We re on the Web! Visit us at www2.kumc.edu/kcr

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1 VOLUME 18 ISSUE 2 April 2014 We re on the Web! Visit us at www2.kumc.edu/kcr April 7-11 is National Cancer Registrars Week! This week was established as an annual celebration to acknowledge the central role that Cancer Registry professionals play in the research, treatment and prevention of cancer. Founded by the National Cancer Registrars Association, NCRW is officially celebrated the second week in April. However, Cancer Registrars should be celebrated year-round for their incredible dedication toward quality cancer data management! The theme is wrapped around the progressive movement of medicine in the world today and the value of the cancer registrar in partnering with the medical community for a cancer free tomorrow The Kansas Cancer Registry would like thank all of you for your continuous hard work and dedication throughout the year! We encourage you to find celebration ideas and promotional material at References:

2 What is the correct histology code if the final diagnosis for an excisional biopsy specimen is reported as malignant melanoma, superficial spreading type but the under the cell type section in the CAP protocol layout of the pathology report it lists cell type: epithelioid? Code the histology to malignant melanoma, superficial spreading type [8743/3] based on the final diagnosis. For cases diagnosed , the steps used to arrive at this decision are: Step 1: Open the Multiple Primary and Histology Coding Rules manual. For a melanoma primary, use the Melanoma Histology rules to determine the histology code because there are site specific rules for cutaneous melanomas. Step 2: Start at Rule H1. The rules are intended to be reviewed in consecutive order from Rule H1 to Rule H10. The rules are intended to be reviewed in consecutive order within the applicable Module. Stop at Rule H9. Code the more specific histologic term when the diagnosis is melanoma, NOS [8720] with a single specific type (i.e., superficial spreading) mentioned in the final diagnosis. NOTE: The final diagnosis takes precedence over the CAP protocol. The CAP protocol may be used when it provides additional or noncontradictory information, but that does not apply in this case. How many primaries are reported for a patient diagnosed with cerebral cavernous malformation disorder (CCM1) and MRI evidence of dozens of cavernous angiomas/malformations throughout the supra and infratentorium? See discussion. Vascular tumors of the CNS are reportable when they arise in the dura or parenchyma of the CNS. When they arise in blood vessels or bone, they are not reportable. First determine the primary site. For those arising in reportable sites, apply the M rules to determine the number of primaries to report. Do not report vascular tumors when there is not enough information to determine whether they arise in the dura or parenchyma or elsewhere. Malformations are not neoplastic and therefore, not reportable. What code should be assigned to this tumor? A single bladder tumor removed via TURB. Final Dx: Invasive urothelial carcinoma with extensive divergent differentiation including small cell carcinoma, micropapillary carcinoma, and squamous cell carcinoma features. MP/H rules seem to lead to H8 - code the numerically higher ICD-O-3 code. Out of this diagnosis, it appears that 8131, micropapillary urothelial carcinoma would be the code. That would ignore the small cell carcinoma, which seems prognostically more significant. Code this combination to mixed small cell (8045) -- a combination of small cell with other types of carcinoma. There is currently no rule in the urinary site rules for this combination of histologies. This will be included in the revised MP/H rules. Is early melanoma reportable? Early melanoma is NOT reportable. In situ melanoma IS reportable. Early in situ melanoma IS reportable. Do you have any questions that you would like answered in an upcoming newsletter? your question(s) to: vhundley@kumc.edu

3 May is Skin Cancer Awareness Month Skin cancer is the most common of all cancer types. More than 3.5 million skin cancers are diagnosed each year in the United States. That's more than all other cancers combined. The number of skin cancer cases has been going up over the past few decades. The good news is that you can do a lot to protect yourself and your family from skin cancer, or to catch it early enough so that it can be treated effectively. Most skin cancers are caused by too much exposure to ultraviolet (UV) rays. Much of this exposure comes from the sun, but some may come from man-made sources, such as indoor tanning lamps. Finding possible skin cancers doesn't require any x-rays or blood tests just your eyes and a mirror. If skin cancer does develop, finding it early is the best way to ensure it can be treated effectively. Sun safety Limit the amount of time you spend in direct sun, especially when the sun s rays are most intense, generally from 10:00 a.m. to 4:00 p.m. Wear protective clothing when you re out in the sun, including long sleeves; sunglasses; and a hat that shades your face, neck, and ears. Wear sunscreen with an SPF of 15 or higher on all skin that isn t covered. Protect your skin even on cool or cloudy days. The American Cancer Society also promotes early detection of skin cancer in adults through regular skin self-exams, and an examination for skin cancer should be part of periodic health exams. References:

