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Kentucky Cancer Registry
Spring Training 2016
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Changes for 2016 New data items Changed data items AJCC Staging
Phase I Phase II New data items Changed data items AJCC Staging Conversions Other Considerations Customized choice lists Edits update The changes for 2016 cases will be phased in, due to our reliance on other national organizations for certain elements, such as GenEdits, which will be released at a later date, and integrated into the CPDMS software. KCR staff have tried to take into consideration your needs for timely abstraction of cases, as well as support your efforts for efficiency and high quality data. Phase I will be implemented in early April and it will include new and changed data items, some conversions of current data items, and some new coding instructions from FORDS Phase II will be performed when the additional software applications are available to KCR, probably not before June.
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New data items Mets at Diagnosis- Distant Lymph Node 0 None
1 Yes, distant lymph node mets 8 Not Applicable 9 Unknown; not documented in patient record Mets at Diagnosis-Other 1 Yes, distant mets known in site other than bone, brain, liver, lung or LN These are similar to CS Mets at Diagnosis for Bone, brain, liver and lung. States not continuing to code CS will still have to enter Mets and Diagnosis for bone, brain, liver, and lung as well as the two new ones for distant lymph nodes and other sites. These will appear on the data entry screen just below the other 4 sites.
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New data items Tumor Size Clinical – size of primary tumor before any treatment Tumor Size Pathologic -size of primary tumor that has been resected Tumor Size Summary - most accurate measurement of a solid primary tumor, usually measured on the surgical resection specimen, but never from surgery after neoadjuvant therapy Tumor size clinical and pathologic are required by SEER; Tumor size Summary is required by CoC and NPCR. Tumor size summary is intended to be a continuation of CS Tumor size. However, there may be some differences for cases with neoadjuvant treatment. CoC is saying to code T size as clinical if the patient received neoadjuvant therapy, otherwise code 999 (even if the size is larger on resection). The new fields will appear on the AJCC page – clinical above the clinical TNM; pathologic above the pathologic TNM and Tumor size summary at the end on the AJCC fields. For pre-2016 cases, the Tsize Summary will be pre-filled with the CS Tumor size value, but converted to 999 if neoadjuvant therapy resulted in a larger tumor size as indicated by a Tumor size/eval code of 6. For 2016 and later cases, enter the path tumor size UNLESS neoadjuvant treatment was given; then enter the clinical size; if clinical size is unknown, enter This field will not be calculated or prefilled for 2016 and later cases.
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Tumor Size Codes Code Definition 000 No mass/tumor found 001
1 mm or described as less than 1 mm Exact size in millimeters (2 mm to 988 mm) 989 989 millimeters or larger 990 Microscopic focus or foci only and no size of focus is given 998 Alternate descriptions of tumor size for specific sites: familial polyposis, circumferential esophagus, diffuse for stomach or GE junction, diffuse lung or breast 999 Unknown, not stated, cannot be assessed, not applicable Tumor size codes remain the same as CS Tumor size.
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Changed data items Clinical and pathologic stage descriptors
Sex – Code 3 is now defined: Other (intersex, disorders of sexual development/DSD) Staged by – clinical and Staged by – pathologic Now a 2-digit code; Requires a conversion Clinical T, N, M and Pathologic T, N, M Added ‘c’ or ‘p’ before values; Requires a conversion Clinical and pathologic stage descriptors Codes were alphabetical; will now be numeric The translation for code 3 for Sex is now Other. Staged by is now a 2 digit code and the conversion of old cases is very straightforward. It is the same choice list for both clinical and pathologic.
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Staged BY Code Label Definitiom 00 Not staged
Not assigned or no information in medical record 10 Physician, NOS Assigned by a physician not listed in 11-15 11 Surgeon Assigned by Surgeon only 12 Radiation Oncologist Assigned by Radiation Oncologist only 13 Medical Oncologist Assigned by Medical Oncologist only 14 Pathologist Assigned by Pathologist only 15 Multiple physicians Assigned by multiple physicians, such as at Tumor Board 20 Cancer registrar Assigned by Cancer registrar only 30 Cancer registrar & physician Includes registrar assignment and physician approval 40 Nurse, PA, other medical staff Assigned by non-physician medical staff person 50 Done at another facility Assigned at another facility 60 Central registry/consolidation Assigned at Central registry based on 1 or more facilities 88 Not eligible for staging Site/histology combination is not defined in AJCC Manual 99 Staged, but unknown who assigned Stage documented in record, unknown who assigned it
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Prefixes added to T, N and M values
Per FORDS, “Beginning in 2016, new T, N, and M categories were implemented. These new categories have been generated by adding the prefixes of ‘c’ and ‘p’ to existing valid clinical and pathologic T, N, and M categories, and modifying, adding, and deleting specific categories. The new categories enable registrars to comply with AJCC clinical and pathologic staging/classification timeframe rules while abstracting. … Please note that not all possible categories were added in 2016, only those addressing prominent issues. Additional T, N, and M categories will be added and use of existing categories will be expanded with the implementation of the AJCC 8th edition.
