Stage a Cancer

Prior to staging cancer, you should enter the cancer diagnosis for the patient. If you do not, you can select a diagnosis during the procedure.

1. Open NextGen® Enterprise EHR and open a patient encounter.
2. Select the specialty as Oncology and visit type as Office Visit.
3. On the homepage, do the following to access the Cancer Details template.
   1. Click the left navigation bar.
   2. Click Cancer Treatment Summary.
      

   3. On the staging panel, click any of the three Add buttons.
      The Cancer Details template opens.

      

4. On the staging panel, click any of the three Add buttons.
5. To document cancer details manually (using free text), select Enable free text.
6. In the Cancer Type section, select Primary or Secondary.
   The system populates the Dx Date field with the original date of diagnosis if it is documented in the Diagnosis module else, the field remains blank.

   Note:

   If the diagnosis (Dx) date is not in sync with the diagnosis date documented in the Problem/Diagnosis module, you must correct it manually.

7. Click the Diagnosis field, and select the cancer diagnosis from the list.
   Note: If you have not already documented the cancer diagnosis, click the Add common assessment link, and select a cancer diagnosis on the Common Assessment template. The selected diagnosis is added to the Diagnosis field for the current encounter.
8. Click the Cancer Type/Site field.
   The Cancer Type Details template opens displaying the cancer types listed by body system and with a secondary type within the system.

   Note: Fields are enabled or disabled based on the cancer type you select.
9. Select the site of the cancer and click Save & Close.
10. Click the Status field and select the status from the list.
11. Click the Behavior field, and select the cancer behavior.
    Note: If you select a value from the Status list, the Behavior list appears automatically.
12. Click the Histology field, and use search for and select the Morphology code.
    Note: If you select an option from the Behavior list, the histology search opens automatically.
    The application associates the appropriate SNOMED code with the selected morphology.
13. Click the Location field to select the location of the tumor for the Esophagus and Esophagogastric Junction - Squamous Cell Carcinoma cancer type.
    Note: This field is enabled only if you select Esophagus and Esophagogastric Junction - Squamous Cell Carcinoma in the Cancer Type/Site field.
14. To search for and select the cancer location, click the Body Site field.
    The application associates the appropriate SNOMED code with the selected location.
15. In Cancer Staging, the Date and Time fields are populated with the current date and time.
    • To specify a different date, click the Date field and use the calendar to select a different date.
    • To specify a different time, click the down arrow next to the Time field and use the Time Entry window to enter a different time.
16. In Cancer Staging, the Date and Time fields are populated with the current date and time.
    • To specify a different date, click the Date field and use the calendar to select a different date.
    • To specify a different time, click the down arrow next to the Time field and use the Time Entry window to enter a different time.
17. If you are not staging cancer now, select the Staging pending option.
    • If you do not have enough data to accurately stage cancer, select the Insufficient data option.
    • If you do not have a staging system, select the No staging system option.
18. If you have clinical staging data, click the Clinical stage of disease field and select a clinical stage from the list.
    Note: These two fields are disabled for some cancer types for which the stage of the disease is not required. The picklist values for Tumor (T), Node (N), and Metastasis (M) in the Clinical and Pathologic sections are displayed based on the cancer type you select.
19. Click the Postneoadjuvant field to select the post neoadjuvant stage of disease for specific cancer types such as stomach, esophagus, and esophagogastric junction.
    Note: You can view the FIGO details in the FIGO Stage section.
20. If data is available, enter values in the Tumor (T), Node (N), and Metastasis (M) fields for Clinical and Pathologic.
21. Click Heritable Trait and select the Retinoblastoma cancer type.
22. If you have a calculated prognostic risk store, enter the value in Prognostic risk score.
23. If you have specified a clinical stage of the disease, click Clinical staged by, and select the entry from the list.
24. If you have specified a pathologic stage of the disease, click Pathologic staged by, and select the option from the list.
25. Enter the remaining fields in the panel for which you have data.
26. In the Staging Detail section, enter additional notations regarding the patient or patient's condition in the Comments.
    For certain cancers, such as breast cancer, lymphoma, and others, you can provide additional staging details.
27. Click Save & Close.

    You can enter details in the Cancer diagnosis narrative field by clicking the My phrase functionality. You must have selected ONC Cancer Dx Narrative in the My phrase type field when creating the phrase. For more information on managing and using the My Phrases functionality, go to NextGen Healthcare Success Community and download the latest Getting Started User Guide for NextGen® Adaptive Content Engine.

    The Onc Treatment Summary template displays the entered data in the Cancer Type andCancer Type grids.