UKACR GYNAE CANCER STUDY DAY ANALYSIS OF CASE STUDIES Tuesday, 8th April 2008 Julian Hodge Building, Cardiff Joy McRae - ACC

UKACR GYNAE CANCER

STUDY DAY

ANALYSIS OF CASE STUDIES

Tuesday, 8th April 2008Julian Hodge Building, Cardiff

Joy McRae - ACC

GENERAL POINTS

CASE STUDIES

Few registries had cases to be submitted for

consideration at this study day.

So, it was decided to re-visit the cases used

at the 1999 Gynae Cancers Study Day.

General Points (2)

Reason for no problem cases?

Is the documentation better now??e.g.

The Royal College of Pathologists have

introduced a pro forma reporting which is

a benefit to data recording in some English

registries.

Instructions

Case Studies:Please bring this sheet with you on 8th April

Please consider the information below as all you can find in yourdata sources and record (as you wouldnormally) -

Instructions (Cont…)

1. The morphology of the tumour(s).

2. The anatomical site(s) of the tumour(s).

3. The ICD (indicating clearly which classn

used) .

4. The anniversary date(s) or “date(s) of diagnosis” for the tumours(s)

Classifications UsedICD10 ECRIC, NI, NYCRIS, OXFORD, SCOTLAND

SWCIS, TRENT, WCISU, WMCIU

ICD02NWCIS – Liverpool Office (LO)

Manchester Office (MO)

ICD03SI, Thames

INTERNATIONAL STANDARDS

Cancer Registration

Use of these classifications and adherence

to the rules therein ensure the recording of

quality data for cancer incidence.

THE CASESTUDIES!

Good News!

Consensus on Cases 6, 8, 9, 12

Case 9

Coding & Classification Group

No. of Primaries = NONE

Comments:

“BENIGN – Not registerable”

Case 12Coding & Classification Group

No. of Primaries = ONE

Morphology Code = M9100/1

ICD Code (Placenta) = D39.2/C58.9

Diagnosis Date = 14.10.06

“Invasive Mole coded as an Uncertain Tumour”

Case 12 – REGISTRIES’ ANSWERS



ICD Code (Placenta) = D39.2/C58.9

Basis of Dx = Histology





ICD Code (Cervix) = C53.9


Case 6 (Cont..)


Comments:

“Poorly differentiated epithelial tumour = carcinoma NOS”

Case 6 – REGISTRIES’ ANSWERSNo. of Primaries = ONE



Basis of Dx = Histology

Diagnosis Date = 03.05.04(ONE - 02.05.04 : ONE – 04.05.04)




ICD Code (Ovary ) = C56/C56.9

Diagnosis Date = 19.06.04“Taken from Cytology”




ICD Code (Ovary ) = C56/C56.9

Diagnosis Date = 19.06.04 x 6 16.06.04 x 3

22.06.04 x 215.06.04 x 120.06.04 x 1

Basis of Dx: 2 Cytology : 11 Histology

Case 1- Coding & ClassificationNo. of Primaries = 1

Morphology code = M8070/5

or M8076/5



C&CG confirm that it is impossible to state the site the tumour has arisen from by histology alone. Therefore unless patholgist states site tumour arises – Cervix NOS


No. of Primaries = 1

Morphology code = M8070/5 x 5

M8076/5 x 3

M8076/3 x 5

ICD Code (Cervix) = (next sheet)

Diagnosis Date = 02.08.05 x 12

03.08.05 x 1

Case 1 – Site code

ECRIC -ICD10 Exocervix C53.1 M8070/5

Northern Ireland -ICD10 In NI microinvasive coded as invasive

C53.9 M8076/3

NWCIS (LO) - ICD02 Cervix M8076/5

NWCIS (MO) - ICD02 Cervix C53 M8076/3

NYCRIS - ICD10 Cervix M8076/5

Oxford - ICD10 Cervix C53.9 M8070/5

Scotland - ICD10 Cervix C53.9 M8076/3

Southern Ireland- ICD03 Cervix - Endocervical canal C53.0 M8076/3

SWCIS - ICD10 Cervix M8070/5

Thames – ICD03 impossible to state the site tumour has arisen from by histology alone. Therefore unless the pathologist states site tumour arises, code site

as cervix NOS.

C53.9 M8076/5

Trent - ICD10 Cervix C53.9 M8070/5

Wales - ICD10 Cervix C53.9 M8076/3

WMCIU - ICD10 Exocervix C53.1 M8070/5

“We default to exocervix for all squamous cell carcinoma” WMCIU


No. of Primaries = 1

Morphology code M8070/3

ICD Code = C51.9

Site in Text = Vulva (Bilateral)


Bilateral diagnosed at the same time therefore ONE registration – see Training Manual section 3 page 9

Case 2 - REGISTRIES’ ANSWERS

Morphology Code = M8070/3 x 13No. of Primaries = 12 x ONE 1 x TWOThe TWO Primary Sites are :Overlapping lesion of Vulva and LabiaMajora

HOWEVER, there are discrepancies in recording the site. (Next Page)

CASE 2

ECRIC Vulva ICD10 C51.1Comments: Right labia majora and bilateral labia minora so code to minora as dominant site.

