First course treatment--Liver: Is planned therapy second course therapy if it is administered after documented progression of disease? See Discussion.
A patient with hepatocellular carcinoma of the liver is waiting for a planned liver transplant. During the waiting period, a CT showed an increase in the liver nodule. The physician performed a bridging chemoembolization. Later on, the patient received a liver transplant. Is the liver transplant still first course treatment? Is the chemoembolization part of first course therapy? Per the SEER manual, first course therapy ends when the treatment plan is completed.
In this case, neither the chemoembolization nor the liver transplant is part of the first course of therapy. The documented treatment plan was changed after disease progression. Chemoembolization was not part of the original treatment plan. First course therapy ends at this point.
MP/H Rules/Histology--Melanoma: How is histology coded for a "melanoma in situ, lentiginous type," arising in the skin of the lower leg? See Discussion.
In researching this, acral lentiginous melanoma is observed on the palms, soles and under the nails. To code to 8744, do we specifically have to see the word "acral" lentiginous melanoma?
For cases diagnosed 2007 to 2020
Assign 8742/2 [lentigo maligna] to "melanoma in situ, lentiginous type."
Acral lentiginous melanoma is not the same as melanoma, lentiginous type. "Acral lentiginous melanoma," 8744, should be used only if the report states acral lentiginous melanoma or malignant melanoma, acral lentiginous type.
Acral lentiginous melanoma most often occurs on the soles of the feet or the palms of the hands.
MP/H Rules/Histology--Breast: How is histology to be coded for a breast primary described as "tubular carcinoma (well differentiated invasive ductal carcinoma)"? See Discussion.
How are terms that are modified by parentheses to be interpreted? Do terms in parentheses modify the stated diagnosis and thus have priority over the stated diagnosis? Or would rule H17 apply and histology would be coded as duct and other carcinoma? For this case, the wording of the diagnosis and use of parentheses seem to indicate that tubular is a type of ductal carcinoma. Tubular is not listed as a specific duct carcinoma in the MP/H rules histology tables for breast.
For cases diagnosed 2007 or later, code the histology as tubular carcinoma [8211/3]. This is not a case of tubular AND infiltrating duct. The histology is stated to be tubular. Tubular is not a specific type of duct carcinoma.
MP/H Rules/Histology--Ovary: How is histology coded for "serous carcinoma, papillary invasive pattern"?
For cases diagnosed 2007 or later, code the histology 8441/3 [Serous carcinoma, NOS]. Use the Other Sites rules. Start with rule H8 and stop at rule H11. "Pattern" is not one of the terms used to identify a specific type (See H16), so papillary is ignored.
Reportability--Anal canal: Are squamous cell carcinomas arising in a condyloma of the rectum reportable or should we assume that the site is skin of anus or perianal area and not reportable?
Squamous cell carcinoma arising in a rectal condyloma is reportable. Do not assume the site is skin of anus or perianal.
Grade-Breast: How is this field coded for a breast tumor described as "intermediate nuclear grade"? See Discussion.
Guidelines for selecting grade for breast primaries prioritize nuclear grade right after B&R grade. The conversion table displays only numeric values for nuclear grade. How is grade coded for tumors in which nuclear grade is described by terminology? Does it make a difference if the tumor is invasive or in situ?
Example 1: Ductal carcinoma, intermediate nuclear grade.
Example 2: Ductal carcinoma, high nuclear grade.
Example 3: Ductal carcinoma, moderate nuclear grade.
Example 4: DCIS, intermediate nuclear grade.
Use the table on page C-607 of the 2007 SEER manual. The terms "low," "intermediate," and "high" appear in the column labeled "BR Grade." Use this column to determine the appropriate grade code when grade is described using these terms. If the grade of an in situ tumor is described using these terms, use the table to determine the appropriate code for the grade field.
MP/H Rules--Bladder: Should an invasive urothelial carcinoma of the bladder diagnosed in 2004 followed by an in situ urothelial carcinoma of the ureter diagnosed in 2008 be reported as multiple primaries per the three-year guideline in Rule M7 or a single primary per the subsite guideline in Rule M8? See Discussion.
Rule M7 states, "Tumors diagnosed more than three (3) years apart are multiple primaries." Should this rule be modified to say, "Bladder tumors diagnosed more than three (3) years apart are multiple primaries"? Does Rule M7 apply to only bladder tumors or does this rule apply to tumors in any of the urinary sites similarly to Rule M8 which states, "Urothelial tumors in two or more of the following sites are a single primary: Renal pelvis (C659) Ureter (C669) Bladder (C670-C679) Urethra/prostatic urethra (C680)"?
For cases diagnosed 2007 or later, Rule M7 pertains to renal pelvis, ureter, bladder and other urinary sites as defined by the topography codes listed in the header of these rules.
An invasive urothelial bladder tumor followed more than three years later by an in situ TCC of the ureter are reported separate primaries. Rule M8 applies when the tumors in these sites are diagnosed within three years of each other.
Surgery of Primary Site - - Esophagus/Stomach/Colon: Is an endoscopic mucosal resection (EMR) for an esophagus, stomach or colon malignancy coded to 20 [local tumor excision, NOS] or to a more specific code such as 22 [local tumor excision combined with electrocautery]?
Assign code 20 [local tumor excision, NOS] for a procedure described as an esophagus stomach or colon endoscopic mucosal resection (EMR), NOS. If there is additional information specifying electrocautery, laser or PDT (for example), assign a more specific code.
CS Lymph Nodes--Head and Neck: How is this field coded when a positive neck FNA is followed by a neck dissection that contains one of seventeen positive lymph nodes? See Discussion.
The primary site is the right tongue. The patient underwent FNA of a right neck mass that was positive for squamous cell carcinoma. Subsequent right modified radical neck dissection showed one out of seventeen nodes positive for metastatic carcinoma. For head and neck primaries, the CS LN codes 10-19 represent a single positive ipsilateral regional node. Codes 20-29 represent multiple positive ipsilateral nodes.
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.If the neck dissection included the area of the positive FNA, count only the positive nodes from the dissection. Avoid double-counting a positive node for both an FNA and a dissection.
In the unlikely event that the dissection did not include the area of the positive FNA, add one positive node to the count from the dissection.
This instruction supersedes previous instructions.
CS Lymph Nodes--Ovary: Are positive lymph nodes removed from "colon tissue" during a modified posterior pelvic debulking regional or distant? If regional, what is the appropriate CS LN code?
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.Pericolonic lymph nodes are "regional" lymph nodes for an ovarian primary. If you do not have enough information to assign codes 12-30, assign code 50 [Regional lymph nodes, NOS].
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