# Presentation: 784910

## 2007 New Data Items

## 2007 New Data Items

- Multiplicity Counter
- Date of Multiple Tumors
- Type of Multiple Tumors Reported as One Primary

**Notes:**
New Data Items

3 are used with Multiple Primary Rules – 
Multiplicity Counter 
Date of Multiple Tumors 
Type of Multiple Tumors Reported as One Primary 

The first three new data items (multiplicity counter, date of multiple tumors & type of multiple tumor reported as one primary) are of key concern in the multiple primary rules. Make sure to train on these 3 even if you don’t have time for all the data items. 

## 2007 New Data Items

- Ambiguous Terminology
- Date of Conclusive Terminology

**Notes:**
New Data Items

The other two new data items are not part of the multiple primary rules but were introduced at the same time so are addressed in this presentation also.  They are:
Ambiguous Terminology
Date of Conclusive Terminology

## Multiplicity Counter

## Multiplicity Counter

- Counts number of tumors (multiplicity) abstracted as a single primary
- Do not count metastatic tumors
- Use multiple primary rules to determine if single primary or multiple primaries
- Leave blank for cases diagnosed prior to 01/01/2007

## Multiplicity Counter - Codes

- 01	One tumor only
- 02	Two tumors present
- 03	Three tumors present
- ..
- 88	Information on multiple tumors not collected/not applicable for this site
- 99	Multiple tumors present, unknown how many

**Notes:**
01	One tumor only 
02	Two tumors present 
03	Three tumors present
..
88	Information on multiple tumors not collected/not applicable for this site 
99	Multiple tumors present, unknown how many

## Multiplicity Counter - Instructions

- Code number of tumors abstracted as a single primary
- Do not count metastasis
- Do not count ‘foci’ when single or multiple foci present

**Notes:**
Code the number of tumors being abstracted as a single primary.

Do not count metastasis.

When there is a tumor or tumors with separate single or multiple foci, ignore/do not count the foci

## Multiplicity Counter - Instructions

- Code 01
- Single tumor in the primary site
- Single tumor with separate foci of tumor
- Unknown if single tumor or multiple tumors _and_ the multiple primary rules instructed you to default to a single tumor

**Notes:**
Use code 01 when
There is a single tumor in the primary site being abstracted
There is a single tumor with separate foci of tumor
It is unknown if there is a single tumor or multiple tumors and the multiple primary rules instructed you to default to a single tumor

## Multiplicity Counter - Instructions

- Code 88
- Leukemia
- Lymphoma
- Immunoproliferative disease
- Unknown primary

**Notes:**
Use code 88 for:
Leukemia
Lymphoma
I,mmunoproliferative disease
Unknown primary

## Multiplicity Counter - Instructions

- Code 99
- Pathology report not available and other report(s) do not specify number of tumors
- Tumor described as multifocal/multicentric and number of tumors not mentioned
- Tumor described as diffuse
- Operative/pathology report describes multiple tumors but does not give exact number

**Notes:**
Use code 99 when
The original pathology report is not available and the documentation does not specify whether there was a single or multiple tumors in the primary site.
The tumor is described as multifocal or multicentric and the number of tumors is not mentioned.
The tumor is described as diffuse.
The operative or pathology report describes multiple tumors but does not give an exact number.

## Date of Multiple Tumors

## Date of Multiple Tumors

- Identifies the date patient diagnosed with multiple tumors
- Use multiple primary rules to determine if single primary or multiple primaries

**Notes:**
Identifies the month, day and year the patient is diagnosed with multiple tumors reported as a single primary

Use the multiple primary rules to determine if single primary or multiple primaries

## Date of Multiple Tumors

- MMDDCCYY format
- 99 for unknown month or day
- 9999 for unknown year
- Leave blank for cases diagnosed prior to 01/01/2007

**Notes:**
This will frequently be the date of initial diagnosis, but not always.  Sometimes, the case will be a single tumor at initial diagnosis, and subsequent tumors will be diagnosed later.  Remember, this date refers to tumors being abstracted as a single primary.

