AJCC TNM STAGING UPDATES ARE YOU READY FOR TNM?

Transcription

1 AJCC TNM STAGING UPDATES ARE YOU READY FOR TNM? FCRA Annual Conference Boca Raton, Florida 7/26/2016 Steven Peace, CTR 1 Introduction Order AJCC Cancer Staging Manual, 7 th ed. How To Use - AJCC Cancer Staging Manual AJCC TNM Self-Instruction Modules I-IV AJCC TNM Additional Presentations AJCC Disease Site Webinars (Cliff Notes) 2016 Instruction Updates 2016 Category Code Updates 2016 TNM Compliant Software Biomarkers and SSF Requirements NEW TNM EDITS 2 1

2 January 1, 2016 REQUIREMENTS TNM ALL CASES DIAGNOSED 1/1/2016 > CS Core - Cases Diagnosed before 1/1/2016 Some States Require CS for DX Only Florida - CS for Active Cancers DX < 1/1/2016 Florida Historical (NED) Cancers FL Defaults SEER Summary Stage 2000 ALL CASES Biomarkers and SSFs ALL CASES INTRODUCTION 3 ORDER YOUR MANUAL AJCC Cancer Staging Manual 7 th edition, 2010 COST: $64.95 ISBN: Required - Florida Mandate FCDS will not purchase Facility may purchase Individual may purchase Also Required to Purchase 8 th Edition in SPRINGER 4 2

3 Purpose and Background Ordering Information Manual Organization Chapter Outline and Contents Locating the Correct Chapter Specific Neoplasms by Chapter Neoplasms Not Included Using AJCC TNM Staging Forms Other Helpful Information Questions 5 AJCC STAGING MANUAL ORGANIZATION Part I Chapter 1 Purposes and Principles of Cancer Staging Part I Chapter 2 Cancer Survival Analysis Parts II -- XII are organized by Body System (digestive/gyn/gu/etc.) Each Body System (Part) includes 1 or more Site Chapters 57 Site Chapters Organized by Primary Site and/or Histologic Type Chapters are grouped by Body System (digestive, urinary, etc.) Chapters are organized by Disease Site (Primary Site) Plus a few Histology-Based Chapters (melanoma, Merkel cell, etc.) Alphabetical Index CD-ROM with Printable Staging Forms 6 3

4 Staging at a Glance Changes in Staging Introduction Anatomic Considerations Rules for Classification Prognostic Features Definitions of TNM Anatomic Stage Prognostic Groups Prognostic Factors (SSFs) Summary of anatomic stage/prognostic grouping Table summarizing changes in staging from the 6 th edition Overview of factors affecting staging and outcome o Primary Tumor o Regional lymph nodes o Metastatic sites o Clinical o Pathologic Identification and discussion of non-anatomic prognostic factors T: Primary tumor N: Regional lymph nodes M: Distant metastasis Grade CHAPTER OUTLINE AND CONTENTS Histopathologic Type Bibliography Staging Form a. Required for staging b. Clinically significant AJCC Cancer Staging Manual, 7 th ed. Chapter 1, Table 1.10, p.14 7 AJCC TNM SELF-INSTRUCTION INTRODUCTION TO TNM STAGING AJCC TNM Staging Basics 8 4

5 AJCC TNM SELF-INSTRUCTION MODULES I-IV Module I Introduction Module II Beginning Module III Intermediate Module IV - Advanced 9 AJCC TNM SELF-INSTRUCTION PRESENTATIONS Registrars Guide to Chapter 1 Explaining Blanks and X Updated T, N, and M Category Options for Registry Data Items in

6 AJCC TNM SELF-INSTRUCTION CRITICAL CLARIFICATIONS Timing is Everything Melanoma Staging More to Come in AJCC 7 th Edition Chapter Specific Slides and Presentations by AJCC Staff Clarifications for Registrars and TNM Cliffs Notes Focus: uniqueness, differences, exceptions, or special concerns Each webinar will include: Overview and Learning Objectives Anatomy Affecting Stage Classification Issues Assigning T, N, M, Stage Group Information & Questions on AJCC Staging and Summary 5 Disease Site webinars will include: Melanoma Lung Breast Colorectal Prostate AJCC TNM SELF-INSTRUCTION 2016 DISEASE SITE WEBINARS 12 6

7 INSTRUCTION UPDATES

8 15 What is the yc prefix? When will yc be allowed? 16 8

9 2016 Clinical T Codes Pathologic T Codes 18 9

10 2016 Clinical N Codes Pathologic N Codes 20 10

11 2016 Clinical M Codes 2016 Pathologic M Codes AJCC Staging Examples These examples are not using any specific site, but rather general information examples CLINICAL (pre-treatment) T N M Gp Stg STAGING EXAMPLES Biopsy of primary site only c1 c0 c0 c1 Biopsy of regional LN w/o primary resection c1 c1 c0 c2 (Bx LN pn) Biopsy of distant mets (LN or organ) c1 c0 p1 c4 Clinical distant mets (no bx) c any c any c1 c4 Incidental dx (Surprise!) at surgery c blank c blank c blank 99 Most chapters = NO ptnm w/o primary resection (only clin info) PATHOLOGICAL NO surgical resection p blank p blank p blank 99 Surgical resection primary & Reg LN p1 p0 c0 p1 Surgical resection primary W/O Reg LN p1 px c0 p99 Surgical resection Reg LN W/O primary ( pn) p blank p blank p blank p99 EXCEPTION: Exc Reg LN ONLY for melanoma px p1 cm0 p99 Poss Exception: Exc Reg LN Hd/Nk w/o resection Surgical resection only distant mets p blank p blank p1 p4 NEOADJUVANT Clinical - answer as above examples Pathological - answer after surgical resection - do NOT forget "Y" in descriptor field 22 Source: Louanne Currence, CTR (reviewed by Donna Gress, CTR) 11

12 COMPLIANT SOFTWARE 23 BIOMARKERS AND SSFS NO Changes for Florida 24 12

13 EDITS MORE EDITS FOR TNM ITEMS Date of Diagnosis Use of c or p prefix Comparison to Surgery Comparison to SSF Values Comparison to Other Data Items No Allowance for Undefined Parent Codes Comparison to New Field, Tumor Size Summary Comparison of Stage Group to T, N, and M Values EDITS MORE COMPLEX EDITS 25 FCDS WEBCAST SERIES 2016 AJCC Staging Review TNM Staging Practice TNM Male GU sites TNM Female GYN Sites Biomarker/Tumor Profiles 26 13

14 QUESTIONS 27 14