EOD Fields--All Sites: Is EOD information limited to what is available exactly two months from the day of diagnosis?
For cases diagnosed 1998-2003:
EOD should include all information available within four months of diagnosis in the absence of disease progression or through completion of surgery(ies) in first course of treatment, whichever is longer.
Mets known to have developed after EOD was established should be excluded.
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.
Histology (Pre-2007): What code is used to represent the histology for a "malignant invasive gastrointestinal stromal tumor (GIST)"?
For tumors diagnosed 2001-2006: Malignant GIST is coded 8936/3.
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--Lymphoma: How should you code the primary site for a lymphoma that presents with involvement of an extranodal site and regional lymph nodes? See discussion.
1. Lymphoma involves the spleen and the splenic lymph nodes.
2. MALT Lymphoma involves the stomach and the gastric and iliac lymph nodes.
1. Code the Primary Site field to C42.2 [spleen].
2. Code the Primary Site field to C16._ [stomach].
When lymphoma presents in an extranodal site and in the regional lymph nodes for that extranodal site, code the Primary Site field to the extranodal site. The typical disease process is that lymphoma can spread from an extranodal organ to its regional lymph nodes. It cannot metastasize from the regional lymph node to the extranodal organ. The exception to this would be if the lymph nodes presented as one large mass that extended into the regional organ.
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: How are these fields coded if radiation to the primary site and/or regional lymph nodes is performed prior to surgery?
For cases diagnosed 1998-2003:
Code the EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined fields per the information in the pathology report(s). Radiation to the primary site would not affect the status of the lymph node involvement. Radiation to the regional lymph node region may or may not affect the pathologic status of the lymph nodes. However, for these fields code the best information available about the status of the lymph nodes which is reflected in the pathology report(s).
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.
EOD-Size of Primary Tumor--Breast: For breast cancer cases, is code 002 [Mammography/xerography diagnosis only with no size given (tumor not clinically palpable)] to be used only when there is no work-up beyond a clinical one? See discussion.
Usually when a mammogram has a malignant diagnosis, the tumor is clinically palpable, but occasionally the tumor is not palpable.
For example, on the mammogram, lesions are identified in the breast. PE--the breasts are palpably normal. Breast biopsies--two ductal carcinomas, no statement of size. Mastectomy--no residual. Should the size be coded to 999 rather than 002?
For cases diagnosed 1998-2003:
In the case you provided, code the EOD-Size of Primary Tumor field to 002 [Mammography/xerography diagnosis only with no size given (tumor not clinically palpable)]. A known code in the size field should always take precedence over 999 [Not stated]. Code size from the records in priority order as stated in EOD, from pathology, op report, PE, mammogram, etc. (See EOD for complete instructions.)
Code size as 999 only when there is a clinically palpable lesion with no size stated in the path, PE, or mammogram.
If there is a lesion seen on mammogram that is not clinically palpable, a stated size taken from the path or mammogram would take precedence over code 002; however, if there is no stated size, use code 002 rather than 999.
Other Therapy: What code is used to represent "gene" therapy? See discussion.
The following form of gene therapy has been described as treatment for malignant brain tumors.
Patients undergo surgery to remove as much of the tumor as possible. After surgery, the patients are infused with a virus that has been genetically altered so that it is not infectious and so that it contains a gene from the herpes simplex virus. The herpes gene is sensitive to a drug called ganciclovir. Once inside the brain, the genetically altered virus infects any remaining tumor cells. When this occurs, the herpes gene is established inside the cancer cells. After the virus infects the cancer cells, the patients are given ganciclovir. This drug would kill both the virus and the brain tumor cells.
Code the Other Cancer-Directed Therapy field to 2 [Other experimental cancer-directed therapy (not included elsewhere)].
EOD-Extension--Lung: Should the phrase "some pleural fluid in both posterior gutters" be interpreted as pleural effusion for lung primaries? See discussion.
CT scan: "3 cm mass left upper lobe of lung. Some pleural fluid in both posterior gutters. Large matted hilar lymph nodes, left. Some narrowing left upper bronchus by this adenopathy. Squamous cell ca lung with mets to left hilar lymph nodes, most likely possibility." Would you code extension to 72 [malignant pleural effusion; pleural effusion, NOS]?
For cases diagnosed 1998-2003:
Yes. Code the EOD-Extension field to 72 [malignant pleural effusion, pleural effusion, NOS]. Pleural effusion is mentioned as being present.
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.