Primary Site: What code should be used to represent the site for an "extraovarian" papillary serous adenocarcinoma located in the "rectal muscle sheath"? See discussion.
The location of the tumor in the rectus muscle sheath is unusual and suggests an origin within a preexisting mullerian.
Code the Primary Site field to C49.4 [connective, subcutaneous and other soft tissues of the abdomen].
EOD-Lymph Nodes--Lung: What code is used to represent this field when the only information is a description of:
1. "hilar mass"
2. "mediastinal mass"
3. "enlarged" or "greater than 1 cm" used to describe any of the lymph nodes listed under code 2 in the EOD Lymph Nodes field?
For cases diagnosed 1998-2003:
Code EOD-Lymph Nodes fields as follows for the examples given:
1) 9 [Unknown; not stated] for a "hilar mass"
2) 2 [Mediastinal] for a "mediastinal mass"
3) 2 [Mediastinal] for "enlarged" or "greater than 1 cm," if used to describe any of the named lymph nodes listed under code 2 in the EOD-Lymph Nodes field.
Primary Site--Esophagus: What is the difference between C15.5 [Lower third of esophagus] and C15.2 [Abdominal esophagus]?
These descriptions represent the use of two different ways the esophagus can be divided anatomically. The two different systems used are illustrated in the SEER Self Instruction Manual for Tumor Registrars: Book 4. Assign the primary site code that describes the location of the tumor in the same way the tumor's location is described in the medical record.
Other Therapy: What code is used to represent "gene" therapy? See discussion.
The following form of gene therapy has been described as treatment for malignant brain tumors.
Patients undergo surgery to remove as much of the tumor as possible. After surgery, the patients are infused with a virus that has been genetically altered so that it is not infectious and so that it contains a gene from the herpes simplex virus. The herpes gene is sensitive to a drug called ganciclovir. Once inside the brain, the genetically altered virus infects any remaining tumor cells. When this occurs, the herpes gene is established inside the cancer cells. After the virus infects the cancer cells, the patients are given ganciclovir. This drug would kill both the virus and the brain tumor cells.
Code the Other Cancer-Directed Therapy field to 2 [Other experimental cancer-directed therapy (not included elsewhere)].
EOD-Extension--Cervix: Should this field be coded to 11 [minimal microscopic stromal invasion] or 12 [microinvasion] when there is only a statement of "microinvasion" but no measurements describing the level of involvement given?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 12 [microinvasion] when there are no depth of invasion measurements given.
Code the EOD-Extension field to 11 [minimal microscopic stromal invasion] when there is a statement of "minimal STROMAL invasion."
EOD-Extension--Lung: Should the phrase "some pleural fluid in both posterior gutters" be interpreted as pleural effusion for lung primaries? See discussion.
CT scan: "3 cm mass left upper lobe of lung. Some pleural fluid in both posterior gutters. Large matted hilar lymph nodes, left. Some narrowing left upper bronchus by this adenopathy. Squamous cell ca lung with mets to left hilar lymph nodes, most likely possibility." Would you code extension to 72 [malignant pleural effusion; pleural effusion, NOS]?
For cases diagnosed 1998-2003:
Yes. Code the EOD-Extension field to 72 [malignant pleural effusion, pleural effusion, NOS]. Pleural effusion is mentioned as being present.
Grade, Differentiation--Brain and CNS: Can grade IV be implied for brain primaries with the histology of glioblastoma multiforme, even if there is no statement of grade in the path report? See discussion.
Dr. Platz has instructed the Iowa registry to code glioblastoma multiforme to grade IV, even when there is no corroborating statement of grade in the path report. This is also supported in some references.
Code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable] in the absence of a stated grade on the pathology report. If a grade is stated, code the stated grade. SEER does not recommend adopting the rule in the Discussion.
Place of Birth: When there is conflicting information, which record takes precedence in coding this field, the medical record or the death certificate?
If there is a discrepancy, use the information from the medical record to code the Place of Birth field. The information from the medical record is provided by the patient, the information on the death certificate is provided by others. If the medical record does not contain birth information, use the information from the death certificate.
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined/Surgical Procedure of Other Site--Kaposi Sarcoma: How do you code these fields for a groin mass excision containing 4 lymph nodes for a Kaposi sarcoma case that presented with multiple skin lesions?
Code the EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined fields to 99 99 for Kaposi cases that present systemically and for those that present in more than one site (which includes cases with more than one skin subsite involved at diagnosis). There are no "regional" lymph nodes for such cases. This represents a majority of currently diagnosed Kaposi cases. However, for localized Kaposi cases, you can count the number of regional lymph nodes positive and examined if the primary site selected has a regional lymph node chain(s) associated with it (e.g., soft palate, hard palate, or a skin subsite).
For cases diagnosed 1/1/2003 and after: Code the groin mass excision in the Surgical Procedure of Other Site field to 1 [Non-primary surgical procedure performed; Non-primary surgical resection to other site(s), unknown if whether the site(s) is regional or distant].
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