Cancer and neoplasms
Certification of cancer and neoplasms
Neoplasms are classified by site, behaviour and morphology. This information is used to assign the appropriate ICD code to the neoplasm. Insufficient information can lead to the incorrect assignment of a term. For example, terms such as 'neoplasm', 'mass,' 'growth' and 'tumour' should not be used without qualification as to whether malignant or benign.
Common issues with certification of neoplasms include:
- Not stating the site of the neoplasm.
- Not stating the behaviour of the neoplasm. For example, sometimes a term such as 'brain tumour' is used interchangeably with 'brain cancer'. If a brain cancer such as a frontoparietal glioblastoma is described as a 'brain tumour' it will be assigned as a benign tumour rather than a malignancy.
- Lack of clarity of whether the cancer is primary or secondary. The term 'metastatic lung cancer' may mean that the cancer has metastasised from the lung or it may mean that it has metastasised to the lung. It is important to clarify if a cancer is primary or secondary.
- The use of broad terms to describe multiple sites resulting in poor specificity such as 'bowel cancer', 'head and neck cancer', or 'oral cancer'. Further specificity is required to identify the exact site.
The following guidelines should be followed:
| Term | Specificity required |
|---|---|
| Behaviour | Malignant, benign, in situ, unknown behaviour. If malignant: clearly define if cancer is primary or secondary. |
| Site | Always state the exact site if known (do not use broad terms to encompass a site). |
| Morphology | If known, specify histological classification of the tissue. |
The following terms should not be used:
| Do not use terms in this column | Use instead |
|---|---|
| Head and neck cancer | Specify precisely if skin surface or other site e.g. skin of lip, skin of eyelid, skin of ear, skin of scalp, skin of neck, inner cheek, base of tongue, dorsal surface of tongue, gum, salivary gland, nasopharynx, hypopharynx, pyriform sinus, etc. |
| Bowel cancer | Specify exact site e.g. colon cancer, sigmoid colon cancer, cancer of rectosigmoid junction, etc. |
| Abdominal cancer | Specify exact site e.g. body of stomach, gastro-oesophageal junction, pylorus, etc. |
| Squamous cell carcinoma | Specify precisely if skin surface or other site e.g. squamous cell carcinoma of lung, squamous cell carcinoma of skin of face, squamous cell carcinoma skin of lip, etc. |
| Neuroendocrine cancer | Specify site e.g. neuroendocrine carcinoma of lung, etc. |
| Melanoma | Specify site e.g melanoma of eye (orbit, ocular, etc), vulvar melanoma, scrotal melanoma, etc. |
| Transitional cell carcinoma | Specify site e.g. transitional cell carcinoma of kidney, transitional cell carcinoma of bladder, transitional cell carcinoma of ureter, etc. |
Certifying primary cancers
- The primary site should always be indicated, even though the primary growth may have been removed long before death. If a secondary growth is included in the sequence of events leading to death, record the site of the secondary growth due to the site of the primary growth.
- If the primary site is unknown, this must be stated on the certificate.
- Avoid using broad terms set out in the table above.
- Add as much specification as possible to the site as set out in the table below.
- Clearly differentiate between primary and secondary cancers on the certificate.
- If there are multiple primary sites, certify all sites individually. Do not use 'multiple primaries'.
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Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Secondary liver adenocarcinoma. Approximate interval between onset and death: 1 year
- Part 1(b): Resected primary adenocarcinoma of the lower lobe of lung. Approximate interval between onset and death: 3 years
- Parts 1(c), 1(d) and 1(e): Blank. Approximate interval between onset and death: Blank
- Part 2: Long term cigarette smoking, alcohol abuse. Approximate interval between onset and death: 40 years, 20 years
Image
Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Secondary liver adenocarcinoma. Approximate interval between onset and death: 1 year
- Part 1(b): Primary cancer unknown. Approximate interval between onset and death: 3 years
- Parts 1(c), 1(d) and 1(e): Blank. Approximate interval between onset and death: Blank
- Part 2: Anaemia, recurrent urinary tract infection, chronic kidney disease. Approximate interval between onset and death: 12 months, 12 months, 5 years
Specificity of neoplasm sites
To provide the details for identification of the underlying cause of death, the primary neoplasm sites listed in the table below require at least one of the qualifying terms (where specificity is available). Certifiers should be as specific as possible when certifying the site of any neoplasm, not just those sites listed below.
