Date Therapy Initiated/Reason no treatment--Lymphoma: Is the date of the lymph node biopsy used as the date of treatment if the lymph node biopsy is the first treatment or the only treatment performed? Is the reason for no surgery coded to 0 [Surgery of the primary site was performed]?
For cases diagnosed prior to January 1, 2008, enter the date of the lymph node biopsy (excisional biopsy or biopsy NOS) as the Date Therapy Initiated for a lymphoma when the biopsy is the first or only therapy performed.
Code Reason for No Surgery of Primary Site as 0 [Surgery of the primary site was performed] and the biopsy of a lymph node is coded to 25 in Surgery to Primary Site.
Do not code a fine needle aspiration or core needle biopsy in Surgery of Primary Site.
Date Therapy Initiated/First-Course of Cancer-Directed Therapy Fields/Summary Stage 2000--Prostate: How do you code these fields for a case that received preventative chemo before a definitive cancer diagnosis?
A patient has a "suspicious but not diagnostic" biopsy of the prostate in 09/2002. Doctor said it was not cancer and put the patient on a preventative chemo drug study (GTX-211). The patient returned for a repeat biopsy on 04/2003. Biopsy returned positive for adenocarcinoma. The patient had not been diagnosed when chemo was administered. Can the case be staged using the post-chemo information?
Stage this case the same as all other cases. Use only the information subsequent to the date of diagnosis to code stage and treatment.
The diagnosis date in the example is 04/2003. Do not use information prior to 04/2003 to code stage or treatment. Do not code the preventative chemo as treatment.
Date Therapy Initiated--Corpus Uteri: How should this field be coded for an endometrial primary when the patient undergoes a hysteroscopic polypectomy on 01/08/2014 (Surgery code 25), followed by a TAH/BSO on 02/07/2014 (Surgery code 50)? See discussion.
The hysteroscopic polypectomy showed multiple tissue fragments with invasive endometrioid adenocarcinoma. The hysterectomy and BSO removed an 8.2cm endometrioid carcinoma with no extra-uterine involvement.
Record 01/08/2014 for date therapy initiated assuming there was no therapy prior to this date. A polypectomy is a surgical procedure for purposes of coding date therapy initiated.
Date Multiple Tumors--Prostate: For a prostate biopsy done 10/20/08, both lobes involved with tumor, unknown how many tumors, what would be coded in date of multiple tumors?
In this case, code the date of the biopsy in Date of Multiple Tumors [10202008]. When the number of tumors is unknown, code the date of diagnosis as the Date of Multiple Tumors. This is the date on which it was determined that there were an unknown number of tumors. This instruction will be added to next edition of the MP/H manual.
DCO/Multiplicity Counter/Type of Multiple Tumors: How are these fields coded for an unknown primary reported as a DCO case? See Discussion.
Do DCO cases have default values for the Multiplicity Counter and Multiple Tumor Reported as One Primary fields? Should these fields be coded as 88 or 99?
In the data item pages for these fields, there is only a reference to see the NAACCR Death Clearance Manual. However, this manual does not provide an answer. There is guidance to use code 88 for unknown primaries but we noticed that SEER edits skip enforcing this requirement for DCO cases (see SEER IF205 and 206).
For a DCO case reported as an unknown primary [C809], code Multiplicity Counter to 99 [Unknown if multiple tumors; not documented] and Type of Multiple Tumors Reported as One Primary to 99 [Unknown].
Computed Ethnicity: Should the Name--Alias field be used when generating Computed Ethnicity?
No, "Alias" is not used and should not be used to generate Computed Ethnicity. Computed Ethnicity records the ethnicity based on last name and/or maiden name using a computer algorithm. Alias is not part of the algorithm.
Collaborative Staging--Lung: Given that the AJCC lung TNM is not applicable for a high grade sarcoma of this site, how do we code Collaborative Stage for this site/histo combination when the pathologist indicates a TNM stage of T2bN0M0=stage III, using AJCC Soft Tissue Sarcoma schema?
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.
Use the lung schema to code CS for sarcoma of the lung. Complete the CS information as best you can from the medical record WITHOUT using the TNM Soft Tissue Sarcoma staging form. Visceral sarcomas are specifically excluded from soft tissue sarcoma TNM staging and sarcomas are excluded from the TNM staging for lung.
Sarcoma is listed on the Histology Exclusion Table for lung. When a case is coded in Collaborative Staging and the histology is on the exclusion list, SEER Summary Stage 1977 and 2000 can be assigned. For these cases, TNM will not be calculated and displayed results will be "T NA N NA M NA and Stage Group NA".
Collaborative Staging--Hematopoietic, NOS: Which Collaborative Staging schema is used for a connective, subcutaneous and soft tissue primary of the pelvis [C495] with the morphology of Langerhans cell sarcoma [9756/39]? See Discussion.
On page C-411 of the SEER manual for the connective, subcutaneous, and other soft tissues schema it lists exceptions for certain morphologies and the above is not listed as an exception. On the Hematopoietic scheme it lists the above morphology.
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.Use the hematopoietic schema on page C-709 of the 2004 SEER manual. The histologically defined schemas have priority over the site schemas when both apply. See page 115 of the 2004 SEER manual.
The morphology codes listed on page C-411 pertain to the SEER Site Specific Guidelines.
Chemotherapy: If a physician does not document the reason chemotherapy was given concurrently with radiation therapy, should it be assumed to have been used as a radiosensitizer or radioprotectant and then, per SEER chemotherapy coding instruction 2, ignore coding the chemo agent as treatment?
Do not assume that a chemo agent given with radiation therapy is a radiosensitizer. Seek additional information.
Compare the dose given to the dose normally given for treatment. When chemotherapeutic agents are used as radiosensitizers or radioprotectants, they are given at a much lower dose.
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