CDCS Final Exam

This question pertains to the Lung Case Study. What is the primary site code? C34.0 C34.1 C34.2 C34.3 C34.8 C34.9

The correct answer is C34.1. There was only one tumor and it was in the upper lobe of the right lung.

This question pertains to the Prostate Case Study. What is the Pathological Grade? 1 2 3 4 5 6 9

The grade was stated to be Gleason's score 6 on resection. A Gleason score 6 is a grade code of 1.

This question pertains to the Colon Case Study. What is the primary site code? C18.0 C18.2 C18.4 C18.6

The only mention of tumor location was on the CT. The tumor was in the ascending colon (C18.2).

This question pertains to the Colon Case Study. What is the Reg LN Pos? 00 03 08 99

Three of the regional nodes were positive.

This question pertains to the Breast Case Study. What should be entered for Reg LN Exam? 00 02 05 07 95 97 98 99

07 There were two sentinel nodes and five axillary nodes examined. The Reg LN exam = the total number of nodes in Reg LN Exam - so it would be 07. The Reg LN Pos would be 02.

This question pertains to the Colon Case Study. What is the Reg LN Exam? 00 03 08 11

08 Eight of the regional nodes were examined.

This question is based on the Solid Tumor Rules. Indicate the number of primary cancers there are according to the Solid Tumor Rules. Case Study: Two tumors in the upper lobe of the right lung. Clinically, both are suspicious for malignancy. One of the tumors is biopsied and is consistent with adenocarcinoma. The patient is referred for chemotherapy and radiation therapy. How many primaries does this represent? 1 2

1 Rule M9: Abstract a single primary when there are simultaneous multiple tumors: In both lungs (multiple in right and multiple in left) OR In the same lung OR Single tumor in one lung; multiple tumors in contralateral lung. Note 4: When there are multiple tumors in one or both lungs, the physician usually biopsies only one mass/tumor. They treat the patient based on that single biopsy, assuming all of the masses/tumors are the same histology.

This question is based on the Solid Tumor Rules. Indicate the number of primary cancers there are according to the Solid Tumor Rules. Case Study: 3/25/2013: Patient has a TURBT for a bladder tumor consistent with invasive papillary transitional cell carcinoma. 8/11/2018: Patient has a TURBT for a bladder tumor consistent with invasive transitional cell carcinoma. How many primaries does this represent? 1 2

1 The correct answer is: One primary. Stop at Rule M7 - Abstract a single primary when the patient has multiple occurrences of invasive tumors in the bladder. Original tumor and subsequent tumor are either: Papillary urothelial carcinoma and a recurrence of papillary urothelial carcinoma 8130/3 OR Urothelial carcinoma and a recurrence of urothelial carcinoma 8120/3

This question pertains to the Lung Case Study. What is the Reg LN Exam? 00 04 12 16

16 Twelve hilar and four mediastinal nodes were examined, all regional nodes.

This question is based on the Solid Tumor Rules. Indicate the number of primary cancers there are according to the Solid Tumor Rules. Case Study: Patient was diagnosed in 2007 with a tumor in the frontal lobe consistent with pilocytic astrocytoma. A resection was performed and the tumor was removed. In 2018, the patient returned and a new tumor was noted in the parietal lobe consistent with a glioblastoma multiforme. How many primaries does this represent? 1 2

2 The first rule that applies is M6. Glioblastoma multiforme following a glial tumor is a multiple primary.

This question is based on the Solid Tumor Rules. Indicate the number of primary cancers there are according to the Solid Tumor Rules. Case Study: Two tumors in the right breast diagnosed at the same time. One tumor is in the upper outer quadrant and the histology is lobular and ductal carcinoma. The second tumor is in the upper inner quadrant and the histology is mucinous carcinoma. How many primaries does this represent? 1 2 3

2 The histology of the tumor in the upper outer quadrant is 8522. The histology of the tumor in the upper inner quadrant is 8480. Comparing the two separate tumors, the first MP rule that applies is M13: Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 3.