## Special (Date) Codes

- 00000000 – Single tumor
- 88888888 – Information on multiple tumors not collected/not applicable for this site
- 99999999 – Unknown date

**Notes:**
00000000 – Single tumor
88888888 – Information on multiple tumors not collected/not applicable for this site 
99999999 – Unknown date

## Date of Multiple Tumors

- Same as date of diagnosis when multiple tumors present at diagnosis
- Change Multiplicity Counter to 02 and enter the date the second tumor was diagnosed when subsequent tumor(s) are counted as same primary

**Notes:**
Same as date of diagnosis when multiple tumors are present at diagnosis
Change Multiplicity Counter 01 to 02 and enter the date the second tumor was diagnosed when subsequent tumor(s) are counted as same primary

## Type of Multiple Tumors Reported as one Primary

## Type of Multiple Tumors Reported as one Primary

- Identifies the type(s) of multiple tumors  abstracted as a single primary
- Do not count metastatic tumors
- Leave blank for cases diagnosed prior to 01/01/2007

**Notes:**
Identifies type of multiple tumors abstracted as a single primary
Do not count metastatic tumors
Leave blank for cases diagnosed prior to 01/01/2007

## Slide 18

| Code | Code Text | Description |
| --- | --- | --- |
| 00 | Single tumor | All single tumors. Includes single tumors with both in situ and invasive components |
| 10 | Multiple benign | At least two benign tumors in same organ/primary site
Use this code for reportable tumors in intracranial and CNS sites only
May be used for reportable by agreement cases |
| 11 | Multiple borderline | At least two borderline tumors in the same organ/primary site
Use this code for reportable tumors in intracranial and CNS sites only
May be used for reportable by agreement cases |

**Notes:**
00	Single tumor	All single tumors. Includes single tumors with both in situ and invasive components
				Code 01 in the Multiplicity Counter 

10	Multiple benign	At least two benign tumors in same organ/primary site
				Use this code for reportable tumors in intracranial and CNS sites
				May be used for reportable by agreement cases

11	Multiple borderline	At least two borderline tumors in the same organ/primary site
				Use this code for reportable tumors in intracranial and CNS sites
				May be used for reportable by agreement cases

## Slide 19

| Code | Code Text | Description |
| --- | --- | --- |
| 12 | Benign and borderline  | At least one benign 
AND at least one borderline tumors in the same organ/ primary site 
Use this code for reportable tumors in intracranial and CNS sites only
May be used for reportable by agreement cases |
| 20 | Multiple in situ | At least two in situ tumors in the same organ/primary site |

**Notes:**
12	Benign and borderline 	At least one benign 
					AND at least one borderline tumors in the same organ/ primary site 
					Use this code for reportable tumors in intracranial and CNS sites
					May be used for reportable by agreement cases

 	Multiple in situ		At least two in situ tumors in the same organ/primary site
					Cystoscopy report documents multiple bladder tumors. Pathology: Flat transitional cell carcinoma of bladder. 

## Slide 20

| Code |  | Code Text | Description |
| --- | --- | --- | --- |
| 30 |  | In situ and invasive | One or more in situ tumor(s)
AND one or more invasive tumors in the same organ/primary site |
|  | 31 | Polyp and adenocarcinoma | One or more polyps with either
 In situ carcinoma or 
 Invasive carcinoma 
AND  one or more frank adenocarcinoma(s) in the same segment of colon, rectosigmoid, and/or rectum |
|  | 32 | FAP with carcinoma | Diagnosis of familial polyposis (FAP) AND carcinoma (in situ or invasive) is present in at least one of the polyps  |

**Notes:**
30		In situ and invasive		One or more in situ tumor(s)
							AND one or more invasive tumors in the same organ/primary site

31		Polyp and adenocarcinoma	One or more polyps with either
						In situ carcinoma or 
						Invasive carcinoma 
							AND  one or more frank adenocarcinoma(s) in the same segment of colon, rectosigmoid,
							and/or rectum

