Q&A Session
Collecting Cancer Data: Ovary
November 03, 2011
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Q: Can you stress that ambiguous terms plus terms that are not reportable does not constitute diagnosis; for example, suspicious mass or probable growth.
A: Very good point. Mass and growth alone do not indicate malignancy even when described with a positive ambiguous term. So, a suspicious mass of the breast is not a reportable disease. However, if the statement was mass of the breast suspicious for malignancy, it would be reportable because the positive ambiguous term modifies malignancy.
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Q: For the date of diagnosis when you have 'suggestive of cancer' in January and in February they do a biopsy that proves patient has cancer, what would your date of diagnosis be? Can you take it back to January, when 'cancer' was first mentioned?
A: The diagnosis date should be the date the cancer was proven using terminology that constitutes a diagnosis of cancer. In this case, the diagnosis date would be February unless the physician documents that in retrospect the patient had cancer at the earlier date.
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Q: If you have cytology that is suspicious for malignancy followed by a positive biopsy, is the diagnosis date the date of the cytology or biopsy?
A: The diagnosis date in this example would be the date of the positive biopsy.
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Q: Do we override a gyne oncologist's statement "M1 due to massive pleural effusion" without positive pleural cytology and NOT code pleural metastasis?
A: We will send this question to standard setters.
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Q: Does the rule regarding not using cytology as diagnostic only apply to ovary?
A: If cytology is identified only with an ambiguous term, do not interpret it as a diagnosis of cancer. This applies to all sites. However, note this is in reference to the use of ambiguous terms. Cytology can be diagnostic if ambiguous terms are not used.
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Q: Can the word likely on its own be used to determine a histology?
A: No. Per a SINQ question, likely on its own should not be considered a diagnostic modifier.
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Q: if statement is "ascites suspicious for adenocarcinoma" do we consider this a positive diagnosis?
A: On its own, no. I would try to get further clarification on this. The pathologist may mean that the patient has malignancy and they suspect adenocarcinoma. It's worth checking, but without clarification you would have to say no it's not reportable.
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Q: If you are working in a central registry and all you have is a cytology report for pleural fluid that states suspicious for adenocarcinoma suggestive of lung primary is the case reportable or not?
A: The case in this question is not reportable.
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Q: If a physician interprets the "worrisome" on a CT to be metastatic involvement we would then code as such correct?
A: Good point! If the CT scan documents worrisome, it is not reportable. However, if a physician looks at that CT and interprets it as metastasis, we would consider it metastasis.
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Q: In the lists of ambiguous terms for staging, what is the difference between adherent and attached?
A: Other than the fact that one is on the list indicating involvement and one is not, I don't know!
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Q: Mass and lesion are synonymous terms with neoplasm and tumor for the multiple primary and histology (MPH) coding rules, but those terms are not included on the reportable list. We have been advised per our state that these terms are reportable terms. Is that correct?
A: Mass and lesion are synonymous with neoplasm and tumor when it comes to determining one primary or multiple primaries per the MPH rules. However, the MPH rules should not be used to determine reportability. SEER specifically states that in their manual. Per SEER coding manual, page 4, "A brain/CNS neoplasm identified by diagnostic imaging is reportable even when no other information is available (from biopsy or resection, for example)". The terms "mass" or "lesion" are not in the list of ambiguous terminology and cannot be used alone, but if supported by additional terms such as "malignant" or "suspicious for malignancy/cancer/metastases", etc., the case is reportable. The CoC refers to this on the CAnswer forum. However, if your state registry wants to require them, they can. However, they should not include them in their counts of benign and borderline brain tumors.
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Q: Patient has imaging of the brain that shows a tumor (8000/1) on 1/1/2010. On 1/10/2010 they have a bx of the tumor and it comes back as glioblastoma multiforme (9440/3).
What is the dx date and what is the method of dx?
A:Diagnostic date would be 1/1/2010 because it is the first date a medical practitioner suspected a neoplasm. The definitive DX method would be histology (1) because there is only one primary, the glioblastoma multiforme and also because we code the diagnostic method in a hierarchical manner, with 1 having the highest priority. The imaging was part of the workup. (Per Carol Johnson at SEER)
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Q: Final diagnosis is borderline tumor of the ovary; however on path comments it is stated that there are implants consistent with intraepithelial carcinoma. What do we do? Does this make the case reportable? What is the histology code?
A: The implants make this a reportable case. If the implants are from the ovary, the behavior of the histology is /3 (malignant).
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Q: An attendee has the following question: “Path report states high-grade sarcomatoid carcinoma in association with seromucinous cystadenocarcinoma. What is the histology code?
A: Shannon and I both came up with the histology code 8323/3. First we assigned histology code 8033/3 to sarcomatoid carcinoma. To get the histology for seromucinous cystadenocarcinoma, use rule H16. Serous and mucinous adenocarcinoma are assigned histology code 8323/3, mixed cell adenocarcinoma. We then ran 8323/3 and 8033/3 through the rules and stopped at rule H17 which told us to code the higher histology code, 8323/3.
