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20021139 | Date of Diagnosis/EOD-Extension--Placenta: How do you code these fields for a patient who presents with a vaginal metastatic lesion for a placenta primary? Should EOD-Extension be coded to 60 [Other genital structures NOS: vagina, ovary, broad ligament, fallopian tube] or 85 [metastasis other than lung]? See discussion. | Pt had D&C Feb 5 with features of complete mole. On March 7, pt seen for a mass just inferior to the urethral meatus. At path, vaginal introitus fragments were consistent with choriocarcinoma. At time of March 23 admit for chemo, history is given as large hydatidiform mole evacuated Feb 5. Her beta hCG titers initially fell but approximately one month later hCG titers rose. At that time, she had an obvious vaginal metastatic lesion. | For cases diagnosed 1998 or after: Code the Date of Diagnosis field to March 7, which is the date that the choriocarcinoma was first diagnosed. There was no slide review or clinical statement that the first occurrence was obviously malignant. Therefore, the vaginal mets is not progression and is codeable as extension. Code the EOD-Extension field to 60 [other genital structures, NOS] according to the current EOD scheme for placenta. Even though the mass is discontinuous, it is still included in code 60 per the guidelines of the FIGO system on which the EOD is based. | 2002 |
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20020051 | 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. |
2002 |
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20020056 | Multiple Primaries (Pre-2007)--Bladder: Is a 1998 transitional cell carcinoma of the bladder, followed by a 2001 squamous cell carcinoma of the bladder reportable as a second primary? | For tumors diagnosed prior to 2007:
Yes. This case is reportable as a second primary. The rule in the SEER Program Code Manual says that invasive bladder cancers with histology codes 8120-8130 [papillary, transitional] are always coded as a recurrence and are an exception to the multiple primary rule. Squamous cell carcinoma [8070] is not a part of that exception.
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. |
2002 | |
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20021050 | EOD-Extension--Pancreas: If the tumor involvement for a case falls between two different regional extension codes, should we code to the lesser of the two codes or should we code extension as unknown? See discussion. | Example 1: CT scan description: Mass in the head of the pancreas. The duodenum is "surrounded" by tumor. Should we code extension to 40 [peripancreatic tissue extension, NOS] or 99 [unknown] because the extension code could be further than 40. It could be 44 [extension to duodenum].
Example 2: CT scan description: Mass in region of pancreatic head and "root" of superior mesenteric artery consistent with pancreatic cancer. Should we code extension to 40 [peripancreatic tissue extension, NOS] or 99 [unknown] because the extension code could be further than 40? It could be 54 [extension to major blood vessels]. |
For cases diagnosed 1998-2003:
In both examples, code the EOD-Extension field to 40 [peripancreatic tissue extension, NOS]. Choose the lowest of a known possible extension code over an unknown code. |
2002 |
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20021015 | Ambiguous Terminology/Reportability: How should the expressions "suspicious for but not diagnostic of" and "suspicious for the possibility of early invasive adenocarcinoma" be interpreted for reportability? Would the interpretation be different depending on the primary site? | For reportability, interpret "suspicious for but not diagnostic of" as NOT diagnostic of cancer.
The phrase "suspicious for the possibility of early invasive adenocarcinoma" may indicate that the case is in situ. If no further information is available, this is not reportable.
