SEER Inquiry System - Search

Example:

Patient has Stage IVA carcinoma of the tongue. The physician states that patient is not felt to be a good surgical candidate secondary to multiple medical frailties. Patient is treated with beam radiation.

In this case, how do we code Reason for No Site Specific Surgery? Do we use code 2 because surgery was contraindicated due to co-existing medical conditions or do we use code 1 because the tumor is very extensive and surgery would probably not be done anyway?

Example Case 1:  2022 mobile tongue tumor biopsy shows squamous cell carcinoma, basaloid non-keratinizing type.

Example Case 2:  2022 base of tongue mass biopsy shows squamous cell carcinoma, basaloid non-keratinizing type, p16 positive.

Table 5, Note 2 (Head and Neck Equivalent Terms and Definitions) instructs us to code non-keratinizing squamous cell carcinoma which is p16 positive to 8085 (Squamous cell carcinoma HPV-positive), ignoring the non-keratinizing subtype. Does p16 or HPV positivity also take priority over multiple subtypes (basaloid non-keratinizing type)?

Example

Multicentric infiltrating lobular carcinoma of left breast treated with MRM. Microscopic summary: Blood/lymphatic Vessel Invasion: present. Path final diagnosis: Angiolymphatic invasion present, including dermal lymphatic invasion in nipple. Micro: There is angiolymphatic invasion, including dermal capillary invasion identified in sections of the nipple.

The path report describes multiple breast tumors, none of which is located adjacent to the nipple.

Example

Chest CT: "Almost complete consolidation of RUL and superior segment of RLL, highly suspicious for malignancy and represents primary bronchogenic carcinoma until proven otherwise. Multiple pulmonary masses bilaterally consistent with metastatic disease."

The physician describes multiple masses throughout RLL and LLL of lung suspicious for met disease, particularly lesion in LLL measuring 2.5 cm. The 2 cm mass in right lung abuts pleura, another mass in RLL measures 2.5 cm, smaller nodules in RLL and another 1 cm lesion abuts the pleura. Bx of a rt supraclavicular LN is positive for met carcinoma c/w lung primary.

Would primary site be coded to RLL because the scan states that the lesions on the right side represent primary bronchogenic carcinoma until proven otherwise and the 2.5 cm lesion in the RLL is the location of the largest tumor on the right? Or should site be coded to right lung, NOS and size to unknown because there is no clear statement as to which lesion on the right represents the primary tumor? If the site is lung, NOS, would CS Extension be coded to 65 to describe the multiple nodules in the RLL?

Example

Cecum, right hemicolectomy: poorly differentiated invasive adenocarcinoma of the cecum. Large vessel invasion (V2-grossly evident) is present. Microscopic description: The grossly described matted lymph node tissue shows an irregular nuclear contour and is classified as V2, grossly evident venous invasion based on staging criteria of the AJCC Cancer Staging Manual, 6th Edition.

Per note 2 in the coding scheme for CS-Extension, a nodule with irregular contour in the pericolic adipose tissue should be coded in CS-Extension to code 45. Is the large vessel invasion described in the path report the same process as a tumor nodule in pericolic fat? Should note 2 be used and CS-Extension coded to 45?

Example 4:  Esophageal biopsy with diagnosis of “focal areas suspicious for adenocarcinoma in situ.” Diagnosis on partial esophagectomy specimen “with foci of high grade dysplasia; no invasive carcinoma identified.” Do not accession the case. The esophagectomy proved that the suspicious biopsy result was false.

Appendix E2 #32 of the SEER Manual states high grade dysplasia in site other than stomach, small intestines, and esophageal primary sites are not reportable. Does this mean high grade dysplasia is reportable for esophagus primaries?

Example 1: Physician states patient has an almost certain melanoma. Due to the patient's age, there is no plan to for any treatment or further workup. Almost certain is not listed as a reportable phrase, so typically we would not accession this case.

Example 2: Imaging states a diagnosis of renal cell carcinoma until proven otherwise. No additional workup is available at this facility. This terminology is also not seen on the ambiguous reportable terminology list but we are seeing it more often and wanted confirmation.

Example 1: Peripheral smear states: "No morphologic evidence of chronic myelogenous leukemia."

Addendum: Molecular diagnostic studies showed a positive rearrangement for the BCR gene with the M-bcr (CML type) and of bcr-abl transcript expression".

Example 2: Hematopathology is negative.

Molecular diagnostic study: "fluorescent in situ hybridization (FISH) studies exceeded the limits established by the XXX Cytogenetics Laboratory for this probe set, and thus, demonstrated statistical evidence of BCR/ABL fusion."

Example 1: Patient with B symptoms. Physical exam reveals large neck mass. Physician impression is lymphoma.

Example 2: CT scans show lymphadenopathy consistent with lymphoma.

In both cases, patient does not return for biopsies.

Example 1: Patient has a history of a BSO without an indication that it was done for malignancy. Pt has a resection. No ovarian tissue found. No site is mentioned in the pathology report. The clinician refers to the diagnosis of adenocarcinoma in the pelvis as an "ovarian" primary.

Example 2: Resected ovaries are negative. No specific site of origin is mentioned in the path. Again, the clinician refers to the diagnosis of adenocarcinoma in the pelvis as an "ovarian" primary.