Cancer Registry Basics [Lung Cancer Edition]

Cancer registration in Japan is an important source of information regarding cancer incidence, treatment, and prognosis in Japan.


Registry data is essential for measuring the effectiveness of cancer control measures, promoting research, and formulating medical policies, and it contributes to the improvement of public health.


By combining hospital-based cancer registries with the national cancer registry, more accurate data analysis becomes possible, leading to the promotion of evidence-based cancer control measures.


Let's check and review!

🔷 Question 1

A 73-year-old male.
A 2.5 cm nodular shadow was observed in the right upper lobe of the lung on a chest CT.
Cytology of the specimen collected via bronchoscopy was negative, but surgery was performed because lung cancer was strongly suspected based on PET-CT.
Postoperative pathological diagnosis was lung adenocarcinoma.

What is the date of diagnosis for this case?

A. Date of chest CT
B. Date of cytology
C. Date of PET-CT
D. Date of surgery

𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣


Correct Answer: C. Date of PET-CT

Explanation

In the standard hospital-based cancer registry format, the date of diagnosis is defined as:

👉 The date of the examination that most strongly suggested cancer.

In this case:

・CT: Abnormal shadow observed

・Cytology: Negative
・PET-CT: Findings strongly suggesting lung cancer
Therefore, the date of diagnosis is the date the PET-CT was performed.

🔷 Question 2

A 68-year-old female.
A tumor was observed in the right upper lobe of the lung, and a biopsy diagnosed it as lung adenocarcinoma.
The pathology report states:

"lepidic adenocarcinoma"

Which histology code should be registered for this case?

A. 8140/3

B. 8250/3
C. 8070/3
D. 8041/3
𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣





Correct Answer: B. 8250/3

ExplanationThe morphology code for lepidic adenocarcinoma is:

👉 8250/3

・8140/3: Adenocarcinoma NOS

・8070/3: Squamous cell carcinoma

・8041/3: Small cell carcinoma
When the pathological diagnosis is specific, use the more detailed histology code rather than NOS.

🔷 Question 3

A 70-year-old male.

A 3 cm squamous cell carcinoma was observed in the right upper lobe of the lung.
At the same time, a 2 cm squamous cell carcinoma was observed in the left lower lobe of the lung.

The pathologist's comment states:

"Both lesions are considered independent primary lung cancers."

Which is the correct registration for this case?

A. Register as a single primary cancer

B. Register only the right lung as a single primary
C. Register only the left lung as a single primary
D. Register as multiple primary cancers
𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣✧𖤣𖥧𖡼𖤣





Correct Answer: D. Register as multiple primary cancers

ExplanationFor multiple lung lesions, determine whether they are primary or metastatic by comprehensively considering:

👉 Pathological findings

👉 Clinical judgment
👉 Multiple primary cancer rules
In this case, the pathologist judged them to be "independent primary lung cancers," but you must always confirm with the multiple primary cancer rules.

In this case, register the right lung cancer and the left lung cancer as separate primaries.

It is important to note that even if they are the same histology, they are not automatically judged as metastatic.

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