CS Lymph Nodes--Breast: Which category has priority when both apply, "Regional lymph nodes, NOS" or "Stated as N_, NOS"? See Discussion.
Example: When there is a clinical diagnosis of axillary lymph node metastasis for a breast primary on a physical exam "Enlarged axillary lymph nodes suspicious for metastatic involvement", as well as a clinical N1 designation, do we code as 60 [Axillary LNS, NOS] or 26 [Stated as N1, 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.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.
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.
Primary Site/CS Extension/CS Lymph Nodes--Lung: How are these fields coded for untreated lung primaries when only limited information is available from scans, bronchoscopies and biopsies? See Discussion.
3/13/04 CT scan Chest: extensive mediastinal, subcarinal, rt hilar lymphadenopathy; separate tumor mass in medial rt lung
3/16/04 Bronchoscopy: RLL/RML completely obstructed with extrinsic compression. Impression: CA of lung with hilar adenopathy.
Bronchial wash: PD non small cell CA
Bx RLL: up to 0.2 cm PD Adenocarcinoma c/w primary lung CA.
Treatment not recommended.
Expired 5/03/04.
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.
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.
CS Extension--Breast: What is the CS Extent for this 2004 breast cancer? See Discussion.
A patient had lobular carcinoma of the left breast in 2000. At that time, she had bilateral simple mastectomies and the right breast was benign. In 2004, she notices a nodule in the right chest wall, which is excised and found to be invasive ductal ca and lobular ca in situ. So is this Sequence 2, C50.9, 8522/3. And what is the CS Extent - 40 chest wall? (The physician stages this as T2N0M0)
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.Residual breast tissue is present following a mastectomy. If the nodule is in the breast tissue (tissue above the ribs), assign CS extension code 10 [Confined to breast tissue...Localized, NOS]. If the nodule is in the chest wall (tissue below the ribs), assign code 40 [Invasion of chest wall].
CS Tumor Size--Bladder: Is tumor size coded to 080 when the bladder mass is described as "greater than 8 cm in diameter"?
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.Based on the information provided above, code CS tumor size 080 [8 cm]. Code the information that is avaliable. Since size of tumor is not used to stage bladder cancer, an approximation is adequate.
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.
2004 SEER Manual Errata/Grade--Colon/Bones: Is the term "pleomorphic" used to code tumor grade to 3 for selected primaries?
Delete the row containing the word "pleomorphic" from the tables on pages 93, C-219 and C-411. This correction will be included in the next set of replacement pages for the 2004 SEER manual.
Reportability/Primary Site--Head & Neck: If a wedge resection/shield resection is performed on the lower lip for SCCA and the path report refers to "lip, NOS" with no mention of vermilion border, is this case reportable?
Review the operative and pathology reports, and the physical exam for mention of "mucosal surface" (reportable) or "skin" (not reportable). If neither are mentioned, lip, NOS is reportable per the ICD-O-3 code of C009.
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