SEER Summary Staging Manual 2000
Whether you refer to it as SS2000, SS2K, SSSM2K, or any other combination, the SEER Summary Staging Manual 2000 (SSSM2K) is currently available.
The Uniform Data Standards (UDS) committee of NAACCR has approved the use of SSSM2K starting with January 1, 2001 diagnoses and forward. The NAACCR Record Layout version 9 is ready to accommodate the SSSM2K code. It is unfortunate that NAACCR Standards for Cancer Registries, Volume II, Fifth Edition, May 15, 2000 contains an erroneous definition of the "time rule" for SSSM2K. The CORRECT "time rule" for SSSM2K is contained in the Sixth Edition of Volume II, and reads:
Summary stage should include all information available through completion of surgery(ies) in the first course of treatment or within four months of diagnosis in the absence of disease progression, whichever is longer.
A major change from the Summary Staging Guide 1977 (SSG77) to the SEER Summary Staging Manual 2000 is the change in the "time rule" from the "two month rule" used in conjunction with SSG77 to the above "time rule" in SSSM2K.
The following is a list of changes and noteworthy items regarding the SSSM2K:
- EVERY anatomic site now has a staging scheme;
- It's now a MANUAL with rules, definitions, and standardized codes;
- The colon sub site schemes in SSG77 are now grouped into one colon scheme in SSSM2K;
- Pleural effusion is now specifically stated under Distant for lung;
- For the lymphomas, the code choices are 1 for Stage I, 5 for Stage II and 7 for Stage III and Stage IV. The use of code 5 for Stage II lymphomas alleviates the confusion of using code 2 (Reg DE), code 3 (Reg LN), or code 4 (Reg DE and LN);
- For breast cases, some cases will shift from Localized to Regional Direct Extension. In SSG77, a note reads as follows:
Skin changes such as dimpling, tethering, attachment, fixation, induration and thickening or Paget's disease of the nipple do not alter the classification.
Due to the fact that dimpling, tethering and nipple retraction are caused by tension on Cooper's ligament(s), and not by actual skin involvement, the new note in SSSM2K reads as follows:
Adherence, attachment, fixation, induration, and thickening are clinical evidence of extension to skin or subcutaneous tissue and are to be coded Regional Direct Extension.
- There are marks denoting those things that are now different than the Historical Stage (#) and those things that are now different from the SSG77 (*) Two examples illustrate this:
Mandible is marked with a # notation in the soft palate (C05.1) scheme because extension to the mandible is now staged Distant in SSSM2K, whereas it was considered regional in the Historical Stage.
Diaphragm is marked with a * notation in the lung (C34.9) scheme because extension to the diaphragm is now staged Regional by Direct Extension in SSSM2K, whereas it was considered Distant in the SSG77.
- SSSM2K should not be used on cases diagnosed prior to January 1, 2001.
- If abstractors follow the recommended abstracting procedure of waiting four months (but no longer than 6 months) before reporting the case, SSSM2K really is not needed until March or April of 2001 since the earliest* a January 1, 2001 case should theoretically be reported is May 1, 2001. The four to six months guideline is a good recommendation for two reasons:
- medical record completion; and
- determination and/or initiation of the first course of treatment.
It is detrimental to cancer surveillance programs to abstract cases too early because case information may therefore be incomplete. Further, multiple subsequent case reports will then be needed to be sent in to the central registry in order to have complete information on the cases.
Printed copies of the SSSM2K are free of charge and are able to be ordered from SEER in the usual manner.
*Except for the expired cases, which normally are abstracted prior to the recommended 4 to 6 months delay. The expired cases can be held and abstracted in early 2001 as soon as the SSSM2K manuals are ready.