The process of converting the medical record information into standardized codes within a uniform data set is
Pediatric tumors are analyzed by _____ rather than origination site.
Benign and borderline CNS and brain tumors became reportable effective_____
January 1, 2004 per Benign Tumor Cancer Registries Amendment Act
All benign/borderline Central Nervous System (CNS) and Intracranial (brain et al) tumors with a behvior code of /0 and /1 and all cases with a behavior code of /2 and /3 in ICDO-3, except:
squamous and basal cell carcinomas of skin (after 01/01/2003)(except reproductive),
Carcinoma In Situ of cervix and Intraepthelial neoplasm of cervix (CIN) III , prostate (PIN) III, vulva (VIN) III, vagina (VAIN) III, and anus (AIN)III. (after 01/01/1996)
Reportable Diagnosis
Analytic cases
Patients who were diagnosed or who received any part of first course of treatment at the hospital
Non-analytic cases
Patients who receive non-first course treatment for a cancer, patients pursing second opinion, patients with a hx of cancer but being seen for another condition
Examples of ____sources:
pathology reports
disease index
medical record reports
radiation oncology logs
medical oncology logs
outpatient records
radiology reports
other hospitals, nursing homes, out of state facilities, hospitces, outpatient centers, physician offices, death clearance
Date of first contact
Date the patient was first physically seen at the facility for a cancer diagnosis or treatment
Non-Reportable diagnoses
squamous and basal cell carcinomas of skin (after 01/01/2003)(except reproductive),
CIS of cervix and CIN III ,PIN III, VIN III, AINIII(after 01/01/1996)
Systematic method for identifying all eligible cases to be included in the cancer registry database
Death certificate only benchmark rates by CCR agencies
Seer no more than 1.5%
Casefinding timliness benchmark rates for NAACCR, SEER, NPCR
NAACCR at least 95% be avail w/in 23 months of dx
SEER complete counts w/in 22 months of dx
NPCR 90% be avail within 12 mos; 95% within 24 mos
CoC 90% be abstracted within 6 months of date of first contact
Ambiguous terms that constitute a diagnosis
comparable with
compatible with
consistent with
malginant appearing
most likely
neoplasm * only for brain, CNS
suspicous for
tumor* only for brain, CNS
typical of
T or F? Abstract cytology with ambigous term only if positive biopsy or physician clinical impression of cancer support cytology findings
Ambigous terms that DO NOT constitue a dx of CA without add'l information
Cannot be rules out
potentially malignant
rule out
bordering on
concerning for
Requests from the facility's cancer committee or central registry to collect information about tumors that are not required to be abstracted by the CoC for accredited programs are called____cases.
Reportable by Agreement
Class of case -- to --are analytic cases
Class of case -- to -- are included in treatment and survival analysis
Analytic class of case -- dx on or after January 1, 2006 are not required to be staged or followed
class of case --to-- are non-analytic
The CoC does not require registries to accession, abstract, or follow class of case -- to -- but the program or central registry may require them
The date the registry database started which is always January 1
reference date
What is the CoC's retention timeframe
abstracts may be destroyed one year after the patient expires
The accession number is a 9 digit number first 4 digists represent
the year patient was first seen at the facility
The accession number is a 9 digit number last 5 digits represent
The sequential order in which the patient was entered into the database for that year
The sequence 00 means the patient has ____malignant primary cancer
The sequence numbers are divided into 2 groups ___ and ____
1. malignant and in situ
2. Non-malignant
GISTS with mets, positive LNs or ________ must have behavior changed to /3 and be abstracted
multiple foci
Brushings, washings, cells aspirates are not _________ procedures
surgical diagnostic staging procedures
Excisional biopsies of primary site are coded as_____procedures
surgical procedure of primary site
Do not code procedures that excise, aspirate or remove lymph nodes to diagnose or stage cancer in "surgical diagnostic staging procedures". Code as_____
code in scope of regional lymph node surgery under surgical procedure of primary site
____ staging rules: Information obtained before treatment or within 4 months of date of diagnosis (whichever is shorter)
Clinical staging
___staging rules: Information through the first course surgery or within 4 months of date of diagnosis (whichever is longer)
Pathological staging
___reporting is considered when cases are need for epidemiologic protocls, research or tumor board presentation at hospitals. Using this method cases are identified within___days.
Rapid case reporting
15-30 days after diagnosis or admission
Local recurrence
recurrence in primary organ
trocar recurrence
recurrence in scar tissue of removed organ
regional recurrence
recurrence in adjacent organ or lymph nodes
distance recurrence
recurrence in location beyond regional
suspense system
system cancer registry uses to maintain identified cases on casefinding but not yet abstracted.
