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Significance of Changes

Changes/Updates that Change the Stage

There are some changes and updates to the SEER Summary Staging Manual - 2000 that will change the stage from what it would have been using the old Summary Staging Guide - 1977 (SSG77).

For example: In the bronchus and lung scheme, a cancer case that has a separate tumor nodule in a different lobe (of the same lung), was staged as localized using SSG77. However, more accurately, this disease description should be staged as distant. Therefore, in the SEER Summary Staging Manual - 2000, there is an asterick (*) notation on the term "Separate tumor nodule(s) in different lobe". That asterick notation signifies a stage change from what was considered localized using SSG77. The magnitude of the stage change in this example is that cases with that disease extension were staged as localized using the SSG77, but they would now more accurately be staged as distant using the SEER Summary Staging Manual - 2000.

Notations

As mentioned above, there are notations used in the SEER Summary Staging Manual - 2000 to denote any changes. Both asterisks (*) and number signs (#) are used. Users are encouraged to pay attention to the notations when comparing data across time, especially when comparing stage data prior to 2001 diagnoses with stage data on or after 2001 diagnoses.

Stage Shifting

It is understood that stage shifting due to updating the SEER Summary Staging Manual - 2000 may be frustrating when comparing data across time, especially when comparing stage data prior to 2001 diagnoses with stage data on or after 2001 diagnoses. The changes that were made and included in SEER Summary Staging Manual - 2000 were NOT arbitrary. Rather, the changes that were made were due to current medical practice and current medical understanding of disease spread and the corresponding impact on stage. In plain English, the world has learned a lot about cancer and cancer staging since the SSG77 and those changes are reflected in the SEER Summary Staging Manual - 2000.

Summary of Changes and Noteworthy Items

The following is a list of changes and noteworthy items regarding the SSSM2K:

  1. EVERY anatomic site has a staging scheme
  2. It's a MANUAL with rules, definitions, and standardized codes
  3. The colon sub site schemes in SSG77 are grouped into one colon scheme in SSSM2K
  4. Pleural effusion is specifically stated under Distant for lung
  5. 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)
  6. 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.

  7. There are marks denoting those things that are different than the Historical Stage (#) and those things that are 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.

  8. SSSM2K should not be used on cases diagnosed prior to January 1, 2001.

A PDF file of the SSSM2K is available. The published hard-copy version of SSSM2K, complete with anatomical drawings and illustrations, is also available.

Printed copies of the SSSM2K are free of charge and can be ordered from SEER in the usual manner.