MP/H Rules--Fallopian Tube: How many primaries are to be abstracted for a case in which a bilateral fallopian tube primary is staged T1c by the pathologist? See Discussion.
A bilateral fallopian tube primary was coded to multiple primaries. However, the AJCC staging for T1b says, "tumor limited to both tubes"
and T1c "tumor limited to one or both tubes." The tumor is T1c according to the pathologist. Is this two T1c primaries or one?
For cases diagnosed 2007 or later, abstract as two primaries using Other Sites rule M8.
This issue will be reviewed during the next update to the MP/H rules.
CS Tumor Size: Is a 5.5 mm tumor coded as 005 or 006? See Discussion.
We interpret the CS Manual general instructions to indicate to ONLY round up to 001 when the tumor size is stated to be 0.1 to 0.9mm.
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 tumor size 006. Because only whole numbers in mm can be collected, basic mathematical principles are used for rounding; 1-4 round down, 5-9 round up.
MPH rules--Rectum: How is the number of primaries to be determined when a treatment plan has been completed, but it is not possible to determine whether there was a disease-free interval between occurrences? See Discussion.
Patient diagnosed with adenocarcinoma of the rectum in March 2006, underwent chemo and radiation therapy as treatment. Patient seen in April 2007 for surveillance colonoscopy. HPI stated patient underwent chemorad with good results. Colonoscopy showed "persistent" disease. Abdominal perineal resection was done in May 2007. Path showed adenocarcinoma of the rectum.
Keeping in mind that we are not to use a clinical statement for determining recurrences, is the April 2007 occurrence counted as a new primary?
For cases diagnosed 2007 or later:
Do not abstract the 2007 events as a new primary. "Persistent disease" indicates there was never a disease free interval.
CS Site Specific Factor--Breast: How is SSF6 coded when CS tumor size is coded from a clinical report, not from pathology? See Discussion.
A breast ultrasound displays a 2 cm tumor. Core biopsy diagnosis is lobular carcinoma in situ. No further record for patient. Tumor size coded to 020. Should SSF 6 be coded to 010 "Entire tumor reported as in situ (no invasive component reported)" because it was pathologically confirmed, or to 888 because size was coded based on a clinical exam - the ultrasound?
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 SSF6 888 [Clinical tumor size coded]. When the size recorded in CS Tumor Size is not determined pathologically, 888 must be coded in SSF6. Note: The code in SSF 6 pertains to pathologic tumor size. It describes the relationship of invasive and in situ tumor in the tumor size coded.
Surgery of Primary Site--Melanoma: Which surgery codes should be used for cases that have a 1 cm margin? See Discussion.
For a melanoma case the surgery codes in the 30's are to be used when margins are stated to be less than 1 cm. The codes in the 40's are to be used for cases where the margins are greater than 1 cm.
If the margin is exactly 1 cm, assign a surgery code from the 20-36 range. Use a code in the 40's only when the margin is greater than 1 cm.
Ambiguous terminology/Reportability--Leukemia: Is a 'suspicious peripheral blood smear' the same as a suspicious cytology? See Discussion.
The final diagnosis on the path report for a peripheral blood smear is stated to be "suspicious for malignancy." The microscopic description states that the "lymphoid population raises the concern of chronic lymphocytic leukemia." Nothing further was done. Is this a reportable case? If so, should it be coded as a leukemia or a malignancy NOS?
For cases diagnosed prior to 1/1/2010:Do not accession a leukemia case based only on a "suspicious" peripheral blood smear. If a confirmed diagnosis, clinical confirmation or further information becomes available later, accession the case at that time.
For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
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.
Radiation Therapy--Breast: If hospital records indicate that a mammocyte intracavitary radiation therapy device was placed in the breast, but there is no follow-up documentation of radiation actually being given, should we code radiation 2 (implants) or 8 (recommended, unknown if given)?
Assign code 8 [recommended, unknown if administered]. Check this case periodically, and others coded 8. Update if further information becomes available.
MP/H Rules/Multiple primaries--Lung: Should a subsequent primary be abstracted using rule M8 for a patient diagnosed in January 2000 with adenocarcinoma of the right upper lung if the patient initially sought alternative therapies and presented in September 2007 for a right upper lobe lung mass with extension into the mediastinum, mediastinal lymph node mets and a pericardial effusion? See Discussion.
After more than seven years, the patient in this case decided to proceed with the originally suggested standard therapy. Is this a multiple primary case because the tumors are "diagnosed" more than 3 years apart? Or should we assume this is further progression of the 2000 case because it was originally only treated with alternative therapies? The clinician in this case indicates the patient is being referred for treatment to the right upper lung originally diagnosed in 2000.
For cases diagnosed 2007 or later:
Do not abstract a 2007 primary for this case. From the information provided, there is disease progression/extension and lymph node metastasis in 2007; but there are no new lung tumors in 2007. Therefore, the 2007 MP/H rules do not apply.
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