What is the follow-up percentage maintenance rate for all analytic patients from the cancer registry's reference date?
What is the follow-up percentage maintainance rate for all analytic patients within the last 5 years?
The group of data items required to be collected by a standard setting organization
data set
What are the 3 major objectives of a cancer registry?
1. Identify and accession all cases meeting criteria for inclusion in the registry
2. Develop and implement a quality control program
3. Disseminate the data while maintaining patients' confidentiality
If 2 malignancies are diagnosed at the same time, assign the lowest sequence number to the tumor with the worst_____. If no difference, assignment is arbitrary.
Sequence 00 to 59 and 99
In situ or malignant cancers
Sequence 01
1st of several malignancies
Sequence 60 to 88
Benign or borderline tumors
Sequence 60
patient has had one and only one nonmalignant primary tumor
Sequence 61
a patient's subsequent nonmalignant primary tumor
The Cancer Identification section of the abstract contains data items that describe the disease and contains additional administrative information, which includes:
class of case
facility referred from
facility referred to
date of first contact
date of initial diagnosis
primary site
behavor code
diagnostic confirmation
tumor size
regional LNs examined
regional LNs positive
The Stage of disease at diagnosis contains the data items that identify, confirm and support the assigned stage of disease, which includes:
AJCC clinical and pathological TNM elements
SEER Summary Stage 2000
Collaborative stage elements
The Patient identification of the abstract consists of items that identify the patient or descriptors and include:
accession number
sequence number
medical record number
social security number
patient name
patient address at diagnosis
place of birth
date of birth
spanish origin
primary payer at diagnosis
comorbidities and complications
physicians who were involved with the diagnosis and treatment
The ______section of the abstract contains data items that describe the surgical procedures, radiation therapy, chemotherapy, hormone therapy, immunotherapy (biologics), hematologic transplant and endocrine procedures, pallative procedures.
First Course of Treatment
The ___section of the abstract consists of the follow up data items, date of first recurrence, type of first recurrence, date of last contact or death, vital status, cancer status, following registry, follow up source, and next follow up source
The demographic section of the abstract contains:
race, age, sex, geographical location (found on facesheet and MD notes)
The ____section of the abstract contains override flags, coding system used to abstract case, reporting facility, abstractor who coded case.
Data collected by____provide:
a source for planning and evaluating patients
administrative planning by cancer committee and physicians
used by government and private entities to develop cancer control programs
investigate cancer research
cancer registries
primary site
cell type
extent of tumor spread
Patients with date of contact > 15 months after date of last contact have been____
lost to follow up
One disadvantage of changing the reference date is
Cases accessioned prior to the new reference date are deleted or become non-analytic
To be considered for initial CoC survey, the cancer registry database must have ___complete years of data
An annual sequential listing of all eligible cases included in the registry database is a definition of
Accession register
A summary of pertinent information about the patient, cancer diagnosis and treatment, and patient follow up is a definition of
A minimum of __________ of the annual analytic caseload should be reviewed for accuracy, completeness, and timeliness by a physician.
A group of diseases in which cells grow and spread unrestrained throughout the body
Cancer of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the bloodstream
The ability of cancer cells to penetrate into lymphatic and blood vessels, circulate through the bloodstream, and then invade normal tissues elsewhere in the body
Cancer of the glands
Tumor that is capable of spreading by invasion and metastasis
A malignant tumor that arises from the cells that cover external and internal body surfaces and is composed of epithelial cell
Loss of normal tissue arrangement and cell structure
Grouping of cases with similar prognosis
Determining how closely a cancer cell resembles normal cells
"new growth"
A cancer that arise in the lymph nodes and tissues of the body's immune system
Tumors that have not invaded the basement membrane
A cancer arising in the bone
Cancer that arises in plasma cells of the bone marrow
Tissue growth leading to a larger than usual number of cells in which cell structure and arrangement remain normal
The direct migration and penetration by cancer cells into neighboring
Structure that supports an overlying epithelium or endothelium
basement membrane
A cancer that arises from cells found in the supporting tissues of the body such as bone, cartilage, fat, connective tissue, and muscle
Encapsulated tumors that do not invade other tissues or organs
How far the disease has spread from the primary site
Extent of disease
Malignant tumor of blood vessels located in the skin. People who develop AIDs after HIV are at high risk for developing.