The four examples after the table show how deaths due to cancer may be certified. In the examples, the site of the cancer is clearly specified as well as whether the cancer is primary or secondary.
| Site | Subsite to be specified where applicable | Examples of subtype or other qualifying terms to be used where applicable |
|---|---|---|
| Lip | Lower, upper, commissure, skin of lip, overlapping | Squamous cell carcinoma |
| Mouth | Cheek (mucosa), vestibule, retro molar, overlapping | Squamous cell carcinoma |
| Pharynx | Nasopharynx, hypopharynx, oropharynx, tonsil, pyriform sinus, overlapping | Squamous cell carcinoma |
| Oral | Tongue, salivary gland, palate, gum, overlapping | Squamous cell carcinoma |
| Skin | Vulva, vagina, penis, scrotum, other specified site | Melanoma (by site), basal cell carcinoma (by site), squamous cell carcinoma (by site) |
| Liver | Hepatocellular, intrahepatic duct | Sarcoma, angiosarcoma, hepatoblastoma |
| Bowel | Large (colon), small, colon with rectum, sigmoid colon | |
| Uterus | Cervix uteri, corpus uteri, ligament, overlapping | |
| Endocrine gland | Parathyroid, pituitary, craniopharyngeal, pineal, aortic body, pluriglandular | |
| Adrenal gland | Medulla, cortex | |
| Respiratory | Nasal cavity, middle ear, accessory sinus, mediastinum, trachea, thymus, bronchus, larynx, overlapping | |
| Lung | Upper lobe, lower lobe, middle lobe, main bronchus, overlapping | Primary, secondary |
| Breast | Upper inner quadrant, lower inner quadrant, upper outer quadrant, axillary tail, central portion, nipple and areola, overlapping | |
| Urinary organs | Kidney, ureter, bladder, urethra, paraurethral gland, overlapping | |
| Central nervous system | Meninges, brain, 'specific' ventricle, brain stem, cranial nerve, spinal cord, cauda equina, overlapping, | Primary, secondary |
| Gastrointestinal system | Cervical part of oesophagus, thoracic part of oesophagus, abdominal part of oesophagus, gastro-oesophageal junction, fundus of stomach, body of stomach, pyloric antrum, pylorus, duodenum, jejunum, ileum, Meckel diverticulum, caecum, appendix, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid colon, anal canal |
Image
Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Example of a completed Medical Certificate of Cause of Death. The certificate is filled out as follows:
- Part 1(a): Aspiration pneumonia. Approximate interval between onset and death: 1 week
- Part 1(b): Dysphagia. Approximate interval between onset and death: 3 weeks
- Part 1(c): Primary oesophageal carcinoma. Approximate interval between onset and death: 6 months
- Parts 1(d) and 1(e) Blank. Approximate interval between onset and death: Blank
- Part 2: Smoking, chronic alcohol abuse, malnutrition. Approximate interval between onset and death: 30 years, 20 years, 5 years
Image
Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Aspiration pneumonia. Approximate interval between onset and death: 5 days
- Part 1(b): Dysphagia. Approximate interval between onset and death: 6 months
- Part 1(c): Primary squamous cell carcinoma of base of tongue. Approximate interval between onset and death: 6 months
- Parts 1(d) and 1(e) Blank. Approximate interval between onset and death: Blank
- Part 2: Cigarette smoking. Approximate interval between onset and death: 30 years
Image
Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Pulmonary embolism. Approximate interval between onset and death: 1 day
- Part 1(b): Secondary adenocarcinoma of peritoneum. Approximate interval between onset and death: 5 months
- Part 1(c): Primary adenocarcinoma of descending colon. Approximate interval between onset and death: 9 months
- Parts 1(d) and 1(e) Blank. Approximate interval between onset and death: Blank
- Part 2: Poor diet, obesity, smoking. Approximate interval between onset and death: 50 years, 50 years, 50 years
Image
Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Respiratory failure. Approximate interval between onset and death: 2 hours
- Part 1(b): Secondary metastatic lung cancer. Approximate interval between onset and death: 1 month
- Part 1(c): Primary gastroesophageal junction cancer. Approximate interval between onset and death: 12 months
- Parts 1(d), 1(e) and Part 2: Blank. Approximate interval between onset and death: Blank