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2018 Solid Tumor Rules

2018 Solid Tumor Rules. Texas Cancer Registry. 2018 Solid Tumor Rules. General Instructions Equivalent Terms & Definitions How to use the Solid Tumor Rules Multiple Primary Rules Histology Rules Important Definitions Practice Exercises The 2018 Solid Tumor Rules are available online

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2018 Solid Tumor Rules

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  1. 2018 Solid Tumor Rules Texas Cancer Registry

  2. 2018 Solid Tumor Rules • General Instructions • Equivalent Terms & Definitions • How to use the Solid Tumor Rules • Multiple Primary Rules • Histology Rules • Important Definitions • Practice Exercises • The 2018 Solid Tumor Rules are available online https://seer.cancer.gov/tools/solidtumor/ Texas Cancer Registry | Multiple Primary and Histology Rules

  3. 2018 Solid Tumor Rules • 2018 General Instructions & 2018 Solid Tumor Rules (dx 2018) • Breast • Colon (includes rectosigmoid and rectum) • Head & Neck • Kidney • Lung • Malignant CNS & Peripheral Nerves • Non-Malignant CNS Tumors • Urinary Sites • 2007 General Instructions & 2007 MP/H Rules (dx 2007-2020) • Other Sites • Cutaneous Melanoma Texas Cancer Registry | Multiple Primary and Histology Rules

  4. 2018 Solid Tumor RulesGeneral Instructions General Equivalent or Equal Terms • And; with • Adenocarcinoma; glandular carcinoma; carcinoma • De novo; new tumor; frank • Majority; major, predominately; greater than 50% • Multicentric; multifocal • Simultaneous; synchronous; at the same time • Topography; site code • Tumor; mass; tumor mass; lesion; neoplasm; nodule • Type; subtype; variant Texas Cancer Registry | Multiple Primary and Histology Rules

  5. 2018 Solid Tumor Rules How to use the Solid Tumor Rules • Single tumor or multiple tumor determined to be a single primary • General Instructions • Equivalent Terms and Definitions • Multiple Primary Rules • Histology Rules • Multiple tumors • Assign “working histology” for each tumor • Multiple Primary Rules • Follow Single tumor steps above for primary(ies) Texas Cancer Registry | Multiple Primary and Histology Rules

  6. 2018 Solid Tumor RulesGeneral Instructions How to use the Solid Tumor Rules • Does not apply to hematopoietic primaries • Determines multiple primaries and histology • Not for case reportability, casefinding, stage or tumor grade • Site-specific rules based on the date of diagnosis • Rules are hierarchical • Use the first rule that applies and STOP Texas Cancer Registry | Multiple Primary and Histology Rules

  7. 2018 Solid Tumor RulesGeneral Instructions How to use the Multiple Primary Rules • Do not count metastatic lesions • For a single tumor, use “Single Tumor” module • For multiple tumors, use “Multiple Tumors” module • If number of tumors unknown, use “Unknown if Single or Multiple Tumors” module • If tumor(s) have separate microscopic foci, ignore the microscopic foci Texas Cancer Registry | Multiple Primary and Histology Rules

  8. 2018 Solid Tumor RulesGeneral Instructions How to use the Multiple Primary Rules • Each site has its own timing rules • One year=365 days • Clinically disease free • Date of last recurrence • Use the Multiple Primary Rules to determine if new primary or recurrence • Do not base it on physician’s statement • Exception: pathologist compares slides and states it is recurrence of previous tumor Texas Cancer Registry | Multiple Primary and Histology Rules

  9. 2018 Solid Tumor RulesGeneral Instructions How to use the Histology Rules • Not for case reportability • 2 sections: • Single Tumor • Multiple Tumors Abstracted as a Single Primary • STOP at first rule that applies Texas Cancer Registry | Multiple Primary and Histology Rules

  10. 2018 Solid Tumor RulesGeneral Instructions Histology Coding Sources: • 2018 Solid Tumor Rules • Updated ICD-O histology codes and terms https://seer.cancer.gov/icd-o-3/ • ICD-O manual • Ask a SEER Registrar https://seer.cancer.gov/registrars/contact.html Texas Cancer Registry | Multiple Primary and Histology Rules

