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Cancer Dataset Cancer Data Manual – Thyroid Cancer Appendix

Appendix for Thyroid Cancer

Table of contents

Cancer Care Spell..................................................................................................................................2Thyroid Cancer Specific Codes.............................................................................................................3Additional data items for Thyroid Cancer...........................................................................................10

Version 0.5 of 19Issue Date: 20.01.04


Cancer Care Spell

In Thyroid cancer, a cancer care spell describes a single lesion of one histological type (same first three digits of the morphology code) even if the lesion crosses site boundaries.

Multifocal cancers (i.e. discrete tumours apparently not in continuity with other primary cancers but originating in the same tissue or ICD site at the three alphanumeric level) would result in one Cancer Care Spell (unless they have different histology and/or different laterality).

Simultaneous bilateral tumours with the same histology would result in two Cancer Care Spells, one for the right and one for the left body site.

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.

All incidental thyroid cancers found at pathological examination should be included.



Thyroid Cancer Specific Codes

3.3 CANCER IMAGING MODALITY [Imaging modality]

Standard radiography 1Chest X-ray 1ASinus X-rays 1BMastoid views 1COrthopantomogram (OPG) 1DSkull base views 1ECT Scan with contrast 2ACT scan without contrast 2BMRI scan with contrast 3AMRI scan without contrast 3BPET scan 4Ultrasound 5Nuclear Medicine imaging 6Bone scan 6AOther isotope scan 6BBarium 8Barium swallow 8BLymphoscintigraphy 9Other 99

3.4 ANATOMICAL EXAMINATION SITE [Anatomical site examined]

OPCS-4 Code OPCS-4 descriptionBrain Z01.9 Tissue of brain necSkull base Z63.8 Specified bone of cranium necHead Z92.1 Head necParotid gland Z26.1 Parotid glandSubmandibular gland Z26.2 Submandibular glandNeck Z92.3 Neck necLarynx Z24.2 Larynx Thyroid gland Z13.1 Thyroid glandThorax Z52.8 Specified chest wall necChest Z92.4 Chest necUpper abdomen Z92.6 Abdomen necLiver Z30.1 LiverBone Z87.1 Bone nec

4.2 PRIMARY DIAGNOSIS (ICD) [Primary site]

ICD-10 Codes for Primary Site (Diagnosis)

C73.X Thyroid glandC75.0 Parathyroid glandC80.X Unknown primary



4.5 HISTOLOGY [Histology]

SNOMed Codes for Histology (Pathology)(SNOMed III (1993)/ICD-O-2 (1990) unless stated)

The order shown is a clustering by pathological type, followed by an alphabetical list, and supplemented by some SNOMed only codes. The details in brackets identify that the codes only apply to the sites shown.

See also data item T.36 – Thyroid histology

Thyroid

M8330/3 Follicular adenocarcinoma, NOS (C73) M8331/3 Follicular adenocarcinoma, well differentiated (C73) M8332/3 Follicular adenocarcinoma, trabecular (C73) M8340/3 Papillary carcinoma, follicular variant (C73) M8510/3 Medullary carcinoma NOS M8511/3 Medullary carcinoma with amyloid stroma (C73)

SNOMed only codes – these relate to items not found in ICD-0-2

M9990/3 No microscopic confirmation, clinically malignant tumourM9990/6 No microscopic confirmation, clinically metastatic tumour

4.6 GRADE OF DIFFERENTIATION (AT DIAGNOSIS) [Grade of differentiation]

Most pathologists do not grade thyroid cancer, so this data item is not required.



7.10 PRIMARY PROCEDURE (OPCS) [Main surgical procedure]7.11 PROCEDURE (OPCS) [Sub-procedure(s)]

OPCS/Read Codes for Surgical Procedures(5 byte Version 2 Read Codes)

1. NECK DISSECTIONS(USING WATKINSON OPCS CODE EXTENSIONS)

NECK DISSECTION RADICAL T85.1 7H600NECK DISSECTION MODIFIED T85.1A

modified Type I accessory preserved T85.1AImodified Type II accessory +IJV kept T85.1AIImodified Type III sternomastoid,IJV + T85.1AIIIaccessory kept

SELECTIVE NECK DISSECTION (SND) T85.1B 7H610SND Level 1 (suprahyoid) T85.1BI 7H606SND Level 1-3 (supra-omohyoid) T85.1BII SND Level 1-4 (anterolateral) T85.1BIIISND Level 2-4 (lateral) T85.1BIVSND Level 5 (posterior) T85.1BV SND Level 2-5 (posterolateral) T85.1BVISND Level 6 (central compartment) T85.1BVIISND Level 7 (superior mediastinum) T85.1BVIII

