2018 Summary Stage PEGGY ADAMO, RHIT, CTR OCTOBER 11, 2018

Transcription

1 Summary Stage PEGGY ADAMO, RHIT, CTR OCTOBER 11, 2018

2 2 Acknowledgement Jennifer Ruhl, NCI SEER

3 3 Introduction 2018 SUMMARY STAGE

4 2018 Summary Stage 4 First update since version compatible with AJCC 8 th edition for sites/histologies staged in AJCC Summary Stage applicable to all sites/histologies

5 Summary Stage Most basic way of categorizing how far cancer has spread Provides standardized, stable measure of stage for populationbased cancer registries CDC NPCR NCI SEER Applies to ALL primary site &histology combinations Reminder: AJCC 8th does not cover every primary site & histology combination

6 2018 Summary Stage Sites Not Staged in AJCC 6 Adnexa Uterine Other Biliary Other Digestive Other Endocrine Other Eye Other Intracranial Gland Lacrimal Sac Middle Ear Pharynx Other Respiratory Other Sinus Other Genital Female Other Skin Other Genital Male Other Ill-Defined Other Trachea Urinary Other

7 2018 Summary Stage 7 Similar to Summary Stage 2001 One digit

8 2018 Summary Stage 8

9 9 General Information

10 Major Updates 10 Updates based on changes in AJCC 6th, 7th, & 8th editions Updated based on recent WHO Classification of Diseases New ICD-O-3 codes added to chapters Referred to as Summary Stage Chapters Schemas are used in reference to EOD

11 11 Differences Between AJCC & SS2018 Differences Some descriptions of extension, nodal involvement that are REGIONAL (T or N) in AJCC may be DISTANT in SS Structure or lymph node cannot be found in localized (code 1) or regional (codes 2-3) Review distant (code 7) Differences exist because Summary Stage needs to be as stable as possible over time AJCC applies the staging system to the years that it is effective

12 Differences Between AJCC & SS2018 Examples 12 Primary Site Involvement AJCC SS Lung Heart T4 D Colon Tumor directly invades / adheres to bladder Bladder Common Iliac Nodes N1, N2 D Esophagus Mediastinal Nodes N1, N2, N3 D T4b D Note: These are just examples and not all inclusive, always check Distant (7) if a structure or lymph node cannot be found in Summary Stage codes 1, 2, or 3

13 13 General Coding Guidelines

14 SS2018 General Guidelines 14 Anatomically based chapters Primary site-based (e.g. breast) Some Histology-based (e.g. melanoma skin) Prognostic factors used for calculation of AJCC 8th stage not needed for SS2018 Some SS2018 chapters require Schema Discriminator Not all Schema Discriminators are needed for SS2018 Chapter-specific guidelines take precedence over general guidelines

15 15 SS2018 General Guidelines, cont d Use all information available within four months of diagnosis in absence of disease progression OR completion of surgery(ies) Combination of most precise clinical & pathological Multiple tumors reported as single primary Assign code for greatest/most advanced involvement from any tumor Use Solid Tumors rules to determine number of primaries Discrepancy between clinical & pathological information Pathological takes priority Discrepancy between pathology & operative reports for excised tissue Pathology takes priority

16 16 SS2018 General Guidelines, cont d Neoadjuvant therapy & post-therapy stage Clinical stage GREATER than post-neoadjuvant surgical information Assign SS2018 based on clinical information Clinical stage LESS than post-neoadjuvant surgical information Assign SS2018 based on post-neoadjuvant surgical information Reminder: post-neoadjuvant surgical information now collected as posttherapy stage for AJCC 8th edition

17 17 SS2018 General Guidelines, cont d Only information available T, N, M or Stage Group Assign SS2018 based on T, N, M or Stage Group Discrepancy between physician staging & documentation in medical record Query physician to resolve discrepancy if possible No access to physician for clarification Assign SS2018 code corresponding to physician staging

18 Ambiguous Terminology 18 Use ambiguous terminology only when NO further documentation available Before using ambiguous terminology, check Physician s definitions/descriptions of involvement How physician treating patient

19 19 Ambiguous Terminology, cont d No further documentation available Chapter guidelines take priority SS2018 Manual Ambiguous Terminology list Not same list as Reportability for SEER Manual, Solid Tumor Rules, or Hematopoietic manual Use this list only for SS2018 or EOD 2018 Do NOT use this list for assigning AJCC 8th edition

20 20 Guidelines by Stage

21 SS2018 Codes 21

22 In Situ 22

23 23 Code 0: In Situ Behavior MUST be /2 May be described as Intracystic Intra-epithelial No penetration below the basement membrane No stromal invasion Non-infiltrating Non-invasive Pre-invasive Note: In situ can only be assigned based on microscopic examination (histologic confirmation)

