EOD-Size of Primary Tumor--Prostate: Is this field coded to the size of a hypoechoic mass identified on a TRUS when there is no tumor size from the prostatectomy specimen?
For cases diagnosed 1998-2003: Ultrasound measurement of a malignancy can be used to code EOD-Size of Primary Tumor. Information on tumor size taken from imaging/radiographic techniques has low priority, just above physical examination.
CS Extension/Polyp--Colon: How is CS extension coded for tumor invasion described as "Haggitt level 4"? See Description.
Polypectomy specimen revealed adenocarcinoma of the rectum in a tubulovillous adenoma. Per path extent of invasion was Haggitt level 4. The micro description of the tumor stated that there was malignant epithelial neoplasm in colonic mucosa.
In a 1985 Gastroenterology journal article, Haggitt described five levels of polyp invasion:
Level 0-confined to mucosa
Level 1-head
Level 2-Neck
Level 3-Stalk
Level 4-Submucosa of underlying colonic wall.
For cases diagnosed 2004 and forward:
Use the best information available to code CS extension. The following conversion may be used when the only information available is the Haggitt level.
Terms of involvement--Lung: Is "intense uptake" described on a PET scan an indication of involvement? See Description.
We are seeing increasing use of PET scans as diagnostic tools for cancer. PET scans use different terminology than the ambiguous terms listed in the EOD manual. Could we please have guidelines for interpreting PET scans?
Example: Patient with right lung cancer. PET scan showed intense uptake in the mediastinum and in the hilum. Can we code "intense uptake" as involvement of mediastinal and hilar lymph nodes?
Do not interpret "intense uptake" as involvement. Look for a statement of involvement or other terminology, such as "highly suspicious," "strongly suspicious for" malignancy, involvement, etc.
Surgical Fields--Head & Neck: How does one code the removal of benign submandibular and sublingual glands performed during a neck dissection for a head and neck cancer? See discussion.
Should the removal be coded as incidental in the surgical Procedure if the Other Site field? Does it make a difference if the submandibular gland is removed en toto with lymph nodes or if the gland is submitted as a separate specimen? Does it make a difference if the glands are involved?
Removal of the lower salivary glands is part of a radical neck dissection and is not recorded in Surgery of Primary Site or Surgery of Other Site. Radical neck dissection is coded under "Scope of Regional Lymph Node Surgery."
It does not matter whether or not the gland is submitted as a separate specimen. It does not matter whether or not the gland is involved.
First Course Treatment/Radiation Therapy/Immunotherapy--Thyroid: For this primary, do we code I-131 as a Radio-isotope as well as a Biological Response Modifier? See Description.
(SEER Book 8 lists I-131 as a Biological Response Modifier.) Immunoglobulin is listed as immunotherapy agent in the CCR manual also coded as immunotherapy. Are there two different types of I-131, immunoglobulin and sodium iodide?
Sodium Iodide is listed as an ancillary drug in SEER Book 8, page 45. The listing on page 63 refers to Antiferritin antibody, or AntiCEA. Both of these were under clinical investigation when Book 8 was written. They are no longer active and this change will be made when Book 8 is revised.
Multiple Primaries (Pre-2007)--Trachea/Lung: Would synchronous lesions, of the same histology, diagnosed in the right upper lobe of the lung and trachea be a single primary when the physician feels they are two separate primaries?
For tumors diagnosed prior to 2007:
According to SEER rules, abstract as one primary because although these sites have separate topography codes in ICD-O-3, they were coded to the same three-digit topography code in the first edition of ICD-O (SEER Program Code Manual, 3rd Edition, page 8, Exception B). Simultaneous lesions of the same histology in trachea and lung are one primary. Code the primary site to C399 [Ill-defined sites within respiratory system].
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.
First Course Therapy: Are radio immune labeled antibodies, such as Bexxar [Tositum--I-131] coded as immunotherapy, radiotherapy, or experimental therapy?
Agents such as Bexxar or Zevalin are radioisotopes and coded as radiation. These agents destroy cancer cells with radiation.
Surgery of Primary Site--Breast: How is this field coded when a patient has a reduction mammoplasty (for macromastia) and within the pathology specimen there is an incidental finding of carcinoma?
For cases diagnosed 1998-2003: Code this reduction mammoplasty to 20, 21 or 30, depending on whether or not there was a nipple resection. According to our surgical consultant, a reduction mammoplasty is more like a partial mastectomy than a lumpectomy or other breast surgery.
Radiation: How would this field be coded for treatment with quadramet [radioactive samarium]? See Description.
Paitent is receiving quadramet for treatment of lung metastases.
Code Quadramet in the RX Summ-Radiation field as 3 [Radioisotopes]. Quadramet is a radioisotope used to palliate bone pain. The instructions in the SEER manual state: "Record all radiation that is given, even if it is palliative."
Primary site--Unknown & ill-defined site/Kidney: How should this field be coded when humeral metastases are compatible with renal cell carcinoma pathologically, no kidney lesion is found clinically and the physician's signout diagnosis is "no primary found, as of now unknown"? See Description.
Path states "biopsy of humerus, mets sarcomatoid carcinoma consistent with renal cell carcinoma." Material was sent to Mayo Clinic for consult & they state "with focus of clear cells, agree that a likely primary is renal cell carcinoma." Abdominal CT showed no abnormality in kidneys. When the registrar abstracted the case she spoke to the managing physician who told her that "no specific site was found and it was, as of now, unknown." This was stated about three months after dx. Can we code as a renal primary based on pathologic information or should we code unknown based on CT and physician's statement?
Code this case to C64.9 [Kidney, NOS].
ICD-O-3 rule H states that the topography code attached to a morphology term may be used when the topographic site is not given in the diagnosis. Topography code C64.9 is attached to morphology code 8312/3 [Renal cell carcinoma] in ICD-O-3.
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