Ireland Overlapping lesion of vulva + Labia major

ICD10 C51.8 C51.1

NWCIS (LO) Vulva NOS ICD02 M8070/3

NWCIS (MO) Vulva ICD02 C51.9

Comment: Possible C51.8 overlapping

NYCRIS Vulva ICD10 M80703

Oxford Vulva (Bilateral) ICD10 C51.9

Scotland Vulva ICD10 C51.8Comment: Registered once as directed in the E&W Training Manual Part 3 p9.

Southern Ireland Overlapping lesion of vulva

ICD03 C51.8

SWCIS Vulva ICD10 M8070/3

Thames Vulva (Bilateral) ICD03 C51.9

Trent Labia Majora ICD10 C51.0Comment: One primary using multiple primary rules in UKACR manual, taken and coded the

biggest tumour component.

Wales Vulva ICD10 C51.8/C51.1

Comment: ONE registration as Bilateral occurring at the same time

WMCIU Vulva ICD10 C51.8


No. of Primaries = TWO

Morphology code = M8070/2 or M8077/2

& M8070/3

ICD10 Site Codes = D06.9 & C53.9 or

ICD0 = C53.9 & C53.9

Site in text = In situ cervix NOS &

invasive cervix NOS

Diagnosis Date = 02.01.04 & 04.07.04


Comments:TWO registrations because first dx.of in situ was diagnosed and treatedFollowed by second diagnosis morethan 3 months later. These both constitute a different episode of care.



Morphology code = M8070/2 or M8077/2

& M8070/3

ICD10 Site Codes = D06.9 & C53.9 or

ICD0 = C53.9 & C53.9

Site in text = In situ cervix NOS &

invasive cervix NOS

(2 registries defaulted to exocervix

Diagnosis Date = 02.01.04 & 04.07.04



Morphology code = M8140/6 (ICD10) M8140/3 (ICD0)

ICD Code = C78.6

Site in Text = Unknown primary peritoneum



No of Primaries : 12 x 1: 1 x 2

Site in Text : Ovary x 6UKP x 2Malignant Ascites x 2UKP/Mets/Ovary x 1UKP/Peritoneum x 1

Morphology: -

Adenocarcinoma x 13

Incidence Date: -

15.04.06 x 13

Basis of Dx:

Cytology



Morphology code = M8140/3 ICD Code = C57.8

Site in Text = Overlapping genital organ


Case 5


Comment:

Text states “involving lower part of

uterus & the cervix therefore point of

origin cannot be established – code as

overlapping.




ICD Code = C57.8


Basis of Dx. = Histology

Cancer Registry

Site in Text Codes

ECRIC Lower Uterus C54.0 M8140/3Comments : Adenocarcinoma of lower uterus with spread into cervix.

Northern Ireland Uterus C55 M8140/3

NWCIS (LO) Isthmus uteri M8140/3

NWCIS (MO) Endo LR Uterus Cx C53.9 C55.9(LR) C54.0 M8140/3

Comment: Site Specification?

NYCRIS Endometrium M8140/3

Comments: Extending into cervix

Oxford Overlapping lesion of Female Genital Tract C57.8 M8140/3

Scotland Lower part of uterus C54.0 M8140/3Southern Ireland Overlapping Lesion of Uterus C54.8 M8140/3

Comment: Spread to Cervix

SWCIS Overlapping lesion of Female Genital Tract M8140/3

Comments: Involves uterus & cervix but no indication of origin of tumour.

Thames Endometrium C54.1 M8140/3Comments: Macro implies that tumour arose in the body of uterus. Typical presentation for

endometrial ca.

Trent Uterus C55 M8140/3

Wales Involves lower uterus and cervix C54.0 M8140/3WMCIU Overlapping genital organ C57.8 M8140/3



Morphology code = a) M8077/2 &/or b) M8140/2 ICD02 Code

or M8148/2 ICD03 Code

ICD10 a) D06.9 & D06.9ICD0 b) C53.9 & C53.9 Site in Text a) Cervix in situ

b) Cervix in situ

Dx Date a) 27.02.05 b) 15.04.05

New term in ICD03 – agreed at C&CG 08.02.08

GINIII or high grade GIN

CGINIII or high grade CGIN

Two morphologies in different morphology groups (see training manual part 3)


