12.4 Recurrence: Type of First Recurrence [1880], Date of First Recurrence [1860] & Recurrence vs. New Primary
Key Takeaways
Type of First Recurrence [1880] records the first recurrence after a documented disease-free period; once a recurrence (04–62 or 88) is recorded, later recurrences are not recorded.
Code 70 means the patient was never disease-free, including distant metastasis at diagnosis, systemic disease, unknown primary, or untreated minimal disease; if the patient later becomes disease-free, change 70 to 00 and keep following.
Codes 13, 22, 52 and 62 are common: 13 local recurrence of an invasive tumor, 22 regional lymph nodes only, 52 lung only, 62 distant recurrence in multiple site categories.
Recurrence codes for tumors first diagnosed in situ are limited to 06, 16, 17, 26, 27, 36 and 46; codes 00, 88 and 99 apply to any tumor.
Leukemia or lymphoma in remission is coded 00, and a relapse is coded 59; whether a later tumor is a recurrence or a new primary is decided by the Solid Tumor Rules or the Hematopoietic manual, not by the physician's wording alone.
Recurrence definitions (STORE)
| Type | Definition |
|---|---|
| Local | Recurs in the initial primary organ, including the remnant of the organ, the anastomosis, or the scar where the organ was |
| Trocar | The organ was removed and the tumor recurs in the trocar path or entrance site |
| Regional | Recurs in adjacent tissue or organs, or in the lymph nodes draining the organ |
| Distant | Recurs in a location beyond regional |
A recurrence requires a documented disease-free period first. Growth of disease that never went away is progression or persistence, not recurrence.
Date of First Recurrence [1860]
- Record the date the physician diagnoses the first progression, metastasis or recurrence after a disease-free period.
- It is transmitted as CCYYMMDD, with blanks for unknown parts or when not applicable (for example, a patient with no recurrence).
Type of First Recurrence [1880]: the code families
| Codes | Meaning |
|---|---|
| 00 | Became disease-free after treatment and has not had a recurrence |
| 04 | In situ recurrence of an invasive tumor |
| 06 | In situ recurrence of an in situ tumor |
| 10 | Local recurrence, not enough information for 13–17 |
| 13 | Local recurrence of an invasive tumor |
| 14 | Trocar recurrence of an invasive tumor |
| 15 | Both local and trocar (13 + 14) |
| 16 / 17 | Local, or local and trocar, recurrence of an in situ tumor |
| 20 | Regional recurrence, not enough information for 21–27 |
| 21 | Invasive, adjacent tissue or organs only |
| 22 | Invasive, regional lymph nodes only |
| 25 | Invasive, both adjacent tissue and regional nodes (21 + 22) |
| 26 / 27 | Regional recurrence of an in situ tumor (NOS, or adjacent plus nodes) |
| 30 | Invasive regional (20–25) and local or trocar (10–15) |
| 36 | In situ regional (26–27) and local or trocar (16–17) |
| 40 | Distant recurrence to a site not listed in 46–62, or not enough information |
| 46 | Distant recurrence of an in situ tumor |
| 51 | Peritoneum only (includes positive ascitic fluid) |
| 52 | Lung only (includes visceral pleura) |
| 53 | Pleura only (includes positive pleural fluid) |
| 54 | Liver only |
| 55 | Bone only (bones other than the primary site) |
| 56 | CNS only (brain and spinal cord, not the external eye) |
| 57 | Skin only (other than the primary site) |
| 58 | Distant lymph nodes only |
| 59 | Distant systemic: lymphoma, leukemia, bone marrow metastasis, carcinomatosis, generalized disease |
| 60 | A single distant category (51–58) plus local, trocar or regional recurrence |
| 62 | Multiple distant categories (for example, liver, lung and bone) |
| 70 | Never disease-free since diagnosis |
| 88 | Recurred, type unknown |
| 99 | Unknown whether recurred or ever disease-free |
Coding rules
- Hierarchy: codes 00–70 are hierarchical, so record the highest-numbered applicable code, within these limits:
- The first time a patient goes from 70 (disease) to disease-free, change the code to 00.
- The first time a patient goes from 00 to a recurrence, record the recurrence code.
- No further changes after that, other than corrections.
- Only the first recurrence counts. Later recurrences are not recorded.
- In situ primaries use only 06, 16, 17, 26, 27, 36 or 46 for recurrence. Codes 00, 88 and 99 can apply to any tumor.
- Codes 51–59 apply only when all first distant recurrences fall in one category. Multiple metastases within one organ (for example, several liver nodules) are still one category.
- Hematopoietic: leukemia or lymphoma in remission is 00. A relapse is 59. Disease controlled by drugs (STORE's example is imatinib for CML) counts as remission.
- Two primaries, recurrence of unknown origin: if the physician cannot tell which primary recurred, code the recurrence on each tumor, and revise when the origin is known.
- Recurrence versus new primary: STORE tells registrars to check the Solid Tumor Rules (or earlier MP/H rules) to decide which later tumors are recurrences. A physician's word "recurrence" does not decide it. For example:
- The breast rules make a tumor diagnosed more than five years after the patient was clinically disease-free a new primary.
- The colon rules make a later tumor a new primary when the patient was clinically disease-free for more than one year (rule M10). Tumors at the anastomosis have their own rules (M7 and M8), based on a 36-month interval and whether the tumor arises in the mucosa (Section 14.2).
Follow-up duties for recurrence
- Code 70, still in treatment: keep checking at follow-up for a later disease-free status, which may come after second-course therapy.
- Code 00: keep following until a recurrence occurs, however long that takes.
- Once 04–62 or 88 is recorded, the recurrence items are final. Cancer Status [1770] continues to be updated from physician sources.
- Standard 6.5 asks the cancer committee to monitor unknown values in Date of First Recurrence, Type of First Recurrence and Cancer Status.
Worked examples
| Scenario | Code |
|---|---|
| Stage II colon cancer resected; CT two years later shows liver metastases only | 54 |
| Breast cancer after lumpectomy; recurrence in the same breast and axillary nodes at the same time | 30 (local 13 plus regional 22) |
| Lung cancer with a solitary adrenal metastasis at diagnosis, treated with chemotherapy, stable disease | 70 |
| Kidney cancer after nephrectomy; recurrence in the renal fossa where the kidney was | 13 (scar tissue where the organ was = local) |
| Colon cancer; recurrence in liver, lung and bone | 62 |
| Melanoma of the back; later metastases in distant skin only | 57 |
| Follicular lymphoma in remission after chemotherapy, then relapse | 59 (was 00 during remission) |
| Recurrence documented, but the record says only "recurrent disease" | 88 |
A patient's colon cancer was resected with no evidence of disease afterward. Eighteen months later, a biopsy confirms metastases in regional mesenteric lymph nodes only. How is Type of First Recurrence coded?
13
22
58
62
A lung cancer patient had bone metastases at diagnosis and received chemotherapy, but has never been free of disease. How is Type of First Recurrence coded at follow-up?
70
55
00
99
Type of First Recurrence was coded 54 (liver only) in 2024. In 2026 the patient develops lung and brain metastases. What should the registrar do with Type of First Recurrence?
Change it to 62, because recurrence now involves multiple distant sites
Change it to 60, to include the new sites
Leave it as 54; once a first recurrence is recorded, later recurrences are not recorded
Change it to 88, because the pattern is now mixed
Sections you finish are checked off in the contents.