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 Extension--Prostate: Can a pathological extension code be assigned when a retropubic prostatectomy is done? See discussion.
The TNM manual states, "Total prostatoseminalvesiculectomy and pelvic lymph node dissection are required for pathologic staging."
For cases diagnosed 1998-2003:
The pathology report from a retropubic prostatectomy should be used to code the Pathologic Extension field. This field is coded using pathology report information from the prostatectomy operation regardless of the surgical approach and regardless of whether or not a pelvic lymph node dissection was performed. This is one area in which TNM rules for pathologic staging and SEER rules for EOD are slightly different.
Grade, Differentiation--Lymphoma: What code is used to represent this field when the only grade/differentiation given is "low grade", "intermediate grade" or "high grade"?
Code the Grade, Differentiation field to 9 [cell type not determined, not stated or not applicable]. For lymphomas, do not code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field. These terms refer to categories in the Working Formulation and not to histologic grade for lymphoma histologies.
Generally, for histologies other than Non-Hodgkin lymphoma, the Grade, Differentiation field is coded to 2 [low grade], 3 [intermediate grade] and 4 [high grade] for most cancers.
EOD-Pathologic Extension--Prostate: If there is residual tumor in the distal urethra on prostatectomy, does that mean there is distal urethral margin involvement? See discussion.
2/98 Prostate bx: Right apex, right mid and right base positive for adenocarcinoma.
6/1/98 Radical retropubic prostatectomy w/ bilateral pelvic lymph node dissection. Pathology: Residual adenocarcinoma in distal urethra, right lateral sections and posterior lobe. Right apical margin, other margins, seminal vesicles, and 7 pelvic LN negative for malignancy.
For cases diagnosed 1998-2003:
For the example above, code the EOD-Pathologic Extension field to 34 [extending to apex] because most of the right side is involved.
The pathology report says all margins are free. The comment on residual tumor in the urethra, meant the first surgery did not completely remove tumor tissue from the urethra, it does not mean that tissue is at the margin.
Behavior Code--Bladder/Lymphoma: Should the "in situ" designation on a bladder primary's pathology report be ignored that states a diagnosis of "in situ lymphoma"?
Ignore the in situ designation. You cannot assign an in situ behavior code to a lymphoma primary. The term or designation of "in situ" is limited to solid tumors; carcinoma and/or cancer.
Radiation: Is "consolidated" radiation therapy coded as part of first course therapy when there is no documentation of "planned treatment" and the radiation is done 4 months after the initiation of treatment?
Yes, "consolidation" treatment is part of a planned treatment regimen. A treatment regimen may consist of the four following phases:
Place of Birth: When there is conflicting information, which record takes precedence in coding this field, the medical record or the death certificate?
If there is a discrepancy, use the information from the medical record to code the Place of Birth field. The information from the medical record is provided by the patient, the information on the death certificate is provided by others. If the medical record does not contain birth information, use the information from the death certificate.
Surgery of Primary Site: Should laparoscopy be coded as exploratory surgery? See discussion.
Many surgeons are doing exploratory surgery with laparoscopy involving a very small incision, but they can examine organs and take biopsies. Should laparoscopy be coded as exploratory surgery?
For cases diagnosed 1/1/1998 and later: Exploratory surgical procedures, such as laparoscopic surgeries, are not coded in the Surgery of Primary Site field.
Surgery of Primary Site--Ovary: What code is used to represent this field when a patient has a history of a previous organ removal and has additional surgery/organ removal for a present cancer (e.g., History of a 1984 hysterectomy and in 2003 has ovarian primary treated with BSO)?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 52 [Bilateral salpingo-oophorectomy WITH hysterectomy].
EOD-Size of Primary Tumor--Lung: Can tumor size of 002 [Malignant cells present in bronchopulmonary secretions] be used when there is a lung mass seen but the diagnosis is from a positive bronchopulmonary secretion?
For cases diagnosed 1998-2003:
EOD-Size of Primary Tumor code 002 [Malignant cells present in bronchopulmonary secretions] is used only when there is no visible primary lung tumor and bronchopulmonary secretions are positive for lung malignancy.
Even if the diagnosis was made by cytology of broncho-pulmonary secretions, if there is a visible mass, code the size of the mass if known, code 999 if size is unknown.