CS Tumor Size--Ovary: The size of a cyst is not coded in this field. However, can the size of a "cystic mass" be coded in this field? See Discussion.
The specimen consists of a cystic mass which weighs 1520 grams and measures 23 x 17 x 10 cm.
If the tumor is described as a "cystic mass" and only the size of the entire mass is given, code the size of the entire mass, because the cysts are part of the tumor itself.
Please note: Ovarian cancer stage is not based on tumor size.
First Course Treatment/Immunotherapy--Colon: Can "Sandostatin" be coded for treatment of carcinoid tumors of the colon because it flushes tumor cells from the colon in addition to controlling diarrhea?
Do not code Sandostatin (Ocreotide Acetate) as treatment. This is an ancillary drug used to treat symptoms of diarrhea. SEER Book 8 is undergoing revision and will include this change.
Histology (Pre-2007): Can we ever code this field using a more specific cell type from a metastatic site specimen rather than to a less specific cell type from the primary site specimen? See Discussion.
The histology for a metastatic deposit biopsy is mucin-producing adenocarcinoma. This report states that the primary site is the stomach. It is more specific than the histology from the stomach biopsy described as adenocarcinoma, NOS.
For tumors diagnosed prior to 2007:
Code the histology for the case example to 8481/3 [mucin-producing adenocarcinoma], the more specific histology.
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.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)/Grade, Differentiation--Thyroid: How many primaries, with what histologies should be coded when a thyroidectomy reveals "anaplastic carcinoma" and "papillary carcinoma" occurring as two separate tumors? See Discussion.
Example: Thyroidectomy revealed anaplastic carcinoma of the thyroid with mets to lymph nodes. The path report stated that the thyroid specimen also contained a small papillary carcinoma. Differentiation for the papillary carcinoma was not stated.
For tumors diagnosed prior to 2007:
Accession and code as two thyroid primaries:
Anaplastic carcinoma [8021/34]
Papillary carcinoma [8260/39]
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.
Surgery of Primary Site--Rectum: How do you code a procedure described as a "transanal resection, debulking of a large rectal mass"? See Discussion.
Patient is not a surgical candidate due to "other medical conditions". Colonoscopy done for anemia and rectal bleeding. At the colonoscopy a "Transanal Resection Debulking of large rectal mass" is performed. Two specimens are sent to the lab. The first is labeled "rectal mass" and is a 2.0 cm diameter spherical fragment of tissue. The second is labeled "transanal debulking rectal mass" and is described as multiple, irregular shaped fragments of tan, rubbery tissue measuring 5.0 x 5.0 x 3.0 cm. Final path diagnosis: Debulking of rectal mass: Adenocarcinoma greater than 2 cm in size, resection margins positive for tumor.
For cases diagnosed 1998-2002, code Surgery of Primary Site to 20 [Local tumor excision, NOS]. Because the procedure was performed via colonoscopy and apparently did not involve proctectomy, the best choice is a local excision.
Histology (Pre-2007)--Breast: Should the histology "non-invasive papillary carcinoma" along with the comment "solid intraductal papillary proliferation includes cytologically atypical cells with scattered mitotic figures" be coded to 8503/2 [intraductal papillary carcinoma] or 8050/2 [papillary carcinoma in situ]?
For tumors diagnosed prior to 2007:
The best histology code for this breast case is 8503/2 [Noninfiltrating intraductal papillary carcinoma]. According to the WHO Classification of Tumors for Breast, Papillary carcinoma, non-invasive is a synonym for Intraductal papillary carcinoma. Further, code a more specific histologic type when found in the microscopic description, according to the SEER Program Code manual.
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.
Surgical Fields--Head & Neck: How does one code the removal of benign submandibular and sublingual glands performed during a neck dissection for a head and neck cancer? See discussion.
Should the removal be coded as incidental in the surgical Procedure if the Other Site field? Does it make a difference if the submandibular gland is removed en toto with lymph nodes or if the gland is submitted as a separate specimen? Does it make a difference if the glands are involved?
Removal of the lower salivary glands is part of a radical neck dissection and is not recorded in Surgery of Primary Site or Surgery of Other Site. Radical neck dissection is coded under "Scope of Regional Lymph Node Surgery."
It does not matter whether or not the gland is submitted as a separate specimen. It does not matter whether or not the gland is involved.
Primary Site: How is this field coded for a mass involving the gastroesophageal junction and lower third of the esophagus? See Description.
We have an EGD report describing an ulcerated and infiltrative circumferential non-bleeding 10 cm. mass of malignant appearance found at the gastro-esophageal junction and lower third of the esophagus. The mass caused a partial obstruction. Biopsies were taken from the the gastroesophageal junction and lower third of esophagus. Pathologic diagnosis: Adenocarcinoma. Would this be coded C26.8?
Search for a statement indicating the site of origin. If the site of origin cannot be determined, and there is evidence of Barrett's esophagus, code the topography in the example above to C15.5 [Lower third of esophagus]. If there is no evidence of Barrett's esophagus, assign code C16.0 [Gastroesophageal junction]. Either C15.5 or C16.0 would be preferable to C26.8, which is very non-specific and includes GI tract, pancreas and biliary tract.
EOD-Extension--Thyroid: Is this field coded as involvement of the thyroid capsule if the thyroidectomy path specimen reveals papillary thyroid ca "tumor present within capsular blood vessels?"
For cases diagnosed 1998-2003: Tumor present within the blood vessels of the thyroid capsule is localized (extension code 30). The tumor has not penetrated the capsule itself if it is contained within the blood vessels.
Keep in mind that tumor size determines the extent of disease for thyroid extension codes 10, 20, 30 and 40.
Multiple Primaries (Pre-2007)--Trachea/Lung: Would synchronous lesions, of the same histology, diagnosed in the right upper lobe of the lung and trachea be a single primary when the physician feels they are two separate primaries?
For tumors diagnosed prior to 2007:
According to SEER rules, abstract as one primary because although these sites have separate topography codes in ICD-O-3, they were coded to the same three-digit topography code in the first edition of ICD-O (SEER Program Code Manual, 3rd Edition, page 8, Exception B). Simultaneous lesions of the same histology in trachea and lung are one primary. Code the primary site to C399 [Ill-defined sites within respiratory system].
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.
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