Q&A Session for Collecting Cancer Data: Esophagus and Stomach
Thursday, June 03, 2010
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Q: Re: EGJ, What do we do if there is no mention of the midpoint of the tumor?
A: Assign code 040 (Esophagus or EGJ involved AND distance of tumor midpoint from EGJ unknown) in SSF25 [Involvement of Cardia and Distance from Esophagogastric Junction (EGJ)].
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Q: On the MP/H slide for Rule H16 it indicates "small adenocarcinoma component". A previous breeze session that indicated we didn't code "component". Could you please verify?
A: I just reviewed the I&R and there are several instances where they allow the use of the term component. I also found an instance where they said not to use it. We will seek clarification.
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Q: Regarding the MPH question, doesn't the word "small" component impact that as well? It doesn't seem to be a predominant histology to me.
A: I don't think so. If they had used the term focus or foci, I would say not to use it. I don't think "small" is a term that I would take into consideration. However, that is my opinion. I will include it in our requests for clarification.
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Q: Presentation says mid Thoracic Esophagus is C15.1. CSv2 Esophagus schema is C15.4. Which is correct?
A: Good catch. The slide is correct. There are some typos in the CSv2. Hired proof readers are currently reviewing the document.
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Q: This new lymph node (FNA/biopsy) rule--is this for all sites or only for esophagus?
A: All sites.
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Q: Would the answer to #5 in Quiz 1 be A - AJCC stage?
A: Grade plays a factor in stage. It is also important for determining prognosis and treatment. The best answer is d, all of the above.
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Q: For Stomach Schema SSF 2 (Location), are the codes to be used hierarchically? That is, if it's indicated as posterior wall body of stomach on one report and lesser curvature body of stomach on different report, what takes priority?
A: I find no specific instructions for this situation in instructions for this data item in either the stomach schema or in the instructions for SSF2 found in section 2 of part 1 of the CSv2 manual.
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Q: Is there any importance to "hyperechoic" information? I had a question on this here this morning.
A: When something is hyperechoic it gives off many echoes during ultrasound. This is something to be checked out, but hyperechoic is not synonymous with malignant.
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Q: If a patient has a history of gastric bypass surgery and develops stomach cancer, do you code to C16.9?
A: It's my understanding that gastric bypass surgery makes the stomach smaller;it does not remove it completely. So, if a patient is diagnosed with stomach cancer after bypass surgery and a specific location in the stomach is not listed, code primary to C16.9.
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Q: In the absence of other indicators, what do you recommend for the site code of an invasive adenocarcinoma arising in Barrett's esophagus? (no specific site for the tissue was provided)
A: It is most likely in the lower part of the esophagus; but with no specific information on tissue location, I would assign code C15.9.
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Q: If there's a positive aspiration of a lymph node followed by a lymph node dissection where all nodes are negative, would we count the aspirated node in regional nodes examined?
A: If the positive aspiration and dissection are from the same lymph node chain, you do not count the aspirated node in regional nodes examined. If the aspirated and dissected nodes are in different regional node chains, you do count the aspirated node in regional nodes examined.
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Q: For SSF4, for Esophagus; did you say to disregard the pathology report "Record the information from the pathology report"?
A: Yes. We had this clarified and we were told that the information must come from sources other than a path report. The pathologist can never measure this, because the patient is not on the table (unless it is anautopsy).
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Q: For CS Lymph nodes code 250 for esophagus, you said celiac are regional nodes.If so should the "D" be changed to an "R"?
A: They are regional for AJCC staging. The 'D' is for summary stage.
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Q: Are we still not coding radiosensitizing chemo?
A: The following was found in the I&R:
# / Date / Class of Question / Site / Category or reference / page # / Question / Answer / Feedback24087
10/5/2007 / SEER Multiple Primary & Histology / / / If a lung cancer patient received xrt with 5FU as a radiosensitizer, is the 5FU coded as a single drug? / Please check with SEER Rx and the physician. Generally, you do not code radiosensitizers. The low dose of the drug only enhances the effect of the radiation and does not kill cancer cells by itself. Curator
(I & R Team) / Click here if you found this question and answer useful
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Q: If you have indication that patient received 5FU but not stated if chemo or radiosensitisation, would you opt/default to chemo?
A: I would code as chemotherapy in that situation.
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Q: Case 1, SSF1; would you code 200 due to the CT stating there are malignant appearing cervical, paraesophageal, paratracheal, and superior mediastinal lymph nodes? You have at least 4 nodes positive, which is N2.
A: I think 400 is the better code. 200 is too specific based on the information provided.
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