The following head and neck 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, you are to identify the primary site and code it; identify the tumor morphology and code it; and then stage each case 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 head and neck would be staged using the lymphoma staging schemes, NOT the head and neck staging schemes).
When assigning stage to each case, remember the following:
- Check the morphology (some morphologies are not "TNM'able" 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 to each of the cases are provided. Discussion as to why these are the correct answers is also provided.
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.