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Report Produced: 04/26/2025 00:26 AM

Report Question ID Question Discussion Answer Year
20031177 EOD-Lymph Nodes--Colon: Are deposits of carcinoma in the pericolic fat still coded as lymph nodes when the pathology report states, "there is a high likelihood that these represent foci of venous invasion"? See Description.

Patient underwent resection for adenocarcinoma of the rectum. Path final diagnosis stated: "Regional lymph nodes: met carcinoma in 18 of

43 lymph nodes. Pathologic stage (AJCC/UICC 6th edition): pT3, V2, pN2, pMx. See comment." Path comment: "There are additional macroscopic stellate deposits of carcinoma in the pericolic soft tissue. According to the 6th edition of the AJCC staging manual, these should be designated as "V2," indicating that there is a high likelihood that these represent foci of venous invasion."

For cases diagnosed 1998-2003: Each grossly detectable nodule in the pericolonic fat is counted as one regional lymph node.

When the number of deposits is not mentioned, code Number of Regional Nodes Positive as 97 [Positive nodes but number of positive nodes not specified]. Unless the procedure is documented as a dissection, code Number of Regional Nodes Examined as 98 [Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not documented as samping or dissection; nodes examined, but number unknown].

 2003
20031165

Behavior Code/EOD-Extension--Colon: Are extension codes 10 [Mucosa, NOS (incl. Intramucosal, NOS)] and 11 [Lamina propria] in situ, in accordance with AJCC stage for this site?

For cases diagnosed 1998-2003: EOD codes 10 and 11 are invasive. SEER, to be compatible with Summary Stage 77 and 2000, calls EOD extension codes 10 and 11 invasive because invasion of the lamina propria is invasion through the lamina propria/basement membrane and therefore invasive.

According to AJCC, the survivial rates for tumors that invade only the mucosa or lamina propria are similar to Tis tumors, so the AJCC classifies them as Tis.

 2003
20031132 EOD-Lymph Nodes--Breast: Are micrometastases in the lymph nodes, found only on immunohistochemical staining, coded as positive lymph nodes?

For cases diagnosed 1998-2003: Do not code as positive lymph nodes that have micrometastases diagnosed ONLY on immunohistochemistry. By traditional diagnostic methods, these are still negative lymph nodes.

Summary Stage and EOD ignore the IHC positive micrometastases for cases diagnosed through 2003. The collaborative staging system that begins with 2004 cases and is based on the sixth edition of TNM addresses this issue.

 2003
20000249

EOD-Lymph Nodes--Melanoma: Should we assume that positive lymph nodes are regional if the primary site for a melanoma is not identified (i.e., C449)?

For cases diagnosed 1998-2003: Code the EOD-Lymph Nodes field to 8 [Lymph Nodes, NOS].

 2000
20021130

EOD-Extension--Breast: If a negative bone scan is followed by a bone marrow biopsy that is positive for metastatic disease, is the bony involvement used when coding extension [85] or as progression of disease (ignore mets when coding extension)? See discussion.

Pt diagnosed with ductal carcinoma of the breast in May. On June 1, oncologist recommended chemo and XRT and planned a metastatic workup. A June 6 marrow MR consistent with mets. June 8 bone scan showed scoliosis of the L-spine with scattered focal areas of increased activity probably related to degenerative changes in the spine. On June 29, biopsies were done of the T2 vertebra with path diagnosis of metastatic adenocarcinoma consistent with breast primary. Chemo started July 15.

For cases diagnosed 1998-2003, is EOD extension code 85 correct? We felt that the bone mets was found within 4 months of diagnosis and is not progression of disease.

For cases diagnosed 1998-2003: Code the EOD-Extension field to 85 [metastasis]. Bone metastasis was documented during the original metastatic workup. Metastasis to the bone was suspected soon after diagnosis and confirmed prior to the start of treatment. The length of time between the diagnosis and the confirmation of the bone metastasis was not used to code extension on this case. The pt was still being worked up as evidenced by the fact that treatment had not yet started.

 2002
20031068

EOD-Extension--Colon: Is a pathology description of "superficial invasion of the muscularis mucosa in the upper stalk of the polyp" coded in this field to 10 [mucosa (including intramucosal) NOS], 12 [Muscularis mucosa], or 14 [Stalk of polyp]? See Description.

Do we use the highest applicable value because all three definitions are used in the following example? Ex: Path diagnosis: Sigmoid polyp: tubulovillous adenoma with a focus within upper portion of stalk consistent with superficially invasive (intramucosal) colonic adenocarcinoma (see Comment). Comment: ... in the upper stalk region, there is evidence of superficially invasive carcinoma which appears to be limited to the muscularis mucosa and thus would be intramucosal by classification.

For cases diagnosed 1998-2003: Code extension as 12 [muscularis mucosae]. For this case, "upper stalk" is a reference to location rather than extension. This adenocarcinoma extends to the muscularis mucosa.

 2003
20031090

EOD-Size of Primary Tumor/First Course Treatment--Breast: How is tumor size coded when preventative tamoxifen treatment precedes breast cancer diagnosis? Can we code the tumor size from the surgical specimen? Is tamoxifen treatment here? See Description.

What is the tumor size in this situation? Patient is on the STAR trial (preventative tamoxifen for women with high risk for breast cancer). Patient develops breast cancer and has surgery.

For cases diagnosed 1998-2003: Code EOD-Size of Primary Tumor from the surgical pathology report.

Do not code this preventative tamoxifen as first course cancer-directed treatment. This tamoxifen was part of a clinical trial intending to delay or prevent beast cancer from developing.

 2003
20031080 Behavior Code/EOD-Extension--Bladder: How are these fields coded for a bladder tumor in which the pathologist states, "there is no definite invasion identified" but the urologist states the case as T1? See Description.

Patient presents with four bladder tumors, described as "each measuring close to 2 cm." A specimen was taken of only one of the tumors. The tops of the tumors were fulgurated, then vaporized methodically. No obvious tumor or residual was noted on re-inspection.

Pathology revealed papillary urothelial carcinoma, high grade, with no definite invasion identified. Small segments of muscularis propria were present. A comment read..."it is difficult to determine if lamina propria invasion is present due to marked necrosis and tissue fragmentation." Urologist staged this as AJCC cT2a, but based on the pathology findings changed it to cT1. The urologist insists this is invasive.

For cases diagnosed 1998-2003: Because of the damage to the specimen from cautery and the insistence of the urologist that the tumor was invasive, code extension for this case to 15 based on the physician's TNM category of T1.

A T1 is invasive--code the behavior /3. The urologist is confident it is invasive, and will likely treat the patient accordingly.

 2003
20031071 EOD-Extension--Brain and CNS: How does one code this field for a brain primary with drop metastases and/or seeding? See Description.

In the past SEER has advised coding these cases to extension 60. However, SS2000 states to code these cases to distant.

1. Primary in the cerebrum, hypothalamic region, with drop mets to spinal cord.

2. Primary in the cerebellum with spinal cord drop mets.

3. Primary in the fourth ventricle, with drop mets along the spinal cord.

For cases diagnosed 1998-2003: Assign extension code 85 [Metastasis] for drop metastases and/or seeding of the spinal cord from a brain primary.

Assign code 85 to each of the three cases above.

 2003
20000247 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.

 2000