Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20150010 | Multiple Primaries/Histology--Colon: What is the correct histology code and MP/H Rule when a colectomy final diagnosis is adenocarcinoma with colloid and signet ring cell features? See discussion. |
The MP/H Equivalent Terms and Definitions for Colon indicate that type, subtype, predominantly, with features of, major, or with ___ differentiation are all equivalent in terms of coding histology. However, this is not indicated in the General Instructions (e.g., Histologic Type ICD-O-3 or General Instructions Histology Coding Rules). It also is not included as a Note under the Rules where one would expect to use these terms, for example, Rule H7. Is this an oversight or error in the Manual?
In this case, Rule H7 seems to be the first (and most appropriate) rule that applies to this mixed histology tumor. However, the specific histology terms that an invasive tumor may be identified as, are only listed under Rule H13. Can these same terms be used when applying rules for which they are not specifically noted? It would seem logical to use the equivalent histology terms to code a mixed histology tumor identified as a subtype or with features, etc., despite the fact that the specific terms are not listed under Rule H7.
|
Rule H7 applies. Assign code 8255. H13 does not apply as mucinous/colloid/signet are not NOS histologies. They are specific histologies. This will be addressed in the upcoming revisions to the rules. |
2015 |
|
20150030 | First course treatment--Surgical rocedure of other sites: How is this field coded when the patient undergoes a lung wedge resection for a pulmonary nodule that was never definitively or was ambiguously stated to be a metastasis? See Discussion. |
The patient was diagnosed with a carcinoid tumor of the small intestine. The pre-surgical work-up also identified a lung nodule that showed no octreotide uptake, but was indeterminate on biopsy. The imaging differential diagnosis included carcinoid, hamartoma, or a non-calcified granuloma. The patient underwent a resection of the primary small bowel tumor, and the physician noted the lung nodule was of unclear diagnosis. The physician stated a solitary lung metastasis would be atypical, but that lung metastatic involvement could not be ruled out. The physician recommended resection of the lung nodule to ensure that the patient was disease free. The lung wedge resection proved a pulmonary hamartoma.
The rules for coding Surgical Procedure of Other Site are not entirely clear. The definitions for First Course of Therapy in the SEER Manual do state that treatment includes, "Procedures that destroy or modify primary (primary site) or secondary (metastatic) cancer tissue." This would seem to exclude the lung resection as it did not destroy, modify or remove metastatic cancer tissue. However, the instructions for coding Surgical Procedure of Other Site do not address removal of distant sites that are not incidental. The lung resection was not incidental; the physician recommended it to ensure the lung was not involved, but it also disproved metastatic involvement. Should the Surgical Procedure of Other Site field be coded 0 (none) or 4 (non-primary surgical procedure to distant site) in this case?
|
Code 0 for Surgical Procedure of Other Site in this case. The Surgical Procedure of Other Site field is used to capture surgery to destroy or modify cancer tissue that is not captured in other surgery fields. |
2015 |
|
20150065 | First course treatment/Chemotherapy/Drug category: Instructions in SEER*Rx state that Ibrance should be coded as chemotherapy. They also state that it is an endocrine-based therapy. Local physicians refer to Ibrance as hormone therapy. Please clarify. |
For cancer registry data collection, follow the instructions in SEER*Rx. It is important for all data collection to be consistent for reporting of cancer information.
Per the FDA: Ibrance is a chemotheraputic agent which was approved for use WITH Letrozole. Letrozole is a hormonal drug which may be why the physicians are stating the patient is receiving hormones. Ibrance should not be given alone to treat breast cancer. This drug will not be changing categories in SEER*Rx. |
2015 | |
|
20150007 | MP/H Rules/Histology: What is the proper histology code -- mucin producing adenocarcinoma or cholangiocarcinoma for the following case? See discussion. |
4/10/13 Partial hepatectomy: well differentiated mucin producing adenoca involve right and left hepatic ducts, common hepatic duct & common bile duct. Invasion beyond wall of bile duct. CT Scan after 1st surgery shows residual neoplasm cannot be excluded
7/31/13 Left lateral segmentectomy: residual well differentiated cholangiiocarcinoma involving connective tissue surrounding major bile ducts. Per medical director, histolgically code to cholangiocarcinoma.
Primary site: Extra hepatic bile duct. Chemo (5FU, Leucovorin, Oxaliplatin) was started 5/1.
|
Code the histology as well differentiated mucin producing adenoca based on the 4/10/13 pathology report.
Code histology from the pathology report of the procedure which removed the most tumor tissue -- this is from the MP/H general instructions for coding histology. We are assuming that the partial hepatectomy removed the most tumor tissue in this case.
