Policy and Procedure Manual
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Introduction
The Georgia Cancer Registry (GCR) is a population-based cancer registry that includes all cancer cases diagnosed in Georgia residents since January 1, 1995. The GCR serves the entire state of Georgia, which includes a population of approximately 11 million people.
The purpose of the GCR is to collect, analyze, utilize, and disseminate cancer incidence information. Such information helps state agencies, health care providers and Georgia citizens to monitor cancer incidence trends; plan and implement cancer control and prevention activities; develop public and professional education programs; and stimulate scientific cancer research.
Legal authority of the Georgia Department of Public Health (DPH) to collect health information established the GCR. The Official Code of Georgia (O.C.G.A.) Chapter 12 § 31-12-1 empowers the DPH to “… conduct studies, research and training appropriate to the prevention of diseases….”. O.C.G.A. § 31-12-2 allows the DPH to require certain diseases and injuries to be reported in a manner and at such times as may be prescribed.
All health care providers in the state of Georgia are required to report specific information on cancer in their patient population to the Georgia Cancer Registry. This includes all facilities providing diagnostic evaluations and/or treatment for cancer patients, such as: hospitals, outpatient surgical facilities, laboratories, radiation therapy and medical oncology facilities, and physician offices. In addition, reporting agreements are maintained with neighboring states so that Georgia residents who are diagnosed or treated in facilities out of state can be identified.
The code also addresses the confidentiality of information requested by DPH, and releases from civil liability providers reporting this information (§ 31-12-2 (a)). This section states, “…all such reports shall be deemed confidential and shall not be open to inspection by the public.”
The GCR participates in the National Program for Cancer Registries (NPCR). NPCR was established by the Centers for Disease Control and Prevention (CDC) in 1992 through the Federal Cancer Registry Amendment Act (Public Law 102-515). NPCR provides funding and guidance for the development of cancer registries throughout the United States.
The GCR is a member of the North American Association of Central Cancer Registries (NAACCR), which is a professional society that was established in 1987. NAACCR provides ongoing development of cancer registries and the establishment of registry standards.
The Georgia Department of Public Health has designated the Georgia Center for Cancer Statistics (GCCS) at the Rollins School of Public Health of Emory University as its agent for the purpose of collecting and editing cancer data. The GCCS is one of the population-based cancer registries supported by the increasingly expanding Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. The SEER Program is the most authoritative source of information on cancer incidence and survival in the United States. Since 1975, the GCCS has collected detailed information on incident cases of cancer in a five-county area of metropolitan Atlanta. In 1978, ten rural Georgia counties were added to the SEER program creating the Metropolitan Atlanta and Rural Georgia SEER Registry. In August 2010, the remaining counties of Georgia were added to the SEER program making Georgia a statewide SEER registry. Given its extensive background in cancer registration, the GCCS was selected to be the designated agent of DPH to conduct the day-to-day data management activities for the entire state of Georgia.
The Georgia Cancer Registry and the Georgia Center for Cancer Statistics as a combined Georgia registry will furthermore be referenced as the Georgia Cancer Registry (GCR).
Reporting
Guidelines
Every cancer diagnosed in Georgia is required by state law to be reported by health care providers. The Georgia Center for Cancer Statistics has been designated by the Georgia Department of Public Health to collect and keep that information confidential in a registry. This registry was designed to track the cancer burden among Georgia residents and to support studies about cancer to improve public health.
The Notifiable Disease Law, Official Code of Georgia Annotated (O.C.G.A.) § 31-12-2, also available on the Georgia Department of Public Health Disease Reporting website mandates the reporting of certain diseases including cancer. All cancers diagnosed since January 1, 1995, in persons receiving cancer diagnostic and/or management services or who have active disease must be reported to the Georgia Cancer Registry (GCR) unless previously reported by that facility. This includes all cancers indicated in the appropriate version of the International Classification of Diseases for Oncology (ICD-O), with a behavior code of 2 or 3.
As of January 1, 2004, any case diagnosed with benign brain or central nervous system tumors are also reportable. The reportable list below is based on the NPCR required data set.
For diagnosis years 2018 forward the authority for reportable histologies is the appropriate version of ICD-O-3.2.The ICD-O-3 Coding Updates for corresponding applicable diagnosis years is in the ICD-O-3 The North American Association of Central Cancer Registries (NAACCR) posts Implementation Guidelines on their website.
For 2022, the major changes apply to reportable terminology. The 2020 update includes: 12 new ICD-O codes/terms, two of which are non-reportable, three histologies have changed behavior with two remaining non-reportable and one becoming reportable, and 42 new preferred or related terms.
For 2023, the major changes apply to behavior code changes to a CNS neoplasm and reportable terminology. The 2023 update includes: 5 new ICD-O codes/terms, one histology changed behavior and is reportable, and 41 new preferred or related terms.
IMPORTANT FOR CASES Diagnosed 2023 FORWARD: Beginning 1/1/2023, all cases diagnosed with pilocytic astrocytoma/juvenile pilocytic astrocytoma and related terminology are to be reported with behavior /1. They will no longer be collected with malignant behavior (/3). ICD-O code 9421/3 will be valid for the diagnosis of high-grade astrocytoma with piloid features or HGAP only. Coding instructions are included in the remarks section for 9421/1 and 9421/3 in the 2023 ICD-O Update Tables 1 and 2.
Check the 2023 ICD-O-3 Update Table 1 or 2 to determine if the histology is listed. If the histology is not included in the update, then review ICD-O-3.2 and/or Hematopoietic and Lymphoid Database and/or Solid Tumor Rules (MP/H).
Many changes for 2024 are new related terms for existing codes, five new ICD-O codes, four reportable and one non-reportable, and one histology that has changed behaviors and is now reportable.
Newly Reportable for 2025: 9971/3: Polymorphic Post Transplant Lymphoproliferative Disorder (PTLD). Reportable 2010-2020. 2021-2024 is coded with behavior/1 and only reportable if associated with a reportable lymphoma, plasmacytoma, or multiple myeloma OR diagnosed in a CNS site (C700-729, 751-753). Beginning in 2025 the behavior reverts back to /3 and is reportable for any site.
Other than 9971/3, there are no new ICD-O-3.2 updates for 2025. Continue to use 2024 Annotated Histology List and 3.2 update.
Please refer to the appropriate program manual for further guidance on reportable neoplasms. It is important to understand that cancer registry reportability rules based on behavior code still apply. Except for primary intracranial and central nervous system benign and borderline tumors, the addition of a /0 or /1 coded term to ICD-O-3 does not imply that it is now reportable. Some /2 behaviors may not be reportable or are reportable for a select site or sites. Again, please refer to your standard setter reporting requirements if you have questions.
Find the 2018-2024 ICD-O-3 Coding Guidelines and Coding tables in PDF or Excel format here.
Please refer to the 2024 and 2025 SEER Program Code Manual Appendix E for reportable and non-reportable examples.
For cases diagnosed prior to 2024, please use this link to access historical SEER Program Coding and Staging Manuals.
The hospital that receives a pathology specimen diagnostic of cancer from another hospital is not required to report the case. It is the responsibility of the hospital or outpatient facility that first collected or received the specimen to report the case. However, if a hospital receives a pathology specimen diagnostic of cancer from a physician's office, the hospital is required to report the case.
NOTE: All providers of health care for cancer patients including, but not limited to, hospitals, outpatient surgical facilities, laboratories (hospital and free-standing), radiation therapy facilities which are independent and/or free-standing facilities, nursing homes, hospice facilities not owned or managed by a hospital, medical oncology facilities and Physicians that diagnose or treat cancer patients that include but not limited to Urologists, Dermatologists, and Hematologists.
The hospital that receives a pathology specimen diagnostic of cancer from another hospital is not required to report the case. It is the responsibility of the hospital or outpatient facility that first collected or received the specimen to report the case. However, if a hospital receives a pathology specimen diagnostic of cancer from a physician's office, the hospital is required to report the case.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) does not impact the status of cancer reporting procedures. HIPAA allows for the reporting of identifiable cancer data and other reportable conditions to public health entities. The GCR falls under the definition of a public health entity. HIPAA allows all facilities to continue reporting data to the GCR in compliance with state law.
For interpretations of HIPAA rules, refer to the Georgia Department of Public Health website.
More overview of legal authority for Georgia reporting of this manual.
For Public Laws, Cancer Registry Amendment Act, see CDC Cancer Control and Prevention, Cancer Registries Amendment Act
Report all required data elements as described in GCR Required Data Set and Instructions for Abstracting and Coding. See dataset details.
All facilities with an average annual case load of greater than or equal to 50 cases must submit the required data electronically using Abstract Plus software provided free of charge by GCR or using other available registry software. Facilities should utilize the monthly data upload feature on our secure web site for submitting electronic data. The facility will be notified by GCR when the data submission has been received.
All facilities with an average annual case load of less than 50 cases annually (Small Reporting Facility) may also submit the required data electronically. Alternatively, the preferred method for small facility reporting is through uploading scanned copies of medical records to the secured Labkey system on the GCCS website. You must be identified as a facility contact within the system to be authorized as a registered user. Please contact your [Regional Coordinator] for your contact information to be entered for your facility in the system.
Contact your Regional Coordinator for setup and instructions.
Small facilities should submit their yearly disease index in excel format in January following the year of diagnosis or date of first contact for cancer.
Small facilities are encouraged to provide electronic access of their medical record to their Regional Coordinator to facilitate/assist in screening for reportability to the GCR. Alternatively, all medical records with a cancer code on the disease index may be submitted.
Medical record submission for small facilities should be submitted with their disease index no later than March following the year of diagnosis or date of first contact for known cancer.
The following reports from the medical record should be submitted: Face sheet, History & Physical, pathology report, relevant labs and tumor markers, operative report, discharge summary, X-Rays, scans, scopes, and other diagnostic reports.
The facility will receive a notification by e-mail from gccs@sph.emory.edu that the data submission has been received. If you do not receive the notification by e-mail within a week after sending your submission, you should email confirmation at gccs@sph.emory.edu.
