Reason no treatment/Surgery of Primary Site: Does the "Reason for No Cancer-Directed Therapy" field only relate to the "Surgery of Primary Site" field? If so, for what diagnosis years is that effective? Have SEER's coding guidelines changed over time? See discussion.
Whenever a surgical procedure is performed that results in a non 0 or 9 code in any one of the Surgery fields, should the Reason for No Site-Specific Surgery field be coded to 0 [Cancer-directed surgery performed]?
For cases diagnosed 2003 and forward: The field "Reason for No Surgery of Primary Site" applies only to surgery of primary site. This is a change from the pre-2003 instructions.
Grade, Differentiation--Bladder: Some pathologists use a two component grade system for bladder carcinomas - either low grade or high grade. Should we continue to code these per SEER rules as grades 2 [low grade] and 4 [high grade]? See discussion.
The AFIP website states that this low grade classification corresponds to grade 1/3, while the high grade corresponds to both grade 2/3 and grade 3/3. Using the 3-grade conversion, this would also classify the low grade as grade 2, but would leave the high grade as a toss-up between grade 3 and grade 4.
Continue to code Grade, Differentiation as specified in the SEER Program Code Manual: "Low grade" is coded to 2 and "high grade" is coded to 4.
Histology--CLL/SLL: If a tissue diagnosis of "small lymphocytic lymphoma" is made six months after an initial blood diagnosis of "chronic lymphocytic leukemia" should the histology be updated from 9823/3 to 9670/3?
For cases diagnosed prior to 1/1/2010:Do not change the histology to small lymphocytic lymphoma (9670/3). The chronic lymphocytic leukemia has advanced/progressed and disseminated into other tissues from the blood during the last six months. If the patient presents with disease in the blood and/or bone marrow only, code to CLL. If a lymph node or other solid tissue is involved initially, code to SLL. For the case cited, the tissue involvement occurred six months after the initial diagnosis and the histology code is not changed to reflect the progression of disease.
For cases diagnosed 2010 forward, 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.
First Course Treatment: What code is used to represent each treatment modality field when there is no indication that a particular modality of treatment was recommended or started?
Code the individual treatment fields to 0 or 00 [None] when the modality is not addressed in the treatment plan (or when a treatment plan is lacking) and there is no indication that a particular modality of treatment was recommended or started.
Histology (Pre-2007)--Prostate: What code is used to represent the histology "prostatic duct carcinoma"? See discussion.
Should the histology be coded to duct carcinoma [8500/3] or endometrioid carcinoma [8380/3]? Prostatic duct carcinoma is defined as endometrioid carcinoma; however, sometimes the pathology report describes the histology as being only "prostatic duct carcinoma."
For tumors diagnosed prior to 2007:
If there is no mention of endometrioid carcinoma in the microscopic description, code the Histology field to 8500/3 [duct carcinoma]. If "endometrioid carcinoma" is mentioned in either the final diagnosis or in the microscopic description, code the Histology field to 8380/3 [endometrioid carcinoma].
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.
Date of Diagnosis--Lung: Based on Note 7 in the lung EOD, should the Date of Diagnosis field be coded to an earlier CT scan date with a reported diagnosis of "RUL mass with mediastinal lymphadenopathy" or to the later biopsy date with a reported diagnosis of small cell carcinoma? See discussion.
Note 7 states that "mediastinal lymphadenopathy" indicates involved lymph nodes for lung primaries. Should the date of diagnosis be back-dated to the date of the scan?
For cases diagnosed 1998-2003:
No, code the Date of Diagnosis field to the later biopsy date. Note 7 is intended for use in coding the EOD-Extension field, not the Date of Diagnosis field. The earlier scan has a diagnosis of RUL "mass" not a "malignancy" so the fact that there is mediastinal lymphadenopathy mentioned in that scan is not used to help determine date of diagnosis.
EOD-Extension--Cervix: How do you code tumor extension described as "the in situ lesion extends from the cervix to the mucosa of the vagina"? See discussion.
Example: Cone biopsy of cervix and vaginal vault both show ca in situ. The op report stated: "lesion extending from the left lateral portion of the cervix onto the left lateral portion of the vagina." The pathologist stated it "appeared to be an in situ lesion extending from the cervix to the mucosa of the vagina."
For cases diagnosed 1998-2003:
Code the Primary Site to C53.9 [Cervix uteri] and the EOD-Extension filed to 00 [in situ]. In situ is a measurement of invasion. Extension of the cervical in situ carcinoma via the mucosa to the vagina does not affect the EOD extension code.
Terminology/EOD-Clinical Extension--Prostate: Is "firm" a term that implies clinically apparent prostate disease? See discussion.
PE: Prostate firm on DRE
IMP: Rule out prostate cancer
For cases diagnosed between 1998-2003:
Code the EOD-Clinical Extension field to clinically inapparent. The clinically apparent term list classifies "firm" as "maybe" being involved. If a maybe term such as "firm" is the only description available, code as clinically inapparent.
EOD-Extension--Bladder: Both papillary transitional cell ca in situ and sessile (flat) transitional cell ca in situ are diagnosed simultaneously in the bladder. We code the higher histology (8130/2). For extension, do we use the code that corresponds to the histology (01), or to the higher extension code (06)?
For cases diagnosed between 1998-2003:
Code the EOD-Extension field to 06 [sessile (flat) (solid) carcinoma in situ], the higher extension code.
Grade, Differentiation--All Sites: Can "Fuhrman nuclear grade" be coded if it is the only grade given for a kidney primary, or is breast the only site for which we can use a nuclear grade in coding the Grade, Differentiation field? See discussion.
Our pathologist consultant disagrees with coding nuclear grade for any site because it is only a component of the grade, in most cases, and is not adequate to use by itself.
If the Fuhrman nuclear grade system can be used by coders, will a conversion table for the system be added to the coding documentation by SEER in the future?
For cases diagnosed 2004 and later: Fuhrman grade can be used to code the Grade, Differentiation field.
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