What the Heck is a Cancer Registrar

1
What the Heck is a Cancer Registrar

• Berna Glassman, CTR
• WY Cancer Surveillance Program

2
Introduction

• Concept of describing disease by stage or extent
  introduced in 1929 by League of Nations World
  Health Organization
• First primary site so described was the cervix
• Stagingshorthand method for grouping cases into
  broad categories based on disease extent
• Primary tumor site, tumor size, number of tumors,
  depth of tumor invasion, involvement of lymph
  nodes and/or spread to distant sites (distant
  metastases)
• Indicates type of treatments to use prognosis

3
What Is Cancer Registry?

• Systematic collection about occurrence of cancer
• Type of cancer
• Extent of disease at time of diagnosis
• Treatments
• Outcomes of treatment
• Quality of Medical care
• Where do we begin?
• Casefinding
• Coding into into specialized database
• Ultimate Goal
• Prevent and control of Cancer!!!

4
How It All Works
5
Now, What the Heck is a Cancer Registrar?

• Medical Healthcare Professional
• Medical Coder
• Cancer-Registry Software Expert
• Public Relations Person
• Educator
• Detective
• STUDENT!

6
Why Would Anyone Want to be a Cancer Registrar?

• Right Livelihood- support yourself without
  harming others
• Challenging
• Worthwhile
• MAKING A POSITIVE DIFFERENCE!

7
Sample Case ScenarioThe Story

• Michael Mouse, aka Mickey--76-yr old married,
  white male, retired actor, lives in Jackson, WY.
  Presented to St. Johns Hospital w/ chief
  complaint of frequent urgent urination
  (3-4x/night). Mickeys PSA was elevated at 22.5
  (normal range 0-4). Mickeys HP were basically
  unremarkable. He is in excellent health for a
  gentleman of his age. A prostate nodule was
  detected on digital rectal exam (DRE). Mickey
  agreed to needle biopsies of his prostate. Needle
  bxs indicated that both prostatic lobes were
  involved with invasive adenocarcinoma. Treatment
  options were discussed. Mickey agreed to hormone
  therapy followed by radical prostatectomy. The
  prostate gland was removed. The 6 lymph nodes
  dissected were negative, as were the surrounding
  tissues surgical margins. Via CT scans, a
  metastatic work up was performed to determine the
  extent of his disease. All scans were negative.
  Mickeys disease was confined to his prostate
  gland with no evidence of disease spread.

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Summary of the Story

• Staging
• T2-tumor involvement - both prostate lobes
• N0-lymph node involvement - none
• M0-Metastases to bones and/or distant organs
  none
• T2 N0 M0- tumor involvement in both lobes ln
  neg no evid mets
• Stage 2, Local Disease
• Treatment
• Hormone Treatment followed by
• Radical Retropubic Prostatectomy w/6 lymph nodes
  sampled
• Outcome
• Patient is Alive
• Cancer Status is No Evidence of Disease (NED)
• Good Prognosis!

9
The Cancer Abstract Part 1

• Patient Information (Demographics)
• MOUSE, MICHAEL WALTER aka MOUSE MICKEY CTR
  10000314-00
• Hos 1 ST. JOHN'S HOSPITAL Hosp.
  231-200500010-00
• Admit 01/10/2005 CC1 DX / RX
• Chart 2310010 Acc Yr2005 Payer60
  (Medicare/Medicade) AbsBLG
• Reporting Source 1 HOSPITAL-IN Follow-up
  Hospital 1
• SSN 987-65-4321 Sex 1 MALE Date of
  Birth 04/15/1928
• ADDR AT DX 444 FRIENDSHIP BLVD JACKSON
  WY 83331
• FU ADDRESS PO BOX 1234 JACKSON
  WY 83331
• Marital St2 MARRIED Place of Birth 097(Calif)
  Age at Dx 76 yrs
• Race 010 WHITE non Hispanic County
  039 TETON
• Occupation ACTOR
• Industry WALT DISNEY ENTERPRISES
  

10
The Cancer Abstract Part 2

• Disease Specific Information
• Date of Dx 01/01/2005 Histology(2) 81403
  ADENOCARCINOMA
• GRADE II MOD DIFF. Hist-3 81403
  ADENOCARCINOMA
• Site C619 PROSTATE Stage
  Stg-2000
• Paired Organ0 NOT PAIRED ORGAN Diag. Conf. 1
  HISTOLOGY
• Tumor Size 999 mm. Positive Nodes 00 Nodes
  Examined 08
• Clinical TNM AJCC Stage
  Staged by NOT STAGED
• Pathological TNM AJCC Stage Staged
  by NOT STAGED
• Sites of Distant Metastasis 0 NONE 0 NONE
  0 NONE

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The Cancer Abstract Part 3

• Best Treatments Code Date
• DIAG/STG 00 00/00/0000
• SURG 50 03/10/2005
• RAD 0 00/00/0000
• CHEM 00 00/00/0000
• HORM 01 01/15/2005
• BRM 00 00/00/0000
• OTHER 0 00/00/0000
• Surgical Approach 8 (retropubic)
• 1st course Scope LN Surg 0 Surg Other Site 0
  Regl LN Examined 06
• Subseq Reconstruct Del 0

12
The Cancer Abstract Part 4

• Follow Up Information

Physicians 21436 ROLAND
FLECK 24481 LISA J FINKELSTEIN 28231 ST. JOHNS
HOSPITAL Survival Time 1 Yr. 9 Mon. Date Last
Seen 10/27/2006 Vital Status1 (alive) Cancer
Status 1 (no evidence of disease)
13
Acknowledgments

• Cancer Registry Management Principles Practices
  Hutchison, Roffers, Fritz (editors)
• National Cancer Registrars Association (NCRA)
  Alexandria, Virginia
• Diagnosis Treatment Workgroup WY Comprehensive
  Cancer Control Coalition
• HIM Cancer Registry Professionals Everywhere
• THANK YOU!
• And now,
• Its Time to Go!