National Bowel Cancer Audit - Frequently Asked Questions (FAQs)
Should sarcomas be included in the audit?
No, they are a very different tumour and therefore not a relevant tumour for the large bowel
cancer audit.
Should patients with a right Hemicolectomy, with bowel perforation, histology, B Cell
Lymphoma be recorded in the audit?
No, a B cell lymphoma would NOT be included.
Can you suggest which procedure a Subtotal colectomy and ileo-sigmoid anastomosis
should come under?
It would go under extended excision of the right colon as this procedure is normally done for an
obstructing cancer.
Should surgical procedure Sub Total excision of colon be grouped as ‘Other', or mapped
to another excision of colon code, or is there a code allocated for the audit?
This should be put under "other colonic resection." In the OPCS code matched to NBOCAP it
states that this is dependent on the extent of the resection. If it is an extended right
hemicolectomy then it would be NBOCAP Code 2, if it is some form of left hemicolectomy then it
is Code 4.
Does colonoscopy include sigmoidoscopy? If so, since sigmoidoscopy doesn't examine
the whole length of the colon, should you record this as "Other" in the question for
"Reason for incomplete colonoscopy" or should you assume it is fully completed when
sigmoidoscopy was performed completely.
Colonoscopy does NOT include sigmoidoscopy. If the colonoscopy does not reach the caecum
then it is incomplete (for whatever reason).
Do we intend to record excision of hepatic metastases in the future?
The proportion of new patients with colorectal, cancer undergoing a liver resection for
metastases within six months of diagnosis will be one of the additions to the audit.
Should all the synchronous tumours be entered as "synchronous", or as the
primary, and just record the other(s) as synchronous tumours?
We assign the 'primary' tumour to the one that requires the 'biggest' procedure to deal with it
and the others as synchronous. In the NBOCAP dataset the following explanation is given for
recording of synchronous tumours: "Record any synchronous tumours as identified by the
clinician at presentation (multiple responses are possible). Multifocal (or synchronous) tumours
are defined as discrete tumours apparently not in continuity with other primary cancers
originating in the same site or tissue."
If a patient is referred to hospital by their GP for a second opinion, after the patient has
had an initial diagnosis at another hospital, and that hospital then goes on to treat them,
generally the ‘hospital of diagnosis‘ does not input the original diagnostic details
(usually colonoscopy / CT etc ) into the NBOCAP system. This means that if the data is
input at hospital A for treatment that has taken place at hospital A, the diagnostic details
are not hospitals B's, and pre-date our ‘referral received' date. If the diagnostic details
are incomplete in any way (e.g. date of colonoscopy) this may be a problem at the data
aggregation and reporting stage, and it should not reflect our own practice. Should this
data be entered?
This really has to be a decision in your cancer network. The Audit does communicate the
importance of complete data but ultimately this is the responsibility of the local
hospital/trust/cancer network. In the annual reports we are able to offer an explanation with
regard to case ascertainment and data completeness for the tertiary centres.
Regarding ‘Modified Dukes staging' - If a patient commences treatment and then the
disease progresses and metastatic disease is found during treatment, at what point do
we assess the ‘Modified Dukes stage' for input?
The Dukes' staging can be updated at any point prior to the data submission deadline.
Should Carcinoid Tumours be included in the Audit?
Carcinoid Tumours should not be included in the Audit.
Should Cloacogenic carcinoma and Diagnosis melanoma be included in the audit?
Neither should be included as in the former the exact site of origin is uncertain and
melanoma is not in the audit.
How should we record the operative surgeon given that NBOCAP does not enable
upload of a second surgeon only the one surgeon.
If the consultant is recorded as being in theatre and scrubbed then he/she should be recorded
as the operating surgeon.
Please could you advise on whether sarcomas should be included in the audit and if a
patient has a de-functioning colostomy, before the main curative procedure should this
be recorded or should they just record the stoma carried out during the main procedure.
No, they are a very different tumour not a relevant tumour for the large bowel cancer audit.