Disease of the left lung ICD 10. Benign tumors of the lungs. Malignant neoplasms of lymphoid

Class II. Neoplasms (C00-D48)

This class contains the following broad groups of neoplasms:

C00-C75 Malignant neoplasms of specified localizations, which are designated as primary or presumably primary, except for neoplasms of lymphoid, hematopoietic and related tissues
C00-C14 Lips, oral cavity and pharynx
C15-C26 Digestive organs
C30-C39 Respiratory and chest organs
C40-C41 Bones and articular cartilage
С43-С44 Leather
C45-C49 Mesothelial and soft tissues
C50 Breast
C51-C58 Female genital organs
C60-C63 Male genital organs
S64-S68 Urinary tract
C69-C72 Eyes, brain and other parts of the central nervous system
C73-C75 Thyroid gland and other endocrine glands
C76-C80 Malignant neoplasms ill-defined, secondary and unspecified localizations
C81-C96 Malignant neoplasms of lymphoid, hematopoietic and related tissues, which are designated as primary or presumably primary
C97 Malignant neoplasms of independent (primary) multiple localizations
D00-D09 In situ neoplasms
D10-D36 Benign neoplasms
D37-D48 Neoplasms of undetermined or unknown nature

NOTES
1. Primary malignant neoplasms, ill-defined and unspecified localizations
Categories C76-C80 include malignancies with an ill-defined primary site or those defined as “disseminated,” “scattered,” or “widespread” without an indication of the primary site. In both cases, the primary location is considered unknown.

2. Functional activity
Class II includes neoplasms, regardless of the presence or absence of functional activity. If it is necessary to clarify the functional activity associated with a particular neoplasm, an additional code from class IV can be used. For example, catecholamine-producing malignant pheochromocytoma of the adrenal gland is coded under category C74 with additional code E27.5; basophilic pituitary adenoma with Itsenko-Cushing syndrome is coded under heading D35.2 with additional code E24.0.

3. Morphology
There are a number of large morphological (histological) groups of malignant neoplasms: carcinomas, including squamous cell and adenocarcinomas; sarcomas; other soft tissue tumors, including mesotheliomas; lymphomas (Hodgkin and non-Hodgkin); leukemia; other specified and location-specific types; unspecified crayfish.

The term "cancer" is general and can be used for any of the above groups, although it is rarely used in relation to malignant neoplasms of lymphoid, hematopoietic and related tissues. The term "carcinoma" is sometimes incorrectly used as a synonym for "cancer".

In class II, neoplasms are classified primarily by location within broad groupings based on the nature of their course. In exceptional cases, morphology is indicated in the names of headings and subheadings. For those wishing to identify the histological type of neoplasm on p. 577-599 (vol. 1, part 2) provides a general list of individual morphological codes. Morphological codes are taken from the second edition of the International Classification of Diseases in Oncology (ICD-O), which is a biaxial classification system that provides independent coding of neoplasms by topography and morphology. Morphological codes have 6 characters, of which the first four determine the histological type, the fifth indicates the nature of the tumor (malignant primary, malignant secondary, i.e. metastatic, in situ, benign, uncertain), and the sixth character determines the degree of differentiation of solid tumors and, in addition, is used as a special code for lymphomas and leukemias.

4. Use of subcategories in class II
It is necessary to pay attention to the special use in this class of the subcategory with the sign.8. Where it is necessary to identify a subcategory for the “others” group, a subcategory is usually used.7.

5. Malignant neoplasms that extend beyond one localization, and the use of a subcategory with the fourth character.8 (lesion that extends beyond one or more specified localizations). Headings C00-C75 classify primary malignant neoplasms according to their place of origin. Many three-digit
the headings are further subdivided into sub-headings according to the different parts of the organs in question. A neoplasm that involves two or more adjacent sites within a three-character category and the site of origin of which cannot be determined should be classified under a fourth-character subcategory.8 (lesion extending beyond one or more of the above localizations), unless such a combination is specifically indexed in others rubrics. For example, carcinoma of the esophagus and stomach is coded C16.0 (cardia), while carcinoma of the tip and undersurface of the tongue should be coded C02.8. On the other hand, carcinoma of the tip of the tongue involving the lower surface of the tongue should be coded in C02.1, since the site of origin (in in this case tip of the tongue) is known. The concept of “lesion extending beyond one or more of the above localizations” implies that the areas involved are contiguous (one continues the other). The numbering sequence of the subcategories often (but not always) corresponds to the anatomical neighborhood of the site (eg, bladder C67.-), and the coder may be forced to consult anatomical references to determine the topographic relationship. Sometimes the neoplasm extends beyond the localizations designated
three-digit rubrics within one organ system. The following subcategories are intended for coding such cases:
C02.8 Damage to the tongue that extends beyond one or more of the above localizations
C08.8 Damage to the major salivary glands, extending beyond one or more of the above localizations
C14.8 Damage to the lips, oral cavity and pharynx, extending beyond one or more of the above localizations
C21.8 Damage to the rectum, anus[anus] and anal canal extending beyond one or more of the above locations
C24.8 Defeat biliary tract, beyond one or more of the above localizations
C26.8 Damage to the digestive organs that extends beyond one or more of the above localizations
C39.8 Damage to the respiratory and intrathoracic organs, extending beyond one or more of the above localizations
C41.8 Damage to bones and articular cartilage, extending beyond one or more of the above localizations
C49.8 Damage to connective and soft tissues, extending beyond one or more of the above localizations
C57.8 Damage to the female genital organs, extending beyond one or more of the above localizations
C63.8 Damage to the male genital organs, extending beyond one or more of the above localizations
C68.8 Damage to the urinary organs, extending beyond one or more of the above localizations
C72.8 Damage to the brain and other parts of the central nervous system, extending beyond one or more of the above localizations

An example is carcinoma of the stomach and small intestine, which should be coded in subcategory C26.8 (damage to the digestive organs beyond one or more of the above locations).

6. Malignant neoplasms of ectopic tissue
Ectopic tissue malignancies should be coded according to the site mentioned, for example, ectopic pancreatic malignancy should be coded as pancreatic, unspecified (C25.9).

7. Use of the Alphabetical Index when coding neoplasms
When coding neoplasms, in addition to their location, the morphology and nature of the disease should be taken into account and, first of all, it is necessary to refer to the Alphabetical Index for a morphological description.
The introductory pages for Volume 3 include general instructions for using the Index. To provide correct use headings and subheadings of class II, it is necessary to take into account special instructions and examples related to neoplasms.

8. Use of the second edition of the International Classification of Diseases in Oncology (ICD-O)
For some morphological types, class II provides a rather narrow topographic classification or does not provide one at all. Topographical ICD-O codes are used for all neoplasms using essentially the same three- and four-digit rubrics as are used in Class II for malignant neoplasms (C00-C77, C80), thereby providing greater accuracy of localization for other neoplasms [malignant secondary (metastatic)
ical), benign, in situ, uncertain or unknown]. Thus, institutions interested in determining the location and morphology of tumors (such as cancer registries, oncology
hospitals, pathology departments and other services specializing in the field of oncology), the ICD-O should be used.

MALIGNANT NEOPLASMS (C00-C97)

MALIGNANT NEOPLOGMS OF THE LIP, ORAL CAVITY AND PHYNARY (C00-C14)

C00 Malignant neoplasm of the lip

Excludes: lip skin (C43.0, C44.0)

C00.0 Outer surface of the lip
Upper lip:
. NOS
. lip surface
. red border
C00.1 Outer surface of the lower lip
Lower lip:
. NOS
. lip surface
. red border
C00.2 The outer surface of the lip is unspecified. Red border NOS
C00.3 Inner surface of the upper lip
Upper lip:
. buccal surface
. bridles
. mucous membrane
. oral surface
C00.4 Inner surface of the lower lip
Lower lip:
. buccal surface
. bridles
. mucous membrane
. oral surface
C00.5 The inner surface of the lip is unspecified.
Lips without specifying upper or lower:
. buccal surface
. bridles
. mucous membrane
. oral surface
C00.6 Lip adhesions
C00.8 Lesion extending beyond one or more of the above lip localizations
C00.9 Lips of unspecified part

C01 Malignant neoplasms of the base of the tongue

The upper surface of the base of the tongue. Fixed part of the tongue NOS. Posterior third of tongue

C02 Malignant neoplasm of other and unspecified parts of the tongue

C02.0 The back of the tongue. Anterior 2/3 of the dorsum of the tongue.
Excluded: upper surface of base of tongue (C01)
C02.1 Lateral surface of the tongue. tip of tongue
C02.2 The lower surface of the tongue. The anterior 2/3 of the lower surface of the tongue. Tongue frenulum
C02.3 Anterior 2/3 of the tongue, unspecified part. Middle part of the tongue NOS. Movable part of tongue NOS
C02.4 Lingual tonsil
Excludes: tonsils NOS (C09.9)
C02.8 Damage to the tongue that extends beyond one or more of the above localizations.
Malignant neoplasm of the tongue, which, according to the place of origin, cannot be attributed to any of the categories
Rick S01-S02.4
C02.9 Unspecified language

C03 Malignant neoplasm of the gums

Includes: mucous membrane of the alveolar surface (ridge) of the gingiva
Excludes: malignant odontogenic neoplasms (C41.0-C41.1)

C03.0 Gums upper jaw
C03.1 Gums of the lower jaw
C03.9 Gums unspecified

C04 Malignant neoplasm of the floor of the mouth

C04.0 The anterior part of the floor of the mouth. Anterior part to the canine-premolar contact point
C04.1 Lateral part of the floor of the mouth
C04.8 Damage to the floor of the mouth that extends beyond one or more of the above locations.
C04.9 Floor of the mouth, unspecified

C05 Malignant neoplasm of the palate

C05.0 Hard palate
C05.1 Soft palate
Excludes: nasopharyngeal surface of the soft palate (C11.3)
C05.2 Tongue
C05.8 Lesions of the palate that extend beyond one or more of the above locations.
C05.9 Sky unspecified. Oral vault

C06 Malignant neoplasm of other and unspecified parts of the mouth

C06.0 Buccal mucosa. Buccal mucosa NOS. Inner surface of the cheek
C06.1 Vestibule of the mouth. Buccal groove (upper, lower). Labial sulcus (upper, lower)
C06.2 Retromolar region
C06.8 Damage to the mouth that extends beyond one or more of the above locations.
C06.9 Mouth, unspecified. Minor salivary gland, unspecified location. Oral cavity NOS

C07 Malignant neoplasm of the parotid salivary gland

C08 Malignant neoplasm of other and unspecified major salivary glands

Excluded: malignant neoplasms of specified minor salivary glands, which are classified according to
depending on their anatomical location, malignant neoplasms of the minor salivary glands NOS (C06.9)
parotid salivary gland (C07)

C08.0 Submandibular gland. Submaxillary gland
C08.1 Sublingual gland
C08.8 Damage to the major salivary glands, extending beyond one or more of the above localizations.
Malignant neoplasm of the major salivary glands, which cannot be attributed to the site of origin
to none of the headings C07-C08.1
C08.9 Large salivary gland, unspecified. Salivary glands (major) NOS

C09 Malignant neoplasm of tonsil

Excludes: lingual tonsil (C02.4)
pharyngeal tonsil (C11.1)

C09.0 Tonsil dimple
C09.1 Arches of the palatine tonsil (anterior) (posterior)
C09.8 Damage to the amygdala that extends beyond one or more of the above locations.
C09.9 Tonsils, unspecified
Tonsils:
. NOS
. pharynx
. palatal

C10 Malignant neoplasm of the oropharynx

Excludes: tonsils (C09. -)

C10.0 Epiglottis pits
C10.1 Anterior surface of the epiglottis. Epiglottis, free border (edge). Glossoepiglottic fold(s).
Excludes: epiglottis (the area above the hyoid bone) NOS (C32.1)
C10.2 Lateral wall of the oropharynx
C10.3 Posterior wall of the oropharynx
C10.4 Gill slits. Gill cysts [localization of neoplasm]
C10.8 Damage to the oropharynx that extends beyond one or more of the above locations.
Border zone of the oropharynx
C10.9 Oropharynx, unspecified

C11 Malignant neoplasm of the nasopharynx

C11.0 The upper wall of the nasopharynx. Fornix of the nasopharynx
C11.1 Posterior wall of the nasopharynx. Adenoid tissue. Pharyngeal tonsil
C11.2 Lateral wall of the nasopharynx. Rosenmüller's fossae. Holes auditory tube. Pharyngeal pocket
C11.3 The anterior wall of the nasopharynx. The bottom of the nasopharynx. Nasopharyngeal (anterior) (posterior) surface of the soft palate.
Posterior edge of nasals:
. joan
. partitions
C11.8 Lesions of the nasopharynx that extend beyond one or more of the above localizations.
C11.9 Nasopharynx, unspecified. Walls of the nasopharynx NOS

C12 Malignant neoplasm of the piriform sinus. Pyriform fossa

C13 Malignant neoplasm of the lower pharynx

Excludes: pyriform sinus (C12)

C13.0 Postcricoid region
C13.1 The aryepiglottic fold of the lower part of the pharynx.
aryepiglottic fold:
. NOS
. edge zone
Excludes: aryepiglottic fold of the laryngeal part (C32.1)
C13.2 Posterior wall of the lower part of the pharynx
C13.8 Damage to the lower part of the pharynx, extending beyond one or more of the above localizations.
C13.9 Lower part of the pharynx, unspecified. Walls of the lower part of the pharynx NOS

C14 Malignant neoplasm of other and ill-defined locations of the lip, oral cavity and pharynx

Excludes: oral cavity NOS (C06.9)

C14.0 Throats unspecified
C14.1 Laryngopharynx
C14.2 Pharyngeal ring Waldeyer
C14.8 Damage to the lip, oral cavity and pharynx, extending beyond one or more of the above localizations.
Malignant neoplasm of the lip, oral cavity and pharynx, which, according to the place of origin, cannot be classified in any of the categories C00-C14.2

MALIGNANT NEW TUMORS OF THE DIGESTIVE ORGANS (C15-C26)

C15 Malignant neoplasm of the esophagus

Note. Two alternative subclassifications are proposed:
.0-.2 according to anatomical description
.3-.5 by thirds of the organ
This deviation from the principle that the rubrics should be mutually exclusive is intentional, since both terminological forms are used, but the anatomical regions identified are not similar.

