Home
| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
|---|---|---|---|---|---|---|---|
|
|
20000526 | EOD-Extension--Lung: Is bilateral pleural effusion coded as 72 [malignant pleural effusion] or 85 [metastasis]? See discussion. | Example: 10/30/98 CXR: Widespread malignancy, hilar, superior mediastinal masses, bilateral pleural effusions, fullness in soft tissue right neck.
11/01/98 CT chest/ABD: Extensive infiltrate mediastinum by radiolucent tumor mass that engulfs esophagus/trachea. Pleural effusion extends so low it apes ascites. Normal ABS/pelvis.
11/01/98 Pathology: FNA right supraclavicular lymph node: metastic oat cell ca. Sputum cytology reported to be negative. |
For cases diagnosed 1998-2003, code the EOD-Extension field to 72 [malignant pleural effusion; pleural effusion, NOS]. | Lung | N/A | 2000 |
|
|
20200054 | Solid Tumor Rules (2018)/Multiple primaries--Liver: When does a hepatocellular carcinoma (HCC) recurrence in the same area of the liver get accessioned as a new tumor following TACE/Y90/RFA? If there is a new HCC in the same area as previously treated but it is stated to be recurrent and/or progressive disease, is that evidence of a disease-free interval? If the tumor area is stated to be LR-TR and non-viable, but then a new HCC in that area is diagnosed, does that count as a disease-free interval? See Discussion. |
Example 1: 5/2013 diagnosis of HCC in segment 4B (single tumor), treated with microwave ablation in 7/2013. CT scan in 11/2017 with new 23mm hypodensity in liver segment 4 suspicious for recurrent disease. Clinical assessment in 1/2018: New enlarging lesion in liver most consistent with progression of HCC. Treated with RFA in 2/2018. Is the 2018 occurrence a new primary as imaging stated this was a new lesion? Example 2: 7/2017 diagnosis of HCC in right liver; 2.5 cm lesion in segment 5/6 with a couple of satellites and 12mm lesion in segment 6, treated with Y90 radioembolization. Follow-up note in 11/2017: complete response of treated cluster of lesions in segment 5/6 and lesion in segment 6, increase in size of caudate lesion not amenable for treatment (this lesion was stated to be indeterminate on 7/2017 imaging). Caudate lesion finally stated as LI-RADS5 on 3/2018 imaging and was treated with chemoembolization 6/2018. 7/2018 and 10/2018 Follow-up imaging states LR-TR nonviable lesion in caudate lobe. 8/2019 CT shows caudate lobe with arterial enhancement, new compared to prior imaging, LR-TR viable. MD note states patient has small local HCC recurrence in segment 1 (caudate lobe) with plan to repeat TACE. Is this 8/2019 HCC a new primary as the patient was disease free for greater than 1 year, or is it the same tumor and a single primary? |
Both examples are multiple primaries. Example 1: The 2018 lesion is a new tumor. Abstract multiple primaries based on 2018 Other Sites Solid Tumor Rules, Rule M10, when tumors are diagnosed more than one year apart. Example 2: 2017 diagnosis showed complete response to treatment. 2019 lesion is a new primary based on timing. The General Instructions of the Solid Tumor Rules instruct: Do not use a physician's statement to decide whether the patient has a recurrence of a previous cancer or a new primary. Each scenario should be evaluated separately using the rules as a guide. |
N/A | N/A | 2020 |
|
|
20200048 | Solid Tumor Rules/Multiple Primaries--Lung: How many primaries are accessioned when a patient is diagnosed with right lower lobe invasive acinar adenocarcinoma (8551/3) in 2018 and treated with lobectomy, followed by a 2019 right middle lobe cancer (NOS, 8000/3) diagnosed as new stage 1 primary by cancer conference? See Discussion. |
Lung Rule M14 appears to be the first rule that applies to this case and instructs the user to abstract a single primary. However, we were hoping for confirmation that a cancer (NOS) or malignancy (NOS) would not be a distinctly different histology that may qualify for Lung Rule M8. Currently, these histologic terms are not included in the Table 3 options or mentioned in the preceding notes. |
Use M14 and code a single primary. Per our SME, carcinoma or cancer, NOS is not an acceptable diagnosis which is why 8000 and 8010 were not included in the tables or rules. We assume there was no tissue diagnosis for the 2019 diagnosis. We recommend searching for more information or better documentation on this case. |
Lung | N/A | 2020 |
|
|
20180079 | Solid Tumor Rules/Multiple primaries--Breast: How many primaries should be abstracted when papillary carcinoma is identified in two biopsies and a subsequent lumpectomy identified invasive ductal carcinoma with multifocal ductal carcinoma in situ (DCIS)? See Discussion. |
The right breast ultrasound shows a 1.4 cm mass at 8 o'clock and a separate mass .6 cm at 7 o'clock (site code for both C50.5). Pathology report: Right 8 o'clock core needle biopsy fragments of intracystic noninvasive papillary carcinoma (8504/2), right 7 o'clock core needle biopsy fragments of intracystic noninvasive papillary carcinoma (8504/2). Then, another facility performs a right breast lumpectomy (operative note not available). Outside Facility: Right breast lumpectomy pathology shows invasive ductal carcinoma .6cm (8500/3) multifocal DCIS .5cm greatest dimension tumor site right breast NOS. Should we use Rule M12-Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 3 in the Equivalent Terms and Definitions. Timing is irrelevant. Note: Each row in the table is a distinctly different histology. So would this be two primaries C50.5 (8504/2) and C50.9 (8500/3)? |
Abstract as multiple primaries using Breast Solid Tumor Rule M12 as these are separate, non-contiguous tumors on different rows in Table 3. |
Breast | N/A | 2018 |
|
|
20160023 | Grade/Histology--Digestive System: What is the grade for neuroendocrine tumor (NET) or neuroendocrine carcinoma (NEC) of gastrointestinal morphologies described as: 1) NET G1 (M8240/3) and NET G2 (M8249/3) or 2) neuroendocrine carcinoma, low grade (M8240/3) and neuroendocrine carcinoma, well differentiation (M8240/3) and neuroendocrine carcinoma, moderate differentiation (M8249/3)? The SEER Instructions for Coding Grade for 2014+, Coding for Solid Tumors section, #3 state: Code the grade shown below (6th digit) for specific histologic terms that imply a grade. NET and NEC are not included in the specific terms. |
You may code grade as follows.
