Reportability--Cervix: The SEER Program Code Manual lists CIN III and carcinoma in situ of the cervix as not being reportable for cases diagnosed in 1996 or later, but does not list "adenocarcinoma in situ" or "squamous cell carcinoma in situ." Are these histologies still reportable?
For primary site cervix uteri, only histologies with behavior codes of 3 [invasive] are reportable to SEER for all registries.
Some SEER registries have opted to continue to collect behavior codes of 2 [in situ] for cervix uteri primaries.
EOD-Extension--Lymphoma: How do you code stage and EOD for an extranodal lymphoma with bilateral involvement of a paired site? See discussion.
For example, we frequently see cases of lymphoma occurring in bilateral orbits, or both lungs. This issue was discussed at a 1991 SEER meeting with the tentative answer being that lymphoma involving both organs of a paired site will be coded as stage I (e.g., both eyes or both lungs), as this would be contiguous disease. However, an extranodal lymphoma involving tissue of both limbs (e.g., soft tissue of both arms) will be coded as stage IV because this represents wide areas of involvement that have no connection.
For cases diagnosed 1998-2003:
Bilateral involvement of an extralymphatic paired organ is coded as involvement of a single extralymphatic organ or site for lymphomas. The EOD extension code would be at least 11 (Stage IE). Staging lymphomas of any site depends on whether one or more lymph node regions and/or extralymphatic organs are involved, and whether sites on one or both sides of the diaphragm are involved.
Terminology/EOD-Size of Primary Tumor--Lung: Can the term "opacity" be used to code the size of the primary lung tumor when it is given a size in an imaging study but the "opacity" is not referred to as being suspicious for cancer? See discussion.
Example: How do you code tumor size for a lung primary in which the patient had a CT of the chest that describes a "4 cm opacity in the RUL of the lung." A biopsy of the RUL lung is positive for carcinoma? Would your answer be different if the opacity was described as being "suspicious for carcinoma"?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 999 [Not stated] for the example given above. However, if the opacity was described as a "mass" or as "suspicious for cancer," the size could be coded to 040 [4 cm].
Multiple Primaries (Pre-2007)--Melanoma: Many melanoma patients have multiple occurrences over time that are not called recurrent and often are even in the same skin subsite, some in situ only and others alternating between in situ and invasive. Should these multiple occurrences really be new primaries?
For tumors diagnosed prior to 2007:
Unless it is stated to be a RECURRENT or METASTATIC melanoma, record each melanoma as a separate primary when:
1. The occurrences are more than two months apart.
2. The fourth digit of the ICD-O topography code for skin [C44._] is different .
3. The first three digits of ICD-O-3 morphology code are different.
4. An in situ melanoma is followed by an invasive melanoma.
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.
EOD Clinical Extension--Prostate: Can you assign code 15 if there is no TURP and no physical exam? See discussion.
[Code 15 = Tumor identified by needle biopsy, e.g. for elevated PSA, (T1c)]
Prostate case: Elevated PSA, Prostate u/s: no abnormal findings, Prostate biopsy: adenocarcinoma. Can this be clinically coded as 15? According to Prostate EOD Coding Guide (6/2001), code 15 requires documentation that the physical exam was negative, but in this case, we have no physical info.
For cases diagnosed 1998-2003:
Code the EOD Clinical Extension field to 30-34 when there is no documentation saying that the physical examination was negative.
Chemotherapy: How is treatment with Iressa (Gefitinib) coded?
Code treatment with Iressa as chemotherapy.
Iressa is an epidermal growth factor inhibitor. While it doesn't kill cells directly, it damages the cell reproduction process. We classify it as a chemotherapy agent.
Grade, Differentiation--Breast: Does SEER agree with our pathologist who contends that "by convention lobular carcinoma is considered to be grade 2"?
No. SEER does not have a default grade code for lobular carcinoma. Code the grade as stated in the pathology report. If no grade is stated, code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable].
EOD-Extension--Urinary Tract: Can the rules used to code bladder extension involving the term "no involvement of muscularis/and no mention of subepithelium/submuscosa" be used to code extension for other urinary tract primaries, such as ureter?
For cases diagnosed 1998-2003:
No. The inferred descriptions of noninvasion apply to bladder cases only.
First Course Treatment--Lymphoma: How should an antibiotic regimen such as bismuth or omeprazole, amoxicillin, and metronidazole be coded for a MALT lymphoma of the stomach associated with Helicobacter pylori infection? See discussion.
If we do not count the antibiotic regimen as cancer-directed treatment but this is the only treatment given and the lymphoma disappears, is it problematic to have a cancer status of "no disease" recorded in a patient that supposedly was not "treated"?
Do not code antibiotic regimens as Cancer-Directed Therapy. These drugs are intended to treat the bacteria and not the cancer. This type of treatment is ancillary even if it is the only type of treatment given. You may designate a user-defined field to capture this information if desired. The coding combination of a cancer status of "no disease" and all treatment fields coded to "no treatment" is allowable.
Histology (Pre-2007)/Grade, Differentiation--All Sites: How do we code these fields for a tumor that is predominantly a "well differentiated liposarcoma" [8851/31] that has a less predominent type of "dedifferentiated liposarcoma" [8858/33]? If we code the predominant cell type [8851/3] and the worst grade [3], the case will not pass edits because well-differentiated liposarcoma requires a differentiation code of 1. See discussion.
Example: Dedifferentiated liposarcoma, with the following features: size 22 cm, FNCLCC grade 3 of 3 [high grade]. Path comment: The tumor consists of predominantly well-differentiated sclerosing subtype liposarcoma and areas of high grade spindle cell (non-lipogenic) sarcoma. The area of high grade spindle cell sarcoma measured up to 7.5 cm.
For tumors diagnosed prior to 2007:
Code the Histology field to 8858/33 [Dedifferentiated liposarcoma, grade 3]. The pathologist gives a final designation of Dedifferentiated liposarcoma and then provides further details in the comment that do not negate the final designation.
Grade is usually coded independent of the cell type. There are a few Catch-22 situations, like this one, in which the grade is built into the name of the cell type.
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.
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