Report | Question ID | Question | Discussion | Answer | Year |
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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 |
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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 |
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20041066 | Reportability/Date of Diagnosis--Ovary: Is a patient SEER reportable in 2001 or 2003 if she presented with a diagnosis of papillary serous tumor of low malignant potential [borderline tumor] per the 5/2001 surgery but at the time of the planned second look laparoscopic surgery is stated to have Stage 3A ovarian cancer? See Discussion. |
A patient was seen in 5/2001 for large pelvic mass growing from right ovary. After TAH and USO and partial omemtectomy, path diagnosis was papillary serous tumor of low malignant potential (borderline tumor), unruptured. Right ovary and omental implant have identical histologic appearance, except the psammoma body formation and the ovary does not. Patient does not return for lap as planned in 6-12 months. In 1/03 she returns to hospital with abdominal pain and has debulking, hemicolectomy and Hartmann's procedure. 1/03 Path report "metastatic papillary serous adenoca." Chart now says "History of stage 3A ovarian cancer." |
Yes, this case is reportable in 2003. Malignancy was confirmed in 2003. The diagnosis made in 2001 is not reportable for that year, and was not reviewed or revised according to the information provided. |
2004 |
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20041047 | Multiple primaries (Pre-2007)/EOD-Extension--Fallopian Tube: How many primaries are coded when endometrioid adenocarcinoma involves bilateral fallopian tubes? See Discussion. | The pathologist states "because of the intimate association with the luminal line of the fallopian tube it is felt that this represents synchronous primaries rather than mets." The SEER Code Manual only lists ovary, retinoblastomas, and Wilms Tumors under the bilateral code stated to be a single primary. | For tumors diagnosed prior to 2007:
Complete two abstracts, one for left fallopian tube and one for right fallopian tube. This case has been determined to be two primaries by the pathologist. Bilateral involvement of paired sites (other than ovary, retinoblastoma and Wilms tumor) with the same histology within two months requires a determination of whether there are one or two primaries. The pathologist in the case above has made this determination.
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 |
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20041009 | Diagnostic Confirmation--Lymphoma: Can lymphoma be diagnosed clinically? See Description. | Example 1: Patient with B symptoms. Physical exam reveals large neck mass. Physician impression is lymphoma. Example 2: CT scans show lymphadenopathy consistent with lymphoma. In both cases, patient does not return for biopsies. |
Yes, lymphoma can be accessioned based on a clinical diagnosis. Code Diagnostic Confirmation in Example 1 as 8 [Clinical diagnosis only]. Code Diagnostic Confirmation in Example 2 as 7 [Radiography and other imaging techniques without microscopic confirmation]. |
2004 |
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20041064 | CS Tumor Size/CS Extension/CS TS/Ext-Eval--Breast: How do you code these fields when the tumor size and extension differ pre and post treatment with neoadjuvant Arimidex? See Discussion. | Clinically on PE 3 cm mass attached to skin with dimpling and erythema overlying the mass. Ultrasound: 2-3 cm breast mass with overlying skin thickened by US evaluation, suggesting dermal invasion. Neoadjuvant Arimidex followed by MRM. Path: 4.5 cm ductal carcinoma (no DCIS), no invasion of skin. | 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.Record the larger tumor size and the farthest extension documented.
Code CS Tumor Size/Extension Evaluation to 6 [Surgical resection performed, WITH pre-surgical systemic treatment...; tumor size/extension based on pathologic evidence].
Code CS Tumor Size for the example to 045 [4.5 cm].
Code CS Extension to 20 [Local skin involvement ...] based on clinical description provided. |
2004 |
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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 | |
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20041096 | 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. |
2004 |
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20041022 | 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. |
2004 | |
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20041089 | Reportablility--Breast: Is lobular neoplasia, grade 2 reportable? See Discussion. |
Path report reads: Lobular neoplasia, grade 2.
According to the AFIP nomenclature for DCIS (taken from the WHO terminology), this would be the equivalent of LCIS. But nowhere can I find this specifically applies to lobular in the same way that ductal neoplasia is treated. |
According to the editors of ICD-O-3, lobular neoplasia grade 2 is not equivalent to LCIS. It is not a reportable term. Lobular neoplasia and lobular intraepithelial neoplasia are equivalent terms having a three grade system. Only LN/LIN grade 3 would be reportable since those terms are analogous to ductal intraepithelial neoplasia grade 3. |
2004 |