Chemotherapy/Immunotherapy: How do we code Rituxan for Non-Hodgkin Lymphoma and Herceptin for breast cancer? See Discussion.
Page 195 of the SEER Manual 2004 lists these as examples of Immunotherapy. The new SEER*Rx categorizes these as chemotherapy.
(Sinq # 20041025 says to code Avastin and Erbitux as chemotherapy, too.)
Code Rituxan and Herceptin as chemotherapy.
SEER*Rx is effective for cases diagnosed 1-1-2005 and forward. It replaces all previous references. Be sure to use SEER*Rx [http://seer.cancer.gov/tools/seerrx/]
because some agents changed categories when SEER*Rx was deployed.
It is neither required nor recommended that cases treated prior to 2005 be recoded.
Chemotherapy--Hematopoietic, NOS: What treatment code is used to represent the drug "Gleevec" being used to treat chronic myelogenous leukemia?
For cases diagnosed 1/1/2003 and after: Code the Chemotherapy field to 02 [Single-agent chemotherapy administered as first course therapy]. It should be classified as a chemotherapy agent, albeit a unique one. Gleevec seems to work the same way many other chemo drugs do. It disrupts cell division for malignant cells containing the BCR-ABL protein only, rather than for normal and abnormal cells together. When the cells can't divide and create a new generation, they simply die. This meets the definition of an antineoplastic chemotherapy agent.
Chemotherapy--Breast: Is chemotherapy administered for inflammatory breast cancer also coded as therapy for an in situ tumor in the contralateral breast?
Yes. Because chemotherapy would likely affect both primaries, code it as treatment for both the in situ and the inflammatory breast cancers.
Chemotherapy--Breast: In the absence of more specific information, is the insertion of a port-a-cath one month after mastectomy enough documentation to code chemotherapy to 88 [Recommended]?
Assign chemotherapy code 88 [Chemotherapy was recommended, but it is unknown if it was administered]. Be sure to confirm whether or not treatment was administered and update this code accordingly.
Cell indicator--Lymphoma: If the primary site for a lymphoma is stated to be the lymph nodes but there is no biopsy of a lymph node, can the immunophenotype designation for a lymphoma be coded based on a bone marrow or liver biopsy indicating "diffuse large B-cell lymphoma"?
For cases diagnosed prior to 1/1/2010:
The cell indicator or immunophenotype designation for lymphomas may be coded from pathology reports on tissue from bone marrow or liver when there is no tissue from the primary site. Code information on cell type from any available source.
See the Appendix C of the 2007 SEER manual, Coding Guidelines for Lymphomas, pages C-1055 to C-1056 for more information about coding this field for lymphomas.
For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Behavior--Lung: How is behavior to be coded for a diagnosis of adenocarcinoma of a lung tumor that is further classified per the CAP protocol as, "non-mucinous bronchiolo-alveolar carcinoma (adenocarcinoma in situ)" while the pathologist also classifies the tumor as pT1b, pN0? See Discussion.
Is the following case coded with an invasive or in situ behavior when a RUL lobectomy specimen reveals adenocarcinoma and the Histologic Type per the CAP protocol layout is non-mucinous bronchiolo-alveolar carcinoma (adenocarcinoma in situ)? The stage per the pathologist is pT1b, pN0. Per the COMMENT section in the pathology report, "The terminology adenocarcinoma in situ is based on a recent publication in the Journal of Thoracic Oncology (Volume 6, #2, February 2011). Based on this criterion, the behavior represents adenocarcinoma in situ with no evident invasive component."
Code the behavior as in situ. The pathologist has the final say on the behavior of the tumor. This pathologist is indicating that in his opinion based on a recent publication, this tumor is in situ.
Behavior--Lung: Can an in situ behavior code be used for a bronchioalveolar carcinoma of the lung when the pathologist appears to use the term bronchioalveolar to describe an in situ pattern of growth exhibited by an adenocarcinoma? Is the use of the term "pattern" in this situation indicative of in situ tumor? See Discussion.
In ICD-O-3, bronchioloalveolar adenocarcinoma is described only by behavior code 3 (invasive). Would the behavior be coded as in situ for the following cases?
Example 1: Left lower lobe, partial resection shows bronchioloalveolar carcinoma with focal areas of fibrosis (see comment). Comment: Although the possibility that these areas represent stromal invasion can not be excluded, we favor the interpretation that these areas do not represent true invasion. Synoptic summary: Minimal pathologic stage: Local Extent.
Example 2: Lung tumor described as adenocarcinoma, predominantly bronchoalveolar pattern. For most sites, the term pattern is used only for in situ cancer and is not a specific term used for invasive tumors. Is the use of the term "pattern" in this situation indicative of in situ tumor?
Code the behavior indicated in the pathology report. If the pathologist states the bronchioloalveolar carcinoma is in situ, apply the ICD-O-3 matrix rule and assign 8250/2. Otherwise, code 8250/3. Do not use the term "pattern" to infer in situ behavior.
Code behavior /3 for both examples based on information provided.
Behavior--Head & Neck: Should the SEER IF_Morph_3 edit be modified because it does not allow a behavior code 2 with histology 8941 [carcinoma in a pleomorphic adenoma] for a parotid primary?
Code the behavior as 2 and over-ride the edit. The edit is there to flag unusual combinations. Once you have verified that the behavior is coded correctly, over-ride the edit.
The surgeon stage of T2 is based on size of tumor, the TIS is based on behavior. Code according to pathologically confirmed TIS.
Behavior--Breast: How is this field coded for a case in which the final diagnosis reports DCIS, but the CAP protocol or microscopic findings show microinvasion? See Discussion.
1. Path report for breast cancer has final diagnosis as 'DCIS' but the CAP protocol in the body of the report says 'microinvasion seen, T1mic.'
2. Path report says 'DCIS' in the final diagnosis and microinvasion is identified in the microscopic portion of the report, but it is not in CAP protocol format and not stated in the final diagnosis.
Code both scenarios /3 [malignant (invasive)]. Information regarding behavior is not limited to the final diagnosis or the CAP protocol. See page 84 in the 2007 SEER manual:
Code the behavior as malignant /3 if any portion of the primary tumor is invasive no matter how limited; i.e. microinvasion.
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