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.
Surgery of Primary Site--Breast: Does the presence of axillary lymph node(s) in a "simple mastectomy" specimen impact the coding of the Surgery of Primary Site field for breast primaries?
Yes. Determine whether there is, in fact, at least a portion of axillary tissue present. If axillary lymph nodes (not internal mammary nodes) are present in the specimen, code the Surgery of Primary Site field to 51 [Modified Radical Mastectomy WITHOUT removal of uninvolved contralateral breast]. If there are no axillary lymph nodes present in the specimen, code the Surgery to Primary Site field to 41 [Total (simple) mastectomy WITHOUT removal of uninvolved contralateral breast].
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)--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.
EOD-Clinical Extension--Prostate: If the tumor arises in the prostatic apex, does that take priority over coding clinical extension based on the stage of cT1c? See discussion.
Physician states prostate primary is a cT1c. Pathology states adenocarcinoma, Gleason 3+3, right apex. All other biopsies were negative. Because the primary appears to be in the prostatic apex, do we code 33 or 15 for clinical extension? Which is more important for SEER? Do you want to capture the "apex" information or the "cT1c" information?
For cases diagnosed 1998-2003:
Code the EOD-Clinical Extension field to 33 [arising in prostatic apex]. Apex information takes priority. The only statement we have is cT1c by the urologist, and we don't know how that stage was determined.
EOD-Size of Primary Tumor: Can you code the tumor size if you have the aggregate size given for two or more tumor masses?
For cases diagnosed 1998-2003:
No. Never code the aggregate size in the Size of Primary Tumor field when the pieces removed come from TWO OR MORE tumors. If there is a clinical statement regarding the size of two or more tumors, code this field to the size of the largest tumor.
The aggregate size can only be used to code the Size of Primary Tumor field when the PATHOLOGIST estimates the size of the tumor from the pieces of ONE tumor removed by the surgeon.
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.
Grade, Differentiation--Breast: How do we code grade for a breast primary diagnosis of "Low grade invasive duct, modified Bloom-Richardson grade II/III (tubule formation 2, nuclear grade 1, mitotic rate 1)"? This appears to add up to a Bloom-Richardson score of 4, which does not fit with a Bloom-Richardson II/III.
Code the Grade, Differentiation field to 1 [grade I] using the information from the BR score.
For cases diagnosed 1998-2003: Grade or differentiation information from breast pathology reports is used in the following priority order:
1. Terminology (well, moderately, poorly)
2. Histologic grade (grade I, grade II)
3. BR scores
4. BR grade
5. Nuclear grade
On the hierarchical list for coding breast grade, the first two priorities do not apply to this case, but the third (Bloom-Richardson scores) does. Add the BR information (2+1+1) for a total score of 4, which translates to BR low grade (code 1). The statement of "II/III" may be a typo that should state I/III.
Primary Site/EOD Fields--Head & Neck: In the absence of an actual resection and a pathologic evaluation of the affected area, would a laryngoscopy or CT scan provide a better assessment of the EOD and the primary site?
For cases diagnosed 1998-2003:
For Primary Site and EOD, CT information has higher priority than laryngoscopy. The CT scan gives a better picture of the involvement of the deeper tissues. A laryngoscopy falls into the "physical exam" category more than the "operative" category. The laryngoscopy report is not an "operative" report like those generated from a surgical procedure.
Surgery of Primary Site--Soft Tissue: What code is used to represent this field when an excisional biopsy of a soft tissue sarcoma is followed two weeks later with a wide excision (re-excision)?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 26 [partial resection]. According to the CoC, "Excision" in the surgery codes refers to the lesion and "partial resection" refers to the organ. The biopsy is a local excision (code 25). The wide resection is code 26, presuming that more than just the remaining lesion was removed.
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