Q&A. Collecting Cancer Data: Breast. Collecting Cancer Data: Breast 4/7/2011. NAACCR Webinar Series 1. Agenda

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1 Cllecting Cancer Data: Breast April 7, 2011 NAACCR Webinar Series 1 Q&A Please submit all questins cncerning webinar cntent thrugh the Q&A panel 2 Agenda Overview Primary Site Reginal Lymph Ndes Distant Metastasis Prgnstic Factrs CSV2 Case Scenari 3 NAACCR Webinar Series 1

2 Primary Site 1. Chest Wall Ribs Intercstal muscles Serratus anterir muscle 2. Pectral Muscle 4 Right 12:00 12:00 Left 9:00 3:00 9:00 3:00 6:00 6:00 5 Primary Site Cding Primary Site Cde the subsite with the invasive tumr when the pathlgy reprt identifies invasive tumr in ne subsite and in situ tumr in a different subsite r subsites. Cde the specific quadrant fr multifcal tumrs all within ne quadrant D nt cde C509 (Breast, NOS) in this situatin 6 NAACCR Webinar Series 2

3 Primary Site Cde the primary site t C508 when There is a single tumr in tw r mre subsites and the subsite in which the tumr riginated is unknwn There is a single tumr lcated at the 12, 3, 6, r 9 clck psitin n the breast Cde the primary site t C509 when there are multiple tumrs (tw r mre) in at least tw quadrants f 7 Grade Histlgic grade, differentiatin, cdes 1 = well differentiated 2 = mderately differentiated 3= prly differentiated 4= undifferentiated 8 Nttingham Cmbined Histlgic Grade Frequency f cell mitsis Glandular/Tubule frmatin Nuclear plemrphism Overall Grade Grade 1: scres f 3, 4, r 5 Grade 2: scres f 6 r 7 Grade 3: scres f 8 r 9 9 NAACCR Webinar Series 3

4 Grade Cde BR (Nttingham) Scre BR Grade Nuclear Grade Terminlgy Lw 1/3 r ½ Well Differentiated 2 6 r 7 Intermediate 2/3 Mderately Differentiated 3 8 r 9 High 2/2 r 3/3 Prly Differentiated /4 Undifferentiated r Anaplastic Histlgic Grade I r I/III r 1/3 II r II/III r 2/3 III r III/III r 3/3 IV r IV/IV r 4/4 10 Questin Final pathlgy Infiltrating ductal carcinma Nttingham scre f 7 Hw d we cde Grade Grade Path Value Grade Path System 11 Questin A bipsy f the breast shwed a Nttingham scre f 6. The lumpectmy shwed a Nttingham scre f 4. D yu take the higher scre, r the scre where the mst tissue was resected? 12 NAACCR Webinar Series 4

5 Answer The grade plays a rle in determining treatment and prgnsis, s it is imprtant t have the highest scre recrded, even if nly a small part f the tumr was mre aggressive since this affects survival. CAnswer Frum When the pathlgy reprt(s) lists mre than ne grade f tumr, cde t the highest grade, even if the highest grade is nly a fcus. Rule G, ICD-O-3, p Ductal Carcinma In Situ A malignant carcinma arising in the lining f the milk ducts. Has nt yet invaded nearby tissues. 14 Ductal Carcinma In Situ ICD O 3 Cde Type 8201 Cribrifrm 8230 Slid 8401 Apcrine 8500 Ductal Carcinma In Situ (Intraductal, NOS) 8501 Cmed 8503 Papillary 8504 Intracystic carcinma 8507 Micrpapillary/Clinging 15 NAACCR Webinar Series 5

6 Intraductal mixed with ther subtypes Intraductal and tw r mre f the histlgies in belw r tw r mre f the histlgies belw are cded t 8523/2 (intraductal mixed with ther types f carcinma) Cribrifrm Slid Apcrine Papillary Micrpapillary Clinging 16 Ductal Carcinma 70-80% f all invasive carcinmas are Ductal in rigin. 17 Ductal Carcinma ICD O 3 Cde Type 8022 Plemrphic carcinma 8035 Carcinma with steclast-like cells 8500 Ductal carcinma, NOS 8501 Cmedcarcinma 8502 Secretry carcinma 8503 Intraductal papillary adencarcinma with invasin 8508 Cystic hypersecretry carcinma 18 NAACCR Webinar Series 6

