Site-Specific Factor 4

Tumor Location after Primary Cytoreduction (Debulking) Surgery

Notes

**Note 1:** The surgery to remove as much of the cancer in the pelvis and/or abdomen as possible, reducing the "bulk" of the cancer is called "debulking" or "cytoreduction" surgery. It is performed when there is widespread evidence of advanced stage of ovarian cancer with obvious spread to other organs outside the ovary, typically in the upper abdomen, intestines, the omentum (the fat pad suspended from the transverse colon like an apron), the diaphragm, or liver. **Note 2:** Optimal debulking is described as removal of all tumor except for residual nodules that measure no more than 1 cm in maximum diameter. **Note 3:** According to the AJCC, "In advanced disease, the most important prognostic factor is the residual disease after the initial surgical management. . . . Not only is the size of the residual important, but the number of sites of residual tumor also appears to be important." Neoadjuvant chemotherapy may be given to obtain optimum cytoreduction with less aggressive surgery; thus recording whether the patient received chemotherapy prior to this procedure provides necessary data for treatment and survival analysis.

Default

988

NAACCR Item

NAACCR #2910
Code Description
010 Residual tumor in ovary, ipsilateral, contralateral, or NOS
AND neoadjuvant chemotherapy not given or unknown if given
015 010
AND neoadjuvant chemotherapy given (before surgery)
020 Residual tumor in:
Fallopian tube, ipsilateral, contralateral, or NOS
Uterus
AND neoadjuvant chemotherapy not given or unknown if given
025 020
AND neoadjuvant chemotherapy given (before surgery)
030 020 + 010

Residual tumor in fallopian tube(s) and/or uterus plus ovary(ies)
AND neoadjuvant chemotherapy not given or unknown if given
040 030
AND neoadjuvant chemotherapy given (before surgery)
050 Residual tumor in pelvis:
Pelvic peritoneum
AND neoadjuvant chemotherapy not given or unknown if given
055 050
AND neoadjuvant chemotherapy given (before surgery)
060 050 + (010 or 020)

Residual tumor in pelvis plus any structures in lower codes
AND neoadjuvant chemotherapy not given or unknown if given
070 060
AND neoadjuvant chemotherapy given (before surgery)
080 Residual tumor in omentum
AND neoadjuvant chemotherapy not given or unknown if given
085 080
AND neoadjuvant chemotherapy given (before surgery)
090 080 + (010 or 020 or 050)

Residual tumor in omentum plus any structures in lower codes
AND neoadjuvant chemotherapy not given or unknown if given
100 090
AND neoadjuvant chemotherapy given (before surgery)
110 Residual tumor in abdomen (excluding colon and small intestine):
Abdominal peritoneum
Retroperitoneum
AND neoadjuvant chemotherapy not given or unknown if given
115 110
AND neoadjuvant chemotherapy given (before surgery)
120 110 + (010 or 020 or 050 or 080)

Residual tumor in abdomen plus any structures in lower codes
AND neoadjuvant chemotherapy not given or unknown if given
130 120
AND neoadjuvant chemotherapy given (before surgery)
140 Residual tumor in colon and/or small intestine
AND neoadjuvant chemotherapy not given or unknown if given
145 140
AND neoadjuvant chemotherapy given (before surgery)
150 140 + (010 or 020 or 050 or 080 or 110)

Residual tumor in colon and/or small intestine plus any structures in lower codes
AND neoadjuvant chemotherapy not given or unknown if given
160 150
AND neoadjuvant chemotherapy given (before surgery)
170 Residual tumor in diaphragm and/or stomach
AND neoadjuvant chemotherapy not given or unknown if given
180 170 + (010 or 020 or 050 or 080 or 110 or 140)

Residual tumor in diaphragm plus any structures in lower codes
AND neoadjuvant chemotherapy not given or unknown if given
190 180
AND neoadjuvant chemotherapy given (before surgery)
200 Residual tumor in liver (peritoneal surface) AND neoadjuvant chemotherapy not given or unknown if given
210 200 + (010 or 020 or 050 or 080 or 110 or 140 or 170)

Residual tumor in liver plus any structures in lower codes AND neoadjuvant chemotherapy not given or unknown if given
220 210
AND neoadjuvant chemotherapy given (before surgery)
300 Residual tumor in other structures not listed above
AND neoadjuvant chemotherapy not given or unknown if given
310 Residual tumor in other structures not listed above
AND neoadjuvant chemotherapy given (before surgery)
988 Not applicable: Information not collected for this case
990 Residual tumor, location not stated
AND neoadjuvant chemotherapy not given or unknown if given
991 Residual tumor, location not stated
AND neoadjuvant chemotherapy given (before surgery)
992 No residual tumor found AND neoadjuvant chemotherapy not given or unknown if given
993 No residual tumor found AND neoadjuvant chemotherapy given (before surgery)
998 No Debulking surgery performed
999 Unknown or no information
Not documented in patient record
(1) American Joint Committee on Cancer., & Edge, S.B. (2010) AJCC Cancer Staging Manual (7th ed.). New York; London: Springer, pg. 420