Date of Diagnosis--Bladder: Should the date of diagnosis be based on the 1/7/04 urine cytology with low grade transitional cell carcinoma or the subsequent 1/27/04 pathology findings of papillary transitional cell carcinoma?
In this case, the date of the cytology is the date of diagnosis, 01-07-2004.
CS Lymph Nodes/CS Site Specific Factor--Breast: When there are no lymph nodes removed and none palpable for an inflammatory breast cancer and the physician stages the case Nx, is the CS Lymph Node field code to 00 [None, no regional lymph nodes involved] or 99 [Unknown, not stated] and would SSF 4 and 5 be coded to 000 [Regional lymph nodes negative...] or 888 [Not applicable]?
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.
Code CS Lymph Nodes 00 [clinically negative]. See note 3 for CS Lymph Nodes.
Histology (Pre-2007)--Melanoma: How is histology coded if the final diagnosis is "melanoma" and only in the comment section of the pathology report is there an indication of "Type: Lentigo Maligna. Cell Type: Small Cell"?
For tumors diagnosed prior to 2007:
Code the histology as 8742 [lentigo maligna melanoma]. Code the specific histologic type, even if stated only in the comment section.
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.
Chemotherapy/Immunotherapy: How do we code Rituxan for Non-Hodgkin Lymphoma and Herceptin for breast cancer? See Discussion.
Page 195 of the SEER Manual 2004 lists these as examples of Immunotherapy. The new SEER*Rx categorizes these as chemotherapy.
(Sinq # 20041025 says to code Avastin and Erbitux as chemotherapy, too.)
Code Rituxan and Herceptin as chemotherapy.
SEER*Rx is effective for cases diagnosed 1-1-2005 and forward. It replaces all previous references. Be sure to use SEER*Rx [http://seer.cancer.gov/tools/seerrx/]
because some agents changed categories when SEER*Rx was deployed.
It is neither required nor recommended that cases treated prior to 2005 be recoded.
Date of Diagnosis--Lung: Should the diagnosis date be coded to the date of the scan or the date of the resection when there is a negative biopsy that occurs between the two procedures? See Discussion.
11/2003 CT chest: 2 cm LLL mass should be considered carcinoma until proven otherwise.
2/2004 CT Chest: stable LLL mass still consistent with primary or metastatic lung neoplasm
11/2004 CT chest: LLL mass suspicious for slow growing carcinoma
3/2005 FNA L lung: atypical cells
4/2005 L lobectomy: well-diff adenocarcinoma
Code the date of diagnosis as 11/2003. A clinical diagnosis was made on 11/2003 and this is the earliest date of diagnosis for this case.
CS Lymph Nodes--Breast: Must there be a statement of "moveable" present to code 25 in this field and if a lymph node is not stated to be "fixed" is it presumed to be moveable? Please provide an example in your answer of when to use code 25.
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.
The word "movable" does not have to be used to assign code 25. A "movable" lymph node is an involved lymph node not described as fixed or matted. The general rule is to code the lesser or lower category, which would be the case if neither movability nor fixation is mentioned. See page C-471 of the 2004 SEER Manual.
Code 25 Example: Involved lymph nodes per lymph node dissection. No mention of fixation or matting. Size of largest met within a lymph node is 4mm.
Surgery of Primary Site--Prostate: How is the use of a Laserscope Niagara laser (modulated KTP-YAG laser beam (Niagara 122 prostate vaporization)) coded for prostate primaries? See Discussion.
The Laserscope Niagara laser performs an operation similar to the TURP, but there is virtually no bleeding and patients can sometimes go home the same day, most without a catheter. The laser is delivered through a fiber (the thickness of hair) into the cavity via an endoscope inserted through the urethra.
When performed as part of the first course of therapy, assign surgery code 15 [Laser ablation] to Niagara laser photovaporization of the prostate.
Reportability/Behavior--Colon: Is a final diagnosis of "mucosal carcinoid" of the colon reportable with a behavior code 2 [in situ] or 3 [invasive] if the microscopic description states that a "malignancy is not appreciated"? See Discussion.
2002 carcinoid case. Path final diagnosis: sigmoid colon polyp, bx-- sm mucosal carcinoid (1.5mm) w/crush artifact in a colonic polyp showing assoc inflammatory and hyperplastic changes. Micro: due to prominent crush artifact, histologic detail is compromised; however, significant atypia or malignancy is not appreciated.
Our state registry requests that this case be abstracted using the histology code 8240/3 because it is a mucosal carcinoid.
AJCC states TIS as being confined w/i basement membrane w/no extension through muscularis mucosae into submucosa. SEER-EOD codes as invasive: mucosa, lamina propria and muscularis mucosae. Our pathologist goes along with AJCC while we are having to code with SEER rules.
1) Assign /3 to mucosal carcinoid, unless stated to be in situ in the final diagnosis. ICD-O-3 is the reference for assigning the behavior code, not AJCC, EOD or CS.
2) The ICD-O-3 code for carcinoid of the sigmoid colon is C187 8240/3. This is reportable to SEER based on the final diagnosis above. Use the histology stated in the final diagnosis.
CS Lymph Nodes--Breast: Are small isolated tumor emboli occasionally found in lymph node capsular or pericapsular lymphatics sufficient to code as a lymph node metastasis?
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.
Code "small isolated tumor emboli" in the pericapsular lymphatics detected by H&E that are less than 0.2 mm as 05 [Regional lymph node(s) with ITC's detected on routine H & E stains].
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