Excision or biopsy of cervical lymph node T87.2 7H621

2. THYROID

Lobectomy + subtotal/near total lobectomy B08.8Partial thyroidectomy NEC B08.6 71105



Lobectomy of thyroid NEC B08.4 71103Isthmusectomy B08.5 71104Hemithyroidectomy B08.3 71102Thyroidectomy, subtotal B08.2 71101Bilateral subtotal lobectomy B08.2 + Z94.1Total thyroidectomy B08.1 71100Biopsy/excision nodule B12.2

If the thyroid remnant after excision is <1ml in volume, then it can be called a "near-total lobectomy" (thyroidectomy if surgery is bilateral.)If the remnant is >1ml, then it should be called a sub-total thyroidectomy.

Note: the following is a list of OPCS-4 procedures containing ‘thyroid’.

B08.1 Total thyroidectomyB08.2 Subtotal thyroidectomyB08.3 HemithyroidectomyB08.4 Lobectomy of thyroid gland necB08.5 Isthmectomy of thyroid glandB08.6 Partial thyroidectomy necB08.8 Excision of thyroid gland OSB08.9 Excision of thyroid gland unspecifiedB09.1 Excision of substernal thyroid tissueB09.2 Excision of sublingual thyroid tissueB09.8 Operations on aberrant thyroid tissue OSB09.9 Operations on aberrant thyroid tissue unspecified

B12.1 Excision of lesion of thyroid glandB12.2 Biopsy of lesion of thyroid glandB12.3 Incision of lesion of thyroid glandB12.4 Exploration of thyroid glandB12.8 Other operations on thyroid gland OSB12.9 Other operations on thyroid gland unspecifiedB14.1 Global parathyroidectomy & transposition parathyroid tissueB14.2 Global parathyroidectomy necB14.3 Partial parathyroidectomy & transposition parathyroid tissu



B14.4 Partial parathyroidectomy necB14.5 Excision of lesion of parathyroid glandB14.8 Excision of parathyroid gland OSB14.9 Excision of parathyroid gland unspecifiedB16.1 Modification of transposed parathyroid glandB16.2 Biopsy of lesion of parathyroid glandB16.3 Exploration of parathyroid glandB16.8 Other operations on parathyroid gland OSB16.9 Other operations on parathyroid gland unspecified



8.11 GRADE OF DIFFERENTIATION [Grade of differentiation]

Most pathologists do not grade thyroid cancer, so this data item is not required.

9.9 DRUG REGIMEN ACRONYM (CANCER) [Regimen acronym]

Doxorubicin single agentDoxorubicin combinationsOther

14.8 MORBIDITY CODE (CANCER SURGERY)[Treatment Related Morbidity]

Coding for post-operative complications (ICD-10)

Major complications

Leak T85.6Abscess T81.4Bleed T81.0

Other complications

Wound infection:Without prosthesis graftWith prosthesis

T81.4T85.7

Lower chest infection J22(X)Upper chest infection J06.9Urinary infectionPost-operativeExcision of an organ

N39.0+Y83.2+Y83.3

Thromboembolic T81.7MRSACardiac I97.8

Abscess T81.4AspirationBacteraemia T81.4Septicaemia T81.4Chyle leak T85.5Cerebrovascular accident T81.7Eating/swallowing difficulty R13 + Y83.-FistulaPharyngocutaneousTracheo-oesophageal

K12.2 + T81.8J39.2 + Y83.-J85.0or J95.0 following tracheo.

Haematoma T81.0T85.8

Nerve damage/division G97.8 re-admissionPulmonary embolus T81.7



Deep vein thrombosis T85.8Myocardial infarction I21.9 + Y83.-Wound dehiscence T81.3Keloid L91.0Hypocalcaemia (if lasting for more than a year)Voice change (if lasting for more than year)



Additional data items for Thyroid Cancer

Recording details about imaging – thyroid cancer specific items

Data Item Repeating? Source of definitionT.20 Imaging type No NCDS

T.20 Imaging type

131I 01123I 0299mTc-MIBI 0318F-FDG (PET) 04201Tl; 0599mTc-DMSA(V) 06111In-octreotide 07123I-MIBG 08131I –MIBG 0999mTc 10

Recording details about the management plan – thyroid cancer specific items

The following data items should be collected for thyroid cancer, at the time that the first management plan is drawn up.

