Mississippi Cancer Registry Reporting Manual Revised 2018

TABLE OF CONTENTS

PROGRAM OVERVIEW

The Mississippi Cancer Registry (MCR) Reporting Manual has been created to assist hospital registries in reporting cancer cases to the MCR. This manual is being implemented due to the requirements from the National Program of Cancer Registries (NPCR), the North American Association for Central Cancer Registries (NAACCR) and the Commission on Cancer (CoC) Facility Oncology Required Data Standards (FORDS). There are also clarifications and rules that are in place in order to accurately complete abstraction of cancer cases.

In October 1992, Congress enacted the Cancer Registries Amendment Act (http://www.cdc.gov/cancer/npcr/npcrpdfs/publaw.pdf) that authorized the Centers for Disease Control and Prevention to establish a national program to support cancer registries. One of the goals of this program was to help establish statewide population-based cancer registries that would meet the minimum standards for quality and completeness set forth by the North American Association of Central Cancer Registries (NAACCR). In 1993, the Mississippi State Legislature authorized the Mississippi State Department of Health (MSDH) to establish a central population-based incidence cancer registry for the state of Mississippi (http://mcr.umc.edu/documents/StateLaw.pdf).

Cancer registration is an important and fundamental tool in assessing the true extent of cancer in Mississippi. The data collected through a statewide cancer registry can be used for epidemiological studies, medical research, and cancer control planning. This information is a valuable and essential tool in the identification of populations at high risk for cancer, the monitoring of cancer incidence trends, the facilitation of studies related to cancer prevention, the evaluation of cancer control initiatives, and the development of educational awareness programs.

The rules and regulations governing reporting of cancer cases to the Central Cancer Registry were presented to the State Department of Health for final adoption in April 1995. These rules and regulations which created a new Class IV level of reportable diseases became effective May 1995. Health Department regulations require that a cancer case be reported within six months of the first date of contact with the patient for the reportable condition.

The Mississippi Cancer Registry began collecting data on January 1, 1996. The MCR collects data that: 1) are compliant with required NPCR data elements; 2) are standard requirements designated by NAACCR for incidence reporting and endorsed by CDC; 3) assist in determining data quality; and 4) provide useful information, feedback and assistance to submitting facilities.

CONFIDENTIALITY

Per State Cancer Law (41-91-11) "Data obtained under this chapter directly from the medical records of a patient is for the confidential use of the department and the persons or public or private entities that the department determines are necessary to carry out the intent of this chapter. The data is privileged and may not be divulged or made public in a manner that discloses the identity of an individual whose medical records have been used for obtaining data under this chapter."

DISCLOSURE OF DATA

The Mississippi Cancer Registry (MCR) may exchange patient-specific information with the reporting facility or clinical facility for the purpose of completing a case record, provided these facilities comply with all MCR confidentiality policies.

To achieve complete case ascertainment, the MCR may exchange patient-specific information with other state cancer registries if reciprocal data sharing agreements and confidentiality provisions are in place. The MCR may not provide information on a patient of a hospital that was obtained from another hospital (i.e., follow-up information).

The Mississippi Cancer Registry Advisory Committee, formed in December 2006, was tasked with developing the protocol for release of information for the purpose of research. The Committee consists of medical representatives from the different disciplines related to cancer, cancer registry professionals and also experts on human subject research. This protocol is complete and available to researchers who are interested in using registry data. Since the MCR is charged with data collection and not authorized to use funds for research, there is a fee for researchers that want to use the MCR data. The protocol and fee schedule are located on the MCR web site (http://mcr.umc.edu). Data obtained from the VA hospitals, Keesler Medical Center and certain other states cannot be used for research.

GENERAL INSTRUCTIONS

The following information provides some basic rules regarding cancer reporting to the MCR.

1. Healthcare providers including, but not limited to, hospitals, ambulatory surgery centers, laboratories, radiation therapy facilities, oncology facilities and physician offices are required to report cancer cases to the MCR. Hospitals need to abstract inpatient and outpatient cancer cases.

2. All required data items should be collected and reported to the MCR. The list is based on the rules and regulations of NPCR and NAACCR.

3. The ICD-O-3 coding scheme must be used for site and histology for cases diagnosed on or after January 1, 2001. The ICD-O-2 coding scheme must be used for cases diagnosed prior to January 1, 2001.

4. The Collaborative Staging Manual is to be used for cases diagnosed between January 1, 2004 and December 31, 2015. Site Specific Factors will continued to be used for cases diagnosed January 1, 2016 to December 31, 2017. AJCC TNM Staging is to be used for cases diagnosed January 1, 2016 to December 31, 2017. The SEER Summary Staging Manual – 2000 is to be used for staging for cases diagnosed between January 1, 2001 and December 31, 2003 and cases diagnosed January 1, 2015 to December 31, 2017. The SEER Summary Staging Manual – 2018 is to be used for staging cases diagnosed January 1, 2018 and forward. The SEER Summary Staging Guide, 1986 reprint, is to be used for cases diagnosed prior to January 1, 2001.

5. The 2007 Multiple Primary and Histology Coding Rules Manual is to be used for cases diagnosed January 1, 2007 to December 31, 2017. The 2018 Solid Tumor Rules should be used for cases diagnosed January 1, 2018 and forward. The Hematopoietic and Lymphoid Database should be used for all hematopoieitic diseases diagnosed January 1, 2010 and later. Appendix A of the FORDS 2016 manual should be used to determine multiple primaries for hematopoietic diseases diagnosed before January 1, 2010.

6. All cases diagnosed and/or treated for cancer in your facility on or after January 1, 1996, must be abstracted and reported to the MCR.

7. Completed cases should be submitted to the MCR within six months of date of initial diagnosis for Class of Case 00 through 14 and within six months of the date of first contact for Class of Case 20 through 22.

8. All pathology reports that are read by hospital pathology laboratories, but the cases are not the responsibility of the hospital registry to abstract, should be forwarded to MCR for further investigation. MCR will be responsible for contacting the physicians on the pathology reports to obtain the information needed to include the case in the registry database.

9. It is important for all reporting facilities to submit data monthly. This will ensure that all data can be processed and submitted to the CDC by the established deadlines.

QUALITY CONTROL

Edits

All cases must pass edits when submitted to the MCR. Edits are built into Web Plus for data entry. No case can be released to the MCR from Web Plus if there are edits on that case. For file uploaders, edits will be run on your submission file. A copy of the state edit set has been provided to all hospital vendors. Since there is often a lag time in getting the edit set added to the hospital software, files with less than 10% edits will be accepted. Otherwise, the file will be rejected and require resubmission after the edits are corrected. The edit report will be provided to the facility.

Visual Review of Cases

All cases submitted to the MCR will be subject to a visual review of key data items. Items include age at diagnosis, sex, race fields, Spanish/Hispanic origin, date of diagnosis, primary site, laterality, histology, grade, staging fields, class of case, dates of first course treatment and treatment data fields. Other items may be included as time and resources permit. The items will be compared to the text submitted, so good text is important to this process. If problems are identified or codes are not justified in text, the facility will be contacted. This process serves to ensure the registry has high quality data.

Audits

The MCR Auditor conducts annual case finding and quality assurance (re-abstracting) audits as required by NPCR. The purpose of these audits is to ensure that all reportable cases are being identified and reported to the cancer registry and that all information submitted to the registry is of good quality and accurately coded. The audits are scheduled in advance to enable the facilities to prepare for the arrival of the registry staff or to set up remote access for the auditor. Case finding audits require a medical record disease index that is usually reviewed before the audit begins. Reviewing of charts, pathology case finding and re-abstracting are performed on site or by remote access to the facility's electronic medical records. A report is provided to the medical record director and administrator which summarize the percentage of case ascertainment or completeness and any suggestions that would help to improve the reporting process.

Case finding audits are performed on inpatient and outpatient disease indices, pathology reports and other pertinent case finding documents such as: clinic sign-in logs, surgery logs, etc. These documents are reviewed and all reportable codes are compared with the MCR database for the facility being audited. All cases that are not identified in the database will have to be reconciled by the registrar at the audited facility. The registrar will have a minimum of 30 days to complete the reconciliation process and return an updated list to MCR with reasons why the identified cases were either not abstracted or not reportable. Cases that are reportable must be abstracted into their database and submitted to the MCR. All cases that were either diagnosed prior to January 1, 1996 or diagnosis/treatment was not performed at the reporting facility are removed from the reconciliation log and a percentage is calculated at that time. A report is sent to the medical record director and the administrator of the facility that summarizes the percentage of case ascertainment and provides suggestions to help improve the case ascertainment process.

Quality assurance or re-abstracting audits consist of the MCR Auditor re-abstracting specific fields selected by MCR and comparing with the original data that has been submitted. Any discrepancies are documented and sent to the audited facility in a summary report. Exceptions are taken into consideration if a case has been merged in the MCR database and the audited facility did not have this information. This could indicate that the other procedures were done elsewhere and not available to the audited facility at the time of abstraction.

REPORTING PROCEDURE

Reporting facilities with 25 or less confirmed cases per year may elect to report their cases on paper. Copies of the following from the medical record need to be sent in for each identified cancer case: Face Sheet, History and Physical, Operation Reports, Scans, X-Rays, Pathology, Chemotherapy, Radiation, and Name of Referring Physician. The paper reporting form should no longer be completed. These records need to be submitted on a monthly basis. It is recommended that the facility keep a copy of what is submitted to prevent duplicate case reporting. The submissions should be faxed to 601-815-5483. The fax machine is the property of the Mississippi Cancer Registry, so the data will not be received or viewed by anyone other than our staff. If you cannot fax the information, you may mail it to the following address:

Mississippi Cancer Registry

2500 N. State Street

Jackson, MS 39261-4583

Facilities with no cases for a given month need to send a letter to the MCR stating that there were no cases to report. For facilities that frequently have no cases, quarterly reporting is acceptable.

Facilities with more than 25 confirmed cases of cancer must report electronically monthly. Facilities with their own cancer registry software should submit a file of cases in the appropriate NAACCR layout to the secure website, https://mscrrweb1.umc.edu/webplus/LogOnEn.aspx. Facilities using Web Plus for direct data entry will abstract their cases and correct edit errors. Once the cases are complete and free of edits, the facility will release the abstracts to the MCR.

CASE FINDING

Cases can be identified via many sources. The pathology reports can provide cases diagnosed by histology, cytology, hematology, bone marrow, or autopsy. Other sources are clinic admission logs, daily discharges, disease indices, inpatient and outpatient surgery logs, radiotherapy consults, treatment reports and logs and oncology clinic treatment reports and logs. The pathology reports should never be the only source of case finding, due to the fact that cases not diagnosed, only treated at your facility, may not have a path report. Also, some cases are clinical diagnoses only. Oncology clinic logs will be a good source in locating these cases. Cases not diagnosed histologically will be either confirmed by the physician in the patient's medical record or on the medical record disease index. A system should be established that would enable you to review a copy of the disease index.

REPORTABLE NEOPLASMS

The Mississippi Cancer Registry produces lists of reportable conditions containing the ICD- 9-CM codes and ICD-10-CM codes depending on year to aid hospitals in case finding. The reportable conditions do not change that often. However, the ICD-10-CM codes for reportable conditions may change as frequently as annually. We update the reportable list annually to reflect those changes, if necessary. The reportable list in its entirety will not be included in this manual since all of the hospitals are not abstracting the same month and year and may need different lists based on what month and year of cancer cases they are abstracting. The most current and all historical reportable lists can be found on our web site at the following link: /Administration/Outreach_Services/Mississippi_Cancer_Registry/Rep ortable_Diseases.aspx .

Not only do these reportable lists contain information on what is reportable and the ICD-9-CM or ICD-10-CM codes for those conditions, but they also include conditions that should be excluded and conditions or procedures that should be screened for a reportable cancer case.

Additionally, they provide a list of ambiguous terms that should be used to help in determining if a case is reportable.

Diagnosis Prior to Birth

Reportability requirements apply to diagnoses made in utero. Diagnoses made in utero are reportable only when the pregnancy results in a live birth. If you have no indication in the record of still birth, abortion or fetal death, assume that there was a live birth. When a reportable condition is confirmed prior to birth and disease is not evident at birth due to regression, report the case based on the pre-birth diagnosis.

Reportability Examples

1. Positive histology from a needle aspiration/biopsy followed by negative resection. This case is reportable based on the positive needle biopsy.

2. Ovarian mucinous borderline tumor with foci of intraepithelial carcinoma. This case is reportable because there are foci of intraepithelial carcinoma (carcinoma in situ)

3. "Squamous cell carcinoma of the anus, NOS." Squamous cell carcinoma of the anus is reportable unless the primary site is confirmed to be the skin of the anus.

Not Reportable Examples

1. • Left thyroid lobectomy shows microfollicular neoplasm with evidence of minimal invasion. Micro portion of path report states "The capsular contour is focally distorted by a finger of the microfollicular nodule which appears to penetrate into the adjacent capsular and thyroid tissue." Do not report this case based on the information provided. There is no definitive statement of malignancy. Search for additional information in the record. Contact the pathologist or the treating physician.

Cases Diagnosed Clinically are Reportable

In the absence of histologic or cytologic confirmation of a reportable cancer, accession a case based on the clinical diagnosis (when a recognized medical practitioner says the patient has cancer or carcinoma). A clinical diagnosis may be recorded in the final diagnosis, on the face sheet or other parts of the medical record.

A pathology report normally takes precedence over a clinical diagnosis. If the patient has a negative biopsy, the case would not be reported.

Exception 1: If the physician treats a patient for cancer in spite of the negative biopsy, report the case.

Exception 2: If enough time has passed that it is reasonable to assume that the physician has seen the negative pathology, but the clinician continues to call this a reportable disease, report the case. A reasonable amount of time would be equal to or greater than 6 months.

Brain or CNS "Neoplasms"

A brain or CNS 'neoplasm' identified by diagnostic imaging is reportable even when no other information is available (from biopsy or resection, for example).

Ambiguous Terminology

Ambiguous terminology may originate in any source document, such as a pathology report, radiology report or clinical report. The terms listed below are reportable.

Ambiguous terms that are reportable:

Do not substitute synonyms such as "supposed" for "presumed" or "equal" for "comparable". Do not substitute "likely" for "most likely." There may be ambiguous terms preceded by a modifier, such as "mildly" suspicious. In general, ignore modifiers or other adjectives and accept the reportable ambiguous term.

This list of ambiguous terms needs to be used correctly. The first and foremost resource for the registrar for a questionable case is the physician who diagnosed the tumor. The ideal way to approach abstracting situations when the medical record is not clear is to follow up with the physician. If the physician in not available, the medical record, and any other pertinent reports (e.g, pathology, etc.) should be read closely for the required information. The purpose of the Ambiguous Terminology lists is so that in the case where wording in the patient record is ambiguous with respect to reportability and no further information is available from any resource, registrars will make consistent decisions. When there is a clear statement of malignancy, then registrars should not refer to the list of ambiguous terms. Registrars should only rely on this list when the situation is not clear and the case cannot be discussed with the appropriate physician/pathologist. Please document any conversations you have about reportability with a physician in your text.

How to Use Ambiguous Terminology for Case Ascertainment

1. If any of the reportable ambiguous terms precede a word that is synonymous with an in situ or invasive tumor, report the case.

   Example: The pathology report says: Breast biopsy with abnormal cells consistent with ductal carcinoma. Report the case.

   Negative example: The final diagnosis reads: Rule out lung cancer. Do not report this case.

2. For benign and borderline primary intracranial and CNS tumors, report the case if any reportable ambiguous term precedes the either the word "tumor" or the word "neoplasm."

3. Discrepancies

   1. Report the case based on the reportable ambiguous term when there are reportable and non-reportable ambiguous terms in the medical record.

      1. Do not report a case when subsequent documents refer to a history of cancer and the original source document used a non-reportable ambiguous term.
         
         Example: Impression from a CT scan of the chest states probable malignant neoplasm of the lung. Discharge diagnosis states possible lung cancer. Report this case because probable lung cancer makes this case reportable.

   2. When there is a single report, accept the reportable term and report the case when one section of a report uses a reportable term such as "apparently" and another section of the same report uses a term that is not on the reportable list.
      
      Example: Abdominal CT reveals a 2cm liver lesion. "The lesion is consistent with hepatocellular carcinoma" appears in the discussion section of the report. The final diagnosis is "2 cm liver lesion, possibly hepatocellular carcinoma." Report this case. "Consistent with" is reportable.
      
      Exception: Do not accession a case based ONLY on suspicious cytology.

   3. Use these terms when screening diagnoses on pathology reports, operative reports, scans, mammograms, and other diagnostic testing other than tumor markers.

      1. Do not report a case when resection, excision, biopsy, cytology, or physician's statement proves the ambiguous diagnosis is not reportable.
         
         Example 1: Stereotactic biopsy of the left breast is "focally suspicious for DCIS" and is followed by a negative needle localization excisional biopsy. Do not report the case. The needle localization excisional biopsy was performed to further evaluate the suspicious stereotactic biopsy finding. The suspicious diagnosis was proven to be false.
         
         Example 2: CT report states "mass in the right kidney, highly suspicious for renal cell carcinoma." CT-guided needle biopsy with final diagnosis "Neoplasm suggestive of oncocytoma. A malignant neoplasm could not be excluded." Discharged back to the nursing home and no other information is available. Do not report the case. The suspicious CT finding was biopsied and not proven to be malignant. "Suggestive of" is not a reportable ambiguous term.

Hematopoietic and Lymphoid Neoplasms

For cases diagnosed January 1, 2010 or later, see the Reportability Instructions in the Hematopoietic and Lymphoid Neoplasm Coding Manual and Database (http://seer.cancer.gov/tools/heme/index.html).

CORRECTIONS, DELETIONS AND ADDITIONS

When reviewing cases submitted to the MCR, delete any duplicate records, such as a case that is found to have been abstracted more than once. Also, delete a previously reported case if subsequent evidence disproves the presence of cancer, or if what was thought to be a new primary cancer is later found to be a manifestation of an earlier primary cancer. All deletions must be reported to the MCR. If your facility reports a class 43 and then the patient comes to your facility for treatment resulting in a class 20, 21, or 22, please resubmit that case to the MCR.

Example:

After a case of "probable lymphoma" had been reported, the patient was referred to a specialty center where additional workup and repeat biopsies were performed. The final diagnosis was changed to "atypical lymphocytic infiltrates," and physicians decided to follow the patient closely but not treat the condition. Since the patient is now deemed not to have cancer, delete the case from the hospital's registry and notify the MCR.

Changes to the Abstract

The information in an abstract should be changed for the following circumstances and should be reported to the MCR.

1. To correct abstracting errors

2. When clarifications or rule changes retroactively affect data item codes.

3. When better information is available later.

   Example 1: Consults from specialty labs, pathology report addendums or comments or other information have been added to the chart after the registrar abstracted the case. Whenever these later reports give better information about the histology, grade of tumor, primary site, etc., change the codes to reflect the better information. Make sure these changes are reported to the MCR.

   Example 2: The primary site was recorded as unknown at the time of diagnosis. At a later date, the physician determines that the cancer is primary to the testis. Change the primary site from unknown to testis. Update all other fields affected by the change in primary site. Make sure these changes are reported to the MCR.

   Example 3: The original diagnosis was in situ. Metastases are diagnosed at a later date. Change the behavior code for the original diagnosis from in situ to invasive when no new primary has been diagnosed in the interim. Make sure these changes are reported to the MCR.

   Example 4: Patient seen in Hospital A. The pathologic diagnosis was negative for malignancy. Patient goes to Hospital B and the slides from Hospital A are re-read. The diagnosis at Hospital B is reportable. Hospital B sends their slide report back to Hospital A. Hospital A reports the case based on the info from Hospital B. Make sure to enter supporting documentation in the text.

4. When the date of diagnosis is confirmed in retrospect to be earlier than the original date abstracted.

   Example: Patient has surgery for a benign argentaffin carcinoid (8240/1) of the sigmoid colon in May 2009. In January 2010, the patient is admitted with widespread metastasis consistent with malignant argentaffin carcinoid. The registrar accessions the malignant argentaffin carcinoid as a 2010 diagnosis. Two months later, the pathologist reviews the slides from the May 2009 surgery and concludes that the carcinoid diagnosed in 2009 was malignant. Change the date of diagnosis to May 2009 and histology to 8241 and the behavior code to malignant (/3). Make sure these changes are reported to the MCR.

ADDITIONAL TREATMENT INFORMATION

If after a case is reported to the MCR, additional information on treatment is added to an abstract, the additional treatment should be reported to the MCR by resubmitting the abstract or by contacting us with the updated information.

CODING RULES AND EXAMPLES

CLASS OF CASE

All cases are assigned a class of case based on the nature of involvement of the facility in the care of the patient.

Analytic Cases

Cases diagnosed at the reporting facility and/or administered any of the first course of treatment there are analytic. A network clinic or outpatient center belonging to the facility is considered part of the facility. These cases would be given a class of case 00 through 22.

Nonanalytic Cases

Nonanalytic cases include class of case 30 through 99. The reporting facility did not diagnosis and/or provide the first course of treatment with the exception of class 38 and class 43. The reporting facility may have performed the autopsy and diagnosed the cancer (Class 38). For a class 43, a specimen was read at the reporting facility. However, the patient never physically entered the facility.

The MCR requires that classes of case 00-22, 30, 31, 32, 34, 36, 38, 43 be reported by all facilities. Class of case 34 and 36 would be used for cases of VIN III, VAIN III and AIN III which are not reportable to the COC but must be reported to the MCR. Cancer registries must also report class of case 40-42 if they collect these cases. New cancer programs should submit class of case 35 and 37 for cases diagnosed January 1, 1996 or later. DO NOT use class of case 99. If you are not sure of what class of case to use, please contact the MCR for assistance.

PATIENT ADDRESS AND RESIDENCY RULES

The patient's address at diagnosis is the patient's place of residence at the time of the original diagnosis. It does not change if the patient moves. If the patient has more than one primary tumor, the address at diagnosis may be different for each primary.

The current address initially is the patient's residence at the time the patient was first seen at the accessioning facility for this primary. The current address is updated if the patient moves. If the patient has more than one primary tumor, the current address should be the same for each primary.

Normally a residence is the home named by the patient. Legal status and citizenship are not factors in residency decisions. Rules of residency are identical to or comparable with the rules of the Census Bureau's definition, "the place where he or she lives and sleeps most of the time or the place the person considers to be his or her usual home." Vital statistics rules may differ from Census rules. Do not record the residence from the death certificate. Review each case carefully.

RULES FOR PERSONS WITH AMBIGUOUS RESIDENCE:

Persons with more than one residence (summer and winter homes): Use the address the patient specifies if a usual residence is not apparent.

Persons with no usual residence (transients, homeless): Use the address of the place the

patient was staying when the cancer was diagnosed. This could be a shelter or a diagnosing facility. In the supplemental address field, add the word "homeless" or "transients", as applicable.

Persons away at school: College students are residents of the school area. Boarding school students below the college level are residents of their parents' homes.

Persons away in institutions: The Census Bureau states, "Persons under formally authorized, supervised care or custody," are residents of the institution. This includes the following:

• Incarcerated persons

• Persons in nursing, convalescent, and rest homes

• Persons in homes, schools, hospitals, or wards for the physically disabled, mentally retarded, or mentally ill

• Long-term residents of other hospitals, such as Veterans Affairs (VA) hospitals.

Persons in the Armed Forces and on Maritime Ships: Members of the armed forces are residents of the installation area. Use the stated address for military personnel and their families. Military personnel may use the installation address or the surrounding community's address.

PRIMARY SITE

The primary site is defined as the organ or site in which the cancer originated or began. A metastatic site indicates that the primary (originating) tumor has spread from the original site to other areas in the body. Cancer registries only code the primary site in this field, using the ICD- O-2 (cases diagnosed prior to January 1, 2001) or ICD-O-3 (cases diagnosed on or after January 1, 2001) manual to determine the correct site code. Indications of metastatic sites are used in the registry for identifying the extent of the patient's disease and for staging purposes.

• Unless otherwise instructed, use all available information, including pathology reports, scans, x-rays, MRIs, etc., to code the primary site.

• Code the site in which the primary tumor originated, even if extends onto/into and adjacent subsite.Example: The patient has a 2cm tumor in the right breast. The tumor originated in the lower inner quadrant and extends into the upper inner quadrant. Code the primary site to the lower inner quadrant of the breast (C50.3).

• Use subcategory ".8" (overlapping lesion code) when a single tumor overlaps the boundaries of two or more categories or subcategories and its point of origin cannot be determined. Overlapping applies to sites that are contiguous (adjacent) to one another.Example: A patient is diagnosed with right lung cancer. The physician states that the lesion involves both the upper and lower lobes, code to C34.8 since the point of origin is not stated.

• Code the site of the invasive tumor when there is an invasive tumor and an in situ tumor in different subsites of the same anatomic site and the port of origin cannot be determined.Example: Patient has an invasive breast tumor in the upper-outer quadrant of the left breast and in situ tumors in multiple quadrants of the left breast. Code the primary site to C50.4 (upper outer quadrant of breast)

• Code the last digit of the primary site to '9' for single primaries, when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined.Example: During a TURB, the physician describes multiple papillary tumors in the bladder neck (C67.5) and the lateral wall of the bladder (C67.2). Code the primary site as bladder, NOS (C67.9).

• Some histology/behavior terms in ICD-O-3 have a related site code in parenthesis; for example: Hepatoma (C22.0)

  1. Code the site as documented in the medical record and ignore the suggested ICD-O-3 code when a primary site is specified in the medical record.Example: The pathology report says "infiltrating duct carcinoma of the head of the pancreas." The listing in ICD-O-3 is infiltrating duct carcinoma 8500/3 (C50._). Code the primary site to head of pancreas (C25.0), not to breast (C50._) as suggested by the ICD-O-3.

  2. Use the site code suggested by ICD-O-3 when the primary site is the same as the site code suggested or the primary site is unknown.Example: An excision of the right axillary nodes reveals metastatic infiltrating duct carcinoma. The right breast is negative. The ICD-O-3 shows infiltrating duct carcinoma (8500) with a suggested site of breast (C50._). Code the primary site as breast, NOS (C50.9).

• Code the primary site, not the metastatic site. If a tumor is metastatic and the primary site is unknown, code the primary site as unknown (C80.9).

• Code C42.2 (Spleen) as the primary site for angiosarcoma of spleen with mets to bone marrow.

• Gastrointestinal Stromal Tumor (GIST): Code the primary site to the location where the malignant GIST originated.

• When the medical record does not contain enough information to assign a primary site:

  1. Consult a physician advisor to assign the site code.

  2. Use the NOS category for the organ system or the Ill-Defined Sites (C76.0- C76.8) if the physician advisor cannot identify a primary site.

  3. Code Unknown Primary Site (C80.9) if there is not enough information to assign an NOS or Ill-Defined Site Category.

• Code to Skin, NOS (C44.9) if a patient is diagnosed with metastatic melanoma and the primary site is unidentified.

• Complete primary site coding rules are described in the ICD-O-2 manual under the heading "Topography," pages xx-xxiii, and in the ICD-O-3 manual under Coding Guidelines for Topography and Morphology.
  
  Note: Kaposi's Sarcoma is coded to the site in which it originates. If the Kaposi's sarcoma is present in the skin and another site simultaneously, code to the specified skin site, (C44._). If the primary site is unknown or cannot be determined, code skin, NOS (C44.9).
  
  Note: The majority of sarcomas arise in mesenchymal or connective tissues that are located in the musculoskeletal system, which includes the fat, muscles, blood vessels, deep skin tissues, nerves, bones, and cartilage. The default code for sarcomas of unknown primary site is C49.9 rather than C80.9. Sarcomas may also arise in the walls of hollow organs and in the viscera covering an organ. Code the primary site to the organ of origin.

Specific Tissue with Ill-Defined Sites

If any of the following histologies appears only with an ill-defined site description (e.g., "abdominal" or "arm"), code it to the tissue in which such tumors arise rather than the ill- defined region (C76._) of the body, which contains multiple tissues.

Coding Instructions for Hematopoietic and Lymphoid Neoplasm (9590/3- 9992/3)

For cases diagnosed January 1, 2010 and later, see the HematopoieticandLymphoidNeoplasm CodingManualandDatabase (http://seer.cancer.gov/tools/heme/) for instructions on coding the primary site for hematopoietic and lymphoid neoplasms.

For hematopoietic and lymphoid neoplasms diagnosed prior to January 1, 2010, use the following rules for coding primary site:

Code all leukemias except myeloid sarcoma (9930/3) to the bone marrow C42.1. Myeloid sarcoma is coded to the site of origin.

Primary Site Coding Lymphoma (Cases diagnosed prior to January 1, 2010)

Use the following guidelines to determine the primary site(s) for malignant lymphomas:

• Code lymphomas arising in lymphatic tissue or nodes to the site of origin. The lymphatic sites are Lymph Node(s) C77._, Tonsil C09._, Spleen C42.2, Waldeyer's Ring C14.2, and Thymus C37.9.

• Code extralymphatic lymphomas (lymphatic cells in nonlymphatic organs such as intestine or stomach) to the organ of origin (Intestine C26.0, Stomach C16.0-C16.9).

• If extranodal/extralymphatic site is suspected but is unknown, code C80.9.

• Code mycosis fungoides and cutaneous lymphomas to Skin (C44._).

• Code to Lymph Nodes, NOS (C77.9) when:

  1. the site of origin is not identified for a lymphoma

  2. a patient has diffuse lymphoma and a primary site is unknown or not specified

  3. a lymphoma mass is identified as "retroperitoneal," "inguinal," "mediastinal," or "mesentery," and no specific information is available to indicate what tissue is involved

  4. bone marrow metastases are present and the primary site of a lymphoma is unknown or not specified

• If origin of a lymphoma is unknown but is suggested by the histology code in ICD-O-3, code to the suggested site. Example: 9689/3 Splenic marginal zone B-cell lymphoma (C42.2)

• Code to Lymph Nodes, Multiple Regions (C77.8) when multiple lymph node chains are involved with disease.

Note: Carefully identify the origin of the tumor. Do not code the biopsy site or a metastatic site as the primary site. Lymphoma may be present in both an extranodal/extralymphatic organ and one or more lymph node chains. Code the primary site as the extranodal/extralymphatic organ or the lymph nodes as directed by the managing physician or physician advisor

MORPHOLOGY (HISTOLOGY, BEHAVIOR, AND GRADE):

The instructions for coding histology, behavior, and grade are found in the Morphology section of the ICD-O-3 "Coding Guidelines for Topography and Morphology" (ICD-O-3 pp. 27-34).

Histology

Histologic type refers to the classification of malignancy described in the pathology or cytology report. Refer to the ICD-O manual to select the correct histologic code. The first three digits of the histology code will indicate the cancer cell type and usually the FINAL pathology diagnosis is used to make the code determination. However, for cases diagnosed prior to January 1, 2007, if the microscopic description indicates a more specific histological diagnosis, use the more definitive code available. For cases diagnosed January 1, 2007 to December 31, 2017, refer to the 2007 Multiple Primary andHistologyCodingRules manual. For cases diagnosed January 1, 2018 and later, use the use the following documentation in priority order

1. Updated ICD-O histology codes and terms (https://seer.cancer.gov/icd-o-3/)

2. The 2018 Solid Tumor Rules

3. The ICD-O-3 manual

Example: On a pathology report dated January 1, 2004, the final pathologic diagnosis is carcinoma (8010) of the prostate. Microscopic description states adenocarcinoma (8140) of the prostate. Adenocarcinoma (8140) should be coded because it provides a more specific description of the type of cancer.

Further instructions and rules that clarify coding rules for histology are found under "Coding Guidelines for Topography and Morphology" in the ICD-O-3 manual. Further instructions and rules that clarify coding rules for histology are found on pages xxiv through xxix in the IC-O-2 manual.

For cases diagnosed January 1, 2007 to December 31, 2017, refer to the 2007Multiple Primary and Histology Coding Rules manual.

2018 Solid Tumors

For cases diagnosed January 1, 2018 and later, apply the general instructions and site-specific instructions for determining histology in the 2018 Solid Tumor Rules.

Apply the site-specific rules in the 2018 Solid Tumor Rules. Site-specific rules cover the following

The General rules do not apply to hematopoietic primaries (lymphoma and leukemia) of any site or to the reportable benign or borderline intracranial or CNS tumors. The head and neck, colon, rectosigmoid and rectum, breast, kidney, urinary sites, and malignant CNS and peripheral nerves rules exclude lymphoma and leukemia (M9590-M9992) and Kaposi sarcoma (M9140). All other sites rules exclude lymphoma and leukemia (M9590-M9992).

Hematopoietic and Lymphoid Neoplasms

Apply the Histology Rules in the HematopoieticandLymphoidNeoplasmCodingManual and Database for cases diagnosed January 1, 2010 and later.

Behavior Code

The behavior code occupies the 5^th space (digit) of the histologic code. This component of the histologic code indicates the way in which the neoplasm will act or behave – invasive (3), non- invasive (2), borderline malignancy (1), benign (0). Reporting facilities should report cases with behavior codes 2 and 3 according to the list of reportable conditions. Tumors of the central nervous system diagnosed on or after January 1, 2004 are the only benign (0) and borderline (1) cases that should be reported to the MCR. If the pathology report describes the

cancer as metastatic, the registrar should be alerted that the primary site is not described on this report and must take steps to identify the primary site with a behavior code of 3. The hospital registry does not utilize behavior codes of 6 and 9.

Clinical evidence alone cannot identify the behavior as in situ; a behavior code of /2 (in situ) must be based on pathologic examination and documentation.

For intracranial and CNS tumors, code the behavior from CT scan, MRI or PET report when there is no tissue diagnosis (pathology or cytology report). Code the behavior listed on the report.

Behavior code is coded as malignant (3) if there is documentation of any invasion present no matter how limited.

Example: Pathology report of the cervix reads: "squamous cell carcinoma in situ (8070/2) with microinvasion of squamous cell carcinoma (8070/3). This case should be coded to the invasive behavior 8070/3.

Exception: If an invasive behavior is ambiguous on a biopsy and the subsequent surgery shows only in situ cancer, code the behavior as in situ (/2).

Example: Needle biopsy of a breast tumor shows ductal carcinoma in situ with a focus suspicious for invasion. Subsequent lumpectomy showed ductal carcinoma in situ. Code the ductal carcinoma in situ (8500/2).

The pathologist has the final say on the behavior of the tumor. ICD-O-3 may have only one behavior code, in situ (/2) or malignant (/3), listed for a specific histology. If the pathology report describes the histology as in situ and the ICD-O-3 histology code is listed only with the malignant behavior (/3), assign the in situ behavior code (/2). If the pathology report describes histology as malignant and the ICD-O-3 histology code is listed one with an in situ behavior (/2), assign the malignant behavior code (/3).

Example: The pathology report says large cell carcinoma in situ. The ICD-O-3 lists large cell carcinoma only with a malignant behavior (8013/3). Code the histology and behavior as 8013/2 as specified by the pathologist.

Grade or Differentiation

This code occupies the 6^th position of the morphology code. This number describes the grade or differentiation characteristics of the cancer. In most cases, the pathology report is the source for this description.

Grade is a measure of the aggressiveness of the tumor and an important prognostic indicator for many tumors. Prior to 2018, grade in cancer registries has been collected based on a generic 4-grade classification with the following categories.

GRADE, DIFFERENTIATION OR CELL INDICATOR

Item Length: 1 NAACCR Item #: 440

NAACCR Name: Grade

Grade, Differentiation for solid tumors (Codes 1, 2, 3, 4, 9) and Cell Indicator for Lymphoid

Neoplasms (Codes 5, 6, 7, 8, 9)

For cases diagnosed prior to January 1, 2014, use the grade codes in the FORDS 2012 manual. For cases diagnosed between January 1, 2014 and December 31, 2017, use the grade codes found at https://seer.cancer.gov/tools/grade/.

For solid tumors, diagnosed January 1, 2018 and forward, grade will be collected in three different data items, Grade Clinical, Grade Pathological, and Grade Post Therapy, and the coding instructions will depend on the type of cancer. The grade manual can be accessed at https://www.naaccr.org/SSDI/Grade-Manual.pdf?v=1556221646.

Prior to 2018, codes 6-8 for grade collected the cell lineage indicator for Hematopoietic and Lymphoid Neoplasms. For cases diagnosed prior to January 1, 2010, the cell lineage had be stated to be coded 6-8. If the linieage was not stated, then cases were coded to "9". For cases diagnosed January 1, 2010 to December 31, 2017, the grade codes were included in the HematopoieticandLymphoidNeoplasmManualandDatabase. Cell lineage indicator will no longer be collected for cases diagnosed January 1, 2018 and later.

Histology Coding Rules for a Single Tumor (Solid tumors diagnosed prior to January 1, 2007 and Hematopoietic and Lymphoid neoplasms diagnosed prior to January 1, 2010).

Source: SeerProgramandCodingandStaging Manual

• The rules are in hierarchical order. Rule 1 has the highest priority.

• Use the rules in priority order.

• Use the first rule that applies to the case. (Do not apply any additional rules.)

1. Code the histology if only one type is mentioned in the pathology report.

2. Code the invasive histology when both invasive and in situ tumors are present.

   Example: Pathology report reads infiltrating ductal carcinoma and cribiform ductal carcinoma in situ. Code the invasive histology 8500/3.

   Exception: If the histology of the invasive component is carcinoma, NOS, adenocarcinoma, NOS, melanoma, NOS, or sarcoma, NOS, then code the histology of the specific term associated with the in situ component and an invasive behavior code.

3. Use a mixed histology code if one exists.

   Example: 9085 Mixed germ cell tumor

4. Use a combination histology code if one exists

   Example: 8255 Renal cell carcinoma, mixed clear cell and chromophobe types

5. Code the more specific term when one of the terms is 'NOS' and the other is a more specific description of the same histology.

   Example 1: Pathology report reads poorly differentiated carcinoma, probably squamous in origin. Code the histology as squamous cell carcinoma rather than the non-specific term "carcinoma."

   Example 2: The pathology report from a nephrectomy reads renal cell carcinoma (8312) (renal cell identifies the affected organ system rather than the histologic cell type) in one portion of the report and clear cell carcinoma (8310) (a histologic cell type) in another section of the report. Code clear cell carcinoma (8310); renal cell carcinoma (8312) refers to the renal system rather than the cell type, so renal cell is the less specific code.

6. Code the majority of tumor.

   1. Based on the pathology report description of the tumor.

   2. Based on the use of majority terms.

      Majority of Tumor:

      Terms that mean the majority of tumor	Terms that DO NOT mean the majority of tumor
      Predominantly	With foci of
      With features of	Focus of/focal
      Major	Areas of
      Type (Effective 1/1/1999)	Elements of
      With…Differentiation (Effective 1/1/1999)	Component (Effective 1/1/1999)

7. Code the numerically higher ICD-O-3 code. This is the rule with the lowest priority and should be used infrequently.

Histology Coding Rules for Multiple Tumors with Different Behaviors in the Same Organ Reported as a Single Primary (Cases diagnosed prior to January 1, 2007) Source: SEER Program Coding and Staging Manual

1. Code the histology of the invasive tumor when one lesion is in situ (/2) and the other is invasive (/3).
   
   Example: At mastectomy for removal of a 2 cm invasive ductal carcinoma, an additional 5 cm area of intraductal carcinoma was noted. Code histology and behavior as invasive ductal carcinoma (8500/3).

Histology Coding Rules for Multiple Tumors in Same Organ Reported as a Single Primary (Cases diagnosed prior to January 1, 2007)

Source: SEERProgramCodingandStagingManual

1. Code the histology when multiple tumors have the same histology.

2. Code the histology to adenocarcinoma (8140/_; in situ or invasive) when there is an adenocarcinoma and an adenocarcinoma in a polyp (8210/_, 8261/_, 8263/_) in the same segment of the colon or rectum.

3. Code the histology to carcinoma (8010/_; in situ or invasive) when there is a carcinoma and a carcinoma in a polyp (8210/_) in the same segment of the colon or rectum.

4. Use a combination code for the following:

   1. Bladder: Papillary and urothelial (transitional cell) carcinoma (8130)

   2. Breast: Paget Disease and duct carcinoma (8541)

   3. Breast: Duct carcinoma and lobular carcinoma (8522)

   4. Thyroid: Follicular and papillary carcinoma (8340)

5. Code the more specific term when one of the terms is 'NOS' and the other is a more specific description of the same histology.

6. Code all other multiple tumors with different histologies as multiple primaries.

Rules for coding mixed or multiple histologies for solid tumors diagnosed January 1, 2007 to January 31, 2017

To code multiple or mixed histologies present in one primary, the SEER 2007 Multiple Primary and Histology Coding Rules replace all previous multiple histology rules. These rules are effective for cases diagnosed January 1, 2007 and after. Do not use these rules to abstract cases diagnosed on or earlier than December 31, 2006.

• Use the rules to make a decision on coding the histology for all reportable solid malignant tumors.

• Use the multiple primary rules to determine whether the patient has a single primary or multiple primaries before coding the histology. Code the histology for each primary in a separate abstract.

Use the Site-specificRules for the following primary site groups excluding leukemia and lymphoma (M9590-9989) and Kaposi sarcoma (M9140):

Use the OtherSitesRules for all solid malignant tumors that occur in primary sites not coded in the site specific rules.

Rules for coding mixed or multiple histologies for solid tumors diagnosed January 1, 2018 and later

To code multiple or mixed histologies present in one primary, the SEER 2018 SolidTumor Rules replace all previous multiple histology rules. These rules are effective for cases diagnosed January 1, 2018 and after. Do not use these rules to abstract cases diagnosed on or earlier than December 31, 2017.

• Use the rules to make a decision on coding the histology for all reportable solid malignant tumors.

• Use the multiple primary rules to determine whether the patient has a single primary or multiple primaries before coding the histology. Code the histology for each primary in a separate abstract.

Use the Site-specificRules for the following primary site groups excluding leukemia and lymphoma (M9590-9989) and Kaposi sarcoma (M9140):

Use the OtherSitesRules for all solid malignant tumors that occur in primary sites not coded in the site specific rules.

For hematopoietic and lymphoid neoplasms diagnosed January 1, 2010 or later, use the histology coding rules in the 2010HematopoieticandLymphoidNeoplasmCaseReportability and Coding Manual to determine the correct histology.

MULTIPLE PRIMARIES:

For solid tumors diagnosed prior to January 1, 2007 and Hematopoietic and Lymphoid neoplasms diagnosed prior to January 1, 2010:

• For hematopoietic and lymphoid neoplasms, use the ICD-O-3 Hematopoietic Primaries Table (http://seer.cancer.gov/icd-o- 3/hematopoietic_primaries.d03152001.pdf) to decide whether differing histologies represent one or more primaries. Primary site and timing are not applicable for determining whether these malignancies represent one or more primaries.

• For nonmalignant tumors of the central nervous system, use the instructions below under the heading Determining Multiple Primaries for Nonmalignant CNS Tumors to decide whether the tumor(s) is one site or multiple sites.

• Use the instructions below under the heading Site Differences to decide whether the tumor(s) is one site or multiple sites.

• Follow the instructions below under the heading Histology Differences to decide whether tumors other than lymphomas, leukemia, or benign or borderline CNS tumors represent a single histology or mixed/multiple histologies.

• Follow the instructions below under the heading Timing to decide if one or more primaries are involved.

For solid tumors diagnosed January 1, 2007 to December 31, 2017:

The SEER 2007 MultiplePrimaryandHistologyCodingRules contain site-specific rules for lung, breast, colon, melanoma of the skin, head and neck, kidney, renal pelvis/ureter/bladder, and brain. A separate set of rules addresses the specific and general rules for all other sites. The multiple primary rules guide and standardize the process of determining the number of primaries.

Apply the 2007 multiple primary rules to the tumor(s) diagnosed January 1, 2007 to December 31, 2017, when the patient had a previous tumor(s) diagnosed prior to 2007.

Example 1: Duct carcinoma of the right breast diagnosed in July 2006. In February 2007, duct carcinoma of the right breast is diagnosed in a separate tumor. Apply the 2007 rules to the tumor diagnosed in 2007. According to the 2007 rules, the 2007 tumor is not a new primary.

Example 2: Duct carcinoma of the right breast diagnosed in July 2006. In February 2007, duct carcinoma of the left breast is diagnosed. Apply the 2007 rules to the 2007 diagnosis. According to the 2007 rules, the 2007 diagnosis is a new primary.

For solid tumors diagnosed January 1, 2018 and later:

The SEER 2018 Solid Tumor Rules contain site specific rules for head and neck, colon, rectosigmoid, rectum, lung, cutaneous melanoma, breast, kidney, urinary sites, non-malignant and malignant CNS, and peripheral nerves. A separate set of rules addresses the specific and general rules for all other sites.

Apply the 2018 SolidTumorRules to the tumor(s) diagnosed January 1, 2018 and later, when the patient had a previous tumor(s) diagnosed prior to 2018.

Example 1: Duct carcinoma of the right breast diagnosed in July 2016. In February 2018, duct carcinoma of the right breast is diagnosed in a separate tumor. Apply the 2018 rules to the tumor diagnosed in 2018. According to the 2018 rules, the 2018 tumor is not a new primary.

The SEER Multiple Primary and Histology Coding Rules do not apply to hematopoietic primaries (lymphoma and leukemia M9590-9989), or Kaposi Sarcoma (M9140) of any site. For hematopoietic and lymphoid neoplasms diagnosed prior to January 1, 2010, use the tables in Appendix D to decide whether differing histologies represent one or more primaries. Primary site and timing are not applicable for determining whether these malignancies represent one or more primaries. For hematopoietic and lymphoid neoplasms diagnosed January 1, 2010 and later, use the Hematopoietic and Lymphoid Neoplasm CodingManualandDatabase (DB) to determine the correct number of primaries to report. Consider Kaposi sarcoma as one primary site.

Determining Multiple Primaries for Nonmalignant CNS Tumors (For cases diagnosed prior to January 1, 2007).

Source: DataCollectionofPrimaryCentralNervousSystemTumors:NationalProgramof Cancer Registries Training Materials

Determining if Site is Same or Different

Each subsite (fourth-digit level) as delineated in ICD-O-3 is considered a separate site.

• If separate tumors with the same histology occur in the same subsite, they are considered the same tumor and one abstract is completed. Therefore, if multiple tumors of the same histology occur in the cerebrum (C71.0), they are considered the same tumor regardless of when they occur and only one abstract is completed.

• If separate tumors with the same histology occur in different subsites, they are different tumors and separate abstracts are completed. Therefore, if a tumor occurs in the cerebral meninges (C70.0), and a separate tumor occurs in the spinal meninges (C70.1), they are considered separate tumors. Likewise, if separate brain tumors of the same histology occur in the frontal lobe (C71.1) and in the occipital lobe (C71.4), they are also considered separate tumors.

• As with malignant tumors, if the first three digits are the same, and the fourth digit is a 9 or not otherwise specified (NOS) site, this is considered one site and should be coded to the more specific site. For example, if a tumor is identified as meninges, NOS (C70.9), and a separate tumor is identified as occurring in either the spinal (C70.1) or cerebral (C70.0) meninges, this is considered one tumor, and only one abstract should be completed using the more specific site code.

• Laterality is used to determine multiple primaries for nonmalignant CNS tumors for sites listed as being lateral. If multiple tumors of the same site and same histologic type are identified and both sides of a site (listed as lateral) are involved, the tumors should be considered to be separate tumors, and separate abstracts should be completed. For example, the right and left temporal lobes of the brain or the right and left acoustic nerves.

How to determine same vs. different histologies for benign and borderline primary intracranial and CNS tumors (C70.0-C72.9, C75.1-C75.3) (Based on histologic groupings)

Note: These rules do not apply to malignant primary intracranial and CNS tumors.

To determine if the histology in multiple nonmalignant CNS tumors is the same, follow these rules in priority order.

When multiple tumors are in the same site; the first three digits of the histology code are the same; and the codes are not found in the table below, then the histology is considered to be the same. Only one abstract should be completed

When multiple tumors are in the same site; the first three digits of the histology code are different, and the codes are not found in the table below, then the histology is considered to be different. Separate abstracts should be completed.

If all histologies are in the same histologic group in the table below, then the histology is considered to be the same, even though the first three digits are different. These two histologies represent a progression, differentiation, or subtype of a single histologic category. One abstract should be prepared.

Example: A patient has a diagnosis of a choroid plexus papilloma, NOS (9390/0), a nonspecific term, and subsequently has a diagnosis of atypical choroid plexus papilloma (9390/1), a more specific histology, in the same site. These terms are both in the grouping of choroids plexus neoplasms in the table below. The 9390/0 is the first diagnosis (earliest diagnosis date), but 9390/1 is more specific. Therefore, 9390/1 should be used.

Example: A patient has subependymoma (9383/1), a specific histology, and is subsequently diagnosed with a choroid glioma (9444/1), also a specific histology. Both histologies are listed in the table below under the ependymomas grouping. In this instance, because both histologies are specific and in the same grouping, the first histology of subependymoma (9383/1) should be coded even though the second histology has a higher code.

If the first three digits are the same as the first three digits for any histologies in one of the groupings in the table below, then the histology is considered to be the same.

Example: A patient has a ganglioglioma (9505/1) listed in the table below in the grouping neuronal and neuronal-glial neoplasm, as well as a separate Pacinian tumor (9507/0) which is not listed in the table below. These two tumors have the same first three digits. In this instance, the Pacinian tumor is considered the same as the ganglioglioma, and only one abstract should be completed. The first histology of ganglioglioma (9505/1) should be coded even though the second histology has a higher code.

If the first three digits are the same and the histologies are from two different groups in the histologic groupings table, the histologies are considered to be different.

Example: A patient has a choroid plexus papilloma (9390/0), listed in the table below in the choroid plexus neoplasm grouping, as well as a myxopapillary ependymoma (9394), which is listed in the ependymoma grouping. In this case, even though the first three digits are the same, the histologies are considered to be different for these tumors because they are listed in different groupings in the table below. Thus, two abstracts should be completed.

Malignant Transformation

In rare cases, a diagnosed nonmalignant tumor transforms into a malignant tumor. In these cases, the behavior changes from code 0 or 1 to code 2 or 3.

When malignant transformation occurs in a previously diagnosed nonmalignant tumor, the tumors are considered separate primaries, and two abstracts should be completed because of the change from nonmalignant to malignant.

SITE DIFFERENCES (Cases diagnosed before January 1, 2007)

• The third numeric digit after the 'C' describes a subsite of the organ; it is not used to define individual (different) sites.
  
  Exception: For the following sites, a difference in the third numeric digit designates a different primary site, except NOS (C_ _.9) with a specific four-digit site code in the same site.

• • Colon (C18.0-C18.9) except polyps involving multiple segments (see Colon and Rectum Polyps).

  • Anus/anal canal (C21.0-C21.8)

  • Pleura (visceral, parietal, NOS) (C38.4 )

  • Bone (C40.0-C41.9)

  • Melanoma of the skin (C44.0-44.9)

  • Peripheral nerves/autonomic nervous system (C47.0-C47.9)

  • Connective tissue (C49.0-C49.9)

  • Non-malignant meninges (C70.0–C70.9 with Behavior Code /0 or /1)

  • Non-malignant brain (C71.0–C71.8 with Behavior Code /0 or /1)

  • Non-malignant spinal cord, cranial nerves, and other parts of central nervous system

  • (C72.0–C72.8 with Behavior Code /0 or /1)

Colon and Rectum Polyps

• Simultaneous lesions and polyps in the same segment of the colon are a single primary.

• Polyps may be present in more than one segment of the colon. If the diagnosis reads adenocarcinoma in multiple polyps, it is one primary, colon, NOS (C18.9).

Familial Polyposis

• This is a genetic disease characterized by polyps that increase in numbers and may cover the mucosal surface of the colon.

• If multiple segments of the colon, rectosigmoid and/or rectum are involved with adenocarcinoma in adenomatous polyposis coli or adenocarcinoma in multiple adenomatous polyps, it is a single primary. Code the primary site to colon, NOS (C18.9).

• If the first two numeric digits after the C are identical, it is the same site.

Possible Exception: Paired Organs

• • It is one primary if a physician states the tumor in one organ is metastatic from the other. Code the laterality to the side in which the primary originated. If the side of origin is unknown, code '4' for laterality.

    • Code as separate primaries if the physician states these are independent primaries or there is no physician statement that one is metastatic from the other with the exception of the following:

      • Simultaneous bilateral involvement of the ovaries with the same histology is one primary. Laterality is coded '4' when the ovary of origin is unknown.

      • Bilateral retinoblastomas are a single primary with laterality of '4.'

      • Bilateral Wilms tumors are always a single primary with laterality of '4.'

    • Laterality should not be used to determine single or multiple primaries of malignant brain and central nervous system tumors. Laterality is used in the determination of single or multiple primaries for benign and borderline brain and central nervous system tumors.

• If there is any difference in the first two numeric digits after the C, it is a different site.

  Exceptions: The following groups of three-character ICD-O-3 topography codes refer to single organs. Lesions within any combination of each group are considered to be the same primary site.

• • C01 Base of tongue; C02 Other and unspecified parts of tongue

  • C05 Palate; C06 Other and unspecified parts of mouth

  • C07 Parotid gland; C08 Other and unspecified major salivary glands

  • C09 Tonsil; C10 Oropharynx

  • C12 Pyriform sinus; C13 Hypopharynx

  • C23 Gallbladder; C24 Other and unspecified parts of biliary tract

  • C30 Nasal cavity and middle ear; C31 Accessory sinuses

  • C33 Trachea; C34 Bronchus and lung

  • C37 Thymus; C38.0 Heart; C38.1-C38.3 Mediastinum; C38.8 Overlapping lesion of heart, mediastinum, and pleura.

  • C51 Vulva; C52 Vagina; C57.7 Other specified female genital organs; C57.8- C57.9 Unspecified female genital organs

  • C56 Ovary; C57.0 Fallopian tube

  • C57.1 Broad ligament; C57.2 Round ligament

  • C57.3 Parametrium; C57.4 Uterine adnexa

  • C60 Penis; C63 Other and unspecified male genital organs

  • C64 Kidney; C65 Renal pelvis; C66 Ureter; C68 Other and unspecified urinary organs

  • C74 Adrenal gland; C75 Other endocrine glands and related structures

HISTOLOGY DIFFERENCES (Cases diagnosed before January 1, 2007) Source: SEER Program and Coding and Staging Manual

The ICD-O-3 morphology code has five digits, for example 8500/3. The fifth digit of the ICD-O-3 morphology code is the behavior code. The first four characters are sometimes referred to as the histology code. Multiple terms may describe a single histology. Refer to the ICD-O-3 histology code to determine whether two or more lesions represent the same tumor histologically.

• If the first three digits of the ICD-O-3 histology codes are the same, it is the same histology.

• Lesion(s) with a single histology (the first three digits of the histology code are the same) containing invasive and in situ components are one primary. Code the behavior of the invasive component.

• A single lesion composed on one histologic type is a single primary, even if the lesion crosses site boundaries.

• A single lesion composed of multiple (different) histologic types is a single primary even if the lesion crosses site boundaries.

• If one lesion is invasive and another lesion of the same histologic type is in situ, or if two or more lesions have invasive and in situ components, this is a single primary.

• A difference in the first three digits of the ICD-O-3 histology code indicates a different histologic type.
  
  Exception 1:
  
  If one malignancy is stated to be carcinoma, NOS, adenocarcinoma, NOS, sarcoma, NOS, or melanoma, NOS and the second lesion is a more specific term, such as large cell carcinoma, mucinous adenocarcinoma, spindle cell sarcoma, or superficial spreading melanoma, consider this to be a single histology.
  
  Exception 2:
  
  For lymphatic and hematopoietic disease, refer to Appendix D to determine which histologies represent single or multiple primaries.
  
  Exception 3:
  
  Consider the following as a single histology, even though the first three digits of the ICD-O-3 morphology codes differ. Code the histology according to the rules for mixed histologies.

  • Transitional cell carcinoma (8120-8131) of the bladder (C67._)

  • Ductal (8500) and lobular (8520) adenocarcinoma of the breast (C50._)

  Exception 4:
  
  See page 20 for determining single or multiple primaries for benign or borderline primary intracranial or CNS tumors.

TIMING RULES (Cases diagnosed prior to January 1, 2007)

• If two malignancies of the same histology occur in the same site simultaneously (within two months of each other), there is only one primary.

  Exception 1:
  
  Each occurrence of melanoma of the skin is a new or separate primary unless a physician states otherwise.

  Exception 2:
  
  Two primary intracranial and central nervous system tumors (C70.0–C72.9, C75.1– C75.3) in which one is malignant (behavior of /2 or /3) and one is non-malignant (behavior of /0 or /1) are always separate primaries regardless of timing. Complete two abstracts.

• If a tumor with the same histology is identified in the same site at least two months after the initial/original diagnosis, this is a separate primary.

  Exception 1:
  
  When there is an in situ followed by an invasive cancer at the same site more than 2 months apart, report the invasive cancer as a second primary even if stated by the physician to be recurrence. This is true for all sites including bladder.

• Multiple lesions with different histologies in a single site are separate primaries, whether they occur simultaneously or at different times.

• If two malignancies of the same histology (following the rules under Histology Differences) and in the same site (following the rules under Site Differences, including rules for laterality for paired sites) are identified more than two months apart, then there are two primaries. Complete a separate report for each one.

  Exceptions:
  
  The following are recurrences of the original disease without time limits.

  • Invasive bladder primaries with morphology codes 8120-8130 (If there is an in situ followed by an invasive more than two months apart, report the invasive cancer as a second primary even if stated by the physician to be a recurrence)

  • Invasive adenocarcinoma of the prostate, site code C61.9.

  • Kaposi sarcoma (9140) of any site.

  • Lymphoma and leukemia histologies that are determined from Appendix D to be the same primary.

EXAMPLES OF SINGLE OR MULTIPLE PRIMARY CODING (Cases diagnosed prior to January 1, 2007)

• A single lesion involving the tongue and floor of mouth is one primary.

• A single, large mucinous adenocarcinoma involving the sigmoid and descending colon segments is one primary.

• A single lesion containing both embryonal cell carcinoma and teratoma is a single primary and would be coded to 9081/3, mixed embryonal carcinoma and teratoma.

• A single lesion of the liver composed of neuroendocrine carcinoma (8246/3) and hepatocellular carcinoma (8170/3) is a single primary and would be coded to the more specific histology, neuroendocrine carcinoma 8246/3.

• At mastectomy for removal of a 2 cm invasive ductal carcinoma, an additional 5 cm area of intraductal carcinoma was noted. Abstract as one invasive primary.

• Adenocarcinoma in adenomatous polyp (8210) in sigmoid colon removed by polypectomy in December 2004. At segmental resection in January 2005, and adenocarcinoma in a tubular adenoma (8210) adjacent to the previous polypectomy site was removed. Count as one primary.

• Infiltrating duct carcinoma of the upper outer quadrant of the right breast diagnosed March 2004 and treated with lumpectomy. Previously unidentified mass in left inner quadrant right breast noted in July 2004 mammogram. This was removed and found to be infiltrating duct carcinoma. Abstract the case as two primaries.

DETERMINING MULTIPLE PRIMARIES AND HISTOLOGIES (Solid tumors

diagnosed on or after January 1, 2007 and Hematopoietic and Lymphoid Neoplasms diagnosed on or after January 1, 2010)

For solid tumors diagnosed January 1, 2007 to December 31, 2017, refer to the Multiple PrimaryandHistologyCodingRules manual for determining the number of primaries and the correct histology for each primary abstracted.

For cases diagnosed January 1, 2018 and later, refer to the 2018 SolidTumorRules manual for determining the number of primaries and the correct histology for each primary abstracted.

For hematopoietic and lymphoid neoplasms diagnosed January 1, 2010 and later, use the HematopoieticandLymphoidNeoplasmCodingManualandDatabase (DB) to determine the correct number of primaries, primary site, histology and grade to report.

STAGING

Collaborative Staging (CS) (http://cancerstaging.org/cstage/manuals/index.html) is to be used for cases diagnosed between January 1, 2004 and December 31, 2015. Site Specific Factors, Regional Nodes Positive and Examined, and Lymph-vascular Invasion from CS will continue to be used with cases diagnosed January 1, 2016 to December 31, 2017.

SEER Summary Stage is used for cases diagnosed prior to January 1, 2004 and cases diagnosed on or after January 1, 2015. AJCC TNM staging will be used with cases diagnosed January 1, 2016 to December 31, 2017. Summary Stage 2018 and the new Site Specific Data Items (SSDI) will be used for cases diagnosed January 1, 2018 and later.

Timing Rule for CS (Cases diagnosed between January 1, 2004 and December 31, 2015)

The timing rule for CS coding was designed to make use of the most complete information possible to yield the "best stage" information for the tumor at the time of diagnosis—"use all information gathered through completion of surgery(ies) in first course of treatment or all information available within four months of the date of diagnosis in the absence of disease progression, whichever is longer." Disease progression is defined as further direct extension, regional lymph node involvement or distant metastasis known to have developed after the diagnosis was established. Information about tumor extension, lymph node involvement, or distant metastasis obtained after disease progression is documented should be excluded from the CS coding.

Ambiguous Terminology for CS (Do not use this list with AJCC TNM Staging)

If the wording in the patient record is ambiguous with respect to tumor spread, use the following guidelines.

Coding CS Values

The complete instructions and site-histology defined codes are available in the Collaborative Staging Manual and Coding Instructions (CS Manual). Part I, Section 1 provides general instructions and the instructions and codes for generic (non site-specific) items. Part I, Section 2 provides information on lab tests, tumor markers, and site specific factors. Part II contains the site-specific instructions and codes.

The MCR collects the following CS Items: CS Tumor Size, CS Extension, CS Tumor Size/Extension Eval, CS Lymph Nodes, Regional Nodes Examined, Regional Nodes Positive, CS Mets at Diagnosis, Site Specific Factor 1 (Lung, Pleura, Retinoblastoma Brain and Central Nervous System and Breast cases only), Site Specific Factor 2 (Breast, corpus adenosarcoma, corpus carcinoma and corpus sarcoma cases only),Site Specific Factor 3 (Prostate Cases Only), Site Specific Factors 8-16 (Breast cases only), Site Specific 25 (Schema discriminator for various sites).

• Read the medical record carefully to identify the primary site and histology and determine their ICD-O-3 codes. While you are reviewing the record, make mental notes about the tissues and lymph nodes that are involved by tumor.

• If the histology is melanoma (8720-8790), Kaposi sarcoma (9140), retinoblastoma (9510-9514), lymphoma (9590-9699 and 9702-9729), mycosis fungoides (9700- 9701), or hematopoietic and reticuloendothelial system (9731-9989), use the histology-specific schema for the appropriate histology-site combination.

• Otherwise, use the correct site-specific schema in Part II of the CS Manual.

• Code your cases.

SEER Summary Stage 2000 (Cases diagnosed prior to January 1, 2004 or diagnosed January 1, 2015 to December 31, 2017)

Summary staging is a basic way to categorize spread of disease from the point of origin. Summary Stage 2000 applies to every anatomic site and to lymphomas and leukemias. Summary stage uses both the clinical and pathologic information in determining the extent of disease. Gross observations at surgery are important when all malignant tissue is not removed. Be sure to also review all clinical information to assure accurate staging.

However, when the pathologic information disproves either the clinical information or the

surgical observations, pathologic information takes precedent. The SEERSummaryStaging Manual - 2000 manual can be found at https://seer.cancer.gov/tools/ssm/ssm2000/.

Summary stage should include all information available through the completion of surgery(ies) in the first course of treatment or within four months of diagnosis in the absence of disease progression, whichever is longer. Summary stage information obtained after radiation or systemic therapy has begun may be included unless it is beyond the timeframe stated in the previous sentence. Autopsy reports are used in summary stage just like pathology reports. If the only information available for stage is the values for T, N, and M from AJCC staging, record the summary stage that corresponds to that information. If there is a discrepancy between the documentation available and the recorded TNM stage, the documentation should be used to record the summary stage.

All schemas apply to all histologies, unless otherwise noted. Some exceptions to this rule include Kaposi's sarcoma and lymphomas which should be staged based on histology schemes and not the primary site scheme. Site specific guidelines take precedence over the general guidelnes. Unlike with CS where site specific guidelines are prior to the coding rules, in Summary Stage 2000 manual, site specific guidelines are documented after the coding rules in each chapter.

The following is a list of ambiguous terms to determine whether or not tissue should be considered involved for summary stage.

AJCC TNM Staging (Cases diagnosed January 1, 2016 to December 31, 2017)

AJCC TNM Stage determines the anatomic extent of disease based on clinical, operative and pathologic findings. AJCC TNM Stage is used to make treatment decisions, assess prognosis, and measure outcomes. The rules in the current AJCCCancerStagingManual should be use to assign the clinical and pathologic T, N, M, and Stage Group. The following are general rules that apply to all sites.

• Clinical stage included any information obtained regarding the extent of disease before the initiation of definitive treatment (surgery, systemic or radiation therapy, active surveillance, or palliative care) or within four months after the date of diagnosis, whichever is shorter, as long as the cancer has not clearly progressed during that time.

• Pathologic stage includes any information obtained regarding the extent of disease through completion of definitive surgery as part of the first course of treatment or identified within four months after the date of diagnosis, whichever is longer, as long as there is no systemic or radiation therapy administered or the cancer has not clearly progressed during that time.

• When a patient has multiple primaries, stage each primary independently.

• If the stage group cannot be determined from the recorded components, then record it as unknown.

• When a patient with multiple simultaneous primaries has metastases, a biopsy may be able to distinguish the source of the distant disease. If the physician cannot determine which primary has metastasized, stage all primaries as having metastatic disease. If, at a later time, the physician identifies which primary has metastasized, update the stage(s) as appropriate.

• If a site/histology combination is not defined in the AJCC Manual, code 88 for clinical and pathologic T, N and M as well as stage group.

• Even if complete AJCC TNM information is not available in the record, any piece of staging information should be collected and reported.

  • Example: If the T and N are available but not information is available on M, the T and N should be reported.

The AJCC items required to be completed are the following:

SEER Summary Stage 2018 (Cases diagnosed January 1, 2018 and later)

Summary staging is a basic way to categorize spread of disease from the point of origin. Summary Stage 2018 applies to every anatomic site and to lymphomas and leukemias. Chapter-specific guidelines take precedence over general guidelines. Always read the information pertaining to a specific primary site or histology chapter. Summary stage uses both the clinical and pathologic information in determining the extent of disease. Gross observations at surgery are important when all malignant tissue is not removed. Be sure to also review all clinical information to assure accurate staging. However, when the pathologic information disproves either the clinical information or the surgical observations, pathologic information takes precedent. The SEER Summary Staging Manual - 2018 manual can be found at https://seer.cancer.gov/tools/ssm/. Summary stage should include all information available through the completion of surgery(ies) in the first course of treatment or within four months of diagnosis in the absence of disease progression, whichever is longer Information for Summary Stage from a surgical resection after neoadjuvant treatment may be used, but ONLY if the extent of disease is greater than the pre-treatment clinical findings. Autopsy reports are used in summary stage just like pathology reports. If the only information available for stage is the values for T, N, and M from AJCC staging, record the summary stage that corresponds to that information. If there is a discrepancy between the documentation available and the recorded TNM stage, the documentation should be used to record the summary stage.

All schemas apply to all histologies, unless otherwise noted. Some exceptions to this rule include Kaposi's sarcoma and lymphomas which should be staged based on histology schemes and not the primary site scheme. Site specific guidelines take precedence over the general guidelines.

The following is a list of ambiguous terms to determine whether or not tissue should be considered involved for summary stage.

Site Specific Data Items (Cases diagnosed January 1, 2018 and later)

In 2018, the Collaborative Staging Site Specific Factors (SSF) were discontinued and Site Specific Data Items (SSDI) were developed to replace them to capture prognostic information. SSDI's have unique names and are not limited to three characters like the SSF's were in Collaborative Staging. The SSDI manual can be accessed at https://apps.naaccr.org/ssdi/list/. The MCR does not require all of the SSDI in the manual. The required SSDI are described in the data variable section of this manual.

First Course of Treatment

Treatment includes all types of therapy intended to modify, control, remove or destroy proliferating cancer cells. The first course of treatment includes all therapy planned and administered during the first diagnosis of cancer. "Active surveillance" is also a form of treatment administered to some patients and coded in RX Summ-Treatment Status. "No treatment" which is also coded in RX Summ-Treatment Status is an option that occurs if the patient or patient's family refuses treatment, the physician recommends that no treatment be given, or the patient dies before starting treatment. For all malignancies except leukemias, any therapy administered after the discontinuation of first course of treatment is considered subsequent treatment. For leukemias, all therapy administered after the first relapse is secondary or subsequent treatment. Information on treatment can be found in the discharge plan, physician(s) treatment plan, or established protocol or accepted management guidelines in the absence of a treatment plan. If no plan, guideline or protocol is available and a physician cannot be consulted, use the following rule: "Initial treatment must begin within four months of the date of initial diagnosis." If no treatment is given, record the date the decision was made not to treat or date of death. If the patient undergoes "Active surveillance," record the date the decision for surveillance was made as the date of first course treatment.

DATA ITEMS AND RECORD LAYOUT

The data items that are collected are those needed to produce age-, race-, sex-, and area-specific cancer incidence rates by cancer site and histologic type. General Summary Stage and Collaborative Staging are included for cancer control studies. Administrative items are included that facilitate death clearance, patient matching, inter-field edit reviews, and hospital admission tracking. The fields are listed in the order that they will be entered into Web Plus.

The following data items are required:

REPORTING FACILITY

Item Length: 10

NAACCR Item #540

STORE 2018 pg. 402

Description

The Facility Identification Number is used to identify reporting facilities in the MCR database. This number is used to monitor data submissions and data accuracy.

Note: This number should be automatically coded by your software.

Examples:

ABSTRACTOR

Item Length: 3

NAACCR Item #570

STORE 2018 pg. 401

Definition:

Records the initials or assigned code of the individual abstracting the case. This item is used for quality control by the MCR.

Coding Instructions:

• Code the initials of the abstractor.

• This code will be automatically generated in Web Plus.

MEDICAL RECORD NUMBER

Item Length: 11

NAACCR Item #2300

STORE 2018 pg. 51

Definition:

Records the medical record number used by the facility to identify the patient. The STORE manual instructs registrars to record the number assigned by the HIM Department, not a department specific number.

This number identifies the patient in a facility. It can be used by the MCR to reference a patient record and it helps to identify multiple reports on the same patient.

Coding Instructions:

• Record the medical record number.

Coding Examples:

DATE OF 1ST CONTACT

Item Length: 8

NAACCR Item #580

STORE 2018 pg. 128

Definition:

Date of first contact with the reporting facility as an inpatient or outpatient for diagnosis and/or treatment of this cancer.

Date of 1^st Contact is one of several data items that can be used to measure timeliness of reporting by individual facilities to the MCR.

Coding Instructions:

• Date the patient first had contact with the facility as either an inpatient or outpatient for diagnosis and/or treatment of a reportable tumor.

• This may be the date of an outpatient visit for a biopsy, x-ray, or laboratory test, or the date a pathology specimen was collected at the hospital.

• For patients diagnosed in a staff physician office, the date of 1^st contact should be the date the patient was seen at the reporting facility, not the date the patient was first seen in the staff physician office.

• When pathology-specimen-only tumors are collected (Class of Case 43), the date of specimen collection is the date of first contact.

• For autopsy only cases, the date of first contact is the same as the date of death.

Coding Examples:

DATE OF 1ST CONTACT FLAG

Item Length: 2

NAACCR Item #581

Valid Codes: 12, Blank

STORE 2018 pg. 130

Definition:

This flag explains why no appropriate value is in the field Date of 1^st Contact. Prior to 2010, date fields included codes that provided information other than dates. As part of an initiative to standardize date fields, new fields were introduced to accommodate non-date information that had previously been transmitted in date fields.

Coding Instructions:

• If a valid date is coded in Date of 1^st Contact, then leave this field blank. A valid date may be just a partial date.

• If date of 1^st contact is completely unknown, then leave date of 1^st contact blank and record 12 in this field indicating that the date is unknown.

Coding Examples:

CLASS OF CASE

Item Length: 2

Allowable Values: 00, 10-14,

20-22, 30-38, 40-43, 49, 99

NAACCR Item #610

STORE 2018 pg. 122-125

Definition:

Classifies cases recorded in the database.

The MCR requires all analytic (class 00- 22) and non-analytic cases including class of case 30-32, 34, 36, 38, and 43 to be reported by all facilities. Class of case 34 and 36 would be used for cases of VIN III, VAIN III and AIN III which are not reportable to the COC but must be reported to the MCR. Cancer registries must also report class of case 40-42 if they collect these cases. New cancer programs should submit class of case 35 and 37 for cases diagnosed January 1, 1996 or later.

Do not use class of case 49 or 99. These are reserved for the central cancer registry only.

This data item divides case records into analytic and nonanalytic categories. This allows reporting facilities to select cases for use within their facility or to be reported to the MCR.

Coding Instructions:

• Analytic cases are coded 00–22.

• Nonanalytic cases are coded 30–99.

• Use the code that best describes the patient's relationship to the reporting facility.

• Code 00 should be used only when it is known that the patient went somewhere else for treatment. If this information is not available, use code 10.

• Codes 34 and 36 should be used for VIN III, VAIN III and AIN III.

• A staff physician is a physician who is employed by the reporting facility, under contract with it, or a physician who has routine admitting privileges there.

• "In-transit" care is care given to a patient who is away from their primary source of care in order to prevent a break in their care. These cases would be coded as Classof Case 31. This would also include cases where the reporting facility is monitoring use of oral medications started somewhere else. If a patient begins infusion therapy or radiation therapy at another facility and then continues that care at the reporting facility, this is not a case of "in transit" care and should be codes as ClassofCase 21.

Coding Examples:

CASEFINDING SOURCE

Item Length: 2

Allowable Values: 10, 20-29, 80, 99

NAACCR Data Item #501

Definition:

This variable codes the earliest source of identifying information. This data item will help reporting facilities, as well as, the MCR prioritize their casefinding activities. It will identify reportable tumors that were first identified through death clearance.

Coding Instructions:

Code the source that first identified the tumor.

TYPE OF REPORTING SOURCE

Item Length: 1

Allowable Values: 1-8

NAACCR Data Item #500

Definition:

This variable codes the source documents used to abstract the majority of information on the tumor being reported. This may not be the source of the original case finding. For example, if a case is identified through a pathology laboratory report review and all source documents used to abstract the case are from a physician's office, code this item 4.

Coding Instructions:

• Code in the following priority order: 1, 2, 8, 4, 3, 5, 6, 7. This is a change to reflect the addition of codes 2 and 8 and to prioritize laboratory reports over nursing home reports. The source facilities included in the previous code 1 (hospital inpatient and outpatient) are split between codes 1, 2, and 8.

• This data item is intended to indicate the completeness of information available to the abstractor.

• Reports from health plans (e.g., Kaiser, Veterans Administration, military facilities) in which all diagnostic and treatment information is maintained centrally and is available to the abstractor are expected to be at least as complete as reports for hospital inpatients. This is the reason these sources are grouped with inpatients and given the code with the highest priority.

• Sources coded with '2' usually have complete information on the cancer diagnosis, staging, and treatment.

• Sources coded with '8' would include, but would not be limited to, outpatient surgery and nuclear medicine services. A physician's office that calls itself a surgery center should be coded as a physician's office. Surgery centers are equipped and staffed to perform surgical procedures under general anesthesia. If a physician's office calls itself a surgery center, but cannot perform surgical procedures under general anesthesia, code as a physician office.

SEQUENCE NUMBER – HOSPITAL

Item Length: 2

Allowable Values: 00–88, 99

NAACCR Item #560

STORE 2018 pg. 49-50

Definition:

Indicates the sequence of malignant neoplasms and benign and borderline brain and central nervous system tumors over the lifetime of the patient even if all were not diagnosed/treated at the reporting facility.

Coding Instructions:

• Codes 00-59 and 99 indicate neoplasms of in situ or malignant behavior (Behavior equals 2 or 3). Codes 60-88 indicate neoplasms of non-malignant behavior (Behavior equals 0 or 1).

• Code 00 only if the patient has a single malignant primary. If the patient develops a subsequent malignant or in situ primary tumor, change the code for the first tumor from 00 to 01, and number subsequent tumors sequentially.

• Code 60 only if the patient has a single non-malignant primary. If the patient develops a subsequent nonmalignant primary, change the code for the first tumor from 60 to 61, and assign codes to subsequent non-malignant primaries sequentially.

• If two or more malignant or in situ neoplasms are diagnosed at the same time, assign the lowest sequence number to the diagnosis with the worst prognosis. If no difference in prognosis is evident, the decision is arbitrary.

• If two or more non-malignant neoplasms are diagnosed at the same time, assign the lowest sequence number to the diagnosis with the worst prognosis. If no difference in prognosis is evident, the decision is arbitrary.

• Because the time period for Sequence Number is the patient's lifetime, reportable neoplasms not included in the hospital registry are allotted a sequence number. For example, a registry may contain a single record for a patient with a sequence number of 02 because the first reportable neoplasm occurred before the hospital's reference date or was diagnosed and treated at another facility. Document all previous primaries and the date or approximate date of diagnosis. Also document where the patient was diagnosed/treated if known.

Malignant, in situ or invasive:

Benign and Borderline Brain and Central Nervous System Tumors

Coding Examples:

DEMOGRAPHICS

NAME – LAST

Item Length: 40

NAACCR Item #2230

STORE 2018 pg. 53

Definition:

Last name of the patient

Coding Instructions:

• Truncate name if more than 40 letters long.

• Blanks, spaces, hyphens, and apostrophes are allowed. Do not use other punctuation.

• If the patient's last name is unknown, enter UNKNOWN.

• If the name becomes available at a later admission, please send the correction to the MCR.

• This field may be updated if the last name changes.

Examples:

NAME - FIRST

Item Length: 40

NAACCR Item #2240

STORE 2018 pg. 54

Definition:

First name of the patient.

Coding Instructions:

• Truncate name if more than 40 letters long.

• Spaces, hyphens, and apostrophes are allowed. Do not use other punctuation.

• If the patient's first name is unknown, enter UNKNOWN.

• If the name becomes available at a later admission, please send the correction to the MCR.

Examples:

NAME - MIDDLE

Item Length: 40

NAACCR Item #2250

STORE 2018 pg. 55

Definition:

Middle name or, if middle name is unavailable, middle initial of the patient.

Coding Instructions:

• Truncate the name if more than 40 letters long.

• Blanks, spaces, hyphens, and apostrophes are allowed. Do not use other punctuation.

• Leave blank if the middle name or middle initial is unknown. Do not use abbreviations such as NMI or NMN to denote that the middle initial/name is unknown.

• This field may be updated if the name changes.

Examples:

NAME - MAIDEN

Item Length: 40

NAACCR Item #2390

Description

Maiden name of female patients who are or have been married.

This is used to link reports on a woman who changed her name between reports. It also is critical when using Spanish surname algorithms to categorize ethnicity.

Coding Instructions:

• Truncate the name if more than 40 letters long.

• If the maiden name is unknown or not applicable, leave the field blank. Any variation of 'unknown' or 'not applicable' is not allowable.

NAME - ALIAS

Item Length: 40

NAACCR Item #2280

Description

Records an alternate name or "AKA" (also known as) used by the patient, if known. Note that maiden name is entered in Name-Maiden.

NAME - SUFFIX

Item Length: 3

NAACCR Item #2270

Description

Title that follows a patient's last name, such as a generation order or credential status (e.g., "MD," "Jr.")

SOCIAL SECURITY NUMBER

Item Length: 9

NAACCR Item #2320

STORE 2018 pg. 52

Definition:

Records the patient's Social Security number.

This data item can be used to identify patients with similar names.

Coding Instructions:

• Code the patient's Social Security number.

• A patient's Medicare claim number may not always be identical to the person's Social Security number.

• Code Social Security numbers that end with "B" or "D" as 999999999. This indicates the patient is using a spouse's social security number.

• If the social security number becomes available at a later admission, update the number and send the correction to the MCR.

BIRTH DATE

Item Length: 8

NAACCR Item #240

STORE 2018 pg. 76

Definition:

Identifies the patient's birth date.

This data item is useful for patient identification and analyzing tumors by age groups.

Coding Instructions:

• Record the patient's date of birth as indicated in the patient record.

• For inutero diagnosis and treatment, record the actual date of birth.

• If age at diagnosis and year of diagnosis are known, but year of birth is unknown, then year of birth should be calculated and so coded. Month and day would be left blank.

• Every effort must be made to collect the correct birth date.

• Estimate the birth date and note in the text field that the birth date is estimated. It is better to estimate the date than code as unknown.

• Corrections to birth date should be sent to the MCR.

BIRTH DATE FLAG

Item Length: 2

NAACCR Item #241

Allowable Values: 12, Blank

STORE 2018 pg. 77

Definition:

This flag explains why no appropriate value is in the field Birth date. Prior to 2010, date fields included codes that provided information other than dates. As part of an initiative to standardize date fields, new fields were introduced to accommodate non-date information that had previously been transmitted in date fields.

Coding Instructions:

• If a valid date is coded in birth date, then leave this field blank. A valid date may be just a partial date.

• If birth date cannot be determined, then leave birth date blank and record 12 in this field indicating that the date is unknown.

Coding Examples:

BIRTHPLACE—STATE

Item Length: 2

NAACCR Item #252

STORE 2018 pg. 74

Definition:

USPS abbreviation for state, commonwealth, U.S. possession in which the patient was born. CanadaPost abbreviations for the Canadian provinces can also be recorded if the patient was born in Canada. If the patient has multiple primaries, this data item should be coded the same for each primary.

Coding Instructions:

• Use the most specific code.

Coding Examples:

BIRTHPLACE—COUNTRY

Item Length: 3

NAACCR Item #254

STORE 2018 pg. 75

Definition:

Code for the country where the patient was born. If the patient has multiple tumors, all records should contain the same code. Place of birth is helpful in patient matching and quality review of race and ethnicity.

Coding Instructions:

• Use the most specific code.

Coding Examples:

ADDRESS AT DIAGNOSIS – NO & STREET

Item Length: 60

NAACCR Item #2330

STORE 2018 pg. 56-57

Definition:

Identifies the patient's address (number and street) at the time of diagnosis.

If the patient has multiple tumors, the address at diagnosis may be different for each tumor. This field should not be updated if the patient's address changes.

Coding Instructions:

• Record the number and street address or the rural mailing address of the patient's usual residence when the tumor was diagnosed.

• The address should be fully spelled out with standardized use of abbreviations and punctuation per U.S. Postal Service postal addressing standards. The USPS Postal Addressing Standards, Pub 28, April 2010 can be found on the Internet at http://pe.usps.gov/cpim/ftp/pubs/pub28/pub28.pdf.

• Abbreviations should be limited to those recognized by the Postal Service standard abbreviations. They include, but are not limited to:

• Do not update this data item if the patient's address changes.

• See "Residency Rules" for further instructions.

• Punctuation marks should be avoided, except when punctuation is necessary to convey the meaning (a period in 39.2 RD, a slash in 100 ½ FIFTH ST, or a hyphen in 259-02 SMITH AVE)

• Leave blanks between numbers and words.

• If the patient's address is unknown, enter UNKNOWN.

Coding Examples:

SUPPLEMENTAL PATIENT ADDRESS, NUMBER & STREET AT DIAGNOSIS

Item Length: 60

NAACCR Item #2335

STORE 2018 pg. 58

Definition:

Provides the ability to store additional address information such as the name of a place or facility, a nursing home, or the name of an apartment complex. If the patient has multiple tumors, the address at diagnosis may be different for every tumor.

Coding Instructions:

• Record the place or facility (i.e., a nursing home or name of an apartment complex) of the patient's usual residence when the tumor was diagnosed.

• Do not update this data item if the patient's address changes.

• See "Residency Rules" in Section One for further instructions.

Example:

SUNNY VIEW NURSING HOME

ADDRESS AT DIAGNOSIS - CITY

Item Length: 50

NAACCR Item #70

STORE 2018 pg. 59

Definition:

Name of the city in which the patient resides at the time of diagnosis. If the patient has multiple primaries, the city of residence may be different for each primary.

Coding Instructions:

• If the patient resides in a rural area, record the name of the city or town used in his or her mailing address.

• Do not update this data item if the patient's city/town of residence changes.

• See "Residency Rules" in Section One for further instructions.

• Do not use punctuation, special characters, or numbers.

• Abbreviate where necessary.

• If the patient's city or town is unknown type UNKNOWN.

ADDRESS AT DIAGNOSIS - STATE

Item Length: 2

NAACCR Item #80

STORE 2018 pg. 60-61

Definition:

USPS abbreviation for the state, territory, commonwealth, or U.S. possession in which the patient resides at the time of diagnosis. If the patient has multiple primaries, the state of residence may be different for each primary.

Coding Instructions:

• If the patient is a foreign resident, then code either XX or YY depending on the circumstance.

• If the patient is a U.S. resident, but the state is unknown, code US.

• If the patient is a Canadian resident and the province is unknown, code CD.

ADDRESS AT DIAGNOSIS – POSTAL CODE

Item Length: 9

NAACCR Item #100

STORE 2018 pg. 62

Definition:

Postal code of the patient's address at diagnosis. If the patient has multiple primaries, the postal code at diagnosis may be different for each primary.

Coding Instructions:

• For U.S. residents, use either the 5-digit or the extended 9-digit ZIP code. Blanks follow the 5-digit code.

• For Canadian residents, record the six-character alphanumeric postal code.

• When available, record the postal code for other countries.

• Do not update this data item if the patient's postal code changes.

• See "Residency Rules" in Section One for further instructions.

COUNTY AT DIAGNOSIS

Item Length: 3

Allowable Values: 001–997, 998, 999

NAACCR Item #90

STORE 2018 pg. 64

Definition:

Code the county of the patient's residence at the time the reportable tumor is diagnosed. If the patient has multiple primaries, the county at diagnosis may be different for each primary.

Coding Instructions:

• Refer to the table below for a list of Mississippi Counties and their FIPS codes.

• For residents of states other than Mississippi and residents of other countries at the time of diagnosis, code 998 for diagnosis county.

• If the county of the patient is unknown, code 999.

• Do not update this data item if the patient's county of residence changes.

SEX

Item Length: 1

Allowable Values: 1–6, 9

NAACCR Item #220

STORE 2018 pg. 90

Definition:

Identifies the sex of the patient.

Transsexual: A person who was assigned under one gender at birth based on physical characteristics but who self-identifies psychologically and emotionally as the other gender.

Transgender: See Transsexual

Transgendered person: A person who identifies with or expresses a gender identity that differs from the one which corresponds to the person's sex at birth.

Coding Instructions:

• Record the patient's sex as indicated in the medical record.

• If the medical record indicates unknown for sex contact the patient's primary physician to identify the sex of the patient.

• When gender is not known

• • Assign code 1 when the primary site is C600-C639

  • Assign code 2 when the primary site is C510-C589

  • Assign code 9 for primary sites not included above.

• Natality was added in 2015 for transsexuals. However, the codes can also be used when abstracting cases diagnosed prior to 2015

• Assign code 3 for Intersexed (persons with sex chromosome abnormalities)

• Assign code 5 for transsexuals who are natally male or transsexuals with primary site of C600-C639

• Assign code 6 for transsexuals who are natally female or transsexuals with primary site of C510-C589

• Assign code 4 for transsexuals with unknown natal sex and primary site is NOT C501-C589 or C600-C639

RACE 1

Item length: 2

Allowable Values: 01–08, 10-17,

20–22, 25–28, 30–32, 96–99

NAACCR Item #160

STORE 2018 pg. 79-80

Definition:

Identifies the primary race of the person. Race is coded separately from Spanish/Hispanic Origin. All tumors for the same patient should have the same race code. If the patient is multiracial, code all races using Race 2 through Race 5.

Coding Instructions:

• Race 1 is the field used to compare with race data on cases diagnosed prior to January 1, 2000.

• Code race using the highest priority source available according to the list below (a is the highest and c is the lowest) when race is reported differently by two or more sources.

  1. The patient's self-declared identification

  2. Documentation in the medical record

  3. Death certificate

• Priorities for coding multiple races:

  1. Code 07 takes priority over all other codes.

  2. Codes 02-32, 96-98 take priority over code 01

  3. Codes 04-17 take priority over code 96

  4. Codes 16-17 take priority over code 15

  5. Codes 20-32 take priority over code 97

  6. Codes 02-32 and 96-97 take priority over code 98

  7. Code 98 takes priority over code 99

• Code as 01 (White) when the race is described as Caucasian regardless of place of birth or there is a statement that the patient is Hispanic or Latino(a) with no further information. DO NOT code 98 for Hispanic, NOS

• Code race as 02 (Black) when the stated race is African-American, Black or Negro.

• Assign code 03 for any person stated to be Native American (western hemisphere) or Indian (whether from North, Central, South or Latin America)

• Assign a specific code when a specific Asian race is stated. Code 96 is not applicable when a specific race is known.

• Code a race based on birthplace information when the race is recorded as Oriental, Mongolian, or Asian and the place of birth is recorded as China, Japan, the Philippines, or another Asian nation.

• Use the appropriate non-specific code 96 (Other Asian including Asian, NOS and Oriental, NOS), 97 (Pacific Islander, NOS) or 98 (Other) when there is no race code for a specific race.

• When a face-sheet indicates "Race Other," look for other descriptions of the patient's race. When no further race information is available, code race as 99 (unknown) and document that the face-sheet indicates "Race Other," and no further information is available.

• Do not use code 96, 97, or 98 for a patient described as "multiracial."

• If Race 1 is coded 99, then Race 2-5 must all be coded 99.

• Do not use patient name as the basis for coding race.

• Refer to Appendix D of the current SEERProgramCodingandStagingManual (http://www.seer.cancer.gov/tools/codingmanuals/index.html) to determine race when only nationality or place of birth is known.

• 1. Example: Record states that the patient is a native of Portugal. Code race as 01 (White) per Appendix D.

  2. Exception: Code Race 1 through 5 as 99 (Unknown) when patient's name is incongruous with the race inferred on the basis of nationality.

     • Example: Patient's name is Siddhartha Rao and the birthplace listed is England. Code Race 1 through Race 5 as 99 (Unknown).

• Patient photographs may be used with caution to determine race in the absence of documented race information.

Coding Examples for Race 1:

RACE 2

Item length: 2

Allowable Values: 01–08, 10-17,

20–22, 25–28, 30–32, 88, 96–99

NAACCR Item #161

STORE 2018 pg. 81-82

Definition:

Identifies the additional race of the person. Race is coded separately from Spanish/Hispanic Origin. All tumors for the same patient should have the same race code. If the patient is multiracial, code all races using Race 2 through Race 5. If a patient is White and another race, the other race should be coded as Race 1 and White should be coded as Race 2.

Coding Instructions: Refer to Race 1 for coding instructions. Coding Examples for Race 2:

RACE 3

Item length: 2

Allowable Values: 01–08, 10-17,

20–22, 25–28, 30–32, 88, 96–99

NAACCR Item #162

STORE 2018 pg. 83-84

Definition:

Identifies the additional race of the person. Race is coded separately from Spanish/Hispanic Origin. All tumors for the same patient should have the same race code. If the patient is multiracial, code all races using Race 2 through Race 5.

Coding Instructions: Refer to Race 1 for coding instructions.

RACE 4

Item length: 2

Allowable Values: 01–08, 10-17,

20–22, 25–28, 30–32, 88, 96–99

NAACCR Item #163

STORE 2018 pg. 85-86

Definition:

Identifies the additional race of the person. Race is coded separately from Spanish/Hispanic Origin. All tumors for the same patient should have the same race code. If the patient is multiracial, code all races using Race 2 through Race 5.

Coding Instructions: Refer to Race 1 for coding instructions.

RACE 5

Item length: 2

Allowable Values: 01–08, 10-17,

20–22, 25–28, 30–32, 88, 96–99

NAACCR Item #164

STORE 2018 pg. 87-88

Definition:

Identifies the additional race of the person. Race is coded separately from Spanish/Hispanic Origin. All tumors for the same patient should have the same race code. If the patient is multiracial, code all races using Race 2 through Race 5.

Coding Instructions: Refer to Race 1 for coding instructions.

SPANISH/HISPANIC ORIGIN

Item Length: 1

Allowable Values: 0–9

NAACCR Item #190

STORE 2018 pg. 89

Definition:

Identifies persons of Spanish or Hispanic origin. Persons of Spanish of Hispanic origin may be of any race. If the patient has a Hispanic name, but there is reason to believe they are not Hispanic (e.g., the patient is a woman known to be non-Hispanic who has a Hispanic married name), then code the patient as non-Hispanic.

This code is used by hospital and central registries to identify whether or not the person should be classified as "Hispanic" for purposes of calculating cancer rates.

Coding Instructions:

• Assign code 7 when the only evidence of the patient's Hispanic origin is a surname or maiden name and there is no evidence that the patient is not Hispanic. Code 7 is ordinarily for central registry use only.

• Portuguese, Brazilians and Filipinos are not presumed to be Spanish or non-Spanish

• • Assign code 7 when the patient is Portuguese, Brazilian, or Filipino and their name appears on a Hispanic surname list.

  • Assign code 0 when the patient is Portuguese, Brazilian, or Filipino and their name does NOT appear on a Hispanic surname list.

• The following information should be referred to determine the Spanish/Hispanic Origin code: stated ethnicity in the medical record, stated Hispanic origin on the death certificate, birthplace, information about the life history and/or language spoken found during the abstracting process, patient's last name or maiden name found on a list of Hispanic/Spanish names.

• A list of Hispanic surnames from the Census Bureau can be found at the following link: https://fcds.med.miami.edu/downloads/DataAcquisitionManual/dam2014/25%20App endix%20E%20Census%20List%20of%20Spanish%20Surnames.pdf

• If the patient has multiple tumors, all records should have the same code.

TEXT--USUAL INDUSTRY

Item Length: 100

NAACCR Item #320

Description

Source: "A Cancer Registrar's Guide to Collecting Industry and Occupation"; DHHS (NIOSH) Publication No. 2011-173 (http://www.cdc.gov/niosh/docs/2011-173/pdfs/2011- 173.pdf)

Text area for information about the patient's usual industry.

Used to identify new work-related health hazards; serves as an additional measure of socioeconomic status; identifies industrial groups or worksite-related groups in which cancer screening or prevention activities may be beneficial.

The patient's usual industry is the type of business or industry where the patient worked in his or her usual occupation.

Coding Instructions

• Be descriptive: Record the primary activity carried on by the industry at the location where the patient was employed.

Inadequate: "automobile industry" Adequate: "automobile manufacturing"

• Be specific: In order to give a clear and exact description of the industry, the entry must indicate both a general and specific function for the employer.

• Be complete: If the primary activity of the industry is unknown, record the name of the company (with city or town) in which the patient worked the most number of years before diagnosis.

• Instructions for reporting government agencies:

  • Record the level: federal, state, county.

Inadequate: "fire department" Adequate: "city fire department"

• • • Record the division of the agency, if available, to help clarify the specific activity of the patient.

    • Use full name of division/agency: Inadequate: "Census"

Adequate: "U.S. Census Bureau"

• If a person worked only at home, then record industry as "own home."

• If a patient worked at someone else's home for pay, then record industry as "private home."

• If patient ever worked outside the home, then report corresponding industry for longest-held job outside the home. Do not report "homemaker" in this case.

Note: This is an exception to the rule that the occupation with the greatest number of years should be recorded as "usual" occupation.

• If the patient is under 14 years of age, then record industry as "child."

• If patient was a student at the time of diagnosis and had never held a job, then record industry as the type of school ("high school," "college")

• If patient was part of the military for most of his/her working life, then record industry as "military."

• If patient was not a student or homemaker and had never worked, then record industry as "none."

• "Unknown" should be entered only after you have tried your best to find job information in the medical record. It is better to enter "unknown" than to leave the field blank.

• A business at a person's home should be reported in the same manner as regular business establishments. If work is in an office located in a private home, report the specific business. Do not report an individual's name as the employer.

Inadequate: "O'Keefe, Brown, & Smith" Adequate: "lawyer's office"

• Here are some common incomplete entries to avoid:

  • "Retired": If retired, enter the kind of work patient did during most of his or her working life if this can be determined. (Do not add "retired".) Inadequate: "retired plumber"

Adequate: "plumber"

• "Institutionalized," "Disabled," or "Unemployed": Do not record such a description if patient was ever employed. Record longest-held occupation and industry.

• "Self-employed": If self-employed, specify the kind of work performed. Inadequate: "self-employed"

Adequate: "automobile manufacturing"

• Make sure that the recorded usual occupation matches the recorded industry.

TEXT USUAL OCCUPATION

Item Length: 100

NAACCR Item #310

Description

Source: "A Cancer Registrar's Guide to Collecting Industry and Occupation"; DHHS (NIOSH) Publication No. 2011-173 (http://www.cdc.gov/niosh/docs/2011-173/pdfs/2011-173.pdf)

The patient's usual occupation is the type of job the patient was engaged in for the longest time. It is not necessarily the highest paid job not the job considered the most prestigious, but the one that accounted for the greatest number of working years.

Coding Instructions

• • Be descriptive: Record the word or words which most clearly describe the kind of work or type of duties performed by the patient.

• • Be specific: General or vague terms are not adequate since they do not always provide enough information to code. You are allowed 100 characters.

• • Be complete: Occupation entries that give only the department or a place of work are inadequate.

Inadequate: "worked in a warehouse", "worked in a shipping department" Adequate: "warehouse forklift operator"

• • Here are some commonly confused occupations:

    • Contractor vs. skilled worker

      • A "contractor" mainly obtains contracts and supervises the work

      • A "skilled worker" works with his or her own tools as a carpenter, plasterer, plumber, or electrician.

    • Machine operator vs. machinist vs. mechanic

      • A "machine operator" operates machines.

      • A "machinist" sets up and operates machines.

      • A "mechanic" repairs, installs, and adjusts machines

• If a patient worked only at home, then record occupation as "homemaker."

• If a patient worked at someone else's home for pay, then record occupation as "housekeeper" (or "nurse," "babysitter," etc.)

• If patient ever worked outside the home, then report corresponding occupation for longest-held job outside the home. Do not report "homemaker" in such cases.

Note: This is an exception to the rule that the occupation with the greatest number of years should be recorded as "usual" occupation.

• If the patient is under 14 years of age, then record occupation as "child."

• If patient was a student at time of diagnosis and had never held a job, then record occupation as "student."

• If patient was part of the military for most of his/her working life, then record occupation as "military."

• If the patient was not a student or homemaker and had never worked, then record occupation as "never worked."

• "Unknown" should be entered only after you have tried your best to find job information in the medical record. It is better to enter "unknown" than to leave blank.

• A business at a person's home should be reported in the same manner as a regular business establishment. If work is in an office located in a private home, report the specific business. Do not report an individual's name as the employer.

Inadequate: "works from home" Adequate: "paralegal"

• If retired, enter the kind of work patient did during most of his or her working life if this can be determined. (Do not add "retired.") For example, record "plumber," not "retired plumber."

• Do not record descriptions such as "institutionalized," "disabled," or "unemployed" if patient was ever employed. Record longest-held occupation.

• If self-employed, specify the kind of work performed. Inadequate: "self-employed"

Adequate: "self-employed auto mechanic"

• Record "manager" only if patient worked most of time managing a business, but include specifics in these cases.

Inadequate: "manager" Adequate: "operations manager"

PRIMARY PAYER AT DIAGNOSIS

Item Length: 2

Allowable Values: 01, 02, 10, 20, 21,

31, 35, 60-68, 99

NAACCR Item #630

STORE 2018 pg. 91-92

Description

Identifies the patient's primary payer/insurance carrier at the time of initial diagnosis and/or treatment. The Joint Commission on Accreditation of Healthcare Organizations requires the patient admission page document the type of insurance or payment structure that will cover the patient while being cared for at the hospital.

Coding Instructions

• Record the type of insurance reported on the patient's admission page.

• If the patient is diagnosed at the reporting facility, record the payer at the time of diagnosis.

• If the patient is diagnosed elsewhere or the payer at the time of diagnosis is not known, record the payer when the patient is initially admitted for treatment.

• Codes 21 and 65-68 are to be used for patients diagnosed on or after January 1, 2006.

• If more than one payer or insurance carrier is listed on the patient's admission page record the first.

• If the patient's payer or insurance carrier changes, do not change the code in the record.

Coding Examples:

CANCER IDENTIFICATION

DATE OF DIAGNOSIS

Item Length: 8

NAACCR Item #390

STORE 2018 pg. 131-132

Definition:

Records the date of initial diagnosis by a recognized medical practitioner for the tumor being reported whether clinically or microscopically confirmed.

Coding Instructions:

• Use the first date of diagnosis whether clinically or histologically confirmed.

• If the physician states that in retrospect the patient had cancer at an earlier date, then use the earlier date as the date of diagnosis.

• Use the date therapy was started as the date of diagnosis if the patient receives a first course of treatment before a definitive diagnosis.

• Refer to the list of "Ambiguous Terms" in Section One for language that represents a diagnosis of cancer.

• The date of death is the date of diagnosis for a Class of Case 38 or 49.

• Use the actual date of diagnosis as the Date of Initial Diagnosis for an in utero diagnosis, for cases diagnosed January 1, 2009 or later.

• If the year is unknown, it should be approximated. The month and day would be unknown.

• If the only information provided is "spring", use April. Use July for "summer" or "mid-year" and October for "fall" or "autumn". In winter, attempt to determine whether the diagnosis was "late in the year" (use December with the applicable year) or "early in year" (use January with the respective year).

Coding Examples:

DATE OF DIAGNOSIS FLAG

Item Length: 2

NAACCR Item #391

Allowable Values: 12, Blank

Definition:

This flag explains why no appropriate value is in the field Date of Diagnosis. Prior to 2010, date fields included codes that provided information other than dates. As part of an initiative to standardize date fields, new fields were introduced to accommodate non-date information that had previously been transmitted in date fields.

Coding Instructions:

• If a valid date is coded in date of diagnosis, then leave this field blank. A valid date may be just a partial date.

• If date of diagnosis cannot be estimated or determined, then leave date of diagnosis blank and record 12 in this field indicating that the date is unknown.

Coding Examples:

PRIMARY SITE

Item Length: 4

NAACCR Item #400

STORE 2018 pg. 133-134

Definition:

Identifies the exact primary site of the tumor being reported using ICD-O-3.

Coding Instructions:

• Record the ICD-O-3 topography code for the site of origin for cases diagnosed on or after January 1, 2001 and the ICD-O-2 topography code for cases diagnosed before January 1, 2001.

• Consult the attending physician to identify the primary site or the most definitive site code if the medical record does not contain that information.

• Topography codes are indicated by a "C" preceding the three-digit code number (do not record the decimal point).

• See rules for coding Primary Site beginning on page 12.

• Use subcategory 8 when a single tumor overlaps the boundaries of two or more sub- sites and the origin of the tumor cannot be determined.

• Use subcategory 9 for multiple tumors originating in different subsites of the same organ.

Examples:

LATERALITY

Item Length: 1

Allowable Values: 0–5, 9

NAACCR Item #410

STORE 2018 pg. 135

Definition:

Identifies the side of a paired organ or the side of the body on which the reportable tumor originated. This applies to the primary site only.

Coding Instructions:

• Always code unknown primary site (C80.9), and lymphoma to 0 (not paired).

• Laterality must be coded 1-5 or 9 for all sites listed in the table below. Laterality may be assigned for sites not listed in the table or tumors in those sites may be assigned a laterality of 0.

• Code the side where the primary tumor originated. If it is known the a primary tumor is confined to one side a paired organ, but that side is unknown, use code 3.

• Code 4 would rarely be used except when both ovaries are involved simultaneously with a single histology, there are diffuse bilateral lung nodules, there are bilateral retinoblastomas or bilateral Wilms tumors.

• Code 5, midline lesion, where the right and left sides of a paired site are contiguous and the tumor is at the intersection of the right and left side. The only sites for which code 5 would be used are C700, C710-C714, C722-C725, C443, C445.

• Code 9 should be used only when the laterality is unknown and there is no information that the tumor is confined to one side of a paired organ.

The following is a list of paired organs:

HISTOLOGIC TYPE ICD-O-3

Item Length: 4

NAACCR Item #522

STORE 2018 pg. 136

Definition:

Identifies the microscopic anatomy of cells.

Coding Instructions:

• Record histology using the ICD-O-3 codes (https://seer.cancer.gov/icd-o-3/) in the Numeric Lists/Morphology section (ICD-O-3, pp. 69–104) and in the Alphabetic Index (ICD-O-3, pp. 105–218).

• ICD-O-3 identifies the morphology codes with an "M" preceding the code number. Do not record the "M".

• For cases diagnosed prior to January 1, 2007, follow the coding rules outlined on pages 20 through 40 of ICD-O-3.

• For cases diagnosed January 1, 2007 to December 31, 2017, use the 2007 Multiple Primary and Histology Coding Rules (https://seer.cancer.gov/tools/mphrules/download.html)

• For cases diagnosed January 1, 2018 and later, use the 2018 Solid Tumor Rules (https://seer.cancer.gov/tools/solidtumor/)

• Carefully review all pathology reports.

• Code the final pathologic diagnosis for solid tumors.

• Refer to rules in Section One for more information on coding histology.

• • Exception:
    
    For cases diagnosed prior to January 1, 2007, if the final diagnosis is "Not Otherwise Specified" (carcinoma, NOS; melanoma, NOS; sarcoma, NOS; lymphoma, NOS; or malignant tumor, NOS), then code the histology from the microscopic description if it identifies a more specific histologic type (higher ICD-O-3 code) such as adenocarcinoma, amelanotic melanoma, spindle cell sarcoma.

• The codes for cancer, NOS (8000) and carcinoma, NOS (8010) are not interchangeable. If the physician says that the patient has carcinoma, then code carcinoma, NOS (8010).

• For leukemias, lymphomas and other hematopoietic diseases, follow the instructions in the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic and Lymphoid Neoplasms Database (https://seer.cancer.gov/tools/heme/).

2018 ICD-O-3 Update

There are new codes, changes in behavior codes, and new terms associated with current codes for all cases diagnosed January 1, 2018 and later. These changes reflect updates to the WHO Classifications for Tumors (Blue Books). The new codes, new terms, and codes with changes to behavior are available at: https://www.naaccr.org/2018-implementation.

ICD-O-3.1

The International Classification of Diseases for Oncology, Third Edition, First Revision has not been approved for use in the United States. This revision was published in 2013. It includes codes and terms which are not approved for use at this time.

2014 ICD-O-3 Update

See the NAACCR Guidelines for ICD-O-3 Update Implementation pages five and six http://www.naaccr.org/LinkClick.aspx?fileticket=u7d3sB71t5w%3d&tabid=126&mid=466. The terms and synonyms for existing ICD-O-3 histology codes listed in the document should be incorporated into your ICD-O-3 manual.

2015 and 2016 ICD-O-3 Update

Effective for 2015 diagnoses, code 8240/1 for Carcinoid tumor, NOS of appendix (C181) is obsolete. Code Carcinoid tumor, NOS of appendix to 8240/3 as this is now reportable (behavior code 3) in 2015.

Effective for 2015 diagnoses, one reportable histology codes is obsolete
8157/3 Enteroglucagonoma, malignant

Use histology code 8152/3 for Enteroglucagonoma, malignant as Enteroglucagonoma is now a related term for Glucagonoma.

New histology terms and codes have been introduced for ICD-O-3, but many cannot be used for 2015 and 2016 diagnoses because they are not included among the acceptable histology codes for the Collaborative Stage algorithms. See the NAACCR Guidelines for ICD-O-3 Update Implementation page 7 for new terms and codes. http://www.naaccr.org/LinkClick.aspx?fileticket=u7d3sB71t5w%3d&tabid=126&mid=466

Examples

BEHAVIOR CODE ICD-O- 3

Item Length: 1

Allowable Values: 0–3

NAACCR Item #523

STORE 2018 pg. 137-138

Definition:

Records the behavior of the tumor being reported. The fifth digit of the morphology code is the behavior code.

Coding Instructions:

• Code 3 if any invasion is present, no matter how limited.

• Recode the behavior as malignant (Code 3) when metastases are attributed to a tumor originally thought to be in situ.

• • Example: Right colon biopsy reveals tubulovillous adenoma with microfocal carcinoma in situ; right hemicolectomy is negative for residual disease. Later core liver biopsy consistent with metastatic adenocarcinoma of gastrointestinal origin. Oncologist states most likely colon primary. Change the behavior code for the colon primary from /2 to /3. There were no other colon primaries in this case.

• If the specimen is from a metastatic site, code the histology of the metastatic site and code 3 for behavior.

• If the pathologist disagrees with the behavior code listed with a particular histology in ICD-O-3, then code the behavior stated by the pathologist.

• • Example: The pathology report says large cell carcinoma in situ. ICD-O-3 lists large cell carcinoma only with a malignant behavior (8013/3). Code the histology and behavior as 8013/3 as stated by the pathologist.

• Clinical evidence is not sufficient to code the behavior as in situ; an in situ behavior (Code 2) must be based on pathologic examination.

• For intracranial and CNS tumors, code the behavior from scans when there is no tissue diagnosis. Do not use the WHO grade to code behavior

Note: The ICD-O-3 behavior code for juvenile astrocytoma (9421/1) is coded as 3. Gastrointestinal stromal tumors (GIST) and thymomas are often non-malignant. However, they must be abstracted and coded with a behavior code 3 if they have multiple foci, positive lymph nodes, or metastasis.

Coding Examples:

GRADE CLINICAL

Item Length: 1

Allowable Values: 1–5, 8, 9, A, B, C, D, E, L, H, M, S

NAACCR Item #3843

STORE 2018 pg. 139

Definition:

Grade Clinical is new in 2018. This data item records the grade of a solid primary tumor before any treatment (surgical resection or initiation of any treatment including neoadjuvant).

Coding Instructions:

For cases diagnosed January 1, 2018 and later, this data item, along with Grade Pathological and Grade Post-Therapy, replaces the data item Grade [NAACCR Item #440] as well as site specific factors for cancer sites with alternative grading systems (e.g., breast [Bloom- Richardson], prostate [Gleason])

This data item cannot be left blank for cases diagnosed January 1, 2018 and later.

Refer to the most recent version of the GradeCodingInstructionsand Tables (https://www.naaccr.org/SSDI/Grade-Manual.pdf) for additional site-specific instructions.

GRADE PATHOLOGICAL

Item Length: 1

Allowable Values: 1–5, 8, 9, A, B, C, D, E, L, H, M, S

NAACCR Item #3844

STORE 2018 pg. 140

Definition:

Grade Clinical is new in 2018. This data item records the grade of a solid primary tumor that has been resected and for which no neoadjuvant therapy was administered.

Coding Instructions:

For cases diagnosed January 1, 2018 and later, this data item, along with Grade Clinical and Grade Post-Therapy, replaces the data item Grade [NAACCR Item #440] as well as site specific factors for cancer sites with alternative grading systems (e.g., breast [Bloom- Richardson], prostate [Gleason])

If AJCC staging is being assigned, the tumor must have met the surgical resection requirements in the AJCC manual. This may include the grade from the clinical workup. Since all clinical information is used in pathological staging, record the highest grade documented from any microscopic specimen of the primary site whether from the clinical workup or the surgical resection.

This data item cannot be left blank for cases diagnosed January 1, 2018 and later.

Refer to the most recent version of the GradeCodingInstructionsandTables (https://www.naaccr.org/SSDI/Grade-Manual.pdf) for additional site-specific instructions.

GRADE POST THERAPY

Item Length: 1

Allowable Values: 1–5, 8, 9, A, B, C, D, E, L, H, M, S

NAACCR Item #3845

STORE 2018 pg. 141

Definition:

Grade Clinical is new in 2018. This data item records the grade of a solid primary tumor that has been resected following neoadjuvant therapy.

Coding Instructions:

For cases diagnosed January 1, 2018 and later, this data item, along with Grade Clinical and Grade Pathological, replaces the data item Grade [NAACCR Item #440] as well as site specific factors for cancer sites with alternative grading systems (e.g., breast [Bloom- Richardson], prostate [Gleason])

If AJCC staging is being assigned, the tumor must have met the surgical resection requirements in the AJCC manual. Record the highest grade documented from the surgical treatment resection specimen of the primary site following neoadjuvant therapy.

Refer to the most recent version of the GradeCodingInstructionsandTables (https://www.naaccr.org/SSDI/Grade-Manual.pdf) for additional site-specific instructions.

AJCC ID

Item Length: 1

NAACCR Item #995

STORE 2018 pg. 7

Definition:

For 2018, AJCC ID is used to link AJCC staging eligible sites/histologies with the appropriate AJCC chapter and staging algorithm.

Coding Instructions:

AJCC ID will be derived by registry software based on the site and histology codes entered by the registrar.

