Histology (Pre-2007)--All Sites: What code is used to represent the histology with a final diagnosis of adenocarcinoma, signet ring type when the comment suggests a "mixed histologic pattern"? See discussion.
The following is the comment from the pathology report: "The histologic features reveal a tumor with a mixed histologic pattern. A diffuse infiltrate of signet ring cells and a second pattern of amphophilic polygonal cells. The latter elements suggest neuroendocrine differentiation, but IHC stains fail to reveal endocrine attributes in these cells."
For tumors diagnosed prior to 2007:
Code the Histology field to 8490/3 [Signet ring cell adenocarcinoma]. Code the specific subtype when the diagnosis says "generic carcinoma, something type." Neuroendocrine differentiation was suspected, but not supported by the IHC stains. A combination code is not appropriate for this example.
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.
Date Therapy Initiated: How would you estimate the date treatment began for a patient who was treated elsewhere and seen only on an outpatient basis at the current facility? See discussion.
July 19th: Retromolar trigone primary was diagnosed.
August 8th note states, "Pt is not a surgical candidate due to multiple medical co-morbidities." Sept 19th note states, "Per Tumor Board, pt has been undergoing radiation for her head and neck cancer." The exact starting date for radiation is not specified.
In the SEER Program Code Manual it states that "In the absence of an exact date of treatment, the date of admission for that hospitalization during which the first cancer directed therapy was begun is an acceptable entry."
If possible, review the radiation treatment summary and outpatient records at the treating facility. If the date treatment began is not stated, look for the completion date and number of treatments, and calculate the first date of treatment.
If the date radiation started cannot be found or calculated, code the month as 09 for the example provided. The determination was made in August NOT to treat with surgery. We know that there was treatment in September.
Primary Site/Histology (Pre-2007)/EOD Fields/Surgery of Primary Site--Abdomen, NOS: What codes are used to represent these fields for a case with a resection of the rectosigmoid and adjacent tumor mass that demonstrated no tumor in the rectosigmoid but extramural to the colon there was an endometrioid adenocarcinoma arising in association with an area of endometriosis (possibly within the pericolic soft tissue or in an ovarian remnant)?
Multiple Primaries (Pre-2007)--Melanoma: Many melanoma patients have multiple occurrences over time that are not called recurrent and often are even in the same skin subsite, some in situ only and others alternating between in situ and invasive. Should these multiple occurrences really be new primaries?
For tumors diagnosed prior to 2007:
Unless it is stated to be a RECURRENT or METASTATIC melanoma, record each melanoma as a separate primary when:
1. The occurrences are more than two months apart.
2. The fourth digit of the ICD-O topography code for skin [C44._] is different .
3. The first three digits of ICD-O-3 morphology code are different.
4. An in situ melanoma is followed by an invasive melanoma.
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.
Tumor Markers--Breast: If the ERA/PRA results reported differ for separate breast specimens removed for a single primary, do we code the results as positive or negative?
For cases diagnosed 1998-2003:
Code both the Tumor Marker 1 and Tumor Marker 2 fields to 1 [positive] when a single primary breast tumor has both positive and negative ERA/PRA receptors.
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.
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.
Primary Site--Head & Neck: What site code is used to represent the following head and neck primary where there is not a clear statement of primary site? See discussion.
6/29/02: PE: 2-3 cm mass in the posterior pharynx that seems to arise from the right side of back of tongue.
6/29/02 CT soft tissue of neck: 3 cm right sided oropharyngeal mass, possibly arising from right tongue mass. There is near occlusion of airway at this level.
7/3/02 Excision of oropharyngeal tumor: Palpated mass could clearly be felt coming off the right lateral tongue in approximately the mid portion of the tongue near the tonsillar base.
Code the Primary Site field to C02.9 [tongue, NOS], based on the information provided.
EOD-Extension--Kidney: If a "tumor thrombus" in a renal vein is discontinuous from the primary tumor in the kidney, is it still coded to 60 [Tumor thrombus in a renal vein, NOS], rather than 85 [Metastasis]?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 60 [Tumor thrombus in a renal vein, NOS]. A thrombus can be a bolus of tumor cells within a large vein that may or may not still be connected/contiguous with the primary tumor. However, both a discontinuous and contiguous thrombus are coded to 60.
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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