Multiple Primaries (Pre-2007)--Bladder: Should an invasive malignancy following an in situ malignancy by more than two months be a new primary? Why? See discussion.
Example: An in situ bladder case was diagnosed and treated. Three months later another TURB diagnosed an invasive bladder carcinoma. Is the invasive case reportable to SEER as a new primary?
For tumors diagnosed prior to 2007:
Yes. These are two primaries.
In situ cancers are not included in SEER incidence rates. Incidence rates must correlate with mortality rates.
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-Extension--Lymphoma: Would a lymphoma involving mesenteric and retroperitoneal nodes (both site code C77.2) be coded to extension 10 [Involvement of a single lymph node region; Stage I], based on the fact that while more than one "chain" is involved only one "region" is involved?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 20 [Involvement of two or more lymph node regions on the same side of diaphram]. The AJCC lists mesenteric as a core nodal region, but does not list retroperitoneal lymph nodes as a part of this region, so retroperitoneal is a separate region.
The EOD staging scheme for lymphoma uses lymph node REGIONS as the criteria for assigning the extension code. Use the AJCC Cancer Staging Manual as the definitive source for classifying lymph node regions, not the ICD-O-3. If it is a separate LN region per the AJCC, it is coded in the EOD as a separate region.
According to the AJCC curator, the nodal regions are defined in Kaplan's book on Hodgkin disease. Bilateral cervical, or axillary, or hilar, or pelvic, or inguinal nodes count as two regions. Mediastinal and para-aortic lymph nodes count as one region regardless of laterality as they are centrally located. A large mediastinal mass constitutes one region involved regardless of the size.
EOD-Extension--Pancreas: How do you code extension when CT scan shows a mass in the head of the pancreas "encompassing" the hepatic branch of the celiac artery? See discussion.
We do not code the term "encompasses" as involvement. However, should we code this case as extension to the peripancreatic tissue, NOS or as unknown?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [Extension to peripancreatic tissue, NOS]. There has to be extension to peripancreatic tissue if the mass encompasses the celiac artery.
Scope of Regional Lymph Node Surgery/EOD-Number of Regional Nodes Examined: What codes is used to represent these fields when the surgeon states that a "lymph node dissection" was done, but no nodes are identified in the pathology report?
For cases diagnosed 1/1/2003 and after: Code the Scope of Regional Lymph Node Surgery field to 3 [Number of regional lymph nodes removed unknown or not stated; regional lymph nodes removed, NOS] and code the EOD-Number of Regional Nodes Examined field to 00 [No nodes examined].
The surgery fields reflect the procedures the physician performed. The EOD fields reflect the results of those procedures.
Histology (Pre-2007): What code is used to represent the histology "adenocarcinoma with abundant mucin production"? See discussion.
If the diagnosis is adenocarcinoma with a mucinous focus, we code as 8140/3. However, when there is abundant mucin production, do we use 8480/3?
See SINQ #20010075: "The tumor must contain at least 50% mucinous, mucin producing, or signet ring to be coded to the specific histology. "
For tumors diagnosed prior to 2007:
Code the Histology field to 8481/3 [mucin-producing adenocarcinoma] if the diagnosis states "adenoca with abundant mucin production". Assume that the term "abundant" represents a term that implies > 50% of the tumor is mucin producing.
When a pathologist makes a diagnosis of mucin-producing adenocarcinoma, the pathologist has determined that more than 50% of the tumor is mucin-producing, so it is unnecessary for the abstractor/coder to look for additional supporting documentation.
If the pathologist states adenocarcinoma "with mucin production," look for a statement about the percentage or amount of mucin production, such as "abundant" or other wording indicating extensive mucin production. If such a statement or wording is present, code 8481/3 [mucin-producing adenocarcinoma]. If not present, code 8140/3 [adenocarcinoma, NOS].
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.
Scope of Regional Lymph Node Surgery/EOD-Lymph Node fields: How do you code these fields if a pt has multiple lymph nodes surgeries at different times? See discussion.
Example: 1/01/03 Biopsy of 1 sentinel lymph node: positive for metastasis. 1/10/03 Modified radical mastectomy and axillary lymph node dissection: ductal carcinoma with 8 neg lymph nodes.
For cases diagnosed 1/1/2003 and later: Code Scope of Reg LN Surgery to 7. Code EOD Lymph Nodes field to 6. Code EOD Pathologic Number of Reg LN Positive and Examined fields to 01 and 09 respectively.
For the Scope of Reg LN Surgery use the highest applicable code number if more than one Scope of Reg LN Surgery was performed. The EOD lymph node fields are cumulative and count all lymph nodes removed during the diagnostic and first course treatment procedures.
All Surgical Fields/Radiation Sequence with Surgery--Unknown Primaries: What codes are used to represent these fields for an unknown primary treated with a radical neck dissection followed by radiation therapy?
For unknown primaries treated with a lymph node dissection and diagnosed 1/1/2003 and after, code:
1) Surgery to Primary Site: 98 [All unknown and ill-defined disease sites, WITH or WITHOUT surgical treatment].
2) Scope of Regional Lymph Node Surgery: 9 [Unknown or not applicable].
3) Surgical Procedure of Other Site: 1 [Surgery to other site(s) or node(s), NOS; unknown if regional or distant].
4) Radiation Sequence with Surgery: 3 [Radiation after surgery]. Any planned surgical treatment is used to code radiation/surgery sequence (per CoC I&R).
EOD-Size of Primary Tumor: How do you code tumor size for lesions described as "at least 2 cm"? See discussion.
The expression "at least 2 cm" seems to be different from "greater than 2 cm." Stating "at least" seems to indicate that if the tumor is larger than 2 cm, it is difficult to ascertain the exact tumor size. Should we accept 2 cm as the best info we have, or default to 999 because of the lack of specificity?
For cases diagnosed between 1998-2003:
Code the EOD-Size of Primary Tumor field to 020 [2 cm], using the rule "code what you know."
Histology (Pre-2007)--Breast: What code is used to represent the histology of "invasive ductal carcinoma and in situ ductal carcinoma, cribriform type"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8500/3 [ductal carcinoma] unless the combination is ductal and lobular.
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.
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