Applying ICD-O-3 and AJCC Staging Rules in Hematopoietic and Lymphoid Cases

QUESTION

1. Apply ICD-O-3 coding rules to the Hematopoietic and Lymphoid abstract.
2. Apply AJCC coding rules to the Hematopoietic and Lymphoid abstract.

The Heme and Lymphoid Scavenger Hunt hopefully familiarized you with the Heme and Lymphoid coding manual. Let’s practice some Heme and Lymphoid coding:

In this Heme and Lymphoid exercise, you will practice abstracting some cases for AJCC staging and ICD-O-3 Topography codes. You will need your AJCC staging manual and ICD-O-3 coding book. Please have these available for this exercise.

Hematopoietic and Lymphoid Exercises
Case 1
History:
62-year-old male with fatigue.
Physical Exam:
Enlarged right cervical nodes, 1.7cm
Laboratory:
6/8 ALC 7,000 cells, Hgb 12.5, Platelet 146
Imaging:
6/10 CT chest/abd/pelvis: right cervical node adenopathy
Procedure:
6/12 Right cervical node biopsy
Pathology Report:
6/12 Small lymphocytic/chronic lymphocytic leukemia, right cervical lymph node biopsy
Code this case for ICD-O-3 and AJCC staging:
ICD-O-3 Topography: C _ _. _ (hint: use the ICD-O-3 manual pages 50-51 and the C77 Lymph Nodes)
AJCC Clinical Stage: _______________________________ (hint: use AJCC manual p. 962 and the pink
Stage chart; Keep in mind that there is only involvement of a single lymphatic site or nodal
region(cervical node))

Case 2
History:
50 year old female with digestive problems and weight gain
Physical Exam:
Soreness in the abdominal region
Imaging:
2/5 MRI abd: mass lesion in jejunum partly obstructing lumen, probably malignant
Procedure:
2/7 Upper GI endoscopy and biopsy: thickened friable mass in jejunum
Pathology report:
2/7 Lymphoma, large B-cell, jejunal mass biopsy. Flow cytometry shows diffuse large B-cell lymphoma
Code this case for ICD-O-3 and AJCC staging:
ICD-O-3 Topography: C _ _. _ (hint: use the ICD-O-3 manual page 36 and the C17 Small Intestine)
AJCC Clinical Stage: _______________________________ (hint: use AJCC manual p. 962 and the pink
Stage chart; Remember that there is a single site (extralymphatic) and no nodal involvement)

ANSWER

Applying ICD-O-3 and AJCC Staging Rules in Hematopoietic and Lymphoid Cases

Introduction

In the field of cancer registry management, precise coding is essential for accurately documenting and tracking cancer cases. In this exercise, we will apply the ICD-O-3 coding rules for topography and the AJCC staging rules to two hematopoietic and lymphoid cases. These cases illustrate the importance of correctly coding both the site and stage of the cancer, providing crucial information for clinical management and research.

Case 1

ICD-O-3 Topography Code: C770

Explanation: In this case, the cancer site is the right cervical lymph node. To determine the ICD-O-3 topography code, we refer to the ICD-O-3 manual, specifically pages 50-51 and the C77 section, which corresponds to “Lymph Nodes.” The correct code for the right cervical lymph node is C770.

AJCC Clinical Stage: Stage I

Explanation: According to the AJCC staging rules (AJCC manual p. 962 and the pink Stage chart), we note that there is only involvement of a single lymphatic site or nodal region, which is the cervical node. Since there is no evidence of spread to other lymph nodes or distant sites, the clinical stage for this case is Stage I.

Case 2

ICD-O-3 Topography Code: C172

Explanation: In this case, the cancer site is the jejunum, which is part of the small intestine. To determine the ICD-O-3 topography code, we refer to the ICD-O-3 manual, page 36, and the C17 section, which corresponds to “Small Intestine.” The correct code for the jejunum is C172.

AJCC Clinical Stage: Stage I

Explanation: According to the AJCC staging rules (AJCC manual p. 962 and the pink Stage chart), we consider that there is a single site (extralymphatic) involvement, which is the jejunum. Furthermore, there is no nodal involvement noted. As a result, the clinical stage for this case is Stage I.

Conclusion

Accurate coding of cancer cases is essential for healthcare providers, researchers, and cancer registries to understand disease patterns, guide treatment decisions, and monitor outcomes. In these two hematopoietic and lymphoid cases, we successfully applied ICD-O-3 topography codes and AJCC staging rules to determine both the site and clinical stage of the cancers. This information is critical for providing appropriate care and contributing to the broader understanding of cancer.