Newsletter Spring 2022

Mississippi Cancer Registry 

March 2022 Volume 17 Issue 1

Forrest General Hospital Cancer Program
Accreditation ACS Commission on Cancer Site Visit
Scheduled for Tuesday, September 13, 2022
Virtual Visit by Surveyor
Administration/Medical Staff in Meeting Rooms

There is Something More Ahead for You: Beyond the CTR Exam

The Research and Informatics credentials of the Certified Tumor Registrar (CTR) is a necessary step in standard requirements and advancing your career is a major accomplishment. Yet, this is not your last step in creating a foundation as an oncology healthcare professional. There is more to learn in the standards of care, case finding, abstracting, follow-up, quality assurance. In addition, you will collaborate with CTR’s, cancer centers, other facilities, health information management, medical records, state registries, and national accreditation agencies. There are always changes and more to learn, making the effort to be a lifelong learner will guide you in your journey.

You will be a key asset to your organization, colleagues, oncology physicians, and other medical staff with your brilliant and prolific skills as a researcher, ensuring this critical component for cancer patients and their families. Your career will be challenging and fascinating, possibly not without a few obstacles and frustrations, but essential to your success. There are development of new procedures and the discovery of new avenues for coding, staging, and treatment guidelines.

The complexity in healthcare services and research, cancer registries and research areas depend on the intellect, skill, knowledge of their CTR’s to ensure complete and accurate cancer patient data upon which the National Cancer Data-base, CDC, CMS, and different national guidelines base the national quality measurements, treatment guidelines, and their patient care standards. The CTR credential offers assurance to an organization that the individual has the neces-sary skills to do their daily duties and tasks in the Cancer Registry, with their colleagues, and other facilities.

Opportunities to acquire new skills, comprehension, and expertise as a CTR:

• Seek clarification from Cancer Forum and other resources on challenging questions.
• Audit the work of other CTRs to ensure it is correct and identify areas for necessary training.
• Lead the approach to abstracting a significant challenge or staging in the EMR.
• Train physicians on new documentation requirements and collaborate with them to complete staging and standard requirements for the cancer program.
• For Accreditation, answer the standard requirement communications and effectively defend the decisions.
• Lead the monthly or annual training programs and consensus building necessary to keep all CTR staff with current education.

Once you have earned this mastery level, you are dedicated to studying and acquiring something new and discover knowledge to ascertain improvement of your skills. Learning about new procedures and advances in medicine are a normal part of your routine. And while the release of the annual rules, principles, procedures, and standard modifications creates a certain level of anxiousness because it takes time to transition, implement and apply them. As you advance in your career, the depth and breadth of your knowledge will continue to expand and improve.

Juliet Hinton, BSB, MBA, CTR, FGH Cancer Registry Manager, Research and Informatics/FGH Cancer Program-American College of Surgeons Commission on Cancer Accreditation

DATE OF FIRST CONTACT……

Record the date the patient first had contact with the facility as either an inpatient or outpatient for diagnosis and/or first course treatment of a reportable tumor.

***If patient was diagnosed at your facility, the Date of First Contact will be the same date as the Date of Diagnosis*

Example: Patient had a CT Chest on 02/02/2022 that showed a 5.5 cm right upper lobe mass. Patient returned on 02/06/2022 for a needle core biopsy and pathology returned squamous cell carcinoma.

The date of First Contact would be 02/06/2022, the date the cancer was diagnosed, not the date the patient was first seen at the facility.*

Now, if the CT Chest dated 02/02/2022 showed a 5.5 cm right upper lobe mass consistent with malignancy, 02/02/2022 would have been the Date of First Contact since the CT was diagnostic of cancer.

For analytic cases (Class of Case 00-22), the Date of First Contact is the date the patient became analytic, which means the Date of First Contact is either the Date of Diagnosis, if diagnosed at your facility or the Date of Treatment, if treated at your facility.

Resource: Store Manual 2021 Page 131

Coding Circumferential Resection Margin (CRM)

For Colon primaries, surgery of primary site must be coded as 30-80

•  If surgery of primary site is 00-29, then CRM must be coded as XX.7

•  For Rectal primaries, surgery of primary site must be coded as 27, 30-80

•  If surgery of primary site is 00-26 or 28, then CRM must be coded as XX.7

The CRM may be referred to as:

• Circumferential radial margin

• Circumferential resection margin

• Mesenteric (mesocolon) (mesorectal) margin

• Radial margin

• Soft tissue margin

Record in Millimeters (mm) to the nearest tenth the distance between the leading edge of the tumor and the nearest edge of surgically dissected margin as recorded in the pathology report.

Examples: If the CRM is 2 mm, code 2.0

If the CRM is 2.78 mm, code 2.8

If the value is recorded in Centimeters, multiply by 10 to get the value in Millimeters (mm).

