HL7 Europe Common Cancer Model
1.0.0-ballot - ballot 150

HL7 Europe Common Cancer Model - Local Development build (v1.0.0-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Logical Model: CancerStage - Detailed Descriptions

Active as of 2026-06-14

Definitions for the CancerStage logical model.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

Guidance on how to interpret the contents of this table can be foundhere

0. CancerStage
Definition | Logical model representing the cancer stage at the time of first diagnosis. The stage may be clinical or pathological: the clinical stage is derived from imaging evidence, while the pathological stage, when available, is derived from surgical evidence. Derived from Cancer_Common_Logical_Model_20260521.xlsx (sheet CancerStage).
Short | CancerStage
Control | 0..*
Is Modifier | false
Logical Model | Instances of this logical model are not marked to be the target of a Reference
Invariants | cs-ev-e1: If type is Clinical, imaging evidence must not be provided. () cs-ev-e2: If type is Pathological, surgery evidence must not be provided. () cs-tnm-1: If classificationType is TNM, 3 values is expected. (`classificationType.text = 'TNM' implies stage.count() >= 3`) cs-nontnm-1: For non-TNM staging systems, a single value is typically expected. (`classificationType.text != 'TNM' implies stage.count() = 1`)
2. CancerStage.cancerConditionAtDiagnosisReference
Definition | Reference to the cancer condition at first diagnosis for which the stage is reported.
Short | CancerCondition AtDiagnosis Reference
Control | 1..1
Type | Reference(CancerConditionAtDiagnosis)
4. CancerStage.classificationType
Definition | Staging classification system used when the staging system needs to be explicitly identified (e.g. TNM).
Short | ClassificationType
Comments | For TNM, this element should be populated with 'TNM'. For single-value systems, it may be omitted when the system/measure is represented through stageComponent.code.
Control | 0..1
Type | CodeableConcept
6. CancerStage.stage
Definition | One or more staging values expressed as (code, value) pairs.
Short | StageValue
Comments | Most staging systems are represented by a single component. TNM is represented by three components, one for each of T, N, and M (codes 'T', 'N', 'M').
Control | 1..*
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. CancerStage.stage.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
10. CancerStage.stage.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `CancerStage.stage.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
12. CancerStage.stage.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
14. CancerStage.stage.code
Definition | Identifies which staging element is being reported (e.g. T category, N category, M category, stage group).
Short | Stage element code
Comments | For single-value staging systems, this represents the staging system/measure being used (e.g. 'FIGO stage group'). For TNM, expected codes include 'T', 'N', and 'M'.
Control | 1..1
Type | CodeableConcept
16. CancerStage.stage.value
Definition | Value associated with the reported staging element (e.g. T2, N1, M0; or a stage group value).
Short | Stage element value
Comments | For TNM, this carries the component value (e.g. T2, N0, M0). For single-value systems, this carries the stage group/value (e.g. IIIB).
Control | 1..1
Type | CodeableConcept
18. CancerStage.type
Definition | It indicates whether the stage instance is of type Clinical or Pathological.
Short | Type
Comments | It indicates whether the stage instance is of type Clinical or Pathological. Choice: Clinical | Pathological
Control | 1..1
Type | CodeableConcept
20. CancerStage.evidenceReference
Definition | Reference(s) to the evidence used to define the stage: imaging in case of a Clinical stage, or surgery in case of a Pathological stage.
Short | EvidenceReference
Comments | It shall be present. The reference shall be to one or more imaging procedures in case the stage is Clinical, or to one surgery in case the stage is Pathological.
Control | 0..*
Type | Reference(Surgery, Imaging)

Guidance on how to interpret the contents of this table can be foundhere

0. CancerStage
Definition | Logical model representing the cancer stage at the time of first diagnosis. The stage may be clinical or pathological: the clinical stage is derived from imaging evidence, while the pathological stage, when available, is derived from surgical evidence. Derived from Cancer_Common_Logical_Model_20260521.xlsx (sheet CancerStage).
Short | CancerStage
Logical Model | Instances of this logical model are not marked to be the target of a Reference
Invariants | cs-ev-e1: If type is Clinical, imaging evidence must not be provided. () cs-ev-e2: If type is Pathological, surgery evidence must not be provided. () cs-tnm-1: If classificationType is TNM, 3 values is expected. (`classificationType.text = 'TNM' implies stage.count() >= 3`) cs-nontnm-1: For non-TNM staging systems, a single value is typically expected. (`classificationType.text != 'TNM' implies stage.count() = 1`)
2. CancerStage.cancerConditionAtDiagnosisReference
Definition | Reference to the cancer condition at first diagnosis for which the stage is reported.
Short | CancerCondition AtDiagnosis Reference
Control | 1..1
Type | Reference(CancerConditionAtDiagnosis)
4. CancerStage.classificationType
Definition | Staging classification system used when the staging system needs to be explicitly identified (e.g. TNM).
Short | ClassificationType
Comments | For TNM, this element should be populated with 'TNM'. For single-value systems, it may be omitted when the system/measure is represented through stageComponent.code.
Control | 0..1
Type | CodeableConcept
6. CancerStage.stage
Definition | One or more staging values expressed as (code, value) pairs.
Short | StageValue
Comments | Most staging systems are represented by a single component. TNM is represented by three components, one for each of T, N, and M (codes 'T', 'N', 'M').
Control | 1..*
Type | BackboneElement
8. CancerStage.stage.code
Definition | Identifies which staging element is being reported (e.g. T category, N category, M category, stage group).
Short | Stage element code
Comments | For single-value staging systems, this represents the staging system/measure being used (e.g. 'FIGO stage group'). For TNM, expected codes include 'T', 'N', and 'M'.
Control | 1..1
Type | CodeableConcept
10. CancerStage.stage.value
Definition | Value associated with the reported staging element (e.g. T2, N1, M0; or a stage group value).
Short | Stage element value
Comments | For TNM, this carries the component value (e.g. T2, N0, M0). For single-value systems, this carries the stage group/value (e.g. IIIB).
Control | 1..1
Type | CodeableConcept
12. CancerStage.type
Definition | It indicates whether the stage instance is of type Clinical or Pathological.
Short | Type
Comments | It indicates whether the stage instance is of type Clinical or Pathological. Choice: Clinical | Pathological
Control | 1..1
Type | CodeableConcept
14. CancerStage.evidenceReference
Definition | Reference(s) to the evidence used to define the stage: imaging in case of a Clinical stage, or surgery in case of a Pathological stage.
Short | EvidenceReference
Comments | It shall be present. The reference shall be to one or more imaging procedures in case the stage is Clinical, or to one surgery in case the stage is Pathological.
Control | 0..*
Type | Reference(Surgery, Imaging)

Guidance on how to interpret the contents of this table can be foundhere

0. CancerStage
Definition | Logical model representing the cancer stage at the time of first diagnosis. The stage may be clinical or pathological: the clinical stage is derived from imaging evidence, while the pathological stage, when available, is derived from surgical evidence. Derived from Cancer_Common_Logical_Model_20260521.xlsx (sheet CancerStage).
Short | CancerStage
Control | 0..*
Is Modifier | false
Logical Model | Instances of this logical model are not marked to be the target of a Reference
Invariants | cs-ev-e1: If type is Clinical, imaging evidence must not be provided. () cs-ev-e2: If type is Pathological, surgery evidence must not be provided. () cs-tnm-1: If classificationType is TNM, 3 values is expected. (`classificationType.text = 'TNM' implies stage.count() >= 3`) cs-nontnm-1: For non-TNM staging systems, a single value is typically expected. (`classificationType.text != 'TNM' implies stage.count() = 1`)
2. CancerStage.cancerConditionAtDiagnosisReference
Definition | Reference to the cancer condition at first diagnosis for which the stage is reported.
Short | CancerCondition AtDiagnosis Reference
Control | 1..1
Type | Reference(CancerConditionAtDiagnosis)
4. CancerStage.classificationType
Definition | Staging classification system used when the staging system needs to be explicitly identified (e.g. TNM).
Short | ClassificationType
Comments | For TNM, this element should be populated with 'TNM'. For single-value systems, it may be omitted when the system/measure is represented through stageComponent.code.
Control | 0..1
Type | CodeableConcept
6. CancerStage.stage
Definition | One or more staging values expressed as (code, value) pairs.
Short | StageValue
Comments | Most staging systems are represented by a single component. TNM is represented by three components, one for each of T, N, and M (codes 'T', 'N', 'M').
Control | 1..*
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. CancerStage.stage.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
10. CancerStage.stage.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `CancerStage.stage.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
12. CancerStage.stage.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
14. CancerStage.stage.code
Definition | Identifies which staging element is being reported (e.g. T category, N category, M category, stage group).
Short | Stage element code
Comments | For single-value staging systems, this represents the staging system/measure being used (e.g. 'FIGO stage group'). For TNM, expected codes include 'T', 'N', and 'M'.
Control | 1..1
Type | CodeableConcept
16. CancerStage.stage.value
Definition | Value associated with the reported staging element (e.g. T2, N1, M0; or a stage group value).
Short | Stage element value
Comments | For TNM, this carries the component value (e.g. T2, N0, M0). For single-value systems, this carries the stage group/value (e.g. IIIB).
Control | 1..1
Type | CodeableConcept
18. CancerStage.type
Definition | It indicates whether the stage instance is of type Clinical or Pathological.
Short | Type
Comments | It indicates whether the stage instance is of type Clinical or Pathological. Choice: Clinical | Pathological
Control | 1..1
Type | CodeableConcept
20. CancerStage.evidenceReference
Definition | Reference(s) to the evidence used to define the stage: imaging in case of a Clinical stage, or surgery in case of a Pathological stage.
Short | EvidenceReference
Comments | It shall be present. The reference shall be to one or more imaging procedures in case the stage is Clinical, or to one surgery in case the stage is Pathological.
Control | 0..*
Type | Reference(Surgery, Imaging)