Staging Made Simple
During the process of staging a tumor, you may want to ask the following questions. Answers to these four basic questions will help determine the correct code for summary stage.
- Where did the cancer start?
In what organ or tissue did the tumor originate? Is there a specific sub site of the organ involved? Information about the "primary site" will usually come from the physical examination, diagnostic imaging report(s), operative report(s), pathology report(s), or laboratory test(s). Code the primary site according to the rules in the International Classification of Diseases for Oncology, Third Edition. In addition to recording this code in the primary site field on the cancer abstract, this code will be useful later in the staging process.
- Where did the cancer go?
Once the primary site is known, determine what other organs or structures are involved. Review the physical examinations, diagnostic imaging report(s), operative report(s), pathology report(s), and laboratory test(s) to identify any structures that are involved by cancer cells. Any of these reports can provide a piece of information that might change the stage. Note whether there is lymphatic or vascular invasion and/or spread, which organs or structures are involved, and whether there is a single focus or multiple foci of tumor.
It is important to know the names of the substructures within the primary site as well as the names of surrounding organs and structures. Note the names of any tissues that are reported to be involved by cancer cells. There is an adjacent structure list in the SEER Summary Stage Manual-2000.
- What is the stage and correct code for this cancer?
- Open the staging manual to the correct site scheme identified in #1 above.
- Review the staging scheme looking for the names of the structures and organs that were reported as involved. If more than one structure or organ is involved, select the highest category that includes an involved structure.
If all reports are negative for spread of the cancer and the pathologist states that the cancer is non-invasive or non-infiltrating, code the stage as 0, in situ.
If all reports are negative for spread of the cancer and the pathologist states that the cancer is invasive or infiltrating, code the stage as 1, localized.
If other organs or structures are involved, assign the highest code associated with an involved structure.