Race: How is race coded for a patient who self-reports as white? In the Family History portion of the genetics consult, it states the maternal family is of mixed European and Cherokee descent; the paternal side is of mixed German/mixed European descent. Is race coded as Race 1: 03-American Indian and Race 2: 01-White, or as 01-White according to self-report by the patient?
Self-reported information is the highest priority for coding race. That is because the race information for the U.S. population comes from census data and that information is self-reported. For national cancer statistics, in order for the numerator (cancer cases) and the denominator (population) to be comparable, use self-reported race information whenever it is available. We will add this clarification to the SEER manual.
Primary Site--Unknown & ill-defined site: Should the primary site be coded to C809 [Unknown primary site] or C761 [Thorax, NOS] if the patient died following a limited work-up that included on a cytology on pericardial fluid that was positive for poor differentiated adenocarcinoma?
Based on the information provided, code the primary site to C809 [Unknown primary site]. There is not enough information provided to suggest that the primary site is the thorax or any other location.
First Course Treatment--Liver: Given that agents can be used that are not chemotherapy drugs, how should treatment be coded for a procedure called a "chemoembolization" when the agent used is not documented?
This issue was discussed among the national standard setters and per the SEER website this issue has been resolved as follows: When "chemoembolization" is done but the agents used are not chemotherapy drugs, then treatment should be coded as "Other Therapy." See http://seer.cancer.gov/tools/codingmanuals/embolization.html
MP/H Rules/Histology--Thyroid: Regarding rule H15, is the mixed code 8340 [Papillary carcinoma, follicular variant] used when there are subtypes of these histologies described, such as a tumor diagnosed with follicular and papillary microcarcinoma or should 8341 [Papillary microcarcinoma] be used?
For cases diagnosed 2007 or later:
For coding purposes, this is a papillary and follicular combination that would be coded to the combination code 8340/3 [Papillary carcinoma, follicular variant].
For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult, usually less than 1 cm. in diameter.
Grade, Differentiation--Breast: How do we code grade for a breast primary diagnosis of "Low grade invasive duct, modified Bloom-Richardson grade II/III (tubule formation 2, nuclear grade 1, mitotic rate 1)"? This appears to add up to a Bloom-Richardson score of 4, which does not fit with a Bloom-Richardson II/III.
Code the Grade, Differentiation field to 1 [grade I] using the information from the BR score.
For cases diagnosed 1998-2003: Grade or differentiation information from breast pathology reports is used in the following priority order:
1. Terminology (well, moderately, poorly)
2. Histologic grade (grade I, grade II)
3. BR scores
4. BR grade
5. Nuclear grade
On the hierarchical list for coding breast grade, the first two priorities do not apply to this case, but the third (Bloom-Richardson scores) does. Add the BR information (2+1+1) for a total score of 4, which translates to BR low grade (code 1). The statement of "II/III" may be a typo that should state I/III.
MP/H Rules/Histology--Colon: When the microscopic description indicates a colon tumor is "tubulovillous," but the final diagnosis only states "adenocarcinoma," is the histology coded to 8263/3 [adenocarcinoma in a tubulovillous adenoma]?
For cases diagnosed 2007 or later:
Yes. This is an example of a site-specific exception to the general rule to code only from the final diagnosis. The Colon Histology Rules specifically state that "other parts of the pathology report" may be used to identify a tumor arising from a polyp, adenomatous polyp, villous adenoma, or tubulovillous adenoma.
EOD-Extension--Head & Neck: How much information is needed for a head and neck primary in order to code extension to localized versus unknown? What code is used to represent this field when the only information for a buccal cavity primary is a positive aspiration of the buccal mass?
For cases diagnosed 1998-2003:
Code the EOD-Extension to 99 [Unknown] for this case until more information is received. The available information does not describe the primary site and there is a complete lack of staging information.
Head and neck cancers spread early and often to nodes. Do not code the EOD-Extension to localized when the information is as limited as it is for this example.
MP/H Rules/HistologyCorpus Uteri: How should histology be coded for a "carcinosarcoma with high grade sarcomatous component within a polyp, with greater component of endometrioid carcinoma and foci papillary serous carcinoma within polyp"?
For cases diagnosed 2007 or later, assign code 8980/3 [Carcinosarcoma] according to rule H17. Rule H12 does not apply since the final diagnosis is not "adenocarcinoma."
Behavior--Breast: How is behavior coded when a biopsy shows in situ carcinoma with a focus suspicious for invasion and a subsequent excision/resection shows only in situ carcinoma?
Code this case as in situ. The specimen from the excision/resection is the more reliable source for determining behavior, compared to a biopsy, especially in this case where the behavior is ambiguous on the biopsy.