This question is based on the Solid Tumor Rules. Indicate the number of primary cancers there are according to the Solid Tumor Rules. Case Study: Three tumors in the colon. One tumor is in the sigmoid colon consistent with adenocarcinoma. There are two polyps in the transverse colon. One polyp is an adenocarcinoma in a tubullovillous adenoma. The second polyp is a tubulopapillary adenocarcinoma. How many primaries does this represent? 1 2 3

3 We have 3 tumors; two in the transverse colon and one in the sigmoid colon. The first rule that applies is Rule M6 which tells us we have multiple primaries when separate, non-contiguous tumors are on different rows in Table 1. We have two adenocarcinomas, one in the sigmoid colon and one in the transverse colon; we have a single tubulopapillary adenocarcinoma in the transverse colon. That tells us the two tumors in the transverse colon are multiple primaries. Now, we need to keep going through the rules to find out if the two adenocarcinomas are multiple primaries. The first rule that applies is M9; separate, non-contiguous tumors that are in sites that differ at the fourth character are multiple primaries. Therefore, we have three separate primaries.

This question pertains to the Hematopoietic Case Study. What is the Clinical Grade? 1 2 3 4 5 6 8 9

8 When you look up chronic lymphocytic leukemia/small lymphocytic lymphoma in the Hematopoietic Database, under the "help me code for diagnosis year 2018" section, the grade is listed as "not applicable". Go to the Grade Manual and refer to Grade Table 88. The only available grade code is 8.

This question pertains to the Lung Case Study. What is the histology and behavior code? 8010/3 8046/3 8140/3 8250/3 8255/3 8310/3

8255/3 There was only one tumor. Use the single tumor module of the histology rules. The histology was carcinoma (8010) with clear cell (8310) and micropapillalry (8265) types. These two specific histologies are both subtypes/variants of adenocarcinoma, NOS. The first rule that applies is H7. According to Table 2, a combination of clear cell and micropapillary should be coded to adenocarcinoma with mixed subtypes (8255). The tumor was all invasive (/3).

Which of the following describes the use of "NOS" in the ICD-O-3? A - Term is not modified with any other term B - Term has an adjective that does not appear elsewhere in ICD-O-3. C - Term is used in the general sense. D - Use only if stated in the pathology report All of the above A, B, and C

A, B, and C NOS (Not Otherwise Specified) is used like NEC (Not Elsewhere Classified) in ICD-9. NOS is not usually found on a pathology report as it is a term relating to coding in cancer registry applications. NOS indicates that the term may be described more specifically. For example, the term Carcinoma is a NOS term. In the ICD-O-3, this term will have an "NOS" associated with it. Carcinoma is a general term used to describe an epithelial tumor and can be described more specifically, such as basal cell carcinoma or squamous cell carcinoma, etc. If a more specific description is given, the most specific term should be coded and not the general NOS term. When the NOS code is assigned, that means there wasn't a more specific term to describe the histology provided in the source document (in other words, the NOS term was not modified). It also means that if a more specific term was provided, there was not a code for it in the ICD-O-3. An example of this is atypical adenocarcinoma. There is not a specific code for the adjective "atypical," so the code for "adenocarcinoma, NOS" must be used.

A patient presented with blood in the stool. A colonoscopy showed a lesion in the transverse colon positive for adenocarcinoma. The patient had a colectomy and the pathology report was read as: Grade III adenocarcinoma penetrating the serosa and extending into the gallbladder. 8 regional lymph nodes examined and none showed evidence of metastases (0/8).What is: Primary Site Code_____________ Summary Stage 2018____________________ C18.4 - 2 C18.5 - 2 C18.3 - 2 C18.4 - 1

C18.4 - 2 Primary Site Code: C18.4 (transverse colon) SS 2000 Code: 2 (Regional by direct extension) Extension to the serosa and the gallbladder. Nodes negative

This question pertains to the Breast Case Study. What is the primary site code? C50.2 C50.8 C50.4 C50.3

C50.4 The only description of the location of the mass is on the mammogram. The 2:00 o'clock position in the left breast is in the upper outer quadrant. The separate 3.0cm mass was described as being in the same area. Since all tumors are in the same quadrant, that specific quadrant can be assigned.

