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EXTENT OF DISEASE (EOD) 2018Jennifer Ruhl, MSHCA, RHIT, CCS, CTR

NCI SEER, Public Health Analyst

November 6, 2017

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Special thank you to Carolyn Callaghan, CTR

SEER Seattle RegistrySEER*Educate

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EOD 2018

Previously collected by SEER registries prior to CS

CS developed based on EOD

CS discontinued in 2015 (some SEER registries continued to collect until 2017)

EOD 2018 is for cases DIAGNOSED 1/1/2018 and forward

Based on date of diagnosis NOT date case abstracted

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EOD 2018

• EOD is used to

• Reflect combination of clinical/pathological information

• Report/monitor trends in cancer incidence/outcomes

• Permit staging of most comprehensive set of patients for all cancer sites

• Support/promote research for all types of cancer

• Enable ongoing continuity of trends over time

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Extent of Disease, Summary Stage 2018, and Derived Variables

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EOD 2018 General Coding Instructions

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EOD 2018 General Coding Instructions

EOD is a DATA COLLECTION SYSTEM

Coded for ALL cases

Coded data items used to derive AJCC 8th Edition (when applicable) and Summary Stage 2018

Schemas based on

Primary site and histology (most schemas)

Examples: Breast, Prostate, Colon

Histology only

Example: Lymphoma

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EOD 2018 General Coding Instructions

Based on combined clinical and operative/ pathological assessment BEST information is coded

Includes ALL information

Within four months of diagnosis (in the absence of disease progression) OR

Upon completion of surgery(ies) in first course of treatment

Exception: additional imaging done after surgery

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EOD 2018 General Coding Instructions

Neoadjuvant treatment

Pre-treatment findings (prior to neoadjuvant)

Code the EOD fields based on pre-treatment if clinical findings are greater

Post neoadjuvant (surgical resection)

Code the EOD fields based on surgical resection if pathological findings greater than clinical

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EOD 2018 General Coding Instructions

Disease progression

Once disease progression is determined (metastatic involvement) collection of stage information stops

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EOD 2018 General Coding Instructions

Clinical information can change EOD stage

Use all clinical information UNLESS operative/ pathology report disproves the clinical information

Exception: Operative findings may be used over pathological findings when entire tumor was not/ could not be resected

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EOD 2018 General Coding Instructions

T, N, M information can be used when only information available

Use the AJCC 8th edition manual to determine what’s included in the T, N, M definition

Example: Lung case, T3, N1, M0

Review AJCC 8th edition chapter to determine what’s included in T3, N1 and then review EOD data items to determine appropriate codes

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EOD 2018 General Coding Instructions

EOD schema-specific guidelines take precedence over general guidelines

ALWAYS read schema notes (when applicable) for more specific coding instructions

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EOD Primary Tumor

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EOD Primary Tumor

Classifies contiguous growth (extension)

Within organ of origin OR

Direct extension into neighboring tissues, structures or organs

Non-contiguous tumor spread to adjacent organs

NOT for all sites, examples include: ovary, fallopian tube (not all inclusive list)

See site-specific schemas to determine extension

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EOD Primary Tumor

Code farthest extension documented

Direct (contiguous) extension

Localized, NOS

Code available for when tumor stated to be “localized” with no other information available

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EOD Primary Tumor

Use highest applicable code

Priority order

Pathology report

Imaging

Physical exam

Note: If extension is positive based on imaging or physical exam and confirmed to be negative on pathological exam, code the extension based on the pathological findings (applies also to EOD Regional Nodes and EOD Mets)

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EOD Primary Tumor

In situ tumors

Code 000

Note: Some schemas have multiple in situ codes

In situ tumors WITH nodal or metastatic involvement

Code 000 for EOD Primary Tumor

Note: This is a change in how these cases were coded in CS. Behavior would be /3, EOD Primary tumor coded as in situ and nodes/mets coded as appropriate

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EOD Primary Tumor

Code 800

Use ONLY for no evidence of primary tumor (occult)

Not applicable for all schemas

Code 999

Use when there is no information on extent of tumor

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EOD Regional Nodes

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EOD Regional Nodes

Classifies regional lymph node(s) involved with cancer at time of diagnosis

Lymph node involvement based on

Location OR

Number of nodes positive OR

Size of positive nodes OR

Some combination of location, number, size

Note: See site-specific schemas for regional lymph nodes and definitions

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EOD Regional Nodes

Classifies regional lymph node(s) involved with cancer at time of diagnosis

Lymph node involvement based on

Location

Number of nodes positive and/or size of positive nodes

See site-specific schemas for regional lymph nodes and definitions

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EOD Regional Nodes

Regional lymph node codes hierarchical (except for code 800)

In general, for nodes based on location, those closest to primary site have lower codes

Note: If lymph node, chain or synonym not listed, check EOD Mets.

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EOD Regional Nodes

Accessible Lymph Nodes

Can be observed, palpable or examined without instruments

“Remainder of examination negative” sufficient to code 000 for negative nodes

If clinical evaluation and no mention positive nodes, assign code 000

Examples: sites with accessible nodes: breast, oral cavity, skin, thyroid (not complete list)

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EOD Regional Nodes

Inaccessible Lymph Nodes

Lymph nodes within body cavities

Cannot be observed, palpated, observed or examined by clinical methods

Examples: sites with inaccessible nodes: bladder, colon, corpus, esophagus (not complete list)

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EOD Regional Nodes

Inaccessible Lymph Nodes

Code EOD Regional Nodes 000 (negative) instead of 999 (unknown) when ALL three conditions met:

No mention of regional lymph in physical exam, pre-treatment diagnostic testing or surgical exploration

Patient has localized disease

Patient receives standard treatment for localized disease

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EOD Regional Nodes

Code 800: Lymph nodes, NOS

Lymph node assignment based on location, number and/or size AND only documentation is lymph nodes involved

Unidentified nodes included with resected primary site

Statement of “regional lymph nodes involved” with no further information

Note: More specific nodes may be identified in the operative or pathology report (including the final diagnosis, microscopic or gross description)

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EOD Mets

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EOD Mets

Classifies metastatic involvement at time of diagnosis

Code 00 unless documented evidence of metastatic by clinical evaluation OR cytological/pathological examination of metastatic site

Note: Only history and physical examination is needed to evaluate mets.

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EOD Schemas

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EOD Schemas

Development

CS schemas (based on AJCC 7th edition) reviewed, some combined

Example: 26 CS Melanoma Head & Neck schemas, 1 EOD Melanoma Head & Neck schema

AJCC 8th edition reviewed to determine if revisions to current schemas or new schemas needed

Examples of new schemas: Thymus, Parathyroid

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EOD Schemas

Development of EOD 2018 schemas (~120)

All schemas reviewed/revised as needed according to AJCC 8th edition

Schemas reviewed/revised for update of Summary Stage

Codes/descriptions from CS simplified when possible

Mappings to only two staging systems

AJCC 8th edition

Summary Stage 2018

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DR

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EOD Resources

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EOD Resources

EOD General Coding Instructions

EOD schemas in SEER*RSA

EOD and Summary Stage modules in SEER*Educate

Questions for EOD to be submitted to Ask SEER Registrar

New category to be added for 2018

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Questions??

www.cancer.gov www.cancer.gov/espanol