Report | Question ID | Question | Discussion | Answer | Year |
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20051007 | CS Tumor Size--Breast: How is this field coded for a 1.5 cm clinically palpable tumor that appeared to be a cyst with a papilloma when the partial mastectomy Path Micro stated the lesion was an "intraductal papilloma with focal noninvasive papillary carcinoma"? See Discussion. | Should the size be coded to 999 [unknown] because the noninvasive papillary carcinoma is described only as "focal" and is not measured and it is not known how much of the tumor is benign and how much is in situ. Or would the size be coded to the size of the palpable mass, 1.5 cm? | 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 999 [unknown]. Size of the focal noninvasive papillary carcinoma is not stated. |
2005 |
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20061039 | CS Tumor Size/CS Site Specific Factor--Breast: Should the tumor size be coded to 1.5 cm or 2.5 cm and SSF6 coded to 020 or 030 respectively for a tumor with invasive and in situ components described as being a 2.5 cm tumor with a "greater than" 1.5 cm invasive portion? See Discussion. | Should tumor size be coded to 1.5 cm and SSF6 coded to 020 [Invasive and in situ components present, size of invasive component stated and coded in CS Tumor Size] or should the tumor size be 2.5 cm with SSF6 coded to 030 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated and in situ described as minimal (less than 25%)]? | 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 992 [stated as greater than 1 cm] and SSF6 code 020. The September 2006 revision to the CS Tumor Size table now lists the 992-995 range codes as "greater than ___ cm." It is better to code the invasive size than the entire size of the tumor. In the TNM mapping, this would more accurately portray the tumor as T1c rather than T2. |
2006 |
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20081090 | MP/H Rules: Does the presence of metastases affect the application of the MP/H rules? See Discussion. | Single lung tumors presenting in each lung but the patient also presents with bone mets? Would rule M6 apply? Or do the bone mets represent additional tumors? | For cases diagnosed 2007 or later, the MP/H rules do not apply to metastases. Ignore metastases when applying the rules. For the case above, use rule M6 and abstract as two primaries (right lung and left lung). The bone mets are ignored. |
2008 |
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20071051 | MP/H Rules/Multiple Primaries--Lung: Please clarify the multiple primary rule M6 and the explanatory note that states when there is a single tumor in each lung, they are to be reported as multiple primaries unless stated or proven to be metastasis. See Discussion. | Single tumor in left lung, single tumor in right lung. The rules take you to M6. Suppose the tumor in left lung is biopsied and there is a physician statement that right lung tumor is metastatic from left lung tumor. The note under M6 is "When there is a single tumor in each lung, abstract as multiple primaries unless stated or proven to be metastatic." In this case, is it a single primary or multiple primaries? | For cases diagnosed 2007 or later: When there is a single tumor in one lung and a single tumor in the other lung, apply rule M6 and abstract as multiple primaries. Use this rule whenever there is a single tumor in each lung, even when neither tumor is biopsied or resected.
This rule is unique to lung. Our physician advisors emphasized that it is very unlikely that a single tumor in one lung could be metastatic from a single tumor in the opposite lung. Therefore, the default is to abstract as multiple primaries.
The note at M6 means that there must be proof that one tumor is metastatic in order to abstract as a single primary. For example, a biopsy of the tumor proving that it is metastatic. An opinion or belief that one tumor is metastatic is not sufficient. In the absence of proof, use rule M6 and abstract as multiple primaries.