This question pertains to the Prostate Case Study. What is the primary site code? C61.5 C61.9 C76.3 C80.9

C61.9 The site code for prostate is C61.9. There are no other subsite codes for prostate.

This question pertains to the Hematopoietic Case Study. What is the primary site? C77.0 C77.1 C77.2 C77.8 C77.9 C42.0 C42.1

C77.1 When you look up chronic lymphocytic leukemia/small lymphocytic lymphoma in the Hematopoietic Database, it refers you to Module 3/PH5 and PH6. Rule PH6: Code to bone marrow if peripheral blood involved. Rule PH6: Code to site of origin (lymph nodes, tissues or organs) if peripheral blood and flow cytometry are negative or unknown. Only lymph nodes are involved. The peripheral blood was negative. The CT showed hilar and mediastinal adenopathy. Hilar and mediastinal lymph nodes have the same topography code of C77.1. Since these fall under the same code, that code should be assigned, not C77.8.

A patient was diagnosed as having centroblastic malignant lymphoma in April of last year. A biopsy five months later in the same area shows diffuse large B-cell lymphoma. What is the histology code for this case? 9681/2 9680/3 9680/2 9679/3

Correct: 9680/3 Reference: Heme database. It is the same disease process.

Reed-Sternberg cells are found in which of the following? Multiple myeloma Hodgkin lymphoma Leukemia All of the above

Hodgkin lymphoma cells are unique and are called Reed-Sternberg cells.

This question pertains to the Breast Case Study. What is the pathological Stage Group? IIA IIB IIIA IIIB IIIC IV

IV The correct answer is IV (pT1c pN1mi cM1). The bone mets (cM1) makes this a pathologic stage IV using the clinical M. For the pathologic stage group, the M can be either clinical or pathologic.

Staging classifications are a coded format, usually numerical, that generally have increasing values that represent which of the following? More aggressive cancer More extensive cancer A higher grade of tumor A higher morphology code

More extensive cancer Staging classifications are a coded format, usually numerical, that have increasing values that represent greater extent of disease, or disease involvement. A higher stage cancer is not necessarily the most aggressive as some cancers are by nature more aggressive than others. Tumor grade is different than staging and is used to describe how much or how little the cancer cells resembles the normal tissue from which it arose. The morphology code denotes the type of cancer and does not represent stage.

This question pertains to the Prostate Case Study. What is the histology and behavior code? 8010/3 8140/3 8260/3 8550/3

Only one histologic type was stated. Using the 2007 MP/H rules for Other Sites (which includes prostate), single tumor invasive only module, the first rule that applies is H11. Adenocarcinoma, invasive (8140/3).

History and Physical:Patient presented to her primary care physician with tender right breast. The physician noted the breast was inflamed, with an orange peel appearance. She had a left breast cancer in 1999; stage III, treated with radical mastectomy, chemotherapy and Tamoxifen.Discharge Summary:Patient seen in outpatient department on 2/8/20xx for a biopsy of the right breast. Pathology was infiltrating duct carcinoma. No axillary nodes were palpable. CXR, bone scan, and LFT's all negative. She was referred to medical and radiation oncology departments. What is: Primary Site Code:______________ Summary Stage 2018___________________ C50.8 - 2 C50.9 - 2 C50.9 - 3 C50.8 - 1

Primary Site Code: C50.9 (subsite not specified)SS 2018Code: 2 (Regional by direct extension) Inflammatory carcinoma is often described by the pathologist as infiltrating ductal carcinoma because inflammatory carcinoma is a clinical term. Often a biopsy is followed by radiation and chemotherapy and later, a Modified Radical Mastectomy (MRM). Read the H&P and discharge summary carefully, Peau d' orange (skin of an orange) makes this at least regional.

According to the general rules in the AJCC Cancer Staging Manual, direct extension of the primary tumor into regional lymph nodes is considered: Local disease Regional lymph node metastasis Direct extension into the surrounding tissues Distant disease

Regional lymph node metastasis Direct extension of the primary tumor into regional lymph nodes is considered lymph node metastasis and is classified in the AJCC N category for regional nodal involvement.

