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Overview 

  • Conditions and staging criteria used to assess the severity and extent of cancer.

Profile: CancerConditionParent (abstract) 

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-cancer-condition-parent.html

  • Base FHIR Resource: Condition
  • Derived from: USCoreCondition
  • Description: Abstract parent class for describing a primary or secondary metastatic neoplastic diseases, or individual tumors.
  • mCODE-specific Attribute Constraints:
    • condition-assertedDate is must support
    • Category is fixed to SNOMED#64572001 “Disease (disorder)”
    • Severity is zeroed out
    • bodySite is must support
    • Recorder reference is restricted to (Practitioner | Practitioner Role)
    • Asserter reference is restricted to (Practitioner | Practitioner Role)
  • mCODE-specific Extensions:
    • mcode-histology-morphology-behavior is must support
    • mcode-laterality is must support
  • mCODE-specific Slices: none
  • mCODE-specific ValueSets:
    • bodySite is bound to Cancer Body Location Value Set (preferred)

Other Notes of Interest 

  • CancerConditionParent is an abstract class and does not appear in the mCODE data dictionary. It was created to describe a primary or secondary neoplastic diseases, or individual tumors.
  • CancerConditionParent is the parent profile for PrimaryCancerCondition and SecondaryCancerCondition. This means that all unique attributes in CancerConditionParent are also included in PrimaryCancerCondition and SecondaryCancerCondition.
  • The Cancer Body Location Value Set contains all codes from the SNOMED CT body structure hierarchy.
  • The condition-assertedDate extension is not an mCODE extension; it’s an already existing FHIR extension.
  • The mcode-histology-morphology-behavior extension was created to describe the morphologic and behavioral characteristics of the cancer.
  • The mcode-laterality extension was added to bodySite to indicate the side of the body location, if needed. See ComorbidCondition – Other Notes of Interest for more details.
  • The recorder and asserter attributes are restricted so references that would not be logical for this profile are not allowed.
  • Severity is zeroed out because including a data elements for this attributes would not be logical for this profile.

Profile: PrimaryCancerCondition

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-primary-cancer-condition.html

  • Base FHIR Resource: Condition
  • Derived from: CancerConditionParent
  • Description: Records the history of the primary cancer condition, the original or first tumor in the body.
  • mCODE-specific Attribute Constraints:
    • stage.assessment references (CancerStageParent)
  • mCODE-specific Extensions:
  • mCODE-specific Slices: none
  • mCODE-specific ValueSets:
    • Code is bound to Primary Or Uncertain Behavior Cancer Disorder Value Set (required)

Other Notes of Interest 

  • CancerConditionParent is the parent profile for PrimaryCancerCondition. This means that all unique attributes in CancerConditionParent are also included in PrimaryCancerCondition.
  • Stage.assessment references CancerStageParent, which is an abstract class and does not appear in the mCODE data dictionary. It was created to promote inheritance for clinical and pathologic TNM staging, both which share common attributes.
  • The Primary or Uncertain Behavior Cancer Disorder Value Set contains SNOMED CT codes and ICD-10-CM codes. To be compliant with US Core, ICD-10-CM should only be used if a suitable code is not available in SNOMED.

Profile: SecondaryCancerCondition

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-secondary-cancer-condition.html

  • Base FHIR Resource: Condition
  • Derived from: CancerConditionParent
  • Description: Records the history of secondary neoplasms, including location(s) and the date of onset metastases.
  • mCODE-specific Attribute Constraints:
    • Stage is zeroed out
  • mCODE-specific Extensions:
    • mcode-related-primary-cancer-condition
  • mCODE-specific Slices: none
  • mCODE-specific ValueSets:
    • Code is bound to Secondary Cancer Disorder Value Set (required)

Other Notes of Interest 

  • CancerConditionParent is the parent profile for SecondaryCancerCondition. This means that all unique attributes in CancerConditionParent are also included in SecondaryCancerCondition.
  • The mcode-related-primary-cancer-condition extension was created to describe the primary cancer related to this secondary cancer.
  • The Secondary Disorder Value Set contains SNOMED CT codes and ICD-10-CM codes. To be compliant with US Core, ICD-10-CM should only be used if a suitable code is not available in SNOMED.