7 Ductal Carcinma A tumr with infiltrating ductal carcinma and any f the ther histlgies listed belw shuld be cded t 8523/3 (infiltrating duct mixed with ther types f carcinma) Tubular -Secretry carcinma Apcrine -Intracystic carcinma, ns Mucinus -Medullary Intraductal papillary adencarcinma with invasin 19 Paget Disease Mre than 95 percent f peple with Paget disease f the nipple als have underlying breast cancer. Symptms include redness and mild scaling and flaking f the nipple skin 20 Paget Disease If Paget disease is present and the underlying tumr is either ductal carcinma r ductal carcinma in situ, cnsider a single primary. Rule M9 MP/H 21 NAACCR Webinar Series 7

8 Paget Disease When Paget disease is present and stated t be in situ and the underlying tumr is intraductal carcinma, cde 8543/2 Rule H24 When Paget disease (NOS) is present and the underlying tumr is intraductal, cde 8543/3 Rule H25 When Paget disease is present and the underlying tumr is invasive ductal, cde 8541/3 Rule H26 22 Inflammatry Carcinma Clinical/pathlgic disease Characterized by diffuse erythema and edema (peau d range) invlving mre than 1/3 f the breast. Skin changes are due t tumr in the dermal lymphatics An underlying mass is ften present A bipsy is dne t prve the presence f an invasive malignancy 23 Inflammatry Carcinma Inflammatry carcinma in ne r bth breasts is a single primary Rule M2 if a single underlying tumr is present Rule M6 if multiple underlying tumrs are present 24 NAACCR Webinar Series 8

9 Inflammatry Carcinma Only use cde 8530 (inflammatry carcinma) when the final diagnsis f the pathlgy reprt specifically states inflammatry carcinma. Rule H13 if a single underlying tumr is present Rule H22 if multiple underlying tumrs are present 25 Reginal Lymph Ndes 26 Level 3 Level 2 Level 1 27 NAACCR Webinar Series 9

10 Reginal Lymph Ndes Axillary lymph ndes level I Lw axillary Intramammary Axillary lymph ndes level II Mid axillary Interpectral Rtter's ndes Axillary lymph ndes level III High axillary Apical Infraclavicular Invlvement f Level I r II axillary ndes is assigned AJCC N1 r N2 Invlvement f Level III axillary ndes is assigned an AJCC N3a 28 Sentinel Lymph Nde Bipsy 29 Distant Metastasis The fur majr sites f metastatic invlvement are Bne Lung Brain Liver Disseminated tumr cells (DTCs) Circulating tumr cells (CTCs) 30 NAACCR Webinar Series 10

11 Clinically Significant Prgnstic Factrs Paget s disease Blm Scarff Richardsn Grade Estrgen receptrs Prgesterne receptrs HER2 status Methd f nde assessment Immunhistchemistry(IHC) testing f lymph ndes Multigene signature scre 31 Questins? 32 Cllabrative Stage Data Cllectin System V NAACCR Webinar Series 11

12 CS Tumr Size: Breast Assign Stated as T_ when n ther infrmatin n tumr size is available Stated as T1mi; assign cde 990 Stated as T1a; assign cde 005 Stated as T1b; assign cde 991 Stated as T1 (NOS) r T1c; assign cde 992 Stated as T2; assign cde 995 Stated as T3; assign cde CS Tumr Size: Breast When cding pathlgic tumr size f breast tumr Cde size f invasive prtin f tumr if tumr is bth invasive and in situ Cde size f entire tumr if tumr is bth invasive and in situ and size f invasive prtin is nt given 35 CS Extensin: Breast Assign Stated as T_ CS Extensin cde when n ther infrmatin n extensin is available Additinal cdes available in CS v02.03 Sme cdes changed in v NAACCR Webinar Series 12

13 CS Extensin: Breast Assign CS Extensin cdes fr skin invlvement as described in the cde WITHOUT diagnsis f inflammatry carcinma Assign CS Extensin cde 600 fr diagnsis f inflammatry carcinma WITH clinical descriptin f specific skin invlvement in less than 1/3 f skin f breast Assign CS Extensin cdes fr diagnsis f inflammatry carcinma with clinical descriptin f skin invlvement as described in the cde 37 CS Lymph Ndes: Breast Certain CS Lymph Ndes cdes are nly used if ndes are evaluated clinically CS Lymph Ndes Eval cde = 0, 1, 5, r 9 Certain CS Lymph Ndes cdes are nly used if ndes are evaluated pathlgically CS Lymph Ndes Eval cde = 2, 3, 6, r 8 38 CS Lymph Ndes: Breast Lymph ndes evaluated clinically Cde 255 Cde 257* Cde 510 Cde 610* Cde 735* Cde 810* *New in v NAACCR Webinar Series 13

