We re on the Web! Visit us at VOLUME 19 ISSUE 1. January 2015

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1 VOLUME 19 ISSUE 1 January 2015 We re on the Web! Visit us at January is National Cervical Cancer Screening Month. Cervical cancer begins in the lining of the cervix (organ connecting the uterus and the vagina), and is one of the most common cancers of a woman s reproductive organs. In the United States in 2015, there will be an estimated 12,900 new cases and 4,100 deaths due to cervical cancer. The two main types of cancer of the cervix are squamous cell carcinoma (80% - 90%) and adenocarcinoma (10% - 20%). Most cases of cervical cancer are found in women over the age of 30. This type of cancer forms slowly and may not show any symptoms. The primary risk factor that increases a women s chance of developing cervical cancer is Human Papilloma Virus (HPV) infection; other risk factors include smoking, diet, weakened immune system and family history of this cancer. The best way to prevent cervical cancer is to find it early by the Pap test. This screening procedure can find abnormalities in cervical cells before cancer develops. Most cervical cancers are found in women who have not had the Pap test when they should. There are now vaccines that can protect women against HPV. References:

2 Among cancers that affect both men and women, colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer deaths in the United States. Every year, more than 140,000 Americans are diagnosed with colorectal cancer, and more than 50,000 people die from it. Colorectal cancer screening saves lives. If everyone who is 50 years old or older were screened regularly, as many as 60% of deaths from this cancer could be avoided. Reference: Kansas Cancer Registry Spring Meeting 2015 Thursday, April 30, :30AM 3:00PM The University of Kansas Medical Center 3901 Rainbow Blvd., Kansas City, KS Registration is FREE! Questions: Call Victoria Hundley at NCRA NCRA 2015 Annual Education Conference May 20 23, 2015 San Antonio, TX (Check out the National Cancer Registrars Association website at

3 Question A path report is presented to you with fragments from the descending colon, ascending colon, and sigmoid colon all testing positive for adenocarcinoma. All of the fragments were taken at the same time and share the same histology. What would you code the primary site as? Answer The proper primary site coding would be over lapping (C18.8) lesions of the colon; rather than just choosing ascending colon (C18.2), descending colon (C18.6), or sigmoid colon (C18.7) individually. Question For the cervix, the SEER Program Code Manual denotes CIN III and carcinoma in situ of the cervix as not being reportable for cases diagnosed in 1996 or later, but does not list "adenocarcinoma in situ" or "squamous cell carcinoma in situ." Are these histologies still reportable? Answer For the primary site designated as cervix to be reportable, the histology behavior code must be 3 (indicating invasiveness) for all cases diagnosed 1996 or later. Question Reportability--Colon: Is a polypectomy that is questionable for invasive adenocarcinoma followed by a partial colectomy with no identifiable neoplasm considered reportable? Answer This case is non-reportable, because the polypectomy uses ambiguous terminology that is not indicative of a proper diagnosis. The partial colectomy also provides no feasible data for a clinical or pathologic diagnosis. Question MP/H Rules/Histology--Colon: How is histology coded if a patient has two invasive adenocarcinomas in one segment of the colon (e.g. descending colon [C18.6]) with one diagnosed in 2011, and the other diagnosed in 2014? Answer For cases diagnosed , the steps used to arrive at the correct decision are: Step 1: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text) and go to the Colon Histology rules to determine the histology code for this case. The Module you use depends on the behavior and number of tumors identified in the primary site. Step 2: Start at M1 in the section of COLON MULTIPLE PRIMARY RULES. Try using the flowchart in this example. The rules are intended to be reviewed in consecutive order from Rule M1 to Rule M11. Stop at the first rule that applies to the case you are processing. Stop at Rule M11. Step 3: After looking over M1 to M3 with no conclusion we arrive at M4 which would lead us to deduce this example as a multiple primary, but the ICD-O-3 topography codes are the same (C18.6); Therefore, we must move on to rule M5. Rule M5 indicates that if the tumors are diagnosed more than one (1) year apart, they must be multiple primaries. In this example, the diagnosis dates were given in an interval of 3 years. With this three year difference we can safely code for two primaries. Do you have any questions that you would like answered in an upcoming newsletter? your question(s) to: vhundley@kumc.edu

