SEER SUMMARY STAGING MANUAL 2000: A REVIEW

Transcription

1 SEER SUMMARY STAGING MANUAL 2000: A REVIEW MARILYN HANSEN, CTR 1

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3 GENERAL SUMMARY STAGING RULES 1. Based on combined clinical and pathological staging 2. Should include all information available through completion of surgery(ies) in the first course of treatment OR within 4 months of diagnosis in the absence of disease progression, whichever is longer 3. Summary stage information obtained after treatment with radiotherapy, chemotherapy, hormonal therapy or immunotherapy has begun may be included unless it is beyond the time frame given above. GENERAL SUMMARY STAGING RULES 4. Exclude any metastasis known to have developed after the diagnosis was established 5. Clinical information, such as description of skin involvement in breast, can change the stage. Be sure to review all information carefully. If the operative/pathology report disproves the clinical information, code the operative/ pathology information 6. All schemas apply to all histologies unless otherwise noted. Exceptions: Lymphoma, Kaposi s Sarcoma 3

4 GENERAL SUMMARY STAGING RULES 7. Autopsy reports are used in coding summary stage just as are pathology reports. Apply the same rules for inclusion and exclusion 8. Death Certificate Only cases and unknown primaries are coded 9 for summary stage 9. If summary staging is described only in terms of TNM, use the code that corresponds to the TNM information. If there is discrepancy between the documentation in the medical record and the physician s assignment of TNM, the documentation takes precedence. 10.Site-specific guidelines take precedence over general guidelines. AMBIGUOUS TERMS IN SUMMARY STAGING: INVOLVEMENT Adherent Apparent(ly) Appears to Comparable with Compatible with Contiguous/continuous with Encroaching upon Extension to, into, onto, out onto Features of Fixation to another structure Fixed Impending perforation of Impinging upon Impose/Imposing on Incipient invasion Induration Infringe/infringing Into Intrude Invasion to, into, onto, out onto Matted (lymph nodes only) Most likely Onto Overstep AMBIGUOUS TERMS IN SUMMARY STAGING: INVOLVEMENT Presumed Probable Protruding into (unless encapsulated) Suspected Suspicious To Up to 4

5 AMBIGUOUS TERMS IN SUMMARY STAGING: NO INVOLVEMENT Abuts Approaching Approximates Attached Cannot be Excluded/Ruled Out Efface/Effacing/Effacement Encased/Encasing Encompass(ed) Entrapped Equivocal Extension to without invasion of/involvement of Kiss/kissing Matted (except for lymph nodes) Possible Questionable Reaching Rule out Suggests Very close to Worrisome USEFUL DEFINITIONS IN SUMMARY STAGING MANUAL Adjacent Tissue(s) Unnamed tissues that immediately surround an organ or structure containing a primary cancer. Connective Tissue Per ICD-O-3, includes adipose tissue, aponeuroses, arteries, blood vessels, bursa, connective tissue NOS, fascia, fatty tissue, fibrous tissue, ganglia, ligaments, lymphatic channels (not nodes), muscle, nerves, skeletal muscles, subcutaneous tissue, synovia, tendons, tendon sheaths, veins, and vessels NOS MORE USEFUL DEFINITIONS IN SUMMARY STAGING MANUAL Adjacent Organs Anatomic structures with specific physiologic functions other than (or in addition to) support and storage. Adjacent Structures Connective tissues large enough to be given a specific name, such as brachial artery or broad ligament. Cortex (adjective: cortical) The external or outer surface layer of an organ, as distinguished from the core, or medulla, of the organ. In some organs, such as the adrenal gland, the cortex has a different function than the medulla. 5

6 EVEN MORE USEFUL DEFINITIONS IN SUMMARY STAGING MANUAL Medulla (adjective: medullary) Central portion of an organ, in contrast to the outer layer or cortex. Sometimes called marrow. In some organs (bone), the medulla or marrow has a different physiologic role than the cortex. Parenchyma Functional portion of an organ, in contrast to its framework or stroma. Stroma The cells and tissues that support, store nutrients, and maintain viability within an organ. Consists of connective tissue, vessels and nerves, and provides the framework of an organ. SOME DEFINITIONS CAN BE HIDING Adventitia: The tissue outside the muscularis of the esophagus, composed of fibrous connective tissue Mesenteric Fat: Also called pericolic fat Serosa: Also called the mesothelium and visceral peritoneum. For the stomach and small intestine, serosa is also referred to as tunica serosa. The term serosa is sometimes generically used to include both the serosa and the subserosa, and therefore the clinician should be consulted to determine if the use of serosa includes the subserosa also. SOME DEFINITIONS ARE SITE-SPECIFIC Commissure of lip: also called corner of mouth Oropharynx is also call Oral Pharynx Parasternal nodes are also called internal mammary nodes Scalene nodes are also called inferior deep cervical Waldeyer ring: ring of lymphoid tissue formed by the two palatine tonsils, the pharyngeal tonsils (adenoids) and the lingual tonsils 6

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8 BE CAREFUL WITH DIFFERENCES BETWEEN TNM AND SUMMARY STAGING Mucosa of Lip: Summary staging includes with lip, TNM with buccal cavity in the oral cavity staging scheme Base of Tongue (root of tongue): The posterior one-third of tongue is part of the oropharynx in TNM staging Lung: Supraclavicular and scalene nodes are N3 in TNM; they are distant in SEER TAKE HOME POINTS Always keep your resources handy, even the old ones Some things, like definitions, don t go out of style. They also may have different meanings depending on the body system Electronic/PDF versions are good because you can hit CTRL + F, type in a key word and search for what you need Don t be afraid to ask questions! 8