Site specific - Urological

The site-specific Urological data set applies additionally to in situ Bladder cancers and pTa Bladder cancers, although these are excluded from Cancer Waits. Please refer to the training guides for more information about coding these tumours for COSD.

ICD-10 codes

Note:

• please refer to Appendix A and B for site specific registerable ICD codes for urological cancer patients

Retired data items

The following data item has been retired from v10:

• UR15320 – Extranodal Metastases
• UR15330 – Lung Metastases Sub-Stage Grouping
• UR15040 – S-Category AFP
• UR15050 – S-Category HCG
• UR15060 – S-Category LDH
• UR15020 – Normal LDH

National Cancer Audit Collaborating Centre (NATCAN)

Future contracting of NPCA

With the formation of the new National Cancer Audit Collaborating Centre (NATCAN), all previously independent cancer audits have been brought into one organisation. Part of the rationale for this is to reduce the burden of data collection and reporting across the NHS.

As a result, all data moving forward will be from existing data sources. It is important therefore for Trusts to collect all the site specific data items within COSD, as these will form a large part of future analysis by the National Prostate Cancer Audit (NPCA).

More information about NATCAN can be found via their official website.

A treatment (Cancer Treatment Modality) of “Active Monitoring” should be recorded for all patients who are largely asymptomatic and may progress to active treatment if the status of the disease progresses, (this covers all patients who are being monitored only and will include “watchful waiting” as used clinically).

For symptomatic patients who are not receiving active treatment, the selected treatment type (Cancer Treatment Modality) will be either “Specialist Palliative Care” or “Non specialist Palliative Care” depending on whether the patient is under the care of a specialist in palliative medicine.

For tumours in unusual sites where there is overlap between a data set based on anatomy and another based on the disease description it is recommended that both data sets are completed. For example, for a melanoma of the penis both the penile and the melanoma data set should be completed.

This is a child of ‘CORE – Diagnostic Procedures’. This mandates the collection of the following data items alongside each choice:

• Organisation Site Identifier (Diagnostic Procedure)
• Diagnostic Procedure Date
• Diagnostic Procedure (OPCS)
• Diagnostic Procedure (SNOMED CT)

The OPCS and SNOMED CT can be either supplied individually or together but you cannot submit a record without one or the other.

It is possible that some legacy data may not have all the required mandatory fields. The recommendation is for Trusts to update their data to meet the new requirements and improve/enrich their data submissions, or not upload the legacy data items in the new record (if that data is not available).

May be up to one occurrence per CORE - Diagnostic Procedures (0..1)

Prostate Biopsy Technique

This is a mandatory data item within this section. Record the type of prostate biopsy technique performed before treatment. This is part of the National Prostate Cancer Audit (NPCA) and the attributes have been changed to make understanding the type of biopsy technique used easier.

Additional Information

TRUS guided biopsy:

• OPCS code - M70.3
• SNOMED CT code - 431605004
• SNOMED CT code - 241487002

Transperineal biopsy:

• OPCS code - M70.2
• SNOMED CT code - 265593007

Notes:

• it is possible that these codes change over time, it is the responsibility of the reporting Trust to ensure correct codes are used
• for TRUS Guided Biopsy and Transperineal Biopsy, you can use only the SNOMED CT or OPCS code (in the ‘Diagnostic Procedures’ section), and then specify the type using this field

Biopsy Anaesthetic

This is a mandatory data item within this section. Record the type of anaesthetic used during the biopsy. This is part of the National Prostate Cancer Audit (NPCA).

May be up to one occurrence per CORE - Diagnosis (0..1)

mpMRI Pre-Biopsy

Indicate if a multiparametric mpMRI performed on the patient before the biopsy? It is important for the NPCA audit to know if the MRI was not a multiparametric as if it was, please ensure this is recorded accurately.

MRI/Fusion Biopsy

Indicate if a MRI/Fusion Biopsy was performed on the patient? It is important for the NPCA audit to know if a MRI/Fusion Biopsy was not performed as if it was, please ensure this is recorded accurately.

PSA (Diagnosis)

‘Prostate Only’. Prostate Specific Antigen blood level in ng/ml, measured at time of diagnosis (positive values only).

May be up to one occurrence per CORE – Cancer Care Plan (0..1)

Estimated Glomerular Filtration Rate

Renal Only’. This is the estimated Glomerular Filtration Rate. It is a measurement of kidney function in mls/min/1.73m². This is to be collected once at diagnosis. Note that this should be recorded as part of standard renal function test. Positive values. Numerical value to be recorded (categories can be derived from this at a later stage) (0-99).

Hydronephrosis

‘Bladder Only’. Consequence of reduced outflow of urine from Kidney. May be present in one or both kidneys.

Preoperative S-Category

‘Testicular Only’. The preoperative S-Category at diagnosis, based on serum tumour markers AFP, HCG and LDH. For Testicular Cancer, preoperative S category is an additional prognostic factor.