4 Coding Caution SURGICAL DIAGNOSTIC AND STAGING PROCEDURE Identifies the surgical procedure(s) performed in an effort to diagnose and/or stage disease at this facility. This data item is used to track the use of surgical procedure resources that are not considered treatment. Record the type of procedure performed as part of the initial diagnosis and workup at this facility. Code Description Definition 00 None No surgical diagnostic or staging procedure was performed. 01 Biopsy other site A biopsy (incisional, needle or aspiration) was done to a site other than the primary. No exploratory procedure was done. 02 Biopsy primary site A biopsy (incisional, needle or aspiration) was done to the primary site; or biopsy or removal of a lymph node to diagnose or stage lymphoma. 03 Surgical exploration A surgical exploration only. The patient was not biopsied or treated. 04 Bypass no biopsy A surgical procedure with a bypass was performed, but no biopsy was done. 05 Exploratory with biopsy An exploratory procedure was performed, and a biopsy of either the primary site or another site was done. 06 Bypass with biopsy A bypass procedure was performed, and a biopsy of either the primary site or another site was done. 07 Procedure, NOS A procedure was done, but the type of procedure is unknown. 09 No information No information of whether a diagnostic or staging procedure was performed. Example: If both an incisional biopsy of the primary site and an incisional biopsy of a metastatic site are done, use code 02 (Incisional biopsy of primary site). Do NOT use this data item to code: Aspiration, biopsy, or removal of regional lymph nodes Brushings, washings, cell aspiration or hematologic findings Excisional biopsies

5 SCOPE OF REGIONAL LYMPH NODE SURGERY Regional lymph nodes for each site are identified in the SEER Summary Staging Manual 2000 ( Any nodes not specified as regional are distant and should be coded in the data field Surgery of Other/Distant Sites. For the majority of sites, Scope of Regional Lymph Node Surgery defines the removal, biopsy, or aspiration of regional lymph node(s). If no cancer-directed regional lymph node procedure was performed, code 0. There is no minimum number of nodes that must be removed. If at least one regional lymph node was removed, the code for this field must be in the range of 1-5. Code Label Definition 0 None No regional lymph node surgery. No lymph nodes found in the pathologic specimen. Diagnosed at autopsy. 1 Biopsy or aspiration of regional lymph node, NOS Biopsy or aspiration of regional lymph node(s) regardless of the extent of involvement of disease. 2 Sentinel lymph node biopsy Biopsy of the first lymph node or nodes that drain a defined area of tissue within the body. Sentinel node(s) are identified by the injection of a dye or radio label at the site of the primary tumor. 3 Number of regional nodes removed unknown or not stated; regional lymph nodes removed, NOS regional lymph nodes removed 5 4 or more regional lymph nodes removed 6 Sentinel node biopsy and code 3, 4,or 5 at same time, or timing not stated 7 Sentinel node biopsy and code 3, 4, or 5 at different times Sampling or dissection of regional lymph node(s) and the number of nodes removed is unknown or not stated. The procedure is not specified as sentinel node biopsy. Sampling or dissection of regional lymph node(s) with fewer than four lymph nodes found in the specimen. The procedure is not specified as sentinel node biopsy. Sampling or dissection of regional lymph nodes with at least four lymph nodes found in the specimen. The procedure is not specified as sentinel node biopsy. Code 2 was performed in a single surgical event with code 3, 4, or 5. Or, code 2 and 3, 4, or 5 were performed, but timing was not stated in patient record. Code 2 was followed in a subsequent surgical event by procedures coded as 3, 4, or 5. 9 Unknown or not applicable It is unknown whether regional lymph node surgery was performed; death certificate-only; for lymphomas with a lymph node primary site; an unknown or ill-defined primary; or for hematopoietic, reticuloendothelial, immunoproliferative, or myeloproliferative disease. The codes are hierarchical. If only one procedure can be recorded, code the procedure that is numerically higher. the specimen.

