SEER Book 2: Cancer Characteristics and Selection of Cases

Can you think of some of the information that you might look for in a medical chart in order to determine extent of disease?

1. Organs or tissues involved by direct extension 2. Distant site involvement via the blood stream or lymphatic system. 3. Regional or distant lymph node involvement 4. Metastasis by seeding or implantation of cancer cells

After the patient is entered into the registry files, follow-up procedures are initiated. You have already learned some of the reasons for patient follow-up. List at least two of them.

1. To ensure early detection of any recurrence of the malignancy. 2. To insure that early detection of the occurrence of any type of malignancy (a second primary site) 3. To obtain information needed to assess the results of various types of treatment. 4. To obtain "end results" information, such as: a. How long the patient has lived b. How well the patient has lived or "quality of survival" c. Whether the patient has expired and whether death was due to the cancer 5. To maintain continuity of patient care (cancer management)

Adenocystoma

A benign tumor involving glandular cells in the form a cyst.

A tumor is defined in terms of two basic characteristics. A cancer or malignant tumor possesses these two characteristics plus a third one. Describe in your own words this third characteristic.

A cancer, or malignant neoplasm, is composed of cells that are growing at an uncontrolled rate and that tend to spread or metastasize to other areas of the body.

Incision

A cut; a wound produced by cutting

Adenoliposarcoma

A malignancy involving glandular cells and fat cells.

Fibromyosarcoma

A malignant tumor involving fibrous-like as well as muscle tissue.

Adenomyosarcoma

A malignant tumor involving glandular cells and cells that compose the muscles.

Cystadenocarcinoma

A malignant tumor involving glandular epithelial cellsin the for of a sac (or cyst).

Choose the statement below that best describes the term remission: A. The patient is asymptomatic but continues on chemotherapy. B. The malignant neoplasm was removed by surgery and the patient is receiving radiation therapy every week. C. Surgery for stomach cancer revealed that the malignancy had spread to the liver. Therefore, chemotherapy was initiated following surgery.

A. Remission means free of symptoms but not necessarily free of disease. Because of the possibility of residual tumor, the patient continues to receive chemotherapy.

Cancer begins by involving only a small number of cells within the primary site. As these cells multiply, they involve a wider area within the organ or tissue of origin. The resultant mass or tumor compresses, invades, and destroys adjacent normal tissues. A. This is spread by direct extension to organs ____ to the primary site. B. Any contiguous growth into neighboring tissues or organs is called involvement by _____.

A. Adjacent B. Direct extension

Tumors are classified into two main types. What are these two types?

A. Benign tumor - sometimes called benign neoplasm B. Malignant tumor - sometimes called malignant neoplasm

When comparing the similarities and differences between the three germ layers, it can be said that: (TRUE or FALSE) a. Carcinomas can arise in tissue that has been derived from any one of the three germ layers. b. Sarcomas can arise in tissue that has been derived from either the ectoderm or the mesoderm. c. Assuming that a structure of the body contains both an epithelial lining and supporting or connective tissue, either a sarcoma or carcinoma could arise in that structure.

A. False. Carcinomas begin in the epithelial tissue which is derived from the ectoderm and endoderm. B. False. C. True. If both epithelial and connective tissues comprise a body structure, a carcinoma could begin in the epithelium and/or a sarcoma could start in the connective tissue.

By definition a tumor has two basic characteristics. Describe these characteristics.

A. New growth of cells; a mass of tissue composed of new cells B. No known useful physiological function

In the following examples select the primary and secondary site that would be recorded on the abstract form: A. Patient has cancer of the prostate gland with regional lymph node involvement. B. Exploratory surgery was performed which showed cancer of the ovaries with metastases to liver and regional lymph nodes. C. Biopsy revealed malignant tumor in the breast, but examinations for metastses proved negative.

A. Primary: Prostate gland Secondary: Regional nodes B. Primary: Ovaries Secondary: Liver and regional lymph nodes C. Primary: Breast Secondary: None

Which of the following types of malignant neoplasms would be example of sarcoma? A. A malignant tumor arising in fibrous tissue B. A malignant tumor arising in cartilage C. A malignant tumor composed of fatty tissue D. A malignant tumor arising in lymph nodes

All are examples of sarcomas.

Excision

An act of cutting away or taking out

Select the term that could be used as the name for a malignant neoplasm which consists of two types of cells--cells of cartilaginous connective tissue and cells of mucinous tissue. A. Chondromyxofibroma B. Chondromyxosarcoma C. Myxochondroma D. Myxochondrosarcoma

B and D. These types of tumor are know as mixed cell tumors.

