Multiple Primaries (Pre-2007)--Bladder: Should an invasive malignancy following an in situ malignancy by more than two months be a new primary? Why? See discussion.
Example: An in situ bladder case was diagnosed and treated. Three months later another TURB diagnosed an invasive bladder carcinoma. Is the invasive case reportable to SEER as a new primary?
For tumors diagnosed prior to 2007:
Yes. These are two primaries.
In situ cancers are not included in SEER incidence rates. Incidence rates must correlate with mortality rates.
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.
Multiple Primaries (Pre-2007)--Breast: Patient diagnosed with two lumps in same breast, different quadrants at same time. One was ductal carcinoma, cribriform type; the other was ductal carcinoma. How many primaries do we code? See discussion.
If the breast cancer had been diagnosed in 2000 we would have coded this case as one primary, code to higher ductal ca. For a 2001 or later diagnosis, should this be coded as two primaries?
For cases diagnosed 1998-2003:
Code this case as two primaries if the tumors are separate. Separate tumors have clear (negative) margins. If the tumors are not separate, code as 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 (Pre-2007)--Prostate: What code is used to represent the histology "adenocarcinoma, cribriform type"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8201/3 [cribriform carcinoma]. The word "type" is a term that indicates majority of the tumor. The term "cribriform" would be a term used to determine the histology code.
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.
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.
Diagnostic Confirmation--Testis: How do you code this field when a testicular mass is confirmed to be cancer on physical exam and testicular antigen, but the orchiectomy specimen was negative and yet the final signout diagnosis on the medical record was "testicular cancer"?
Code the Diagnostic Confirmation field to 5 [Positive laboratory test/marker study] because the disease was confirmed both clinically and by a positive marker. Code 8 [Clinical diagnosis only] is used when the diagnosis is based on information other than that coded in 5, 6, or 7 [positive lab test/marker study, visualization, and radiography or other imaging techniques]. Code 8 is rarely used.
Reportability/Ambiguous Terminology--Breast: Should the American College of Radiology (ACR) BI-RADS assessment categories 4 [Suspicious Abnormality--biopsy should be considered] and 5 [Highly Suggestive of malignancy-appropriate action should be taken], impressions for mammograms and sonograms, be used as the sole basis for reportability? See discussion.
ACR website:
Category 4: Lesions that do not have the characteristic morphologies of breast cancer but have a definite probability of being malignant.
Category 5: lesions have a high probability of being cancer.
EOD-Extension--Bladder: Both papillary transitional cell ca in situ and sessile (flat) transitional cell ca in situ are diagnosed simultaneously in the bladder. We code the higher histology (8130/2). For extension, do we use the code that corresponds to the histology (01), or to the higher extension code (06)?
For cases diagnosed between 1998-2003:
Code the EOD-Extension field to 06 [sessile (flat) (solid) carcinoma in situ], the higher extension code.
Terminology/Terms of involvement: When the terms "lytic" or "lysis" are used in an imaging study, are they to be interpreted as synonymous with metastasis, or can these terms be used to describe a non-malignant condition?
Although the term "lytic lesion" is often used to describe bone lesions and "tumor lysis" develops in response to systemic therapy, the words are not a part of the SEER list of terms used to describe involvement. Do not code distant metastasis based only on these words.
Histology (Pre-2007)/EOD-Lymph Nodes/SEER Summary Stage 2000--Breast: What codes are used to represent these fields for a breast case with a diagnosis of ductal carcinoma in situ and a positive regional lymph node?
For tumors diagnosed prior to 2007:
Code the Histology field to 8500/3 [Infiltrating duct carcinoma, NOS]. Code the EOD-Lymph Nodes field to 6 [Axillary/regional lymph nodes, NOS] and the SEER Summary Stage 2000 field to 3 [Ipsilateral regional lymph nodes(s) involved only].
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.
All Surgical Fields/Radiation Sequence with Surgery--Unknown Primaries: What codes are used to represent these fields for an unknown primary treated with a radical neck dissection followed by radiation therapy?
For unknown primaries treated with a lymph node dissection and diagnosed 1/1/2003 and after, code:
1) Surgery to Primary Site: 98 [All unknown and ill-defined disease sites, WITH or WITHOUT surgical treatment].
2) Scope of Regional Lymph Node Surgery: 9 [Unknown or not applicable].
3) Surgical Procedure of Other Site: 1 [Surgery to other site(s) or node(s), NOS; unknown if regional or distant].
4) Radiation Sequence with Surgery: 3 [Radiation after surgery]. Any planned surgical treatment is used to code radiation/surgery sequence (per CoC I&R).
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