Primary Site/Histology--CLL/SLL: How should these fields be coded when the pathological diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma is made on bone marrow biopsy only but scans show lymphadenopathy? See Description.
What histology would we give these two examples?
1. Bone marrow bx: CLL/SLL. CT chest/abdomen: Mediastinal and retroperitoneal adenopathy.
2. Bone marrow bx: CLL/SLL. CT chest/abdomen: Mediastinal and retroperitoneal adenopathy suspicious for lymphoma.
For cases diagnosed prior to 1/1/2010:If a lymph node or other solid tissue is involved initially, code to SLL. For lymphoma, any mention of lymph nodes is indicative of involvement. Involvement does not have to be proven pathologically in order to code to Small Lymphocytic Lymphoma (SLL). Code both of the examples to SLL.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
EOD-Size of Primary Tumor/First Course Treatment--Breast: How is tumor size coded when preventative tamoxifen treatment precedes breast cancer diagnosis? Can we code the tumor size from the surgical specimen? Is tamoxifen treatment here? See Description.
What is the tumor size in this situation? Patient is on the STAR trial (preventative tamoxifen for women with high risk for breast cancer). Patient develops breast cancer and has surgery.
For cases diagnosed 1998-2003: Code EOD-Size of Primary Tumor from the surgical pathology report.
Do not code this preventative tamoxifen as first course cancer-directed treatment. This tamoxifen was part of a clinical trial intending to delay or prevent beast cancer from developing.
Reportability--Ovary: Is a Stage IIIC serous borderline tumor (micropapillary type) of the ovary diagnosed in 2003 reportable?
Serous borderline tumor of the ovary diagnosed in 2003 is not reportable to SEER. The behavior code is /1 in ICD-O-3. The high stage does not make this borderline tumor reportable.
Terminology, NOS/Recurrence/Multiple Primaries (Pre-2007): Is the term "residual disease" equivalent to "recurrence"? See Description.
Example 1. Patient underwent excision and re-excision of lentigo maligna in 1998. Final path showed close but negative margins. In 1999 a biopsy of a brown patch (over the scar) in the same location was done. Pathology reported residual lentigo maligna. Is the 1999 melanoma a new primary because it was diagnosed more than two months after the first melanoma and there is no mention of recurrence? Or is the term "residual" another way of saying recurrence?
Example 2. In 1999, patient underwent excisonal biopsy of intraductal carcinoma of the right breast, followed by radiation therapy. In 2000, mammogram showed calcifications in right breast. Biopsy was done with path showing residual ductal carcinoma in situ. There is no mention of recurrence. Is this one or two primaries?
For tumors diagnosed prior to 2007:
According to our pathologist consultant, "residual" disease indicates incomplete eradication of the original disease process. Residual means that the disease process was not completely removed/eradicated in the initial therapy. Therefore cells from the original primary were never completely removed or destroyed.
In each example above, this is not a recurrence per se but rather
progression of disease. Do not abstract the latter diagnosis as a new primary.
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.
Multiple Primaries (Pre-2007)/Date of diagnosis--Cervix: How is this field coded when initially carcinoma in situ is diagnosed by biopsy and at a later date invasive tumor is found pathologically?
For tumors diagnosed prior to 2007:
Since carcinoma in situ of the cervix is not reportable to SEER (as of 1/1/1996), the diagnosis date is the date of the invasive diagnosis.
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.
Reportability: Is pseudomyxoma peritonei always reportable? See Description.
In the ICD-O-3, pseudomyxoma peritonei has a behavior code of 6, indicating that it is malignant. Does this imply that pseudomyxoma peritonei is always a reportable malignancy? In the past, our pathologist consultant told us that pseudomyxoma peritonei is only a reportable malignancy if the underlying tumor is malignant. A benign cystadenoma of the appendix, for example, can rupture causing pseudomyxoma perionei. Does SEER agree with our pathologist consultant?
Example: Patient was found to have psuedomyxoma peritonei. Right hemicolectomy was done. Path reported an appendix with mucinous cystic tumor of undetermined malignant potential. A definite diagnosis of cancer can not be rendered.
Reportability is determined from the behavior of the primary tumor and the behavior of implants. If either are malignant, the case is reportable.
The case example does not seem to be reportable, based on the available information. Cancer diagnosis has not been made according to the pathology report.
Primary Site/EOD-Extension--Kaposi Sarcoma: How are these fields coded for localized disease described as "Nodal Kaposi Sarcoma" found on inguinal node biopsy only?
Code the site of involvement as the primary site when no other involvement is documented. For the case above, code C774 [inguinal lymph node] as primary site.
For cases diagnosed 1998-2003: Code EOD-extension as 13 [Visceral].
Grade, Differentiation--Prostate: Has SEER officially changed the conversion code for Gleason score 7 to grade 3 [poorly differentiated] for cases diagnosed in 2003 or later?
For prostate cases diagnosed in 2003 and forward: convert Gleason score 7 to grade 3 [poorly differentiated].
Radiation: How would this field be coded for treatment with quadramet [radioactive samarium]? See Description.
Paitent is receiving quadramet for treatment of lung metastases.
Code Quadramet in the RX Summ-Radiation field as 3 [Radioisotopes]. Quadramet is a radioisotope used to palliate bone pain. The instructions in the SEER manual state: "Record all radiation that is given, even if it is palliative."