Radiation: How would this field be coded for treatment with quadramet [radioactive samarium]? See Description.
Paitent is receiving quadramet for treatment of lung metastases.
Code Quadramet in the RX Summ-Radiation field as 3 [Radioisotopes]. Quadramet is a radioisotope used to palliate bone pain. The instructions in the SEER manual state: "Record all radiation that is given, even if it is palliative."
Summary Stage 2000--Colon: How should this field be coded for involvement of "pericolonic fat, NOS" when there is no mention of whether the fat is sub-serosal or supra-serosal? See Description.
In the summary staging manual pericolic fat is listed under regional direct extension with no mention of whether sub-serosal or supra-serosal. According to our report the pathologist must specify whether involvement of pericolonic fat is of subserosal or supraserosal fat. If involvement of pericolonic fat was not specified as such, this should be localized vs regional direct extension.
Code Summary Stage as 2 [Regional by direct extension only].
In Summary Stage 1977 and 2000, pericolic fat is listed under Regional Direct Extension. If there is no indication by the pathologist that the involved fat is subserosal, code as Regional Direct Extension.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: How many primaries are coded and what code(s) is/are used to represent the histology "invasive ductal carcinoma with extensive spindle metaplastic change [metaplastic carcinoma] with a second, separate, tumor "invasive ductal carcinoma, moderately differentiated with extensive associated DCIS"? See Description.
The comment on the pathology report states, "due to the associated DCIS this smaller lesion is felt to most likely represent a synchronous second primary." Is this two primaries, one coded 8575/33 and the other coded 8500/32 or is this a single primary with a combination code -- 8523/33?
For tumors diagnosed prior to 2007:
Abstract as two breast primaries. Code to 8575/33 (metaplastic carcinoma) and 8500/32 (infiltrating duct carcinoma). There are two lesions with different histologic types.
Do not use code 8523 to combine separate tumors with different histologies.
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.
Multiple Primaries (Pre-2007): Is a small bowel carcinoid diagnosed 10 years after the diagnosis of metastatic carcinoid of unknown primary site a new primary or a new recurrence? See Description.
A patient was diagnosed in 1991 with metastatic carcinoid to liver-no primary found. In 2001, the patient is diagnosed with small bowel carcinoid at another hospital. Hospital 2 has no other information.
For tumors diagnosed prior to 2007:
Code as two primaries unless there is a physician's statement that the liver lesion is metastatic from the later small bowel carcinoid. Without such a statement regarding lesions 10 years apart, do not make an assumption that one is metastatic from the other.
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.
Histology (Pre-2007)/Multiple Primaries (Pre-2007)--Breast: How is the histology of invasive small cell carcinoma of lobular histogenesis coded?
Could high grade ductal carcinoma in situ, comedo type be a recurrence of ductal carcinoma diagnosed 18 years earlier?
Is "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" one or two primaries? See Description.
A patient was diagnosed in 1984 with 1st breast primary, histology was ductal carcinoma, T1N0, LIQ left breast. In 2002 a mass was found on mammogram, MRM with axillary sampling performed. Histology was invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type, nuclear grade 3/3, T2N1, UOQ left breast. Is the ductal carcinoma in situ recurrent disease from the 1st primary? Does it go with the lobular histogenesis, i.e., lobular carcinoma and DCIS histology code 8522/3 or is the ductal in situ a 3rd primary?
For tumors diagnosed prior to 2007:
According to our pathologist consultant:
Invasive small cell carcinoma of lobular histogenesis appears to be an unusual histology for a breast primary. Code it as such 8041 [Small cell carcinoma, NOS].
The 2002 lesion is most likely a new primary since the previous lesion was 18 years ago, in a different quadrant, and invasive. A comedo DCIS would probably not be asymtomatic for 18 years; an unlikely "recurrence" of an earlier ducal carcinoma.
Code "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" as two primaries. Code the small cell as a separate primary (8041/3), and the DCIS separately (8501/2).
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.
EOD-Pathologic Extension--Prostate/Lymphoma: How is this field coded for a prostatic lymphoma?
For cases diagnosed 1998-2003: Do not code the prostate pathologic extent of disease field for prostatic lymphoma. Leave the path extension for prostate field blank. Code the extent of disease using the lymphoma scheme. Use ONLY the lymphoma scheme - do NOT try to code both lymphoma and prostate extension fields for prostatic lymphoma.
EOD-Size of Primary Tumor/First Course Treatment--Breast: How is tumor size coded when preventative tamoxifen treatment precedes breast cancer diagnosis? Can we code the tumor size from the surgical specimen? Is tamoxifen treatment here? See Description.
What is the tumor size in this situation? Patient is on the STAR trial (preventative tamoxifen for women with high risk for breast cancer). Patient develops breast cancer and has surgery.
For cases diagnosed 1998-2003: Code EOD-Size of Primary Tumor from the surgical pathology report.
Do not code this preventative tamoxifen as first course cancer-directed treatment. This tamoxifen was part of a clinical trial intending to delay or prevent beast cancer from developing.
Primary Site/Histology (Pre-2007)--Bone: How are these fields coded for a squamous cell carcinoma in bone? See Description.
The consult path report says "I believe that there is definitely high grade malignant tumor in this amputation specimen, and that this tumor represents an invasive squamous cell carcinoma, which is extending into the bone and permeating in between the bone trabeculae. ... The fact that squamous cell carcinoma can arise from the sinuses of chronic osteomyelitis is well recognized."
For tumors diagnosed prior to 2007:
Based on the information provided, code the primary site as C40._ or C41._ [bone] because the tumor originated in the sinuses of chronic osteomyelitis. Code to the site in which the tumor arises. Override the SEER site/histology edits to allow this rare combination of bone and squamous cell 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.
First-Course of Cancer-Directed Therapy Fields/Hematopoietic, NOS: How do you code treatment for a myelodysplastic syndrome when a patient is admitted to receive a "second transfusion 7 months after diagnosis"?
The first course of treatment for these hematopoietic primaries lasts until there is a treatment change. For the case you cite the second transfusion (7 months after diagnosis) would be first course treatment. Code the Other Cancer-Directed Therapy Field to 1 [Other cancer-directed therapy].
EOD-Extension--Lymphoma/Brain and CNS: How is this field coded for a primary brain lymphoma that is described as multi-focal?
For cases diagnosed 1998-2003: Since brain is the only site involved in this example, assign code 11 [Localized involvement of a single extralymphatic organ or site].