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SEER Training Modules

Colon Practice Case

  1. Read the following practice case. (This is all the information you have.)

    Colon Practice Case
    Surgical Pathology Report #1

    Surgical Pathology Report
    July 21, 2007

    Specimen:

    1. Colon biopsy, ascending mass
    2. Colon biopsy, sigmoid polyp

    Final Diagnosis:

    1. Ascending colon, biopsy: Villous adenoma with high-grade dysplasia, cannot exclude carcinoma.
    2. Sigmoid colon, biopsy: Adenomatous polyp with focal adenocarcinoma and high-grade dysplasia.

    Colon Practice Case
    Surgical Pathology Report #2

    Surgical Pathology Report
    August 1, 2007

    Specimen:

    1. Colon resection, right (ascending)
    2. Colon, sigmoid

    Final Diagnosis:

    1. Right hemicolectomy - area of previous biopsy site shows moderately differentiated adenocarcinoma, cecum, with one of ten lymph nodes positive with metastatic tumor.
    2. Segment of sigmoid colon with focal ulceration at previous biopsy site of adenomatous polyp showing focal adenocarcinoma with no residual tumor or dysplastic changes identified on current resection.

    Ask yourself the following questions (answers in italics)

    1. How many procedures?
      Two
    2. What are the dates?
      The second procedure was about 10 days after the first in 2007
    3. Are the pathology specimens similar?
      Yes, the first procedure biopsied the ascending and sigmoid colon, the second procedure removed those colon segments
    4. What is the primary site?
      Colon
    5. What site-specific set of rules should I use?
      Colon
    6. How many separate malignant, non-metastatic tumors are there?
      Two, ascending colon tumor {C18.2} and sigmoid colon tumor {C18.7}
  2. Open the 2007 MPH document to the Equivalent Terms and Definitions for colon and read through them.
    1. Are there any important points to note?
      Both tumors are in the colon; there is no mention of mucin; the first ascending colon tumor showed no malignancy but the resection of that area did; the ascending colon tissue mentions villous adenoma; the sigmoid tissue mentions a polyp
  3. Turn to the colon multiple primaries rules in your preferred format.
    1. We know from scanning the documentation that there are two tumors, so the "Unknown if single or multiple tumors" module does not apply, and the "Single Tumor" module does not apply.
    2. Start reading the "Multiple Tumors" rules beginning with M3.

      M3. Adenocarcinoma in adenomatous polyposis coli...
      No mention of adenomatous polyposis or other equivalent terms. Rule M3 does not apply. Keep reading.

      M4. Tumors in sites different at 2nd, 3rd, or 4th character of ICD-O-3...
      Ascending colon is C18.2, sigmoid colon is C18.7. These sites are different at the 4th character of the code. Rule M4 applies: these are multiple primaries. The ** footnote says to complete two (or more) abstracts.

    3. STOP. You have found a multiple primaries rule that applies to the case. Look no further.
  4. Pick one of the two tumors and start an abstract.

    There are separate rules in the FORDS and SEER manuals about sequencing cancers diagnosed at the same time. Based on the fact that the ascending colon resection showed cancer at regional stage (a positive lymph node), that tumor has a worse prognosis and should be sequence 01.

  5. Turn to the colon histology coding rules in your preferred format.
    1. We are now working only with the ascending colon tumor. It is a single tumor, so start reading the histology coding rules for "Single Tumor" starting with rule H1.

      H1. If there's no pathology/cytology report...
      We have a pathology report. Rule H1 does not apply. Keep reading.
      H2. Code histology from a metastatic site...
      We have tissue from the primary site. Rule H2 does not apply. Keep reading.
      H3. If the pathology report describes intestinal type adenocarcinoma...
      Intestinal type adenocarcinoma is not mentioned. Rule H3 does not apply. Keep reading.
      H4. Use a specific adenocarcinoma in a polyp code when...
      For this tumor, the initial biopsy describes a villous adenoma (which is a type of polyp architecture) and the resection describes adenocarcinoma at the previous biopsy site. The third bullet says 'adenocarcinoma and there is a reference to a residual or pre-existing polyp'. Rule H4 applies.

    2. STOP. Look no further. Code the histology for this abstract (sequence 01) to 8261, adenocarcinoma in villous adenoma.
    3. Finish this abstract.
    4. Set up the second abstract for this case (sequence 02). We are now working only with the sigmoid colon tumor. It is a single tumor, so start reading the histology coding rules for "Single Tumor" starting with rule H1.

      H1. If there's no pathology/cytology report...
      We have a pathology report. Rule H1 does not apply. Keep reading.
      H2. Code histology from a metastatic site...
      We have tissue from the primary site. Rule H2 does not apply. Keep reading.
      H3. If the pathology report describes intestinal type adenocarcinoma...
      Intestinal type adenocarcinoma is not mentioned. Rule H3 does not apply. Keep reading.
      H4. Use a specific adenocarcinoma in a polyp code when...
      For this tumor, the initial biopsy describes an adenomatous polyp with focal adenocarcinoma. Remember that "focal" means a confined area that can be either microscopic or macroscopic. The resection specimen refers to the biopsy specimen and indicates that no residual tumor was found in the resection specimen. Rule H4 applies.

    5. STOP. Look no further. Code the histology for this abstract (sequence 02) to 8210, adenocarcinoma in adenomatous polyp.
    6. Finish the abstract.
  6. This case had two primaries in different segments of the colon. Sequence 01, the more advanced tumor in the ascending colon, was coded as an adenocarcinoma in villous adenoma. Sequence 02, the sigmoid tumor, was coded as an adenocarcinoma in an adenomatous polyp.