V.4.1.1 Tumor Size Clinical

This data item records the size of a solid primary tumor before any treatment and is essential for treatment decision making and prognosis determination for many types of cancer.

Coding Instructions:

• Code the tumor size from the largest invasive component of the primary tumor measured on physical exam, imaging, or other diagnostic procedures performed before any form of treatment.

• Code the largest tumor size from all information available within four months of the date of diagnosis, in the absence of disease progression when no treatment is administered.

• Tumor size from imaging/radiographic techniques can be used to code clinical size when there is not more specific size information from a biopsy or operative report. It should be taken as a lower priority, but over a physical exam.

• Code the largest size in the record, regardless of the imaging technique, when there is a difference in reported tumor size among imaging and radiographic reports, unless the physician specifies the imaging that is most accurate.

• 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.

• 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.

• Code the size of the primary tumor before neoadjuvant (preoperative) treatment.

Example:

Patient has a 2.8 cm mass in the hypopharynx; fine needle aspiration of mass confirms squamous cell carcinoma. Patient receives a course of neoadjuvant combination chemotherapy. Pathologic size of tumor after total resection is 3.2 cm. Record clinical tumor size as 028 (28 mm).

• Record tumor size only in millimeters (mm). Convert to millimeters when the size of tumor is measured in centimeters.

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

• Tumor size noted in a resection operative report is a clinical tumor size, and not a pathologic tumor size.

• Check the Clinical History/Clinical Impression/Clinical Information section of the pathology report for information on the clinical size of the tumor.

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 4.5 millimeters in size. Round up to 5 mm and code as 005.

• Cancer in a polyp described as 2.3 millimeters in size. Round down to 2 mm and code as 002.

• Tumor size code 999 is used when size is unknown or not applicable.

• Sites/Morphologies where tumor size is not applicable are listed here:

• Hematopoetic, 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 Clinical code.   

Codes:

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