CS Tumor Size/CS Extension/CS Lymph Nodes--Lung: How are these fields coded when there is no description of a primary lung tumor, lymph node biopsies are negative, but biopsy of a "level 7 mass" is positive for squamous cell carcinoma? See Discussion.
Example: Chest CT: Enlarging subcarinal mass, 3.4 cm, is most likely malignant adenopathy or perhaps primary tumor. The clinician subsequently described a patient history of mediastinal lymphadenopathy. He stated that a PET scan revealed multifocal thoracic disease consistent with stage 3B carcinoma. This was followed by mediastinoscopy with lymph node biopsies (all negative) but the biopsies of "level 7 mass and subcarinal level 7 mass" showed squamous cell carcinoma.
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 this case is determined to be a lung primary, code the CS fields:
CS Tumor Size: 999 [Unknown]
CS Extension: 99 [Primary tumor cannot be assessed]
CS Lymph Nodes: 20 [Subcarinal lymph node involvement] based on positive level 7 biopsy, history of mediastinal lymphadenopathy and subcarinal "adenopathy" per CT.
CS Tumor Size/CS Extension--Brain and CNS: How are these fields coded for a glioblastoma multiforme occurring in a 3.5 cm tumor in the parietal lobe and a 3.0 cm tumor in the occipital lobe?
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.
CS Extension code is 10 [confined to cerebral hemisphere]. Record the size of the largest lesion in CS Tumor Size. Both the occipital and parietal lobes are supratentorial and confined to the cerebral hemisphere with no mention of crossing midline or involvement of ventricles.
Reportability--Brain and CNS: Which types of neurofibromatosis are reportable to SEER? See Discussion.
Clin exam: probable neurofibromatosis, type I. On the trunk alone are >14 cafe au lait spots all at least 10mm. Both axillary regions have freckling. No palpable fibromas, spine is straight, no organomegaly. MRI of head: no abnormality.
Neurofibromatosis type I (von Recklinghausen's disease, the Elephant Man disease) is primarily tumors of the subcutaneous tissues. By itself, NF1 is not reportable. NF2 is much more likely to develop acoustic neuromas. This syndrome is reportable only when acoustic neuroma(s) is present, because the acoustic neuroma is what is reportable. This case is not reportable because none of the symptoms affect the central nervous system.
Primary Site/Priorities--Breast: When there are conflicting references to subsite in different reports, which report has priority? See Discussion.
The clinical site of the palpable mass is outer quadrant. The pathologist states inflammatory breast cancer located in the central breast. Should the site be coded to C501 for central breast, C509 for inflammatory breast ca, or C508 for outer quadrant?
Code the breast subsite from the pathology report (C501, central).
The priority order for coding subsite from conflicting reports is
1. Pathology report
2. Operative report
3. Physical examination
4. Mammogram, ultrasound
The primary site of inflammatory breast carcinoma is coded to C509 when there is no palpable tumor.
Histology (Pre-2007)/Diagnostic Confirmation: Which histology code is preferred if the CBD brushing is positive for malignant cells, cytologically most consistent with ductal adenocarcinoma [8500/3], and the common hepatic artery lymph node biopsy has metastatic adenocarcinoma, consistent with cholangiocarcinoma [8160/3]?
For tumors diagnosed prior to 2007:
Assign histology code 8160 [Cholangiocarcinoma]. Code from the pathology specimen when available. In this case, the only pathology is from the lymph node specimen.
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 Extension--Prostate: Can the EOD Manual clarifications regarding apparent and inapparent tumors be used to determine CS clinical extension for prostate primaries?
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.Do not use the EOD information to determine apparent and inapparent when coding Collaborative Stage for tumors diagnosed 1/1/2004 or later.
The August 2007 CoC Flash stated that "After consultation with the AJCC curators for genitourinary disease, the CS Steering Committee has determined that the SEER list of terms for apparent and inapparent in the SEER Extent of Disease Manual is NOT to be used for interpreting reports for Collaborative Staging. While it was a convenient tool for registrars, the curators are of the opinion that the use of the list will lead to misinterpretation of reports. Rather, the curators recommend that registrars rely on a direct physician statement of apparent or inapparent disease for Collaborative Staging."
August 2007 CoC Flash: http://www.facs.org/cancer/cocflash/august07.pdf, Coding Prostate Cancer: A Message from the Collaborative Staging Steering Committee.
Histology--Lymphoma: How is "histiomonocytic lymphoma" coded?
For cases diagnosed prior to 1/1/2010:Assign code 9755 [Histiocytic sarcoma; True histiocytic lymphoma]. "Histiomonocytic" is not standard terminology, according to our expert consultant. However, 9755 is the best code to assign.
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.
Grade, Differentiation--Bladder: If the only indication of grade for a bladder primary is "grade 2, NOS," and we do not know the grading system being used by the pathologist, is the numeric grade 2 coded?
See the General Coding Rules on page 92 of the 2004 SEER Manual for instructions about coding grade.
If the only information available is "Grade 2," assign code 2 [Grade II].
Reportability/AmbiguousTerminology: Because there is a caveat in the SEER PCM, 3rd edition to ignore adverbs such as "strongly" when assessing reportability, should a term such as "likely" cancerous be reportable given than the expression "most likely" cancerous is reportable?
"Likely cancerous" is NOT reportable.
The CoC, NPCR and SEER have agreed to a strict interpretation of the ambiguous terms list. Terms that do not appear on the list are not diagnostic of cancer.
CS Tumor Size--Breast: How is this field coded for a 1.5 cm clinically palpable tumor that appeared to be a cyst with a papilloma when the partial mastectomy Path Micro stated the lesion was an "intraductal papilloma with focal noninvasive papillary carcinoma"? See Discussion.
Should the size be coded to 999 [unknown] because the noninvasive papillary carcinoma is described only as "focal" and is not measured and it is not known how much of the tumor is benign and how much is in situ. Or would the size be coded to the size of the palpable mass, 1.5 cm?
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.
Code CS tumor size as 999 [unknown]. Size of the focal noninvasive papillary carcinoma is not stated.
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