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Advanced Abstracting Issues for the Lung Cancer Diagnosis Judy Andrews, CTR Metropolitan Regional Coordinator Georgia Center for Cancer Statistics GATRA.

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Presentation on theme: "Advanced Abstracting Issues for the Lung Cancer Diagnosis Judy Andrews, CTR Metropolitan Regional Coordinator Georgia Center for Cancer Statistics GATRA."— Presentation transcript:

1 Advanced Abstracting Issues for the Lung Cancer Diagnosis Judy Andrews, CTR Metropolitan Regional Coordinator Georgia Center for Cancer Statistics GATRA Fall Meeting 2004

2 ICD ‑ O-3 CODES ICD ‑ 0 ‑ 3TERM C34.0Main bronchus C34.1Upper lobe, lung C34.2Middle lobe, lung C34.3Lower lobe, lung C34.8Overlapping lesion of lung C34.9Lung, NOS

3 Anatomy Related adjectives: Lung= pneumo-, pulmono-, broncho-, bronchiolo-, alveolar, hilar Breathing= -pnea (difficulty with breathing=dyspnea) Paired organ Subsites: Right lobe: 3 lobes Left Lobe: 2 lobes

4 Lung Anatomy Carina Upper Lobe Oblique Fissure Middle Lobe Lower Lobe

5 Lung Anatomy: Key Words Apex Hilum Carina Lingula Cardiac Notch Pleural Cavity Chest Wall Mediastinum Base

6 ICD-O-3 Morphology Codes Small cell lung cancers include ICD ‑ O-3 morphology codes M ‑ 80413, M ‑ 80423, M ‑ 80433, M ‑ 80443, and M80453 Common non ‑ small cell lung cancer histologies Squamous or epidermoid (807_3) Adenocarcinoma (814_3) Bronchioloalveolar (82503) Large cell carcinoma (80123) Other subtypes of adenocarcinoma are acinar, papillary,and mucinous Adenosquamous carcinoma (85603) Mesothelioma (905_3) Bronchogenic carcinoma IS NOT a specific cell type

7 Regional Lymph Nodes for the Lung The regional lymph nodes for the lung are all above the diaphragm Intrathoracic nodes include mediastinal and intrapulmonary nodes Scalene and supraclavicular nodes are also considered regional nodes for staging

8 Regional Lymph Nodes for the Lung Intrathoracic Pulmonary 12 Peribronchial 11 Intrapulmonary 10 Hilar 13 Segmental Superior mediastinal 1 Superior Mediastinal 3Pretracheal,retrotracheal 2 Paratracheal 4 Lower paratracheal, azygos Intrathoracic Aortic 5 Subaortic (aortic window) 6 Para-aortic (ascending aorta or phrenic ) Inferior mediastinal 7 Carinal, subcarinal 8 Paraesophageal 9 Pulmonary ligament

9 Regional Lymph Nodes for the Lung Extrathoracic Scalene Supraclavicular or transverse cervical

10 Common Metastatic Sites for the Lung Lymphatic Spread Cervical Lymph Nodes Contralateral Lung Contralateral Mediastinum Hematogenic Spread Brain Bone Liver Adrenal glands Contralateral Lung

11 Extent of Disease Evaluation for the Lung Diagnostic Studies: Physical Exam Signs and Symptoms Palpable lymph nodes or organs Pancoast Tumor Horner’s Syndrome

12 Extent of Disease Evaluation for the Lung Diagnostic Studies: Imaging Chest X-ray CAT Scan MRI Scan PET Scan Bone Scan

13 Extent of Disease Evaluation for the Lung Diagnostic Studies: Endoscopies Bronchoscopy Mediastinoscopy Thoracoscopy

14 Extent of Disease Evaluation for the Lung Diagnostic Studies: Pathological Closed Chest Needle Biopsy Cytology (Thoracentesis) Sputum Cytology Bronchial Washings Bone Marrow Biopsy

15 Extent of Disease Evaluation for the Lung Diagnostic Studies: Tumor Markers Neuron Specific Enolase (NSE) Squamous Cell Carcinoma Antigen DNA Studies Adrenocorticotropic Hormone (ACTH) Carcinoembryonic Antigen (CEA) Calcitonin Tissue Polypeptide Antigen (TPA)

16 Staging Systems for Lung SEER Extent of Disease 3 rd Edition (Diagnosis year 1988-2003) SEER Summary Staging 2000 (Diagnosis year 2001-2003) American Joint Committee on Cancer (AJCC) TNM 6 th Edition (Diagnosis year 2003 forward) Collaborative Staging (Diagnosis year 2004 forward)

17 Staging Systems for Lung SEER EOD Size Extent Regional Lymph Nodes Reg LN Positive Reg LN Examined SEER Summary Stage 2000 In Situ Localized Reg by Direct Ext Reg Ipsilateral LN only Reg by Direct & Ipsilateral Reg LN Reg, Nos Distant Site/Node Involv AJCC TNM 6 th Edition cT,pT: Extent of primary tumor cN,pN: Absence or presence & Ext of regional lymph nodes cM,pM: Absence/presence of metastasis [Clinical (c) and pathologic (p)] Collaborative Stage CS Tumor Size CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval CS Mets at Dx CS Mets Eval CS Site Specific Factors 1-6

18 Collaborative Stage General Guidelines Timing Rule Site-specific guidelines Highest applicable number for each field Greatest extent of disease

