Cancer registries should first examine the sources used to identify malignant CNS tumors and expand the procedures to include non-malignant CNS tumors.
Since surgery is often the treatment for CNS tumors of all behaviors, pathology reports are an excellent casefinding source. Inpatient and outpatient surgery logs should also be reviewed. Many patients with CNS tumors of all behaviors are treated with adjuvant radiation therapy and review of radiation oncology appointment logs is a way to identify these cases.
If the hospital has a gamma/cyber knife center, review logs and schedules as part of casefinding. Gamma/cyber knife is becoming a common treatment for non-malignant CNS tumors. Hormone therapy and immunotherapy are medical treatments given for both non-malignant and malignant CNS tumors.
Central cancer registries have additional casefinding sources. Freestanding radiation therapy centers, freestanding MRI centers, and freestanding gamma/cyber knife centers not associated with a hospital, are a case ascertainment source for CNS cases. Central cancer registries should check with the licensing board in their state/region to ensure identification of all facilities using nuclear sources for treatment. Freestanding oncology centers are another source of information for central registries.
The facility disease index is one source of casefinding utilized by cancer registrars and central registry staff. Data is stored in the index by ICD code. At this time, facilities in the United States continue to assign ICD-9-CM codes to final diagnoses. The ICD-9-CM codes shown below should be added to casefinding lists to identify non-malignant CNS tumors through the facility disease index.
ICD-9 Casefinding Codes
|225||Benign neoplasm of brain and other parts of central nervous system|
|225.2||Cerebral meninges; meninges, NOS; meningioma|
|225.3||Spinal cord; cauda equina|
|225.8||Other specified sites of nervous sytem|
|225.9||Nervous system, part unspecified|
|227.3||Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch)|
|227.4||Benign neoplasm of pineal gland/body|
|237||Neoplasm of uncertain behavior of endocrine glands and nervous system|
|237.0||Pituitary gland and craniopharyngeal duct|
|237.5||Brain and spinal cord|
|237.6||Meninges (NOS, cerebral, spinal)|
237.71 Type I (von Recklinghausen's disease)
237.72 Type II (acoustic neurofibromatosis)
|237.9||Other and unspecified parts of nervous system; cranial nerves|
CNS cases may also be identified through data exchange with other central registries and through the death clearance process. Below the ICD-10 casefinding codes for death certificates.
|D32||Benign neoplasm of meninges|
|D33||Benign neoplasm of brain and other parts of central nervous system|
|D33.7||Other specified sites of nervous system|
|D33.9||Central nervous system, part unspecified|
|D35||Benign neoplasm of other and unspecified endocrine glands|
|D42||Benign neoplasm of meninges|
|Q85.0||Neurofibromatosis (non-malignant); (von Recklinghausen's disease)|
|D43||Neoplasm of uncertain or unknown behavior of brain and central nervous system|
|D43.7||Other specified sites of nervous system|
|D43.9||Central nervous system, part unspecified|
|D44||Neoplasm of uncertain or unknown behavior of endocrine glands|
In summary, listed below are some important casefinding sources:
- Disease indices
- Surgery logs
- Diagnostic imaging
- Radiation oncology
- Neurology clinics
- Medical oncology
- Autopsy reports
- Pathology reports
- Freestanding radiation therapy centers
- Freestanding MRI centers
- Freestanding gamma/cyber knife centers
- Freestanding oncology centers
- Data exchange with other central registries
- Death clearance process