First course treatment--Prostate: If a patient has a prostatectomy and the margins are positive, then several months later radiation is given because the PSA levels never decreased or have risen, is the radiation coded as first course of treatment or subsequent treatment?
Record the radiation as first course of treatment even though it was delayed for several months.
Radiation is highly effective when there is a small or microscopic amount of tissue left at the margin following prostatectomy. In most regions, radiation therapy is the standard of care for positive margins at prostatectomy.
Surgery of Primary Site/CS Reg LN Exam/Scope Regional LN Surgery--Rectum: How are these fields coded when a patient develops a non-tumor related complication that requires an additional sigmoid resection that removes 2 additional lymph nodes one week following a low anterior resection that removed 4 lymph nodes? See Discussion.
Patient had a low-lying rectal cancer that was biopsied and then treated with radiation and chemo followed by a low anterior resection. Four nodes were removed. There was no residual tumor. The patient returned one week later due to a rectal bleed, thought to be an abscess. During surgical exploration it was found that the anastomosis had broken down and it was decided to do a sigmoid colectomy. Residual disease was not suspected. Two additional nodes were removed.
Surgery of primary site: Assign code 30 [low anterior resection]. Code the most extensive surgery (i.e. the highest surgery code) applicable.
CS Reg LN Exam: Code 04 [four nodes removed].
Scope of regional lymph node surgery: Code 5 [4 or more regional lymph nodes removed].
The sigmoid colectomy was performed for a surgical complication, thus it was not cancer-directed therapy. The regional lymph nodes removed during that procedure were not removed to diagnose cancer or stage the disease, and they were not removed during the initial treatment. Please see SEER manual for instructions for coding Regional Lymph Node Surgery.
Reportability/Diagnostic Confirmation: If a physician signs a case out as "precancerous melanosis of the face" (8741/2) and there is no microscopic confirmation of the disease, is this a reportable clinical diagnosis?
This case is reportable because the diagnosis of precancerous melanosis was stated by a recognized medical practitioner. Precancerous melanosis meets the reportable diagnosis criteria (See 2007 SEER Manual page 1).
Surgery of Primary Site--Breast: How is this field coded when a re-excision follows a prior mastectomy?
Code the most extensive surgery in Surgery of Primary Site. This is a cumulative field. Assign the appropriate code including all surgeries of the primary site performed during the first course of treatment.
The correct code for mastectomy followed by re-excision will depend on the extent of the re-excision. For example, if the re-excision removed muscle, code radical mastectomy.
CS Extension--Lung: How is "subpleural extension" coded?
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.Subpleural extension means that the tumor extends to the subpleural space, but the pleura itself is not involved. Assign the appropriate extension code based on the other facts for the case. Do not code pleural involvement.
Multiplicity Counter: Is there a time frame for the Multiplicity Counter or is it related to the duration for counting new tumors (i.e. 5 years for breast, etc) to capture the number of "local recurrences"?
Record the number of tumors counted as a single primary at the time the case is abstracted. Later, if additional tumors are determined to be the same primary, update this field once. Do not update the multiplicity counter more than once.
Histology/Behavior--Brain and CNS: How are these fields coded for an "anaplastic glioneuronal neoplasm with spongioblastic architecture"? See Discussion.
Scenario: Addendum from Mayo Clinic review, IHC and consultation made dx of "anaplastic glioneuronal neoplasm with spongioblastic architecture". The original micro states 'high grade glial neoplasm w/o characteristic features of glioblastoma multiforme in that it lacks areas of significant necrosis, no nuclear palisading nor endothelial vascular proliferation...."
The best code available according to our pathologist consultant is 9505/3 [Ganglioglioma, anaplastic]. According to our consultant, while ganglioglioma is traditionally a benign tumor, anaplastic ganglioglioma is classified as malignant by WHO (page 103), and comes as close to fitting the description of this tumor as any other term.
First course treatment/Histology--Lymphoma: What treatment, if any, is coded for a patient with methotrexate induced lymphoma when the treatment plan is to take the patient off methotrexate? Also, is there a specific histology for drug induced lymphoma? See Discussion.
Diffuse Large B-cell Lymphoma of soft palate & nasal septum, methotrexate induced, in 5/07. Patient was taken off methotrexate with complete resolution of disease. No other treatment was given. Patient was on methotrexate for treatment of rheumatoid arthritis.
For cases diagnosed prior to 1/1/2010:Treatment: Code the treatment fields to 00 [not done] in this case.
Document the discontinuation of methotrexate for rheumatoid arthritis in a text field.
Histology: Assign code 9680/36 [Malignant lymphoma, large B-cell, diffuse, NOS]. There is no specific histology code for therapy-related lymphoma.
For cases diagnosed 1/1/10 and later, 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.
Reportability--Brain and CNS: For von Hippel Lindau disease with multiple hemagioblastomas, is each hemangioblastoma reportable as a new primary? See Discussion.
Diagnosis of von Hippel-Landau disease, multiple brain surgeries between 2002 and 2007 for recurring hemangioblastomas, 9161/1. This disease manifests as multiple (recurring) hemangioblastomas.
For cases diagnosed 2007-2014:
If the hemagioblastomas occur in sites with different ICD-O-3 topography codes, they are separate primaries.
Please note: Rule M4 in the Benign & Borderline Intracranial and CNS Tumors MP/H coding rules on the SEER website has been corrected to read:
Primary site: What is the correct primary site code for angiosarcoma of the spleen with mets to bone marrow C42.2 vs C49x? See Discussion.
Robbins Pathology states the following about liver angiosarcomas: Hepatic angiosarcomas are rare but of interest because they are associated with distinct carcinogens, including arsenic (exposure to arsenical pesticides), Thorocast (a radioactive contrast medium previously widely used in radiology), and polyvinyl chloride (PVC) (widely used in plastics). The increased frequency of angiosarcomas among works in the PVC industry is one of the truly well-documented instances of chemical carcinogenesis in humans. With all these agents, there is a very long latent period of many years between exposure and the development of tumors.
Could the same apply to the spleen?
Code C422 [Spleen] as the primary site for angiosarcoma of spleen with metastasis to bone marrow.
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