Histology (Pre-2007): What code should be assigned to acinar adenocarcinoma and ductal adenocarcinoma?
For tumors diagnosed prior to 2007:
Assign code 8255 [Adenocarcinoma with mixed subtypes]. According to histology rule #4 for a single tumor on page 86 of the 2004 SEER manual, use a combination code if one exists.
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: Should radiosensitizing chemotherapy agents (i.e., drugs typically coded as treatment for cancer) be coded as treatment when they are given in combination with radiation therapy with the intention of enhancing that treatment? See discussion.
Per our consultant, these drugs are given at a lower dose than that typically given to treat cancer patients.
Do not code radiosensitizers and radioprotectants as cancer-directed therapy. Drugs typically classified as chemotherapy agents would be "ancillary drugs" for the purpose of coding cancer-directed therapy because the drugs are given at a much lower dosage than that typically given to treat cancer patients. Per Book 8, ancillary drugs are not to be coded as cancer-directed therapy. Radiosensitizers and radioprotectants do not work directly on the cancer and are not coded under any of the systemic therapy fields.
Date of Diagnosis: If an originally diagnosed "benign" tumor is later discovered to have "metastasized", should the date of diagnosis be back-dated to the date the original tumor was discovered or to the date the metastatic disease was identified?
Code the Date of Diagnosis field to the date the malignancy is diagnosed. If there was a medical or pathologic review of the original benign diagnosis that indicates that the patient had cancer at the earlier time, then the earlier date is coded as the date of diagnosis. If no medical or pathologic review of the original benign diagnosis is done, then code the date of diagnosis to the date the metastasis is discovered.
Histology (Pre-2007): What code is used to represent the histology "non oat cell carcinoma"?
For tumors diagnosed 2001-2006:
Code the Histology field to 8046/3 [non-small cell carcinoma] if the pathologist does not provide a more specific histologic type. "Non oat cell" is a synonym for "non-small cell."
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.
Primary Site: How do we code the primary site for a malignancy that occurs in parenchyma located in an ectopic site? See discussion.
1. Patient presented with a subcutaneous nodule in right axilla. Pathologic impression by initial and reviewing pathologists is that the lesion represents a breast adenocarcinoma arising in ectopic mammary parenchyma. Subsequent breast biopsies were negative.
2. Patient presented with right branchial cleft cyst. The pathologist states the cyst is a primary thyroid adenocarcinoma arising in an ectopic focus of thyroid tissue. The subsequent total thyroidectomy is negative.
Code the primary site to the location of the malignancy.
1. Code the Primary Site field to C76.1 [Axilla NOS].
2. Code the Primary Site field to C10.4 [Branchial cleft].
Grade, Differentiation--Breast: Does SEER agree with our pathologist who contends that "by convention lobular carcinoma is considered to be grade 2"?
No. SEER does not have a default grade code for lobular carcinoma. Code the grade as stated in the pathology report. If no grade is stated, code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable].
Histology (Pre-2007): What code is used to represent a review of slides histology of "in situ squamous cell carcinoma and multiple detached fragments of atypical papillary squamous epithelium; highly suspicious for invasive carcinoma"? See discussion.
The original pathologist indicated a final diagnosis of moderately differentiated squamous cell carcinoma. The slides were sent for review to another facility. The reviewing pathologist rendered the diagnosis stated in the question section.
For tumors diagnosed prior to 2007:
Code the Histology field to 8070 [squamous cell carcinoma].
The review diagnosis was also squamous cell carcinoma. The expression "atypical papillary squamous epithelium" does not modify the cancer histology.
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.
Terminology/EOD-Size of Primary Tumor--Lung: Can the term "opacity" be used to code the size of the primary lung tumor when it is given a size in an imaging study but the "opacity" is not referred to as being suspicious for cancer? See discussion.
Example: How do you code tumor size for a lung primary in which the patient had a CT of the chest that describes a "4 cm opacity in the RUL of the lung." A biopsy of the RUL lung is positive for carcinoma? Would your answer be different if the opacity was described as being "suspicious for carcinoma"?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 999 [Not stated] for the example given above. However, if the opacity was described as a "mass" or as "suspicious for cancer," the size could be coded to 040 [4 cm].
Chemotherapy: How is treatment with Iressa (Gefitinib) coded?
Code treatment with Iressa as chemotherapy.
Iressa is an epidermal growth factor inhibitor. While it doesn't kill cells directly, it damages the cell reproduction process. We classify it as a chemotherapy agent.
EOD-Extension--Meninges: How do you code extension for a malignant meningioma that invades into the adjacent brain tissue?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 60. Code 60 is defined as a brain tumor that extends into the meninges. It is also the appropriate code to use for a tumor that extends from the meninges to the brain.
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