Progressed Abstracting Issues for the Lung Growth Analysis.


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Little cell lung tumors incorporate ICD-O-3 morphology codes M-80413, M-80423, M-80433, M-80443, and M80453. Normal non-little cell lung disease histologies ...
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Progressed Abstracting Issues for the Lung Cancer Diagnosis Judy Andrews, CTR Metropolitan Regional Coordinator Georgia Center for Cancer Statistics GATRA Fall Meeting 2004

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ICD‑O-3 CODES ICD‑0‑3 TERM C34.0 Main bronchus C34.1 Upper flap, lung C34.2 Middle projection, lung C34.3 Lower projection, lung C34.8 Overlapping sore of lung C34.9 Lung, NOS

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Anatomy Related descriptors: Lung= pneumo-, pulmono-, broncho-, bronchiolo-, alveolar, hilar Breathing= - pnea (trouble with breathing=dyspnea) Paired organ Subsites: Right projection: 3 flaps Left Lobe: 2 projections

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Lung Anatomy Carina Upper Lobe Oblique Fissure Middle Lobe Lower Lobe

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Lung Anatomy: Key Words Apex Hilum Carina Lingula Cardiac Notch Pleural Cavity Chest Wall Mediastinum Base

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ICD-O-3 Morphology Codes Small cell lung malignancies incorporate ICD‑O-3 morphology codes M‑80413, M‑80423, M‑80433, M‑80443, and M80453 Common non‑small cell lung growth histologies Squamous or epidermoid (807_3) Adenocarcinoma (814_3) Bronchioloalveolar (82503) Large cell carcinoma (80123) Other subtypes of adenocarcinoma are acinar, papillary,and mucinous Adenosquamous carcinoma (85603) Mesothelioma (905_3) Bronchogenic carcinoma IS NOT a particular cell sort

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Regional Lymph Nodes for the Lung The provincial lymph hubs for the lung are all over the stomach Intrathoracic hubs incorporate mediastinal and intrapulmonary hubs Scalene and supraclavicular hubs are additionally viewed as territorial hubs for arranging

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Intrathoracic Pulmonary 12 Peribronchial 11 Intrapulmonary 10 Hilar 13 Segmental Superior mediastinal 1 Superior Mediastinal 3 Pretracheal,retrotracheal 2 Paratracheal 4 Lower paratracheal, azygos Intrathoracic Aortic 5 Subaortic (aortic window) 6 Para-aortic (climbing aorta or phrenic ) Inferior mediastinal 7 Carinal, subcarinal 8 Paraesophageal 9 Pulmonary tendon Regional Lymph Nodes for the Lung

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Regional Lymph Nodes for the Lung Extrathoracic Scalene Supraclavicular or transverse cervical

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Common Metastatic Sites for the Lung Lymphatic Spread Cervical Lymph Nodes Contralateral Lung Contralateral Mediastinum Hematogenic Spread Brain Bone Liver Adrenal organs Contralateral Lung

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Extent of Disease Evaluation for the Lung Diagnostic Studies: Physical Exam Signs and Symptoms Palpable lymph hubs or organs Pancoast Tumor Horner\'s Syndrome

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Extent of Disease Evaluation for the Lung Diagnostic Studies: Imaging Chest X-beam CAT Scan MRI Scan PET Scan Bone Scan

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Extent of Disease Evaluation for the Lung Diagnostic Studies: Endoscopies Bronchoscopy Mediastinoscopy Thoracoscopy

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Extent of Disease Evaluation for the Lung Diagnostic Studies: Pathological Closed Chest Needle Biopsy Cytology (Thoracentesis) Sputum Cytology Bronchial Washings Bone Marrow Biopsy

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Extent of Disease Evaluation for the Lung Diagnostic Studies: Tumor Markers Neuron Specific Enolase (NSE) Squamous Cell Carcinoma Antigen DNA Studies Adrenocorticotropic Hormone (ACTH) Carcinoembryonic Antigen (CEA) Calcitonin Tissue Polypeptide Antigen (TPA)

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Staging Systems for Lung SEER Extent of Disease 3 rd Edition (Diagnosis year 1988-2003) SEER Summary Staging 2000 (Diagnosis year 2001-2003) American Joint Committee on Cancer (AJCC) TNM 6 th Edition (Diagnosis year 2003 forward) Collaborative Staging (Diagnosis year 2004 forward)

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Staging Systems for Lung SEER EOD Size Extent Regional Lymph Nodes Reg LN Positive Reg LN Examined SEER Summary Stage 2000 In Situ Localized Reg by Direct Ext Reg Ipsilateral LN just Reg by Direct & Ipsilateral Reg LN Reg, Nos Distant Site/Node Involv AJCC TNM 6 th Edition cT,pT: Extent of essential tumor cN,pN: Absence or nearness & Ext of local lymph hubs cM,pM: Absence/nearness of metastasis [Clinical (c) and pathologic (p)] Collaborative Stage CS Tumor Size CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval CS Mets at Dx CS Mets Eval CS Site Specific Factors 1-6

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Collaborative Stage General Guidelines Timing Rule Site-particular rules Highest pertinent number for every field Greatest degree of illness

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Collaborative Stage for Bronchus and Lung General Guidelines proceeded with : CS Tumor Size/Ext CS Tumor Size/Ext Eval CS Regional LN CS Reg Nodes Eval CS Mets CS Mets Eval Regional LN Pos/Regional LN Exam Site Specific Factors

