EOD-Clinical Extension--Prostate: How do you distinguish between clinical extension codes of 10, 13, 14, and 20 for cases with a benign prostate per digital rectal exam that appear localized after TURP/prostatectomy? Can the clinical extension code of 10 be used if the term "microscopic carcinoma" is noted in the pathology report without also mentioning "foci" or "Stage A" for clinically inapparent tumors?
For cases diagnosed 1998-2003:
When the prostate feels benign and the cancer is found incidentally at the time of the microscopic exam, code the EOD-Extension field to 10 [number of foci or % of involved tissue not specified]. Code as 13 (less than or equal to 5%) or 14 (greater than 5%) if percentage involved is given in the tissue resected. If the path report states "solitary focus of carcinoma" without mentioning the total amount of tissue resected, code extension to 13. If there is more than one focus, code extension to 10. Don't assign a code of 20 unless the tumor is clinically apparent.
EOD-Pathologic Extension--Prostate: Is extracapsular extension implied by the following phrases: "case staged as C" and "case staged as T3a"? See discussion.
Example: A prostatectomy was done on 6/29. The physician staged the case as a "C" on 7/2 and as T3a on 8/6. It appears the physician is interpreting the following pathology information as unilateral extracapsular extension: "The tumor on the right extends to the inked surface of the gland. In this area the capsule appears absent." Should pathologic extension be coded to unilateral extracapsular extension [42]?
For cases diagnosed 1998-2003:
Yes. Use the best information available to stage this case. In this case, the best information is the physician's statement that the case is stage T3a. Without any additional information, the EOD-Extension field is coded to 42 [Unilateral extracapsular extension (pT3a)] on the basis of the T3a stage by the MD. When there is a conflict between different staging systems, default to the AJCC stage.
First Course Treatment: If the patient receives no treatment at the time of diagnosis (either because it is not recommended or because the patient refused treatment at that time) but treatment is later instituted after disease progression, should this treatment be coded as part of the first course of treatment?
The SEER rules changed in 1998 regarding what constitutes First Course of Cancer-Directed Therapy.
For cases diagnosed on or after 1/1/98: The First Course of Cancer-Directed Therapy fields will all be coded to 0 [None] for these types of cases. The documented disease progression would stop the timeframe for inclusion of any treatment to be part of first course of therapy.
EOD-Size of Primary Tumor--Breast/Cervix: When coding tumor size, when do you use 997 for breast cases and 000 versus 999 for breast and other primaries? See discussion.
Example 1: Ductal carcinoma found in axillary lymph nodes. No tumor found in breast on physical exam or by pathological exam of the breast, but physician states that the breast is definitely the primary site.
Example 2: Paget disease for breast carcinoma with no underlying tumor.
Example 3: Inspection of the cervix shows no visible tumor; biopsy of the cervix reveals CIN III or squamous cell carcinoma, either invasive or in situ.
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field as follows:
Example 1: Code to 000 [No mass, no tumor found, no Paget disease] when a tumor of a stated primary site is not found, but the tumor has metastasized.
Example 2: Code to 997 [Paget disease of nipple with no demonstrable tumor] if there is no underlying tumor and the patient presents with Paget of the breast.
Example 3: Code to 999 [Size not stated] when no size of tumor is given on the pathology report. Do not use 000 in the size field when a tumor is not visible on physical exam or by imaging, but tumor is found microscopically.
Histology (Pre-2007)--Skin: Are "atypical melanocytic hyperplasia" and "severe melanotic dysplasia" synonyms for melanoma in situ?
For tumors diagnosed prior to 2007:
No. SEER determines its reportable list from the ICD-O-3. The above terms are listed as tumor-like lesions and conditions, but are not in situ or malignant.
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.
Surgery of Primary Site--Cervix: How is this field coded for a cervix primary when a biopsy removes the entire tumor? See discussion.
Path from biopsy shows "severe dysplasia--CIN III" and the report from an endocervical curettage (ECC) is "chronic cervicitis"?
For cases diagnosed 1998 and later: Code the Surgery of Primary Site field to 25 [Dilatation and curettage; endocervical curettage (for in situ only)].
Histology (Pre-2007): What code is used to represent the histology "non-small cell carcinoma, NOS"? See discussion.
Should a non-small cell carcinoma histology be assumed to be a large cell carcinoma [8031/3] or should the histology be coded to carcinoma, NOS [8010/3]?
For tumor diagnosed 2001-2006: Code the Histology field to 8046/3 [non-small cell 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.
EOD-Extension--Mycosis Fungoides: Explain the difference between extension codes 25 [% of body surface not stated, no tumors] and 30 [skin involvement, NOS; extent not stated, no tumors. Localized, NOS]?
For cases diagnosed 1998-2003:
For mycosis fungoides: Use code 25 when skin involvement is present but only a general location/site is mentioned (i.e., face, legs, torso, arms).
Use code 30 when there is skin involvement but there is no mention of location/site.
Primary Site: What code should be used to represent the site for an "extraovarian" papillary serous adenocarcinoma located in the "rectal muscle sheath"? See discussion.
The location of the tumor in the rectus muscle sheath is unusual and suggests an origin within a preexisting mullerian.
Code the Primary Site field to C49.4 [connective, subcutaneous and other soft tissues of the abdomen].
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