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National Program of Cancer Registries - page 5 / 93





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Transverse colon C18.4

Hepatic flexure C18.3

Splenic flexure C18.5

Overlapping C18.8

Ascending (right) colon C18.2

Colon, NOS C18.9

Descending (left) colon C18.6

Cecum C18.0

Appendix C18.1

Sigmoid C18.7 Rectosigmoid C19.9

Rectum C20.9

Graphic from CS Steering Committee Training Materials

Shown here is a diagram of the colon and rectum including ICD-O-3 topography codes. The appendix is a wormlike pouch that protrudes from the cecum. Tumors found in the appendix are most often non-reportable carcinoid tumors. The right colon extends up on the right side of the body and includes the cecum and ascending colon. The cecum attaches to the small intestine at the ileocecal junction. The hepatic flexure is at the bend between the ascending colon and transverse colon. The transverse or middle colon crosses the body from right to left. The splenic flexure is at the bend of the transverse colon and descending colon. The descending colon travels down on the left side of the body. The sigmoid colon is a loop of s-shaped intestine. The rectosigmoid junction is between the sigmoid colon and rectum and 15 to 17 cm from the anal verge. The rectum is approximately 12 cm long and 4 to 16 cm from the anal verge. Rectal tumors are less than 16 cm from the anal verge and located at least partially within the supply of the superior rectal artery. When trying to determine the appropriate site for rectosigmoid and rectum tumors, you cannot always rely on distance from the anal verge alone. Practitioners measure differently. If all documentation indicates that the tumor originated in the rectum, but it is stated to be 18 cm from the anal verge, assign the primary site to the rectum. A single tumor that crosses the border of two colon subsites is coded C18.8, overlapping lesion of colon, if the subsite of origin cannot be determined. When a specific subsite of the colon cannot be determined, code topography to C18.9, colon, NOS.


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