  11. 2018 Solid Tumor RulesGeneral Instructions How to use the Histology Rules • Code prior to neoadjuvant therapy • Terms and definitions within each site-specific module • Ambiguous terminology • clinically confirmed by a physician • Treated for that histology • Case is accessioned based on that histology • Priority order for using documentation Texas Cancer Registry | Multiple Primary and Histology Rules

  12. 2018 Solid Tumor RulesGeneral Instructions Ambiguous Terminology Apparently Appears Comparable with Compatible with Consistent with Favor(s) Malignant appearing Most likely Presumed Probable Suspect(ed) Suspicious (for) Typical (of) Texas Cancer Registry | Multiple Primary and Histology Rules

  13. Equivalent Terms & Definitions by Site Site-Specific Instructions for M Rules: • Changes from 2007 MP/H Rules • Equivalent and Equal Terms • Terms that are NOT Equivalent or Equal • Tables • Primary Site Codes • Histology Combination Codes • Specific Histologies, and Subtypes/Variants • Non Reportable Histologies • Paired Sites • Illustrations Texas Cancer Registry | Multiple Primary and Histology Rules

  14. Equivalent Terms & Definitions by Site Site-Specific Instructions for H Rules: • Important Notes • Priority Order for Using Documentation • Coding Multiple Histologies • List of Ambiguous Terminology Texas Cancer Registry | Multiple Primary and Histology Rules

  15. Definitions for Solid Tumor Rules • Bilateral-Relating to the right and left sides of the body or of a body structure; not an indication of single or multiple primaries • Clinical diagnosis-A diagnosis that is not microscopically confirmed; may be based on information from diagnostic imaging or the clinician’s expertise • Contiguous tumor-A single tumor that involves, invades, or bridges adjacent or connecting sites or subsites • De novo-In cancer, the first occurrence of cancer in the body Texas Cancer Registry | Multiple Primary and Histology Rules

  16. Definitions for Solid Tumor Rules • Focal-An adjective meaning limited to one specific area. A focal cancer is limited to one specific area or organ. The area may be microscopic or macroscopic • Foci-Plural of focus • Focus-A term used by pathologists to describe a group of cells that can be seen only by a microscope. The cells are noticeably different from the surrounding tissue either by their appearance, chemical stain, or other testing • Laterality-Indication of which side of a paired organ/site a tumor is located Texas Cancer Registry | Multiple Primary and Histology Rules

  17. Definitions for Solid Tumor Rules • Multiple primaries-More than one reportable case • NED-Acronym for “no evidence of disease”; disease free • Non-contiguous-Not touching along the boundary; not being in actual contact • Overlapping tumor-A single tumor which has spread from the primary site to adjacent organs or tissue. Adjacent organs/tissue are next to each other • Paired organ/site-There are two organs, one on the left side of the body and one on the right side of the body Texas Cancer Registry | Multiple Primary and Histology Rules

  18. Definitions for Solid Tumor Rules • Recurrence- 2 different meanings: • The reappearance of disease that was thought to be cured or inactive (in remission). • A new occurrence of cancer in the same primary site • Single primary-one reportable case, per the Multiple Primary Rules • Unilateral-Relating to one side of the body or one side of a body structure. Texas Cancer Registry | Multiple Primary and Histology Rules

  19. M Rules-Lung Unknown if Single or Multiple Tumors • Rule M1 Abstract a single primary when it is not possible to determine if there is a single tumor or multiple tumors Texas Cancer Registry | Multiple Primary and Histology Rules

  20. M Rules-Lung Single Tumor • Rule M2 Abstract a single primary when there is a single tumor Texas Cancer Registry | Multiple Primary and Histology Rules

  21. M Rules-Lung Multiple Tumors • Rule M3 Abstract multiple primaries when there are separate, non-contiguous tumors in sites with ICD-O site codes that differ at the second CXxx and/or third character CxXx • Rule M4 Abstract multiple primaries when the patient has a subsequent tumor after being clinically disease-free for greater than three years after the original diagnosis or last recurrence Texas Cancer Registry | Multiple Primary and Histology Rules

