EOD-Size of Primary Tumor--Testis: Should this field be coded to the gross pathological size when the pathology states "tumor dimension essentially the same as testicle, but is not appropriate in this case because the infiltrate does not form a mass lesion"? See Description.
Gross describes a testicle that measures a 4cm. Path micro states "several large atypical cells...These never form a true mass. Path comment states, "tumor dimension essentially the same as testicle, but is not appropriate in this case because the infiltrate does not form a mass lesion."
For cases diagnosed 1998-2003: Code the tumor size as 999 [Not stated] for the case example above. Keep in mind that tumor size is not used in analysis for certain sites such as testis, stomach, colon & rectum, ovary, prostate, and urinary bladder. Tumor size is important for analysis for certain sites such as lung, bone, breast, and kidney.
Surgery of Primary Site--Breast: How is this field coded when a patient has a reduction mammoplasty (for macromastia) and within the pathology specimen there is an incidental finding of carcinoma?
For cases diagnosed 1998-2003: Code this reduction mammoplasty to 20, 21 or 30, depending on whether or not there was a nipple resection. According to our surgical consultant, a reduction mammoplasty is more like a partial mastectomy than a lumpectomy or other breast surgery.
EOD-Pathological Extension--Prostate: How is this field coded when biopsy findings differ from prostatectomy findings? See Description.
Needle biopsy of prostate clearly states cancer arising in the apex. Clinical extension would then be 33. After prostatectomy, the path report states only one lobe involved with cancer and the apex was negative for cancer. Would the pathological extension then be coded to a 20 to truly reflect the surgical findings?
For cases diagnosed 1998-2003: Combine the information from the needle biopsy and the prostatectomy and code the pathologic EOD to 34 [Extending to the prostatic apex]. The case example above is very similar to Example 4 on page 2 of the Prostate EOD Coding Guidelines.
EOD-Pathologic Extension--Prostate/Lymphoma: How is this field coded for a prostatic lymphoma?
For cases diagnosed 1998-2003: Do not code the prostate pathologic extent of disease field for prostatic lymphoma. Leave the path extension for prostate field blank. Code the extent of disease using the lymphoma scheme. Use ONLY the lymphoma scheme - do NOT try to code both lymphoma and prostate extension fields for prostatic lymphoma.
EOD-Extension--Breast: Should clinically mentioned "thickening" of the breast be ignored if the pathology report does not mention thickening or skin involvement? See discussion.
For cases diagnosed 1998-2003: Can clinical "thickening" of the breast be coded to 20-28 extension code when there is no mention of the thickening or skin involvement in the pathology report? How do we code cases when pathology reports don't support the clinical finding of skin involvement.
For cases diagnosed 1998-2003: Do not use code 20-28 when there is no preoperative treatment and the pathology report does not confirm skin invasion. The clinical diagnosis of skin involvement was not supported by the pathology report.
EOD-Clinical Extension--Prostate: Is this field coded to 15 [Tumor identified by needle biopsy for elevated PSA] when it is unknown whether or not a TRUS was done? See Description.
Patient was admitted for radiation therapy for prostate cancer. H&P states that patient had elevated PSA. PE showed benign feeling prostate. Stage is clinical T1c. There is no mention of whether or not TRUS had been done.
For cases diagnosed 1998-2003: EOD extension code 15 is correct for this case example. When there is no other documentation available, the AJCC stage may be used to determine extension.
EOD-Lymph Nodes/EOD-Extension: Does extracapsular lymph node extension into adjacent tissue or organs affect EOD coding? See Description.
For a lung primary a PET scan showed marked uptake in the right hilum consistent with metastatic disease. A radical pneumonectomy was performed and the operative findings showed that the pulmonary artery was involved with a mass.
Pathology: Small cell carcinoma in the lung parenchyma. The distal bronchi showed obstructive pneumonitis. There were mets found on 02/05 on the hilar lymph nodes and 00/02 peribronchial nodes. The mets in the hilar nodes extended beyond the lymph node capsule into the pulmonary artery.
For cases diagnosed 1998-2003: Extracapsular lymph node extension does not affect the extent of disease. Code the extent of regional lymph node involvement in EOD lymph nodes.
EOD-Extension/EOD-Lymph Nodes--Colon: For this primary, under which field are satellite tumor nodules in mesenteric adipose tissue coded? See Description.
Sigmoid colon, low anterior resection: Invasive adenocarcinoma, 5.5 cm greastest dimension, moderately differentiated. Tumor invades through muscularis propria, into mesenteric adipose tissue. No penetration of visceral peritoneum. Proximal, distal, and radial margins free of tumor. Satellite tumor nodule present within mesenteric adipose tissue, 1.5 cm diameter, located 2.8 cm from main bowel wall tumor. Ten lymph nodes identified, with no evidence of metastatic tumor.
Comment: The satellite tumor nodule present within the mesenteric adipose tissue has an infiltrating, irregular contoured appearance and does not appear to represent a previously replaced lymph node. This appears to be a local metastasis with histologic features most commonly associated with venous invasion (see AJCC Cancer Staging Handbook, Sixth Edition, 2002, page 131 for current staging terminology).
For cases diagnosed 1998-2003: For EOD, each grossly detectable nodule in the regional mesenteric fat is counted as one regional lymph node.
EOD Extension--Lung: Do we ignore pericardial effusion seen on a CXR if a subsequent lobectomy reveals only a localized tumor? See discussion.
Note 6 in the lung EOD scheme instructs us to assume that a pleural effusion is negative if a resection is done. Does this also apply to a pericardial effusion? For example, if a pericardial effusion is seen on CXR, and a subsequent lobectomy reveals only a localized tumor, should the effusion be ignored?
For cases diagnosed 1998-2003: Ignore pericardial effusion which is negative for tumor. Assume that a pericardial effusion is negative if a resection is done and the tumor is pathologically confirmed to be localized.
EOD-Extension--Sarcoma: How is this field coded for a soft tissue sarcoma that involves the overlying skin?
For cases diagnosed 1998-2003: It depends on the location of the soft tissue sarcoma. If the tumor is very superficial, code EOD-Extension to 60 [Adjacent organs/structures]. However, if the soft tissue sarcoma is between muscles or "deep" according to the AJCC definition, then it would have to grow through the superficial fascia to get to the skin. In this case code EOD-Extension to 80 [Further contiguous extension].
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