Data Editing
GCR requires all submitted data to be edited by the GA edit software. GCR recommends an edit report be attached to or included with each submitted data file. To obtain the GA edit software please contact your Regional Coordinator. The GA edit software is free of charge and available to all hospitals.
File Naming Conventions for Data Sent to the Georgia Cancer Registry
Small Facilities (less than 50 cases a month) should contact their Regional Coordinator for methods for securing their data during transmission to the GCR via Labkey.
File Formatting
Submitted files should follow the format: XXXXXXMMMYY_#EXT.xxx where,
| XXXXXX | = the 6-digit facility number of the facility submitting the data |
| MMM | = the first 3 characters of the month in which the file is submitted |
| YY | = the last 2 digits of the year in which the file is submitted |
| _ | = an ‘underscore’ character (hold shift key and press minus sign) |
| # | = the submission number for that month of the same file type (see EXT below) |
| EXT | = a file extension indicating the type of the data submission (see below) |
| .xml | = a NAACCR 21 or higher version xml file extension |
Re-submitted files due to records rejected during a prior submission should follow the format:
XXXXXXMMMYY_#EXTR.xml where the R represents the file is a resubmission.
Valid File Extensions
Valid file extensions (EXT) include:
- HOS: Monthly hospital submission
- HOSR: Monthly hospital resubmission
(resubmitted data from corresponding rejected abstract reports) - CFA: Case-finding audit submission (data identified as missing from the registry based on the Casefinding audit match or other GCR activities)
- DCO: Death clearance submission
(data identified as missing from the Registry based on the state death certificates) - DIS: Hospital discharge submission
(data identified as missing from the Registry based on Hospital discharge match) - CSA: Cancer state aid submission
(data identified as missing from the Registry based on the Cancer State Aid match) - RCA: Rapid Case Ascertainment
(data identified as part of rapid case ascertainment process) - MOD: Modified Records
(Monthly modification/correction files are required to be submitted monthly) - MSC: Any other miscellaneous data submission
(all other submissions not falling into any of the above categories should include detailed text describing exactly what the miscellaneous submission includes) - OFF: Yearly Offload Submission
(entire year’s reportable cancer cases for selected diagnostic year)
Examples
Facility Number | Type of Data Submission | Data submitted in Month Current Year | Submission number that month for the same file type | Appropriate File Name |
| 380000 | Monthly Hospital | January 2019 | 1 | 380000JAN19_1HOS.xml |
| 380000 | Monthly Hospital (second submission, same month, and year) | January 2019 | 2 | 380000JAN19_2HOS.xml |
| 380000 | Resubmission of January 2019 rejected data | January 2019 | 1 | 380000JAN19_1HOSR.xml |
| 380000 | Case-Finding Audit | March 2019 | 1 | 380000MAR19_1CFA.xml |
| 380000 | Death Clearance | January 2019 | 1 | 380000JAN19_1DCO.xml |
GCR should comply with the established goals and standards set by the National Program for Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC) for timeliness of data collection. The established standard for timeliness is to have each cancer reported to the central registry within six months from the date of diagnosis of the cancer.
Large facilities should report monthly by electronic submission. Facilities should utilize the monthly data upload feature on our secure web site for submitting electronic data. Facilities will be notified by GCR when the data submission has been received.
A large facility will be considered delinquent for the monthly submission if data has not been received at GCR by the end of the business day of the last day of the month. For example: January submissions should be received on or before 5:00 pm, January 31st to be considered timely. If it is not possible for a facility to submit data during a given month, a notice should be submitted by email to gccs@sph.emory.edu prior to the end of the month stating both the reason for not submitting data and when the hospital plans to report. If an acceptable reason is provided the facility will not be considered delinquent. Acceptable reasons for not reporting include but are not limited to 1) recent personnel losses, 2) recent computer problems (software/hardware), 3) natural disasters, and 4) no data to report.
Timeliness will be monitored by GCR staff. The facility will receive communication from the GCR Regional Coordinator if a data submission is overdue.
How to Submit:
- Upload to Labkey
- Labkey Instructions
- Contact your Regional Coordinator if assistance is needed.
Each electronic data monthly submission will receive an electronic data receipt including a summary of cases submitted, rejected, and duplicated. Detailed reports may be retrieved from Labkey for each facility. It is up to the contractor to obtain any reports containing rejected or edit error data and to resubmit any pending resubmissions in a timely manner.
Rejected data must be resubmitted to the GCR within 30 days of the date stated on the email receipt your facility receives. Re-submitted files due to records rejected during a prior submission should follow the format stated in Edits and Naming Conventions for data sent to the GCR. Only rejected abstracts should be electronically resubmitted. Do not resubmit the entire original submission.
Modification/correction files are required to be submitted to GCR Monthly.
Facilities using registry software that is capable of identifying abstracts containing modifications/corrections made since the abstract was transmitted to the central registry, will be able to send a separate file of these corrections. Modification/correction abstracts are identified by the NAACCR data item number 10 – Record Type as ‘M’. You DO NOT need to run edits on this submission.
Please note the following:
This submission file is not counted as your regular monthly submission and should be submitted as a separate file
Use ‘MOD’ file extension for the name of the file i.e. 380000Jul19_1MOD.xml
Be sure you compact/compress the file prior to uploading
File can be uploaded using the Monthly Data submission link in Labkey .
Each year, GCR may require that facilities offload all reportable cancer cases diagnosed within a particular year to assure that all cases from each facility are being reported. Please refer to Edits and Naming Conventions for these files. The extract should be based on diagnosis year for the specified year. Do not use the date of first contact or accession number to extract the file.
Facilities converting software from one vendor to a different vendor must ensure that data is not compromised, and all data is converted accurately. An accounting of all complete, suspense and incomplete abstracts should be made prior to conversion, as well as identifying abstracts that have not been transmitted to the state versus those previously transmitted. The facility must confirm that abstracts are not flagged erroneously as transmitted. At the request of the facility, GCR will provide a list of all abstracts submitted by the facility to the state prior to the conversion for comparison.
- https://seer.cancer.gov/tools/staging/
- ICD-O-3
- SEER Appendix E – Reportable and Non-reportable Examples
- ICD-O-3 is not to be used for coding hematopoietic or lymphoid neoplasms after 1/1/2010. Use the Hematopoietic and Lymphoid Neoplasm Database and Manual for coding histology and determining multiple primaries for diagnosis years 2010 forward. https://seer.cancer.gov/tools/heme/
- 2024 & 2025 SEER Program Code and Staging Manual
- Extent of Disease 2018 General Instructions
- Summary Stage 2018 Manual
- SEER*RSA
- Site – Specific Data Items (SSDI) Manual, SSDI Appendix A & SSDI Appendix B
- Grade Manual
- SEER Solid Tumor Rules
- Hematopoietic Database
NOTE: The stand-alone version of the Hematopoietic database is no longer provided. The web-based tool is the most up-to-date information.
In April 2011, GCR required Nursing Home and Hospice facilities to report their diagnosed cancer patients. Facilities are required to complete a reporting form in its entirety by its designee when the patient is admitted to its service.
- Each cancer needs to be reported by the facility only once. It is of note that all the fields on the form are important, with special emphasis on the diagnosis date of the patient’s cancer, be it an exact date or estimation.
- Please contact your Regional Coordinator for the form and relevant instructions. Regional Coordinators will follow back to facilities for any clarifications or questions.
- The information reported is entered into a tracking database to allow the GCR to contact the diagnosing facility or physician if the patient has not been reported to GCR by the end of the diagnosed year. The requirement to report will facilitate complete cancer incidence reporting in Georgia and reduce the number of death certificate only cases.
Facilities reporting to the GCR with an annual caseload of less than 50 cancer cases per year will be required to submit a disease index on a yearly basis to the GCR.
The disease index should be in electronic format (ex: Excel, CSV). A template provided by your Regional Coordinator that contains the minimum required fields that must be used for reporting your disease index. Additional fields may be submitted if available from your electronic medical record system. Pathology reports may be in an electronic or pdf format. If you or your IT representative needs assistance in this format, please contact your Regional Coordinator.
Facilities reporting to the GCR with an annual caseload of less than 50 cancer cases per year:
- May submit abstracts electronically using Abstract Plus (free software from GCR) or other registry software.
- May submit medical records to the GCR to be abstracted.
If a facility has NO reportable cases for a month, an email to gccs@sph.emory.edu or gccs@gccs.gadirect.net should be submitted stating so. If it is not possible for a facility to submit during a given month, a notice must be submitted by email stating the reason and when the hospital plans to report. The facility will not be considered delinquent if notice is received by the last day of the non-reporting month. Acceptable reasons for not reporting include 1) recent personnel losses, 2) recent computer problems (software/hardware), and 3) natural disasters.
Confirmation of Submission
The facility will receive an email notification from GCR notifying the facility that the data submission has been received. If you do not receive this notification within a week after sending your submission, you should contact GCR for confirmation. You should maintain a copy of your confirmations for future reference
How to Submit:
- Upload to Labkey
- Labkey Instructions
- Contact your Regional Coordinator if assistance is needed
Medical Records Submitted Must Include the Following Information
Cover Sheet
A cover sheet should indicate the following:
- Reporting facility
- Date of submission
- Number of cases being sent
Individual Records
Individual records must include the following:
- Demographic or Face Sheet
- Discharge Summary
- History and Physical, Consult, and Progress Reports
- Pertinent x-ray reports, scans. Do not send routine laboratory reports unless specific for the cancer
- Operative report
- Pathology Report
- Cytology Report
- Cancer Treatment Information
Guidelines For Small Facilities
A facility will be considered delinquent for the monthly submission if data has not been received by GCR by the last day of the month except for Small Facilities. Small facilities should submit an entire year disease index for the prior year in January of the year following diagnosis or admission for cancer. Medical records should be submitted between January and March of the following year of diagnosis or admission for cancer.
If a facility has NO reportable cases for a month, an email to gccs@sph.emory.edu or gccs@gccs.gadirect.net should be submitted stating so. If it is not possible for a facility to submit during a given month, a notice must be submitted by email stating the reason and when the hospital plans to report. The facility will not be considered delinquent if notice is received by the last day of the non-reporting month. Acceptable reasons for not reporting include 1) recent personnel losses, 2) recent computer problems (software/hardware), and 3) natural disasters.
