Grade--Liver: How should grade be coded for a liver lesion treated with radio frequency ablation (RFA) followed by a transplant showing moderately differentiated hepatocellular carcinoma? See discussion.
The SEER Manual emphasizes the importance of coding grade only prior to neoadjuvant treatment as systemic treatment and radiation can alter a tumor's grade. This patient did not have neoadjuvant chemotherapy or radiation, but did undergo a prior surgical procedure (RFA) in an attempt to destroy tumor tissue. The subsequent transplant showed residual moderately differentiated HCC.
For this case, record the grade specified even though it is after RFA. RFA is not systemic or radiation treatment and should not alter the grade.
Grade, Differentiation--Bladder: How is this field coded for a five grade system? See Description.
Example: Invasive, high grade transitional cell carcinoma (Grade 4-5/5)
For this example, code grade as 4 based on the term "High grade." If "high grade" was not stated, the grade would be coded as 9, not determined. There is no SEER translation between the ICD-O grades and a five grade system for bladder. None of the pathololgist experts we querried knew of a five grade system for bladder.
EOD-Size of Primary Tumor--Breast: When the pathology report does not specify dimensions for the invasive component, how is tumor size coded? See discussion.
In some cases the tumor has both invasive and in situ components. The pathologist sometimes does not report the size for the invasive portion of the tumor. In most cases, the invasive portion is described as a percentage of the tumor mass.
From January 1, 1998 and forward: Follow the Revised Breast EOD instructions. If the size of the invasive component is not given, record the size of the entire tumor in the EOD-Size of Primary Tumor field. Assign the appropriate EOD-Extension code for the situation.
Histology--Ovary: How is histology coded for an ovarian mucinous neoplasm of low malignant potential (borderline mucinous cystadenoma) that shows extensive intraepithelial carcinoma and focal microinvasion? See Discussion.
At surgery a 25 cm left ovarian mass is found adherent to the anterior abdominal wall. The final diagnosis per the pathology report is, "Mucinous neoplasm (26 cm) of low malignant potential (borderline mucinous cystadenoma) with extensive intraepithelial ca and focal microinvasion. Right ovary, fallopian tubes, uterus, omentum, biopsies of diaphragm, 28 para-aortic and pelvic LNS and peritoneal fluid are all negative for malignancy."
Histology code 8470/3 [mucinous cystadenocarcinoma] is the best choice in this case. There is a mucinous cystadenoma [8470/0] with intraepithelial carcinoma and focal microinvasion. 8470/3 comes as close as possible to the description of the tumor.
Hormone Therapy--Hematopoietic, NOS: Is hormonal therapy coded for myelodysplastic syndrome, NOS? See Description.
Patient with myelodysplastic syndrome refused chemotherapy and was treated with high dose steroids. Patient also received Rituxan.
Hormones, such as glucocorticoids and androgens, are generally of little if any benefit to patients with myelodysplastic syndrome, according to the NCI PDQ. Do not code steroids as treatment in the example above.
Multiplicity Counter: Are in situ tumors diagnosed more than 60 days after invasive tumors of the same site and histology included in the Multiplicity Counter?
If an in situ tumor following an invasive tumor is a single primary according to the multiple primary rules for that particular site, include the in situ and the invasive tumors in the multiplicity counter.
Laterality--Brain and CNS: When a meningioma extends to both right and left sides, is laterality coded 4 for bilateral or 9 for midline? See Discussion.
Operative Findings: Bilateral frontal craniotomies for excision of giant meningioma which extended onto optic chiasm.
Path: Bifrontal tumor, 6.5 cm meningotheliomatous meningioma.
If it is not possible to determine whether the meningioma originated on the left or the right, assign code 4 [Bilateral involvement, lateral origin unknown; stated to be single primary].
Surgery of Primary Site/Date Therapy Initiated--Head & Neck: Would a biopsy, NOS, that removed the majority of the tumor be used to code these fields? See Description.
Patient underwent biopsy, NOS, of a carcinoma of the tongue. Subsequent glossectomy revealed microscopic focus of residual squamous cell carcinoma.
If the biopsy NOS removed all macroscopic disease, code the date of the biopsy NOS as the date therapy initiated. If macroscopic disease remained following the biopsy NOS, code the glossectomy date as the date therapy initiated.
Heme & Lymphoid Neoplasms: How is cancer status to be coded when a patient diagnosed with MDS, undergoes treatment, but the MDS subsequently transforms to AML?
If the bone marrow no longer shows evidence of MDS, the cancer status for the MDS is disease-free. When cancer status is coded as disease-free (NED), it means that currently there is no clinical evidence of this disease (MDS).
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