Radiation Sequence with Surgery--Head & Neck: How is this field coded for a tonsil primary diagnosed on 4/16/07 by a regional lymph node FNA when the patient subsequently initiates radiation on 5/8/07 and has a tonsillectomy with neck dissection on 7/30/07?
The best way to handle this situation is to assign code 2 [Radiation before surgery] in Radiation Sequence with Surgery. Code 2 provides the best description of the sequence of events in this case. Radiation was delivered prior to the resection of the primary site.
Race, Ethnicity/Spanish Surname or Origin: Which Spanish Surname List (from 1980 census or 1990 census) would SEER prefer us to use to code 7 in Spanish Surname or Origin? See Discussion.
In the SEER coding manual, it refers to "a list of Hispanic/Spanish names" (5e), but does not specify which one to use. Again, for the Computed Ethnicity field, which Spanish Surname List does SEER prefer us to use?
Determine which list is better suited for your geographic area. If the 1990 list is used, determine the probability cut-off that seems most reasonable for your geographic area.
Race, ethnicity/Spanish surname or origin: SEER Program Manual instructions state, "Portugese, Brazilians and Filipinos are not Spanish; Code non-Spanish (code 0)." How is that determined? Is that based SOLELY on birthplace? See Discussion.
The following are scenarios for which we would like clarification on how to code Spanish Ethnicity.
Birthplace Portugal; text states Spanish, south American or European Spanish
Birthplace Brazil, last name is on Spanish surname list; pt is married female. Text states "Hispanic female, NOS"
Birthplace Brazil or Portugal, text states patient is "Mexican", last name is on Spanish surname list
Information about Spanish origin is available for both of these cases; code the race as Hispanic. Use the SEER manual instruction when the only information available is that the patient was born in Portugal, Brazil or the Philippines. In the absence of additional information, do not assume Hispanic. However, if additional information is available stating that the patient is Hispanic, code as Hispanic.
Race, ethnicity/Spanish surname or origin: If birthplace is Brazil or Portugal, patient's last name is on the Spanish Surname list, and there is no text to further clarify ethnicity, what is the correct Spanish Ethnicity code: 0 or 7? See Discussion.
See also SINQ 20081075.
Assign code 7 [Spanish surname only] when the last name is on the Spanish Surname list. This includes cases for which the birthplace is Brazil, Portugal or the Philippines and there is no text to further clarify ethnicity.
The instruction to use code 0 [Non-Spanish/Non-Hispanic] in the SEER manual on page 51 (#2) applies when the only information available is the birthplace or a statement of "Portuguese," "Brazilian" or "Filipino."
Priorities/EOD-Lymph Nodes--Breast: Which part of the pathology report takes precedence when there is a discrepancy between the final path diagnosis and the CAP summary? See Description.
For example, breast primary: Final path states "14/18 nodes (+) for tumor & separate matted aggregate of axillary nodes (+) for tumor. Subpectoral lymph node (+) for mets ca. Path Gross states "18 separate lymph nodes identified...many (+) for tumor grossly. Aggregate of matted lymph nodes within axillary tissue (+) for tumor. Multiple separate lymph nodes submitted." CAP Micro Summary lists "20/16 nodes examined/positive." What is correct number of nodes positive & nodes examined in this case?
For cases diagnosed 1998-2003: The final pathology diagnosis has highest priority. The CAP summary is second priority. However, you always use the best information available. If the final path diagnosis is vague or unclear, information from the CAP summary can be used. In the case example, the total lymph node count from the final path diagnosis is unclear and the CAP summary provides clarification. Code the number of lymph nodes positive as 16 and the number examined 20. Subpectoral lymph nodes are regional nodes for breast primaries.
Primary Site: What would the primary site be for carcinoma of the renal pelvis, status post transplant? Please see details below. See Discussion.
The patient has a renal pelvis urothelial carcinoma confined to the pelvis but is status post renal pelvic transplant of the same renal pelvis.
Code the primary site to renal pelvis [C659]. Code the site in which the primary tumor originated. The transplant status in this example does not affect the primary site.
Primary Site: What site code is used to classify a femur biopsy with pathologic diagnosis of "Ewing sarcoma/primitive neuroectodermal tumor (PNET)"? See discussion.
ICD-O-3 lists PNET as being site specific to C71._. The pathology report states "some authors consider both Ewing sarcoma and PNET to be the same histologic entity given that they share the same translocation between chromosomes 11 and 23."
Code the Primary Site field to C40.2 [femur] based on Rule H in the ICD-O-3 that states, "Use the topography code provided when a topographic site is not listed in the diagnosis. This topography code should be disregarded if the tumor is known to arise at another site."
Primary site: What is the single primary site used for a patient with multiple tumors in the duodenum and jejunum? See discussion.
The patient has a tumor in the jejunum and another tumor in the duodenum. Both tumors have the same histology. This disease process is a single primary per Other Sites Rule M18. Is the primary site coded to the more invasive tumor? If the tumors are equally invasive, is the primary site coded to C179?
Code the primary site to C179 [small intestine, NOS] for multiple invasive tumors of the small intestine accessioned as a single primary.
The steps used to arrive at this decision are:
Step 1: Go to the Primary Site subsection located in Section IV of the 2012 SEER Manual titled "Description of This Neoplasm."
Step 2: Apply instruction 5. "Code the last digit of the primary site code to '9' for single primaries, when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined." Code the primary site to C179 [small intestine, NOS].
When multiple tumors arising in different subsites are accessioned as a single primary, the primary site is coded to the NOS code, in this case small intestine, NOS [C179]. The level of invasion does not determine the primary site, unless one or more of the tumors is in situ and another is invasive.
Primary site: What is the correct primary site code for angiosarcoma of the spleen with mets to bone marrow C42.2 vs C49x? See Discussion.
Robbins Pathology states the following about liver angiosarcomas: Hepatic angiosarcomas are rare but of interest because they are associated with distinct carcinogens, including arsenic (exposure to arsenical pesticides), Thorocast (a radioactive contrast medium previously widely used in radiology), and polyvinyl chloride (PVC) (widely used in plastics). The increased frequency of angiosarcomas among works in the PVC industry is one of the truly well-documented instances of chemical carcinogenesis in humans. With all these agents, there is a very long latent period of many years between exposure and the development of tumors.
Could the same apply to the spleen?
Code C422 [Spleen] as the primary site for angiosarcoma of spleen with metastasis to bone marrow.
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