Physicians may utilize incomplete information to assign cancer staging for treatment purposes or so a patient can have a better understanding of their prognosis; however, cancer registrars should not assign stage grouping to cases where incomplete or uncertain staging components exist. The following are highlights of best practices for staging when you encounter incomplete or uncertain staging items.
Best Practices for Incomplete Information and Cancer Staging:
- Staging with incomplete information is considered presumptive staging and is only used by a physician for patient care purposes.
- Clinical Staging is updated throughout the workup phase (scans, biopsy, etc.), before any treatment is given. If a final clinical stage is never recorded by the physician, only preliminary/incomplete staging, the stage grouping will be unknown (99).
- Pathological Staging cannot be assigned with incomplete T, N, and M categories.
- A physician may use a combination of clinical and pathologic categories for treatment purposes, however, this cannot be used to assign a stage group in the record.
- Treatment plans can be contingent upon incomplete or clinical/pathologic combination staging by physicians, but the registrar should only assign complete and correct T, N, and M categories based on the rules from the AJCC 8th edition manual.
- If recorded physician staging breaks the staging rules, do not document in the T, N, and M fields. Use blanks or X for any T, N, or M category where information is incomplete and unknown (99) stage grouping.
Uncertain Staging Items:
- If uncertain between two different categories, choose the lower of the two for T or N assignment.
- If the information is completely unknown, the registrar cannot assign the lower category.
- If a T or N assignment has a subcategory and the registrar does not have the information available to assign that subcategory, the T or N would be assigned the main category and stage grouping will always be unknown (99).
- e.g., T2 has subcategory T2a and T2b, but if the registrar does not have information available to assign the subcategory, then T is assigned as T2 and Stage Group is 99.
Registry Documentation and unusual cases:
- Registry must record facts only!
- Primary path is Tis, but LN’s found to be positive.
- Document pTis, appropriate N category and Stage Group 99.
- Do not amend the Tis assignment to T1, in order to assign a Stage Grouping.