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Part I General Rules And Instructions Stuart Herna, CTR

Collaborative Staging System. Part I General Rules And Instructions Stuart Herna, CTR. CS General Rules. Collaborative Staging items are collected on all cases regardless of whether or not they are microscopically confirmed Data collected on all sites, all histologies. CS General Rules.

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Part I General Rules And Instructions Stuart Herna, CTR

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  1. Collaborative Staging System Part I General Rules And Instructions Stuart Herna, CTR

  2. CS General Rules • Collaborative Staging items are collected on all cases regardless of whether or not they are microscopically confirmed • Data collected on all sites, all histologies

  3. CS General Rules • Timing rule (same as EOD, TNM 6th Ed., Summary Stage 2000) • Includes all information gathered through completion of surgery(ies) in first course of treatment OR • within four months of diagnosis in absence of disease progression • whichever is LONGER

  4. CS General Rules • Site-specific guidelines take precedence over general guidelines • For each field, code the highest applicable number

  5. CS General Rules Record greatest extent of disease based upon combined clinical and operative/ pathologic assessment • If no pre-operative neo-adjuvant treatment was performed, pathologic information takes priority • If pre-operative neo-adjuvant treatment was performed, clinical information takes priority in most cases

  6. CS General Rules • Information formerly coded as Tumor Markers is now included under Site Specific Factors • Site Specific Factors are included in every schema

  7. Site Specific Factors Used For Primary Site/Histology Schemas SSF Sites/Histologies • Head & neck, colon, rectum, liver, pleura, melanoma, mycosis fungoides, breast, ovary, placenta, prostate, testis, retinoblastoma, brain, other CNS, thyroid, other endocrine, Kaposi sarcoma, lymphoma • Head & neck, liver, melanoma, breast, prostate, testis, lymphoma • Head & neck, melanoma, breast, prostate, testis, lymphoma • Head & neck, melanoma, breast, prostate, testis • Head & neck, breast, prostate, testis • Head & neck, breast, prostate

  8. CS General Rules • Disease progression is excluded when determining extent of disease • Autopsy Reports are treated the same way as Pathology Reports in coding CS • In the event of a discrepancy, the documented TNM stage in the medical record takes precedence over the physician’s assignment of TNM stage

  9. New Rule For ‘Inaccessible’ Sites • Cancers of certain primary sites are not easily examined by physical examination, observation, palpation, or other clinical methods. A new coding rule in the Collaborative Staging System applies to these inaccessible sites, primarily for local or early stage cancers

  10. New Rule For ‘Inaccessible’ Sites • Record regional lymph nodes and distant metastasis as negative (rather than unknown) when • there is no mention of LN or metastatic involvement in the PE, diagnostic testing or surgical exploration AND • the patient receives ‘usual’ treatment to the primary site

  11. New Rule For ‘Inaccessible’ Sites • New rule Applies to early stage (T1, T2, localized) tumors • Unknown should be coded when there is reasonable doubt that the tumor is no longer localized

  12. No Rule Change For ‘Accessible’ Sites • Breast, oral cavity, salivary gland, skin, etc. • Code as negative if statement in chart such as ‘remainder of exam negative’

  13. CS General Rules • Most CS schemas apply to cases defined by primary site • A few schemas apply to cases defined by histology • Histology specific schemas take precedence over site specific schemas

  14. CS General Rules Histology specific coding schemas are used for: Melanoma (8720-8790) Kaposi Sarcoma (9140) Retinoblastoma (9510-9514) Lymphoma (9590-9699 & 9702-9729) Mycosis Fungoides (9700-9701) Hematopoietic and Reticuloendothelial System (9731-9989)

  15. CS General Rules For the following Sites, Melanomas are divided by Primary Site code • Malignant melanoma of skin, vulva, penis and scrotum (C44.0-C44.9, C51.0-C51.2, C51.8-C51.9, C60.0-C60.1, C60.8-C60.9, C63.2) • Malignant melanoma of conjunctivia (C69.0) • Malignant melanoma of iris and ciliary body (C69.4) • Malignant melanoma of choroid (C69.3) • Malignant melanoma of other eye (C69.1, C69.2, C69.5, C69.8-C69.9)

  16. Lip & Oral Cavity Oropharynx/ Hypopharynx Major Salivary Glands Thyroid Anal Canal Liver/Intrahepatic Bile Ducts Exocrine Pancreas Lung Bone Soft Tissue Sarcoma Carcinoma of the Skin Carcinoma of the Eyelid Breast Vulva Cervix Uteri Kidney Carcinoma of the Conjunctivia Malignant Melanoma of the Uvea (ciliary body, choroid) Carcinoma of the Lacrimal Gland Sarcoma of the Orbit Schemas Requiring Tumor Size For AJCC Staging

  17. Nasopharynx Larynx Nasal Cavity/Paranasal Sinuses Esophagus Stomach Small Intestine Colon/Rectum Gallbladder Extrahepatic Bile Ducts Ampulla of Vater Pleural Mesothelioma Melanoma of Skin Vagina Corpus Uteri Ovary Fallopian Tube Gestational Trophoblastic Tumor Penis Prostate Testis Renal Pelvis/Ureter Urinary Bladder Urethra Malignant Melanoma of Conjunctivia Malignant Melanoma of Uvea (iris) Retinoblastoma Lymphoid Neoplasm Schemas Not Requiring Tumor Size For AJCC Staging

  18. Other Pharynx Other Digestive Middle Ear Other Sinus Trachea Other Respiratory Other Adnexa Other Female Genital Other Male Genital Other Urinary Brain Other CNS Other Endocrine Other Eye Melanoma of other Eye Kaposi Sarcoma Hematopoietic, Reticuloendothelial, Immunoproliferative, Myeloproliferative Neoplasms Other Ill Defined/Unknown Primary Sites Schemas For Which AJCC Staging Is Not Applicable

  19. CS General Rules Review • Disregard mets that develop after initial extent of disease is established • Autopsy reports can be used for coding CS

  20. CS General Rules Review • Every site yields a Summary Stage; TNM is generated only when applicable • CS data fields for Death Certificate Only Cases are coded either as unknown (9’s) or Not Applicable (8’s) in all CS Staging fields

  21. CS General Rules Review • If the histology for a given tumor is melanoma, Kaposi sarcoma, retinoblastoma, lymphoma, mycosis fungoides, or hematopoietic and reticuloendothelial system, use the histology specific schema for the appropriate histology–site combination • All other schemas are site specific and are in ICD-O-3 order • Read the notes and review the site-histology specific instructions at the beginning of each of the 15 CS data fields • Some schemas may have associated site specific factors. Review these carefully as you assign the codes

  22. Regional Lymph Nodes Positive Conversion • Regional Lymph Nodes Positive will require a conversion when NAACCR Version 10.1 is implemented • There are no other conversion requirements necessary to implement the Collaborative Staging system

  23. CS General Rules Review • The NAACCR 2004 Implementation Guidelines are based upon the NAACCR record layout Version 10.1 which accommodates the data elements necessary to support the Collaborative staging schema and the reporting requirements for benign and borderline CNS and intracranial tumors

  24. CS: FCDS Requirements • As of July 1st, 2004, FCDS will require all cases to be submitted in the NAACCR v10.1 record layout and must include all 15 items of the Collaborative Staging scheme • Because of the change in the record layout, no 2004 cases will be accepted by FCDS prior to July 1, 2004

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