Per WHO, mucin producing adenoca is a variant of cholangiocarcioma. |
2015 |
|
20150067 | MP/H Rules/Histology--Kidney: What is the correct histology for this diagnosis? See discussion. |
Procedure: Nephrectomy
Laterality: Left
Tumor type: SOLID VARIANT RENAL CELL CARCINOMA
Nuclear grade: High grade (3/4)
Histologic grade: Poorly differentiated
Pattern of growth: Solid
Tumor size: 5x4.5x4cm
Local invasion: Present
Renal vein invasion: None
Surgical margins: Negative
Non-neoplastic kidney: Unremarkable
Adrenal gland: Not submitted
Lymph nodes: Not present
Pathologic stage: T1b
There are solid sheets of tumor cells without papillary structure. The tumor stains positive for Pax-2, negative for Ecadherin, P63 and CK7, consistent with renal cell carcinoma, solid variant. |
Assign histology code 8312, renal cell ca, NOS. There is no specific code for the solid variant of renal cell carcinoma. |
2015 |
|
20150026 | First course treatment--Breast: When Lupron is given as cancer-directed treatment for metastatic breast cancer, should it be coded as Hormone Therapy or Other Therapy? See Discussion. |
Per the SEER*Rx Database, Lupron is coded as Other Therapy for breast cancer until such time that it receives FDA approval. However, SINQ 20021042 states Lupron should be coded as Hormone Therapy when given as cancer-directed therapy. These two sources contradict each other.
Information regarding hormone therapy for breast cancer in both the SEER*Rx Database and the National Cancer Institute's Cancer Topics website (http://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet) seem to indicate that the SINQ answer is the correct choice. The NCI Cancer Topics website states that Lupron acts to block ovarian function and is an example of an ovarian suppression drug that has been approved by the FDA. The SEER*Rx Database Remarks section states that a combination of letrozole and leuprolide (Lupron) "is considered standard treatment for metastatic breast cancer and is sometimes used for treatment of early stage breast cancer." But the Remarks go on to state that Lupron should be coded as Other Therapy until it receives FDA approval.
It is unclear how to code Lupron for breast cancers when the NCI website indicates that it is standard treatment while the SEER*Rx Database states both that it is and that it is not standard treatment. |
Code Lupron given for breast cancer in the "Other" treatment field using code 6 (other-unproven). Lupron is still not an approved hormone treatment for breast cancer and should not be coded in the hormone field.
|
2015 |
|
20150043 | Seq no-central--Brain and CNS: How should subsequent tumors be sequenced when the patient has a history of a brain tumor, with no information on the behavior of the brain tumor? According to the sequencing rules, it appears some assumption must be made regarding the behavior of the brain tumor. |
Sequence the brain tumor in the 60-87 series when you do not know the behavior. If you have reason to believe the brain tumor was malignant, sequence it in the 00-59 series. |
2015 | |
|
20150029 | First course treatment/Hormone Therapy--Lung: How is this field coded when the patient receives Prednisone for a metastatic lung adenocarcinoma? See Discussion. |
The SEER*Rx Database, Prednisone Primary Site indicates "Prednisone is used to treat multiple sites and histologies." The Remarks information states, "Prednisone may be coded as treatment (hormonal) for all sites and histologies. It is most often used as part of a drug regimen." While it is clear that Prednisone is coded as hormone therapy when administered as part of a drug regimen like CHOP, how is Prednisone coded when given outside of a drug regimen? Also, how is Prednisone coded for cancer-directed treatment of a metastatic lung primary? The NCI's PDQ does not list hormone therapy as cancer-directed treatment for a Stage IV lung adenocarcinoma.
In our specific case, Prednisone was started just after diagnosis, and before the completion of work-up proving distant metastasis. Often, Prednisone (or another hormone agent) is given as an ancillary treatment for the symptoms associated with the malignancy, and not as cancer-directed treatment.
|
Do not code Prednisone when it is given for symptoms. In most cases when Prednisone is given by iteself, not as part of a drug regimen, it does not affect the cancer and would not be coded as treatment. |
2015 |
|
20150061 | Reportability--Vulva: Is this reportable? We have begun to see the following diagnosis on biopsies of the vulva with the statement below. The diagnosis is being given as simply VULVAR INTRAEPITHELIAL NEOPLASIA, no grade is noted. See discussion. |
The note explains: The International Society for the Study of Vulvovaginal Disease (ISSVD) in 2004 revised its classification of VIN by eliminating VIN 1 and combining VIN 2 and VIN 3 into a single category (see table below). Classification of VIN (usual type) ISSVD [International Society for the Study of Vulvovaginal Disease]1986 classification 2004 classification VIN 1 VIN2 VIN3 VIN Note: VIN 2 and VIN 3 combined into single [non-graded] category, VIN Reference: Scurry J and Wilkinson EJ. Review of terminology of precursors of vulvar squamous cell carcinoma. Journal of lower genital tract disease, 2006; 10(3): 161-169 |
Vulvar intraepithelial neoplasia with no grade specified is not reportable. Reportability instructions have not changed. See page 11 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf |
2015 |
|
20150051 | Reportability--Brain and CNS: Is schwannoma of the extracranial part of a cranial nerve reportable? Some cranial nerves, like facial nerve, have intracranial and extracranial branches. |
An extracranial schwannoma is not reportable. The schwannoma must arise on the intracranial part of the nerve to be reportable. |
2015 |