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For tumors diagnosed prior to 2007:

Histology is coded 8140/3 [adenocarcinoma]. This is one reportable tumor of the left lung. According to our pathologist consultant, the tumorlets are collections of cells which appear to be of neuroendocrine origin, but are not malignant.

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.

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.

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 description of large vessel invasion and irregular nuclear contour from the example above describes grossly matted LYMPH NODE tissue. Do not code this in the CS Extension field. Code the CS Lymph Nodes field appropriately based on the rest of the information for this case.

When large vessel invasion and irregular nuclear contour is used to describe a "tumor nodule," rather than a recognizable lymph node, code it in the CS extension field.

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 the example provided, assign code 25 [Movable axillary lymph node(s)...] for "Enlarged axillary lymph nodes suspicious for metastatic involvement." Code 60 [Axillary/regional lymph node(s), NOS] is the least specific and would not be used in this case because axillary nodes are defined in code 25. Code 26 is for cases in which "N1, NOS" documented by the physician is the only information available.

For tumors diagnosed prior to 2007:

Abstract the July 2004 diagnosis as a new endocervical primary. Abstract an invasive cancer in the same site more than two months after an in situ cancer as a new primary. Residual cervical tissue is present following a hysterectomy.

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.

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 tumor size as 100 [10 cm]. Size from pathology or operative report is preferred over size from imaging.

Code SSF6 as 050 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated and proportions of in situ and invasive not known.]

There is invasive tumor present (as proven by the bone metastasis), but the size and proportion of the invasive component is unknown.

Please note: Extension must be coded at least to 10 [Confined to the breast tissue and fat including nipple and areola; Localized, NOS] in this case. Do not assign extension code 00 [in situ].

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 the primary site C772 [Intra-abdominal lymph nodes]. Assign CS extension code 22 [Involvement of spleen plus lymph nodes below diaphragm]. The description from the chest CT is not sufficient to code lymph node involvement above the diaphragm.

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.

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.

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 primary is in the right lung according to the available information.

Assign CS extension code 10 [Tumor confined to one lung]. The only information on extension is that there is a tumor in one lung.

Assign CS Lymph Nodes code 20 [Mediastinal and subcarinal lymph node involvement]. The CT scan confirms mediastinal and subcarinal lymphadenopathy.

Code tumor Size as 999 [Unknown]. "Completely obstructed" is not a size. Do not code the size of the biopsy specimen.