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20031024 | Surgical Fields--Head & Neck: How does one code the removal of benign submandibular and sublingual glands performed during a neck dissection for a head and neck cancer? See discussion. | Should the removal be coded as incidental in the surgical Procedure if the Other Site field? Does it make a difference if the submandibular gland is removed en toto with lymph nodes or if the gland is submitted as a separate specimen? Does it make a difference if the glands are involved? | Removal of the lower salivary glands is part of a radical neck dissection and is not recorded in Surgery of Primary Site or Surgery of Other Site. Radical neck dissection is coded under "Scope of Regional Lymph Node Surgery." It does not matter whether or not the gland is submitted as a separate specimen. It does not matter whether or not the gland is involved. |
2003 |
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20061137 | Reportability/Grade, Differentiation: Does the term "grade 0" refer to differentiation or does its use as a modifying phrase in the final diagnosis of "grade 0 immature teratoma" impact reportability? |
Regarding the term "grade 0" for an immature teratoma, determine whether the pathologist is using that term to describe the primary tumor or its implants. The term can be used to describe both situations. An immature teratoma (IT) may have grade 0 (benign) implants. Grade 0 implants may affect the prognosis and treatment, but the primary tumor (IT) would still be malignant and therefore reportable. If grade 0 pertains to the primary tumor (as opposed to implants) it is benign, and therefore not reportable. |
2006 | |
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20081047 | Reason no surgery of primary site/First course treatment: If the Reason no Surgery of Primary Site field is coded as 7 (refused), must the other treatment options (radiation, chemo, hormone) also be coded as 7? See Discussion. | Coding instruction #5 in the SEER manual states: "Assign code 7 (refused) if the patient refused recommended surgery or made a blanket statement that he/she refused all treatment." | Refused [code 7] means this modality was specifically recommended by the physician and the patient refused. If two treatment alternatives were offered and surgery was refused, code Reason no surgery of primary site 1 [Surgery of the primary site was not performed because it was not part of the planned first-course treatment]. Refusal of surgery does not necessarily mean that all treatment was refused. Coding Surgery of Primary Site as "refused" does not affect the coding of Radiation, Chemotherapy, Hormone Therapy, etc. |
2008 |
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20250020 | Solid Tumor Rules/Histology--Vulva: Can instructions and descriptions from registry manuals be used to determine p16 status for the human papillomavirus (HPV)-related histology codes in the Solid Tumor Rules (STR)? Does it have to state that p16 is “positive” or “over-expressed” only? See Discussion. |
The STR states that p16 can be used to code HPV-associated and HPV-independent histologies for selected sites depending on diagnosis year but contains no instructions about how to interpret p16 staining results on pathology reports. These are often stated in various ways in our area, depending on the pathology lab and different pathologists. The SSDI Manual and SEER Coding and Staging Manual each have some instructions and code definitions for p16, including: - Code 0 for p16 expression of weak intensity or limited distribution - Code 0: p16 Negative; Nonreactive - Code 1: p16 Positive; Diffuse, Strong reactivity - IHC for p16 expression is a surrogate marker for HPV infection Example: 2023 squamous cell carcinoma of the vulva, partial vulvectomy; pathology states vulvar intraepithelial neoplasia-3, p16 immunohistochemistry demonstrates block-like expression, which supports the diagnosis. The next path report states invasive squamous cell carcinoma, stain for p16 is strong and diffuse in the lesion, supporting the above diagnosis. Neither path report specifically states "HPV-related," so are p16 "expression" and "strong and diffuse" staining enough to code the histology as 8085/3 for this case? |
Refer to the College of American Pathologists (CAP) protocols to determine how to interpret p16 staining results on pathology reports. Per the Vulva CAP Protocol, p16 positive is defined as diffuse or block-like expression. Since the pathology report states "block-like expression," code the histology as 8085/3 (invasive squamous cell carcinoma, HPV-associated). |
2025 |
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20081013 | 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. |
2008 | |
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20110088 | Chemotherapy/Neoadjuvant treatment: Should neoadjuvant chemotherapy be coded for an incidental second primary discovered at the time of surgery? If so, how is the diagnosis date coded? See Discussion. |
The patient had neoadjuvant chemotherapy for rectal carcinoma. An AP resection revealed an incidental second primary intramucosal carcinoma in adenomatous polyp in the descending colon. Is the chemotherapy coded as therapy for the intramucosal carcinoma of the descending colon? |
Record the neoadjuvant therapy only for the first primary and do not record the neoadjuvant therapy for the incidental new primary found on surgery. |
2011 |
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20160042 | First course treatment/Date 1st surgical procedure--Colon: Should the date of a polypectomy be recorded in the Date of First Surgical Procedure field when the entire tumor is not removed by polypectomy? See Discussion. |
The patient underwent a polypectomy. The endoscopy report noted the "single piece polypectomy" only partially removed the polyp/mass as the remainder of the mass was more fixed to the wall. The margins were not noted on the pathology report, but were presumably positive given the endoscopy report and the subsequent low anterior resection (LAR) that proved macroscopic residual tumor. Should the date of the polypectomy be recorded in Date of First Surgical Procedure field? Or would the date of the subsequent LAR be recorded since macroscopic residual tumor was present following polypectomy? |
Record the date of the polypectomy as the date of first surgical procedure. Polypectomies are surgery for the purposes of cancer registry data collection regardless of whether or not there is residual tumor after the polypectomy. |
2016 |
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20150040 | Surgery of Primary Site--Pleura: How is this field coded if the patient underwent an exploratory thoracotomy with partial decortication that excised some, but not all, of the pleural mesothelioma tumors? See Discussion. |
This patient underwent a "partial decortication" per the operative report. While the operative report does not specifically note that this was performed with a partial pleurectomy, it appears the patient had a partial pleurectomy because the largest specimen removed was a "pleural peel" specimen, which included the parietal and visceral pleural surfaces with a small amount of underlying lung tissue. The operative report notes the patient had involvement of both the lung and chest wall. A total resection was not possible due to the extent of the tumor. However, this patient does appear to have undergone at least a partial resection of the pleura/tumor burden. The patient did not simply undergo a pleurodesis to free adhesions. Per the NCI's PDQ, pleurectomy and decortication are performed together. Because the operative report and pathology report only called this procedure a "partial decortication" without specifically mentioning a pleurectomy, would this be coded as a tumor excision (surgery code 20)? Or should we assume the procedure is best coded as a partial pleurectomy and decortication and use code 30 (simple/partial resection)? |
Read the operative report and the pathology report and assign the surgery code that best represents the extent of the surgery. In this case, code 30 seems most appropriate. Do not assign the surgery code based only on the name of the procedure; use all information available to chose the most representative code. |
2015 |
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20160035 | 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. |
2016 | |
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20150049 | Reportability--Brain and CNS: Is pseudotumor cerebri reportable? |
Pseudotumor cerebri is not reportable. It is not a neoplasm. The pressure inside the skull is increased and the brain is affected in a way that appears to be a tumor, but it is not a tumor. |
2015 |
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