MCR: MANAGEMENT OF 2018 CHANGES By: Maricarmen Traverso-Ortiz MPH, CGG, CTR
LEARNING OBJECTIVES Discuss a summary of the new changes for 2018 Overview of how the Maryland Cancer Registry is managing and implementing all these changes Discuss resources for registrars related to changes
SITE SPECIFIC DATA ITEMS
SITE SPECIFIC DATA ITEMS (SSDI) Specific for Primary Site Meets the requirements of AJCC Chapters for primary sites Most of the SSDIs were previously collected as Collaborative Stage Site-Specific Factors (SSFs) Into effect for cases diagnosed in January 1, 2018 +
SITE SPECIFIC DATA ITEMS (SSDI) Schema ID Based on primary site, histology and schema discriminator (when applicable) Defines the SSDIs, Grade, AJCC 8 th edition chapter, EOD Schema, Summary Stage chapter Schema discriminator 1 A schema discriminator is used to discriminate for primary site CXXX for the specific subsite in which the tumor arose. Schema discriminator 2 Additional schema differentiation (histology subdivisions or p16 in Oropharynx)
SITE SPECIFIC DATA ITEMS (SSDI) Cervical Lymph Nodes and Unknown Primary Tumor of the Head and Neck Schema Discriminator 1: discriminate between head and neck tumors with unknown primary site coded as C760 Extranodal Extension (ENE) both clinical and pathological Regional lymph nodes (Levels I-VII, Other)- several different data items Occult head and neck tumor? Yes Cervical metastasis in level II/II lymph nodes? Yes Epstein-Barr virus encoded small RNAs by in situ hybridization? Negative, unknown, or not done P16 immunostain? Negative, unknown, or not done Chapter 6: Cervical Lymph Nodes and Unknown Primary Tumors of the Head and Neck No Positive Positive Ill Defined, Other (Summary Stage Only) No Chapter 9: Nasopharynx Histology consistent with HPV-mediated orophryngeal carcinoma (OPC)? Yes Chapter 10: HPV- Mediated (p16+) Oropharyngeal Cancer
SITE SPECIFIC DATA ITEMS (SSDI) Colon and Rectum CEA (Lab value and interpretation) Circumferential Resection Margin (CRM) KRAS Microsatellite Instability (MSI) Perineural Invasion Tumor Deposits Code Description 00 No tumor deposits 01-99 01-99 tumor deposits (Exact # of tumor deposits) X1 100 or more tumor deposits X2 Tumor deposits present, number unknown X8 Not applicable (Not collected for this case) X9 Unknown
SITE SPECIFIC DATA ITEMS (SSDI) Lung Separate tumor nodules Presence of separate tumor nodules, where and histology Visceral and parietal pleural invasion Pleural effusion status (mesothelioma)
SITE SPECIFIC DATA ITEMS (SSDI) Skin Melanoma Breslow tumor thickness Record actual measurement in tenths of mm from the pathology report. Measurement given in hundredths of mm should be rounded to the nearest tenth. Ulceration Mitotic rate melanoma LDH Pre-treatment value LDH Pre-treatment level LDH upper limits of normal
SITE SPECIFIC DATA ITEMS (SSDI) Prostate PSA Lab Value Documented in tenths, round to the nearest tenth Do not enter leading zeros for values less than 100.0 Ex. PSA 5.25 enter 5.3 Gleason Patterns and Score Clinical - from a needle core biopsy or TURP only Pathological - from prostatectomy or autopsy report Tertiary Number of Cores Positive and Examined
SITE SPECIFIC DATA ITEMS (SSDI) Female Reproductive Organs (Corpus carcinoma and carcinosarcoma) FIGO Stage Number of Positive Pelvic Nodes Number of Examined Pelvic Nodes Number of Positive Para-aortic Nodes Number of Examined Para-aortic Nodes Peritoneal Cytology
SITE SPECIFIC DATA ITEMS (SSDI) Breast Estrogen Receptor (ER) and Progesterone Receptor (PR) Percentage has to be coded Interpretation (+/-) Allred Score (percentage and intensity of that staining) HER2 (IHC and FISH, CISH or SISH) and Overall summary HER2 ISH Dual Probe Copies HER2 ISH Dual Probe Ratio HER2 ISH Single Probe Copy Number Multigene signature results (Risk of recurrence) Method (Test) and Results