The site of the cancer diagnosis does not change the interpretation. |
2002 | |
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20021112 | Multiple Primaries/Histology--Hematopoietic, NOS: The subsequent primary table for 2001 and later indicates that 9863/3 [acute myelogenous leukemia (AML)] followed by 9980/3 [refractory anemia (RAEB)] is a new primary, but 9989/3 [myelodysplastic syndrome, NOS (MDS)] is not. Is the case below two primaries? See discussion. | Bone marrow bx states: The morphologic blast count of 7% exceeds 5%, traditionally used to define relapse in the setting of acute leukemia. Given the clinical hx that the pt's peripheral blood counts had initially normalized after induction therapy, the recent fall in counts is worrisome for the possibility of early relapse. Alternatively, therapy may have simply reverted the pt's marrow from AML to a precursor myelodysplastic syndrome (such as RAEB given the blast count) from which the AML arose, with the falling counts being progression of the underlying MDS. The identification of significant dysplasia in the bone marrow at the time of diagnosis would tend to support the possibility of an underlying MDS. Clinically, it is unlikely to make a difference whether one regards the present situation as early relapse or progression of an underlying MDS. The final clinical diagnosis is "Myelodysplasia, classified as RAEB." | For cases diagnosed prior to 1/1/2010: This case demonstrates a relapse of AML. The original classification of Histology as 9863/3 [AML] is correct. There is no second primary based on the information provided for this case. 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. |
2002 |
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20021063 | EOD-Pathologic Review of Number of Regional Lymph Nodes Examined: What code is used to represent this field when a path report from a lymph node biopsy or dissection describes lymph node "portions" or "fragments"? See discussion. | 1) Lymph nodes, right pelvic dissection: No evidence of malignancy in 4 portions of lymph node examined. (Should we code the number examined as 01, 04, or 97?) 2) Lymph nodes, left pelvic dissection: 5 fragments of lymph nodes show no evidence of malignancy. (Should we code the number examined as 05 or 97?) 3) Biopsy of right neck mass: Malignancy in fragments of lymph nodes. The following month, pt had a right modified lymph node dissection: 16/32 lymph nodes are positive for malignancy. (Should we code the number examined as 32, 33, 97, 98?) |
For cases diagnosed 1998-2003:
The total number of lymph nodes examined is recorded in EOD-Num of Reg LN Examined. If the number of actual lymph nodes represented by the "fragments" or "portions" cannot be determined, assign code 96, 97, or 98 as appropriate. 1) Based on the terminology "four portions of lymph node (singular)" code to 01 despite "dissection" terminology. 2) Code to 97 based on "fragments of lymph nodes (pleural)" terminology and procedure identified as dissection. 3) Code to 97 based on statement of "fragments of lymph nodes (pleural)" for biopsy plus dissection. |
2002 |
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20021152 | Primary Site: Can we assume the primary site for "chordoma" is soft tissue if the bone is not stated to be involved? | Default the coding of the Primary Site field for chordomas to the bone where the tumor began in the body if the primary site is not clearly stated to be soft tissue. Bone is often the primary site for chordomas.
Based on advice from pathologist consultants: This is one of those situations where we can be quite comfortable with a default, in this case to bone, not soft tissue. Chordoma is a tumor arising in the nucleus pulposis, presumably from remnants of notochord - thus its exclusive origin is in the sacrococcygeal region, spheno-occipital region, and vertebral bodies, otherwise known collectively as the axial skeleton. Any "chordoma" in soft tissue (with no relationship to axial skeleton) is probably a myxoid chondrosarcoma or parachordoma (extremely rare). |
2002 | |
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20021146 | Primary Site--Lymphoma: Is the primary site likely to be extranodal for a lymphoma that presents in an extranodal site and lymph nodes which are regional for that site? Is the primary site also likely to be extranodal if an extranodal site and lymph nodes are excised? See discussion. | Example: Work-up included a negative CXR. A CT showed multiple dilated loops of small bowel consistent with obstruction and nodular prominence at the base of bladder. Laparotomy with resection of small bowel and multiple biopsies of enlarged mesentric lymph nodes performed. Final path diagnosis: Lymphoma in a "mesenteric mass" and in "small bowel." There was no mention of lymph nodes in the final diagnosis and the detailed micro described the mesenteric mass as just adipose tissue replaced by lymphoma. However, the gross for that specimen states 4 lymph nodes were found in the fat. The small bowel micro described an ulcerated lesion of the small bowel extending into muscularis. | For cases diagnosed prior to 1/1/2010:Code the Primary Site field to C17.9 [small bowel] for the example. When an extranodal organ and that organ's regional nodes are involved, the extranodal site is most likely the primary, unless there is extension from the regional nodes to the organ. If the primary site cannot be determined for a lymphoma diagnosed in both a nodal and extranodal site, code to C77.9 [lymph nodes NOS]. 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. |
2002 |
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20021103 | Surgery of Primary Site/First Course Treatment--Liver: If disease progression is so rapid that the initial therapy plan is changed before patient receives any therapy, would "no therapy" be the first course? See discussion. | Patient was diagnosed with liver cancer on 8/23 and on 9/6 a hepatectomy was recommended. However, patient was hospitalized on 9/19 with ascites. Patient underwent embolization instead of a hepatectomy during that admission. | Code the "embolization" (or hepatic artery embolization, HAE) in Surgery of Primary Site. Assign code 10 [local tumor destruction, NOS]. The embolization is coded as first course of therapy for this case because it seems that this patient was not adequately staged until 9/19 -- there is no indication on this case of the stage of disease in August or early September. Furthermore, no treatment was started before the embolization. Therefore, the ascites is not "progression of disease" in this case -- it is taken into account as part of the initial stage of disease. This procedure was previously coded as other therapy, experimental. Code as surgery as of July 2005. |
2002 |