EOD-Size of Primary Tumor--Prostate: When there are multiple nodules in the prostate, can size of tumor be based on the size of the largest nodule? See discussion.
Rectal exam: Prostate enlarged, nodular and irregular. No masses. Pathology from prostatectomy: Focal nodules measuring up to 1.3 cm in diameter. Moderately differentiated adenocarcinoma. Would tumor size be 013 or 999?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 013 [1.3 cm]. Code the size of a mass or nodule only when there is pathologic confirmation of malignancy. In the case you mention, the nodules were pathologically confirmed as cancer, so you would code the size of the largest nodule. If a nodule/or mass in the prostate is confirmed as cancer by needle biopsy, you would code the size of the mass or nodule.
Radiation: Is "consolidated" radiation therapy coded as part of first course therapy when there is no documentation of "planned treatment" and the radiation is done 4 months after the initiation of treatment?
Yes, "consolidation" treatment is part of a planned treatment regimen. A treatment regimen may consist of the four following phases:
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Colon: What codes are used to represent these fields when the pathology from a colon cancer resection describes 2/16 positive pericolonic lymph nodes and a "metastatic nodule in the pericolonic fat"?
For cases diagnosed 1998-2003:
Code the Number of Regional Lymph Nodes Positive field to 03 and the Number of Regional Lymph Nodes Examined field to 17. Each grossly detectable nodule in the pericolonic fat is counted as one regional lymph node.
Other Therapy: What code is used to represent "gene" therapy? See discussion.
The following form of gene therapy has been described as treatment for malignant brain tumors.
Patients undergo surgery to remove as much of the tumor as possible. After surgery, the patients are infused with a virus that has been genetically altered so that it is not infectious and so that it contains a gene from the herpes simplex virus. The herpes gene is sensitive to a drug called ganciclovir. Once inside the brain, the genetically altered virus infects any remaining tumor cells. When this occurs, the herpes gene is established inside the cancer cells. After the virus infects the cancer cells, the patients are given ganciclovir. This drug would kill both the virus and the brain tumor cells.
Code the Other Cancer-Directed Therapy field to 2 [Other experimental cancer-directed therapy (not included elsewhere)].
EOD-Size of Primary Tumor--Prostate: Should the size of tumor be recorded as 001 (focus) or the actual size when both are stated? See Discussion.
The pathology report from a TURP identifies a 3-mm focus of adenocarcinoma.
For cases diagnosed 1998-2003, code the EOD-Size of Primary Tumor field to 003 [3 mm]. The rule that says to code a focus or foci of tumor as 001 was developed for use when no tumor size is given.
EOD-Extension--Lung: Should the phrase "some pleural fluid in both posterior gutters" be interpreted as pleural effusion for lung primaries? See discussion.
CT scan: "3 cm mass left upper lobe of lung. Some pleural fluid in both posterior gutters. Large matted hilar lymph nodes, left. Some narrowing left upper bronchus by this adenopathy. Squamous cell ca lung with mets to left hilar lymph nodes, most likely possibility." Would you code extension to 72 [malignant pleural effusion; pleural effusion, NOS]?
For cases diagnosed 1998-2003:
Yes. Code the EOD-Extension field to 72 [malignant pleural effusion, pleural effusion, NOS]. Pleural effusion is mentioned as being present.
EOD-Extension/SEER Summary Stage 2000--Kidney/Eye: What codes are used to represent these fields for simultaneous bilateral Wilms tumor or simultaneous bilateral retinoblastoma?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis] and the SEER Summary Stage 2000 field to 7 [Distant] for both types of tumor. Each kidney and each eye are staged separately in the AJCC, 6th ed., but for SEER we would abstract these diagnoses as one case and code the EOD and stage fields to distant to reflect the involvement of both eyes or both kidneys.
Primary Site--Lymphoma: How should you code the primary site for a lymphoma that presents with involvement of an extranodal site and regional lymph nodes? See discussion.
1. Lymphoma involves the spleen and the splenic lymph nodes.
2. MALT Lymphoma involves the stomach and the gastric and iliac lymph nodes.
1. Code the Primary Site field to C42.2 [spleen].
2. Code the Primary Site field to C16._ [stomach].
When lymphoma presents in an extranodal site and in the regional lymph nodes for that extranodal site, code the Primary Site field to the extranodal site. The typical disease process is that lymphoma can spread from an extranodal organ to its regional lymph nodes. It cannot metastasize from the regional lymph node to the extranodal organ. The exception to this would be if the lymph nodes presented as one large mass that extended into the regional organ.
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: What codes are used to represent these fields when only a regional lymph node (positive) aspiration is performed?
For cases diagnosed 1998-2003:
With the exception of those sites/histologies that require 99 in these fields, code the Number of Regional Lymph Nodes Positive field to 97 [Positive nodes but number of positive nodes not specified]. Code the Number of Regional Lymph nodes Examined field to 95 [No regional Lymph nodes removed, but aspiration of regional Lymph nodes was performed].
Primary Site--Kaposi Sarcoma: Would the following Kaposi primaries be examples of cases not coded to skin for primary site? See discussion.
1. KS developed initially as a lesion in the oral cavity and followed by the appearance of skin lesions.
2. KS found in a resected parotid gland with metastasis to the parotid gland lymph node. No skin lesions identified.
3. KS discovered in a biopsied 3 cm axillary lymph node. Clinically, the patient had hepatosplenomegaly, ascites, and extensive mesenteric lymph nodes. (No mention of skin.)
Code the Primary Site field as follows:
1. C44.9 [Skin, NOS] as the default value when lesions develop simultaneously in skin and non-skin areas.
2. C07.9 [Parotid gland]
3. C44.9 [Skin, NOS] as the default value when there is no mention of lesions in the skin or other primary site.
Edward Klatt states in Practical AIDS Pathology, "...Visceral Kaposi (involving one or more internal organ sites) is also present in three-fourths of cases, but may not be diagnosed prior to autopsy. Visceral involvement frequently includes the lung, lymph nodes and gastro-intestinal tract."
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