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Code the "embolization" (or hepatic artery embolization, HAE) in Surgery of Primary Site. Assign code 10 [local tumor destruction, NOS].

The embolization is coded as first course of therapy for this case because it seems that this patient was not adequately staged until 9/19 -- there is no indication on this case of the stage of disease in August or early September. Furthermore, no treatment was started before the embolization. Therefore, the ascites is not "progression of disease" in this case -- it is taken into account as part of the initial stage of disease.

This procedure was previously coded as other therapy, experimental. Code as surgery as of July 2005.

For tumors diagnosed prior to 2007:

Code the Histology field to 9100/3 [Choriocarcinoma]. Gestational trophoblastic neoplasia includes the diagnosis of choriocarcinoma.

Code the Diagnostic Confirmation field to 8 [Clinical diagnosis only] based on the information above. However, if imaging, direct visualization, or another method identified the pulmonary metastases, then code the Diagnostic Confirmation accordingly.

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.

For tumors diagnosed prior to 2007:

Example 1: Code the Histology and Grade, Differentiation fields to 8140/39 [adenocarcinoma, NOS, grade not stated]. Because there was no microscopic examination of tissue from the primary site, the histology may be coded from the microscopic examination of the tissue from a metastatic site. Do not code grade from a metastatic site regardless of whether the involvement of the metastatic site is by direct extension or by discontinuous metastases.

Example 2: Code the Histology and Grade, Differentiation fields to 8046/33 [non-small cell carcinoma, poorly differentiated]. Because there is a microscopic examination of tissue from the primary site, that information should be used to code histology rather than a cytology of a metastatic site.

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.

For cases diagnosed 1998-2003:

The information provided for these pancreatic primary examples is very limited. Additional information should be sought. If not available, code the EOD-Extension field to:

1) 10

2) 10

3) 10

4) 99

5) Assuming primary in head, body or tail of pancreas, 76

6) 85

For tumors diagnosed prior to 2007:

Assign code 8255 [Adenocarcinoma with mixed subtypes]. According to histology rule #4 for a single tumor on page 86 of the 2004 SEER manual, use a combination code if one exists.

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.

For cases diagnosed 1998-2003:

Code the EOD-Extension field to 85 [Metastasis] because the tumor nodules are discontinuous from the primary tumor.

Typically, the final diagnosis of the reviewing pathologist is the one used to determine whether the case is SEER reportable. If two or more reviewing pathologists disagree as to whether the case should be reportable, determine reportability based on the following priority order:

1) If the patient is treated for cancer, the case is reportable.

2) If the patient is not treated for cancer, use the amended diagnosis on the original pathology report if the hospital pathologist used the reviewing pathologists' opinions in establishing his new diagnosis.

3) If there is not an amended diagnosis for the original hospital pathology report, use the clinician's opinion regarding what the diagnosis is to determine whether the case is reportable.