First Course Treatment--Thyroid: Is hormone replacement following total thyroidectomy coded as first course treatment for all thyroid cases?
Code Hormone therapy as 01 [Hormone therapy administered as first course therapy] when thyroid replacement therapy is part of the first course of treatment for follicular or papillary thyroid cancer following thyroidectomy.
Thyroid hormone replacement therapy has a treatment effect on differentiated (follicular and papillary) carcinomas of the thyroid. This treatment effect is not seen for most medullary and undifferentiated thyroid cancers.
Multiple Primaries (Pre-2007)--Breast: Synchronous invasive right breast tumors. Ductal carcinoma, NOS in UIQ and Ductal carcinoma, tubular type in LOQ. Are these two primaries or a single primary coded to 8523/3?
For tumors diagnosed prior to 2007:
Code as two primaries, one 8500/3 [Infiltrating duct carcinoma] and one 8211/3 [Tubular carcinoma].
Apply the multiple primary rules first. These are synchronous right breast tumors with different histologies. Therefore, they are separate primaries according to rule 5.a on page 12 of the SEER Program Code Manual. ICD-O-3 histology code 8523/3 is NOT to be used to combine histologies from separate primaries; it is used for mixed histologies in a single primary.
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.
Grade, Differentiation: Is grade always coded to 4 for a diagnosis of Ewing's sarcoma?
Do not code the ICD-O-3 grade for Ewing sarcoma unless documented in the record.
In the TNM system, grade is required to place Ewing sarcoma into a stage group. For TNM staging purposes, Ewing sarcoma is classified as G4. Do not apply TNM rules to ICD-O coding.
EOD-Extension--Breast: How is this field coded when the diagnosis includes both invasive and in situ disease, and the pathology report stated the tumor size may or may not include the size of the in situ portion of the tumor? See Description.
Examples:
1. Invasive ductal carcinoma well differentiated, 1.2 cm, gross tumor size, ductal carcinoma in situ.
2. Gross tumor size 3.2 x 2.5 x 2.3 cm. well differentiated to moderately differentiated invasive ductal ca, accompanying component well differentiated ductal carcinoma in situ, solid, cribiform.
For cases diagnosed 1998-2003: Use extension codes 16, 26, or 36 depending on extent of involvement. These codes indicate that invasive and in situ components are present, the size of the entire tumor is coded in Tumor Size, the size of the invasive component is not stated, and the proportions of in situ and invasive are not known.
Both examples above measure the entire tumor including invasive and in situ components. Assign extension code 16, unless there is evidence of further involvement.
EOD-Extension--Stomach: How is this field coded for a stomach primary that has metastases to "Sister Mary Joseph's Nodes?"
For cases diagnosed 1998-2003: For a stomach primary, code extension to 70 [Abdominal wall]. Sister Mary Joseph's nodule is a cutaneous umbilical metastasis most commonly from an intra-abdominal primary.
This rare form of cutaneous umbilical metastasis results from spread of tumor within the falciform ligament. The umbilicus is part of the abdominal wall.
Diagnostic Confirmation--Hematopoietic, NOS: Is a multiple myeloma diagnosed by an FNA of the lumbar spine (or any other non-bone marrow location) a diagnostic confirmation 1 or 2? See Description.
Does the rule on page 111 of the SEER Program Coding Manual, 3rd Edition, for code 1 apply to myelomas (in the same way it applies to leukemias)?
Assign code 1 [Positive histology] for aspiration of bone marrow. This rule is not limited to leukemias.
Laterality--Head & Neck: Does the site code C098 need a laterality code? See Description.
In the SEER EOD-88 3rd edition, page 36, site code C098 does not need laterality. In the SEER Program code manual, 3rd edition, page 93, site code C098 is listed as a site that needs a laterality code 1-9.
Topography code C098 [Overlapping lesion of tonsil] requires a laterality code of 1-9. Follow the laterality guidelines in the SEER Program Code Manual.
EOD-Extension--Colon: How should this field be coded for "adenocarcinoma penetrating through bowel wall into adjacent adipose tissue?
For cases diagnosed 1998-2003: The difference between EOD-extension codes 40 and 45 is the level of the fat involved. Code 40 is subserosal fat immediately adjacent to the muscular wall of the colon inside the serosa/visceral peritoneum. Code 45 is pericolic fat in areas where there is a serosal surface or in the retroperitoneal areas of the ascending and descending colon where there is no serosa. Code 42 was added for use when it is not possible to determine whether subserosal fat or pericolic fat is involved. Code 42 should be used only when there is a reference to 'fat' (NOS) The answer for the case example above depends on the location of the primary and whether the fat referred to is within or outside the entire thickness of the colon wall. If no additional information is available, use code 42 [Fat, NOS].
EOD-Extension: How is this field coded for synchronous primaries when metastatic disease is found and there is no statement to indicate which primary is the source of the metastases? See Description.
Patient was diagnosed with both esophageal and pancreatic cancer. Liver metastases were also identified. The source of the liver mets is unknown.
For cases diagnosed 1998-2003: Search the record for information about the source of the metastasis. If no such information can be found, code the metastasis to both primaries. Update the abstracts when information becomes available confirming the primary site responsible for the metastasis. Assuming the liver metastases in the example above are distant (i.e. not contiguous) code extension as 85 [Metastasis].
Surgery of Primary Site--Skin: How should this field be coded for a re-excision or wide excision of a skin primary when the margins are NOS?
For cases diagnosed 2003 and later:
Assign surgery codes 45, 46 and 47 only when the margins are documented to be more than 1cm. Use the most appropriate code from 30-36 if re-excision or wide excision followed a biopsy. Use a code from the 20's series if the procedure is called a "biopsy."