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Reason for No Cancer-Directed Surgery: Could you explain why this field would be coded to 1 [Cancer-directed surgery was not recommended] or 2 [Contraindicated due to other conditions] for a case that presents with distant metastasis at diagnosis?
For cases diagnosed 1998-2002:
Code the Reason for No Cancer-Directed Surgery field to 1 [Cancer-directed surgery was not recommended] for patients who present with either a primary site or histology for which surgery is not a standard treatment. Also use code 1 for those patients who present with distant disease for a primary site that is typically treated surgically. Patients with distant metastasis typically do not have surgery performed as part of first course of treatment.
Code 2 [Contraindicated due to other conditions] is used when surgery would normally be recommended for the site (given the current stage of the tumor) but other medical conditions pose too much of a risk for the patient to undergo surgery.
Primary Site--Ovary/Peritoneum: Should this field be coded to ovary or peritoneum when the bulk of the tumor is in the peritoneum and there is only surface involvement of the ovary?
If it is not clear where the tumor originated, use the following criteria to distinguish ovarian primaries from peritoneal primaries.
The primary site is probably ovarian, unless:
--Ovaries have been previously removed
--Ovaries are not involved (negative)
--Ovaries have no area of involvement greater than 5mm.
Descriptions such as "bulky mass," "omental caking" probably indicate an ovarian primary.
Descriptions such as "seeding," "studding," "salting" probably indicate a peritoneal primary.
MP/H Rules--Breast: What histology code is used for lobular with focal ductal features? Do we ignore the focal features and code as lobular or do we use the combination code for duct and lobular?
For cases diagnosed 2007 or later, use rule H14 and assign code 8520 [lobular]. Ignore histologies described as "focal," "foci," or "focus." This instruction will be added to the next version of the MP/H manual.
MP/H Rules--Ovary: How do you code histology for a diagnosis of "clear cell CA, predominately cystic."
For cases diagnosed 2007 or later, assign histology code 8310 [Clear cell carcinoma]. Cystic describes the appearance of the tumor. Clear cell is the histologic type. Code clear cell carcinoma 8310/3. Rule H11 applies.
Histology (Pre-2007): What code is used to represent the histology "poorly differentiated invasive transitional cell carcinoma with extensive squamous and focal glandular differentiation"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8120/33 [transitional cell carcinoma, NOS, poorly differentiated]. The ICD-O-3 does not have a separate code for transitional cell carcinoma with squamous and/or glandular differentiation.
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.
CS Site Specific Factor 6--Breast: Can we interpret the in situ component as "minimal" when the pathology report states "1.1 cm infiltrating duct carcinoma and no extensive intraductal component"?
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.
Yes. Based on the information provided above, the in situ component is "mininmal" for the purpose of coding Breast CS Site Specific Factor 6. The phrase "no extensive intraductal component" suggests that there is some intraductal carcinoma present.
Histology (Pre-2007)--Bladder: How is a "carcinoma with squamous, mucinous, and signet ring cell features" coded?
For tumors diagnosed prior to 2007:
Code histology to 8490 [Signet ring cell carcinoma]. Rule 7 on page 87 of the 2004 SEER Manual applies to this case.
Rule 7: Code the numerically higher ICD-O-3 code. This is the rule with the lowest priority and should be used infrequently.
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.
Histology--Vulva: How is the histology coded for vulvar intraepithelial neoplasia III (VIN III)/Squamous cell carcinoma in situ from a pathology report of the vulva, 8070/2 for squamous cell carcinoma in situ or 8077/2 for VIN III? The rules do not discuss this particular situation.
Assign 8077/2 for high-grade squamous intraepithelial lesion, VIN 3 in this case. The WHO Classification of Female Genital Tumors, 5th edition, states that squamous intraepithelial lesions (SILs) of the vulva are also known as vulvar intraepithelial neoplasia, HPV-associated. The term squamous cell carcinoma in situ is not recommended.
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