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Abstracting Keys

The organs of the true pelvis are the bladder, ureters, urethra, uterus, fallopian tubes, ovaries, vagina and rectum.

The adnexa are the fallopian tubes, ovaries and the supporting ligaments of the internal genitalia.

A cytologic diagnosis of CIN III (cervical intraepithelial neoplasia grade iii) must be carefully reviewed, because this diagnosis includes both carcinoma in situ and severe dysplasia. If the pathology report describes severe dysplasia, the tumor need not be abstracted. If the CIN III diagnosis includes a description of carcinoma in situ, the case should be abstracted.

Microinvasive tumor is that which has invaded the stroma microscopically. This is considered a localized lesion.

In situ tumor with microinvasion should not be classified Tis.

Stage IA (microinvasive carcinoma) must be determined by a pathologist. All other Stage I cases are subcategorized Stage IB.

Ignore extension into the corpus when determining stage.

Extension to the vagina is at least Stage II; extension to ovary is at least Stage III.

Bullous edema is a blister-like appearance of the interior surface of the bladder or rectum, which is not to be considered evidence of a T4 lesion.

Nephrosis or non-functioning kidney due to stenosis of the ureter assigns the case to stage III.

When there is doubt about which stage is appropriate for a particular cancer, the rule is to use the lower stage. For example, if it is not clear that a case should be included in Stage III, the case should be Stage II.

Involvement of the anterior or posterior septum (fornix) is coded as involvement of the vaginal wall.

Seeding, implants, and tumor nodules in the omentum, peritoneum or on the diaphragm are considered distant disease (Stage IV).

There must be evidence of actual tumor on the interior (mucosal) surface of the bladder or rectum in order for the tumor to be assigned to the T4 (Stage IVA) category.

Occasionally, it is not possible to determine whether the primary is in the corpus or cervix. In such cases, after all diagnostic workup is complete, assign adenocarcinomas to a corpus primary and epidermal (squamous) carcinomas to a cervical primary.

If the operative report states that the adnexa were palpated but gives no mention of nodes, assume that the lymph nodes are negative.

If exploratory or definitive surgery is performed and lymph nodes are not mentioned in the operative report, assume that the lymph nodes are negative.

Treatment for cervical carcinoma in situ may be only a D & C or conization, laser surgery, or cryosurgery. These can be coded as curative treatment if the procedure is not followed by a hysterectomy. If a hysterectomy is performed, this is considered the cancer-directed surgery.

"Sounding" of the uterus is accomplished by inserting a probe and measuring the distance from the back of the uterine cavity to the external os. The depth may be measured in inches or centimeters. A D & C may also give this information.

Both pleural effusion and ascites must be cytologically proven to have an effect on TNM staging.

FIGO is the acronym for the French term that means International Federation for Gynecology and Obstetrics. This clinical staging system uses the categories Stage 0 through Stage IV. It is sometimes called the League of Nations staging system. The American Joint Committee on Cancer has developed the tumor (T) component of the TNM staging system to correspond to FIGO staging.