Report | Question ID | Question | Discussion | Answer | Year |
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20140065 | Summary Stage 2000--Melanoma: How should Summary Stage 2000 be coded for 2014+ diagnosed melanoma cases with satellite nodules or in transit metastases? See discussion. |
The SEER SS (SSS) 2000 Manual indicates satellite nodules (NOS or less than/equal to 2cm from primary tumor) are regional by direct extension (code 2) and in-transit metastasis (satellite nodules greater than 2 cm from primary tumor) are coded as involvement of regional lymph nodes (code 3). However, CSv0205 indicates mapping for satellite nodules/in transit metastasis (coded in CS LN) was changed to Regional, NOS (code 5). There are no definitions listed for code 5 in the SSS 2000 Manual.
Our staff independently code SSS 2000. Should we code the existence of satellite nodules and in transit metastases according to the current definitions in the SSS 2000 Manual or using the mapping information from CSv0205? |
Code the existence of satellite nodules and in transit metastases according to the current definitions in the SSS 2000 Manual. Do not use the mapping information from CS to code SSS. |
2014 |
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20190014 | Reportability--Behavior: Is reportable if it shows invasion or microinvasion pathologically? See Discussion. |
The SEER Manual states, Generally, this rule is invoking the Matrix principle in the ICD-O-3. We are aware this is not the same as a VIN III or an adenoma with microinvasion because those tumors have a valid histology code listed in the ICD-O-3. The terms or or do not have a valid ICD-O-3 code to apply the Matrix principle. If severe dysplasia is felt to be consistent with a carcinoma in situ, then a severe dysplasia with microinvasion would be reportable as 8010/3. But in the U.S., we do not accession severe dysplasia as equivalent to carcinoma in situ unless the pathologist also states the severe dysplasia is equivalent to carcinoma in situ (e.g., ). |
Severe dysplasia alone is not reportable. No further instructions apply because this term is not reportable.In order to use the instructions for behavior, you must first have a reportable neoplasm. If carcinoma in situ is mentioned and there is microinvasion, code the behavior as /3 according to the instructions in the SEER manual. You are correct, do not accession severe dysplasia as equivalent to carcinoma in situ unless the pathologist also states the severe dysplasia is equivalent to carcinoma in situ (e.g., ). |
2019 |
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20210055 | Tumor Size--Pathologic/EOD 2018: How is Tumor Size--Pathologic coded when Extent of Disease (EOD) Primary Tumor is 800 (No evidence of primary tumor) and there has been no surgery to the primary site? See Discussion. |
The SEER Manual states to assign Tumor Size--Pathological code 000 when EOD Primary Tumor is coded to 800 (No evidence of primary tumor) for any schema. However, the definition of Tumor Size--Pathologic states that it records the size of a solid primary tumor that has been resected. If the primary site has not been resected (does not meet the pathologic staging criteria), then it seems that Tumor Size Pathologic should be 999 when EOD Primary Tumor is coded as 800. |
Assign code 999 for Tumor Size--Pathologic when there is no surgery of the primary site. Code 999 includes "No excisional biopsy or tumor resection done." |
2021 |
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20220048 | First Course Treatment/Immunotherapy--Other Therapy: Should all therapies given as part of a clinical trial be coded as Other Therapy (NAACCR #1420), or only those that cannot be classified in one of the other treatment categories (systemic therapy, surgery, radiation) or as ancillary treatments? Does it matter what is listed in SEER*Rx under Primary Sites or Remarks regarding FDA approvals? See Discussion. |
The SEER Manual states that the Other Therapy data item identifies treatments given that cannot be classified as surgery, radiation, systemic therapy, or ancillary treatment; and the instructions for code 2, Other-Experimental, say to assign this for any experimental or newly developed treatment, such as a clinical trial, that differs greatly from proven types of cancer therapy. Does this mean that only unclassifiable treatments should be coded in Other Therapy, even if given as part of a clinical trial? For example, if a patient is given a drug as part of a trial that is categorized in SEER*Rx as immunotherapy, should it be assigned both Immunotherapy (NAACCR #1410) code 1 and Other Therapy code 2, or only coded in Immunotherapy since it is classified as such? How should a clinical trial drug be coded if it has a treatment classification in SEER*Rx, but the type of cancer being treated is not listed under the Primary Site or Remarks sections as being FDA approved? A real case scenario is atezolizumab given for colon cancer as part of a trial; this drug's category is Immunotherapy in SEER*Rx but colon is not listed under Primary Sites or in the Remarks detailing FDA approvals. |
When a drug is being administered as part of a clinical trial and it is not yet approved as treatment for the cancer site for which it is being administered, code in Other Therapy. Do not code it as Immunotherapy (for the example provided). While a drug may be approved to treat one type of malignancy, it may be in clinical trials to determine its value in treating other malignancies. Coding as immunotherapy is misinformation in this case since there are other types of approved immunotheraputic agents. |
