This page is part of the HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU1 (v3.0.0-ballot: STU 3 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions

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Resource Profile: TNM Distant Metastases Category Profile

Category describing the extent of a tumor metastasis in remote anatomical locations, based on evidence such as physical examination, imaging, and/or biopsy.

Usage:

• Use this Resource Profile: mCODE Patient Bundle Profile
• Refer to this Resource Profile: TNM Stage Group Profile
• Examples for this Resource Profile: Observation/tnm-clinical-distant-metastases-category-cM0, Observation/tnm-clinical-distant-metastases-category-jenny-m and Observation/tnm-pathologic-distant-metastases-category-jenny-m

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from CancerStageGroup

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	CancerStageGroup	Measurements and simple assertions
code		1..1	CodeableConcept	The type of stage information reported. Binding: TNM Distant Metastases Staging Type Value Set (required)
value[x]		0..1	CodeableConcept	Actual result Binding: TNM Distant Metastases Category Value Set (preferred) Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
method		1..1	CodeableConcept	How it was done Binding: TNM Staging Method Value Set (extensible)
hasMember		0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Not used in this profile
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.code	required	TNMDistantMetastasesStagingTypeVS
Observation.value[x]	preferred	TNMDistantMetastasesCategoryVS Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
Observation.method	extensible	TNMStagingMethodVS

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	CancerStageGroup	Measurements and simple assertions
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
code	SΣ	1..1	CodeableConcept	The type of stage information reported. Binding: TNM Distant Metastases Staging Type Value Set (required)
subject	SΣ	0..1	Reference(Cancer Patient Profile)	Who and/or what the observation is about
focus	SΣ	0..*	Reference(Primary Cancer Condition Profile)	The cancer condition associated with staging assessment.
effective[x]	SΣ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
value[x]	SΣC	0..1	CodeableConcept	Actual result Binding: TNM Distant Metastases Category Value Set (preferred) Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
method	S	1..1	CodeableConcept	How it was done Binding: TNM Staging Method Value Set (extensible)
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Not used in this profile
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Observation.status	required	ObservationStatus
Observation.code	required	TNMDistantMetastasesStagingTypeVS
Observation.value[x]	preferred	TNMDistantMetastasesCategoryVS Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
Observation.method	extensible	TNMStagingMethodVS

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	CancerStageGroup	Measurements and simple assertions
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	SΣ	1..1	CodeableConcept	The type of stage information reported. Binding: TNM Distant Metastases Staging Type Value Set (required)
subject	SΣ	0..1	Reference(Cancer Patient Profile)	Who and/or what the observation is about
focus	SΣ	0..*	Reference(Primary Cancer Condition Profile)	The cancer condition associated with staging assessment.
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	SΣC	0..1	CodeableConcept	Actual result Binding: TNM Distant Metastases Category Value Set (preferred) Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method	S	1..1	CodeableConcept	How it was done Binding: TNM Staging Method Value Set (extensible)
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	Not used in this profile
referenceRange	C	0..*	BackboneElement	Not used in this profile
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Not used in this profile
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	ObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.code	required	TNMDistantMetastasesStagingTypeVS
Observation.value[x]	preferred	TNMDistantMetastasesCategoryVS Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
Observation.dataAbsentReason	extensible	DataAbsentReason
Observation.interpretation	extensible	ObservationInterpretationCodes
Observation.bodySite	example	SNOMEDCTBodyStructures
Observation.method	extensible	TNMStagingMethodVS
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes
Observation.component.code	example	LOINCCodes (a valid code from LOINC)
Observation.component.dataAbsentReason	extensible	DataAbsentReason
Observation.component.interpretation	extensible	ObservationInterpretationCodes

This structure is derived from CancerStageGroup

Summary

Mandatory: 1 element

Differential View

This structure is derived from CancerStageGroup

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	CancerStageGroup	Measurements and simple assertions
code		1..1	CodeableConcept	The type of stage information reported. Binding: TNM Distant Metastases Staging Type Value Set (required)
value[x]		0..1	CodeableConcept	Actual result Binding: TNM Distant Metastases Category Value Set (preferred) Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
method		1..1	CodeableConcept	How it was done Binding: TNM Staging Method Value Set (extensible)
hasMember		0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Not used in this profile
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.code	required	TNMDistantMetastasesStagingTypeVS
Observation.value[x]	preferred	TNMDistantMetastasesCategoryVS Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
Observation.method	extensible	TNMStagingMethodVS

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	CancerStageGroup	Measurements and simple assertions
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
code	SΣ	1..1	CodeableConcept	The type of stage information reported. Binding: TNM Distant Metastases Staging Type Value Set (required)
subject	SΣ	0..1	Reference(Cancer Patient Profile)	Who and/or what the observation is about
focus	SΣ	0..*	Reference(Primary Cancer Condition Profile)	The cancer condition associated with staging assessment.
effective[x]	SΣ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
value[x]	SΣC	0..1	CodeableConcept	Actual result Binding: TNM Distant Metastases Category Value Set (preferred) Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
method	S	1..1	CodeableConcept	How it was done Binding: TNM Staging Method Value Set (extensible)
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Not used in this profile
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Observation.status	required	ObservationStatus
Observation.code	required	TNMDistantMetastasesStagingTypeVS
Observation.value[x]	preferred	TNMDistantMetastasesCategoryVS Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
Observation.method	extensible	TNMStagingMethodVS

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	CancerStageGroup	Measurements and simple assertions
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	SΣ	1..1	CodeableConcept	The type of stage information reported. Binding: TNM Distant Metastases Staging Type Value Set (required)
subject	SΣ	0..1	Reference(Cancer Patient Profile)	Who and/or what the observation is about
focus	SΣ	0..*	Reference(Primary Cancer Condition Profile)	The cancer condition associated with staging assessment.
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	SΣC	0..1	CodeableConcept	Actual result Binding: TNM Distant Metastases Category Value Set (preferred) Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method	S	1..1	CodeableConcept	How it was done Binding: TNM Staging Method Value Set (extensible)
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	Not used in this profile
referenceRange	C	0..*	BackboneElement	Not used in this profile
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Not used in this profile
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	ObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.code	required	TNMDistantMetastasesStagingTypeVS
Observation.value[x]	preferred	TNMDistantMetastasesCategoryVS Additional Bindings Purpose TNM Distant Metastases Maximum Value Set Max Binding
Observation.dataAbsentReason	extensible	DataAbsentReason
Observation.interpretation	extensible	ObservationInterpretationCodes
Observation.bodySite	example	SNOMEDCTBodyStructures
Observation.method	extensible	TNMStagingMethodVS
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes
Observation.component.code	example	LOINCCodes (a valid code from LOINC)
Observation.component.dataAbsentReason	extensible	DataAbsentReason
Observation.component.interpretation	extensible	ObservationInterpretationCodes

This structure is derived from CancerStageGroup

Summary

Mandatory: 1 element

Other representations of profile: CSV, Excel, Schematron