Profile: CancerStageParent

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-cancer-stage-parent.html

  • Base FHIR Resource: Observation
  • Derived from: Observation
  • Description: Abstract parent class for members of cancer staging panels.
  • mCODE-specific Attribute Constraints:
    • basedOn reference is restricted to (ServiceRequest)
    • partOf reference is restricted (Procedure)
    • Status is must support
    • Code is must support
    • Subject reference is (Cancer Patient) and is must support
    • Focus reference is restricted to (Primary Cancer Condition)
    • Effective[x] is must support
    • Performer reference is restricted to (Practitioner)
    • Value[x] is restricted to valueCodeableConcept and is required, must support
    • Method is must support
    • dataAbsentReason, bodySite, specimen, device, referenceRange, and component are zeroed out
  • mCODE-specific Extensions: none
  • mCODE-specific Slices: none
  • mCODE-specific ValueSets:
    • Method is bound to Cancer Staging System Value Set (extensible)

Other Notes of Interest 

  • CancerStageParent is an abstract class and does not appear in the mCODE data dictionary. It was created to describe members of cancer staging panels.
  • CancerStageParent is the parent profile for all the TNM Staging profiles. This means that all unique attributes in CancerStageParent are also included in all the TNM Staging profiles.
  • The basedOn, partOf, subject, focus, performer, and value[x] attributes are restricted so references that would not be logical for this profile are not allowed.
  • The dataAbsentReason, bodySite, specimen, device, referenceRange, and component attributes are zeroed out because including data elements for these attributes would not be logical for this profile.
  • The Cancer Staging System Value Set indicates which system was used for staging.

Profile: TNMClinicalDistantMetastasesCategory

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-tnm-clinical-distant-metastases-category.html

  • Base FHIR Resource: Observation
  • Derived from: CancerStageParent
  • Description: Describes the extent of a tumor metastasis in remote anatomical locations, based on evidence such as physical examination, imaging, and/or biopsy
  • mCODE-specific Attribute Constraints:
    • Code is fixed to LOINC#21907-1 “Distant metastases.clinical [Class] Cancer”
  • mCODE-specific Extensions: none
  • mCODE-specific Slices: none
  • mCODE-specific ValueSets:
    • Value[x] is bound to TNM Distant Metastases Category Value Set (preferred)

Other Notes of Interest 

  • CancerStageParent is the parent profile for TNMClinicalDistantMetastasesCategory. This means that all unique attributes in CancerStageParent are also included in TNMClinicalDistantMetastasesCategory.
  • Aligns with AJCC prognostic staging
  • The TNM Clinical Distant Metastases Category Value Set is intended to contain allowable values for the M category
    • This profile is for TNMClinicalDistantMetastasesCategory, so the prefix “c” should be used to denote the evidence is clinical
    • Example – cM0
  • SNOMED CT codes do not always make a distinction between clinical and pathological classifications. Supplementation with codes from another controlled vocabulary may be needed (NCI Thesaurus)


Profile: TNMClinicalPrimaryTumorCategory 

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-tnm-clinical-primary-tumor-category.html

  • Base FHIR Resource: Observation
  • Derived from: CancerStageParent
  • Description: Describes the category of the primary tumor, based on its size and extent, based on evidence such as physical examination, imaging, and/or biopsy
  • mCODE-specific Attribute Constraints:
    • Code is fixed to LOINC#21905-5 “Primary tumor.clinical [Class] Cancer”
  • mCODE-specific Extensions: none
  • mCODE-specific Slices: none
  • mCODE-specific ValueSets:
    • Value[x] is bound to TNM Primary Tumor Category Value Set (preferred)

Other Notes of Interest 

  • CancerStageParent is the parent profile for TNMClinicalPrimaryTumorCategory. This means that all unique attributes in CancerStageParent are also included in TNMClinicalPrimaryTumorCategory.
  • Aligns with AJCC prognostic staging
  • The TNM Clinical Primary Tumor Category Category Value Set is intended to contain allowable values for the T category
    • This profile is for TNMClinicalPrimaryTumorCategory, so the prefix “c” should be used to denote the evidence is clinical
    • Example – cT0
  • SNOMED CT codes do not always make a distinction between clinical and pathological classifications. Supplementation with codes from another controlled vocabulary may be needed (NCI Thesaurus)

Profile: TNMClinicalRegionalNodesCategory

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-tnm-clinical-regional-nodes-category.html