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Collaborative Stage for Bronchus and Lung CS Tumor Size 000 No mass/tumor discovered 001-998 001-998 millimeters (precise size) 989 989 millimeters or bigger 990 Microscopic center or foci just, no size of center given 991 Described as under 1 cm 992-995 Described as under (2,3,4,5 cm) 996 Malignant cells in bronchopulmonary secretions, however no tumor is seen radiographically or amid bronchoscopy 997 Diffuse (whole flap) 998 Diffuse (whole lung) 999 Unknown; size not stated Not archived in patient record

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Collaborative Stage for Bronchus and Lung CS Extension Primary Tumor expansion DO NOT CODE DISCONTINOUS METASTASES IN THIS FIELD Priority request for augmentation Notes 1-7: Read deliberately

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Collaborative Stage for Bronchus and Lung CS TS/EXT EVAL Evaluates hotspot for "CS Tumor Size" and "CS Extension" Describes clinical or obsessive organizing of the tumor

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Collaborative Stage for Bronchus and Lung CS TS/EXT EVAL Code 0, 1, 9 No surgery Code 2 Autopsy (conclusion suspected) Code 3 Surgery took after by other treatment Code 5 Determined before neoadjuvant therapy Code 6 Determined after neoadjuvant therapy Code 8 Autopsy (finding unsuspected) Code 9 Unknown, Not surveyed, Not expressed

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Collaborative Stage for Bronchus and Lung CS Lymph Nodes Regional Nodes and Nodes, NOS just Highest Applicable Code Exception (NOS) New Rule for Inaccessible Site Lung Notes 1-4: Read painstakingly

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Collaborative Stage for Bronchus and Lung CS Reg Nodes Eval Code 0, 1, 9 No LN(s) expulsion Code 2 Autopsy (analysis suspected) Code 3 LN(s) surgery took after by other therapy Code 5 LN(s) status decided preceding neoadjuvant treatment Code 6 LN(s) status decided after neoadjuvant therapy Code 8 Autopsy (determination unsuspected) Code 9 Unknown, Not evaluated, Not expressed

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Regional Nodes Positive 00 All hubs inspected negative 01-89 1-89 hubs positive 90 or more hubs positive 95 Positive goal of LN(s) was performed 97 Positive hubs documented, number unspecified 98 No hubs examined 99 Unknown if hubs positive, not relevant, not expressed in record Regional Nodes Examined 00 No hubs analyzed 01-89 1-89 hubs inspected 90 or more hubs inspected No Reg LN expelled, Aspiration of Reg LN performed Reg LN evacuation reported as sampling, number obscure/not stated 97 Reg LN evacuation archived as dissection, number obscure/not stated 98 Reg LN surgically expelled, number of LNs obscure/not stated, not recorded as sampling or analyzation; hubs examined, number unknown 99 Unknown, not material, not stated in record Collaborative Stage for Bronchus and Lung

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Collaborative Stage for Bronchus and Lung CS Mets at Dx 00 No; none 10 Distant Lymph Nodes (s), including cervical hubs 35 Separate tumor knobs (s) in various projection, same lung 37 Extension to sternum, skeletal muscle, skin of mid-section 39 Extension to contralateral lung, contralateral principle stem bronchus, separate tumor nodule(s) in contralateral lung 40 Abdominal organs, far off metastasis but to removed lymph hubs (code 10), far off mets, NOS, carcinomatosis 50 Distant mets + far off node(s) (10) + any [35-40] 99 Unknown; far off metastasis can\'t be evaluated, not documented in patient record.

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Collaborative Stage for Bronchus and Lung CS Mets Eval Code 0, 1, 9 No surgery Code 2 Autopsy (analysis suspected) Code 3 Surgery took after by other therapy Code 5 Determined before neoadjuvant treatment Code 6 Determined after neoadjuvant therapy Code 8 Autopsy (finding unsuspected) Code 9 Unknown, Not surveyed, Not expressed

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Collaborative Stage for Bronchus and Lung CS Site Specific Factors SSF 1 Code 888 SSF 2 Code 888 SSF 3 Code 888 SSF 4 Code 888 SSF 5 Code 888 SSF 6 Code 888

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Treatment for Bronchus and Lung Surgery Non-little cell carcinoma: Stage I and II (Localized) Small cell carcinoma: Not suggested Radiation Non-little cell carcinoma: Inoperable, Advanced Small cell carcinoma: Recommended Systemic Therapy Non-little cell carcinoma: Chemotherapy Small cell carcinoma: Combination chemotherapy Hormonal & Endocrine Not ended up being helpful

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Treatment for Bronchus and Lung Surgery Codes Primary Site Scope of Regional Lymph Node Surgical Procedure of Other Site

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Treatment for Bronchus and Lung Surgery Codes proceeded with Primary Site Scope of Regional Lymph Node Surgical Procedure of Other Site

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Treatment for Bronchus and Lung Surgery Codes proceeded with Primary Site Scope of Regional Lymph Node Surgical Procedure of Other Site

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Treatment for Bronchus and Lung Radiation Treatment Volume Treatment Modality Regional Dose Boost Modality Boost Dose Prophylactic Cranial Radiation (PCI)

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Treatment for Bronchus and Lung Chemotherapy Non-Small Cell Carcinoma Small Cell Carcinoma Hormones Immunotherapy Other Endoscopic Photodynamic Therapy

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Keys to Abstracting Organization Dates Procedure Documentation Resources

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