Kaposi Sarcoma
Tumors that have gone beyond the basement membrane
Causes of cancer
chemicals (smoking)
Prevention or reversal of disease using drugs, chemicals, vitamins or minerals
Sebacious gland produces
sudoforius gland produces
ceruminous gland produces
Endoscopic* & clinical esophagus descriptors (3)
lower third
Radiographic and intraoperative esophagus descriptors (3)
6th digit grade code for T-cell lymphoma/leukemia
code 5
6th digit/grade code for B-cell lymphoma/leukemia
code 6
Well-differentiated/Differentiated, NOS-
Grade I
code 1
Moderately differntiated/moderately well differentiated/intermediate differentiated-Grade II
code 2
Poorly differentiated
Grade III
code 3
Grade IV
code 4
Grade or differentiated not determined or not applicable
code 9
When did ICDO-3 become effective?
January 1, 2001
Slender flexible, lighted tube used to examine the rectum and PART of the colon
slender, long, flexible, lighted tube used to examine the ENTIRE colon
The discover of the _____led to the pathological study of cancer and the birth of oncology
Grade for carcinoma in situ is always
"foci of invasion" , "microinvasive" make the tumor
invasive /3
MPH timing rules for melanoma, colon, lung, breast
2 months-melanoma
1 year-colon
3 years-lung
5 years-breast
Do not use the physician's statement of recurrence v. new primary, unless pathologist ________
compares the current tumor to the original tumor and states that it is a recurrence.
MPH rules: If tumor described as "multifocal" or "multicentric" use ______rules
unknown if multiple/single tumor
MPH rules: If tumors with separate microscopic foci, ignore and use _____rules
single or multiple
A single tumor that involves, invades, or bridges adjacent or connecting sites or subsites.
Contiguous tumor
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.
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.
Plural of focus.
Indication of which side of a paired organ/site a tumor is located.
The pathologic specimen from the surgical procedure that removed the most tumor tissue.
Most representative specimen
The involved sites are adjacent (next to each other) and the tumor is contiguous.
Overlapping tumor
This term has two meanings:
1. The reappearance of disease that was thought to be cured or inactive (in remission). Recurrent cancer starts from cancer cells that were not removed or destroyed by the original therapy.
2. A new occurrence of cancer arising from cells that have nothing to do with the earlier (first) cancer. A new or another occurrence, incidence, episode, or report of the same disease (cancer) in a general sense - a new occurrence of cancer.
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.
MPH rules
MPH site specific rules for these sites____ and use "other sites" for all other solid tumors.
Brain, malignant, Brain non-malignant, (intracranial and CNS;) Breast; Colon; Head and neck; Kidney; Lung; Malignant melanoma of the skin; Renal pelvis, ureter, bladder, and other urinary
_____tumor can arise anywhere in the kidney tissue. This tumor typically appears in children between 2-5 years of age.
Wilms Tumor/nephroblastoma, NOS (8960)
Adenocarcinoma, intestinal type (8144) is a form of stomach cancer. Do not use this code when the tumor arises in the ______.
colon. code to 8140
98% of colon cancers are
Must have > ---% mucinous to code mucinous adenocarcinoma in the colon
MPH colon rules: exophytic" and "polypoid" are not synonymous with______.
Adenocarcinoma arising from the colon wall (no evidence of a polyp) =
Frank adenocarcinoma
Rectum and rectosigmoid are covered by The Other Sites rules(not the colon site rules) . True or False?
Frequently a patient may have two or more tumors in one lung and may have one or more tumors in the contralateral lung. The physician may biopsy only one of the tumors. Code the case as _______ tumor unless one of the tumors is proven to be a different histology
MPH Lung rules: Do not base multiple primary decision on this phrase; It does not mean this is a single or multiple primary.
Bilateral. Use the multiple primary rules to decide whether to code bilateral lung cancers as a single or multiple primary.
A villous adenoma is a
The middle dividing line that separates the body into right and left sides.
Most common cancer in women
Breast cancer
Most common cancer in men
Prostate cancer
Second most common cancer in men and women. Leading cause of total cancer deaths
Lung cancer
Third most common cancer in men and women. Second leading cause of cancer deaths
Colon cancer
After breast, lung and colon cancer the most common cancers in women are (2)
Uterine and ovarian
After prostate, lung, colon cancer, the most common cancers in men are (2)
Bladder and melanoma
RT-PCR (Reverse Transcriptase Polymerase Chain Reaction)
Lab test used to detect/quantify RNA. Used to detect ITCs in lymph nodes/ tumor cells within a tissue.
