Transcript The Anatomy of Collaborative Staging: Ovary
The Anatomy of Collaborative Staging: Ovary
2005 Update Presentation developed by Collaborative Staging Steering Committee [email protected]
Structures of Female Pelvis
CS Ovary Coding 2005
Ovarian Cancer
Collaborative Stage fields
• Tumor Size--standard • Extension • TS/Ext Eval--standard • Lymph Nodes • LN Eval--standard • LN Pos--standard • LN Exam--standard • Mets at Dx • Mets Eval--standard • Site-specific Factor 1--CA-125 • Site-specific Factors 2-6--not applicable
CS Ovary Coding 2005
CS Extension--Notes
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Ascites Positive ascites changes stages I and II to IC and IIC. Disregard negative ascites or ascites, NOS Pelvic organs* coded to 50-65 (FIGO Stage II)
Adnexa, bladder (including serosa), uterine ligaments, cul de sac, fallopian tubes, parametrium, pelvic peritoneum, pelvic wall, rectum, sigmoid colon, ureter, uterus, uterine serosa Abdominal organs* coded to 70-75 (FIGO III)
Abdominal mesentery, diaphragm, gallbladder, infracolic omentum, kidneys, large intestine except rectum and sigmoid, peritoneal surface of liver, omentum, pancreas, pericolic gutter, peritoneum, NOS, small intestine, spleen, stomach, ureters * Involvement may be direct or discontinuous CS Ovary Coding 2005
CS Extension--Notes
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Liver parenchymal metastases are coded in Mets at Dx.
Implants (discontinuous metastases) 4.
3.
Other names: seeding, salting, studding, talcum powder appearance Determine whether implants are in pelvis (code 60-64) or abdomen (code 70-73) or unspecified (code 75) Implants outside the pelvis must be microscopically confirmed and coded by size 70 Microscopic only 71 Macroscopic < 2 cm 72 Macroscopic > 2 cm 73 Mets outside pelvis, size not stated 75 Peritoneal implants, NOS [not stated as pelvic or abdominal] CS Ovary Coding 2005
CS Extension Codes (FIGO I)
10 One ovary, capsule intact, no tumor on surface, negative ascites (FIGO IA) 20 Both ovaries, capsules intact, no tumor on surface, negative ascites (FIGO IB) Source: TNM Atlas, 3rd ed. 2nd rev., by B. Spiessl et al. Springer Verlag 1992.
CS Ovary Coding 2005
CS Extension Codes (FIGO IC)
One or both ovaries 35 Capsule ruptured 36 Tumor on surface 41 One or both ovaries positive ascites or washings Source: TNM Atlas, 3rd ed. 2nd rev., by B. Spiessl et al. Springer Verlag 1992.
CS Ovary Coding 2005
CS Extension Codes 50-52 (FIGO IIA)
Extension to or implants on: (negative ascites/washings) 50 Adnexa/tubes, ipsilateral 52 Adnexa/tubes, contralateral 52 Uterus Source: TNM Atlas, 3rd ed. 2nd rev., by B. Spiessl et al. Springer Verlag 1992.
CS Ovary Coding 2005
CS Extension Codes 60, 61 (FIGO IIB)
Extension to or implants on: (negative ascites) 60 Other pelvic structures* (ipsilateral) 61 Other pelvic structures* (contralateral) * ligaments, mesovarium, pelvic wall, adjacent peritoneum Source: TNM Atlas, 3rd ed. 2nd rev., by B. Spiessl et al. Springer Verlag 1992.
CS Ovary Coding 2005
CS Extension Codes 62-64 (FIGO IIC)
Tumor confined to pelvis with positive ascites 62 Ipsilateral (50 and/or 60) 63 Contralateral (52 and/or 61) 64 Other pelvic structures Source: TNM Atlas, 3rd ed. 2nd rev., by B. Spiessl et al. Springer Verlag 1992.
CS Ovary Coding 2005
CS Extension Code 70-75 (FIGO III)
72 Macroscopic peritoneal implants > 2 cm (FIGO IIIC) 70 Microscopic peritoneal implants (FIGO IIIA) 71 Macroscopic peritoneal implants < 2 cm (FIGO IIIB) Source: TNM Atlas, 3rd ed. 2nd rev., by B. Spiessl et al. Springer Verlag 1992.