No. of Primaries = 7 x ONE Morphology = M8560/2 = 6 X TWO

Morphology code = a) M8077/2 &/or b) M8140/2 ICD02 Code

or M8148/2 ICD03 CodeICD10 a) D06.9 & D06.9ICD0 b) C53.9 & C53.9 Site in Text a) Cervix in situ

b) Cervix in situ

Dx Date a) 27.02.05 b) 15.04.05

Case 7Site in Text No. Classn Codes Incidence

Date Basis of Diagnosis

Exocervix 1 ICD10 D06.1 M8560/2 27.02.05 histology

In situ Endocervix 1 ICD10 D06.0 M8010/2 27.02.05 histology

Cervix NOS 1 ICDO2 M8560/2 27.02.05 Histol of prim

Cervix 2 ICD02 C53.9 M8140/2

M8077/2

27.02.0515.04.05

Histology

Endo-cx-in-situ 1 ICD10 M8560/2 27.02.05 Histopath

CIS Cervix CIS Endocervix

2 ICD10 D06.0 M8140/2 D06.9 M8077/2

15.04.0527.02.05

Histology Histology

Cervix 2 ICD10 D06.9 M8077/2 D06.9 M8140/2*

27.02.0515.04.05

Path Path

Cervix NOS 1 ICD03 C53.9 M8148/2 27.02.05 Pathology

Cervix – Endocervix

2 ICD10 M8077/2 M8560/2 27.02.0515.04.05

Histo Histo

Cervix NOS 2 ICD02 C53.9 M8077/2 M8148/2

27.02.0515.04.05

Histology

Cervix 1 ICD10 D06.9 M8560/2 Mixed CGIN & CINIII

tumour

27.02.05 Histology

Cervix 1 ICD10 D06.7 M8560/2 Mixed CGIN & CINIII

27.02.05 Histology

CINIII & CGINIII 2 ICD10 D06.1 M8077/2 D06.0 M8140/2

27.02.05 15.04.05

Histology Histology

No Problems with

Case 10




ICD Site Codes = C56 or C56.9

Site in text = Ovary


Coded as ovarian origin as the report states “probable” – a registerable term, see Training Manual part 3, Page 21 (training group version

C&CG agree this could be interpreted as “female genital tract or UKP peritoneum” – not all cases have a black and white answer!!

HOWEVER

Case 10- Registries’ AnswersSite in Text No

.Classn Codes Incidence

DateBasis of

Diagnosis

Ovary 1 ICD10 C56 M8020/3 19.06.07 Hist

Ovary 1 ICD10 C56 M8020/3 19.06.07 Hist

Female Genital Tract 1 ICD02 M8020/3 19.06.07 Histology

Female Genital Tract 1 ICD02 C57.9 M8020/3 19.06.07 Histology

Fem Gen NOS 1 ICD10 M8020/3 19.06.07 Histopath

Ovary 1 ICD10 C56X 8020/3 19.06.07 Histology from Mets

Ovary 1 ICD10 C56X M8020/3 19.06.07 Pathology From Mets

Female Genital Tract 1 ICD03 C57.9 M8020/3 19.06.07 Pathology

Ovary 1 ICD10 M8020/3 19.06.07 Pathology

Female Genital Tract NOS

1 ICD03 C57.9 M8020/3 19.06.07 Histology

Ovary 1 ICD10 C56 M8020/3 19.06.07 Histo

Ovary 1 ICD10 C56 M8020/3 19.06.07 Histology


Case 11




ICD Site Codes = C79.6 or C80Site in text = UKP Ovary Diagnosis Date = 02.02.06Krukenberg always metastatic therefore UKP as no primary yet detected.

Case 11 - REGISTRIES’ ANSWERSSite in Text No. Classn Codes Incidence

DateBasis of diagnosis

Secondary Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Hist of Mets

Secondary Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Histology

Left Ovary 1 ICD02 M8490/6 02.02.06 Histology of mets

Ovary (Stomach) 1 ICD02 C56.9 M8490/6 02.02.06 Histology

Secondary Ovary 1 ICD10 M8490/6 02.02.06 HM

Secondary Malignant Neoplasm of Ovary

1 ICD10 C79.6 M8490/6 02.02.06 Histology of mets

GI Tract 1 ICD10 C26.9 M8490/6 02.02.06 Pathology

Primary Unknown 1 ICD03 C80.9 M8490/6 02.02.06 pathology

Ovary but goes to C79.6 1 ICD10 C79.6 M8490/6 02.02.06 Hist of Mets

Unknown Primary 1 ICD03 C80.9 M8490/6 02.02.06 Histology

Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Histo

Unknown primary 1 ICD10 C79.6 M8490/6 02.02.06 Histo

UKP - Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Histology

Case 13




ICD Site Codes = C56

or C56.9

Site in text = Ovary


LOR – PO/00/04

“The C&CG following advice from gynaecological pathologists and oncologists, recommends that is appropriate to classify mixed tumours as surface epithelial tumours of the ovary.”

