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20031053 | Reportability/History (Pre-2007)/Behavior Code--Ovary: Should the matrix principal in Rule F be applied to code a 2002 right ovary case to 8462/3 [Papillary serous borderline ovarian tumor] when peritoneal washings reveal the same histology? | For tumors diagnosed prior to 2007:
Do not apply the matrix principle in this case. This ovarian tumor is not reportable (behavior /1 per ICD-O-3). The peritoneal washings reveal the same histology (/1), rather than malignant cells. Based on the information provided, there is no evidence to support changing the behavior code.
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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20031198 | Surgery of Primary Site/Date Therapy Initiated--Head & Neck: Would a biopsy, NOS, that removed the majority of the tumor be used to code these fields? See Description. | Patient underwent biopsy, NOS, of a carcinoma of the tongue. Subsequent glossectomy revealed microscopic focus of residual squamous cell carcinoma. | If the biopsy NOS removed all macroscopic disease, code the date of the biopsy NOS as the date therapy initiated. If macroscopic disease remained following the biopsy NOS, code the glossectomy date as the date therapy initiated. | 2003 |
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20031171 | Reportability: Is pseudomyxoma peritonei always reportable? See Description. | In the ICD-O-3, pseudomyxoma peritonei has a behavior code of 6, indicating that it is malignant. Does this imply that pseudomyxoma peritonei is always a reportable malignancy? In the past, our pathologist consultant told us that pseudomyxoma peritonei is only a reportable malignancy if the underlying tumor is malignant. A benign cystadenoma of the appendix, for example, can rupture causing pseudomyxoma perionei. Does SEER agree with our pathologist consultant? Example: Patient was found to have psuedomyxoma peritonei. Right hemicolectomy was done. Path reported an appendix with mucinous cystic tumor of undetermined malignant potential. A definite diagnosis of cancer can not be rendered. |
Reportability is determined from the behavior of the primary tumor and the behavior of implants. If either are malignant, the case is reportable. The case example does not seem to be reportable, based on the available information. Cancer diagnosis has not been made according to the pathology report. |
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20031174 | Multiple Primaries (Pre-2007)/Recurrence--Breast: Has SEER established a priority of medical opinions to determine the number of primaries or a time parameter establishing recurrence? When a pathologist and a physician refer to the subsequent reappearence in the same breast as both "recurrence" and "new primary"? See Description. | Example 1. Patient was diagnosed with right breast cancer in 1999 and underwent lumpectomy followed by radiation therapy. In 2001, patient was again found to have right breast cancer and was admitted for mastectomy. The surgeon stated that this was recurrence. The patient's primary care physician stated the patient had a new primary. Is there a priority order if the multiple physicians involved in a patient's care do not agree on the diagnosis? Example 2. Patient was diagnosed in 1998 with left breast cancer. In 2000, the patient again was diagnosed with left breast cancer. There was no mention of recurrence so case was accessioned as a second primary. In 2003, patient was again admitted for an unrelated disease. In the H&P, the physician stated that the patient had recurrent breast cancer in 2000. Do we remove the second primary from our file based on this statement three years later? Example 3. Patient was diagnosed with Paget's disease with intraductal carcinoma, left breast, in 1997. In August 2002, patient underwent left mastectomy for DCIS, left breast. In November 2002, patient's oncologist stated that patient had been on Evista for 5 years and had recurrent cancer despite Evista. Do we accession this as one or two primaries? |
For tumors diagnosed prior to 2007:
Use the best information available. In general, information from the time closest to the event in question is more accurate than later information. The opinion of the pathologist tends to be the most valuable. Beyond that, SEER has not established a hierarchy of physician opinions. Be aware that a physician's use of the term "recurrence" does not always mean that the second tumor originated from cells from the first tumor. Examples 1, 2 & 3. Follow SEER rules for determining multiple primaries. In each case, the diagnoses are more than two months apart. Abstract as two primaries.
