Guidelines for Assigning Summary Stage 2000 Mary Lewis, CTR National Program of Cancer Registries 2014 NCRA Annual Meeting May 17, 2014 National Center for Chronic Disease Prevention and Health Promotion
Outline: 1. Review of General Guidelines 2. Detailed review of primary s of : a. Female Breast b. Lung c. Colo-rectal d. Prostate e. Uterus
In situ: General Guidelines What can be ruled out? Only apply to carcinomas and melanoma Must be microscopically examined Can not have evidence of invasion, nodal involvement or metastatic spread Distant: STOP once distant disease is identified Systemic Disease Review reports Localized: Rule out confined to organ or origin Be careful of terms: blood vessel or perineural invasion Vascular Invasion isn t determining factor
Regional: General Guidelines continued: If other stages have been ruled out then the stage is Regional. Lymph Node involvement stage is at least regional-nodes Assume ipsilateral unless stated Unknown: Unknown Primary Site Not enough information Source: SEER Summary Stage Manual 2000 http://www.seer.cancer.gov/tools/ssm/sssm2000-122012.pdf
Breast Sources of Information: Diagnostic Studies: Physical Examination: Mass, size, ulceration, swelling, fixation, palpable lymph nodes Imaging Mammogram Unilateral, bilateral, contralateral Surgical Pathology: Cell Type, tumor size, number of lesions Lymph node involvement Extension to adjacent tissue
Breast - Assigning Summary Stage 2000 In situ: Synonymous Terms Pathology Report Local: Pathology Physical Examination Regional Direct Extension: Physical Exam includes: Skin edema, Peau d orange, Inflammation Skin ulceration
Breast - Assigning Summary Stage 2000 Regional Lymph Nodes: Pathology Report Nodules in fat Nodes, NOS Axillary Lymphadenopathy Distant: Scans and Xrays: Distant Lymph Nodes Contiguous Extension Bone, Lung MRI Physical Exam/Consult Reports/Pathology Reports
Lung Sources of Information: Diagnostic Studies: Chest x-ray Imaging, Lung Esophagogram Imaging, Bone Imaging, Brain Imaging, Liver/spleen Bronchoscopy Mediastinoscopy Esophagoscopy Thoroscopy Laryngoscopy
Lung Assigning Summary Stage: Radiographic Exams: Chest X-ray CT Scans MRI Operative Report Review Findings Pathology: Cell Type Bone Marrow Biopsy Cytology, Bronchial Washings Closed Chest Needle Biopsy
In situ: Lung Assigning Summary Stage: Pathology, Cytology, Aspirate Localized: Bronchoscopy Chest Xray CT Scans, MRI Regional Direct Extension: Bronchoscopy Chest Xray CT Scans, MRI
Lung Assigning Summary Stage: Regional Lymph Node Chest Xray/CT Scans Hilar Nodes Peri-aortic Nodes Mediastinal Nodes Distant CT Scans, MRI Pleural Effusion Separate tumor nodules in different lobe Separate tumor nodules in contralateral lung Distant Lymph Nodes Distant Metastasis
Colo-Rectal Sources of Information: Diagnostic Studies: Physical Exam: Abdomen masses, enlarged organs, palpable nodes, jaundice Rectal bleeding, palpable tumor, fixation Imaging: Barium Enema, Small Bowel series, Chest x-ray, Imaging of Abdomen/Pelvis, Liver/Spleen, Brain and Bone. Endoscopies: Colonoscopy, Sigmoidoscopy, Cystoscopy
Colo-Rectal Sources of Information Operative Report Anatomic Site, Lymph Nodes Gross Tumor Involvement Pathology: Cell Type Tumor Size Location of tumor Extension Dukes Staging Biopsy results of additional tumor sites Number of Lymph Nodes
In situ: Colo-Rectal Assigning Summary Stage Pathologic Examination (Adeno)carcinoma in a polyp or adenoma, non-invasive Localized: Pathologic Examination: Polyp, NOS Submucosa, subserosal tissue/fat Operative Report, Discharge Summary, Consult Report: Confined to Colon, NOS Localized, NOS
Colo-Rectal Assigning Summary Stage Regional Direct Extension and Nodal Involvement: Pathology Report/Findings Endoscopy Operative Report Direct Extension Lymph Nodes Distant General and Site Specific Scans, X-rays Physical Exam Pathology Report