C15.0 Cervical esophagus
C15.1 Thoracic esophagus
C15.2 Abdominal esophagus
C15.3 Upper third of the esophagus
C15.4 Middle third of the esophagus
C15.5 Lower third of the esophagus
C15.8 Damage to the esophagus that extends beyond one or more of the above locations.
C15.9 Esophagus, unspecified

C16 Malignant neoplasm of the stomach

C16.0 Cardia. Cardiac orifice. Cardioesophageal junction. Gastroesophageal junction. Esophagus and stomach
C16.1 Fundus of the stomach
C16.2 Body of the stomach
C16.3 Vestibule of the gatekeeper. Vestibule of the stomach
C16.4 Gatekeeper. Gatekeeper. Gatekeeper channel
C16.5 Lesser curvature of the stomach, unspecified part. Lesser curvature of the stomach, not classified
rikah C16.1-C16.4
C16.6 Greater curvature of the stomach, unspecified part. Greater curvature of the stomach, not classified
rikah C16.0-16.4
C16.8 Damage to the stomach that extends beyond one or more of the above localizations
C16.9 Stomach of unspecified localization. Gastric carcinoma NOS

C17 Malignant neoplasm of the small intestine

C17.0 Duodenum
C17.1 Jejunum
C17.2 Ileum.
Excludes: ileocecal valve (C18.0)
C17.3 Meckel's diverticulum
C17.8 Damage to the small intestine that extends beyond one or more of the above localizations.
C17.9 Small intestine of unspecified location

C18 Malignant neoplasm of colon

C18.0
C18.1 Appendix
C18.2 Rising colon
C18.3 Hepatic flexure
C18.4 Transverse colon
C18.5 Splenic flexure
C18.6 Descending colon
C18.7 Sigmoid colon. Sigmoid (bending).
Excludes: rectosigmoid junction (C19)
C18.8 Damage to the colon that extends beyond one or more of the above locations.
C18.9 Colon of unspecified location. Colon NOS

C19 Malignant neoplasm of the rectosigmoid junction.

Colon and rectum. Rectosigmoid (colon)

C20 Malignant neoplasm of the rectum. Rectal ampoules

C21 Malignant neoplasm of the anus [anus] and anal canal

C21.0 Anus, unspecified location
Excluded: anal region:
. edges (C43.5, C44.5)
. skin (C43.5, C44.5)
skin of the perianal area (C43.5, C44.5)
C21.1 Anal canal. Anal sphincter
C21.2 Cloacogenic zone
C21.8 Involvement of the rectum, anus [anus] and anal canal, extending beyond one or more
the above localizations. Anorectal connection. Anorectal area.
A malignant neoplasm of the rectum, anus [anus], and anal canal that is
occurrence cannot be attributed to any of the categories C20-C21.2

C22 Malignant neoplasm of the liver and intrahepatic bile ducts

Excludes: biliary tract NOS (C24.9)
secondary malignant neoplasm of the liver (C78.7)

C22.0 Hepatic cell carcinoma. Hepatocellular cancer. Hepatoma
C22.1 Cancer of the intrahepatic bile duct. Cholangiocarcinoma
C22.2 Hepatoblastoma
C22.3 Angiosarcoma of the liver. Kupffer cell sarcoma
C22.4 Other liver sarcomas
C22.7 Other specified liver cancers
C22.9 Malignant neoplasm of the liver, unspecified

C23 Malignant neoplasm of the gallbladder

C24 Malignant neoplasm of other and unspecified parts

biliary tract

Excludes: intrahepatic bile duct (C22.1)

C24.0 Extrahepatic bile duct. Bile duct or passage NOS. Common bile duct.
Cystic duct. Hepatic duct
C24.1 Ampulla of Vater's papilla
C24.8 Damage to the bile ducts that extends beyond one or more of the above localizations.
A malignant neoplasm involving the intrahepatic and extrahepatic bile ducts.
Malignant neoplasm of the biliary tract, which, based on the place of origin, cannot be attributed to any one
from categories C22.0-C24.1
C24.9 Biliary tract, unspecified

C25 Malignant neoplasm of the pancreas

C25.0 Heads of the pancreas
C25.1 Pancreatic bodies
C25.2 Tail of the pancreas
C25.3 Pancreatic duct
C25.4 Pancreatic islet cells. Islets of Langerhans
C25.7 Other parts of the pancreas. Neck of the pancreas
C25.8 Damage to the pancreas that extends beyond one or more of the above localizations.
C25.9 Pancreas, unspecified

C26 Malignant neoplasm of other and ill-defined digestive organs

Excludes: peritoneum and retroperitoneal space (C48. -)

C26.0 Intestinal tract, unspecified part. Intestine NOS
C26.1 Spleens
Excludes: Hodgkin's disease (C81. -)
non-Hodgkin's lymphoma (C82-C85)
C26.8 Damage to the digestive organs that extends beyond one or more of the above localizations.
Malignant neoplasm of the digestive organs, which cannot be attributed to the place of origin
to one of the headings C15-C26.1
Excludes: cardioesophageal junction (C16.0)
C26.9 Ill-defined locations within the digestive system.
Alimentary canal or tract NOS. Gastrointestinal tract NOS

MALIGNANT NEOPLOGMS OF THE RESPIRATORY ORGANS

AND CHEST (C30-C39)

Included: middle ear
Excludes: mesothelioma (C45.-)

C30 Malignant neoplasm of the nasal cavity and middle ear

C30.0 Nasal cavities. Nose cartilage. Nasal turbinates. The inside of the nose. Nasal septum. The vestibule of the nose.
Excludes: nasal bones (C41.0)
nose NOS (C76.0)
olfactory bulb (C72.2)
posterior edge of the nasal septum and choanae (C11.3)
nasal skin (C43.3, C44.3)
C30.1 Middle ear. Eustachian tube. Inner ear. Cells of the mastoid process.
Excludes: auditory canal (external) (C43.2, C44.2)
ear bones (passage) (C41.0)
ear cartilage (C49.0)
skin (outer) ear (C43.2, C44.2)

C31 Malignant neoplasm of the paranasal sinuses

C31.0 Maxillary sinus. Sinus (maxillary) (maxillary)
C31.1 Ethmoid sinus
C31.2 Frontal sinus
C31.3 Sphenoid sinus
C31.8 Damage to the paranasal sinuses that extends beyond one or more of the above localizations.
C31.9 Paranasal sinus, unspecified

C32 Malignant neoplasm of the larynx

C32.0 The actual voice apparatus. Actually the larynx. Vocal fold (true) NOS
C 32.1 Above the vocal apparatus itself. The aryepiglottic fold of the laryngeal part.
Epiglottis (part above the hyoid bone) NOS. Extralaryngeal part. False vocal folds.
Posterior (laryngeal) surface of the epiglottis. Ventricular fold of the larynx.
Excludes: anterior surface of the epiglottis (C10.1)
aryepiglottic fold:
. NOS (C13.1)
. lower pharyngeal part (C13.1)
. marginal zone (C13.1)
C32.2 Under the vocal apparatus itself
C32.3 Laryngeal cartilage
C32.8 Damage to the larynx that extends beyond one or more of the above localizations.
C32.9 Larynx, unspecified

C33 Malignant neoplasm of the trachea

C34 Malignant neoplasm of bronchus and lung

C34.0 Main bronchi. Carina trachea. Root lung
C34.1 Upper lobe, bronchi or lung
C34.2 Middle lobe, bronchi or lung
C34.3 Lower lobe, bronchi or lung
C34.8 Damage to the bronchi or lung, extending beyond one or more of the above localizations.
C34.9 Bronchi or lung, unspecified location

C37 Malignant neoplasm of the thymus

C38 Malignant neoplasm of the heart, mediastinum and pleura

Excludes: mesothelioma (C45.-)

C38.0 Hearts. Pericardium.
Excludes: large vessels (C49.3)
C38.1 Anterior mediastinum
C38.2 Posterior mediastinum
C38.3 Mediastinum unspecified part
C38.4 Pleura
C38.8 Damage to the heart, mediastinum and pleura, extending beyond one or more of the above localizations.

C39 Malignant neoplasm of other and ill-defined

localizations of the respiratory and intrathoracic organs

Excludes: intrathoracic NOS (C76.1)
chest NOS (C76.1)

C39.0 Upper respiratory tract unspecified part
C39.8 Damage to the respiratory and intrathoracic organs, extending beyond one or more of the above localizations. Malignant neoplasm of the respiratory organs and intrathoracic organs, which, according to the place of origin, cannot be classified in any of the categories C30-C39.0
C39.9 Ill-defined locations within the respiratory system. Respiratory tract NOS

MALIGNANT NEW FORMATIONS OF BONES AND ARTICULAR CARTILAGE (C40-C41)

Excluded: bone marrow NOS (C96.7)
synovial membrane(C49. -)

C40 Malignant neoplasm of bones and articular cartilage of the extremities

C40.0
C40.1
C40.2
C40.3
C40.8 Damage to the bones and articular cartilages of the extremities, extending beyond one or more of the above localizations.
C40.9 Bones and articular cartilages of an extremity of unspecified localization

C41 Malignant neoplasm of bones and articular cartilage of other and unspecified sites

Excludes: limb bones (C40.-)
cartilage:
. ear (C49.0)
. larynx (C32.3)
. limbs (C40. -)
. nose (C30.0)

C41.0
odontogenic:
. maxillary sinus(C31.0)
. maxilla (C03.0)
jaw (lower) bone part (C41.1)
C41.1 Lower jaw. Lower jaw bone part.
Excluded: carcinoma of any type other than intraosseous or
odontogenic:
. jaws NOS (C03.9)
. bottom (C03.1)
upper jaw bone part (C41.0)
C41.2 Spinal column.
Excludes: sacrum and coccyx (C41.4)
C41.3 Ribs, sternum and collarbone
C41.4 Bones of the pelvis, sacrum and coccyx
C41.8 Damage to bones and articular cartilage that extends beyond one or more of the above locations.
Malignant neoplasm of bones and articular cartilage, which cannot be attributed to the place of origin
to one of the headings C40-C41.4
C41.9 Bone and articular cartilage, unspecified

MELANOMA AND OTHER SKIN MALIGNANTS (C43-C44)

C43 Malignant melanoma of the skin

Included: morphological codes M872-M879 with character of the neoplasm code /3
Excludes: malignant melanoma of the skin of the genital organs (C51-C52, C60. -, C63. -)

C43.0 Malignant melanoma of the lip.
Excludes: vermilion border of the lip (C00.0-C00.2)
C43.1 Malignant melanoma of the eyelid, including eyelid adhesion
C43.2 Malignant melanoma of the ear and external auditory canal
C43.3 Malignant melanoma of other and unspecified parts of the face
C43.4 Malignant melanoma of the scalp and neck
C43.5 Malignant melanoma of the trunk.
Anal region:
. the edges
. skin
Excludes: anus [anus] NOS (C21.0)
C43.6 Malignant melanoma of the upper extremity, including the shoulder area
C43.7 Malignant melanoma of the lower extremity, including the hip area
C43.8 Malignant melanoma of the skin, extending beyond one or more of the above localizations.
C43.9 Malignant melanoma of the skin, unspecified. Melanoma (malignant) NOS

C44 Other malignant neoplasms of the skin

Includes: malignant neoplasms:
. sebaceous glands
. sweat glands
Excludes: Kaposi's sarcoma (C46. -)
malignant melanoma of the skin (C43. -)
skin of the genital organs (C51-C52, C60. -, C63. -)

C44.0 Lip skin. Basal cell carcinoma lips.
Excludes: malignant neoplasms of the lip (C00. -)
C44.1 Skin of the eyelid, including the commissure of the eyelids.
C44.2 .
Excluded: connective tissue ear (C49.0)
C44.3
C44.4
C44.5 Skin of the body.
Anal region:
. the edges
. skin
Skin of the perianal area. Skin of the breast.
Excludes: anus [anus] NOS (C21.0)
C44.6
C44.7
C44.8 Skin lesions that extend beyond one or more of the above localizations.
C44.9 Malignant neoplasms of the skin, unspecified area

MALIGNANT NEOPLOGMS OF MESOTHELIAL AND SOFT TISSUE (C45-C49)

C45 Mesothelioma

Included: morphological code M905 with neoplasm character code /3

C45.0 Pleural mesothelioma.
Excludes: other pleural malignancies (C38.4)
C45.1 Peritoneal mesothelioma. Mesenteries. Mesenteries of the colon. Oil seal. Peritoneum (parietal, pelvic).
Excludes: other peritoneal malignancies (C48. -)
C45.2 Pericardial mesothelioma.
Excludes: other pericardial malignancies (C38.0)
C45.7 Mesothelioma of other locations
C45.9 Mesothelioma, unspecified

C46 Kaposi's Sarcoma

Included: morphological code M9140 with neoplasm character code
vocation /3

C46.0 Kaposi's sarcoma of the skin
C46.1 Kaposi's sarcoma of soft tissue
C46.2 Kaposi's sarcoma of the palate
C46.3 Kaposi's sarcoma of lymph nodes
C46.7 Kaposi's sarcoma of other localizations
C46.8 Kaposi's sarcoma of multiple organs
C46.9 Kaposi's sarcoma of unspecified location

C47 Malignant neoplasm of peripheral nerves and autonomic nervous system

Includes: sympathetic and parasympathetic nerves and ganglia

C47.0Peripheral nerves head, face and neck.
Excludes: peripheral nerves of the orbit (C69.6)
C47.1 Peripheral nerves of the upper limb, including the shoulder girdle area
C47.2 Peripheral nerves of the lower limb, including the hip area
C47.3 Peripheral nerves of the chest
C47.4 Peripheral nerves of the abdomen
C47.5 Peripheral nerves of the pelvis
C47.6 Peripheral nerves of the trunk, unspecified
C47.8 Damage to peripheral nerves and the autonomic nervous system, extending beyond one or more of the above localizations.
C47.9 Peripheral nerves and autonomic nervous system of unspecified localization

C48 Malignant neoplasm of the retroperitoneum and peritoneum

Excludes: Kaposi's sarcoma (C46.1)
mesothelioma (C45. -)

C48.0 Retroperitoneal space
C48.1 Specified parts of the peritoneum. Mesenteries.
Mesenteries of the transverse colon. Oil seal. Peritoneum:
. parietal
. pelvic
C48.2 Peritoneum of unspecified part
C48.8 Damage to the retroperitoneal space and peritoneum, extending beyond one or more of the above localizations.

