Residence at dx: After living elsewhere (Florida) and traveling around the country in an RV with his spouse, is a patient a resident of this area for either primary if he was diagnosed with his first primary less than a month after arriving in the area and a second primary more than a year after parking his RV here?
Use the patient's usual residence to determine residency. If the usual residence is not known or the information is not available, use the residence the patient specifies at the time of diagnosis. The SEER rules for determining "usual residence" match the rules used by the US Census Bureau.
MP/H Rules/Histology--Skin: How is the histology coded for "infiltrative carcinoma with ductal alterations compatible with squamoid eccrine ductal carcinoma" of the skin?
Code the histology to 8413/3 [eccrine adenocarcinoma]. This is the most specific code available for this diagnosis.
According to our expert pathologist advisor, "The adnexal glands in the skin, sweat (eccrine) glands and apocrine glands, all have ducts which connect the business portion of each gland to the skin surface. Some of the adnexal tumors have features of differentiation which appear to be duct-like, hence the designation 'ductal.'"
In addition, "The 'squamoid' simply indicates some degree of squamous differentiation, but doesn't alter the usefulness of [code 8413/3] because we have no way of coding anything more specific in this case anyway."
EOD-Clinical Extension--Prostate: How is this field coded when biopsies of the prostatic apex are positive and the physician clinically stages the case as T1c?
For cases diagnosed 1998-2003:
Code clinical extension to 33 [arising in the prostatic apex] when a biopsy of the prostatic apex is positive for malignancy, with no further evidence of involvement. If biopsies of both the apex and another site within the prostate (for example right lobe) are positive and there is no mention that the malignancy arose in the apex, code extension to 34 [extending into the prostatic apex].
Reportability--Head & Neck: Would this be reportable and if so what histology would be coded? Soft tissue mass left cheek excision reveals Carcinoma Ex Pleomorphic Adenoma Non-Invasive with focal vascular invasion. Margins clear.
Carcinoma ex pleomorphic adenoma (Ca-ex-PA) is reportable. Assign 8941/3. The WHO classification of head and neck tumors defines Ca-ex-PA as an epithelial malignancy arising in a benign pleomorphic adenoma. Most of these originate in the parotid gland but can also arise in other salivary glands.
EOD-Lymph Nodes/EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Cervix: What codes are used to represent these fields for a cervix primary when the only information on lymph nodes is a CT of the pelvis showing "pelvic adenopathy" (no surgery was done)?
Code the EOD-Lymph Nodes field to 9 [unknown]. Code the Pathologic Review of Number of Regional Lymph Nodes Positive field to 98 [No nodes examined] and the Lymph Nodes Examined to 00 [No nodes examined] because there was no resection of the primary organs. Adenopathy, NOS, per SEER guidelines, is not coded as lymph node involvement
EOD-Extension: General instructions, page 7, note 3 states: " Extent of disease information obtained after treatment with neoadjuvant chemotherapy, hormone or immunotherapy has begun may be included." Because the SEER manual does not mention radiation treatment, can we use information from a lobectomy to code EOD if a patient has neoadjuvant radiation therapy?
Radiation therapy was inadvertently omitted from the list. Please see SINQ 20031012 answer as to when the surgical information can be used to stage the case.
Primary Site--Ovary/Peritoneum: Should this field be coded to ovary or peritoneum when the bulk of the tumor is in the peritoneum and there is only surface involvement of the ovary?
If it is not clear where the tumor originated, use the following criteria to distinguish ovarian primaries from peritoneal primaries.
The primary site is probably ovarian, unless:
--Ovaries have been previously removed
--Ovaries are not involved (negative)
--Ovaries have no area of involvement greater than 5mm.
Descriptions such as "bulky mass," "omental caking" probably indicate an ovarian primary.
Descriptions such as "seeding," "studding," "salting" probably indicate a peritoneal primary.
Primary Site--Breast: If a patient has multifocal tumors all in the upper outer quadrant of the breast, is the primary site coded to C-504 because all of the tumors are in UOQ or would the site be coded to C509 to reflect the fact that multiple tumors exist?
Code the primary site to C504 [Upper outer quadrant]. All disease is located in one quadrant, code that quadrant. When disease involves two or more quadrants and the point of origin cannot be determined, code C509 [Breast, NOS]. See 2004 SEER manual, page C-470 for instructions about invasive and in situ in different quadrants.
Primary Site: Can we assume the primary site for "chordoma" is soft tissue if the bone is not stated to be involved?
Default the coding of the Primary Site field for chordomas to the bone where the tumor began in the body if the primary site is not clearly stated to be soft tissue. Bone is often the primary site for chordomas.
Based on advice from pathologist consultants: This is one of those situations where we can be quite comfortable with a default, in this case to bone, not soft tissue. Chordoma is a tumor arising in the nucleus pulposis, presumably from remnants of notochord - thus its exclusive origin is in the sacrococcygeal region, spheno-occipital region, and vertebral bodies, otherwise known collectively as the axial skeleton. Any "chordoma" in soft tissue (with no relationship to axial skeleton) is probably a myxoid chondrosarcoma or parachordoma (extremely rare).
Update to Current Manual/Neoadjuvant Therapy--Pancreas: How are the neoadjuvant items coded for a patient who has unresectable pancreatic cancer and starts chemotherapy but will be evaluated after X cycles to see if patient may become a surgical candidate?
Assign the neoadjuvant therapy data items as if the patient had neoadjuvant therapy. Neoadjuvant Therapy data item would be coded either code 1 or 2 depending on whether the chemotherapy was completed or not. In this case, they are a surgical candidate by having the chemotherapy with the plan from the beginning to evaluate the chemotherapy after X cycles to see if surgery can be performed. After the patient is evaluated, update the abstract as needed.
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