1. For each site, summary stage is based on a combined clinical and operative/pathological assessment. Gross observations at surgery are particularly important when all malignant tissue is not removed. In the event of a discrepancy between pathology and operative reports concerning excised tissue, priority is given to the pathology report.

2. Summary stage should include all information available through completion of surgery(ies) in the first course of treatment or within four months of diagnosis in the absence of disease progression, whichever is longer.

3. Summary stage information obtained after treatment with radiotherapy, chemotherapy, hormonal therapy, or immunotherapy has begun may be included, keeping in mind the timeline described in #2 above.

4. Exclude any metastases known to have developed after the diagnosis was established.

5. Clinical information, such as description of skin involvement for breast cancer and distant lymph nodes for any site, can change the stage. Be sure to review the clinical information carefully to assure the accurate summary stage. If the operative/pathology information disproves the clinical information, code the operative/pathology information.

6. All staging schemes apply to all histologies unless otherwise noted. Exceptions to this, for example, include all lymphomas and Kaposi sarcoma which should be staged using the histology schemes regardless of the primary site.

7. Autopsy reports are used in coding summary stage just as are pathology reports, applying the same rules for inclusion and exclusion.

8. Death Certificate Only cases and unknown primary (C80.9) cases are coded '9' for summary stage.

9. The summary stage may be described only in terms of T (tumor), N (node) and M (metastasis) characteristics. In such cases, record the summary stage code that corresponds to the TNM information. If there is a discrepancy between documentation in the medical record and the physician's assignment of TNM, the documentation takes precedence. Cases of this type should be discussed with the physician who assigned the TNM stage.

10. Site-specific guidelines take precedence over general guidelines. Always consider the information pertaining to a specific site.

11. When assigning a stage using the Summary Staging Guide 1977, the amount of information available to assign the stage is limited to two months from the date of diagnosis.