CISH (chromogenic in situ hybridization)
Lab test used to localize a specific DNA or RNA sequence in a specimen. Bright light field. Similar to IHC. Used to determine HER2 status. Doesn't require a special microscope.
IHC (immunohistochemistry)
Lab test-Antibody staining method to enable visualization of specific antigens w/an electron microscope.
Lab test-rapid technique used to detect cytogenetic abnormalities in malignant cells. Uses fluorescence.
Subsequent (secondary) treatment
All treatment following discontinued first course treatment, including discontinuance due to trt failure or progression.
For Leukemia: all therapy after relapse.
Adjuvant therapy
Prophylactic treatment in the hope of delaying/preventing recurrence. Given in conjunction with or after other trt methods.
Neoadjuvant therapy
Systemic and/or radiation therapy given before surgical resection
The amount of radiation given in 1 treatment and frequency w which the doses are given.
1 gray=___rads
1 cGy=____Gray
Radiation treatment volume
Code the Anatomical location
Location of radiation treatment
Code the Facility where RT administered
Regional treatment modality
Code the Type of energy and technique (eg. Electrons, IMRT) used in dominant/most clinically significant trt. Do not include boost trt
Regional dose:cGy
Code the most dominant or clinically significant regional dose.
The Number of treatments to this volume
Code the actual number of sessions.
Group of anti cancer drugs that inhibit reproduction of cancer cells interfering w DNA and mitosis (rapidly dividing).
Boost treatment modality
Code the Type of energy and technique (eg. Electrons, IMRT) used in dominant/most clinically significant boost trt. Do not include regional trt
Boost dose:cGy
Code the most dominant or clinically significant boost dose.
Chemotherapy treatment cycle
Chemo regimen administered to a specific regimen. 21 or 28 days.
Chemotherapy regimen
Several cycles
Alkylating agents
Chemotherapy that interferes with DNA responsible for cell function and replication. Phase non-specific. E.g. Cytoxan, Leukeran
Inhibit enzymes required for protein synthesis and cell metabolism. S-phase specific. Eg. Leucovoran, methotrexate, 5 FU
Natural agents
Anti tumor antibiotics, (andriamycin)plant alkaloids (oncovin), taxanes, (taxotere) enzymes (elspar)
Misc chemotherapy agents
Cisplatin, hydroxyurea, carboplatin
Only code ____as cancer directed hormone therapy when administered in combo with chemo. Eg. CHOP
Drugs that mimic the actions of hormone releasing factors
Drugs that inhibit the actions of hormone releasing factors
In men, ____hormone surpresses LH blocking testosterone and used to treat advanced prostate cancer
Interfere with hormone molecule and receptor site on cancer cell that stimulates growth and proliferation. eg. Tamoxifen
Aromatase inhibitors (anti estrogens)
Block enzyme that's a major source of estrogen. Eg. Anastrazole, Femara
Radiation and/or surgery must be bilateral to qualify as ______surgery, unless only 1 gland is intact.
Endocrine/hormone. Eg. Oophorectomy, orchiectomy
Do not code hormone replacement therapy as cancer directed hormone therapy , except for______.
Thyroid stimulating hormone (TSH)
The timeframe for calculating survival starts when there is a diagnosis of a _______tumor
MPH rules: there are 3 sections in MP section
Unknown if single or multiple
MPH rules: there are 2 sections in H section
Only ____tumors are included in nationally published incidence data
A single tumor is a single primary when
It is always a single, it contains multiple histology terms, and is confined to the primary site of origin
_____stage primarily used by central registries that report to NPCR
SEER Summary Stage
______stage is not well understood by physicians
SEER Summary Stage
Summary Stage went into effect
January 1, 2001
Summary Stage one digit code from 1 to
Summary Stage 0=
In situ:-within the cells, can only be pathologically confirmed
Summary Stage 1=
Local: limited to the organ of origin
Summary Stage 2-5=
Regional: beyond the organ of origin-
-direct extension
-extension to reg LNs
-combo of ext to reg organ/LNs
Summary Stage 7=
Distant: cells broke away from primary site and traveled to distant site
Summary Stage 9=
For _____ cancer, any mention of LN s equals involvement
For _____tumors, fixed or matted and/or a mass in the mediastinum, retroperitoneum and/or mesentary means LNs are involved
Solid tumors
Enlarged LNS or lymphadenopathy considered involved LNs only for ____cancer.