14 CS Lymph Ndes: Breast Lymph Ndes Evaluated Pathlgically Cde 050 Cde 130 Cde 150 Cde 155* Cde 250 Cde 258* Cde 520 Cde 620* Cde 710 Cde 720 Cde 730 Cde 815 *New in v CS Lymph Ndes: Breast Islated tumr cells (ITC) Single tumr cells r clusters nt greater than 0.2 mm Micrmetastases Tumr depsits greater than 0.2 mm but nt greater than 2.0 mm Macrmetastases Tumr depsits greater than 2.0 mm 41 CS Mets at DX: Breast Assign cde 00 (n distant metastasis) unless there is dcumented evidence f distant metastasis Assign cde 05 if there is n clinical r radigraphic evidence f metastasis but there are circulating tumr cells (CTC), bne marrw micrmetastases, r disseminated tumr cells 0.2 mm r less in size in distant tissue detected mlecularly r micrscpically 42 NAACCR Webinar Series 14

15 SSF1: Estrgen Receptr (ER) Assay SSF2: Prgesterne Receptr (PR)Assay Recrd highest value fr ERA and/r PRA if mre than 1 value is reprted Recrd pre-treatment ERA and/r PRA if patient is given neadjuvant therapy unless there are n pretreatment ERA and/r PRA results D nt recrd ERA and/r PRA results frm multigene test in SSF1 r SSF2 43 SSF3: Number f Psitive Ipsilateral Level I-II Axillary Lymph Ndes Cde number f psitive ipsilateral level I and II axillary ndes and intramammary ndes D nt include level III axillary ndes, internal mammary, r supraclavicular ndes that are invlved D nt cde lymph ndes with nly islated tumr cells (ITC) Assign cde 098 if n ipsilateral axillary ndes are remved and pathlgically examined Based n pathlgic infrmatin nly 44 SSF4 and SSF5 SSF 4: Immunhistchemistry (IHC) f Reginal Lymph Ndes SSF5: Mlecular (MOL) Studies f Reginal Lymph Ndes Reverse Transcriptase Plymerase Chain Reactin (RT-PCR) Cde invlvement r nn-invlvement f reginal ndes by ITC ITC are single tumr cells r clusters nt greater than 0.2 mm 45 NAACCR Webinar Series 15

16 SSF6: Size f Tumr-Invasive Cmpnent Indicates hw pathlgical tumr size was cded in CS Tumr Size Assign cde 987 if clinical tumr size is cded in CS Tumr Size 46 SSF7: Nttingham r Blm-Richardsn (BR) Scre/Grade BR scre is based n: Degree f tubule frmatin Mittic activity Nuclear plemrphism Cde in the fllwing pririty 1. BR scres BR grade (lw, intermediate, high) Cde highest scre if multiple scres are dcumented 47 HER2 Testing Human Epidermal grwth factr Receptr 2 Fur knwn HER prteins HER1, 2, 3, and 4 Testing fr ver expressin f HER2 48 NAACCR Webinar Series 16

17 HER2 Testing Usually nly ne test will be perfrmed Immunhistchemistry (IHC) Flurescence In Situ Hybridizatin (FISH) Chrmgenic In Situ Hybridizatin (CISH) May be referred t as: HER2, HER2 neu, c-erbb2, c-neu 49 HER2 Test Lab Values and Interpretatins SSF8 & SSF9: HER2 IHC Test Lab value is a scre 0 r SSF10 & SSF11: HER2 FISH Test Lab value is a rati between the number f cpies f Her2/neu gene and number f cpies f chrmsme HER2 Test Lab Values and Interpretatins SSF12 & SSF13: HER2 CISH Test Lab value is mean number f cpies f HER2/neu gene n either 30 r 60 tumr cells SSF14: Other r Unknwn HER2 Test Silver in-situ hybridizatin (SISH) Rapid in situ hybridizatin against mrna (RISH) 51 NAACCR Webinar Series 17

18 HER2 Test Lab Values and Interpretatins SSF15: Her2 Summary Results If multiple HER2 tests are perfrmed, gene-amplificatin (in situ hybridizatin) test takes precedence If IHC is perfrmed t clarify results f a brderline/equivcal gene-amplificatin test, cde IHC results If results f 1 test are available and it is knwn that a 2 nd test was perfrmed and results are nt available, use cde 997 (test rdered, results nt in chart) 52 SSF16: Cmbinatins f ER, PR, and HER2 Results Identifies patients wh are triple negative ER negative, PR negative, HER2 negative Less likely t respnd t hrmne therapy r Herceptin Cde ER results in 1st digit, PR results in 2 nd digit, HER2 results in 3 rd digit Assign cde 999 if 1 r mre f tests is nt perfrmed 53 SSF17: Circulating Tumr Cells (CTC) and Methd f Detectin Recrd whether CTC are present and test used t detect them CTC Depsits f mlecularly r micrscpically detected tumr cells in circulating bld Tests Immunmagnetic separatin (IMS) Reverse transcriptin plymerase chain reactin (RT-PCR) 54 NAACCR Webinar Series 18

