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Report Produced: 07/21/2024 09:29 AM

Report Question ID Question Discussion Answer Year
20031090

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.

 2003
20031091 EOD-Pathologic Extension--Prostate/Lymphoma: How is this field coded for a prostatic lymphoma? For cases diagnosed 1998-2003: Do not code the prostate pathologic extent of disease field for prostatic lymphoma. Leave the path extension for prostate field blank. Code the extent of disease using the lymphoma scheme. Use ONLY the lymphoma scheme - do NOT try to code both lymphoma and prostate extension fields for prostatic lymphoma. 2003
20031055

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.

 2003
20031068

EOD-Extension--Colon: Is a pathology description of "superficial invasion of the muscularis mucosa in the upper stalk of the polyp" coded in this field to 10 [mucosa (including intramucosal) NOS], 12 [Muscularis mucosa], or 14 [Stalk of polyp]? See Description.

Do we use the highest applicable value because all three definitions are used in the following example? Ex: Path diagnosis: Sigmoid polyp: tubulovillous adenoma with a focus within upper portion of stalk consistent with superficially invasive (intramucosal) colonic adenocarcinoma (see Comment). Comment: ... in the upper stalk region, there is evidence of superficially invasive carcinoma which appears to be limited to the muscularis mucosa and thus would be intramucosal by classification.

For cases diagnosed 1998-2003: Code extension as 12 [muscularis mucosae]. For this case, "upper stalk" is a reference to location rather than extension. This adenocarcinoma extends to the muscularis mucosa.

 2003
20031054 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.

 2003
20031005 Histology (Pre-2007): Do the terms "keratinizing" or "non-keratinizing" have to be present in the final diagnosis to use codes 8071 through 8073? See discussion. Should "squamous cell carcinoma, small cell variant" be coded to 8073 even though the final diagnoses does not include the phrase "non-keratinizing?"

For tumors diagnosed prior to 2007:

It is acceptable to assign code 8073/3 for squamous cell carcinoma, small cell, NOS. Code squamous cell carcinoma, large cell, NOS to 8072/3. Code to non-keratinizing unless the pathology report specifies keratinizing.

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.

 2003
20031042 Histology (Pre-2007): How are the following four histologies coded: 1) Adenocarcinoma with focal mucinous adenocarcinoma; 2) Adenocarcinoma with focal areas of bronchioalveolar adenocarcinoma, 3) Mixed infiltrating duct and focal medullary carcinoma, and 4) Mixed infiltrating duct and focal medullary carcinoma? See Description.

1. How do we code colon: Adenocarcinoma with focal Mucinous adenoca? 8140/3 or 8255/3?

2. A lung lesion with predominant adenoca with focal areas of bronchioalveolar adenoca? 8140/3 or 8255/3?

3. Mixed infiltrating duct carcinoma and medullary ca? 8510/3 or 8255/3?

4. Mixed infil duct ca and focal medulary ca? 8510/3 or 8255/3?

For tumors diagnosed prior to 2007:

1. 8140/3, Adenocarcinoma. Mucinous has a specific rule (see sinq 20010075): Include the mucinous component only if it is 50% or more of the tumor. "Focal" is not a majority term.

2. 8250/3, Bronchiolo-alveolar adenoca. Code the more specific histology.

3. 8523/3, Infiltrating duct mixed with other types of carcinoma. Combination of infiltrating duct and another type of carcinoma.

4. 8523/3, Infiltrating duct mixed with other types of carcinoma. Combination of infiltrating duct and another type of 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.

 2003
20031028

EOD-Lymph Nodes--Head & Neck: If a pre-treatment description of a chain of lymph nodes doesn't meet the criteria for involvement but the post-treatment description of the same chain of lymph nodes does, should those nodes be counted as involved in coding EOD? See Description.

(Primary site = larynx)

9/12/02 CT neck showed right cervical chain adenopathy. After chemotherapy, an 11/18/02 CT soft tissue of neck showed decrease in size by 50% of what was probably necrotic metastatic node to right mandibular angle.

The term "lymphadenopathy" should be ignored when determining involvement of lymph nodes per SEER. In this case, a probable necrotic metastatic node is mentioned in a subsequent CT taken after treatment.

Should lymph node involvement be coded to 9 based on the 9/12/02 CT or coded to 4 because of the mention of a decrease in size of what was probably a metatastic node on the 11/18/03 CT?

For cases diagnosed 1998-2003, code EOD using the best information available. In this example, the post-treatment description of lymph nodes. A post-treatment description of lymph nodes can be used to code lymph node involvement in the absence of disease progression. Pre-operative treatment does not affect lymph node involvement.

Case example: Code lymph nodes as involved (codes 1-4 depending on size and number) based on the later CT report.

 2003
20031173 Hormone Therapy--Thyroid: Is pre-op hormone replacement therapy coded in this field? See Description. Patient was admitted for thyroidectomy with a diagnosis of probable thyroid cancer. Patient's history stated that patient received work-up for hypothyroidism and was found to have thyroid nodule. FNA suggested carcinoma. Patient's medications included Cytomel and Synthroid. Do not code hormone replacement given to treat hypothyroidism as cancer treatment. Thyroid hormone therapy is coded as treatment only for follicular and papillary thyroid carcinomas. 2003
20031156 Histology (Pre-2007)--Ovary: Should the histology "endometroid adenocarcinoma arising in a serous fibroadenoma" be coded to 8380 [Endometroid adenocarcinoma, NOS] or 9014 [Malignant serous fibroadenoma]?

For tumors diagnosed prior to 2007:

The best code is 8381/3 [Endometroid adenofibroma, malignant]. According to our pathologist consultant: "Serous 'fibroadenoma' is not exactly standard terminology. I would guess the pathologist is looking at an adenofibroma with more fibro and less adeno and thus has changed the terminology around. The combination of the benign serous and malignant edometrioid is also a bit unusual. Each of the proposed codes is defendable, but I prefer endometrioid adenofibroma, 8381/3, because it puts the tumor in the adenofibroma category (less common) yet still identifies the malignant element (endometrioid), even though it does lose the serous. But anyone wanting to look at malignant adenofibromas would find the case, and we would carry it under the appropriate malignant component."

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.

 2003