MP/H Rules--Urinary: How many primaries are abstracted when a patient has a May 2000 invasive papillary transitional cell carcinoma of the bladder, a November 2004 invasive papillary transitional cell carcinoma of the right ureter and a May 2007 urothelial carcinoma in situ of both the left and right ureters?
For cases diagnosed 2007 or later:
Using the pre-2007 multiple primary rules, the PTCC of the bladder in 2000 and the invasive TCC of the right ureter in Nov. 2004 would have been abstracted as separate primaries.
Use the 2007 MP/H rules to evaluate the May 2007 diagnosis. Start with rule M3. Stop at rule M8. The May 2007 diagnosis is the same primary.
Rule M4 does not apply because of the 2000 bladder primary. A clarification will be added to M4 to stress that for the urinary rules, any urinary tumor up to the present point in time is counted when applying this rule.
Radiation Therapy: How is radiation coded when it is "recommended" but the patient dies before radiation is started? See Discussion.
Code 0 seems appropriate but then we would lose the fact that it had been recommended. All of the other modalities give an option for 'recommended but patient died prior to treatment.' Is there a reason this option is not given for radiation?
Code Radiation (Rx Summ--Radiation) to 0 [None; diagnosed at autopsy].
SEER does not collect the Reason For No Radiation field. However, those who abstract using software that captures this data item can identify these cases. Code 5 [radiation not administered because patient died] reflects this situation.
Radiation (Rx Summ-Radiation) is a SEER field. This field is derived from the data collected in Rad-Boost Rx Modality and Rad-Regional TX Modality. These fields do not include a choice for "radiation not given because the patient died prior to treatment." Therefore, this information cannot be coded in the Radiation field.
First Course Treatment--Liver: Given that agents can be used that are not chemotherapy drugs, how should treatment be coded for a procedure called a "chemoembolization" when the agent used is not documented?
This issue was discussed among the national standard setters and per the SEER website this issue has been resolved as follows: When "chemoembolization" is done but the agents used are not chemotherapy drugs, then treatment should be coded as "Other Therapy." See http://seer.cancer.gov/tools/codingmanuals/embolization.html
CS Lymph Nodes--Kidney, renal pelvis: Under what circumstances would code 80 [Lymph nodes, NOS] be used to document the presence of positive lymph nodes? See Discussion.
The CS Schema for Kidney (Renal Parenchyma) states to use code 70 for Regional Lymph Nodes, NOS. The schema for for Renal Pelvis states to use code 50 for Regional Lymph Nodes, NOS. Both schemas have a Code 80, for Lymph Nodes, NOS that maps to N1 in both schemas.
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 80 can be used for positive lymph nodes when you are unable to determine if they are regional or distant. CS Lymph Nodes code 80 is provided for this situation in accordance with the downstaging rule.
Code 80 should be used very infrequently and only when there is no indication whether the involved lymph nodes are regional or distant.
Primary Site: Is an "angiosarcoma" stated as arising in the skin of the breast and treated with a mastectomy, coded to the primary site of skin or breast?
Code the primary site as skin of breast when skin of breast is documented as the site of origin.
According to the WHO classification of soft tissue tumors, the majority of angiosarcomas "develop as cutaneous tumors...less than one quarter present as a deep soft tissue mass."
Multiplicity Counter--Breast: How should the multiplicity counter be coded for a 3.8 cm infiltrating duct carcinoma with two "satellite nodules" measuring 5 mm and 7mm that are not described as either metastases or multiple foci?
Include these nodules in the multiplicity counter because they are measured and are part of the final diagnosis on the pathology report.
Flag: For cases diagnosed prior to 2001, how is the ICD-O-3 Conversion Flag set if the ICD-O-2 and ICD-O-3 histology and behavior fields are both directly coded, as registrars in this region are instructed to do when submitting late cases, and as a result no conversion is necessary? Is it to 0 [Morphology (Morph--Type&Behav ICD-O-3 originally coded in ICD-O-3)] or Blank [Not converted]?
Assign code 3 [converted with review].
In your scenario above, ICD-O-2 and ICD-O-3 are being independently coded which should yield the same result as converting the case and then reviewing it.
Otherwise, if there is an ICD-O-3 code which differs from the ICD-O-3 code based on the conversion criteria, it will trigger an edit.
Multiple Primaries/Histology--Lymphoma/Leukemia: How many primaries and what histologies are coded when a path diagnosis for a cervical/neck mass demonstrates classical Hodgkin's lymphoma on a background of chronic lymphocytic leukemia?
For cases diagnosed prior to 1/1/2010:Hodgkin disease and chronic lymphocytic leukemia are separate primaries according to our current instructions. Abstract and code them separately.
For cases diagnosed 1/1/10 and later, 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/Chemotherapy--Hematopoietic, NOS: Is pyridoxine-responsive sideroblastic anemia (SA) reportable and is pyridoxine coded as chemotherapy for SA and refractory anemia with ringed sideroblasts (RARS)? See Discussion.
Patient has refractory anemia with ringed sideroblasts on bone marrow path. The physician mentions it might be due to pyridoxine deficiency. Per the SEER*Rx, pyridoxine (aka Vitamin B6) is not coded as treatment. What causes RARS and SA? Is pyridoxine treatment for either disease process? Or is the pyridoxine just treating one aspect of the anemia? The patient has no other treatment but this.
For cases diagnosed prior to 1/1/2010:Sideroblastic anemia (SA) is not reportable. SA is not the same as refractory anemia with ringed sideroblasts (RARS). Therefore, do not code pyridoxine administered for SA as therapy. If the patient had RARS that "might be due to pyridoxine deficiency," the replacement pyridoxine would not be coded as chemotherapy because it does not control or kill malignant cells. If the pyridoxine was successful in alleviating the refractory anemia, the RARS would be reversible and would not meet the criteria for a reportable blood disease; i.e. irreversible, clonal.
For cases diagnosed 1/1/10 and later, 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.
MP/H Rules/Recurrence--Breast: If the pathologist and oncologist call a 2007 lobular carcinoma that appears in a skin nodule of a mastectomy scar a recurrence of a patient's 1975 primary breast duct carcinoma, should we abstract this as a new primary? See Discussion.
According to the pathologist and oncologist, the change in histology is attributed to the present availability of E-cadherin, which was not available in 1975.
For cases diagnosed 2007 or later, abstract the 2007 diagnosis as a separate primary using rule M5.
Rule M5 applies to this case because it comes before rule M12. Furthermore, based on your statement, the answer presumes that the original tumor was duct carcinoma only, there was no lobular carcinoma present. This must be a new primary because there are two different histologies.
The 2007 MP/H rules were developed with input from clinicians. They advised that a subsequent breast tumor more than five years later is a new primary. It is important to apply the rules so that these cases are handled in a consistant manner across all registries.
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