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Primary Site--Bladder: Does instruction #4 in the Urinary Sites Solid Tumor Rules Instructions for Coding Primary Site apply to a mix of in situ and invasive urothelial tumors?
Instruction #4: Code Urinary System NOS C689 when there are multiple non-contiguous tumors in multiple organs within the urinary system.
See Discussion.
Example: Patient has multiple biopsies with final diagnosis of in situ papillary urothelial carcinoma in the prostatic urethra and invasive papillary urothelial carcinoma in the bladder.
How should primary site be coded in this type of mixed in situ and invasive situation?
Code Urinary System NOS C689 for this case since there are two separate urinary sites involved. Apply instruction #4 when there is a mix of in situ and invasive urothelial tumors.
Primary site--Bladder: What is the primary site for bladder tumor biopsy: invasive adenocarcinoma, enteric type favor urachal origin, stage III
Based on the information provided, code the primary site to urachus (C677). Primary adenocarcinoma of the bladder accounts for less than 1% of all bladder malignancies. Of these, 20–39% are urachal in origin.
Primary Site--Brain and CNS: Are meninges surrounding cranial nerves cranial meninges [C700] or a part of the specific nerve's sheath? Is the primary site for an optic nerve sheath meningioma coded to optic nerve [C723] or cranial meninges [C700]?
Primary site--Brain and CNS: How is the primary site to be coded if a clinician used an MRI to diagnose a left cerebellar venous angioma? See Discussion.
According to the WHO Classification of Brain/CNS Tumors, code 9122/0 (venous angioma) does not appear under tumors of the cerebellum (C716).
Venous angiomas (9122/0) are not reportable wherever they arise. The primary site for venous angioma arising in the cerebellum is C490. The combination of 9122/0 and C490 is not reportable. Venous angioma is a venous abnormality, currently referred to as a developmental venous anomaly (DVA).
Primary site--Breast: how is subsite coded for a breast cancer when it is described as central portion between 1-3:00 or central portion at 12:00?
See the SEER coding guidelines for breast, https://seer.cancer.gov/manuals/2018/AppendixC/Coding_Guidelines_Breast_2018.pdf Generally, codes C502 - C505 are preferred over C501. C501 would be preferred over C508. Apply these general guidelines when there is no other way to determine the subsite using the available medical documentation.
Table 1, Primary Site codes, in the breast solid tumor rules also provide helpful information for coding site.
Primary site--Breast: Patient was diagnosed with invasive ductal carcinoma of the left breast. Site of mass is 2:00 to 3:00. What is the correct site code, C504 upper outer quadrant (UOQ) or C50.8 (overlapping)?
Primary Site--Cervix Uteri: When no other information is available regarding the origin of the tumor, can an overlapping cervical adenocarcinoma (C538, 8140/3) be coded to the endocervix (C530) based on the histology? See Discussion.
Adenocarcinoma is a glandular tumor and the endocervix is generally the origin of glandular tissue for the cervix. However, if the only available information is pathology proving a single tumor overlapping the endocervix and exocervix, can we code the site to C530 instead of C538?
Applying the current primary site coding instructions, primary site would be coded as C538 because there is no specific statement of the tumor origin; the primary site coding instructions state the tumor is coded to an overlapping site in the absence of a specific statement of origin and there is no existing SINQ confirming the site can be assumed to be the endocervix based on the histology.
Code Primary Site as Overlapping lesion of cervix uteri (C538). The 2023 SEER Program Coding and Staging Manual Primary Site Coding Instructions for Solid Tumors #4 says to code the last digit of the primary site code to ‘8’ when a single tumor overlaps an adjacent subsite(s) of an organ and the point of origin cannot be determined. This is also supported by the ICD-O-3, 3rd edition, note in the Topography section that states: In categories C00 to C809, neoplasms should be assigned to the subcategory that includes the point of origin of the tumor. A tumor that overlaps the boundaries of two or more subcategories and whose point of origin cannot be determined should be classified to subcategory ‘8.”
Primary site--Colon: What is the correct topography code for appendiceal orifice? See Discussion.
From a number of definitions reviewed, it seems unclear if it's part of the appendix or the cecum of the colon. For example: The cecum is usually located in the right iliac fossa. In the pole of the cecum, there is often the appearance of fusion of the three teniae coli around the appendix, giving rise to the tri-radiate fold (Mercedes Benz sign), but the anatomy can be variable. The most reliable landmarks of the cecum are the appendiceal orifice and ileocecal valve. The appendiceal orifice is usually an unimpressive slit, often crescentic in shape. The ileocecal valve is made up of the superior and inferior lips (usually not seen en face) and is the gateway leading into the terminal ileum. It is located on the prominent ileocecal fold encircling the cecum, between 3 and 5 cm distal to the cecal pole. (https://www.sciencedirect.com/science/article/pii/S2212097113701730)
Assign C180, Cecum, when the neoplasm originates in the appendiceal orifice. The appendiceal orifice is a landmark in the cecum. During colonoscopy, visualization of the appendiceal orifice indicates that the entire colon was examined, from the anus to the cecum.
Primary site--Esophagus: How is primary site coded for a tumor arising in a segment of the esophagus that was reconstructed using a segment of the colon? See Discussion.
A patient had a ruptured esophagus 25 years ago and had a segment of colon removed and transplanted to serve as esophagus. In 2007, the patient was diagnosed with carcinoma in a polyp by endoscopic biopsy of the transplanted 'esophagus'. What is the primary site code? Is this the same site schema to be used for Collaborative staging and surgery coding?
Code the primary site esophagus, NOS [C159]. Use the surgery codes and collaborative staging schema for esophagus. Document the unusual nature of this case in text fields.
Primary site--Head & Neck: Are cases with positive cervical lymph nodes that are EBV positive (EBV+) coded to the nasopharynx, and cases with positive cervical lymph nodes that are p16 positive (p16+) coded to the oropharynx, when no primary site is identified? See Discussion.
This question involves positive cervical lymph nodes with an unknown primary site. The SEER Manual says under the coding instructions for Primary Site:
14. b.Use the NOS category for the organ system or the Ill-Defined Sites (C760-C768) if the physician advisor cannot identify a primary site.
Note: Assign C760 for Occult Head and Neck primaries with positive cervical lymph nodes.
Schema Discriminator 1: Occult Head and Neck Lymph Nodes is used to discriminate between these cases and other uses of C760. Does SEER agree with AJCC that cases with positive cervical lymph nodes that are EBV+ should be coded to the nasopharynx and cases with positive cervical lymph nodes that are p16+ should be coded to the oropharynx, if no primary site is identified?
Assign primary site C119 (nasopharynx) for occult head and neck tumors with cervical metastasis in Levels I-VII, and other group lymph nodes that are positive for Epstein "Barr virus (EBV+) (regardless of p16 status) encoded small RNAs (EBER) identified by in situ hybridization.
Assign primary site C109 (oropharynx) for occult head and neck tumors with cervical metastasis in Levels I-VII, and other group lymph nodes, p16 positive with histology consistent with HPV-mediated oropharyngeal carcinoma (OPC).
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