How to Submit:
- Upload to Labkey
- Labkey Instructions
- Contact your Regional Coordinator if assistance is needed
Confirmation of Submission
The facility will receive an email notification from GCR notifying the facility that the data submission has been received. If you do not receive this notification within a week after sending your submission, you should email gccs@sph.emory.edu for confirmation. You should maintain a copy of your confirmations for future reference.
Abstract Plus is an abstracting tool used to summarize the medical record into an electronic report of cancer diagnosis and treatment. This software was developed by the Centers for Disease Control and Prevention (CDC) in support of CDC's National Program of Cancer Registries (NPCR).
A customized version of Abstract Plus for Georgia state reporting and accompanying help documents are available in the Abstract Plus section of the Georgia Center for Cancer Statistics (GCCS) web site at the Application Download link under Cancer Reporting.
New users of Abstract Plus should contact their Regional Coordinator or GCR for assistance with installation and use.
Quality
Data Quality and Completeness Improvement Activities
This section describes activities that contribute to data quality and completeness. It also describes linkages conducted by the Central Registry that are shared with facilities for follow-up purposes. Also described is the required yearly process for Abstractor Registration.
The GCR director selects on an “as needed” basis hospitals that will undergo casefinding audits. NPCR Program Standards requires at least once every 5 years, a combination of case-finding and re-abstracting activities are conducted for each hospital-based reporting facility. The purpose of the casefinding audits is to provide reporting facilities with an external assessment of the completeness of their reporting. A hospital also can request an audit be conducted on their facility. To do so, please contact your Regional Coordinator. The following steps are taken when a hospital participates in a casefinding audit:
- Regional coordinator contacts the facility to schedule an audit.
- GCR provides the regional coordinator with a list of reported patients for the facility.
- Regional coordinator identifies all casefinding sources at the hospital.
- Regional coordinator requests and reviews a disease index for the audit period.
- Once the screening of hospital records is done, the regional coordinator compares the list of cases reported by the hospital before the audit with the cancers identified during the audit.
- Regional coordinator provides a list of all patients missed by the hospital to the appropriate hospital personnel.
- Hospital submits missed cases within 60 days after the end of the casefinding audit.
- The Casefinding Audit report is completed by the Regional Coordinator and sent to the GCR Director and Director of Registry Operations.
GCR and/or the Regional Coordinator selects hospitals for a re-abstracting audit on an “as needed” basis. The purpose of the re-abstracting audit is to provide facility abstractors with an external assessment of their abstracting quality. A Facility Registry Manager can also request a re-abstracting audit be conducted for their facility. To do so, please contact your Regional Coordinator. The following steps are taken when a hospital has a re-abstracting audit.
- Regional Coordinator contacts the facility to schedule an audit.
- Regional Coordinator establishes primary sites, number of cases, and data items to be re-abstracted.
GCCS randomly selects facility cases. - Regional coordinator blindly re-abstracts selected data items using Abstract Plus.
- Regional Coordinator compares re-abstracted data items to facility’s abstract submitted to the GCR.
- Regional Coordinator provides facility with a final report summarizing abstractor data item discrepancies as well as facility results with any recommendations.
- The Re-abstraction Audit Summary report is sent to the GCR Director and Director of Registry Operations.
The hospital discharge linkage is another method used by GCR to improve completeness. Each year the Hospital Discharge Reports are sent to the responsible Regional Coordinator for each hospital in their region. The hospital discharge is then reviewed with the tumors reported by that facility. This review is necessary to ensure that all reportable tumors are reported.
- The GCR Data Manager links the hospital discharge database records to the cancer registry database records with three possible outcomes: positive matches, possible matches and non- matches.
- The Data Manager sends non-match list to the appropriate Regional Coordinator.
- The Regional Coordinator and the appropriate hospital review the non-matches and determine case reportability based on guidelines in the appropriate corresponding year SEER Program Coding and Staging Manual and ICD-O-3.2 .
- Hospitals submit identified missed cases within 30 days to GCR including the appropriate naming and submission of the hospital discharge follow-back records.
- Hospital Discharge Summary Report is sent to gccs@sph.emory.edu.
An internal review of facility or individual abstractor’s submitted cases will be performed on an as needed basis. Coding issues identified by GCR editors or requests by facility managers may precipitate these reviews.
A detailed data item report is provided to the facility manager. Please contact your Regional Coordinator whenever you would like an assessment.
The GCR links with the Social Security Administration vital status data on a yearly basis. All persons who are alive and do not have an updated follow-up date are sent for linkage. Date of last contact and vital status are updated in the registry with the results from the linkage.
The GCR also links with the National Death Index on a yearly basis. All alive persons in the registry as well as those people whose vital status is dead but there is an unknown cause of death are sent for linkage. Those that link with the National Death Index are dead and have died in a state other than Georgia. Vital status, date of last contact, death state, and primary and secondary causes of death are updated in the registry.
Bi-annually (May and November) a tumor registry follow-up report is sent to cancer registries at the facility level with the most recent date of last contact and cause of death. The available formats for the report are available for software vendors who can then electronically update the facility’s cancer registry database with the incoming information from the central registry. Excel lists as well as Access database are also available to facilities.
Effective January 1, 2014, all abstractors must complete a registration process to obtain a state-assigned Abstractor ID, which is required to be recorded in the Abstracted By data item field (NAACCR Item #570) for abstracts submitted to the state of Georgia. Once the abstractor has completed the registration process, a unique ID will be assigned. This ID is to be used by the abstractor for abstracting in any facility in Georgia. The registration process allows the registrar to associate any Georgia facility with their name and the assigned ID. Please contact your Regional Coordinator for any questions you may have during the registration process.
The state database will be linked to the registration ID for each abstractor. Abstracts that are submitted to the state without the unique abstractor ID will not be imported into the State database. An email will be sent to the appropriate supervisor for that facility notifying them of the rejected abstracts.
As a service to our facilities, all new abstractors will have a sampling of 10 cases abstracted early in their employment reviewed for quality assurance (coding and text), and the Regional Coordinator will provide the facility manager with the findings. The facility manager may request an additional review of 10 abstracts should that be required. GCR will assist the facility with recommendations for training as appropriate.
The unique ID for each abstractor will expire once a year and the abstractor will need to re-register before submitting any further abstracts. Advance notices will be automatically sent to the email address of the abstractor and to the abstractor’s facility manager.
Confidentiality
Confidentiality
Confidentiality of data is of great concern to the Georgia Cancer Registry (hereafter referred to as Registry) and is extremely important to the operation and maintenance of the Registry. The following are critical elements of the Registry's comprehensive confidentiality policies and procedures that relate to research use, reporting, and release of cancer data. Confidentiality policies, pledges, and procedures are required in all phases of the Registry operation to:
- Protect the privacy of the individual cancer patient.
- Protect the privacy of the facilities reporting the case.
- Protect the privacy of the physicians and other providers responsible for the care of the cancer patient.
- Provide public assurance that the data will not be abused.
Since 1989 cancer has been a reportable disease in Georgia and the Registry has been delegated with the responsibility for collecting data on cancer from health care facilities or providers, including but not limited to hospitals, outpatient surgical facilities, laboratories (hospital and free standing), radiation therapy facilities which are independent and/or free standing facilities, nursing homes and hospice facilities not hospital owned or operated, medical oncology facilities and physicians that diagnose or treat cancer patients that include but not limited to Urologists, Dermatologists and Hematologists.
Furthermore, the GCR database under O.C.G.A § 31-12-2(b) protects persons submitting reports or data to the Registry, in good faith, from liability for any civil damages. Refer to Updated Mandate for New Template.pdf for more information.
The Registry defines confidential as all data that identifies patient-specific information. The Registry also treats information that specifically identifies a health care provider or an institution as confidential. Information that characterizes the caseload of a specific institution or health care professional is considered proprietary and confidential.
It is the responsibility of the Registry to protect the data from unauthorized access and release. The Registry maintains the same standards of confidentiality as customarily apply to the physician-patient relationship as well as the confidentiality of medical records. This obligation extends indefinitely, even after the patient is deceased.
The costs of inappropriate release of confidential data are many. Inappropriate release of data could damage an individual whose diagnosis of cancer is made public. In addition, support and cooperation of facilities providing data to the Registry could also be severely compromised. Registry personnel responsible for violating confidentiality policies and procedures will be administratively disciplined up to and including dismissal from employment.
Security of data maintained both on paper and in electronic form are addressed below in this section under the heading Data Security.
Each staff member, as part of his/her employment agreement, reads the GCR Confidentiality Statement.pdf and signs a pledge that confidential information will not be released to unauthorized persons. The pledge remains in effect after cessation of employment. The Registry Director maintains a file of staff members who have signed pledges.
The orientation and training of each new staff member includes instructions concerning the confidentiality of data.
Failure to observe the confidentiality policies will result in firm disciplinary action up to and including dismissal from employment. In extreme circumstances legal action may be warranted against a staff member who fails to comply with the Registry's confidentiality policies.
The Registry Director is responsible for data security.
Registry staff are responsible for the confidentiality of all data encountered during the collection of cancer data.
The following components are required to assure data security in all areas of registry operation:
- Suitable locks are installed to control access to the Registry and custodial staff are notified of the importance of maintaining a secure environment.
- Confidential data will not be transmitted from the registry by any means (mail, telephone, electronic, or facsimile) without explicit authority from the Registry Director or a staff member to whom such authority has been delegated. All mail with confidential data must be marked “confidential”.
- Precautions must be taken, for both physical and electronic security of confidential data sent on electronic media, to include secure packaging and tracking (i.e. using federal express for deliveries to be delivered only to the appropriate person.
- The use of desktop and notebook computers for the ascertainment and management of confidential data must be controlled by electronic and physical measures to protect the security of the data. These include passwords, screen savers, and whole disk encryption utilizing two-factor authentication.
- Training and demonstration of computer systems must be performed with separate fictitious and/or anonymous data sets, or when this is not possible (i.e. training registry staff on new procedures, or during data audit for quality assurance), observers are required to sign confidentiality agreements.
