EOD-Extension/EOD-Lymph Nodes--Rectosigmoid: How do you code these fields for a scan-based clinically staged T3 N1 rectosigmoid primary in a patient who received chemotherapy and radiation prior to a resection that demonstrated invasion only into the muscularis and no positive lymph nodes?
For cases diagnosed 1998-2003:
Use the best information available, in this case, the clinical staging, to code EOD. Code the EOD-Extension field to 40 [Invasion through muscularis propria or muscularis, NOS] and the EOD Lymph Node field to 3 [Regional lymph node(s) NOS] because the case had a clinical stage of T3 N1. EOD is coded using the most extensive clinical or pathologic stage.
Multiple Primaries (Pre-2007)--Vulva/Vagina: SEER Program Code Manual rule #3 on page 11 states "If a new cancer of the same histology is diagnosed in the same site after two months, consider this new cancer a separate primary unless stated to be recurrent or metastatic. Should vulva and vagina be exceptions to rule #3, as are prostate and bladder?
For tumors diagnosed prior to 2007:
No. There is no exception for vulva or vagina.
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.
Radiation/Chemotherapy: How do we code radiation and chemotherapy when the only statement we have is that the patient is "referred to either an oncologist or a radiation therapist"?
For cases diagnosed 1/1/2003 and after: A referral does not mean that the radiation therapy or chemotherapy was actually recommended. These cases need follow-back to see if treatment was recommended and/or administered. Some registries code these cases as 8 [Radiation recommended, unknown if administered] or 88 [Chemotherapy recommended, unknown if it was administered] and routinely review all cases with 8 or 88 codes. Upon review, the codes are updated depending on the information found. If there is no information available, the code 8 or 88 is changed to 0 or 00 [None].
Histology (Pre-2007)/Terminology: Are "pattern", "architecture", and "architectural pattern" terms that indicate a majority of tumor?
For tumors diagnosed 2004 to 2006:
The terminology "Architectural pattern: ____________," when used in the final pathology diagnosis, indicates a subtype that can be coded. This type of format in a pathology report is based on a College of American Pathologists (CAP) protocol. Disregard "pattern" and "architecture" when not used in accordance with the CAP protocol. See www.cap.org for cancer protocols.
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.
Primary Site/Surgery of Primary Site--Lymphoma: What codes are used in these fields when both regional lymph nodes and an extra-nodal site are involved with lymphoma and there is not a clear statement from the clinician as to the primary site? See discussion.
In our registry, we code the primary site for such cases to the extra-lymphatic site if there is one extra-nodal site involved with disease and the patient does not have disseminated involvement of multiple extra-nodal sites. Is this correct? Example: A patient with a submandibular lymphoma and involved nodes undergoes a salivary gland excision and a modified radical neck dissection yielding 100 nodes.
For cases diagnosed prior to 1/1/2010:Code the Primary Site to C08.0 [submandibular gland] and use the surgery code schemes that apply to that site (Parotid and Other Unspecified Glands). Physiologically, lymphoma cells in regional lymph nodes do not "back-flow" into the extralymphatic organ to involve it secondarily. As a result, the primary site is usually the extralymphatic organ with regional lymph node involvement. Do not be afraid to code an extralymphatic site as primary when that site and its regional nodes are involved.
If the lymph nodes are not regional to the extra-nodal involved site and the primary site cannot be determined, code the primary site to C77.9 [Lymph node, NOS].
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.
Histology: How do we code this field when a less representative specimen has a more specific morphology? See discussion.
Example: Biopsy revealed endometrioid adenocarcinoma and the resection demonstrated adenocarcinoma, NOS. Do we code histology per the most representative sample, or to the more specific morphology?
Code the histology using the pathology report from the most representative specimen, even if that histology is less specific.
For the case example above, code 8140 [adenocarcinoma, NOS].
The rationale is that a diagnosis from a smaller specimen will be less accurate and less representative of the true histology compared to a larger tumor specimen.
Reportability--Cervix: The SEER Program Code Manual lists CIN III and carcinoma in situ of the cervix as not being reportable for cases diagnosed in 1996 or later, but does not list "adenocarcinoma in situ" or "squamous cell carcinoma in situ." Are these histologies still reportable?
For primary site cervix uteri, only histologies with behavior codes of 3 [invasive] are reportable to SEER for all registries.
Some SEER registries have opted to continue to collect behavior codes of 2 [in situ] for cervix uteri primaries.
Multiple Primaries/Histology (Pre-2007)--Colon: Would one primary be reported when adenocarcinoma arising in a polyp NOS [8210/3] and adenocarcinoma arising in a tubulovillous adenoma [8263/3] were simultaneously diagnosed in the sigmoid colon (first 3-digits of the histology are different)?
For tumors diagnosed prior to 2007:
Code as one primary. Code the Histology field to 8263/3 [Adenocarcinoma in tubulovillous adenoma].
Count as a single primary and code the more specific term when simultaneous lesions are present and one lesion is an "NOS" term and the other is a more specific term. "Polyp" is an NOS term. Adenoma is an associated term, but is more specific (Tubulovillous adenoma is more specific than "polyp").
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.
Hormone Therapy--Breast: Should Zoladex (gosrelin) or Lupron (leuprolide acetate) be coded as treatment for breast cancer when the physician does not indicate whether or not these drugs are intended as cancer-directed therapy? See discussion.
According to an oncologist at the research hospital in our region, these drugs are given in combination with chemotherapy for two reasons:
1) To preserve ovarian function.
2) The agents may be more effective in treating breast cancer when given in conjunction with chemotherapy than with chemotherapy alone.
For cases diagnosed 1/1/2003 to 12/31/2010: Code Zoladex (gosrelin) and Lupron (leuprolide acetate) as 01 [Hormone therapy administered as first course therapy] only when stated to be given as part of the first course of cancer-directed therapy. If you do not know whether these drugs were given to preserve ovarian function or as an adjunct to chemotherapy (i.e, there is no treatment plan), do not code as Hormonal treatment given.