Cancer Dataset
Cancer Data Manual - Lung Cancer Appendix
Appendix for Lung Cancer
Table of contents
Cancer Care Spell................................................................................................................................. 2
Lung Cancer Specific Codes and definitions........................................................................................ 3
Additional data items for Lung Cancer ............................................................................................... 9
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Cancer Data Manual - Lung Cancer Appendix
Cancer Care Spell
A new Cancer Care Spell for
00Any tumour with a different histology, irrespective of ICD-10 code or laterality
00A tumour with a different three-character ICD-10 code, except in cases where this is
considered to be recurrence of the original primary tumour
00A tumour with different laterality except in cases where this is considered to be recurrence of
the original primary tumour
However, a single lesion of one histologic type is considered a single primary (i.e. one Cancer Care
Spell), even if the lesion crosses site boundaries. Differences in histologic type refer to differences in
the first three digits of the morphology code.
So, simultaneous bilateral lung tumours with the same histology (excluding metastases) would result in
two Cancer Care Spells, one for the right lung and one for the left lung.
Multifocal tumours (i.e. discrete tumours apparently not in continuity with other primary cancers
originating in the same site or tissue) would result in one Cancer Care Spell (unless they have different
histology and/or different laterality) - unless these were considered to be metastatic from the primary
tumour.
Recurrence at the same site is considered to be part of the same care spell but would be the subject of a
new care plan for its management.
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Cancer Data Manual - Lung Cancer Appendix
Lung Cancer Specific Codes and definitions
3.3 CANCER IMAGING MODALITY [Imaging modality]
Standard radiography
1
CT Scan with contrast
2A
CT scan without contrast
2B
MRI scan with contrast
3A
MRI scan without contrast
3B
PET scan
4
Ultrasound
5
Nuclear Medicine imaging
6
Radio-isotope bone scan
6A
Ventilation/Perfusion scan
6C
Other
99
3.4 ANATOMICAL EXAMINATION SITE [Anatomical site examined]
OPCS-4 Code
OPCS-4 description
Brain
Z01.9
Tissue of brain nec
Chest
Z92.4
Chest nec
Upper abdomen
Z92.6
Abdomen nec
Pelvis
Z75.9
Bone of pelvis nec
Whole body
Z99.9
not an OPCS code
4.2 PRIMARY DIAGNOSIS (ICD) [Primary site]
ICD-10 Codes for Primary Site
C34 Malignant neoplasm of bronchus or lung
C34.0 Main bronchus, Carina, Hilus of lung
C34.1 Upper lobe, bronchus or lung
C34.2 Middle lobe (or lin gular lobe on left), bronchus or lung
C34.3 Lower lobe, bronchus or lung
C34.8 Overlapping lesion of bronchus and lung
C34.9 Bronchus or lung, unspecified
C33 Trachea
C38 Malignant neoplasm of heart, mediastinum and pleura
C38.3 Mediastinum, part unspecified
C38.4 Pleura
C38.8 Overlapping lesion of heart, mediastinum and pleura
C45 Mesothelioma
C45.0 Mesothelioma of pleura
Please note that malignant pleural effusion is coded as C78.2 if another primary site cannot be
identified. If another primary site can be identified, then the code for that site would be used.
