COLON Case # Primary Data Item Preferred Answer Rationale Namecampus.ahima.org/campus/courses/cancerreg/crmcdcs... · H11 - Ascending colon. Single histology. Polypoid and polyp are

Answers and Rationale

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COLON

Case # Primary Data Item Name Preferred Answer Rationale

Colon 1

Is this a multiple primary? No M2 - Single tumor, right colon

Primary 1 Histologic Type 8140/3 Adenocarcinoma

H3 – Code the histology from the most representative specimen, the resection on 11/24/07. Stop at the first rule that applies. The definitions tell us not to code intestinal type adenocarcinoma (8144) when you have a colon primary site. The equivalent terms (p 29) tell us focal mucin production is not synonymous with mucinous type, so code 8480 is not appropriate.

Colon 2

Is this a multiple primary? Yes M4 - Tumors in sites with ICD-O-3 topography codes that are different at

the fourth (C18.X) character are different primaries for the colon. Cecum (C18.0) and transverse colon (C18.4)

Primary 1 Histologic Type 8261/3 Adenocarcinoma in villous polyp

H4 – Cecum (C18.0). Even though the final diagnosis just states adenocarcinoma, there is reference to the polyp architecture (two ‘villous polyps’) in the gross description. Rule H4, 2nd statement.

Primary 2 Histologic Type 8261/3 Adenocarcinoma in villous polyp

H4 - Transverse (C18.4). Reference to villous polyp in gross description

Colon 3

Is this a multiple primary? No M2 - Single tumor, sigmoid colon

Primary 1 Histologic Type 8210/3 Adenocarcinoma in polyp

H4 - Reference to pre-existing polyp in the final diagnosis (item #7)

Colon 4

Is this a multiple primary? No M3 - Colon, NOS. Use the multiple tumors module. Adenocarcinoma in

adenomatous polyposis with one or more malignant polyps is a single primary (item #A3). Because multiple sections of the colon are involved, the site code is C18.9.

Primary 1 Histologic Type 8221/3 Adenocarcinoma in multiple adenomatous polyps

H19 - Single histology. Use the multiple tumors abstracted as single primary module. The term ‘familial polyposis’ is not specifically stated. The exact number of tumors is unknown.

Colon 5


the fourth (C18.X) character are different primaries for the colon. Transverse (C18.4) and sigmoid (C18.1)


H11 – Transverse (C18.4). Single histology. There was no mention of polyps. Only one histology term is stated (adenocarcinoma).


H11 – Sigmoid (C18.1). Single histology. There was no mention of polyps. Only one histology term is stated (adenocarcinoma).


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Colon 6


the fourth (C18.X) character are different primaries for the colon. Cecum/ascending (C18.0) and sigmoid (C18.7)

Primary 1 Histologic Type 8261/3 Adenocarcinoma in villous adenoma

H4 – Cecum. Reference to villous adenoma in the previous biopsy report for the same tumor (item A). Polyp and adenoma are synonymous terms.

Primary 2 Histologic Type 8210/3 Adenocarcinoma in adenomatous polyp

H4 – Sigmoid. Reference to adenomatous polyp in both the biopsy and resection report (item B). In the ICD-O-3, ‘adenocarcinoma in adenomatous polyp’ and ‘adenocarcinoma in a polyp, NOS’ both have the same code of 8210.

Colon 7

Is this a multiple primary? No M2 - Single tumor. Do not count tumors stated to be metastatic (item #F). Count primary tumors only.

Primary 1 Histologic Type 8255/3 Adenocarcinoma with mixed subtypes

H7 - Combination of signet ring cell and mucinous adenocarcinoma. H5 and H6 is used when there is signet ring cell OR mucinous, not both. Because the tumor contains both signet ring cell AND mucinous, then the combination code should be used.

Colon 8

Is this a multiple primary? Yes M10 - Tumors in same anatomic site (ascending colon) with ICD-O-3

histology codes different at the first (xxxx), second (xxxx), or third (xxxx) number are separate primaries.


H11 - Ascending colon. Single histology. Polypoid and polyp are not synonymous terms so this is not in a polyp.

Primary 2 Histologic Type 8240/3 Carcinoid tumor

H8 - Ascending colon. Code 8240/3 when the diagnosis is neuroendocrine and carcinoid tumor

Colon 9

Is this a multiple primary? No M2 – Colon, NOS. Single tumor.

Primary 1 Histologic Type 8261/3 Adenocarcinoma in villous adenoma

H4 - Single histology. The final diagnosis refers to a villous adenoma.

Colon 10

Is this a multiple primary?

Yes M4 - Tumors in sites with ICD-O-3 topography codes that are different at the fourth (C18.X) character are different primaries for the colon. Ascending (C18.0) and transverse colon (C18.4) M7 - Transverse colon. A frank adenocarcinoma and adenocarcinoma in a polyp in the same segment of the colon are a single primary (item B and C)

Primary 1 Histologic Type 8210/3 Adenocarcinoma in adenomatous polyp

H4 – Ascending. Code 8210 when there is mucinous adenocarcinoma in a polyp (rule H4, 4th statement). It is more important to identify that it was in a polyp than it had a mucinous component.


