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Report Produced: 09/17/2024 15:20 PM

Report Question ID Question Discussion Answer Year
20041036

Surgery of Primary Site/Surgery codes, NOS--Colon: What tissue specimens are included under this field's code 41 [Subtotal colectomy/hemicolectomy plus resection of contiguous organ; example: small bowel, bladder]? See Discussion.

How is site specific surgery coded for the following two cases?

Example 1. A right hemicolectomy normally includes a portion of ileum.

Example 2. Subtotal colectomy with bilateral oophorectomy.

Code 40 includes a right hemicolectomy. A right hemicolectomy normally includes a small portion of the terminal ileum removed with the ileocecal valve. Assign code 41 when resection of CONTIGUOUS organs goes beyond what would normally be removed as part of a subtotal colectomy/hemicolectomy. Record non-contiguous organ resection in Surgical Procedure of Other Site.

Example 1: Surgery of Primary Site -- 40 [Subtotal colectomy/hemicolectomy].

Example 2: Surgery of Primary Site -- 40 [Subtotal colectomy/hemicolectomy]. Surgical Procedure of Other Site -- 2 [Non-primary surgical procedure to other regional sites].

Addendum July 2021

For coding Surgical Procedure of Other Site, see the instructions for determining regional vs distant sites in the 2021 SEER manual under Coding Instructions #6 and #7 on pages 184-185. Do not use Summary Stage to determine regional vs distant for this data item.

 2004
20041070 Primary Site: What would the primary site be for carcinoma of the renal pelvis, status post transplant? Please see details below. See Discussion. The patient has a renal pelvis urothelial carcinoma confined to the pelvis but is status post renal pelvic transplant of the same renal pelvis. Code the primary site to renal pelvis [C659]. Code the site in which the primary tumor originated. The transplant status in this example does not affect the primary site. 2004
20041086 Histology (Pre-2007)/CS Tumor Size/CS Extension--Colon: How are these fields coded if a 3 cm sessile polyp is snared and removed piecemeal during a colonoscopy and the path microscopic description indicates a polypoid lesion with foci of malignant transformation found associated with bundles of smooth muscles followed by a LAR with no residual invasive tumor but the final path diagnosis is stated to be a M.D. adenocarcinoma? See Discussion.

3/04 colonoscopy 3cm sessile polyp snared & removed piecemeal. Path Micro: Polypoid lesion consists of branching & complex neoplastic glands lined by tall columnar epithelial...These foci of malignant transformation are assoicated with large polygonal epithelial...associated with desmoplastic stromal reaction & neoplastic glands can be found associated with bundles of smooth muscle.

4/04 LAR: focus of residual HG dysplasia: no residual invasive tumor. Final path dx: MD adenocarcinoma. Physician staged: T2 N0 M0.

Histology: 8140 vs 8210

Tumor Size: 030 vs 999 vs 990

Extension: 12 vs 20

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 tumors diagnosed prior to 2007:

Based only on information provided:

Histology: 8210 [Adenocarcinoma in a polyp]

Tumor Size: 999 [Unknown]

CS Extension: 20 [Muscularis propria invaded]

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.

 2004
20041100 Sequence Number-central/Multiple Primaries (Pre-2007): What criteria are to be used to determine which primary site carries a worse prognosis? Should we take survival into consideration? See Discussion.

In the case of two or more simultaneously diagnosed primary tumors, instructions in the SEER manual state that the tumor with the worse prognosis is to be assigned the lower sequence number. Prognosis decisions should be based on primary site, histology and extent of disease.

Stage as a criteria for decision making is fairly straightforward. On the other hand, decisions based on primary site seem to be more subjective than objective.

For tumors diagnosed prior to 2007:

Compare the combination of the primary site, histology and extent of disease for each primary, and assign the lowest sequence number to the primary with the worst prognosis. Do not use primary site or histology alone to determine prognosis in the case of assigning sequence number. Survival is a component of prognosis.

If there is no difference in prognosis, assign the sequence numbers in any order.

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.

 2004
20041054 CS Extension--Prostate: For a tumor that is clinically inapparent, but a biopsy from the prostatic apex is positive, is this field coded to 15 [Tumor identified by needle biopsy, e.g., for elevated PSA (clinically inapparent)]?

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.

Yes. Code CS Extension-Clinical Extension to 15 [Tumor identified by needle biopsy, e.g., for elevated PSA (clinically inapparent)] for clinically inapparent prostate cancer with positive apex biopsy.

 2004
20041003 EOD-Size of Tumor: How is this field coded when the only description is "greater then 10 cm?" For cases diagnosed 1998-2003: When the only information available is a statement such as "Greater than 10 cm," code tumor size 101 [10.1 cm]. 2004
20041045 Histology (Pre-2007)--Ovary: What code is used to represent clear cell cystadenocarcinoma of the ovary?

For tumors diagnosed prior to 2007:

Code histology to 8310/3 [Clear cell adenocarcinoma, NOS]. This is consistent with the WHO Classification of Tumours and reflects the current practice of placing less emphasis on "cyst-" prefix for ovarian malignancies.

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.

 2004
20041021 Histology (Pre-2007)--Corpus Uteri: How should this field be coded when the D&C which shows "adenocarcinoma with mucinous and papillary features" and the TAH demonstrates only "endometroid carcinoma"? See Discussion. Should Histology be coded to 8380 [endometroid adenocarcinoma] because it is the most representative sample or to 8323 [mixed cell adenocarcinoma], per the Complex Morphology Coding Guidelines? The instructions in the Guidelines seem to imply that it is most important to represent combination histologies first, with majority (most representative sample) of tumor having a lower priority.

For tumors diagnosed prior to 2007:

Code Histology based on the pathology report from the most representative tissue. For the example above, code Histology to 8380 [Endometroid adenocarcinoma] based on the TAH/BSO pathology report.

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.

 2004
20041065 Date Therapy Initiated/First-Course of Cancer-Directed Therapy Fields/Summary Stage 2000--Prostate: How do you code these fields for a case that received preventative chemo before a definitive cancer diagnosis? A patient has a "suspicious but not diagnostic" biopsy of the prostate in 09/2002. Doctor said it was not cancer and put the patient on a preventative chemo drug study (GTX-211). The patient returned for a repeat biopsy on 04/2003. Biopsy returned positive for adenocarcinoma. The patient had not been diagnosed when chemo was administered. Can the case be staged using the post-chemo information?

Stage this case the same as all other cases. Use only the information subsequent to the date of diagnosis to code stage and treatment.

The diagnosis date in the example is 04/2003. Do not use information prior to 04/2003 to code stage or treatment. Do not code the preventative chemo as treatment.

 2004
20041046

CS Tumor Size--Breast: When the diagnosis is inflammatory carcinoma of the breast, must the CS tumor size always be 998? See Discussion.

I have no specific example of a situation; I am writing an edit check and wondering if there would be any exceptions to this rule.

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. For inflammatory carcinoma, code the size of the tumor in CS tumor size. Use code 998 [diffuse] when the tumor is stated to be "diffuse."

Page 27 in Part I of the CS manual will be corrected to define code 998 for breast as only "diffuse." The errata should be distributed in July 2004.

 2004