C49 Malignant neoplasm of other types of connective and soft tissues

Included: blood vessel
joint capsule
cartilage
fascia
adipose tissue
ligaments other than the uterine ligament
lymphatic vessel
muscles
synovyl membrane
Excluded: cartilage:
. articular (C40-C41)
. larynx (C32.3)
. nose (C30.0)
connective tissue of the mammary gland (C50. -)
Kaposi's sarcoma (C46. -)
mesothelioma (C45. -)
peritoneum (C48. -)
retroperitoneum (C48.0)

C49.0 Connective and soft tissues of the head, face and neck.
Connective tissue:
. ear
. century
Excludes: connective tissue of the orbit (C69.6)
C49.1 Connective and soft tissues of the upper limb, including the shoulder girdle area
C49.2 Connective and soft tissues of the lower limb, including the hip area
C49.3 Connective and soft tissues of the chest. Armpit. Diaphragms. Large vessels.
Excludes: breast (C50. -)
hearts (C38.0)
mediastinum (C38.1-C38.3)
C49.4 Connective and soft tissues of the abdomen. Abdominal wall. Subcostal areas
C49.5 Connective and soft tissues of the pelvis. Buttocks. Groin area. Crotch
C49.6 Connective and soft tissues of the body of unspecified localization. Backs NOS
C49.8 Damage to connective and soft tissues that extends beyond one or more of the above localizations.
Malignant neoplasm of connective and soft tissues, which cannot be located at the site of origin
classified in none of the categories C47-C49.6
C49.9 Connective and soft tissues of unspecified localization

MALIGNANT NEOPOLOGY OF THE BREAST (C50)

C50 Malignant neoplasm of the breast

Included: connective tissue and mammary gland
Excludes: breast skin (C43.5, C44.5)

C50.0 Nipple and areola
C50.1 Central part of the mammary gland
C50.2 Upper inner quadrant of the mammary gland
C50.3 Lower inner quadrant of the mammary gland
C50.4 Upper outer quadrant of the breast
C50.5 Lower outer quadrant of the breast
C50.6 Axillary posterior part of the breast
C50.8 Damage to the mammary gland that extends beyond one or more of the above localizations
C50.9 Mammary gland, unspecified part

MALIGNANT NEOPLASMS OF THE FEMALE GENITAL ORGANS (C51-C58)

Includes: skin of female genital organs

C51 Malignant neoplasm of the vulva

C51.0 Large pudendal lips. Bartholin's gland (large gland of the vestibule of the vagina)
C51.1 Labia minora
C51.2 Clitoris
C51.8 Lesion of the vulva extending beyond one or more of the above localizations.
C51.9 Vulva, unspecified part. External female genitalia NOS. Pudendal area

C52 Malignant neoplasm of the vagina

C53 Malignant neoplasm of the cervix

C53.0 Interior
C53.1 Outer part
C53.8 Damage to the cervix that extends beyond one or more of the above locations.
C53.9

C54 Malignant neoplasm of the uterine body

C54.0 Isthmus of the uterus. Lower uterine segment
C54.1 Endometrium
C54.2 Myometrium
C54.3 Fundus of the uterus
C54.8 Damage to the body of the uterus that extends beyond one or more of the above localizations.
C54.9 Uterine bodies of unspecified location

C55 Malignant neoplasm of the uterus, unspecified location

C56 Malignant neoplasm of the ovary

C57 Malignant neoplasm of other and unspecified female genital organs

C57.0 Fallopian tube. Oviduct. Fallopian tube
C57.1 Broad ligament
C57.2 Round ligament
C57.3 Parametria. Uterine ligaments NOS
C57.4 Unspecified uterine appendages
C57.7 Other specified female genital organs. Wolffian body or duct
C57.8 Damage to the female genital organs that extends beyond one or more of the above localizations.
Malignant neoplasm of the female genital organs, which cannot be attributed to the place of origin
to none of the headings C51-C57.7, C58. Tubal-ovarian. Utero-ovarian
C57.9 Female genital organs of unspecified localization. Genitourinary tract in women NOS

C58 Malignant neoplasm of the placenta. Chorionic carcinoma NOS. Chorionepithelioma NOS

Excludes: chorionadenoma (destroying) (D39.2)
hydatidiform mole:
. NOS (O01.9)
. invasive (D39.2)
. malignant (D39.2)

MALIGNANT NEOPLASMS OF THE MALE GENITAL ORGANS (C60-C63)

Includes: skin of male genitalia

C60 Malignant neoplasm of the penis

C60.0 Foreskin. Preputium
C60.1 Heads of the penis
C60.2 Body of the penis. Corpus cavernosum
C60.8 Lesion of the penis that extends beyond one or more of the above locations.
C60.9 Penis of unspecified location. Penile skin NOS

C61 Malignant neoplasm of the prostate gland

C62 Testicular malignancy

C62.0 Undescended testicle. Ectopic testicle [localization of neoplasm].
Retained testicle [localization of neoplasm]
C62.1 Descended testicle. Testicle located in the scrotum
C62.9 Testicles, unspecified

C63 Malignant neoplasm of other and unspecified male genital organs

C63.0 Epididymis
C63.1 Spermatic cord
C63.2 Scrotums. Skin of the scrotum
C63.7 Other specified male genital organs. Seminal vesicles. Tunica vaginalis testis
C63.8 Damage to the male genital organs that extends beyond one or more of the above localizations.
Malignant neoplasm of the fly genital organs, which cannot be attributed to the place of origin
to none of the headings C60-C63.7
C63.9 Male genital organs of unspecified localization. Genitourinary tract in men NOS

MALIGNANT NEOPLASMS OF THE URINARY TRACT (C64-C68)

C64 Malignant neoplasm of the kidney, other than the renal pelvis

Excluded: renal:
. cups (C65)
. pelvis (C65)

C65 Malignant neoplasm of the renal pelvis

Pelvic-ureteric junction. Kidney cups

C66 Malignant neoplasm of the ureter

Excludes: ureteral orifice of the bladder (C67.6)

C67 Malignant neoplasm of the bladder

C67.0 Bladder triangle
C67.1 Bladder domes
C67.2 Lateral wall of the bladder
C67.3 Anterior wall of the bladder
C67.4 Posterior wall of the bladder
C67.5 Bladder necks. Internal urethral opening
C67.6 Ureteral orifice
C67.7 Primary urinary duct (urachus)
C67.8 Damage to the bladder that extends beyond one or more of the above locations.
C67.9 Bladder, unspecified part

C68 Malignant neoplasm of other and unspecified urinary organs

Excludes: genitourinary tract NOS:
. in women (C57.9)
. in men (C63.9)

C68.0 Urethra.
Excludes: urethral opening of the bladder (C67.5)
C68.1 Paraurethral glands
C68.8 Damage to the urinary organs that extends beyond one or more of the above localizations.
Malignant neoplasm of the urinary organs, which, according to the place of origin, cannot be classified in any of the categories C64-C68.1
C68.9 Urinary organs, unspecified. Urinary system NOS

MALIGNANT NEW TUMORS OF THE EYE AND BRAIN

AND OTHER DEPARTMENTS OF THE CENTRAL NERVOUS SYSTEM (C69-C72)

C69 Malignant neoplasm of the eye and its adnexa

Excludes: connective tissue of the eyelid (C49.0)
eyelid (skin) (C43.1, C44.1)
optic nerve(C72.3)

C69.0 Conjunctiva
C69.1 Corneas
C69.2 Retina
C69.3 Choroid
C69.4 Ciliary [ciliary] body. Eyeball
C69.5 Lacrimal gland and duct. Lacrimal sac. Lacrimal duct
C69.6 Eye sockets. Connective tissue of the orbit. External ocular muscle. Peripheral nerves of the orbit.
Retrobulbar tissue. Retroocular tissue.
Excludes: orbital bones (C41.0)
C69.8 Damage to the eye and its adnexa, extending beyond one or more of the above localizations.
C69.9 Eyes of unspecified part

C70 Malignant neoplasm of meninges

C70.0 Meninges
C70.1 Sheaths of the spinal cord
C70.9

C71 Malignant neoplasm of the brain

Excludes: cranial nerves (C72.2-C72.5)
retrobulbar tissue (C69.6)

C71.0 Big brain, except for the lobes and ventricles. Corpus callosum. Above the tentorium NOS
C71.1 Frontal lobe
C71.2 Temporal lobe
C71.3 Parietal lobe
C71.4 Occipital lobe
C71.5 Ventricle of the brain.
Excludes: fourth ventricle (C71.7)
C71.6 Cerebellum
C71.7 Brainstem. Fourth ventricle. Under the tentorium NOS.
C71.8 A lesion extending beyond one or more of the above brain locations.
C71.9 Brain of unspecified location

C72 Malignant neoplasm of the spinal cord, cranial nerves

and other parts of the central nervous system

Excludes: meninges (C70.-)
peripheral nerves and autonomic nervous system (C47. -)

C72.0 Spinal cord
C72.1 Horse tail
C72.2 Olfactory nerve. Olfactory bulb
C72.3 Optic nerve
C72.4 Auditory nerve
C72.5 Other and unspecified cranial nerves. Cranial nerve NOS.
C72.8 Damage to the spinal cord and other parts of the central nervous system, extending beyond one or more
the above localizations.
Malignant neoplasm of the spinal cord and other parts of the central nervous system, which
occurrence cannot be attributed to any of the categories C70-C72.5
C72.9 Central nervous system, unspecified part. Nervous system NOS

MALIGNANT NEOPLASIS OF THE THYROID GLAND

AND OTHER ENDOCRINE GLANDS (C73-C75)

C73 Malignant neoplasm of the thyroid gland

C74 Malignant neoplasm of the adrenal gland

C74.0 Adrenal cortex
C74.1 Adrenal medulla
C74.9 Adrenal gland, unspecified part

C75 Malignant neoplasm of other endocrine glands and related structures

Excludes: adrenal gland (C74. -)
pancreatic islet cells (C25.4)
ovary (C56)
testicles (C62. -)
thymus gland [thymus] (C37)
thyroid gland (C73)

C75.0
C75.1 Pituitary gland
C75.2 Craniopharyngeal duct
C75.3 Pineal gland
C75.4 Carotid glomus
C75.5
C75.8 Involvement of more than one endocrine gland, unspecified
Note: If the locations of multiple lesions are known, they should be coded separately.
C75.9

IMPRESSIVELY DESIGNATED MALIGNANT NEOPLOGMS,

SECONDARY AND UNSPECIFIED LOCATIONS (C76-C80)

C76 Malignant neoplasm of other and ill-defined sites

Excluded: malignant neoplasm:
. genitourinary tract NOS:
. in women (C57.9)
. in men (C63.9)
. lymphoid, hematopoietic and related tissues (C81-C96)
. unspecified location (C80)

C76.0 Heads, faces and necks. Cheeks NOS. Nose NOS
C76.1 Chest. Armpit NOS. Intrathoracic NOS. Chest NOS
C76.2 Belly
C76.3 Taza. Groin NOS.
Locations that extend beyond the system within the pelvis, such as:
. rectovaginal (septum)
. rectovesical (septum)
C76.4 Upper limb
C76.5 Lower limb
C76.7 Other unspecified locations
C76.8 Involvement of other and ill-defined localizations, extending beyond one or more of the above localizations.

C77 Secondary and unspecified malignant neoplasm of lymph nodes

Excluded: malignant neoplasms of lymph nodes, specified as primary (C81-C88, C96. -)

C77.0 Lymph nodes of the head, face and neck. Supraclavicular lymph nodes
C77.1 Intrathoracic lymph nodes
C77.2 Intra-abdominal lymph nodes
C77.3 Lymph nodes of the armpit and upper limb. Thoracic lymph nodes
C77.4 Lymph nodes groin area and lower limb
C77.5 Intrapelvic lymph nodes
C77.8 Lymph nodes of multiple locations
C77.9 Lymph nodes of unspecified localization

C78 Secondary malignant neoplasm of the respiratory and digestive organs

C78.0 Secondary malignant neoplasm of the lung
C78.1 Secondary malignant neoplasm of the mediastinum
C78.2 Secondary malignant neoplasm of the pleura
C78.3 Secondary malignancy of other and unspecified respiratory organs
C78.4 Secondary malignant neoplasm of the small intestine
C78.5 Secondary malignant neoplasm of the colon and rectum
C78.6 Secondary malignant neoplasm of the retroperitoneum and peritoneum. Malignant ascites NOS
C78.7 Secondary malignant neoplasm of the liver
C78.8 Secondary malignancy of other and unspecified digestive organs

C79 Secondary malignant neoplasm of other sites

C79.0 Secondary malignant neoplasm of the kidney and renal pelvis
C79.1 Secondary malignant neoplasm of the bladder, other and unspecified urinary organs
C79.2 Secondary malignant neoplasm of the skin
C79.3 Secondary malignant neoplasm of the brain and meninges
C79.4 Secondary malignant neoplasm of other and unspecified parts of the nervous system
C79.5 Secondary malignant neoplasm of bones and bone marrow
C79.6 Secondary ovarian malignancy
C79.7 Secondary malignant neoplasm of the adrenal gland
C79.8 Secondary malignant neoplasm of other specified locations

C80 Malignant neoplasm without specification of localization

Cancer )
Carcinoma)
Carcinomatosis) unspecified
Generalized: ) localization
. cancer) (primary)
. malignant neoplasm) (secondary)
Malignant neoplasm)
Multiple cancer)
Malignant cachexia
Primary location unknown

MALIGNANT NEW TUMORS OF LYMPHOID,

HEMATOPOIETIC AND RELATED TISSUE (C81-C96)

Note: The terms used in C82-C85 for non-Hodgkin's lymphoma represent a working classification that attempts to find a common basis for several major classification schemes. The terms used in these schemes are not given in the main list of headings, but are presented in the Alphabetical Index; full identification with the terms of the main list is not always possible.
Included: morphological codes M959-M994 with character of the neoplasm code /3
Excludes: secondary and unspecified neoplasms of lymph nodes (C77. -)

C81 Hodgkin's disease [lymphogranulomatosis]

Included: morphological codes M965-M966 with neoplasm character code /3

C81.0 Lymphoid predominance. Lymphohistiocytic predominance
C81.1 Nodular sclerosis
C81.2 Mixed cell variant
C81.3 Lymphoid depletion
C81.7 Other forms of Hodgkin's disease
C81.9 Hodgkin's disease, unspecified

C82 Follicular [nodular] non-Hodgkin's lymphoma

Includes: follicular non-Hodgkin's lymphoma with diffuse areas or without them morphological code M969 with the character of the neoplasm code /3

C82.0 Small cell with split nuclei, follicular
C82.1 Mixed, small cell with split nuclei and large cell, follicular
C82.2 Large cell, follicular
C82.7 Other types of follicular non-Hodgkin lymphoma
C82.9 Follicular non-Hodgkin's lymphoma, unspecified. Nodular non-Hodgkin's lymphoma NOS

C83 Diffuse non-Hodgkin's lymphoma

Included: morphological codes M9593, M9595, M967-M968 with tumor character code /3

C83.0 Small cell (diffuse)
C83.1 Small cell with split nuclei (diffuse)
C83.2 Mixed small and large cell (diffuse)
C83.3 Large cell (diffuse). Reticulosarcoma
C83.4 Immunoblastic (diffuse)
C83.5 Lymphoblastic (diffuse)
C83.6 Undifferentiated (diffuse)
C83.7 Burkitt's tumor
C83.8 Other types of diffuse non-Hodgkin's lymphomas
C83.9 Diffuse non-Hodgkin's lymphoma, unspecified

C84 Peripheral and cutaneous T-cell lymphomas

Included: morphological code M970 with character of the neoplasm code /3

C84.0 Mycosis fungoides
C84.1 Sezary's disease
C84.2 T-zone lymphoma
C84.3 Lymphoepithelioid lymphoma. Lennert's lymphoma
C84.4 Peripheral T-cell lymphoma
C84.5 Other and unspecified T-cell lymphomas
Note: If T-cell origin or involvement is mentioned in connection with a specific lymphoma, code for a more specific description.

