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.
Histology (Pre-2007)--Skin: Are "atypical melanocytic hyperplasia" and "severe melanotic dysplasia" synonyms for melanoma in situ?
For tumors diagnosed prior to 2007:
No. SEER determines its reportable list from the ICD-O-3. The above terms are listed as tumor-like lesions and conditions, but are not in situ or malignant.
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-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.
Surgery of Primary Site/Date Therapy Initiated--Cervix: Should "negative endocervical curettings" be coded as surgical treatment for carcinoma in situ of the cervix primaries and should the date of the procedure ever be used in coding the Date Therapy Initiated field?
For cases diagnosed 1/1/2003 and later: Code Surgery of Primary Site to 25 [D&C endocervical curettage (for in situ only)]. If this is the first treatment given, the Date Therapy Initiated is coded to the date of the curettage.
Primary Site--Breast: What subsite code should be used for a diagnosis of "inflammatory carcinoma"?
Code the Primary Site field to C50.9 [Breast, NOS] for a breast primary presenting with inflammatory cancer unless there is a palpable mass within the breast. If there is a palpable mass, code the primary site to the position of the mass.
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].
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-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.
EOD-Extension--Lung: If LUL mass "crosses the pleural surface" into the LLL, do we assume this represents extension to the pleura? See discussion.
9/22/93 Left upper lobe lobectomy: 3 x 3 cm mass in the periphery of the LUL near the LLL. Multiple enlarged nodes around the aortic arch and within the pulmonary fissure.
9/22/93 Pathology: Moderately differentiated Adenoca. The neoplasm does cross the pleural surface into the segment of the lower lobe. Lower margin of resection is free of neoplasm. Six lymph nodes negative for metastatic carcinoma. Tumor staged as T2N0M0 Stage Ib by physician.
Is tumor extension coded 10 [confined to one lung] or 40 [extension to pleura]?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [extension to pleura]. The tumor has penetrated (extended to) the pleura.
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