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Cancer Data Manual - Lung Cancer Appendix
4.5 HISTOLOGY [Histology]
SNOMed Codes for Histology (Pathology)
(SNOMed III (1993)/ICD-O-2 (1990) unless stated)
M 8010/2
Carcinoma in situ
M 8010/6
Secondary carcinoma
M 8041/3
Small cell carcinoma
M 8046/3
Non-small cell carcinoma (ICD-O-3)
(includes adenosquamous carcinoma)
M 8070/3
Squamous cell carcinoma NOS
M 8140/3
Adenocarcinoma NOS
(Adenocarcinoma without alveolar cell features)
M 8250/3
Bronchio-alveolar cell carcinoma
(Adenocarcinoma with alveolar cell features)
M 8012/3
Large cell Carcinoma NOS
M 8020/3
Large cell -undifferentiated
M 8013/3
Large cell neuroendocrine (ICD-O-3)
M 8240/3
Carcinoid tumour NOS
(includes atypical carcinoid)
M 8980/3
Carcinosarcoma NOS
M 9050/3
Malignant Mesothelioma
M 9052/3
Mesothelioma (epithelioid)
M 9051/3
Mesothelioma (sarcomatoid) (ICD-O-3)
M 8940/3
Mixed tumour (malignant)
5.5 CANCER CARE PLAN INTENT [Cancer Care Plan Intent]
Curative. Include here patients whose treatment includes:
00Surgical resection (including 'open and close')
00Radical radiotherapy to primary site with potential for cure
00Chemotherapy in Limited Stage and/or Good Prognosis Small
Cell Carcinoma (e. g. using 'Manchester' prognostic score)
00Adjuvant radiotherapy in Small Cell carcinoma
00Prophylactic Cranial Irradiation
C
Palliative. Include here patients whose treatment includes:
00Specialist Palliative Care
00Chemotherapy in Non-Small Cell Carcinoma (excepting
Adjuvant and Neo-adjuvant therapy)
00Radiotherapy to primary tumour with palliative intent
00Radiotherapy to site of secondary cancer
00Brachytherapy (Endobronchial radiotherapy)
00Other endobronchial treatments (e.g. laser therapy, diathermy,
cryotherapy, insertion of bronchial stent)
00Chemotherapy in Extensive Stage and/or Poor Prognosis Small
Cell Carcinoma (e.g. using the 'Manchester' prognostic score)
00Pleurodesis
P
Palliative - supportive care only
S
No specific anti-cancer treatment
N
Unknown (Note: it is highly unlikely that any treatment plan would
be drawn up, where the intention of the treatment is Unknown. The
use of this code should be carefully monitored)
9
6.9 SITE-SPECIFIC CLASSIFICATION [Site-specific classification]
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For Small Cell Lung Cancer, an alternative to the TNM staging is the categorisation into 'Limited' and
'Extensive' Disease.
Stage unknown
X
Limited
1
Extensive
2
Limited disease
Extensive disease
Disease confined to one hemithorax
including involvement of ipsi-and/or
contralateral hilar, mediastinal or
supraclavicular lymph nodes. Patients
with ipsilateral pleural effusion,
regardless or pleural cytology, should be
included in this group.
Any disease beyond the definition of
limited stage.
7.10 PRIMARY PROCEDURE (OPCS) [Main surgical procedure]
7.11 PROCEDURE (OPCS) [Sub-procedure(s)]
OPCS/Read Codes for Surgical Procedures
Diagnostic Procedures
Lymph node biopsy -mediastinal
T87.4
Lymph node biopsy - suoraclavical
T87.3
Skin biopsy
S15 - site using Z code
Liver biopsy (Biopsy of liver nec)
J14.1
Bone marrow biopsy (Diagnostic extraction of bone marrow nec)
W36.5
Mediastinoscopy E6
3.9
Mediastinotomy E6
1.4
Closed pleural biopsy
T14.1
Open pleural biopsy
T09.2
Thorascopic pleural biopsy (Endoscopic)
T11.1
Bronchoscopy (fibreoptic)
E49.9
Bronchoscopy (rigid)
E51.9
Pleural aspiration
T12.3
Thoracoscopy T1
1.9
Thoracotomy T0
3.9
Video-assisted thorascopic surgical (VATS) lung biopsy
Need main procedural
code
+ Y49.8 (minimal access
code)
+Y53.8 (image control
code)
Main Procedures
For all procedures: add into next position lateralities:
Z94.2 Right
Z94.3 Left
Wedge resection of lesion of lung (segment)
E54.4
Multiple wedges resected
E54.8
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Segmental resection
E54.4
Sleeve resection
E54.8
Lung resection with resection of chest wall (not identifying which lobe
resection)
E54.8 + T01
Carinal resection
E44.1
Lobectomy
E54.3
Pneumonectomy E5
4.1
Bilobectomy E5
4.2
Open operation on lung (open and close) (Incision of lung nec)
E57.4
Other open operation on lung
E57.8
Sub procedures
Incidental lymph node sampling
T86.