C85 Other and unspecified types of non-Hodgkin's lymphoma

Included: morphological codes M9590-M9592, M9594, M971 with tumor character code /3

C85.0 Lymphosarcoma
C85.1 B-cell lymphoma, unspecified
Note: If B-cell origin or involvement is mentioned in connection with a specific lymphoma, code for a more specific description.
C85.7 Other specified types of non-Hodgkin's lymphoma.
Malignant:
. reticuloendotheliosis
. reticulosis
Microglioma
C85.9 Non-Hodgkin's lymphoma unspecified type. Lymphoma NOS. Malignant lymphoma NOS. Non-Hodgkin's lymphoma NOS

C88 Malignant immunoproliferative diseases

Included: morphological code M976 with character of the neoplasm code /3

C88.0 Waldenström's macroglobulinemia
C88.1 Alpha heavy chain disease
C88.2 Gamma heavy chain disease. Franklin's disease
C88.3 Immunoproliferative disease of the small intestine. Mediterranean lymphoma
C88.7 Other malignant immunoproliferative diseases
C88.9 Malignant immunoproliferative diseases, unspecified. Immunoproliferative disease NOS

C90 Multiple myeloma and malignant plasma cell neoplasms

Included: morphological codes M973, M9830 with tumor character code /3

C90.0 Multiple myeloma. Kahler's disease. Myelomatosis.
Excludes: solitary myeloma (C90.2)
C90.1 Plasma cell leukemia
C90.2 Extramedullary plasmacytoma. Malignant plasma cell tumor NOS.
Plasmacytoma NOS. Solitary myeloma

C91 Lymphoid leukemia [lymphocytic leukemia]

Included: morphological codes M982, M9940-M9941 with tumor character code /3

C91.0 Acute lymphoblastic leukemia.
Excludes: exacerbation of chronic lymphocytic leukemia (C91.1)
C91.1 Chronic lymphocytic leukemia
C91.2 Subacute lymphocytic leukemia
C91.3 Prolymphocytic leukemia
C91.4 Hairy cell leukemia. Leukemic reticuloendotheliosis
C91.5 Adult T-cell leukemia
C91.7 Other specified lymphoid leukemia
C91.9 Lymphoid leukemia, unspecified

C92 Myeloid leukemia [myeloid leukemia]

Included: leukemia:
. granulocytic
. myelogenous
morphological codes M986-M988, M9930 with the code of the nature of the neoplasm /3

C92.0 Acute myeloid leukemia.
Exception: exacerbation of chronic myeloid leukemia (C92.1)
C92.1 Chronic myeloid leukemia
C92.2 Subacute myeloid leukemia
C92.3 Myeloid sarcoma. Chloroma. Granulocytic sarcoma
C92.4 Acute promyelocytic leukemia
C92.5 Acute myelomonocytic leukemia
C92.7 Other myeloid leukemia
C92.9 Myeloid leukemia unspecified

C93 Monocytic leukemia

Includes: monocytoid leukemia
morphological code M989 with neoplasm character code /3

C93.0 Acute monocytic leukemia.
Excludes: exacerbation of chronic monocytic leukemia (C93.1)
C93.1 Chronic monocytic leukemia
C93.2 Subacute monocytic leukemia
C93.7 Other monocytic leukemia
C93.9 Monocytic leukemia, unspecified

C94 Other specified cell type leukemia

Included: morphological codes M984, M9850, M9900, M9910, M9931-M9932 with tumor character code /3
Excludes: leukemic reticuloendotheliosis (C91.4) plasma cell leukemia (C90.1)

C94.0 Acute erythremia and erythroleukemia. Acute erythraemic myelosis. DiGuglielmo's disease
C94.1 Chronic erythremia. Heilmeyer-Schöner disease
C94.2 Acute megakaryoblastic leukemia.
Leukemia:
. megakaryoblastic (acute)
. megakaryocyte (acute)
C94.3 Mast cell leukemia
C94.4 Acute panmyelosis
C94.5 Acute myelofibrosis
C94.7 Other specified leukemia. Lymphosarcoma cell leukemia

C95 Leukemia of unspecified cell type

Included: morphological code M980 with neoplasm character code /3

C95.0 Acute leukemia of unspecified cell type. Blastocellular leukemia. Stem cell leukemia.
Excluded: exacerbation of unspecified chronic leukemia(C95.1)
C95.1 Chronic leukemia of unspecified cell type
C95.2 Subacute leukemia of unspecified cell type
C95.7 Other leukemia of unspecified cell type
C95.9 Leukemia, unspecified

C96 Other and unspecified malignant neoplasms of lymphoid, hematopoietic and related tissues

Included: morphological codes M972, M974 with character of the neoplasm code /3 C96.0 Letterer-Sieve disease.
Non-lipid:
. reticuloendotheliosis
. reticulosis

C96.1 Malignant histiocytosis. Histiocytic medullary reticulosis
C96.2 Malignant mast cell tumor.
Malignant:
. mastocytoma
. mastocytosis
Mast cell sarcoma.
Excludes: mast cell leukemia (C94.3)
mastocytosis (cutaneous) (Q82.2)
C96.3 True histiocytic lymphoma
C96.7 Other specified malignant neoplasms of lymphoid, hematopoietic and related tissues
C96.9 Malignant neoplasm of lymphoid, hematopoietic and related tissues, unspecified

MALIGNANT NEOPLASMS OF INDEPENDENT

(PRIMARY) MULTIPLE LOCATIONS (C97)

C97 Malignant neoplasm of independent (primary) multiple localizations

Note: When using this category, mortality coding rules and guidelines should be followed.
rations set out in part 2.

NEW PLANTS IN SITU (D00-D09)

Note. Many in situ neoplasms are considered as sequential morphological changes between dysplasia and invasive carcinoma. For example, for cervical intraepithelial neoplasia (CIN), three grades are recognized, of which the third (CIN III) includes both frank dysplasia and carcinoma in situ. This grading system is also extended to other organs, such as the vulva and vagina. Descriptions of grade III intraepithelial neoplasia with or without indication of severe dysplasia are presented in this section; Grades I and II are classified as dysplasias of the organ systems involved and should be coded according to the grades corresponding to those organ systems.

Includes: Bowen's disease
erythroplasia
morphological codes with the code of the nature of the neoplasm /2
Keir's erythroplasia

D00 Carcinoma in situ of the oral cavity, esophagus and stomach

D00.0 Lips, oral cavity and pharynx.
aryepiglottic folds:
. NOS
. lower pharyngeal part
. edge zone
Red border of the lip.
Excludes: aryepiglottic fold of the laryngeal part (D02.0)
epiglottis:
. NOS (D02.0)
. above the hyoid bone (D02.0)
. lip skin (D03.0, D04.0)
D00.1 Esophagus
D00.2 Stomach

D01 Carcinoma in situ of other and unspecified digestive organs

Excludes: melanoma in situ (D03.-)

D01.0 Colon.
Excludes: rectosigmoid junction (D01.1)
D01.1 Rectosigmoid junction
D01.2 Rectum
D01.3
Excluded: anal region:
. edges (D03.5, D04.5)
. leather (D03.5, D04.5)
skin of the perianal area (D03.5, D04.5)
D01.4 Other and unspecified parts of the intestines.
Excludes: ampullae of the papilla of Vater (D01.5)
D01.5
D01.7 Other specified digestive organs. Pancreas
D01.9

D02 Carcinoma in situ of the middle ear and respiratory organs

Excludes: melanoma in situ (D03.-)

D02.0 Larynx. The aryepiglottic fold of the laryngeal part. Epiglottis (above the hyoid bone).
. NOS (D00.0)
. lower pharyngeal part (D00.0)
. edge zone (D00.0)
D02.1 Trachea
D02.2 Bronchi and lung
D02.3 Other parts of the respiratory system. Paranasal sinuses [sinuses]. Middle ear. The planes of the nose.
Excludes: ear (external) (skin) (D03.2, D04.2)
nose:
. NOS (D09.7)
. skin (D03.3, D04.3)
D02.4 Respiratory organs, unspecified

D03 Melanoma in situ

Included: morphological codes M872-M879 with character of the neoplasm code /2

D03.0 Melanoma in situ of the lips
D03.1 Melanoma in situ of the eyelid, including eyelid commissure
D03.2 Melanoma in situ of the ear and external auditory canal
D03.3 Melanoma in situ of other and unspecified parts of the face
D03.4 Melanoma in situ of the scalp and neck
D03.5 Melanoma in situ of the trunk.
Anal region:
. the edges
. skin
Breast gland (skin) ( soft fabric). Skin of the perianal area
D03.6 Melanoma in situ of the upper limb, including the shoulder girdle area
D03.7 Melanoma in situ of the lower extremity, including the hip area
D03.8 Melanoma in situ of other locations
D03.9 Melanoma in situ, unspecified location

D04 Carcinoma in situ of the skin

Excludes: erythroplasia of Queir (penis) NOS (D07.4)
melanoma in situ (D03. -)

D04.0 Lip skin.
Excludes: vermilion border of the lip (D00.0)
D04.1 Skin of the eyelid, including the commissure of the eyelids
D04.2 Skin of the ear and external auditory canal
D04.3 Skin of other and unspecified parts of the face
D04.4 Skin of the scalp and neck
D04.5 Skin of the body.
Anal region:
. the edges
. skin
Skin of the perianal area
Breast skin
Excludes: anus [anus] NOS (D01.3)
genital skin (D07. -)
D04.6 Skin of the upper limb, including the shoulder girdle area
D04.7 Skin of the lower limb, including the hip area
D04.8 Skin of other localizations
D04.9

D05 Carcinoma in situ of the breast

Excludes: carcinoma in situ of the skin of the breast (D04.5)
melanoma in situ dairy glands (skin) (D03.5)

D05.0 Lobular carcinoma in situ
D05.1 Intraductal carcinoma in situ
D05.7 Other carcinoma in situ of the breast
D05.9 Carcinoma in situ of the breast, unspecified

D06 Carcinoma in situ of the cervix

Includes: cervical intraepithelial neoplasia (CIN) grade III, with or without mention of expression
female dysplasia
Excludes: melanoma in situ of the cervix (D03.5)
severe cervical dysplasia NOS (N87.2)

D06.0 Interior
D06.1 Outer part
D06.7 Other parts of the cervix
D06.9 Cervical part unspecified

D07 Carcinoma in situ of other and unspecified genital organs

Excludes: melanoma in situ (D03.5)

D07.0 Endometrium
D07.1 Vulvas. Vulvar intraepithelial neoplasia grade III with or without mention of severe dysplasia.
Excludes: severe vulvar dysplasia NOS (N90.2)
D07.2 Vaginas. Vaginal intraepithelial neoplasia grade III with or without mention of severe dysplasia.
Excludes: severe vaginal dysplasia NOS (N89.2)
D07.3 Other and unspecified female genital organs
D07.4 Penis. Erythroplasia Queyra NOS
D07.5 Prostate
D07.6 Other and unspecified male genital organs

D09 Carcinoma in situ of other and unspecified sites

Excludes: melanoma in situ (D03.-)

D09.0 Bladder
D09.1 Other and unspecified urinary organs
D09.2 Eyes.
Excludes: eyelid skin (D04.1)
D09.3 Thyroid and other endocrine glands.
Excludes: pancreatic islet cells (D01.7)
ovary (D07.3)
testicles (D07.6)
D09.7 Carcinoma in situ of other specified locations
D09.9 Carcinoma in situ, unspecified site

BENIGN NEOPLASMS (D10-D36)

Included: morphological codes with neoplasm character code /0

D10 Benign neoplasm of the mouth and pharynx

D10.0 Lips/
Lips (frenulum, inner surface, mucous membrane, red border).
Excludes: lip skin (D22.0, D23.0)
D10.1 Language. Lingual tonsil
D10.2 Floor of the mouth
D10.3 Other and unspecified parts of the mouth. Minor salivary gland NOS.
Excluded: benign odontogenic neoplasms (D16.4-D16.5)
mucous membrane of the lip (D10.0)
nasopharyngeal surface of the soft palate (D10.6)
D10.4 Tonsils. Tonsils (throat) (palatine).
Excludes: lingual tonsil (D10.1)
pharyngeal tonsil (D10.6)
almond(s):
. dimples (D10.5)
. temples (D10.5)
D10.5 Other parts of the oropharynx. The anterior part of the epiglottis.
Mindalikova(s):
. dimples
. temples
The pits of the epiglottis.
Excluded: epiglottis:
. NOS (D14.1)
. area above the hyoid bone (D14.1)
D10.6 Nasopharynx. Pharyngeal tonsil. Posterior edge of the septum and choanae
D10.7 Laryngopharynx
D10.9 Throats of unspecified location

D11 Benign neoplasm of the major salivary glands

Excluded: benign neoplasms of specified minor salivary glands, which are classified according to
Based on their anatomical location, benign neoplasms of the minor salivary glands NOS (D10.3)

D11.0 Parotid salivary gland
D11.7 Other major salivary glands.
Glands:
. sublingual
. submandibular
D11.9 Major salivary gland, unspecified

D12 Benign neoplasm of the colon, rectum,

anus [anus] and anal canal

D12.0 Cecum. Ileocecal valve
D12.1 Appendix
D12.2 Ascending colon
D12.3 Transverse colon. Hepatic flexure. Splenic flexure
D12.4 Descending colon
D12.5 Sigmoid colon
D12.6 Colon, unspecified part. Adenomatosis of the colon.
Colon NOS. Polyposis (congenital) of the colon
D12.7 Rectosigmoid junction
D12.8 Rectum
D12.9 Anus [anus] and anal canal.
Excluded: anal region:
. edges (D22.5, D23.5)
. skin (D22.5, D23.5)
skin of the perianal area (D22.5, D23.5)

D13 Benign neoplasm of other and ill-defined digestive organs

D13.0 Esophagus
D13.1 Stomach
D13.2 Duodenum
D13.3 Other and unspecified parts of the small intestine
D13.4 Liver. Intrahepatic bile ducts
D13.5 Extrahepatic bile ducts
D13.6 Pancreas.
Excludes: pancreatic islet cells (D13.7)
D13.7 Pancreatic islet cells. Islet cell tumor. Islets of Langerhans
D13.9 Ill-defined locations within the digestive system. Digestive system NOS.
Intestines NOS. Spleens

D14 Benign neoplasm of the middle ear and respiratory organs

D14.0 Middle ear, nasal cavity and paranasal sinuses. Nose cartilage.
Excludes: auditory canal (external) (D22.2, D23.2)
bones:
. ear (D16.4)
. nose (D16.4)
ear cartilage (D21.0)
ear (external) (skin) (D22.2, D23.2)
nose:
. NOS (D36.7)
. skin (D22.3, D23.3)
olfactory bulb (D33.3)
polyp:
. paranasal sinus (J33.8)
. ear (middle) (H74.4)
. nasal (cavity) (J33. -)
posterior edge of the nasal septum and choanae (D10.6)
D14.1 Larynx. Epiglottis (part above the hyoid bone).
Excludes: anterior epiglottis (D10.5)
polyp of the vocal cord and larynx (J38.1)
D14.2 Trachea
D14.3 Bronchi and lung
D14.4 Respiratory system, unspecified location

D15 Benign neoplasm of other and unspecified organs of the chest

Excludes: mesothelial tissue (D19.-)

D15.0 Thymus gland
D15.1 Hearts.
Excludes: large vessels (D21.3)
D15.2 Mediastinum
D15.7 Other specified organs of the chest
D15.9 Chest organs, unspecified

D16 Benign neoplasm of bones and articular cartilage

Excluded: connective tissue:
. ear (D21.0)
. century (D21.0)
. larynx (D14.1)
. nose (D14.0)
synovial membrane (D21. -)

