Collaborative Stage

Note 1: The surgery to remove as much cancer in the pelvis and/or abdomen as possible, reducing the "bulk" of the cancer, is called "debulking" or "cytoreductive" 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 1centimeter (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." Neoadjuvant chemotherapy may be given to obtain optimum cytoreduction with less aggressive surgery; Recording whether the patient received chemotherapy prior to this procedure provides necessary data for treatment and survival analysis.
Note 4: Record the largest residual tumor nodule(s) remaining after primary cytoreductive surgery, as described by the surgeon in the operative report.

Code	Description
000	No gross residual tumor nodules
010	Residual tumor nodule(s) 1 centimeter (cm) or less AND neoadjuvant chemotherapy not given or unknown if given
020	Residual tumor nodule(s) 1 cm or less AND neoadjuvant chemotherapy given (before surgery)
030	Residual tumor nodule(s) greater than 1 cm AND neoadjuvant chemotherapy not given or unknown if given
040	Residual tumor nodule(s) greater than 1 cm AND neoadjuvant chemotherapy given (before surgery)
888	OBSOLETE DATA CONVERTED V0200 See code 988 Not applicable for this site
988	Not applicable: Information not collected for this case (May include cases converted from code 888 used in CSv1 for "Not applicable" or when the item was not collected. If this item is required to derive T, N, M, or any stage, use of code 988 may result in an error.)
990	Macroscopic residual tumor, size not stated AND neoadjuvant chemotherapy not given or unknown if given
991	Macroscopic residual tumor nodule(s), size not stated AND neoadjuvantchemotherapy given (before surgery)
992	Procedure described as optimal debulking and size of residual tumor nodule(s) not given AND neoadjuvant chemotherapy not given or unknown if given
993	Procedure described as optimal debulking and size of residual tumor nodule(s) not given AND neoadjuvant chemotherapy given (before surgery)
998	No cytoreductive surgery performed
999	Unknown or no information Not documented in patient record

CS Site-Specific Factor 3
Residual Tumor Status and Size After Primary Cytoreduction Surgery