of the entire mass is given, code the size of the entire mass, since the cysts are part of the tumor itself.

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

• If the size of the invasive component is not given, record the size of the entire tumor from the surgical report, pathology report, radiology report or clinical examination.

• If both an in situ and an invasive component are present and the invasive component is measured, record the size of the invasive component even if it is smaller.

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

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

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

• Use Code 999 in the following situations:

• Neoadjuvant (preoperative) therapy was administered and pretreatment tumor size is unknown.

• Sites/morphologies where tumor size is not applicable

• Hematopoietic, Reticuloendothelial, and Myeloproliferative neoplasms (histology codes 9590-9992)

• Kaposi Sarcoma

• Melanoma Choroid

• Melanoma Ciliary Body

• Melanoma Iris

• Pieces or chips are the only measurement provided

• Recording 'less than'/ 'greater than' Tumor Size:

• If tumor size is reported as less than x mm or less than x cm, the reported tumor size should be 1 mm less; for example if size is < 10 mm, code size as 009.

• If tumor size is reported as more than x mm or more than x cm, code size as 1 mm more; for example if size is > 10 mm, size should be coded as 011.

• If tumor size is reported to be between two sizes, record tumor size as the midpoint between the two: i.e., add the two sizes together and then divide by two.

• Rounding decimals: Round the tumor size only if it is described in fractions (decimals) of millimeters.

• If the largest dimension of a tumor is less than 1 millimeter (between 0.1 and 0.9 mm), record size as 001 (do not round down to 000).

• If tumor size is greater than 1 millimeter, 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.

• Do not round tumor size expressed in centimeters to the nearest whole centimeter (rather, move the decimal point one space to the right, converting the measurement to millimeters).

Examples:

• Breast tumor described as 6.5 millimeters in size. Round up Tumor Size as 007.

• Cancer in polyp described as 2.3 millimeters in size. Round down Tumor Size as 002.

• Focus of cancer described as 1.4 mm in size. Round down as 001.

• The CCR requires text documentation to support the Tumor Size Summary code.

Codes:

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