Systematic lymph node sampling
T86.8
Lymph node clearance
T85 (dissection)
Lymph node excision or biopsy
T87
Video assisted thoracic surgery
Need main procedural
code
+ Y49.8 (minimal access
code)
+Y53.8 (image control
code)
Palliative thoracoscopy
T11.9
Pleurodesis (mechanical)
T09.3
Pleurodesis (chemical)
T09.4
Pleurodesis (open)
T09.5
Specialised treatments
Bronchoscopic stenting
Therapeutic endoscopic operation on lower respiratory tract (flexible)
Therapeutic endoscopic operation on lower respiratory tract (rigid)
+Permanent implant
+Bronchus
E48.8
E50.8
+Y02.2
+Z24.5
Diathermy (whole organ)
Y11.1
Diathermy (lesion)
Y13.1
Laser destruction of lesion rigid
E50.2
Laser destruction of lesion fibreoptic
E48.2
SVCO stenting
L79.8 Y02.2 (Z39.1)
SVC
Insertion of pleuro-peritoneal shunts video assisted
T12.1 + Y49.8 + Y53.8
Insertion of pleuro-peritoneal shunts open
T12.1 + Y02.2
Endobronchial therapies
Bronchoscopic de-bulking rigid
E50.8
Bronchoscopic de-bulking fibroptic
E48.8
Laser therapy
E48.8 or E50.8
All of Y08
E48.2 for destruction
E50.2
Photo-dynamic therapy
Not in OPCS4
Electrocautery (diathermy) (of organ) rigid
E50. +Y11.1
Electrocautery (diathermy) (of organ) fibroptic
E48. +Y11.1
Electrocautery (diathermy) (of lesion) rigid
E50. +Y13.1
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Cancer Data Manual - Lung Cancer Appendix
Electrocautery (diathermy) (of lesion) fibroptic
E48. +Y13.1
Cryotherapy (of organ) rigid
E50. +Y11.2
Cryotherapy (of organ) fibroptic
E48. +Y11.2
Cryotherapy (of lesion) rigid
E50. +Y13.2
Cryotherapy (of lesion) fibroptic
E48. +Y13.2
Radio-frequency ablation (of organ) rigid
E50. +Y11.4
Radio-frequency ablation (of organ) fibroptic
E48. +Y11.4
Radio-frequency ablation (of lesion) rigid
E50. +Y13.4
Radio-frequency ablation (of lesion) fibroptic
E48. +Y13.4
8.25 T CATEGORY EXTENDED (PATHOLOGICAL) [Local invasion - tumour extent]
The table below shows the value to be entered for this data item in the left hand column.
The right hand column gives the corresponding 'T' Category.
TX(i)
Primary tumour cannot be assessed
TX(ii)
Tumour proven by the presence of malignant cells in
sputum or bronchial washings but not visualised by
imaging or microscopy
T0
No evidence of primary tumour
Tis
Carcinoma in situ
T1 (i)
Tumour 30mm or less, or superficial tumours confined to
brochial wall
T2(i) Atelectasis /obstructive pneumonitis involving hilar
region but not whole lung
T2 (ii)
Involves main bronchus, 20 mm or more distal to carina#
T2 (iii) Invades visceral pleura
T2(iv)
Tumour more than 30mm in greatest dimension
T3(i) Atelectasis /obstructive pneumonitis involving whole
lung
T3 (ii)
Tumour involves main bronchus, within 20 mm of carina
T3 (iii)
Tumour invades parietal pleura /chest wall (including
superior sulcus tumours)
T3(iv)
Tumour invades mediastinal pleura
T3(v)
Tumour invades pericardium
T3(vi)
Tumour invades diaphragm
T4(i)
Tumour invades great vessel (aorta, central pulmonary
artery or vein)
T4(ii)
Tumour invades atrium, mediastinum or heart
T4 (iii)
Tumour invades trachea
T4(iv)
Tumour invades oesophagus
T4 (v)
Tumour invades vertebral body
T4(vi)
Tumour invades carina
T4(vii)
Separate tumour nodules in same lobe
T4 (viii)
Tumour with malignant pleural effusion
8.26 M CATEGORY EXTENDED (PATHOLOGICAL) [Distant metastases]
The right hand column gives the corresponding 'M' Category.
MX
Distant metastases cannot be assessed
M0
No distant metastases
M1 (i)
Metastases present in tumour nodules in different lobes
(ipsilateral or contralateral)
M1 (vii)
Liver metastases present
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M1 (viii)
Other distant metastases present
9.9 DRUG REGIMEN ACRONYM (CANCER) [Regimen acronym]
Note: for Lung Cancer, do not include corticosteroids.
