MP/H Rules/Histology--Melanoma: Regarding SINQ #20081044, when would you apply Rule H6 rather than Rule H5 for a cutaneous malignant melanoma given that you normally always have a specific cell type mentioned?
For cases diagnosed 2007 or later, Rule H6 is used when you do not have a specific cell type other than regressing melanoma, or malignant melanoma, regressing. If you have regressing melanoma with a specific cell type, apply rule H5.
Behavior--Breast: Is a breast biopsy diagnosis of "ductal carcinoma in situ with focal and very early stromal invasion" an invasive tumor with a behavior code 3?
Code the behavior to /3 [malignant, invasive].
"Stromal invasion" means the cancer is invasive. "Stroma" is the supporting connective tissue around and between ducts. It is outside the duct basement membrane. If the tumor cells extend into the stroma, the proper behavior designation for the tumor is invasive.
First Course Treatment: If an "aromatase inhibitor" used as a complement to Tamoxifen is treatment, how should it be coded?
When an aromatase inhibitor is part of the planned first course of therapy, code it under hormone treatment.
When a change of drug is PLANNED, it is part of the same course even if subcategories change. This is the usual situation with Tamoxifen and aromatase inhibitor (for example: Femara). The switch to Femara is planned, so it is not a new course. When a drug change happens that is not planned, it is still the same course if both drugs are in the same category and subcategory. An unplanned drug change to a different subcategory would be a new course.
2004 SEER Manual Errata/Grade--Colon/Bones: Is the term "pleomorphic" used to code tumor grade to 3 for selected primaries?
Delete the row containing the word "pleomorphic" from the tables on pages 93, C-219 and C-411. This correction will be included in the next set of replacement pages for the 2004 SEER manual.
Scope of Regional Lymph Node Surgery/EOD Fields: When a patient has two simultaneously diagnosed primaries, and a regional lymph node dissection intended for one of the primaries removes nodes that are also regional for the other primary, is the information from the lymph node dissection coded for both primaries?
For cases diagnosed 1998-2003:
If the lymph nodes are negative, the status of nodes that are regional for both sites would be used to code the EOD and Site-Specific Surgery fields for both sites.
If any of the lymph nodes are positive use the histology from the lymph nodes to determine how the EOD and Site-Specific Surgery will be coded. For example: If prostate cancer is an incidental finding when a cystoprostatectomy and pelvic lymph node dissection are done to treat a bladder cancer, and all of the positive lymph nodes reflect the histology of the prostate primary (adenocarcinoma), code the nodes as positive for the prostate primary and negative for the bladder primary.
Surgery of Primary Site--Prostate: Is a prostate saturation biopsy coded under diagnostic biopsy or surgery?
A prostate saturation biopsy is a transperineal template-guided stereotactic saturation prostate biopsy that typically produces 30 to 80 core biopsies. This is an alternative biopsy technique used for some high-risk patients including men with persistently elevated PSA, those who have atypia on prior prostate biopsies, or men with biopsies showing high-grade prostate intraepithelial neoplasia (PIN). Although this is a different procedure, it is still a diagnostic biopsy. Do not code prostate saturation biopsy under Surgery of Primary Site.
Date of Diagnosis: How do you code this field when the pathologic confirmation is delayed for 2 months because the clinician decides to "watch and see what happens" to a CT identified mass thought to be either a "metastasis from a previously diagnosed malignancy or a new primary"?
Code the Date of Diagnosis field to the date of the scan. This is the earliest date that a recognized medical practitioner said the patient had cancer. The diagnosis on the CT scan was a malignancy. The only question was whether the mass on the scan was metastatic or a primary.
Histology (Pre-2007)--Breast: What code is used to represent the histology "Ductal carcinoma in situ; 6 mm focus of invasion is a pure mucinous carcinoma that appears to have arisen in the background of encysted papillary carcinoma."
Code to mucinous (8480) since that is the only clearly invasive component of this diagnosis.
According to our pathologist consultant, "Encysted papillary carcinoma is the same thing as intracystic papillry carcinoma, which I think of as an intraductal papillary carcinoma which has greatly expanded the duct to form a cyst-like structure. It generally behaves in an in-situ rather than an invasive fashion. The only clearly invasive component is the mucinous carcinoma, which is what I would code."
Histology (Pre-2007)--Skin: Are "atypical melanocytic hyperplasia" and "severe melanotic dysplasia" synonyms for melanoma in situ?
For tumors diagnosed prior to 2007:
No. SEER determines its reportable list from the ICD-O-3. The above terms are listed as tumor-like lesions and conditions, but are not in situ or malignant.
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.
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