4 NCRA 40 th Annual Education Conference May 15 May 18, 2014 Gaylord Opryland Resort & Convention Center in Nashville, TN Check out the National Cancer Registrars Association website at Reporting Schedule Month of Diagnosis Due to KCR by: January 2013 July 2013 February 2013 August 2013 March 2013 September 2013 April 2013 October 2013 May 2013 November 2013 June 2013 December 2013 July 2013 January 2014 August 2013 February 2014 September 2013 March 2014 October 2013 April 2014 November 2013 May 2014 December 2013 June 2014 Are You Current? Use NAACCR Record Layout Version 13.0 for transmitting cases and NAACCR Version 13.0 Edits for error checking. KCR is currently distributing updated Abstract Plus software that is compatible with NAACCR Version Use Collaborative Staging & Coding Manual, Version (released December 2011) ( to code collaborative stage fields for 2012 and 2013 cases. Use the 2012 Hematopoietic & Lymphoid Database and Manual for 2012 and 2013 cases. The 2012 database is available as a web-based version at or as a software download at The web-based version is the preferred method to access the current data. Both versions include the Multiple Primaries Calculator and the current Hematopoietic Coding Manual. Please pay close attention to pages for new histology terms and codes. Please check our website to download the Kansas Cancer Registry Coding and Information Manual, ( Use Multiple Primary and Histology Coding Rules Manual (Revised August 24, 2012) ( for all cases diagnosed January 1, 2007 and forward.

5 Case Finding List ICD-9-CM Codes Explanation of ICD-9CM Code 140._ _, Malignant neoplasms, stated or presumed to be primary (of specified sites), and certain 174._ , 209.7_ specified histologies (Except ) Benign neoplasms of brain and spinal cord neoplasm 227.3, Benign neoplasm of pituitary gland, craniopharyngeal duct (pouch) and pineal gland Hemangioma; of intracranial structures Lymphangioma, any site Note: Includes only lymphangioma of the brain, other parts of nervous system and endocrine gland Carcinoma in situ (Except and 233.1) Neoplasm of uncertain behavior of endocrine glands and nervous system: pituitary gland, craniopharyngeal duct and pineal gland Neoplasm of uncertain behavior of endocrine glands and nervous system: brain and 237.5, 237.6, spinal cord, meninges, endocrine glands and other and unspecified parts of nervous system Polycythemia vera (9950/3) Plasma cells 238.7_ Other lymphatic and hematopoietic diseases 239.6, Neoplasms of unspecified nature, brain, endocrine glands and other parts of nervous system Macroglobulinemia (Waldenström's macroglobulinemia) Other specified disorders of metabolism Reportable includes terms: Hand-Schuller-Christian disease; histiocytosis (acute) (chronic); histiocytosis X (chronic) Hemophagocytic syndrome (histiocytic syndromes) Familial polycythemia (syndrome for polycythemia vera) 795.0_ _ Papanicolaou smear of cervix and vagina with cytologic evidence of malignancy 796.7_ Abnormal cytologic smear of anus and anal HPV V10.0_ - V10.9_ Personal history of malignancy Note: Screen for recurrences, subsequent primaries, and/or subsequent treatment V12.41 Personal history of benign neoplasm of the brain V58.0, V58.1_ Encounter for radiotherapy, chemotherapy, immunotherapy V67.1, V67.2 Follow up examination: following radiotherapy or chemotherapy V76._ Special screening for malignant neoplasm V86._ Estrogen receptor positive status [ER+], negative status (ER-) Reference: Kansas Cancer Registry Spring Meeting 2014 Stormont-Vail HealthCare, Inc. (Pozez Education Center) 1414 SW 8th Ave Topeka, KS Monday, May 5, :30AM 4:30PM Registration is FREE! s: Call Victoria Hundley at or vhundley@kumc.edu

6 Updating Contact Information! Please visit our website (www2.kumc.edu/kcr/downloads) Submit the updated form to Victoria Hundley ( Fax: ) The Kansas Cancer Registry (KCR), under the direction of Dr. Sue Min Lai, has expanded in recent years to collect and maintain a population based longitudinal database of all Kansans diagnosed with cancer. KCR is the only population-based source of information on cancer incidence in the State of Kansas. It provides information on the occurrence of cancer, stage at diagnosis, survival and subpopulations affected by different types of cancer. Registry information can be used by researchers to evaluate the effectiveness of new treatments and by public health professionals to implement and monitor prevention efforts. Thanks to facilities across the state of Kansas who report cancer cases, KCR has quality data to help in the fight against cancer. KCR Staff Sue-Min Lai SLAI@kumc.edu John Keighley JKEIGHLE@kumc.edu Sarma Garimella SGARIMEL@kumc.edu Qin Wang QWANG@kumc.edu Jessica Jungk JJUNGK@kumc.edu Mollee Enko MENKO@kumc.edu Victoria Hundley VHUNDLEY@kumc.edu Thanks to all KCR staff members who contributed to the publication of this newsletter. Kansas Cancer Registry University of Kansas Medical Center 130 Support Services, MS Rainbow Boulevard, Kansas City, Kansas Tel: Fax: