Sequence Number-central/Multiple Primaries (Pre-2007): What criteria are to be used to determine which primary site carries a worse prognosis? Should we take survival into consideration? See Discussion.
In the case of two or more simultaneously diagnosed primary tumors, instructions in the SEER manual state that the tumor with the worse prognosis is to be assigned the lower sequence number. Prognosis decisions should be based on primary site, histology and extent of disease.
Stage as a criteria for decision making is fairly straightforward. On the other hand, decisions based on primary site seem to be more subjective than objective.
For tumors diagnosed prior to 2007:
Compare the combination of the primary site, histology and extent of disease for each primary, and assign the lowest sequence number to the primary with the worst prognosis. Do not use primary site or histology alone to determine prognosis in the case of assigning sequence number. Survival is a component of prognosis.
If there is no difference in prognosis, assign the sequence numbers in any order.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
First Course Treatment: If a patient makes a blanket refusal of all recommended therapy or refuses all treatment before any therapy was recommended, are only immunotherapy and hematologic/endocrine therapies to be coded as refused (code 87)? Or should all treatment modalities be coded as refused if a patient makes a blanket refusal? Or should none of the treatment modalities be coded as refused because we do not know what would have been recommended? See Discussion.
Coding instructions for immunotherapy and for hematologic/endocrine procedures state that Code 87 is to be assigned if either of the following circumstances apply: 1) If the patient made a blanket refusal of all recommended treatment. 2) If the patient refused all treatment before any was recommended. These instructions are not included for other treatment modalities.
When the patient refuses treatment, the first course of therapy is no treatment. Code all treatments as refused.
Histology--Prostate: We are seeing numerous pathology reports with the following diagnosis: "Conventional (acinar) prostatic adenocarcinoma (M81403)." What is the correct histology code?
For cases diagnosed prior to January 1, 2007, assign histology code 8550/3 [Acinar adenocarcinoma].
Reportability--Brain and CNS: Is a skull tumor schwannoma an intracranial reportable benign tumor if the physician states it arose in the occipital nerve?
No. These schwannomas are not intracranial and therefore, are not reportable to SEER. The occipital nerve is not one of the 12 intracranial nerves (i.e., Abducens, Auditory (vestibulocochlear), Facial, Glossopharyngeal, Hypoglossal, Oculomotor, Olfactory, Optic, Spinal Accessory, Trigeminal, Trochlear, and Vagus).
Behavior Code--Breast: How is this field coded for a "non-invasive Paget disease of the breast?" See Discussion.
Historically, SEER collected Paget Disease of the breast with a behavior code of 3 [invasive]. There is no documentation to support this. The SEER EOD Manual only states that if the code is "05" [Pagets disease (without underlying tumor)], the behavior must be a 2 [in situ] or a 3 [invasive].
Code the behavior as /2 [in situ] for noninvasive Paget disease of breast. Noninvasive is a synonym of in situ.
If the pathology report documents that the Paget disease is in situ, the matrix principle in ICD-O allows you to change the behavior code to match the pathologist's statement.
Primary site: How is this field coded for a malignancy described as a "intracranial squamous cell carcinoma (8070) arising in a previous epidermoid cyst"? See Discussion.
4-5-02 MRI Brain: Enhancing mass is probably a recurrence of the original tumor resected in 1983 (benign). 4-8-02 Gross resection. Lesion was coming up against her brain stem: Removed it grossly.
Path: 4-8-02 Brain tumor, left temporal: SCC arising from a previous epidermoid cyst of the brain. XRT began 4-25-02.
Path states: "Squamous lesions suspicious for malignant transformation of old epidermal cyst (1983). It has been reported in literature that epidermoid cysts in the brain can undergo a malignant transformation which is what happened in this case."
It appears the patient has an intracranial epidermoid cyst that is now
giving rise to SCC. Squamous cell carcinoma (8070) of the brain (C71_) fails the edit Primary Site, Morphology-Imposs ICDO3 (SEER IF38).
Code the primary site to C760 [Ill-defined site; Head, face or neck, NOS]. There is an intracranial malignancy arising from a previously resected epidermoid cyst. Squamous cell carcinoma, primary of the brain, is a non-overridable edit error.
CS Extension/Histology (Pre-2007)--Breast: Paget disease with underlying DCIS. How should CS Extension, SEER Summary Stage 2000, histology, and behavior be coded?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
For tumors diagnosed prior to 2007:
Based only on the information provided above,
1. The CS extension code is 07 [Paget disease of nipple (without underlying invasive carcinoma pathologically)].
2. The SS 2000 stage is 1 [Localized].
3. The histology code is 8543 [Paget disease and intraductal carcinoma of breast]. The behavior code is 3 [Malignant].
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Reportability: When a biopsy is suspicious for cancer and re-biopsy is negative, is reportability based on the clinician's judgement (cancer vs NED)?
If the re-biopsy was done because the first biopsy was inconclusive, do not report this case. If the re-biopsy was more complete, or performed in an attempt to gain a wider margin, this case is reportable based on the first biopsy.
CS Extension--Bladder: How would the following statements be coded for bladder extension -- Code 03 [inferred description of non-invasion] vs code 15 [invasive confined to subepithelial connective tissue]. See Discussion.
1) no smooth muscle invasion
2) no muscle invasion
3) without muscle invasion
4) no invasion of muscularis propria
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
For cases diagnosed in 2004 and later code CS extension:
Primary Site/Summary Stage 2000/EOD-Extension--Lymphoma: How are these fields coded when a CT Impression states: Large retroperitoneal/abdominal mass resulting in extra-hepatic biliary obstruction & bilateral urinary tract obstruction & encasement of major vessels most c/w lymphoma? See Discussion.
CT findings state: Very lg sft tiss mass encasing pancreatic head & portion of body, splenic & portal veins, celiac axis, sup mesenteric artery & bilateral renal veins. Two components to this mass: 1) retroperitoneal mass encasing great vessels and 2) peritoneal component 10.8cm size, displaces bowel & other structures & encases vessels.
If the physician stated "this is bulky disease" would that change the EOD?
For tumors diagnosed 1998-2003:
Based on the information provided:
The topography code for this lymphoma is C772 [Intra-abdominal lymph nodes].
Code SEER Summary Stage 2000 to 5 [Regional NOS].
Code EOD Extension to 20. More than one lymph node region below the diaphragm is involved (retroperitoneal and peritoneal). The organs mentioned are not involved by the lymphoma. The bulk of the masses is causing obstruction by displacing and/or encasing organs.
A physician description of "bulky disease" would not change the EOD for this case.
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