Non small cell lung cancer
MVP
Mitomycin, vinblastine, cisplatin
MIC
Mitomycin, ifosfamide, cisplatin
Gem Gem
citabine
GCis Gemcitabine, cisplatin
GCar Gemcitabine, carboplatin
Vin Vinorelbine
VCis Vinorelbine, cisplatin
VCar Vinorelbine, carboplatin
PC or TC
Paclitaxel, carboplatin
Doc Docetaxel
CV Cisplatin, vindesine
DocC Do
xetaxel, carboplatin
Small cell lung cancer
CAV Cyclophosphamide, doxorubicin, vincristine
CAE
Cyclophosphamide, doxorubicin, etoposide
PE Cisplatin, etoposide
CE C
arboplatin, etoposide
VICE
Vincristine, ifosfamide, carboplatin, etoposide
ICE
Ifosfamide, carboplatin, etoposide
CAV/PE
CAV alternating with PE
Carb Carbo
platin
14.8 MORBIDITY CODE (CANCER SURGERY)[Treatment Related Morbidity]
Coding for post-operative complications (ICD-10)
Major complications
Leak
If caused by graft/implant/prosthesis
T85.6
T85.7
Abscess unless caused by implant/graft/prosthesis
T81.4
Abscess caused by implant/graft/prosthesis
T85.7
Bleed unless caused by implant/graft/prosthesis
T81.0
Bleed caused by implant/graft/prosthesis
T85.8
Renal failure requiring dialysis
N17.9 + Y83.
(+N99.0 if re-admission)
Respiratory failure requiring ventilation
J96.9 + Y83. + J95.8
(+N99.0 if re-admission)
Septicaemia requiring ionotropic support
T81.4 or T85.7
Prolonged air leak
Broncho-pleural fistula
T81.8
Infection/emphysema
Other complications
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Wound infection
Without prosthesis graft
With prosthesis
T81.4
T85.7
Lower chest infection
J22(X)
Upper chest infection
J06.9
Urinary infection
Post-operative
Excision of an organ
N39.0
+Y83.2
+Y83.3
Thromboembolic T8
1.7
MRSA
Cardiac
I97.8
Additional data items for Lung Cancer
Recording details about the management plan -lung cancer specific items
The following data items should be collected for lung cancer, at the time that the first management plan
is drawn up.
Data Item
Repeating? Source of definition
L.1 SMOKING STATUS
[History of smoking]
No NCDS
L.2 YEAR STOPPED SMOKING
[Year stopped smoking]
No
4 character year
L.3 ESTIMATED PACK YEARS
[Estimated pack-years of smoking]
No Numeric
L.4 COPD PRESENT
[COPD present? ]
No NCDS
L. 5
FEV1 ABSOLOTE AMOUNT
[FEV1 (absolute)]
No Numeric
L. 6 FEV1 PERCENTAGE
[FEV1 (percentage of predicted)]
No Numeric
L. 1 SMOKING STATUS [History of smoking]
Record the patient's history of smoking.
Current
1
Ex smoker
2
Non-smoker - history unknown
3
Never smoked
4
Unknown (default)
9
Note: this refers only to cigarette smoking; the definition of 'smoking' is more than one cigarette per
day for a minimum of 1 year.
L.2 YEAR STOPPED SMOKING [Year stopped smoking]
If the patient is known to have smoked in the past, then record the year that he/she stopped smoking.
This data item is mandatory if Smoking History above is '2'. Record the four-character year that the
patient stopped smoking.
L.3 ESTIMATED PACK YEARS [Estimated pack-years of smoking]
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Cancer Data Manual - Lung Cancer Appendix
If the patient is a current or ex-smoker, record the value of the estimated pack-years of smoking.
This is calculated as follows:
Average number of cigarettes smoked per day divided by 20 (a pack) multiplied by number of years
smoked.
For example: 20 a day for 20 years = 20 pack years. 10 a day for 20 years = 10 pack years.
L.4 COPD PRESENT [Is COPD present?]
Record whether there is evidence of Chronic Obstructive Pulmonary Disease.
Yes Y
No
N
Not known (default)
9
L.5 FEV1 ABSOLUTE AMOUNT [FEV1 (Absolute)]
If COPD is present, then record the absolute value of the patient's Forced Expiratory Volume in 1
second, in litres. Numeric field in 9.99 format e.g. 2.16 litres.
L.6 FEV1 PERCENTAGE [FEV1 (Percentage of predicted)]
If COPD is present, then record the patient's Forced Expiratory Volume in 1 second, as a percentage of
the predicted value. Numeric field.
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