Chemotherapy/Immunotherapy: Which drugs changed categories when SEER*Rx came out?
Please refer to http://seer.cancer.gov/tools/seerrx/
SEER*Rx is effective for cases diagnosed 1-1-2005 and forward. It replaces all previous references. It is neither required nor recommended that cases treated prior to 2005 be recoded.
The following drugs in the 5/17/02 Book 8 update changed from immunotherapy to cytostatic chemotherapy in SEER*Rx:
alemtuzumab/Campath
bexarotene/Targretin
bevacizumab/Avastin
bortezomib/Velcade
pegaspargase/Oncaspar
rituximab/Rituxan
trastuzumab/Herceptin
asparaginase
The following drugs may have been coded as monoclonal antibodies but are radioisotopes in SEER*Rx:
epratuzumab/LymphoCide
ibrituzumab
tiuxetan/Zevalin
tositumomab/Bexxar
Any other monoclonal antibodies either remained as monoclonal antibodies or it was a local decision to code them as immunotherapy.
There were no drugs that changed from chemotherapy to immunotherapy.
First Course Treatment--Unknown & ill-defined site: We have a case with an unknown primary site and the patient had chemoembolization into the hepatic artery. We don't know how to code this treatment. See Discussion.
We were told to code as surgery (10) and chemo (01). However an unknown primary automatically gets a (98) surgery code & the chemo is coded (01) but we can't code as systemic therapy. This is an edit. Chemo coded but no date of systemic therapy.
Effective for cases coded prior to the change in policy made on January 9, 2008, code chemoembolization of a metastatic site as 1 [nonprimary surgical procedure performed] in Surgical Procedure of Other Site.
Surgery of Primary Site code 98 is assigned to all cases with an unknown primary.
In the case of a liver primary, it would be coded 10 [local tumor destruction, NOS] in Surgical Procedure of Primary Site.
Surgery of Primary Site--Melanoma: If the surgical margins are greater than 1 cm for length and width but less than 1 cm for depth, do we code surgery in the 30-33 range?
Yes, assign a surgery code from the 30-33 range when any margin is less than 1 cm. Since tumor thickness is an important prognostic factor for cutaneous melanoma, the deep margin is of particular importance.
Reportability/In Situ--Prostate: Was there a time period when PIN III was reportable to SEER?
Per the 2004 SEER Manual, page 2, Reportable Diagnoses, Exceptions, 1.b.iii "Prostatic intraepithelial neoplasia (PIN III) of the prostate (C619). (Collection stopped effective with cases diagnosed 1/1/2001 and later.)"
Reportability/Behavior--Thyroid: Does the term "invasion" indicate the presence of a malignant tumor? See Discussion.
Left thyroid lobectomy showed microfollicular neoplasm with evidence of minimal invasion. Micro portion of path report stated, "The capsular contour is focally distorted by a finger of the microfollicular nodule which appears to penetrate into the adjacent capsular and thyroid tissue."
We recommend that you contact the pathologist for further information. If no further information is available, do not accession this case based on the information provided. There is no definitive statement of malignancy.
If the case was sent to a consultant, there may be another opinion available. If there is information in the record, or the treating physician can be contacted, find out whether the tumor was benign or malignant and whether there was any further treatment.
According to our pathologist consultant, based only on the information above and nothing else, do not report since there is no diagnosis of malignancy.
Primary Site/Histology (Pre-2007)--Rectum: How are rectal biopsies with the histology of "poorly differentiated carcinoma with mixed basaloid and squamous features" coded if, per the SEER site/histology validation table, the histology 8094/3 [basosquamous carcinoma] histology cannot be coded to the rectum for the primary site?
For tumors diagnosed prior to 2007:
Code primary site C209 [rectum] and histology 8094/3 [basosquamous carcinoma]. As of 6/9/2003, this is no longer an impossible site/histology combination.
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.
Histology (Pre-2007)--Breast: Is a "noninvasive papillary carcinoma, solid type, of the breast" coded to 8503/2 [noninfiltrating intraductal papillary carcinoma] or 8230/2 [Intraductal carcinoma, solid type]?
For tumors diagnosed prior to 2007:
Code histology to 8503/2 [Noninfiltrating intraductal papillary adenocarcinoma]. "Solid" is one of four subtypes of intraductal papillary carcinoma. The other subtypes are cribriform, micropapillary and spindle cell. ICD-O-3 does not provide codes for each intraductal papillary subtype, so code to intraductal papillary carcinoma.
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.
Grade, Differentiation--Bladder: If the only indication of grade for a bladder primary is "grade 2, NOS," and we do not know the grading system being used by the pathologist, is the numeric grade 2 coded?
See the General Coding Rules on page 92 of the 2004 SEER Manual for instructions about coding grade.
If the only information available is "Grade 2," assign code 2 [Grade II].
First Course Treatment--Prostatic Urethra: Is Lupron coded for a papillary carcinoma of the prostatic urethra that is treated with a TUR with fulguration and beam radiation even though the prostate biopsies are negative?
Do not code lupron as treatment for a primary in the prostatic urethra.
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