D16.0 Scapula and long bones of the upper limb
D16.1 Short bones of the upper limb
D16.2 Long bones of the lower limb
D16.3 Short bones of the lower limb
D16.4 Bones of the skull and face. Jaw (upper). Orbital bones.
Excludes: lower jaw bone part (D16.5)
D16.5 Lower jaw bone part
D16.6 Spinal column.
Excludes: sacrum and coccyx (D16.8)
D16.7 Ribs, sternum and collarbone
D16.8 Pelvic bones, sacrum and coccyx
D16.9 Bone and articular cartilage, unspecified

D17 Benign neoplasm of adipose tissue

Included: morphological codes M885-M888 with neoplasm character code /0

D17.0 Benign neoplasm of adipose tissue of the skin and subcutaneous tissue head, face and neck
D17.1 Benign neoplasm of adipose tissue of the skin and subcutaneous tissue of the body
D17.2 Benign neoplasm of adipose tissue of the skin and subcutaneous tissue of the extremities
D17.3 Benign neoplasm of adipose tissue of the skin and subcutaneous tissue of other and unspecified localizations
D17.4 Benign neoplasm of adipose tissue of the chest organs
D17.5 Benign neoplasm of adipose tissue of intra-abdominal organs.
Excludes: peritoneum and retroperitoneal space (D17.7)
D17.6 Benign neoplasm of adipose tissue of the spermatic cord
D17.7 Benign neoplasm of adipose tissue in other locations. Peritoneum. Retroperitoneal space
D17.9 Benign neoplasm of adipose tissue of unspecified localization. Lipoma NOS

D18 Hemangioma and lymphangioma of any location

Included: morphological codes M912-M917 with character of the neoplasm code /0
Excludes: blue or pigmented nevus (D22.-)

D18.0 Hemangioma of any location. Angioma NOS
D18.1 Lymphangioma of any location

D19 Benign neoplasm of mesothelial tissue

Included: morphological code M905 with character of the neoplasm code /0

D19.0 Mesothelial tissue of the pleura
D19.1 Peritoneal mesothelial tissue
D19.7 Mesothelial tissue of other locations
D19.9 Mesothelial tissue of unspecified localization. Benign mesothelioma NOS

D20 Benign neoplasm of soft tissues of the retroperitoneum and peritoneum

Excluded: benign neoplasm of adipose tissue of the peritoneum and retroperitoneum (D17.7)
mesothelial tissue (D19. -)

D20.0 Retroperitoneal space
D20.1 Peritoneum

D21 Other benign neoplasms of connective and other soft tissues

Included: blood vessel
joint capsule
cartilage
fascia
adipose tissue
ligaments other than uterine
lymphatic vessel
muscles
synovial membrane
tendon (tendon sheath)
Excluded: cartilage:
. articular (D16. -)
. larynx (D14.1)
. nose (D14.0)
connective tissue of the mammary gland (D24)
hemangioma (D18.0)
neoplasms of adipose tissue (D17. -)
lymphangioma (D18.1)
peritoneum (D20.1)
retroperitoneal space (D20.0)
uterus:
. leiomyoma (D25. -)
. any bunches (D28.2)
vascular tissue (D18. -)

D21.0 Connective and other soft tissues of the head, face and neck.
Connective tissue:
. ear
. century
Excludes: connective tissue of the orbit (D31.6)
D21.1 Connective and other soft tissues of the upper limb, including the shoulder girdle area
D21.2 Connective and other soft tissues of the lower limb, including the hip area
D21.3 Connective and other soft tissues of the chest. Armpit. Diaphragms. Large vessels
Excluded: hearts (D15.1)
mediastinum (D15.2)
D21.4 Connective and other soft tissues of the abdomen
D21.5 Connective and other soft tissues of the pelvis
Excluded: uterus:
. leiomyoma (D25. -)
. any bunches (D28.2)
D21.6 Connective and other soft tissues of the body, unspecified parts. Backs NOS
D21.9 Connective and other soft tissues of unspecified localization

D22 Melanoform nevus

Included: morphological codes M872-M879 with character of the neoplasm code /0
nevus:
. NOS
. cyan [blue]
. hair
. pigmentary

D22.0 Melanoform nevus of the lip
D22.1 Melanoform nevus of the eyelid, including eyelid adhesion
D22.2 Melanoform nevus of the ear and external auditory canal
D22.3 Melanoform nevus of other and unspecified parts of the face
D22.4 Melanoform nevus of the scalp and neck
D22.5 Melanoform nevus of the trunk.
Anal region:
. the edges
. skin
Skin of the perianal area. Breast skin
D22.6 Melanoform nevus of the upper limb, including the shoulder girdle area
D22.7 Melanoform nevus of the lower limb, including the hip area
D22.9 Melanoform nevus, unspecified

D23 Other benign skin neoplasms

Includes: benign neoplasms:
. hair follicles
. sebaceous glands
. sweat glands
Excluded: benign neoplasms of adipose tissue (D17.0-D17.3)
melanoform nevus (D22. -)

D23.0 Lip skin.
Excluded: vermilion border of the lip (D10.0)
D23.1 Skin of the eyelid, including the commissure of the eyelids
D23.2 Skin of the ear and external auditory canal
D23.3 Skin of other and unspecified parts of the face
D23.4 Skin of the scalp and neck
D23.5 Skin of the body.
Anal region:
. the edges
. skin
Skin of the perianal area. Skin of the breast.
Excludes: anus [anus] NOS (D12.9)
genital skin (D28-D29)
D23.6 Skin of the upper limb, including the shoulder joint area
D23.7 Skin of the lower limb, including the hip joint area
D23.9 Skin of unspecified localization

D24 Benign neoplasm of the breast

Mammary gland:
. connective tissue
. soft tissue
Excludes: benign mammary dysplasia (N60.-)
breast skin (D22.5, D23.5)

D25 Leiomyoma of the uterus

Includes: benign neoplasms of the uterus with morphological code M889 and nature of the neoplasm code /0 uterine fibroids

D25.0 Submucosal leiomyoma of the uterus
D25.1 Intramural leiomyoma of the uterus
D25.2 Subserous leiomyoma of the uterus
D25.9 Leiomyoma of the uterus, unspecified

D26 Other benign neoplasms of the uterus

D26.0 Cervix
D26.1 Body of the uterus
D26.7 Other parts of the uterus
D26.9 Uterus, unspecified part

D27 Benign neoplasm of the ovary

D28 Benign neoplasm of other and unspecified female genital organs

Includes: adenomatous polyp of the skin of the female genital organs

D28.0 Vulvas
D28.1 Vaginas
D28.2 Fallopian tubes and ligaments. Fallopian tube. Uterine ligament (wide, round)
D28.7 Other specified female genital organs
D28.9 Female genital organs of unspecified localization

D29 Benign neoplasm of male genital organs

Included: skin of male genitalia

D29.0 Penis
D29.1 Prostate gland.
Excludes: prostatic hyperplasia (adenomatosis) (N40)
prostate:
. adenoma (N40)
. increase (N40)
. hypertrophy (N40)
D29.2 Testicles
D29.3 Epididymis
D29.4 Scrotums. Skin of the scrotum
D29.7 Other male genital organs. Seminal vesicles. Spermatic cord. Tunica vaginalis testis
D29.9 Male genital organs of unspecified location

D30 Benign neoplasms of the urinary organs

D30.0 Kidneys.
Excluded: renal:
. cups (D30.1)
. pelvis (D30.1)
D30.1 Renal pelvis
D30.2 Ureter.
Excludes: ureteral orifice of the bladder (D30.3)
D30.3 Bladder.
Bladder openings:
. urethral
. ureteral
D30.4 The urethra.
Excludes: urethral opening of the bladder (D30.3)
D30.7 Other urinary organs. Paraurethral glands
D30.9 Urinary organs, unspecified. Urinary system NOS

D31 Benign neoplasm of the eye and its adnexa

Excludes: connective tissue of the eyelid (D21.0)
optic nerve (D33.3)
eyelid skin (D22.1, D23.1)

D31.0 Conjunctiva
D31.1 Corneas
D31.2 Retina
D31.3 Choroid
D31.4 Ciliary body. Eyeball
D31.5 Lacrimal gland and duct. Lacrimal sac. Nasolacrimal duct
D31.6 Eye sockets of unspecified part. Connective tissue of the orbit. Extraocular muscles. Peripheral nerves of the orbit. Retrobulbar tissue. Retroocular tissue.
Excludes: orbital bones (D16.4)
D31.9 Eyes of unspecified part

D32 Benign neoplasm of the meninges

D32.0 Meninges
D32.1 Sheaths of the spinal cord
D32.9 Meninges of the brain, unspecified. Meningioma NOS

D33 Benign neoplasm of the brain and other parts of the central nervous system

Excludes: angioma (D18.0)
meninges (D32. -)
peripheral nerves and autonomic nervous system (D36.1)
retroocular tissue (D31.6)

D33.0 The brain above the tentorium. Ventricle of the brain.
Big brain.
Frontal)
Occipital)
Parietal lobe
Temporal)
Excludes: fourth ventricle (D33.1)
D33.1
D33.2 Brain, unspecified
D33.3 Cranial nerves. Olfactory bulb
D33.4 Spinal cord
D33.7 Other specified parts of the central nervous system
D33.9 Central nervous system of unspecified localization. Nervous system (central) NOS

D34 Benign neoplasm of the thyroid gland

D35 Benign neoplasm of other and unspecified endocrine glands

Excludes: pancreatic islet cells (D13.7)
ovary (D27)
testicles (D29.2)
thymus gland [thymus] (D15.0)

D35.0 Adrenal gland
D35.1 Parathyroid [parathyroid] gland
D35.2 Pituitary gland
D35.3 Craniopharyngeal duct
D35.4 Pineal gland
D35.5 Carotid glomus
D35.6 Aortic glomus and other paraganglia
D35.7 Other specified endocrine glands
D35.8 Involvement of more than one endocrine gland
D35.9 Endocrine gland, unspecified

D36 Benign neoplasm of other and unspecified sites

D36.0 Lymph nodes
D36.1
Excludes: peripheral nerves of the orbit (D31.6)
D36.7 Other specified localizations. Nose NOS
D36.9 Benign neoplasm of unspecified localization

NEW PLANTS OF UNDETERMINED OR UNKNOWN CHARACTER (D37-D48)

Note. Categories D37-D48 classify neoplasms of uncertain or unknown nature (i.e. neoplasms that raise doubts about whether they are malignant or benign). In the classification of tumor morphology, such neoplasms are coded according to their nature with code /1.

D37 Neoplasm of undetermined or unknown nature of the oral cavity and digestive organs

D37.0 Lips, oral cavity and pharynx.
aryepiglottic fold:
. NOS
. lower pharyngeal part
. edge zone
Major and minor salivary glands. Red lip border
Excludes: aryepiglottic fold of the laryngeal part (D38.0)
epiglottis:
. NOS (D38.0)
. above the hyoid bone (D38.0)
lip skin (D48.5)
D37.1 Stomach
D37.2 Small intestine
D37.3 Appendix
D37.4 Colon
D37.5 Rectum. Rectosigmoid junction
D37.6 Liver, gallbladder and bile ducts. Ampulla of Vater's papilla
D37.7 Other digestive organs.
Anal:
. channel
. sphincter
Anus NOS. Intestines NOS. Esophagus. Pancreas
Excluded: anal region:
. edges (D48.5)
. leather (D48.5)
skin of the perianal area (D48.5)
D37.9 Digestive organs, unspecified

D38 Neoplasm of undetermined or unknown nature

middle ear, respiratory organs and chest

Excluded: hearts (D48.7)

D38.0 Larynx. The aryepiglottic fold of the laryngeal part of the epiglottis (above the hyoid bone).
Excluded: aryepiglottic fold:
. NOS (D37.0)
. lower pharyngeal part (D37.0)
. marginal zone (D37.0)
D38.1 Trachea, bronchi and lung
D38.2 Pleura
D38.3 Mediastinum
D38.4 Thymus gland
D38.5 Other respiratory organs. Paranasal sinuses. Nose cartilage. Middle ear. Nasal cavities.
Excludes: ear (external) (skin) (D48.5)
nose:
. NOS (D48.7)
. leather (D48.5)
D38.6 Respiratory organs, unspecified

D39 Neoplasms of undetermined or unknown nature of the female genital organs

D39.0 Uterus
D39.1 Ovarian
D39.2 Placenta. Destructive chorioadenoma.
Bubble skid:
. invasive
. malignant
Excludes: hydatidiform mole NOS (O01.9)
D39.7 Other female genital organs. Skin of female genital organs
D39.9 Female genital organs, unspecified

D40 Neoplasm of undetermined or unknown nature of the male genital organs

D40.0 Prostate
D40.1 Testicles
D40.7 Other male genital organs. Skin of male genital organs
D40.9 Male genital organs, unspecified

D41 Neoplasm of undetermined or unknown nature of the urinary organs

D41.0 Kidneys.
Excludes: renal pelvis (D41.1)
D41.1 Renal pelvis
D41.2 Ureter
D41.3 Urethra
D41.4 Bladder
D41.7 Other urinary organs
D41.9 Urinary organs, unspecified

D42 Neoplasm of undetermined or unknown nature of the meninges

D42.0 Meninges
D42.1 Sheaths of the spinal cord
D42.9 Meninges unspecified

D43 Neoplasm of undetermined or unknown nature of the brain and central nervous system

Excludes: peripheral nerves and autonomic nervous system (D48.2)

D43.0 The brain above the tentorium. Ventricle of the brain.
Big brain
Frontal)
Occipital)
Parietal lobe
Temporal)
Excludes: fourth ventricle (D43.1)
D43.1 The brain is under the tentorium. Brainstem. Cerebellum. Fourth ventricle
D43.2 Brain, unspecified
D43.3 Cranial nerves
D43.4 Spinal cord
D43.7 Other parts of the central nervous system
D43.9 Central nervous system, unspecified part. Nervous system (central) NOS

D44 Neoplasm of undetermined or unknown nature of the endocrine glands

Excludes: pancreatic islet cells (D37.7)
ovary (D39.1)
testicles (D40.1)
thymus gland [thymus] (D38.4)

D44.0 Thyroid gland
D44.1 Adrenal gland
D44.2 Parathyroid [parathyroid] gland
D44.3 Pituitary gland
D44.4 Craniopharyngeal duct
D44.5 Pineal gland
D44.6 Carotid glomus
D44.7 Aortic glomus and other paraganglia
D44.8 Involvement of more than one endocrine gland. Multiple endocrine adenomatosis
D44.9 Endocrine gland, unspecified

D45 Polycythemia vera

Morphological code M9950 with neoplasm character code /1

D46 Myelodysplastic syndromes

Included: morphological code M998 with neoplasm character code /1

D46.0 Refractory anemia without sideroblasts, so designated
D46.1 Refractory anemia with sideroblasts
D46.2 Refractory anemia with excess blasts
D46.3 Refractory anemia with excess blasts with transformation
D46.4 Refractory anemia, unspecified
D46.7 Other myelodysplastic syndromes
D46.9 Myelodysplastic syndrome, unspecified. Myelodysplasia NOS. Preleukemia (syndrome) NOS

