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UKACR GYNAE CANCER
STUDY DAY
ANALYSIS OF CASE STUDIES
Tuesday, 8th April 2008Julian Hodge Building, Cardiff
Joy McRae - ACC
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.
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.
Instructions
Case Studies:Please bring this sheet with you on 8th April
Please consider the information below as all you can find in yourdata sources and record (as you wouldnormally) -
Instructions (Cont…)
1. The morphology of the tumour(s).
2. The anatomical site(s) of the tumour(s).
3. The ICD (indicating clearly which classn
used) .
4. The anniversary date(s) or “date(s) of diagnosis” for the tumours(s)
Classifications UsedICD10 ECRIC, NI, NYCRIS, OXFORD, SCOTLAND
SWCIS, TRENT, WCISU, WMCIU
ICD02NWCIS – Liverpool Office (LO)
Manchester Office (MO)
ICD03SI, Thames
INTERNATIONAL STANDARDS
Cancer Registration
Use of these classifications and adherence
to the rules therein ensure the recording of
quality data for cancer incidence.
THE CASESTUDIES!
Good News!
Consensus on Cases 6, 8, 9, 12
Case 9
Coding & Classification Group
No. of Primaries = NONE
Comments:
“BENIGN – Not registerable”
Case 12Coding & 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”
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
Case 6Coding & Classification Group
No. of Primaries = ONE
Morphology Code = M8010/3
ICD Code (Cervix) = C53.9
Diagnosis Date = 03.05.04
Case 6 (Cont..)
Coding & Classification Group
Comments:
“Poorly differentiated epithelial tumour = carcinoma NOS”
Case 6 – REGISTRIES’ ANSWERSNo. 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)
Case 8Coding & Classification Group
No. of Primaries = ONE
Morphology Code = M8380/3
ICD Code (Ovary ) = C56/C56.9
Diagnosis Date = 19.06.04“Taken from Cytology”
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 215.06.04 x 120.06.04 x 1
Basis of Dx: 2 Cytology : 11 Histology
Case 1- Coding & ClassificationNo. 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
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
Case 1 – Site code
ECRIC -ICD10 Exocervix C53.1 M8070/5
Northern Ireland -ICD10 In NI microinvasive coded as invasive
C53.9 M8076/3
NWCIS (LO) - ICD02 Cervix M8076/5
NWCIS (MO) - ICD02 Cervix C53 M8076/3
NYCRIS - ICD10 Cervix M8076/5
Oxford - ICD10 Cervix C53.9 M8070/5
Scotland - ICD10 Cervix C53.9 M8076/3
Southern Ireland- ICD03 Cervix - Endocervical canal C53.0 M8076/3
SWCIS - ICD10 Cervix M8070/5
Thames – ICD03 impossible to state the site tumour has arisen from by histology alone. Therefore unless the pathologist states site tumour arises, code site
as cervix NOS.
C53.9 M8076/5
Trent - ICD10 Cervix C53.9 M8070/5
Wales - ICD10 Cervix C53.9 M8076/3
WMCIU - ICD10 Exocervix C53.1 M8070/5
“We default to exocervix for all squamous cell carcinoma” WMCIU
Case 2Coding & 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
Case 2 - REGISTRIES’ ANSWERS
Morphology Code = M8070/3 x 13No. of Primaries = 12 x ONE 1 x TWOThe TWO Primary Sites are :Overlapping lesion of Vulva and LabiaMajora
HOWEVER, there are discrepancies in recording the site. (Next Page)
CASE 2
ECRIC Vulva ICD10 C51.1Comments: Right labia majora and bilateral labia minora so code to minora as dominant site.
Ireland Overlapping lesion of vulva + Labia major
ICD10 C51.8 C51.1
NWCIS (LO) Vulva NOS ICD02 M8070/3
NWCIS (MO) Vulva ICD02 C51.9
Comment: Possible C51.8 overlapping
NYCRIS Vulva ICD10 M80703
Oxford Vulva (Bilateral) ICD10 C51.9
Scotland Vulva ICD10 C51.8Comment: Registered once as directed in the E&W Training Manual Part 3 p9.
Southern Ireland Overlapping lesion of vulva
ICD03 C51.8
SWCIS Vulva ICD10 M8070/3
Thames Vulva (Bilateral) ICD03 C51.9
Trent Labia Majora ICD10 C51.0Comment: One primary using multiple primary rules in UKACR manual, taken and coded the
biggest tumour component.
Wales Vulva ICD10 C51.8/C51.1
Comment: ONE registration as Bilateral occurring at the same time
WMCIU Vulva ICD10 C51.8
Case 3Coding & 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
Case 3Coding & Classification Group
Comments:TWO registrations because first dx.of in situ was diagnosed and treatedFollowed by second diagnosis morethan 3 months later. These both constitute a different episode of care.
