The following pancreatic and biliary cancer cases are presented to help you abstract the primary site and then code that primary site. Further, the exercises will help you abstract the tumor morphology (histology) and then code the morphology correctly. And finally, these exercises will help you abstract, stage, and code the cases using the three staging systems that are currently in use in various parts of the United States, and the world, namely, SEER Summary Stage, TNM (AJCC/UICC) Sixth Edition (TNM6), and Collaborative Stage.
For the purposes of these exercises, assume that all tests and observations were performed within 4 months of diagnoses or discharge.
For each case, identify and code the primary site and morphology and stage each using the three staging systems. Note: It is important to identify the correct primary site and the correct histology before assigning a stage to each case (for example, a lymphoma of the pancreatic and biliary would be staged using the lymphoma staging schemes, NOT the pancreatic and biliary cancer staging schemes).
When staging each case, remember the following:
- Check the morphology (some morphologies cannot be staged using TNM, and some morphologies will dictate the correct staging scheme to be used)
- Where did the malignancy start (primary site)?
- Where did it go (spread or not)?
- How did it get there (direct extension or metastasis)?
- Use the correct standard reference, follow the rules, and assign the correct stage.
Correct answers along with appropriate discussion is provided for each case.
Note: These exercises were written for Collaborative Stage version 1, CSv01.04.00 (October 2007). They are currently being updated and will be replaced with exercises based on CSv2 version 02.03.02.