D47 Other neoplasms of undetermined or unknown nature of lymphoid, hematopoietic and related tissues

Included: morphological codes M974, M976, M996-M997 with tumor character code /1

D47.0 Histiocytic and mast cell tumors of undetermined or unknown origin. Mast cell tumor NOS. Mastocytoma NOS.
Excludes: mastocytoma (cutaneous) (Q82.2)
D47.1 Chronic myeloproliferative disease. Myelofibrosis (with myeloid metaplasia).
Myeloproliferative disease, unspecified. Myelosclerosis (megakaryocyte) with myeloid metaplasia
D47.2 Monoclonal gammopathy
D47.3 Essential (hemorrhagic) thrombocythemia. Idiopathic hemorrhagic thrombocythemia
D47.7 Other specified neoplasms of undetermined or unknown nature of lymphoid, hematopoietic
and related tissues
D47.9 Neoplasm of unspecified or unknown nature of lymphoid, hematopoietic and related tissues. Lymphoproliferative disease NOS

D48 Neoplasm of undetermined or unknown nature, other and unspecified localizations

Excludes: neurofibromatosis (non-malignant) (Q85.0)

D48.0 Bones and articular cartilage.
Excluded: cartilage:
. ear (D48.1)
. larynx (D38.0)
. nose (D38.5)
connective tissue of the eyelid (D48.1)
synovial membrane (D48.1)
D48.1 Connective and other soft tissues.
Connective tissue:
. ear
. century
Excluded: cartilage:
. joints (D48.0)
. larynx (D38.0)
. nose (D38.5)
connective tissue of the mammary gland (D48.6)
D48.2 Peripheral nerves and autonomic nervous system.
Excludes: peripheral nerves of the orbit (D48.7)
D48.3 Retroperitoneal space
D48.4 Peritoneum
D48.5 Skin.
Anal region:
. the edges
. skin
Skin of the perianal area
Breast skin
Excludes: anus [anus] NOS (D37.7)
genital skin (D39.7, D40.7)
red lip border (D37.0)
D48.6 Mammary gland. Connective tissue of the mammary gland. Cystosarcoma foliate.
Excludes: breast skin (D48.5)
D48.7 Other specified localizations. Eyes. Hearts. Peripheral nerves of the orbit.
Excludes: connective tissue (D48.1)
eyelid skin (D48.5)
D48.9 Neoplasm of uncertain or unknown nature, unspecified. Growth NOS. Neoplasm NOS. New growth NOS. Tumor NOS

Lungs' cancer is a malignant disease that occurs in the form of a malignant neoplasm in the lungs.

Lung oncology, represented by a group of different malignant tumors, which are capable of being formed in this organ. They can grow from the cells lining the lungs and bronchi and have fairly rapid rates of growth and metastasis, which poses a threat in the form of rapid damage to distant organs.

Lung cancer occurs many times more often in men than in women, and the risk of developing pathology increases in parallel with a person’s age. According to statistics, the majority of diagnosed malignant tumors are registered in people over 60-70.

Causes

According to statistics, lung cancer leads in the incidence of cancer among the population. Many scientists still cannot understand the mechanism of transformation of normal cells into malignant ones. Despite this, repeated studies have been carried out that have made it possible to identify a specific group of factors and substances that have the ability to have a certain effect on cells, thereby provoking their mutation. All substances that can cause cancer are called carcinogens.

Main causes of lung cancer:

• Smoking- The main reason why lung cancer develops is the inhalation of carcinogens. As is known, more than 60 substances with such properties are concentrated in tobacco smoke; about 90% of patients diagnosed with lung cancer are heavy smokers. In addition to this, the risk of cancer increases proportionally with the length of the smoker's experience and the number of cigarettes he smokes per day. Unfiltered cigarettes containing low-quality tobacco are especially dangerous.

Passive smoking also poses a greater danger, meaning people who inhale smoke also have a higher chance of developing cancer. The smoke exhaled by a smoker is more dangerous than the smoke he inhaled.

In the photo below you can see the difference in the condition of the lungs of a smoker and a person who does not smoke.

• Pollution atmosphere– the state of the environment in which a person lives plays an important role in his health. It has been noted that the population of large cities, where processing or mining plants and enterprises are located, are much more likely to suffer from lung cancer than residents of villages.
• Occupational contact with various substances– arsenic, asbestos, nickel, cadmium and many others;
• Exposure to high doses of ionizing radiation;
• Chronic and long-term respiratory diseases – bronchitis, tuberculosis, pneumonia, bronchiectasis.

Features of the course of lung cancer

The proliferation of mutated cells occurs quite quickly, which is why the tumor actively increases its size. If the patient does not begin treatment, the malignant neoplasm gradually grows into neighboring organs, large vessels, the heart, esophagus and spine. Such complications of the disease in any case lead to damage and dysfunction of the organs affected by the tumor.

When cancer has reached a certain stage of development, metastasis begins to occur in the body. Malignant cells enter the lymphatic and bloodstream and circulate throughout the body. As a result, secondary nodes appear in the patient’s body. tumor formations. According to statistics, lung cancer very often metastasizes to another lung, to regional lymph nodes, to the liver, bones, kidneys, adrenal glands and brain.

According to histological structure, lung cancer has 4 types of course:

• Squamous cell lung cancer;
• Glandular or adenocarcinoma;
• Small cell;
• Large cell.

The degree of differentiation of tumor cells also plays an important role; the lower it is, the more malignant the tumor is. Taking this feature into account, each histological type of cell has some special characteristics, these include:

• Squamous cell lung cancer has a protracted period of development and is characterized by a later onset of metastasis;
• Adenocarcinoma (glandular cancer) also develops slowly, but unlike squamous cell carcinoma, it metastasizes much earlier, through the body’s bloodstream;
• The undifferentiated type of tumor (especially small cell) is characterized by a very rapid rate of development and early metastasis to distant areas of the body through the lymph and blood flow. This characteristic makes it the most malignant species of all.

Classification according to ICD 10 code

By international classification diseases ICD 10, lung cancer is divided into:

• Code C34 – malignant neoplasm of the bronchi (central lung cancer) and lung;
• Code C78.0 – secondary malignant tumors of the lung;
• Code C44 – Squamous cell lung cancer;
• Code C34.0 – main bronchi;
• Code C34.1 – upper lobe of the lung or bronchi;
• Code C34.2 Middle lobe of bronchi or lung;
• Code C34.3 Lower lobe of bronchi or lung;
• Code C34.8 Damage to the bronchi or lung, extending beyond one or more of the above localizations;
• Code C34.9 Bronchi or lung, unspecified location.

Features of neoplasm growth

Lung cancer originates from the epithelium of the mucous membrane. There is no predisposition to the right or left lung; they are affected almost equally. If the oncological process affects the lobes, segmental or central bronchi, then central lung cancer is diagnosed. If the tumor originates from the bronchi, the caliber of which is smaller than the segmental ones, in this situation peripheral lung cancer can be diagnosed.

• Peripheral lung cancer — is formed from the epithelium of the bronchi, very often develops within the parenchyma and forms a round neoplasm with a typical spherical shape. Further development of such a tumor often causes the disease to spread to extrapulmonary structures: pleura, diaphragm, chest wall and others.
• Central lung cancer - this form of the oncological process originates in the bronchi with a fairly large caliber (lobar and segmental). The peculiarity of localization leads to obstruction of patency in the bronchi with subsequent hypoventilation. In the future, it can develop into atelectasis (collapse of the lung).
• Squamous cell lung cancer - begins its growth from cells squamous epithelium, and is characterized by a rather long development phase. Symptomatically, it can occur in different ways, as it can occur in many areas of the organ where squamous epithelium is present.

The photo shows various types of lung cancer, with the characteristic location and course of the tumor.

Stages of lung cancer

• I stage – the tumor is small and does not affect the lymph nodes.
• I A – the neoplasm reaches sizes up to 3 centimeters.
• I B – the size can reach 3-5 centimeters.
• II stage – is also divided into 2 substages:
• II A – the tumor grows to 5-7 centimeters, but does not yet affect the lymph nodes.
• II B – the neoplasm is quite large, but does not exceed 7 centimeters. The presence of malignant cells in the pulmonary lymph nodes is possible.
• IIIstage – distributed into 2 substages:
• III A – the size of the cancer exceeds 7 centimeters in diameter, the process is already affecting regional lymph nodes and nearby organs (pleura, diaphragm and others). There may be cases of tumor spread to the lymph nodes of the heart and large respiratory tracts (bronchi, trachea), which contributes to difficulty breathing in the patient.
• III B – Cancer of this stage affects multiple lymph nodes of the chest. There may also be variants of damage to the diaphragm and the middle of the chest (mediastinal lymph nodes), cardiac pericardium.
• IV stage (last) – This stage means that the tumor has already spread to other organs (metastasized to distant parts of the body). Or it has provoked the accumulation of a large amount of fluid, which contains a lot of malignant cells.

The photo shows the degree of lung damage depending on the stage of the process.

Symptoms

Very often the disease is diagnosed at a fairly advanced stage, since it is very rarely possible to identify lung cancer by symptoms at an early stage. In most sick people, lung cancer does not show any clinical picture, even the smallest deviations that can bother a person do not appear. Given this feature, there have been a lot of assumptions about the long phase of cancer development, sometimes up to several years.

The process of development of lung tumors is divided into 3 periods:

• Biological – this period is the period of time from the appearance of a neoplasm to the identification of its first signs on an x-ray.
• Preclinical (asymptomatic) – distinguished by noticeable changes in the progress of the tumor on x-rays;
• Clinical period - in addition to changes in radiography, the presence of clear symptoms and signs is noted;

Based on the above stages of the disease, we can conclude that stages I-II belong to the biological period and partly to the asymptomatic period, which is why people do not seek medical help on their own. If they did go to the doctor, it was only because of the appearance of various kinds of symptoms, and this is direct evidence that the cancer has reached at least stage III, and serious disorders are occurring in the lungs.

Early stage lung cancer can cause a number of nonspecific signs, which manifest themselves in the form of decreased performance and rapid fatigue; at the same time, the patient is in a state of apathy - indifferent to everything around him.

The further course is also veiled, which can occur in the form of frequently recurring diseases of the respiratory system: influenza, pneumonia and others. At the same time, patients have a concomitant temperature with lung cancer, which is variable in nature and is accompanied by mild malaise.

Typically, the use of anti-inflammatory and antipyretic drugs at home can only eliminate symptoms for a while. The temperature associated with lung cancer, although short-lived, is poorly responsive to drugs. If a person notices such pathologies over the course of 1-2 months, he should not delay visiting a therapist.

Video on the topic

Characteristic symptoms for lung cancer

There may be a more complicated version of hemoptysis in the form of pulmonary hemorrhage, then the patient’s sputum will not be filled with streaks of blood, but will consist of a large amount of scarlet fresh blood (as in the photo). This symptom is an emergency condition and requires immediate calling an ambulance.

• Chest pain - This symptom is characteristic of the area affected by the tumor. Many doctors and patients mistake this symptom for an attack of neuralgia, but it is only a cover for the real picture. Attacks of pain do not have a clear frequency or intensity, and always appear unexpectedly and with varying strength. The main cause of pain is the involvement of the pleura in the process (it contains a large number of nerve endings), as well as intercostal nerves or the ribs themselves (cancer often leads to their destruction). If destruction develops, the pain becomes constant and brings a lot of suffering to the patient, which is practically not relieved with the help of analgesics. Many patients feel a significant increase in pain during coughing and during inhalation/exhalation.

• Dyspnea– a person with lung cancer feels suffocation and lack of air, which can appear even in a calm state. This symptom appears as a result of the neoplasm blocking the lumen of large bronchi, which can completely disrupt air ventilation in a certain area of ​​the organ.
• Occasionally, a patient may experience a symptom of cancer, in the form of difficulty passing food through the esophagus. It occurs in the case of a highly complicated oncological process of the esophagus, which could develop against the background of lung cancer, or when the esophagus is compressed by lymph nodes that have enlarged due to metastases.
• Metastasis to distant organs, such as: brain, bones, kidneys and many others, gradually leads to an increase in already present symptoms, as well as manifestations local symptoms in places of secondary damage. This trend is observed only in stage IV cancer, which has another name – terminal. It’s sad, but many people turn to doctors precisely at this stage, when the symptoms are fully expressed.

If a person is bothered by a cough, pain or fever due to lung cancer, then he can mistake them for symptoms of a simple cold or flu and treat himself at home. According to the latest statistics, without proper treatment, cancer is always fatal. Indicators of how people die from lung cancer cannot be completely accurate, because each person experiences the disease individually. On average, about 50% of patients who do not treat cancer die in the first year, only 3-4% survive to three years, and only 1% are able to reach the 5-year mark.

Diagnosis

Given the predisposition to an asymptomatic course, all people are recommended to undergo routine diagnostics, especially those who are at increased risk (smokers working in harmful conditions) since it is almost impossible to identify lung cancer by symptoms alone. Every adult should undergo a fluorographic examination - a preventive x-ray diagnostic method.

If pathological changes were detected on fluorography, the doctor prescribes additional diagnostic methods to the patient that can establish an accurate diagnosis, these include:

• X-ray of the OGK– in the image you can see the structures of the lungs, as well as evaluate suspicious areas of darkening that were identified on fluorography. Also, on an X-ray image you can see possible anomalies in the placement of organs, the condition of the lymph nodes and a host of other pathologies that may indicate lung cancer. Photo showing an X-ray of the chest, which clearly shows a tumor in the right lung.
• CT– the most modern and very informative diagnostic method is computed tomography. This method allows you to examine in more detail possible lesions in the lungs, as well as detect those that were missed on radiography. Photo showing the lungs on a computed tomography scan.
• Bronchoscopy– carrying out this diagnostic method allows the doctor to biopsy the tumor. The essence of bronchoscopy is to insert a flexible tube into the respiratory tract, at the end of which there is a camera and illumination (pictured). Thanks to this, the specialist managing the process can visually see the tumor and take a biopsy sample.
• Biopsy– can be performed in parallel with bronchoscopy, or performed by a doctor through a needle biopsy through the skin (if the tumor is localized in the small bronchi). The obtained biopsy samples are sent to the laboratory for microscopic examination, which helps determine the histological type of cancer cells. Example in the photo.

Treatment

Doctors choose the method of how to treat lung cancer depending on the characteristics of the course of the disease (how it manifests itself) in each patient individually, as well as the stage of cancer present in him and the type of malignant cells. The main methods of treatment are chemotherapy, surgery and radiation therapy.

• Operation– depending on the extent of organ damage, doctors may perform surgery to remove the tumor, part or all of the lung. At the end of the operation, the patient is prescribed chemotherapy or radiation, which is aimed at destroying the malignant cells remaining in the body.
• Radiotherapy (methodology in the photo)– a treatment method that consists of the use of high doses of ionizing radiation that can destroy cancer cells, or at least influence the rate of their growth (slowing down the process). This procedure is relevant for those patients whose tumor has spread to the lymph nodes, as well as when surgery is contraindicated.

Many patients often ask the question, can lung cancer be cured with radiation alone?

In fact, this is unlikely. There is a small chance of getting rid of lung cancer using radiation alone, but only if it is diagnosed at an early stage. Basically this is an additional method to the operation.

