EOD-Extension: If extension/metastasis is found within 4 months of diagnosis, but after first course of cancer-directed therapy has ended, should that involvement be excluded when coding the EOD-extension field? See discussion.
Example: Spinal drop metastasis was diagnosed within 4 months of the initial diagnosis of a localized astrocytoma, but after treatment with surgery and XRT was completed.
For cases diagnosed 1998-2003:
Do not include the spinal metastasis because it was diagnosed after the extent of disease was established. If metastasis was not present at diagnosis, and not discovered during the original metastatic work-up, it is progression of disease.
Primary Site--Head & Neck (Middle ear): How do you code site for a skull based tumor consistent with a low grade papillary adenocarcinoma of "endolymphatic sac origin"?
Code Primary Site to C30.1 [Middle ear]. The endolymphatic sac is part of the inner ear labyrinth located with in the petrous portion of the temporal bone.
Reason for No Cancer-Directed Surgery: Could you explain why this field would be coded to 1 [Cancer-directed surgery was not recommended] or 2 [Contraindicated due to other conditions] for a case that presents with distant metastasis at diagnosis?
For cases diagnosed 1998-2002:
Code the Reason for No Cancer-Directed Surgery field to 1 [Cancer-directed surgery was not recommended] for patients who present with either a primary site or histology for which surgery is not a standard treatment. Also use code 1 for those patients who present with distant disease for a primary site that is typically treated surgically. Patients with distant metastasis typically do not have surgery performed as part of first course of treatment.
Code 2 [Contraindicated due to other conditions] is used when surgery would normally be recommended for the site (given the current stage of the tumor) but other medical conditions pose too much of a risk for the patient to undergo surgery.
EOD-Extension--Breast: The SEER coding scheme classifies the in situ portion as less than 25% [code 14] or equal to or greater than 25% [code 15]. How do you code a pathologist's statement of "less than or equal to 25%"? See discussion.
"insitu ca constitutes less than or equal to 25% of the total mass."
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 14 [invasive and in situ components present, size of entire tumor coded in Tumor Size AND in situ described as minimal (less than 25%)]. The pathologist did not use a code as defined by SEER. For cases described as "less than or equal to 25%", choose the lower of the two EOD code choices.
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.
Grade/Histology (Pre-2007)--All Sites: What code is used to represent these fields for the histology "High grade dysplasia (adenocarcinoma in situ)" or "AIN III/High grade AIN"?
For tumors diagnosed prior to 2007:
Code the Histology field for the first example to 8140/2 [Adenocarcinoma, NOS, in situ] and for the second example to 8077/2 [AIN, grade III]. For both of the cases code the Grade, Differentiation field to 9 [Cell type not determined not stated or not applicable]. The 6th digit (grade code) of ICD-O-3 describes how much or how little a malignant tumor resembles the normal tissue from which it arose. In contrast, "grade" is used in the examples above to describe the degree of dysplasia, from mild dysplasia (low grade) to severe dysplasia (high grade). Do not record the degree of dysplasia in the 6th digit grade field.
For tumors diagnosed 2007 or later, refer to the MP/H rules for histology coding instructions. 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.
First Course Treatment--Lymphoma: How should an antibiotic regimen such as bismuth or omeprazole, amoxicillin, and metronidazole be coded for a MALT lymphoma of the stomach associated with Helicobacter pylori infection? See discussion.
If we do not count the antibiotic regimen as cancer-directed treatment but this is the only treatment given and the lymphoma disappears, is it problematic to have a cancer status of "no disease" recorded in a patient that supposedly was not "treated"?
Do not code antibiotic regimens as Cancer-Directed Therapy. These drugs are intended to treat the bacteria and not the cancer. This type of treatment is ancillary even if it is the only type of treatment given. You may designate a user-defined field to capture this information if desired. The coding combination of a cancer status of "no disease" and all treatment fields coded to "no treatment" is allowable.
Reportability--Hematopoietic, NOS: Is "evolving" multiple myeloma reportable to SEER?
For cases diagnosed prior to 1/1/2010:No, it is not SEER reportable. The diagnosis of "evolving" multiple myeloma could represent a plasmacytoma, plasma cell dyscrasia or another lymphoproliferative disorder. Some of these histologies are SEER reportable, but some are not. Additional information would be needed to determine reportability. If you are unable to obtain more information, the case is non-reportable.
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-Lymph Nodes: If chemotherapy or radiation is given prior to the excision of an involved lymph node, should the size of the metastasis within the lymph node be coded from the subsequent surgical pathology report? See discussion.
For several sites, the size of the metastasis in an involved lymph node is integrated into the EOD-Lymph Node field. Should the size of the metastasis mentioned on the pathology report be ignored if the patient received radiation or chemotherapy prior to having the lymph node removed?
For cases diagnosed 1998-2003:
Record the size of a lymph node metastasis described in the pathology report for cases that had pre-surgical treatment. However, if both the pre-treatment and post-treatment size of the lymph node metastases are available, use the larger size when coding the EOD-Lymph Node field.
EOD-Extension--Hematopoietic, NOS: If a solitary plasmacytoma originates in the right tonsil and extends to the left tonsil, vallecula and hypopharynx, is extension still coded to 10 [localized disease, solitary plasmacytoma only]?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 10 [localized disease, solitary plasmacytoma only] for all cases of solitary plasmacytoma.