2022 |
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20180019 | Marital Status: Is Marital Status always a self-reported status? See Discussion. |
The SEER Manual states that Marriage is self-reported for the instruction in code 2, but it does not indicate if all other marital statuses are self-reported. Examples: How is Marital Status reported for the following situations? 1. Patient with multiple tumors in the database, for the first tumor marital status is reported as married (code 2), for the subsequent tumor, marital status is reported as single (code 1). 2. Patient self- reports as single, but also has children. 3. Patient states they are in common law marriage, but our state is not a common law marriage state. |
Marital Status is self-reported because the information is recorded in the medical record based on information obtained from the patient. Use text fields to document relevant information. Examples 1. Assign code 2 for the first tumor and assign code 1 for the subsequent tumor unless the available information indicates the patient is divorced at the time of the subsequent tumor diagnosis. Patient may self-report single after a divorce. Assign code 4 in that situation. The code assigned for marital status reflects the patient's marital status at the time of diagnosis for the tumor being abstracted. It is possible that marital status may be different for each tumor if the patient has multiple tumors. 2. If marital status is stated to be single, assign code 1. 3. If marital status is stated to be common law marriage, assign code 2. Common Law Marriage is defined as a couple living together for a period of time and declaring themselves as married to friends, family, and the community, having never gone through a formal ceremony or obtained a marriage license. |
2018 |
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20240049 | First Course Treatment/Neoadjuvant Therapy--Breast: When are pre-operative therapies given as part of a clinical trial coded as neoadjuvant treatment versus limited systemic exposure in the Neoadjuvant Therapy data item? See Discussion. |
The SEER Manual seems to give somewhat conflicting instructions for clinical trial therapies under the Neoadjuvant Therapy data item. One section states that limited systemic therapy may occur in clinical trials to impact the biology of a cancer, but is not a full course of neoadjuvant therapy with the intent to impact extent of surgical resection or other outcomes (organ preservation, function or quality of life); do not code as neoadjuvant therapy for the purposes of this data item. Then another section states for purposes of this data item, the criteria for neoadjuvant therapy include that treatment must follow recommended guidelines for the type and duration of treatment for that particular cancer site and/or histology, and that neoadjuvant therapy may be given as part of a clinical trial. For example, a patient was diagnosed with invasive ductal carcinoma of the breast, 6 cm in size; treatment planning conference recommended neoadjuvant chemotherapy. The patient elected to participate in a clinical trial and was assigned to a group given the antibody drug conjugate datopotamab deruxtecan (Dato-DXd) plus durvalumab for 12 weeks. There was no physician documentation of intent or expected outcomes, nor yC staging or statement of clinical response. Post-therapy imaging showed no residual mass, and post-therapy mastectomy path report showed only residual ductal carcinoma in situ, stating "Treatment Effect (after neoadjuvant): Residual Cancer Burden - pCR, In the breast - complete response." The medical oncologist stated post-therapy stage was ypTis ypN0 cM0. The trial drugs this patient were given do not appear to be approved or standard neoadjuvant/pre-operative drugs in SEER*Rx or NCCN guidelines for this type of cancer; however, the duration of treatment was fairly substantial, and although we don't have clear documentation from physicians as recommended in the SEER manual (which is usually not stated, in our experience), it seems like they may be considering it as neoadjuvant therapy. How should the Neoadjuvant Therapy data item be coded for cases like this? What is the best way to differentiate between clinical trial therapies that are "limited systemic exposure" (code 3) versus true neoadjuvant therapy (code 1)? |
When pre-operative therapies are given as part of a clinical trial, code as neoadjuvant treatment in the Neoadjuvant Therapy data item when the intent is neoadjuvant and/or when surgical resection follows the clinical trial therapies. In the example, neoadjuvant chemotherapy was recommended in the treatment planning and the patient had the planned resection after neoadjuvant treatment. The treatment effect outcome is based on imaging that reported no mass and as documented by the physician, pathologist in this case as complete response to the neoadjuvant therapy based on the resection. Use code 3 (limited systemic exposure) when treatment does not meet the definition of neoadjuvant therapy in the data item, Neoadjuvant Therapy. Limited exposure occurs when the patient receives some therapy prior to surgical resection, but the treatment is not enough to qualify for a full course of neoadjuvant therapy with the intent to impact extent of surgical resection or other outcomes. While this type of treatment may given as part of a clinical trial, it mostly refers to short term treatments such as hormone therapy. When neoadjuvant therapy is given prior to surgical resection that is planned (intended) or performed to improve outcomes, use Code 1 or 2. Because a clinical trial is a type of research study that tests new methods of screening, prevention, diagnosis, or treatment of a disease, the treatment regimens likely will not be incorporated in recommended guidelines until all phases of the trial are completed and approved by the U.S. Food and Drug Administration. ClinicalTrials.gov is available to learn more about clinical studies around the world. |
