Part One: “Many CTRs did not attend NCRA. Can you provide brief bullet points of what your consultants learned?”


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A Registrar’s Guide to Chapter 1 of   AJCC, 7th edition

  • Clinical Staging is related to a time frame (within 4 months after date of diagnosis or from time of diagnosis until first treatment whichever is shorter)
  • Central registries requires pathologic exam of one lymph node to assign a pN.
  • Assign X when:
    • Unknown to physician
    • Not unknown to one physician but known to other physicians
    • Not unknown to registrar due to lack of documentation in chart
  • Assign a lower category if uncertain or unclear information. Often called down staging.
    • (does not apply to unknown information, only uncertain)
  • TX or NX cases usually cannot have a stage assigned


Transition from Collaborative Staging to Directly coded Staging/ Updates from Collaborative Stage Transition

  • AJCC educational modules are available for free and are highly recommended
  • Currently, 32 predictive and prognostic biomarkers
  • HPV (+) oropharyngeal cancers tend to do better
  • SEER will begin reporting breast overall and subtypes
  • Will not be using derived stage for diagnosis year 2016
  • Treatment dates will become more important with directly coded staging and will be submitted to the CDC
  • Text will be needed with Directly Coded Staging to validate codes
  • NAACCR’s new webinar series will focus on AJCC Staging and Summary Stage.   Less time will be used for lectures, more time on case scenarios and quizzes


CoC Staging Intervention

  • Summary stage strictly looks at anatomic involvement
  • AJCC stage looks at anatomic involvement, prognostic/predictive factors, and SSFs
  • Cannot assign clinical stage for an incidental finding at the time of surgical resection
  • Registrars do not have legal authority to document in the medical record. Registrars can  code their interpretation of the medical record in the registry database.
  • If a physician stage is not accurate, indicate registrars assigned stage in the database
  • If no physician stage, registrar assigns stage in database


ICD10: What Every Cancer Registrar Should Know –

  • ICD10 will increase up to 7 digits
  • ICD10 is more specific with 69,000 codes vs. 13,600 codes in ICD9
  • ICD10 introduces laterality with over 5000 diagnoses having right or left distinction
  • Canada does not code for reimbursement
  • ICD10 has codes for abnormal tumor markers
  • The ‘V’ does will be replaced with ‘Z ‘codes
  • Malignant codes: C00-C96
  • Insitu Codes: D00-D09