California Cancer Reporting System Standards Volume I: Abstracting and Coding Procedures
Physicians sometimes describe disease involvement with ambiguous terms. A list of these terms with rules for interpretation may differ depending on the staging system.
As a general rule, the first and foremost resource for a registrar for questionable cases would be to contact the provider who diagnosed and/or staged the tumor. If the provider is not available, the medical record and any other pertinent reports should be read closely to determine required information. The Ambiguous Terminology list in FORDS and the SEER Summary Stage 2000 manual should be used as a guideline for cases where the wording in the patient record is ambiguous with respect to reportability or tumor spread and there is NO further information available from any source. Do not refer to the Ambiguous Terminology list(s) when there is a clear statement of malignancy or tumor spread. Registrars should only rely on Ambiguous Terminology lists when the information is not clear and the case cannot be discussed with the appropriate provider/pathologist.
Summary Stage 2000:
Refer to page 15 in the Summary Stage 2000 Manual: Interpreting Ambiguous Terminology for Summary Stage
AJCC TNM Stage:
AJCC TNM staging does not define ambiguous terminology nor mandate how words should be interpreted.
For examples and further instruction please refer to the AJCC presentation “Explaining Blanks and X, Ambiguous Terminology and Support for AJCC Staging” updated December 2015 at:
Commission on Cancer (CoC):
The CoC recognizes that not every registrar has access to the physician who diagnosed and/or staged the tumor, as a result, the Ambiguous Terminology lists continue to be used in CoC-accredited programs and maintained by the CoC as “references of last resort”. See current FORDS Manual for instructions regarding Ambiguous Terminology.