  • Base FHIR Resource: Observation
  • Derived from: CancerStageParent
  • Description: Describes the category of the presence or absence of metastases in regional lymph nodes, based on evidence such as physical examination, imaging, and/or biopsy
  • mCODE-specific Attribute Constraints:
    • Code is fixed to LOINC#21906-3 “Regional nodes.clinical [Class] Cancer”
  • mCODE-specific Extensions: none
  • mCODE-specific Slices: none
  • mCODE-specific ValueSets:
    • Value[x] is bound to TNM Regional Nodes Category Value Set (preferred)

Other Notes of Interest 

  • CancerStageParent is the parent profile for TNMClinicalRegionalNodesCategory. This means that all unique attributes in CancerStageParent are also included in TNMClinicalRegionalNodesCategory.
  • Aligns with AJCC prognostic staging
  • The TNM Clinical Regional Nodes Category Category Value Set is intended to contain allowable values for the N category
    • This profile is for TNMClinicalRegionalNodesCategory, so the prefix “c” should be used to denote the evidence is clinical
    • Example – cN0
  • SNOMED CT codes do not always make a distinction between clinical and pathological classifications. Supplementation with codes from another controlled vocabulary may be needed (NCI Thesaurus)

Profile: TNMClinicalStageGroup

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-tnm-clinical-stage-group.html

  • Base FHIR Resource: Observation
  • Derived from: CancerStageParent
  • Description: Describes the extent of the cancer in the body, according to the TNM classification system, based on evidence such as physical examination, imaging, and/or biopsy
  • mCODE-specific Attribute Constraints:
    • Code is fixed to LOINC#21908-9 “Stage group.clinical Cancer”
  • mCODE-specific Extensions: none
  • mCODE-specific Slices:
    • hasMember.hasMember:TNMClinicalPrimaryTumorCategory references (TNM Clinical Primary Tumor Category) and is must support
    • hasMember.hasMember:TNMClinicalRegionalNodesCategory references (TNM Clinical Regional Nodes Category) and is must support
    • hasMember.hasMember:TNMClinicalDistantMetastasesCategory references (TNM Clinical Distant Metastases Category) and is must support
  • mCODE-specific ValueSets:
    • Value[x] is bound to TNM Stage Group Value Set (preferred)

Other Notes of Interest 

  • CancerStageParent is the parent profile for TNMClinicalStageGroup. This means that all unique attributes in CancerStageParent are also included in TNMClinicalStageGroup.
  • Aligns with AJCC prognostic staging
  • The TNM Clinical Stage Group Value Set intends to contain allowable values for Stage Group, according to TNM staging
  • SNOMED CT codes do not always make a distinction between clinical and pathological classifications. Supplementation with codes from another controlled vocabulary may be needed (NCI Thesaurus)
  • This profile references the other TNM Clinical staging profiles in the hasMember attribute to indicate TNM Clinical Stage Group is a group observation based on the other TNM clinical staging profiles

Profile: TNMPathologicalDistantMetastasesCategory 

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-tnm-pathological-distant-metastases-category.html

  • Base FHIR Resource: Observation
  • Derived from: CancerStageParent
  • Description: Describes the presence of metastasis in remote anatomical locations, assessed through pathologic analysis of a specimen
  • mCODE-specific Attribute Constraints:
    • Code is fixed to LOINC#21901-4 “Distant metastases.pathology [Class] Cancer”
  • mCODE-specific Extensions: none
  • mCODE-specific Slices: none
  • mCODE-specific ValueSets:
    • Value[x] is bound to TNM Distant Metastases Category Value Set (preferred)

Other Notes of Interest 

  • CancerStageParent is the parent profile for TNMPathologicalDistantMetastasesCategory. This means that all unique attributes in CancerStageParent are also included in TNMPathologicalDistantMetastasesCategory.
  • Aligns with AJCC prognostic staging
  • The TNM Pathological Distant Metastases Category Value Set is intended to contain allowable values for the M category
    • This profile is for TNMPathologicalDistantMetastasesCategory, so the prefix “p” should be used to denote the evidence is pathological
    • Example – pM0
  • SNOMED CT codes do not always make a distinction between clinical and pathological classifications. Supplementation with codes from another controlled vocabulary may be needed (NCI Thesaurus)

Profile: TNMPathologicalPrimaryTumorCategory

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-tnm-pathological-primary-tumor-category.html

