Summary Stage 2018/Extension--Colon: Are colon primaries coded as local or regional (direct extension) on Summary Stage based on invasion into the pericolorectal tissues? For example, is a case with an ascending colon tumor that extends into the pericolorectal tissues, pT3, local or regional by direct extension?
Code as Localized using the SEER Summary Stage Manual, Colon and Rectum, Note 6.
Localized is for subsites that are not peritonealized, including the posterior side of the ascending colon, or when the pathologist does not further describe the "pericolic/perirectal tissues" as either "non-peritonealized pericolic/perirectal tissues" vs "peritonealized pericolic/perirectal tissues" fat and the gross description does not describe the tumor relation to the serosa/peritoneal surface, and it cannot be determined whether the tumor arises in a peritonealized portion of the colon.
Refer to the coding instructions in both EOD and Summary Stage for a list of sites that are nonperitonealized or peritonealized.
Multiplicity Counter--Breast: How should the multiplicity counter be coded for a 3.8 cm infiltrating duct carcinoma with two "satellite nodules" measuring 5 mm and 7mm that are not described as either metastases or multiple foci?
Include these nodules in the multiplicity counter because they are measured and are part of the final diagnosis on the pathology report.
Surgery of Primary Site--Bladder: Do we code "random bladder biopsies" as an excisional biopsy (27) or as no cancer directed surgery (00) even if the only involvement mentioned on the pathology reports is "focal carcinoma in situ"?
Code the Surgery of Primary Site field to 00 [None; no surgery of primary site] when only random biopsy procedures are performed on the bladder.
Grade, Differentiation--Lymphoma: What code is used to represent this field when the only grade/differentiation given is "low grade", "intermediate grade" or "high grade"?
Code the Grade, Differentiation field to 9 [cell type not determined, not stated or not applicable]. For lymphomas, do not code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field. These terms refer to categories in the Working Formulation and not to histologic grade for lymphoma histologies.
Generally, for histologies other than Non-Hodgkin lymphoma, the Grade, Differentiation field is coded to 2 [low grade], 3 [intermediate grade] and 4 [high grade] for most cancers.
MP/H Rules--Colon: What histology would you assign to a single tumor with the histology 'well differentiated mucinous cystadenocarcinoma in a villous adenoma confined to the appendix'? Does rule H4 apply to this diagnosis or should we continue on in the rules to H14 and code the higher histology?
For cases diagnosed 2007 or later, use rule H4.
Stop at the first rule that applies to the case. Rule H4 is the first rule that applies.
The polyp rule, H4, comes before many of the other colon rules because it is important to know that the malignancy originated in a polyp.
Reportability/Histology--Stomach: According to the AJCC manual, histology codes 8240 and 8249 are excluded from site code C160. Does that mean that I cannot use either of these histology codes with C160 even if the pathologist's diagnosis is neuroendocrine carcinoma?
Please understand that AJCC sets the standards for TNM Staging and the Cancer PathCHART (CPC) initiative sets standards for the validity of site and morphology combinations. The statement in the AJCC manual “8240 and 8249 are excluded for topography code C160” means that these two histologies are not staged using the AJCC Staging System. As with numerous other reportable entities that are not staged by AJCC, the case is reportable and a Summary Stage should be assigned. Combinations of C160 with 8240 or 8249 are valid site/histology combinations for registry reporting and should not be discouraged from use if they correspond to the pathologist’s diagnosis. This goes for any other similar note in the AJCC manual. All CPC standards are enforced via the Primary Site, Morphology-Type, Beh ICDO3, 2024 (SEER) N7040 and Histologic Type ICDO3, Primary Site, Date of Diagnosis (NAACCR) N4911 data quality edits. Registrars can also look up the validity of site and morphology combinations using the CPC*Search tool: https://seer.cancer.gov/cancerpathchart/search/tool/.
It is important to remember the following.
ALWAYS code the tumor histology stated by the pathologist/physician
NEVER change the tumor histology to assign TNM
Not all tumors or histologies can be staged per TNM
Cases that cannot be assigned TNM are assigned a summary stage
Update to Current Manual/Neoadjuvant Treatment: What codes should be used for Neoadjuvant Therapy--Clinical Response and Neoadjuvant Therapy--Treatment Effect when the neoadjuvant therapy is still in progress at the time the case is initially abstracted as with rapid reporting. There is no code for neoadjuvant therapy still in progress and code 9 generates an edit for Neoadjuvant Therapy--Clinical Response.
Assign code 8 for Neoadjuvant Therapy--Clinical Response and assign a code 9 for Neoadjuvant Therapy--Treatment Effect when the treatment is still in progress. Revise these codes after the treatment has been completed.
We will update the manual to include these instructions.
Histology--Pancreas: What is the correct code for "non-secretory pancreatic endocrine tumor" with positive lymph nodes on excision indicating a malignant tumor? Pathologist indicated it was not an exocrine tumor.
Code as islet cell carcinoma [8150/3].
There are several cell types in the islets, and each produces a different hormone. The custom has been to name the tumors by their hormone production e.g. insulinoma, glucagonoma, etc. Occasional tumors do not produce any hormone (at least one that can be determined or measured). These tumors are called non-functioning endocrine tumors. Most of the endocrine tumors in the pancreas are islet cell tumors.
Date of Diagnosis: How do you code this field when the pathologic confirmation is delayed for 2 months because the clinician decides to "watch and see what happens" to a CT identified mass thought to be either a "metastasis from a previously diagnosed malignancy or a new primary"?
Code the Date of Diagnosis field to the date of the scan. This is the earliest date that a recognized medical practitioner said the patient had cancer. The diagnosis on the CT scan was a malignancy. The only question was whether the mass on the scan was metastatic or a primary.
MP/H Rules/Histology--Thyroid: Regarding rule H15, is the mixed code 8340 [Papillary carcinoma, follicular variant] used when there are subtypes of these histologies described, such as a tumor diagnosed with follicular and papillary microcarcinoma or should 8341 [Papillary microcarcinoma] be used?
For cases diagnosed 2007 or later:
For coding purposes, this is a papillary and follicular combination that would be coded to the combination code 8340/3 [Papillary carcinoma, follicular variant].
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.
An official website of the United States government
Home