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Abstracting Keys

The stomach (all sections) is considered a single organ. The esophagus (entire length) is considered a single organ. The small intestine is considered three organs: duodenum, jejunum, ileum.

Gastric ulcers in patients with achlorhydria are malignant until proven otherwise.

Debulking is surgical removal of as much macroscopic tumor as possible in the abdomen. The principle behind debulking is to reduce the size of the largest residual tumor to less than 2.0 cm in greatest dimension so that the patient's total tumor mass is minimal. The effectiveness of postoperative adjuvant radiation and chemotherapy is increased when the tumor burden is smallest. Also called: tumor reduction surgery, cytoreductive surgery.

Record circumferential lesion (entire circumference) of the esophagus as 998 in the field "Size of Tumor."

Record 998 in "Size of Tumor" field if involvement of stomach is described as 3/4 or more of stomach, diffuse, linitis plastica, or widespread.

Use TX if the primary tumor was excised at another facility and no information about tumor size is available.

Do not add together the sizes of pieces of tumor removed at biopsy and at resection. Use the largest size of tumor, even if this is from the biopsy specimen. If no size is stated, record as 999 in the field "Size of Tumor."

For esophageal cancer, disregard extension within the wall (intraluminal) to adjacent segments of esophagus and code the maximum depth of invasion through the esophageal wall or extra-esophageal spread wherever it occurs.

For stomach cancer, disregard extension within the wall (intraluminal) to esophagus or duodenum and code the maximum depth of invasion through the stomach wall or extra-gastric spread wherever it occurs.

For small bowel cancer, disregard extension within the wall (intraluminal) to adjacent segments of small intestine and code the maximum depth of invasion or spread beyond small bowel wall wherever it occurs.

If a partial resection of the stomach is performed for diagnosis and a more complete procedure, such as a Billroth II, is done as cancer-directed surgery, code the more complete surgical procedure. The surgical code should indicate the status of the primary organ at the completion of the procedure.