19 SSF17: Circulating Tumr Cells (CTC) and Methd f Detectin Recrd whether CTC are present and test used t detect them CTC Depsits f mlecularly r micrscpically detected tumr cells in circulating bld Tests Immunmagnetic separatin (IMS) Reverse transcriptin plymerase chain reactin (RT-PCR) 55 SSF18: Disseminated Tumr Cells (DTC) and Methd f Detectin Recrd whether DTC are present and test used t detect them DTC Depsits f mlecularly r micrscpically detected tumr cells in bne marrw r ther nn-reginal ndal tissue n larger than 0.2 mm Tests Immunhistchemistry (IHC) Reverse transcriptin plymerase chain reactin (RT-PCR) 56 SSF19: Assessment f Psitive Ipsilateral Axillary Lymph Ndes Recrd infrmatin used t determine the number f psitive axillary and intramammary lymph ndes cded in SSF3 (Number f Psitive Ipsilateral Level I-II Axillary Lymph Ndes) Examples: Clinical nly; fine needle aspiratin; cre bipsy; sentinel lymph nde bipsy; lymph nde dissectin 57 NAACCR Webinar Series 19

20 SSF20: Assessment f Psitive Distant Metastases Recrd infrmatin used t determine metastases cded in CS Mets at DX, CS Mets at DX - Bne, CS Mets at DX - Brain, CS Mets at DX - Liver, and CS Mets at DX Lung Assign cde 000 if CS Mets at DX is assigned cde 00 Use highest cde that applies if multiple methds were used 58 SSF21: Respnse t Neadjuvant Therapy Cde clinician s statement regarding respnse t neadjuvant therapy D nt interpret r infer ther dcumentatin int a respnse 59 SSF22: Multigene Signature Methd SSF23: Multigene Signature Results Multigene signature testing Evaluates multiple genes frm the tumr specimen Plans treatment Evaluates prgnsis Predicts recurrence Types: Onctype DX; MammaPrint; IHC- based Multigene Predictrs; FISH-based Predictrs; RT-PCR-based Multigene Predictrs; Genmic Micrarray-based Multigene Predictrs 60 NAACCR Webinar Series 20

21 SSF24: Paget Disease Recrd absence r presence f Paget disease Recrd any mentin f Paget disease, clinical r pathlgic, giving pathlgic pririty Cde 020 New in v02.03 Stated as pagetid invlvement f nipple D nt assign cde 020 if pagetid invlvement is f ducts r lbules 61 Standard Setters SSF Requirements fr Breast Cmmissin n Cancer and NCI/SEER Required SSF1 SSF14, SSF21 23 SSF15 beginning with CS v02.03 CDC/NPCR Required SSF1, SSF2 SSF15, SSF16 beginning with CS v02.03 Required t calculate AJCC stage; required when available SSF3 SSF5, SSF8 SSF Standard Setters SSF Requirements fr Breast Canadian Cuncil f Cancer Registries Cllected in CSv1 SSF1, SSF2, SSF6 Essential fr TNM SSF3 SSF5 Essential fr decisin making SSF7 SSF16 Cllect if in pathlgy reprt SSF17, SSF18, SSF21- SSF24 Cllect if readily available in chart SSF19, SSF NAACCR Webinar Series 21

22 Case Scenaris 64 Case Scenari 1 1/3/11-A 57 year ld white female presents fr her annual mammgram and is fund t have a suspicius area f calcificatin, spread ut ver at least 4 centimeters. 1/7/11 Final Pathlgy frm steretactic bipsy-high grade Ductal carcinma insitu ER 95% (psitive) and PR 90% (psitive) HER2/Neu-Negative per IHC 1/7/11-MRI f the breast did nt shw any additinal areas f abnrmality. She was referred t a surgen fr breast cnserving surgery t be fllwed by radiatin. 65 Case Scenari 1 1/27/11 Final pathlgy frm lumpectmy High-grade DCIS, with n invasin. The specimen dimensin was 4.6 cm x 3.5 cm x 1.6 cm. Architectural patterns: cribrifrm, micrpapillary, papillary, slid. Necrsis: Present, fcal. 9 mm negative margin. 2/15/2011 Radiatin The patient received IMRT 45 Gy at 1.8 Gy per fractin fr 25 fractins. 2/30/2011-Tamxifin Patient started a 5 year curse f tamxifen 66 NAACCR Webinar Series 22

