**SEER Site-Specific Coding Guidelines**

Colon

C180--C189

# Grade

Colon cancer is often graded using a two-grade system; Low Grade (2) or
High Grade (4). If the grade is listed as 1/2 or as low grade, convert
to a grade 2. If the grade is listed as 2/2 or as high grade, convert to
a code 4.

Code the highest grade given.

  -----------------------------------------------------------------------
  Term                                          Grade    SEER Code
  --------------------------------------------- -------- ----------------
  Well differentiated                           I        1

                                                         

  Fairly well differentiated                    II       2

  Low grade                                     I-II     2

  Mid differentiated                            II       2

  Moderately differentiated                     II       2

  Partially differentiated                      II       2

  Partially well differentiated                 I-II     2

  Partially well differentiated                 II       2

  Relatively or generally well differentiated   II       2

                                                         

  Medium grade, intermediate grade              II-III   3

  Moderately poorly differentiated              III      3

  Moderately undifferentiated                   III      3

  Poorly differentiated                         III      3

  Relatively poorly differentiated              III      3

  Relatively undifferentiated                   III      3

  Slightly differentiated                       III      3

                                                         

  High grade                                    III-IV   4

  Undifferentiated, anaplastic, not             IV       4
  differentiated                                         
  -----------------------------------------------------------------------

# Familial Polyposis

Familial polyposis is an inherited, benign disease. The patients have
hundreds of adenomatous polyps throughout their large intestines, and at
times, throughout the digestive system. These polyps, if left untreated,
invariably develop cancer.

Patients develop polyps as early as ten years of age, but more commonly
at puberty. Approximately half of all patients with familial polyposis
develop polyps by age 14 and 90% have detectable polyps by age 25.

These patients are usually treated with a colectomy. The pathology
report will frequently identify carcinoma insitu in many of the polyps
and may also identify invasive carcinomas. Prepare one abstract and code
the primary site to colon, NOS (C189). Code the stage of disease using
the most invasive of the cancers.

**Synonyms** for familial polyposis:

Adenomatosis of the colon and rectum (ACR)

Familial adenomatous colon polyposis

Familial adenomatous polyposis (FAP)

Familial colonic polyposis

Multiple familial polyposis

Polyposis coli

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**Laterality**

Laterality must be coded for all subsites.

### Tumor Markers

Estrogen and progesterone receptors (ERA and PRA) are positive in most
breast cancers. A positive ERA and PRA indicates a better prognosis and
response to estrogen therapy.

**Size of Primary Tumor**

## General Coding Guidelines

If **multiple** **masses** are present, code the diameter of the
**largest** **invasive** **mass.** Ignore the insitu even if it is
larger than the invasive.

If the patient had **neoadjuvant** treatment, code the **largest** tumor
size **documented**, clinical or pathologic.

Tumors That Are Purely Invasive or Purely Insitu

For purely invasive or purely insitu tumors, record the size of tumor
based on the following priority of reports.

**Priority in which to use Reports to Code Tumor Size**

1\. **Pathology** report

2\. **Operative** report

3\. Physical examination

4\. Imaging (**mammography**)

5\. Imaging (**ultrasound**)

Single Tumors with Both Invasive and Insitu Components

Record the **size** of the **invasive** component, if given.

If **both** an ***insitu*** and an **invasive** component are present,
and the invasive component is measured, record the size of the invasive
component even if it is smaller.

*Example:* Tumor is 37 mm mixed insitu and invasive adenocarcinoma.
Pathology documents that 14 mm is invasive. *Record tumor size as 014.*

### General Staging Guidelines

**DO NOT USE** the following to determine tumor extension:

A. Dimpling of the skin, tethering, nipple retraction, nipple
involvement or skin changes other than those listed

in CS extension code 51 (See also CS Extension, Note 1)

B. **Micro**scopic satellite skin nodules

(**macro**scopic or **gross** nodules in skin of primary breast **are**
used in staging)

C. Microscopically proven invasion of lymphatic vessels within the
breast

#### SEER Site-Specific Coding Guidelines

#### BLADDER

#### C670--C679

**Primary Site**

C670 **Trigone** of bladder

Base of bladder

Floor

C671 **Dome** of bladder

Vertex

Roof

Vault

C672 **Lateral wall** of bladder

Right wall

Left wall

Lateral to ureteral orifice

Sidewall

C673 **Anterior wall** of bladder

C674 **Posterior wall** of bladder

C675 Bladder **neck**

Vesical neck

Internal urethral orifice

C676 **Ureteric orifice**

Just above ureteric orifice

C677 **Urachus**

Mid umbilical ligament

C678 **Overlapping** lesion of bladder

Lateral-posterior wall (hyphen)

C679 **Bladder, NOS**

Lateral posterior wall (no hyphen)

**Bladder Anatomy and ICD-O-3** ![](media/image1.wmf)

Priority Order for Coding Subsites

Use the information from reports in the following priority order to code
a subsite when the medical record contains conflicting information:

Operative report (TURB)

Pathology report

#### Bladder Wall Pathology

The bladder wall is composed of three layers. There may be "sub layers"
within the major layer of the bladder.

  -------------------------------------------------------------------------------
  Bladder Layer   Sub layer     Synonyms       Staging              Description
  --------------- ------------- -------------- -------------------- -------------
  Mucosa                        Epithelium,    No blood vessels,    First layer
                                transitional   insitu/noninvasive   on inside of
                                epithelium,                         bladder Lines
                                urothelium,                         bladder,
                                mucosal                             ureters, and
                                surface,                            urethra
                                transitional                        
                                mucosa                              

  -------------------------------------------------------------------------------

#### SEER Site-Specific Coding Guidelines

#### THYROID GLAND

#### C739

**Coding Hormone Therapy**

Hormones as Replacement Therapy -- Do Not Code as Treatment

The thyroid gland produces hormones that influence essentially every
organ, tissue and cell in the body. When the thyroid is partially or
totally removed, it is no longer able to secrete these essential
hormones and the patient is placed on hormone replacement therapy. Do
not code replacement therapy as treatment.

Hormone Treatment for Follicular Papillary Thyroid Cancer -- Code in the
Hormone Field

The growth of follicular cell cancer depends on thyroid stimulating
hormone. Suppression of these hormones is thought to deprive the cells
of a growth-promoting influence. Patients with follicular cell-derived
cancers have been treated with supraphysiologic doses of thyroid hormone
to suppress serum thyroid-stimulating hormones. This treatment has been
an industry standard for more than forty years. Record the delivery of
these hormones in the Hormone treatment field.

Generic Thyroid Drug Names

Levothyroxine /L-thyroxine

Liothyronine

Liotrix

Methimazole

Natural Thyroid

Propylthiouracil / PTU

Thyrotropin alfa

Thyroid Drugs Brand Names

Armour Thyroid

Cytomel

Levothroid

Levoxyl

Naturethroid

Synthroid

Tapazole

Thyrogen

Thyrolar

Unithroid

Westhroid

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