Other Therapy: What code is used to represent treatment with "Epithilone" or "Epothilone"?
Code the Other Cancer-Directed Therapy field to 2 [Other experimental cancer-directed therapy (not included elsewhere)], until the exact mechanism of action is determined for this drug. This drug is in phase I clinical trials. It has a similar action to Taxol, but is derived from a different source.
Primary Site--Liver: What is the topography code for combined hepatocellular carcinoma/cholangiocarcinoma (M-8180/3) especially when there is no documentation that intrahepatic bile duct is the tumor site? Reports usually just indicate a liver mass(es) but since the intrahepatic ducts are within the liver, is the code C221 due to the cholangiocarcinoma component, thus making the case stageable?
If there is no further information about where the cancer originated, assign C220. Use ICD-O-3 as the source for coding topography. The topography code associated with combined hepatocellular and cholangiocarcinoma (8180/3) is C220 when there is no other information available, according to ICD-O-3.
Reportability--Ovary: Is immature teratoma of the ovary reportable if a subsequent comment states that "the teratoma shows immature neuroepithelium, but no malignant elements"?
There is conflicting information for this case. The final diagnosis conflicts with the comment. Go back and check with the physician to clarify his/her intent. If no further information can be obtained, the final diagnosis is preferred over the comment. This case is reportable based on the final diagnosis: "immature teratoma."
First course treatment--Heme & Lymphoid Neoplasms: How is a "donor lymphocyte infusion" that is used in the treatment of CLL coded?
Donor lymphocyte infusion (DLI) is coded as immunotherapy. The lymphocytes are donated by the same person who donated the original stem cell transplant. The lymphocyte infusion creates an immune response in which the T-cells are activated to attack the cancer cells.
Histology--Heme & Lymphoid Neoplasms: How is histology coded if the pathology report final diagnosis is "plasma cell dyscrasia, consistent with multiple myeloma" when no further work-up is performed because the patient either refuses additional testing or dies?
Ambiguous terminology is used to accession cases (determine reportability) because it has been used for over 30 years to do so. Any deviation from using ambiguous terminology to determine case reportability would cause the reporting of incidence counts to vary. In this case, there was a reportable, ambiguous terminology diagnosis of multiple myeloma on the pathology report.
The instruction "Do not code histology based on ambiguous terminology" is intended to be used when there is a reportable and reportable stated in the diagnosis. Ambiguous terminology cannot be used to report the more specific diagnosis in cases of Heme & Lymphoid neoplasms. For example, if the pathology report final diagnosis was "Myeloproliferative neoplasm, probably Polycythemia Vera" the histology would be coded as myeloproliferative neoplasm, unclassifiable [9975/3]. The ambiguous terminology indicates that the genetic testing, immunophenotyping, etc., probably are not complete or are not diagnostic of the more specific disease. Wait to code the histology until there is a definite diagnosis given.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
CS Site Specific Factor--Breast: What estrogen receptor/progesterone receptor (ER/PR) values should be coded in a case with two separate tumors (1 ductal, 1 lobular) diagnosed simultaneously in the same breast (single primary) with differing ER/PR values for each tumor? One is ER/PR positive; the other is ER/PR negative.
In cases where ER (or PR) is reported on more than one tumor specimen, record the highest value. If any sample is positive, record as positive.
Guidance on Collaborative Stage (CS) site-specific factors (SSFs) in the breast schema can be found in the SEER Registrar Staging Assistant (SEER*RSA): SSF1-Estrogen Receptor (ER) Assay and SSF2-Progesterone Receptor (PR) Assay.
Reportability/Terminology--Head & Neck: Is an "evolving" squamous cell carcinoma of the vermillion border of the left lower lip reportable?
For solid tumors, ignore the term "evolving" and apply the registry rules for reportability to this case. Squamous cell carcinoma of the vermillion border of the lower lip (C001) is reportable.
Other Therapy/Immunotherapy--Hematopoietic, NOS: How should erythropoietin be coded for leukemia or other hematopoietic diseases?
Do not code Erythropoietin as treatment, it is used as an ancillary drug for leukemias or other hematopoietic diseases. Record information about erythropoietin in the text field.
EOD 2018/EOD Primary Tumor/EOD Mets--Lung: Is EOD Primary Tumor coded to 500 and EOD Mets 10 when there are bilateral lung nodules with nodules in same lobe as the primary tumor? How is EOD Primary Tumor coded when separate tumor nodes are in an ipsilateral lung but there is no documentation as to whether it is in the same or different ipsilateral lobe from the primary tumor?
Assign 999 to EOD Primary Tumor if this is the only information you have for your case.The mention of nodules does not automatically mean that you have separate tumor nodules. There are many reasons for the appearance of nodules in the lung, some of which are not due to cancer. Unless you have further information on whether the physician has determined that they are related to the lung cancer, then assume that they are not related.
Assign 00 to EOD Mets. Do not code EOD Mets to 10 since you cannot determine whether those nodules are based on the tumor or not.
If you are able to obtain more information, then you can update the EOD Primary Tumor and EOD Mets.
Regarding the second question, if separate tumor nodules are noted, you cannot assume that they are due to tumor. Further information, or clarification, is needed on whether the separate tumor nodules are related to the lung cancer. Without further information, code EOD Primary Tumor to 999.
There is also some information in the CAnswer Forum since Separate Tumor Nodules are a Site-Specific Data Item: http://cancerbulletin.facs.org/forums/forum/site-specific-data-items-grade-2018/96061-lung-separate-tumor-nodules
MP/H Rules/Histology--Thyroid: How would the histology "micropapillary carcinoma" of the thyroid be coded for cases dx'd 2007 and after?
For cases diagnosed 2007 or later, assign code 8260/3 [Papillary adenocarcinoma] according to rule H14.
For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult, usually less than 1 cm. in diameter.
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