EOD-Size of Primary Tumor: Should a 2.0 cm ulcerated mass be coded to 020 or 999 for tumor size? See discussion.
With regard to tumor size, how would SEER interpret "2.0 cm ulcerated mass"? Should this be interpreted as an ulcer, or is it a gross description of the appearance of a mass and therefore acceptable to code tumor size to it?
For cases diagnosed 1998-2003:
If this ulcerated mass is pathologically confirmed to be malignant, code the EOD-Size of Primary Tumor field to 020 [2.0 cm] based on the size of this mass in the absence of a more precise tumor size description.
EOD/Summary Stage--Eye: How is stage coded for a patient with extranodal non-Hodgkin lymphoma involving bilateral choroids (single focus, both sites) and no lymph node involvement? Since the eyes are a paired site, is this two separate extranodal sites? If so, there are no Summary Stage or EOD tumor codes that best fit this scenario.
Assign as Stage IV as recommended by our expert hematological oncologist. This is a rare occurrence and this type of presentation does not fit the definition of intraocular extension. Stage IV is probably the best stage for this type of presentation, since there are two extranodal organs involved, even though they involve a bilateral site.
Extent of Disease/EOD Regional Nodes--Small Intestine: For an ileal/jejunal neuroendocrine primary, how should mesenteric soft tissue deposits (less than 2 cm) be collected in Extent of Disease (EOD) Staging? See Discussion.
Example: Patient is diagnosed with grade 1 well-differentiated neuroendocrine tumor of the ileum, confirmed on ileocolic resection in 2023. The final diagnosis is a 2.8 cm ileal mass, with focal lymph-vascular invasion and a single 0.6 cm tumor deposit within mesenteric fat; primary tumor completely resected with widely negative margins and 10 regional nodes negative for malignancy.
According to AJCC, mesenteric masses less than 2 cm should be stated in the pathology report as being present and collected by registrars but do not affect stage. EOD Regional Nodes has a code for large mesenteric masses greater than 2 cm only. How should we record these smaller tumor deposits if they are not supposed to affect stage?
Do not code 500 for involvement of the mesentery unless the mesentery is specifically stated to be involved (and we don't have that information). We need more information on this case to assign EOD primary tumor.
First course of treatment--Immunotherapy: Should Rituxan be coded to immunotherapy? See discussion.
Is the instruction under #4.b. on page 114 of the 2014 SEER Program Coding and Staging Manual incorrect? It says to code Rituxan as chemotherapy.
Rituxan changed categories from chemotherapy to a biologic therapy/Immunotherapy agent effective with cases diagnosed January 1, 2013. See page 150 or page 164 in the 2015 SEER manual. The instruction in the 2014 SEER manual was incorrect regarding Rituxan.
First Course of Treatment/Hormone Therapy--Breast: Is hormone therapy (HT) prescribed for invasive ductal carcinoma of the right breast coded as treatment for lobular carcinoma in situ (LCIS) of the left breast even though the treatment plan for the LCIS was documented as surveillance? See Discussion.
Patient is diagnosed with invasive ductal carcinoma (IDC), right breast, receives HT, radiation therapy, and surgery. The same patient is diagnosed with LCIS, left breast one month later--recommend surveillance only (no surgery). Is the HT for the left breast coded at all? I think for COC/NCCN, we do not, but for SEER what would I do? Treatment in the SEER Manual 2018 states, "Code the treatment on each abstract when a patient has multiple primaries and the treatment given for one primary also affects/treats another primary." The example include bladder/prostate and ovarian/cervix. It also states, "Code the treatments only for the site that is affected when a patient has multiple primaries and the treatment affects only one of the primaries." The example includes colon/tonsil. Breast LCIS treatment appears complicated. Per NCCN guidelines, this condition no longer has recommendations, however it appears as though they still state that if a core biopsy is done and is LCIS, follow up should be ultrasound or surgical excision. Nowhere does it state hormone is recommended.
Do not code the hormone treatment for the LCIS since it was clearly documented that the hormone treatment was given for the IDC and the treatment for the LCIS was documented as "surveillance." Use text fields to record the details on both abstracts.
First course of treatment/Other therapy--How do you code medical marijuana when given as "treatment?" See Discussion.
The patient has gastric cancer and the physician prescribed medical marijuana as treatment. SEER*Rx says marijuana is ancillary as a psychoactive cannabinoid and antiemetic and advises not to code it. The physician specifically wrote "treatment with" in the record. Should it be coded as Other (Code 1) under Other Therapy?
Do not code as treatment. Enter the information regarding the use of marijuana in a text field. There have been some early clinical trials of cannabinoids in treating cancer in humans and more studies are planned. While the studies so far have shown that cannabinoids can be safe in treating cancer, they do not show that they help control or cure the disease. At this time, marijuana is used to treat side-effects (such as nausea, vomiting, and pain) and to help increase appetite which helps patients tolerate standard therapies.
First Course of Treatment/Other Therapy: Where do you code Optune TTF therapy? What needs to be included in the text portion to document this treatment?
If OPTUNE was administered for recurrence, be sure NOT to record it in the first course of treatment fields. Check with CoC if you have questions about coding treatment for recurrence.
First course of treatment/Radiation therapy--Kidney: Patient has a CT-guided biopsy of a right renal mass with procedure details under the Interventional Radiology Procedure Note stating "Gelfoam tract embolization." Is this particular embolization treatment?
Gelfoam tract embolization for a CT-guided renal biopsy is not treatment. It is a method to plug the biopsy track to reduce the risk of hemorrhage.
First Course of Treatment/Surgery of Primary Site--Corpus uteri: Do you code total hysterectomy or radical hysterectomy when a specimen indicates the uterus, cervix, ovaries, fallopian tubes, and right and left parametrium were resected, but shows no portion of the vagina. See Discussion.
AFS1-AFS2-frozen section control, endomyometrium; AFS3-frozen section control, subserosal intramural mass; A4-anterior cervix; A5-posterior cervix; A6-anterior cervical endometrial junction; A7-posterior cervical endometrial junction; A8-A10-anterior endomyometrium, including tumor; A11-A13-posterior endomyometrium, including tumor and adjacent mass; A14-random section subserosal mass; A15-left parametrium at margin of resection; A16-right parametrium at margin of resection; A17-A18-left ovary and fallopian tube; A19-A20-right ovary and fallopian tube. The final diagnosis includes Endometrial adenocarcinoma, favor serous carcinoma, with papillary and solid areas. Tumor involves: Cervix present, Right ovary, Left ovary, Right fallopian tube, Left fallopian tube, Right parametrium, Left parametrium.
Assign code 50 for total hysterectomy. According to Appendix C Surgery Codes for Corpus Uteri of the 2016 SEER Coding and Staging Manual, total hysterectomy is surgery to remove the entire uterus, including the cervix; whereas, radical hysterectomy includes the vagina.
First Course of Treatment/Surgery of Primary Site--Melanoma: How do you code UVB therapy treatment for melanoma?
Code UVB therapy for melanoma as photodynamic therapy under Surgery of Primary Site for skin. Assign code 11 [Photodynamic therapy (PDT)] if there is no pathology specimen. Assign code 21 [Photodynamic therapy (PDT)] if there is a pathology specimen. Use text fields to document details.
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