CS Lymph Nodes/CS Reg Nodes Eval -- Rectum: If the rectal tumor is not treated with a resection but on endoscopic ultrasound the patient is stated to have a lymph node above the primary tumor and the physician stages the case clinically as N1, should the CS Lymph Nodes field be coded to 30 [Regional lymph node(s), NOS] or 10[Rectal, NOS]? Should the evaluation field be coded to 0 [No lymph nodes removed. Evidence based on other non-invasive clinical evidence] or 1 [No lymph nodes removed. Evidence based on endoscopic examination.]? See Discussion.
Rectal primary:
5/04 sigmoidoscopy w/bx of rectal mass: adenocarcinoma. 6/04 Endoscopic ultrasound of rectal mass: invasion through wall but no definite invasion of prostate or seminal vesicles; 7.5mm lymph node located above tumor, no other enlarged lymph nodes detected. Patient did not have surgery. Physician staged lymph node involvement to clinical N1.
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 Lymph Nodes code 10 [Regional lymph nodes] based on the physician's N1. Assign code 10 because it is the lowest numerical CS code that corresponds to N1 in the scheme for rectum. Use the physician's assignment of TNM when the information in the medical record is incomplete or ambiguous. Code CS Reg Nodes Eval field 0 [No lymph nodes removed] for the case described above because there is no indication that N1 was assigned based on the endoscopic exam. The NI may be based solely on TNM documentation provided by the clinician and you do not know what the clinician used as the basis for the staging.
Primary site/Histology (Pre-2007)/Behavior: What is the correct site and histology/behavior for the following diagnosis: "mucinous cystadenoma of the appendix with perforation and pseudomyxoma peritonei." This was diagnosed at e-lap for a separate adenocarcinoma of the ascending colon.
For tumors diagnosed prior to 2007:
The appropriate code for mucinous cystadenoma of the appendix with perforation and pseudomyxoma peritonei is C18.1 8470/0. It is not reportable to SEER. According to our pathologist consultant, mucinous cystadenoma is a legitimate term for such appendiceal tumors. They may implant all over the peritoneum as pseudomyxoma peritonei, especially in the face of perforation, without being histologically 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.
Histology (Pre-2007)--Colon: Is the histology coded as adenocarcinoma arising in a polyp when the final diagnosis on the pathology report is adenocarcinoma but the colonoscopy report associated with the path states that the surgeon performed a polypectomy? See Discussion.
Histology: 3/04 Colonoscopy with polypectomy of a sessile appearing polyp. Path report: Final Dx: Adenocarcinoma; Micro: Adenocarcinoma apparently arising from the mucosa...noted to invade the muscularis mucosa into the submucosa.
For tumors diagnosed prior to 2007
Code this case to adenocarcinoma [8140]. The best source for histology is the final diagnosis on the path report from the procedure that removed the most tumor tissue. When there is a conflict, the path diagnosis has higher priority than the colonoscopy diagnosis for coding histology.
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.
Behavior Code--Breast: How is this field coded for a "non-invasive Paget disease of the breast?" See Discussion.
Historically, SEER collected Paget Disease of the breast with a behavior code of 3 [invasive]. There is no documentation to support this. The SEER EOD Manual only states that if the code is "05" [Pagets disease (without underlying tumor)], the behavior must be a 2 [in situ] or a 3 [invasive].
Code the behavior as /2 [in situ] for noninvasive Paget disease of breast. Noninvasive is a synonym of in situ.
If the pathology report documents that the Paget disease is in situ, the matrix principle in ICD-O allows you to change the behavior code to match the pathologist's statement.
Immunotherapy/Chemotherapy: Are monoclonal antibodies, such as Avastin and Erbitux, coded as immunotherapy or chemotherapy? See Discussion.
In review of the "FDA-approved oncology agents not listed in SEER Book 8" provided in 5/02, it appears "monoclonal antibodies" are coded as immunotherapy.
Code Avastin and Erbitux as chemotherapy because both of these drugs are growth inhibitors. Code growth inhibitors (cytostatic agents) as chemotherapy. Do not assume that monoclonal antibodies are coded as immunotherapy.
CS Extension--Head of Pancreas: What code is used to represent extension to the superior mesenteric artery? See Discussion.
In the CS coding scheme for Head of Pancreas, superior mesenteric artery is listed under both code 54 (T3) and 60 (T4).
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 60 for a primary in the head of the pancreas extending to the superior mesenteric artery. CS Extension code 54 should be Superior mesenteric VEIN and code 60 should be Superior mesenteric ARTERY. An errata will be issued by CS. In addition, extension 54 indicates resectable disease and code 60 is not resectable.
Reporting Source: Is an ER patient who is diagnosed on peripheral smear with an acute leukemia coded as an outpatient if the patient died while in the process of being admitted for treatment or is the patient coded as a death certificate case?
Code reporting source as 1 [Hospital Inpatient/Outpatient or Clinic] for the case above. This case will be abstracted using information from the outpatient/ER record (and the death certificate).
CS Extension--Colon: What is the difference between codes 46 [Adherent to other organs or structures, but no microscopic tumor found in adhesion(s)] and 57 [Adherent to other organs or structures, NOS]? See Discussion.
Code 46 reads "Adherent to other organs or sturcture, but no microscopic tumor found in adhesion(s)".
Would these examples be coded to 46?
Example 1: 7/04 Op findings: mass was adherent to duodenum without obvious invasion. Path: margins negative (no mention of duodenum). Case staged to pT3.
Example 2: Op findings: large mass involving cecum adherent to peritoneum & retroperitoneum. Path: invasion of pericolic soft tissue; margins negative (no metion of peritoneum & retroperitoneum). Case staged to pT3.
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 46: Attached to other organ (on imaging or surgical observation); pathology says no invasion of the other organ. Code 57: Attached to other organ; pathology is positive for invasion of other organ, or pathology does not specify whether there is invasion of the other organ.
Example 1: Code extension to 46 [Adherent to other organs or sturcture, but no microscopic tumor found in adhesion(s)]. The tumor was attached to the duodenum, but not invading
Example 2: Code extension to 46 [Adherent to other organs or structure, but no microscopic tumor found in adhesion(s)]. The tumor was attached to peritoneum & retroperitoneum, but not invading based on negative margins and no peritoneum or retroperitoneum specimen submitted to pathologist.
Reportability--Bladder: Is "low grade papillary urothelial neoplasm with no evidence of invasion" reportable to SEER?
"Neoplasm" means "new growth," not malignancy. A low grade papillary urothelial NEOPLASM with no evidence of invasion [8130/1] is not reportable to SEER. However, a low grade papillary urothelial CARCINOMA with no evidence of invasion [8130/2] is reportable.