V.5.1 Stage at Diagnosis

Coding Guidelines:

• Include pertinent findings from autopsy reports if the patient dies within four months of the diagnosis of cancer. However, as with other types of information, exclude data about progression of disease since the time of the original diagnosis.

• Progression of Disease: Any regional or distant metastasis known to have developed after the stage at diagnosis was established.

Examples:

Case scenario: Prostate biopsy 1/10/15 is diagnostic of Adenocarcinoma. There is no suspicion of and/or evidence of disease beyond the prostate. On 2/28/15 the patient underwent a Radical prostatectomy. He was seen again on 4/28/15 complaining of hip pain. On 5/1/15 Bone scan reveals bony metastases.

• The subsequent findings of bony mets, even though within four months from diagnosis would be excluded when coding stage at diagnosis.

• Alternatively, if a patient is undergoing first course treatment and then develops new symptoms or is not responding to treatment, and upon investigation is found to have disease progression, the progression of disease would be excluded when coding the stage at diagnosis.

• Documentation of treatment failure and/or disease progression signifies the end of the first course of treatment.

• Sometimes stage may be stated incorrectly in the medical record due to a typographical, transcription, or similar error. If the stage recorded in one report is clearly contradicted in another, query the physician or the registry's medical consultant. Do not code stage based on information that appears to be inaccurate.

• Three methods commonly used to determine stage are the American Joint Committee on Cancer (AJCC) TNM staging system,  SEER Summary Stage and the Collaborative Stage Data Collection System:

• AJCC TNM: Used in the clinical setting by physicians to define spread of disease to make appropriate treatment decisions, determine prognosis, and measure end results. Refer to the most current AJCC Cancer Staging Manual for coding instructions.

• SEER Summary Stage: Used by Epidemiologists and researchers where cases are grouped into standardized and simplified broad categories to ensure consistent definitions over time. Refer to the most current SEER Summary Stage Manual for coding instructions.

• Collaborative Stage Data Collection System: Used by registrars to code data items necessary to derive AJCC T, N, M, Stage Group, Summary Stage 1977, and Summary Stage 2000. Refer to the most current Collaborative Stage Coding Instructions Manual for coding instructions.

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