Malignant cells released into bodily fluid. E.g. Peritoneal, ascites
Common mets sites
Liver, lung, bone, brain
Diagnostic confirmation for bone marrow biopsies/asirations of any site should be coded as positive ______findings
Hematologic confirmation of leukemia only by peripheral blood smear, CBCs, WBCs, should be coded as positive _________________confirmation
3 Conditions must be met for the "inaccesible Lymph Node rule" (i.e. Can code 00 no lymph node involvement).
1. no mention of LN involvement clinically
2. Low stge, T1, T2, localized
3. Usual treatment for low stage
Accessible lymph node rule applies to palpable lymph nodes
A statement such as "WNL, remainder of exam neg or no further disease" must be stated in order to code 00 no lymph node involvement
SEER EOD Stage ended 12/31/2003 and was replaced by SEER___Stage effective 01/01/2004.
Seer Collaborative Stage
SEER EOD stage consisted of a 10 digit code.
a. 3 digits for ______
b. 2 digits for ____
c. 1 digit for ___ involvement
d. 2 digitis for # of ______ positive Reg LNs
e. 2 digits for # Reg LNs examined _______
a. size of tumor in mm
b. extension (+2 for prostatectomy extension)
c. lymph node
d. pathologically
e. pathologically
What was the con of SEER EOD staging?
1. Local extension or Regional lymph node involvement was lost when distant lymph nodes or mets were involved.
SEER Summary Stage 2000 went into effect 01/01/2001. It consists of a ____digit code
SEER Summary Stage codes:
a. 0 or _____= within the cells, only pathologically confirmed
b. 1 or ____=limited to organ of origin
c. 2-5 or ____=beyond the organ of origin
(1. direct extension; 2. involving
Reg LNs, 3. combo of 1. and 2.)
d. 7 or ____=Cells broke away from primary
site and traveled.
e. 9 or _____
a. 0 or in-situ
b. 1 or local
c. 2-5 or regional
d. 7 or distant
e. 9 or unkown
T or F? Lymphoma can arise in any site
What are the 4 lymphatic structures
Peyer's patch (ileum)
Waldeyer's ring (tonsils)
What are the common extra lymphatic sites lymphoma arises in? (6)
small intenstive
GI tract
(any organ can be involved by lymphoma)
When multiple LN chains are involved with lymphoma code to
When there are multiple LNs involved in one LN chain for lymphoma code to that chain
extranodal site and regional LN involvement for lymphoma code the primary site as
the extranodal site
If its suspected that lymphom is extra nodal and known not to arise in the LNs, and no site is given code to
unknown primary site c80.9
?-cells transform into plasma cells and secrete antibodies that attache to the infection and causes it to die. ?-cells go straight from the bone marrow into the lymph system
? cells are formed in the thymus gland an attack foreign substances by engulfing it with a toxic effect
For hematopoietic primaries the 6th digit is not grade/differentiation but the immunophenotype based on ____type
For lymphomas, the number of _______involved affects the site code. The number of _____involved affects the stage.
chains (site)
regions (stage)
For Lymphoma, Bilateral nodal involvement is considered two regions for ____purposes
Bilateral involvement of a paried extra-nodal organ for ______is considered a single organ
Any mention of enlarged lymph nodes (palpable, enlarged, visible swelling, shotty, lymphadenopathy) is considered involved for these 2 sites only
equivocal means
Leukemias grouped by how quickly the disease develops or gets worse (2)
chronic or acute
Leukemais are grouped by type of white blood cell affected (2)
lymphoid (lymphocytic) or myeloid (myelogenous)
2 More common type of leukemia among children
acute lymphocytic leukemia -ALL (more than half of all childhood leukemias)
acute myelogenous leukemia -AML (just under half of all childhood leukemias)
Non-malignant tumors must originate in the ___ and ____, not in the skull or vertebrae (bone) to be reportable
brain and
spinal cord
Rathke pouch (craniopharyngioma) is located in the ______ reportable as a brain related benign tumor
craniopharngeal duct
Chondroma must origniate in a ___related site (not the skull, ie.bone) to be reporable
True or false ? Chordoma (not chondroma) is a malignant tumor arising from the embryonic tissue; malignant tumor of the cartilage cells and is reportable.
True or false? For non-malignant brain/CNS tumors only, Count ALL non-malignant CNS tumors over the lifetime of the patient, even if diagnosed prior to 2004.
True or false? Refractory Anema did not become reportable until 01/01/2001
True or false? There is no AJCC TNM staging for any of the brain schema sites.
Superior vena cava syndrome is associated with which type of cancer?
Which body cavaties are frequently checked for cancerous involvement of cells in fluid?
