Histology (Pre-2007): What code is used to represent the histology "poorly differentiated invasive transitional cell carcinoma with extensive squamous and focal glandular differentiation"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8120/33 [transitional cell carcinoma, NOS, poorly differentiated]. The ICD-O-3 does not have a separate code for transitional cell carcinoma with squamous and/or glandular differentiation.
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.
Grade, Differentiation--Breast: Does SEER agree with our pathologist who contends that "by convention lobular carcinoma is considered to be grade 2"?
No. SEER does not have a default grade code for lobular carcinoma. Code the grade as stated in the pathology report. If no grade is stated, code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable].
Multiple Primaries (Pre-2007)--Bladder: Is a 1998 transitional cell carcinoma of the bladder, followed by a 2001 squamous cell carcinoma of the bladder reportable as a second primary?
For tumors diagnosed prior to 2007:
Yes. This case is reportable as a second primary. The rule in the SEER Program Code Manual says that invasive bladder cancers with histology codes 8120-8130 [papillary, transitional] are always coded as a recurrence and are an exception to the multiple primary rule. Squamous cell carcinoma [8070] is not a part of that exception.
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.
Histology: What code is used to represent the histology "endometrioid adenocarcinoma, villoglandular type"?
Assign code 8262/3 [Villous adenocarcinoma].
According to the WHO Classification of Tumours, Breast and Female Genital Organs (2003), villoglandular is one of four variants of endometroid adenocarcinoma. The corresponding ICD-O-3 code according to WHO is 8262/3.
Multiple Primaries (Pre-2007)--Soft Tissue: Does SEER agree that one primary of the soft tissues of pelvis [C49.5] should be reported when a pathologic diagnosis for bilateral herniorrhaphies is "right and left inguinal hernias with low grade spindle cell sarcoma"?
For tumors diagnosed prior to 2007:
Yes. This is one primary and should be coded to C49.5 [Connective, subcutaneous and other soft tissue of pelvis]. According to Rule A in ICD-O-3, the type of tumor ("sarcoma") indicates origin from a particular tissue, resulting in the primary site code of C49.5 [Inguinal region, NOS] for this sarcoma.
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.
Chemotherapy: Should radiosensitizing chemotherapy agents (i.e., drugs typically coded as treatment for cancer) be coded as treatment when they are given in combination with radiation therapy with the intention of enhancing that treatment? See discussion.
Per our consultant, these drugs are given at a lower dose than that typically given to treat cancer patients.
Do not code radiosensitizers and radioprotectants as cancer-directed therapy. Drugs typically classified as chemotherapy agents would be "ancillary drugs" for the purpose of coding cancer-directed therapy because the drugs are given at a much lower dosage than that typically given to treat cancer patients. Per Book 8, ancillary drugs are not to be coded as cancer-directed therapy. Radiosensitizers and radioprotectants do not work directly on the cancer and are not coded under any of the systemic therapy fields.
Primary Site/EOD Fields--Head & Neck: In the absence of an actual resection and a pathologic evaluation of the affected area, would a laryngoscopy or CT scan provide a better assessment of the EOD and the primary site?
For cases diagnosed 1998-2003:
For Primary Site and EOD, CT information has higher priority than laryngoscopy. The CT scan gives a better picture of the involvement of the deeper tissues. A laryngoscopy falls into the "physical exam" category more than the "operative" category. The laryngoscopy report is not an "operative" report like those generated from a surgical procedure.
EOD-Extension--Breast: If a negative bone scan is followed by a bone marrow biopsy that is positive for metastatic disease, is the bony involvement used when coding extension [85] or as progression of disease (ignore mets when coding extension)? See discussion.
Pt diagnosed with ductal carcinoma of the breast in May. On June 1, oncologist recommended chemo and XRT and planned a metastatic workup. A June 6 marrow MR consistent with mets. June 8 bone scan showed scoliosis of the L-spine with scattered focal areas of increased activity probably related to degenerative changes in the spine. On June 29, biopsies were done of the T2 vertebra with path diagnosis of metastatic adenocarcinoma consistent with breast primary. Chemo started July 15.
For cases diagnosed 1998-2003, is EOD extension code 85 correct? We felt that the bone mets was found within 4 months of diagnosis and is not progression of disease.
For cases diagnosed 1998-2003: Code the EOD-Extension field to 85 [metastasis]. Bone metastasis was documented during the original metastatic workup. Metastasis to the bone was suspected soon after diagnosis and confirmed prior to the start of treatment. The length of time between the diagnosis and the confirmation of the bone metastasis was not used to code extension on this case. The pt was still being worked up as evidenced by the fact that treatment had not yet started.
EOD-Extension--Lung: When only minimal information is available, such as scans and needle biopsies, should EOD extension be coded to localized or unknown? See discussion.
The patient was diagnosed with non-small carcinoma of the lung by needle biopsy of the right upper lobe Feb. 2, 2001. History revealed that CT performed prior to needle bx showed 2 right sided lung lesions and right hilar adenopathy. Chest x-ray following needle bx showed irregular opacity within the RML appears unchanged. Soft tissue prominence in the azygos region, possibly related LN enlargement. This is the only information available.
Should we code extension as 30 [localized, NOS]?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 99 [unknown] if no additional information is available for this case. Because the second lesion in the right lung could be malignant, the extension code might be 77 [separate tumor nodule(s) in different lobe]. With the possibility of a more extensive stage, the status of the hilar lymph nodes is also not clear. The abstracted information is insufficient to stage this case.
EOD-Extension--Head & Neck: How much information is needed for a head and neck primary in order to code extension to localized versus unknown? What code is used to represent this field when the only information for a buccal cavity primary is a positive aspiration of the buccal mass?
For cases diagnosed 1998-2003:
Code the EOD-Extension to 99 [Unknown] for this case until more information is received. The available information does not describe the primary site and there is a complete lack of staging information.
Head and neck cancers spread early and often to nodes. Do not code the EOD-Extension to localized when the information is as limited as it is for this example.