H20 Transverse. Code the most invasive histology. The polyp contained in situ carcinoma only, so code to the histology of the frank lesion.


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LUNG Case # Primary Data Item Name Preferred Answer Rationale

Lung 1

Is this a multiple primary? Yes/No

No M2 - Report does say the RUL mass the primary tumor and the RLL mass is due to transbronchial spread. So you may have considered this 1 tumor and used the single tumor module. M12 – Or, if you were not sure if this was considered a metastasis, you may have considered this 2 tumors and used the multiple tumor module. Either is ok. The rules are designed to derive to the same answer. Tumors with the same histology in the same lung are a single primary.


H3 - If you considered this 1 tumor, then you should have used the single tumor module in the histology rules. H10 – If you considered these 2 tumors, then you should have used the multiple tumors module in the histology rules. Again, either is ok in this case. Code the single histology present.

Lung 2

Is this a multiple primary? Yes/No No M2 – Single tumor involving carina, right bronchus

intermedius, and left upper lobe, lingual. Do not count the liver lesions as these are questionable for metastases.

Primary 1 Histologic Type 8070/3 Squamous cell carcinoma

H3 – Code the single histology present

Lung 3

Is this a multiple primary? Yes/No No M10 - Two tumors in same lung, non-small cell

carcinoma (8046) and adenocarcinoma (8140) histologies are on the same branch of Chart 1


H12. Multiple histologies within the same branch on Chart 1. Code the more specific histology using Chart 1. The first 3 digits of the histology code are not the same, so cannot use H11.

Lung 4

Is this a multiple primary? Yes/No No M2 - Single tumor in RUL.

Primary 1 Histologic Type 8253/3 Bronchiolo-alveolar carcinoma, mucinous

H3 - Single histology present. Bronchiolo-alveolar carcinoma, mucinous type is a specific histology with a code of 8253 in the ICD-O-3 (p 121).


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Case # Primary Data Item Name Preferred Answer Rationale H5 – Or, you may have interpreted this as multiple histology terms on the same branch in Chart 1. If so, you would have been instructed to code the most specific type of bronchiolo-alveolar carcinoma, which is the mucinous type bronchiolo-alveolar carcinoma. Bronchiolo-alveolar carcinoma by itself is a NOS term. Either interpretation will derive the same answer.

Lung 5


No M1, note 2. Multiple ill-defined tumor nodules in both lungs. Histology known for right only. We don’t know if the tumor in the left is the same histology or not. Remember the general rules: 1) Use the histology term stated in the final diagnosis 2) Use the final diagnosis from the most representative specimen 3) The word “bilateral” is not used to determine number of primaries. It does, however; tell us that there is a tumor on the left and the right 4) Lung has a default rule that says if there is a tumor on the left and a tumor on the right and only 1 is biopsied, it is considered a single primary (p 33).

Primary 1 Histologic Type 8013/3 Large cell neuroendocrine carcinoma

H10 - Single histology present. This is a specific histology with a code of 8013 in the ICD-O-3 (p 122).

Lung 6

Is this a multiple primary? Yes/No No M2 - Single tumor

Primary 1 Histologic Type 8041/3 Small cell carcinoma

H3 - Single histology stated in the final diagnosis.

Lung 7


Primary 1 Histologic Type 8033/3 Sarcomatoid carcinoma

H3 – Single histology stated in the final diagnosis. ‘Areas of” is not a term used to describe the more specific subtype. Only use the descriptive terms listed in the rules.

Lung 8 Is this a multiple primary? Yes/No

No M1, note 2 - Multiple tumors in right lung. Although there was sputum cytology, we don’t know which tumor this cytology may have come from. None of


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Case # Primary Data Item Name Preferred Answer Rationale the actual tumors were specifically biopsied. So, we

will have to use the default rule. Primary 1 Histologic Type 8140/3

Adenocarcinoma H8 - Code the histology documented by the physician that references the cytology.

Lung 9

Is this a multiple primary? Yes/No Yes M11 - Two tumors in RUL lung. Histology codes

differ at the 2nd number. Bronchioloalveolar (8250) and squamous (8070). Also, these two histologies are on different branches of Chart 1.

Primary 1 Histologic Type 8250/3 Bronchiolo-alveolar carcinoma

H5 - Carcinoma with bronchioloalvelar features. “Features” is a term used to identify a more specific histology. Also, mucin production is not a synonymous term with mucinous.


H5 - Carcinoma with squamous differentiation. “With ____ differentiation” is a term used to identify a more specific histology.