- The physical security of confidential data stored on paper documents, computer printouts, and other media present in the Registry must be ensured. For instance, when reports or computer printouts are no longer necessary, they are disposed of by shedding. Data abstracts are kept secure in a locked room and have limited access by the Registry staff.
- Confidential documents to be destroyed are kept in a secure environment (i.e. kept in a box labeled “confidential documents to be shredded” and kept in a locked room with limited Registry staff access) until they are shredded.
Computer security safeguards must be followed, including, but not limited to:
- whole disk encryption is required for all desktops and laptops, as are secure passwords (e.g. database content is password protected, password is changed every 90 days).
- all back-ups of registry data must be encrypted.
Release of registry data for clinical purposes, research, and health care planning is central to the purpose of the Registry. The Registry has developed procedures for data release that ensure the maintenance of confidentiality.
For complete case ascertainment, the Registry exchanges confidential data with the other state registries with whom Georgia has reciprocal case-sharing agreements.
The Registry may release limited patient data to providers of health services for that patient. Such data will not include the names of the other health care providers used by the patient.
Individual patient information may also be released in response to a request to provide confidential data for approved research projects where a written agreement specifies and ensures the protection of information identifying any individual patient. Such studies should be approved by the Registry management team and the appropriate Institutional Review Board (IRB).
No information identifying an individual health care provider or facility will be made available except as required by Georgia Law or with written consent of that health care provider or facility.
Copies of specific patient information will not be provided to individuals (patients), except when required by Georgia Law.
Confidential information will not, under any circumstances, be published or made available to the general public.
Inquiries from the press should be referred to the cancer registry director, state epidemiologist, state chronic disease epidemiologist or other persons designated by the Georgia Department of Public Health. Inquiries could be referred to the Georgia Center for Cancer Statistics (GCCS) Director or another member of the staff who has been delegated the authority to respond by emailing gccs@sph.emory.edu . Measures will be taken to eliminate the possible identification of individual patients from data table cells containing very small numbers (i.e. less than five).
Researchers are reminded that all publications resulting from research performed under the National Cancer Institute (NCI), Department of Public Health (DPH), and Centers for Disease Control and Prevention (CDC), or other funded contract shall acknowledge support of the supporting organization.
Any data released or published where it is known that fewer than 90% of the expected cancer cases have been registered should include a qualifier indicating this fact (e.g. Data in this geographic area is less than 90% complete).
Confidential data will never be made available for commercial purposes including but not limited to:
- Businesses that are trying to market a product to cancer patients.
- Health care institutions that are trying to recruit new patients.
- Insurance companies that are trying to determine the status of an individual patient.
The Registry has a data request form GCR Research Agreement.pdf for use by researchers, registry staff, and others. The form serves as internal documentation of data requests, documents all requests for information, assists in the monitoring of staff efforts, and is used to prepare periodic data request summary reports.
Statistical data requests received via the telephone and in writing (such as cancer inquiries from citizens) are processed by the Registry's Program Director. Written documentation of the requested data is prepared for the programming staff. Copies of all correspondence along with a computer output of the data are filed in locked cabinets at the Georgia Department of Public Health to be used for summary tabulations to prepare routine reports.
Reports of summary statistics do not generally raise concerns about confidentiality. However, confidential information may be inadvertently conveyed through summary statistics. The Registry has instituted a policy to suppress the publication of summary statistics in some instances, especially where data are being presented for geographic areas with small populations. For example, the Registry will suppress the reporting of statistical data when there are fewer than five cases reported in a single cell of a table, if a cell of the table represents a combination of variables, such as small geographic area, race, age, and sex, which can inadvertently identify individuals. However, breakdowns by age, sex, and large geographic areas such as the state of Georgia and having cells with less than five cases will not be suppressed.
The Registry uses the following guidelines for controlling access to registry data for research purposes:
Requests for research data should be in writing and include a detailed outline of the proposed research and justification for the need of any confidential data. The Registry management team (i.e. director of the registry, director of the Georgia Center for Cancer Statistics, and the chronic disease chief epidemiologist) and others, who serve in an advisory capacity, review, and approve research requests.
The written proposed research plan will be reviewed by the appropriate registry management team or committee to assess the following:
- Scientific and technical merit of the study
- Type of confidential and/or non-confidential data required
- Adherence to Registry's guidelines on confidentiality
- Approval of the appropriate Institutional Review Board (IRB)
- Credentials of the researcher
- Costs incurred and budget requirements
The investigator should assure that he/she requests consent to conduct this research from each health care facility. In addition, physician consent should be obtained for each case to be contacted and consent should be obtained from each patient (a copy of the consents should be attached to the research proposal).
IRB approval is required before releasing registry data on individual patients. If the researcher is affiliated with another institution, then IRB approval is also required from that institution (e.g. academic institution, health care facility, government agency, etc.).
The scientific objectives of the study should be peer reviewed to ensure scientific validity.
After the review of the research proposal, the registry management team may request the researcher to revise the data request, work plan, and/or the cost estimate. Work will not begin on the data request until there is a mutually agreed upon plan and cost estimate.
The researcher must complete and sign a written agreement to adhere to all confidentiality policies. Written agreements will include provisions for use of this information and for its return or destruction at the end of the study. The researcher should demonstrate adequate resources to conduct the research, including funding, staff, and technical expertise.
The Registry will ensure that confidential information is not under any circumstances published or displayed in reports that summarize the research results. The Registry will retain the right to review any reports prior to their dissemination to ensure that confidentiality has been respected.
A researcher who receives computerized data sets from the Registry should provide assurances that any confidential data will be destroyed or returned to the Registry after the project ends. Confidential data should be protected after the research investigator leaves the employment of the institution. The researcher is liable for civil damages for improper use of data.
Quality control studies of the cancer registry data, including re-abstracting and completeness studies will be conducted periodically by Registry staff and funding agency contractors. Registry staff and agency contractor persons are subject to the same confidentiality standards as indicated in this document. The results of the quality control audits for each individual institution will be kept confidential and only shared with that institution.
More information about cancer data requests. Cancer Data Requests.pdf
Manuals
Reporting Manuals
This section provides information on current and historical manuals used for cancer registry data collection and case abstraction.
For updates and errata to ICD-O-3 see the NAACCR website at https://www.naaccr.org/icdo3/#1582820761130-74100b9f-e677
As the coronavirus 2019 (COVID-19) pandemic continues, people with compromised immune systems are at an increased risk for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. Based on the National Cancer Institute (NCI), more than 15,700,000 people are estimated to be living with cancer in the United States. Incidence of COVID-19 has been reported to be higher among cancer patients than in the general population. Additionally, recent studies have shown patients with cancer had higher observed death rates, higher rates of ICU admission, and higher risk of complications when compared to non-cancer patients. Radiotherapy, chemotherapy, and immunotherapy may be postponed to decrease the risk of infection of COVID-19 or increase in treatment co-morbidity. A technical report stated that 8% of cancer patients had alterations in treatment plans due to COVID-19. These patients had delays in treatment and for almost half of these patients, treatment was indefinitely delayed or stopped entirely due to confirmed COVID-19 infections. Even with the small sample sizes of these studies, the COVID-19 pandemic has observable and potentially long-lasting effects on cancer outcomes. It is imperative to collect SARS-CoV-2 infection status and modifications to treatment for both incident and prevalent cases at the population-level, using the existing cancer surveillance infrastructure and standards. (see https://seer.cancer.gov/tools/covid-19/ for references page 13).
Following the above rationale, the COVID-19 Data Abstraction Guidance (Guidance v1.0. available at https://seer.cancer.gov/tools/covid-19/COVID-19-Abstraction-Guidance.pdf provides directions for using NAACCR text data items and standards to collect information on cancer patients’ SARS-CoV-2 laboratory tests, infection status, and delays or modifications of the treatment plan (Page 4-12, 14-15). The implementation of this guidance will take advantage of existing data items and text blocks, with minimal additional efforts for collection of COVID- 19 information. Meanwhile, the abstraction of COVID-19 information will not require changes to case ascertainment, reportability rules, list of required data items, modifications of edits metafiles, or other alterations of the current data acquisition process. In the application of directions listed in the Guidance, there is no expectation that registrars seek medical documents beyond the sources they currently use routinely for case abstraction and coding.
The following directions for recording COVID-19 information in the required NAACCR text data items are applicable to cases diagnosed January 1st, 2020, or later and completed on or after June 1st, 2020. COVID-19 Information must be entered in the text fields shown below to facilitate data retrieval. Entering text in a way that is different from this guidance (page 4-12 and as available on https://seer.cancer.gov/tools/covid-19/COVID-19-Abstraction-Guidance.pdf will make the information useless. Please follow the instructions for entering COVID-19 information in the following eight required NAACCR text data items.
TEXT DX PROC--LAB TESTS (NAACCR # 2500)
TEXT REMARKS (NAACCR # 2680)
RX TEXT SURGERY (NAACCR # 2610)
RX TEXT RADIATION (BEAM) (NAACCR # 2620)
RX TEXT RADIATION Other (NAACCR # 2630)
RX TEXT CHEMO (NAACCR # 2640)
RX TEXT HORMONE (NAACCR # 2640)
RX TEXT BRM (NAACCR # 2640)
COVID information is not required by SEER for cases diagnosed in 2023 and forward.
The National Cancer Institute estimates there are over 17 million cancer survivors in the United States today and these numbers are rising rapidly thanks to advances in early diagnosis and treatment. Georgia’s cancer registries are on the frontline in facilitating the capture of the necessary data to monitor our state’s progress in cancer prevention and control. Registries also provide clinical data that is critical to our research community. As our survivor population grows, it is ever more important that we capture additional outcomes to assess progress in life following a diagnosis of cancer.
Effective with cases diagnosed 2013 forward, the Georgia Cancer Registry is adding recurrence to its list of reportable data. We know that facilities participating in the Commission on Cancer Program have been collecting some data on recurrence for years but we need to expand the collection to all patients in our state and ensure that patients are followed for recurrence regardless of where they receive their future cancer care. As part of this new reporting mandate, we are not asking for any additional work on behalf of our cancer registrars in Georgia. The Georgia Cancer Registry is building an infrastructure to utilize data streams to provide signals of cancer recurrence. These signals will be validated by Georgia Cancer Registry staff on a sample of patients and then the algorithms defining the recurrence signals will be refined to improve their accuracy. This iterative process will continue until the algorithms are optimized. Once optimized, the Georgia Cancer Registry will share the recurrence data we have collected with any interested facility in Georgia for their respective set of cancer patients in the registry.