24 24 Code 0: In Situ, cont d Code 0 is not applicable for these Summary Stage chapters Bone Brain Cervical Lymph Nodes, Occult Head and Neck CNS other Corpus Sarcoma Heart, Mediastinum, and Pleura HemeRetic Ill-defined other Kaposi Sarcoma Lymphoma Lymphoma Ocular Adnexa Mycosis Fungoides Myeloma Plasma Cell Disorder Pleural Mesothelioma Primary Cutaneous Lymphoma (non-mf and SS) Retinoblastoma Retroperitoneum Soft Tissue

25 In Situ Tumors with Nodal or Other Mets 25 Pathology report indicates in situ tumor AND there is Evidence of positive lymph nodes or distant metastases Code to regional nodes or distant metastases Behavior = 3 Note: For AJCC 8th edition, this would be an unknown stage; however, SS2018 would be staged according to the lymph node or distant metastasis

26 In Situ Example: Breast 26 0 In situ, intraepithelial, noninvasive In situ: noninfiltrating; intraepithelial Intraductal WITHOUT infiltration Lobular neoplasia, grade 3 (LIN 3) Paget disease, in situ

27 Localized 27

28 Code 1: Localized Only 28 Localized is defined as Malignancy limited to site of origin Spread no further than site of origin in which started Infiltration past basement membrane of epithelium into parenchyma (functional part of the organ), but no spread beyond boundaries of organ

29 Code 1: Localized Only, cont d 29 Code 1 not applicable for Cervical Lymph Nodes & Unknown Primary Ill-defined other (includes unknown primary site C809)

30 Localized Example: Breast 30 1 Localized only (localized, NOS) Confined to breast tissue & fat including nipple &/or areola Paget disease WITH or WITHOUT underlying tumor

31 Regional Stage: Codes Regional by direct extension only Regional lymph node(s) involved only Regional by BOTH direct extension AND regional lymph node(s) involved

32 Regional by Direct Extension 32

33 Code 2: Regional by Direct Extension Only 33 Direct tumor extension beyond limits of site of origin Adjacent connective tissue Extension to/adherence to adjacent organs/structures For sites with walls (e.g. GI sites) Invasion through entire wall Invasion of/through serosa No lymph node involvement (clinical or pathological) No distant metastasis (clinical or pathological)

34 Code 2: Regional by Direct Extension Only, cont d 34 Code 2 not applicable for Cervical Lymph Nodes & Unknown Primary HemeRetic Ill-defined other (includes unknown primary site C809) Myeloma Plasma Cell Disorder

35 Regional by Direct Extension Example Breast 35 2 Regional by direct extension only Attachment or fixation to pectoral muscle(s) or underlying tumor Chest wall Deep fixation Extensive skin involvement WITH or WITHOUT dermal lymphatic filtration Edema of skin En cuirasse Erythema Inflammation of skin Lenticular nodule(s) Peau d'orange ("pigskin") Satellite nodules Skin edema Ulceration of skin of breast Inflammatory carcinoma, NOS Intercostal or serratus anterior muscle(s) Local infiltration of dermal lymphatics adjacent to primary tumor involving skin by direct extension Pectoral fascia or muscle(s) Rib(s) Subcutaneous tissue Skin infiltration of primary breast including skin of nipple and/or areola

36 Code 3: Regional Lymph Nodes Only 36 Localized (code 1) WITH regional lymph node involvement Regional lymph nodes listed for each SS chapter Terms fixed or matted & mass in hilum, mediastinum, retroperitoneum, &/or mesentery recorded as involvement of lymph nodes Following terms not coded as involvement for solid tumors Enlarged, lymphadenopathy, palpable, shotty, visible swelling No evidence of distant metastasis (clinical or pathological)

37 37 Code 3: Regional Lymph Nodes Only, cont d Code 3 not applicable for Brain, CNS Other, Intracranial Gland HemeRetic Ill-defined other (includes unknown primary site C809) Lymphoma Except: Code 3 applicable to Primary Cutaneous Lymphoma & Ocular Adnexal Lymphoma Separate chapters for these

38 Regional Lymph Nodes Only Example Breast 38 3 Regional lymph node(s) involved only Axillary (ipsilateral), NOS Level I (low-axilla) (low) (superficial), NOS [adjacent to tail of breast] Anterior (pectoral) Lateral (brachial) Posterior (subscapular) Level II (mid-axilla) (central), NOS Interpectoral (Rotter s) Level III (high) (deep), NOS Apical (subclavian) Axillary vein Fixed/matted ipsilateral axillary Infraclavicular (subclavicular) Internal mammary (parasternal) (ipsilateral) Intramammary Regional lymph node(s), NOS Lymph node(s), NOS

39 Cancer Registrar Math 39 When does = 4?

40 Code 4: Regional by BOTH Direct Extension AND Regional Lymph Node(s) Involved 40 Regional by direct extension only (code 2) WITH regional lymph node involvement (code 3) Same instructions for coding regional lymph node involvement apply to codes 3 & 4 No evidence of distant metastasis (clinical or pathological)

