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For cases diagnosed 1998-2003:

If only the extramedullary site is involved, such as colon, code the Primary Site field to the site of origin. Granulocytic or myeloid sarcoma is an exception to the rule that all leukemias should be coded to bone marrow as the primary site. Granulocytic sarcoma is a deposit of malignant myeloid cells in a site other than bone marrow (extramedullary). For EOD staging, granulocytic sarcoma [9930/3] is included in the Hematopoietic, Reticuloendothelial, Immunoproliferative and Myeloproliferative Neoplasms scheme and the Extension field is coded to 10 when the lymph nodes are negative, since it (like solitary plasmacytoma) is a localized deposit of tumor.

However, if the regional lymph nodes associated with the extramedullary primary site are involved, code the EOD-Extension field to 80 [Systemic disease] because the disease is no longer an isolated deposit of malignant granulocytes (in other words, it is not localized).

The EOD-Lymph Nodes field is coded to 9 regardless of whether or not the lymph nodes are involved because that is the only allowable code for that field.

For cases diagnosed 1998-2003:

Code the EOD-Size of Primary Tumor field to 045 [4.5 cm]. Document how the size was determined in the EOD-Extension field.

Code the EOD-Extension field to 16 [Invasive and in situ components present, size of entire tumor coded in Tumor Size (size of invasive component not stated) AND proportions of in situ and invasive not known]. By virtue of the lymph node metastasis, this must be an invasive breast carcinoma. The size of the invasive component is unknown.

For cases diagnosed 1998-2003:

Code the EOD-Extension field to 20 [Involvement of two or more lymph node regions on the same side of diaphram]. The AJCC lists mesenteric as a core nodal region, but does not list retroperitoneal lymph nodes as a part of this region, so retroperitoneal is a separate region.

The EOD staging scheme for lymphoma uses lymph node REGIONS as the criteria for assigning the extension code. Use the AJCC Cancer Staging Manual as the definitive source for classifying lymph node regions, not the ICD-O-3. If it is a separate LN region per the AJCC, it is coded in the EOD as a separate region.

According to the AJCC curator, the nodal regions are defined in Kaplan's book on Hodgkin disease. Bilateral cervical, or axillary, or hilar, or pelvic, or inguinal nodes count as two regions. Mediastinal and para-aortic lymph nodes count as one region regardless of laterality as they are centrally located. A large mediastinal mass constitutes one region involved regardless of the size.

For cases diagnosed 1998-2003:

Code the EOD-Extension field for both cases to 40 [Tumor limited to larynx WITH vocal cord fixation]. Code 35 [Impaired vocal cord mobility] implies that mobility is diminished in strength and/or quality but is not rigid. Impaired mobility is a T2 tumor. Because the second case is T3, the physician implies he/she is using the term "immobility" to describe complete fixation.

For cases diagnosed 1998-2003:

Code EOD-extension to 30 [localized, NOS]. This is mucosal spread (since there is no muscle in the uvula). Soft palate and uvula are handled as a single site, and extension from uvula to soft palate is not addressed in EOD.

For cases diagnosed 1998-2003:

Code "perivesical nodules" in the EOD-Lymph Nodes field as involvement of regional lymph nodes. Each gross nodule of metastatic carcinoma in the fat surrounding an organ is counted as one positive regional lymph node.

For cases diagnosed 1998-2003:

Assign extension code 65 for contiguous (direct) extension of tumor from the cervix to the pelvic wall. Assign extension code 85 only if the pelvic wall is involved with discontinuous extension from the cervix; i.e., the cervical tumor spread indirectly (through lymph or vascular channels) to the pelvic wall. Code the pelvic wall involvement in the Extension field and the periaortic lymph node involvement in the Lymph Node field. When the computer does the algorithm, it will look at the periaortic lymph nodes and report the summary stage as distant and the TNM stage group as IV because periarotic nodes are M1. Do not code the periaortic lymph nodes in both fields. This is stage IV, distant disease, due to the periaortic lymph node involvement (EOD lymph nodes code 6).

For cases diagnosed 1998-2003: Use extension codes 16, 26, or 36 depending on extent of involvement. These codes indicate that invasive and in situ components are present, the size of the entire tumor is coded in Tumor Size, the size of the invasive component is not stated, and the proportions of in situ and invasive are not known.

Both examples above measure the entire tumor including invasive and in situ components. Assign extension code 16, unless there is evidence of further involvement.

For cases diagnosed 1998-2003: Tumor present within the blood vessels of the thyroid capsule is localized (extension code 30). The tumor has not penetrated the capsule itself if it is contained within the blood vessels.

Keep in mind that tumor size determines the extent of disease for thyroid extension codes 10, 20, 30 and 40.

For cases diagnosed 1998-2003: The term "within" is not one of the listed ambiguous terms for EOD. Determine extent of involvement from the context in which "within" appears.

In the example, "Encased" is an ambiguous term meaning not involved. Code extension for the example to 10 [Invasive cancer confined to kidney cortex and/or medulla].