Lung 10

Is this a multiple primary? Yes/No No M2 - Single tumor in RLL. LLL was negative for

cancer. Primary 1 Histologic Type 8255/3

Adenocarcinoma with mixed subtypes

H6 – Multiple specific histologies (acinar, papillary, bronchiolo-alveolar). Instructions tell you to refer to Table 1 to obtain the appropriate combination code. In row 6, there are at least two of histologies listed in Column 2. In fact, all 3 are listed. So, it is appropriate to assign the combination code of 8255.


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BREAST Case # Primary Data Item Name Preferred Answer Rationale

Breast 1

Is this a multiple primary? Yes/No No M3 - Single tumor in left breast. Because

inflammatory was not mentioned in the final diagnosis, rule M2 would not apply.

Primary 1 Histologic Type 8500/3 Infiltrating duct carcinoma

H14 – There was DCIS stated in the microscopic summary, but not the final diagnosis. So, use the single tumor, invasive only module. The single tumor, invasive and in situ module instructs to code the invasive histology. If you had of used the single tumor, invasive and in situ module, you would have been instructed to code he invasive histology. So, you would have derived the same answer. Inflammatory carcinoma was stated in the microscopic description, not in the final diagnosis. So, we can’t use this to code the histology. The fact that there was inflammatory carcinoma will be captured and coded in the staging (CS Extension). Dermal lymphatic invasion is not coded as inflammatory carcinoma (p 48 and rules H13 and H22).

Breast 2

Is this a multiple primary? Yes/No No M3 - Single tumor in left breast

Primary 1 Histologic Type 8201/2 Duct carcinoma in situ, cribriform type

H3 – Use the single tumor, in situ only module. DCIS and intraductal are synonymous (p 47). Intraductal NOS and a specific intraductal carcinoma identified by the word “pattern” in Table 1. The instructions tell you to refer to Table 1 to see a list of the common specific types of intraductal carcinomas. Cribriform is listed. Code the more specific term of cribriform.

Breast 3

Is this a multiple primary? Yes/No No M10 – Multiple tumors in left breast. Lobular and duct

tumors in same breast are a single primary Primary 1 Histologic Type 8522/3

Infiltrating duct and lobular carcinoma

H28 – Use the multiple tumors abstracted as a single primary module. Assign the combination code for duct and lobular, even if they are in separate tumors.

Breast 4

Is this a multiple primary? Yes/No No M11 – Two tumors in right breast. Both are

infiltrating duct carcinoma. Multiple duct carcinomas in same breast are a single primary. You can use the Multiplicity Counter data item to document the


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Case # Primary Data Item Name Preferred Answer Rationale number of tumors abstracted as a single primary.


H23 – Only one histology stated in final diagnosis

Breast 5

Is this a multiple primary? Yes/No Yes M7 - Tumors in the right breast and in the left breast

are multiple primaries Primary 1 Histologic Type, Left 8520/2

Lobular carcinoma in situ

H2 - Left Breast. Use single, in situ only module. There is not invasive component. Single histology present

Primary 2 Histologic Type, Right 8520/2 Lobular carcinoma in situ

H2 - Right Breast. Use single, in situ only module. Single histology present

Breast 6

Is this a multiple primary? Yes/No Yes M7 - Tumors in the right breast in the left breast are

multiple primaries Primary 1 Histologic Type, Right 8522/3

Infiltrating duct and lobular carcinoma

H16 - Right Breast. Combination of invasive duct and invasive lobular carcinoma (item #1).

Primary 2 Histologic Type, Left 8522/3 Infiltrating duct and lobular carcinoma

H16 - Left Breast. Combination of invasive duct and invasive lobular carcinoma (item #2 and 7).You code the invasive component (rule H9) so the DCIS comedo and non-comedo types are not included in coding the histology.

Breast 7

Is this a multiple primary? Yes/No No M3 - Single tumor in right breast

Primary 1 Histologic Type 8520/3 Lobular carcinoma

H9 - Code from the final diagnosis from the most representative specimen which is the excisional biopsy on 5/4/07. Invasive lobular carcinoma and focal DCIS, cribriform pattern. Code the histology of the invasive component. Ignore the in situ terms.

Breast 8

Is this a multiple primary? Yes/No No M3 - Single tumor in right breast


H9 – Tumor has invasive and in situ components. Ignore the in situ terms. Code the histology of the invasive component even if it is less specific.


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Case # Primary Data Item Name Preferred Answer Rationale Breast 9 Is this a multiple primary? Yes/No

Yes M12 - Two tumors in the right breast. One (item A) is infiltrating ductal carcinoma (8500). The other (item B) is a mixed duct carcinoma with other types of carcinoma (8523). The ICD-O-3 histology codes are different at the third (xxxx) number. The most representative specimen is the 3/16/07 report.


H9, item A. Code the invasive component.

