Surgery of Primary Site--Cervix: How is this field coded for a cervix primary when a biopsy removes the entire tumor? See discussion.
Path from biopsy shows "severe dysplasia--CIN III" and the report from an endocervical curettage (ECC) is "chronic cervicitis"?
For cases diagnosed 1998 and later: Code the Surgery of Primary Site field to 25 [Dilatation and curettage; endocervical curettage (for in situ only)].
EOD-Lymph Nodes/TNM--Breast: Do we code these lymph nodes fields for a breast primary that describes ipsilateral axillary lymph node involvement as "extending through the lymph node capsule and into perinodal soft tissue/fat" as "fixed/matted"?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 6 [Axillary regional lymph nodes, NOS], if the size of the metastasis within the lymph node is not known. "Extension into perinodal soft tissue" does not imply that the lymph nodes are fixed to one another or to other structures. AJCC stage for lymph nodes is coded to N1 [Metastasis to moveable ipsilateral axillary lymph nodes].
In order to code the EOD-Lymph Nodes field to 5 [Fixed/matted ipsilateral axillary nodes] which is the equivalent to AJCC equivalent N2, there must be some clinical or pathologic statement of fixation or matting. There can be extension through the capsule without fixation or matting. "Fixation" is a clinical term and "matting" can be either clinical or pathologic. A pathologist can recognize two or more lymph nodes stuck together by tumor.
EOD-Extension/EOD-Lymph Nodes: Can the AJCC TNM/Stage be used to help code these fields when there is limited text information in the medical record that describes the tumor involvement?
For cases diagnosed 1998-2003:
Yes, this staging information can be used to help code the SEER EOD fields but only if a physician does the TNM/Stage at the time of diagnosis and there is limited text information that describes tumor involvement.
Histology (Pre-2007)/Grade, Differentiation--Brain and CNS: What code is used to represent the histology and grade for "WHO-II astrocytoma, grade II" of the brain when the WHO-II classification is different from the classification systems previously used? See discussion.
According to the WHO-I classification system, this is a moderately anaplastic astrocytoma. According to the Duke criteria, this is an astrocytoma. By Dauma-Dupont criteria, this is a grade 2 astrocytoma.
For tumors diagnosed prior to 2007:
Code the Histology and Grade, Differentiation fields to 9401/34 [anaplastic astrocytoma].
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-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: How are these fields coded if radiation to the primary site and/or regional lymph nodes is performed prior to surgery?
For cases diagnosed 1998-2003:
Code the EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined fields per the information in the pathology report(s). Radiation to the primary site would not affect the status of the lymph node involvement. Radiation to the regional lymph node region may or may not affect the pathologic status of the lymph nodes. However, for these fields code the best information available about the status of the lymph nodes which is reflected in the pathology report(s).
Surgery of Primary Site--Lung: What code is used to represent "photodynamic therapy" (PDT) for lung primaries? See Discussion.
PDT is not listed in the Surgery to Primary Site field codes for lung.
For cases diagnosed 2003 and later, code the Surgery of Primary Site field to 19 [Local destruction or excision, NOS] for lung primaries. Photodynamic therapy is a surgical procedure that results in the local destruction of tumor.
Primary Site--Esophagus: What is the difference between C15.5 [Lower third of esophagus] and C15.2 [Abdominal esophagus]?
These descriptions represent the use of two different ways the esophagus can be divided anatomically. The two different systems used are illustrated in the SEER Self Instruction Manual for Tumor Registrars: Book 4. Assign the primary site code that describes the location of the tumor in the same way the tumor's location is described in the medical record.
Multiple Primaries (Pre-2007)--Thyroid: Does the rule in the 3rd Edition of the SEER Program Code Manual apply to cases diagnosed before 1998 that states if there are two separate carcinomas in the thyroid, one papillary and the other follicular, it is one primary and coded to the combination code 8340/3 [Papillary and follicular carcinoma]? See discussion.
If the rule applies to cases diagnosed before 1998, does SEER plan to ask that cases diagnosed prior to 1998 be recoded?
The rule applies to tumors diagnosed 1998-2006. The rule is not retroactive. At this time, SEER does not plan to ask that tumors diagnosed prior to 1998 be recoded.
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-Extension--Head & Neck (Larynx): When "fixed" is stated for a larynx primary does it specifically have to say that it is the vocal cord that is fixed? Are the terms "fixed" and "immobile" synonymous? Should these cases be coded to 40 rather than 35? See discussion.
1. The tumor is fixed, the arytenoid on left side is fixed and the right arytenoid is partially fixed. Palpation of the tumor reveals it to be fixed in the larynx. T3 N0 M0 Stage III.
2. Erythema and swelling of right false cord with bulging and immobility. Left cord moves normally. T3 N0 M0 Stage III.
For cases diagnosed 1998-2003:
Code the EOD-Extension field for both cases to 40 [Tumor limited to larynx WITH vocal cord fixation]. Code 35 [Impaired vocal cord mobility] implies that mobility is diminished in strength and/or quality but is not rigid. Impaired mobility is a T2 tumor. Because the second case is T3, the physician implies he/she is using the term "immobility" to describe complete fixation.
EOD-Clinical Extension--Prostate: In the SEER EOD manual, there is a list of terms to distinguish apparent from inapparent tumor for prostate primaries. Are terms in the "maybe" category and are terms not on the list clinically inapparent or clinically apparent when there is no physician staging of the case? See discussion.
The rectal examination states that there is "asymmetrical enlargement of the prostate, firmness over the right lobe" and the physical exam impression is extensive carcinoma of right lobe. A needle biopsy of the right lobe was positive. "Enlarged" is on SEER's list of clinically inapparent terms; "asymmetrical" and "firm, NOS" are on the "maybe" list.
For cases diagnosed 1998-2003:
On the basis of the physical exam impression, code the EOD-Clinical Extension field to 20 [involvement of one lobe, NOS] for this case. Although the medical record did not provide a physician's staging of the case as clinically apparent, the physician did suspect carcinoma prior to the biopsy.
If clarifying stage information is missing and the term is in the "maybe" category or the term is not on the list, then code extension as 30 [localized, NOS] for cases that appear localized.
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