Glossary

Cancer diagnosis date

Adapted from: Tyczynski JE, Demaret E, Parkin DM. Standards and guidelines for cancer registration in Europe. The ENCR Recommendations, Volume 1. IARC Technical Publication No 40.

The NCRAS ‘diagnosis date’ (DIAGNOSISDATEBEST) is derived using the UK and Ireland Association of Cancer Registries (UKIACR) definition. The following date is used in order of declining priority:

1. Date of first histological or cytological confirmation of this malignancy (with the exception of histology or cytology at autopsy). This date should be, in the following order: Date when the specimen was taken (biopsy), or Date of receipt by the pathologist, or Date of the pathology report
2. Date of admission to hospital because of this malignancy.
3. When evaluated at an out-patient clinic only: date of first consultation at the out-patient clinic because of this malignancy.
4. Date of diagnosis, other than 1, 2 or 3.
5. Date of death, if no information is available other than the fact that the patient has died because of malignancy.
6. Date of death, if the malignancy is discovered at autopsy.

Cancer diagnosis trust

Adapted from: National Prostate Cancer Audit guideline on Trust of diagnosis and Date of diagnosis.

Determining the ‘Trust of diagnostic event’ for a cancer patient takes into account a variety of different events that are recorded by NCRAS along the patient pathway. The following process is followed:

Eligible events must occur between 1 day before and 183 days after the date of diagnosis to be included as a trust of diagnosis.

The date taken from the list of events is the one on or closest to the date of diagnosis. The trust associated with this event is therefore designated the ‘Trust of Diagnosis’.

In the event of a patient having multiple events on the same date, the following rules are used:

• If one event has a valid hospital code and the others do not, take the event with the valid code.
• Select an event based on the ranking system shown below. As an example, the preferred earliest event for first seeing a patient is the biopsy event:

1. Biopsy
2. Surgical procedure
3. Pathology (Non-biopsy)
4. COSD Diagnosis Record
5. Radiological Investigation
6. MDT Discussion
7. Referral
8. Chemotherapy
9. Radiotherapy
10. Other Treatment
11. Active Monitoring
12. Cancer Care Plan Discussed
13. Other investigations
14. Death

Case registration status

To make the cases as contemporaneous as possible we include the most recent additions to the cancer registry. Recent cases marked as ‘Provisional’ still require a validation process which can take up to 12 months at which point they will be signed off and marked as ‘Final’.

There is therefore a possibility that either the nature of the cancer, or the date of diagnosis is wrong in the ‘Provisional’ cases. Providing cases that do not fit the project criteria is the small price we pay for having the most recent cases.

Index endoscopy

The index endoscopy is the most recent non-diagnostic endoscopy performed 3-36 months prior to cancer diagnosis.

Siewert classification

The Siewert classification is a system of anatomical classification used for adenocarcinomas of the gastro-oesophageal junction.

• Type I: Adenocarcinoma of the distal part of the oesophagus. The tumour center is located 1-5 cm above the gastric cardia.
• Type II: Adenocarcinoma of the real cardia. The tumour center is located 1 cm above or 2 cm below the gastric cardia. Considered to be true gastro-oesophageal junction.
• Type III: Adenocarcinoma of the subcardial stomach. The tumour center is located 2-5 cm below the gastric cardia.

Avoidability

Adapted from: Anderson R, Burr NE, Valori R. Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis. Gastroenterology. 2020. doi: 10.1053/j.gastro.2019.12.031.

PEUGICs can be considered unavoidable if:

1. The recommended pathway was not followed because the patient declined investigations or was deemed by the responsible clinician to be too frail to proceed with further investigation.
2. The patient had a dysplastic lesion detected on index endoscopy and subsequently underwent endoscopic resection with evidence of cancer on histology over three months later, provided the delay was related to patient not clinical or administrative factors.
3. The patient was recognised to have a neoplastic lesion but repeated attempts with adequate biopsy sampling, without inappropriate clinical or administrative delay, failed to provide definitive histological evidence of cancer (e.g. patients with gastric linitus plastica).
4. They are small PEUGICs and they are growing by < 5 mm/year, as they will have been unlikely to be detectable during the index endoscopy.

All other PEUGICs are considered potentially avoidable.