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

Advanced Abstracting Issues for the Lung Cancer

Diagnosis

Judy Andrews, CTRMetropolitan Regional Coordinator

Georgia Center for Cancer StatisticsGATRA 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

C34.3 Lower lobe, lung

C34.8 Overlapping lesion of lung

C34.9 Lung, NOS

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

Lung Anatomy

Carina

Upper Lobe

ObliqueFissure

Middle Lobe

Lower Lobe

Lung Anatomy: Key Words

Apex Hilum Carina Lingula Cardiac Notch Pleural Cavity Chest Wall Mediastinum Base

ICD-O-3 Morphology CodesSmall cell lung cancers include ICD‑O-3 morphology codes M‑80413, M‑80423, M‑80433, M‑80443, and M80453Common 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

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


IntrathoracicPulmonary

12 Peribronchial

11 Intrapulmonary10 Hilar13 Segmental

Superior mediastinal

1 Superior Mediastinal

3Pretracheal,retrotracheal2 Paratracheal4 Lower paratracheal, azygos

IntrathoracicAortic

5 Subaortic (aortic window)6 Para-aortic (ascending

aorta or phrenic)

Inferior mediastinal

7 Carinal, subcarinal

8 Paraesophageal9 Pulmonary ligament


Extrathoracic

Scalene

Supraclavicular or transverse cervical

Common Metastatic Sites for the Lung

Lymphatic Spread Cervical Lymph Nodes Contralateral Lung Contralateral Mediastinum

Hematogenic Spread Brain Bone Liver Adrenal glands Contralateral Lung

Extent of Disease Evaluation for the Lung

Diagnostic Studies: Physical Exam

Signs and Symptoms

Palpable lymph nodes or organs

Pancoast Tumor

Horner’s Syndrome


Diagnostic Studies: Imaging

Chest X-ray

CAT Scan

MRI Scan

PET Scan

Bone Scan


Diagnostic Studies: Endoscopies

Bronchoscopy

Mediastinoscopy

Thoracoscopy


Diagnostic Studies: Pathological

Closed Chest Needle Biopsy

Cytology (Thoracentesis)

Sputum Cytology

Bronchial Washings

Bone Marrow Biopsy


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)

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)

Staging Systems for Lung

SEER EOD

Size

Extent

Regional Lymph Nodes

Reg LN Positive

Reg LN Examined

SEER Summary Stage 2000In 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 StageCS 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

Collaborative Stage

General Guidelines

Timing Rule

Site-specific guidelines

Highest applicable number for each field

Greatest extent of disease

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


CS Tumor Size000 No mass/tumor found001-998 001-998 millimeters (exact size)989 989 millimeters or larger990 Microscopic focus or foci only, no

size of focus given991 Described as less than 1 cm992-995 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


CS Extension

Primary Tumor extensionDO NOT CODE DISCONTINOUS METASTASES IN THIS FIELD

Priority order for extension

Notes 1-7: Read carefully


CS TS/EXT EVAL

Evaluates source for “CS Tumor Size” and

“CS Extension”

Describes clinical or pathological staging

of the tumor


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


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


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


Regional Nodes Positive00 All nodes examined

negative01-89 1-89 nodes positive90 90 or more nodes positive95 Positive aspiration of LN(s)

was performed97 Positive nodes

documented, number unspecified

98 No nodes examined99 Unknown if nodes

positive, not applicable, not stated in record

Regional Nodes Examined00 No nodes examined 01-89 1-89 nodes examined90 90 or more nodes examined95 No Reg LN removed,

Aspiration of Reg LN performed

96 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


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.


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


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

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


Surgery Codes

Primary Site

Scope of Regional Lymph Node

Surgical Procedure of Other Site


Surgery Codes continued

Primary Site




Surgery Codes continued

Primary Site




Radiation Treatment Volume

Treatment Modality

Regional Dose

Boost Modality

Boost Dose

Prophylactic Cranial Radiation (PCI)


Chemotherapy Non-Small Cell Carcinoma

Small Cell Carcinoma

Hormones

Immunotherapy

Other Endoscopic Photodynamic Therapy

Keys to Abstracting

Organization Dates

Procedure Documentation

Resources Diagnosis year

Text Pertinent

Acronyms

Documents

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