Data Item Repeating? Source of definitionT.1 History of thyroid disease Yes NCDST.2 Previous irradiation Yes NCDST.3 Previous treatment for thyroid related

diseaseYes NCDS

T.4 Family history of thyroid disease Yes NCDST.5 Family history of other non-thyroid

cancersYes NCDS

T.5a RELATIONSHIP TO PERSON [Family history – relationship]

Yes NCDS

T.5b PRIMARY DIAGNOSIS OF RELATION (ICD) [Site of relation’s cancer]

Yes NCDS

T.6 Medullary carcinoma No NCDST.7 Genetic screening No NCDST.7a Results of genetic screening No NCDS

T.1 History of thyroid disease

Record any thyroid disease in past medical history, obtained directly from information given by the patient or from documented medical history.Multiple responses are permitted.

Under active thyroid 1Over active thyroid 2Lump, within or related to the thyroid 3Other 4None 5



T.2 Previous irradiation

Record whether the patient has received previous irradiation, unrelated to thyroid cancer management

Yes, therapeutic 1Yes, environmental 2No 3

T.3 Previous treatment for thyroid related disease

This should be obtained directly from information given by the patient or from documented medical history.Multiple responses are permitted.

Surgery (previous operative procedure to the thyroid) 1Radioiodine (administration of 131Iodine) 2Drug treatment for thyrotoxicosis (carbimazole, methimazole, propylthiouracil)

3

Thyroid hormone therapy T4 and T3 4None 5

T.4 Family history of thyroid disease

Record information about first- and second-degree blood relatives only.Multiple responses are permitted.

FH of under-active thyroid 1FH of over-active thyroid 2FH of other thyroid disease 3FH of non-medullary thyroid cancer 4FH of thyroid surgery for other reason 5FH details unknown 6

T.5 FAMILY HISTORY OF CANCER

T.5a RELATIONSHIP TO PERSON [Family history – relationship]

If the patient has a relation who has, or has had cancer, record the relationship to the patient. Note that this applies only to close, blood relatives (except for ‘husband’ and ‘wife’).

Aunt ABrother BChild unspecified CDaughter DFather FGrandparent GHusband HCousin KMother MNephew/niece NParent unspecified PSister SUncle UWife W



Grandchild unspecified XSon Z

T.5b PRIMARY DIAGNOSIS OF RELATION (ICD) [Site of relation’s cancer]

If the patient has a close family relative who has, or has had cancer, record the site of any cancer.

Record as ICD-10 codes.

T.6 Medullary carcinoma

Familial basis for some medullary carcinomas

Yes YNo NUnknown 9

T.7 Genetic screening

Mutation known to be present for MEN 1Mutation not identified for MEN 2Other 3Genetic screening not carried out 4

T.7a Results of genetic screening

MENIIa 1MENIIb 2FMTC 3Other 9

T.8 Method of presentation

Replaces presenting symptoms. To include all incidental thyroid cancers found at pathological examination.

Thyroid mass 01Incidental via imaging 02Incidental pathological –at thyroid surgery 03Incidental pathological –at other surgery 04Neck node metastasis 05Distant metastasis 06Genetic screening 07Other 08

T.9 Result of THY for cytology

Based on RCPath, best practice document and RCP guidelines.

Thy1- non-diagnostic (inadequate or where technical artefact precludes interpretation. Smears must contain six or more groups of greater than 10 thyroid follicular cells to be considered adequate.)

1

Thy2- non-neoplastic (features consistent with a nodular goitre or thyroiditis)

2



Thy3- all follicular lesions and other aspirates in which neoplasia cannot be fully excluded.

3

Thy4- abnormal, suspicious of malignancy (suspicious, but not diagnostic, of papillary, medullary or anaplastic carcinoma or of lymphoma)

4

Thy5- diagnostic of malignancy (unequivocal features of papillary, medullary or anaplastic carcinoma, or of lymphoma or metastatic tumour)

5

Not done 9



Recording details about surgery and other procedures – thyroid cancer specific items

The following additional data items should be collected for thyroid cancer.

Data Item Repeating? Source of definitionT.10a Operative findings No NCDST.12 Thyroid hormone commencement date No NCDS

T.10a Operative findings

1 Macroscopic local extension beyond thyroid capsule2 Suspected lymph node metastases3 Recurrent laryngeal nerve involvement

T.12 Thyroid hormone commencement date

Collect this, in date format.



Recording details about pathology – thyroid cancer specific items

The following pathology data items should be collected for thyroid cancer.

Data Item Repeating? Source of definitionT.36 Thyroid histology No NCDST.14 Pathological features 1 No NCDST.15 Pathological features 2 No NCDST.16 Pathological features No NCDST.17 Undifferentiated component No NCDST.18 Pathological features of adjacent gland. Yes NCDST.19 Parathyroid gland(s) identified No NCDS

T.36 Thyroid histology

The histology of the tumour is recorded in the generic dataset (data items 4.5 and 8.10) using ICD-O-2 coding. The additional level of data required below is not represented by ICD-O-2 with unique codes, so this additional data item is required.

