Collecting Cancer Data: Larynx Including Mucosal Melanoma of Larynx

Q&A Session Collecting Cancer Data: Larynx Including Mucosal Melanoma of Larynx October 06, 2011 ______Q: Regarding the mature teratoma correction, will the archived I&R (47678) that you previously referred to be updated or removed?

A: We have been told that it will be removed. ______Q: The name of the site-specific factor (SSF) for CGA is "Serum" chromogranin A", and AJCC lists "pre-op PLASMA CGA" under prognostic factors (SSFs,) so should this only come from blood and not tissue?

A: Currently, information in CSv2 Part I Section 2 indicates that the information may be coded from either blood or tissue. This may be an issue to refer to the CS mapping team. ______Q: Please explain the difference between the epiglottis that is coded to Larynx (C32) and that not coded to Larynx (C10.1). Are both staged as Larynx?

A: The epiglottis is kind of like a big flap. The flap is open when you breathe, and it closes and covers the entrance to the larynx when you swallow. The part that faces down into the larynx when it is closed is the posterior epiglottis (C32.1). The part that faces outward when it is closed is the anterior portion of the larynx and called the anterior epiglottis (C10.1). The surface of the anterior epiglottis is more like the upper esophagus, and the surface of the posterior is more like the respiratory tract. If the primary site is epiglottis (C32.1), use the Supraglottic Larynx CS schema when assigning codes for CS data items. If the primary site is anterior surface of the epiglottis (C10.1), use the Anterior Surface of the Epiglottis CS schema when assigning codes for CS data items. ______Q: In regards to CS Tumor Size Ext/Eval code, assigning pathological takes precedence in only this schema right?

A: No, this is not schema specific. The CS Tumor Size/Ext Eval code should indicate whether the derived T, and not the CS Extension Code, was based on clinical or pathologic means. ______Q: The answer to the pop quiz does not seem to follow CS rules. If the patient does not have pre- operative treatment, then don't we use the pathologic information to code CS Extension and CS Tumor Size/Ext Eval? I thought CS says only use clinical information if the patient had pre-op treatment.

A: The evaluation codes in CS determine the AJCC c (clinical) and p (pathologic) descriptors. For larynx, the T category is based on extension so the code for CS Tumor Size/ Ext Eval should indicate whether the derived T, and not the specific extension code assigned to the case, was determined by clinical or pathologic means. In the pop quiz the primary of the glottic larynx had clinically impaired vocal cord mobility (CS Extension code 350) and pathologically had extension of the glottic tumor into the subglottis (CS Extension code 300). Both codes 300 and 350 derive T2. General instructions for CS instruct to assign the highest applicable code number as specifically as possible. CS is a combined clinical-pathologic coding system. So, because the furthest involvement is code 350, that code is assigned in CS Extension. The code for CS Tumor Size/Ext Eval is 3 (pathologic) because the code is assigned in relation to the AJCC T value that is derived, and not in relation to the CS Extension code that is actually used.

______Q: I still disagree...Reference page 34 rule a and rule b talk about no neoadjuvant treatment. They say code extension from the PATH when there is NO neoadjuvant treatment.

A: See rule 7 in the general rules page 15. We are instructed to code the highest applicable code regardless of whether that information is clinical or pathologic unless the pathologic information with a lower code disproves the clinical information with a higher code. ______Q: When a chart makes a reference to let’s say lymph node levels 1, 2, 3 but no mention to the other levels... do we assume that those other levels are negative or do we code them as unknown?

A: Code 000 would be appropriate per the CS manual Part I - Section 2 - Page 26. ______Q: How should we code SSF 3 if the path report only says '1 node positive in Level II/III specimen'?

A: 000 would be appropriate per CS Manual Part I - Section 2 - Page 26. ______Q: For SSF3-6, if nodes are involved but you don't know the level, would you code 999 or 000 in SSF3-6?

A: 000 would be appropriate per CS manual Part I - Section 2 - Page 26. ______Q: For SSF8 (extracapsular extension clinically), does the clinical exam or radiology report have to specifically say "extracapsular extension" or are we supposed to code extracapsular extension based on the given examples, i.e. 'matted mass of nodes adherent to skin/soft tissue', etc.?

A: If there is documentation of matted mass of nodes clinically, code as clinical extracapsular extension. It does not have to specifically say clinical extracapsular extension. ______Q: What if HPV testing on non-cancer tissue? For example; patient with laryngeal carcinoma has a cervical pap test that is HPV positive.

A: The instructions in Part I Section 2 for HPV status document the following:” Record the results of any HPV testing performed on pathologic specimens from the primary tumor or a metastatic site, including regional nodes.” I'm not sure what you would do if you had a patient with HPV on cervical PAP and laryngeal malignancy. ______Q: If a biopsy shows tumor invasion and the resected specimen shows only residual in situ disease, do we go back to the biopsy and code invasive histology? It seems that the rule to code from the largest specimen gets over ruled by the rule to code from the invasive portion. Am I correct?

A: Always code the invasive tumor. The MP/H rules instruct us to code the histology of the most representative tumor specimen. The specimen containing invasive tumor as opposed to that containing only in situ tumor would be the most representative tumor specimen. ______Q: In reference to rule M9 (timing rule for head and neck), where do we find the rule referencing to calculate from recurrence date?

A: It's not in the manual, but we did get a clarification from SEER. ______Q: For case scenario 1, CS Extension, shouldn't we code the hoarseness x 6 months, code 350, and not code 300?

A: Documentation of history of hoarseness is not enough to code as vocal cord immobility (CS Extension code 350). ______Q: In case scenario 1 why not code SSF10 (HPV status) as test not done as opposed to unknown?

A: The description of code 998 for SSF10 for larynx is test not done (test was not ordered and was not performed), including no pathologic specimen available for HPV testing. There was a pathologic specimen from the larynx tumor; however, it was biopsy only. In this scenario, we don’t know if that specimen could be used for HPV testing or not. So, since there is no information in the scenario about HPV status, the best code is 999 (unknown). ______