Histology (Pre-2007): What code is used to represent the histology "non-small cell carcinoma, NOS"? See discussion.
Should a non-small cell carcinoma histology be assumed to be a large cell carcinoma [8031/3] or should the histology be coded to carcinoma, NOS [8010/3]?
For tumor diagnosed 2001-2006: Code the Histology field to 8046/3 [non-small cell carcinoma].
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.
Surgery of Primary Site/Reconstruction-First Course--Breast: If the plan is to "reconstruct" the breast 6 months after an ipsilateral modified radical mastectomy, is the time span a problem or should it be coded in the Surgery of Primary Site field because it was planned?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 55 [Modified radical mastectomy WITHOUT removal of uninvolved contralateral breast, Implant]. The time span is not a problem as long as the reconstruction was planned as first course, which is indicated by tissue expander insertion at the time of the original surgery.
EOD-Pathologic Extension--Prostate: If there is residual tumor in the distal urethra on prostatectomy, does that mean there is distal urethral margin involvement? See discussion.
2/98 Prostate bx: Right apex, right mid and right base positive for adenocarcinoma.
6/1/98 Radical retropubic prostatectomy w/ bilateral pelvic lymph node dissection. Pathology: Residual adenocarcinoma in distal urethra, right lateral sections and posterior lobe. Right apical margin, other margins, seminal vesicles, and 7 pelvic LN negative for malignancy.
For cases diagnosed 1998-2003:
For the example above, code the EOD-Pathologic Extension field to 34 [extending to apex] because most of the right side is involved.
The pathology report says all margins are free. The comment on residual tumor in the urethra, meant the first surgery did not completely remove tumor tissue from the urethra, it does not mean that tissue is at the margin.
EOD-Extension/SEER Summary Stage 2000--Kidney/Eye: What codes are used to represent these fields for simultaneous bilateral Wilms tumor or simultaneous bilateral retinoblastoma?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis] and the SEER Summary Stage 2000 field to 7 [Distant] for both types of tumor. Each kidney and each eye are staged separately in the AJCC, 6th ed., but for SEER we would abstract these diagnoses as one case and code the EOD and stage fields to distant to reflect the involvement of both eyes or both kidneys.
EOD Fields--All Sites: Is EOD information limited to what is available exactly two months from the day of diagnosis?
For cases diagnosed 1998-2003:
EOD should include all information available within four months of diagnosis in the absence of disease progression or through completion of surgery(ies) in first course of treatment, whichever is longer.
Mets known to have developed after EOD was established should be excluded.
Grade, Differentiation--Lymphoma: What code is used to represent this field when the only grade/differentiation given is "low grade", "intermediate grade" or "high grade"?
Code the Grade, Differentiation field to 9 [cell type not determined, not stated or not applicable]. For lymphomas, do not code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field. These terms refer to categories in the Working Formulation and not to histologic grade for lymphoma histologies.
Generally, for histologies other than Non-Hodgkin lymphoma, the Grade, Differentiation field is coded to 2 [low grade], 3 [intermediate grade] and 4 [high grade] for most cancers.
EOD-Extension--Stomach: What code is used to represent this field for a stomach primary described as linitis plastica?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 30 [Localized, NOS], unless more information is known about the extent of tumor involvement. Coding the Histology field to 8142/3 [Linitis plastica] and the Size of Primary Tumor field to 998 [Diffuse; widespread; 3/4 or more: Linitis plastica] identifies this diagnosis.
In the EOD-Extension field, the depth of invasion is the important characteristic to be coded. The 10 digit EOD corresponds to the AJCC Staging Manual in which the "T" is based on level of invasion. While a diagnosis of linitis plastica indicates a worse prognosis, it does not define the extent of infiltration. There is no luminal mass with linitis plastica. Instead, the entire gastric wall is thickened by tumor.
Diagnostic Confirmation: Is it appropriate to code this field to "radiography" confirmation when a CT scan does not actually contain a diagnosis of malignancy, however, the discharge diagnosis in the medical record of "probable malignancy" is likely based on the abnormal CT findings? See discussion.
10/1/02 CT of Chest: 1) Huge (left) suprahilar mass. 2) Moderate volume loss, left lung. Appearance suspicious of LLL collapse. An infiltrate is seen in the aerated upper lobe as well as pleural effusion. 3) Streaky and nodular changes are noted at the right base that may represent possible lymphangetic spread of tumor.
Code the Diagnostic Confirmation field to 7 [Radiography]. This is appropriate because it was the scan evidence that was used to make the clinical diagnosis.
EOD-Extension--Head & Neck (Larynx): When "fixed" is stated for a larynx primary does it specifically have to say that it is the vocal cord that is fixed? Are the terms "fixed" and "immobile" synonymous? Should these cases be coded to 40 rather than 35? See discussion.
1. The tumor is fixed, the arytenoid on left side is fixed and the right arytenoid is partially fixed. Palpation of the tumor reveals it to be fixed in the larynx. T3 N0 M0 Stage III.
2. Erythema and swelling of right false cord with bulging and immobility. Left cord moves normally. T3 N0 M0 Stage III.
For cases diagnosed 1998-2003:
Code the EOD-Extension field for both cases to 40 [Tumor limited to larynx WITH vocal cord fixation]. Code 35 [Impaired vocal cord mobility] implies that mobility is diminished in strength and/or quality but is not rigid. Impaired mobility is a T2 tumor. Because the second case is T3, the physician implies he/she is using the term "immobility" to describe complete fixation.
Multiple Primaries (Pre-2007)--Thyroid: Does the rule in the 3rd Edition of the SEER Program Code Manual apply to cases diagnosed before 1998 that states if there are two separate carcinomas in the thyroid, one papillary and the other follicular, it is one primary and coded to the combination code 8340/3 [Papillary and follicular carcinoma]? See discussion.
If the rule applies to cases diagnosed before 1998, does SEER plan to ask that cases diagnosed prior to 1998 be recoded?
The rule applies to tumors diagnosed 1998-2006. The rule is not retroactive. At this time, SEER does not plan to ask that tumors diagnosed prior to 1998 be recoded.
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.
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