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Report Produced: 07/12/2025 21:19 PM

Report Question ID Question Discussion Answer Year
20021022 Histology (Pre-2007): What code is used to represent the histology "non oat cell carcinoma"?

For tumors diagnosed 2001-2006:

Code the Histology field to 8046/3 [non-small cell carcinoma] if the pathologist does not provide a more specific histologic type. "Non oat cell" is a synonym for "non-small cell."

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.

 2002
20031116

EOD-Size of Primary Tumor: Can the term "filling defect" be used to code tumor size? See Description.

Site: Bladder

CT abd/pelvis: 4 cm filling defect of the bladder encasing jetstream of distal ureter. 2-3 cm lesion may be extension to bladder. KUB: 3-4 cm filling defect within bladder.

Cystoscopy: large bladder tumor with small tumor extending out of the large tumor.

OP Findings: Large tumor on right of bladder extending from bladder neck lateral and posterior

Pathology: TURB: High grade TCC, Grade III with focal lamina propria invasion.

For tumors diagnosed 1998-2003:

Information on size from imaging/radiographic techniques can be used to code size when there is no more specific size information from a pathology or operative report, but it should be taken as low priority, just above a physical exam.

The term "filling defect" from a CT or KUB may be used to code tumor size for bladder in the absence of more reliable size information from path, operative or endoscopic reports.

 2003
20041091 Primary Site/Summary Stage 2000/EOD-Extension--Lymphoma: How are these fields coded when a CT Impression states: Large retroperitoneal/abdominal mass resulting in extra-hepatic biliary obstruction & bilateral urinary tract obstruction & encasement of major vessels most c/w lymphoma? See Discussion.

CT findings state: Very lg sft tiss mass encasing pancreatic head & portion of body, splenic & portal veins, celiac axis, sup mesenteric artery & bilateral renal veins. Two components to this mass: 1) retroperitoneal mass encasing great vessels and 2) peritoneal component 10.8cm size, displaces bowel & other structures & encases vessels.

If the physician stated "this is bulky disease" would that change the EOD?

For tumors diagnosed 1998-2003:

Based on the information provided:

The topography code for this lymphoma is C772 [Intra-abdominal lymph nodes].

Code SEER Summary Stage 2000 to 5 [Regional NOS].

Code EOD Extension to 20. More than one lymph node region below the diaphragm is involved (retroperitoneal and peritoneal). The organs mentioned are not involved by the lymphoma. The bulk of the masses is causing obstruction by displacing and/or encasing organs.

A physician description of "bulky disease" would not change the EOD for this case.

 2004
20021143 Multiple Primaries (Pre-2007)--Breast: Should just one primary be reported when only ductal carcinoma in situ is diagnosed initially but the mastectomy performed as part of the first course of cancer-directed therapy, but more than 2 months after diagnosis, contains a diagnosis of invasive ductal carcinoma? See discussion. How do we code this case in light of the EOD guideline that states we include all information collected within 4 months of diagnosis or through the completion of first surgery in the absence of disease progression when coding.

For tumors diagnosed 1998-2003:

Report this case as one invasive primary, unless stated to be two primaries by the clinician. This appears to be a single primary with different behaviors, rather than separate tumors.

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.

 2002
20031015 EOD-Extension--Lymphoma: How is the following guideline of "any mention of lymph nodes is considered indicative of involvement" applied for EOD-Extension of lymphoma cases when there is a discrepancy between physicians as to the stage at diagnosis? See discussion. A biopsy of mesenteric nodes confirmed lymphoma. A bone marrow biopsy was negative. A CT of the chest indicates "small mediastinal and bilateral hilar nodes, but without convincing adenopathy." The case was Stage 2 per the oncologist and Stage 3 per the surgeon's TNM form.

For tumors diagnosed 1998-2003:

Based on the information provided for this example, the lymphoma involves one site, mesenteric nodes. Code EOD extension as 10 [Involvement of a single lymph node region].

