CS Extension--Breast: How is this field coded when path describes dermal lymphatic invasion of the nipple? See Discussion.
Example
Multicentric infiltrating lobular carcinoma of left breast treated with MRM. Microscopic summary: Blood/lymphatic Vessel Invasion: present. Path final diagnosis: Angiolymphatic invasion present, including dermal lymphatic invasion in nipple. Micro: There is angiolymphatic invasion, including dermal capillary invasion identified in sections of the nipple.
The path report describes multiple breast tumors, none of which is located adjacent to the nipple.
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.
Assign CS Extension code 20 [Invasion of subcutaneous tissue...] based on the final diagnosis on the path report. There is "dermal lymphatic invasion in nipple." In this case, the stage will be determined by the tumor size.
CS Extension--Brain and CNS: How is this field coded for a malignant tumor presenting as a confluent lesion over right parietal, posterior frontal and thalamic regions?
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.
Assign CS extension code 40 [Tumor crosses the midline; Tumor involves contralateral hemisphere; Tumor involves corpus callosum (including splenium)]
The thalamus is located between the corpus callosum and the cerebellum and brain stem. A supratentorial tumor extending to the thalamus involves the corpus callosum (extension code 40) but has not yet reached the cerebellum or brain stem. Code 40 applies, but code 50 or any higher code is not applicable in this case.
CS Extension--Brain and CNS: How is this field coded for a malignant brain tumor that presents as a lesion with significant pressure on the left frontal ventricle and dilation of the right ventricles? See Discussion.
CS Extension code 30 includes tumor that invades or encroaches upon the ventricular system. Does significant pressure mean the same thing as encroach?
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.Do not assign extension code 30 in this case unless there is evidence elsewhere of ventricular system involvement.
"Significant pressure" is not synonymous with encroachment or involvement. See the list of ambiguous terms for CS staging on page 121 of the 2007 SEER manual.
CS Extension--Bladder: How would the following statements be coded for bladder extension -- Code 03 [inferred description of non-invasion] vs code 15 [invasive confined to subepithelial connective tissue]. See Discussion.
1) no smooth muscle invasion
2) no muscle invasion
3) without muscle invasion
4) no invasion of muscularis propria
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.
For cases diagnosed in 2004 and later code CS extension:
CS Extension--Bladder: How should this field be coded when the pathology states "papillary transitional cell carcinoma with no invasion into the submucosa or deep muscularis" but there is "focal extension of tumor into bladder diverticula"?
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.
Code the CS Extension field to 01 [Papillary transitional cell carcinoma stated to be noninvasive]. Extension into bladder diverticula does not change the code. Diverticula are pouches in the mucosa (mucous membrane).
CS Extension--Bladder: How should this field be coded for a high grade urothelial carcinoma with "focal micropapillary features and invasion of lamina propria, with a note stating there is invasive carcinoma focally involving thin muscle bundles...difficult to distinguish whether muscularis propria or muscularis mucosae"?
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.Assign CS Extension code 15 [Invasive tumor confined to subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma)]. The information provided confirms invasion of the lamina propria (code 15) but is not definitive enough to assign a code higher than 15.
CS Extension--Bladder: How is extension coded if the bladder tumor involves the right ureter per cystoscopy but the TURB specimen demonstrates muscularis propria invasion?
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.
Code CS extension based on the area of deepest invasion. According to the TNM Supplement, which was used as a resource in the development of CS, "Direct invasion of the distal ureter is classified by the depth of greatest invasion in any of the involved organs." Record the greatest extent of disease using both clinical and operative/pathologic assessment.
CS Extension--Bladder: Can the physician TNM be viewed as a clarifying statement when it provides information not documented elsewhere in medical record as in the example of a pathology report for bladder primary that demonstrates extension into bladder muscle, NOS but the physician documented TNM notes a more definitive T code for depth of muscle invasion? See Discussion.
In the Collaborative Stage manual in general instructions this guideline exists:
"The extent of disease may be described only in terms of T (tumor), N (node), and M (metastasis) characteristics. In such cases, assign the code in the appropriate field that corresponds to the TNM information. If there is a discrepancy between documentation in the medical record and the physician's assignment of TNM, the documentation takes precedence..." (Similar to language to use SEER information over TNM).
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.Yes, you may code CS extension using the physician assigned "T" when it provides information not found elsewhere in the medical record.
CS Extension (Clinical)/SSF 3 (Pathologic Extension)--Prostate: Upon prostatectomy, the case was determined to be localized. There is no clinical assessment of the tumor prior to prostatectomy. Should clinical extension be coded to 99 [Unknown]? Please see discussion below. See discussion.
We have a prostate case that is clinically inapparent. There is no staging info at all, no biopsy done. Then the patient has a prostatectomy with a single 0.4cm focus of Adenoca gr 3+3.
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.Yes, code CS Extension (clinical) as 99 [unknown]. The extension based on the prostatectomy is coded in Site Specific Factor 3 - Pathologic Extension.
CS Eval/Surgery of Primary Site--Colon: When the only procedure performed is a polypectomy, if there is NO tumor at the margins, should CS TS/EXT-Eval be coded as 3 and the surgery coded as a polypectomy?
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.Assign eval code 3. A polypectomy with no tumor at the margin meets the criteria for pathologic staging.
Code polypectomy in Surgery of Primary site in this case.
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