CS Lymph Nodes/CS Site Specific Factor 3--Breast: How are positive intramammary lymph nodes reflected in these fields? See Discussion.
Patient with breast cancer underwent mastectomy. No axillary lymph nodes were positive, but 1 out of 2 intramammary lymph nodes were positive for mets (greater than 2 mm). CS Lymph node codes describe axillary and internal mammary nodes, but do not describe intramammary 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.
Intramammary lymph nodes are coded as axillary lymph nodes for staging purposes. Intramammary node are nodes within the breast tissue. Both staging and treatment suggest these are equivalent to axillary nodes.
CS Extension/CS Mets at Dx--Colon: How is a small focus of metastatic disease in the submucosa coded for a sigmoid primary? See Discussion.
Path final diagnosis states: "No lymph node metastases identified. One submucosal met in a block taken from a surgical margin section." Path micro states: "Microscopic involvement of the border between the serosa and muscularis propria. Sections of proximal & distal surgical margins reveal no tumor in one, and a small focus of metastatic disease in the submucosa of the other. This focus of tumor exists in a small vascular channel and is complete in and of itself; ie, it has not been cut thru by excision of the specimen from the patient."
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.
This submucosal metastasis does not affect CS extension. It is not part of CS or TNM staging.
According to the TNM supplement, "Multiple tumour foci in the mucosa or submucosa ("skip metastasis") are not part of the TNM classification and should not be classified as distant metastasis.
Surgery of Primary Site--Colon: In the absence of detailed operative or pathology report descriptions of the specific segment(s) of the colon removed, should a hemicolectomy be coded if stated by the surgeon to be such?
Yes, code hemicolectomy as stated by the surgeon when there is no conflicting or additional information avaliable.
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.
CS Eval--Colon: When the surgical resection occurs after radiation or chemo, how is the tumor size/extension evaluation field coded when there is no mention of the tumor size or extension in the surgical resection pathology report? See Discussion.
6/30/04 CT Scan abd/pelvis: 7.5x7.2 cm large rectal mass with l cm nodular densities in perirectal region probably adenopathy; irregularity of perirectal soft tissue which could be due to tumor infiltration. 7/26/04 Patient has radiation therapy and 5FU. 10/19/04 LAR: MD Adenoca rectum with regional node mets (3/8).
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.Based on the information provided above, code CS Tumor Size and Extension from CT scan. Code CS TS/Ext eval 5 [Surgical resection performed with pre-surgical treatment...size based on clinical evidence].
Code CS lymph nodes using information from resection. Code CS Reg Nodes eval 6 [Regional LN removed...with pre-surgical treatment...based on pathologic evidence].
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].
CS Extension/CS Mets at Dx--Pineal Gland: In Collaborative Stage, how is positive cerebral spinal fluid 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.Assign CS Mets at DX code 40 [Distant metastases] for a pineal gland primary with positive cerebral spinal fluid.
CS Tumor Size/CS Eval--Breast: How are these fields coded when there is a clinical size recorded but the tumor size is not specified on the pathology report associated with a subsequent resection? See Discussion.
4/8/04 excisional biopsy of 1.5 cm palpable mass. Path: gives a specimen size only and states that there is a nodular firm area that correlates with the clustered microcalcification on radiograph. No pathologic tumor size is given. Would the size be coded to the clinical size of 1.5 cm? The patient did have surgery but the only size available is a clinical one. Because the size is clinical, is the CS Eval field coded to 0 [No surgical resection done. Evaluation based on PE...]?
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.
Clinical size can be coded when the patient has had surgery. For the case above, code the tumor size as 015 [1.5 cm] using the clinical information. The CS Tumor Size/Extent Eval field refers to both tumor size and extension. In this case, record the eval field as 0 or 1 (which ever is appropriate). The tumor size sets the T category unless the resection shows skin or chest wall or dermal lymphatic involvement.
Primary Site--Breast: If a patient has multifocal tumors all in the upper outer quadrant of the breast, is the primary site coded to C-504 because all of the tumors are in UOQ or would the site be coded to C509 to reflect the fact that multiple tumors exist?
Code the primary site to C504 [Upper outer quadrant]. All disease is located in one quadrant, code that quadrant. When disease involves two or more quadrants and the point of origin cannot be determined, code C509 [Breast, NOS]. See 2004 SEER manual, page C-470 for instructions about invasive and in situ in different quadrants.
Date of Diagnosis--Sarcoma: Should the date of diagnosis be coded to the date of biopsy or the date of birth for an infant biopsied at 3 days of age and stated to have a diagnosis of congenital alveolar rhabdomyosarcoma, widely metastatic?
Code the date of the biopsy as the date of diagnosis. This is the date the cancer was first identified by a medical practitioner.
Note: SEER collects the Month and Year of diagnosis. The "day" of diagnosis is not collected by SEER.