Primary 2 Histologic Type 8523/3 Infiltrating duct carcinoma mixed with other types of carcinoma

H17, item B. – Combination of duct and any other carcinoma. There were invasive and in situ components. H9 tells us to code the invasive component, and ignore the in situ terms, but we still don’t know which invasive component to code (mucinous or ductal). So, we need to go to the single tumor, invasive only module. If you will remember from the presentation, Table 3 can be used with rules H5-8, H16-19, H24-26, and H28. You should make a note of this beside table 3 and beside each of these rules. Table 3, row 5 is instructing us to use the combination code of 8523 when there is infiltrating ductal carcinoma and any of the terms listed in column 2. Mucinous is listed in column 2.

Breast 10

Is this a multiple primary? Yes/No No M11 - All foci of carcinoma are in the same breast and

all are duct carcinoma Primary 1 Histologic Type 8500/3

Infiltrating duct carcinoma

H23 - Single histology present


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HEAD AND NECK Case # Primary Data Item Name Preferred Answer Rationale

Head/Neck 1

Is this a multiple primary? Yes M7 - Tumors in sites with ICD-O-3 topography codes that are

different at the second character are multiple primaries - mandibular alveolus/gingival (C031) and anterior tongue (C023)

Primary 1 Histologic Type 8070/2 Squamous cell carcinoma in-situ

H3 - Mandibular alveolus - Single histology

Primary 2 Histologic Type 8070/2 Squamous cell carcinoma in-situ

H3 - Anterior tongue - Single histology

Head/Neck 2

Is this a multiple primary? No M2 - Single tumor - parotid gland, right (C079)

Primary 1 Histologic Type 8200/3 Adenoidcystic carcinoma

H3 - Right parotid gland - Single histology. Code from the final diagnosis.

Head/Neck 3


different at the second character are multiple primaries - left tonsil (C099) and tongue, NOS (C029)

Primary 1 Histologic Type 8010/3 Carcinoma, NOS

H1 - Left tonsil - Code from the source document that references the pathology when the path report is not available, in this case from the history and physical. The biopsy of the tonsil was consistent with carcinoma.


H1 - Tongue - Code from history and physical when no path report available. The biopsy of the tongue was consistent with squamous cell carcinoma.

Head/Neck 4

Is this a multiple primary? No M2 - Single tumor – Use priority order to code the primary site

from endoscopy – the tumor started on the soft palate (C051) Primary 1 Histologic Type 8070/3

Squamous cell carcinoma H3 - Soft palate - Single histology

Head/Neck 5


different at the second character are multiple primaries (endoscopy has priority over CT scan to determine primary site) – left tonsillar pillar (C091) and aryepiglottic fold (C131)

Primary 1 Histologic Type 8010/3 Carcinoma

H1 - Left tonsillar pillar - Code histology stated by physician when no path report available


H1 - Aryepiglottic fold - Code histology as stated by physician when no path report available


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Case # Primary Data Item Name Preferred Answer Rationale Head/Neck 6

Is this a multiple primary? Yes M9 - Tumors diagnosed more than 5 years apart – vocal cord

(C320) Primary 1 Histologic Type 8051/3

Verrucous carcinoma H1 - Vocal cord - Code as histology stated in history by physician when no cytology/pathology report available

Primary 2 Histologic Type 8051/3 Verrucous carcinoma

H3 - Vocal cord - Single histology

Head/Neck 7

Is this a multiple primary? No M2 - Single tumor – maxillary alveolar ridge (C030)

Primary 1 Histologic Type 8052/2 Papillary squamous cell carcinoma

H3 - Maxillary alveolar ridge - Code the most representative specimen which is the specimen listed in item G on the path report from the excision. You may also have used H5 if you considered these two terms.

Head/Neck 8


different at the third character are multiple primaries– left lateral tongue (C029) and left lateral floor of mouth (C041)

Primary 1 Histologic Type 8071/3 Keratinizing squamous cell carcinoma

H3 or H5 – Left lateral tongue - Code the most specific histology


H3 - Lateral floor of mouth - Single histology. There was superficial invasion so this would be a behavior code of 3.

Head/Neck 9 Is this a multiple primary?

No M1 - Tumor involved the tongue, tonsil and retromolar trigone. It is not clear if this was a single tumor or multiple tumors. Default to single tumor and single primary. Because we don’t know where the tumor started and it overlaps more than one site, code to overlapping lesion of the lip, oral cavity, and pharynx (C148)


H3 or H4 – This is considered a single tumor in the histology rules. Single histology with in situ and invasive components. Code the invasive component.

Head/Neck 10 Is this a multiple primary?

Yes M3 - Tumors in both left and right sides of paired organ – left tonsil (C099) and right tonsil (C099). The operative report has the priority over the pathology report when determining the primary site for head and neck primaries ONLY. The histology is still coded from the final diagnosis.


H1 - Left tonsil - Code 8010/3 histology stated by physician in history when no cytology/pathology available


H3 - Right tonsil - Single histology


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MELANOMA Case # Primary Data Item Name Preferred Answer Rationale

Melanoma 1


Yes M4. Different laterality. Skin, left foot (C44.7) and skin, right thigh (C44.7) so M3 does not apply.