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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20031202 | Surgery of Primary Site--Head & Neck: How is this field coded for a surgery titled "Parotidectomy with facial nerve dissection"? See Description. | If the operative report is not titled "total parotidectomy," can we assume that less than total parotidectomy was done? Can we assume that "facial nerve dissection" and "facial nerve monitoring" are other ways of stating "facial nerve spared"? | Use the best information available to determine whether or not all of the parotid has been removed. It is important to read the entire operative report and review the content of the pathology report. The Op report will usually include wording about how much was removed, and this can be confirmed by the path report. Do not make assumptions about the extent of the surgery based solely on the title used on the operative report.
For cases diagnosed 1998-2003: Code 30 [less than total parotidectomy] can be used when the parotid is not totally removed, but the exact type of partial parotidectomy cannot be determined. "Facial nerve monitoring" and "Facial nerve dissection" are synonymous with "facial nerve sparing." |
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20031127 | Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: Would the simultaneously occurring histologies of "high grade ductal carcinoma in situ with micro invasion" and "keratinizing squamous cell carcinoma" be coded as two primaries or as a single primary when the pathologist is not clear whether two separate tumor masses exist? | For tumors diagnosed prior to 2007:
Code as two primaries, assuming the tumors are separate and the margins are clear/negative. Code 8071/3 [Invasive squamous cell ca, keratinizing] and 8500/3 [Ductal carcinoma, "microinvasive"].
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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20031079 | Primary Site: Should we code C80.9 [unknown primary] or code C34.9 [Lung] according to the terminology, "most likely site of origin is lung"? See Description. | We have a case of metastatic keratinizing squamous cell ca. The work-up shows small densities in the lung that may represent inflammatory or chronic changes. No other imaging that shows origin. Physical exam states 2 months of left axillary mass. H/O SCCA of the skin involving chest wall. Path reads: Metastatic w/d keratinizing SCCA. This lesion almost undoubtedly represents mets. The most likely site of origin is lung followed by esophageal primary or head & neck. The final discharge states, "Metastatic SCCA to Left Axilla". |
Code the primary site according to the physicians' opinion, especially the treatment decision. If the physician treats the patient for a lung primary, code primary site as lung. If the primary site cannot be determined, code C80.9. According to the pathologist, the most likely primary site for the example above is lung. The final discharge diagnosis does not reflect the pathologist's opinion, and does not contradict it either. If there is no conflicting medical opinion, code primary site to C34.9 [lung]. |
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20031094 | Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: How many primaries are coded and what code(s) is/are used to represent the histology "invasive ductal carcinoma with extensive spindle metaplastic change [metaplastic carcinoma] with a second, separate, tumor "invasive ductal carcinoma, moderately differentiated with extensive associated DCIS"? See Description. | The comment on the pathology report states, "due to the associated DCIS this smaller lesion is felt to most likely represent a synchronous second primary." Is this two primaries, one coded 8575/33 and the other coded 8500/32 or is this a single primary with a combination code -- 8523/33? | For tumors diagnosed prior to 2007:
Abstract as two breast primaries. Code to 8575/33 (metaplastic carcinoma) and 8500/32 (infiltrating duct carcinoma). There are two lesions with different histologic types. Do not use code 8523 to combine separate tumors with different histologies.
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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20031210 | Other Cancer-Directed Therapy--Hematopoietic, NOS: Is there a hierarchy for selecting which code to use when a patient receives more than one type of "other treatment"? See Description. | Patient was diagnosed with Myelodysplastic Syndrome, probably refractory cytopenia with multilineage dysplasia. Good candidate for investigational studies for transfusion-dependent patients. Patient was enrolled in a high dose vitamin D study. Patient also received transfusions. | SEER has not established a hierarchy of the codes listed under Other Treatment. If the patient receives more than one type of other treatment as the first course of treatment, assign the code that provides the most information about how the patient was treated and use the remarks fields to explain. Code Other Treatment for the case example above as 2 [Other experimental therapy]. Use the remarks fields to describe the transfusions and vitamin D therapy. |
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20031045 | Other Therapy: How do we classify "thalidomide" when it is given as cancer directed therapy? | Code to the appropriate code (1, 2 or 3) under Other Therapy, depending on whether the drug was given as part of a clinical trial. If not part of a clinical trial, assign code 1 [Other cancer-directed therapy]. Thalidomide is not FDA approved for treating cancer. It is under investigation for anti-angiogenesis effects in different cancers. |
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