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
Case 4Coding & 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
Case 4 - REGISTRIES’ ANSWERS
No of Primaries : 12 x 1: 1 x 2
Site in Text : Ovary x 6UKP x 2Malignant Ascites x 2UKP/Mets/Ovary x 1UKP/Peritoneum x 1
Morphology: -
Adenocarcinoma x 13
Incidence Date: -
15.04.06 x 13
Basis of Dx:
Cytology
Case 5Coding & 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
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.
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
Cancer Registry
Site in Text Codes
ECRIC Lower Uterus C54.0 M8140/3Comments : Adenocarcinoma of lower uterus with spread into cervix.
Northern Ireland Uterus C55 M8140/3
NWCIS (LO) Isthmus uteri M8140/3
NWCIS (MO) Endo LR Uterus Cx C53.9 C55.9(LR) C54.0 M8140/3
Comment: Site Specification?
NYCRIS Endometrium M8140/3
Comments: Extending into cervix
Oxford Overlapping lesion of Female Genital Tract C57.8 M8140/3
Scotland Lower part of uterus C54.0 M8140/3Southern Ireland Overlapping Lesion of Uterus C54.8 M8140/3
Comment: Spread to Cervix
SWCIS Overlapping lesion of Female Genital Tract M8140/3
Comments: Involves uterus & cervix but no indication of origin of tumour.
Thames Endometrium C54.1 M8140/3Comments: Macro implies that tumour arose in the body of uterus. Typical presentation for
endometrial ca.
Trent Uterus C55 M8140/3
Wales Involves lower uterus and cervix C54.0 M8140/3WMCIU Overlapping genital organ C57.8 M8140/3
Case 7Coding & 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 & D06.9ICD0 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
Two morphologies in different morphology groups (see training manual part 3)
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 CodeICD10 a) D06.9 & D06.9ICD0 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
Case 7Site in Text No. Classn Codes Incidence
Date Basis of Diagnosis
Exocervix 1 ICD10 D06.1 M8560/2 27.02.05 histology
In situ Endocervix 1 ICD10 D06.0 M8010/2 27.02.05 histology
Cervix NOS 1 ICDO2 M8560/2 27.02.05 Histol of prim
Cervix 2 ICD02 C53.9 M8140/2
M8077/2
27.02.0515.04.05
Histology
Endo-cx-in-situ 1 ICD10 M8560/2 27.02.05 Histopath
CIS Cervix CIS Endocervix
2 ICD10 D06.0 M8140/2 D06.9 M8077/2
15.04.0527.02.05
Histology Histology
Cervix 2 ICD10 D06.9 M8077/2 D06.9 M8140/2*
27.02.0515.04.05
Path Path
Cervix NOS 1 ICD03 C53.9 M8148/2 27.02.05 Pathology
Cervix – Endocervix
2 ICD10 M8077/2 M8560/2 27.02.0515.04.05
Histo Histo
Cervix NOS 2 ICD02 C53.9 M8077/2 M8148/2
27.02.0515.04.05
Histology
Cervix 1 ICD10 D06.9 M8560/2 Mixed CGIN & CINIII
tumour
27.02.05 Histology
Cervix 1 ICD10 D06.7 M8560/2 Mixed CGIN & CINIII
27.02.05 Histology
CINIII & CGINIII 2 ICD10 D06.1 M8077/2 D06.0 M8140/2
27.02.05 15.04.05
Histology Histology
No Problems with
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
C&CG agree this could be interpreted as “female genital tract or UKP peritoneum” – not all cases have a black and white answer!!
HOWEVER
Case 10- Registries’ AnswersSite in Text No
.Classn Codes Incidence
DateBasis of
Diagnosis
Ovary 1 ICD10 C56 M8020/3 19.06.07 Hist
Ovary 1 ICD10 C56 M8020/3 19.06.07 Hist
Female Genital Tract 1 ICD02 M8020/3 19.06.07 Histology
Female Genital Tract 1 ICD02 C57.9 M8020/3 19.06.07 Histology
Fem Gen NOS 1 ICD10 M8020/3 19.06.07 Histopath
Ovary 1 ICD10 C56X 8020/3 19.06.07 Histology from Mets
Ovary 1 ICD10 C56X M8020/3 19.06.07 Pathology From Mets
Female Genital Tract 1 ICD03 C57.9 M8020/3 19.06.07 Pathology
Ovary 1 ICD10 M8020/3 19.06.07 Pathology
Female Genital Tract NOS
1 ICD03 C57.9 M8020/3 19.06.07 Histology
Ovary 1 ICD10 C56 M8020/3 19.06.07 Histo
Ovary 1 ICD10 C56 M8020/3 19.06.07 Histology
Ovary 1 ICD10 C56 M8020/3 19.06.07 Histology
Case 11
Coding & Classification Group
No. of Primaries = ONE
Morphology code = M8490/6
ICD Site Codes = C79.6 or C80Site in text = UKP Ovary Diagnosis Date = 02.02.06Krukenberg always metastatic therefore UKP as no primary yet detected.
