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.
Histology/Grade, Differentiation--Lymphoma/Leukemia: Do you agree with coding a diagnosis of Nasal NK/T cell lymphoma to 9719/38?
For cases diagnosed prior to 1/1/2010:Yes. Code the Grade, Differentiation field to 8 [NK cell] rather than 5 [T-cell]. Code the Histologic Type to 9719/38 [NK/T-cell lymphoma, nasal and nasal-type with Cell indicator of NK (8)].
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.
Multiple Primaries (Pre-2007)--Head & Neck: How many primaries are represented when a1998 invasive squamous cell carcinoma of the true vocal cord is followed by a 1999 diagnosis of in situ squamous cell carcinoma of the true vocal cord (called "recurrent" by the clinician), and in 2001 there is another invasive squamous cell carcinoma of the true vocal cord (no statement of recurrence)? Would your answer be any different if no statement of "recurrent" had been made in 1999?
For tumors diagnosed prior to 2007:
Code this case as two primaries, an invasive true vocal cord primary in 1998 and another invasive true vocal cord primary in 2001.
If there had been no statement of recurrence for the 1999 in situ diagnosis and the 1999 diagnosis was more than two months following the 1998 diagnosis, this case would be coded as three primaries.
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.
Ambiguous Terminology/Reportability: How should the expressions "suspicious for but not diagnostic of" and "suspicious for the possibility of early invasive adenocarcinoma" be interpreted for reportability? Would the interpretation be different depending on the primary site?
For reportability, interpret "suspicious for but not diagnostic of" as NOT diagnostic of cancer.
The phrase "suspicious for the possibility of early invasive adenocarcinoma" may indicate that the case is in situ. If no further information is available, this is not reportable.
The site of the cancer diagnosis does not change the interpretation.
Multiple Primaries (Pre-2007)--Ovary: Are mucinous cystic tumors of low malignant potential diagnosed in the left ovary in 12/2000 and in the right ovary in 7/2001 reportable as two primaries? See discussion.
Page 14 of the SEER Program Code Manual, 3rd Edition, states that bilateral retinoblastomas and bilateral Wilms tumor are always single primaries whether simultaneous or not. Does this apply to bilateral ovarian tumors as well?
For cases diagnosed 2001-2006:
Borderline tumors are not reportable to SEER as of 2001. If you are collecting them in your registry, use the following procedure: Exception 1 in the SEER Program Code Manual, 3rd Edition, responds to the issue of processing ovarian tumors. Simultaneously occurring ovarian tumors with a single histology are coded as one primary. In the case you cite, the right ovary primary occurred 7 months after the left ovary primary. This is not simultaneous, so it would be counted as a second primary.
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 (Pre-2007)--Testis: What code is used to represent the histology of "mixed germ cell tumor, embryonal carcinoma and mature teratoma" of the testis? See discussion.
Is the teratoma required to be described as "immature" or "malignant" in order to use the histology code of 9081/3 [mixed embryonal carcinoma and teratoma]?
For tumors diagnosed prior to 2007:
Code the Histology field to 9081/3 [Teratocarcinoma, mixed embryonal carcinoma and teratoma], in both ICD-O-2 and ICD-O-3.
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.
Multiple Primaries (Pre-2007)--Bladder/Prostatic Urethra: Is the prostatic urethra a new primary for a case with a history of recurrent noninvasive bladder cancer that was subsequently diagnosed with transitional cell carcinoma in situ of the prostatic urethra and had a subsequent clinical diagnosis of "refractory bladder carcinoma"?
For tumors diagnosed prior to 2007:
If the histology of the bladder primary is "transitional cell carcinoma" or "papillary transitional cell carcinoma," do not code the prostatic urethra as a new primary. This is probably a case of intraluminal (mucosal) spread of the original tumor, rather than separate primaries. The clinical diagnosis supports this view.
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.
EOD-Size of Primary Tumor--Colon: When an adenocarcinoma is stated to be arising in an adenoma and the "tumor size" stated in the final pathologic diagnosis is the same size as the mass described in the gross description, should we assume that the entire polyp has been totally/near totally replaced by tumor and code the tumor size stated in the final path diagnosis?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field as stated by the pathologist in the final pathologic diagnosis. If the size of the tumor is the same as the size of the polyp, assume the polyp was completely replaced by tumor.
EOD-Extension--Pancreas: If the tumor involvement for a case falls between two different regional extension codes, should we code to the lesser of the two codes or should we code extension as unknown? See discussion.
Example 1: CT scan description: Mass in the head of the pancreas. The duodenum is "surrounded" by tumor. Should we code extension to 40 [peripancreatic tissue extension, NOS] or 99 [unknown] because the extension code could be further than 40. It could be 44 [extension to duodenum].
Example 2: CT scan description: Mass in region of pancreatic head and "root" of superior mesenteric artery consistent with pancreatic cancer. Should we code extension to 40 [peripancreatic tissue extension, NOS] or 99 [unknown] because the extension code could be further than 40? It could be 54 [extension to major blood vessels].
For cases diagnosed 1998-2003:
In both examples, code the EOD-Extension field to 40 [peripancreatic tissue extension, NOS]. Choose the lowest of a known possible extension code over an unknown code.
EOD-Extension--Head & Neck: How do you code extension for a supraglottic larynx primary with "pre-epigolottic space" invasion?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 65 [Pre-epiglottic tissues]. Extension to "pre-epiglottic space" is equivalent to extension to "pre-epiglottic tissue."
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