Primary 1 Histologic Type 8744/3 Acral lentiginous melanoma

H9. Skin, left foot - Code the most specific histologic term when the diagnosis is melanoma, NOS with a single specific type (“with features of”)

Primary 2 Histologic Type 8743/3 Superficial spreading melanoma

H9. Skin, right thigh - Code the invasive component when invasive and in situ melanoma is present. Code the most specific histologic term when the diagnosis is melanoma, NOS with a single specific type (“type”).

Melanoma 2


No M1. Unknown whether single or multiple melanomas on scalp. Default to single primary.

Primary 1 Histologic Type 8772/3 Spindle cell melanoma, NOS

H10. Skin, scalp - Code the histology with the numerically higher ICD-O-3 code. H9 is used when there is only one specific type stated. “Type” and “with features” allows inclusion of all terms used to describe tumor. Since there is more than one specific type, H9 does not apply.

Melanoma 3


Yes M4. Different laterality. Skin, left back (C44.5) and skin, right back (C44.5). Note: Upper and lower cannot be used to determine number of primaries.

Primary 1

Histologic Type 8720/2 Melanoma in situ

H3. Skin, left back - Amended Final Diagnosis supersedes the Final Diagnosis

Primary 2

Histologic Type 8743/2 Superficial spreading melanoma, in situ

H9. Skin, right back - Amended final diagnosis supersedes the final diagnosis. Code the most specific histologic term when the diagnosis is melanoma, NOS with a single specific type (“type”).

Melanoma 4


Yes M3. Sites with ICD-O-3 topography codes that are different at the fourth digit (skin, abdomen C44.5 and skin, thigh C44.7)

Primary 1

Histologic Type 8720/2 Melanoma, in situ

H3. Skin, left abdomen - Single histology

Primary 2

Histologic Type 8761/2 Melanoma in situ arising in congenital melanocytic nevus

H5. Skin, left thigh - Code the specific type (single histology). Do not code “features of regression” when a specific melanoma is documented

Melanoma 5


No M2. Single melanoma

Primary 1 Histologic Type 8772/3 H10. Skin, left trunk - Code the histology with the numerically


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Case # Primary Data Item Name Preferred Answer Rationale Spindle cell melanoma, NOS higher ICD-O-3 code. Do not code “pattern” for invasive

melanoma. This term is used for in situ lesions only. See list in H9.

Melanoma 6



Primary 1 Histologic Type 8721/3 Malignant melanoma, nodular

H9. Skin, scalp - Code the specific type of melanoma (nodular). Do not code spindle cell because “variant” is not coded. See list in H9.

Melanoma 7


No M8. Two melanomas, same site, same laterality, same histology (skin, left shin, C44.7). Use multiplicity counter to record number of tumors abstracted as single primary.

Primary 1 Histologic Type 8720/2 H3. Skin, left shin - Code 8720/2 from final diagnosis (per general instructions). “With evidence of regression” is not coded – was mentioned only in microscopic description.

Melanoma 8



Primary 1 Histologic Type 8730/3 Amelanotic melanoma

H7. Skin, neck - Code from the biopsy because it is the most representative specimen. Code the histologic type (amelanotic) when the diagnosis is lentigo maligna melanoma and a histologic type

Melanoma 9



Primary 1 Histologic Type 8723/3 Malignant melanoma, regressing

H5. Skin, right chest - Code from the biopsy because it is the most representative specimen. Code regression only when there is no other specific melanoma type noted. There is no code for nevoid type melanoma.

Melanoma 10


Yes M5. Melanomas with ICD-O-3 histology codes that are different at the third number are multiple primaries. 8720 and 8743 are different at 3rd number. The laterality is unknown so can’t use M4.

Primary 1

Histologic Type 8720/2 Melanoma in situ

H3. Skin, abdomen - Single histology

Primary 2

Histologic Type 8743/3 Superficial spreading melanoma

H9. Skin, back - Code the most specific term when the diagnosis is melanoma and a single specific type


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KIDNEY Case # Primary Data Item Name Preferred Answer Rationale

Kidney 1

Is this a multiple primary? Yes/No No M2 - Single tumor in left kidney


H6 - Two or more renal cell types from Table 1 (papillary type and clear cell type), code 8255

Kidney 2



H6 - Two or more renal cell types from Table 1 (sarcomatoid type and clear cell type), code 8255. We do not code the majority of tumor with the new rules.

Kidney 3

Is this a multiple primary? Yes/No Yes M5 - Tumor in the right kidney and tumor in the left

kidney. One is not stated to be metastatic from the other.


H6 - Right kidney - Two or more renal cell types from Table 1 (cystic type and clear cell type), code 8255

Primary 2 Histologic Type 8310/3 Clear cell

H5 - Left kidney - Code the specific type when there is renal cell carcinoma and one specific renal cell type (clear cell) on Table 1

Kidney 4


Primary 1 Histologic Type 8310/3 Clear cell

H5 - Code the specific type when there is renal cell carcinoma and one specific renal cell type (clear cell type) on Table 1. Do not code “architecture” for invasive tumors.