  22. M Rules-Lung • Rule M6 Abstract multiple primary when separate/non-contiguous tumors are two or more different subtypes/variants in Column 3, Table 3 in Equivalent Terms and Definitions • Rule M7 Abstract a single primary when synchronous, separate/non-contiguous tumors in the same lung are on the same row in Table 3 in the Equivalent Terms and Definitions • Rule M8 Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 3 in the Equivalent Terms and Definitions. Timing is irrelevant Texas Cancer Registry | Multiple Primary and Histology Rules

  23. M Rules-Lung • Rule M10 Abstract a single primary when an insitu tumor is diagnosed after an invasive tumor AND tumors occur in the same lung • Rule M12 Abstract a single primary (the invasive) when an invasive tumor is diagnosed less than or equal to 60 days after an in situ tumor in the same lung • Rule M13 Abstract multiple primaries when an invasive tumoroccurs more than 60 days after an in situ tumor in the same lung Texas Cancer Registry | Multiple Primary and Histology Rules

  24. H Rules-Lung Single Primary/Multiple Tumors Abstracted As Single • Code the histology diagnosed prior to neoadjuvant treatment • Code the histology assigned by the physician • Use the Priority Order (per site) to identify histology and code the most specific histology from either the resection or biopsy • Subtype/variant • Code the invasive when there is in situ and invasive components in single tumor • Discrepancy between bx and resection, code the histology from the most representative specimen Texas Cancer Registry | Multiple Primary and Histology Rules

  25. H Rules-Lung Single Primary/Multiple Tumors Abstracted As Single • Code the most specific histology • Majority or predominant • Minority of tumor • Component • MUST describe “carcinoma” or “sarcoma” • Code the histology described as differentiation or features ONLY when there is a specific ICD-O code Texas Cancer Registry | Multiple Primary and Histology Rules

  26. H Rules-Lung Single Primary/Multiple Tumors Abstracted As Single • Code the histology described by ambiguous terminology • Histology is clinically confirmed by physician • Patient is treated for the histology described with ambiguous term • Case is accessioned based on ambiguous terminology • Do not code histology when described as • Architecture • Foci; focus; focal • Pattern Texas Cancer Registry | Multiple Primary and Histology Rules

  27. 2018 Solid Tumor RulesExercise A patient was diagnosed with an invasive carcinoma, NST in the left breast and an invasive lobular carcinoma in the right breast 2/6/2018. How many primaries? What is the M Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  28. 2018 Solid Tumor RulesExercise A patient was diagnosed with an invasive carcinoma, NST in the left breast and an invasive lobular carcinoma in the right breast 2/6/2018. 8500/3 Invasive Carcinoma 8520/3 Invasive Lobular Carcinoma Rule M7 Texas Cancer Registry | Multiple Primary and Histology Rules

  29. 2018 Solid Tumor RulesExercise A patient has a single invasive tumor in the breast with carcinoma NST and pleomorphic carcinoma. The percentage of pleomorphic carcinoma is 50%. What is the histology code? What is the H Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  30. 2018 Solid Tumor RulesExercise A patient has a single invasive tumor in the breast with carcinoma NST and pleomorphic carcinoma. The percentage of pleomorphic carcinoma is 50%. 8500/3-Carcinoma, NST Rule H15 Texas Cancer Registry | Multiple Primary and Histology Rules

  31. 2018 Solid Tumor RulesExercise A patient is diagnosed with the following tumors: invasive micropapillary carcinoma in the sigmoid colon Invasive mucoepidermoid carcinoma in the cecum How many primaries? What M Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  32. 2018 Solid Tumor RulesExercise A patient is diagnosed with the following tumors: invasive micropapillary carcinoma in the sigmoid colon Invasive mucoepidermoid carcinoma in the cecum 8265/3 invasive micropapillary carcinoma 8430/3 invasive mucoepidermoid carcinoma Rule M5 Texas Cancer Registry | Multiple Primary and Histology Rules

  33. 2018 Solid Tumor RulesExercise A patient is diagnosed with a single tumor in the colon with adenocarcinoma and mucinous carcinoma. The percentage of the mucinous carcinoma is unknown. What is the histology? What is the H Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  34. 2018 Solid Tumor RulesExercise A patient is diagnosed with a single tumor in the colon with adenocarcinoma and mucinous carcinoma. The percentage of the mucinous carcinoma is unknown. 8140/3 Adenocarcinoma Rule H5 Texas Cancer Registry | Multiple Primary and Histology Rules