To minimize the burden of this work on cancer registrars in our state, we will be conducting the recurrence signal validation ourselves as discussed above. Our Regional Coordinators will be reaching out to you to facilitate setting up periodic access for GCR staff to visit your facility to conduct the validation. We know this does require some advanced planning to establish a space for our staff to work and as such we will reach out well in advance to ensure ample time to prepare. If there is any possible way to facilitate remote access for Georgia Cancer Registry staff to complete this work, we would greatly appreciate this and will complete any necessary paperwork that is required. We can provide a log of all cases that will be reviewed if that would be helpful along with any other information that is required.
This section in GCR Policy and Procedure Manual for Reporting Facilities can be found in link: https://seer.cancer.gov/manuals/2024/appendixc.html . This is a live link and will have the current codes and rules by primary site.
This information brings together the site-specific instructions needed to abstract a case. The Site-Specific Coding Modules include the following sections/documents for each primary site grouping:
- Coding Guidelines document whenever there are guidelines for a primary site
- Solid Tumor Rules
- 2018 EOD Schemas
- Surgery codes
For older surgery code manuals use the following link: http://www.seer.cancer.gov/tools/codingmanuals/historical.html
Scroll down until you see “Surgery”.
There are two historical manuals available for reference:
- Diagnostic Procedures April 1997, effective 1997- 1987
- Site-Specific Surgery Codes, effective 1983- 1997
Surgery codes for 1998 – 2022 are in Appendix C of the SEER Program Code Manual (SPCM), 3rd Ed., located in historical manuals section.
This section of the GCR Policy and Procedure Manual for Reporting Facilities can be found in the SEER 2025 Solid Tumor Rules. This is a live link and will have the current Multiple Primary/ Histology Rules. Use this reference when a Primary site does not have its own set of Multiple Primary/Histology rules.
Historical Cases for diagnosis years 1995-2023. Refer to SEER Historical Staging and Coding Manuals.
List of Paired Organ Sites
Refer to pages 116-117 in the SEER Program Coding and Staging Manual 2025.
Coding
GCR Required Data Set and Instructions for Abstracting and Coding
The required dataset for cancer reporting in Georgia can be found on the Georgia Center for Cancer Statistics website, where you can review the requirements in detail and compare changes from the previous year.Summary
International Classification of Diseases for Oncology (ICD-O-3 Online)
SEER Reporting Guidelines:
Casefinding Lists; SEER Program Coding and Staging Manual; Hematopoietic Project; Solid Tumor Rules; Historical Staging and Coding Manuals, Appendix C (Site Specific Coding Modules, Appendix D (Race Codes)
https://seer.cancer.gov/registrars/guidelines.html
Solid Tumor Rules (General Instructions, Multiple Primaries, Histology Rules)
https://seer.cancer.gov/tools/solidtumor/
SEER EOD
https://seer.cancer.gov/tools/staging/eod/
Registrar Staging Assistant (SEER*RSA)
https://seer.cancer.gov/tools/staging/rsa.html
SEER Summary Stage 2018
https://seer.cancer.gov/tools/ssm/
TNM 7th Edition Staging
Facility Oncology Registry Data Standards (FORDS)
TNM 8th Edition Staging
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837738/pdf/jclintranslres-2020-6-4-145.pdf
Standards for Oncology Registry Entry (STORE)
https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/ncdb-call-for-data/
Collaborative Stage Data Collection System Version 2 (CSv2.05)
https://www.facs.org/quality-programs/cancer/ajcc/cs-schema
North American Association of Central Cancer Registries, Standards for Cancer Registries Volume II, Data Standards and Data Dictionary
https://www.naaccr.org/data-standards-data-dictionary/a
Law & Mandate
Reporting Law & Mandate
The attached documents outline the legal authority that empower the Georgia Cancer Registry to collect cancer information in the state of Georgia and in neighboring states.
Resources & References
Resources & References
This section contains useful reference material, study guides, sites of interest, and contact information.
Standard References
| International Classification of Diseases for Oncology, (ICD-) books: ICD-O-1, First Edition: 1976 – 1991 ICD-O-2, Second Edition: 1992 – 2000 ICD-O-3, Third Edition: 2001 – 2017 ICD-O-3, Third Edition Histology Revisions 2018-2023 https://iris.who.int/bitstream/handle/10665/96612/9789241548496_eng.pdf?sequence=1&isAllowed=y ICD-O-3.2, 2024-2025 |
| SEER Extent of Disease Manuals (EOD) First Edition: 1988 – 1991 Second Edition: 1992 – 1997 Third Edition: 1998 – 2003 Extent of Disease 2018 General Instructions https://seer.cancer.gov/tools/staging/ |
| Collaborative Staging System:2004–2017 CS Version 02.02 effective 2010 CS Version 02.03 effective 2011 CS version 02.04 effective 2012 CS version 02.05 effective 2014 - 2017 |
| Summary Staging Summary Staging Guide, General Stage, field N760, 1977 – 2000 SEER Summary Staging, Summary Stage 2000, field N759, 2001 – 2003 and 2015-2017 SEER Summary Stage 2018 Manual https://seer.cancer.gov/tools/staging/ |
| SEER Rx Interactive Antineoplastic Drugs Database Application first available 2005. Link to download application and to sign up for email updates: https://seer.cancer.gov/tools/seerrx/ |
| SEER Hematopoietic Project: Hematopoietic and Lymphoid Database Application for cases diagnoses January 1, 2010 and later. Replaces ICD-O-3 for hematopoietic and lymphoid neoplasms https://seer.cancer.gov/seertools/hemelymph/ |
Effective Date | Field Name (s) | NAACCR Item Number or Other Comments |
| 2000 | Race 2, 3, 4, 5 | 161, 162, 163, 164 |
| 2001 | Histology ICD-O-3 | 522 |
| Behavior ICD-O-3 | 523 | |
| Summary Stage 2000 | ||
| 2003 | Rx Summ – Surg Primary Site | 1290 |
| Rx Summ – Scope Reg LN Surg | 1292 | |
| Rx Summ – Surg Oth Reg/Dis | 1294 | |
| 2004 | Benign Brain | Behavior code 0 or 1; Sequence number starts at 60 |
| Collaborative Stage coded EOD 10-digit no longer coded | ||
| 2006 | Case Finding Source | 501 |
| Primary Payer at Diagnosis | 630 | |
| Rx Sum Systemic Surg Seq | 1639 | |
| 2007-2012 | Ambiguous Terminology DX | 442 |
| Date Conclusive DX and Flag | 443. 448 | |
| Mult Tum Rpt as One Primary | 444 | |
| Date of Mult Tumors and Flag | 445, 439 | |
| Multiplicity Counter | 446 | |
| Multiple Primary/Histology Rules | ||
| 2010 | Grade Path Value 2010 - 2013 | 441 |
| Grade Path System 2010 - 2013 | 449 | |
| Lymphovascular Invasion | 1182 | |
| CS Mets at Dx – Bone, Brain, Liver, Lung 2010 - 2015 | 2851 - 2854 | |
| Laterality code 5 added Midline tumor | 410 | |
| Race Code 15 added | Code 15: Asian Indian or Pakistani | |
| Race Code 16 added | Code 16: Asian Indian | |
| Race Code 17 added | Code 17: Pakistani | |
| 2016 | Tumor Size Clinical | 752 |
| Tumor Size Pathologic | 754 | |
| Tumor Size Summary | 756 | |
| Mets at DX-Bone, Brain, Distant LN, Liver, Lung, Other | 1112 - 1117 | |
| 2018 | Collaborative Stage no longer coded | |
| ICD-O-3 histology and behavior update | ||
| 2018 Solid Tumor Coding Rules and SEER Hematopoietic Database update | ||
| Date Reg Lymph Node Dissection and Flag | 682, 683 | |
| Summary Stage 2018 | 764 | |
| EOD Primary Tumor, Reg Nodes and Mets | 772, 774, 776 | |
| Date of Sentinel Lymph Node Biopsy and Flag (Breast and Skin Melanoma) | 832, 833 | |
| Sentinel Lymph Nodes Pos and Examined | 835, 834 | |
| Phase I – Phase III Radiation fields | 1501 - 1533 | |
| SEER Site-Specific Factor 1 | 3700 | |
| Site-Specific Data Items (SSDIs), includes Grade Clinical, Grade Pathological and Grade Post Therapy | 3800 - 3937 | |
| 2021 | CD-O-3 histology and behavior update | |
| 2018 Solid Tumor Rules Update and 2021 Cutaneous Melanoma Rules | ||
| SEER Hematopoietic Database update | ||
| NAACCR XML Data Transmission Format | ||
| Grade Post Therapy Clin (yc) | 1068 | |
| Neoadjuvant Therapy | 1632 | |
| Neoadjuvant Therapy-Clinical Response | 1633 | |
| Neoadjuvant Therapy-Treatment Effect | 1634 | |
| Name--Birth Surname | 2232 | |
| New Site-Specific Data Items (SSDIs) | 3938 - 3942 | |
| NCDB--SARSCoV2--Test | 3943 | |
| NCDB--SARSCoV2--Pos | 3944 | |
| NCDB--SARSCoV2--Pos Date | 3945 | |
| NCDB--COVID19--Tx Impact | 3946 | |
| 2022 | ICD-O-3 histology and behavior update | |
| Solid Tumor Rules Update | ||
| SEER Hematopoietic Database update | ||
| Tobacco Use Smoking Status | 344 | |
| Macroscopic Evaluation of Mesorectum | 3950 | |
| New Site-Specific Data Items (SSDIs) | 3956 - 3959 | |
| Cancer Status | 1770 * | |
| Date of Last Cancer (tumor) Status and Flag | 1772, 1773 * | |
| Recurrence Date--1 st and Flag | 1860, 1861* | |
| Recurrence Type--1st | 1880* | |
| 2023 | All date flag data items retired | |
| ICD-O-3 histology and behavior update | ||
| Solid Tumor Rules Update | ||
| RX Hosp--Surg Prim Site 2023 | 671 | |
| RX Summ--Surg Prim Site 2023 | 1291 | |
| New Site-Specific Data Items (SSDIs) | 3960-3961 | |
| Secondary Diagnosis 1-10 | 3780-3798* | |
| 2024 | ICD-O-3 histology and behavior update | |
| Solid Tumor Rules Update | ||
| Cancer PathCHART ICD-O-3 Site Morphology Validation List (SMVL). | ||
| RX Hosp-Recon Breast | 751 | |
| RX Summ-Recon Breast | 1335 | |
| New Site-Specific Data Item (SSDI) | 3964 | |
| 2025 | Solid Tumor Rules update | |
| Cancer PathCHART update | ||
| SEER Hematopoietic Database update | ||
| New Site-Specific Data Items (SSDIs) | 1172, 1174 | |
| *New GA requirement |
- Anatomy book
- Medical dictionary
- AJCC Manual for Staging of Cancer - current edition
- SEER Self Instructional Manuals (1-5, and 7)
- American Cancer Society Textbook of Clinical Oncology
- Physician's Desk Reference or other drug reference book, current edition
- Cancer Registry Management Principles and Practice, Carol L. Hutchison, Steven D. Roffers, April G. Fritz.
