Download Mini-Update - April 2013 - Missouri Cancer Registry

MCR MINI-UPDATE APRIL 2013
Fellow Registrars,
No foolin'? The calendar and my heart say spring, but I saw snowflakes this morning! I guess
we've been spoiled by early spring warmth the past few years. In any case, I hope this finds you
well. Here's your April Update.
MCR NEWS
Due Date:
All hospitals should report abstracted cases to us by April 15, 2013. To be on schedule this should
include cases diagnosed through Sept 2012.
EDUCATION - SAVE THE DATE!
Fundamentals of Abstracting Workshop will be April 29-30, 2013 at the Missouri Cancer Registry and
Research Center. This is a hands-on class for those new to abstracting. Each MCR-ARC required data
item is discussed using the MCR-ARC Abstract Code Manual and laptops are available to abstract
practice cases using Abstract Plus software. The class is generally small and there is ample time for
questions and one on one help. Class size is limited so if you want to register please do so as soon as
possible!
NAACCR Webinars Recorded Webinars are now available to view. Request Access Now! Check out our Education and
Training page to find out how you can receive access to the recorded NAACCR Webinars.
April 4, 2013 - Collecting Cancer Data: Breast
Live Meetings April 10, 2013 - Web Plus File Upload, Presenter Alena Headd
May 8, 2013 - Understanding Edits, Presenter Nancy Rold. If you have a particular edit that you would
like explained, please let me know in advance so that I can include it.
As always, to register for any of our educational opportunities, contact Shari Ackerman (note
name/email change) at [email protected] or 1-866-240-8809. Please be sure to clarify
which you will be attending when you register.
ABSTRACTING TIPS from the QA Staff
Coding and text for surgical procedures - Just a reminder that in some instances various components of
the tumor data and the appropriate surgery and date may be defined in other than the most definitive
surgery. It is necessary for text with procedure names/dates and the brief but concise findings to be
documented for all biopsies and procedures performed on the patient to support coded data items.
Specify the anatomical source of tissue specimens removed as a part of the procedure.
Example: Breast case - 1/10/13 core biopsy of UOQ mass shows invasive ductal ca, MBR grade 3; then
1/20/13 excisional biopsy grossly removing the entire tumor with SLN bx reveals a 3cm invasive ductal
carcinoma, pleomorphic type, MBR grade 2, no dermal lymphatic invasion, 3/3+ SLN's; but 2/15/13
modified radical mastectomy reveals residual 5mm invasive ductal ca, MBR 2, 4/8+ axillary lymph
nodes. In this case  The grade would be coded from the core bx because it is the highest of the multiple path
diagnoses;
 The CSE, histology and date of first surgery would be coded from the excisional biopsy because
it is the most representative tumor specimen and the first date that cancer directed treatment
was received (Note: If documented gross tumor is left behind on a stated excisional biopsy that is
followed by a mastectomy, the mastectomy would be the first date of cancer directed treatment.)


CS LN's and scope of regional LN surgery would be coded from both the excisional bx and
mastectomy specimen;
The surgery summary would be coded from the mastectomy specimen.
If only the most definitive surgery is recorded in the text, without brief but concise information from
previous bxs/excisional bxs, the appropriate codes for some key data elements cannot be verified.
Another scenario is an incisional bx may be performed and there is no residual tumor on an excisional bx
or mastectomy. That renders the bx as an actual excisional bx because the entire tumor was removed.
Therefore, it becomes the most representative tumor specimen and the date of first cancer directed
treatment. In addition to the excisional bx and/or mastectomy information, it is very important to
include the date and tumor data for the incisional biopsy in the text and to code the date of first surgical
procedure based on that. Just stating in the text that the patient had a bx and excisional bx or
mastectomy without specifics is not adequate.
Colon Histology - Adenocarcinoma NOS - For colon cases, a final diagnosis stated as mucinous/colloid
carcinoma or signet ring cell carcinoma are assigned histology codes 8480 or 8490, respectively - per
MP/H rule H5. If the final dx is Adenocarcinoma along with a stated term such as "with features of
mucinous ca" or "with features of signet ring cell ca", histology codes 8480 and 8490 do not apply unless
the microscopic description verifies that the mucinous or signet ring cell component is 50 % or more. In
the absence of that confirmation, the correct histology code is 8140, per MP/H rule H6. If the final dx is
'Adenocarcinoma' and no other descriptor, before assigning the histology code to 8140 always review
the microscopic description to confirm if mucinous/colloid or signet ring cell components are included
and, if so, the percentage.
Paired Sites and MP/H Rules for Other Sites - For Multiple Primary/Histology, when determining
multiple primaries for paired sites in the Other schema, use Table 1 - Paired Sites and Organs with
Laterality, per rule M8. The table is located in the Terms and Definitions section for Other Sites. Keep
in mind that the paired sites table shown for a specific module in the MP/H manual pertains only to
determining multiple primaries for sites within the module. i.e.: To determine if two tumors of the
tonsil are multiple primaries refer to the paired sites table within Terms and Definitions for 'Head and
Neck', not to the paired sites table within Terms and Definitions for 'Other', in the MPH schema.
STANDARD SETTER NEWS
From NPCR:
The NPCR-CSS SSDI Web site has recently been updated with data generated by the Social Security
Administration for the 4th quarter of 2012.
From NAACCR:
The Fast Stats page http://faststats.naaccr.org has been updated with the latest 2005-2009 Incidence
data and is now available to anyone visiting the NAACCR website. NAACCR Fast Stats is an interactive
tool for quick access to key NAACCR and US cancer statistics for major cancer sites by age, sex,
race/ethnicity, registry and data type. Statistics are presented as graphs and tables and can be stratified
by:
 Cancer Site
 Race/Sex
 Race/Ethnicity
 Age at Diagnosis
 Sex
 Registry
 Data Type
RESOURCES
Lymphoseek Approved by FDA for Lymph Node Detection
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm343525.htm
Nanoparticle Chemotherapy is Gentler on Fertility
http://www.medicalnewstoday.com/articles/258172.php
Math Models to Predict Spread of Cancer
http://www.futurity.org/health-medicine/google-math-predicts-lung-cancer%E2%80%99s-path/
Nasopharynx Cancer Detection Using Brushings and Blood Analysis for Epstein - Barr Virus Load
http://clincancerres.aacrjournals.org/content/early/2013/03/14/1078-0432.CCR-12-2897
Chemotherapy in Metastatic Prostate Cancer
http://www.urologic.theclinics.com/article/S0094-0143(12)00073-0/fulltext#sec8
LVI Prognostic in Renal Cell Carcinoma
http://www.urologiconcology.org/article/S1078-1439(12)00395-X/abstract
Increased Incidence of Breast Cancer in Young Women
http://jama.jamanetwork.com/article.aspx?articleid=1656255
Nancy H. Rold, CTR
QA Unit Supervisor
Missouri Cancer Registry and Research Center