23 Case Scenari 1 Hw many primaries are present? Hw wuld we cde the histlgy? 67 Case Scenari 1 TS Ext TS/Ext Eval LN s LN Eval RN Ps RN Ex Mets Mets Eval SSF 1 SSF 2 SSF 3 SSF 4 SSF 5 SSF 6 SSF 7 SSF 8 SSF 9 68 Case Scenari 1 SSF 10 SSF 11 SSF 12 SSF 13 SSF 14 SSF 15 SSF 16 SSF 17 SSF 18 SSF 19 SSF 20 SSF 21 SSF 22 SSF 23 SSF 24 SSF NAACCR Webinar Series 23

24 Case Scenari 1 Surgical Cdes Surgical Prcedure f Primary Site Scpe f Reginal Lymph Nde Surgery Surgical Prcedure/Other Site Systemic Therapy Cdes Chemtherapy Hrmne Therapy Immuntherapy Hematlgic Transplant/Endcrine Prc 70 Case Scenari 1 Radiatin Radiatin Treatment Vlume Radiatin Treatment Mdality Reginal Dse Bst Treatment Mdality Bst Dse Number f Treatments t Vlume Reasn n Radiatin 71 Case Scenari 2 62 year ld female presented with a large palpable mass in the left breast. Mammgram shwed a 5.7cm mass highly suspicius fr malignancy. Physical exam revealed a single level I mvable enlarged axillary lymph nde. Additinal imaging was negative. 72 NAACCR Webinar Series 24

25 Case Scenari 2 Cre needle bipsy f primary tumr-final reprt Infiltrating ductal carcinma with features f cmedcarcinma Estrgen receptr psitive Prgesterne receptr psitive Her 2/Neu 2+ equivcal n IHC Her 2/Neu 2.4 psitive n FISH Nttingham scre 7 Cre needle bipsy f enlarged axillary lymph nde Metastatic ductal carcinma Clinical AJCC Stage T3 N1 f M0 Stage IIB 73 Case Scenari 2 The patient pted fr neadjuvant treatment fllwed by breast cnserving surgery. Cncurrent chemtherapy and hrmne therapy fr nine weeks. Per the physicians ntes she experienced a near ttal respnse t the chemtherapy. 74 Case Scenari 2 Final pathlgy reprt-lumpectmy and axillary nde dissectin. Largest dimensin f invasive tumr: 1.7cm Extensin: N skin, nipple r skeletal muscle invlvement Histlgic type: Invasive ductal carcinma, cmed type Blm Scarff Richardsn grade: Grade 2 Margins: Negative Partial respnse t presurgical therapy 75 NAACCR Webinar Series 25

26 Case Scenari 2 Final pathlgy reprt-lumpectmy and axillary nde dissectin 23 axillary lymph ndes negative fr metastasis AJCC Stage yp1c N0 Stage Ia Adjuvant therapy included cntinuatin f hrmne therapy and IMRT radiatin therapy 50 Gy in 2Gy fractins t the whle breast and reginal ndes ver 25 days. 10 Gy Bst in 2Gy fractins ver 5 days t the tumr bed. 76 Case Scenari 2 Hw many primaries are present? Hw wuld we cde the histlgy? 77 Case Scenari 2 TS Ext TS/Ext Eval LN s LN Eval RN Ps RN Ex Mets Mets Eval SSF 1 SSF 2 SSF 3 SSF 4 SSF 5 SSF 6 SSF 7 SSF 8 SSF 9 78 NAACCR Webinar Series 26

27 Case Scenari 2 SSF 10 SSF 11 SSF 12 SSF 13 SSF 14 SSF 15 SSF 16 SSF 17 SSF 18 SSF 19 SSF 20 SSF 21 SSF 22 SSF 23 SSF 24 SSF Case Scenari 2 Surgical Prcedure f Primary Site Scpe f Reginal Lymph Nde Surgery Surgical Prcedure/Other Site Systemic Therapy Chemtherapy Hrmne Therapy Immuntherapy Hematlgic Transplant/Endcrine Prc 80 Case Scenari 2 Radiatin Radiatin Treatment Vlume Radiatin Treatment Mdality Reginal Dse Bst Treatment Mdality Bst Dse Number f Treatments t Vlume Reasn N Radiatin 81 NAACCR Webinar Series 27