SEER Self Instructional Manuals (Book 1 – Book 8) for Tumor Registrars:
To download manuals, go to https://seer.cancer.gov/archive/training/manuals/
Book 1: Objectives and Functions of a Tumor Registry (1999) Self-instructional Manual, describes the functions, objectives, activities required to run a tumor registry, and the various portions of a registry. (e.g. describes the various record systems required to run a registry accession file, case file, follow-up cards).
Book 2: Cancer Characteristics and Selection of Cases (1991) Self-instructional Manual, provides instruction in the terminology associated with cancer. Brief description of the natural history of the major cancer types. Introduces the use of ICD-O.
Book 3: Tumor Registrar Vocabulary: The Composition of Medical Terms (1992) Self-instructional Manual, medical terminology.
Book 4: Human Anatomy as Related to Tumor Formation (1995) Self-instructional Manual, introduction to human anatomy and neoplasm(s) associated with each body system.
Book 5: Abstracting Medical Record: Patient Identification, History, and Examinations (1993) Self- instructional Manual, describes the medical record, how to locate and record the information related to a cancer registry (abstract case information).
Book 6: Out of print, substitute: Summary Staging Guide (1977) Provides anatomical diagrams and rules for determining localized, regional, and distant stage for major cancer sites.
Book 7: Statistics and Epidemiology for Cancer Registries (1994) Self-instructional Manual, introduces tumor registrar to the statistics required to run a registry: includes discussion of incidence, mortality, and survival.
Book 8: Antineoplastic Drugs (Third Edition, 1993) See SEER*Rx - Interactive Antineoplastic Drugs Database, which was developed to replace Book 8 as an annually updated list of oncology drug and regimen treatment categories.
ODS Workshops by NCRA: https://www.ncra-usa.org/Education.
North American Association of Central Cancer Registries (NAACCR): https://www.naaccr.org/
Click on Education
ODS Exam Prep and Review Webinar Series: https://education.naaccr.org/CTR.
SEER*Educate ODS Exam Prep Module: https://educate.fredhutch.org/LandingPage.aspx.
AJCC COC Cancer Forum AJCC COC Cancer Forum: http://cancerbulletin.facs.org/forums/.
American Cancer Society: Cancer statistics, information, research, and community activities: https://www.cancer.org/.
American College of Surgeons (ACOS): www.facs.org.
Brain Tumor Foundation: https://www.braintumorfoundation.org/.
Cancer Quest: Information on cancer biology, treatment, and more:
https://cancerquest.org.
Central Brain Tumor Registry of the US: https://cbtrus.org.
Collaborative Stage Data Collection System: latest version CS coding manual Part I & II, other information: http://www.cancerstaging.org/cstage/.
FFIEC County Look Up: https://geomap.ffiec.gov/ffiecgeomap/.
GA Center for Cancer Statistics (GCCS): https://sph.emory.edu/GCCS/.
GCCS NAACCR Webinars: https://labkey.emory.edu/project/RSPH_GCCS/_Webinar/NAACCR%20Webinar/begin.view?.
(Must be a registered Labkey User to access)
Georgia Composite Medical Board: https://medicalboard.georgia.gov/.
GA Comprehensive Cancer Registry (GCCR): https://dph.georgia.gov/chronic-disease-prevention/georgia-comprehensive-cancer-registry.
GA Tumor Registrar’s Association (GATRA): https://gatrainc.org//.
National Cancer Institute (NCI): Cancer information, research, cancer statistics and resources. https://www.cancer.gov/.
National Cancer Registrar’s Association (NCRA): https://www.ncra-usa.org/.
National Comprehensive Cancer Network (NCCN): https://www.nccn.org/professionals/physician_gls/default.aspx.
National Library of Medicine: https://www.nlm.nih.gov/.
National Program Cancer Registries (NPCR): https://www.cdc.gov/cancer/npcr/index.htm.
North American Association of Central Cancer Registries (NAACCR): https://www.naaccr.org/.
NPI Registry Search: https://npiregistry.cms.hhs.gov/search.
Online ICD-10 codes: https://www.icd10data.com/.
SEER Training: https://seer.cancer.gov/training/.
SEER*Educate: https://educate.fredhutch.org/LandingPage.aspx.
Zip Code Look Up - look up zip and county with known address, or know zip and find city and county: https://www.zipinfo.com/search/zipcode.htm.
Region 1 Cancer Registry Coordinator
LeRue Perry, ODS
North Region Coordinator
284 First St. Statham GA 30666
Phone/Fax: 770-725-6258 Cell: 706-983-2676
LeRue.Perry@dph.ga.gov
Lisa Connor, ODS
Georgia Center for Cancer Statistics
1518 Clifton Road NE Atlanta, GA 30322
Phone: 706-975-8951 Fax: 404-712-8609
Lisa.connor@emory.edu
Debbie Chambers, ODS
North Central Georgia Health District
950 Ousley Place Macon, GA 31210
Phone: 478-319-3450 Cell: 478-319-3450
Fax: 478-599-9833
Debbie.Chambers@dph.ga.gov
Sheree Holloway, RN, ODS
Southeast Georgia Health District
1856 Wilmington Island Rd. Savannah, GA 31410
Cell: 912-663-8721
Sheree.Holloway@dph.ga.gov
Rana Bayakly, MPH
Chief, Chronic Disease, Health Behaviors, and Injury Epidemiology Section
Epidemiology Staff:
Chrissy McNamara, MSPH
Alissa Berzen, MPH
Zeytun Tobeyubo, BS
Regional Coordinators:
LaRue Perry, CTR
Region 1 Cancer Coordinator, North Public Health District
Lisa Connor, CTR
Region 2 Cancer Coordinator, Georgia Center for Cancer Statistics
Debbie Chambers, CTR
Region 3 Cancer Coordinator, North Central Georgia Health District
Sheree Holloway, RN, CTR
Region 4 Cancer Coordinator, Georgia Department of Public Health
GCR is thankful to the following contributors for their guidance and support in preparation of this website.
Rana Bayakly, MPH
Chief, Chronic Diseases, Healthy Behaviors and Injury Epidemiology Section
Director, Georgia Comprehensive Cancer Registry (GCR)
Kevin Ward, PhD
Director, Georgia Center for Cancer Statistics (GCCS)
Robin Billet, MA, CTR
Director of Registry Operations, GCCS
Deborah Stephenson, M. Ed
Center Coordinator, GCCS
Abstracting
Abstracting Guide
Abstracting cancer cases is both an art and a science. This section outlines standards, dictionaries, abbreviations, measurements, and shares a useful article on the art of abstracting.
Standards for Cancer Registries
NAACCR Recommended Abbreviation List
The main principle is one should be able to enter abstract codes from one’s written text. Therefore, put the text in first and then code the abstract. If unable to code the data field from the text, refer back to the medical record and revise the text.
The second principle is to include only the text that is relevant to the specific cancer that is abstracted. For example, if the cancer is a lymphoma include information on HIV and B symptoms. This information is not relevant and should not be included in text for a breast cancer abstract. If a patient has more than one primary diagnosed at the same time, do not enter information for other primaries in the same abstract. Only include text information for the specific cancer that is coded on the abstract. It is tempting to put text in one abstract for both primaries and copy text to next tumor…. DON’T DO THIS!!!
The third principle is to Date all relative fields: all procedures and PE.
The following is a brief outline of relevant information and format to use for the basic text fields in an abstract.
- PE: date and location of visit, age, sex, race, marital status, brief description of symptoms relevant to specific cancer, where patient resided at diagnosis, if not diagnosed at your facility, and patient’s previous history of reportable cancers, insurance.
- Xray/Scans: date and location, type of scan, relevant findings of mass; size, position in organ, organs or structures within normal limits, impression with qualifying terms used to identify cancer. If nothing is found on scans, state Negative.
- Labs: date and test type. Only information relative to tumor with ranges. Specifically: Breast ER, PR, Her2; Prostate: PSA; Colon & Rectum: CEA; Testis & Liver: AFP; Ovary: CA-125; Kaposi Sarcoma & Lymphoma: HIV/AIDS and B symptoms; Hematopoietic: blood work relevant to diagnosis. If the test is not done, text should state test name, not done with field coded appropriately as not done; if test is not in the medical record, state test name, not in MR and code appropriately as unknown in abstract field. Whatever code is entered in the abstract must have text documentation! Include text for applicable SSDIs.
- Pathology report: date, path lab name if not your facility, path number, name of tissue, laterality, final diagnosis histology, grade, tumor size, number lymph nodes positive and negative, and margins. If more information is required to code lymph node information include this also, for example, extracapsular extension, size of involved lymph node for Head & Neck tumors. For all primaries, include information on tests to support coding for SSDIs.
