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20021081 | 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. |
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20021002 | Histology (Pre-2007)--Breast: What code is used to represent the histology "ductal carcinoma in situ with comedo necrosis"? See discussion. | SEER distributed breast questions to the Advisory Group made up of pathologists from different SEER regions. One question dealt with the terms comedo type, comedo necrosis and comedocarcinoma. Per the Advisory Group, "Do not code comedo necrosis. These three phrases each represent a different level of diagnosis and can't be compared. "Comedocarcinoma" is an established diagnosis of in situ carcinoma and should be coded as such. "Comedo type" refers to a type of intraductal cancer; whether it is considered to be a true diagnosis is probably still equivocal. "Comedo necrosis" refers to a description of cellular pathological events that occasionally occur within an intraductal tumor of comedo type, which should not be coded at all."
Per the SEER preferred answer: Comedo type = comedocarcinoma. Ignore comedo necrosis. |
For tumors diagnosed prior to 2007:
Code the Histology field to 8500/2 [ductal carcinoma in situ].
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. |
2002 |
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20021178 | Histology (Pre-2007): What code is used to represent the histology "poorly differentiated invasive transitional cell carcinoma with extensive squamous and focal glandular differentiation"? | For tumors diagnosed prior to 2007:
Code the Histology field to 8120/33 [transitional cell carcinoma, NOS, poorly differentiated]. The ICD-O-3 does not have a separate code for transitional cell carcinoma with squamous and/or glandular differentiation.
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. |
2002 | |
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20021188 | Multiple Primaries (Pre-2007)--Testis: How many primaries should be reported when seminoma is diagnosed simultaneously in both testicles and both tumors are encapsulated? | For tumors diagnosed prior to 2007:
Report this cases as two primaries, unless there is information in the record confirming 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. |
2002 | |
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20021165 | EOD-Size of Primary Tumor--All Sites: Is there a hierarchy for using information from clinical tests (scans, radiography) to determine clinical tumor size? When the size on a radiographic report prior to pathologic diagnosis is smaller than the size of the tumor on the radiographic report that is post pathologic diagnosis, which tumor size should be used? See discussion. | Which size should be used for these examples? 1) Tumor size on a mammogram is smaller than the tumor size on an ultrasound. 2) CT of the lung reveals a 2.5 cm RUL malignancy in June. A biopsy in July confirms a malignancy. A CT is done in August prior to initiating RT which reveals a 3.1 cm RUL nodule. |
For cases diagnosed 1998-2003:
Generally, code the EOD-Size of Primary Tumor field to the largest size identified in any scan. Use the largest tumor size for most cases. There is no hierarchy for multiple imaging studies, with the exception of the two situations represented in the question examples. 1). Code the size stated on the mammogram, even if that size is smaller than the one specified on the ultrasound. Generally the mammogram size is more accurate for breast cases than ultrasound. 2). Code the EOD-Size of Primary Tumor field to 2.5 cm. In this example, the second scan was the same type as the first. Usually there is not that much of a difference in size between the same tests, unless the tumor has an aggressive histology. The example does not mention the histology. With certain histologies, such as small cell of the lung, a rapid growth in a short amount of time is the normal process. The fact that the size increased that much in a short period of time, using the same type of scan, is an indication of a rapidly growing tumor. It would be better to use the size on the initial scan to code the EOD-Size of Primary Tumor. |
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20021078 | Primary Site: How do you code the primary site when the tumor is identified in a bladder that was reconstructed using a stomach augmentation procedure and the pathology report states, "Bladder/prostate: adenocarcinoma arising within gastric mucosa, with the following features: highly infiltrative through the bladder wall"? | Code the Primary Site field to bladder [C67.9]. Code the location of the tumor as the primary site. | 2002 | |
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20021042 | Hormone Therapy--Breast: Should Zoladex (gosrelin) or Lupron (leuprolide acetate) be coded as treatment for breast cancer when the physician does not indicate whether or not these drugs are intended as cancer-directed therapy? See discussion. |
According to an oncologist at the research hospital in our region, these drugs are given in combination with chemotherapy for two reasons:
1) To preserve ovarian function. 2) The agents may be more effective in treating breast cancer when given in conjunction with chemotherapy than with chemotherapy alone. |
For cases diagnosed 1/1/2003 to 12/31/2010: Code Zoladex (gosrelin) and Lupron (leuprolide acetate) as 01 [Hormone therapy administered as first course therapy] only when stated to be given as part of the first course of cancer-directed therapy. If you do not know whether these drugs were given to preserve ovarian function or as an adjunct to chemotherapy (i.e, there is no treatment plan), do not code as Hormonal treatment given. |
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20021018 | First Course Treatment--Prostate: How do you code "watchful waiting" in these fields for prostate primaries? | For cases diagnosed 1/1/2003 and later: When "watchful waiting" is the first course of therapy for prostate cancer, code the case as follows:
Date Therapy Initiated: 000000 Surgery of Primary Site: 00 Scope of Regional Lymph Node Surgery: 0 Surgical Procedure of Other Site: 0 Reason for No Cancer-Directed Surgery: 1 Radiation: 0 Chemotherapy: 00 Hormone Therapy: 00 Immunotherapy: 00 Hematologic Transplant and Endocrine Procedures: 00 Other Cancer Directed Therapy: 0 |
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20021028 | 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. |
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20021144 | EOD-Extension--Colon: What code is used to represent this field for a mid-ascending colon primary that invades through muscularis propria and into subserosal fibroadipose tissue that also presents with a "separate serosal nodule" of carcinoma within cecum that is consistent with a tumor implant (cT3, N0, M1)? | For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis], because the nodule of carcinoma in the cecum is not contiguous with the mid-ascending primary colon tumor. |
2002 |
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