28 Case Scenari 3 Physician Office Reprt 1/3/11 A 47 year female presents with changes t her left breast. She was diagnsed with ductal carcinma f the left breast in February f At that time she underwent breast cnserving surgery with an axillary nde dissectin shwing 3 f 21 psitive lymph ndes. She received chemtherapy and radiatin. 82 Case Scenari 3 She recently presented t my ffice with cncerns that her left breast has becme swllen, warm t the tuch and that areas f the skin had becme thickened and pinkish. Physical exam revealed edema and a peau d range appearance t the breast. Als nted was a palpable mass in the lwer inner prtin f her breast. A steretactic needle bipsy was perfrmed and she was fund t have invasive ductal carcinma, ER and PR psitive, HER2/neu 3+ (psitive) per IHC. She was referred t an nclgist fr treatment planning. 83 Scenari 3 Onclgy Cnsult/Assessment and Plan 1/12/11 A patient with a previus histry f ductal carcinma nw presents with inflammatry breast cancer invlving a little less than half her breast. A cmplete staging wrk-up revealed a 4.8cm tumr in the left breast. N direct invlvement f the skin r chest wall. It is nted that the axillary ndes were previusly remved. N metastasis is nted. Hwever, IMS testing fr circulating tumr cells was psitive. It wuld be my plan t treat her relatively quickly with presurgical chemtherapy. If she respnds t the chemtherapy this will be fllwed by mastectmy and additinal chemtherapy. Due t previus radiatin she is nt a candidate fr additinal radiatin treatment. 84 NAACCR Webinar Series 28

29 Scenari 3 Prgress ntes 2/21/11 Patient received a nine week preperative curse f anthracycline, taxane, and trastuzumab. She had an excellent partial respnse t treatment. She has been scheduled fr a simple mastectmy with insertin f a tissue expander later this week. 85 Scenari 3 Simple mastectmy 2/28/11 Final Reprt Histlgic type: Invasive ductal carcinma Largest dimensin f invasive tumr: 1.3cm Extensin: Invlvement f the dermal lymphatics by tumr embli. Nttingham scre: 8 Definite respnse t presurgical therapy 86 Scenari 3 Onclgy Prgress Reprt - 4/1/11 She started her final curse f anthracycline and taxane last week. She will cntinue t take her Herceptin until she cmpletes her ne year curse. She started her five year curse f Tamxifen. 87 NAACCR Webinar Series 29

30 Case Scenari 3 Hw many primaries are assigned t this patient Hw wuld we cde the histlgy? 88 Case Scenari 3 TS Ext TS/Ext Eval LN s LN Eval RN Ps RN Ex Mets Mets Eval SSF 1 SSF 2 SSF 3 SSF 4 SSF 5 SSF 6 SSF 7 SSF 8 SSF 9 89 Case Scenari 3 SSF 10 SSF 11 SSF 12 SSF 13 SSF 14 SSF 15 SSF 16 SSF 17 SSF 18 SSF 19 SSF 20 SSF 21 SSF 22 SSF 23 SSF 24 SSF NAACCR Webinar Series 30

31 Case Scenari 2 Surgical Prcedure f Primary Site Scpe f Reginal Lymph Nde Surgery Surgical Prcedure/Other Site Systemic Therapy Chemtherapy Hrmne Therapy Immuntherapy Hematlgic Transplant/Endcrine Prc 91 Case Scenari 3 Radiatin Radiatin Treatment Vlume Radiatin Treatment Mdality Reginal Dse Bst Treatment Mdality Bst Dse Number f Treatments t Vlume Reasn N Radiatin 92 Questins? 93 NAACCR Webinar Series 31

32 Standard Setters SSF Requirements fr Breast Cmmissin n Cancer and NCI/SEER Required SSF1 SSF14, SSF21 23 SSF15 beginning with CS v02.03 CDC/NPCR Required SSF1, SSF2 SSF15, 16 beginning with CS v02.03 Required t calculate AJCC stage; required when available SSF3 SSF5, SSF8 SSF Standard Setters SSF Requirements fr Breast Canadian Cuncil f Cancer Registries Cllected in CSv1 SSF1, SSF2, SSF6 Essential fr TNM SSF3 SSF5 Essential fr decisin making SSF7 SSF16 Cllect if in pathlgy reprt SSF17, SSF18, SSF21- SSF24 Cllect if reading available in chart SSF19, SSF Thank Yu! Cllecting Cancer Data: Prstate May 5, NAACCR Webinar Series 32

