Reportability--Cervix: The SEER Program Code Manual lists CIN III and carcinoma in situ of the cervix as not being reportable for cases diagnosed in 1996 or later, but does not list "adenocarcinoma in situ" or "squamous cell carcinoma in situ." Are these histologies still reportable?
For primary site cervix uteri, only histologies with behavior codes of 3 [invasive] are reportable to SEER for all registries.
Some SEER registries have opted to continue to collect behavior codes of 2 [in situ] for cervix uteri primaries.
Date Therapy Initiated: What date should be entered in Date Therapy Initiated when treatment follows a surgical procedure that is not coded under Surgery of Primary Site? See discussion.
If a patient has a surgical procedure that is not coded in the Surgery of Primary Site field and then the patient undergoes additional first course of treatment, such as radiation therapy, how should the Date Therapy Initiated field be coded?
In this example, code the Date Therapy Initiated field to the date of the first surgical procedure. If a SEER edit is triggered, please notify us.
Histology: What code is used to represent the histology for the abbreviation "ca"? See discussion.
The abbreviation "ca" results in inconsistency when coding histology by a group of coders. Many abbreviation guides list both cancer (8000/3) and carcinoma (8010/3) as definitions for "ca." Page 261 of the SEER Self Instructional Manual, Book 5 lists carcinoma as the definition for "ca."
Example: What histology is used for a case with a clinical diagnosis of "recently diagnosed uterine ca" with metastasis to the pelvic lymph nodes?
For uterine primaries, code the abbreviation "ca" to 8010/3 [carcinoma, NOS].
When coding death certificate only (DCO) cases, if the site is coded to an unknown primary and no specific histology information is available other than the abbreviation "ca," interpret ca as cancer (8000/3) per NAACCR Procedure Guidelines for Registries, Series V; Resolving Death Clearance Issues, page V-15.
Histology (Pre-2007)/Grade, Differentiation--All Sites: How do we code these fields for a tumor that is predominantly a "well differentiated liposarcoma" [8851/31] that has a less predominent type of "dedifferentiated liposarcoma" [8858/33]? If we code the predominant cell type [8851/3] and the worst grade [3], the case will not pass edits because well-differentiated liposarcoma requires a differentiation code of 1. See discussion.
Example: Dedifferentiated liposarcoma, with the following features: size 22 cm, FNCLCC grade 3 of 3 [high grade]. Path comment: The tumor consists of predominantly well-differentiated sclerosing subtype liposarcoma and areas of high grade spindle cell (non-lipogenic) sarcoma. The area of high grade spindle cell sarcoma measured up to 7.5 cm.
For tumors diagnosed prior to 2007:
Code the Histology field to 8858/33 [Dedifferentiated liposarcoma, grade 3]. The pathologist gives a final designation of Dedifferentiated liposarcoma and then provides further details in the comment that do not negate the final designation.
Grade is usually coded independent of the cell type. There are a few Catch-22 situations, like this one, in which the grade is built into the name of the cell type.
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.
Multiple Primaries--Hematopoietic, NOS: When the SEER Single versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table indicates that a disease is not a new primary, but a pathologist or clinician states that it is a new primary, do we use the physician information or the table?
For cases diagnosed prior to 1/1/2010:If the physician clearly states that this is a new primary, submit it as a new primary. Otherwise, use the Single versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
EOD-Clinical Extension--Prostate: If the tumor arises in the prostatic apex, does that take priority over coding clinical extension based on the stage of cT1c? See discussion.
Physician states prostate primary is a cT1c. Pathology states adenocarcinoma, Gleason 3+3, right apex. All other biopsies were negative. Because the primary appears to be in the prostatic apex, do we code 33 or 15 for clinical extension? Which is more important for SEER? Do you want to capture the "apex" information or the "cT1c" information?
For cases diagnosed 1998-2003:
Code the EOD-Clinical Extension field to 33 [arising in prostatic apex]. Apex information takes priority. The only statement we have is cT1c by the urologist, and we don't know how that stage was determined.
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.
Grade, Differentiation--All Sites: What code is used to represent this field when a pathology report describes a tumor as a low grade neoplasm consistent with a specific histologic type (e.g., Low grade neoplasm consistent with carcinoid)?
Code the Grade, Differentiation field to 2 [Low grade].
CS Extension (Clinical)/SSF 3 (Pathologic Extension)--Prostate: Upon prostatectomy, the case was determined to be localized. There is no clinical assessment of the tumor prior to prostatectomy. Should clinical extension be coded to 99 [Unknown]? Please see discussion below. See discussion.
We have a prostate case that is clinically inapparent. There is no staging info at all, no biopsy done. Then the patient has a prostatectomy with a single 0.4cm focus of Adenoca gr 3+3.
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.Yes, code CS Extension (clinical) as 99 [unknown]. The extension based on the prostatectomy is coded in Site Specific Factor 3 - Pathologic Extension.
Multiple Primaries (Pre-2007)--Soft Tissue: Does SEER agree that one primary of the soft tissues of pelvis [C49.5] should be reported when a pathologic diagnosis for bilateral herniorrhaphies is "right and left inguinal hernias with low grade spindle cell sarcoma"?
For tumors diagnosed prior to 2007:
Yes. This is one primary and should be coded to C49.5 [Connective, subcutaneous and other soft tissue of pelvis]. According to Rule A in ICD-O-3, the type of tumor ("sarcoma") indicates origin from a particular tissue, resulting in the primary site code of C49.5 [Inguinal region, NOS] for this sarcoma.
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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