How would you classify a new growth that appears to be spreading and ulcerated? A. Probably benign tumor or benign neoplasm B. Probably a malignant tumor or malignant neoplasm C. Can't say

B. - Probably malignant tumor The description "spreading and ulcerated" sounds like a malignant condition. However the malignancy of a tumor can only be determined by microscopic examination of the cells taken from that tumor.

Sometimes the name given to a malignant tumor will also describe the type of cells involved. For example, a cancer that arises in glandular tissue might be called: A. Myeloma B. Adenocarcinoma C. Epithelioma

B. Adenocarcinoma Cancers often are named for the type of cells involved.

Choose the diagnostic statement below that does not contain anatomical site information: A. Cancer of the cervix as determined by a Papanicolaou test. B. Malignant tumor with possible metastatic characteristics. C. Benign tumor of the stomach located during exploratory surgery.

B. Does not contain anatomical site for the tumor - meaning organ, bone or tissue named.

Which of the following malignancies would most likely be classified as sarcomas? A. Cancer of the colon B. Malignancy arising in muscle C. Cancer of the skin or the lip D. Gallbladder malignancy E. Malignant bone tumor

B. Muscle E. Bone

Surgery, radiation, chemotherapy, and immunotherapy can be used together or separately to control, modify or eliminate the growth of cancer. When used in this fashion, they are forms of treatment. Some surgical procedures, however, are diagnostic in that their purpose is to aid in the identification of the disease. Chose from the following the procedure that is a form of treatment: A. A surgical incision into the abdomen (laparotomy) to visually inspect a suspected malignancy B. The excision of part of the lung plus chemotherapy to control the spread of lung cancer C. A surgical biopsy and/or x-ray to diagnose a bone tumor

B. The excision and chemotherapy The use of surgery to remove the primary lesion supplemented by chemotherapy to control possible metastasis. (The location and spread of the cancer are two factors the physician considers before determining the best method of treatment)

A patient was found to have a tumor. It had been slowly enlarging for five years, but there apparently was no evidence of invasion or metastases. The tumor probably is: A. Malignant. B. Benign C. Can't say

B.- Benign Benign tumors may grow in size. However, microscopic examination is necessary to rule out malignancy.

Indicate classification and tissue: Adenoma

Benign -- Glandular

Indicate classification and tissue: Chondroma

Benign--Cartilage

Indicate classification and tissue: Lipoma

Benign--Fat

Indicate classification and vessel: Lymphangioma

Benign--Lymph

Indicate classification and tissue: Myoma

Benign--Muscle

Indicate classification and vessel: Hemangioma

Benign-Blood

Word Root: Oste

Bone

Which of the following types of information might be considered end results information? A. The number of cancer cases diagnosed during the past year, arranged by anatomical site, by stage of disease and by age of patient. B. The cost and length of time required to diagnose various types of cancer. C. The number of people surviving five years after treatment for various types of cancer. D. The number of former cancer patients who have been followed during the past year who were free of disease.

C and D. - Forms of "end results" A - is a frequency distribution of cancer cases and B is a cost analysis of actual costs and time.

A new mass of tissue that has been growing in size for two months is probably: A. A benign tumor B. A malignant tumor C. Either benign or malignant D. Neither benign nor malignant

C. - Either benign or malignant Both benign and malignant tumors may grow. However, benign tumors may stop growing of their own accord. This is quite unlikely for a malignant neoplasm. A biopsy and microscopic examination must be made to determine specifically whether a tumor is malignant or benign.

Which of the following statements best describes a cancerous condition? A. The neoplasm appeared two months ago and has doubled in size since that time. B. The neoplasm ceased to grow after a two-month period. C. After the first occurrence of the neoplasm, a secondary site of neoplasm appeared. D. The new growth appeared to have no planned physiological function.

C. Best describes the condition of spread or metastasis which is the main distinction between benign and malignant neoplasms.

Indicate which of the following would be a cystic malignant growth of glandular epithelium. A. Adenocarcinoma B. Cystadenoma C. Cystadenocarcinoma

C. Cystadenocarcinoma

Which of the activities described below might be involved in making a diagnosis? A. Forecasting the probable outcome of the disease. B. Providing special care to combat the disease. C. Distinguishing one disease from another.

C. Distinguishing one disease from another. This is but one aspect of the total process of diagnosis. Some diseases have similar symptoms, especially during early stages. Therefore, it is necessary to identify a patient's particular disease. This is often deemed as a "differential diagnosis". A. represents prognosis B. represents treatment

Which of the following statements best describes the difference between a malignant tumor and a benign tumor? A. Malignant tumors grow much larger than benign tumors B. Malignant tumors grow much faster than benign tumors C. Malignant tumors spread to other organs; benign tumors do not spread to other organs.

