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.
Summary Stage 2000--Colon: How should this field be coded for involvement of "pericolonic fat, NOS" when there is no mention of whether the fat is sub-serosal or supra-serosal? See Description.
In the summary staging manual pericolic fat is listed under regional direct extension with no mention of whether sub-serosal or supra-serosal. According to our report the pathologist must specify whether involvement of pericolonic fat is of subserosal or supraserosal fat. If involvement of pericolonic fat was not specified as such, this should be localized vs regional direct extension.
Code Summary Stage as 2 [Regional by direct extension only].
In Summary Stage 1977 and 2000, pericolic fat is listed under Regional Direct Extension. If there is no indication by the pathologist that the involved fat is subserosal, code as Regional Direct Extension.
Primary Site/EOD-Size of Primary Tumor--Lung: If the only lung mass described in CXR is a "hilar mass," is the primary site coded to C34.9 [Lung, NOS] or C34.0 [Main Bronchus; incl. Carina]? Also, can the size of the hilar mass be used to code the size of tumor field?
Because the only description available is "hilar mass," code primary site as C34.0.
For cases diagnosed 1998-2003: Use size of mass for EOD-Size of Primary Tumor.
EOD-Lymph Nodes/EOD-Extension: Does extracapsular lymph node extension into adjacent tissue or organs affect EOD coding? See Description.
For a lung primary a PET scan showed marked uptake in the right hilum consistent with metastatic disease. A radical pneumonectomy was performed and the operative findings showed that the pulmonary artery was involved with a mass.
Pathology: Small cell carcinoma in the lung parenchyma. The distal bronchi showed obstructive pneumonitis. There were mets found on 02/05 on the hilar lymph nodes and 00/02 peribronchial nodes. The mets in the hilar nodes extended beyond the lymph node capsule into the pulmonary artery.
For cases diagnosed 1998-2003: Extracapsular lymph node extension does not affect the extent of disease. Code the extent of regional lymph node involvement in EOD lymph nodes.
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.
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.
EOD-Clinical Extension--Liver: How do the segments of the liver described by AJCC Manual correspond to the lobes of the liver described by the SEER EOD Manual? See Description.
CT described hepatocellular ca involvement of the liver with nodules identified in segments 5 and 7. Would EOD-extension be coded to 30 [multiple tumors (one lobe)]?
Segments 2, 3, and 4 correspond to the left lobe of the liver. Segments 5, 6, 7 and 8 correspond to the right lobe of the liver. Segment 1 is the caudate lobe, which has completely different drainage and vascularization, is separate from the larger right and left lobes.
For cases diagnosed 1998-2003: Since segments 5 and 7 are both in the right lobe, assign EOD-extension code 30 for the case above, unless there is mention of vascular invasion. Be sure to record the size of the largest primary tumor.
Tumor size and vascular invasion are the most important factors for AJCC 6th edition staging.
Primary Site/Histology (Pre-2007)--Bone: How are these fields coded for a squamous cell carcinoma in bone? See Description.
The consult path report says "I believe that there is definitely high grade malignant tumor in this amputation specimen, and that this tumor represents an invasive squamous cell carcinoma, which is extending into the bone and permeating in between the bone trabeculae. ... The fact that squamous cell carcinoma can arise from the sinuses of chronic osteomyelitis is well recognized."
For tumors diagnosed prior to 2007:
Based on the information provided, code the primary site as C40._ or C41._ [bone] because the tumor originated in the sinuses of chronic osteomyelitis. Code to the site in which the tumor arises. Override the SEER site/histology edits to allow this rare combination of bone and squamous cell 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.
Surgery of Primary Site--Skin: When would one use codes 30-33 for this field on a skin primary?
Surgery of Primary Site codes 30-33 under "skin" are used for various types of biopsies followed by a gross excision of the lesion. The two procedures (biopsy and gross excision) may be performed on different days, at different facilities, by different physicians as long as both procedures are performed during the first course of treatment.
Answer applies to both pre-2002 and 2003+ surgury code definitions.
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