EOD-Extension--Stomach: What code is used to represent this field for a stomach primary described as linitis plastica?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 30 [Localized, NOS], unless more information is known about the extent of tumor involvement. Coding the Histology field to 8142/3 [Linitis plastica] and the Size of Primary Tumor field to 998 [Diffuse; widespread; 3/4 or more: Linitis plastica] identifies this diagnosis.
In the EOD-Extension field, the depth of invasion is the important characteristic to be coded. The 10 digit EOD corresponds to the AJCC Staging Manual in which the "T" is based on level of invasion. While a diagnosis of linitis plastica indicates a worse prognosis, it does not define the extent of infiltration. There is no luminal mass with linitis plastica. Instead, the entire gastric wall is thickened by tumor.
Extension/Ambiguous terminology: How should the terms "entrapped by tumor" and "encased by tumor" be interpreted when coding these fields?
Each case must be reviewed in its entirety to determine the appropriate coding of these fields. However, in general the terms "entrapped" and "encased" should NOT be interpreted as involvement unless there is other clinical or pathologic evidence to support involvement.
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-Size of Primary Tumor--Melanoma: How do you code tumor size for a melanoma diagnosed by a positive lymph node biopsy when the primary site is coded C44.9 because no primary site was identified? See discussion.
Should the size be 000 because no primary was found or 999 for unknown?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 000 [No mass; no tumor found] when primary site is coded to C449.
Primary Site: What code should be used to represent the site for an "extraovarian" papillary serous adenocarcinoma located in the "rectal muscle sheath"? See discussion.
The location of the tumor in the rectus muscle sheath is unusual and suggests an origin within a preexisting mullerian.
Code the Primary Site field to C49.4 [connective, subcutaneous and other soft tissues of the abdomen].
Surgery of Primary Site--Skin: Explain the difference between code 30 and code 45.
Code 30 [Biopsy of primary tumor followed by a gross excision of the lesion]
Code 45 [Wide excision or re-excision of lesion or minor (local) amputation with margins more than 1 cm, NOS. Margins MUST be microscopically negative.]
For cases diagnosed 1/1/2003 and after: Code 30 represents a biopsy or excision in which the margins of excision are less than 1 cm or the margins are unknown. Code 45 represents a wide excision in which it is known that the margins of excision are greater than 1 cm.
First Course Treatment: If the patient receives no treatment at the time of diagnosis (either because it is not recommended or because the patient refused treatment at that time) but treatment is later instituted after disease progression, should this treatment be coded as part of the first course of treatment?
The SEER rules changed in 1998 regarding what constitutes First Course of Cancer-Directed Therapy.
For cases diagnosed on or after 1/1/98: The First Course of Cancer-Directed Therapy fields will all be coded to 0 [None] for these types of cases. The documented disease progression would stop the timeframe for inclusion of any treatment to be part of first course of therapy.
EOD-Extension--Ovary: What code is used to represent this field for an ovarian primary presenting with "spread to the omentum"?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 75 [Peritoneal implants, NOS] because the size of the implants on the omentum is not known.
Note 6 was added to the EOD scheme which states that both direct extension and discontinuous metastasis to the omentum are coded in the range 70-75 depending on how the peritoneal implants are described.
Surgery of Primary Site--Ovary: What code is used to represent this field when a patient has a history of a previous organ removal and has additional surgery/organ removal for a present cancer (e.g., History of a 1984 hysterectomy and in 2003 has ovarian primary treated with BSO)?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 52 [Bilateral salpingo-oophorectomy WITH hysterectomy].
An official website of the United States government
Home