CS Extension--Prostate: How do you code clinical extension for prostate primaries diagnosed at autopsy? See discussion.
A patient was not diagnosed prior to autopsy. The autopsy diagnosis states that this is adenocarcinoma of the prostate without capsular invasion.
Should clinical extension be coded to clinically inapparent, NOS (10) and pathologic extension be coded to no prostatectomy done within first course of treatment (97)?
Code CS Extension (clinical) to 99 [Unknown]. Code SSF 3 according to the amount of tumor found using the information from the autopsy.
EOD-Extension/EOD-Lymph Nodes--Bladder: Are "perivesical nodules" coded in the EOD-Lymph Nodes field or are they discontinuous extension and coded in the EOD-Extension field?
For cases diagnosed 1998-2003:
Code "perivesical nodules" in the EOD-Lymph Nodes field as involvement of regional lymph nodes. Each gross nodule of metastatic carcinoma in the fat surrounding an organ is counted as one positive regional lymph node.
EOD-Pathologic Extension--Prostate: Can a pathological extension code be assigned when a retropubic prostatectomy is done? See discussion.
The TNM manual states, "Total prostatoseminalvesiculectomy and pelvic lymph node dissection are required for pathologic staging."
For cases diagnosed 1998-2003:
The pathology report from a retropubic prostatectomy should be used to code the Pathologic Extension field. This field is coded using pathology report information from the prostatectomy operation regardless of the surgical approach and regardless of whether or not a pelvic lymph node dissection was performed. This is one area in which TNM rules for pathologic staging and SEER rules for EOD are slightly different.
Histology (Pre-2007): What code is used to represent the histology for a "malignant invasive gastrointestinal stromal tumor (GIST)"?
For tumors diagnosed 2001-2006: Malignant GIST is coded 8936/3.
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.
Date of Diagnosis: When doing follow-back at nursing homes on DCO cases, we find it difficult to code diagnosis date because the nursing home records are often vague or incomplete. Should the diagnosis date be coded as unknown (excluded from SEER database), the date of death, or the approximate date of diagnosis as reported on the death certificate?
If the nursing home record indicates that the patient had cancer, use the best approximation for date of diagnosis.
If the record says the patient had cancer when admitted, but it does not provide a date of diagnosis, use the date of admission as the date of diagnosis.
If there is no mention of cancer in the nursing home record and/or all work-up in the record is negative, assume the cancer was discovered at autopsy. Use the date of death as the date of diagnosis, and leave as a Death Certificate Only case.
EOD-Clinical Extension/EOD-Lymph Nodes--Prostate: How do you code clinical extension and lymph nodes for path only prostate cases treated with a TURP? Would clinical extension be coded to unknown or localized, NOS?
For cases diagnosed 1998-2003: Code the EOD-Clinical Extension field to 30 [localized, NOS] and the EOD-Lymph Nodes field to 0 [no lymph node involvement]. Per Note 7: Use code 30 when there is insufficient information as to whether the tumor is clinically apparent or inapparent but the tumor is confined to the prostate. This is an example of a case where there is insufficient information as to whether the tumor is clinically apparent or inapparent. Assume the tumor is confined to the prostate.
Multiple Primaries (Pre-2007)--Thyroid: Does the rule in the 3rd Edition of the SEER Program Code Manual apply to cases diagnosed before 1998 that states if there are two separate carcinomas in the thyroid, one papillary and the other follicular, it is one primary and coded to the combination code 8340/3 [Papillary and follicular carcinoma]? See discussion.
If the rule applies to cases diagnosed before 1998, does SEER plan to ask that cases diagnosed prior to 1998 be recoded?
The rule applies to tumors diagnosed 1998-2006. The rule is not retroactive. At this time, SEER does not plan to ask that tumors diagnosed prior to 1998 be recoded.
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.
Histology (Pre-2007)/Grade, Differentiation--Brain and CNS: What code is used to represent the histology and grade for "WHO-II astrocytoma, grade II" of the brain when the WHO-II classification is different from the classification systems previously used? See discussion.
According to the WHO-I classification system, this is a moderately anaplastic astrocytoma. According to the Duke criteria, this is an astrocytoma. By Dauma-Dupont criteria, this is a grade 2 astrocytoma.
For tumors diagnosed prior to 2007:
Code the Histology and Grade, Differentiation fields to 9401/34 [anaplastic astrocytoma].
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.
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: Should a lymph node biopsy be counted in these fields or are these fields for lymph node dissections only? See discussion.
These fields record the number of regional lymph nodes examined pathologically whether from a biopsy or from a dissection. If the single lymph node biopsied was a regional lymph node, code the Number of Regional Lymph Nodes Positive field to 05 and the Number of Regional Lymph Nodes Examined field to 16. If the lymph node biopsied was a distant node, code these fields to 04 and 15 respectively.
EOD-Size of Primary Tumor--Prostate: When there are multiple nodules in the prostate, can size of tumor be based on the size of the largest nodule? See discussion.
Rectal exam: Prostate enlarged, nodular and irregular. No masses. Pathology from prostatectomy: Focal nodules measuring up to 1.3 cm in diameter. Moderately differentiated adenocarcinoma. Would tumor size be 013 or 999?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 013 [1.3 cm]. Code the size of a mass or nodule only when there is pathologic confirmation of malignancy. In the case you mention, the nodules were pathologically confirmed as cancer, so you would code the size of the largest nodule. If a nodule/or mass in the prostate is confirmed as cancer by needle biopsy, you would code the size of the mass or nodule.