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Report Produced: 04/03/2025 22:26 PM

Report Question ID Question Discussion Answer Year
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
20010167 EOD Fields--Lymphoma: Was MALT Lymphoma [9715/3 (ICD-O-2) and 9699/3 (ICD-O-3)] inadvertently excluded from SEER EOD manual, top of page 180?

For cases diagnosed 1998-2003:

Yes. Use the scheme on page 180 for MALT lymphoma. The ICD-O-2 morphology code 9715 was omitted in error. It should have been added when the EOD was printed in 1998.

 2001
20000535 EOD-Pathologic Extension--Prostate: Is extracapsular extension implied by the following phrases: "case staged as C" and "case staged as T3a"? See discussion.

Example: A prostatectomy was done on 6/29. The physician staged the case as a "C" on 7/2 and as T3a on 8/6. It appears the physician is interpreting the following pathology information as unilateral extracapsular extension: "The tumor on the right extends to the inked surface of the gland. In this area the capsule appears absent." Should pathologic extension be coded to unilateral extracapsular extension [42]?

For cases diagnosed 1998-2003:

Yes. Use the best information available to stage this case. In this case, the best information is the physician's statement that the case is stage T3a. Without any additional information, the EOD-Extension field is coded to 42 [Unilateral extracapsular extension (pT3a)] on the basis of the T3a stage by the MD. When there is a conflict between different staging systems, default to the AJCC stage.

 2000
20000485 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.

 2000
20021060 EOD-Size of Primary Tumor: The EOD Manual instructs us not to code the size of a cyst. Can we code the size of tumor lesions described as being multicystic, multiloculated, or as a complex mass with cystic areas? See discussion.

Example 1: Large multicystic ovarian mass lesion measuring 10 cm. Sections through the specimen show a multicystic and solid mass with abundant fluid exuding from the cut surfaces (Size of the solid portions is not stated).

Example 2: A brain MRI: 9-cm. complex mass with cystic areas.

For cases diagnosed 1998-2003:

Yes, if the cystic mass is pathologically confirmed to be malignant, code the EOD-Size of Primary Tumor field based on the size of the mass in the absence of a more precise tumor size description. For the examples in the discussion section, code the EOD-Size of Primary Tumor field to: 1) 100 [10 cm]. 2) 090 [9 cm].

As a point of interest, the size of tumor for ovarian and brain primaries is not used in either analysis or as a prognostic indicator for survival. Therefore, spending time separating the cystic and solid portions of the tumor is unnecessary.

 2002
20000428 EOD-Clinical Extension--Prostate: How do you distinguish between clinical extension codes of 10, 13, 14, and 20 for cases with a benign prostate per digital rectal exam that appear localized after TURP/prostatectomy? Can the clinical extension code of 10 be used if the term "microscopic carcinoma" is noted in the pathology report without also mentioning "foci" or "Stage A" for clinically inapparent tumors?

For cases diagnosed 1998-2003:

When the prostate feels benign and the cancer is found incidentally at the time of the microscopic exam, code the EOD-Extension field to 10 [number of foci or % of involved tissue not specified]. Code as 13 (less than or equal to 5%) or 14 (greater than 5%) if percentage involved is given in the tissue resected. If the path report states "solitary focus of carcinoma" without mentioning the total amount of tissue resected, code extension to 13. If there is more than one focus, code extension to 10. Don't assign a code of 20 unless the tumor is clinically apparent.

 2000