Chemotherapy--Hematopoietic, NOS: What treatment code is used to represent the drug "Gleevec" being used to treat chronic myelogenous leukemia?
For cases diagnosed 1/1/2003 and after: Code the Chemotherapy field to 02 [Single-agent chemotherapy administered as first course therapy]. It should be classified as a chemotherapy agent, albeit a unique one. Gleevec seems to work the same way many other chemo drugs do. It disrupts cell division for malignant cells containing the BCR-ABL protein only, rather than for normal and abnormal cells together. When the cells can't divide and create a new generation, they simply die. This meets the definition of an antineoplastic chemotherapy agent.
Date of Diagnosis--Lung: Based on Note 7 in the lung EOD, should the Date of Diagnosis field be coded to an earlier CT scan date with a reported diagnosis of "RUL mass with mediastinal lymphadenopathy" or to the later biopsy date with a reported diagnosis of small cell carcinoma? See discussion.
Note 7 states that "mediastinal lymphadenopathy" indicates involved lymph nodes for lung primaries. Should the date of diagnosis be back-dated to the date of the scan?
For cases diagnosed 1998-2003:
No, code the Date of Diagnosis field to the later biopsy date. Note 7 is intended for use in coding the EOD-Extension field, not the Date of Diagnosis field. The earlier scan has a diagnosis of RUL "mass" not a "malignancy" so the fact that there is mediastinal lymphadenopathy mentioned in that scan is not used to help determine date of diagnosis.
Grade, Differentiation--All Sites: Can "Fuhrman nuclear grade" be coded if it is the only grade given for a kidney primary, or is breast the only site for which we can use a nuclear grade in coding the Grade, Differentiation field? See discussion.
Our pathologist consultant disagrees with coding nuclear grade for any site because it is only a component of the grade, in most cases, and is not adequate to use by itself.
If the Fuhrman nuclear grade system can be used by coders, will a conversion table for the system be added to the coding documentation by SEER in the future?
For cases diagnosed 2004 and later: Fuhrman grade can be used to code the Grade, Differentiation field.
Reason no treatment/Surgery of Primary Site: Does the "Reason for No Cancer-Directed Therapy" field only relate to the "Surgery of Primary Site" field? If so, for what diagnosis years is that effective? Have SEER's coding guidelines changed over time? See discussion.
Whenever a surgical procedure is performed that results in a non 0 or 9 code in any one of the Surgery fields, should the Reason for No Site-Specific Surgery field be coded to 0 [Cancer-directed surgery performed]?
For cases diagnosed 2003 and forward: The field "Reason for No Surgery of Primary Site" applies only to surgery of primary site. This is a change from the pre-2003 instructions.
First Course Treatment: What code is used to represent each treatment modality field when there is no indication that a particular modality of treatment was recommended or started?
Code the individual treatment fields to 0 or 00 [None] when the modality is not addressed in the treatment plan (or when a treatment plan is lacking) and there is no indication that a particular modality of treatment was recommended or started.
Surgery of Primary Site--Prostate: What treatment code is used to represent prostate carcinoma treated with "high intensity focused ultrasound" (HIFU)?
For cases diagnosed 1998 and later:
Code the Surgery of Primary Site field to 17 [Other method of local tumor destruction]. HIFU uses focused energy to destroy tissue. It is classified as a surgical procedure.
EOD-Size of Primary Tumor: Should the code 001 in tumor size be used for tumors described as having "focal" involvement? See discussion.
Is tumor size coded to 001 for the following examples:
Example 1: Focal adenoca in left lobe on prostatectomy.
Example 2: Multifocal ductal carcinoma of breast on mastectomy.
Example 1 and 2: There is insufficient information in the examples to determine whether EOD-Size of Primary Tumor should be coded to 001.
The instructions are that code 001 is used for a microscopic focus or foci of tumor only. That means that the tumor is small enough that it could not be seen by the naked eye, nor would it be palpable. Be careful with the term "focal" because it is most often used to describe tumor cells grouped or concentrated in one area as in example 1. There is no implication that this focus was microscopic only. Was it mentioned in the gross or macroscopic portion of the pathology report? If so, it is not coded to 001. Was it palpable? If so, it is not coded to 001.
Example 2 cites a multifocal breast cancer. Again, did the pathologist visualize the cancer (was it reported on the gross or macroscopic portion of the pathology?) If so, do not use code 001. Was the lesion palpable? If so, do not use code 001.
EOD-Extension: There is a one to many relationship between T values in TNM staging and SEER EOD-Extension values (one T value can be coded to many extension values). For most situations, we can typically code EOD-Extension to the lowest value in the range available for that T value per the SEER guidelines. But, what happens if another tumor feature, such as tumor size, was involved in the assignment of a T value? See discussion.
Example: Physician stages lung tumor as T2. The lowest extension code, 20, doesn't precisely fit the guidelines for a T2 tumor because the T2 stage may be based on the size of the tumor, which doesn't have anything to do with the EOD-Extension field. Should EOD-Extension be coded to 30 rather than 20?
The criteria for AJCC stage T2 consists of both size and tumor extension values. Size of tumor is recorded in the EOD-Size of Primary Tumor field. If you determine that size is the physician's sole criteria for assigning a T2 value, code an EOD-Extension value that reflects more specific information than 30 [localized, NOS]. Code to 10 or 25, depending on the case.
If the tumor size is not provided, and there is only a clinician statement that describes the lung tumor as a stage T2, code EOD-Extension to 20, the numerically lowest equivalent EOD-Extension code for the lung T2 category.
EOD-Size of Primary Tumor: Can you code the known size of the residual tumor in a further resected specimen if the size of the tumor in a prior excisional biopsy is unknown? See discussion.
Excisional biopsy is done prior to admission and the tumor size is unknown. Pt is admitted for a mastectomy and the residual tumor size is 5 mm.
For cases diagnosed between 1998-2003:
Code the EOD-Size of Primary Tumor field to 999 [unknown]. The majority of the tumor would have been removed during excisional biopsy and it is possible that the tumor could have been quite large.
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].
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