Pleura (enclosing the lungs)
Peritoneum (enclosing the intestinal tract)
pericardium (enclosing the heart)
____imaging uses a scan using pencil thin radiation beam for a slice or cross section of the body, to create a series of pctures taken from different angles
CT scan
___imaging uses a scan taking cross-sectional slices (views) from many angles, using magnets
___imgaing produces shadow-like images of bones and certain organs and tissues
____imaging used for persons diagnosed with breast cancer or at a high risk for breast cancer
Breast MRI
___scans make pictures based on the body's chemistry rather than on physical shapes using liquid substances called radionuclides/radiopharmaceuticals/tracers that release low levels of radiation
nuclear medicine scan (e.g. bone scan, PET scan, thyroid scan, MUGA scan, Gallium scan)
Other studuies that use idodine based dyes/contrast (2) examples
barium enema
intravenous pyelogram
tumor marker CA 125 is used in screening for ___cancer
ovarian cancer
tumor marker CA19-9 is used in screening ___ cancer
Gastrointestinal cancer
tumor marker CA 549 is used in screening for___cancer
advanced cancer
tumor marker CA 195 is used in screening for ___cancer
Gastrointestinal cancer
tumor marker CEA is used in screening for any
malignancy check? colon?
tumor marker CA 15-3 is used in screening for ___cancer
metastatic breast cancer
___procedures in clude endoscopic and operative explorations that examine the body through and opening or small incision
manipulative procedures
The most widley used tumor marker to help screen for cancer in the general population
PSA blood test
In determining sequence number, make sure first malignancy was reportable at the time of the new malignancy diagnosis (except for benign brain/CNS tumors). For example polycythemia vera was not reportable until 2000. true or false?
When determining class of case, first course treatment options include "recommended but refused" and "not recommended". true or false?
Any first course treatment, whether curative or pallaiative is used for determining class of case. true or false?
For class of case, pathology specimens read in pathology the date should be 1. the date of procedure or, 2. the date the pathology was received or read?
1. the date of the procedure
If the patient was seen at the facility for a radiation consult, the date of the first contact would be the date of the consult if ____ was developed at that time.
the treatment plan
Estimating dates-Spring =
Estimating dates-middle of the year=
Estimating dates-Fall=
Estimating dates-winter=
December or January
Most paired sites cannot develop a midline tumor with the exception of____
skin of trunk
Bone marrow aspirations or biopsies of any site are considered ____diagnostic confirmation
Peripheral blood smears, CBCs, and WBCs for leukemia only are considered____diagnostic confirmation
If work-up negative on the visit, but positive on a later visit the date of first contact would be___.
the later visit
According to FORDS, the date of diagnosis is the____
earliest date that a recognized medical practitioner says the patient has cancer
Prostate CA: Average age at the time of diagnosis
66 yo
___syndrome, also known as hereditary non-polyposis colorectal cancer or HNPCC, inherited gene changes having an increased risk for a number of cancers including prostate cancer
Lynch syndrome
Certain genes that cause cells to grow, dividie, stay alive
Genes that slow down cell division, repair mistakes in DNA or cause cells to die at the right time
tumor surpressor genes
Prostate cancer metastasizes to where first?
Prostate CA: which has priority for grading/6th digit? Gleason score or terminology (eg. well-differentiated)
Gleason score has priority
Which is the primary pattern? which is the secondary pattern? 4+3=7
4 is primary pattern
3 is secondary pattern
Gleason score: If only one number is given and it is =<5, assume it describes the_____
Gleason score: if only one number is given and it is >5, assume it describes the____
Prostate CA: If there are multipble biopsies and Gleason scores. Code the ____score.
Highest score.
Prostate Ca: 10/10 Gleason the score is:
Prostate Ca: cN is determined via biopsy or imaging. For pN a __is required.
LN dissection
Prostate Ca: Code the highest ____value prior to diagnostic biopsy or treatment
PSA value
Prostate Ca: TURP is a clinical staging method but is coded in SPPS (keep rules for data items separate!) T or F?
A Prostatectomy is required for pathological staging of the T. True or False?
True. (exception Bx of rectum permits pT4 or of extraprostatic soft tissue permits pT3)
Prostate Ca: ipsilateral, contralateral or bilateral involvemnt is regional for prostate LNs. true or false?
Prostate Ca: The pathologist should count cores, not fragments, chips, pieces, speciments or positive lobes.