• Chemotherapy– use of specific antitumor drugs by infusion into the bloodstream (photo). Chemotherapy drugs affect the rate of cell growth and also destroy most of them. Can be used both before and after surgery.

Many people are also interested in whether lung cancer can be cured with medication?

The answer is the same as in the case of irradiation, because these 2 methods do not have enough strong action In order to completely eliminate the tumor, they only slow down the rate of cell growth and can cope well with metastases.

Prevention

To prevent lung cancer, oncologists have developed several sets of measures that can reduce the risk of developing malignant neoplasms by type (central lung cancer, squamous cell lung cancer, etc.). These measures are divided into two subgroups:

• primary (main).
• secondary (medical).

These measures are based on several basic rules:

• Refusal bad habits(smoking and drinking alcohol);
• Compliance with a specific anti-cancer diet;
• Use of medications.

Video on the topic

Clinical manifestations of benign lung tumors depend on the location of the tumor, its size, direction of growth, hormonal activity, degree of bronchial obstruction, and complications caused.
Benign (especially peripheral) lung tumors may not produce any symptoms for a long time. In the development of benign lung tumors, the following are distinguished:
asymptomatic (or preclinical) stage.
stage of initial clinical symptoms.
stage of severe clinical symptoms caused by complications (bleeding, atelectasis, pneumosclerosis, abscess pneumonia, malignancy and metastasis).
With peripheral localization in the asymptomatic stage, benign lung tumors do not manifest themselves in any way. In the stage of initial and severe clinical symptoms, the picture depends on the size of the tumor, the depth of its location in the lung tissue, and its relationship to the adjacent bronchi, vessels, nerves, and organs. Lung tumors large sizes can reach the diaphragm or chest wall, causing chest or heart pain and shortness of breath. In case of vascular erosion by a tumor, hemoptysis and pulmonary hemorrhage are observed. Compression of the large bronchi by the tumor causes disruption of bronchial obstruction.
Clinical manifestations of benign lung tumors of central localization are determined by the severity of bronchial obstruction, in which grade III is distinguished:
I degree - partial bronchial stenosis;
II degree - valvular or valve bronchial stenosis;
III degree - bronchial occlusion.
In accordance with each degree of bronchial obstruction, the clinical periods of the disease differ. In the first clinical period, corresponding to partial bronchial stenosis, the bronchial lumen is narrowed slightly, so its course is often asymptomatic. Sometimes there is a cough, with a small amount of sputum, less often with blood. General health does not suffer. Radiologically, a lung tumor is not detected during this period, but can be detected by bronchography, bronchoscopy, linear or computed tomography.
In the 2nd clinical period, valvular or valve bronchial stenosis develops, associated with tumor obstruction of most of the bronchial lumen. With ventral stenosis, the lumen of the bronchus partially opens on inspiration and closes on exhalation. In the part of the lung ventilated by the narrowed bronchus, expiratory emphysema develops. Complete closure of the bronchus may occur due to swelling, accumulation of blood and sputum. IN lung tissue, located on the periphery of the tumor, develops inflammatory reaction: the patient’s body temperature rises, cough with sputum, shortness of breath, sometimes hemoptysis, chest pain, fatigue and weakness. Clinical manifestations central tumors lungs in the 2nd period are intermittent. Anti-inflammatory therapy relieves swelling and inflammation, leads to the restoration of pulmonary ventilation and the disappearance of symptoms for a certain period.
The course of the 3rd clinical period is associated with the phenomena of complete occlusion of the bronchus by the tumor, suppuration of the atelectasis zone, irreversible changes in the area of ​​lung tissue and its death. The severity of symptoms is determined by the caliber of the bronchus obstructed by the tumor and the volume of the affected area of ​​the lung tissue. There is a persistent increase in temperature, severe chest pain, weakness, shortness of breath (sometimes attacks of suffocation), bad feeling, cough with purulent sputum and blood, sometimes pulmonary hemorrhage. X-ray picture of partial or complete atelectasis of a segment, lobe or the entire lung, inflammatory and destructive changes. Linear tomography reveals a characteristic pattern, the so-called “bronchial stump” - a break in the bronchial pattern below the obstruction zone.
The speed and severity of bronchial obstruction depends on the nature and intensity of lung tumor growth. With peribronchial growth of benign lung tumors clinical manifestations less pronounced complete occlusion bronchus rarely develops.

Peripheral lung cancer is one of the most serious and common malignant diseases, affecting organs respiratory system. The pathology is insidious in that a person learns about it late, since in the early stages the tumor practically does not manifest itself. Initially, the cancer process affects medium-sized bronchi, but in the absence of medical care it develops into a central form with a more unfavorable prognosis.

Concept and statistics

Peripheral lung cancer begins its development from the epithelium of small bronchi, gradually affecting the entire lung tissue. The pathogenesis of the disease is characterized by a latent course of the first stages of the malignant process and metastasis to the lymph nodes and distant organs.

Lung cancer, both peripheral and central, occupies a leading place in the ranking of deadly pathologies. According to statistics, the disease is usually diagnosed in men over 45 years of age. Women are susceptible this disease less often, which is explained by the lower percentage of smokers among them.

The tumor is usually localized in upper lobe organ, with the right lung being affected more often than the left. However, cancer of the left lung has a much aggressive course, leaving no hope for recovery.

According to statistics, the disease code according to the ICD-10 registry is: C34 Malignant neoplasm of the bronchi and lungs.

Causes

But carcinogens also enter the lungs due to environmental pollution. In areas where chemical and other industrial production operates, the incidence of respiratory tract cancer increases several times.

Factors that provoke the oncological process also include:

• ionizing radiation;
• immunodeficiency developed against the background of chronic somatic conditions;
• advanced diseases of the respiratory system - inflammatory and infectious lesions of the bronchi and lungs;
• constant interaction with chemicals such as nickel, radon, arsenic, etc.

Who is at risk?

Most often, the following groups of people are included in the number of cases:

• smokers with many years of experience;
• workers in chemical industries, for example, in plastic production;
• persons suffering from COPD - chronic obstructive bronchopulmonary diseases.

The condition of the bronchi and lungs plays an important role in the development of oncology. It is important not to leave respiratory problems unattended and treat them promptly to avoid various complications, including deadly ones.

Classification

Peripheral lung cancer is divided into several forms, each of which has its own characteristics. We invite you to consider them in more detail.

Corticopleural form

The malignant process develops in the form of a tumor with a lumpy surface, which quickly spreads through the bronchi, growing into the lungs and chest with thin writhing threads. It refers to squamous cell carcinoma, therefore it metastasizes to the bones of the spine and ribs.

Nodal form

The tumor has a nodular nature and a bumpy surface, starting to develop from the tissues of the bronchioles. On the radiograph, this neoplasm is characterized by a depression - Rigler's syndrome - it indicates the entry of the bronchus into the malignant process. The first symptoms of the disease make themselves felt when it spreads to the lungs.

Pneumonia-like form

A tumor of a glandular nature, represented by multiple malignant nodes that tend to gradually merge. The middle and lower lobe parts of the lung are mainly affected. When diagnosing of this disease On the patient’s radiograph, light spots are clearly visible on a picture of a solid dark background, the so-called “air bronchogram”.

The pathology occurs as a protracted infectious process. The onset of the pneumonia-like form is usually hidden, and symptoms increase with tumor progression.

Cavity form

The neoplasm is nodular in nature with a cavity inside, which appears as a result of its gradual disintegration. The diameter of such a tumor usually does not exceed 10 cm, so quite often differential diagnosis malignant process turns out to be incorrect - the disease may be confused with tuberculosis, an abscess or a lung cyst.

This similarity often leads to the fact that cancer, left without appropriate treatment, actively progresses, aggravating the picture of oncology. For this reason, the cavitary form of the disease is detected extremely late, mainly in inoperable terminal stages.

Peripheral cancer of the left upper and lower lobe

When the upper lobe of the lung is affected by a malignant process, the lymph nodes do not enlarge, and the neoplasm has an irregular shape and heterogeneous structure. During X-ray diagnostics, the pulmonary pattern in the root part expands in the form of a vascular network. When the lower lobe is affected, on the contrary, the lymph nodes increase in size.

Peripheral cancer of the upper lobe of the left and right lung

With damage to the upper lobe of the right lung clinical manifestations of the oncological process will be the same as when the left lung is involved in the disease. The only difference lies in the fact that anatomical features the organ on the right is more susceptible to cancer.

Peripheral apical cancer with Pancoast syndrome

Atypical cells in this form of cancer actively invade the nerve tissues and vessels of the shoulder girdle. The disease is characterized by the following clinical manifestations:

• pain in the collarbone area is initially periodic, but over time it is painfully constant;
• disruption of the innervation of the shoulder girdle, which leads to atrophic changes arm muscles, numbness and even paralysis of the hands and fingers;
• development of destruction of rib bones, visible on x-ray;
• Horner's syndrome with characteristic signs of pupil constriction, ptosis, recessed eyeballs, etc.

The disease also causes such general symptoms as hoarseness in the voice, increased sweating, facial hyperemia from the affected lung.

Stages

The disease proceeds according to certain stages of the malignant process. Let's look at them in more detail in the following table.

Stages of cancer	Description
FIRST	The tumor, surrounded by a visceral capsule, is no more than 3 cm in size. The bronchi are slightly affected. The neoplasm can affect the bronchial and peribronchial lymph nodes (extremely rare).
SECOND	The tumor varies between 3-6 cm. Inflammation of the lung tissue closer to the root region of the organ is characteristic, most often of the type of obstructive pneumonia. Atelectasis often appears. The tumor does not spread to the second lung. Metastases are fixed in the bronchopulmonary lymph nodes.
THIRD	The tumor reaches a significant size and extends beyond the organ. As a rule, at this stage it affects adjacent tissues, namely the mediastinum, diaphragm and chest wall. The development of bilateral obstructive pneumonia and atelectasis is characteristic. Metastases are found in regional lymph nodes.
FOURTH	The tumor is of impressive size. In addition to both lungs, it grows into neighboring organs and gives distant metastases. The malignant process enters the final terminal stage, which means gradual disintegration of the tumor, poisoning of the body and complications such as gangrene, abscess and much more. Metastases are most often found in the kidneys, brain and liver.

Symptoms

First and main clinical sign A cough is considered a pathology. At the early stage of tumor growth and development, it may be absent, but as the disease progresses, its manifestations begin to intensify.

Initially, we are talking about a dry cough with periodic scanty sputum, mainly in the morning. Gradually it acquires a barking, almost hysterical character, with an increased volume of sputum secreted with the presence of streaks of blood. This symptom is important in diagnosing cancer in 90% of cases. Hemoptysis begins when the tumor grows into the walls of adjacent vessels.

Pain appears after coughing. This is an optional symptom for lung cancer, but the vast majority of patients note its manifestations are aching or dull in nature. Depending on the location of the tumor, unpleasant sensations can radiate (give) to the liver, when the tumor is in the right lung, or to the heart area, if we are talking about damage to the left lung. With the progression of the malignant process and metastases, the pain intensifies, especially with physical impact on the cancer site.

Many patients already have a subfebrile body temperature at the first stage of the disease. Usually it is persistent. If the situation is complicated by the development of obstructive pneumonia, the fever becomes high.

Gas exchange in the lungs is disrupted, the patient’s respiratory system suffers, and therefore shortness of breath appears even in the absence of physical activity. Additionally, signs of osteopathy may occur - night pain in the lower extremities.

The course of the malignant process itself depends entirely on the structure of the tumor and the body’s resistance. At strong immunity The pathology can develop over a long period of time, over several years.

Diagnostics

Identification of a malignant process begins with a questioning and examination of the person. When collecting anamnesis, the specialist pays attention to the patient’s age and presence of bad habits, smoking history, employment in hazardous industrial production. Then the nature of the cough, the fact of hemoptysis and the presence of pain are clarified.

The main laboratory and instrumental diagnostic methods are:

• MRI. Helps establish the localization of the malignant process, tumor ingrowth into neighboring tissues, and the presence of metastases in distant organs.
• CT. Computed tomography scans the lungs, making it possible to detect tumors down to a small size with high accuracy.
• PAT. Positron emission tomography makes it possible to view the emerging tumor in a three-dimensional image and identify it structural structure and stage of the oncological process.
• Bronchoscopy. Determines the patency of the respiratory tract and allows you to remove biomaterial for histological examination in order to differentiate the neoplasm.
• Sputum analysis. Lung discharge when coughing is examined for the presence of atypical cells. Unfortunately, it does not guarantee 100% results.

Treatment

The fight against peripheral lung cancer is carried out by two main methods - surgery and radiation therapy. The first is not relevant in all cases.

In the absence of metastases and the tumor size is up to 3 cm, a lobectomy is performed - an operation to remove the tumor without resection of adjacent organ structures. That is, we are talking about removing a lobe of the lung. Quite often, with a larger intervention, relapses of the pathology occur, so surgical treatment at the first stage of the malignant process is considered the most effective.

If regional lymph nodes are affected by metastases and the tumor size corresponds to the second stage of cancer, a pneumonectomy is performed - complete removal of the diseased lung.

If the malignant process has spread to neighboring organs and metastases have appeared in distant areas of the body, surgery contraindicated. Serious concomitant pathologies cannot guarantee a favorable outcome for the patient. In this case, radiation exposure is recommended, which can also be an auxiliary method to surgery. It helps reduce the volume of malignant neoplasms.

Along with these treatment methods, chemotherapy is also used. Patients are prescribed drugs such as Vincristine, Doxorubicin, etc. Their use is justified if there are contraindications to surgery and radiation therapy.

Oncologists believe that chemotherapy for this diagnosis should be carried out for 6 cycles at intervals of 4 weeks. At the same time, 5-30% of patients show signs of objective improvement in well-being, sometimes the tumor resolves completely, and with a combination of all methods of combating lung cancer, a positive outcome can be achieved in many cases.

FAQ

Is it possible to remove both affected lungs at the same time? A person cannot live without two lungs, therefore, if both organs are affected by cancer at once, surgical intervention is not performed. As a rule, in this case we are talking about advanced cancer, when surgical treatment is contraindicated and other methods of therapy are resorted to.

Is lung transplantation performed for cancer? Oncological diseases are a limitation to performing a donor organ transplant or transplantology. This is due to the fact that during a malignant process it is used specific therapy, against the background of which the probability of survival of the donor lung is reduced to zero.

Traditional treatment

People usually resort to informal medicine when there is no effect from traditional therapy or there is a desire to achieve better results and speed up the healing process.

In any case, folk recipes are not a panacea in the fight against cancer and cannot act as an independent treatment. Their use in practice must necessarily be agreed upon with a specialist.

Dig up the roots of the plant after flowering, wash, cut into pieces 3 mm thick and dry in the shade. Pour 50 g of dry raw material into 0.5 liters of vodka and leave for 10-14 days. Take 1 tsp orally. 3 times a day before meals.

Badger fat remedy. This product is highly effective in the first stage of lung cancer. Mix in equal proportions badger fat, honey and aloe juice. The product is taken orally, 1 tbsp. l. 3 times a day on an empty stomach.

