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UKACR GYNAE CANCER STUDY DAY

UKACR GYNAE CANCER STUDY DAY. ANALYSIS OF CASE STUDIES. Joy McRae - ACC. Tuesday, 8th April 2008 Julian Hodge Building, Cardiff. GENERAL POINTS. CASE STUDIES Few registries had cases to be submitted for consideration at this study day. So, it was decided to re-visit the cases used

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UKACR GYNAE CANCER STUDY DAY

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  1. UKACR GYNAE CANCERSTUDY DAY ANALYSIS OF CASE STUDIES Joy McRae - ACC Tuesday, 8th April 2008Julian Hodge Building, Cardiff

  2. GENERAL POINTS CASE STUDIES Few registries had cases to be submitted for consideration at this study day. So, it was decided to re-visit the cases used at the 1999 Gynae Cancers Study Day.

  3. General Points (2) Reason for no problem cases? Is the documentation better now?? e.g. The Royal College of Pathologists have introduced a pro forma reporting which is a benefit to data recording in some English registries.

  4. Instructions Case Studies: Please bring this sheet with you on 8th April Please consider the information below as all you can find in your data sources and record (as you would normally) -

  5. Instructions (Cont…) • The morphology of the tumour(s). • The anatomical site(s) of the tumour(s). • The ICD (indicating clearly which classn used) . • The anniversary date(s) or “date(s) of diagnosis” for the tumours(s)

  6. Classifications Used ICD10 ECRIC, NI, NYCRIS, OXFORD, SCOTLAND SWCIS, TRENT, WCISU, WMCIU ICD02 NWCIS – Liverpool Office (LO) Manchester Office (MO) ICD03 SI, Thames

  7. INTERNATIONAL STANDARDS Cancer Registration Use of these classifications and adherence to the rules therein ensure the recording of quality data for cancer incidence.

  8. THE CASESTUDIES! Good News! Consensus on Cases 6, 8, 9, 12

  9. Case 9 Coding & Classification Group No. of Primaries = NONE Comments: “BENIGN – Not registerable”

  10. Case 12 Coding & Classification Group No. of Primaries = ONE Morphology Code = M9100/1 ICD Code (Placenta) = D39.2/C58.9 Diagnosis Date = 14.10.06 “Invasive Mole coded as an Uncertain Tumour”

  11. Case 12 – REGISTRIES’ ANSWERS No. of Primaries = ONE Morphology Code = M9100/1 ICD Code (Placenta) = D39.2/C58.9 Basis of Dx = Histology Diagnosis Date = 14.10.06

  12. Case 6 Coding & Classification Group No. of Primaries = ONE Morphology Code = M8010/3 ICD Code (Cervix) = C53.9 Diagnosis Date = 03.05.04

  13. Case 6 (Cont..) Coding & Classification Group Comments: “Poorly differentiated epithelial tumour = carcinoma NOS”

  14. Case 6 – REGISTRIES’ ANSWERS No. of Primaries = ONE Morphology Code = M8010/3 ICD Code (Cervix) = C53.9 Basis of Dx = Histology Diagnosis Date = 03.05.04 (ONE - 02.05.04 : ONE – 04.05.04)

  15. Case 8 Coding & Classification Group No. of Primaries = ONE Morphology Code = M8380/3 ICD Code (Ovary ) = C56/C56.9 Diagnosis Date = 19.06.04 “Taken from Cytology”

  16. Case 8 – REGISTRIES’ ANSWERS No. of Primaries = ONE Morphology Code = M8380/3 ICD Code (Ovary ) = C56/C56.9 Diagnosis Date = 19.06.04 x 6 16.06.04 x 3 22.06.04 x 2 15.06.04 x 1 20.06.04 x 1 Basis of Dx: 2 Cytology : 11 Histology

  17. Case 1- Coding &Classification No. of Primaries = 1 Morphology code = M8070/5 or M8076/5 ICD Code (Cervix) = C53.9 Diagnosis Date = 02.08.05 C&CG confirm that it is impossible to state the site the tumour has arisen from by histology alone. Therefore unless patholgist states site tumour arises – Cervix NOS

  18. Case 1– REGISTRIES’ ANSWERS No. of Primaries = 1 Morphology code = M8070/5 x 5 M8076/5 x 3 M8076/3 x 5 ICD Code (Cervix) = (next sheet) Diagnosis Date = 02.08.05 x 12 03.08.05 x 1

  19. Case 1 – Site code “We default to exocervix for all squamous cell carcinoma” WMCIU

  20. Case 2 Coding & Classification Group No. of Primaries= 1 Morphology code M8070/3 ICD Code = C51.9 Site in Text = Vulva (Bilateral) Diagnosis Date = 18.01.04 Bilateral diagnosed at the same time therefore ONE registration – see Training Manual section 3 page 9

  21. Case 2 - REGISTRIES’ ANSWERS Morphology Code = M8070/3 x 13 No. of Primaries = 12 x ONE 1 x TWO The TWO Primary Sites are : Overlapping lesion of Vulva and Labia Majora HOWEVER, there are discrepancies in recording the site. (Next Page)

  22. CASE 2

  23. Case 3 Coding & Classification Group No. of Primaries = TWO Morphology code = M8070/2 or M8077/2 & M8070/3 ICD10 Site Codes = D06.9 & C53.9 or ICD0 = C53.9 & C53.9 Site in text = In situ cervix NOS & invasive cervix NOS Diagnosis Date = 02.01.04 & 04.07.04

  24. Case 3 Coding & Classification Group Comments: TWO registrations because first dx. of in situ was diagnosed and treated Followed by second diagnosis more than 3 months later. These both constitute a different episode of care.

