metastasize

DEFINITION of metastasize

Metastasization is the hallmark of malignant cancer progression, representing the dissemination of neoplastic cells from a primary tumor to establish secondary tumors at distant anatomical sites. This complex, multi-step process involves:

• Local Invasion: Cancer cells breach the basement membrane and invade surrounding tissues.
• Intravasation: Cells enter the bloodstream (hematogenous spread) or lymphatic vessels (lymphatic spread).
• Circulation: Cells survive transport through the circulatory or lymphatic system.
• Extravasation: Cells exit the vessels at distant sites.
• Colonization: Cells establish micrometastases that grow into macroscopic secondary tumors.

Common sites of metastasis include the lungs, liver, bones, brain, and adrenal glands. The pattern of spread often depends on the primary tumor type and its anatomical drainage pathways. Metastatic disease (Stage IV cancer) is generally considered incurable in most solid tumors, though treatment can prolong survival and improve quality of life. Some cancers (e.g., testicular, certain lymphomas) remain curable even with metastasis.

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ETYMOLOGY of metastasize

greek Derived from Greek roots:

• Meta-: Meaning “after,” “beyond,” or “change.”
• Stasis: From Greek histanai, meaning “to place” or “to stand.”
• -ize: Verb-forming suffix indicating “to make” or “to become.”
• Literally translates to “to place beyond” or “to change position,” referring to cancer cells relocating from their original site to distant locations.
• The term metastasis (noun) was first used in medical literature in the 19th century to describe the migration of disease.

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Related Terms

• Primary Tumor: The original site where cancer first developed.
• Secondary Tumor: The metastatic lesion at a distant site.
• TNM Staging: Tumor-Node-Metastasis system; “M” category indicates metastasis (M0 = none, M1 = present).
• Lymph Node Metastasis: Spread to regional or distant lymph nodes (N category in TNM).
• Hematogenous Spread: Metastasis via the bloodstream.
• Lymphatic Spread: Metastasis via the lymphatic system.
• Direct Extension/Invasion: Local spread into adjacent tissues (not true metastasis).
• Carcinomatosis: Widespread metastatic disease throughout a body cavity (e.g., peritoneal carcinomatosis).
• Oligometastasis: Limited number of metastases (typically 1-5), potentially amenable to curative treatment.
• Circulating Tumor Cells (CTCs): Cancer cells detected in the bloodstream during metastatic process.
• Sentinel Lymph Node: The first lymph node to receive drainage from a tumor; biopsied to assess metastatic spread.
• cachexia: Wasting syndrome often associated with advanced metastatic cancer.

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CODING AND NUANCES

ICD-10-CM Codes Note: “Metastasize” is a process/verb, not a diagnosis. ICD-10-CM codes below represent metastatic cancer diagnoses. Coding requires specification of both the primary site and metastatic site(s). Secondary/metastatic codes are in the C76-C79 range.

Secondary (Metastatic) Malignancy by Site

Secondary Malignancy of Common Metastatic Sites

• C78.00: Secondary malignant neoplasm of unspecified lung
• C78.01: Secondary malignant neoplasm of right lung
• C78.02: Secondary malignant neoplasm of left lung
• C78.1: Secondary malignant neoplasm of mediastinum
• C78.2: Secondary malignant neoplasm of pleura
• C78.7: Secondary malignant neoplasm of liver and intrahepatic bile duct
• C78.80: Secondary malignant neoplasm of unspecified digestive organ
• C79.00: Secondary malignant neoplasm of unspecified kidney and renal pelvis
• C79.10: Secondary malignant neoplasm of unspecified bladder
• C79.31: Secondary malignant neoplasm of brain
• C79.32: Secondary malignant neoplasm of cerebral meninges
• C79.40: Secondary malignant neoplasm of unspecified part of nervous system
• C79.51: Secondary malignant neoplasm of bone
• C79.52: Secondary malignant neoplasm of bone marrow
• C79.60: Secondary malignant neoplasm of unspecified ovary
• C79.70: Secondary malignant neoplasm of unspecified adrenal gland
• C79.81: Secondary malignant neoplasm of skin
• C79.82: Secondary malignant neoplasm of breast
• C79.89: Secondary malignant neoplasm of other specified sites

Secondary Malignancy of Lymph Nodes

• C77.0: Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck
• C77.1: Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes
• C77.2: Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes
• C77.3: Secondary and unspecified malignant neoplasm of axillary and upper limb lymph nodes
• C77.4: Secondary and unspecified malignant neoplasm of inguinal and lower limb lymph nodes
• C77.5: Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes
• C77.8: Secondary and unspecified malignant neoplasm of lymph nodes of multiple regions
• C77.9: Secondary and unspecified malignant neoplasm of lymph node, unspecified

Secondary Malignancy of Unspecified Site

• C67.9: Secondary malignant neoplasm of unspecified site

Primary Malignancy with Metastasis (Example Primary Codes) Note: Both primary AND secondary codes are typically required.

• C50.919: Malignant neoplasm of unspecified site of unspecified female breast
• C34.90: Malignant neoplasm of unspecified part of unspecified bronchus or lung
• C18.9: Malignant neoplasm of colon, unspecified
• C25.9: Malignant neoplasm of pancreas, unspecified
• C61: Malignant neoplasm of prostate
• C64.9: Malignant neoplasm of unspecified kidney, except renal pelvis

Personal History of Cancer (Post-Treatment)

• Z85.00: Personal history of malignant neoplasm of unspecified digestive organ
• Z85.3: Personal history of malignant neoplasm of breast
• Z85.40: Personal history of malignant neoplasm of unspecified genital organ
• Z85.818: Personal history of malignant neoplasm of other organs and systems

CPT Codes CPT codes depend on procedures performed to diagnose, stage, or treat metastatic disease. There is no CPT code for “metastasize” as a diagnosis.

Diagnostic/Staging Procedures

• 92083: Visual field examination (for brain metastasis assessment)
• 71045: Radiologic examination, chest; single view
• 71046: Radiologic examination, chest; 2 views
• 71250: CT thorax without contrast
• 71260: CT thorax with contrast
• 74176: CT abdomen and pelvis with contrast
• 70553: MRI brain with and without contrast
• 78815: PET/CT scan, tumor imaging (whole body)
• 78816: PET/CT scan, skull base to mid-thigh

Biopsy Procedures (To Confirm Metastasis)

• 10004: Fine needle aspiration biopsy, without imaging guidance
• 10005: Fine needle aspiration biopsy, with ultrasound guidance
• 10006: Fine needle aspiration biopsy, with fluoroscopic guidance
• 10007: Fine needle aspiration biopsy, with CT guidance
• 20205: Biopsy, bone, trocar, or needle
• 20206: Biopsy, bone, open
• 32405: Biopsy, lung or mediastinum, percutaneous needle
• 47000: Biopsy of liver, percutaneous
• 47001: Biopsy of liver, open

Surgical Treatment of Metastases

• 61510: Craniotomy for excision of metastatic tumor
• 32440: Pneumonectomy for metastatic disease
• 32480: Lobectomy for metastatic disease
• 47120: Hepatectomy, partial, for metastatic disease
• 69990: Microsurgical techniques (often used for metastatic tumor resection)

Radiation Therapy (Common for Metastases)

• 77301: Intensity Modulated Radiation Therapy (IMRT) plan
• 77371: Radiation treatment delivery, stereotactic radiosurgery (SRS)
• 77372: … stereotactic body radiation therapy (SBRT)
• 77401: Radiation treatment delivery, superficial
• 77402: … intermediate
• 77403: … deep
• 77427: Radiation treatment management, 5 treatments

Chemotherapy Administration

• 96401: Chemotherapy administration, subcutaneous or intramuscular
• 96413: Chemotherapy administration, intravenous, push technique
• 96415: … intravenous, infusion technique, first hour
• 96417: … each additional hour
• 96521: Refill and maintenance of portable pump

Important Coding Notes:

• Primary + Secondary: When coding metastatic cancer, BOTH the primary malignancy code (C00-C75) AND the secondary/metastatic site code (C76-C79) must be reported.
• Sequence: If the encounter is for treatment of the metastasis only (primary removed/treated), the secondary code may be sequenced first.
• History vs. Active: Use Z85 codes (personal history) only when the primary cancer has been completely eradicated and no longer exists. Active metastatic disease requires C codes.
• Palliative Care: If encounter is specifically for palliative care, code Z51.5 (Encounter for palliative care) may be added as secondary.
• TNM Staging: Clinical staging documentation supports medical necessity but is not directly coded in ICD-10-CM (except through specific metastasis codes).

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DERIVATIONS of metastasize

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Query functionality

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Med roots Appendix A Prefixes Appendix B Combining Forms Appendix C Suffixes Appendix D Suffix forms