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Coding Guidelines
Bladder
C670–C
Reportability
Do not report bladder cancer based on UroVysion test results alone. Report the case if there is a physician statement of malignancy and/or the patient was treated for cancer.
Not reportable Papillary urothelial neoplasms of low malignant potential (PUNLMPs) The WHO classification categorizes "PUNLMP" as borderline, 8130/1. The definition is "a papillary urothelial tumor which resembles the exophytic urothelial papilloma, but shows increased cellular proliferation exceeding the thickness of normal urothelium." The histopathologic description is "the papillae of PUNLMP are discrete, slender and not fused and are lined by multilayered urothelium with minimal to absent cytologic atypia….Mitoses are rare and have a basal location." Papilloma of bladder The WHO classification categorizes "urothelial papilloma" as benign, 8120/0. The definition is "composed of a delicate fibrovascular core covered by urothelium indistinguishable from that of normal urothelium." The histopathologic description is "characterized by discrete papillary fronds with occasional branching…the epithelium lacks atypia…mitoses are absent to rare and, if present, are basal in location and not abnormal. The lesions are often small and occasionally show concomitant inverted growth pattern. Rarely, papilloma may show extensive involvement of the mucosa."
Primary Site
C670 Trigone of bladder Base of bladder Floor Below interureteric ridge* (interureteric crest, or interureteric fold)
C671 Dome of bladder Vertex Roof Vault
C672 Lateral wall of bladder Right wall Left wall Lateral to ureteral orifice Sidewall
C673 Anterior wall of bladder
C674 Posterior wall of bladder
C675 Bladder neck Vesical neck Internal urethral orifice Internal urethral/uretero orifice
C676 Ureteric orifice Just above ureteric orifice
C677 Urachus Mid umbilical ligament Urachal remnant
C678 Overlapping lesion of bladder Lateral-posterior wall (hyphen) Fundus
C679 Bladder, NOS Lateral posterior wall (no hyphen)
*The interureteric ridge is a fold of mucous membrane extending across the bladder between the ureteric orifices and forms one of the boundaries for the trigone of the bladder.
Bladder Anatomy and ICD-O-
Source: UICC TNM Atlas, 3rd^ edition, 2nd^ revision
Bladder Wall Pathology
The bladder wall is composed of three layers. There may be “sub layers” within the major layer of the bladder.
Bladder Layer Sub layer Synonyms Staging Description Mucosa Epithelium, transitional epithelium, urothelium, mucosal surface, transitional mucosa
No blood vessels, in situ/noninvasive
First layer on inside of bladder; Lines bladder, ureters, and urethra Basement membrane
No invasion of basement membrane is in situ Invasion/penetratio n of basement membrane is invasive
Single layer of cells that lies beneath the mucosal layer separating the epithelial layer from the lamina propria Submucosa Submucous coat, lamina propria, areolar connective tissue
Invasive Areolar connective tissue interlaced with the muscular coat. Contains blood vessels, nerves, and in some regions, glands Lamina propria Submucosa, Suburothelial connective tissue, subepithelial tissue, stroma, muscularis mucosa, transitional epithelium
Invasive
Muscle Bladder wall Muscularis, muscularis propria, muscularis externa, smooth muscle
Invasive
Tumor extends through the bladder wall (invades regional tissue) when the tumor is stated to involve one of the following areas:
Serosa (Tunica serosa) : The outermost serous coat is a reflection of the peritoneum that covers the superior surface and the upper parts of the lateral surfaces of the urinary bladder. The serosa is part of visceral peritoneum. The serosa is reflected from these bladder surfaces onto the abdominal and pelvic walls. Perivesical fat Adventitia : Some areas of the bladder do not have a serosa. Where there is no serosa, the connective tissue of surrounding structures merges with the connective tissue of the bladder and is called adventitia.
Histology^1
Most bladder cancers are transitional cell carcinomas. Other types include squamous cell carcinoma and adenocarcinoma. Adenocarcinomas tend to occur in the urachus or, frequently, the trigone of the bladder^2 Other bladder histologic types include sarcoma, lymphoma, and small cell carcinoma. Rhabdomyosarcoma occurs in children.
Behavior Code
Code the behavior as malignant /3, not in situ /2, when
- the only surgery performed is a transurethral resection of the bladder (TURB) documenting that depth of invasion cannot be measured because there is no muscle in the specimen AND
- the physician’s TNM designation is not available OR
- the pathology report says the submucosa is invaded with tumor OR
- the pathology report does not mention whether the submucosa is free of tumor or has been invaded by tumor
Code the behavior as in situ /2 when
- the TNM designation is Ta for TURB with no muscle in the specimen OR
- the pathology report says the submucosa is free of tumor
First Course Treatment
BCG
Code BCG as both surgery and immunotherapy. See the SEER manual, appendix C, Bladder Surgery Codes, SEER Note under code 16
Treatment Modalities (most common treatments)
TURB with fulguration TURB with fulguration followed by intravesical BCG (bacillus Calmette-Guerin) is usually used for patients with multiple tumors or for high-risk patients. TURB with fulguration followed by intravesical chemotherapy Photodynamic therapy (PDT) using laser light and chemotherapy Segmental cystectomy (rare)
(^1) PDQ
(^2) Clinical Oncology, 8th edition
