2004 SEER Manual Errata/CS Tumor Size--Can the Determining Descriptive Tumor Size information, on page 6 in the SEER EOD Manual, January 1998, be used to code descriptive tumor size in Collaborative Stage?
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.
Use the instructions in the CS Manual, Appendix 1, page 62. This information will be added to the 2004 SEER manual in the next update.
Do not use the Determining Descriptive Tumor Size information from EOD for CS Tumor Size.
Chemotherapy/Immunotherapy: How do we code Rituxan for Non-Hodgkin Lymphoma and Herceptin for breast cancer? See Discussion.
Page 195 of the SEER Manual 2004 lists these as examples of Immunotherapy. The new SEER*Rx categorizes these as chemotherapy.
(Sinq # 20041025 says to code Avastin and Erbitux as chemotherapy, too.)
Code Rituxan and Herceptin as chemotherapy.
SEER*Rx is effective for cases diagnosed 1-1-2005 and forward. It replaces all previous references. Be sure to use SEER*Rx [http://seer.cancer.gov/tools/seerrx/]
because some agents changed categories when SEER*Rx was deployed.
It is neither required nor recommended that cases treated prior to 2005 be recoded.
CS Tumor Size--Breast: How is this field coded for a 1.5 cm clinically palpable tumor that appeared to be a cyst with a papilloma when the partial mastectomy Path Micro stated the lesion was an "intraductal papilloma with focal noninvasive papillary carcinoma"? See Discussion.
Should the size be coded to 999 [unknown] because the noninvasive papillary carcinoma is described only as "focal" and is not measured and it is not known how much of the tumor is benign and how much is in situ. Or would the size be coded to the size of the palpable mass, 1.5 cm?
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.
Code CS tumor size as 999 [unknown]. Size of the focal noninvasive papillary carcinoma is not stated.
Chemotherapy/Radiation Therapy--Lymphoma: How is treatment coded when Rituxan is given in combination with the monoclonal antibody Zevalin conjugated to 90-Yttrium or the monoclonal antibody Bexxar conjugated to 131-Iodine in the treatment of NHL?
Code Rituxan as chemotherapy. Code 90-Yttrium as radioisotope. Code 131-Iodine as radioisotope when given with Rituxan as treatment for lymphoma.
Zevalin is a monoclonal antibody conjugated to Yttrium 90. Bexxar is a monoclonal antibody conjugated to Iodine 131. In both drugs, the monoclonal antibody is only the delivery agent for the radioisotope. Both drugs should be coded as radioisotopes. The one-two-three punch of Rituxan and zevalin followed by Rituxan and Bexxar should be coded as chemotherapy plus radioisotopes. Zevalin is also used by itself for people who have not responded to Rituxan.
Histology--Lymphoma: How is "histiomonocytic lymphoma" coded?
For cases diagnosed prior to 1/1/2010:Assign code 9755 [Histiocytic sarcoma; True histiocytic lymphoma]. "Histiomonocytic" is not standard terminology, according to our expert consultant. However, 9755 is the best code to assign.
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.
Primary Site/Priorities--Breast: When there are conflicting references to subsite in different reports, which report has priority? See Discussion.
The clinical site of the palpable mass is outer quadrant. The pathologist states inflammatory breast cancer located in the central breast. Should the site be coded to C501 for central breast, C509 for inflammatory breast ca, or C508 for outer quadrant?
Code the breast subsite from the pathology report (C501, central).
The priority order for coding subsite from conflicting reports is
1. Pathology report
2. Operative report
3. Physical examination
4. Mammogram, ultrasound
The primary site of inflammatory breast carcinoma is coded to C509 when there is no palpable tumor.
CS Tumor Size--Bladder: Is tumor size coded to 080 when the bladder mass is described as "greater than 8 cm in diameter"?
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.Based on the information provided above, code CS tumor size 080 [8 cm]. Code the information that is avaliable. Since size of tumor is not used to stage bladder cancer, an approximation is adequate.
Date of Diagnosis--Lung: Should the diagnosis date be coded to the date of the scan or the date of the resection when there is a negative biopsy that occurs between the two procedures? See Discussion.
11/2003 CT chest: 2 cm LLL mass should be considered carcinoma until proven otherwise.
2/2004 CT Chest: stable LLL mass still consistent with primary or metastatic lung neoplasm
11/2004 CT chest: LLL mass suspicious for slow growing carcinoma
3/2005 FNA L lung: atypical cells
4/2005 L lobectomy: well-diff adenocarcinoma
Code the date of diagnosis as 11/2003. A clinical diagnosis was made on 11/2003 and this is the earliest date of diagnosis for this case.
CS Site Specific Factor--Melanoma: What is the correct code for measured thickness in SSF 1 for a melanoma of the choroid without an enucleation? See Discussion.
CS Site Specific Factor 1 for melanoma of the choroid codes "Measured Thickness (Depth), Breslow's Measurement." The note for this field states "Record actual measurement in millimeters from the pathology report." For melanoma of the eye, there is often only an eye exam report stating the thickness. Can PE thickness (clinical statement only) be coded for SSF 1 or is this field coded only from pathology? (i.e., all cases treated without enucleation would have this field coded to 999)
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.
Code SSF 1 999 [Unknown] when there is no enucleation, and therefore, no pathology report for a choroid melanoma.
Primary Site--Sarcoma: What is the correct topography code for a partial lung lobectomy with pathology diagnosis of "pulmonary sarcoma with smooth muscle differentiation"? See Discussion.
Operative report: palpable 2x2cm mass in the mediastinal surface of the rt middle lobe and the contiguous upper lobe together.
Path comment after partial lung lobectomy: In all likelihood this is a malignant process occurring in smooth muscle changes surrounding vessels within the lung versus an undifferentiated epithelial tumor.
ADDENDUM DX: low grade pulmonary sarcoma with smooth muscle differentiation.
Consultant's report concurs with that of the original pathologist's report of malignant neoplasm compatible with smooth muscle origin.
This case is unique. Assign topography code C493 [Connective, subcutaneous and other soft tissue of thorax]. Based on the information provided, this sarcoma has smooth muscle differentiation and originated in the muscle. Code the primary site to muscle.
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