The 2021 National Cancer Registrars Association Education Conference brought together many professionals in the cancer registry field virtually this year. 2,576 total attendants brought a huge increase compared to past years. There were education sessions on numerous topics as well as round table discussions offered. The conference had great energy in the virtual environment. The question & answer and chat boxes were positive and well utilized allowing for real-time interaction similar to an in-person setting. The conference portal was very user-friendly and had great resources as well.
Aleisha Williams, MBA, CTR, and Cindy Traylor Richards, CTR presented on some of the latest improvements coming to AJCC staging and the STORE Manual. There will be added explanatory notes for all staging classifications in AJCC as well as Chapter 1 being broken down and color-coded. The STORE Manual will have more clarification for the LVI data field when it pertains to the thyroid & adrenal sites and it will remove the option to use C770-779 codes with any histology for the Mets at Diagnosis data fields.
Dr. Jimmy Lin, MD, Ph.D., MSH gave a presentation on the topic of cancer detection, therapy selection, and monitoring. Part of his presentation described the improvements made over the years. In the early days, the treatment was not targeted and given to everyone. Advances now use a liquid biopsy with multiomics. Five steps were shown on how Signatera works:
- Analyze tumor from the biopsy and matched blood.
- Identify 16 individual biomarkers.
- Obtain whole-blood sample at time points.
- Cell-free DNA extraction.
- Analyze data to detect presence of ct DNA.
Catching cancer earlier is the main goal. Currently, 67% are being screened with a colonoscopy and 80% is the goal.
Jennifer Ruhl from NCI SEER presented on 2022 SSDI updates. A timing rule will be added to all laboratory values which will state that all laboratory values must be within three months of diagnosis in order to be recorded. When discussing ulceration to the melanoma skin schema, in 2022 cases we will code 1 if any biopsy is positive or wide excision is positive for ulceration. Furthermore, the lymph node status femoral-inguinal, para-aortic, pelvic SSDI data field has been split into three different SSDIs. When we abstract for the vulva, the pelvic lymph nodes will still be coded in the SSDI even though they are distant.
The Radiation Coding Deconstructed: Phases, Primary Treatment Volumes, and Total Dose, with Marla Cole, BA, CTR, was put together utilizing the Version 2.0 Guide. The term ‘BOLUS’ is not defined in STORE or the CTR Guide to Coding Radiation Therapy but was clearly defined as a tissue-like equivalent material used to depth of maximum dose, it does NOT represent a change in phase.
Three main volumes in treatment planning were discussed: GTV – Gross Tumor volume, CTV – Clinical Target Volume, PTV – Planning Target Volume. The PTV is designed to allow for uncertainties to the CTV area. The PTV is the volume on which coding is based. If radiation is discontinued to any area in the PTV that equals a change in target volume resulting in a new phase, only exception being the PTV changed due to tumor shrinkage.
The information presented provided wonderful examples and breakdowns of specific coding guidelines and scenarios in addition to changes to the STORE and the CTR Guide to Coding Radiation Therapy. It is recommended to review the CTR Guide to Coding Radiation Therapy Treatment in the STORE, Version 3.0 February 2021, Appendix D, for a review of the summary of coding rules, with specific emphasis on item #11, Coding Volume when the Site of Cancer Origin has been removed.
Deconstructing Lymph Nodes, with Melissa Riddle, CTR provided great information on defining regional nodes and sentinel nodes. Sentinel Lymph Nodes Positive, code 97 – If positive sentinel nodes are documented, but the number is unspecified; for breast ONLY: SLN and RLND occurred during the same procedure. Additionally, positive ITC for breast primaries, sentinel nodes are considered NEGATIVE while ITC positive for melanoma, sentinel nodes are considered POSITIVE. Coding of regional lymph node surgery stressed the importance of utilizing the operative report as the primary source document to determine whether or not sentinel or regional or a combination of both were removed.
We would also like to take a moment to thank everyone who visited our virtual booth! It was a pleasure chatting with you all and getting to learn about your exciting Summer plans! At this year’s virtual conference, Registry Partners raffled off 3 $50 Amazon eGift Cards and a curved computer monitor as a grand prize! This year’s lucky eGift Card winners and curved computer monitor winners were:
- Diana Evans
- Marlene Borja
- Susan Thompson
- Erin Espinoza
We are looking forward to seeing all of your smiling faces at next year’s conference in Washington, D.C.!