SEER Inquiry System - Search

CT showed multiple masses in the liver and lymphadenopathy in areas of gastrohepatic ligament, celiac axis, superior mesenteric and left periaortic regions. No mention of a mass in pancreas or common duct. When the term "pancreatobiliary" primary is stated in the final diagnosis, what site code should be used?

CT scan showed retroperitoneal and inguinal adenopathy. Right inguinal lymph node biopsy revealed "malignant lymphoma, peripheral T-cell type, with some features of angioimmunoblastic t-cell lymphoma and follicular t-cell lymphoma." Flow cytometry studies showed no evidence of B-cell lymphoma and atypical CD3+/CD10+/CD7-/CD4+/CD56+ T cells are detected (19%). The bone marrow biopsy was negative for involvement. Patient was staged as Stage II Peripheral T-Cell lymphoma by the oncologist and started chemotherapy.

CT guided core biopsy of pelvic mass is positive for B-cell non-Hodgkin lymphoma. Bone marrow biopsy is negative. Mediastinoscopy with mediastinal and pretracheal nodes biopsy is positive for follicular lymphoma grade 1 of 2. The patient has a PET demonstrating positive extensive metastatic disease with nodes in neck, chest, abdomen/pelvis and bone involvement. Should the histology be coded 9591/3 [NHL, NOS] or 9695/3 [FL, grade 1]? Which rule applies?

The table of contents for the Hematopoietic Manual indicates Module 8 for these histologies, however, Module 8 rules do not seem to apply. Continuing on to Module 9, the first rule that applies is PH30. PH30 states use the Heme DB to determine primary site/histology. The Heme DB indicates these are separate primaries, but both histologies are B-cell lymphomas.

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?

CT described hepatocellular ca involvement of the liver with nodules identified in segments 5 and 7. Would EOD-extension be coded to 30 [multiple tumors (one lobe)]?

CT chest findings: 1. There is a dominant 1 cm. nodule in the left mid lung. 2. In addition, there is a new rather dominant bilobed nodule in the left lung base. 3. Distant metastases are not identified. Four months later, a doctor's note says routine follow-up visit status post Cyber Knife stereotactic body radiation therapy for synchronous early stage non-small cell carcinomas of the left upper and left lower lobes, both Stage IA. He is medically inoperable. This situation is described as a second primary tumor in AJCC8 page 438. However, by the 2018 Lung Solid Tumor rules, this would be a single primary, per rule M7. Is that correct?

CT a/p read by radiologist shows: "Bosniak 4 cystic lesion of right kidney." Follow-up MRI a month later reads "right kidney cystic lesion with enhancing mural nodule concerning for cystic renal cell carcinoma (RCC)." Urologist consult used the same wording of "Bosniak 4 cystic lesion" and "concerning for renal cell carcinoma." Treatment discussed but due to patient health status recommended repeat imaging. Repeat CT few months later reads: "cystic right renal lesion with enhancing nodule similar to most recent prior and suspicious for cystic RCC."

Though "suspicious for cystic RCC" per latest imaging is reportable, Bosniak 4 is "clearly malignancy, ~100% malignant" by definition, so is the case actually reportable with the first CT a/p date as date of diagnosis?

CT A/P massively enlarged uterus with no distention between the vagina, cervix or proximal to mid uterus identified. Highly concerning for malignancy though distinct etiology not clear. Ovarian not favored though not excluded given lack of clearly defined fat planes between uterus and either ovary. Extensive bilateral iliac chain and periaortic/pericaval lymphadenopathy.

Trying to work through Module 7 in the Hem DB. According to the ovary site, regional lymph nodes include the iliac and the para-aortic lymph nodes. This makes me think I should use Rule PH35 (organ and regional nodes). However, using Appendix C in the Hem DB, the iliac lymph nodes are part of the pelvic C775 while the para-aortic (periaortic) are intra-abdominal C772. This makes me wonder if I should go with rule PH36 present in organ and nodes that are not regional.

CAP Protocol for the Examination of Cystectomy Specimens From Patients With Carcinoma of the Urinary Bladder/Treatment Effect Post Neoadjuvant Chemotherapy (BCG not included) selections

o No known presurgical neoadjuvant therapy

o Complete response: Absence of histologically identifiable residual cancer cells and extensive fibrosis of the tumor bed after presurgical neoadjuvant therapy (TRG1)

o Strong response: Predominant fibrosis of the tumor bed, with residual cancer cells occupying less than 50% of this area (TRG2)

o Weak or no response: Residual cancer cells occupying ≥50% of the tumor bed or absence of regressive changes (TRG3)

o Other (specify): _________________

SEER Coding Instruction for Site-Specific Codes for Neoadjuvant Therapy Treatment Effect - Schemas: All Other Schemas selections

0 Neoadjuvant therapy not given/no known presurgical therapy

1 Complete pathological response

Present: No viable cancer cells/no residual invasive carcinoma identified

Residual in situ carcinoma only

2 Near complete pathological response

Present: Single cells or rare small groups of invasive cancer cells

3 Partial or minimal pathological response

Present: Residual invasive cancer with evident tumor regression, but more than single cells or rare small groups of cancer cells

4 Poor or no pathological response

Absent: Extensive residual cancer with no evident tumor regression

6 Neoadjuvant therapy completed and surgical resection performed, response not documented or unknown

Cannot be determined

7 Neoadjuvant therapy completed and planned surgical resection not performed

9 Unknown if neoadjuvant therapy performed

Unknown if planned surgical procedure performed after completion of neoadjuvant therapy

Death Certificate only (DCO)

Bronchial washings were negative. Four lymph nodes were biopsied and found to have metastatic poorly differentiated neuroendocrine carcinoma. The treating oncologist calls it small cell carcinoma, extensive stage, and treats patient with carboplatin and VP-16 (etoposide) The MP/H rule says to take path/cyto from a metastatic site if no pathology/cytology available from the primary site. Is the physician's statement and treatment taken into consideration here?