Primary Site--Breast: If a patient has multifocal tumors all in the upper outer quadrant of the breast, is the primary site coded to C-504 because all of the tumors are in UOQ or would the site be coded to C509 to reflect the fact that multiple tumors exist?
Code the primary site to C504 [Upper outer quadrant]. All disease is located in one quadrant, code that quadrant. When disease involves two or more quadrants and the point of origin cannot be determined, code C509 [Breast, NOS]. See 2004 SEER manual, page C-470 for instructions about invasive and in situ in different quadrants.
Primary Site--Breast: Is there a hierarchy for coding subsite for breast cases when there is conflicting information in the physical exam, mammogram, operative and pathology reports as to the exact location of the primary? See discussion.
Example: Two mammograms were performed. One report indicates the lesion is at 12:00 and the other indicates it is in the upper central quadrant. However, the pathology report from the modified radical mastectomy specimen indicates the mass is in the UIQ.
According to one of our physicians, when a pathologist has a mastectomy specimen with attached axillary contents, the location of the lesion (subsite) is very accurate.
Code the Primary Site field to C50.2 [upper inner quadrant]. In general, the priority for using information is pathologic, operative, and clinical findings. The pathology report would take precedence in this case.
The 2004 SEER Program Code manual will include the following instructions for determining breast subsite.
Priority Order for Coding Subsites
Use the information from reports in the following priority order to code a subsite when the medical record contains conflicting information:
1 Pathology report
2 Operative report
3 Physical examination
4 Mammogram, ultrasound
If the pathology proves invasive tumor in one subsite and insitu tumor in all other involved subsites, code to the subsite involved with invasive tumor.
Primary Site--Breast: What subsite code should be used for a diagnosis of "inflammatory carcinoma"?
Code the Primary Site field to C50.9 [Breast, NOS] for a breast primary presenting with inflammatory cancer unless there is a palpable mass within the breast. If there is a palpable mass, code the primary site to the position of the mass.
Primary Site--Breast: What subsite is to be coded for a case of invasive Paget disease of the nipple with an infiltrating ductal carcinoma of the lower inner quadrant?
Code C50.9 [Breast, NOS]. Code the last digit of the primary site to '9' for single primaries when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined. Nipple [C50.0] and LIQ [C50.3] fit this rule. This is a single primary per MP/H Breast Rule M9.
Primary Site--Esophagus: What is the difference between C15.5 [Lower third of esophagus] and C15.2 [Abdominal esophagus]?
These descriptions represent the use of two different ways the esophagus can be divided anatomically. The two different systems used are illustrated in the SEER Self Instruction Manual for Tumor Registrars: Book 4. Assign the primary site code that describes the location of the tumor in the same way the tumor's location is described in the medical record.
Primary Site--Head & Neck (Middle ear): How do you code site for a skull based tumor consistent with a low grade papillary adenocarcinoma of "endolymphatic sac origin"?
Code Primary Site to C30.1 [Middle ear]. The endolymphatic sac is part of the inner ear labyrinth located with in the petrous portion of the temporal bone.
Primary Site--Head & Neck: What is the anatomical distinction among tonsillar fossa, tonsillar pillar, and tonsil NOS?
Operative findings describe a right tonsil three times the size of the left tonsil. Tonsil is dissected from the tonsillar fossa. There appeared to be no involvement of tumor below the tonsillar capsule.
The tonsil lies in an indentation called the tonsillar fossa. The tonsillar fossa is bordered on either side by the tonsillar pillars. The tonsillar pillars are part of the supporting structure of the throat opening.
Code C09.9 [Tonsil NOS] as the primary site for the case above.
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