Download Mini-Update - November 2016

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Fellow registrars,
Once again MCR staff got out early to walk in the Race for the Cure, this time in Columbia.
Thanks to Shari for organizing our four walkers and to those who donated to the cause.
If MCR is ready to accept v16 cases by then, large hospitals (>500 cases/yr.) are to finish April 2016 cases
by Nov 15 and smaller facilities (<300 cases /yr.) would report held cases from the 1st Quarter of 2016 at
that time. Blast emails will be sent out before and after the date of our conversion. That date is not
known at this time.
NAACCR Webinars
Live: November 3, 2016, 8-11 a.m., Collecting Cancer Data: Hematopoietic and Lymphoid Neoplasm. To
attend the live broadcast in Columbia, sign up here:
Recordings: Earn 3 CEs by viewing recorded webinars. Check out our Education and Training page to find
out how you can receive access to the recorded NAACCR Webinars.
Upcoming: If you have additional topics that you would like to have taught by MCR in GoToMeeting
webinars, contact Jennifer Sedovic with your suggestions: [email protected]
Recordings: Previous GoToMeeting presentations are posted to the MCR website as recordings.
How to use Sign Up Genius to register for all educational events
Click on any “signupgenius” link provided above. Click the check box for the listed event and then click
the button that says “Submit and Sign Up”. You do not need to create an account; just fill in the boxes
with your name, email, number of registrants and any needed ADA accommodations. That information
will not be made public. Click the “Sign Up Now” button to complete your registration. You can also go
back later and change your reservation. You will get a confirmation email that allows you to put the
webinar on your Outlook, Mac or Google calendar.
MCR Help-Line
Reach us at 1-800-392-2829 during regular office hours, or leave a message; a member of our QA team
will return your call within one business day.
AJCC TNM Webinars
11/10/16 at 1 p.m. CST, AJCC 8th Edition Overview webinar-To sign up go to:
AJCC Staging Moments
Staging Moments is a facility-level educational series developed by the AJCC and is intended to promote
physician discussion on proper and accurate cancer staging. This series offers succinct, case-based
presentations following the common cancer conference format of: symptom presentation; imaging
work-up; and pathology diagnosis. The presentations target difficult and common staging scenarios and
clarify the finer points of staging and are ideal for department or cancer board conferences. To View go
SEER: Learn by Doing
SEER ran a de-identified search across all the completed SEER Educate Practical Application tests to
identify the most problematic data items. Site, histology, grade, and surgery topped the list, so SEER
Educate has again added new case scenarios, preferred answers, and rationales for coding drills that
supports focused practice in these areas:
Grade/Differentiation: 11 tests, 10 scenarios per test, 110 total scenarios.
Histology (Solid Tumors): 100 scenarios (each one its own test).
Histology (Heme and Lymphoid): 20 scenarios (each one its own test).
Site: 6 tests, 10 histologic diagnoses per test. Focuses on identifying a primary site for a given
specific histology when a site is not provided by either the clinician or the pathologist.
Surgery fields: 135 scenarios (each one its own test).
This new content is being released in the CTR Prep section of SEER*Educate. Although no CEs are
available for content in the CTR Prep section, these drills are challenging for both new and experienced
staff. Even though these drills are in the CTR Prep section of SEER*Educate, the material may be useful
for full staff training at both hospital and central registries. We encourage both hospital and central
registries to use the Management Report functionality of SEER*Educate to enable you to compare staff
coding accuracy and consistency over groups of cases and to help identify cases or topics that might best
be addressed in a staff meeting.
The Missouri Tumor Registrars Association (MoSTRA) Annual Conference will be held in Lake Ozark, MO
from November 9-11, 2016. Info at:
Software updates (previously mentioned in blast email on 10/21/16):
Web Plus is supposed to be rolled out to state registries this week. When we find out where we are in
the customization line, we will email you with specific dates that we will be down for conversion and
then again when we are open for v16 submissions.
Abstract Plus with program fixes and edits should be released as an update soon.
MO edits metafile v16C has been in the hands of vendors for 10 days and is posted on MCR website. No
word nationally on any errors remaining in it!
Melanoma Ulceration
Per the AJCC Cancer Answer Forum and Donna Gress AJCC webinars, a statement addressing the
presence or absence of ulceration must be made by the pathologist in order to assign the T1, T2, etc.
elements with the a and b designations. It is not correct to assume that ulceration is not present without
this information. This is a change from the past CS rules and is not clearly stated in the AJCC 7th edition.
If your pathologist uses CAP protocol reporting this information should be readily available. If it is not,
TNM pick lists allow you to assign a T code without the a or b (T1, etc.) however, this will result in group
stage calculating as unknown.