  • Base FHIR Resource: Observation
  • Derived from: CancerStageParent
  • Description: Describes the category of the primary tumor, based on its size and extent, assessed through pathologic analysis of a specimen
  • mCODE-specific Attribute Constraints:
    • Code is fixed to LOINC#21899-0 “Primary tumor.pathologic [Class] Cancer”
  • mCODE-specific Extensions: none
  • mCODE-specific Slices: none
  • mCODE-specific ValueSets:
    • Value[x] is bound to TNM Primary Tumor Category Value Set (preferred)

Other Notes of Interest 

  • CancerStageParent is the parent profile for TNMPathologicalPrimaryTumorCategory. This means that all unique attributes in CancerStageParent are also included in TNMPathologicalPrimaryTumorCategory.
  • Aligns with AJCC prognostic staging
  • The TNM Pathological Primary Tumor Category Category Value Set is intended to contain allowable values for the T category
    • This profile is for TNMPathologicalPrimaryTumorCategory, so the prefix “p” should be used to denote the evidence is pathological
    • Example – pT0
  • SNOMED CT codes do not always make a distinction between clinical and pathological classifications. Supplementation with codes from another controlled vocabulary may be needed (NCI Thesaurus)

Profile: TNMPathologicalRegionalNodesCategory 

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-tnm-pathological-regional-nodes-category.html

  • Base FHIR Resource: Observation
  • Derived from: CancerStageParent
  • Description: Describes the category of the presence or absence of metastases in regional lymph nodes, assessed through pathologic analysis of specimen
  • mCODE-specific Attribute Constraints:
    • Code is fixed to LOINC#21900-6 “Regional nodes.pathologic [Class] Cancer”
  • mCODE-specific Extensions: none
  • mCODE-specific Slices: none
  • mCODE-specific ValueSets:
    • Value[x] is bound to TNM Regional Nodes Category Value Set (preferred)

Other Notes of Interest 

  • CancerStageParent is the parent profile for TNMPathologicalRegionalNodesCategory. This means that all unique attributes in CancerStageParent are also included in TNMPathologicalRegionalNodesCategory.
  • Aligns with AJCC prognostic staging
  • The TNM Pathological Regional Nodes Category Category Value Set is intended to contain allowable values for the N category
    • This profile is for TNMPathologicalRegionalNodesCategory, so the prefix “p” should be used to denote the evidence is pathological
    • Example – pN0
  • SNOMED CT codes do not always make a distinction between clinical and pathological classifications. Supplementation with codes from another controlled vocabulary may be needed (NCI Thesaurus)

Profile: TNMPathologicalStageGroup

http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-tnm-pathological-stage-group.html

  • Base FHIR Resource: Observation
  • Derived from: CancerStageParent
  • Description: Describes the extent of the cancer in the body, according to the TNM classification system, assessed through pathologic analysis of a specimen
  • mCODE-specific Attribute Constraints:
  • Code is fixed to LOINC#21908-9 “Stage group.pathologic Cancer”
  • mCODE-specific Extensions: none
  • mCODE-specific Slices:
    • hasMember.hasMember:TNMPatholigicalPrimaryTumorCategory references (TNM Pathological Primary Tumor Category) and is must support
    • hasMember.hasMember:TNMPathologicalRegionalNodesCategory references (TNM Pathological Regional Nodes Category) and is must support
    • hasMember.hasMember:TNMPathologicalDistantMetastasesCategory references (TNM Pathological Distant Metastases Category) and is must support
  • mCODE-specific ValueSets:
    • Value[x] is bound to TNM Stage Group Value Set (preferred)

Other Notes of Interest 

  • CancerStageParent is the parent profile for TNMPathologicalStageGroup. This means that all unique attributes in CancerStageParent are also included in TNMPathologicalStageGroup.
  • Aligns with AJCC prognostic staging
  • The TNM Pathological Stage Group Value Set intends to contain allowable values for Stage Group, according to TNM staging
  • SNOMED CT codes do not always make a distinction between clinical and pathological classifications. Supplementation with codes from another controlled vocabulary may be needed (NCI Thesaurus)
  • This profile references the other TNM Pathological staging profiles in the hasMember attribute to indicate TNM Pathological Stage Group is a group observation based on the other TNM pathological staging profiles



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