EOD Fields--All Sites: Is EOD information limited to what is available exactly two months from the day of diagnosis?
For cases diagnosed 1998-2003:
EOD should include all information available within four months of diagnosis in the absence of disease progression or through completion of surgery(ies) in first course of treatment, whichever is longer.
Mets known to have developed after EOD was established should be excluded.
EOD-Extension--Ovary: What code is used to represent this field for an ovarian primary presenting with "spread to the omentum"?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 75 [Peritoneal implants, NOS] because the size of the implants on the omentum is not known.
Note 6 was added to the EOD scheme which states that both direct extension and discontinuous metastasis to the omentum are coded in the range 70-75 depending on how the peritoneal implants are described.
Multiple Primaries (Pre-2007): Is an in situ tumor followed by another in situ tumor in the same location a new primary? See discussion.
Example: Six months after an in situ lesion was excised from the buccal mucosa, another in situ lesion was excised from the same area of the buccal mucosa with no mention of it being recurrent.
For tumors diagnosed prior to 2007:
Code as a second primary if the second in situ tumor occurred more than 2 months after the first, and it is not referred to as recurrent by the clinician or pathologist. There are no special rules for determining the number of primaries when an in situ lesion follows an in situ.
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.
EOD-Size of Primary Tumor--Breast/Cervix: When coding tumor size, when do you use 997 for breast cases and 000 versus 999 for breast and other primaries? See discussion.
Example 1: Ductal carcinoma found in axillary lymph nodes. No tumor found in breast on physical exam or by pathological exam of the breast, but physician states that the breast is definitely the primary site.
Example 2: Paget disease for breast carcinoma with no underlying tumor.
Example 3: Inspection of the cervix shows no visible tumor; biopsy of the cervix reveals CIN III or squamous cell carcinoma, either invasive or in situ.
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field as follows:
Example 1: Code to 000 [No mass, no tumor found, no Paget disease] when a tumor of a stated primary site is not found, but the tumor has metastasized.
Example 2: Code to 997 [Paget disease of nipple with no demonstrable tumor] if there is no underlying tumor and the patient presents with Paget of the breast.
Example 3: Code to 999 [Size not stated] when no size of tumor is given on the pathology report. Do not use 000 in the size field when a tumor is not visible on physical exam or by imaging, but tumor is found microscopically.
Grade, Differentiation--Brain and CNS: Can grade IV be implied for brain primaries with the histology of glioblastoma multiforme, even if there is no statement of grade in the path report? See discussion.
Dr. Platz has instructed the Iowa registry to code glioblastoma multiforme to grade IV, even when there is no corroborating statement of grade in the path report. This is also supported in some references.
Code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable] in the absence of a stated grade on the pathology report. If a grade is stated, code the stated grade. SEER does not recommend adopting the rule in the Discussion.
Histology (Pre-2007): What code is used to represent the histology "non-small cell carcinoma, NOS"? See discussion.
Should a non-small cell carcinoma histology be assumed to be a large cell carcinoma [8031/3] or should the histology be coded to carcinoma, NOS [8010/3]?
For tumor diagnosed 2001-2006: Code the Histology field to 8046/3 [non-small cell carcinoma].
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.
EOD-Extension: General instructions, page 7, note 3 states: " Extent of disease information obtained after treatment with neoadjuvant chemotherapy, hormone or immunotherapy has begun may be included." Because the SEER manual does not mention radiation treatment, can we use information from a lobectomy to code EOD if a patient has neoadjuvant radiation therapy?
Radiation therapy was inadvertently omitted from the list. Please see SINQ 20031012 answer as to when the surgical information can be used to stage the case.
Measured Thickness/EOD-Extension--Melanoma: If the Clark's level is not provided, can it be estimated using the depth of invasion provided in the pathology report and associating that number with the Clark's levels identified in the SEER Summary Staging Guide?
For cases diagnosed 1998-2003:
No. Do not use the SEER Summary Stage Guide or any other guide to derive an estimated Clark's level from the thickness identified in the pathology report. The two measurements need to come directly from the pathology report. Each is coded separately in EOD. Thickness is collected in a separate field so we can capture the actual measurement stated in the pathology report. This has made it possible for us to group depth of invasion for analysis purposes in any manner we might wish. In addition, we can always collapse this information to the Summary Stage or TNM using the AJCC rules. AJCC rules use both depth of invasion and thickness in determining pathologic staging, and, if there is an inconsistency between them, the rules say code to the higher T classification, that is, the least favorable finding.
EOD-Size of Primary Tumor--Melanoma: How do you code tumor size for a melanoma diagnosed by a positive lymph node biopsy when the primary site is coded C44.9 because no primary site was identified? See discussion.
Should the size be 000 because no primary was found or 999 for unknown?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 000 [No mass; no tumor found] when primary site is coded to C449.
Multiple Primaries (Pre-2007)--Ovary/Endometrium: Is endometrioid adenocarcinoma occuring simultaneously in the left ovary and the endometrium one primary or two? See discussion.
Pathology Final Diagnosis:
Left Ovary: Moderately differentiated endometrioid adenocarcinoma squamous differentiation grade 2 (scale of 3)
Uterus: Moderately differentiated endometrioid adenocarcinoma with squamous differentiation, grade II (scale of III). Focal, very superficial invasion to inner third myometrium with extension to lower uterine segment. Endocervix, cervix, right ovary and fallopian tubes negative for tumor.
For tumors diagnosed prior to 2007:
Code the case you describe as two primaries. The endometrioid adenocarcinoma can arise in the endometrium without a concomitant ovarian carcinoma.
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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