32		FAP with carcinoma		Diagnosis of familial polyposis (FAP) AND carcinoma (in situ or invasive) is present in 
							at least one of the polyps 	

## Slide 21

| Code | Code Text | Description |
| --- | --- | --- |
| 40 | Multiple invasive | At least two invasive tumors in the same organ  |
| 80 | Unk in situ or invasive | Multiple tumors present in the same organ/primary site, unknown if in situ or invasive |
| 88 | NA | Information on multiple tumors not collected/not applicable for this site |
| 99 | Unk | Unknown |

**Notes:**
 	Multiple invasive		At least two invasive tumors in the same organ 

 	Unk in situ or invasive	Multiple tumors present in the same organ/primary site, unknown if in situ or invasive

 	NA				Information on multiple tumors not collected/not applicable for this site
					Leukemia, lymphoma, immunoproliferative diseases, and unknown primaries. 
					Code 88 in Multiplicity Counter

99	Unk				Unknown

## Ambiguous Terminology

## Ambiguous Terminology

- Identifies all cases, including DCO and autopsy only, accessioned based on ambiguous terminology
- Allows identification of cases in database

**Notes:**
Identifies all cases, including DCO and autopsy only, accessioned based on ambiguous terminology

Allows identification of cases in database

## Ambiguous Terminology

- Cases excluded from research studies
- Direct patient contact not recommended
- Leave blank for cases diagnosed prior to 01/01/2007

**Notes:**
Cases excluded from research studies  

Direct patient contact not recommended

Leave blank for cases diagnosed prior to 01/01/2007

## Ambiguous Terminology

- Reportable case when term used as basis for a diagnosis
- See list of terms
- Detailed instructions
- 2007 SEER Coding and Staging Manual
- FORDS

**Notes:**
Reportable when term used in a diagnosis

See the reportable list of terms 

See the 2007 SEER Coding and Staging Manual or the FORDS for detailed instructions on how to use the list

## Conclusive Terminology

- A clear and definite statement of cancer
- Statement may be from a physician (clinical diagnosis); or from a laboratory test, autopsy, cytologic findings, and/or pathology

## Ambiguous terms that are reportable 

- Apparent(ly)
- Appears (effective with cases diagnosed 1/1/1998 and later)
- Comparable with (effective with cases diagnosed 1/1/1998 and later)
- Compatible with (effective with cases diagnosed 1/1/1998 and later)
- Consistent with
- Favor(s)

**Notes:**
Continued on next slide

## Ambiguous terms that are reportable 

- Malignant appearing (effective with cases diagnosed 1/1/1998 and later)
- Most likely
- Presumed
- Probable
- Suspect(ed)
- Suspicious (for)
- Typical (of)

**Notes:**
Continued from previous slide

## Slide 29

| Code | Label | Definition | Time Frame |
| --- | --- | --- | --- |
| 0 | Conclusive term | There was a conclusive diagnosis within 60 days of the original diagnosis. Case was accessioned based on conclusive terminology. Includes all diagnostic methods such as clinical diagnosis, cytology, pathology, etc. | Within 60 days of the date of initial diagnosis. |

**Notes:**
Coding Instructions

Leave this data item blank for cases diagnosed prior to 01/01/2007. 

Use Code 0 when a case is accessioned based on conclusive terminology. The is clear and definite terminology describing the malignancy within 60 days of the original diagnosis.
 Note: Usually the patient undergoes a diagnostic work-up because there is a suspicion of cancer (ambiguous terminology). For example, a mammogram may show calcifications suspicious for intraductal carcinoma; the date of the mammogram is the date of initial diagnosis. When there is a clear and definite diagnosis within 60 days of that mammogram (date of initial diagnosis) such as the pathology from an excisional biopsy showing intraductal carcinoma, assign a code 0.

Examples: 
1. Adenocarcinoma in TURP chips.
2. Mammogram suspicious for DCIS. Excisional biopsy 1 week later positive for DCIS. 

