Report | Question ID | Question | Discussion | Answer | Year |
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20051124 | CS Site Specific Factor--Prostate: Are the EOD guidelines developed for coding apex involvement still in effect for determining the code for apical involvement in SSF 4? See Discussion. | How do the old prostate codes 31, 33, and 34 correspond to the new SSF 4 field? Because "arising in" or "extending into" apex is rarely, if ever, stated, previous SEER guidelines instructed us to use code 33 for "apex only" involvement, and code 34 for "apex and any other area of prostate". Code 31 [into/arising, NOS] was to be avoided. | 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.No, the EOD guidelines for coding apex involvement are not in effect for coding SSF4. The codes for CS site specific factor 4 include code 2 [into prostatic apex/arising in prostatic apex, NOS]. When it cannot be determined if apical involvement is arising in, or extending to, the apex, use code 2. |
2005 |
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20051020 | CS Extension/CS Site Specific Factor--Breast: How is extension (localized or unknown) and SSF6 (entire tumor in situ or 888) coded for an in situ breast primary in which bone metastasis is diagnosed 4 months following the mastectomy? See Discussion. | In situ breast primary with bone mets. No mets work up prior to mastectomy done 2/04. Path: 2.5 cm mass: ductal carcinoma in situ, solid type, with comedonecrosis (no invasive carcinoma found in mastectomy specimen). Bone scan done 4/04 showed compression fractures. MRI 6/04 showed diffuse metastatic disease of the bones. | 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. First, determine whether the bone mets in this case are progression of disease. If the patient was asymptomatic at the time of the mastectomy, the bone mets are disease progression, not initial stage. If the initial stage includes the bone mets and they are not disease progression, extension must be coded to at least 10. Code site-Specific Factor 6 to 040 [Size of entire tumor coded, size of invasive component not stated]. |
2005 |
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20051087 | CS Site Specific Factor 3--Prostate: When a prostatectomy specimen shows tumor focally penetrating through the capsule into periprostatic striated muscle tissue, is the involvement coded to 041 [periprostatic tissue] or 052 [skeletal muscle, NOS]? | 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 052 [Levator muscle, Skeletal muscle, NOS, Ureter]. The description for this case states periprostatic "striated" muscle tissue. According to our pathologist consultant, "striated muscle in this context is skeletal muscle and the term is being used to differentiate the muscle from smooth (non-striated) muscle." Smooth muscle involvement would be most likely be coded 050 [Extension to bladder neck...] because smooth muscle in a prostatectomy or TURP specimen is usually from the urinary bladder neck. |
2005 | |
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20051101 | CS Extension--Cervix: How are "positive pelvic washings" coded for a cervical primary? | 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. According to the CS Steering Committee, positive pelvic washings for primary cervical cancer are not part of the staging criteria in the collaborative staging system (nor in TNM and FIGO). Document positive pelvic washings in a text field. The CS steering committee will add a statement to CS extension to clarify this for cervix uteri. |
2005 | |
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20051145 | 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. |
2005 |
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20051092 | CS Extension--Kidney: When an incidentally found 5 cm mass discovered on a CT scan during a work-up for colon carcinoma is stated to be consistent with renal cell ca, should the case be staged as localized or unknown when no other information is available related to a work-up for the kidney primary? | 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 what is known. In the example above, the tumor size and the extension are known and can be coded. The information is limited, but not completely missing. Code what you DO know rather than coding nothing. Any metastases from the kidney would have been discovered during the workup of the rectal cancer. |
2005 | |
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20051053 | Reportability/Multiple Primaries (Pre-2007)/Histology--Anus: How many primaries exist if an 11/7/03 anal lesion presents with poorly differentiated adenocarcinoma with signet ring features and extensive mucin production and the 1/9/04 wide excision has adenocarcinoma and Paget disease (intraepidermal adenocarcinoma) extends to skin margin? | For tumors diagnosed prior to 2007:
This is a single primary: the adenocarcinoma with the Paget representing intraepithelial extension of the process. Tumor cells can invade from their place in the epithelium into the underlying stroma either at the primary site, or at their extension site (skin).
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. |
2005 | |
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20051046 | Reportability/Diagnostic Confirmation--Leukemia: What is the diagnostic confirmation if a positive BCR/ABL result is diagnostic of a malignancy in a patient suspected to have chronic myelogenous leukemia? See Discussion. |
Example 1: Peripheral smear states: "No morphologic evidence of chronic myelogenous leukemia." Addendum: Molecular diagnostic studies showed a positive rearrangement for the BCR gene with the M-bcr (CML type) and of bcr-abl transcript expression". Example 2: Hematopathology is negative. Molecular diagnostic study: "fluorescent in situ hybridization (FISH) studies exceeded the limits established by the XXX Cytogenetics Laboratory for this probe set, and thus, demonstrated statistical evidence of BCR/ABL fusion." |
For cases diagnosed prior to 1/1/2010: Do not determine reportablility using cytogenetics or molecular studies alone. Since these are not routine screening tests, we suggest that you query the physician and review the medical record to see what prompted the study and what is being done with the result, but the test alone is not in and of itself sufficient to report the case. 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. |
2005 |
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20051028 | Date of Diagnosis--Bladder: Should the date of diagnosis be based on the 1/7/04 urine cytology with low grade transitional cell carcinoma or the subsequent 1/27/04 pathology findings of papillary transitional cell carcinoma? | In this case, the date of the cytology is the date of diagnosis, 01-07-2004. | 2005 | |
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20051096 | Primary Site--Peritoneum: During a second look staging lap following a diagnosis of serous carcinoma of the left ovary, did the physician correctly indicate a new peritoneum, NOS primary for disease described as an endometrioid adenocarcinoma in a "paracaval cyst" that appears to have arisen in endometriosis? | The primary site is C482 [Peritoneum, NOS]. "Paracaval" means alongside or near the vena cava. Code the site in which the primary tumor originated. |
2005 |