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Chapter II

This chapter contains the following blocks:

C00-C97Malignant neoplasms
o C00-C75Malignant neoplasms, stated or presumed to be primary, of specified sites, except
of lymphoid, haematopoietic and related tissue
C00-C14Malignant neoplasms of lip, oral cavity and pharynx
C15-C26Malignant neoplasms of digestive organs
C30-C39Malignant neoplasms of respiratory and intrathoracic organs
C40-C41Malignant neoplasms of bone and articular cartilage
C43-C44Melanoma and other malignant neoplasms of skin
C45-C49Malignant neoplasms of mesothelial and soft tissue
C50-C50Malignant neoplasm of breast
C51-C58Malignant neoplasms of female genital organs
C60-C63Malignant neoplasms of male genital organs
C64-C68Malignant neoplasms of urinary tract
C69-C72Malignant neoplasms of eye, brain and other parts of central nervous system
C73-C75Malignant neoplasms of thyroid and other endocrine glands
o C76-C80Malignant neoplasms of ill-defined, secondary and unspecified sites
o C81-C96Malignant neoplasms, stated or presumed to be primary, of lymphoid,
haematopoietic and related tissue
o C97-C97Malignant neoplasms of independent (primary) multiple sites
D00-D09In situ neoplasms
D10-D36Benign neoplasms
D37-D48Neoplasms of uncertain or unknown behaviour


1. Primary, ill-defined, secondary and unspecified sites of

malignant neoplasm

Categories C76C80 include malignant neoplasms for which there is no clear indication of
the original site of the cancer or the cancer is stated to be "disseminated", "scattered" or
"spread" without mention of the primary site. In both cases the primary site is considered
to be unknown.

2. Functional activity
All neoplasms are classified in this chapter, whether they are functionally active or not. An
additional code from Chapter IV may be used, if desired, to identify functional activity
associated with any neoplasm. For example, catecholamine-producing malignant
phaeochromocytoma of adrenal gland should be coded to C74 with additional code E27.5;
basophil adenoma of pituitary gland with Cushing syndrome should be coded to D35.2 with
additional code E24.0.

3. Morphology

There are a number of major morphological (histological) groups of malignant neoplasms:

carcinomas including squamous (cell) and adenocarcinomas; sarcomas; other soft tissue
tumours including mesotheliomas; lymphomas (Hodgkin and non-Hodgkin); leukaemia;
other specified and site-specific types; and unspecified cancers. Cancer is a generic term
and may be used for any of the above groups, although it is rarely applied to the
malignant neoplasms of lymphatic, haematopoietic and related tissue. "Carcinoma" is
sometimes used incorrectly as a synonym for "cancer".

In Chapter II neoplasms are classified predominantly by site within broad groupings for
behaviour. In a few exceptional cases morphology is indicated in the category and
subcategory titles.

For those wishing to identify the histological type of neoplasm, comprehensive separate
morphology codes are provided (see section Morphology of neoplasms). These morphology
codes are derived from the second edition of International Classification of Diseases for
Oncology (ICDO), which is a dual-axis classification providing independent coding systems
for topography and morphology. Morphology codes have six digits: the first four digits
identify the histological type; the fifth digit is the behaviour code (malignant primary,
malignant secondary (metastatic), in situ, benign, uncertain whether malignant or
benign); and the sixth digit is a grading code (differentiation) for solid tumours, and is also
used as a special code for lymphomas and leukaemias.

4. Use of subcategories in Chapter II

Attention is drawn to the special use of subcategory .8 in this chapter [see note 5]. Where
it has been necessary to provide subcategories for "other", these have generally been
designated as subcategory .7.

5. Malignant neoplasms overlapping site boundaries and the

use of subcategory .8 (overlapping lesion)

Categories C00C75 classify primary malignant neoplasms according to their point of

origin. Many three-character categories are further divided into named parts or
subcategories of the organ in question. A neoplasm that overlaps two or more contiguous
sites within a three-character category and whose point of origin cannot be determined
should be classified to the subcategory .8 ("overlapping lesion"), unless the combination is
specifically indexed elsewhere. For example, carcinoma of oesophagus and stomach is
specifically indexed to C16.0 (cardia), while carcinoma of the tip and ventral surface of the
tongue should be assigned to C02.8. On the other hand, carcinoma of the tip of the tongue
extending to involve the ventral surface should be coded to C02.1 as the point of origin,
the tip, is known. "Overlapping" implies that the sites involved are contiguous (next to
each other). Numerically consecutive subcategories are frequently anatomically
contiguous, but this is not invariably so (e.g. bladder C67.) and the coder may need to
consult anatomical texts to determine the topographical relationships.

Sometimes a neoplasm overlaps the boundaries of three-character categories within

certain systems. To take care of this the following subcategories have been designated:

C02.8 Overlapping lesion of tongue

C08.8 Overlapping lesion of major salivary glands

C14.8 Overlapping lesion of lip, oral cavity and pharynx

C21.8 Overlapping lesion of rectum, anus and anal canal

C24.8 Overlapping lesion of biliary tract

C26.8 Overlapping lesion of digestive system

C39.8 Overlapping lesion of respiratory and intrathoracic organs

C41.8 Overlapping lesion of bone and articular cartilage

C49.8 Overlapping lesion of connective and soft tissue

C57.8 Overlapping lesion of female genital organs

C63.8 Overlapping lesion of male genital organs

C68.8 Overlapping lesion of urinary organs

C72.8 Overlapping lesion of central nervous system

An example of this is a carcinoma of the stomach and small intestine, which should be
coded to C26.8 (Overlapping lesion of digestive system).

6. Malignant neoplasms of ectopic tissue

Malignant neoplasms of ectopic tissue are to be coded to the site mentioned, e.g. ectopic
pancreatic malignant neoplasms are coded to pancreas, unspecified (C25.9).
7. Use of the Alphabetical Index in coding neoplasms

In addition to site, morphology and behaviour must also be taken into consideration when
coding neoplasms, and reference should always be made first to the Alphabetical Index
entry for the morphological description.

The introductory pages of Volume 3 include general instructions about the correct use of
the Alphabetical Index. The specific instructions and examples pertaining to neoplasms
should be consulted to ensure correct use of the categories and subcategories in Chapter

8. Use of the second edition of International Classification of

Diseases for Oncology (ICD-O)

For certain morphological types, Chapter II provides a rather restricted topographical

classification, or none at all. The topography codes of ICD-O use for all neoplasms
essentially the same three- and four-character categories that Chapter II uses for
malignant neoplasms (C00C77, C80), thus providing increased specificity of site for other
neoplasms (malignant secondary (metastatic), benign, in situ and uncertain or unknown).

It is therefore recommended that agencies interested in identifying both the site and
morphology of tumours, e.g. cancer registries, cancer hospitals, pathology departments
and other agencies specializing in cancer, use ICD-O.