33 UNKNOWN IF SINGLE OR MULTIPLE TUMORS MULTIPLE PRIMARY RULES Rule M1 When it is nt pssible t determine if there is a single tumr r multiple tumrs, pt fr a single tumr and abstract as a single primary. SINGLE TUMOR Rule M2 Inflammatry carcinma in ne r bth breasts is a single primary. Rule M3 A single tumr is always a single primary MULTIPLE TUMORS Rule M4 Tumrs in sites with ICD-O-3 tpgraphy cdes (Cxxx) with different secnd (Cxxx) and/r third characters (Cxxx) are multiple primaries. Rule M5 Tumrs diagnsed mre than five (5) years apart are multiple primaries Rule M6 Inflammatry carcinma in ne r bth breasts is a single primary. Rule M7 Tumrs n bth sides (right and left breast) are multiple primaries. Rule M8 An invasive tumr fllwing an in situ tumr mre than 60 days after diagnsis is a multiple primary. Rule M9 Tumrs that are intraductal r duct and Paget Disease are a single primary. Rule M10 Tumrs that are lbular (8520) and intraductal r duct are a single primary. Rule M11 Multiple intraductal and/r duct carcinmas are a single primary. Rule M12 Tumrs with ICD-O-3 histlgy cdes that are different at the first (xxxx), secnd (xxxx) r third (xxxx) number are multiple primaries. Rule M13 Tumrs that d nt meet any f the abve criteria are abstracted as a single primary.

34 HISTOLOGY RULES SINGLE TUMOR: IN SITU ONLY Rule H1 Cde the histlgy dcumented by the physician when the pathlgy/cytlgy reprt is nt available. Rule H2 Cde the histlgy when nly ne histlgic type is identified Rule H3 Cde the mre specific histlgic term when the diagnsis is: Carcinma in situ, NOS (8010) and a specific carcinma in situ r Adencarcinma in situ, NOS (8140) and a specific adencarcinma in situ r Intraductal carcinma, NOS (8500) and a specific intraductal carcinma (Table 1) Rule H4 Cde 8501/2 (cmedcarcinma, nn-infiltrating) when there is nn-infiltrating cmedcarcinma and any ther intraductal carcinma (Table 1). Rule H5 Cde 8522/2 (intraductal carcinma and lbular carcinma in situ) (Table 3) when there is a cmbinatin f in situ lbular (8520) and intraductal carcinma (Table 1). Rule H6 Cde 8523/2 (intraductal carcinma mixed with ther types f in situ carcinma) (Table 3) when there is a cmbinatin f intraductal carcinma and tw r mre specific intraductal types OR there are tw r mre specific intraductal carcinmas. Rule H7 Cde 8524/2 (in situ lbular mixed with ther types f in situ carcinma) (Table 3) when there is in situ lbular (8520) and any in situ carcinma ther than intraductal carcinma (Table 1). Rule H8 Cde 8255/2 (adencarcinma in situ with mixed subtypes) (Table 3) when there is a cmbinatin f in situ/nn-invasive histlgies that des nt include either intraductal carcinma (Table 1) r in situ lbular (8520). SINGLE TUMOR: INVASIVE ONLY Rule H10 Cde the histlgy dcumented by the physician when there is n pathlgy/cytlgy specimen r the pathlgy/cytlgy reprt is nt available. Rule H11 Cde the histlgy frm a metastatic site when there is n pathlgy/cytlgy specimen frm the primary site. Rule H12 Cde the mst specific histlgic term when the diagnsis is: Carcinma, NOS (8010) and a mre specific carcinma r Adencarcinma, NOS (8140) and a mre specific adencarcinma r Duct carcinma, NOS (8500) and a mre specific duct carcinma (8022, 8035, ) r Sarcma, NOS (8800) and a mre specific sarcma Rule H13 Cde 8530 (inflammatry carcinma) nly when the final diagnsis f the pathlgy reprt specifically states inflammatry carcinma. Rule H14 Cde the histlgy when nly ne histlgic type is identified. Rule H15 Cde the histlgy with the numerically higher ICD-O-3 cde when there are tw r mre specific duct carcinmas.

35 Rule H16 Cde 8522 (duct and lbular) when there is a cmbinatin f lbular (8520) and duct carcinma (Table 3). Rule H17 Cde 8523 (duct mixed with ther types f carcinma) when there is a cmbinatin f duct and any ther carcinma (Table 3). Rule H18 Cde 8524 (lbular mixed with ther types f carcinma) when the tumr is lbular (8520) and any ther carcinma (Table 3). Rule H19 Cde 8255 (adencarcinma with mixed subtypes) (Table 3) fr multiple histlgies that d nt include duct r lbular (8520). MULTIPLE TUMORS ABSTACTED AS A SINGLE PRIMARY Rule H20 Cde the histlgy dcumented by the physician when there is n pathlgy/cytlgy specimen r the pathlgy/cytlgy reprt is nt available. Rule H21 Cde the histlgy frm a metastatic site when there is n pathlgy/cytlgy specimen frm the primary site. Rule H22 Cde 8530 (inflammatry carcinma) nly when the final diagnsis f the pathlgy reprt specifically states inflammatry carcinma. Rule H23 Cde the histlgy when nly ne histlgic type is identified. Rule H24 Cde 8543/2 (in situ Paget disease and intraductal carcinma) (Table 3) when the pathlgy reprt specifically states that the Paget disease is in situ and the underlying tumr is intraductal carcinma (Table 1). Rule H25 Cde 8543/3 (Paget disease and intraductal carcinma) fr Paget disease and intraductal carcinma (Table 3). Rule H26 Cde 8541/3 (Paget disease and infiltrating duct carcinma) fr Paget disease and invasive duct carcinma.(table 3). Rule H27 Cde the invasive histlgy when bth invasive and in situ tumrs are present. Rule H28 Cde 8522 (duct and lbular) when there is any cmbinatin f lbular (8520) and duct carcinma. (Table 3). Rule H29 Cde the histlgy with the numerically higher ICD-O-3 cde.