Case 11 - REGISTRIES’ ANSWERSSite in Text No. Classn Codes Incidence
DateBasis of diagnosis
Secondary Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Hist of Mets
Secondary Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Histology
Left Ovary 1 ICD02 M8490/6 02.02.06 Histology of mets
Ovary (Stomach) 1 ICD02 C56.9 M8490/6 02.02.06 Histology
Secondary Ovary 1 ICD10 M8490/6 02.02.06 HM
Secondary Malignant Neoplasm of Ovary
1 ICD10 C79.6 M8490/6 02.02.06 Histology of mets
GI Tract 1 ICD10 C26.9 M8490/6 02.02.06 Pathology
Primary Unknown 1 ICD03 C80.9 M8490/6 02.02.06 pathology
Ovary but goes to C79.6 1 ICD10 C79.6 M8490/6 02.02.06 Hist of Mets
Unknown Primary 1 ICD03 C80.9 M8490/6 02.02.06 Histology
Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Histo
Unknown primary 1 ICD10 C79.6 M8490/6 02.02.06 Histo
UKP - Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Histology
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.”
Case 13 - REGISTRIES’ ANSWERSSite in Text No. Classn Codes Incidence Date Basis of
Diagnosis
Ovary 1 ICD10 C56 M8461/3 12.03.07 Hist
Ovary 1 ICD10 C56 M8010/3 12.03.07 Histology
Rt. Ovary ?1 or 2 ICD02 M8460/3
M8380/3
12.03.07 Histol Prim
Ovary 1 ICD02 C56.9 M8460/3 12.03.07 H
Ovary 1 ICD10 M8460/3 12.03.07 HP
Ovary 1 ICD10 C56X M8460/3 12.03.07 Histology
R. Ovary 1 ICD10 C56X M8461/3 12.03.07 Path
Ovary 1 ICD03 C56.9 M8461/3 12.03.07 pathology
Ovary 1 ICD10 M8460/3 12.03.07 Histo
Ovary 1 ICD03 C56.9 M8461/3 12.03.07 HI
Ovary 1 ICD10 C56.9 M8460/3
12.03.07 Histo
Ovary 1 ICD10 C56X M8460/3 12.03.07 Histo
Ovary 1 ICD10 C56 M8461/3 12.03.07 Histology
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
Case 14 - REGISTRIES’ ANSWERSSite in Text No. Classn Codes Incidence
Date Basis ofDiagnosis
Peritoneum 1 ICD10 C48.2 M8460/3 30.06.06 Hist
Peritoneum 1 ICD10 C48.2 M8441/3 30.06.06 Hist
Peritoneum 1 ICD02 M8441/3 30.06.06 Cytol
NK 1 ICD02 C80.9 M8441/3 30.06.06 H
Peritoneum 1 ICD10 M8441/3 30.06.06 HP
Peritoneum 1 ICD10 C48.1 M8441/3 30.06.06 Histology
Peritoneum 1 C48.2 M8441/3 30.06.06 Cytology
Peritoneum/Omentum 1 ICD03 C48.1 M8461/3 30.06.06 Pathology
Peritoneum 1 ICD10 M8441/3 30.06.06 Histo
Peritoneum 1 ICD03 C48.2 M8441/3 30.06.06 HI
Peritoneum 1 ICD10 C48.2 M8460/3 30.06.06 Histo
Peritoneum 1 ICD10 C48.2 M8461/3 30.06.06 Histo
Peritoneum 1 ICD10 C48.2 M8441/3 30.06.06 Histology
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
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).
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
Case 15 - REGISTRIES’ ANSWERSSite in Text No. Classn Codes Incidence
DateBasis of Diagnosis
Peritoneum 1 ICD10 C48.2 or C76.3 M8441/3 29.11.06 Histology
Pelvis 1 ICD10 C76.3 M8441/3 29.11.06 Histology
Rectovaginal septum 1 ICD02 M8441/3 29.11.06 Histol Prim
Rectovaginal septum 1 ICD02 C76.3 M8441/3 29.11.06 H
Endometrium 1 ICD10 M8441/3 29.11.06 HP
Rectovaginal septum 1 ICD10 C76.3 M8441/3 29.11.06 Histology
Rectovaginal septum 1 ICD10 C76.3 M8441/3 29.11.06 Path
Rectovaginal septum 1 ICD03 C76.3 M8441/3 29.11.06 pathology
Rectovaginal septum 1 ICD10 M8441/3 29.11.06 Histo
Peritoneum 1 ICD03 C48.2 M8441/3 29.11.06 HI
Rectosigmoid septum 1 ICD10 C76.3 M8441/3 29.11.06 Histo
Rectosigmoid septum 1 ICD10 C76.3 M8441/3 29.11.06 Histology
Rectovaginal septum 1 ICD10 C76.3 M8441/3 29.11.06 Histology
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
Summary (Cont..)
Here is your very own GOLD STAR
GOODBYE
WE HOPE YOU HAVE ENJOYED THE DAY
THANK YOU FOR YOUR ATTENTION
SAFE JOURNEY HOME!