Concept: Overview of the Manitoba Cancer Registry and Treatment Data
Last Updated: 2016-02-16
Cancer Site
Cancer site indicates the part of the body where the cancer originated; the primary site, regardless of metastasis. International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) codes are used to catalogue cancer tumours by site and type. These codes may appear similar to ICD-10-CA diagnosis codes, but there are subtle differences that allow for a more precise classification of cancer. The Cancer Registry dataset also contains a cancer site variable which describes/categorizes the cancer site (e.g.: brain, lung and bronchus).
ICD-O-3 codes have two parts:
- Topography axis (cancer site). Topography classifies cancer based on part of the body the primary tumour originated from, such as lung or brain.
- Morphology axis (cancer type/histology). Morphology classifies cancer based on the type of cells it originated from, like bone marrow (leukemia) or skin or tissue that line internal organs (carcinoma), etc.
Additional Information
- For a list of the frequency (%) of patients diagnosed with cancer by cancer site and sex, for 1984-2011, see Appendix Table 2.11 in the deliverable.
- For information on the specific cancers investigated in Lix et al. (2016), including the ICD-O-3 topography and morphology codes used to identify each cancer, see the Cancer Site glossary term.
Cancer Stage
Cancer stage indicates the severity of an individual's cancer at the time of diagnosis. Information about cancer stage is available in the Manitoba Cancer Registry dataset from January 1, 2004 forward. Stage information is captured and coded according to the latest national standard - currently collaborative stage. This includes detailed information about the primary tumour, regional lymph nodes and metastasis.
The most widely used stage reporting system, and the system used in Manitoba, is TNM (Tumour, Node, Metastasis), based on the American Joint Committee on Cancer (AJCC) guidelines. TNM is not static; it changes over time based on new developments in cancer prognosis so that it can remain relevant to both clinicians and patients. The TNM system considers:
- Tumour (T) Stage: size of primary tumour and extent of tumour(s)
- Node (N) Stage: whether the cancer has spread to adjacent lymph nodes; and
- Metastasis (M): whether the cancer has spread from the primary site to other parts of the body
A summary cancer stage is calculated and recorded in the Cancer Registry, based on the detailed tumour, node and metastasis data collected. Summary cancer stage is likely the simplest way to categorize severity of cancer. However, in some cases summary cancer stage has sublevels such as IIa, IIb, etc., so it may need to be further truncated to get summary stage values I, II, III and IV. In Lix et al. (2016), cancer stage was collapsed into summary cancer stage I (least severe) to stage IV (most severe) and unknown stage.
In the Manitoba Cancer Registry, summary stage is coded using:
- AJCC 6th Edition guidelines from 2004-2009; and
- AJCC 7th Edition from 2010 onwards.
Not all cancers in the Cancer Registry contain stage information. The reasons for this include:
- the tumour is not accessible for biopsy;
- some cancers, by their nature, cannot be staged; and
- data prior to January 1, 2004 did not record cancer stage information.
Additional information
- For information on the percent of cancer stage information by cancer site in the Manitoba Cancer Registry from Lix et al. (2016), see Appendix Table 2.3 (2004-2009) and Table 2.4 (2010-2011) in the deliverable.
- For information on the summary cancer stage (%) by cancer site in the Manitoba Cancer Registry (2004-2011) from Lix et al. (2016), see Appendix Table 2.5 in the deliverable.
