Chemotherapy: If a physician does not document the reason chemotherapy was given concurrently with radiation therapy, should it be assumed to have been used as a radiosensitizer or radioprotectant and then, per SEER chemotherapy coding instruction 2, ignore coding the chemo agent as treatment?
Do not assume that a chemo agent given with radiation therapy is a radiosensitizer. Seek additional information.
Compare the dose given to the dose normally given for treatment. When chemotherapeutic agents are used as radiosensitizers or radioprotectants, they are given at a much lower dose.
Reportability--Brain and CNS: Is Langerhans cell histiocytosis [9751/1] of the meninges [C709] reportable?
For cases diagnosed prior to 1/1/2010:Yes. The criteria for reportable benign/borderline CNS tumors is based on location (site) and behavior (benign/borderline). There is no caveat for histologic type. Therefore, this would be reportable as these tumors have been reported arising from the meninges or choroid plexus.
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.
Reportability--Ovary: Is an "aggressive adult granulosa cell tumor with one of two lymph nodes positive for metastatic granulosa cell tumor" reportable?
Malignant granulosa cell tumor is reportable. The case described above is malignant as proven by metastasis to the lymph node.
2004 SEER Manual Errata/CS Lymph Nodes--Head & Neck: On page C-353, in the supraglottic larynx schema, there is no mention of Level IV nodes in the CS Lymph Node codes.
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.The CS Steering Committee is aware of this issue and is working to resolve it.
CS Site Specific Factor--Prostate: Can autopsy results also be used when coding SSF3, pathologic extension, given that the instructions only address the use of prostatectomy findings when coding this field?
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 prostate cancer was diagnosed on autopsy, or the autopsy was performed within the staging timeframe (See 2004 SEER Manual, page 112), code SSF3 using the autopsy information.
Histology (Pre-2007): Is histology for an anorectal biopsy of "Cloacogenic carcinoma (squamous cell carcinoma with basaloid features)" coded to 8124/3 [Cloacogenic carcinoma] or 8083/3 [Basaloid squamous cell carcinoma]?
For tumors diagnosed prior to 2007:
Code histology to 8124/3 [Cloacogenic carcinoma]. These are squamous cell carcinomas of basaloid type that are found in the cloacogenic (transitional) zone of the anal canal.
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 Site Specific Factor--Head & Neck: If a lymph node dissection of the neck reveals that 1/24 lymph nodes is positive and the positive 5.6 cm lymph node extends throughout levels II-IV, how are the SSF 3 (status of levels I-III lymph nodes) and SSF4 (status of levels IV-V lymph nodes) fields coded?
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.According to the CS Steering Committee, code 999 for SSF 3 and SSF 4. In this case, do not make assumptions about which level of lymph nodes were involved.
CS Site Specific Factor--Prostate: How are SSF 5 (Gleasons Primary and Secondary Pattern Value) and SSF 6 (Gleasons Score) coded when there is a higher Gleason's pattern in less than 5% of the tumor? See Discussion.
Radical prostatectomy pathology states prostate adenocarcinoma "combined Gleasons score 3+3=6, with a small portion of Gleasons pattern 4 component comprising less than 5% of tumor volume."
The WHO Classification of Tumors of the Urinary System and Male Genital Organs refers to "tertiary" Gleasons patterns in addition to the primary and secondary patterns. On prostatectomy, when this tertiary pattern is 4 or 5, WHO recommends that it should be reported in addition to the Gleasons score even when it is less than 5% of the tumor.
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.
Record Gleason's pattern and score from the largest specimen, even if this is a lower number. Ignore the tertiary pattern for now.
This may change when the AJCC 7th Edition is published, as there is much discussion regarding the tertiary patterns and when they should be utilized. If there is a change in AJCC, at that time there will be a change to CS.
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