Prostate Ca: non-regional LNs are:
common iliac
Prostate Ca: regional LNs are:
iliac-internal/external, nos
Prostate Ca:
Gleason 8-10= Grade:
Grade 3 (Grade 3 2003-2013)
Prostate Ca:
Gleason 7=Grade:
Grade 2 (Grade 3 2003-2013)
Prostate Ca:
Gleason 5-6=Grade:
Grade 1 (Grade 2 2003-2013)
Prostate Ca:
Gleason 2-4=Grade
Grade 1 (Grade 1 2003-2013)
Prostate Ca: 2 types of radiation therapy treatment
brachytherapy-LDR-seeds implanted in area or HDR seeds implanted into prostate
External beam-EBRT, 3D-CRT, IMRT (most common), SBRT, PBRT
Prostate Ca: HT therapy or Androgen Deprivation Therapy (ADT)
LHRH analogs-leuprolide, goserelin, triptoorelin, histrelin; Degarelix, Abiraterone (LHRH antagonists)
Antiandrogens-flutamide, bicalutamide, nilutamide, Enzaltutamide
Other-estrogen, Ketoconazole
Prostate Ca: Common Chemo drugs used
Lung Ca: Most common mets sites:
adrenal glands
contralaeral lung
subcutanous tissue
virturally any organ
Lung Ca: If biopsied primary tumor cannot be reomoved, and if the higest T and N or M1 categories of the tumor can be confirmed microscopically, ther criteria for pathologica staging may be met without resection. True or False?
Lung Ca: When term hilar, perihilar, infrahilar or soft tissue mass it should be considered Lymph Node involvement. True or False?
Lung Ca: When term mediastinal mass it should be considered Lymph Node involvement. True or False?
Lung Ca: If Hilary Mass is only description, code to Hilum C34.0. T or F?
Lung Ca:
Left Lung has ___lobes
Right lung has ___lobes
2 membranes that surround the lungs:
visceral pleura-covering lungs
patietal pleura-adherent to rib cage, diaphragm, pericardim (space around heart)
Use ypT, ypN categoreis to pathologically stage after _____treatment
Lung Ca: presence of pleural effusion for lung only is enough to code M1a. Does not have to state malignant pleural effusion. T or F?
Lung Ca: Any lymphadenopathy, enlargement or mass of LNs=
LN involvement
Lung Ca: Staging procedures include:
exploratory thoracotomy
Biopsy, FNA
surgical observation w/o biopsy
Lung Ca: TX used when primary tumor cannot be assessed but it was proved to be lung ca based on presence of maligant cellsin sputum or washings. T or F?
Lung Ca: T0pM1a : No evidence of lung lesion on imaging, yet pleural effusion biopsied & was malignant consistent with Ca. true or false?
Lung Ca: cases that have nodules in the contralateral lung are considered distant (M1a) disease. T or F?
Lung Ca: Common chemo drugs:
Paclitaxel /Taxol
Lung Ca: Targeted therapies:
Avastin(angiogenesis inhibitors)
Cetuximab/Erbitux(angiogenesis inhibitors)
Ramucirumab/Cyramza(angiogenesis inhibitors)
Tarceva (EGFR inhib)
Gilotrif(EGFR inhib)
Iressa/Gefitinib (EGFR inhib)
Breast Ca: T can be based on clinical or pathological, though pathological takes precedence. T or F?
Breast Ca: Must have resection or ___biopsy with neg or micro margins only for pathological T
excisional biopsy
Breast Ca: ____LNs reside within the breast tissue and are coded as axillary LNs
INTRAmammary LNs
Breast Ca: Clinical diagnosis of ___breast cancer not enough. Must be stated in final diagnosis of pathology report to be coded as such.
Inflammatory breast cancer
Breast Ca: satellite skin nodule or skin involvement includes:
peau d'orange
Breast Ca: Distant mets includes:
Cervical LNs
contralateral internal mammary or axillary
contralateral infraclavicular or supraclavicular LNs
Breast Ca: LNs positive for ITCs are not considered positive LNs. T or F?
Breast Ca: Pathological N is used for excision or sentinel LN biopsy only in conjunction with a pathological T assignment. T or F?
True (i.e. Excisional bx of LN or bx of SLN in absence of pT assignment is classified as a clinical N, for example cN1)
Breast Ca:____ are small clusters of cells not >0.2mm
Breast Ca:___ are tumor deposits >0.2 mm but not >2.0 mm. They are designated as pN1mi
Breast Ca: No clinical/radiologic evidence of distant mets, but deposits of molecularly/microscopically detected tumor cells in circulating blood, bone marrow or other distan nodal tissue not >0.2 mm (circulating tumor cells-CTCs) are designated as cM0(i+) . True or False
Breast Ca: primary site for tumor that overlaps more than one quadrant
C50.8 overlapping lesion
Breast Ca: primary site for tumor when quadrant is unknown or multiple tumors in different quadrants of the same breast
C50.9 Breast, NOS
Breast Ca: A biopsy with macroscopically positive margins is an _____ biopsy and cannot be used for pathological staging.
