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Malignant Neoplasm of the Lung B004

Last amended 
22 September 2023
Current RMA Instruments
Reasonable Hypothesis SOP
86 of 2023 as amended
Balance of Probabilities SOP
87 of 2023 as amended

Changes from previous Instruments

SOP Bulletin 238

ICD Coding

ICD-10-AM Codes: C33, C44, D02.1, D02.2

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
  • Lymphoepithelial 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
  •  Malignant melanoma
  •  Mesenchymal tumours:
    • Soft tissue sarcoma of the lung * Soft tissue sarcoma SOP
  •  Mesothelioma*
  •  Non-Hodgkin lymphoma*  Non- Hodgkin lymphoma SOP
  •  Secondary/metastatic cancer involving the lung   (code to primary cancer site)

* another SOP applies  

# 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.