EOD-Extension--Corpus Uteri: How is this field coded for a stage III A endometrial primary with positive pelvic washings, involvement of the omental serosa, and negative lymph nodes?
For cases diagnosed 1998-2003: Code EOD-extension as 85 [Metastasis]. According to our TNM consultant, Omental metastasis is M1, Stage IVB [EOD 85].
EOD-Lymph Nodes--Colon: Are deposits of carcinoma in the pericolic fat still coded as lymph nodes when the pathology report states, "there is a high likelihood that these represent foci of venous invasion"? See Description.
Patient underwent resection for adenocarcinoma of the rectum. Path final diagnosis stated: "Regional lymph nodes: met carcinoma in 18 of
43 lymph nodes. Pathologic stage (AJCC/UICC 6th edition): pT3, V2, pN2, pMx. See comment." Path comment: "There are additional macroscopic stellate deposits of carcinoma in the pericolic soft tissue. According to the 6th edition of the AJCC staging manual, these should be designated as "V2," indicating that there is a high likelihood that these represent foci of venous invasion."
For cases diagnosed 1998-2003: Each grossly detectable nodule in the pericolonic fat is counted as one regional lymph node.
When the number of deposits is not mentioned, code Number of Regional Nodes Positive as 97 [Positive nodes but number of positive nodes not specified]. Unless the procedure is documented as a dissection, code Number of Regional Nodes Examined as 98 [Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not documented as samping or dissection; nodes examined, but number unknown].
EOD-Clinical Extension--Prostate: How is this field coded when biopsies of the prostatic apex are positive and the physician clinically stages the case as T1c?
For cases diagnosed 1998-2003:
Code clinical extension to 33 [arising in the prostatic apex] when a biopsy of the prostatic apex is positive for malignancy, with no further evidence of involvement. If biopsies of both the apex and another site within the prostate (for example right lobe) are positive and there is no mention that the malignancy arose in the apex, code extension to 34 [extending into the prostatic apex].
EOD-Extension--Corpus uteri: How should EOD extension be coded when the pathology report shows adenocarcinoma arising in the endometrium with the statement "no invasive carcinoma identified?"
For cases diagnosed 1998-2003: Code endometrial cancer with no invasion to EOD extension code 11 [Confined to endometrium (stroma)]. "No invasion" most likely means no invasion of the myometrium.
EOD-Size of Primary Tumor: Can size be coded from a needle bx that removes all of the invasive tumor and just leaves a "focus of in situ"? See Description.
For example: needle bx diagnosis is "tiny focus of tissue highly suspicious for tubular ca." The lumpectomy path states "single focus of low grade DCIS, no residual ductal ca." Can size be coded 001?
Code tumor size to 001 [Microscopic focus or foci only] for the invasive component. Code the tumor size 990 for cases diagnosed in 2004 and forward. Disregard the microscopic tumor found at further resection.
EOD-Clinical Extension--Liver: How do the segments of the liver described by AJCC Manual correspond to the lobes of the liver described by the SEER EOD Manual? See Description.
CT described hepatocellular ca involvement of the liver with nodules identified in segments 5 and 7. Would EOD-extension be coded to 30 [multiple tumors (one lobe)]?
Segments 2, 3, and 4 correspond to the left lobe of the liver. Segments 5, 6, 7 and 8 correspond to the right lobe of the liver. Segment 1 is the caudate lobe, which has completely different drainage and vascularization, is separate from the larger right and left lobes.
For cases diagnosed 1998-2003: Since segments 5 and 7 are both in the right lobe, assign EOD-extension code 30 for the case above, unless there is mention of vascular invasion. Be sure to record the size of the largest primary tumor.
Tumor size and vascular invasion are the most important factors for AJCC 6th edition staging.
Surgery of Primary Site--Skin: Should this field be coded to 45 [wide excision or reexcision of lesion or minor (local) amputation with margins more than 1 cm, NOS], 46 [with margins between 1 and 2 cm], or 47 [with margins greater than 2 cm] for a skin primary diagnosed in 2003 when margins are stated exactly as 2 cm?
Use code 46 [Wide excision...with margins more than 1 cm and less than 2 cm] when margins are exactly 2 cm.
Histology (Pre-2007): Is a small cell undifferentiated carcinoma coded to 8041/34 [small cell carcinoma undifferentiated] or to 8045/34 [combination small cell AND undifferentiated carcinoma] using terms from the 2 columns in Appendix 1 of Coding Complex Morphologic Diagnoses? See discussion.
Per pathology report, diagnosis is small cell undifferentiated carcinoma in biopsies taken from the laryngeal surface of the epiglottis and left false vocal cord.
For tumors diagnosed prior to 2007:
Code histology as 8041/34 [small cell carcinoma, undifferentiated]. The diagnosis indicates that this is an undifferentiated small cell carcinoma, rather than a mixture of small cell carcinoma with undifferentiated carcinoma.
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.
EOD Extension--Lung: Do we ignore pericardial effusion seen on a CXR if a subsequent lobectomy reveals only a localized tumor? See discussion.
Note 6 in the lung EOD scheme instructs us to assume that a pleural effusion is negative if a resection is done. Does this also apply to a pericardial effusion? For example, if a pericardial effusion is seen on CXR, and a subsequent lobectomy reveals only a localized tumor, should the effusion be ignored?
For cases diagnosed 1998-2003: Ignore pericardial effusion which is negative for tumor. Assume that a pericardial effusion is negative if a resection is done and the tumor is pathologically confirmed to be localized.
Hormone Therapy--Hematopoietic, NOS: Is hormonal therapy coded for myelodysplastic syndrome, NOS? See Description.
Patient with myelodysplastic syndrome refused chemotherapy and was treated with high dose steroids. Patient also received Rituxan.
Hormones, such as glucocorticoids and androgens, are generally of little if any benefit to patients with myelodysplastic syndrome, according to the NCI PDQ. Do not code steroids as treatment in the example above.
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