Kidney 5

Is this a multiple primary? Yes/No No M3 - Wilms tumors (unilateral or bilateral) are a single

primary Primary 1 Histologic Type 8960/3

Wilms tumor H10 - Single tumor

Kidney 6


Primary 1 Histologic Type 8312/3 Renal cell carcinoma, NOS

H3 - Code the single histology. Do not code “architecture” or “pattern” for kidney. These terms are for in situ only tumors.


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Case # Primary Data Item Name Preferred Answer Rationale Kidney 7



H6 - Two or more renal cell types from Table 1 (clear cell and sarcomatoid), code 8255

Kidney 8

Is this a multiple primary? Yes/No No M2 - Single tumor in right kidney

Primary 1 Histologic Type 8260/3 Papillary renal cell carcinoma

H5 - Code the specific type when there is renal cell carcinoma and one specific renal cell type (papillary) on Table 1. Do not code “variant”.

Kidney 9


Primary 1 Histologic Type 8480/3 Mucinous carcinoma

H7 - Code the histology with the numerically higher ICD-O-3 code if none of the above conditions are met


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URINARY Case # Primary Data Item Name Preferred Answer Rationale

Bladder 1


Primary 1 Histologic Type 8120/3 Transitional cell carcinoma

H3 – Squamous cell carcinoma is a special situation. A tumor must be pure squamous cell carcinoma to be coded 8070. When combined with urothelial (transitional cell) carcinoma, code 8120. Focal or component not a factor used in determining histology. Urothelial and transitional are equivalent terms (p 61).

Bladder 2


Primary 1 Histologic Type 8490/3 Signet ring cell carcinoma

H7 - Code the specific histology. The specific histology may be identified by the term “features.”

Bladder 3



H5 - Carcinoma with squamous features is coded 8070/3 when there is no urothelial (transitional cell) carcinoma documented.

Bladder 4

Is this a multiple primary? Yes/No Yes M9 - Multiple (papillary) transitional cell carcinomas

are one primary. Squamous cell carcinoma is a separate primary with ICD-O-3 histology code different at second (xxxx) and third (xxxx) number

Primary 1 Histologic Type 8130/3 Papillary transitional cell carcinoma

H4 - Single histology

Primary 2 Histologic Type 8071/3 Keratinizing squamous cell carcinoma


Bladder 5


Primary 1 Histologic Type 8120/3 Transitional/urothelial cell carcinoma

H3 – Single histology in the final diagnosis


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RP and Ureter 1 Is this a multiple

primary?

No M1 - It is not clear if these are tumor implants or intraepithelial spread along urothelial surface. If you viewed as unknown if single or multiple tumors, default to single primary. M8 - If you viewed case as multiple tumors, you still arrive at single primary urothelial (transitional cell or papillary transitional cell) carcinoma in more than one urinary site (Table 1). Left ureter – site of origin.

Primary 1 Histologic Type 8120/3 Urothelial (transitional cell) carcinoma

H3 - Left ureter. Pure transitional carcinoma. Urothelial and transitional are synonymous terms (p 61). If you considered this as unknown and defaulted to a single primary, then you will use the single tumor module in the histology rules. H11 - Left ureter. Pure transitional carcinoma. If you considered this as multiple tumors, then you will use the multiple tumors abstracted as a single primary module in the histology rules.

RP and Ureter 2 Is this a multiple

primary?

No M8 - Multiple tumors in more than one urinary site (Table 1). All tumors are non-invasive papillary urothelial (transitional cell) carcinoma. This is typical presentation for intraepithelial spread of cancer along the urothelium. Therefore, single primary – site coded to C68.9 urinary system, NOS

Primary 1 Histologic Type 8130/2 Non-invasive papillary urothelial (transitional cell) carcinoma

H4 - Urinary system, NOS – Single histology

RP and Ureter 3


No M8 - Single primary. Right renal pelvis (calyx) – site of invasive tumor. Multiple (unilateral) urothelial (transitional cell or papillary transitional cell) carcinoma in renal pelvis and ureter (Table 1) are a single primary

Primary 1 Histologic Type 8130/3 Papillary urothelial (transitional cell) carcinoma

H12 - Right renal pelvis. Code the invasive histology

RP and Ureter 4


No M8 - Single primary. Left ureter – site of invasive tumor. Multiple (unilateral) urothelial (transitional cell or papillary transitional cell) carcinoma in renal pelvis and ureter (Table 1) are a single primary

Primary 1 Histologic Type 8130/3 H12 - Left ureter. Code the invasive histology


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Papillary urothelial (transitional cell) carcinoma

RP and Ureter 5


Yes M7 - Tumors diagnosed more than 3 years apart are multiple primaries. First primary: bladder. Second primary: right renal pelvis – site of invasive tumor - multiple tumors of (unilateral) renal pelvis and ureter (Table 1) are a single primary


H1 – Bladder. Code histology per history when path not available

Primary 2 Histologic Type 8130/3 Papillary urothelial (transitional cell) carcinoma

H4 - Right renal pelvis. Code the invasive histology

RP and Ureter 6


No M1. Unknown if single or multiple tumors. There is no information from the primary site. Default to a single primary – Urinary system, NOS


H2 - Urinary system, NOS. Code the histology from a metastatic site when there is no cytology or pathology from the primary site.

