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Advanced Abstracting Issues for the Lung Cancer Diagnosis

Advanced Abstracting Issues for the Lung Cancer Diagnosis. Judy Andrews, CTR Metropolitan Regional Coordinator Georgia Center for Cancer Statistics GATRA Fall Meeting 2004. ICD‑O-3 CODES . ICD‑0‑3 TERM C34.0 Main bronchus C34.1 Upper lobe, lung C34.2 Middle lobe, lung

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Advanced Abstracting Issues for the Lung Cancer Diagnosis

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  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‑0‑3 TERM C34.0 Mainbronchus C34.1 Upper lobe, lung C34.2 Middle lobe, lung C34.3 Lower lobe, lung C34.8 Overlapping lesion of lung C34.9 Lung, 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. Intrathoracic Pulmonary 12 Peribronchial 11 Intrapulmonary 10 Hilar 13 Segmental Superior mediastinal 1 Superior Mediastinal 3 Pretracheal,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 Regional Lymph Nodes for the Lung

  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 3rd Edition (Diagnosis year 1988-2003) • SEER Summary Staging 2000 (Diagnosis year 2001-2003) • American Joint Committee on Cancer (AJCC) TNM 6th 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 6th 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 000 No mass/tumor found 001-998 001-998 millimeters (exact size) 989 989 millimeters or larger 990 Microscopic focus or foci only, no size of focus given 991 Described as less than 1 cm 992-995 Described as less than (2,3,4,5 cm) 996 Malignant cells in bronchopulmonary secretions, but no tumor is seen radiographically or during bronchoscopy 997 Diffuse (entire lobe) 998 Diffuse (entire lung) 999 Unknown; 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, 9 No surgery • Code 2 Autopsy (diagnosis suspected) • Code 3 Surgery followed by other therapy • Code 5 Determined prior to neoadjuvant therapy • Code 6 Determined after neoadjuvant therapy • Code 8 Autopsy (diagnosis unsuspected) • Code 9 Unknown, 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, 9 No LN(s) removal • Code 2 Autopsy (diagnosis suspected) • Code 3 LN(s) surgery followed by other therapy • Code 5 LN(s) status determined prior to neoadjuvant therapy • Code 6 LN(s) status determined after neoadjuvant therapy • Code 8 Autopsy (diagnosis unsuspected) • Code 9 Unknown, Not assessed, Not stated

  26. Regional Nodes Positive 00 All nodes examined negative 01-89 1-89 nodes positive 90 or more nodes positive 95 Positive aspiration of LN(s) was performed 97 Positive nodes documented, number unspecified 98 No nodes examined 99 Unknown if nodes positive, not applicable, not stated in record Regional Nodes Examined 00 No nodes examined 01-89 1-89 nodes examined 90 or more nodes examined No Reg LN removed, Aspiration of Reg LN performed Reg LN removal documented as sampling, number unknown/not stated 97 Reg LN removal documented as dissection, number unknown/not stated 98 Reg LN surgically removed, number of LNs unknown/not stated, not documented as sampling or dissection; nodes examined, number unknown 99 Unknown, not applicable, not stated in record Collaborative Stage for Bronchus and Lung

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

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

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