Breast Ca: Simultaneous tumors in each reast are considered separate primaries per MPH rules. T or F
Breast Ca: ___disease with a palpable mass on clinical exam and with an invasive component on pathology is classified according to the invasive component.
Breast Ca: ___disease with a palpable mass on PE, but no invasive component on pathology is assigned Tis (DCIS or LCIS)
What are considered local therapies? (2)
Surgery and radiation therapy
What are considered systemic therapies? Drugs which can give given by mouth or directly to the bloodsream to reach cancer cells. (3)
targeted therapy
Breast CA: common chemotherapy drugs:
Breast CA: Hormone treatments
Tamoxifen-blocks estrogen in breast cancer cells
Femara (Aromatase inhibitor)
Anastrazole/Arimidex (AI)
Aromasin (AI)
Breast Ca: Targeted therapy (biologics/immuno)
Colon Ca: T category is not based on size, but depth of ____
Colon Ca: Tumors are either Frank/De Novo or arise in a
Colon Ca: TDs/Foci/satellite nodules in fat are to be recorded in the N category, if no other LN involvement described.T or F?
Colon Ca: Regional LNs depends on subsite of primary site
Colon Ca: Superior mesenteric LNs are Distant LNs for all colon subsites
Lung Ca: most common histologies (3):
squamous cell carcinoma
small cell carcinoma
The return or reappearance of the cancer after a disease-free interval
When a patient who was never disease-free develops further regional or distant mets
Use MPH Rules to determine if new primary or recurrence. What are the 2 exceptions to this rule?
1. If the pathologist compares the current tumor to the original tumor and states it is a recurrence.
2. If the physicians says the current tumor is a metastasis of the prevous tumor.
Direct extension or distant mets that developed after the diagnosis was established, and ithe the ___plan is discontinued or changed due to a change in disese status is considered a progression of disease
treatment plan
What data items are followed until first recurrence? (2)
date of first recurrence
type of first recurrence
What data items are updated throughtout patients lifetime?
Date of last contact/death
vital status
cancer status (only by physician or healthcare provider)
following registry/with NPI
follow up source
next follow up source
Epithelial tissue
Covers body surfaces, both inside and out. Eg. Skin, mucosa, serosa.
Functions are to protect, secrete, absorb, filtrate
Squamous cell carcinoma
Malignant tumors of epethelial cells
Malignant tumors of glandular cekks
Transitional cell carcinoma
Malignant tumors w mixed glandular and Squamous cell carcinomas
Connective tissue
Most abundant and widely distributed of all Adipose/fat, collagenous/tendons, ligaments/deep fascia, dense elastic/vocal cords, walls of arteries/trachea, reticular/spleen liver LNs, ligaments, bone
Connect, support, protect
Muscle tissue
1/3 body weight
Striated/skeletal-attach to bones of skeleton
Smooth/visceral-hollow organs
Cardiac-walls if heart
Nerve tissue
Brain, spinal cord, nerves
Move and coordinate bodily functions
Central portion of organ
Outer surface of organ
Functional portion of organ
Cells/tissues that support organ
Mets diagnosed at same time as primary site
Mets diagnosed after primary site diagnosed and treated
Mets diagnosed w an unk primary site
Malignant tumor of embryonic connective tissue
tumor supressor gene, the mutation in breast cancer is associated with a more aggressive disease and poorer survival rates
AJCC General Rule: Biopsy of primary site only is classified as Clinical T, unless the biopsy provides the highest possible T category, in which case it may be classified as a Pathological T. T orF?
AJCC General Rules: Pathological exam of a single LN in the absence of pathological evaluation ofthe primary tumor is classified as a Clinical N. T or F?
AJCC General Rules: Tumor sizes reported in smaller units than mm, such as a tenth or undreth of a mm should be round to the nearest whole mm for reporting staging. e.g. breast tuor of 1.2 mm should be recorded as 1 mm; 1.7mm tumor should be reported as a 2 mm. T or F?
MPH RULES: 2 or more separate primaries, different topographical sites, same morphology=
Separate multiple primaries
MPH RULES: certain tumors which occur in multiple sites eg. Adenomatous polyps)=
One cancer