Case 13 - REGISTRIES’ ANSWERSSite in Text No. Classn Codes Incidence Date Basis of

Diagnosis

Ovary 1 ICD10 C56 M8461/3 12.03.07 Hist


Rt. Ovary ?1 or 2 ICD02 M8460/3

M8380/3

12.03.07 Histol Prim

Ovary 1 ICD02 C56.9 M8460/3 12.03.07 H

Ovary 1 ICD10 M8460/3 12.03.07 HP

Ovary 1 ICD10 C56X M8460/3 12.03.07 Histology

R. Ovary 1 ICD10 C56X M8461/3 12.03.07 Path

Ovary 1 ICD03 C56.9 M8461/3 12.03.07 pathology

Ovary 1 ICD10 M8460/3 12.03.07 Histo

Ovary 1 ICD03 C56.9 M8461/3 12.03.07 HI

Ovary 1 ICD10 C56.9 M8460/3

12.03.07 Histo

Ovary 1 ICD10 C56X M8460/3 12.03.07 Histo


Case 14




ICD Site Codes = C48.2

Site in text = Peritoneum


C&CG agree that M8461/3 may be allowed as an alternative morphology code


Date Basis ofDiagnosis

Peritoneum 1 ICD10 C48.2 M8460/3 30.06.06 Hist

Peritoneum 1 ICD10 C48.2 M8441/3 30.06.06 Hist

Peritoneum 1 ICD02 M8441/3 30.06.06 Cytol

NK 1 ICD02 C80.9 M8441/3 30.06.06 H

Peritoneum 1 ICD10 M8441/3 30.06.06 HP

Peritoneum 1 ICD10 C48.1 M8441/3 30.06.06 Histology

Peritoneum 1 C48.2 M8441/3 30.06.06 Cytology

Peritoneum/Omentum 1 ICD03 C48.1 M8461/3 30.06.06 Pathology

Peritoneum 1 ICD10 M8441/3 30.06.06 Histo

Peritoneum 1 ICD03 C48.2 M8441/3 30.06.06 HI

Peritoneum 1 ICD10 C48.2 M8460/3 30.06.06 Histo

Peritoneum 1 ICD10 C48.2 M8461/3 30.06.06 Histo

Peritoneum 1 ICD10 C48.2 M8441/3 30.06.06 Histology

Case 15





Site in text = Peritoneum


Case 15


LOR: Endometrial carcinoma of endometrioma is a tumour containing endometrial tissue: Where a carcinoma occurs wthin ectopic endometrial material inside the peritoneal cavity the cases should be coded with an endometrial morphology M8380/3 but with the primary site of peritoneum C48.2 (C&CG email sent 16.12.05 Nigel Brook).

Case 15





Site in Text = Rectosigmoid septum



DateBasis of Diagnosis

Peritoneum 1 ICD10 C48.2 or C76.3 M8441/3 29.11.06 Histology

Pelvis 1 ICD10 C76.3 M8441/3 29.11.06 Histology

Rectovaginal septum 1 ICD02 M8441/3 29.11.06 Histol Prim

Rectovaginal septum 1 ICD02 C76.3 M8441/3 29.11.06 H

Endometrium 1 ICD10 M8441/3 29.11.06 HP

Rectovaginal septum 1 ICD10 C76.3 M8441/3 29.11.06 Histology

Rectovaginal septum 1 ICD10 C76.3 M8441/3 29.11.06 Path

Rectovaginal septum 1 ICD03 C76.3 M8441/3 29.11.06 pathology

Rectovaginal septum 1 ICD10 M8441/3 29.11.06 Histo

Peritoneum 1 ICD03 C48.2 M8441/3 29.11.06 HI

Rectosigmoid septum 1 ICD10 C76.3 M8441/3 29.11.06 Histo

Rectosigmoid septum 1 ICD10 C76.3 M8441/3 29.11.06 Histology

Rectovaginal septum 1 ICD10 C76.3 M8441/3 29.11.06 Histology

Summary

We are good at -• Determining how many primaries exist• Selecting correct Incidence Date• Recording correct basis of diagnosis• Interpreting medical terminology to assign

clinical codes.We adhere to Cancer Registration

STANDARDS

Summary (Cont..)

Here is your very own GOLD STAR

GOODBYE

WE HOPE YOU HAVE ENJOYED THE DAY

THANK YOU FOR YOUR ATTENTION

SAFE JOURNEY HOME!

Documents

UKACR GYNAE CANCER STUDY DAY ANALYSIS OF CASE STUDIES Tuesday, 8th April 2008 Julian Hodge Building, Cardiff Joy McRae - ACC