EOD/Surgery of Primary Site--Melanoma: If a melanoma primary site is other than skin, vulva, penis, or scrotum should these fields be coded using melanoma schemes? See discussion.
Should a melanoma of the cervix be coded using the melanoma or the cervix schemes for these fields?
For cases diagnosed 1998-2003: Use the EOD and surgery code schemes for cervix uteri. The EOD scheme for melanoma excludes melanoma of the cervix uteri. The surgery code scheme for skin excludes cervix uteri.
EOD-Lymph Nodes--Lung: Are positive "neck nodes" coded to 7 [Distant lymph nodes, other than above (including cervical lymph nodes)] in this field because we do not have a specific lymph node chain named or are they coded to 6 [Contra lateral hilar or mediastinal (incl. bilateral); supraclavicular (transverse cervical), ipsilateral or contralateral; scalene, ipsilateral or contralateral] because this code represents the lowest possible code for involved neck nodes?
For cases diagnosed 1998-2003: Code EOD-Lymph Nodes as 7 [Distant lymph nodes, other than above (incl. cervical neck nodes)]. Lymph nodes in the "neck" are distant, rather than regional, for lung.
EOD-Lymph Nodes--Breast: Are micrometastases in the lymph nodes, found only on immunohistochemical staining, coded as positive lymph nodes?
For cases diagnosed 1998-2003: Do not code as positive lymph nodes that have micrometastases diagnosed ONLY on immunohistochemistry. By traditional diagnostic methods, these are still negative lymph nodes.
Summary Stage and EOD ignore the IHC positive micrometastases for cases diagnosed through 2003. The collaborative staging system that begins with 2004 cases and is based on the sixth edition of TNM addresses this issue.
Multiple Primaries (Pre-2007)--Kidney/Bladder/Renal Pelvis: Would transitional cell carcinoma of the left renal pelvis, diagnosed two years after a diagnosis of invasive bladder cancer, be a second primary when the discharge is "recurrent transitional cell carcinoma, left kidney"?
For tumors diagnosed prior to 2007:
This is an example of the term "recurrent" being used loosely to refer to another primary in the urinary tract. It is highly unlikely that a bladder tumor would metastasize to the kidney. Much more likely is the field defect or regional breakdown of the urothelial tissue that lines the tract from the renal pelvis to the urethra. Furthermore, bladder tumors don't spread retrograde to the kidney. Code as two primaries.
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.
Reportability/Behavior Code--Melanoma: If a dermatologist states a "proliferation of atypical melanocytes confined to epidermis" is melanoma in situ, is it reportable to SEER?
For this case only, it is reportable to SEER because the physician states that it is "melanoma in situ."
The phrase "proliferation of atypical melanocytes confined to epidermis" alone is not reportable to SEER. This phrase means that there are a number of (proliferation) pigmented cells (melanocytes) not showing the normal cell structure (atypical).
CS Site Specific Factor 4--Prostate: If PAP is not mentioned in the chart, should Site Specific Factor 4 be coded to 999 [unknown or no information] or 000 [test not done]?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.For tumors diagnosed 2004 only:
Code the CS Site Specific Factor 4 to 999 [Unknown or no information; Not documented in patient record]. If there is no report of a lab test in the health record, code as 999.
Code this field to 000 [Test not done] when there is a statement in the record that a test was not performed.
Tumors diagnosed 1/1/2005 forward no longer have PAP coded in the Site Specific Factor 4 field.
Multiple Primaries (Pre-2007)--Colon: What is the number of primaries for a case of familial polyposis with at least three separate tumors having invasive adenocarcinoma, one in the rectum? See Discussion.
A patient had a total proctocolectomy and was found to have familial polyposis. At least 3 separate tumors were identified with invasive adenocarcinoma, one of which was in the rectum. Is this 2 primaries: C18.9 with 8220/3 and C20.9 with 8140/3 or is this all one primary cancer?
For tumors diagnosed prior to 2007:
Familial polyposis is always a single primary. Code the primary site for the case example above to C199 [colon and rectum].
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.
CS Tumor Size/CS Extension/CS TS/Ext-Eval--Breast: How do you code these fields when the tumor size and extension differ pre and post treatment with neoadjuvant Arimidex? See Discussion.
Clinically on PE 3 cm mass attached to skin with dimpling and erythema overlying the mass. Ultrasound: 2-3 cm breast mass with overlying skin thickened by US evaluation, suggesting dermal invasion. Neoadjuvant Arimidex followed by MRM. Path: 4.5 cm ductal carcinoma (no DCIS), no invasion of skin.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Record the larger tumor size and the farthest extension documented.
Code CS Tumor Size/Extension Evaluation to 6 [Surgical resection performed, WITH pre-surgical systemic treatment...; tumor size/extension based on pathologic evidence].
Code CS Tumor Size for the example to 045 [4.5 cm].
Code CS Extension to 20 [Local skin involvement ...] based on clinical description provided.
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