General Guidelines for CS

1. Collaborative Staging System applies to cases diagnosed on or after January 1, 2004. Collaborative Stage is not used for cases diagnosed prior to January 1, 2004.
2. Data for stage is collected on all cancer cases, (all sites and all histologies) regardless of whether the case has been microscopically confirmed.
3. Diagnostic confirmation is collected in a separate data item.
4. Summary Stage 1977 and 2000 are generated for all sites and histologies.
5. TNM elements and stage group are only generated for some sites and apply to all histologies defined by AJCC.
6. Cases not microscopically confirmed should be coded from the scheme for the site the clinician considers most likely to be the primary.
7. The timing rule is the same for TNM 6th Edition, SS 2000, and Collaborative Staging. Staging is based on information gathered through completion of surgery(ies) in first course of treatment or all information available within four months of the date of diagnosis (in the absence of disease progression), whichever is longer.
8. Metastasis known to have developed after the diagnosis was established should be excluded when determining the farthest extent of disease at diagnosis.
9. The codes are ordered in a hierarchy so that increasing numbers generally indicate increasing degrees of tumor involvement. For each field, code the highest applicable number. Exception: Codes for Unknown and Not Applicable are a lower priority over codes with lower numbers.
10. Coding is based on the best available clinical and pathologic information.
11. For the fields CS Tumor Size, CS Extension, CS Lymph Nodes, and CS Mets at DX, Collaborative Staging records the farthest extent of disease based on combined clinical and operative/pathological assessment. Gross observations at surgery are important when all malignant tissue is not removed. In the event of a discrepancy between pathology and operative reports, pathology report is given priority. If there is no pre-op treatment, pathologic information takes priority; if there is pre-op treatment, clinical information takes priority in most cases. Clinical information, such as description of involvement of skin, or size of primary lesion or distant lymph nodes can change a stage and should be reviewed carefully to assure accurate coding.
12. When the patient does not receive pre-operative therapy (that is systemic chemotherapy, hormone, immunotherapy, and radiation therapy), and the operative/pathology report information disproves the clinical information, code the operative/pathology information.
13. When the patient does receive pre-operative cancer directed therapy, the greatest extent of disease should be recorded, whether determined clinically or pathologically.
14. The fields CS Tumor Size/Ext Eval, CS Reg Nodes Eval, and CS Mets Eval, document the methods used to determine tumor size and extension, lymph node involvement and distant metastasis, as well as the status of pre-operative treatment.
15. Site specific and histology specific guidelines take precedence over general guidelines. Always read the information pertaining to a specific site or histology.
16. Autopsy reports are used in coding Collaborative Stage in the same manner as pathology reports, applying the same inclusions and exclusions.
17. Death Certificate Only cases are usually coded as either unknown (9,99,999), or not applicable (8,88,888) in all CS fields.
18. Site-Specific Factors (SSF) are included in every scheme, and are incorporated into the algorithms when additional information is necessary to derive tumor (T), lymph node (N), metastasis (M), or TNM stage group, or where the factor is considered to be of clinical or prognostic importance. Information formerly coded as tumor markers, such as estrogen receptor for breast is coded in a site-specific factor. For sites/histologies where they are not used they are coded as "not applicable"
19. The fields "Regional Lymph Nodes Positive" and "Regional Lymph Nodes Examined" are based on pathologic (microscopic) information only.
20. Clinical information may be used in coding CS fields, minimizing the use of coding "unknown", instead coding "none" for regional lymph nodes or distant metastases. This applies primarily to localized or early (T1, T2) stage in the TNM system. This applies to situations where there is no reason to doubt that the tumor is local, based on the clinical information available. By coding regional lymph nodes as negative and/or coding distant metastasis as none rather than coding these fields as unknown, the CS computer algorithms will derive a stage group that includes the best information available.
21. CS records the farthest extent of disease based on combined clinical and operative / pathologic assessment. Gross observations at surgery are important when all malignant tissue is not removed. In the event of a discrepancy between path and op reports, the pathology report takes priority. If there is no pre-operative treatment, pathologic information takes priority; if there is a pre-operative treatment, clinical information takes priority in most cases. Clinical information can change a stage and should be reviewed carefully to assure accurate coding. For example, skin involvement in a breast cancer case and / or clinically assessed distant lymph nodes can change a stage.