Grade 1 – NET G1 (M8240/3)
Grade 2 – NET G2 (M8249/3)
Grade 1 – neuroendocrine carcinoma, low grade (M8240/3) or neuroendocrine carcinoma, well differentiation (M8240/3)
Grade 2 – neuroendocrine carcinoma, moderate differentiation (M8249/3) |
N/A | N/A | 2016 | |
|
|
20000242 | EOD-Size of Primary Tumor--Prostate: Should the size of tumor be recorded as 001 (focus) or the actual size when both are stated? See Discussion. | The pathology report from a TURP identifies a 3-mm focus of adenocarcinoma. | For cases diagnosed 1998-2003, code the EOD-Size of Primary Tumor field to 003 [3 mm]. The rule that says to code a focus or foci of tumor as 001 was developed for use when no tumor size is given. | Prostate | N/A | 2000 |
|
|
20130184 | Reportability--Appendix: Are low-grade appendiceal mucinous neoplasms reportable? |
For cases diagnosed prior to 1/1/2022 A low-grade appendiceal mucinous neoplasm (LAMN) is not reportable. The WHO classification designates LAMN with the behavior code /1 [uncertain whether benign or malignant]. |
N/A | N/A | 2013 | |
|
|
20000262 | EOD-Clinical Extension/EOD-Lymph Nodes--Prostate: How do you code clinical extension and lymph nodes for path only prostate cases treated with a TURP? Would clinical extension be coded to unknown or localized, NOS? | For cases diagnosed 1998-2003: Code the EOD-Clinical Extension field to 30 [localized, NOS] and the EOD-Lymph Nodes field to 0 [no lymph node involvement]. Per Note 7: Use code 30 when there is insufficient information as to whether the tumor is clinically apparent or inapparent but the tumor is confined to the prostate. This is an example of a case where there is insufficient information as to whether the tumor is clinically apparent or inapparent. Assume the tumor is confined to the prostate. | Prostate | N/A | 2000 | |
|
|
20110073 | MP/H Rules/Multiple primaries--Sarcoma: Does a prior clinical diagnosis of a metastatic deposit for a previously diagnosed sarcoma have priority if the diagnosis on a subsequent resection (18 months later) indicates it is also a sarcoma but does not state it represents metastasis from the original sarcoma primary? See Discussion. |
1/28/08 Patient was diagnosed with spindle cell sarcoma in the right gluteus muscle. Metastatic tumors were found in a vertebral body and in the lung. Chemotherapy was started.
4/22/08 PET scan done to evaluate response to chemo. The primary tumor had increased in size. New mass in the left thigh that was highly suspicious for metastasis found. (The left thigh tumor was not accessioned at that time as it was described as a metastatic tumor.)
7/3/09 Left thigh tumor was resected and path revealed spindle cell sarcoma. There was no mention that it represented metastasis.
Does the left thigh tumor represent a new primary per rule M12? Or does the previous clinical description of the left thigh tumor representing metastasis have priority? |
this is a single primary per Rule M1. According to our expert pathologist, "if multiple solid tissue tumors are present (sarcomas), then almost always there is one primary and the rest are metastases. There are infrequent occasions of multifocal liposarcoma or osteosarcoma occurring, but the patient would be treated as a patient with metastatic disease."
The steps used to arrive at this answer are:
Open the Multiple Primary and Histology Coding Rules manual. For a soft tissue primary, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites MP rules to determine the number of primaries because soft tissue primaries do not have site specific rules.
Go to the UNKNOWN IF SINGLE OR MULTIPLE TUMORS module, Rule M1.
Rule M1 states, "It is not possible to determine if there is a single tumor or multiple tumors, opt for a single tumor and abstract a single primary." Given the information from the expert pathologist, this case should be reported as a single primary applying this rule. |
Sarcoma | N/A | 2011 |
|
|
20100104 | Grade--Heme & Lymphoid Neoplasms: Is the phrase "aberrant T-cell expression" enough to code the grade field to T-cell when the final diagnosis on the pathology report is "AML with aberrant T-cell antigen expression"? | Yes. Code grade to 5 [T-cell]. The T cell receptor, or TCR, is a molecule found on the surface of T lymphocytes (or T cells). | Heme & Lymphoid Neoplasms | N/A | 2010 |
An official website of the United States government