The statement "For lymphomas, any mention of lymph nodes is indicative of involvement" refers to the terms in the paragraph above it on page 8 of the EOD manual: Palpable, enlarged, visible swelling, shotty, lymphadenopathy. While these terms are ignored for other malignancies, they should not be ignored for lymphomas. None of these terms apply to the example provided here. According to the CT, the mediastinal and hilar nodes are "small" "without convincing adenopathy." In other words, the mediastinal and hilar nodes are negative.

 2003
20000547 Histology (Pre-2007): What code is used to represent the histology "non-small cell carcinoma, NOS"? See discussion. Should a non-small cell carcinoma histology be assumed to be a large cell carcinoma [8031/3] or should the histology be coded to carcinoma, NOS [8010/3]?

For tumor diagnosed 2001-2006: Code the Histology field to 8046/3 [non-small cell 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.

 2000
20210072

Hormone Therapy--Breast:  How are hormone therapy (HT) and other related data items coded when a patient had a previous breast primary and is still on HT when diagnosed with a new breast primary? See Discussion.

In this scenario, we record that HT began for the second primary on the date of diagnosis, and the Systemic/Surgery Sequence ends up usually being coded 4 because the HT continues even if the specific agent may be changed. This does not seem to meet the definition of neoadjuvant therapy for the second primary so we approach the staging and grade coding as just clinical/pathological? For example, if the tumor size at surgery is a little larger than estimated on imaging, we would use the pathologic size for our staging. The tumor size and grade of the second primary are not being changed by the ongoing HT. Do we have the right approach?

For this example: 1. Code HT as treatment on the date of diagnosis for the second primary. 2. Code Systemic/Surgery Sequence as 4. 3. Do not code neoadjuvant data items as neoadjuvant started/completed. The HT given would not qualify for neoadjuvant therapy since the intent of the HT was not neoadjuvant. The HT would affect the second primary, but it is still not neoadjuvant. 4. Code clinical and pathological tumor size accordingly, based on the imaging and the pathological findings. 5. Code Extent of Disease data items based on the pathological findings since pathological findings take priority over clinical and this is not neoadjuvant therapy.

 2021
20200039

EOD 2018/Summary Stage 2018--GIST: How should Extent of Disease (EOD) and Summary Stage be coded for a multifocal gastrointestinal stromal tumor (GIST)? See Discussion.

Example: Patient is found to have a 9.4 cm GIST in the jejunum and 2 cm GIST in the stomach during resection, neither stated to be outright malignant. Similar to the instruction in SINQ 20190041, this case is coded as a malignant jejunal primary due to multifocal tumor. However, it is unclear how to account for the stomach tumor, or any other multifocal tumor for GIST, when coding EOD and Summary Stage.

For this case, report each GIST diagnosis separately. This differs from SINQ 20190041 because in that case the stomach GIST was incidental and measured only 0.3 cm. Reporting these separately means that each one is no longer a multifocal tumor. If there is no other indication of malignancy for these, they would not be reportable if diagnosed in 2020 or earlier.

For cases diagnosed 2021 or later, all GIST are reportable. Report this as two primaries. Use the new GIST schema for EOD and assign EOD Primary Tumor 100 for each. There is no mention of extension outside the primary site. Summary Stage is Localized for each.

 2020
20091055 Date therapy initiated/Systemic/Surgery Sequence--Breast: How are these fields coded when a patient has chemotherapy after a sentinel lymph node biopsy and has a lumpectomy after completing chemotherapy? See Discussion. On 4-10-08 a patient underwent sentinel lymph node biopsies. This was followed by chemotherapy which started on 4-15-08. The patient subsequently underwent a lumpectomy on 11-10-2008.

For this case, code Date Therapy Initiated to the date of the sentinel lymph node biopsy [04102008]. Assign code 3 [Systemic therapy after surgery] in Systemic/Surgery Sequence.

2009
20091079 Primary site--Bladder: What is the correct subsite for "interureteric ridge"? See Discussion. Description: 4 mm nodule at base of bladder near interureteric ridge.

For this case, assign code C670 [Trigone of bladder]. The description for this case states that the tumor location is the base of the bladder. Base is a synonym for trigone.

The interureteric ridge (or interureteric crest, or interureteric fold) is a fold of mucous membrane extending accross the bladder between the two ureteric orifices. The trigone is located below the interureteric ridge.

 2009