SITE SPECIFIC DATA ITEMS (SSDI) Breast Oncotype Dx Tests (Risk of recurrence) Recurrence Score Risk Level Ki-67 (marker of cell proliferation) A high value indicates a tumor that is proliferating more rapidly LN Positive Axillary Level I-II Number of lymph nodes positive in these levels as recorded previously in SSF #3. Response to Neoadjuvant Therapy (SSF #21) As stated in the medical record
GRADE
GRADE Grade: Clinical Before any treatment (surgical resection or initiation of any treatment including neoadjuvant) Histological (microscopic) exam (FNA, biopsy, needle core biopsy, etc.) Highest grade from the primary tumor Grade: Pathological From resection when neoadjuvant treatment was not given. Note 3: Assign the highest grade from the primary tumor. If the clinical grade is the highest grade identified, use the grade that was identified during the clinical time frame for both the clinical grade and the pathological grade. Grade: Post-Therapy Resected following neoadjuvant therapy. Leave post-therapy grade blank when there was no neoadjuvant therapy
GRADE Prior to 2018 Description 2018 and forward 1 Well differentiated; Differentiated, NOS; Grade I A 2 Moderately differentiated; Fairly well differentiated; Intermediate differentiation; Low grade; Mid differentiated; Moderately well differentiated; Partially differentiated; Partially well differentiated; Relatively or generally well differentiated; Grade II 3 Poorly differentiated; Medium grade, intermediate grade; Moderately poorly differentiated; Moderately undifferentiated; Relatively poorly differentiated; Relatively undifferentiated; Slightly differentiated; Dedifferentiated; Grade III 4 Undifferentiated, anaplastic; High grade; Undifferentiated, anaplastic, not differentiated; Grade IV 9 Unknown 9 B C D
SOLID TUMOR RULES 2018
SOLID TUMOR RULES 2018 Revised for 2018: Head & Neck Colon (includes rectosigmoid and rectum for cases diagnosed 1/1/2018 forward) Lung Breast Kidney Urinary Sites Non-malignant CNS Malignant CNS and Peripheral Nerves Continue using the 2007 Multiple Primary & Histology Rules Cutaneous Melanoma: Revised for 2019 implementation (WHO 4 th Edition Tumors of Skin) Other sites (excluded): Rectosigmoid and rectum (now included in 2018 Colon rules) Peripheral nerves (now included in 2018 Malignant Brain rules)
SOLID TUMOR RULES 2018 Drafts are available by primary site: General Instructions, Head & neck, Colon, Cutaneous Melanoma, Breast, Kidney and Other Sites Use the draft and flag the cases OR Wait until the final rules are posted and review 2018 cases
AJCC 8TH ED UPDATES
AJCC 8 TH ED UPDATES: HISTOLOGY & TOPOGRAPHY CODES First chapter General information Errata New Neuroendocrine Tumors Endocrine pancreas All other neuroendocrine tumors by primary site Thymus Soft tissue sarcoma Separate by primary sites Skin Squamous cell carcinoma is no longer available for staging Breast LCIS/in situ- still reportable, but not staged
RADIATION TX
RADIATION TREATMENT NAACCR Item # Item Name 1501 Phase I Dose per Fraction 1502 Phase I Radiation External Beam Planning Tech 1503 Phase I Number of Fractions 1504 Phase I Radiation Primary Treatment Volume 1505 Phase I Radiation to Draining Lymph Nodes 1506 Phase I Radiation Treatment Modality 1507 Phase I Total Dose 1531 Radiation Treatment Discontinued Early 1532 Number of Phases of Rad Treatment to this Volume 1533 Total Dose
STANDARDS VOLUME II, VERSION 18
STANDARDS VOLUME II, VERSION 18 10. Summary for Hospital Cancer Registrars and Reporting Facilities Review the 2018 Implementation Guidelines Changes specific by facility (i.e., ACoS CoC Approved Programs and non-approved hospitals within states that report to the CDC NPCR and/or NCI SEER) 10.1 Prioritize Case Abstracting Abstract cases by site 10.2 Communicate with Software Vendors and Central Cancer Registries Timeline for registry software release Requirements for completion of cases Edit validation and transmitting of cases 10.3 Education and Training https://www.naaccr.org/2018-implementation/#education Standard setting organizations may be open to suggestions for training/education needs.
