Multiple Primaries (Pre-2007)--Breast: When simultaneously diagnosed breast tumors of the same histology in the same breast are stated by the pathologist and/or clinician to be more than one primary, should these be reported as multiple primaries? See discussion.
For example, based on special pathology studies that showed a difference in appearance between tumors, a pathologist may state that two ductal, NOS tumors diagnosed at the same time in the same breast represent two primaries.
For tumors diagnosed prior to 2007:
Code as a single primary. Follow the guidelines in the SEER Program Code Manual for determining multiple primaries. Simultaneous multiple lesions of the same histologic type in the same site (same breast) are a single primary for SEER, even though the pathologist may perform special studies and state that the patient has more than one 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: What code is used to represent the histology "endometrioid adenocarcinoma, villoglandular type"?
Assign code 8262/3 [Villous adenocarcinoma].
According to the WHO Classification of Tumours, Breast and Female Genital Organs (2003), villoglandular is one of four variants of endometroid adenocarcinoma. The corresponding ICD-O-3 code according to WHO is 8262/3.
EOD-Extension--Lung: How do you code extension for a lung tumor described on bronchoscopy as "obstructing the RUL and intruding into the right bronchus intermedius. Small tumor nodules distally in midline of anterior trachea wall"?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis] because the tumor nodules are discontinuous from the primary tumor.
Chemotherapy: How is treatment with Iressa (Gefitinib) coded?
Code treatment with Iressa as chemotherapy.
Iressa is an epidermal growth factor inhibitor. While it doesn't kill cells directly, it damages the cell reproduction process. We classify it as a chemotherapy agent.
EOD-Extension--Pancreas: Should these terms be ignored when coding extension to 10 or 30, or do they indicate involvement for non-surgically treated pancreas primaries?
1) Stricture of the common bile duct
2) Common bile duct is narrowed
3) Common bile duct is obstructed
4) Common bile duct dilation
5) Malignant stricture of the common bile duct
6) Ampullary or common bile duct stricture with a negative biopsy or brush.
For cases diagnosed 1998-2003:
Ignore these terms when coding extension to 10 or 30. These terms do not verify involvement by pancreatic cancer of the organs mentioned. Other non-malignant circumstances could cause these conditions.
Histology (Pre-2007)/Primary Site/EOD-Extension--All Sites: How do you code these fields for a resected thyroid that is negative for any diagnostic abnormality and a left ovary that demonstrates "papillary thyroid carcinoma arising in a cystic teratoma"? See discussion.
Teratomas occurring in the ovaries frequently contain various types of fully differentiated tissue that normally occur in other body parts. Should the primary be coded to the ovary or to the organ in which that type of tissue normally occurs?
For tumors diagnosed prior to 2007:
Code the Primary Site field to the organ in which the cancer arose. For this tumor, code the Primary Site field to C56.9 [ovary] and Histology to 8260/3 [papillary carcinoma of thyroid]. Use the ovary EOD for tumors diagnosed 1998-2003.
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)--Breast: What code is used to represent the histology "infiltrating lobular carcinoma, solid and classical subtypes"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8520 [Lobular carcinoma].
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.
Reportability/Histology (Pre-2007)--Pancreas: Are the following pancreatic tumors with mention of "low grade malignant potential/borderline" reportable to SEER? If so, what histology and behavior codes should be used? See discussion.
1. AFIP diagnosis: Pancreas, tail, resection: Mucinous cystadenocarcinoma (mucinous cystic neoplasm) of low grade malignant potential. Comment: There are no reliable histomorphologic features which can separate these neoplasms into benign and malignant tumors, and so we consider them all to be low grade malignant tumors.
2. Whipple resection: Intraductal papillary mucinous tumor of the pancreas with extensive low grade and multifocal high grade ductal dysplasia (so-called borderline tumor and carcinoma in-situ).
For tumors diagnosed prior to 2007:
Both tumors are reportable to SEER.
1. Code the Histology and Behavior Code fields to 8470/3 [Mucinous cystadenocarcinoma, NOS].
2. Code the Histology and Behavior Code fields to 8453/2 [Intraductal papillary-mucinous carcinoma, non-invasive].
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, Differentiation--Unknown Site: Is grade coded to 9 [Cell type not determined, not stated or not applicable] for all unknown primaries?
Most unknown primaries would be coded to grade 9 [Cell type not determined, not stated or not applicable] in the Grade, Differentiation field unless the case is coded to one of the histologies for which the grade is implied, such as undifferentiated carcinoma, NOS [802034].
Scope of Regional Lymph Node Surgery/EOD-Number of Regional Nodes Examined: What codes is used to represent these fields when the surgeon states that a "lymph node dissection" was done, but no nodes are identified in the pathology report?
For cases diagnosed 1/1/2003 and after: Code the Scope of Regional Lymph Node Surgery field to 3 [Number of regional lymph nodes removed unknown or not stated; regional lymph nodes removed, NOS] and code the EOD-Number of Regional Nodes Examined field to 00 [No nodes examined].
The surgery fields reflect the procedures the physician performed. The EOD fields reflect the results of those procedures.