Tumor Staging

Please note that different staging questions will populate depending on the ICD-10 diagnosis code entered. For medical oncologic diagnosis codes, AJCC clinical and pathological staging questions will populate.  For gynecologic oncologic diagnosis codes, FIGO staging questions will populate. Limited or Extensive stage may be chosen for Small Cell Lung Cancer (SCLC) diagnoses only.

• Collect staging information prior to initiation of chemotherapy/hormonal therapy/radiation. Do not collect post-treatment (ypT, ypN) or recurrence/progression (rcT, rpT) staging for Med Onc cases.  Please see the Gyn Onc specific section for additional guidance regarding specific collection rules for Gynecologic Oncology staging.
• Collect only AJCC stage, TNM values and “Limited” or “Extensive” stage for Small Cell Lung Cancer (SCLC).
• Do not collect information from any other staging systems (such as Ann Arbor, ISS, R-ISS, MASS or Rai -often used in hematologic malignancies/lymphoma). You may collect staging from anywhere in the EMR.
• If staging is NOT specified between clinical and pathologic, abstract as pathologic 
• If staging is documented as a range (ie: stage IB-IIA) or if two stages are documented (prior to treatment), choose the higher of the two stages
• Do not attempt to assign any part of staging on your own, choose “not documented” for any part of the TNM staging that is not documented
• FIGO staging for gynecologic oncologic diagnosis codes is preferred over AJCC staging of gynecologic cancers.

*Choose anatomical NOT prognostic stage for breast cancer cases.

*If mixed TNM staging (containing both clinical and pathological values) is documented, enter the clinical/pathologic TNM values as documented and choose “not documented” for any values that are not specified as clinical or pathological.  Example of Mixed TNM Staging

Ovarian and Cervical Cancers – use the stage prior to surgery if available.  If no stage is documented prior to surgery, use the FIGO stage documented after surgery. 

Uterine Cancers (Endometrial) – most often this cancer is surgically staged, therefore use FIGO stage documented after surgery, unless not available then use stage prior to surgery.

    **Only use “not documented”  if there is no stage documented at all.  

FIGO staging for gynecologic oncologic diagnosis codes is preferred over AJCC staging of gynecologic cancers.

FIGO 2009 Stage Group and FIGO 2023 Stage Group

• AJCC 8th edition is equivalent to FIGO 2009
• FIGO 2009 Stage Group populates for all gynecologic oncology diagnosis codes.  
• For Uterine Cancer diagnosis codes, FIGO 2009 Stage Group and FIGO 2023 Stage Group will populate. The updated FIGO 2023 staging of endometrial cancer includes various histological types, tumor patterns, and molecular classification to better reflect the improved understanding of the complex nature of the several types of endometrial carcinoma and their underlying biologic behavior.
• The pathology report is considered the source of truth for staging information
• If the FIGO Staging year can not be determined, enter the stage in the FIGO 2009 Stage Group
• If abstractors are unable to locate staging information for either FIGO 2009 or FIGO 2023 Stage Group, choose “Not Done” for that stage group

FIGO Staging information is commonly found in pathology reports, tumor board notes and provider notes, see example: Pathology Report of Examples of FIGO 2009 and 2023 Staging

A tumor’s histologic grade describes how abnormal the cancer cells and tissue look under a microscope, and how likely the cancer cells are to grow and spread.

TUMOR GRADE CONVERSION LIST

• GX: The grade cannot be evaluated

• GB: The tissue is considered borderline cancerous

• G1: The tissue is well-differentiated (contains many healthy-looking cells) – (Low)

• G2: The tissue is moderately differentiated (more cells appear abnormal than healthy) – (Intermediate)

• G3: The tissue is poorly differentiated (most cells appear abnormal) – (High)

• G3 to G4: The tissue is undifferentiated (all cells appear abnormal) – (High)

Clear cell, mixed mullerian (carcinosarcomas) and all high grade histologies, are considered tumor grade “ G3-poorly differentiated”

A borderline histologic grade, or GB: Grade Borderline (“B”), is a tumor grade assigned when a tumor is considered borderline cancerous. 

If a pathology report refers to the histologic grade as a range, for example “moderately to poorly differentiated”, choose the highest grade reported (“poorly differentiated”-G3).