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Q: Referring to slide concerning ovary metastasis to parenchyma, the data item, CSMets atDX(Liver) will be coded to 1 as well. However, is it correct that involvement of the liver surface would not be coded in CS Mets at DX (Liver)?
A: If there is metastasis to liver parenchyma from ovarian primary, assign code 1 to CS Mets at DX (Liver). If the liver metastasis from ovary is only on the surface or serosa of liver, CA Mets at DX (Liver) is coded 0.
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Q: Regional lymph nodes for ovary: if you have positive mesenteric lymph nodes would they be considered regional or distant? I believe this question was asked to I and R & they said distant because they were not specifically listed. Which is correct?
A: This was sent for clarification
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Q: Please address the term 'carcinomatosis'. This term is listed under CS Mets at DX code 40. Should it ever be coded to CS Extension depending on the location of the 'carcinomatosis'?
A: Carcinomatosis to pelvic or abdominal (intraperitoneal) organs with an ovarian primary should be coded in CS Extension as implant or seeding.
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Q: Code 40 in CS Mets at DX includes the description "carcinomatosis". Do we code carcinomatosis, NOS, in CS Extension or in CS Mets at DX?
A: Carcinomatosis means widespread metastasis. For ovary if the carcinomatosis is limited to the abdomen and pelvis, code in CS Extension. If metastasis is extraperitoneal, code in CS Mets at DX.
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Q: Is involvement of the parenchyma of the spleen considered T3 or M1 disease?
A: Note 7 preceding the CS Extension codes documents that discontinuous metastasis to any of the following abdominal organs by way of peritoneal seeding or implants is included in the T3 category (FIGO Stage III) and coded in CS Extension. It lists spleen but does not differentiate between spleen and parenchyma of spleen like it does for liver.
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Q: Is FIGO stage the same as FIGO grade? Pathologists here use only grade.
A: No; FIGO stage and FIGO grade are not the same thing. FIGO stage describes the spread of the primary gynecologic cancer, and FIGO grade describes the structure and growth patterns of the cancer cells.
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Q: A case is stated as FIGO grade 2 with pathologic stage group IA. Can I assume that IA corresponds to a FIGO stage?
A: I would assume pathologic stage group IA refers to AJCC stage. AJCC should not be converted to FIGO stage.
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Q: There is no choice for no residual tumor in SSF4. What do you select if there is no residual tumor?
A: In CS v02.03 the best code is 999. I believe a code will be added for no residual tumor in v02.04.
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Q: I want to make sure that I understand your answer for CS SSF 4.Even if chemo is given and there is residual tumor, why would code 170 be used?
A: Unfortunately, there is no code for residual tumor in diaphragm and chemo given. Code 170 is the best choice to get the information about location of residual tumor. However, we will lose the information about pre-op chemo.
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Q: In reference to the scenario given for SSF 4 when selecting code 170, will the NAACCR edits package note an error when the chemo code is coded as treatment before surgery?
A: Not currently.
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Q: What code should be used for SSF5, malignant ascites, if patient does not have any ascites?
A: Assign code 999in SSF5 if the patient does not have ascites.
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Q: For SSF5 when would you use code 988?
A: If SSF5 is not required by your standard setters and you choose not to abstract the data item, assign code 988.
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Q: If the physician documents the surgery as Tumor Reduction Surgery without the actual terminology we usually see (cytoreductive or debulking), do we consider it to be a cytoreductive surgery?
A: Sent for clarification.
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Q: What if the patient had a TAH/BSO with omentectomy with a debulking? What would we code?
A: Code the highest code, which is the code for debulking.
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Q: Patient had laparoscopic total hysterectomy followed by right salpingo-oophorectomy with staging biopsies. What is the code for these procedures done on 2 separate dates?
A: Sent for clarification
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Q: In scenario 1, please explain why CS Mets Eval is coded to 1, rather than 0?
A: Good question. We decided to go with 1 based on the evaluation of the liver. We felt that the surgeon evaluated for more than just surface metastasis that justified use of code 1. ______
Q: In case scenario 2, Regional Nodes Examined is coded to 98 which is no nodes examined. Shouldn't the code for unknown be assigned?
A: Code 98 is used for RegionalNodes Examined when nodes are surgically removed but it is not known how many and not known if the removal was a dissection or sampling, which is the case in case 2.
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Q: For case scenario 2, why is the size of the cyst included in tumor size?
A: 4a) Always code the size of the primary tumor, not the size of the polyp, ulcer, cyst, or distant metastasis. However, if the tumor is described as a “cystic mass,” and only the size of the entire mass is given, code the size of the entire mass, since the cysts are part of the tumor itself - Part I Section I coding instructions for CS Tumor Size.
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Q: Should the code for Regional Nodes Examined in case scenario 2 be 97?
A:The description for code 97 for Regional Nodes Examined is regional lymph node removal documented as dissection and number of nodes unknown or not stated. The description for code 98 is regional lymph nodes surgically removed but number of lymph nodes unknown or not stated and not documented as sampling or dissection. I believe 98 is the better code for Regional Nodes Examined in case scenario 2 because the number of nodes examined is not known and it is not documented whether the procedure performed was node sampling or node dissection. ______