Surgery of Primary Site--Breast: Should code 51 (Modified radical mastectomy without removal of uninvolved contralateral breast) be used when a patient has excisional biopsy (22) and axillary dissection followed by a simple mastectomy without removal of uninvolved contralateral breast (41) as part of the first course of treatment?
Assign code 51 or 52 if a patient has an excisional biopsy and axillary dissection followed by a simple mastectomy during the first course of therapy. Code the cumulative result of the surgeries, which is a modified radical mastectomy in this case.
SEER collects only one surgery code per case. Code the most invasive, extensive or definitive surgery in Surgery of Primary Site.
Histology--Corpus uteri: Because coding a pathology final diagnosis of "serous carcinoma" for an endometrial primary to 8441/3 triggers the site/histology error in the SEER Edits, should histology be coded to 8010/3 [Carcinoma, NOS] instead?
Assign histology code 8441 [serous carcinoma] and override the edit. Endometrium with serous carcinoma is NOT one of the "impossible" site / histology combinations.
CS Eval/Surgery of Primary Site--Colon: When the only procedure performed is a polypectomy, if there is NO tumor at the margins, should CS TS/EXT-Eval be coded as 3 and the surgery coded as a polypectomy?
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.Assign eval code 3. A polypectomy with no tumor at the margin meets the criteria for pathologic staging.
Code polypectomy in Surgery of Primary site in this case.
Reporting Source: If the only patient record available for a physician office biopsy is the pathology report identified from a freestanding laboratory, is reporting source coded to 3 [Laboratory Only (hospital-affiliated or independent)] or 4 [Physicians office/Private Medical Practitioner (LMD)]? See Discussion.
A case was identified through a pathology report from a freestanding lab. The doctor who submitted the specimen left the state. His records cannot be located. Because the patient had the specimen removed at a physician's office, not at a path lab, is Type of Reporting Source field coded to the physicians office?
Reporting Source is the source that provided the best information used to abstract the case.
For this case, assign code 3 [Laboratory Only (hospital-affiliated or independent)]. Reporting source should reflect the lab where this case was identified. The MD office added nothing to the case, not even a confirmation of malignancy.
MP/H Rules--Lung: Why the term "nodule" is not included as an equivalent term along with tumor, mass, lesion and neoplasm in the 2007 lung multiple primary rules?
Answer revised July 2008
For cases diagnosed 2007 or later:
For the purpose of applying the Lung MP/H rules, the word "Nodule" can be used interchageably with "Tumor," "Mass," "Lesion" and "Neoplasm." HOWEVER, this does NOT apply to casefinding or staging.
This revision will be added to the next version of the MP/H rules. Sinq question 20071028 will be revised.
Primary Site: For malignant gastrointestinal tumors (GISTs), how should the primary site be coded and which Collaborative Stage and TNM staging schemes should be used for disease found in the stomach, small intestine or other locations?
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 the primary site to the location where the GIST originated. If the primary site cannot be determined, assign code C809 [Unknown primary site].
GIST of gastrointestinal hollow viscera cannot be staged in TNM.
In Collaborative Staging, use the stomach scheme for GIST of the stomach. Use the small intestine scheme for GIST of the small intestine. For GIST of other primary sites, use the CS scheme for the specific site.
Systemic/Surgery Sequence--Breast: How is this field coded for a breast cancer patient treated with a lumpectomy followed by chemotherapy and then a mastectomy?
Assign code 2 [Systemic therapy before surgery]. The code in Systemic Treatment/Surgery Sequence is related to the surgery coded in Surgery of Primary Site. For SEER, the mastectomy will be coded in the surgery field. The chemotherapy occurred before the mastectomy.
EOD-Pathologic Extension--Prostate: When coding a prostate case with a date of diagnosis prior to 1995, is the EOD-Pathologic Extension-Prostate field left blank?
For tumors diagnosed prior to 1995, leave EOD-Pathologic Extension--Prostate field blank.
Code all EOD fields according to the EOD coding scheme in effect for that year of diagnosis.
Scope of Regional Lymph Node Surgery/CS Reg LN Pos/Exam: How are these fields coded if the operative report does not mention a separate lymph node procedure at the time of the surgery to the primary site? See Discussion.
LUL lobectomy: 1.7 cm apical tumor, diagnosis: moderately well differentiated subpleural squamous cell carcinoma, with involvement of pleural surface. 3 peribronchial LN neg and 2 AP window LNs neg. Stage T2N0.
1. No lymph node dissection or sampling was stated to be done
2. The lobectomy specimen contained the LNs
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 the Scope of Regional LN Surgery, Regional Nodes Positive and Regional Nodes Examined fields using the available information on the case. The lymph nodes can be obtained or biopsied during any procedure within the first course of treatment. A separate lymph node surgery is not required to complete these data items.
CS Extension/CS Lymph Nodes--Lung: How are these fields coded if a lobectomy path specimen indicates that two intrapulmonary lymph nodes are involved by direct extension from the primary tumor?
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 regional lymph node involvement in CS lymph nodes even when the lymph nodes are involved by direct extension. Do not code direct extension to lymph nodes in CS extension.
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