EOD-Size of Primary Tumor--Breast: When the pathology report does not specify dimensions for the invasive component, how is tumor size coded? See discussion.
In some cases the tumor has both invasive and in situ components. The pathologist sometimes does not report the size for the invasive portion of the tumor. In most cases, the invasive portion is described as a percentage of the tumor mass.
From January 1, 1998 and forward: Follow the Revised Breast EOD instructions. If the size of the invasive component is not given, record the size of the entire tumor in the EOD-Size of Primary Tumor field. Assign the appropriate EOD-Extension code for the situation.
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/SEER Summary Stage 2000--Kidney/Eye: What codes are used to represent these fields for simultaneous bilateral Wilms tumor or simultaneous bilateral retinoblastoma?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis] and the SEER Summary Stage 2000 field to 7 [Distant] for both types of tumor. Each kidney and each eye are staged separately in the AJCC, 6th ed., but for SEER we would abstract these diagnoses as one case and code the EOD and stage fields to distant to reflect the involvement of both eyes or both kidneys.
Multiple Primaries/Histology (Pre-2007)--Bladder: What code is used to represent the histology and how many primaries should be coded for a TURB specimen that demonstrates carcinoma in situ, Grade I to II papillary transitional cell carcinoma, and high grade transitional cell carcinoma? See discussion.
Pathology report:
A. Biopsy, bladder neck, @ 6:00: Carcinoma in situ
B. Biopsy, Bladder wall, lateral, left:
1. Papillary carcinoma (Grade I-II)
2. Loose fragments of high-grade transitional carcinoma
C. Biopsy, Bladder neck @ 5:00: Carcinoma in situ
D. Biopsy, Bladder neck @ 7:00: Cystitis Glandularis
E. Biospsy, Bladder wall, posterior: Papillary carcinoma (Grade I)
For tumors diagnosed prior to 2007:
Code this case as one primary and code the Histology and Grade, Differentiation fields to 8130/34 [papillary transitional cell carcinoma, high grade].
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-Extension--Lung: If a CT scan indicates that a patient has evidence of "long-standing pneumonia," is that synonymous with "pneumonitis" for the purposes of coding extension for lung primaries?
No. These terms are not synonymous. For cases diagnosed 1998-2003, disregard the pneumonia and use the other available information to code extension.
EOD-Extension/EOD-Lymph Nodes--Kaposi Sarcoma: What code is used to represent this field for a Kaposi sarcoma with no skin lesions but positive lymph node and bone marrow biopsies?
Code the EOD-Extension field to 13 [Visceral (e.g., pulmonary, gastrointestinal tract, spleen, other)], because of the positive bone marrow. Code the EOD-Lymph Nodes field to 3 [Both clinically enlarged palpable lymph nodes (adenopathy) and pathologically positive lymph nodes], for the pathologically positive node.
Note: Potential revision of the extension scheme will be referred to SEER Medical Advisory Group (SMAG).
EOD-Size of Primary Tumor--Prostate: When there are multiple nodules in the prostate, can size of tumor be based on the size of the largest nodule? See discussion.
Rectal exam: Prostate enlarged, nodular and irregular. No masses. Pathology from prostatectomy: Focal nodules measuring up to 1.3 cm in diameter. Moderately differentiated adenocarcinoma. Would tumor size be 013 or 999?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 013 [1.3 cm]. Code the size of a mass or nodule only when there is pathologic confirmation of malignancy. In the case you mention, the nodules were pathologically confirmed as cancer, so you would code the size of the largest nodule. If a nodule/or mass in the prostate is confirmed as cancer by needle biopsy, you would code the size of the mass or nodule.
Multiple Primaries (Pre-2007)--Breast: When a breast cancer is treated with less than a total mastectomy and more than 2 months later a tumor of the same histology is diagnosed in the same breast with no statement of "recurrence," is this a new primary?
For tumors diagnosed prior to 2007:
Count as 2 primaries when a subsequent malignant breast tumor is diagnosed more than 2 months later unless stated to be a recurrence. For cases diagnosed after 1/1/94, an in situ followed by an invasive breast cancer is counted as two primaries even if stated to be a recurrence.
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.
Primary Site: What code should be used to represent the site for an "extraovarian" papillary serous adenocarcinoma located in the "rectal muscle sheath"? See discussion.
The location of the tumor in the rectus muscle sheath is unusual and suggests an origin within a preexisting mullerian.
Code the Primary Site field to C49.4 [connective, subcutaneous and other soft tissues of the abdomen].
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined/Surgical Procedure of Other Site--Kaposi Sarcoma: How do you code these fields for a groin mass excision containing 4 lymph nodes for a Kaposi sarcoma case that presented with multiple skin lesions?
Code the EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined fields to 99 99 for Kaposi cases that present systemically and for those that present in more than one site (which includes cases with more than one skin subsite involved at diagnosis). There are no "regional" lymph nodes for such cases. This represents a majority of currently diagnosed Kaposi cases. However, for localized Kaposi cases, you can count the number of regional lymph nodes positive and examined if the primary site selected has a regional lymph node chain(s) associated with it (e.g., soft palate, hard palate, or a skin subsite).
For cases diagnosed 1/1/2003 and after: Code the groin mass excision in the Surgical Procedure of Other Site field to 1 [Non-primary surgical procedure performed; Non-primary surgical resection to other site(s), unknown if whether the site(s) is regional or distant].