International

Classification of
Diseases for
Oncology

Vrindha K V
 Introduction

• The International Classification of Diseases for Oncology (ICD-O) has been used for over 35 years
to categorize and code information about cancer, including where it's located and what it looks
like under a microscope. In 1990, a new edition was published, with changes made to the part
that describes how cancer cells look. This update was necessary to include new types of cancer,
like lymphomas and leukemias, and to align with other classification systems used by doctors and
researchers. The new edition was tested in 1999 with feedback from cancer registries worldwide.
• The editors of the ICD-O tried to make as few changes as possible when updating the
classification system, but sometimes they had to alter codes for certain terms to keep similar
types of cancer together. They also had to deal with limitations in available code numbers, which
could make the order of terms seem less logical. They aimed to use the naming conventions from
the World Health Organization's International Histological Classification of Tumours series to
ensure consistency. In this update, some terms related to certain types of cancer changed from
being uncertain whether they were benign or malignant to being considered malignant.
Additionally, some ovarian cystadenomas that were previously coded as malignant are now coded
differently for consistency in databases.
• Since the third edition of ICD-O was published in 2000, the World Health Organization (WHO) has
been updating its Blue Book series with new information about various types of tumors. During
the development of the fourth edition of the Blue Book, authors worked together with the
IARC/ICD-O Committee to review and assign codes to newly identified cancer types. This updated
version of ICD-O-3 now includes the latest terms, codes, synonyms, and changes related to the
morphology and behavior of cancers found in WHO Blue Books from 2007 to 2010, focusing on
tumors in the blood and lymphatic system, the central nervous system, and the digestive system.
An appendix in the manual provides a summary of these new or revised terms and codes.
Historical background

• Since 1893, there has been an international system for categorizing causes of death,
which was later managed by the United Nations and the World Health Organization
(WHO). In 1948, the Sixth Revision of the International Statistical Classification of
Diseases (ICD) was introduced, initially for tracking mortality data but later extended to
cover illnesses too.
• During the 1950s and 1960s, when it came to naming and coding cancer, the main
system used was the WHO's ICD series. This system was used for recording and
organizing diagnoses in medical records, and it always included a section specifically for
cancer. However, until recently, there was no standardized way to code various types of
cancer beyond their location and whether they were malignant, benign, or unspecified,
except for a few specific types.
• In 1951, the American Cancer Society (ACS) created the first code manual for categorizing the
appearance and behavior of tumors, with a two-digit code for morphology and a third digit
indicating whether the tumor was malignant or not. This system served as the foundation for a
statistical code proposed by the World Health Organization (WHO) in 1956. In the 1960s, the
College of American Pathologists (CAP) developed a comprehensive classification system called
the Systematized Nomenclature of Pathology (SNOP), which included detailed codes for both the
appearance and location of tumors. The ACS and CAP collaborated, allowing the ACS to use
SNOP's morphology codes and publish them alongside their own location codes. This
collaboration led to the widespread use of these codes by cancer registrars. In 1968, the
International Agency for Research on Cancer (IARC), under WHO, worked on recommendations
for the neoplasm chapter in the International Classification of Diseases (ICD) and integrated the
morphology codes based on the 1968 edition of the ACS's Manual of tumor nomenclature and
coding (MOTNAC), which had been influenced by SNOP. This system was well-accepted and
translated into various languages.
• In the past, doctors realized that simply knowing where a tumor is located in the body
(topography) wasn't enough for effective treatment or research because different types of tumors
(morphology) behave differently. So, a special classification system called the International
Classification of Diseases for Oncology (ICD-O) was created in 1976 to provide detailed
information about both the location and appearance of tumors. This system has since been used
in cancer registries and specialized medical departments to improve cancer diagnosis and
treatment.
• The second edition of ICD-O was widely used around the world and translated into many
languages. The third edition, developed by a working group at IARC/WHO, brings important
updates, especially for lymphomas and leukemias. It incorporates the latest WHO classification,
replacing the previous classifications, and recognizes distinct combinations of cancer
characteristics, like specific genetic abnormalities, to provide more accurate and detailed
information for medical diagnosis and research.
Conversions and updates

