CS Site Specific Factor/CS Lymph Nodes--Breast: If the ITCs are greater than 0.2 mm, how are these fields 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.
Lymph nodes with metastases greater than 0.2 mm are counted as positive. Code in CS Lymph Nodes and CS Regional LN Positive. Do not code ITC's greater than 0.2 mm in CS Site Specific Factor 4.
Histology--Breast: Does "cancerization" mean invasive for a breast tumor described as "DCIS with lobular cancerization"?
No, cancerization is not a synonym for invasive. Cells of DCIS can extend not only along the duct but also into the terminal lobules. This extension is referred to as lobular cancerization.
CS Extension/CS Mets: For primary sites within the peritoneum (abdominalpelvic walls) such as stomach, colon, does the presence of malignant ascites affect the coding of CS Extension or CS Mets?
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.
The Collaborative Staging system is governed by site-specific coding rules. Refer to each set of site rules rather than looking for a general answer for all sites in peritoneum. In particular, Ovary and Corpus allow malignant ascites to be coded in CS Extension, but not CS Mets at Dx. For each site, both CS Extension and CS Mets at Dx should be checked for the proper field to code malignant ascites.
Behavior--Head & Neck: Should the SEER IF_Morph_3 edit be modified because it does not allow a behavior code 2 with histology 8941 [carcinoma in a pleomorphic adenoma] for a parotid primary?
Code the behavior as 2 and over-ride the edit. The edit is there to flag unusual combinations. Once you have verified that the behavior is coded correctly, over-ride the edit.
The surgeon stage of T2 is based on size of tumor, the TIS is based on behavior. Code according to pathologically confirmed TIS.
First Course Treatment--Lymphoma: Should the use of proton pump inhibitors be coded as treatment for lymphoma primaries in patients with H Pylori?
No, do not code proton pump inhibitors as treatment. These are used for gastric acid suppression. Proton pump inhibitors are used to treat symptoms, not the lymphoma itself.
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 Extension--Lung: How is extension coded if there is only one cytology done on a pleural effusion that is negative for carcinoma (but shows an exudate) and there is no clinical assessment of the pleural effusion found in the medical record? See Discussion.
CS lung extension note 6 provides instructions from the SEER manual and also from the AJCC manual. Per SEER manual, "ignore the effusion that is negative for tumor." Do we ignore the pleural effusion for the case in question because it was negative? Per AJCC manual, "most pleural effusions associated with lung cancers are due to tumor. However, there are a few patients in whom multiple cytopathologic examinations of pleural fluid are negative for tumor. In these cases, fluid is non-bloody and is not an exudate. When these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element." For the case in question, pleural fluid was examined only once and clinical judgment is not available. As a SEER registry, do we follow the SEER portion of the note and ignore the pleural effusion? Or do we code extension as involving pleural effusion because it was an exudate?
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.A single negative pleural effusion by itself does not impact the coding of extension.
The SEER note does not alter the AJCC note and the AJCC note does not alter the SEER note. They are two separate statements from two separate staging authorities. Registries follow both notes. For this case, ignore the pleural effusion because there is no clinical judgment available and there was only one cytology on the effusion.
Histology (Pre-2007)--Melanoma: Is the code 8740/3 [malignant melanoma in a junctional nevus] to be used when the pathologic diagnosis is "malignant melanoma arising in a compound nevus"?
For tumors diagnosed prior to 2007:
Assign code 8720/3 [malignant melanoma, NOS] for malignant melanoma arising in a compound nevus. A compound nevus is not the same as a junctional nevus.
ICD-O-3 does not have a specific code for melanoma in a compound nevus. Assign the code for the type of melanoma specified; for example, NOS, superficial spreading, etc.
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.
Diagnostic Confirmation: How is this field coded for a case with a cytology that is suspicious for ductal carcinoma and the clinical diagnosis is carcinoma? See Discussion.
SINQ 20031152 states that histology for this type of case is to be coded per the clinical diagnosis of "carcinoma." Does it follow then that Diagnostic Confirmation is to be coded 8 (clinical diagnosis only)? Would we code Diagnostic Confirmation differently if the clinician stated that the diagnosis of malignancy was confirmed by the suspicious cytology?
Code diagnostic confirmation as 8 [clincial diagnosis] when there is a suspicious cytology and a physician's clinical diagnosis. Do not accession cases with only suspicious cytology.
Code diagnostic confirmation as 8 when the clinician's diagnosis of malignancy is confirmed by the suspicious cytology. It is still a clinical diagnosis made by the physician using the information available for the case.
Chemotherapy--Breast: Is chemotherapy administered for inflammatory breast cancer also coded as therapy for an in situ tumor in the contralateral breast?
Yes. Because chemotherapy would likely affect both primaries, code it as treatment for both the in situ and the inflammatory breast cancers.
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