Use of Online ICD-O-3
For those of you who appreciate web-based resources, the ICD-O-3 manual is available at
It should be used with caution keeping in mind the following:
Future updates may appear in the international online version that are not yet adopted by
NAACCR for implementation by North American registries. For instance, specific 2011 updates to
ICD-O-3 were adopted in stages here in 2014-2015 (see link below).
The user must choose from multiple versions available online (3.0 is similar to book; 3.1 which
includes 2011 updates; future revisions may be forthcoming).
The online versions do not currently include introductory discussion of the structure of the
codes that were in the hard copy.
The search feature brings up terms utilizing the searched word, but not the full entry (which in
the case of morphology may include a typical site in parentheses).
MPH rules still influence the way that ICD-O-3 codes are to be applied.
NPCR education coordinators are discussing these issues and may provide further guidance. You may
certainly continue to use your purple book which you have annotated with changes that have been
adopted in the United States over time. For a reminder of 2014-2015 changes, see the NAACCR Work
Group 2014 guidelines:
Uncertain vs. Unknown
Please review to be sure that you understand the difference between “uncertain” and “unknown”
information as taught in the AJCC presentation “Registrar’s Guide to Chapter 1, AJCC Seventh Edition”
slide 17 & 18. Uncertain information involves known but ambiguous information and a decision can be
made by a clinician to choose the lower of the 2 possible stage assignments (“downstaging”).
Downstaging is not to be used when information is Unknown. See examples at:
AJCC - AJCC Releases Cancer Staging Manual, Eighth Edition
The American Joint Committee on Cancer (AJCC) has released the eighth edition of its Cancer Staging
Manual. It reflects current understanding of cancer biology concepts and emphasizes a more
individualized approach to cancer classification and treatment. This edition presents evidence-based
revisions for staging cancer and includes the rationale and site-specific rules for staging; the definitions
of tumor, lymph node involvement, and metastasis (TNM); stage group values; and histologic grade.
Cancer registrars will use the eighth edition for all cancer cases diagnosed on or after January 1, 2017.
The manual, developed in cooperation with the TNM Committee of the Union for International Cancer
Control (UICC), is available for purchase online.
NCCN - Gastric Cancer Guidelines Updated
“Gastric cancer is the fifth most frequently diagnosed cancer and the third leading cause of death from
cancer in the world. Several advances have been made in the staging procedures, imaging techniques,
and treatment approaches. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for
Gastric Cancer provide an evidence- and consensus-based treatment approach for the management of
patients with gastric cancer. This manuscript discusses the recommendations outlined in the NCCN
Guidelines for staging, assessment of HER2 overexpression, systemic therapy for locally advanced or
metastatic disease, and best supportive care for the prevention and management of symptoms due to
advanced disease.”
Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer Incidence and Mortality –
United States, 1999–2014 (NPCR & SEER data)
Factors Associated With Persistently Positive Margin Status After Breast-Conserving Surgery in Women
with Breast Cancer (NCDB data)
Breast-Cancer Tumor Size and Mammography Screening Effectiveness (SEER data)
Ten-year survival in women with primary stage IV breast cancer (SEER data)
State-Level Cancer Mortality Attributable to Cigarette Smoking in the United States (Missouri ranks #7)
Agency for Healthcare Research and Quality (clearing house for various national quality measure
Fruit flies could be helpful to fight cervical cancer caused by HPV (MU research)
Harvard Medical School Prostate Knowledge Site, Discussion of Positive Margins
Pediatric melanomas often mimic benign skin lesions: A retrospective study
Ki67 May Help Avoid Sentinel Lymph Node Biopsy in Some Patients
What Is HPV Cancer? Six Types of Cancer Caused By Human Papillomavirus
Prognostic impact of the number of retrieved lymph nodes in patients with gastric cancer
Molecular biomarkers in acute myeloid leukemia
Comparison of Pathological Outcomes for Men with Low Risk Prostate Cancer from Diverse Practice
Settings: Similar Results from Immediate Prostatectomy or Initial Surveillance with Delayed
Less Frequent Cervical CA Screens May Be OK After HPV Vaccine
Hookah Smoking: A Rapidly Emerging Threat to the Health of the Nation's Young Adults
Cryoablation May Be Alternative to Breast Cancer Surgery
Histopathologic Phenotype of Periampullary Adenocarcinomas Predicts Survival
Radiotherapy in Glioblastoma: the Past, the Present and the Future
Thankful for your efforts that contribute to cancer surveillance for Missouri!
Nancy H. Rold, CTR - Operations Manager, Missouri Cancer Registry and Research Center