41 Code 4: Regional by BOTH Direct Extension AND Regional Lymph Node(s) Involved, cont d 41 Code 4 not applicable for Brain, CNS Other, Intracranial Gland Cervical Lymph Nodes and Unknown Primary HemeRetic Ill-defined other (includes unknown primary site C809) Lymphoma Except: Code 4 applicable to Primary Cutaneous Lymphoma and Ocular Adnexal Lymphoma Separate chapters for these Myeloma Plasma Cell Disorder

42 Summary of Regional Stages 42 A = Code 2, regional by direct extension B = Code 3, regional lymph nodes C = Code 4, both direct extension & regional lymph nodes

43 Note for Codes 3 & 4 43 Both 3 & 4 = regional lymph node involvement Check Regional LNs Positive for agreement!

44 Distant 44

45 Code 7: Distant Sites(s)/Node(s) Involved 45 Cancer cells spread from the primary site Extension from primary organ beyond adjacent or regional tissue/organ(s) into next organ Travel in lymph channels beyond the first (regional) drainage area Hematogenous or blood-borne metastases Spread through fluids in a body cavity Common metastatic sites: bone, brain, liver, lung

46 Code 7: Distant Sites(s)/Node(s) Involved, cont d 46 Some Hematopoietic neoplasms ALWAYS code 7 Leukemias, myelodysplastic/myeloproliferative disorders See Summary Stage manual for histology-specific instructions (HemeRetic chapter) Continuous mets vs discontinuous mets Continuous mets are direct extension from primary tumor to metastatic sites May be regional or distant, check specific chapters Discontinuous mets are indirect extension from primary tumor to metastatic sites Distant Code 7 not applicable for Ill-defined other (includes unknown primary site C809) chapter

47 Distant Sites Example: Breast 47 7 Distant site(s)/lymph node(s) involved Distant site(s) (including further contiguous extension) Adrenal (suprarenal) gland Bone other than adjacent rib Contralateral (opposite) breast-if stated as metastatic Lung Ovary Satellite nodule(s) in skin other than primary breast Skin over Axilla Contralateral (opposite) breast Sternum Upper abdomen Distant lymph node(s), NOS Axillary, contralateral or bilateral Cervical, NOS Internal mammary (parasternal), contralateral or bilateral Supraclavicular (transverse cervical), ipsilateral or contralateral Distant metastasis, NOS Carcinomatosis Distant metastasis WITH or WITHOUT distant lymph node(s)

48 Code 8: Benign/Borderline 48 Applicable ONLY for the following chapters Brain CNS Other Intracranial Gland Behavior MUST be 0 or 1 Note: If your registry (central or hospital) collects other 0 s or 1 s SS2018 MUST be 9

49 Code 9: Unknown if Extension or Metastasis (Unstaged, Unknown or Unspecified) 49 Summary Stage MUST be 9 for C420-C424, C770-C775, C778-C779 (excluding ) and C760-C765, C767-C768, C809 Death Certificate only cases Used by default for Death Certificate Only (DCO) cases; however, assign appropriate SS2018 when specific staging information available on death certificate Use code 9 sparingly for all other cases

50 Code 9: Unknown if Extension or Metastasis (Unstaged, Unknown or Unspecified), cont d 50 Examples of when code 9 appropriate Patient expires before workup completed Patient refuses diagnostic or treatment procedure Limited workup due to patient s age or simultaneous comorbid or contraindicating condition Only biopsy done and does not provide enough information to assign stage

51 51 SS2018 Appendices

52 Appendix I 52 Lymph Node/Lymph Node Chain Reference Table Same table used in Hematopoietic & Lymphoid Neoplasm Coding Manual

53 Appendix II 53 Summary Stage 2018 (SS2018) Chapters Based on Primary Site and/or Histology, Solid Tumors ( ) Detailed description of primary sites and/or histology combinations included in each SS2018 chapter Primary site order Includes information on which chapters require Schema Discriminator Provided to registry software vendors & will be part of registry software

54 Appendix II Example: Breast 54 Primary Site(s) Description Histology SS2018 Chapter

55 Appendix III 55 Summary Stage 2018 (SS2018) Chapters Based on Histology and/or Primary Site, Hematopoietic and Lymphoid Neoplasms ( ) Detailed description of histology combinations included in each SS2018 chapter SS2018 Order Grouped by histology Includes information on which chapters require Schema Discriminator Provided to software vendors & will be part of registry software

56 56

57 2018 Summary Stage Link 57

58 58 Online manual Only No printed copies will be made available PDF format Can be printed from PDF 365 pgs complete manual 30 pgs general instructions Manual.pdf

59 59

60 60 Thank you!! Questions?