Inquiry And Response

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Inquiry And Response

• American College of Surgeons

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Introduction

• Discussion IR
• Pamela moats, RHIT, CTR

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Topics of Discussion

• ACOS standards
• Fords
• AJCC staging

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Question One

• 18186.
• 4/6/2006.
• Fords.
• There is an OP surgery center not owned by our
  hospital system but used by some of our surgeons.
  The path specimens are sent to our hospital but
  the patient never comes here for treatment even
  though we know the treatment for the patients. We
  can't stage since the chart isn't located here
  but can we enter the cases as class of case 6 or
  7?
• If the patient never comes to your facility and
  the pathologist is only reviewing the tissue,
  your facility would not be required to abstract
  and report this case. This would be a non
  analytic case for your facility, as a class of
  case 7.

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Question Two

• 17983.
• 3/30/2006.
• Cancer PROG STDS 2004.
• IR says that CTR's should attend a national
  cancer related educational activity annually for
  commendation, however, a message last year said
  "once every 3 years." Did that change?

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Question Two Continued

• No. For compliance (1) all members of the cancer
  registry staff must participate in a local,
  state, regional, or national cancer-related
  education activity annually. For commendation
  (1) the cancer registry staff members who are
  CTR's attend a national cancer-related
  educational activity every 3 years AND all other
  registry staff members participate in local,
  state, or national cancer-related educational
  activity annually.

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Question Three

• 18073.
• 3/30/2006.
• Cancer PROG STDS 2004.
• If a patient was diagnosed by cytology from a
  paracentesis or the diagnosis is by CT scan but
  no subsequent treatment was used, is this still
  an analytical case requiring AJCC staging? Our
  pathologists are under the impression that AJCC
  staging is only for resected tumors. If there is
  no resection, such as brachy or cryotherapy, do
  these cases still need to be staged?

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Question Three Continued

• Cases diagnosed from cytology can be clinically
  staged in most cases. All analytic cases with the
  exception of class of case 0 (diagnosed or first
  seen on or after 1-1-06) must be staged at least
  clinically.

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Question Four

• 3/13/2006.
• Fords cancer PROG STDS 2004.

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Question FourContinued

• A staff physician submitting a specimen to the
  lab is a class 7 But what if the pt comes into
  the facility for a bone scan, does this change
  the class of case to 0 or is it still 7 because
  no Tx was performed?
• This case would be a class 0 for your facility.
  On or after 1/1/06 class of case 0 are no longer
  required to be staged or followed. If the
  diagnosis date is prior to 1/1/06, staging and
  follow-up is required. Standard 4.3 requires AJCC
  staging for all analytic cases. The CoC still
  requires class of case 0 patients to be collected
  and abstracted.

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Question Five

• 17843
• 3/8/2006
• Fords seer
• SEER RX does not list the new chemo drug
  Lenalidomide, but should it be entered as a
  chemotherapy agent?

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Question Five Continued

• Yes. Lenalidomide (Revlimid) was highly
  effective in a phase II study of previously
  treated patients with myelodyspastic syndromes
  (MDS) who had a particular gene abnormality.
  Nearly two in three patients no longer required
  regular blood transfusions after a median period
  of only four weeks on the drug. Their blood cells
  also reflected other positive changes.
  Lenalidomide is an anticancer compound related
  to, and less toxic than thalidomide. Lenalidomide
  is the generic name for Revlimid or CC-5013. The
  missing information has been forwarded to SEER
  and the additional drug name will be added to the
  next update of seerrx. Curator

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Question Six

• 17873.
• 3/9/2006.
• AJCC.
• C54 corpus uteri.
• Is the primary site for leiomyosarcoma of the
  uterus coded to C49 or C54?
• Yes, the site would be uterus, however, uterine
  leiomyosarcoma is not stageable according to
  either the soft tissue sarcoma chapter or the
  corpus uteri chapter. This may be staged using
  the CS system, but an AJCC stage will not be
  derived.

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Question Seven

• 17558.
• 2/9/2006.
• AJCC.
• C50 breast.
• Why it is necessary to clinically and
  pathologically stage breast cancers?

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Question Seven Continued

• Clinical stage is essential to selecting and
  evaluating primary therapy. Clinical stage is
  assigned prior to any cancer-directed treatment
  and is not changed on the basis of subsequent
  information. Pathologic stage uses the evidence
  acquired before treatment, supplemented by the
  additional evidence acquired during surgery,
  particularly from pathologic examination.
  Pathologic stage provides additional precise data
  used for estimating prognosis and calculating end
  results. When it is possible, both clinical and
  pathologic stage should be documented.

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