Recovery process

The rehabilitation period after the therapeutic effect on the body requires a sufficient amount of time. Oncologists notice that some patients recover easier and faster, while others take months and even years to return to their previous lives.

• conducting special respiratory exercises under the guidance of a physical therapy instructor, aimed at training the chest muscles and maintaining the respiratory system in good shape;
• constant physical activity even at rest - kneading the limbs allows you to improve blood circulation and avoid congestion in the lungs.

In addition, attention is paid to compliance with the principles dietary nutrition- it should not only be fractional, but also sufficiently fortified and easily digestible to maintain the body’s energy balance.

Diet

In the system of treatment and preventive approach, nutrition for lung cancer, although not the main type of assistance, plays an important role. A balanced diet allows you to provide the body of both a healthy and sick person with the necessary energy support and nutrients, normalize metabolism and minimize the side effects of chemotherapy and radiation therapy.

Unfortunately, there is no specially developed and generally accepted diet for peripheral and central lung cancer. Rather, we are talking about the principles on which this nutrition system is built, taking into account the state of human health, the stage of the oncological process, the presence of disorders in the body (anemia, pneumonia, etc.) and the development of metastases.

First of all, we list which products that have antitumor activity should be included in the diet in equal measure both preventively and therapeutic purpose for peripheral lung cancer:

• foods rich in carotene (vitamin A) - carrots, parsley, dill, rose hips, etc.;
• dishes containing glucosinolates - cabbage, horseradish, radish, etc.;
• food with monoterpene substances - all types of citrus fruits;
• products with polyphenols - legumes;
• fortified dishes - green onions, garlic, offal, eggs, fresh fruits and vegetables, loose leaf tea.

You need to give up obviously unhealthy foods - fried and smoked foods, fast food, carbonated sweet drinks, alcohol, etc.

As lung cancer progresses, many patients refuse to eat, so for their life support in hospital conditions, enteral nutrition is organized - through a tube. Especially for people facing this disease, there are ready-made mixtures enriched essential vitamins and minerals, for example, Composite, Enpit, etc.

Course and treatment of the disease in children, pregnant and lactating women, the elderly

Children. Oncology in childhood, caused by damage to the bronchi and lungs, rarely develops. Typically, in young patients, this disease is associated with unfavorable environmental conditions or a serious hereditary predisposition. For example, we may be talking about the tobacco addiction of a mother who did not stop smoking while pregnant.

Clinical symptoms of peripheral lung cancer in a child are not difficult to identify - in the absence of data on bronchopulmonary disease, the pediatrician refers the child for an additional examination to a pulmonologist or TB specialist for correct diagnosis. If cancer is detected as early as possible and treatment is started, the prognosis for recovery is positive. The principles of therapy used will be the same as for adult patients.

Pregnancy and lactation. The diagnosis of peripheral lung cancer cannot be excluded in women during pregnancy and breastfeeding. In this case, treatment must be completely entrusted to specialists of the appropriate profile. The issue of keeping the child is decided on an individual basis. If the stage is operable, surgery is recommended in the second trimester without termination of pregnancy. The risk of fetal death is 4%. In the presence of metastases in the case of advanced cancer, the prognosis for a woman is unfavorable - no more than 9 months from the date of diagnosis.

Advanced age. In elderly people, peripheral lung cancer often occurs as a latent type and is detected too late. Due to their state of health and advanced age, such patients rarely pay attention to periodic coughing, appearance sputum and other signs of trouble, attributing them to weakened immunity and chronic pathologies. Therefore, the disease is more often detected at a terminal, inoperable stage, when assistance is limited only to palliative medicine.

Treatment of peripheral lung cancer in Russia, Israel and Germany

Statistics collected over the past decade indicate that lung cancer or adenocarcinoma is one of the most destructive diseases. According to the same study, over 18.5% of all cancer patients die annually from this diagnosis. Modern medicine has a sufficient arsenal to combat this disease; with early treatment, the likelihood of stopping the malignant process and getting rid of it is high. We invite you to learn about the possibility of treating peripheral lung cancer in different countries.

Treatment in Russia

The fight against cancer of the respiratory system is carried out here in accordance with the requirements of the World Health Organization. Assistance provided to patients is generally provided free of charge if they have a medical insurance policy and citizenship of the Russian Federation.

We invite you to find out where you can go for peripheral lung cancer in Moscow and St. Petersburg.

• Oncological center "Sofia", Moscow. Specializes in areas such as oncology, radiology and radiation therapy.
• Moscow Research Institute named after P.A. Herzen, Moscow. Leading oncology center in Russia. It provides the necessary range of medical services to patients seeking treatment for lung cancer.
• National Medical and Surgical Center named after. N.I. Pirogov, St. Petersburg Clinical Complex.

Let's look at what reviews there are online about the listed medical institutions.

Natalia, 45 years old. “With a diagnosis of stage 2 peripheral lung cancer of the left lung, my 37-year-old brother and I went to the Moscow Research Institute named after. Herzen. We are satisfied with the result and are very grateful to the doctors. A year and a half has passed since discharge - everything is normal.”

Marina, 38 years old. “My father was operated on for peripheral cancer of the right lung in St. Petersburg at the Pirogov Research Institute. At that time in 2014, he was 63 years old. The operation was successful, followed by chemotherapy courses. In the fall of 2017, a relapse occurred in one of the bronchi, unfortunately, it was recognized late, the process has started, now the doctors’ prognosis is not the best, but we do not lose hope.”

Treatment in Germany

Innovative methods of treating peripheral lung cancer are highly effective, accurate and tolerable, but they are not carried out in domestic hospitals, but abroad. For example, in Germany. This is why the fight against cancer is so popular in this country.

So, where can you get help fighting peripheral lung cancer in German clinics?

• University clinic Giessen and Marburg, Hamburg. A large medical complex in Western Europe, carrying out practical and scientific activities.
• University Hospital Essen, Essen. Specializes in the treatment of cancer, including the respiratory system.
• Lung Oncology Clinic "Charite", Berlin. The Department of Pulmonary Oncology with specialization in the field of infectology and pulmonology operates on the basis of the university medical complex.

We invite you to consider reviews of some of the listed medical institutions.

Sergey, 40 years old. “5 years ago in Germany, the Charité clinic performed an operation and several courses of chemotherapy on my wife with peripheral lung cancer. I can say that everything went better than we expected. Thanks to the clinic staff. They did not waste time with diagnosis and treatment, they helped quickly in the shortest possible time.”

Marianna, 56 years old. “My husband was diagnosed with peripheral lung cancer; he is an experienced smoker. We contacted the Essen clinic in Germany. The difference with domestic service is obvious. After treatment we immediately went home; my husband received disability. 2 years have passed, there are no relapses, we regularly check with an oncologist. We recommend the Essen Clinic."

Treatment of peripheral lung cancer in Israel

This country is rightfully popular in the direction of medical tourism. It is Israel that is famous the highest level diagnosis and treatment of malignant neoplasms at any stage of their development. The results of the fight against cancer in this part of the world are considered the best in practice.

We invite you to find out where you can get help for oncology of the bronchopulmonary system in this country.

• Cancer Center, Herzliya Clinic, Herzliya. For more than 30 years, she has been accepting patients from different parts of the world for cancer treatment.
• Medical Center "Ramat Aviv", Tel Aviv. The clinic uses everything innovative technologies in the field of surgery and radioisotope research.
• Clinic "Assuta", Tel Aviv. A private medical institution, thanks to which patients do not have to wait in line to be admitted and undergo the necessary medical procedures.

Let's look at reviews of some clinics.

Alina, 34 years old. “8 months ago, my father was diagnosed with stage 3 peripheral lung cancer. In Russia they refused to operate, citing metastases and a high risk of complications. We decided to turn to Israeli specialists and chose the Assuta clinic. The operation was carried out successfully, the doctors are simply professionals in their field. Additionally, chemotherapy and radiation therapy were completed. After discharge, my father feels fine, we are being seen by an oncologist at his place of residence.”

Irina, 45 years old. “With stage 1 peripheral cancer of the right lung, I urgently flew to Israel. The diagnosis was confirmed. Radiotherapy was carried out at the Ramat Aviv clinic, after which tests showed the absence of an oncological process, and a computed tomography scan did not detect a tumor. No operation was performed. The doctors are the most attentive. They helped me return to a full life."

Metastasis

The development of secondary cancer foci is an inevitable process in advanced cancer. Metastases in peripheral malignant lung damage spread throughout the body in the following ways:

• Lymphogenic. The lung tissue has a dense network of lymphatic vessels. When a tumor grows into their structure, atypical cells disperse throughout the lymphatic system.
• Hematogenous. Dissimilation of metastases occurs throughout the body. The adrenal glands are affected first, then the bones of the skull and chest, the brain and the liver.
• Contact. The tumor implants into nearby tissues - this process usually begins in the pleural cavity.

Complications

With advanced stages of peripheral lung carcinoma, the consequences of the disease are metastases that spread to the intraorgan structures of the body. Their presence worsens the prognosis for survival, the stage of oncology becomes inoperable, and the death of the patient is considered a further complication.

The immediate consequences of the oncological process in respiratory system is bronchial obstruction, pneumonia, pulmonary hemorrhage, atelectasis, tumor decay with intoxication of the body. All this negatively affects the patient’s well-being and requires comprehensive medical care.

Relapse

According to statistics, approximately 75% of malignant tumors relapse within the next 5 years after completion. primary treatment. Relapses are the most risky in the coming months - against this background a person can live up to one year. If cancer relapse does not occur within 5 years, the probability of secondary tumor development, according to oncologists, is reduced to minimal values, dangerous period passed

With peripheral lung damage, the recurrence of the malignant process is extremely aggressive and treatment is successful only at the early stage of the disease. Unfortunately, in other cases, the prognosis for how long the patient will live is extremely unfavorable, since the tumor is practically insensitive to repeated chemotherapy and radiation therapy, and surgical intervention is often contraindicated in this situation.

Forecast (how long they live)

Figures regarding survival for peripheral lung cancer vary depending on the classification of the histological structure of the tumor. In the following table we present the average prognosis criteria among all cancer patients with this diagnosis.

Stages	Success rate
FIRST	50,00%
SECOND	30,00%
THIRD	10,00%
FOURTH	0,00%

Prevention

The development of peripheral lung cancer can be prevented through timely and adequate treatment of infectious and inflammatory processes in the bronchi to prevent them from becoming chronic. In addition, it is extremely important to give up tobacco addiction and use personal protection(respirators, masks, etc.) when working in hazardous industries and strengthening the immune system.

The main problem in oncology today is still the late detection of malignant processes in the body. Therefore, a person’s own attentive attitude to changes in well-being will help maintain health and life - only thanks to this can the disease be detected in time and successfully treated.

Are you interested in modern treatment in Israel?

Thanks to the use modern methods and drugs, timely detected lung cancer (LC) is successfully treated in most cases. However, the tumor rarely makes itself felt at the onset of the disease. That is why it is difficult to overestimate the role of conventional fluorography - a preventive examination that is recommended to be done annually.

Causes of lung cancer

Malignant degeneration of lung tissue can contribute to various factors, the main ones are listed below.

Other risk factors include:

• inhalation of radon, a radioactive gas released by certain types of rocks;
• the effect of radiation;
• contact with certain chemicals - arsenic, asbestos, beryllium, cadmium, coal dust, silicon and nickel dioxides;
• inhalation of diesel fuel fumes;
• previous treatment of cancer;
• reduced immunity due to HIV infection;
• rheumatoid and autoimmune diseases (systemic lupus, etc.).

Forms of the disease

When diagnosing lung cancer, it is customary to divide it according to the type of malignant cells ( non-small cell and small cell), as well as by the location of the primary tumor and the extent of the process.

For convenient statistical processing and simplification of documentation, the diagnosis is coded using the Unified International Classification of Diseases (ICD), according to which RL is assigned the general ICD code C34. To clarify the location of the source, additional designations are used. So, for example, if it is in the main bronchi, it receives ICD code C34.0, in the lower lobe - C34.3, etc.

Squamous cell type

This type of neoplasm belongs to non-small cell forms and accounts for up to 80% of the total number of cases. Typically, squamous cell tumors grow quickly but respond well to treatment.

Small cell carcinoma (SLC)

This type of formation is difficult to diagnose and treat. First of all, this applies to the common form of MPD, in which numerous small foci appear in the organ tissue.

Central RL

Such a focus is localized in the area of ​​the main bronchi. These tumors are more treatable simply because they manifest themselves more often early symptoms and are detected on fluorographic and x-ray photographs.

Central lung cancer is clearly visible on images

Peripheral lung cancer (PLC)

PRL develops directly in the lung tissue, which has virtually no pain receptors. As a result, the disease can be asymptomatic until the patient begins to feel unwell caused by tumor growth and the appearance of secondary lesions - metastases (mts).

Form with metastases

At a late stage of the disease, diagnosis and treatment are complicated by the appearance of mts. They are formed from cells of a disintegrating tumor, which are carried throughout the body by the flow of lymph and blood. Most often, distant metastases affect the brain, kidneys and adrenal glands, liver, and bones.

More about the disease

Characteristic symptoms

Patients are characterized by early onset of symptoms cancer intoxication manifested by increased fatigue, depression, weight loss, slight increase in temperature. When the tumor is located in the large bronchi, pain and cough appear quite early. These and other symptoms of lung cancer are similar to those of lung infections and other non-cancer diseases. A diagnostic examination allows you to exclude or confirm the presence of a malignant lesion of the lungs when suspicious signs appear.

Diagnostic methods

Diagnostics include endoscopic methods (bronchoscopy, thoracoscopy, etc.), laboratory analysis of tumor tissue samples and biological fluids (blood, sputum, contents of the pleural cavity), and various ways imaging (CT, PET/CT).

Based on the results of the studies, the doctor determines the nature and scope of the problems, on the basis of which an individual treatment regimen is drawn up.

Among the above methods, a special place is occupied by complex scanning using a PET/CT installation. The study is most informative in small cell lung cancer, since tumors of this type actively absorb fluorodeoxyglucose (a radiopharmaceutical used to obtain tomograms using a PET scanner).

A comprehensive PET/CT study revealed a lesion in the lower lobe of the right lung with regional metastases

At primary diagnosis this method is usually used as a clarifying method and is prescribed when difficulties arise with the interpretation of the results of computed tomography, or when for some reason it is undesirable to perform a biopsy.

PET/CT is also widely used to monitor the effectiveness of chemotherapy, including in the early stages of treatment.

TO absolute advantages positron emission tomography in combination with CT should include:

• the possibility of simultaneous detection of not only the primary tumor and regional metastases, but also distant foci (primarily in the adrenal glands);
• reduction in the number of ineffective thoracotomies by half (during preoperative examination);
• reducing the area of ​​tumor irradiation, which leads to a decrease in toxicity and allows you to increase the dose.

Treatment methods

Radiosurgery using the CyberKnife system is most effective in the treatment of squamous cell forms of LC

Treatment for lung cancer is usually complex. Radical methods include traditional surgery and a modern highly effective low-traumatic method - radiosurgery using the CyberKnife device. In addition, treatment regimens usually include chemotherapy; in later stages of the disease, courses of radiation therapy may be added.