  25. Case 3– REGISTRIES’ ANSWERS No. of Primaries = TWO Morphology code = M8070/2 or M8077/2 & M8070/3 ICD10 Site Codes = D06.9 & C53.9 or ICD0 = C53.9 & C53.9 Site in text = In situ cervix NOS & invasive cervix NOS (2 registries defaulted to exocervix Diagnosis Date = 02.01.04 & 04.07.04

  26. Case 4 Coding & Classification Group No. of Primaries = ONE Morphology code = M8140/6 (ICD10) M8140/3 (ICD0) ICD Code = C78.6 Site in Text = Unknown primary peritoneum Diagnosis Date = 15.04.06

  27. Case 4 - REGISTRIES’ ANSWERS Morphology: - Adenocarcinoma x 13 Incidence Date: - 15.04.06 x 13 Basis of Dx: Cytology No of Primaries : 12 x 1: 1 x 2 Site in Text : Ovary x 6 UKP x 2 Malignant Ascites x 2 UKP/Mets/Ovary x 1 UKP/Peritoneum x 1

  28. Case 5 Coding & Classification Group No. of Primaries = ONE Morphology code = M8140/3 ICD Code = C57.8 Site in Text = Overlapping genital organ Diagnosis Date = 02.12.04

  29. Case 5 Coding & Classification Group Comment: Text states “involving lower part of uterus & the cervix therefore point of origin cannot be established – code as overlapping.

  30. Case 5 - REGISTRIES’ ANSWERS No. of Primaries = ONE Morphology code = M8140/3 ICD Code = C57.8 Diagnosis Date = 02.12.04 Basis of Dx. = Histology

  31. Case 7 Two morphologies in different morphology groups (see training manual part 3) Coding & Classification Group No. of Primaries = TWO Morphology code = a) M8077/2 &/or b) M8140/2 ICD02 Code or M8148/2 ICD03 Code ICD10 a) D06.9 & D06.9 ICD0 b) C53.9 & C53.9 Site in Text a) Cervix in situ b) Cervix in situ Dx Date a) 27.02.05 b) 15.04.05 New term in ICD03 – agreed at C&CG 08.02.08 GINIII or high grade GIN CGINIII or high grade CGIN

  32. Case 7 - REGISTRIES’ ANSWERS No. of Primaries = 7 x ONE Morphology = M8560/2 = 6 X TWO Morphology code = a) M8077/2 &/or b) M8140/2 ICD02 Code or M8148/2 ICD03 Code ICD10 a) D06.9 & D06.9 ICD0 b) C53.9 & C53.9 Site in Text a) Cervix in situ b) Cervix in situ Dx Date a) 27.02.05 b) 15.04.05

  33. No Problems with Case 7

  34. Case 10 Coding & Classification Group No. of Primaries = ONE Morphology code = M8020/3 ICD Site Codes = C56 or C56.9 Site in text = Ovary Diagnosis Date = 19.06.07 Coded as ovarian origin as the report states “probable” – a registerable term, see Training Manual part 3, Page 21 (training group version HOWEVER C&CG agree this could beinterpreted as “female genital tract or UKP peritoneum” – not all cases have a black and white answer!!

  35. Case 10- Registries’ Answers

  36. Case 11 Coding & Classification Group No. of Primaries = ONE Morphology code = M8490/6 ICD Site Codes = C79.6 or C80 Site in text = UKP Ovary Diagnosis Date = 02.02.06 Krukenberg always metastatic therefore UKP as no primary yet detected.

  37. Case 11 - REGISTRIES’ ANSWERS

  38. Case 13 Coding & Classification Group No. of Primaries = ONE Morphology code = M8461/3 ICD Site Codes = C56 or C56.9 Site in text = Ovary Diagnosis Date = 12.03.07 LOR – PO/00/04 “The C&CG following advice from gynaecological pathologists and oncologists, recommends that is appropriate to classify mixed tumours as surface epithelial tumours of the ovary.”

  39. Case 13 - REGISTRIES’ ANSWERS

  40. Case 14 Coding & Classification Group No. of Primaries = ONE Morphology code = M8441/3 ICD Site Codes = C48.2 Site in text = Peritoneum Diagnosis Date = 30.06.06 C&CG agree that M8461/3 may be allowed as an alternative morphology code

  41. Case 14 - REGISTRIES’ ANSWERS

  42. Case 15 Coding & Classification Group No. of Primaries = ONE Morphology code = M8441/3 ICD Site Codes = C48.2 Site in text = Peritoneum Diagnosis Date = 29.11.06

  43. Case 15 Coding & Classification Group LOR: Endometrial carcinoma of endometrioma is a tumour containing endometrial tissue: Where a carcinoma occurs wthin ectopic endometrial material inside the peritoneal cavity the cases should be coded with an endometrial morphology M8380/3 but with the primary site of peritoneum C48.2 (C&CG email sent 16.12.05 Nigel Brook).

  44. Case 15 Coding & Classification Group No. of Primaries = ONE Morphology code = M8441/3 ICD Site Codes = C76.3 Site in Text = Rectosigmoid septum Diagnosis Date = 29.11.06

  45. Case 15 - REGISTRIES’ ANSWERS

  46. Summary We are good at - • Determining how many primaries exist • Selecting correct Incidence Date • Recording correct basis of diagnosis • Interpreting medical terminology to assign clinical codes. We adhere to Cancer Registration STANDARDS

  47. Summary (Cont..) Here is your very own GOLD STAR

  48. GOODBYE WE HOPE YOU HAVE ENJOYED THE DAY THANK YOU FOR YOUR ATTENTION SAFE JOURNEY HOME!

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