C. Malignant tumors spread to adjacent organs and tissues or metastasize to distant sites. Benign tumor do not do this, which is the most important distinction between benign and malignant tumors.

Which patient in the list below will never have a recurrence of cancer? A. A person who has just been treated for colon cancer B. A person who was treated for colon cancer three years ago C. A person who was treated for colon cancer seven years ago D. All of the patients have the same probability of recurrence. E. None of the above patients can be absolutely certain of never having a recurrence.

C. None of these persons can be absolutely certain of never having a recurrence. However, the longer the patient has lived without a recurrence, the greater the probability that there will be no recurrence.

Periodic follow-up examination of the cancer patient is an essential component of his/her _____ _____.

Cancer Management It is important to remember that management of a cancer patient does not end with treatment. At periodic intervals throughout the patient's life, the patient should be examined so that any recurrences of the original cancer or growth of new types of cancer (second primaries) may be discovered. The quality of survival (the capacity of assuming the activities of normal life) is of great importance in planning treatment. Physicians want not only to keep the patient alive but to allow for the most normal life after therapy.

A malignant tumor

Cancerous or Harmful tumor

If a tumor is malignant, the terms _____ or _____ is added to the root. This indicates that the tumor is cancerous or malignant.

Carcinoma or Sarcoma

All malignant neoplasms arising from the lining of such organs as the external ear and nasal cavity would be called ________.

Carcinomas

Cancers arising from epithelial cells are classified as ______.

Carcinomas

For the present, we will distinguish two general types of tissue: (1) epithelial and (2) nonepithelial. In a previous block of instruction, you learned about two general types of malignancies: carcinomas and sarcomas. Which one of these is associated with malignancies arising in epithelial cells?

Carcinomas These are the most common of all malignant neoplasms. On the other hand, the general term sarcoma is used to describe malignancies that arise in connective tissue. Connective tissue is used here in the very general and broad sense to include all nonepithelial tissues--bone, muscle, blood, and cartilage, for example.

Word Root: Chondr

Cartilage

The term designating a benign tumor of the brain covering.

Cerebral memingioma

Because of the disease of cancer is an ongoing process or an ordered sequence of biological events continuing throughout the lifetime of the patient, it must be viewed as biological _____.

Continuum

A recent lump under the skin of the thigh which was found to contain new cells or tissue would be called a tumor or neoplasm. Which of the statements below probably describes a neoplasm? A. A swelling around the ankle that was found to contain "old blood". B. A callus on the finger of a baseball player C. A recent swelling about a scratch D. A recent lump under the arm that feels as if it contains fleshy material

D. - A lump under the arm. It most nearly meets the definition of a tumor or neoplasm-namely, that it is a mass of new cells having no directed physiological function.

Extent of Disease

Detailed description of how far the disease has spread from the primary site.

These malignancies would all arise in ______ tissue.

Epithelial

What type of tissue is derived from the ectoderm and the endoderm?

Epithelial tissue is derived from both endoderm and the ectoderm.

The technique used by the tumor registry to record the degree to which cancer has spread from its primary site to other locations throughout the body is called determining the _____ __ _____.

Extent of Disease

True or False: Chapter 3 of ICD-9 is for neoplasms.

False -- Chapter 2

True or False: SNOMED's topography section is the same as ICD-O-2.

False -- It is completely different than ICD-O-2

True or False: SNOMED stands for Systematized Nomenclature of Medical Entities and Diseases.

False -- It stands for Systematized Nomenclature of Medicine

True or False: The ICD-9-CM is used for coding death certificates in the United States.

False -- The ICD-9 published by WHO must be used for coding death certificates.

True or False: The revised ICD-O, Second Edition, topography section is based on the Ninth revision of the International Classification of Diseases (ICD-9)

False -It is based on ICD-10

Word Root: Lip

Fat

Labeled the germ layer and tumor type: Epithelial tissue

Germ Layer: Ectoderm Endoderm Tumor type: Carcinoma

Labeled the germ layer and tumor type: Fibrous connective tissue

Germ Layer: Mesoderm Tumor type: Sarcoma

Labeled the germ layer and tumor type: Nerve tissue

Germ Layer: Ectoderm Tumor type: Carcinoma

Labeled the germ layer and tumor type: Muscular tissue

Germ Layer: Mesoderm Tumor type: Sarcoma

Labeled the germ layer and tumor type: Vascular tissue

Germ Layer: Mesoderm Tumor type: Sarcoma

Word Root: Aden

Gland

Stage of Disease

Grouping cases with similar prognoses into broad extent-of-disease categories, e.g. localized, regional and distant spread.

