Scenario: Patient presents to your facility status post lumpectomy for:
- Invasive Ductal Carcinoma of the breast
- ER+, PR+, HER2-
- Metastasis to 1 of 3 movable ipsilateral axillary lymph nodes
- No distant metastasis identified
Unfortunately, the physician does not provide a tumor size, and there is no access to the pathology report or any other source to determine the primary tumor size.
Since the registrar does not know the tumor size AJCC will be assigned:
- pT = BLANK
- pN = pN1a
- cM0
Question: How should Summary Stage 2018 be assigned?
- 3 Regional Lymph Nodes
- 9 Unknown
Answer: 3 Regional Lymph Nodes
Summary Stage 2018 Manual-GENERAL INSTRUCTIONS FOR USING THE SUMMARY STAGE 2018 MANUAL {page 21}
Although Summary Stage is based on all information, the evaluation of the following is still needed to determine the correct Summary Stage
iii. If there is no information on the extent of the tumor, but there is known regional lymph node involvement or distant metastasis, code based on those
- Default to code 3 when the status of the primary tumor is not known, but there is regional lymph node involvement
Discussion: The presence of metastasis to movable ipsilateral axillary lymph nodes provides enough information to identify regional lymph node involvement. Even though the primary tumor size is unknown and AJCC staging cannot be fully completed, Summary Stage 2018 is based on the information that is known.
Remember:
- AJCC may be incomplete because specific staging elements are missing.
- Summary Stage 2018 may still be assignable based on known extension or nodal involvement.
- Code what is documented.
- Use all available information to determine the furthest extent of disease known.
- Do not automatically assign Summary Stage 9 simply because AJCC staging is incomplete.
- Summary Stage 2018 and EOD are independent data collection systems that should be coded from the available documentation.