- Primary Site: specific site or subsite and laterality (for paired sites where the cancer arose). Do not code the biopsy site, if there are other areas of involvement and it is not stated that the biopsy site is the primary, particularly for head and necks tumors and lymphomas. Name the source that identified the H&N primary site using rules for determining primary site from Solid Tumor Rules, Head and Neck module.
- Histology: histology name from most definitive surgical pathology final and highest grade from any specimen prior to treatment; if do not have path report, record physician’s diagnostic statement. For cases 2018 and later, follow the site specific Solid Tumor Rules.
- Stage: give brief description of stage and document SEER Summary Stage and AJCC staging when possible. Always indicate physician staging when available.
- Op Report: date and location, procedure name, pertinent information in report specific to cancer: location of tumor, size, if other organs and tissue in the area are mentioned as involved or normal.
- Treatment: start date and location for all treatment (if estimated so state), and list surgery type, chemo/hormone/immunotherapy agents and radiation type, regional and boost modality and dose. For 2018 and later, refer to the latest version of the Standards for Oncology Registry Entry STORE Manual and the CTR Guide to Coding Radiation Therapy Treatment in the STORE, Version 4.0 for updated radiation coding instructions. Document physician name administering treatment.
- Place of diagnosis: name the facility where patient was diagnosed. If diagnosed at your facility, state here.
Tumor Size Coded in Millimeters
General Codes for Tumor Size
GCR has reviewed the Revisions for 2010 SEER Program Coding and Staging Manual “Date of Diagnosis” document below. We have added more specific instructions (in bold type) to be followed by Georgia registrars.
We are requiring the year, month, and day of diagnosis for analytic cases. Please follow back with the physician to confirm a date or estimate as best as possible. Age at diagnosis and survival cannot be calculated without the complete YYYYMMDD diagnosis date known or estimated. This data element is critical for all analytical cases.
Please review the following document and note the more specific instructions.
To: SEER Registries and other users of the SEER Program Coding and Staging Manual (SPCSM)
RE: Revisions for 2010 SEER Program Coding and Staging Manual, Section IV, NAACCR Item # 390, Date of Diagnosis, page 49
Effective Date: January 1, 2010
Date of diagnosis must be transmitted in the YYYYMMDD format. Date of diagnosis may be recorded in the transmission format or recorded in the traditional format (MMDDYYYY) and converted electronically to the transmission format.
Regardless of the format, at least Year of diagnosis must be known or estimated for analytic cases. Year of diagnosis cannot be blank or unknown for analytic cases. Month and day cannot be blank or unknown for analytic cases.
Transmitting Dates
Transmit date fields in the year, month, day format (YYYYMMDD). Leave the month, day and/or year* blank when they cannot be estimated or are unknown.
Common Formats
| YYYYMMDD | Complete date is known |
| YYYYMM | Year and month are known/estimated; day is unknown |
| YYYY | Year is known/estimated; month and day cannot be estimated or are unknown |
| Blank | Year*, month, and day cannot be estimated or are unknown |
Non-analytic cases only – Whenever possible, an attempt should be made to get an accurate diagnosis date from the physician or estimate the complete date. This is to be done especially for class of case 30: “reporting facility participated in diagnostic workup (consult only, staging workup after initial diagnosis elsewhere”.
Transmit Instructions
- Transmit date fields in the year, month, day format (YYYYMMDD).
- Leave the month, and/or day blank when they cannot be estimated or are unknown.
- Most SEER registries collect the month, day, and year of diagnosis. When the full date (YYYYMMDD) is transmitted, the seventh and eighth digits (day) will be deleted when the data are received by SEER.
Definitions
Analytic case: Case for which the registry has information on the original diagnosis and/or the first course of treatment. For definition of first course treatment, see the 2023 SEER Program Coding and Staging Manual Section VII, First Course of Therapy.
Non-analytic case: All cases for which the registry does not have information on the original diagnosis and/or first course of treatment. Examples of those cases would be a patient who moved to your state after the original diagnosis and first course of treatment were complete and treatment was for persistent disease or metastatic disease; DCO with history of cancer, unknown when and where patient was diagnosed; follow-back gives no additional information. (Note: SEER instructions indicate an attempt at follow back should be made for non-analytic cases as well).
Analytic cases
- Follow-back must be done to obtain the date of diagnosis. If no information can be found, follow instruction 2.
- Date of diagnosis must be estimated. See the SEER Program Coding and Staging Manual 2023, Date of Diagnosis, Coding Instructions, Coding instruction for estimating date of diagnosis.
- For reports dated December or January of a given year code the month of the report or the month of admission (instruction 10a viii). Coding the month of the report or the month of admission results in a better estimate of the date of diagnosis than coding month as 99 and having the computer assign July as the month of diagnosis, for example.
- When the diagnosis date is stated to be spring, summer, fall, or winter, follow instructions 10a i, ii, iii, and iv.
Non-Analytic Cases
Please refer to the Date of Diagnosis Estimation in the NAACCR Data Standard and Data Dictionary. Class of Case 30 should have complete diagnosis date known or estimated.
Providing the diagnosis date at the time of reporting may positively impact the amount of your death clearance follow-back.
Consider getting your facility to update their patient information history page that a patient completes when seeing a physician or being admitted including Diagnosis of Cancer, site of cancer, date of diagnosis, where living at diagnosis (City and State)
Effective 2/1/2011
Records the date of initial diagnosis by a Health Care Professional for the tumor being reported.
Instructions for Coding
- Use the first date of diagnosis whether clinically or histologically confirmed.
- If the physician states that in retrospect the patient had cancer at an earlier date, use the earlier date as the date of diagnosis.
- Use the date therapy was started as the date of diagnosis if the patient receives a first course of treatment before a definitive diagnosis.
- The date of death is the date of diagnosis for a Class of Case 49.
- Avoid using code 9’s unknown for month, day, or year.
- Use all information in the medical record to estimate the date of diagnosis if the exact date cannot be determined. The date of initial diagnosis is the month, day, and year that this primary cancer was first diagnosed by a recognized medical practitioner. If estimated, clearly document in the text that the diagnosis date is estimated.
Class of Case (COC) 30, 31, 32, 33, 40, 41, 42, and 43 should have an accurate or estimated date of diagnosis using the following guidelines:
Condition | Estimate Date Suggestion |
| Accurate Diagnosis Date | Date 1st called cancer or suspicious for Cancer by physician, scan, pathology report, see list of ambiguous terms considered involvement. |
| Workup | Estimate Dx Date 1 to 2 weeks before workup date for blood work, scans, etc. |
| Treatment Date | Estimate Dx two weeks before 1st TX date |
| Estimate month dx | |
| Spring | April |
| Summer | July |
| Middle of Year | July |
| Fall/Autumn | October |
| Winter | Use information to estimate either December or January |
| Early in Year | January |
| Late in Year | December |
| Couple of weeks ago | 2 weeks prior to admission date |
| Couple of months ago | 2 months prior to admission date |
| Few weeks ago. Few months ago | 3 weeks prior to admission date 3 months prior to admission date |
| Several weeks ago | 4 weeks prior to admission date |
| Several months ago | 4 months prior to admission date |
| Diagnosed X months ago | X months prior to admission date |
| Estimate Year: Couple Years | Subtract 2 years from admission date |
| Few Years | Subtract 4 years from admission date |
| Site C22._,C24._, C25._ | Since these have poorest prognosis, estimate date within 1 year of death |
| Site C15._,C16._, C34._ | Since these have usually a poor prognosis, estimate date within 2 years of date 1st contact without other more specific information of Dx Date. |
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Casefinding
Casefinding Information
Casefinding is a system for identifying every patient that is diagnosed and/or treated with a reportable diagnosis of cancer. This section describes multiple casefinding procedures.
- Admission and discharge documents
- Autopsy reports
- Disease indexes
- Outpatient’s medical records/logs
- Surgery schedules/logs
- Nuclear medicine documents
- Pathology and Cytology reports
- Radiation oncology logs
- Hematology reports
- Medical oncology logs
- Diagnostic imaging
- Neurology clinics
Casefinding in medical records/health information should be done using both inpatient and outpatient disease/diagnostic indexes. Review all records with the following ICD-10-CM codes.
Reproduceable current year and past years’ case finding lists can be found here:
ICD-10-CM Casefinding List, 2025
Based on the International Classification of Diseases, ICD-10-CM Tabular List of Diseases and Injuries, FY 2025
- Health Information Management Department (HIM)/Medical Records Dept. This department maintains the medical records and a disease index that identifies the patient, date of service, and the diagnosis. See SEER Casefinding Lists ICD-10-CM codes and procedures for casefinding by Disease Index.
- Pathology and Cytology Departments. The histology, cytology, bone marrow, and autopsy reports are source documents for identifying eligible cases.
- Oncology-related services. Radiation and medical oncology treatment areas are sources of casefinding. All in-patient and outpatient services should be checked.
- Staff physician’s office. The physician’s office is a source of casefinding.
The Notifiable Disease Law, Official Code of Georgia (OCGA) Annotated 31-12-2 ., mandates the reporting of certain diseases including cancer. All CANCERS diagnosed since January 1, 1995, in persons receiving cancer diagnostic and/or management services or who have active disease MUST be reported to the Georgia Cancer Registry (GCR), unless previously reported by that facility.
All health care providers in the state of Georgia are required to report specific information on cancer in their patient population to the Georgia Cancer Registry. This includes all facilities providing diagnostic evaluations and/or treatment for cancer patients, such as: hospitals, outpatient surgical facilities, laboratories, radiation therapy and medical oncology facilities, physicians, and physicians’ offices.
Cases to Report
The Georgia Cancer Registry Requires the Following Cases to Be Reported:
All neoplasms diagnosed or treated in a hospital with a behavior code of “2” or “3”, as specified in the International Classification of Diseases for Oncology, appropriate edition according to the year of diagnosis, regardless of class of case. Refer to the Reportability Section as well as Appendix E of the corresponding year SEER Program Coding and Staging Manual for exceptions.
As of January 1, 2004, any case diagnosed with benign brain and central nervous system tumors are reportable.
Patients with active disease while an inpatient or outpatient at a facility, regardless of reason for admission or service. Also, patients who had cancer diagnostic and/or management services given or planned while at the facility even without active disease.