A list of MP/H clarifications will be available. This issue will be included on the list. |
2007 |
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20031145 | EOD-Extension--Head & Neck: Is this field coded 10 [Invasive tumor confined to one of the following subsites: interior wall, one lateral wall, posterior wall] or 30 [Localized, NOS] for tonsillar primary when there is no mention of involvement of surrounding structures? See Description. | Site is stated to be "left tonsil" and was coded to site C099. "The lesion is admixed in tonsillar tissue." No surrounding structures are stated to be involved. Is it logical to assume that since code C099 includes the palantine tonsils and the palatine tonsils are on the lateral wall and since no other areas are stated to be involved that extension code 10 [confined to one lateral wall] would be more appropriate than code 30 [localized NOS]? | For cases diagnosed 1998-2003: Code EOD-extension for the case example to 10 [Invasive tumor confined to one of the following subsites: anterior wall, one lateral wall, posterior wall]. The tonsil lies in a pocket on the wall (tonsillar fossa), so you know it is confined to the wall. | 2003 |
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20041104 | Histology (Pre-2007)--Bladder: What is the correct histology code for this tumor of the bladder? See Discussion. | TURBT was performed with invasive residual tumor remaining - path report reads "Mixed carcinoma of the urinary bladder, with components of invasive high grade urothelial carcinoma, invading deep muscle, and small cell carcinoma." | For tumors diagnosed prior to 2007:
Code combined small cell carcinoma [8045]. This mixed carcinoma is both urothelial and small cell. It is important to capture the small cell information in the code because the prognosis for small cell is different from pure urothelial 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. |
2004 |
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20021077 | Histology (Pre-2007)/Primary Site/EOD-Extension--All Sites: How do you code these fields for a resected thyroid that is negative for any diagnostic abnormality and a left ovary that demonstrates "papillary thyroid carcinoma arising in a cystic teratoma"? See discussion. | Teratomas occurring in the ovaries frequently contain various types of fully differentiated tissue that normally occur in other body parts. Should the primary be coded to the ovary or to the organ in which that type of tissue normally occurs? | For tumors diagnosed prior to 2007:
Code the Primary Site field to the organ in which the cancer arose. For this tumor, code the Primary Site field to C56.9 [ovary] and Histology to 8260/3 [papillary carcinoma of thyroid]. Use the ovary EOD for tumors diagnosed 1998-2003.
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. |
2002 |
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20061046 | First Course Treatment--Hematopoietic, NOS: How are Decadron and Zometa coded when used in the treatment of multiple myeloma? See Discussion. | The 2004 SEER Program Manual instructions for coding hormone therapy do not provide any specific instructions for coding adrenocorticotrophic agents. Per Abstracting and Coding Guide for the Hematopoietic Diseases pg. 3, prednisone and decadron are coded as hormonal therapy (when given as part of a chemotherapy regimen). Does this mean that Decadron without chemo agents is not coded as treatment? In paging through the hematopoietic disease manual, one sees this instruction for other sites as well. Yet, for other diseases (e.g., Waldenstroms macroglobulinemia on page 18), prednisone is coded as hormone therapy (not necessarily as part of chemo regimen). | Code the decadron as hormonal treatment. Do not code the zometa--it is an ancillary agent. In the August 2006 update of SEER*Rx, a note was added to decadron and other hormonal agents that they can be used to control white cell proliferation in lymphoma and multiple myeloma. In general, decadron is used more commonly for supportive care and as an antiemetic than as hormone therapy. |
2006 |
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20091095 | CS Site Specific Factor--Prostate: Please clarify how SEER registries should use code 040 for Site-Specific Factor 3 on prostate cases. See Discussion. | The 6/11/09 NAACCR Webinar on prostate cancer pointed out that SSF 3 code 040 refers the registrar to Note 4, which states "when the apical, distal urethral, bladder base, or bladder neck margins are involved and there is no extracapsular extension, use code 040." The webinar went on to say that code 040 ONLY applies to these specific margins, and that if other margins are involved (for example, the 'right lateral margin'), we should not use code 040. Is this consistent with SEER's interpretation of Note 4? Are we to ignore involvement of margins other than those specified in Note 4, and consequently code SSF 3 within the 000-032 range? Would this also apply to code 048 (extracapsular extension and margins involved)? | Yes, SEER agrees. Code SSF3, code 040 per page C-740 of 2007 SEER manual exactly as stated in Note 4. According to the Inquiry and Response System of the CoC, Note 4 lists specific margins that were once thought to have a prognostic impact. Code 040 in SSF3 should be used only when those margins are involved.
Note 4 pertains to code 040, not to code 048. |
2009 |
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20010022 | Grade, Differentiation--Bladder: Some pathologists use a two component grade system for bladder carcinomas - either low grade or high grade. Should we continue to code these per SEER rules as grades 2 [low grade] and 4 [high grade]? See discussion. | The AFIP website states that this low grade classification corresponds to grade 1/3, while the high grade corresponds to both grade 2/3 and grade 3/3. Using the 3-grade conversion, this would also classify the low grade as grade 2, but would leave the high grade as a toss-up between grade 3 and grade 4. | Continue to code Grade, Differentiation as specified in the SEER Program Code Manual: "Low grade" is coded to 2 and "high grade" is coded to 4. | 2001 |