6 Record all surgical procedures that remove, biopsy, or aspirate regional lymph node(s) whether or not there were any surgical procedures of the primary site. The regional lymph node surgical procedure may be done to diagnose cancer, stage the disease, or as part of the initial treatment. Include lymph nodes obtained or biopsied during any procedure within the first course of treatment. A separate lymph node surgery is not required. Add the number of all of the lymph nodes removed during each surgical procedure performed as part of the first course of treatment. The Scope of Regional Lymph Node field is cumulative. Lymph node aspirations do not double-count when a regional lymph node is aspirated and that node is in the resection field. Reporting Schedule Month of Diagnosis Due to KCR by: January 2014 July 2014 February 2014 August 2014 March 2014 September 2014 April 2014 October 2014 May 2014 November 2014 June 2014 December 2014 July 2014 January 2015 August 2014 February 2015 September 2014 March 2015 October 2014 April 2015 November 2014 May 2015 December 2014 June 2015 Are You Current? o Use NAACCR Record Layout Version 14.0 for transmitting cases and NAACCR Version 14.0 Edits for error checking. o Use Collaborative Staging & Coding Manual, Version ( to code collaborative stage fields for cases diagnosed on or after January 1, o Use the web-based Hematopoietic & Lymphoid Neoplasm Database ( for coding all diagnosis years. The 2010 and 2012 databases have been combined into one database, which also has all changes for You must now select a diagnosis year to be shown the correct information and the correct version of the manual. o Please check our website to download the Kansas Cancer Registry Coding and Information Manual, ( o Use Multiple Primary and Histology Coding Rules Manual (Revised August 24, 2012) ( for all cases diagnosed January 1, 2007 and forward

7 Site-Specific AJCC TNM Staging and Directly Coded Summary Staging Training, 2015 Month January 29, 2015 February 26, 2015 March 26, 2015 April 30, 2015 May 28, 2015 June 25, 2015 July 30, 2015 August 20, 2015* September 24, 2015 October 29, 2015 December 3, 2015* Primary Site Kidney Renal pelvis, ureter, urethra Thyroid Pancreas Uterus Ovary, peritoneal Testicle Esophagus & stomach Other GYN Head & neck GISTs and NETs * Please make note of the date changes All the sessions will be conducted using ZOOM software. The PowerPoint slides and exercises will be ed to all registrants a week prior to the meeting. All participants are required to RSVP for each session separately. There are no continuing education (CE) hours for any of the above sessions If you have any questions please contact Victoria Hundley at or vhundley@kumc.edu

8 ICD-9-CM Codes 140._ _, 174._ , 209.7_ Case-Finding List Explanation of ICD-9CM Code Malignant neoplasms, stated or presumed to be primary (of specified sites), and certain 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 237.5, 237.6, Neoplasm of uncertain behavior of endocrine glands and nervous system: brain and spinal cord, meninges, endocrine glands and other and unspecified parts of nervous system Polycythemia vera (9950/3) 238.7_ 239.6, Other lymphatic and hematopoietic diseases Neoplasms of unspecified nature, brain, endocrine glands and other parts of nervous system Macroglobulinemia (Waldenström's macroglobulinemia) Hemophagocytic syndrome 795.0_ _ 796.7_ V10.0_ - V10.9_ Other specified disorders of metabolism Reportable includes terms: Hand-Schuller-Christian disease; histiocytosis (acute) (chronic); histiocytosis X (chronic) Papanicolaou smear of cervix and vagina with cytologic evidence of malignancy Abnormal cytologic smear of anus and anal HPV 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_ V67.1, V67.2 V76._ V86._ Encounter for radiotherapy, chemotherapy, immunotherapy Follow up examination: following radiotherapy or chemotherapy Special screening for malignant neoplasm Estrogen receptor positive status [ER+], negative status (ER-) Reference:

9 Happy New Year We would like to wish you and your families a very Happy New Year! From the Kansas Cancer Registry Staff Updating Contact Information! Please visit our website ( Submit the updated form to Victoria Hundley ( vhundley@kumc.edu; Fax: ) The Kansas Cancer Registry (KCR) collects and maintains 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 sub-populations 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. Sue-Min Lai SLAI@kumc.edu John Keighley JKEIGHLE@kumc.edu Sarma Garimella SGARIMEL@kumc.edu Jessica Jungk JJUNGK@kumc.edu Mollee Enko MENKO@kumc.edu Scott Hoffman SHOFFMAN3@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: