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

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Advanced abstracting issues for the lung cancer diagnosis l.jpg

Advanced Abstracting Issues for the Lung Cancer Diagnosis

Judy Andrews, CTR

Metropolitan Regional Coordinator

Georgia Center for Cancer Statistics

GATRA Fall Meeting 2004


Icd o 3 codes l.jpg
ICD‑O-3 CODES

  • ICD‑0‑3 TERM

    C34.0 Mainbronchus

    C34.1 Upper lobe, lung

    C34.2 Middle lobe, lung

    C34.3 Lower lobe, lung

    C34.8 Overlapping lesion of lung

    C34.9 Lung, NOS


Anatomy l.jpg
Anatomy

  • Related adjectives: Lung= pneumo-, pulmono-, broncho-, bronchiolo-, alveolar, hilar

  • Breathing= -pnea (difficulty with breathing=dyspnea)

  • Paired organ

  • Subsites:

    • Right lobe: 3 lobes

    • Left Lobe: 2 lobes


Lung anatomy l.jpg
Lung Anatomy

Carina

Upper Lobe

Oblique

Fissure

Middle

Lobe

Lower

Lobe


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Lung Anatomy: Key Words

  • Apex

  • Hilum

  • Carina

  • Lingula

  • Cardiac Notch

  • Pleural Cavity

  • Chest Wall

  • Mediastinum

  • Base


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ICD-O-3 Morphology Codes

  • Small cell lung cancers include ICD‑O-3 morphology codes M‑80413, M‑80423, M‑80433, M‑80443, and M80453

  • Common non‑small cell lung cancer histologies

    • Squamous or epidermoid (807_3)

    • Adenocarcinoma (814_3)

    • Bronchioloalveolar (82503)

    • Large cell carcinoma (80123)

    • Other subtypes of adenocarcinoma are acinar, papillary,and mucinous

    • Adenosquamous carcinoma (85603)

    • Mesothelioma (905_3)

    • Bronchogenic carcinoma IS NOT a specific cell type


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Regional Lymph Nodes for the Lung

  • The regional lymph nodes for the lung are all above the diaphragm

    • Intrathoracic nodes include mediastinal and intrapulmonary nodes

    • Scalene and supraclavicular nodes are also considered regional nodes for staging


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Intrathoracic

Pulmonary

12 Peribronchial

11 Intrapulmonary

10 Hilar

13 Segmental

Superior mediastinal

1 Superior Mediastinal

3 Pretracheal,retrotracheal

2 Paratracheal

4 Lower paratracheal, azygos

Intrathoracic

Aortic

5 Subaortic (aortic window)

6 Para-aortic (ascending aorta or phrenic)

Inferior mediastinal

7 Carinal, subcarinal

8 Paraesophageal

9 Pulmonary ligament

Regional Lymph Nodes for the Lung


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Regional Lymph Nodes for the Lung

  • Extrathoracic

    • Scalene

    • Supraclavicular or transverse cervical


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Common Metastatic Sites for the Lung

  • Lymphatic Spread

    • Cervical Lymph Nodes

    • Contralateral Lung

    • Contralateral Mediastinum

  • Hematogenic Spread

    • Brain

    • Bone

    • Liver

    • Adrenal glands

    • Contralateral Lung


  • Extent of disease evaluation for the lung l.jpg
    Extent of Disease Evaluation for the Lung

    • Diagnostic Studies: Physical Exam

      • Signs and Symptoms

      • Palpable lymph nodes or organs

      • Pancoast Tumor

      • Horner’s Syndrome


    Extent of disease evaluation for the lung12 l.jpg
    Extent of Disease Evaluation for the Lung

    • Diagnostic Studies: Imaging

      • Chest X-ray

      • CAT Scan

      • MRI Scan

      • PET Scan

      • Bone Scan


    Extent of disease evaluation for the lung13 l.jpg
    Extent of Disease Evaluation for the Lung

    • Diagnostic Studies: Endoscopies

      • Bronchoscopy

      • Mediastinoscopy

      • Thoracoscopy


    Extent of disease evaluation for the lung14 l.jpg
    Extent of Disease Evaluation for the Lung

    • Diagnostic Studies: Pathological

      • Closed Chest Needle Biopsy

      • Cytology (Thoracentesis)

      • Sputum Cytology

      • Bronchial Washings

      • Bone Marrow Biopsy


    Extent of disease evaluation for the lung15 l.jpg
    Extent of Disease Evaluation for the Lung

    • Diagnostic Studies: Tumor Markers

      • Neuron Specific Enolase (NSE)

      • Squamous Cell Carcinoma Antigen

      • DNA Studies

      • Adrenocorticotropic Hormone (ACTH)

      • Carcinoembryonic Antigen (CEA)

      • Calcitonin

      • Tissue Polypeptide Antigen (TPA)


    Staging systems for lung l.jpg
    Staging Systems for Lung

    • SEER Extent of Disease 3rd Edition

      (Diagnosis year 1988-2003)

    • SEER Summary Staging 2000

      (Diagnosis year 2001-2003)

    • American Joint Committee on Cancer (AJCC)

      TNM 6th Edition

      (Diagnosis year 2003 forward)

    • Collaborative Staging

      (Diagnosis year 2004 forward)


    Staging systems for lung17 l.jpg
    Staging Systems for Lung

    SEER EOD

    • Size

    • Extent

    • Regional Lymph Nodes

    • Reg LN Positive

    • Reg LN Examined

    SEER Summary Stage 2000

    • In Situ

    • Localized

    • Reg by Direct Ext

    • Reg Ipsilateral LN only

    • Reg by Direct & Ipsilateral Reg LN

    • Reg, Nos

    • Distant Site/Node Involv

    AJCC TNM 6th Edition

    • cT,pT: Extent of primary tumor

    • cN,pN: Absence or presence & Ext of regional lymph nodes

    • cM,pM: Absence/presence of metastasis

      [Clinical (c) and pathologic (p)]

    Collaborative Stage

    • CS Tumor Size

    • CS Tumor Size/Ext Eval

    • CS Lymph Nodes

    • CS Lymph Nodes Eval

    • CS Mets at Dx

    • CS Mets Eval

    • CS Site Specific Factors 1-6


    Collaborative stage l.jpg
    Collaborative Stage

    • General Guidelines

      • Timing Rule

      • Site-specific guidelines

      • Highest applicable number for each field

      • Greatest extent of disease


    Collaborative stage for bronchus and lung l.jpg
    Collaborative Stage for Bronchus and Lung

    • General Guidelines continued:

      • CS Tumor Size/Ext

      • CS Tumor Size/Ext Eval

      • CS Regional LN

      • CS Reg Nodes Eval

      • CS Mets

      • CS Mets Eval

      • Regional LN Pos/Regional LN Exam

      • Site Specific Factors


    Collaborative stage for bronchus and lung20 l.jpg
    Collaborative Stage for Bronchus and Lung

    • CS Tumor Size

      000 No mass/tumor found

      001-998 001-998 millimeters (exact size)

      989 989 millimeters or larger

      990 Microscopic focus or foci only, no size of focus given

      991 Described as less than 1 cm

      992-995 Described as less than (2,3,4,5 cm)

      996 Malignant cells in bronchopulmonary secretions, but no tumor is seen radiographically or during bronchoscopy

      997 Diffuse (entire lobe)

      998 Diffuse (entire lung)

      999 Unknown; size not stated Not documented in patient record


    Collaborative stage for bronchus and lung21 l.jpg
    Collaborative Stage for Bronchus and Lung

    • CS Extension

      • Primary Tumor extension

        • DO NOT CODE DISCONTINOUS METASTASES IN THIS FIELD

      • Priority order for extension

      • Notes 1-7: Read carefully


    Collaborative stage for bronchus and lung22 l.jpg
    Collaborative Stage for Bronchus and Lung

    • CS TS/EXT EVAL

      • Evaluates source for “CS Tumor Size” and

        “CS Extension”

      • Describes clinical or pathological staging

        of the tumor


    Collaborative stage for bronchus and lung23 l.jpg
    Collaborative Stage for Bronchus and Lung

    • CS TS/EXT EVAL

      • Code 0, 1, 9 No surgery

      • Code 2 Autopsy (diagnosis suspected)

      • Code 3 Surgery followed by other therapy

      • Code 5 Determined prior to neoadjuvant therapy

      • Code 6 Determined after neoadjuvant therapy

      • Code 8 Autopsy (diagnosis unsuspected)

      • Code 9 Unknown, Not assessed, Not stated


    Collaborative stage for bronchus and lung24 l.jpg
    Collaborative Stage for Bronchus and Lung

    • CS Lymph Nodes

      • Regional Nodes and Nodes, NOS only

      • Highest Applicable Code

        • Exception (NOS)

      • New Rule for Inaccessible Site

        • Lung

      • Notes 1-4: Read carefully


    Collaborative stage for bronchus and lung25 l.jpg
    Collaborative Stage for Bronchus and Lung

    • CS Reg Nodes Eval

      • Code 0, 1, 9 No LN(s) removal

      • Code 2 Autopsy (diagnosis suspected)

      • Code 3 LN(s) surgery followed by other therapy

      • Code 5 LN(s) status determined prior to neoadjuvant therapy

      • Code 6 LN(s) status determined after neoadjuvant therapy

      • Code 8 Autopsy (diagnosis unsuspected)

      • Code 9 Unknown, Not assessed, Not stated


    Collaborative stage for bronchus and lung26 l.jpg

    Regional Nodes Positive

    00 All nodes examined negative

    01-89 1-89 nodes positive

    90 or more nodes positive

    95 Positive aspiration of LN(s) was performed

    97 Positive nodes documented, number unspecified

    98 No nodes examined

    99 Unknown if nodes positive, not applicable, not stated in record

    Regional Nodes Examined

    00 No nodes examined

    01-89 1-89 nodes examined

    90 or more nodes examined

    No Reg LN removed, Aspiration of Reg LN performed

    Reg LN removal documented as sampling, number unknown/not stated

    97 Reg LN removal documented as dissection, number unknown/not stated

    98 Reg LN surgically removed, number of LNs unknown/not stated, not documented as sampling or dissection; nodes examined, number unknown

    99 Unknown, not applicable, not stated in record

    Collaborative Stage for Bronchus and Lung


    Collaborative stage for bronchus and lung27 l.jpg
    Collaborative Stage for Bronchus and Lung

    • CS Mets at Dx

      • 00 No; none

      • 10 Distant Lymph Nodes (s), including cervical nodes

      • 35 Separate tumor nodules (s) in different lobe, same lung

      • 37 Extension to sternum, skeletal muscle, skin of chest

      • 39 Extension to contralateral lung, contralateral main stem bronchus, separate tumor nodule(s) in contralateral lung

      • 40 Abdominal organs, distant metastasis except to distant lymph nodes (code 10), distant mets, NOS, carcinomatosis

      • 50 Distant mets + distant node(s)

        (10) + any [35-40]

      • 99 Unknown; distant metastasis cannot be assessed, not documented in patient record.


    Collaborative stage for bronchus and lung28 l.jpg
    Collaborative Stage for Bronchus and Lung

    • CS Mets Eval

      • Code 0, 1, 9 No surgery

      • Code 2 Autopsy (diagnosis suspected)

      • Code 3 Surgery followed by other therapy

      • Code 5 Determined prior to neoadjuvant therapy

      • Code 6 Determined after neoadjuvant therapy

      • Code 8 Autopsy (diagnosis unsuspected)

      • Code 9 Unknown, Not assessed, Not stated


    Collaborative stage for bronchus and lung29 l.jpg
    Collaborative Stage for Bronchus and Lung

    • CS Site Specific Factors

      • SSF 1 Code 888

      • SSF 2 Code 888

      • SSF 3 Code 888

      • SSF 4 Code 888

      • SSF 5 Code 888

      • SSF 6 Code 888


    Treatment for bronchus and lung l.jpg
    Treatment for Bronchus and Lung

    • Surgery

      • Non-small cell carcinoma: Stage I and II (Localized)

      • Small cell carcinoma: Not recommended

    • Radiation

      • Non-small cell carcinoma: Inoperable, Advanced

      • Small cell carcinoma: Recommended

    • Systemic Therapy

      • Non-small cell carcinoma: Chemotherapy

      • Small cell carcinoma: Combination chemotherapy

    • Hormonal & Endocrine

      • Not proven to be useful


    Treatment for bronchus and lung31 l.jpg
    Treatment for Bronchus and Lung

    • Surgery Codes

      • Primary Site

      • Scope of Regional Lymph Node

      • Surgical Procedure of Other Site


    Treatment for bronchus and lung32 l.jpg
    Treatment for Bronchus and Lung

    • Surgery Codes continued

      • Primary Site

      • Scope of Regional Lymph Node

      • Surgical Procedure of Other Site


    Treatment for bronchus and lung33 l.jpg
    Treatment for Bronchus and Lung

    • Surgery Codes continued

      • Primary Site

      • Scope of Regional Lymph Node

      • Surgical Procedure of Other Site


    Treatment for bronchus and lung34 l.jpg
    Treatment for Bronchus and Lung

    • Radiation

      • Treatment Volume

      • Treatment Modality

      • Regional Dose

      • Boost Modality

      • Boost Dose

      • Prophylactic Cranial Radiation (PCI)


    Treatment for bronchus and lung35 l.jpg
    Treatment for Bronchus and Lung

    • Chemotherapy

      • Non-Small Cell Carcinoma

      • Small Cell Carcinoma

    • Hormones

    • Immunotherapy

    • Other

      • Endoscopic Photodynamic Therapy


    Keys to abstracting l.jpg
    Keys to Abstracting

    • Organization

      • Dates

      • Procedure Documentation

  • Resources

    • Diagnosis year

  • Text

    • Pertinent

    • Acronyms


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