2024 |
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20140061 | Primary Site/In Situ: How is primary site coded for an in situ carcinoma arising in a mucinous cystadenoma with ovarian stroma (focal) located in the right lobe of the liver? See discussion. |
The SEER Coding and Staging Manual instructs one to code the primary site to the location where the tumor originated, in this case the liver. However, there is no CS Extension code for in situ tumors found in the CS Manual Liver Schema. |
Based on the information provided, the primary site is liver. Submit the CS question to the CoC CAnswer Forum, http://cancerbulletin.facs.org/forums/content.php |
2014 |
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20150014 | Reportability--Brain and CNS: Is "Lhermitte-Duclos disease" is reportable? See discussion. |
The MRI states "Lhermitte-Duclos disease" but does not include "dysplastic gangliocytoma of cerebellum"; is this the same as "Lhermitte-Duclos dysplastic gangliocytoma of cerebellum (C716)"? |
"Lhermitte-Duclos disease" alone can be interpreted as "Lhermitte-Duclos dysplastic gangliocytoma of cerebellum (C716)" and reportable. The WHO classification for CNS tumors lists this entity as "Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease)" signifying that the terms are used synonymously. |
2015 |
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20120030 | MP/H Rules/Histology- -Melanoma: What is the correct histology code if the final diagnosis for an excisional biopsy specimen is reported as "malignant melanoma, superficial spreading type" but the under the "cell type" section in the CAP protocol layout of the pathology report it lists "cell type: epithelioid"? See Discussion. |
The MP/H rules do not address the concept of "cell type" for melanomas when the pathologist uses the CAP protocol to report findings and the cell type listed in that section of the report differs from the specific cell type mentioned in the final diagnosis. Does a case have two specific cell types when the final diagnosis and the "cell type" sections of a single pathology report indicate two more specific melanoma histologies? Pre-2007 SINQ entries indicate the cell type should be coded. However, if it differs from the specific cell type listed in the final diagnosis does it matter? Do the MP/H rules still take the cell type into account? |
Code the histology to malignant melanoma, superficial spreading type [8743/3] based on the final diagnosis. For cases diagnosed 2007 or later, the steps used to arrive at this decision are: Open the Multiple Primary and Histology Coding Rules manual. For a melanoma primary, use the Melanoma Histology rules to determine the histology code because there are site specific rules for cutaneous melanomas. Start at Rule H1. The rules are intended to be reviewed in consecutive order from Rule H1 to Rule H10. The rules are intended to be reviewed in consecutive order within the applicable Module. Code the more specific histologic term when the diagnosis is melanoma, NOS [8720] with a single specific type (i.e., superficial spreading) mentioned in the final diagnosis. The final diagnosis takes precedence over the CAP protocol. The CAP protocol may be used when it provides additional or noncontradictory information, but that does not apply in this case. |
2012 |
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20091049 | P/H Rules/Multiple Primaries--Lung/Breast: Can we assume that a current tissue specimen is a recurrence of previous primary if a pathologist states that he has compared the current specimen with the slides from the prior tumor and concludes that the current tumor is "similar" to a previous tumor? See Discussion. | The MP/H rule general information section states that we do not accession a second primary unless a pathologist compares the current tumor to the original tumor and states that the current tumor is a recurrence of cancer from the previous primary. In our experience it is rare that a pathologist speaks so bluntly. They frequently hedge somewhat. Are the following statements worded strongly enough for us to make the assumption that the current tumor is a recurrence of patient's previous cancer? Example 1: Pathologist states: Patient's prior lung tumor reviewed. The tumor in the current case (left lower lobe) shows similarities to some areas of the patient's prior left lower lobe tumor. Example 2: Pathologist states: The focus of ductal carcinoma in the mastectomy specimen does resemble the carcinoma in the previous partial mastectomy specimen. (Slides reviewed). |
All pathologists do not use words in the same way. Therefore, we will not provide a list of specific words to accept or not to accept in order to determine recurrence. For cases diagnosed 2007 or later, do not base your decision about recurrence on words such as "similar" or "resembles." If the pathologist believes two or more tumors are the same or believes one is a recurrence of another after comparison, accept it. When pathologists believe that two or more tumors are not the same or believe that one is not a recurrence of another, there is usually a strong statement indicating that opinion. | 2009 |