4 multiple primaries lutz

7/29/2019 4 Multiple Primaries Lutz

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JM Lutz 18-20 September 2013

Universit degli

Studi di CataniaMonotoraggio e

valutazione del

rischio ambientale

mutageno,

teratogeno

Multiples Primaries


2/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

What is a primary tumour ?

! Up to now, only malignant invasive (/3)and in situ (/2) tumours are registered, atleast for localisations linked with possiblescreening (e.g. breast, cervix) and few

specific sites (brain, bladder, skin).

! Possible recommendation: to registermore tumours with behaviour

/1 : benign or malignant, not certain/2 : in situ/3 : invasive

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

Exceptions

Comments

Data quality


3/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

Multiple primaries

! For comparability, it is necessary to followInternational Rules for Multiple PrimaryCancers (ICD-0 Third Edition), Lyon, 2004

http://www.iacr.com.fr

in "publications"

! Tumour after a first tumour is also aprimary, characterized by its topography,its morphology, its behaviour and itsgrade of differentiation

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

Exceptions

Comments

Data quality


4/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

General rules for registration

! Rule 1 : Time (i.e. duration since the firsttumour) is not a criteria

! Synchronous or metachronous arepossible others primary tumours

! Rule 2 : Neither extension nor metastasisnor relapse

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

Exceptions

Comments

Data quality


5/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno


! Rule 3 : Only one tumour shall berecognised to as arising in an organ or pairof organs or tissue

! an organ or a group of organ

! Multifocal tumours : not in continuity withother primary originating in the sameprimary site = single cancer

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

Exceptions

Comments

Data quality


6/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

Groups of topography codesconsidered as single site

ICD-O(3)site code

Label

iIf metachronous :code first diagnosis

site ; if synchronouscode as following

C01-C02

Base of tongue ; Other and

unspecified parts of the tongue C02.9

C00, C03,C04, C05,C06

Lip, Gum, Floor of mouth,Palate, other and unspecifiedparts of mouth

C06.9

C09, C10,C12, C13,C14

Tonsil, Oropharynx, Pyriform

sinus, Hypopharynx, Other andill defined sites in lip, oral cavityand pharynx

C14.0

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

Exceptions

Comments

Data quality


7/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

Groups of topography codesconsidered as single site

ICD-O(3)site code

Label

iIf metachronous :code first diagnosis

site ; if synchronouscode as following

C19, C20 Rectosigmoid junction, Rectum C20.9

C23, C24 Gallbladder, Other andunspecified parts of biliary tracts C34.9

C40, C41

Bones, joints and articularcartilage of limbs, joint andarticular cartilage of other andunspecified site

C41.9

C65, C66,C67, C68

Renal pelvis, Ureter, Bladder,Other and unspecified urinaryorgans

C68.9

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

Exceptions

Comments

Data quality


8/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno


Rule 3 does not apply in two circumstances:

! Rule 4.1 :Systemic (or multicentric) cancersinvolving many different organs, (i.e tumours of

haematopoietic system, kaposi sarcoma)Registering only one tumour

! Rule 4.2 : Neoplasm ofdifferent morphologyshould be regarded as other primary, even if

diagnosed simultaneously in the same siteRegistering different tumours

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

Exceptions

Comments

Data quality


9/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

Groups of malignant neoplamshistologically different

(Berg, 1996)

Group Carcinomas ICD-O(3) codes

1. Squamous and transitional cellcarcinomas

851-8084, 81208131

2. Basal cell carcinomas 8090-8110

3. Adenocarcinomas

8140-8149, 8160-8162, 8190-8221,

8260-8337, 8350-8551, 8570-8576,894089410

4. Other specific carcinomas8030-8046, 8150-8157, 8170-8180,8230-8255, 8340-8347, 8560-8562,85808671

(5) Unspecified carcinomas (NOS) 8010-8015, 80208022, 8050

6. Sarcomas and soft tissuestumours

86808713, 88008921, 8990-8991,90409044, 9120-9125, 9130-9136,91419252, 9370-9373, 95409582