Papillary carcinoma 01Follicular carcinoma 02Oncocytic follicular (Hurthle cell) carcinoma 03Medullary carcinoma 04Poorly differentiated carcinoma 05Insular carcinoma 06Undifferentiated/anaplastic carcinoma 07Mixed/combination tumour 08Lymphoma 09Other tumours 10No residual tumour 11

T.14 Pathological features 1

Record for papillary carcinoma.

Classical 01Follicular 02Encapsulated 03Cystic 04Tall cell 05Columnar cell 06Trabecular 07Oncocytic 08Diffuse sclerosing 09Cribriform 10Solid 11Incidental microcarcinoma 12Other 99

T.15 Pathological features 2

Record for any type of thyroid tumour

Single lesion 1



Multiple intrathyroidal foci 2Not recorded 9

T.16 Pathological features

Record for follicular carcinoma

Minimally invasive 1Widely invasive 2

T.17 Undifferentiated component

The presence of undifferentiated or poorly differentiated component in a differentiated tumour

Yes YNo N

T.18 Pathological features of adjacent gland.

Multiple responses are permitted.

Thyroiditis 1Nodular goitre 2Other 3Not recorded 9

T.19 Parathyroid gland(s) identified

Record the actual number within the pathological specimen.



Recording details about radio-iodine ablation and therapy – thyroid cancer specific items

The following data items should be collected for thyroid cancer.Note: multiple occurrences of this section are permitted, as radio-iodine therapy may be repeated on several occasions.

This section may occur many timesData Item Repeating? Source of definition

T.24 Administered activity No NCDST.22 Date No NCDST.21 Result Yes NCDST.25 Thyroglobulin level No NCDST.26 TSH level No NCDST.27 Thyroid hormone status Yes NCDS

T.24 Administered activity

Amount of iodine administered in Giga Bequerels

T.22 Date

Record the date of the report.

T.21 Result

Neck and whole body scan report(Multiple responses are permitted)

Only physiological uptake 1Thyroid bed 2Neck nodes 3Distant – lung 4Distant – bone 5Distant – other 6

T.25 Thyroglobulin level

Actual value in micrograms/litre

T.26 TSH level

Actual value, mU/litre

T.27 Thyroid hormone status

On thyroid hormone therapy 1Off thyroid hormone therapy 2rhTSH 3



Recording details about follow-up – thyroid cancer specific items

The following data items should be collected for thyroid cancer.

Data Item Repeating? Source of definitionT.29 Marker response No NCDST.30 Marker level No NCDST.35 Assay method No NCDST.30a Follow-up imaging result No NCDST.31 Subsequent salivary complications

(Note: in addition to Cancer Dataset generic data item 14.8)

Yes NCDS

T.32 Subsequent non-thyroid malignancy No NCDST.34 Cord mobility No NCDS

T.29 Marker responseThis should be collected in addition to marker response defined in generic dataset (14.5)

TSH 1Thyroglobulin RIA 2Thyroglobulin IMA 3Thyroglobulin antibody 4Calcitonin RIA 5Calcitonin IMA 6CEA 7

T.30 Marker level

Actual value in nanograms/litre

T.35 Assay method

Record the method used in measuring thyroglobulin or calcitonin. The coding system used is from UK NEQAS.

BY3 BYK Liaison/NicholsCI2 CIS ELSADC11 DPC Immulite 2000DC7 DPC ImmuliteGD1 Genesis DiagnosticsHE1 Brahms DYNOtestIN2 DiaSorin IRMAIT1 Immunotech IRMAMP1 Medipan SELcoNI1 Nichols AllegroNI2 Nichols Institute [C]NI4 Nichols AdvantageOO10 In-house [IMA]OO61 In-house Salford IRMAOOO In-house [RIA]PH2 Wallac Delfia [Perkin Elmer]SA1 Bangui Biotech ELSASF3 Sanofi PasteurUUU undefined/vague

T30a Follow-up imaging result



Negative/normal 1Positive/abnormal – loco regional 2Positive/abnormal – distant 3

T.31 Subsequent salivary complications

Salivary gland problems 1Other 2

T.32 Subsequent non-thyroid malignancy

Haematological malignancy/myelodysplasiasolid tumours –bladder,colon breast,other

To be collected using ICD-10 coding.

T.34 Cord mobility

Only performed if voice change detected.

Normal 1Abnormal 2


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