EOD-Size of Primary Tumor--Breast: If the patient has inflammatory carcinoma of the breast, is the tumor size coded as 998 even though we have a tumor size?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary tumor field to 998 [Diffuse; widespread; 3/4 or more of breast; inflammatory carcinoma] for all inflammatory breast carcinomas.
These cases have a worse prognosis because of the dermal lymphatic invasion. Half of the inflammatory breast carcinomas will have no palpable mass.
EOD-Extension--Lung: Is bilateral pleural effusion coded as 72 [malignant pleural effusion] or 85 [metastasis]? See discussion.
Example:
10/30/98 CXR: Widespread malignancy, hilar, superior mediastinal masses, bilateral pleural effusions, fullness in soft tissue right neck.
11/01/98 CT chest/ABD: Extensive infiltrate mediastinum by radiolucent tumor mass that engulfs esophagus/trachea. Pleural effusion extends so low it apes ascites. Normal ABS/pelvis.
11/01/98 Pathology: FNA right supraclavicular lymph node: metastic oat cell ca. Sputum cytology reported to be negative.
For cases diagnosed 1998-2003, code the EOD-Extension field to 72 [malignant pleural effusion; pleural effusion, NOS].
Surgery of Primary Site--Skin: Explain the difference between code 30 and code 45.
Code 30 [Biopsy of primary tumor followed by a gross excision of the lesion]
Code 45 [Wide excision or re-excision of lesion or minor (local) amputation with margins more than 1 cm, NOS. Margins MUST be microscopically negative.]
For cases diagnosed 1/1/2003 and after: Code 30 represents a biopsy or excision in which the margins of excision are less than 1 cm or the margins are unknown. Code 45 represents a wide excision in which it is known that the margins of excision are greater than 1 cm.
EOD-Extension: General instructions, page 7, note 3 states: " Extent of disease information obtained after treatment with neoadjuvant chemotherapy, hormone or immunotherapy has begun may be included." Because the SEER manual does not mention radiation treatment, can we use information from a lobectomy to code EOD if a patient has neoadjuvant radiation therapy?
Radiation therapy was inadvertently omitted from the list. Please see SINQ 20031012 answer as to when the surgical information can be used to stage the case.
Grade, Differentiation--Lymphoma: What code is used to represent this field when the only grade/differentiation given is "low grade", "intermediate grade" or "high grade"?
Code the Grade, Differentiation field to 9 [cell type not determined, not stated or not applicable]. For lymphomas, do not code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field. These terms refer to categories in the Working Formulation and not to histologic grade for lymphoma histologies.
Generally, for histologies other than Non-Hodgkin lymphoma, the Grade, Differentiation field is coded to 2 [low grade], 3 [intermediate grade] and 4 [high grade] for most cancers.
Multiple Primaries (Pre-2007)--Ovary/Endometrium: Is endometrioid adenocarcinoma occuring simultaneously in the left ovary and the endometrium one primary or two? See discussion.
Pathology Final Diagnosis:
Left Ovary: Moderately differentiated endometrioid adenocarcinoma squamous differentiation grade 2 (scale of 3)
Uterus: Moderately differentiated endometrioid adenocarcinoma with squamous differentiation, grade II (scale of III). Focal, very superficial invasion to inner third myometrium with extension to lower uterine segment. Endocervix, cervix, right ovary and fallopian tubes negative for tumor.
For tumors diagnosed prior to 2007:
Code the case you describe as two primaries. The endometrioid adenocarcinoma can arise in the endometrium without a concomitant ovarian 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.
Multiple Primaries (Pre-2007): Is an in situ tumor followed by another in situ tumor in the same location a new primary? See discussion.
Example: Six months after an in situ lesion was excised from the buccal mucosa, another in situ lesion was excised from the same area of the buccal mucosa with no mention of it being recurrent.
For tumors diagnosed prior to 2007:
Code as a second primary if the second in situ tumor occurred more than 2 months after the first, and it is not referred to as recurrent by the clinician or pathologist. There are no special rules for determining the number of primaries when an in situ lesion follows an in situ.
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-Lymph Nodes/TNM--Breast: Do we code these lymph nodes fields for a breast primary that describes ipsilateral axillary lymph node involvement as "extending through the lymph node capsule and into perinodal soft tissue/fat" as "fixed/matted"?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 6 [Axillary regional lymph nodes, NOS], if the size of the metastasis within the lymph node is not known. "Extension into perinodal soft tissue" does not imply that the lymph nodes are fixed to one another or to other structures. AJCC stage for lymph nodes is coded to N1 [Metastasis to moveable ipsilateral axillary lymph nodes].
In order to code the EOD-Lymph Nodes field to 5 [Fixed/matted ipsilateral axillary nodes] which is the equivalent to AJCC equivalent N2, there must be some clinical or pathologic statement of fixation or matting. There can be extension through the capsule without fixation or matting. "Fixation" is a clinical term and "matting" can be either clinical or pathologic. A pathologist can recognize two or more lymph nodes stuck together by tumor.
EOD-Size of Primary Tumor--Melanoma: How do you code tumor size for a melanoma diagnosed by a positive lymph node biopsy when the primary site is coded C44.9 because no primary site was identified? See discussion.
Should the size be 000 because no primary was found or 999 for unknown?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 000 [No mass; no tumor found] when primary site is coded to C449.
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