CS Extension--Prostate: Can the EOD Manual clarifications regarding apparent and inapparent tumors be used to determine CS clinical extension for prostate primaries?
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.Do not use the EOD information to determine apparent and inapparent when coding Collaborative Stage for tumors diagnosed 1/1/2004 or later.
The August 2007 CoC Flash stated that "After consultation with the AJCC curators for genitourinary disease, the CS Steering Committee has determined that the SEER list of terms for apparent and inapparent in the SEER Extent of Disease Manual is NOT to be used for interpreting reports for Collaborative Staging. While it was a convenient tool for registrars, the curators are of the opinion that the use of the list will lead to misinterpretation of reports. Rather, the curators recommend that registrars rely on a direct physician statement of apparent or inapparent disease for Collaborative Staging."
August 2007 CoC Flash: http://www.facs.org/cancer/cocflash/august07.pdf, Coding Prostate Cancer: A Message from the Collaborative Staging Steering Committee.
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/Recurrence (Pre-2007)--Bladder: If a patient has had recurrent invasive bladder cancers since 1971, should the latest recurrence in 2003 be SEER reportable because the case has yet to be reported to SEER?
For tumors diagnosed prior to 2007:
Because this 2003 recurrent bladder cancer was initially diagnosed prior to 1973, it is not reportable to SEER.
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.
CS Lymph Nodes--Breast: Are small isolated tumor emboli occasionally found in lymph node capsular or pericapsular lymphatics sufficient to code as a lymph node metastasis?
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 "small isolated tumor emboli" in the pericapsular lymphatics detected by H&E that are less than 0.2 mm as 05 [Regional lymph node(s) with ITC's detected on routine H & E stains].
CS Site Specific Factor--Prostate: Is there an established range of values that can be used to code negative, borderline or elevated PSA values? See Discussion.
Previous SEER prostate coding guidelines listed a PSA range that could be used to code negative, borderline, or elevated values in the absence of any statement concerning elevated PSA in the medical record. Is this still in effect for SSF 2, or do we need a definite statement when only a numeric value is given?
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 matter is under consideration by the CS Steering Committee. The CS Steering committee is reviewing options for incorporating SEER guidelines into the CS manual.
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.
CS Eval--All Sites: If any of the CS fields (TS/Extension, LN, or Mets) are based on the TNM and there is no text documenting the basis for the evaluation, are the evaluation fields coded to 0 instead of 1?
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 code 0 [No surgical resection done...based on physical exam...or other non-invasive clinical evidence] to the corresponding eval fields when CS Extension, Lymph Nodes or Mets at Diagnosis are coded based only on the TNM and no further information is available.
CS Tumor Size/CS Extension/CS Lymph Nodes--Lung: How are these fields coded when there is no description of a primary lung tumor, lymph node biopsies are negative, but biopsy of a "level 7 mass" is positive for squamous cell carcinoma? See Discussion.
Example: Chest CT: Enlarging subcarinal mass, 3.4 cm, is most likely malignant adenopathy or perhaps primary tumor. The clinician subsequently described a patient history of mediastinal lymphadenopathy. He stated that a PET scan revealed multifocal thoracic disease consistent with stage 3B carcinoma. This was followed by mediastinoscopy with lymph node biopsies (all negative) but the biopsies of "level 7 mass and subcarinal level 7 mass" showed squamous cell carcinoma.
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.If this case is determined to be a lung primary, code the CS fields:
CS Tumor Size: 999 [Unknown]
CS Extension: 99 [Primary tumor cannot be assessed]
CS Lymph Nodes: 20 [Subcarinal lymph node involvement] based on positive level 7 biopsy, history of mediastinal lymphadenopathy and subcarinal "adenopathy" per CT.
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.
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