RP and Ureter 7


Yes M4 - Tumors in the left and in the right ureter are multiple primaries when no other urinary sites involved


H3 - Left ureter. Single histology


H3 - Right ureter. Single histology

RP and Ureter 8| Is this a multiple

primary?

No M8 - Multiple invasive and non-invasive tumors in more than one urinary site (Table 1) All tumors are urothelial (transitional cell) carcinoma. This is typical presentation for intraepithelial spread of cancer along the urothelium. Therefore, single primary – site coded to C68.9 urinary system, NOS Tumors in the left and in the right ureter are not multiple primaries when other urinary sites are involved.




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OTHER SITES Case # Primary Data Item Name Preferred Answer Rationale

Other Sites 1 Prostate

Is this a multiple primary? Yes/No No M3 – Prostate. Adenocarcinoma of the prostate is

always a single primary Primary 1 Histologic Type 8140/3

Adenocarcinoma, NOS H10 - Code adenocarcinoma (8140) when diagnosis is acinar adenocarcinoma of prostate

Other Sites 2 Endometrium and Ovary

Is this a multiple primary? Yes/No Yes M11 - Tumors with ICD-O-3 topography codes that

are different at the third character (C54.1 and C56.9) are multiple primaries. According to the comment, these are separate primaries, not metastases.

Primary 1

Histologic Type 8380/3 Endometroid adenocarcinoma

H2 – Endometrium. Single histology

Primary 2

Histologic Type 8380/3 Endometroid adenocarcinoma

H2 – Ovary. Single histology

Other Sites 3 Ovary

Is this a multiple primary? Yes/No No M7 – Ovary. Bilateral epithelial tumors (ICD-O-3

histology codes 8000-8799) of the ovary are a single primary

Primary 1 Histologic Type 8323/3 Mixed cell adenocarcinoma

H30 - See Table 2. Combinations of endometroid and papillary serous carcinoma of GYN sites are coded as mixed cell adenocarcinoma – Table 2

Other Sites 4 Thyroid Is this a multiple primary? Yes/No

Yes M17 – Thyroid. Tumors with ICD-O-3 histology codes that are different at the second number (8510 and 8260) are multiple primaries. Papillary carcinoma is one primary and multifocal medullary carcinoma is one primary.

Primary 1 Histologic Type 8510/3 Medullary carcinoma


Primary 2 Histologic Type 8260/3 Papillary carcinoma of thyroid

H11 - Single histology. Papillary carcinoma of thyroid has a specific code in the ICD-O-3. Do not use code 8050 for this site and histology.

Other Sites 5 Testicle

Is this a multiple primary? Yes/No Yes M17 - Right testicle. Two tumor nodules with ICD-O-

3 histology codes that are different at the third number are multiple primaries.

Primary 1 Histologic Type 9061/3 Seminoma

H11 - Larger tumor nodule. Single tumor, all invasive. Single histology – seminoma only

Primary 2 Histologic Type 9070/3 Embryonal carcinoma

H17 - Smaller tumor nodule. Code the histology with the numerically higher ICD-O-3 code. There is no combination code available in Table 2 for embryonal


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Case # Primary Data Item Name Preferred Answer Rationale and seminoma. The code 9085 for mixed germ cell tumor can only be used if there is teratoma (a required term) and either seminoma or yolk sac tumor.

Other Sites 6 Choroid

Is this a multiple primary? Yes/No No M2 - Right eye (choroid). Single tumor. Do not use

cutaneous melanoma rules for non-skin sites Primary 1 Histologic Type 8774/3

Spindle cell melanoma, type B

H16 - Code the most specific term. Spindle cell melanoma (8772) ‘predominantly’ B cell type (8774). There is no code for the term Callender.

Other Sites 7 Femur

Is this a multiple primary? Yes/No No M2 – Femur. Single tumor

Primary 1 Histologic Type 8000/3 Malignant neoplasm, NOS

H8 - Code the histology documented by the MRI when there is no cytology/pathology report (priority order for using documents to code histology)

Other Sites 8 GI Tract, NOS

Is this a multiple primary? Yes/No No M1 – Impossible to determine if single or multiple

tumors. The default is a single primary. There is no information from the tumors in the primary site. The liver tumor is a metastatic lesion.

Primary 1 Histologic Type 8936/3 malignant gastrointestinal stromal tumor

H9 - GI Tract, NOS. Use the single tumor module. Code from the amended diagnosis. Code the histology from metastatic site when there is no cytology/histology from the primary site.