36 BREAST C50.0 C50.9 (Except fr M-9727, 9733, , , 9832, , , , and ) Cdes 00 Nne; n surgery f primary site; autpsy ONLY 19 Lcal tumr destructin, NOS N specimen was sent t pathlgy fr surgical events cded 19 (principally fr cases diagnsed prir t January 1, 2003). 20 Partial mastectmy, NOS; less than ttal mastectmy, NOS 21 Partial mastectmy WITH nipple resectin 22 Lumpectmy r excisinal bipsy 23 Reexcisin f the bipsy site fr grss r micrscpic residual disease 24 Segmental mastectmy (including wedge resectin, quadrantectmy, tylectmy) Prcedures cded remve the grss primary tumr and sme f the breast tissue (breast cnserving r preserving). There may be micrscpic residual tumr. 30 Subcutaneus mastectmy A subcutaneus mastectmy, als called a nipple sparing mastectmy, is the remval f breast tissue withut the nipple and arelar cmplex r verlying skin. It is perfrmed t facilitate immediate breast recnstructin. Cases cded 30 may be cnsidered t have undergne breast recnstructin. 40 Ttal (simple) mastectmy 41 WITHOUT remval f uninvlved cntralateral breast 43 With recnstructin NOS 44 Tissue 45 Implant 46 Cmbined (Tissue and Implant) 42 WITH remval f uninvlved cntralateral breast 47 With recnstructin NOS 48 Tissue 49 Implant 75 Cmbined (Tissue and Implant) A ttal (simple) mastectmy remves all breast tissue, the nipple, and arelar cmplex. An axillary dissectin is nt dne. Fr single primaries nly, cde remval f invlved cntralateral breast under the data item Surgical Prcedure/Other Site (NAACCR Item #1294) r Surgical Prcedure/Other Site at This Facility (NAACCR Item #674). If cntralateral breast reveals a secnd primary, each breast is abstracted separately. The surgical prcedure is cded 41 fr the first primary. The surgical cde fr the cntralateral breast is cded t the prcedure perfrmed n that site. Recnstructin that is planned as part f first curse treatment is cded r 75, whether it is dne at the time f mastectmy r later. 50 Mdified radical mastectmy 51 WITHOUT remval f uninvlved cntralateral breast 53 Recnstructin 54 Tissue 55 Implant 56 Cmbined (Tissue and Implant)

37 52 WITH remval f uninvlved cntralateral breast 57 Recnstructin, NOS 58 Tissue 59 Implant 63 Cmbined (Tissue and Implant) 60 Radical mastectmy, NOS 61 WITHOUT remval f uninvlved cntralateral breast 64 Recnstructin, NOS 65 Tissue 66 Implant 67 Cmbined (Tissue and Implant) 62 WITH remval f uninvlved cntralateral breast 68 Recnstructin, NOS 69 Tissue 73 Implant 74 Cmbined (Tissue and Implant) 70 Extended radical mastectmy 71 WITHOUT remval f uninvlved cntralateral breast 72 WITH remval f uninvlved cntralateral breast 80 Mastectmy, NOS Specimen sent t pathlgy fr surgical events cded Surgery, NOS 99 Unknwn if surgery perfrmed; death certificate ONLY

38 Radiatin Vlume Cdes 18 Breast The primary target is the intact breast and n attempt has been made t irradiate the reginal lymph ndes. Intact breast includes breast tissue that either was nt surgically treated r received a lumpectmy r partial mastectmy (C50.0 C50.9, Surgical Prcedure f Primary Site [NAACCR Item #1290] cdes 0 24). 19 Breast/lymph ndes A deliberate attempt has been made t include reginal lymph ndes in the treatment f an intact breast. See definitin f intact breast abve. 20 Chest wall Treatment encmpasses the chest wall (fllwing mastectmy). 21 Chest wall/lymph ndes Treatment encmpasses the chest wall (fllwing mastectmy) plus fields directed at reginal lymph ndes.