Abstracting Tips

Relevant Site-Specific Data Items (SSDIs)

  • FIGO Stage
  • CA-125 Pretreatment Interpretation
  • Residual Tumor Volume Post Cytoreduction

Anatomical Abstracting Tips

Concept Key Words
“True Pelvis” organs
  • Bladder
  • Ureters
  • Urethra
  • Uterus
  • Fallopian tubes
  • Ovaries
  • Vagina
  • Rectum
Included in “Adnexa Uterine Other” schema
  • Broad ligament (C571)
  • Round ligament (C572)
  • Parametrium (C573)
  • Uterine adnexa (C574)
Bilateral Involvement

Bilateral involvement of ovaries with the same histology is a single primary for the purposes of cancer registry reporting.

Bilateral involvement can affect staging. One ovary involved is FIGO Stage IA, while involvement of both ovaries is FIGO Stage IB and above.
Ruptured ovarian capsule Review the operative and pathology reports and note whether rupture was intraoperative or occurred before surgery. This information is used for staging.
Nodes: palpated adnexa or exploratory surgery If no mention of nodes, assume that the lymph nodes are negative.
Tumor size Record the size of the tumor, not the size of the cyst.
FIGO Staging

FIGO Stage is based on:

  • Involvement of one or both ovaries
  • Rupture of ovaries
  • Malignant cells in ascites or peritoneal washings
  • Implants within adnexa
  • Microscopic vs. macroscopic peritoneal implants

Surgery of a Primary Site

If a resection of one ovary is done for diagnosis and a more complete procedure, such as resection of the other ovary, is done as cancer directed surgery, code the more complete surgical procedure. If a left oophorectomy was done in the past for a previous primary or other problem and a right oophorectomy is now being performed for a new primary, code the current procedure as bilateral oophorectomy. The surgical code should indicate the status of the primary organ at the completion of the procedure.

Endometrioid Carcinoma

Endometrioid carcinoma may be primary in the ovary. It should not be coded as metastatic from the endometrium, nor should the endometrium be coded as a metastatic site unless histologically proven.

Residual Tumor

Residual disease after debulking refers to the size of the largest tumor mass left in the pelvis and abdomen. In other words, a 1 cm residual means that the largest of any remaining tumor nodules is 1 cm. Residual tumor may be described as minimal (1 cm or less) or macroscopic (over 1 cm). For more information, see the notes for the SSDI ‘Residual Tumor Volume Post Cytoreduction’.

FIGO Staging and Abdominal Structures

Structures in the pelvis related to FIGO Stage II (confined to pelvis)

  • FIGO Stage IIA
    • Adnexa
    • Fallopian tube(s)
    • Uterus, NOS
  • FIGO Stage IIB
    • Adjacent peritoneum
    • Bladder
    • Bladder serosa
    • Cul de sac (rectouterine pouch)
    • Ligament(s) (broad, ovarian, round, suspensory)
    • Mesovarium
    • Parametrium
    • Pelvic wall
    • Rectosigmoid
    • Rectum
    • Sigmoid colon (including sigmoid mesentery)
    • Ureter (pelvic portion)
  • FIGO Stage II, NOS
    • Tumor involves one or both ovaries
    • Pelvic extension, NOS (below pelvic brim)

Structures in the abdomen related to FIGO Stage III (spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes)

  • Abdominal mesentery
  • Diaphragm
  • Gallbladder
  • Intestine, large (except rectum)
  • Kidneys
  • Liver (peritoneal surface)
  • Omentum (infracolic, NOS)
  • Pancreas
  • Pericolic gutter
  • Peritoneum, NOS
  • Rectosigmoid
  • Sigmoid colon
  • Small instestine
  • Spleen (capsular involvement only)
  • Stomach
  • Ureters (outside pelvis)

Regional Lymph Nodes

  • Aortic, NOS
    • Lateral (lumbar)
    • Para-aortic
    • Periaortic
  • Iliac, NOS
    • Common
    • External
    • Internal (hypogastric, obturator, NOS)
  • Intra-abdominal
  • Lateral sacral (laterosacral)
  • Pelvic, NOS
  • Retroperitoneal, NOS
  • Subdiaphragmatic (primary peritoneal carcinoma)
  • Regional lymph node(s), NOS

Updated: June 8, 2018