CS Ovary Coding 2005
Liver Involvement
CS Extension codes 70-73: Tumor on capsule or surface of liver (FIGO III) Mets at Dx code 40: Metastasis inside liver (parenchymal) (FIGO IV) Source: TNM Atlas, 3rd ed. 2nd rev., by B. Spiessl et al. Springer Verlag 1992.
CS Ovary Coding 2005
CS Lymph Nodes--Notes
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Code distant nodes in Mets at Dx.
If there is a statement that “adnexa palpated” with no mention of lymph nodes, assume lymph nodes are not involved (code 00).
If exploratory or definitive surgery with no mention of nodes, assume nodes are negative (00).
Regional nodes include bilateral and contralateral involvement of named nodes.
CS Ovary Coding 2005
CS Lymph Nodes
Code 10 1 Hypogastric (internal iliac) Obturator 2 Common iliac 3 External iliac Code 12 4 Lateral sacral Code 20 5 Para-aortic Code 30 6 Inguinal 40 10 + 20 42 [12 or 30] + [10 or 20] Source: TNM-Interactive, UICC, 1998 CS Ovary Coding 2005
CS Mets at Dx
10 Distant nodes, NOS 40 Distant metastases except nodes Liver parenchyma Pleural effusion with positive cytology FIGO Stage IVB 50 Distant mets plus distant nodes 99 Unknown, not assessed, not documented CS Ovary Coding 2005
Site-Specific Factor 1 CA-125
Tumor marker for ovarian cancer; monitors for disease progression
Also called cancer antigen 125 or carbohydrate
antigen 125 Normal range < 35 U/ml (SI: < 35 kU/L) Code the lowest pre-treatment test 000 Test not done 010 Positive/elevated 020 Negative/normal; within normal limits 030 Borderline; undetermined whether positive or negative 080 Ordered but results not in chart 999 Unknown, no information, not documented CS Ovary Coding 2005
Ovarian Cancer Case Study 1: Limited to ovaries
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Enlarged right ovary on PE; mass confirmed by ultrasound. No further tests. Laparotomy, RSO, and random biopsies: tumor confined to ovary, capsule intact. All bx and washings negative Tumor size Extension 999 Size not stated 10 One ovary involved, capsule intact TS/Ext Eval 3 Based on surgical resection Lymph nodes 00 Note 3: expl. surgery, no mention of LN Reg LN Eval 1 Reg LN Pos Based on surgical observation, no bx.
98 No nodes examined Reg LN Exam 00 No nodes removed Mets at Dx Mets Eval 00 Inaccessible sites rule--presumed neg.
0 Based on non-invasive clinical evidence SSF1 SSF2 - SSF8 999 CA-125 not documented 888 Not applicable CS Ovary Coding 2005
Ovarian Cancer Case Study 2: Malignant ascites
Pt had vague abdominal symptoms. Pelvic exam showed right ovary mass. Oophorectomy and Bxs: Adenoca in right ovary and in tumor implants on R fallopian tube. Peritoneal washings positive.
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Tumor size Extension Mets at Dx Mets Eval 999 Size not stated 62 TS/Ext Eval 3 Lymph nodes 00 Reg LN Eval 1 Reg LN Pos 98 Reg LN Exam 00 0 Ipsilat. tube (50) + pos. ascites Based on pathology report Note 3: expl. surgery, no mention of LN Based on surgical observation, no bx.
No nodes removed No nodes examined 00 Inaccessible sites rule--presumed neg.
Based on non-invasive clinical evidence
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SSF1 SSF2 - SSF6 999 CA-125 not documented 888 Not applicable CS Ovary Coding 2005
Ovarian Cancer Case Study 3: Extensive disease
Large pelvic mass on PE. CA-125 highly pos. TAH BSO and biopsies: cystadenoca in both ovaries and tumor nodules (> 2 cm) on cervix, pelvic sidewall, small intestine, and surface of liver. 0/8 LN pos.
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Tumor size Extension 999 Size not stated 72 TS/Ext Eval 3 Lymph nodes 00 Reg LN Eval 3 Reg LN Pos 00 Reg LN Exam 08 Mets at Dx Mets Eval 00 0 Peritoneal mets > 2 cm Based on pathology report No nodes involved Based on pathology report No nodes involved Eight nodes examined Inaccessible sites rule--presumed neg.
Based on non-invasive clinical evidence
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SSF1 SSF2 - SSF6 010 CA-125 elevated 888 Not applicable CS Ovary Coding 2005