Tumor Markers--Breast: If the ERA/PRA results reported differ for separate breast specimens removed for a single primary, do we code the results as positive or negative?
For cases diagnosed 1998-2003:
Code both the Tumor Marker 1 and Tumor Marker 2 fields to 1 [positive] when a single primary breast tumor has both positive and negative ERA/PRA receptors.
EOD-Size of Primary Tumor/EOD-Extension--Breast: How do you code extension when the tumor in the breast is in situ and the regional axillary lymph nodes are positive? See discussion.
For example, what extension code is used for a 4.5 cm DCIS (no invasive ca found in excisional biopsy or mastectomy specimen) with mets to 01/07 LNs?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 045 [4.5 cm]. Document how the size was determined in the EOD-Extension field.
Code the EOD-Extension field to 16 [Invasive and in situ components present, size of entire tumor coded in Tumor Size (size of invasive component not stated) AND proportions of in situ and invasive not known]. By virtue of the lymph node metastasis, this must be an invasive breast carcinoma. The size of the invasive component is unknown.
Multiple Primaries (Pre-2007)--Breast: When simultaneously diagnosed breast tumors of the same histology in the same breast are stated by the pathologist and/or clinician to be more than one primary, should these be reported as multiple primaries? See discussion.
For example, based on special pathology studies that showed a difference in appearance between tumors, a pathologist may state that two ductal, NOS tumors diagnosed at the same time in the same breast represent two primaries.
For tumors diagnosed prior to 2007:
Code as a single primary. Follow the guidelines in the SEER Program Code Manual for determining multiple primaries. Simultaneous multiple lesions of the same histologic type in the same site (same breast) are a single primary for SEER, even though the pathologist may perform special studies and state that the patient has more than one primary.
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)--Head & Neck: How many primaries are represented when a1998 invasive squamous cell carcinoma of the true vocal cord is followed by a 1999 diagnosis of in situ squamous cell carcinoma of the true vocal cord (called "recurrent" by the clinician), and in 2001 there is another invasive squamous cell carcinoma of the true vocal cord (no statement of recurrence)? Would your answer be any different if no statement of "recurrent" had been made in 1999?
For tumors diagnosed prior to 2007:
Code this case as two primaries, an invasive true vocal cord primary in 1998 and another invasive true vocal cord primary in 2001.
If there had been no statement of recurrence for the 1999 in situ diagnosis and the 1999 diagnosis was more than two months following the 1998 diagnosis, this case would be coded as three primaries.
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.
Measured Thickness--Melanoma: Can in situ melanoma cases have "depth of invasion" coded to something other than 999? See discussion.
Biopsy of the left arm: Melanoma, 0.2mm in thickness. The in situ component extends to a peripheral margin.
For cases diagnosed 1998-2003:
Code the Measured Thickness (depth) field to 020 [0.2 mm] for this case.
In situ disease can have a depth of invasion because the surface epithelium can be of varying depths without the melanoma breaking through the basement membrane.
Surgery of Primary Site/First Course Treatment--Liver: If disease progression is so rapid that the initial therapy plan is changed before patient receives any therapy, would "no therapy" be the first course? See discussion.
Patient was diagnosed with liver cancer on 8/23 and on 9/6 a hepatectomy was recommended. However, patient was hospitalized on 9/19 with ascites. Patient underwent embolization instead of a hepatectomy during that admission.
Code the "embolization" (or hepatic artery embolization, HAE) in Surgery of Primary Site. Assign code 10 [local tumor destruction, NOS].
The embolization is coded as first course of therapy for this case because it seems that this patient was not adequately staged until 9/19 -- there is no indication on this case of the stage of disease in August or early September. Furthermore, no treatment was started before the embolization. Therefore, the ascites is not "progression of disease" in this case -- it is taken into account as part of the initial stage of disease.
This procedure was previously coded as other therapy, experimental. Code as surgery as of July 2005.
Primary Site: Can we assume the primary site for "chordoma" is soft tissue if the bone is not stated to be involved?
Default the coding of the Primary Site field for chordomas to the bone where the tumor began in the body if the primary site is not clearly stated to be soft tissue. Bone is often the primary site for chordomas.
Based on advice from pathologist consultants: This is one of those situations where we can be quite comfortable with a default, in this case to bone, not soft tissue. Chordoma is a tumor arising in the nucleus pulposis, presumably from remnants of notochord - thus its exclusive origin is in the sacrococcygeal region, spheno-occipital region, and vertebral bodies, otherwise known collectively as the axial skeleton. Any "chordoma" in soft tissue (with no relationship to axial skeleton) is probably a myxoid chondrosarcoma or parachordoma (extremely rare).
Histology (Pre-2007)--Corpus Uteri: What code is used to represent the histology "endometrioid carcinoma with squamous differentiation" for an endometrium primary?
For cases diagnosed 2004-2006:
Endometrioid adenocarcinoma with squamous differentiation is coded 8570 [Adenocarcinoma with squamous metaplasia].
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.
Histology (Pre-2007)/Diagnostic Confirmation: What code is used to represent the histology that initially presents on uterine curettage as a hydatidiform mole and after pulmonary metastases develop a month later, the clinical diagnosis is "metastatic gestational trophoblastic disease"?
For tumors diagnosed prior to 2007:
Code the Histology field to 9100/3 [Choriocarcinoma]. Gestational trophoblastic neoplasia includes the diagnosis of choriocarcinoma.
Code the Diagnostic Confirmation field to 8 [Clinical diagnosis only] based on the information above. However, if imaging, direct visualization, or another method identified the pulmonary metastases, then code the Diagnostic Confirmation accordingly.
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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