EOD Fields--Lymphoma: Was MALT Lymphoma [9715/3 (ICD-O-2) and 9699/3 (ICD-O-3)] inadvertently excluded from SEER EOD manual, top of page 180?
For cases diagnosed 1998-2003:
Yes. Use the scheme on page 180 for MALT lymphoma. The ICD-O-2 morphology code 9715 was omitted in error. It should have been added when the EOD was printed in 1998.
EOD-Size of Primary Tumor--Corpus Uteri: If both the width and depth of the tumor are provided, do we code the largest dimension in the tumor size field? If the width dimension is not provided, can we code the depth of the tumor in the tumor size field? See discussion.
Example: An endometrial primary is described as having, "a soft lobulated tumor diffusely involving the entire endometrium, extending 2.0 cm into the myometrium."
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 999 [unknown] for this case because this field is supposed to reflect the dimension for tumor width and not tumor depth. Tumor depth is coded in the EOD-Extension field.
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.
EOD-Extension--Lymphoma: Would a lymphoma involving mesenteric and retroperitoneal nodes (both site code C77.2) be coded to extension 10 [Involvement of a single lymph node region; Stage I], based on the fact that while more than one "chain" is involved only one "region" is involved?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 20 [Involvement of two or more lymph node regions on the same side of diaphram]. The AJCC lists mesenteric as a core nodal region, but does not list retroperitoneal lymph nodes as a part of this region, so retroperitoneal is a separate region.
The EOD staging scheme for lymphoma uses lymph node REGIONS as the criteria for assigning the extension code. Use the AJCC Cancer Staging Manual as the definitive source for classifying lymph node regions, not the ICD-O-3. If it is a separate LN region per the AJCC, it is coded in the EOD as a separate region.
According to the AJCC curator, the nodal regions are defined in Kaplan's book on Hodgkin disease. Bilateral cervical, or axillary, or hilar, or pelvic, or inguinal nodes count as two regions. Mediastinal and para-aortic lymph nodes count as one region regardless of laterality as they are centrally located. A large mediastinal mass constitutes one region involved regardless of the size.
Scope of Regional Lymph Node Surgery: Should this field be coded to "unknown or not applicable" for all hematopoietic morphologies, brain primaries and unknown primaries?
For cases diagnosed 1/1/2003 and after: Code the Scope of Regional Lymph Node Surgery field to 9 [Unknown or not applicable] for all hematopoietic morphologies, brain primaries and unknown primaries. .
EOD-Clinical Extension--Prostate: Note 8 of the clinical EOD scheme for prostate states, "B1, Small, discrete nodule(s)<1.5 cm, and B2 Nodule(s)>1.5 cm ... " Does Note 8 still apply for cases diagnosed 1998 or later?
For cases diagnosed 1998-2003:
Note 8 in the EOD scheme does not apply because nodule size does not apply in the 5th or 6th edition of TNM.
Scope of Regional Lymph Node Surgery/EOD-Lymph Node fields: How do you code these fields if a pt has multiple lymph nodes surgeries at different times? See discussion.
Example: 1/01/03 Biopsy of 1 sentinel lymph node: positive for metastasis. 1/10/03 Modified radical mastectomy and axillary lymph node dissection: ductal carcinoma with 8 neg lymph nodes.
For cases diagnosed 1/1/2003 and later: Code Scope of Reg LN Surgery to 7. Code EOD Lymph Nodes field to 6. Code EOD Pathologic Number of Reg LN Positive and Examined fields to 01 and 09 respectively.
For the Scope of Reg LN Surgery use the highest applicable code number if more than one Scope of Reg LN Surgery was performed. The EOD lymph node fields are cumulative and count all lymph nodes removed during the diagnostic and first course treatment procedures.
Surgical Procedure of Other Site: Is the excision of a distant lymph node or a fine needle aspirate (FNA) of a distant lymph node coded as a Surgical Procedure of Other Site, even though they are performed for diagnostic purposes and not intended as treatment?
For cases diagnosed 1/1/2003 and after: Code the Surgical Procedure of Other Site field to 3 [Non-primary surgical procedure to distant lymph nodes] for an excision of a distant lymph node because it is a surgical procedure. However, if only a fine needle aspirate of a distant lymph node is done, code this field to 0 [None].
Fine needle aspirates of regional lymph nodes are the only FNA biopsies to be coded in a surgery field (Scope of Regional Lymph Node Surgery field). In addition, FNA biopsies of regional nodes are also included in the EOD-Number of Positive Regional and Examined Lymph Nodes fields.
EOD-Extension--Pancreas: How do you code extension when a mass is described on exploratory laparotomy as compressing the duodenum, arising in the head of the pancreas, "extending around" the superior mesenteric vein and artery, and "encasing" the portahepatis?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [extension to peripancreatic tissue, NOS]. Neither of the terms "extending around" nor "encasing" are interpreted as involvement with tumor by SEER.
Multiple Primaries (Pre-2007)--Bladder/Prostatic Urethra: When invasive TCC of the bladder and TCC in-situ of the prostatic urethra are diagnosed at the same time, are they reportable as two primaries? See discussion.
There is no direct extension of tumor from the bladder to the urethra. According to the SEER rules for determining separate primaries, bladder (C67) and urethra (C68) are separate sites. However, it seems that TCC in the bladder and urethra should be reported as a single primary.
For tumors diagnosed prior to 2007:
This is one primary. Mucosal spread of in situ cancer from a hollow organ (bladder) into another hollow organ (prostatic urethra) is coded as a single primary.
This type of mucosal spread of tumor is sometimes referred to as "intramucosal extension" or " in situ component extending to." Mucosal spread can also be expressed as a statement of an invasive component in one organ with adjacent or associated in situ carcinoma in a contiguous organ with the same type of epithelium.
This case represents an invasive bladder tumor with in situ extension to the prostatic urethra. A tumor that is breaking down can be invasive in the center with in situ cancer at its margins. Occasionally, the in situ margin can move into a contiguous organ with the same type of epithelium.
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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