NEW REQUIRED DATA ITEMS AJCC TNM Clin T AJCC TNM Clin N AJCC TNM Clin M AJCC TNM Clin Stage Group AJCC TNM Path T AJCC TNM Path M AJCC TNM Path Stage Group AJCC TNM Post Therapy T AJCC TNM Post Therapy N AJCC TNM Post Therapy M AJCC TNM Post Therapy Stage Group Adenopathy AFP Pretreatment Interpretation Anemia B symptoms Breslow Tumor Thickness CA-125 Pretreatment Interpretation CEA Pretreatment Interpretation Circumferential Resection Margin (CRM) Estrogen Receptor Summary Esophagus and EGJ Tumor Epicenter Extranodal Extension Head and Neck Pathological
NEW REQUIRED DATA ITEMS Gestational Trophoblastic Prognostic Scoring Index Gleason Patterns Clinical Gleason Patterns Pathological Gleason Score Clinical Gleason Score Pathological Gleason Tertiary Pattern Grade Clinical Grade Pathological Grade Post Therapy HER2 IHC Summary HER2 ISH Summary HER2 Overall Summary Heritable Trait High Risk Cytogenetics KIT Gene Immunohistochemistry LDH Pretreatment Level LN Size Lymphocytosis Microsatellite Instability (MSI)
NEW REQUIRED DATA ITEMS Mitotic Rate Melanoma Number of Cores Examined Number of Cores Positive Oncotype Dx Recurrence Score-Invasive Organomegaly Percent Necrosis Post Neoadjuvant Peripheral Blood Involvement Progesterone Receptor Summary PSA (Prostatic Specific Antigen) Lab Value S Category Clinical S Category Pathological Schema Discriminator 1 Schema Discriminator 2 Schema Discriminator 3 Serum Albumin Pretreatment Level Serum Beta-2 Microglobulin Pretreatment Level Thrombocytopenia Ulceration
EDITS/TNM EDITS Web Plus updates Display Edits Depending on all the materials for abstracting AJCC, EOD, Solid Tumor Rules
RESOURCES
RESOURCES CoC 2018 STORE Manual Expected to be release on April, 2018. SSDI Manual Instructions on how to code by primary site NCI website: https://staging.seer.cancer.gov/eod_public/list/1.0/ ICD-O-3 Histology Revisions Use the new lists Available in the NAACCR and AJCC website ICD-O-3.1 Derived from the blue books Online: Not updated since 2011 Not approved for use in North America.
RESOURCES Solid Tumor Rules Completed (drafts): Head & Neck, Colon, Cutaneous Melanoma, Breast, Kidney, Ureter/Renal Pelvis/Bladder Lung, Malignant Brain, Benign CNS (still under review) Expected to be released by November 1st. Melanoma of the skin will be revised for 2019 implementation. Available in the NAACCR and SEER website AJCC 8 th Edition Errata SEER Hematopoietic and Lymphoid Neoplasm Database Expected to be released by May 1 st, 2018. SEER Summary Stage 2018 and SEER EOD 2018 Released on March 20, 2018. MCR will not be collecting the EOD fields.
THANK YOU!
QUESTIONS??? Contact Information: E-mail: maricarmentraversoortiz@westat.com