19 Collaborative Stage for Bronchus and Lung General Guidelines continued : CS Tumor Size/Ext CS Tumor Size/Ext Eval CS Regional LN CS Reg Nodes Eval CS Mets CS Mets Eval Regional LN Pos/Regional LN Exam Site Specific Factors

20 Collaborative Stage for Bronchus and Lung CS Tumor Size 000No mass/tumor found 001-998 001-998 millimeters (exact size) 989989 millimeters or larger 990Microscopic focus or foci only, no size of focus given 991Described as less than 1 cm 992-995Described as less than (2,3,4,5 cm) 996Malignant cells in bronchopulmonary secretions, but no tumor is seen radiographically or during bronchoscopy 997Diffuse (entire lobe) 998Diffuse (entire lung) 999Unknown; size not stated Not documented in patient record

21 Collaborative Stage for Bronchus and Lung CS Extension Primary Tumor extension DO NOT CODE DISCONTINOUS METASTASES IN THIS FIELD Priority order for extension Notes 1-7: Read carefully

22 Collaborative Stage for Bronchus and Lung CS TS/EXT EVAL Evaluates source for “CS Tumor Size” and “CS Extension” Describes clinical or pathological staging of the tumor

23 Collaborative Stage for Bronchus and Lung CS TS/EXT EVAL Code 0, 1, 9No surgery Code 2Autopsy (diagnosis suspected) Code 3 Surgery followed by other therapy Code 5Determined prior to neoadjuvant therapy Code 6Determined after neoadjuvant therapy Code 8Autopsy (diagnosis unsuspected) Code 9Unknown, Not assessed, Not stated

24 Collaborative Stage for Bronchus and Lung CS Lymph Nodes Regional Nodes and Nodes, NOS only Highest Applicable Code Exception (NOS) New Rule for Inaccessible Site Lung Notes 1-4: Read carefully

25 Collaborative Stage for Bronchus and Lung CS Reg Nodes Eval Code 0, 1, 9No LN(s) removal Code 2Autopsy (diagnosis suspected) Code 3LN(s) surgery followed by other therapy Code 5LN(s) status determined prior to neoadjuvant therapy Code 6LN(s) status determined after neoadjuvant therapy Code 8Autopsy (diagnosis unsuspected) Code 9Unknown, Not assessed, Not stated

26 Collaborative Stage for Bronchus and Lung Regional Nodes Positive 00All nodes examined negative 01-891-89 nodes positive 90 90 or more nodes positive 95 Positive aspiration of LN(s) was performed 97Positive nodes documented, number unspecified 98No nodes examined 99Unknown if nodes positive, not applicable, not stated in record Regional Nodes Examined 00No nodes examined 01-891-89 nodes examined 90 90 or more nodes examined 95 No Reg LN removed, Aspiration of Reg LN performed 96Reg LN removal documented as sampling, number unknown/not stated 97Reg LN removal documented as dissection, number unknown/not stated 98Reg LN surgically removed, number of LNs unknown/not stated, not documented as sampling or dissection; nodes examined, number unknown 99Unknown, not applicable, not stated in record

27 Collaborative Stage for Bronchus and Lung CS Mets at Dx 00No; none 10Distant Lymph Nodes (s), including cervical nodes 35Separate tumor nodules (s) in different lobe, same lung 37Extension to sternum, skeletal muscle, skin of chest 39Extension to contralateral lung, contralateral main stem bronchus, separate tumor nodule(s) in contralateral lung 40Abdominal organs, distant metastasis except to distant lymph nodes (code 10), distant mets, NOS, carcinomatosis 50Distant mets + distant node(s) (10) + any [35-40] 99Unknown; distant metastasis cannot be assessed, not documented in patient record.

28 Collaborative Stage for Bronchus and Lung CS Mets Eval Code 0, 1, 9No surgery Code 2Autopsy (diagnosis suspected) Code 3Surgery followed by other therapy Code 5Determined prior to neoadjuvant therapy Code 6Determined after neoadjuvant therapy Code 8Autopsy (diagnosis unsuspected) Code 9Unknown, Not assessed, Not stated

29 Collaborative Stage for Bronchus and Lung CS Site Specific Factors SSF 1Code 888 SSF 2Code 888 SSF 3Code 888 SSF 4Code 888 SSF 5Code 888 SSF 6Code 888

30 Treatment for Bronchus and Lung Surgery Non-small cell carcinoma: Stage I and II (Localized) Small cell carcinoma: Not recommended Radiation Non-small cell carcinoma: Inoperable, Advanced Small cell carcinoma: Recommended Systemic Therapy Non-small cell carcinoma: Chemotherapy Small cell carcinoma: Combination chemotherapy Hormonal & Endocrine Not proven to be useful

31 Treatment for Bronchus and Lung Surgery Codes Primary Site Scope of Regional Lymph Node Surgical Procedure of Other Site

32 Treatment for Bronchus and Lung Surgery Codes continued Primary Site Scope of Regional Lymph Node Surgical Procedure of Other Site

33 Treatment for Bronchus and Lung Surgery Codes continued Primary Site Scope of Regional Lymph Node Surgical Procedure of Other Site

34 Treatment for Bronchus and Lung Radiation Treatment Volume Treatment Modality Regional Dose Boost Modality Boost Dose Prophylactic Cranial Radiation (PCI)

35 Treatment for Bronchus and Lung Chemotherapy Non-Small Cell Carcinoma Small Cell Carcinoma Hormones Immunotherapy Other Endoscopic Photodynamic Therapy

36 Keys to Abstracting Organization Dates Procedure Documentation Resources Diagnosis year Text Pertinent Acronyms


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