7. Mesothelioma 9050-9055

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

ExceptionsComments

Data quality


10/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno


(Berg, 1996)

Tumours of haematopoietic and lymphoid tissues

8. Myeloid9840, 9861-9931, 9945-9946, 9950,99619964, 9980-9987

9. B-Cell neoplasms96709699, 9728, 97319734, 97619767, 9769, 98239826, 9833, 9836,9940

10. T-cell and NK-cell neoplasms97009719, 9729, 9768, 98279831,9834,9837, 9948

11. Hodgkin lymphoma 9650966712. Mast-cell tumours 9740974213. Histiocytes and Accessory

Lymphoid cell 9750-9758(14) Unspecified types

95909591, 9596, 9727, 9760, 98009801, 9805, 9820, 9832, 9835, 9860,9960, 9970,9975, 9989

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

ExceptionsComments

Data quality


11/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno


(Berg, 1996)

Tumours of haematopoietic and lymphoid tissues

15. Kaposi sarcoma 9140

16. Other specified types of cancer87208790, 8930-8936, 89508983,90009030, 90609110, 92609365,93809539

(17) Unspecified types of cancer 8000-8005

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

ExceptionsComments

Data quality


12/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

General rules for registrationTopography - Morphology

! Topography (CXX.) different, any morphologyRegistering all tumours

! Same topography (CXX.) and morphologywithin a different "Berg morphology group"

Registering all tumours

! Same topography (CXX.) and morphologywithin the same "Berg morphology group" :

Registering only one tumour,highest ICD-0 morphology code

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

ExceptionsComments

Data quality


13/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

Exceptions, or subtle precisionsfor registration

4.2. : Single tumour containing several

different morphologies within the samehistological group (i.e. "Berg" group), then

registering a single tumour, using thehighest ICD-O morphology code :

However, if morphologies are mixed specific

and non specific, this later one should beignored and the case be reported with

specific histology.

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

ExceptionsComments

Data quality


14/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno


Organ pair : Topographies (CXX.) andmorphologies within the same Berg group :breast (C50), testis (C62), kidney (C64), eye

(C69) :

Registering all tumours, with laterality

Remark: not for tonsils (C09), vocal cords(32.0), lung (C34) ovaries (C56), Wilm's tumour

(nephroblastoma of kidney) and retinoblastoma,all recorded as single bilateral when occuring on

both sides

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

ExceptionsComments

Data quality


15/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno


Multifocal tumours in colon (C18), skin (C44),bladder (C67), with morphologies within the samehistological group :

Registering all tumours (CXX.X)for C18 and C44

and a single tumour for C67

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

ExceptionsComments

Data quality


16/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

Recommendations

! To flag registered multiple primaries not inline with international rules, in order toexclude them when publishing incidencedata.

! With synchronous tumours, to flag the lessagressive (measured with TN), in order tobe excluded from incidence data.

! To remind rules of topography grouping.

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

ExceptionsComments

Data quality


17/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

Comments

The main difficulty is not in coding (since it'scoded as a primary), but in deciding whetheror not it is an other tumour and to define adate of incidence, when

It's only suspicious of other tumour, withuncertain basis of diagnosis (clinical, poorlyinvestigated,...) and when the path reportis not clearly positive.

The localisation is known to be at highprobability of metastasis

The information arrives unexpectedly atdeath

and other situations to discover (neverended list of...)

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

ExceptionsComments

Data quality


18/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

Data quality

Keep possibilities to analyse multipleprimaries data

! Incidence! Frequencies for topography distribution! To revise difficult situation with a

pathologist

! Quality of the follow-up (active vs passive)!

Cause of death and mortality data

Introduction

Rules 1 & 2

Rule 3

Topo groups

Rules 4

Morpho groups

General

ExceptionsComments

Data quality


19/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

SEER coding scheme


20/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

SEER coding scheme


21/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

SEER coding scheme


22/22


Universit degli


valutazione del

rischio ambientale

mutageno,

teratogeno

F. Bray, M. Parkin, European Journal of Cancer, 2009

4 multiple primaries lutz

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