EOD-Size of Primary Tumor--Breast: For breast cancer cases, is code 002 [Mammography/xerography diagnosis only with no size given (tumor not clinically palpable)] to be used only when there is no work-up beyond a clinical one? See discussion.
Usually when a mammogram has a malignant diagnosis, the tumor is clinically palpable, but occasionally the tumor is not palpable.
For example, on the mammogram, lesions are identified in the breast. PE--the breasts are palpably normal. Breast biopsies--two ductal carcinomas, no statement of size. Mastectomy--no residual. Should the size be coded to 999 rather than 002?
For cases diagnosed 1998-2003:
In the case you provided, code the EOD-Size of Primary Tumor field to 002 [Mammography/xerography diagnosis only with no size given (tumor not clinically palpable)]. A known code in the size field should always take precedence over 999 [Not stated]. Code size from the records in priority order as stated in EOD, from pathology, op report, PE, mammogram, etc. (See EOD for complete instructions.)
Code size as 999 only when there is a clinically palpable lesion with no size stated in the path, PE, or mammogram.
If there is a lesion seen on mammogram that is not clinically palpable, a stated size taken from the path or mammogram would take precedence over code 002; however, if there is no stated size, use code 002 rather than 999.
Histology (Pre-2007): What code is used to represent the histology "papillary adenocarcinoma: mixed serous, endometrioid and mucinous subtypes"? See discussion.
Example: Fallopian tube right (salpingectomy): Primary adenocarcinoma: mixed serous, endometrioid, and mucinous subtypes
For tumors diagnosed prior to 2007:
For cases diagnosed on or after 1/1/98: Code the Histology field to 8323/3 [adenocarcinoma, mixed cell]. The case is coded using the mixed histology rule A in the Coding Complex Morph Dx's.
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--Lung: If a CT scan indicates that a patient has evidence of "long-standing pneumonia," is that synonymous with "pneumonitis" for the purposes of coding extension for lung primaries?
No. These terms are not synonymous. For cases diagnosed 1998-2003, disregard the pneumonia and use the other available information to code extension.
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.
Date of Diagnosis--All Sites: Is it better to estimate the month in the date of diagnosis field using the re-excision pathology report date or code the month to unknown if the only available information is the re-excision date? See discussion.
The only available information is the following pathology report:
On 7/18/00 a wide excision of the primary lesion is done. The report reads, "Lesion approximately 1 cm. Residual superficial spreading malignant melanoma with deepest penetration 4 mm."
Code the Date of Diagnosis field to 07/2000 for this case. Estimate the month of diagnosis whenever possible.
Given the usual delay between the initial excision of the lesion and a wide excision for a melanoma, estimate the month of diagnosis as July.
Primary Site--Lymphoma: How should you code the primary site for a lymphoma that presents with involvement of an extranodal site and regional lymph nodes? See discussion.
1. Lymphoma involves the spleen and the splenic lymph nodes.
2. MALT Lymphoma involves the stomach and the gastric and iliac lymph nodes.
1. Code the Primary Site field to C42.2 [spleen].
2. Code the Primary Site field to C16._ [stomach].
When lymphoma presents in an extranodal site and in the regional lymph nodes for that extranodal site, code the Primary Site field to the extranodal site. The typical disease process is that lymphoma can spread from an extranodal organ to its regional lymph nodes. It cannot metastasize from the regional lymph node to the extranodal organ. The exception to this would be if the lymph nodes presented as one large mass that extended into the regional organ.
EOD-Size of Primary Tumor--Lung: Can tumor size of 002 [Malignant cells present in bronchopulmonary secretions] be used when there is a lung mass seen but the diagnosis is from a positive bronchopulmonary secretion?
For cases diagnosed 1998-2003:
EOD-Size of Primary Tumor code 002 [Malignant cells present in bronchopulmonary secretions] is used only when there is no visible primary lung tumor and bronchopulmonary secretions are positive for lung malignancy.
Even if the diagnosis was made by cytology of broncho-pulmonary secretions, if there is a visible mass, code the size of the mass if known, code 999 if size is unknown.
Other Therapy: What code is used to represent "gene" therapy? See discussion.
The following form of gene therapy has been described as treatment for malignant brain tumors.
Patients undergo surgery to remove as much of the tumor as possible. After surgery, the patients are infused with a virus that has been genetically altered so that it is not infectious and so that it contains a gene from the herpes simplex virus. The herpes gene is sensitive to a drug called ganciclovir. Once inside the brain, the genetically altered virus infects any remaining tumor cells. When this occurs, the herpes gene is established inside the cancer cells. After the virus infects the cancer cells, the patients are given ganciclovir. This drug would kill both the virus and the brain tumor cells.
Code the Other Cancer-Directed Therapy field to 2 [Other experimental cancer-directed therapy (not included elsewhere)].
EOD-Extension: General instructions, page 7, note 3 states: " Extent of disease information obtained after treatment with neoadjuvant chemotherapy, hormone or immunotherapy has begun may be included." Because the SEER manual does not mention radiation treatment, can we use information from a lobectomy to code EOD if a patient has neoadjuvant radiation therapy?
Radiation therapy was inadvertently omitted from the list. Please see SINQ 20031012 answer as to when the surgical information can be used to stage the case.
EOD-Extension--Small Intestine: How do we interpret a pathology description of "extending through serosa and forming masses in the periserosal tissue" for a jejunum primary?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 55 [Invasion of/through serosa and adjacent connective tissue]. The description states the tumor extended through the serosa into periserosal tissue. The periserosal tissue in this case refers to adjacent connective tissue lying exterior to the intestinal wall and not the (sub)serosal tissue that lies exterior to the muscularis but inferior to the serosa. Analyze each case individually since pathologists are not consistent when using the above terminology.
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