Contiguous

In contact, adjacent Example: Cancer of the stomach with uninterrupted spread to the esophagus. (Non-comtiguous -- not in contact or not adjacent; for example, breast cancer that has metastasized to the brain).

Indicate classification and vessel: Hemangiosarcoma

Malignant--Blood

Indicate classification and tissue: Liposarcoma

Malignant--Fat

Indicate classification and tissue: Adenocarcinoma

Malignant--Glandular

Indicate classification and vessel: Lymphangiosarcoma

Malignant--Lymph

Indicate classification and tissue: Myosarcoma

Malignant--Muscle

Indicate classification and vessel: Angiosarcoma

Malignant--Type of vessel not specified (could be blood or lymph)

Word Root: Myelo

Marrow

Word Root: Mening

Membrane

Word Root: My

Muscle

After a series of tests was performed on a sample of tissue removed while the patient was under anesthesia, the patient was diagnosed as having cancer. Would you say this patient received treatment?

NO. A biopsy is a diagnostic technique - an aid in identifying the disease, not in treating it. Removal of a portion of a tumor for diagnosis is called and incisional biopsy.

A term meaning "new growth"

Neoplasm

Benign neoplasm

Noncancerous tumor Harmful tumor - is an option as sometimes benign tumors can be harmful.

Muscle and fat tissues are composed of what types of cells?

Nonepithelial cells

The term designating a malignant neoplasm of the bone.

Osteosarcoma

When metastasis occurs, we know that the cancer has spread from the ___ ___ and a secondary site is involved by cancer.

Primary Site

A patient was diagnosed as having a breast cancer and a lung cancer. The lung was called a metastatic site. Where in the body did the lung cancer begin--that is, where was its primary site?

Primary Site - Breast The cancer began in the breast. Calling the lung a metastatic site is the same as saying that the lung tumor is a "secondary" tumor. It is composed of cells that came from some other place in the body.

Word Root: Cyst

Sac, bladder, or cysts

Cancers arising from connective tissue are classified as ______.

Sarcomas

In some cases the disease of cancer will start at one location or site in the body and spread or metastasize to other areas of the body. The place where the cancer started is the first location and would be called the primary _____.

Site

Word Root: Myx

Slime, glue-like

Word Root: Lei

Smooth

Word Root: Fibr

Thread-like, fibers

Immunotherapy

Treatment by stimulating the body's own defense mechanism against disease or supplying antibodies and/or other missing molecules in a deficient immune system

Chemotherapy

Treatment using chemicals in cancer therapy

True or False: An alphanumeric system of categories means a mixture of letters of the alphabet and numeric digits.

True

True or False: The morphology section of ICD-O is based on the histologic terms in the International Classification of Tumors series.

True

True or False: The principal change in the morphology section of ICD-O-2 is the Non-Hodgkin's Lymphoma section.

True

True or False: ICD-O-2 does not use all the malignant rubrics of ICD-10.

True -- It only uses the rubrics from C00-C80 as the other categories are for histologic entities - lymphomas, leukemia etc. that are coded in the morphology section of ICD-O-2.

The patient was admitted to the hospital complaining of weight losss, a persistent cough, and shortness of breath. He was diagnosed as having cancer of the lung and was referred to a radiologist for radiation therapy. Would you say this patient received treatment?

UNCERTAIN. A form of treatment was prescribed, but the statement contains no evidence that the treatment actually was administered. Presumably it was. However, when abstracting a medical chart, you must be careful to distinguish between a prescription and a statement of treatment. Don't assume that a person has been treated unless it says so on the medical chart.

Word Root: Angi

Vessel

As far as you know, are tissues from the endoderm exclusively epithelial?

YES.

Can carcinomas arise in an organ derived from the endoderm and an organ derived from the ectoderm?

YES.

The patient was admitted to the emergency room because of bleeding from a small ulcer of the skin of the face. The emergency room surgeon recommended total excision of the lesion to which the patient agreed. The resulting specimen was sent to pathology and diagnosed as basal cell carcinoma. Did this patient received treatment?

YES. Removal of an entire small tumor, for whatever purpose, is called an excisional biopsy.

Write in the names of the three germ layers corresponding to their relative position to one another in the embryo. a. Inner layer b. Middle layer c. Outer layer

a. endoderm b. mesoderm c. ectoderm