Behavior Code--Bladder/Lymphoma: Should the "in situ" designation on a bladder primary's pathology report be ignored that states a diagnosis of "in situ lymphoma"?
Ignore the in situ designation. You cannot assign an in situ behavior code to a lymphoma primary. The term or designation of "in situ" is limited to solid tumors; carcinoma and/or cancer.
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-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Colon: What codes are used to represent these fields when the pathology from a colon cancer resection describes 2/16 positive pericolonic lymph nodes and a "metastatic nodule in the pericolonic fat"?
For cases diagnosed 1998-2003:
Code the Number of Regional Lymph Nodes Positive field to 03 and the Number of Regional Lymph Nodes Examined field to 17. Each grossly detectable nodule in the pericolonic fat is counted as one regional lymph node.
EOD-Pathologic Extension--Prostate: If there is residual tumor in the distal urethra on prostatectomy, does that mean there is distal urethral margin involvement? See discussion.
2/98 Prostate bx: Right apex, right mid and right base positive for adenocarcinoma.
6/1/98 Radical retropubic prostatectomy w/ bilateral pelvic lymph node dissection. Pathology: Residual adenocarcinoma in distal urethra, right lateral sections and posterior lobe. Right apical margin, other margins, seminal vesicles, and 7 pelvic LN negative for malignancy.
For cases diagnosed 1998-2003:
For the example above, code the EOD-Pathologic Extension field to 34 [extending to apex] because most of the right side is involved.
The pathology report says all margins are free. The comment on residual tumor in the urethra, meant the first surgery did not completely remove tumor tissue from the urethra, it does not mean that tissue is at the margin.
Multiple Primaries (Pre-2007): Is an in situ tumor followed by another in situ tumor in the same location a new primary? See discussion.
Example: Six months after an in situ lesion was excised from the buccal mucosa, another in situ lesion was excised from the same area of the buccal mucosa with no mention of it being recurrent.
For tumors diagnosed prior to 2007:
Code as a second primary if the second in situ tumor occurred more than 2 months after the first, and it is not referred to as recurrent by the clinician or pathologist. There are no special rules for determining the number of primaries when an in situ lesion follows an in situ.
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-Lymph Nodes/TNM--Breast: Do we code these lymph nodes fields for a breast primary that describes ipsilateral axillary lymph node involvement as "extending through the lymph node capsule and into perinodal soft tissue/fat" as "fixed/matted"?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 6 [Axillary regional lymph nodes, NOS], if the size of the metastasis within the lymph node is not known. "Extension into perinodal soft tissue" does not imply that the lymph nodes are fixed to one another or to other structures. AJCC stage for lymph nodes is coded to N1 [Metastasis to moveable ipsilateral axillary lymph nodes].
In order to code the EOD-Lymph Nodes field to 5 [Fixed/matted ipsilateral axillary nodes] which is the equivalent to AJCC equivalent N2, there must be some clinical or pathologic statement of fixation or matting. There can be extension through the capsule without fixation or matting. "Fixation" is a clinical term and "matting" can be either clinical or pathologic. A pathologist can recognize two or more lymph nodes stuck together by tumor.
EOD-Extension/EOD-Lymph Nodes--Lung: Is "subcarinal extension" with no mention of lymph nodes coded in the EOD extension field or in the EOD lymph node involvement field? See discussion.
Should "subcarinal extension" with no mention of lymph nodes be assumed to be direct contiguous extension of the primary tumor or does it represent lymph node involvement?
If it is direct extension, should we code it as 70 in the extension field? If not, should we code it as 2 in the lymph node involvement field?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 70 [mediastinum, direct extension].
Histology (Pre-2007)--Colon: What code is used to represent the histology "adenocarcinoma arising in a papillary adenomatous polyp"? See discussion.
Is "adenocarcinoma arising in a papillary adenomatous polyp" equivalent to adenocarcinoma in a villous adenoma [8261/3] or adenocarcinoma in an adenomatous polyp [8210/3]?
For tumors diagnosed prior to 2007:
Code the Histology field to 8261/3 [adenocarcinoma in a villous adenoma]. In describing colon polyps, papillary and villous are equivalent terms.
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/EOD-Lymph Nodes: Can the AJCC TNM/Stage be used to help code these fields when there is limited text information in the medical record that describes the tumor involvement?
For cases diagnosed 1998-2003:
Yes, this staging information can be used to help code the SEER EOD fields but only if a physician does the TNM/Stage at the time of diagnosis and there is limited text information that describes tumor involvement.
Histology (Pre-2007)--Colon: What code is used to represent histology when the surgeon describes a sessile polyp and the final path diagnosis is stated as: "Rectal sessile polyp: Invasive moderately differentiated adenocarcinoma" (pathologist does not state that it is "arising in a sessile polyp")?
For tumors diagnosed prior to 2007:
Code the Histology field to 8210/3 [adenocarcinoma arising in a polyp]. The structure in which this adenocarcinoma is arising, is a polyp.
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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