Vocab. Cancer_Modifier

Cancer Modifier

Metastasis

Rationale

The Metastasis Concept Class as part of Cancer Modifier Vocabulary is developed to capture facts of distant metastatic spread.

The Class is designed to be utilized as an obvious trigger of Metastatic Disease Episode and in some cases as a trigger of Progression Episode from Disease Extent and Disease Dynamic Episode domain classes respectively.

• The first time a Metastasis occurs the Metastatic Disease Episode could be initiated

• Every new distinct concept_id from the class could trigger the Progression Episode as the majority of widely used clinical protocols interpret new cancerous lesions as Progression.

• The concepts are designed as comprehensive and self-sufficient facts. However, if tracking of the Metastasis dynamics (and episodes) is desired we suggest storing the distinct value_as_concept_id for the same Metastasis concept (measurement_concept_id) to reflect the time course of the metastasis in its origin site. For the very first occcurece of each Metastasis you shild put the Present as value_as_concept_id.

Values appropriate to explain the dynamics are in the table below:

value_concept_id	value_concept_name	value_concept_class_id	value_vocabulary_id
4181412	Present	Meas Value	SNOMED
4132135	Absent	Meas Value	SNOMED
4128639	Decrease	Meas Value	SNOMED
4123515	Increase	Meas Value	SNOMED
… etc

• In case of several primary malignancies link the Metastasis to the Generic Malignancy term not the certain Primary Cancer Diagnosis.

Source structure

The Class encompasses about half a thousand concepts primarily designed to capture the fact of distant metastatic spread. The majority of concepts are standard. The concept class was developed de novo as a part of the Oncology OMOP CDM initiative.

Concept Standertness	Number of concepts
Standard	529
Non-Standard*	50

*The existence of Non-Standard concepts is attributed to nature of development process of ontology

Relationships

Hierarchy

The concepts in the Class are structurized in internal hierarchical relationships to ease the phenotyping and querying.

See the example of a branch

Metastasis to ethmoid bone Is a -> Metastasis to bone of skull Is a -> Metastasis to bone Is a -> Metastasis

This is inherited in CONCEPT_ANCESTOR

Finding site signature

The concepts are also linked to special anatomical sites according to the metastasis location. These links are built to be used to non trivial querying depending on special research scenarios as they provide access to the major Standard OMOP terminology - SNOMED.