Reason for No Cancer-Directed Surgery--Lung: How do you code this field for a lung primary that presents with metastasis to the bone and brain in which the oncologist's treatment plan includes only radiation and chemotherapy?
Code the Reason for No Cancer-Directed Surgery field to 1 [Cancer-Directed Surgery Not Recommended].
Surgery of Primary Site: Should laparoscopy be coded as exploratory surgery? See discussion.
Many surgeons are doing exploratory surgery with laparoscopy involving a very small incision, but they can examine organs and take biopsies. Should laparoscopy be coded as exploratory surgery?
For cases diagnosed 1/1/1998 and later: Exploratory surgical procedures, such as laparoscopic surgeries, are not coded in the Surgery of Primary Site field.
Extension/Ambiguous terminology: How should the terms "entrapped by tumor" and "encased by tumor" be interpreted when coding these fields?
Each case must be reviewed in its entirety to determine the appropriate coding of these fields. However, in general the terms "entrapped" and "encased" should NOT be interpreted as involvement unless there is other clinical or pathologic evidence to support involvement.
EOD-Extension--Stomach: What code is used to represent this field for a stomach primary described as linitis plastica?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 30 [Localized, NOS], unless more information is known about the extent of tumor involvement. Coding the Histology field to 8142/3 [Linitis plastica] and the Size of Primary Tumor field to 998 [Diffuse; widespread; 3/4 or more: Linitis plastica] identifies this diagnosis.
In the EOD-Extension field, the depth of invasion is the important characteristic to be coded. The 10 digit EOD corresponds to the AJCC Staging Manual in which the "T" is based on level of invasion. While a diagnosis of linitis plastica indicates a worse prognosis, it does not define the extent of infiltration. There is no luminal mass with linitis plastica. Instead, the entire gastric wall is thickened by tumor.
EOD-Extension/EOD-Lymph Nodes--Bladder: Are "perivesical nodules" coded in the EOD-Lymph Nodes field or are they discontinuous extension and coded in the EOD-Extension field?
For cases diagnosed 1998-2003:
Code "perivesical nodules" in the EOD-Lymph Nodes field as involvement of regional lymph nodes. Each gross nodule of metastatic carcinoma in the fat surrounding an organ is counted as one positive regional lymph node.
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.
Primary Site--Esophagus: What is the difference between C15.5 [Lower third of esophagus] and C15.2 [Abdominal esophagus]?
These descriptions represent the use of two different ways the esophagus can be divided anatomically. The two different systems used are illustrated in the SEER Self Instruction Manual for Tumor Registrars: Book 4. Assign the primary site code that describes the location of the tumor in the same way the tumor's location is described in the medical record.
EOD-Clinical Extension--Prostate: In the SEER EOD manual, there is a list of terms to distinguish apparent from inapparent tumor for prostate primaries. If a physician uses a term not currently on the list or if a physician uses a list in the "maybe" category, should we assume the tumor to be clinically inapparent or clinically apparent tumor?
For cases diagnosed 1998-2003:
If the physician used a term not on the clinically apparent/inapparent list, ignore that term and use the best information available from other sources to code the EOD-Extension field.
If clarifying stage information is missing and the term is in the maybe category or the term is not on the list, then code EOD-Extension as 30 [localized, NOS] for cases that appear localized.
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.
Surgery of Primary Site--Skin: Explain the difference between code 30 and code 45.
Code 30 [Biopsy of primary tumor followed by a gross excision of the lesion]
Code 45 [Wide excision or re-excision of lesion or minor (local) amputation with margins more than 1 cm, NOS. Margins MUST be microscopically negative.]
For cases diagnosed 1/1/2003 and after: Code 30 represents a biopsy or excision in which the margins of excision are less than 1 cm or the margins are unknown. Code 45 represents a wide excision in which it is known that the margins of excision are greater than 1 cm.
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