CS Extension--Head of Pancreas: What code is used to represent extension to the superior mesenteric artery? See Discussion.
In the CS coding scheme for Head of Pancreas, superior mesenteric artery is listed under both code 54 (T3) and 60 (T4).
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Assign code 60 for a primary in the head of the pancreas extending to the superior mesenteric artery. CS Extension code 54 should be Superior mesenteric VEIN and code 60 should be Superior mesenteric ARTERY. An errata will be issued by CS. In addition, extension 54 indicates resectable disease and code 60 is not resectable.
Reportability/Date of Diagnosis--Ovary: Is a patient SEER reportable in 2001 or 2003 if she presented with a diagnosis of papillary serous tumor of low malignant potential [borderline tumor] per the 5/2001 surgery but at the time of the planned second look laparoscopic surgery is stated to have Stage 3A ovarian cancer? See Discussion.
A patient was seen in 5/2001 for large pelvic mass growing from right ovary. After TAH and USO and partial omemtectomy, path diagnosis was papillary serous tumor of low malignant potential (borderline tumor), unruptured. Right ovary and omental implant have identical histologic appearance, except the psammoma body formation and the ovary does not.
Patient does not return for lap as planned in 6-12 months.
In 1/03 she returns to hospital with abdominal pain and has debulking, hemicolectomy and Hartmann's procedure. 1/03 Path report "metastatic papillary serous adenoca." Chart now says "History of stage 3A ovarian cancer."
Yes, this case is reportable in 2003. Malignancy was confirmed in 2003. The diagnosis made in 2001 is not reportable for that year, and was not reviewed or revised according to the information provided.
First Course Treatment/Immunotherapy--Colon: Can "Sandostatin" be coded for treatment of carcinoid tumors of the colon because it flushes tumor cells from the colon in addition to controlling diarrhea?
Do not code Sandostatin (Ocreotide Acetate) as treatment. This is an ancillary drug used to treat symptoms of diarrhea. SEER Book 8 is undergoing revision and will include this change.
Histology--Hematopoietic, NOS: When the histology is described in both WHO and FAB terms, which terminology has priority to code this field? See Discussion.
Example: Bone marrow biopsy was reported as: "Markedly hypercellular marrow aspirate with myelodysplastic alterations morphologically consistent with refractory anemia (FAB) or refractory cytopenia with multilineage dysplasia (WHO)."
For cases diagnosed prior to 1/1/2010:Give preference to the WHO terminology when both are used in the final pathology diagnosis. The WHO classification of tumors is the current standard and is recommended by the College of American Pathologists.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Multiple Primaries (Pre-2007)--Vulva/Vagina: In 2004 if multiple biopsies reveal VAIN III of the vaginal wall, and VIN III of the left fourchette and the right labia minora is thisĀ one primary per the SEER Site Grouping Table on page 9 of the 2004 SEER Manual because vulva and vagina are supposed to be abstracted as a single site?
For tumors diagnosed prior to 2007:
Abstract the case above as one primary according to multiple primary rule 3a. Code the primary site to C579 [Female genital, NOS] according to the table on page 9 of the 2004 SEER Manual.
Multiple tumors of the same site and same histology diagnosed at the same time are abstracted as one primary. Multiple independent tumors of the vulva and vagina are abstracted as a single site when diagnosed simultaneously. VAIN III and VIN III have the same histology code [8077].
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.
CS Tumor Size--Ovary: The size of a cyst is not coded in this field. However, can the size of a "cystic mass" be coded in this field? See Discussion.
The specimen consists of a cystic mass which weighs 1520 grams and measures 23 x 17 x 10 cm.
If the tumor is described as a "cystic mass" and only the size of the entire mass is given, code the size of the entire mass, because the cysts are part of the tumor itself.
Please note: Ovarian cancer stage is not based on tumor size.
CS Tumor Size: Can we take the size of a "polypoid" mass? See Discussion.
3/04 Colonoscopy: 4 cm semi-circumferential friable mass in sigmoid colon. Path: Tubulovillous adenoma indeterminate for malignancy. 4/04 Sigmoid Colectomy: 5 x 4 polypoid mass: WD Adenocarcinoma arising in a tubulovillous adenoma.
Define "Polypoid". Size of "polypoid" mass. Would the size be coded to 050 or 999?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.If the pathology report confirms that the entire polyp is malignant, code the size of the polyp/polypoid mass. If the pathology report does not confirm that the entire polyp is malignant, code 999.
Code tumor size as 999 [Unknown] for the example above. Do not code the size of the polypoid mass in this example. The size given above is the size of the polypoid mass, not the size of the malignancy.
First Course Cancer-Directed Treatment--Bladder: How should Mitomycin-C instillation for bladder cancer be coded?
Code the instillation of Mitomycin-C into the bladder for a bladder primary in both the Chemotherapy and Surgery to Primary Site fields. Code the Chemotherapy field to 02 [Single-agent chemotherapy administered as first course therapy]. Mitomycin-C is listed in SEER book 8 as a chemotherapeutic drug, specifically an alkylating agent.
Also, code the Surgery of Primary Site field to 15 [intravesical therapy]. Code the surgical procedure as well as the type of drug (chemotherapy in this case).
Multiple Primaries (Pre-2007)--Colon: What is the number of primaries for a case of familial polyposis with at least three separate tumors having invasive adenocarcinoma, one in the rectum? See Discussion.
A patient had a total proctocolectomy and was found to have familial polyposis. At least 3 separate tumors were identified with invasive adenocarcinoma, one of which was in the rectum. Is this 2 primaries: C18.9 with 8220/3 and C20.9 with 8140/3 or is this all one primary cancer?
For tumors diagnosed prior to 2007:
Familial polyposis is always a single primary. Code the primary site for the case example above to C199 [colon and rectum].
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.