Cancer registries should first examine the sources used to identify malignant CNS tumors and expand the procedures to include non-malignant CNS tumors.

Since surgery is often the treatment for CNS tumors of all behaviors, pathology reports are an excellent casefinding source. Inpatient and outpatient surgery logs should also be reviewed. Many patients with CNS tumors of all behaviors are treated with adjuvant radiation therapy and review of radiation oncology appointment logs is a way to identify these cases.

If the hospital has a gamma/cyber knife center, review logs and schedules as part of casefinding. Gamma/cyber knife is becoming a common treatment for non-malignant CNS tumors. Hormone therapy and immunotherapy are medical treatments given for both non-malignant and malignant CNS tumors.

Central cancer registries have additional casefinding sources. Freestanding radiation therapy centers, freestanding MRI centers, and freestanding gamma/cyber knife centers not associated with a hospital, are a case ascertainment source for CNS cases. Central cancer registries should check with the licensing board in their state/region to ensure identification of all facilities using nuclear sources for treatment. Freestanding oncology centers are another source of information for central registries.

The facility disease index is one source of casefinding utilized by cancer registrars and central registry staff. Data is stored in the index by ICD code. At this time, facilities in the United States continue to assign ICD-9-CM codes to final diagnoses. The ICD-9-CM codes shown below should be added to casefinding lists to identify non-malignant CNS tumors through the facility disease index.

ICD-9 Casefinding Codes
Code Definition
225 Benign neoplasm of brain and other parts of central nervous system
225.0 Brain
225.1 Cranial nerves
225.2 Cerebral meninges; meninges, NOS; meningioma
225.3 Spinal cord; cauda equina
225.4 Spinal meninges
225.8 Other specified sites of nervous sytem
225.9 Nervous system, part unspecified
227.3 Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch)
227.4 Benign neoplasm of pineal gland/body
237 Neoplasm of uncertain behavior of endocrine glands and nervous system
237.0 Pituitary gland and craniopharyngeal duct
237.1 Pineal gland
237.5 Brain and spinal cord
237.6 Meninges (NOS, cerebral, spinal)
237.7 Neurofibromatosis
237.70 Unspecified
237.71 Type I (von Recklinghausen's disease)
237.72 Type II (acoustic neurofibromatosis)
237.9 Other and unspecified parts of nervous system; cranial nerves

CNS cases may also be identified through data exchange with other central registries and through the death clearance process. Below the ICD-10 casefinding codes for death certificates.

ICD-10 Casefinding Codes (for death certificates)
Code Definition
D32 Benign neoplasm of meninges
D32.0 Cerebral meninges
D32.1 Spinal meninges
D32.9 Meninges, unspecified/NOS
D33 Benign neoplasm of brain and other parts of central nervous system
D33.0 Brain, supratentorial
D33.1 Brain, infratentorial
D33.2 Brain, unspecified
D33.3 Cranial nerves
D33.4 Spinal cord
D33.7 Other specified sites of nervous system
D33.9 Central nervous system, part unspecified
D35 Benign neoplasm of other and unspecified endocrine glands
D35.2 Pituitary gland
D35.3 Craniopharyngeal duct
D35.4 Pineal gland
D42 Benign neoplasm of meninges
D42.0 Cerebral meninges
D42.1 Spinal meninges
D42.9 Meninges, unspecified/NOS
Q85.0 Neurofibromatosis (non-malignant); (von Recklinghausen's disease)
D43 Neoplasm of uncertain or unknown behavior of brain and central nervous system
D43.0 Brain, supratentorial
D43.1 Brain, infratentorial
D43.2 Brain, unspecified
D43.3 Cranial nerves
D43.4 Spinal cord
D43.7 Other specified sites of nervous system
D43.9 Central nervous system, part unspecified
D44 Neoplasm of uncertain or unknown behavior of endocrine glands
D44.3 Pituitary gland
D44.4 Craniopharyngeal duct
D44.5 Pineal gland

In summary, listed below are some important casefinding sources:

  • Disease indices
  • Surgery logs
  • Diagnostic imaging
  • Radiation oncology
  • Neurology clinics
  • Medical oncology
  • Autopsy reports
  • Pathology reports
  • Freestanding radiation therapy centers
  • Freestanding MRI centers
  • Freestanding gamma/cyber knife centers
  • Freestanding oncology centers
  • Data exchange with other central registries
  • Death clearance process