Refer to the SSDI Manual Appendix A (https://www.naaccr.org/SSDI/SSDI-Manual-Appendix-A.pdf) for crosswalks for sites/histology, AJCC ID and Schema ID.

SCHEMA ID

Item Length: 1

NAACCR Item #3800

STORE 2018 pg. 7

Definition:

For 2018, Schema ID is used to link all combinations of sites and histologies with the appropriate stage data collection systems and site-specific data items.

Coding Instructions:

Schema ID will be derived by registry software based on the site and histology codes entered by the registrar.

Refer to the SSDI Manual Appendix A (https://www.naaccr.org/SSDI/SSDI-Manual- Appendix-A.pdf ) for crosswalks for sites/histology, AJCC ID and Schema ID.

SCHEMA DISCRIMINATOR 1

Item Length: 1

NAACCR Item #3926

STORE 2018 pg. 8

Definition:

Introduced in CSv2, schema discriminators are used when the primary site and/or histology are not sufficient to identify the correct AJCC staging algorithm. Schema discriminators are used to define both AJCC ID and Schema ID.

Coding Instructions:

Schema Discriminator 1 is used for the following sites/histologies.

Occult Head and Neck Lymph Nodes Nasopharynx/Pharyngeal Tonsil Esophagus GE Junction (EGJ)/Stomach

Bile Ducts Distal/Bile Ducts Perihilar/Cystic Duct Primary Peritoneum Tumor

Urethra/Prostatic Urethra

Melanoma Ciliary Body/Melanoma Iris Lacrimal Gland/Sac

Thyroid Gland/Thyroglossal Duct Plasma Cell Myeloma Terminology Histology Discriminator for 9591/3

Refer to the SSDI Manual (https://www.naaccr.org/SSDI/SSDI-Manual.pdf) for crosswalks for the schema discriminators and for codes and coding instructions.

SCHEMA DISCRIMINATOR 2

Item Length: 1

NAACCR Item #3927

STORE 2018 pg. 8

Definition:

Introduced in CSv2, schema discriminators are used when the primary site and/or histology are not sufficient to identify the correct AJCC staging algorithm. Schema discriminators are used to define both AJCC ID and Schema ID.

Coding Instructions:

Schema Discriminator 2 is used for the following sites/histologies.

Oropharyngeal p16

Histology Discriminator for 8020/3

Refer to the SSDI Manual (https://www.naaccr.org/SSDI/SSDI-Manual.pdf) for crosswalks for the schema discriminators and for codes and coding instructions.

LYMPH-VASCULAR INVASION

Item Length: 1

Allowable Values: 0-4, 8-9

NAACCR Item #1182

STORE 2018 pg. 152-156

Definition:

Lymph-vascular invasion is defined as the presence of tumor cells found inside small blood vessels or lymphatic channels within the tumor and surrounding tissues in the primary site. The tumor cells have broken free of the primary tumor and now have the capability to float throughout the body. Other names for lymph-vascular invasion are LVI, lymphovascular invasion, vascular invasion, blood vessel invasion, and lymphatic invasion. Vascular invasion is not the same as direct tumor extension from the primary tumor into adjacent blood vessels; LVI cells are not attached to or growing into the wall of the blood vessel. Lymphatic invasion is not the same as involvement of regional lymph nodes. Lymph-vascular invasion does not include perineural invasion.

Coding Instructions:

1. Code from pathology report(s). Code the absence or presence of lymph-vascular invasion as described in the medical record.

   1. The primary sources of information about lymph-vascular invasion are the pathology check lists (synoptic reports) developed by the College of American Pathologists. If the case does not have a checklist or synoptic report, code from the pathology report or a physician's statement, in that order.

   2. Do not code perineural invasion in this field.

   3. Information to code this field can be taken from any specimen from the primary tumor (biopsy or resection.)

   4. If lymph-vascular invasion is identified in any primary tumor specimen, it should be coded as present/identified.

   5. Assign Code 8 Not applicable for benign/borderline brain and CNS tumors.

   6. For cases treated with neoadjuvant therapy, refer to table below in order to code this field. However, if documentation in the medical record indicates information that conflicts with this table, code lymph-vascular invasion with the documentation in the medical record.

1. Use of codes.

   1. Use code 0 when the pathology report indicates that there is no lymphovascular invasion. Assign code 0 for in situ cases.

   2. Use code 1 when the pathology report or a physician's statement indicates that lymphovascular invasion (or one of its synonyms) is present in the specimen.
      
      Synonyms include, but are not limited to 

      1. Angiolymphatic invasion

      2. Blood vessel invasion

      3. Lymph vascular emboli

      4. Lymphatic invasion

      5. Lymph-vascular invasion

      6. Vascular invasion

   3. Lymphovascular invasion must be coded 0, 1, 2, 3, 4, or 9 for the following Schemas/Schema IDs
      
      Ampulla Vater 00270
      Appendix 00190
      Bile Ducts Distal 00260
      Bile Ducts Intrahepatic 00230
      Bile Ducts Perihilar 00250
      Bladder 00620
      Buccal Mucosa 00076
      Cervix 00520
      Colon and Rectum 00200 Corpus Adenosarcoma 00542
      Corpus Carcinoma 00530
      Corpus Sarcoma 00541
      Esophagus (including GE Junction) (excluding Squamous) 00169
      Esophagus (including GE Junction) Squamous 00161
      Floor of Mouth 00074
      Gum 00073
      Hypopharynx 00112
      Larynx Glottic 00132
      Larynx Other 00130
      Larynx Subglottic 00133
      Larynx Supraglottic 00131
      Lip 00071
      Lung 00360
      Major Salivary Glands 00080
      Maxillary Sinus 00121
      Melanoma Skin 00470
      Merkel Cell Skin 00460
      Mouth Other 00077
      Nasal Cavity and Ethmoid Sinus 00122
      NET Ampulla of Vater 00302
      NET Appendix 00320
      NET Colon and Rectum 00330
      NET Duodenum 00301
      NET Pancreas 00340
      NET Stomach 00290
      Oropharynx (p16-) 00111
      Oropharynx (p16+) 00100
      Palate Hard 00075
      Pancreas 00280
      Penis 00570
      Placenta 00560
      Small Intestine 00180
      Stomach 00170
      Testis 00590
      Thymus 00350
      Thyroid 00730
      Thyroid Medullary 00740
      Tongue Anterior 00072
      Vagina 00510
      Vulva 00500

   4. Lymphovascular invasion must be coded 0, 1, 2, 3, 4, 8, or 9 for the following Schemas/IDs
      
      Anus 00210
      Breast (Invasive) 00480
      Bone Appendicular Skeleton 00381
      Bone Pelvis 00383
      Bone Spine 00382
      Cystic Duct 00242
      Gallbladder 00241
      Heart, Mediastinum, and Pleura 00422
      Kidney Parenchyma 00600
      Kidney Renal Pelvis 00610
      Liver 00220
      Melanoma Choroid and Ciliary Body 00672
      Melanoma Conjunctiva 00660
      Melanoma Iris 00671
      Orbital Sarcoma 00700
      Parathyroid 00750
      Prostate 00580
      Retroperitoneum 00440
      Skin Eyelid 00640
      Soft Tissue Abdomen and Thorax 00421
      Soft Tissue Head and Neck 00400
      Soft Tissue Other 00450
      Soft Tissue Trunk and Extremities 00410
      Urethra 00631
      Urethra-Prostatic 00632

   5. Use code 8 for the following Schemas/IDs
      
      Adnexa Uterine Other 00558
      Biliary Other 00278
      Brain 00721
      Cervical Lymph Nodes, Occult Head and Neck 00060
      CNS Other 00722
      Conjunctiva 00650
      Cutaneous Carcinoma Head and Neck 00150
      Digestive Other 00288
      Endocrine Other 00778
      Eye Other 00718
      Fallopian Tube 00553
      Genital Female Other 00559
      Genital Male Other 00598
      HemeRetic 00830
      Ill-Defined Other 99999
      Intracranial Gland 00723
      Kaposi Sarcoma 00458
      Lacrimal Gland 00690
      Lacrimal Sac 00698
      Lymphoma 00790
      Lymphoma (CLL/SLL) 00795
      Lymphoma Ocular Adnexa 00710
      Melanoma Head and Neck 00140
      Middle Ear 00119
      Mycosis Fungoides (MF) 00811
      NET Adrenal Gland 00770
      Ovary 00551
      Pharynx Other 00118
      Plasma Cell Disorder 00822
      Plasma Cell Myeloma 00821
      Pleural Mesothelioma 00370
      Primary Cutaneous Lymphoma (excluding MF and SS) 00812
      Primary Peritoneal Carcinoma 00552
      Respiratory Other 00378
      Retinoblastoma 00680
      Sinus Other 00128
      Skin Other 00478
      Trachea 00358
      Urinary Other 00638

   6. Use code 9 when

      1. there is no microscopic examination of a primary tissue specimen

      2. the primary site specimen is cytology only or a fine needle aspiration

      3. the biopsy is only a very small tissue sample

      4. it is not possible to determine whether lymph-vascular invasion is present

      5. the pathologist indicates the specimen is insufficient to determine lymph-vascular invasion

      6. lymph-vascular invasion is not mentioned in the pathology report

      7. primary site is unknown

   7. Clarification between codes 8 and 9:

      1. Code 8 should only be used in the following situations: 1. Standard- setter does not require this item and you are not collecting it. 2. Those

      2. histologies noted above described in code 8 for which LVI is always not applicable.

      3. For those cases where there is no information/documentation from the pathology report or other sources, use code 9

DIAGNOSTIC CONFIRMATION

Item Length: 1

Allowable Values: 1, 2, 4–9

NAACCR Item #490

STORE 2018 pg. 142-144

Definition:

Records the best method of diagnostic confirmation of the cancer being reported at any time in the patient's history.

The codes and instructions for hematopoietic and lymphoid neoplasms are different from the codes for solid tumors. See below.

Codes for Solid Tumors

Coding Instructions for Solid Tumors (all tumors except histologies 9590-9992)

1. The codes are in priority order; code 1 has the highest priority. Always code the procedure with the lower numeric value when presence of cancer is confirmed with multiple diagnostic methods.

1. Change to a lower code if, at any time during the course of the disease, the patient has a diagnostic confirmation with a higher priority.

Example: Benign brain tumor diagnosed on MRI. Assign diagnostic confirmation code 7. Patient later becomes symptomatic and the tumor is surgically removed.

Change diagnostic confirmation code to 1.

1. Assign code 1 when the microscopic diagnosis is based on

2. Tissue specimen from biopsy, frozen section, surgery, autopsy or D&C

3. Bone marrow specimens (aspiration and biopsy)

4. Assign code 2 when the microscopic diagnosis is based on

5. Examination of cells (rather than tissue) including but not limited to: sputum smears, bronchial brushings, bronchial washings, prostatic secretions, breast

6. secretions, gastric fluid, spinal fluid, peritoneal fluid, pleural fluid, urinary sediment, cervical smears, or vaginal smears

7. Paraffin block specimens from concentrated spinal, pleural or peritoneal fluid.

8. Assign code 4 when there is information that the diagnosis of cancer was microscopically confirmed, but the type of confirmation is unknown.

9. Assign code 5 when the diagnosis of cancer is based on laboratory tests or marker studies that are clinically diagnostic for that specific cancer.

10. Example 1: The presence of alpha-fetoprotein for liver cancer

11. Example 2: If the workup for a prostate cancer patient is limited to a highly elevated PSA and the physician diagnoses and/or treats the patient based only on the PSA, code the diagnostic confirmation to 5.

12. Assign code 6 when the diagnosis is based only on

13. The surgeon's operative report from a surgical exploration or endoscopy such as colonoscopy, mediastinoscopy, or peritoneoscopy and no tissue was examined.

14. Gross autopsy findings (no tissue or cytologic confirmation)

15. Assign code 7 when the only confirmation of malignancy was diagnostic imaging such as computerized axial tomography (CT scans), magnetic resonance imaging (MRI scans), or ultrasounds/sonography.

16. Assign code 8 when the case was diagnosed by any clinical method not mentioned in preceding codes. The diagnostic confirmation is coded 8 when the only confirmation of disease is a physician's clinical diagnosis.

17. Example: CT diagnosis is possible lung cancer. Patient returns to the nursing home with a DNR order. Physician enters a diagnosis of lung cancer in the medical record. Code the diagnostic confirmation to 8: there is a physician's clinical diagnosis- clinical diagnosis made by the physician using the information available for the case.

18. Assign code 9

19. When it is unknown if the diagnosis was confirmed microscopically

20. For death-certificate-only cases

Codes for Hematopoietic and Lymphoid Neoplasms (9590/3- 9992/3)

Coding Instructions for Hematopoietic and Lymphoid Neoplasms (9590/3- 9992/3)

1. There is no priority order or hierarchy for coding the Diagnostic Confirmation for hematopoietic or lymphoid neoplasms. Most commonly the specific histology type is determined through immunophenotyping or genetic testing.

Note: See the glossary in the 2010 Hematopoietic and Lymphoid Neoplasm Case ReportabilityandCodingManual for definitions of immunophenotyping and genetic testing.

1. See the Hematopoietic Database for information on the definitive diagnostic confirmation method(s) for the specific neoplasm being abstracted.

1. Assign code 1 when the microscopic diagnosis is based on:

1. 1. Tissue specimens form biopsy, frozen section, surgery, or autopsy

   2. Bone marrow specimens (aspiration and biopsy)

   3. For leukemias only, complete blood count (CBC), white blood count (WBC), and peripheral blood smear

Note: Use code 1 when ONLY the tissue, bone marrow, or blood was used to diagnose the specific histology. Do not use code 1 if the diagnosis was based on immunophenotyping or genetic testing using tissue, bone marrow, or blood.

1. Code 2 would rarely be used for hematopoietic or lymphoid neoplasms. Use code 2 when the microscopic diagnosis is based on

   1. Examination of cells (other than tissue) including but not limited to: spinal fluid, peritoneal fluid, or pleural fluid.

   2. Paraffin block specimens from concentrated spinal, pleural or peritoneal fluid.

1. Assign code 3 when BOTH a histology positive for cancer AND also positive immunophenotyping and/or positive genetic testing are available.

Example 1: Bone marrow examination is positive for acute myeloid leukemia (9861/3). Genetic testing shows AML with inv(16)(p13.1q22) (9871/3). Code the Diagnostic Confirmation 3, positive histology and positive genetic testing.

Example 2: Skin biopsy positive for cutaneous T-cell lymphoma, NOS (9709/3). Immunophenotyping shows CD8 positive. Diagnosis is primary cutaneous CD 8 positive aggressive epidermitropic T-cell lymphoma (9709/3). Code the Diagnostic Confirmation 3, positive histology and positive genetic testing.

1. Assign code 4 when there is information that the diagnosis of cancer was microscopically confirmed, but the type of confirmation is unknown.

1. Assign code 5 when the diagnosis of a hematopoietic or lymphoid neoplasm is based ONLY on laboratory tests or marker studies that are diagnostic for that specific cancer.

Note: See the glossary in the Hematopoietic and Lymphoid Neoplasm Coding Manual and Database (https://seer.cancer.gov/tools/heme/ ) for definitions of immunophenotyping and genetic testing which are marker studies for hematopoietic and lymphoid neoplasms.

Example: The only information available is that the patient had a positive JAK2 done on a blood sample and is diagnosed with polycythemia vera. Code 5 for diagnosis based on a marker study that is diagnostic of polycythemia vera.

1. Assign code 6 when the diagnosis is based only on

   1. The surgeon's operative report from a surgical exploration or endoscopy and no tissue was examined.

   2. Gross autopsy findings (no tissue or cytologic confirmation)

1. Assign code 7 when the only confirmation of malignancy was diagnostic imaging such as computerized axial tomography (CT), magnetic resonance imaging (MRI), or ultrasounds/sonography.

1. Assign code 8 when the case was diagnosed by any clinical method not mentioned in the preceding codes. A number of hematopoietic and lymphoid neoplasms are diagnosed clinically; these are called "diagnoses of exclusion" (the tests for the

disease are equivocal and the physician does a clinical diagnosis based on the information from the equivocal tests and the patient's clinical presentation).

Note: The hematopoietic DB will identify clinical diagnosis as the definitive diagnostic method.

1. Assign code 9

   1. When it is unknown if the diagnosis was confirmed microscopically

   2. For death-certificate-only cases

AGE AT DIAGNOSIS Item Length: 3

Allowable Values: 000–120, 999

NAACCR Item #230

STORE 2018 pg. 78

Definition:

The item must be computer generated.

Records the age of the patient at diagnosis in complete years.

Coding Instructions:

If the patient has multiple primaries, then the age at diagnosis may be different for subsequent primaries.

STAGE/PROGNOSTIC FACTORS

TUMOR SIZE SUMMARY Item Length: 3

Allowable Values: 000-990, 998, 999

NAACCR Item #756

STORE 2018 pg. 174-177

Description

This data item records the most accurate measurement of a solid primary tumor, usually measured on the surgical resection specimen. Tumor size can indicate extent of disease and be used for quality assurance.

Coding Instructions

• All measurements should be in millimeters(mm)

• Record size in the specified order:

1. 1. 1. Size measured on the surgical resection specimen, when surgery is administered as the first definitive treatment. No pre-surgical treatment has been administered.

         • If there is a discrepancy among tumor size measurements in the various sections of the pathology report, code the size from the synoptic report (also known as the CAP protocol or pathology checklist). If only a text report is available, use final diagnosis, microscopic, or gross examination, in that order.

      2. If neoadjuvant therapy followed by surgery, do not record the size of the pathologic specimen. Code the largest size of tumor prior to neoadjuvant treatment. If unknown, codes size as 999.

      3. If no surgical resection, then largest measurement of the tumor from physical exam, imaging, or other diagnostic procedures prior to any other form of treatment (See Coding Rules below).

      4. If 1, 2, and 3 do not apply, the largest size from all information available within four months of the date of diagnosis, in the absence of disease progression.

• Coding Rules

1. Tumor size is the diameter of the tumor, not the depth or thickness of the tumor.

2. Recording less than/greater than Tumor Size

   • If a tumor size is reported as less than x mm or less than x cm, the reported tumor size should be 1 mm less; for example if size is <10 mm, code size as 009. Often these are given in cm such as <1 cm which is coded as 009, <2 cm is coded as 019, <3 cm is coded as 029,

<4 cm is coded as 039, <5 cm is coded as 049. If stated as less than 1 mm uses code 001.

1. • • If tumor size is reported as more than x mm or more than x cm, code size as 1 mm more; for example if size is <10 mm, size should be coded as 011. Often these are given in cm such as >1 cm, which is coded as 011, >2 cm is coded as 021, >3 cm is coded as 031, >4 cm is coded as 041, >5 cm is coded as 051. If described as anything greater than 989 mm (98.9 cm) code as 989.

     • If tumor size is reported to be between two sizes, record rumor size as the midpoint between the two: i.e., add the two sized together and then divide by two ("between 2 and 3 cm" is coded as 025).