## Slide 30

| Code | Label | Definition | Time Frame |
| --- | --- | --- | --- |
| 1 | Ambiguous term only | The case was accessioned based only on ambiguous terminology. There was no conclusive terminology during the first 60 days following the initial diagnosis. Includes all diagnostic methods except cytology.
Note: Cytology is excluded because registrars are not required to collect cases with ambiguous terms describing a cytology diagnosis. | N/A |

**Notes:**
Coding Instructions

Use Code 1 when a case is accessioned based on ambiguous terminology and there is no clear and definite terminology used to describe the malignancy within 60 days of the date of initial diagnosis.
The diagnosis may be from a pathology report, a radiology report, an imaging report, or on the medical record.

Examples:
1. Chest MRI shows a malignant appearing lesion in the right upper lobe. Patient refused further workup or treatment.
2. Pt with elevated PSA admitted for TRUS. Biopsy. Pathology: Prostatic chips: Consistent with adenocarcinoma. No further information is available 

## Slide 31

| Code | Label | Definition | Time Frame |
| --- | --- | --- | --- |
| 2 | Ambiguous term followed by conclusive term | The case was originally assigned a code 1 (was accessioned based only on ambiguous terminology). More than 60 days after the initial diagnosis the information is being updated to show that a conclusive diagnosis was made by any diagnostic method including clinical diagnosis, cytology, pathology, autopsy, etc. | 60 days or more after the date of diagnosis |
| 9 | Unknown term | There is no information about ambiguous terminology. | N/A |

**Notes:**
Coding Instructions

Use Code 2 when a case is accessioned based on ambiguous terminology followed by clear and definite terminology more than 60 days after the initial diagnosis.
Follow-back to a physician or subsequent readmission (following the initial two month period) may eventually confirm cancer (conclusive cancer term more than 60 days after ambiguous term).  Assign Code 2.

Examples:  
The biopsy of the thyroid reads: most likely thyroid cancer. Three months later a biopsy is positive for papillary follicular cancer. The case would have been coded 1 Ambiguous term only. Change the code to 2 Ambiguous term followed by conclusive term. 

Leave this data item blank for cases diagnosed prior to 01/01/2007. 

## Date of Conclusive Terminology

## Date of Conclusive Terminology

- Date of definite statement of malignancy
- Abstractor must change the code for “Ambiguous Terminology” from a 1 to a 2
- Abstractor must enter the date that the malignancy was described conclusively

**Notes:**
Date of definite statement of malignancy
Abstractor must change the code for “Ambiguous Terminology” from a 1 to a 2
Abstractor must enter the date that the malignancy was described conclusively

## Date of Conclusive Terminology

- MMDDCCYY format
- 99 for unknown month or day
- 9999 for unknown year
- Leave blank for cases diagnosed prior to 01/01/2007

**Notes:**
MMDDCCYY format
99 for unknown month or day 
9999 for unknown year
Leave blank for cases diagnosed prior to 01/01/2007

## Special (Date) Codes

- 00000000 – Accessioned based on ambiguous terminology only
- Code 1 in data item “Ambiguous Terminology”
- 88888888 – Not applicable. Case was accessioned based on conclusive diagnosis
- Code 0 in data item “Ambiguous Terminology”

**Notes:**
00000000 – Accessioned based on ambiguous terminology only 
Code 1 in data item “Ambiguous Terminology”

88888888 – Not applicable. Case was accessioned based on conclusive diagnosis 
Code 0 in data item “Ambiguous Terminology”

## Special (Date) Codes

- 99999999 – Unknown date; unknown if diagnosis was based on ambiguous terminology or conclusive terminology
- Code 9 in data item “Ambiguous Terminology”

**Notes:**
99999999 – Unknown date; unknown if diagnosis was based on ambiguous terminology or conclusive terminology 
Code 9 in data item “Ambiguous Terminology”

## MP/H Task Force