Cancer registrars rely on a wealth of manuals to ensure the accuracy and integrity of oncology data. These resources serve as essential tools for coding and classification, but their value extends beyond traditional use. By thinking creatively, registrars can leverage these manuals in unexpected ways to enhance data quality and problem-solving.
The Essential Role of Cancer Registry Manuals
Oncology Data Specialists (ODS-certified cancer registrars) understand the importance of precise data collection. Factors such as tumor site, histologic type, grade, stage, and biomarkers contribute to a comprehensive picture that aids prognosis, treatment planning, and outcomes. Ensuring the accuracy of this information requires diligence—and the right resources.
Each case we abstract requires referencing at least 11 key manuals, including:
- ICD-O-3
- Solid Tumor Rules
- AJCC Staging
- SEER Summary Staging
- Site-Specific Data Items (SSDI)
- Grade Coding
- Extent of Disease (EOD)
- Hematopoietic & Lymphoid Neoplasm Coding
- STORE Manual
- SEER Manual
- State Reporting Guidelines
Each manual plays a vital role in ensuring data accuracy. For instance, the Grade Manual helps us assign a tumor grade, a key prognostic factor indicating how aggressive a tumor appears microscopically. Lower-grade tumors generally have better outcomes, while higher-grade tumors often require immediate intervention. The Solid Tumor Rules Manual assists in coding complex histologies and prevents over-reporting of tumors. These are standard uses, but sometimes, registrars find creative ways to apply these resources beyond their primary purpose.
Unexpected Ways to Leverage Cancer Registry Manuals
During the abstracting process, I often find myself using manuals for guidance in ways I hadn’t anticipated. These unconventional applications can be invaluable in resolving complex coding scenarios.
Using the Hematopoietic Manual for Solid Tumor Staging
One example involves the Hematopoietic and Lymphoid Neoplasm Coding Manual, Appendix C, which contains the Lymph Node/Lymph Node Chain Reference Table. While this table is primarily intended for determining the primary site of lymphomas, I often use it to clarify lymph node regions when staging solid tumors.
Pathology reports or staging manuals sometimes list synonyms or broad lymph node regions that may not explicitly appear in staging guidelines. By referencing Appendix C, I can verify whether a lymph node is considered regional or distant for SEER Summary Stage or AJCC Staging. This cross-referencing ensures that staging assignments are as precise as possible.
AJCC Staging Manual as a Starting Point for Site/Histology Validation
Another unique approach involves using the AJCC Staging Manual to validate site and histology combinations. If a histology isn’t listed in the AJCC chapter for a specific site, it may indicate that the combination is morphologically improbable.
This is a helpful first step in resolving site/histology edits. If the combination is missing from the AJCC chapter, I then verify it using resources like Cancer PathCHART or the SEER Validation List. If the combination is included, I know further investigation is required—leading me to the Edit Details Report for the current metafile. This process helps streamline error resolution and ensures the accuracy of our data.
Maximizing the Value of Our Registry Manuals
Cancer registry manuals are more than just static references; they are dynamic tools that support problem-solving in unexpected ways. By thinking beyond their traditional applications, registrars can enhance data quality, improve abstraction efficiency, and ensure the most accurate information is available for research and patient care.
Whether used in conventional or creative ways, these manuals remain invaluable assets in the field of oncology data collection. Their thoughtful application allows us to maintain the highest standards of accuracy—one case at a time.
This article was written by Monica Reece, Quality Consultant at Registry Partners, with contributions from Heather Donohue, Educational Programs Director. Their combined expertise in oncology data abstraction and education highlights the importance of leveraging cancer registry manuals in both traditional and innovative ways.