Other Sites 9 Thyroid

Is this a multiple primary? Yes/No No M6 – Two separate tumors in the thyroid. One is

follicular cell carcinoma and the other is papillary carcinoma of thyroid. Follicular cell and papillary carcinoma of the thyroid are a single primary.

Primary 1 Histologic Type 8340/3 Papillary carcinoma, follicular variant

H27 - Code follicular and papillary carcinoma of the thyroid to papillary carcinoma, follicular variant


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NEW DATA ITEMS CASE 1

Data Item Answer Rationale Ambiguous Terminology 0 Conclusive diagnosis within 2 months of original diagnosis Date of Conclusive Terminology 88888888 NA – Case accessioned based on conclusive diagnosis Multiplicity Counter 01 One tumor only Date of Multiple Tumors 00000000 Single tumor Type of Multiple Tumors 00 Single tumor CASE 2

Data Item Answer Rationale Ambiguous Terminology 0 Conclusive diagnosis w/in 60 days of original diagnosis Date of Conclusive Terminology 88888888 N/A – Case accessioned based on conclusive diagnosis Multiplicity Counter 03 Three tumors present Date of Multiple Tumors 01042007 Multiple tumors were present at time of original diagnosis and

abstracted as a single primaryType of Multiple Tumors 40 Multiple invasive tumors CASE 3

Data Item Answer Rationale Ambiguous Terminology 0 Conclusive term Date of Conclusive Terminology 88888888 NA – Case accessioned based on conclusive diagnosis Multiplicity Counter 99 Widespread, multicentric/multifocal tumors present, unknown how

many Date of Multiple Tumors 07272007 Multiple tumors were present at time of original diagnosis and

abstracted as a single primary Type of Multiple Tumors 30 Mixed in situ tumors and invasive tumors


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CASE 4 Data Item Answer Rationale Ambiguous Terminology 0 Conclusive diagnosis within 60 days of original diagnosis. Note: The

phrase ‘probably clear cell type of renal cell carcinoma’ is used to qualify the type of adenocarcinoma, not whether or not the case must be accessioned.

Date of Conclusive Terminology 88888888 NA – Case accessioned based on conclusive diagnosis Multiplicity Counter 01 One tumor only Date of Multiple Tumors 00000000 Single tumor Type of Multiple Tumors 00 Single tumor CASE 5

Data Item Codes when abstracted

Final codes

Rationale

Ambiguous Terminology 1 2 When the case was originally accessioned, it would have been based on the ambiguous terminology – suspicious for adenocarcinoma on June 2, 2007. When patient returns for treatment MORE THAN 60 DAYS LATER, conclusive terminology is used. This data item must be updated to reflect the use of conclusive terminology.

Date of Conclusive Terminology 00000000 10142007 Date the conclusive diagnosis was made was on 10/14/2007. Multiplicity Counter 01 01 One tumor only. This will remain the same since there was still only 1 tumor. Date of Multiple Tumors 00000000 00000000 Single tumor Type of Multiple Tumors 00 00 Single tumor

CASE 6 Data Item Answer Rationale Ambiguous Terminology 0 Conclusive diagnosis within 2 months of original diagnosis. Both

the biopsy and re-excision were submitted for special staining both of which were positive for dermatofibrosarcoma protuberans

Date of Conclusive Terminology 88888888 NA – Case accessioned based on conclusive diagnosis Multiplicity Counter 01 One tumor only Date of Multiple Tumors 00000000 Single tumor Type of Multiple Tumors 00 Single tumor


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CASE 7 Data Item Answer Rationale Ambiguous Terminology 1 Cases is accessioned based only on ambiguous terminology

(suspicious for malignancy) Date of Conclusive Terminology 00000000 Based on ambiguous terminology only Multiplicity Counter 01 One tumor only Date of Multiple Tumors 00000000 Single tumor Type of Multiple Tumors 00 Single tumor CASE 8 Data Item Answer Rationale Ambiguous Terminology 0 Conclusive term Date of Conclusive Terminology 88888888 NA – Case accessioned based on conclusive diagnosis Multiplicity Counter 99 The tumor is described as multifocal - “at least” three foci. Date of Multiple Tumors 09122007 Multiple tumors were present at time of original diagnosis and

abstracted as a single primary Type of Multiple Tumors 40 At least two invasive tumors CASE 9 Data Item Answer Rationale Ambiguous Terminology 0 Conclusive term Date of Conclusive Terminology 88888888 NA – Case accessioned based on conclusive diagnosis Multiplicity Counter 01 One tumor present (default to single tumor – see Melanoma Case 2) Date of Multiple Tumors 00000000 Single tumor Type of Multiple Tumors 00 Single tumor

Documents

COLON Case # Primary Data Item Preferred Answer Rationale Namecampus.ahima.org/campus/courses/cancerreg/crmcdcs... · H11 - Ascending colon. Single histology. Polypoid and polyp are