Types of Cancer Treatment
Treatments for specific types of cancer (bladder, breast, chronic lymphocytic leukemia, colorectal, lung and prostate) were investigated in Lix et al. (2016). Treatments were divided into the following four broad categories: surgical intervention, chemotherapy, hormone therapy and radiation therapy. Each of these are listed below, with links provided to the glossary term definition, and a list of the ICD-9-CM and CCI codes used to identify each type of cancer treatment in this research:
- Surgical Intervention
- ICD-9-CM codes: - any intervention in 0.1.xx–86.xx, excluding:
- 34.92 - injection into thoracic cavity;
- 38.00 - incision of vessel at unspecified site;
- 38.99 - other puncture of vein;
- 57.33 - closed [transurethral] biopsy of bladder;
- 85.12 - open biopsy of breast
- 85.6 - mastopexy
- CCI codes: - any physical/physiological therapeutic intervention in 1.xx.xx.^^, excluding:
- 1.xx.00.^^ –1.xx.58.^^
- 1.xx.70.^^ –1.xx.86.^^
- 1.FU.59.HA-V1 - destruction, thyroid gland, using percutaneous (needle) approach and radioactive pharmaceutical agent [e.g. I-131, radioiodine]
- Chemotherapy;
- ICD-9-CM codes:
- 99.25 - injection or infusion of cancer chemotherapeutic substance
- CCI codes:
- 1.ZZ.35.CA-M0 - pharmacotherapy, total body, per orifice (oral) approach, using antineoplastic agent NOS
- 1.ZZ.35.CA-M5 - pharmacotherapy, total body, per orifice (oral) approach, using other antineoplastic
- 1.ZZ.35.CA-M9 - pharmacotherapy, total body, per orifice (oral) approach, using combination [multiple] antineoplastic agents
- 1.ZZ.35.HA-M0 - pharmacotherapy, total body, percutaneous approach [intradermal, intramuscular, intravenous, subcutaneous], using antineoplastic agent NOS
- 1.ZZ.35.HA-M5 - pharmacotherapy, total body, percutaneous approach [intradermal, intramuscular, intravenous, subcutaneous], using other antineoplastic
- 1.ZZ.35.HA-M9 - pharmacotherapy, total body, percutaneous approach [intradermal, intramuscular, intravenous, subcutaneous], using combination [multiple] antineoplastic agents
- 1.ZZ.35.YA-M0 - pharmacotherapy, total body, route NEC [transdermal, etc.], using antineoplastic agent NOS
- 1.ZZ.35.YA-M5 - pharmacotherapy, total body, route NEC [transdermal, etc.], using other antineoplastic
- 1.ZZ.35.YA-M9 - pharmacotherapy, total body, route NEC [transdermal, etc.], using combination [multiple] antineoplastic agents
- Hormone Therapy
- ICD-9-CM codes:
- 99.24 - injection of other hormone
- CCI codes:
- 1.ZZ.35.CA-M6 - pharmacotherapy, total body, per orifice (oral) approach, using endocrine therapy
- 1.ZZ.35.HA-M6 - pharmacotherapy, total body, percutaneous approach [intradermal, intramuscular, intravenous, subcutaneous], using endocrine therapy
- 1.ZZ.35.YA-M6 - pharmacotherapy, total body, route NEC [transdermal, etc.], using endocrine therapy
- Radiation Therapy
- ICD-9-CM codes:
- 92.2–92.29 - therapeutic radiology and nuclear medicine
- CCI codes:
- 1.FU.59.CA-V1 - destruction, thyroid gland, using oral approach radioactive pharmaceutical agent [e.g. I 131, radioiodine]
- 1.FU.59.HA-V1 - destruction, thyroid gland, using percutaneous (needle) approach and radioactive pharmaceutical agent [e.g. I-131, radioiodine]
- 1.OA.59.DA-AW - destruction, liver, endoscopic [abdominal] approach, using radiofrequency
- 1.ZZ.35.HA-V1 - pharmacotherapy, total body, percutaneous approach [intradermal, intramuscular, intravenous, subcutaneous], using radioactive pharmaceutical agent
- x.xx.26.^^ - brachytherapy on any section of the body
- x.xx.27.^^ - radiation on any section of the body
For information on the demographics, diagnosis and treatment characteristics of the cancer cohort used in Lix et al. (2016), see Table 4.1: Demographic, Diagnosis, and Treatment Characteristics of Cancer Cohort in the deliverable.Treatment Dates
The treatment date that is recorded in the Cancer Treatment data varies by the type of treatment, including:
- for surgical interventions, the date of surgery is recorded as the treatment date;
- for chemotherapy and hormone therapy, the start date of treatment is recorded for that calendar year. If the chemotherapy or hormone therapy extends over the calendar year, then another treatment record is generated with January 1st as the treatment date; and
- for radiation therapy, the start date of each round of radiation therapy is recorded as the treatment date.