• Conversion algorithms, also known as comparability codes, are available to translate cancer data
from the third edition of ICD-O into other coding systems, such as ICD-10. These tools can help
researchers and healthcare professionals work with cancer data in different formats. The third
edition of ICD-O includes updates, especially in the morphology section, to provide more accurate
information for cancers of the blood and lymphatic system, central nervous system, and digestive
system. You can access these conversion tools and updates on the International Association of
Cancer Registries (IARC) and World Health Organization (WHO) websites.
Differences between ICD-O and ICD-10
Aspect ICD 10 (Chapter II - Neoplasms) ICD-O (Third Edition)
Topography Code (Lung) Describes behavior (malignant, Uses a single set of four characters
benign, in situ, uncertain) by for topography regardless of
assigning to specific behavior code behavior. Example: All lung
ranges. Example: Malignant lung neoplasms have the same
tumors are coded C34.x (e.g., C34.0 topography code C34.9.
for main bronchus).
Aspect ICD 10 (Chapter II - Neoplasms) ICD-O (Third Edition)

Behavior Code (Morphology) N/A Incorporated as the fifth digit in the

morphology field, identifies
malignancy, benign nature, etc.
Example: Adenocarcinoma of the
lung is coded C34.9, 8140/3
(malignant), Squamous cell
carcinoma of the lung is coded
C34.9, 8070/3 (malignant).
Aspect ICD 10 (Chapter II - Neoplasms) ICD-O (Third Edition)

Histological Types (Lung) Very few histological types Provides detailed information
distinguished. Example: ICD doesn't about the histological or
differentiate between morphological type of the
adenocarcinoma and squamous cell neoplasm. Example: ICD-O allows
carcinoma of the lung. Both are distinguishing between different
coded as C34.9. cancer types. Adenocarcinoma of
the lung is coded C34.9, 8140/3,
while squamous cell carcinoma of
the lung is coded C34.9, 8070/3.
ICD-10 categories not used in ICD-O, third edition
• In ICD-10, there are certain categories (C00-C97) that either describe cancer based on its
appearance or indicate metastatic or secondary tumors. ICD-O, on the other hand, uses behavior
codes to describe these aspects. For instance, ICD-10 may use a code like C83.1 for mantle cell
lymphoma of the stomach, while ICD-O would use stomach C16.9 and a morphology code like
9673/3 to provide more specific information about the tumor. However, ICD-O doesn't include
category C97 from ICD-10 because primary tumor sites are typically coded separately, and the
criteria for identifying multiple primary tumors can differ between countries.
Special codes in ICD-O for topography of lymph nodes (C77)
and hematopoietic and reticuloendothelial systems (C42)
• In ICD-10, category C77 is used for secondary and unspecified malignant neoplasms of
lymph nodes. However, in ICD-O, C77 is used as the topography code for lymph nodes.
This means that most malignant lymphomas in ICD-10 (coded C81-C85) are assigned the
topography code C77 in ICD-O.
• Additionally, in ICD-10, category C42 is vacant, but in ICD-O, it is used to specify various
topographic sites within the hematopoietic and reticuloendothelial systems. For
example, chronic lymphocytic leukemia, coded as C91.1 in ICD-10, is coded as C42.1
(bone marrow) and 9823/3 (B-cell chronic lymphocytic leukemia/small lymphocytic
lymphoma) in ICD-O. Similarly, malignant neoplasms of the spleen, coded as C26.1 in
ICD-10, are assigned the code C42.2 in ICD-O under the hematopoietic and
reticuloendothelial systems.
• HIV disease and AIDS :
Malignant neoplasms linked to HIV (Human Immunodeficiency Virus) should be coded using the
guidelines provided in this manual. However, the condition of AIDS (Acquired Immunodeficiency
Syndrome) should be coded separately in its own field.
• Functions of neoplasms:
ICD-O typically does not include specific code numbers for the functions of
neoplasms, such as the production of certain substances by a malignant tumor.
Instead, you would use separate codes from ICD-10, specifically from Chapter IV
"Endocrine, Nutritional, and Metabolic Diseases," to record these functions. For
example, if a malignant pheochromocytoma produces catecholamines, you
would code this function separately as E27.5.
Thankyou