2. Rounding

   • Round the tumor size only if it is described in fractions of millimeters. If the largest dimension of a tumor is less than 1 millimeter (between 0.1 and 0.9 mm), record size as 001 (do not round down to 000). If tumor size is greater than 1 millimeter, round tenths of millimeters in the 5-9 range up to the nearest whole millimeter. Do not round tumor size expressed in centimeters to the nearest whole centimeters (rather, move the decimal point one space to the right, converting the measurement to millimeters).

3. Priority of imaging/radiographic techniques

   • Information on size from imaging/radiographic techniques can be used to code size when there is no more specific size information from a pathology or operative report, but it should be taken as low priority, over physical exam.

4. Tumor size discrepancies among imaging and radiographic reports

   • If there is a difference in reported tumor size among imaging and radiographic techniques, unless the physician specifies which imaging is most accurate, record the largest size in the record, regardless of which imaging technique reports it.

5. Always code the size of the primary tumor, not the size of the polyp, ulcer, cyst, or distant metastasis.

   • If the tumor is described as a "cystic mass," and only the size of the entire mass is given, code the size of the entire mass, since the cysts are part of the tumor itself.

6. Record the size of the invasive component, if given.

   • If both an in situ and invasive component are present and the invasive component is measured, record the size of the invasive component even if it is smaller.

   • If the size of the invasive component is not given, record the size of the entire tumor from the surgical report, pathology report, radiology report or clinical examination.

7. Record the largest dimension or diameter of the tumor, whether it is from an excisional biopsy specimen or the complete resection of the primary tumor.

8. Record the size as stated for purely in situ lesions.

9. Disregard microscopic residual or positive surgical margins when coding tumor size.

   • Microscopic residual tumor does not affect the overall tumor size. The status of primary tumor margins may be recorded in a separate data item.

10. Do not add the size of pieces of chips together to create a whole.

    • The pieces or chips may not be from the same location, or they may represent only a very small portion of a large tumor. However, if the pathologist states an aggregate or composite size (determined by fitting the tumor pieces together and measuring the total size), record that size. If the only measurement describes pieces or chips, record tumor size as 999.

11. Multifocal/multicentric tumors

    • If the tumor is multi-focal or if multiple tumors are reported as a single primary, code the size of the largest invasive tumor or if all of the tumors are in situ, code the size of the largest in situ tumor.

12. Tumor size code 999 is used when size is unknown or not applicable.

    • Site/morphologies where tumor size is not applicable are listed here. Hematopoietic, Reticuloendothelial, and Myeloproliferative neoplasms: histology codes 9590-9992

Kaposi Sarcoma Melanoma Choroid Melanoma Ciliary Body Melanoma Iris

1. Document the information to support coded tumor size in the appropriate text data item of the abstract.

Coding Examples:

SUMMARY STAGE 2018 Item Length: 1

Allowable Values: 0-5, 7, 8, 9, Blank

NAACCR Item #764

STORE 2018 pg. 190-191

Definition:

Summary Stage 2018 is effective for cases diagnosed 1/1/2018 or later. Summary stage groups cases into broad categories of in situ, local, regional, and distant. Summary stage can be used to evaluate disease spread at diagnosis, treatment patterns and outcomes over time.

Coding Instructions:

Code summary stage at the initial diagnosis or treatment of the reportable tumor. Summary stage should include all information available through completion of surgery(ies) in the first course of treatment or within 4 months of diagnosis in the absence of disease progression, whichever is longer.

• Refer to the site and histology-specific definitions of categories and coding instructions in the SEER Summary Staging Manual 2018 (https://seer.cancer.gov/tools/ssm/ ).

• Use Code 8 for benign and borderline brain/CNS cases.

*Applicable for the following Summary Stage 2018 chapters: Brain, CNS Other, Intracranial Gland.

BRAIN MOLECULAR MARKERS Item Length: 2

Allowable Values: 01-09, 85-88, 99, Blank

NAACCR Item #3816

Definition:

This data item only applies to cancers with primary site C700, C710- C719.

Multiple brain molecular markers have become standard pathology components necessary for diagnosis. This data item captures clinically important brain cancer subtypes identified by molecular markers that are not distinguishable by ICD-O-3 codes.

Coding Instructions:

Note 1: This data item applies only to ICD-O-3 histology codes: 9400/3, 9401/3, 9440/3, 9450/3, 9451/3, 9471/3 and 9478/3. If a histology is not included in this list, assign, code 85.

Note 2: Physician statement of histologic subtype can be used to code this data item. Note 3: Only one code is applicable for each tumor.

• IDH mutation status distinguishes between clinically important subtypes within ICD- O-3 9400/3, Diffuse astrocytoma and 9401/3, Anaplastic astrocytoma.

• IDH mutant and 1p/19q co-deletion distinguishes between clinically important subtypes within ICD-O-3 code 9450/3, Oligodendroglioma and 9451/3, Anaplastic Oligodendroglioma.

• IDH-wildtype distinguishes clinically important subtypes within ICD-O-3 9400/3, Diffuse astrocytoma, 9401/3, Anaplastic astrocytoma and 9440/3, Glioblastoma, Epithelioid glioblastoma and Glioblastoma, NOS (note that the new ICD-O-3 code 9445/3 applies to Glioblastoma, IDH-mutant; information regarding this subtype is not collected using this data item).

• SHH-activation and TP53-wildtype distinguishes between clinically important subtypes within ICD-O-3 histology code 9471/3, Medulloblastoma.

• C19MC alteration status distinguishes a clinically important highly aggressive subtype within ICD-O-3 9478/3, Embryonal tumor with multilayered rosettes.

Coding Examples:

BRESLOW TUMOR THICKNESS Item Length: 4

Allowable Values: 0.0-99.9, XX.1, A0.1-A9.9,

AX.0, XX.8, XX.9, Blank NAACCR Item #3817

Definition:

This data item only applies to cancers with primary site C000-C002, C440-C449, C500, C510-C512, C518-C519, C600-C602, C608-C609, C632 and histologies 8720-8790.

Breslow Tumor Thickness, the measurement of the thickness of a melanoma as defined by Dr. Alexander Breslow, is a prognostic factor for Melanoma of the Skin. Breslow Tumor Thickness is a Registry Data Collection Variable in AJCC. It was previously collected as Melanoma Skin, CS SSF# 1.

Coding Instructions:

Note 1: Physician statement of Breslow Tumor Thickness can be used to code this data item when no other information is available, or the available information is ambiguous.

Note 2: Code Breslow tumor thickness, not size. Record actual measurement in tenths of millimeters from the pathology report. Measurement given in hundredths of millimeters should be rounded to the nearest tenth.

Examples:

0.4 mm - 0.4

1.0 mm- 1.0

2.5 mm - 2.5

2.56 mm- 2.6

11 mm - 11.0

12.35 mm - 12.4

Note 3: Code the greatest measured thickness from any procedure performed on the lesion, whether it is described as a biopsy or an excision.

• For example, if a punch biopsy with a thickness of 1.5 mm is followed by a re- excision with a thickness of residual tumor of 0.2 mm, code 1.5.

Note 4: Do not add measurements together from different procedures (even in the rare circumstance that the pathologist adds the measurements from two specimens).

Note 5: If the pathologist describes the thickness as "at least," use the appropriate A code.

An exact measurement takes precedence over A codes.

• If the pathologist states "greater than" instead of "at least", code to XX.9, unless it is greater than 9.9 mm (Code AX.0).

Coding Examples:

ER (ESTROGEN RECEPTOR) SUMMARY Item Length: 1

Allowable Values 0, 1, 7, 9, Blank

NAACCR Item #3827

Definition:

This data item only applies to cancers with primary site C500-C506, C508-C509 with histologies 8000-8700, 8720-8790, 8982-8983, 9700-9701.

ER (Estrogen Receptor) Summary is a summary of results of the estrogen receptor (ER) assay. It was previously collected as Breast CS SSF # 1.

Coding Instructions:

Note 1: Physician statement of ER (Estrogen Receptor) Summary status can be used to code this data item when no other information is available.

Note 2: The result of the ER test performed on the primary breast tissue is to be recorded in this data item. Results from nodal or metastatic tissue may be used ONLY when there is no evidence of primary tumor.

Note 3: In cases where ER is reported on more than one breast tumor specimen, record the highest value. If any sample is positive, record as positive.

• Exception: If ER is positive on an in situ specimen and ER is negative on all tested invasive specimens, code ER as negative (code 0).

Note 4: If neoadjuvant therapy is given, record the assay from tumor specimens prior to neoadjuvant therapy. If neoadjuvant therapy is given and there are no ER results from pre-treatment specimens, report the findings from post-treatment specimens.

Note 5: If the patient is ER positive and node negative, a multigene test such as Oncotype Dx may be performed, in which case another ER test will be performed. Do not record the results of that test in this field.

• Record only the results of the test which made the patient eligible to be given the multigene test.

Coding Examples:

PR (PROGESTERONE RECEPTOR) SUMMARY Item Length: 1

Allowable Values 0, 1, 7, 9, Blank

NAACCR Item #3915

Definition:

This data item only applies to cancers with primary site C500-C506, C508-C509 with histologies 8000-8700, 8720-8790, 8982-8983, 9700-9701.

PR (Progesterone Receptor) Summary is a summary of results of the progesterone receptor (PR) assay. It was previously collected as Breast CS SSF # 2.

Coding Instructions:

Note 1: Physician statement of PR (Progesterone Receptor) Summary status can be used to code this data item when no other information is available.

Note 2: The result of the PR test performed on the primary breast tissue is to be recorded in this data item. Results from nodal or metastatic tissue may be used ONLY when there is no evidence of primary tumor.

Note 3: In cases where PR is reported on more than one breast tumor specimen, record the highest value. If any sample is positive, record as positive.

• Exception: If PR is positive on an in situ specimen and PR is negative on all tested invasive specimens, code PR as negative (code 0).

Note 4: If neoadjuvant therapy is given, record the assay from tumor specimens prior to neoadjuvant therapy. If neoadjuvant therapy is given and there are no PR results from pre-treatment specimens, report the findings from post-treatment specimens.

Note 5: If the patient is PR positive and node negative, a multigene test such as Oncotype Dx may be performed, in which case another PR test will be performed. Do not record the results of that test in this field.

• Record only the results of the test which made the patient eligible to be given the multigene test.

Coding Examples:

HER2 OVERALL SUMMARY Item Length: 1

Allowable Values 0, 1, 7, 9, Blank

NAACCR Item #3855

Definition:

This data item only applies to cancers with primary site C500-C506, C508-C509 with histologies 8000-8700, 8720-8790, 8982-8983, 9700-9701.

HER 2 Overall Summary is a summary of results of the HER2 testing. It was previously collected as Breast CS SSF # 15.

Coding Instructions:

Note 1: Physician statement of HER2 Overall Summary status can be used to code this data item when no other information is available.

Note 2: The result of the HER2 test performed on the primary breast tissue is to be recorded in this data item.

Note 3: Results from nodal or metastatic tissue may be used ONLY when there is no evidence of primary tumor.

Note 4: In cases where HER2 is reported on more than one breast tumor specimen, record the highest value. If any sample is positive, record as positive.

• Exception: If HER2 is positive on an in situ specimen and HER2 is negative on all tested invasive specimens, code HER2 as negative (code 0).

Note 5: If neoadjuvant therapy is given, record the assay from tumor specimens prior to neoadjuvant therapy.

• If neoadjuvant therapy is given and there are no HER2 results from pre-treatment specimens, report the findings from post-treatment specimens.

Note 6: If the patient is HER2 positive and node negative, a multigene test such as Oncotype Dx may be performed, in which case another HER2 test will be performed. Do not record the results of that test in this field.

• Record only the results of the test which made the patient eligible to be given the multigene test.

Coding Examples:

FIBROSIS SCORE Item Length: 1

Allowable Values 0, 1, 7, 8, 9, Blank

NAACCR Item #3835

Definition:

This data item only applies to cancers with primary site C220-C221 with histologies 8000-8700, 8720-8790, 9700-9701.

Fibrosis Score, the degree of fibrosis of the liver based on pathological examination, is a prognostic factor for liver cancer. This data item was previously collected for Liver, CS SSF #2.

Coding Instructions:

Note 1: Physician statement of fibrosis score can be used to code this data item when no other information is available. However, code 7 when the physician statement of fibrosis score is not based on histologic examination of the liver.

Note 2: FIB-4 is NOT a pathological fibrosis score of 4. It is a scoring method using the patient's age and relevant lab values to calculate a score. The medical record may show something like "FIB-4 = 3.52." Do not code FIB-4 values in this data item.

Note 3: AJCC classifies Ishak fibrosis scores 0-4 (none to moderate fibrosis) as F0, and Ishak fibrosis scores 5-6 (cirrhosis/severe fibrosis) as F1. This is not the same as METAVIR score F0 or F1.

Note 4: Record the results based on information collected during the initial work-up. If multiple biopsies are taken and have conflicting scores, use the results from the biopsy closest to the start of treatment. Information collected after the start of treatment may not be used to code this data item.

Note 5: Code the absence (code 0) or presence (code 1) of fibrosis as documented in the pathology report.

Note 6: If no score is mentioned, descriptive terms may be used to assign codes 0 and 1 - see specific terms in the table below.

Note 7: If a fibrosis score is stated but the scoring system is not recorded, consult with the physician. If no further information is available, code 9.

MICROSATELLITE INSTABILITY (MSI) Item Length: 1

Allowable Values 0, 1, 2, 8, 9, Blank

NAACCR Item #3890

Definition:

This data item only applies to cancers with primary site C180, C182-189, C199, C209 with histologies 8000-8149, 8154, 8157, 8160-8231, 8243-8248, 8250-8682, 8690-8700,

8720-8790, 9700- 9701.

Microsatellite Instability (MSI) is a form of genetic instability manifested by changes in the length of repeated single- to six-nucleotide sequences (known as DNA microsatellite sequences). High MSI, found in about 15% of colorectal carcinomas, is an adverse prognostic factor for colorectal carcinomas and predicts poor response to 5-FU chemotherapy (although the addition of oxaliplatin in FOLFOX regimens negates the adverse effects [page 266 AJCC manual]). High MSI is a hallmark of hereditary nonpolyposis colorectal carcinoma, also known as Lynch syndrome.

Coding Instructions:

Note 1: Physician statement of MSI status can be used to code this data item when no other information is available.

Note 2: The microsatellite instability (MSI) test is a genetic test performed on tumor tissue to look for differences in length of certain non-functioning sections of DNA. The differences are caused by problems with the genes that encode proteins that normally repair certain types of DNA damage. A high proportion of colon cancers arising in patients with hereditary nonpolyposis colorectal cancer (HNPCC) (also known as Lynch syndrome) have high MSI and a smaller percentage of colon cancers not associated with Lynch syndrome have high MSI. Patients with colon cancers with high MSI may be further tested to determine if they have HNPCC. In addition, MSI is a useful prognostic marker in that patients with high MSI colon cancers have better response to surgery and survival.

Note 3: Testing for MSI may be done by immunology or genetic testing. Only genetic testing results will specify whether the MSI is low or high.

• Some laboratories only test for MSI via an immunologic test for Mismatch Repair (MMR) Protein. Results from immunology will only provide you with positive or negative results and will not specify whether the MSI is low or high.

• Results of Mismatch Repair (MMR) may be recorded in this data item - see codes 0 and 2

• MMR proficient (pMMR or MMR-P) should be coded as a 0

Note 4: If both tests are done and one or both are positive, code 2. Note 5: If all tests done are negative, code 0.

PSA (PROSTATIC SPECIFIC ANTIGEN) LAB VALUE Item Length: 5

Allowable Values 0.1, 0.2-999.9, XXX.1,

XXX.7, XXX.9, Blank NAACCR Item #3920

Definition:

This data item only applies to cancers with primary site C619 with histologies 8000- 8700, 8720-8790, 9700-9701.

PSA (Prostatic Specific Antigen) is a protein produced by cells of the prostate gland and is elevated in patients with prostate cancer. This data item pertains to PSA lab value. It was previously collected as Prostate, CS SSF# 1.

Coding Instructions:

Note 1: Physician statement of prostatic specific antigen (PSA) pre-diagnosis can be used to code this data item when no other information is available.

Note 2: PSA is a prognostic factor required for AJCC staging. It affects the stage group in most cases.

Note 3: Record to the nearest tenth in nanograms/milliliter (ng/ml) the last pre-diagnosis PSA lab value prior to diagnostic biopsy of prostate and treatment. The lab value may be recorded in the lab report, history and physical, or clinical statement in the pathology report, etc.

• A lab value expressed in micrograms per liter (ug/L) is equivalent to the same value expressed in nanograms per milliliter (ng/ml)

• Record 0.1 when the lab results are stated as less than 0.1 ng/ml with no exact value.

Note 4: A discrepancy between the PSA documented in the lab report and the PSA documented by the clinician may arise due to the clinician's adjusting the PSA value. Certain medications for benign prostatic hypertrophy (BPH) decrease the PSA.

• If there is documentation by a clinician within the medical record of an adjusted PSA value, record the adjusted value.

• The registrar does not adjust the PSA value based on BPH medication use.

• If there is no documentation by a clinician within the medical record of an adjusted PSA value, record the PSA value provided.

  • The fact that an adjusted PSA value is being recorded should be documented in the Dx Proc - Lab Tests text field (NAACCR Item # 2550).

Coding Examples:

TREATMENT – 1ST COURSE

DATE OF FIRST COURSE OF TREATMENT - COC Item Length: 8

Allowable Values: CCYYMMDD, Blank

NAACCR Item #1270

STORE 2018 pg. 232

Definition:

Records the date on which treatment (surgery, radiation, systemic, or other therapy) of the patient was initiated at any facility. This includes the date a decision was made not to treat.

Coding Instructions:

• Record the earliest of the following dates:

  • Date of First Surgical Procedure

  • Date Radiation Started

  • Date Systemic Therapy Started

  • Date Other Treatment Started

• In cases of non-treatment, in which a physician decides not to treat a patient or a patient's family or guardian declines all treatment, the date of first course of treatment is the date this decision was made.

• If active surveillance ("watchful waiting") was selected, record the date of that decision.

• Leave this item blank if the cancer was diagnosed at autopsy and not suspected prior to that.

Coding Examples

DATE OF FIRST COURSE OF TREATMENT FLAG Item Length: 2

Allowable Values: 10-12, Blank

NAACCR Item #1261

STORE 2018 pg. 233

Definition:

This flag explains why no appropriate value is in the field, Date of 1st Crs RX. Before Version 12 (through 2009 diagnosis), date fields included codes that provided information other than dates. As part of an initiative to standardize date fields, new fields were introduced to accommodate non-date information that had previously been transmitted in date fields.

Coding Instructions

• Leave this item blank if Date of First Course Treatment has a full or partial date recorded.

• Assign code 10 when it is unknown whether any treatment was administered.

• Assign code 11 when the initial diagnosis was at autopsy.

• Assign code 12 if the Date of First Course Treatment cannot be determined, and the patient did receive first course treatment.

• Use code 12 if a decision not to treat was made or a decision to use active surveillance was made, but the date when the decision was made is totally unknown.