CS Tumor Size--Melanoma: How is this field coded when a smaller invasive and a larger in situ melanoma are reported as a single primary? See Discussion.
Patient has a 1.2 cm lesion right upper arm with a diagnosis of melanoma in situ. A second lesion on right wrist, 0.5 cm mole, has a diagnosis malignant melanoma, Breslow's 0.78, Clark's level III.
According to the 2007 MP/H rules, this is a single primary. Because the larger lesion is completely in situ, do you ignore it altogether and go with the smaller, invasive lesion? SEER Program Manual 2007, page 127, rule 4.l, states that when two lesions are reported as a single primary, code the size of the larger lesion, which in this case would be the in situ.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code CS Tumor Size as 005 (0.5 cm). Code CS Tumor Size based on the invasive lesion.
Use the data items "Multiplicity Counter" and "Type of Multiple Tumors Reported as One Primary" to document that there are two tumors present, in situ and invasive.
Priorities/CS Tumor Size--Breast: What is the priority order used in coding tumor size for this site when there is a larger 2 cm lesion noted on the PET scan and smaller sizes described in the pathology report as two malignant masses one measuring 0.8 cm and the second measuring 1.0 cm per the GROSS?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code CS Tumor Size as 1.0 cm. The pathology report is the highest priority source for coding tumor size. When multiple tumors are present, code the size of the largest tumor.
CS Lymph Nodes/CS Mets at Dx--Ovary: How are renal lymph nodes coded for ovary primaries?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code involvement of renal lymph nodes under CS Mets at Dx. Renal lymph nodes are not listed as regional lymph nodes for ovary; therefore, code involvement of renal lymph nodes under CS Mets at Dx.
CS Extension/CS Mets at Dx--Wilm's Tumor: Is the fact that a Wilm's tumor case is bilateral captured in the CS Extension field or is the CS Mets at Dx field coded to 40?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code laterality as bilateral, code the greatest extension from either side in CS extension.
Code CS Mets at diagnosis 00 [None] UNLESS true distant metastases were identified.
CS Tumor Size/CS Extension--Prostate: Because prostatectomy results are excluded from the CS Extension field for prostate, is code 95 [No evidence of primary tumor] accurate to reflect bilateral lobe involvement of prostate cancer when it is incidentally found following a radical cystectomy for a bladder primary? Why must tumor size be 000 when the CS Extension code is 95?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code prostate CS Extension to 99 [Extension unknown] and code CS Tumor Size according to the information available from the surgery.
CS Extension code 95 [No evidence of primary tumor] should be used only in that rare situation when the only evidence of disease is distant mets or lymph node involvement, no primary tumor found. That is why CS tumor Size must be 000 when CS Extension code 95 is used.
CS Extension/CS Lymph Nodes--Lung: How are these fields coded if a lobectomy path specimen indicates that two intrapulmonary lymph nodes are involved by direct extension from the primary tumor?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code regional lymph node involvement in CS lymph nodes even when the lymph nodes are involved by direct extension. Do not code direct extension to lymph nodes in CS extension.
CS Reg LN Pos/Exam--Melanoma: How should these fields be coded for a case that is an unknown primary site melanoma with liver involvement and a positive axillary lymph node?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code regional lymph nodes positive 01 [one positive lymph node] and regional lymph nodes examined 01 [one lymph node examined] (assuming the positive node was the only node examined).
If the only lymph node involvement is the positive axillary lymph node, it is reasonable to conclude that this is a regional lymph node. When only one chain of lymph nodes is involved with metastatic melanoma, the metastatic cells had to come from skin with direct drainage to those lymph nodes.
CS Site Specific Factor--Lymphoma: Can the term "intermediate risk" be used to code IPI score? See Discussion.
Patient has Hodgkin disease. The physician states that the patient has bulky stage IIA intermediate risk disease. Is the term "risk" another way of stating IPI score? If so, how would intermediate risk be coded?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code SSF 3 for lymphoma based on the IPI score stated in the record. Do not attempt to interpret statements or terms in order to assign a code to SSF 3. If no further information is available for this case, code SSF 3 999 [Unknown].
CS Site Specific Factor 6--Breast: Should we assume that the invasive portion of the tumor is being referred to when a pathologist provides only a single tumor size but includes both invasive and in situ descriptors when discussing the size of that tumor? See Discussion.
There seems to be subtle variations in wording and punctuation in these cases. Would these three examples be coded the same way?
Examples:
"invasive ductal carcinoma 2.0 cm, DCIS present"
"2 cm invasive ductal carcinoma with DCIS present"
"invasive ductal carcinoma 2.0 cm. DCIS present"
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code SSF6 050 [invasive and insitu components present, entire size coded in CS TS, size of invasive not stated, proportion invasive and insitu not known] when the size of the invasive portion is not provided and clarification is not available.
If possible, obtain clarification from the pathologist for phrases like these and document in a text field. For example, a pathologist may confirm that when he/she states "invasive ductal carcinoma 2.0 cm, DCIS present" the size of the invasive portion is 2 cm. If so, code CS tumor size 020 and SSF6 020 and explain in a text field.
CS Site Specific Factor--Breast: How is SSF6 coded when CS tumor size is coded from a clinical report, not from pathology? See Discussion.
A breast ultrasound displays a 2 cm tumor. Core biopsy diagnosis is lobular carcinoma in situ. No further record for patient. Tumor size coded to 020. Should SSF 6 be coded to 010 "Entire tumor reported as in situ (no invasive component reported)" because it was pathologically confirmed, or to 888 because size was coded based on a clinical exam - the ultrasound?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code SSF6 888 [Clinical tumor size coded]. When the size recorded in CS Tumor Size is not determined pathologically, 888 must be coded in SSF6. Note: The code in SSF 6 pertains to pathologic tumor size. It describes the relationship of invasive and in situ tumor in the tumor size coded.
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