1.3 Standard-Setting Organizations & the Manuals They Publish

Why "who publishes what" is tested

Domain 2 names six organizations outright: CAP, CoC, NAACCR, NCCN, NPCR and SEER. Many coding questions are really asking which manual to open. When two manuals seem to disagree, the answer usually comes from knowing which standard setter owns the data item. For example, hospital registries use STORE rules for Class of Case, while central registries in SEER areas use the SEER manual for SEER-specific items.

The organizations

National Cancer Registrars Association (NCRA)

The professional association for cancer registrars. Its Council on Certification, an elected certification board created in 2002, runs the ODS exam and credential maintenance. NCRA also publishes the Cancer Registry Management: Principles & Practice textbook (4th edition), the Journal of Registry Management and the Professional Practice Code of Ethics, and it accredits formal cancer registry education programs.

Commission on Cancer (CoC) of the American College of Surgeons

A consortium of more than 50 national professional organizations, founded in 1922, that accredits about 1,500 cancer programs in the U.S. and Puerto Rico. Its main publications are:

• Optimal Resources for Cancer Care (2020 Standards), effective January 2020 and updated October 2025: the accreditation standards, such as Standard 2.1 (cancer committee), 4.3 (registry staff credentials), 6.1 (registry quality control) and 6.5 (follow-up).
• Standards for Oncology Registry Entry (STORE): the data dictionary and coding rules that CoC-accredited registries must follow, including case eligibility, Class of Case, treatment items and follow-up. STORE replaced FORDS for 2018 diagnoses; the NCRA exam references STORE 2025.
• National Cancer Database (NCDB), run jointly with the American Cancer Society, including the Rapid Cancer Reporting System (RCRS).

NCI Surveillance, Epidemiology, and End Results (SEER) Program

The National Cancer Institute's population-based surveillance program, collecting data since 1973 and now covering about 48% of the U.S. population. SEER publishes:

• The SEER Program Coding and Staging Manual (reportability and coding rules for SEER registries).
• The Solid Tumor Rules (multiple primary and histology rules for solid tumors).
• The Hematopoietic and Lymphoid Neoplasm Coding Manual and the Hematopoietic Database (Heme DB).
• Summary Stage 2018 and Extent of Disease (EOD) 2018.
• SEER*Rx, the interactive drug database used to classify drugs as chemotherapy, hormone therapy, immunotherapy or ancillary.

CDC National Program of Cancer Registries (NPCR)

Created by the Cancer Registries Amendment Act of 1992 (Public Law 102-515). NPCR funds and sets data standards for central registries in 46 states, the District of Columbia, Puerto Rico, the U.S. Pacific Island jurisdictions and the U.S. Virgin Islands. NPCR and SEER together cover the entire U.S. population and jointly publish U.S. Cancer Statistics.

North American Association of Central Cancer Registries (NAACCR)

The consensus body for data standards across U.S. and Canadian central registries. Standard setters such as CoC, SEER, NPCR and the Canadian Council of Cancer Registries agree on changes through NAACCR. NAACCR maintains:

• Standards for Cancer Registries, Volume II: Data Standards and Data Dictionary (item numbers, lengths and codes) and the NAACCR XML exchange format.
• The Site-Specific Data Item (SSDI) Manual and the Grade Manual (Grade Coding Instructions and Tables v3.2 is an open-book reference for 2026).
• The EDITS metafiles that registry software runs to validate data.
• Registry certification (Gold and Silver) for central registries.

American Joint Committee on Cancer (AJCC)

Publishes the TNM staging system. The 8th edition took effect for 2018 diagnoses. AJCC now updates individual sites as Version 9 protocols; cervix, appendix, anus and lung (effective with 2025 diagnoses) are examples. The 2026 open-book PDFs contain AJCC 8th edition Parts XI (Breast), XIII (Male Genital Organs) and XIV (Urinary Tract) plus Lung Version 9.

College of American Pathologists (CAP)

Publishes the CAP Cancer Protocols, the templates that define the required "core elements" of a synoptic pathology report. CoC Standard 5.1 requires that at least 90% of eligible cancer pathology reports use CAP synoptic format (see Chapter 10).

National Comprehensive Cancer Network (NCCN)

An alliance of leading cancer centers that publishes the NCCN Clinical Practice Guidelines in Oncology, with evidence-and-consensus categories 1, 2A, 2B and 3. Registrars use these guidelines when preparing cancer conference cases, monitoring concordance studies and judging whether expected treatment was given.

World Health Organization (WHO) and IARC

Publish the International Classification of Diseases for Oncology, Third Edition, Second Revision (ICD-O-3.2) and the WHO Classification of Tumours ("Blue Books"). The Solid Tumor Rules and the Hematopoietic Database are built on the Blue Books. NAACCR issues annual ICD-O histology and behavior updates that registries apply alongside ICD-O-3.2.

Which manual governs which decision

Using the open-book PDFs efficiently

1. Identify the governing manual before you search. A question about "how many abstracts" belongs in the Solid Tumor Rules; a question about "which T category" belongs in an AJCC chapter.
2. Use bookmarks first, then search. Every open-book PDF has embedded bookmarks. Jump to the site module or chapter, then search inside it for a specific term such as "Paget" or "seminal vesicle."
3. Follow the hierarchy inside each manual. The Solid Tumor Rules must be applied in order: use the first rule that applies and stop. The Summary Stage and AJCC chapters also have general rules that come before the site-specific tables.