CS Extension--Lung: How is this field coded for a tumor in the right middle lobe with extension to the bronchus intermedius?
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 CS extension code 20
[Extension from other parts of lung to main stem bronchus, NOS
(EXCLUDES superficial tumor as described in code 11)
Tumor involving main stem bronchus greater than or equal to 2.0 cm from carina (primary in lung or main stem bronchus)].
A right middle lobe tumor that extends to the bronchus intermedius is one that is extending to the main stem bronchus from another part of the lung. The bronchus intermedius is the lower part of the main stem bronchus on the right. It is more than 2.0 cm away from the carina.
Reason for No Cancer-Directed Surgery--Lung: How do you code this field for a lung primary that presents with metastasis to the bone and brain in which the oncologist's treatment plan includes only radiation and chemotherapy?
Code the Reason for No Cancer-Directed Surgery field to 1 [Cancer-Directed Surgery Not Recommended].
CS Lymph Nodes--Colon: Are positive paracecal lymph nodes for cecal primaries coded to 10 [paracolic] or code 20 [cecal: anterior (prececal), posterior (retrocecal); NOS]?
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 code 20 [Regional lymph node(s) for specific subsites]. Paracecal means near the cecum. Paracecal lymph nodes are regional nodes for the cecum and not for other colon subsites.
Reportability/Histology--Pituitary Gland: How are Rathke cleft cyst and Rathke pouch tumor distinguished and are they both reportable?
Rathke cleft cyst is not reportable. Cysts are not neoplastic. However, Rathke pouch tumor (C751, 9350/1) is a reportable neoplasm for cases diagnosed 2004 and later. The Rathke pouch is coded to the pituitary gland. Benign and borderline pituitary tumors have been reportable since 2004.
EOD 2018/EOD Primary Tumor--Melanoma: The code and level translations in the Note 4 of Extent of Disease (EOD) Primary Tumor for Melanoma Skin seem incorrect. Please advise.
* Code 000: In situ
* Code 100: Level I (should be level II) (< 0.75 mm Breslow's Depth)
* Code 200: Level II (should be level III) (0.76 mm to 1.50 mm Breslow's Depth)
* Code 300: Level III (should be level IV) (> 1.50 mm Breslow's Depth)
Please see the corrected levels below for the note. Note 4: If a Breslow's depth is given in the pathology report and there is no other indication of involvement, the following guidelines may be used (Note: If a physician documents a different Clark's Level than provided by these guidelines, go with the physician's Clark Level)
Code 000: Level I (In situ)
Code 100: Level II (< 0.75 mm Breslow's Depth)
Code 200: Level III (0.76 mm to 1.50 mm Breslow's Depth)
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.
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is diagnosed with small lymphocytic lymphoma in 1996, received chemotherapy on and off for 15 years due to relapses, and was subsequently diagnosed with diffuse large B-cell lymphoma in 2012?
Per Rule M10, this case should be accessioned as two primaries. According to Rule M10, one is to abstract as multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm AND there is a second diagnosis of an acute neoplasm more than 21 days after the chronic diagnosis.
The histology for the 1996 chronic neoplasm is coded to 9670/3 [small lymphocytic lymphoma]. The histology for the 2012 acute neoplasm is 9680/3 [diffuse large B-cell lymphoma].
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Laterality: Why is a code 5 for laterality midline only allowed for certain sites of brain and skin? I have a nasal cavity tumor and the path report specifically says "Tumor laterality: midline". What is the correct laterality code here?
Assign laterality code 9 for midline nasal cavity tumor. We will investigate this issue further.
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned for a patient with a history of CLL undergoing chemotherapy who is subsequently diagnosed on a liver biopsy with diffuse large B-cell lymphoma (Richter transformation)?
Abstract the diffuse large B-cell lymphoma (Richter transformation) as a second primary per Rule M10. Rule M10 states to abstract as multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm (CLL) AND there is a second diagnosis of an acute neoplasm (the diffuse large B-cell lymphoma (Richter transformation)) more than 21 days after the chronic diagnosis.
"Richter transformation," also known as "Richter syndrome," is a term that indicates CLL has transformed to DLBCL. Richter syndrome is listed under the Alternate Names section in the Heme DB for DLBCL (9680/3).
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Primary Site--Lymphoma: How should this field be coded when a diffuse large B-cell lymphoma is found in the femur and in the soft tissue of the anterior chest wall but all CT scans are negative for lymphadenopathy?
For cases diagnosed prior to 1/1/2010:Code the Primary Site field to C809 [Unknown primary site]. The primary site of diffuse large B cell lymphoma can be either nodal or extranodal. The case described above is likely extranodal because there is no evidence of lymph node involvement. Because the extranodal site of origin is unknown, code the Primary Site to C809.
For cases diagnosed 2010 forward, 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.
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