Multiplicity Counter--Ill-defined sites: How is this field coded for Ill-Defined sites (C760-C768)?
Code the number of tumors present if known. If the number of tumors present is not known, code 99 [unknown number of tumors, unknown if multiple tumors].
Primary Site (Pre-2007)--Prostate/Prostatic Urethra: What code is used to represent primary site for an "adenocarcinoma with spindle cell differentiation" of the prostatic urethra?
For tumors diagnosed prior to 2007:
Code the Primary Site field to C61.9 [prostate] because the histology is adenocarcinoma.
When a malignancy is identified in the prostatic urethra, look at the histology to determine the primary site. If it is a transitional cell carcinoma, code the Primary Site field to C68.0 [urethra] and if it is an adenocarcinoma, code to C61.9 [prostate].
The EOD scheme is ultimately collapsed into the TNM scheme. The TNM system differentiates between adenocarcinoma of the prostate and transitional cell carcinoma of the urethra. Only adenocarcinoma of the prostate is staged by the prostate scheme. Transitional cell carcinoma of the prostatic urethra is coded to C68.0 [urethra] and staged with that scheme.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Grade, Differentiation--Bladder: If the only indication of grade for a bladder primary is "grade 2, NOS," and we do not know the grading system being used by the pathologist, is the numeric grade 2 coded?
See the General Coding Rules on page 92 of the 2004 SEER Manual for instructions about coding grade.
If the only information available is "Grade 2," assign code 2 [Grade II].
EOD-Extension--Colon: What code is used to represent this field for a mid-ascending colon primary that invades through muscularis propria and into subserosal fibroadipose tissue that also presents with a "separate serosal nodule" of carcinoma within cecum that is consistent with a tumor implant (cT3, N0, M1)?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis], because the nodule of carcinoma in the cecum is not contiguous with the mid-ascending primary colon tumor.
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a patient with a several month history of refractory anemia with excess blasts (RAEB), that may or may not have been treated, who now presents with a bone marrow biopsy that is compatible with acute myeloid leukemia?
Per Rule M10, abstract multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm AND there is a second diagnosis of an acute neoplasm more than 21 days after the chronic diagnosis. Two primaries should be accessioned for this case: refractory anemia with excess blasts (RAEB) [9983/3] (a chronic neoplasm), and acute myeloid leukemia [9861/3] (an acute neoplasm).
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.
Reportability/Multiple Primaries (Pre-2007)/Histology--Anus: How many primaries exist if an 11/7/03 anal lesion presents with poorly differentiated adenocarcinoma with signet ring features and extensive mucin production and the 1/9/04 wide excision has adenocarcinoma and Paget disease (intraepidermal adenocarcinoma) extends to skin margin?
For tumors diagnosed prior to 2007:
This is a single primary: the adenocarcinoma with the Paget representing intraepithelial extension of the process. Tumor cells can invade from their place in the epithelium into the underlying stroma either at the primary site, or at their extension site (skin).
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Scope of Regional Lymph Node Surgery/EOD Fields: When a patient has two simultaneously diagnosed primaries, and a regional lymph node dissection intended for one of the primaries removes nodes that are also regional for the other primary, is the information from the lymph node dissection coded for both primaries?
For cases diagnosed 1998-2003:
If the lymph nodes are negative, the status of nodes that are regional for both sites would be used to code the EOD and Site-Specific Surgery fields for both sites.
If any of the lymph nodes are positive use the histology from the lymph nodes to determine how the EOD and Site-Specific Surgery will be coded. For example: If prostate cancer is an incidental finding when a cystoprostatectomy and pelvic lymph node dissection are done to treat a bladder cancer, and all of the positive lymph nodes reflect the histology of the prostate primary (adenocarcinoma), code the nodes as positive for the prostate primary and negative for the bladder primary.
MP/H Rules/Histology--Gallbladder: What histology is coded for a tumor described as "90% high grade neuroendocrine ca, large cell type; and 10% low grade adenocarcinoma, conventional type"?
For cases diagnosed 2007 or later:
MP/H Rule H17 for Other Sites applies. Code the histology 8140 [adenocarcinoma].
The ICD-O-3 code for large cell neuroendocrine carcinoma is 8013 and the code for adenocarcinoma is 8140.
Reportability--Brain and CNS: Are lipomas of the spinal column reportable as a benign tumor of the central nervous system (CNS)? This is seen occassionally at our pediatric facility.
Spinal cord tumors (including lipomas) are reportable when they arise in the spinal dura or nerve root. The tumor must be of the spinal cord itself or within the spinal cord dura. Spinal cord tumors are reportable when they arise in the intradural space. A reportable intradural tumor can be either intramedullary or extramedullary. Extramedullary intradural spinal tumors are reportable. A spinal tumor originating in the extradural space is not reportable. If it is outside the dura, it is not reportable because it would be outside the CNS. They are not reportable when they arise in the peripheral nerves.
CS Tumor Size--Bladder: Is tumor size coded to 080 when the bladder mass is described as "greater than 8 cm in diameter"?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Based on the information provided above, code CS tumor size 080 [8 cm]. Code the information that is avaliable. Since size of tumor is not used to stage bladder cancer, an approximation is adequate.
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