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Report Produced: 04/21/2025 19:14 PM

Report Question ID Question Discussion Answer Year
20021103 Surgery of Primary Site/First Course Treatment--Liver: If disease progression is so rapid that the initial therapy plan is changed before patient receives any therapy, would "no therapy" be the first course? See discussion. Patient was diagnosed with liver cancer on 8/23 and on 9/6 a hepatectomy was recommended. However, patient was hospitalized on 9/19 with ascites. Patient underwent embolization instead of a hepatectomy during that admission.

Code the "embolization" (or hepatic artery embolization, HAE) in Surgery of Primary Site. Assign code 10 [local tumor destruction, NOS].

The embolization is coded as first course of therapy for this case because it seems that this patient was not adequately staged until 9/19 -- there is no indication on this case of the stage of disease in August or early September. Furthermore, no treatment was started before the embolization. Therefore, the ascites is not "progression of disease" in this case -- it is taken into account as part of the initial stage of disease.

This procedure was previously coded as other therapy, experimental. Code as surgery as of July 2005.

 2002
20031206 EOD-Extension: How is this field coded for synchronous primaries when metastatic disease is found and there is no statement to indicate which primary is the source of the metastases? See Description. Patient was diagnosed with both esophageal and pancreatic cancer. Liver metastases were also identified. The source of the liver mets is unknown. For cases diagnosed 1998-2003: Search the record for information about the source of the metastasis. If no such information can be found, code the metastasis to both primaries. Update the abstracts when information becomes available confirming the primary site responsible for the metastasis. Assuming the liver metastases in the example above are distant (i.e. not contiguous) code extension as 85 [Metastasis]. 2003
20031210 Other Cancer-Directed Therapy--Hematopoietic, NOS: Is there a hierarchy for selecting which code to use when a patient receives more than one type of "other treatment"? See Description. Patient was diagnosed with Myelodysplastic Syndrome, probably refractory cytopenia with multilineage dysplasia. Good candidate for investigational studies for transfusion-dependent patients. Patient was enrolled in a high dose vitamin D study. Patient also received transfusions.

SEER has not established a hierarchy of the codes listed under Other Treatment. If the patient receives more than one type of other treatment as the first course of treatment, assign the code that provides the most information about how the patient was treated and use the remarks fields to explain.

Code Other Treatment for the case example above as 2 [Other experimental therapy]. Use the remarks fields to describe the transfusions and vitamin D therapy.

 2003
20100048 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a patient diagnosed with Langerhans cell histocytosis/eosinophilic granuloma involving both the seventh rib and the right temporal bone? See Discussion. Patient was diagnosed with Langerhans cell histiocytosis/eosinophilic granuloma following a biopsy of the seventh rib on 3/22/10. On 4/13/10 the patient had a right external ear canal mass (right temporal bone) biopsy with same diagnosis. Should the primary site be coded to bone, NOS [C419]?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Per Rule PH30, use the Heme DB to determine the primary and code it to bone, NOS [C419]. Langerhans cell histiocytosis can occur as a solitary lesion, multifocal lesions, or multisystem disease. In this case, the patient has multifocal disease of the bone. The abstractor notes in the Hematopoietic DB were used as a reference for this answer.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2010
20130118 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of Langerhans cell histiocytosis with extensive bony metastatic disease and lymphadenopathy? See Discussion. Patient was diagnosed with LCH on a biopsy of the right femur. Imaging showed extensive bony metastatic disease, extensive infiltrative perinephritis, encasement of both kidneys, renal hilar, retroperitoneal and periaortic lymphadenopathy. The right femur biopsy pathology report did not state this was metastatic.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to C419 [bone, NOS] per Rule PH30.

This patient has widely metastatic disease. Per Rule PH30, one needs to reference the Heme DB to determine the primary site and histology for this case. Per the Abstractor Notes section, Langerhans cell histiocytosis arises in the bone and many times can involve multiple bones, along with other organs and lymph nodes. Although the right femur was biopsied, this does not prove that the primary site is the femur [C402] because the patient has what was described as extensive bony metastatic disease.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2013
20031173 Hormone Therapy--Thyroid: Is pre-op hormone replacement therapy coded in this field? See Description. Patient was admitted for thyroidectomy with a diagnosis of probable thyroid cancer. Patient's history stated that patient received work-up for hypothyroidism and was found to have thyroid nodule. FNA suggested carcinoma. Patient's medications included Cytomel and Synthroid. Do not code hormone replacement given to treat hypothyroidism as cancer treatment. Thyroid hormone therapy is coded as treatment only for follicular and papillary thyroid carcinomas. 2003
20031195 EOD-Clinical Extension--Prostate: Is this field coded to 15 [Tumor identified by needle biopsy for elevated PSA] when it is unknown whether or not a TRUS was done? See Description. Patient was admitted for radiation therapy for prostate cancer. H&P states that patient had elevated PSA. PE showed benign feeling prostate. Stage is clinical T1c. There is no mention of whether or not TRUS had been done. For cases diagnosed 1998-2003: EOD extension code 15 is correct for this case example. When there is no other documentation available, the AJCC stage may be used to determine extension. 2003
20091114 MP/H Rules/Multiple primaries--Breast: Would a left chest wall mass excision stated to be ductal carcinoma consistent with a breast primary and, "compatible with either local recurrence or potentially a metastasis" be a new primary per the MP/H rules? See Discussion. Patient underwent mastectomy in 1986 for infiltrating ductal carcinoma of left breast. Excision of left chest wall mass in March 2009 showed ductal carcinoma consistent with breast primary. The pathology report COMMENT stated it would be compatible with either local recurrence or a metastasis. The patient's primary breast carcinoma material is not available for direct comparison and the MP/H rules instruct us to ignore metastasis. For cases diagnosed 2007 or later, the MP/H rules do not apply to metastasis. If there is no further information available for this case, the MP/H rules do not apply to the 2009 diagnosis. 2009
20031198 Surgery of Primary Site/Date Therapy Initiated--Head & Neck: Would a biopsy, NOS, that removed the majority of the tumor be used to code these fields? See Description. Patient underwent biopsy, NOS, of a carcinoma of the tongue. Subsequent glossectomy revealed microscopic focus of residual squamous cell carcinoma. If the biopsy NOS removed all macroscopic disease, code the date of the biopsy NOS as the date therapy initiated. If macroscopic disease remained following the biopsy NOS, code the glossectomy date as the date therapy initiated. 2003
20120073 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a 2011 diagnosis of systemic mastocytosis? See Discusson. Patient presented with leukopenia, anemia and monoclonal gammopathy. A bone marrow biopsy in 2011 showed systemic mastocytosis [9741/3]. A subsequent shave biopsy of abdominal skin showed histologic features that were consistent with a diagnosis of mastocytosis. A later bone marrow biopsy was subsequently performed that showed progressive systemic mastocytosis.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Per Rule PH30, use the Heme DB to determine the primary site and histology when rules PH1-PH29 do not apply. The Heme DB indicates the primary site for systemic mastocytosis is always coded to C421 [bone marrow].

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2012