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Clinical T Code Definition (blank) Not recorded c1B cT1b c3 cT3 cX cTX
cT3a c0 cT0 c1B2 cT1b2 c3B cT3b pA pTa c1C cT1c c3C cT3c pIS pTis c1D cT1d c3D cT3d pISU pTispu c2 cT2 c4 cT4 pISD pTispd c2A cT2a c4A cT4a c1MI cT1mi, cT1 mic c2A1 cT2a1 c4B cT4b c1 cT1 c2A2 cT2a2 c4C cT4c c1A cT1a c2B cT2b c4D cT4d c1A1 cT1a1 c2C cT2c c4E cT4e c1A2 cT1a2 c2D cT2d 88 Not applicable This will be the new choice list for Clinical T. Note in red that a few pT values will be allowed in the clinical T field – only if the tumor is in situ or non-invasive. This is a generic choice list for all sites. CPDMS will incorporate site specific choice lists when they become available to us from NPCR.
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Clinical N Code Definition (blank) Not recorded c1A cN1a c3 cN3 cX cNX
c1B cN1b c3A cN3a c0 cN0 c1C cN1c c3B cN3b c0A cN0a c2 cN2 c3C cN3c c0B cN0b c2A cN2a c4 cN4 c1 cN1 c2B cN2b 88 Not applicable c2C cN2c Note – there are no pN values allowed in the clinical N field. If the lymph node status is confirmed pathologically, but there is no resection of the primary site, then you still assign a cN value.
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Clinical M Code Definition (blank) Not recorded p1 pM1 c0 cM0 p1A pM1a
c0I+ cM0(i+) p1B pM1b c1 cM1 p1C pM1c c1A cM1a p1D pM1d c1B cM1b p1E pM1e c1C cM1c 88 Not applicable c1D cM1d c1E cM1e Note – pathologic confirmation of metastases may be entered in the cM data field to establish a clinical stage group of 4.
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pathologic T Code Definition (blank) Not recorded p1B pT1b p3 pT3 pX
pTX p1B1 pT1b1 p3A pT3a p0 pT0 p1B2 pT1b2 p3B pT3b pA pTa p1C pT1c p3C pT3c pIS pTis p1D pT1d p3D pT3d pISU pTispu p2 pT2 p4 pT4 pISD pTispd p2A pT2a p4A pT4a p1MI pT1mi, pT1 mic p2A1 pT2a1 p4B pT4b p1 pT1 p2A2 pT2a2 p4C pT4c p1A pT1a p2B pT2b p4D pT4d p1A1 pT1a1 p2C pT2c p4E pT4e p1A2 pT1a2 p2D pT2d 88 Not applicable Note – there a no clinical T values that may be entered in the pT field.
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pathologic N Code Definition (blank) Not recorded p0A pN0a p2C pN2c pX
pNX p0B pN0b p3 pN3 c0 cN0 p1 pN1 p3A pN3a p0 pN0 p1A pNla p3B pN3b p0I- pN0i- p1B pN1b p3C pN3c p0I+ pN0i+ p1C pN1c p4 pN4 p0M- pN0m- p2 pN2 88 Not applicable p0M+ pN0m+ p2A pN2a p1MI pN1mi p2B pN2b Note – you may enter a cN0 in the pathologic N field, but only to establish a pathologic Stage 0.
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pathologic M Code Definition (blank) Not recorded p1C pM1c c1C cM1c c0
p1D pM1d c1D cM1d c0I+ cM0(i+) p1E pM1e c1E cM1e p1 pM1 c1 cM1 88 Not applicable p1A pM1a c1A cM1a p1B pM1b c1B cM1b Note – the choice lists for clinical M and pathologic M are identical. There is no pM0 allowed in either field.
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Ajcc stage descriptors
Clinical descriptor Pathologic descriptor New code Description Old KCR code None 1 E-Extranodal lymphomas only E 2 S- Spleen, lymphomas only S 3 M- Multiple tumors in a single site M 5 E&S- Extranodal and spleen ES 9 Unknown, not stated in record New Descriptor Old KCR None 1 E-Extranodal lymphomas only E 2 S- Spleen, lymphomas only S 3 M- Multiple tumors in a single site M 4 Y- Staged after multimodality therapy Y 5 E&S- Extranodal and spleen ES 6 M&Y – Multiple tumors and multimodality therapy MY 9 Unknown, not stated in record A conversion will be performed for all cases. This change is to bring CPDMS into agreement with the FORDS standard data definition.
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conversions Staged by fields require a conversion to two digit codes
The T, N, and M fields (but not Stage Group) require a conversion to insert the c and p prefixes as appropriate. Clinical and pathologic descriptors (E, S, Y, etc.) will now be numeric codes. Tumor Size Summary will contain converted values from CS Tumor size for cases diagnosed before 2016.
