Histology (Pre-2007): Is histology for an anorectal biopsy of "Cloacogenic carcinoma (squamous cell carcinoma with basaloid features)" coded to 8124/3 [Cloacogenic carcinoma] or 8083/3 [Basaloid squamous cell carcinoma]?
For tumors diagnosed prior to 2007:
Code histology to 8124/3 [Cloacogenic carcinoma]. These are squamous cell carcinomas of basaloid type that are found in the cloacogenic (transitional) zone of the anal canal.
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.
CS Lymph Nodes--Colon: What criteria is used to distinguish between code 30 [Regional lymph nodes, NOS] and 80 [Lymph nodes, NOS] when positive lymph nodes are removed during a colon resection but the lymph node location is not stated? See Discussion.
Example 1: Descending colon excision: Metastatic adenocarcinoma in 8 of 9 lymph nodes.
Example 2: Hepatic flexure and en bloc resection of liver. Adenocarcinoma in 3 of 10 lymph nodes.
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 positive nodes included with the resected specimen as regional lymph nodes, NOS when the location is not stated. See number 3.e under the general instructions for coding CS lymph nodes.
Based only on the information provided, code CS lymph nodes 30 [Regional lymph nodes, NOS] for both examples.
CS Site Specific Factor 6--Breast: If the tumor size for the breast is unknown, and it is unknown whether the tumor is mixed in situ and invasive or "pure", how is SSF6 to be coded? See Discussion.
The definition for SSF6 for breast changed from "Unknown if invasive and in situ components present, unknown if tumor size represents mixed tumor or a pure tumor" to an added clarification of "Clinical tumor size coded." Since the clinical tumor size is NOT coded, this does not fit.
The definition for 060 is "Invasive and in situ components present, unknown size of tumor (CS Tumor Size coded 999). Since it is unknown if the tumor is mixed, this definition does not fit either.
It seems that the revised (April 2005) definition for 888 has left a situation that cannot be coded.
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.SSF 6 should be coded 888 in this case. SEER will make the CS task force aware of this situation.
Surgery of Primary Site--Lung: Is this field coded to 30 [Resection of lobe or lobectomy] or 33 [Lobectomy with mediastinal lymph node dissection] when a lobectomy specimen includes 2 AP window lymph nodes? See Discussion.
LUL lobectomy: 1.7cm apical tumor, DX=mod well diff subpleural SCC, with involvement of pleural surface. 3 peribronchial LN neg and 2 AP window LNs neg. Stage T2N0.
1. No lymph node dissection or sampling was stated to be done
2. The lobectomy specimen contained the LNs
3. Scope of regional LN surgery is coded
Would the surgery to primary site code 30 or 33?
Code surgery of primary site to 30 [Resection of lobe or lobectomy]. According to the information provided, there was no lymph node dissection in this case. The 2 AP window nodes were obtained as part of the lobectomy specimen.
Chemotherapy: If a physician does not document the reason chemotherapy was given concurrently with radiation therapy, should it be assumed to have been used as a radiosensitizer or radioprotectant and then, per SEER chemotherapy coding instruction 2, ignore coding the chemo agent as treatment?
Do not assume that a chemo agent given with radiation therapy is a radiosensitizer. Seek additional information.
Compare the dose given to the dose normally given for treatment. When chemotherapeutic agents are used as radiosensitizers or radioprotectants, they are given at a much lower dose.
Multiple Primaries/Histology--Lymphoma: If an oral mucosa, right hard palate biopsy contains a composite lymphoma [low-grade follicular + chronic lymphocytic leukemia], how many tumors should be abstracted and how should the histology field(s) be coded?
For cases diagnosed prior to 1/1/2010:This is one primary. Assign code 9590 [Malignant lymphoma, NOS]. This is a composite lymphoma. Code to lymphoma when there is any solid tumor (in lymph nodes, tissue, etc.) Code to lymphoma, NOS since this is not purely follicular and there is no code for composite lymphoma.
For cases diagnosed 2010 forward, 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.
CS Site Specific Factor--Breast: If there are two ER/PR tests, one positive and one negative, which result should be coded in the SSF fields 1 and 2? See Discussion.
SINQ #20021074 states that for cases up to 2003, if there are differences in ER/PR results, to code the positive findings over the negative findings. Does this hold true for coding SSF1 & SSF2 for breast?
Scenario: 10/19 Breast bx: ER + PR -; No date/specimen: ER/PR -; 12/3 Partial Mast: ER/PR +
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.
For cases diagnosed prior to January 1, 2007, according to the CS Steering Committee, record the pathologist's interpretation of the assay value for the most representative tumor specimen. This may require conversation with the pathologist when specimen size is not specified.
CS Lymph Nodes--Esophagus: Is a resected positive "periesophageal nodule" coded as an involved lymph node for an esophagus primary? See Discussion.
Per SINQ 20000846: Each gross nodule of metastatic carcinoma in the fat surrounding an organ is counted as one positive regional lymph node. SINQ 2000846 applied to EOD. Can this concept be used for Collaborative Stage?
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.
For cases diagnosed on or after January 1, 2004:
Search for additional information on the "nodule." Review the gross and microscopic descriptions to determine whether or not the nodule is a lymph node. If it is not possible to obtain further information, apply the downstaging rule and select the Extension or LN code that results in the lower category.
CS Extension--Lung: Can extension be coded to 10 (Tumor confined to one lung) when either an autopsy or a CT scan describes the tumor as a mass of a specified size located in one lobe of the lung without any description of extension and no available TNM provided? See Discussion.
Example 1: Lung primary within the right lower lobe described clinically as greater than 3 cm on scan but was found to be 3 cm at autopsy.
Example 2: CT scan February shows 2 cm mass in RUL.
In both cases, the only tumor description was the size of tumor without any information regarding extension.
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.
Yes, assign code 10 [Tumor confined to one lung] for a mass in one lobe when none of the descriptions in codes 11 to 80 are documented.
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