See below for further details of values to be recorded:

Note:

• this has a new name in v10, to allow for the separation of preoperative and postoperative S-Category being recorded
• the description and data definitions have been updated in v10

Postoperative (NADIR) S-Category

This is a new data item in v10. ‘Testicular Only’. The postoperative (NADIR) S-Category, based on serum tumour markers AFP, HCG and LDH. For Testicular Cancer postoperative S category is an additional prognostic factor.

See below for further details of values to be recorded:

This section and all its content have been retired from v10.

It is important that all stageable cancers are staged for every case. All site specific staging fields are mandatory and a child of ‘CORE – Site Specific Staging’ Section, and together mandates the collection of:

• the date the sample was taken which provided a positive site specific stage outcome or the MDT where the stage was agreed
• the organisation who carried out the stage
  • this is a ‘required’ data item from v10, but important to collect if known
• the stage itself

Testicular

For testicular cancer, it is important that the TNM stage components should both be collected as follows:

• UICC stage groupings should now be used for testicular cancer in the CORE – Staging section (Pre-treatment TNM Stage components are optional)
• S category (the IGCCCG classification for testicular cancer) should be collected separately
• first CT scan performed (usually after orchidectomy) prior to chemotherapy/radiotherapy should be reported in the Core Imaging section

Notes:

• after many discussions with SME’s, it has been agreed to keep the Royal Marsden staging classification for testicular cancer for v10
• this will be reviewed again during the v11 review
• TNM staging as described above should still be collected in addition to the RMH anatomical groupings

May be up to one occurrence per CORE – Site Specific Staging (1..1)

Stage Grouping (Testicular)

‘Testicular Only’. Nationally agreed anatomical stage groupings as defined by The Royal Marsden Hospital (RMH).

Note:

• this is now a mandatory data item if applicable

Additional staging advice

Stage 1:

• Confined to testis

Stage 1S:

• (Not used)

Stage 1M:

• Rising post orchidectomy markers only

Stage 2A:

• Abdominal lymphadenopathy < 2cm

Stage 2B:

• Abdominal lymphadenopathy 2cm - 5cm

Stage 2C:

• Abdominal lymphadenopathy > 5cm

Stage 3A:

• Supradiaphragmatic lymphadenopathy with abdominal lymphadenopathy < 2cm

Stage 3B:

• Supradiaphragmatic lymphadenopathy with abdominal lymphadenopathy 2cm - 5cm

Stage 3C:

• Supradiaphragmatic lymphadenopathy with abdominal lymphadenopathy > 5cm

Stage 4A:

• Extralymphatic metastases with abdominal lymphadenopathy < 2cm

Stage 4B:

• Extralymphatic metastases with abdominal lymphadenopathy 2cm - 5cm

Stage 4C:

• Extralymphatic metastases with abdominal lymphadenopathy > 5cm

This is a child of ‘CORE – Treatment’, and will mandate:

• the date the treatment started
• the treatment modality
• the organisation that provided the treatment

It is possible that some legacy data may not have all the required mandatory fields. The recommendation is for Trusts to update their data to meet the new requirements and improve/enrich their data submissions, or not upload the legacy data items in the new record (if that data is not available).

Must be one occurrence if chosen per CORE - Treatment (1..1)
Urological - Treatment - Choice 0..1
Urological - Treatment - Choice 1
Urological - Treatment - Intravesical Indicator Choice 1..1
Urological - Treatment - Intravesical Indicator - Choice 1

End of Urological - Treatment - Intravesical Indicator - Choice 1

Urological - Treatment - Intravesical Indicator - Choice 2

End of Urological - Treatment - Intravesical Indicator - Choice 2
End of Urological - Treatment - Intravesical Indicator Choice
End of Urological - Treatment - Choice 1
Urological - Treatment - Choice 2

End of Urological - Treatment - Choice 2
End of Urological - Treatment - Choice

Intravesical Indicator – Choice 1

Intravesical Chemotherapy Received Indicator

‘Bladder Only’. If selected, this is a mandatory data item. (Only required for patients having chemotherapy). Record as YES for patients having intravesical chemotherapy to distinguish from intravenous. This data item requires clinical involvement to ensure completeness.

Intravesical Indicator – Choice 2:

Intravesical Immunotherapy Received Indicator

‘Bladder Only’. If selected, this is a mandatory data item. (Only required for patients having immunotherapy). Record as YES for patients having immunotherapy to distinguish from systemic. This data item requires clinical involvement to ensure completeness.

Notes:

• either ‘Intravesical Chemotherapy Received Indicator’ or ‘Intravesical Immunotherapy Received Indicator’ is required for patients having anti-cancer therapy treatment to distinguish between modes of delivery
• only one will be applicable for each treatment, as specified by the 2 ‘Intravesical Indicator’ choices above

Procedure – Nerve Sparing

Extent of surgical nerve sparing. This is also required for the National Prostate Cancer Audit (NPCA).

Radical Prostatectomy Margin Status

The surgical margin status following radical prostatectomy. This is also part of the National Prostate Cancer Audit (NPCA).