Report | Question ID | Question | Discussion | Answer | Year |
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20031199 | CS Extension/Polyp--Colon: How is CS extension coded for tumor invasion described as "Haggitt level 4"? See Description. | Polypectomy specimen revealed adenocarcinoma of the rectum in a tubulovillous adenoma. Per path extent of invasion was Haggitt level 4. The micro description of the tumor stated that there was malignant epithelial neoplasm in colonic mucosa. | In a 1985 Gastroenterology journal article, Haggitt described five levels of polyp invasion: Level 0-confined to mucosa Level 1-head Level 2-Neck Level 3-Stalk Level 4-Submucosa of underlying colonic wall.
For cases diagnosed 2004 and forward: Use the best information available to code CS extension. The following conversion may be used when the only information available is the Haggitt level. Level 0 - Extension 10 Level 1 - Extension 13 Level 2 - Extension 15 Level 3 - Extension 14 Level 4 - Extension 16 |
2003 |
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20031056 | Multiple Primaries (Pre-2007)--Breast: For a patient with a remote history of lobular breast carcinoma, would a new diagnosis of lobular breast carcinoma with DCIS be a new primary, even though the physician designates it as recurrent? See Description. |
A history of right breast lobular ca in 1991 treated with a partial mastectomy. Diagnosed 3/02 with "recurrent right breast ca" per physician; pathology in 2002 is lobular and DCIS. Would the DCIS make this a new primary regardless of the physician's designation of 'recurrent' or is this the same primary? |
For tumors diagnosed prior to 2007: Accession as two breast primaries -- the first lobular ca in 1991; the second lobular and DCIS in 2002. The differing histologies and the length of time between them negate the physician's designation as "recurrent" in this case. 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. |
2003 |
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20031141 | Priorities/EOD-Lymph Nodes--Breast: Which part of the pathology report takes precedence when there is a discrepancy between the final path diagnosis and the CAP summary? See Description. | For example, breast primary: Final path states "14/18 nodes (+) for tumor & separate matted aggregate of axillary nodes (+) for tumor. Subpectoral lymph node (+) for mets ca. Path Gross states "18 separate lymph nodes identified...many (+) for tumor grossly. Aggregate of matted lymph nodes within axillary tissue (+) for tumor. Multiple separate lymph nodes submitted." CAP Micro Summary lists "20/16 nodes examined/positive." What is correct number of nodes positive & nodes examined in this case? | For cases diagnosed 1998-2003: The final pathology diagnosis has highest priority. The CAP summary is second priority. However, you always use the best information available. If the final path diagnosis is vague or unclear, information from the CAP summary can be used. In the case example, the total lymph node count from the final path diagnosis is unclear and the CAP summary provides clarification. Code the number of lymph nodes positive as 16 and the number examined 20. Subpectoral lymph nodes are regional nodes for breast primaries. | 2003 |
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20031211 | EOD-Extension--Thyroid: Is this field coded as involvement of the thyroid capsule if the thyroidectomy path specimen reveals papillary thyroid ca "tumor present within capsular blood vessels?" |
For cases diagnosed 1998-2003: Tumor present within the blood vessels of the thyroid capsule is localized (extension code 30). The tumor has not penetrated the capsule itself if it is contained within the blood vessels. Keep in mind that tumor size determines the extent of disease for thyroid extension codes 10, 20, 30 and 40. |
2003 | |
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20031204 | Surgery of Primary Site--Breast: How is this field coded for cryosurgery of the breast? | For cases diagnosed 2003 and later: For cryosurgery alone, without a pathology specimen, assign site-specific surgery code 19 [Local tumor destruction, NOS]. Cryosurgery, cryotherapy or cryoablation uses extreme cold to destroy the tumor cells. If a specimen is sent to pathology use code 20 [Partial mastectomy, NOS] rather than code 19. If cryosurgery is followed by further surgery, do not use code 19. |
2003 | |
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20031049 | Histology (Pre-2007)--Stomach: What code is used to represent the histology of "mucin-secreting adenocarcinoma, intestinal type "for a stomach primary? | For tumors diagnosed prior to 2007:
For this specific example, code histology to 8481 [Mucin-producing adenocarcinoma] as it is a more specific cell type with inherent prognostic information. Code 8255/3 [Adenocarcinoma with mixed subtypes] is not appropriate for this case because "intestinal type" is a more specific description of this cancer and not another type of cancer. There are two broad categories of gastrointestinal adenocarcinomas: Intestinal and Diffuse.
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. |
2003 | |
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20031040 | First Course Treatment/Radiation Therapy/Immunotherapy--Thyroid: For this primary, do we code I-131 as a Radio-isotope as well as a Biological Response Modifier? See Description. | (SEER Book 8 lists I-131 as a Biological Response Modifier.) Immunoglobulin is listed as immunotherapy agent in the CCR manual also coded as immunotherapy. Are there two different types of I-131, immunoglobulin and sodium iodide? | Code Radioactive Iodine, Sodium Iodide 131-I, as radiation (code 3, Radioisotopes). Sodium Iodide is listed as an ancillary drug in SEER Book 8, page 45. The listing on page 63 refers to Antiferritin antibody, or AntiCEA. Both of these were under clinical investigation when Book 8 was written. They are no longer active and this change will be made when Book 8 is revised. |
2003 |
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20031090 | 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. |
2003 |
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20031205 | EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: How are these fields coded when an autopsy report reveals pathologically involved regional lymph nodes but does not state how many nodes were positive nor how many were examined? See Description. | A final autopsy report described widely disseminated adenocarcinoma, probably lung primary. Metastatic tumor in brain, lungs, and in lymph nodes. The Gross description of the autopsy report stated that there were numerous metastases to hilar and mediastinal lymph nodes. The Micro description of the autopsy report did not add any clarification. In the absence of a stated number of lymph nodes, the options for coding number of regional lymph nodes examined are codes 96-98. These codes include descriptions of surgical procedures such as sampling and dissection. How do we code number of regional lymph nodes examined when the pathological examination of lymph nodes was done only at autopsy and not during a surgical procedure? | For cases diagnosed 1998-2003: The rules that apply to the use of pathology reports for EOD coding also apply to autopsy reports. When a cancer diagnosis is made and positive lymph nodes are discovered on autopsy, in the absence of a stated number of lymph nodes, code the number of lymph nodes positive to 97 [Positive nodes but number of positive nodes not specified]. Code the number of lymph nodes examined to 97 [Regional lymph node removal documented as dissection and number of lymph nodes unknown/not stated]. An autopsy is a dissection. |
2003 |
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20031153 | Laterality/Multiple Primaries (Pre-2007)--Ovary: Are ovarian primaries with bilateral involvement always coded to laterality 4 (bilateral)? See Description. | Example: "Right ovary with mass replacing majority of ovarian tissue consistent with serous adenoca. Lt ovary with foci of adenoca." No specific statement of primary. Can we assume that the malignancy originated in the right ovary since it is more extensively involved or should laterality be coded 4 because both ovaries have tumor? | For tumors diagnosed prior to 2007:
If one ovary is listed as the primary site, code laterality to that ovary. The example above is one of those times when you would code to the single ovary. The issue of one or both ovaries being involved is handled in staging.
Abstract the example above as a single primary with code 1 [Right] for laterality.
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. |
2003 |