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.
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.
Histology (Pre-2007)/Primary Site/Diagnostic Confirmation: How would these fields be coded for a diagnosis of cholangiocarcinoma based on clinical findings only? See Discussion.
We have a case of reported "cholangiocarcinoma" of the liver diagnosed only by a CT of the abdomen. There is no pathologic confirmation. CT ABD: Heterogeneous liver mass suspicious for cholangiocarcinoma; mass causes right portal & right hepatic vein occlusion & right and left biliary duct dilatation....
Should this be coded to cholangiocarcinoma by radiology alone and should it be liver as primary site?
For tumors diagnosed prior to 2007:
Code according to the prevailing medical opinion in this case. If no further information can be obtained, code as cholangiocarcinoma of the intrahepatic bile duct.
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): Is a small cell undifferentiated carcinoma coded to 8041/34 [small cell carcinoma undifferentiated] or to 8045/34 [combination small cell AND undifferentiated carcinoma] using terms from the 2 columns in Appendix 1 of Coding Complex Morphologic Diagnoses? See discussion.
Per pathology report, diagnosis is small cell undifferentiated carcinoma in biopsies taken from the laryngeal surface of the epiglottis and left false vocal cord.
For tumors diagnosed prior to 2007:
Code histology as 8041/34 [small cell carcinoma, undifferentiated]. The diagnosis indicates that this is an undifferentiated small cell carcinoma, rather than a mixture of small cell carcinoma with undifferentiated carcinoma.
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.
Ambiguous Terminology/Histology (Pre-2007): How do we code histology when there is a difference between the histology mentioned on a suspicious cytology and the clinical diagnosis by the treating physician? See Description.
An FNA of pancreas is stated as "highly atypical cells present, suspicious for pancreatic ductal carcinoma." The attending physician states the patient has pancreatic carcinoma. Can histology be coded 8500/3 [infiltrating duct carcinoma, NOS] or should it be 8010/3 [carcinoma, NOS]?
For tumors diagnosed prior to 2007:
Code the histology from a suspicious cytology when this histology is supported by the clinical diagnosis.
Code the example above to 8010/3 [Carcinoma, NOS].
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-Size of Primary Tumor/First Course Treatment--Breast: How is tumor size coded when preventative tamoxifen treatment precedes breast cancer diagnosis? Can we code the tumor size from the surgical specimen? Is tamoxifen treatment here? See Description.
What is the tumor size in this situation? Patient is on the STAR trial (preventative tamoxifen for women with high risk for breast cancer). Patient develops breast cancer and has surgery.
For cases diagnosed 1998-2003: Code EOD-Size of Primary Tumor from the surgical pathology report.
Do not code this preventative tamoxifen as first course cancer-directed treatment. This tamoxifen was part of a clinical trial intending to delay or prevent beast cancer from developing.
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.
Other Cancer-Directed Therapy--Hematopoietic, NOS: Is there a hierarchy for selecting which code to use when a patient receives more than one type of "other treatment"? See Description.
Patient was diagnosed with Myelodysplastic Syndrome, probably refractory cytopenia with multilineage dysplasia. Good candidate for investigational studies for transfusion-dependent patients. Patient was enrolled in a high dose vitamin D study. Patient also received transfusions.
SEER has not established a hierarchy of the codes listed under Other Treatment. If the patient receives more than one type of other treatment as the first course of treatment, assign the code that provides the most information about how the patient was treated and use the remarks fields to explain.
Code Other Treatment for the case example above as 2 [Other experimental therapy]. Use the remarks fields to describe the transfusions and vitamin D therapy.
EOD-Extension--Lymphoma: How is the following guideline of "any mention of lymph nodes is considered indicative of involvement" applied for EOD-Extension of lymphoma cases when there is a discrepancy between physicians as to the stage at diagnosis? See discussion.
A biopsy of mesenteric nodes confirmed lymphoma. A bone marrow biopsy was negative. A CT of the chest indicates "small mediastinal and bilateral hilar nodes, but without convincing adenopathy." The case was Stage 2 per the oncologist and Stage 3 per the surgeon's TNM form.
For tumors diagnosed 1998-2003:
Based on the information provided for this example, the lymphoma involves one site, mesenteric nodes. Code EOD extension as 10 [Involvement of a single lymph node region].
The statement "For lymphomas, any mention of lymph nodes is indicative of involvement" refers to the terms in the paragraph above it on page 8 of the EOD manual: Palpable, enlarged, visible swelling, shotty, lymphadenopathy. While these terms are ignored for other malignancies, they should not be ignored for lymphomas. None of these terms apply to the example provided here. According to the CT, the mediastinal and hilar nodes are "small" "without convincing adenopathy." In other words, the mediastinal and hilar nodes are negative.