  35. 2018 Solid Tumor RulesExercise A patient was diagnosed with tumors in the left and right submandibular gland; both are invasive squamous cell carcinoma. How many primaries? What is the M Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  36. 2018 Solid Tumor RulesExercise A patient was diagnosed with tumors in the left and right submandibular gland; both are invasive squamous cell carcinoma. 8070/3 Invasive Squamous Cell Carcinoma 8070/3 Invasive Squamous Cell Carcinoma Rule M5 Texas Cancer Registry | Multiple Primary and Histology Rules

  37. 2018 Solid Tumor RulesExercise A patient was diagnosed simultaneously with bilateral nephroblastomas of the kidneys. How many primaries? What is the M Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  38. 2018 Solid Tumor RulesExercise A patient was diagnosed simultaneously with bilateral nephroblastomas of the kidneys. 8960/3 Nephroblastoma Rule M4 Texas Cancer Registry | Multiple Primary and Histology Rules

  39. 2018 Solid Tumor RulesExercise A patient was diagnosed with a single invasive tumor of the left kidney with renal cell carcinoma and clear cell renal cell carcinoma. What is the histology? What is the H Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  40. 2018 Solid Tumor RulesExercise A patient was diagnosed with a single invasive tumor of the left kidney with renal cell carcinoma and clear cell renal cell carcinoma. 8310/3 Clear Cell Renal Cell Carcinoma Rule H3 Texas Cancer Registry | Multiple Primary and Histology Rules

  41. 2018 Solid Tumor RulesExercise A patient is diagnosed with a single tumor with invasive colloid adenocarcinoma in the left upper lobe of the lung and a single tumor with invasive adenoid cystic carcinoma in the left lower lung. How many primaries? What is the M Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  42. 2018 Solid Tumor RulesExercise A patient is diagnosed with a single tumor with invasive colloid adenocarcinoma in the left upper lobe of the lung and a single tumor with invasive adenoid cystic carcinoma in the left lower lung. 8480/3 Invasive Colloid Adenocarcinoma 8200/3 Invasive Adenoid Cystic Carcinoma Rule M6 Texas Cancer Registry | Multiple Primary and Histology Rules

  43. 2018 Solid Tumor RulesExercise A patient is diagnosed with a single invasive tumor identified as non-small cell carcinoma consistent with adenocarcinoma. The treatment plan states that the patient is being treated for adenocarcinoma of the lung. What is the histology? What is the H Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  44. 2018 Solid Tumor RulesExercise A patient is diagnosed with a single invasive tumor identified as non-small cell carcinoma consistent with adenocarcinoma. The treatment plan states that the patient is being treated for adenocarcinoma of the lung. 8140/3 Adenocarcinoma Rule H3 Texas Cancer Registry | Multiple Primary and Histology Rules

  45. 2018 Solid Tumor RulesExercise A patient is diagnosed with an invasive glioblastoma, NOS in the temporal lobe and a benign meningioma in the cerebral meninges. How many primaries? What is the M Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  46. 2018 Solid Tumor RulesExercise A patient is diagnosed with an invasive glioblastoma, NOS in the temporal lobe and a benign meningioma in the cerebral meninges. 9440/3 Invasive Glioblastoma, NOS 9530/0 Benign meningioma Rule M5 Texas Cancer Registry | Multiple Primary and Histology Rules

  47. 2018 Solid Tumor RulesExercise A patient is diagnosed with a single invasive tumor with glioblastoma NOS and giant cell glioblastoma. What is the histology? What is the H Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  48. 2018 Solid Tumor RulesExercise A patient is diagnosed with a single invasive tumor with glioblastoma NOS and giant cell glioblastoma. 9441/3 Giant Cell Glioblastoma Rule H4 Texas Cancer Registry | Multiple Primary and Histology Rules

  49. 2018 Solid Tumor RulesExercise A patient is diagnosed with two benign meningiomas, one in the right cerebral meninges and one in the left cerebral meninges. How many primaries? What is the M Rule? Texas Cancer Registry | Multiple Primary and Histology Rules

  50. 2018 Solid Tumor RulesExercise A patient is diagnosed with two benign meningiomas, one in the right cerebral meninges and one in the left cerebral meninges. 9530/0 Meningioma Rule M9 Texas Cancer Registry | Multiple Primary and Histology Rules

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