Prostate: Diagnostic Studies: Physical Exam: Palpable mass, size of nodule, nodularity, palpable lymph nodes, evidence of frozen pelvis, digital rectal exam Key words: Density, abnormal echo, abnormal density, mass effect Imaging: Prostatic Ultrasound, IVP, Chest Xray, Imaging Abdomen/Pelvis, Bone Scan, Liver-Spleen Scan, Lymphangiogram Endoscopies: Cystoscopy, Proctosigmoidoscopy, Laparoscopy
Prostate Assigning Summary Stage Surgical Pathology: Cell Type Tumor Grade Gleason s Grade or Score Tumor Size Capsule Invasion Invasion of Apex Lymph Nodes Extension to Adjacent Tissues Biopsy Results Structures Removed
In situ: Prostate Assigning Summary Stage Surgical Pathology Report, Non-invasive Operative Report/Discharge Summary: Stage 0 Localized: Surgical Pathology Report Invasion into prostatic capsule (but not beyond) Intracapsular involvement only Operative Findings/Discharge Summary Stage A or Stage B Localized, NOS
Prostate Assigning Summary Stage Regional Direct Extension: Physical Exam/Imaging: Fixation, NOS Pathology Report Extension through capsule Seminal Vesicles Operative Report - Cystoscopy Extension to Bladder neck, periprostatic tissue Regional Lymph Nodes: Pathology Report, Scans, Physical Exam
Prostate Assigning Summary Stage Distant Sites/Lymph Nodes: Pathology Report/Scans: Inguinal Lymph Nodes Para-aortic Nodes Frozen Pelvis Extension to/fixed to Pelvic Wall or Pelvic Bone Extension to: Penis, Sigmoid Colon Discharge Summary/Consult Reports: Stage D2 Stage D - NOS
Diagnostic Studies: Corpus Uteri History & Physical Pelvic Examination (including under anesthesia) Xrays and Scans Chest X-ray, Bone Survey, Liver/Spleen Scan, Lymphangiogram, Hysterosalpingogram Procedures: Culdoscopy, Cystoscopy, Hysteroscopy, Laparoscopy, Pelvic Ultrasound
Operative Report: Corpus Uteri Depth of uterus ("sounding" of uterus), Appearance and size of uterus, Extent of involvement of other abdominal organs (ovaries, adnexae, pelvic wall, pelvic tissues), Seeding, implants, encasement, nodularity of viscera, Frozen pelvis, any tumor on or in the liver that is not biopsied, which organs were removed (fallopian tubes, ovaries, lymph nodes), Location of tumor not resected, results of examination under anesthesia
Uterus Assigning Summary Stage Surgical Pathology: Histology Cell type Primary Site Tumor Size Depth of invasion Multifocal Tumors Direct Extension of Tumor FIGO Stage II-III Lymph Nodes Distant Spread: Surgical Observations Results of bone marrow aspiration/biopsy
In Situ: Uterus Assigning Summary Stage Pathology Report Consultation/Pre-admission work-up Localized: Pathologic Details re: Confined to Endometrium Invasion of Myometrium Operative Report/Consult/Discharge Summary: FIGO Stage IA, Stage IB, Stage IC or Stage I NOS
Uterus Assigning Summary Stage Regional Direct Extension: Operative report/consult Report/Discharge Summary: FIGO Stage II NOS, FIGO Stage IIA, FIGO Stage IIB Extension or Metastasis FIGO Stage IIIB Pathology/Cytology: Cancer Cells in Ascites Cancer Cells in Peritoneal Washings Regional Lymph Nodes: Xrays and Scans/Operative Report Aortic, NOS; Parametrial, Pelvic, NOS FIGO Stage IIIC
Uterus Assigning Summary Stage Distant Sites/Nodes: Physical Exam/Scans: Inguinal nodes, Other distant nodes Surgical Pathology Report/Operative Findings: Abdominal Serosa (peritoneum) Cul de sac (recto-uterine pouch) Sigmoid Colon Small Intestine Consult Report/Discharge Summary: FIGO Stage IV Carcinomatosis
Information Resources: SEER Summary Staging Manual 2000 Site Specific Guidelines for Summary Stage SEER Training Modules: http://training.seer.cancer.gov Site Specific Abstracting, Coding & Staging Key Information SEER Coding Manuals Historic 1977 http://www.seer.cancer.gov/archive/manuals/historic/abstracting- EOD.pdf Abstracting Instructions and Diagnostic Procedures
Summary: Summary Stage Background Features Timing Rule General Information Resources Site-specific Resources Are there any questions? cancerstaging@cdc.gov
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Mary Lewis, CTR NPCR Public Health Advisor bkf5@cdc.gov For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion