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Malignant Neoplasm of the Lung B004

Last amended 
8 December 2022
Current RMA Instruments
Reasonable Hypothesis SOP
92 of 2014 as amended
Balance of Probabilities SOP
93 of 2014 as amended
Changes from previous Instruments

SOP Bulletin 213

ICD Coding

ICD-10-AM Codes: C33, C34

Brief description

This is a primary malignant neoplasm of the lung. That is the neoplasm has originated in the lung or trachea (primary) and has not migrated from another primary site (secondary or metastasis). The lung tissue includes the alveoli, bronchioles, bronchi, and trachea, but not the pleura.

Confirming the diagnosis

The diagnosis requires histology.  This usually involves obtaining tissue from a biopsy of the lung.  A diagnosis based on cytology can be used if biopsy and histopathology are not readily obtainable.

The appropriate medical specialist is a respiratory physician, thoracic surgeon or oncologist.

Additional diagnoses covered by these SOPs
  • adenocarcinoma of the lung
  • carcinosarcoma of the lung
  • large cell carcinoma of the lung
  • large cell neuroendocrine carcinoma of the lung
  • non-small cell carcinoma of the lung
  • oat cell carcinoma of the lung
  • primary melanoma of the lung
  • small cell carcinoma of the lung
  • small cell lung cancer
  • squamous cell carcinoma of the lung
  • undifferentiated carcinoma of the lung
Conditions not covered by these SOPs
  •  carcinoid tumour of lung (typical and atypical)#
  •  Hodgkin lymphoma* of the lung
  •  mesothelioma*
  •  non-Hodgkin lymphoma* of the lung
  •  secondary/metastatic cancer involving the lung (code to primary cancer site)
  •  soft tissue sarcoma* of the lung

* another SOP applies  - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

The condition may be dected incidentally on radiological imaging.  Typical presenting symptoms are cough, haemoptosis (coughing blood), dyspnoea (shortness of breath) or chest pain.  Patients presenting with clinical features typically have advanced disease. However, the above symptoms may all be features of other diseases.  Once the diagnosis has been confirmed it may be possible to back date onset to an earlier time based on the clinical picture.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  Appropriate management of the disease varies considerably with the type and stage of the disease and other factors.  A delay in obtaining treatment could lead to a worsening of the prognosis.