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Other considerations SEER explicitly lists these terms as reportable:
Laryngeal intraepithelial neoplasia III (LIN III) (C320-C329) Lobular neoplasia grade III (LN III)/lobular intraepithelial neoplasia grade III (LIN III) Penile intraepithelial neoplasia, grade III (PeIN III) (C600-C609) Squamous intraepithelial neoplasia III (SIN III) excluding cervix Vaginal intraepithelial neoplasia III (VAIN III) (C529) Vulvar intraepithelial neoplasia III (VIN III) (C510-C519) Anal intraepithelial neoplasia III (AIN III) of the anus or anal canal (C210-C211) FORDS explicitly excludes CIN III, VIN III, VAIN III, AIN III, PIN III, LIN III (laryngeal), and SIN III. The terms reportable to KCR are the ones required by SEER. Not reportable to KCR are CIN III and PIN III.
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Other considerations The CS derived values will no longer be displayed. The FORDS 2016 Manual explicitly states, “For cases diagnosed and later, no software-derived values should be submitted in the directly assigned AJCC Stage data items. Registrars should…never copy over any derived values…Algorithms are under development to identify derived values… Programs will receive a deficiency on COC Program standard 5.6 if submission of derived values is detected.” The FORDS 2016 Manual explicitly states, “For cases diagnosed 2016 and later, no software-derived values should be submitted in the directly assigned AJCC Stage data items. Registrars should…never copy over any derived values…Algorithms are under development to identify derived values… Programs will receive a deficiency on COC Program standard 5.6 if submission of derived values is detected.”
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Other considerations FORDS has added language to emphasize that
Accession numbers should never be changed. “Once cases are submitted to NCDB or RQRS, accession numbers are not to be changed for any reason. Even if there is a clerical error, or if cases are found in an out-of-order fashion when case- finding, the accession number serves as a permanent identifier for a patient at your facility. NCDB does not accommodate any requests for accession number changes for cases already submitted.”
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FORDS added new rules for use of code 88 in AJCC Staging
Other considerations FORDS added new rules for use of code 88 in AJCC Staging If a site/histology combination is not defined in the AJCC Manual, code 88 for clinical and pathologic T, N, and M as well as Stage Group. For in situ tumors that are considered ‘impossible diagnoses’ in the AJCC Manual, code 88 for clinical and pathologic T, N, and M as well as Stage Group.
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Other considerations FORDS revised the Surgical Procedure of Primary Site instruction: If a needle biopsy precedes an excisional biopsy or more extensive surgery, and upon the excisional surgery, no tumor remains, DO NOT consider the needle biopsy to be an excisional biopsy. The needle biopsy should be considered a diagnostic or staging procedure (therapy type N), and the excisional or more extensive surgery should be coded in therapy type S as the Surgical Procedure of Primary Site.
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Other considerations FORDS revised the Chemotherapy instruction: If chemotherapy was provided as a radiosensitizer or radioprotectant, DO NOT code as chemotherapy. In this scenario, it is given in low doses that do not affect the cancer.
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Other considerations - RQRS
NAACCR 16 format is required for 2016 cases but currently the appropriate edits are not available. The current NAACCR 15 format is recommended by CoC for RQRS submissions until they are prepared to accept NAACCR 16 files. CPDMS.net submission files for NCDB and RQRS will remain in NAACCR 15 format until CoC is prepared to accept NAACCR 16 files.
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Other considerations New feature shows when a patient has other abstracts associated with it from other facilities.
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Phase ii Customized choice lists from the CDC’s NPCR program will be incorporated into the CPDMS software for the AJCC data items. These will be specific to each site/histology combination as defined in the AJCC Manual, 7th ed. All tables display attribution to AJCC in Note 1 Additional notes will be taken directly from AJCC manual or other official communication, such as CAnswer forum Categories and their descriptions are taken directly from the AJCC manual, some may be reformatted for clarity Any added words or codes are indicated by square brackets Customized choice lists will be available to KCR from the CDC’s NPCR program. These will be specific to each site/histology combination. These will be similar to the web pages for Collaborative Stage, with Notes at the top and the Stage categories, codes and definitions in a Table underneath. All tables display attribution to AJCC in Note 1 Categories and their descriptions are taken directly from the AJCC manual, some may be reformatted for clarity, such as using bullet points Additional notes will be taken directly from AJCC manual or other official communication, such as CAnswer forum Any added words or codes are indicated by square brackets. For example an implied statement from an earlier paragraph in the Manual might be repeated in the code definition for the sake of clarity. It’s important to note that AJCC is licensing CDC to use parts of their manual in our software, and the licensing agreement will stipulate the specific uses and limits on distribution .
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Phase ii The Edits program for 2016 cases is not yet available, but will be implemented in CPDMS when it is available. When this update is implemented, you must run CoC Edits on your 2016 cases. Select Reports, then QA, then CoC Edits, and enter dates in 2016 to create a report of any errors that need to be fixed. It is possible that you will not have any errors to fix. But this report will show cases that have an invalid category for that particular site. For example, Stage Group I for Lung cancer where Stage groups 1A or 1B are valid but Stage Group 1 is not a valid value. Or you’ve entered M1a for breast cancer, where only M0 or M1 are valid values. The 2016 edits program will have many new TNM edits as well as other edits, so you will need to run this report and fix any errors found.
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2016 changes That’s all! Questions?
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