Patients whose diagnoses are not histologically confirmed (clinical diagnoses). Georgia and non-Georgia residents.
Types Of Cases to Include
For specific codes and explanation see Class of Case.pdf .
Inpatient and Outpatient:
All inpatient and outpatient cases must be included in the casefinding process. This includes outpatient departments located within the facility and those physically located outside the facility.
IF the facility owns the medical record. An example of this would be if a hospital owns a freestanding outpatient surgical center. The cases from this center would be identified and reported.
All Class of Cases (Analytic and Non-Analytic)
All accessioned cases are assigned a Class of Case (NAACCR Item #610) based on the nature of involvement of the facility in the care of the patient.
Analytic Cases
Class of Case 00-22: Cases diagnosed and/or administered any of the first course of treatment at the accessioning facility after the registry’s reference date are analytic. A network clinic or outpatient center belonging to the facility is part of the facility. Class of Case 10-22 are included in treatment and survival analysis. If the patient receives no treatment, either because the patient refuses recommended treatment or a decision is made not to treat, the Class of Case is 14. If there is no information about whether or where the patient was treated, the Class of Case is 10.
Nonanalytic Cases
Class of Case 30-99 are not usually included in routine treatment or survival statistics. The CoC does not require registries in accredited programs to accession, abstract, or follow these cases, but the GCR requires them. GCR does not collect “history only” cases (class of case 33). Do not submit these cases to GCR.
Modifications to Class of Case in 2010
Class of Case was redefined for use beginning in 2010. The codes in this manual allow differentiation between analytic and nonanalytic cases and make additional distinctions.
For analytic cases, the codes distinguish cases diagnosed in a staff physician’s office from those diagnosed initially by the facility and patients fully treated at the facility from those partially treated by the reporting facility. Nonanalytic cases are distinguished by whether the patient received care at the facility or did not personally appear there.
Patients who received care from the facility are distinguished by the reasons a case may not be analytic: diagnosed prior to the patient’s reference date, type of cancer that is not required by CoC to be abstracted, consultation, in-transit care, and care for recurrent or persistent disease. Patients who did not receive care from the reporting facility are distinguished by care given in one or more staff physician offices, care given through an agency whose cancer cases are abstracted by the reporting facility but are not part of it, pathology only cases, and death certificate only cases. Treatment in staff physician offices is now coded “treated elsewhere” because the hospital has no more responsibility over this treatment than it would if the patient were treated in another hospital.
Clinical diagnoses:
It is important to remember that all clinical diagnoses are also reportable. Histologic confirmation is not required for these cases. The clarification regarding ambiguous terminology (Refer to Ambiguous Terminology in the Reportability Section of the corresponding year SEER Program Coding and Staging Manual) may be helpful in determining if a case with an unclear diagnosis is reportable. NOTE: Radiology only cases (x-rays and scans) must be reported if diagnostic of cancer, including those with reportable ambiguous terminology; however, Lab only cases are not required to be reported (for example PSA reports).
Tissue Only cases (pathology):
This is sometimes referred to as “tissue, no body” and occurs when a facility’s pathology department processes and interprets specimens that were collected from outside sources, such as another hospital or from a physician’s office. If the facility receives a pathology specimen diagnostic of cancer from another hospital, the facility is NOT required to report the case. The facility that receives a pathology specimen diagnostic of cancer from a physician’s office must report that case. It is the responsibility of the reporting facility that first collected or received the specimen to report the case. Just remember to follow two basic guidelines:
If the specimen originates (or is collected) from a physician’s office, report the case.
If the specimen is from another hospital, do not report the case.
Remember:
ALL items in the GCR Required Data Set must be completed if reporting electronically or included if submitting photocopies of medical records.
Data needed by GCR includes all information from the date of initial diagnosis (OR FIRST VISIT TO YOUR FACILITY) through completion of first course treatment.
If you discover a case that was previously diagnosed, you should go back and submit the first admission to your facility indicating the presence of cancer. The earliest information available regarding a patient’s cancer is needed. Of course, if you had previously submitted that case, you would not need to submit it again. For example, you are conducting your casefinding for June 2024 and you have a patient on your disease index with a diagnosis of colon cancer. The H & P states that the patient is being admitted for a bowel obstruction, possibly a recurrence. First determine the patient does not have a new primary using the Solid Tumor Rules. If not a new primary, and in reviewing the record you see that the patient was admitted to your facility in October 2022 for colon cancer, but not reported at that time, you would need to go back and update your abstract to include the October 2022 admission as date of first contact. This would be sent as an update to GCR in your monthly Modified Record submission.
Death clearance is conducted every year by GCR to improve completeness of reporting. The first step matches Death Certificates that list a reportable cancer as a cause of death against the data base of reported cancers. This initial step produces three outcomes: positive matches, possible matches and non- matches. The non-matches create a follow-back list which is distributed to the institution mentioned on the death certificate or hospital discharge file. The facility is to find information about the specific cancer diagnosis listed on their follow-back list. Hospitals are expected to send the follow-back data to GCR within 60 days from the date they receive the list.
How to Submit:
- Upload to Labkey
- Labkey Instructions
- Contact your Regional Coordinator if assistance is needed.
Rapid Case Ascertainment (RCA) is a case finding procedure to identify newly diagnosed reportable cancer cases as rapidly as possible following diagnosis. Information obtained through RCA will serve as one method to assess case completeness, will provide an additional source of quality control for incoming data, and will permit cancer incidence in Georgia to be reported earlier than would otherwise be possible. The RCA system can also assist researchers in identifying cases that may be eligible to participate in research studies approved by the Georgia Department of Public Health, Institutional Review Board (DPH/IRB) see Confidentiality.
The Georgia Cancer Registry (GCR) implemented a statewide policy for RCA requiring the monthly submission of pathology reports related to reportable cancers from all facilities in Georgia beginning January 1, 2011. The adoption of electronic pathology reporting for all electronic reporting facilities is paramount to the timely, efficient collection and integration of these critical data into the GCR. Electronic data can be more effectively imported into existing cancer data management systems while paper reports still require a substantial amount of manual effort related to data integration. To move this important effort forward, the GCR is mandating the electronic submission of pathology reports from all electronic reporting facilities/labs in Georgia and from all other non-electronic facilities as available, effective in 2017.
The procedures below outline the options currently available for RCA. Option A is the only option available to electronic reporting facilities as electronic reporting is now mandatory.
Rapid Case Ascertainment Options
- Epath, an electronic pathology reporting system, is the preferred and most efficient method to meet the requirement for timely pathology reporting. Epath is an application that can be installed on an existing machine (or virtual machine) in the pathology laboratory. Pathology reports are filtered by the Epath system to identify and send only reportable cancer reports. The security infrastructure of Epath is compliant with HIPAA requirements. Reports are encrypted and electronically transmitted in real time to a dedicated computer at the GCR. For hospital pathology laboratories, the same reports are simultaneously sent to the hospital tumor registry facilitating efficient and timely registry pathology case finding. Electronic reporting facilities that cannot, or elect not to report through Epath, must report their pathology through another electronic (machine readable) format. Please contact your Regional Coordinator for other electronic options.
- Non-electronic pathology facilities should utilize the preferred Labkey System on the GCCS website to upload pathology reports and accompanying patient demographics. The reports can also be uploaded to a secure sFTP site provided by the GCR. Please contact the GCR at gccs@sph.emory.edu if you would like to establish a sFTP site for your facility.
- Non-electronic facilities without a pathology laboratory are to send an electronic (i.e., excel, csv) disease index file at the end of each month, or as instructed by your Regional Coordinator, to the GCR using the Labkey System on the GCCS website. GaDirect webdirect account or sFTP accounts are available while users are transitioning to the Labkey System. A receipt confirmation is sent by email to the facilities.
- Apparent(ly)
- Appears
- Comparable with
- Compatible with
- Consistent with
- Favor(s)
- Malignant appearing
- Most likely
- Presumed
- Probable
- Suspect(ed)
- Suspicious (for)
- Typical (of)
Refer to the SEER Program Coding and Staging Manual 2025
Reportable Diagnoses
- Generate a list using appropriate ICD-10-CM Codes.
- Delete any codes that are not reportable (Facility IT should be able to exclude non-reportable codes when producing this list).
- Submit only cases that meet the criteria for Reportability as identified in the corresponding year SEER Program Coding and Staging Manual.
Things to Consider
- Know the codes (specific to your facility). Do your disease index codes reflect codes for procedures, symptoms, provisional diagnosis, diagnosis as stated on order from doctor, or final diagnosis? (You need to use the final diagnosis code for Casefinding.)
- Are all points of service included on the disease index?
- How are x-rays and scans coded? Is there a way to obtain abnormal reports to review?
V-Codes – no need to include these. If diagnosis is being coded correctly and they have active disease, code will reflect the “cancer code”. - This is a SCREENING TOOL ONLY.
- Visually review ALL path reports if there is no automated screening mechanism currently in place.
- Check for missing numbers in sequential accession numbers.
- Note the clinical diagnosis if listed on the path report (patient may have a negative path that was treatment for a cancer).
The suspense file documents and organizes casefinding and is an essential component of reporting. This file is used to store or keep a record of the cases which have been determined to be reportable. The cases are kept in this file until they are actually abstracted or submitted.
Some registries use copies of pathology reports, which are checked against the patient index and then sorted alphabetically by month. In addition to the pathology report, a listing of cases identified from other sources/departments is maintained. The hospital’s diagnostic indices by month may also be placed in the pending file.
A computer program can serve as your pending file. In this case, preliminary data is entered into the program and once the case is completed, by adding all required data to the file, it would then be converted to a primary site file (abstract).
Your pending file is also helpful in preventing duplication. When a new case is identified, you should check it against your patient index file (master file) and against your pending file to make sure the case hasn’t already been identified. Another method that is helpful in preventing duplication is to “flag” the medical record charts of the submitted cases It is important to use the Solid Tumor Rules and the Hematopoietic and Lymphoid Neoplasm Coding Manual to determine if a cancer is a duplicate or a new primary. Your Regional Coordinator can assist you in determining multiple primaries.