Example: CRM recorded as 0.2 cm. Multiply 0.2 x 10 and record 2.

If the margin is involved (positive), code 0.0. If the margin is described as less than 0.1 mm with no more specif-ic measurement, Code 0.0; margins of 0- 1.0 mm are recorded by the pathologist as involved.

Code XX.2 (Margins cannot be assessed) ONLY when the pathology reports/CAP checklist states that the mar-gin cannot be assessed/evaluated.

An exact measurement takes precedence over codes 0.0 and those beginning with XX.

• Exact measurement takes priority even if the pathologist states the margin is positive.

Example: CRM stated as 0.3 mm in Final Diagnosis and Synoptic states: Circumferential (Radial) Margin Interpret-ed as involved by invasive carcinoma (tumor less than 1mm from margin).
Code the 0.3 mm instead of 0.0 (margin involved with tumor)

Code XX.9 when:

• Tumor is in situ only (/2)

• Checked “Not applicable: Radial or Mesenteric Margin” on CAP Checklist

• Pathology report describes only distal and proximal margins, or margins, NOS

• Only specific statements about the CRM are collected in this data item

•  CRM not mentioned in the record

AJCC Cancer Staging Manual
Cases with a diagnosis date of 01/01/2018 and forward should be staged using AJCC 8th Edition Cancer Staging Manual. The 3rd printing 2018 Edition is now available.
Please visit https://cancerstaging.org/references-tools/deskreferences/Pages/8EUpdates.aspx# for all 8th Edition updates and corrections. For all other information, visit https://cancerstaging.org/Pages/default.aspx.

Summary Stage 2018
The 2018 version of Summary Stage applies to every site and/or histology combination, including lymphomas and leukemias. Summary Stage uses all information available in the medical record; in other words, it is a combination of the most precise clinical and pathological documentation of the extent of dis-ease. The Sum-mary Stage 2018 manual is available at https://seer.cancer.gov/tools/ssm/.

Site Specific Data Items (SSDI)
Site Specific Data Items (SSDI) are similar to the Site Specific Factors (SSF) collected with Collaborative Stage. These data items are specific to certain site/histology combinations. For example, the SSDI’s for breast will be used to collect information such as estrogen receptor status, progesterone receptor status, Her2 status, Nottingham grade, and additional information related to primary tumors of the breast. The infor-mation collected in these data items are specific to breast. The SSDI manual is available at https://apps.naaccr.org/ssdi/list/.

Grade
Beginning with cases diagnosed in 2018 grade information will be collected in three fields; Clinical Grade, Pathological Grade, and Post-Therapy Grade. Within the Grade Manual you will find definitions for the three new grade data items, coding instructions, and the site/histology specific grade tables. The Grade manual is available at https:// www.naaccr.org/SSDI/Grade-Manual.pdf?v=1527859766.

SEER Hematopoietic and Lymphoid Neoplasm Database
This provides data collection rules for hematopoietic and lymphoid neoplasms for 2010+.The SEER Hemato-poietic and Lymphoid Neoplasm manual is available at https://seer.cancer.gov/tools/heme/Hematopoietic_Instructions_and_Rules.pdf.

2018 Solid Tumor Coding Manual
Use the 2018 Solid Tumor coding rules to determine the number of primaries to abstract and the histology to code for cases diagnosed 2018 and forward. The Solid Tumor coding rules replace the 2007 Multiple Prima-ry and Histology( MP/H) Rules. The manual is available at https://seer.cancer.gov/tools/solidtumor/. The change log contains updates made to the FINAL module sections. This does not include changes made to the drafts.

CoC 2018 STORE Manual
The STORE Manual has replaced the FORDS Manual. The STORE is now available at https://www.facs.org/quality-programs/cancer/ncdb/registrymanuals/cocmanuals.

Fall Educational Workshop 2022….
Plans are underway for the Fall Workshop. If you have any suggestions or ideas on what you would like to learn about this year, please email me at adavis6@umc.edu.

Director UMMC & MCR: Deirdre Rogers, drogers@umc.edu

MCR Manager: La’Tawnya Roby, ldroby@umc.edu

Clinical Systems Analyst-Intermediate: Tresheena Boyd, tboyd@umc.edu

Data Quality Analyst–Trainer: Angel Davis, adavis6@umc.edu

Data Quality Analyst-Auditor: April Wright, ahuggins@umc.edu

Electronic Data Source Coordinator: Lisa Hamel, lhamel@umc.edu

Cancer Registrars:

Stacy Major, semajor@umc.edu

Stephanie N. Engelman, nengelman@umc.edu

Madeline N. Hall, mnhall@umc.edu

Mallory R. Israel, misrael@umc.edu

Administrative Assistant:

Michelle R. Smith, mrsmith2@umc.edu

University of MS Medical Center
2500 North State Street
Jackson, MS 39216
Phone: 601-815-5482
Fax: 601-815-5483