EOD-Extension--Kidney: How would this field be coded when the pathology report shows a 20 mm surface neoplasm with smaller yellow metastatic implants on the surface of the kidney?"
For cases diagnosed 1998-2003: Code extension as 10 [Invasive cancer confined to kidney cortex]. Tumor involves the cortical surface of the kidney with separate surface lesions, but does not extend beyond cortex.
Surgery of Primary Site/Immunotherapy--Bladder: Is administration of BCG coded as both surgery and immunotherapy?
Yes, code as both surgery and immunotherapy. The CoC included immunotherapy/BCG under surgery and also under immunotherapy by request of the clinical advisor for bladder, reflecting the mixed-modality nature of the treatments. [Answer from CoC I & R]
Date of diagnosis: Can a positive VMA:HVA test be used as a date of diagnosis for neuroblastoma? See Description.
Rubin's Clinical Oncology states: Both the catecholamines and their metabolites are used as markers for neuroblastoma, with vanillylmandelic acid (VMA) and homovanillic acid (HVA) being the most commonly used. While their absolute values are not of prognostic significance, a higher VMA:HVA ratio suggests a better prognosis for patients with disseminated disease.
Updated answer July 2024
No. Do not code the neuroblastoma diagnosis date from only the date of an elevated urine catecholamine test (VMA or HVA). Neuroblastoma diagnosis should be made on the basis of tissue biopsy or bone marrow aspiration along with elevated urinary catecholamines. Elevated urinary catecholamines alone are not diagnostic of neuroblastoma.
Other Therapy: How do we classify "thalidomide" when it is given as cancer directed therapy?
Code to the appropriate code (1, 2 or 3) under Other Therapy, depending on whether the drug was given as part of a clinical trial. If not part of a clinical trial, assign code 1 [Other cancer-directed therapy].
Thalidomide is not FDA approved for treating cancer. It is under investigation for anti-angiogenesis effects in different cancers.
Multiple Primaries (Pre-2007)--Breast: For a patient with a remote history of lobular breast carcinoma, would a new diagnosis of lobular breast carcinoma with DCIS be a new primary, even though the physician designates it as recurrent? See Description.
A history of right breast lobular ca in 1991 treated with a partial mastectomy. Diagnosed 3/02 with "recurrent right breast ca" per physician; pathology in 2002 is lobular and DCIS.
Would the DCIS make this a new primary regardless of the physician's designation of 'recurrent' or is this the same primary?
For tumors diagnosed prior to 2007:
Accession as two breast primaries -- the first lobular ca in 1991; the second lobular and DCIS in 2002.
The differing histologies and the length of time between them negate the physician's designation as "recurrent" in this case.
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.
Primary site: How is this field coded for a malignant spindle cell neoplasm in a subcutaneous mass of the right knee? See Description.
The pathology report says: Right knee tumor:
A. discrete subcutaneous mass 3.5x5.2x1.4 cm malignant spindle cell neoplasm (see Comment)
B. A focus of subcutaneous malignant neoplasm is identified in the superior resection margin.
C.All other margins are clear.
The comment mentions that the specimen has been sent to Mayo Clinic and the Mayo clinic consult says, "we still believe that the diagnosis of spindle cell carcinoma is correct. Obviously the differential diagnosis involves melanoma and sarcoma also. The results of the immunoperoxidase stains strongly support the prior diagnosis of a carcinoma."
Code the site to C49.2 [Connective, subcutaneous and other soft tissues of lower limb and hip]. The site is a subcutaneous mass. C49 with 8032/3 will not be impossible following the next updates to the SEER edits.
EOD-Extension--Thyroid: Is this field coded as involvement of the thyroid capsule if the thyroidectomy path specimen reveals papillary thyroid ca "tumor present within capsular blood vessels?"
For cases diagnosed 1998-2003: Tumor present within the blood vessels of the thyroid capsule is localized (extension code 30). The tumor has not penetrated the capsule itself if it is contained within the blood vessels.
Keep in mind that tumor size determines the extent of disease for thyroid extension codes 10, 20, 30 and 40.
EOD-Clinical Extension--Prostate: Is this field coded to 15 [Tumor identified by needle biopsy for elevated PSA] when it is unknown whether or not a TRUS was done? See Description.
Patient was admitted for radiation therapy for prostate cancer. H&P states that patient had elevated PSA. PE showed benign feeling prostate. Stage is clinical T1c. There is no mention of whether or not TRUS had been done.
For cases diagnosed 1998-2003: EOD extension code 15 is correct for this case example. When there is no other documentation available, the AJCC stage may be used to determine extension.
Histology (Pre-2007)/Sarcoma: What code is used to represent the histology "Ewing's Sarcoma/Primitive Neuroectodermal Tumor (PNET)"? See Description.
A comment on one path report states "some authors consider both Ewing's & PNET to be the same biologic entity given that they share the same translocation between chromosomes 11 & 22." The pathologists at our children's hospital agree with this statement and contend that the two should have the same histologic code.
For tumors diagnosed prior to 2007:
Code histology as 9260/3, Ewing sarcoma. Ewing sarcoma is a specific histology on the continuum of primitive neuroectodermal tumors. Code Ewing sarcoma as it is more specific than PNET, NOS.
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.
Multiple Primaries (Pre-2007): Is a small bowel carcinoid diagnosed 10 years after the diagnosis of metastatic carcinoid of unknown primary site a new primary or a new recurrence? See Description.
A patient was diagnosed in 1991 with metastatic carcinoid to liver-no primary found. In 2001, the patient is diagnosed with small bowel carcinoid at another hospital. Hospital 2 has no other information.
For tumors diagnosed prior to 2007:
Code as two primaries unless there is a physician's statement that the liver lesion is metastatic from the later small bowel carcinoid. Without such a statement regarding lesions 10 years apart, do not make an assumption that one is metastatic from the other.
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.
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