This question pertains to the Breast Case Study. What is the best code and classification for the AJCC M? cMX pMX cM0 pM0 cM1 pM1

The bone scan was positive for metastasis in the bones (femur). The mets found on imagine are considered a clinical assignment of M1. A pathological M is not applicable in this case because there was no positive biopsy, so the best classification for this case is the clinical M. There are no cMX, pMX or pM0 categories in AJCC.

This question pertains to the Breast Case Study. What is the Pathological Grade? 1 2 3 4 5 6 9

The correct answer is 2. The grade was reported as grade 2 and Bloom Richardson Score 6. See the Grade Manual at NAACCR (Grade Table 12. The grade for a tumor is determined by assessing morphologic features (tubule formation, nuclear pleomorphism, and mitotic count), assigning a value from 1 (favorable) to 3 (unfavorable) for each feature, and totaling the scores for all three categories. A combined score of 3-5 points is designated as grade 1; a combined score of 6-7 points is grade 2; a combined score of 8-9 points is grade 3. Do not calculate the score unless all three components are available.

This question pertains to the Lung Case Study. What is the AJCC clinical stage group? 0 IA IB IIA IIB IIIA IIIB IV

The correct answer is IB (cT2a cN0 cM0).

This question pertains to the Lung Case Study. What is the AJCC pathological stage group? 0 IA IB IIA IIB

The correct answer is IB (pT2a pN0 cM0) stage IB ). For the pathological stage group, the M can be either clinical or pathological.

This question pertains to the Breast Case Study. What is the clinical Stage Group? IIA IIB IIIA IIIB IIIC IV

The correct answer is IV (cT2 cN0 cM1). The bone mets (cM1) makes this a clinical stage IV with any T, any N, and any values for the prognostic studies (ER, PR, Her2).

This question pertains to the Lung Case Study. What is the best code and classification for the AJCC M? cMX pMX cM0 pM0 cM1

The correct answer is cM0. The chest x-ray and CT scan were negative for metastatic disease. There are no cMX, pMX, or pM0 categories in AJCC.

This question pertains to the Breast Case Study. What is the AJCC clinical N? cNX cN0 cN1 cN2a

The correct answer is cN0. The physical exam stated there were no palpable lymph nodes.

This question pertains to the Breast Case Study. What is the AJCC pathologic T? pT1a pT1b pT1c pT2 pT3

The correct answer is pT1c. When surgery is the first treatment, the tumor size from the pathology has priority over the imaging size. The T category is based on the size of the invasive component. The invasive tumor measured 2.0 cm on resection. T1c is used for tumors that are greater than 1.0 cm but not greater than 2.0cm. Tumors that are exactly 2.0cm are coded to T1c.

The "Multiple Tumors" module of the Solid Tumor Rules should be used for which situation(s)? A - A patient with two tumors. One is the primary tumor and the other is described as metastatic from the primary tumor. B - A patient with two tumors. One is the primary tumor and the other is described as a recurrence from the primary tumor by the physician. No pathological comparison is made. C - A patient with a single primary tumor that has separate microscopic foci. All of the above None of the above A and B A and C B and C

The correct choice is B, a patient with two tumors. One is the primary tumor and the other is described as a recurrence from the primary tumor by the physician. No pathological comparison is made. Do not use a physician's statement to decide whether the patient has a recurrence of a previous cancer or a new primary. Use the multiple primary rules as written unless a pathologist compares the present tumor to the "original" tumor and states that this tumor is a recurrence of cancer from the previous primary. Since a comparison of the pathology was not made in this situation, these two tumors will need to be taken through the Solid Tumor Rules using the multiple tumors module to determine the number of primaries. Answer options A and C would use the single tumor module. When determining the appropriate module, do not count metastatic lesions. When there is a tumor with separate microscopic foci, ignore the separate microscopic foci and use the "Single Tumor" module.

This question pertains to the Colon Case Study. What is the Pathological Grade? 1 2 3 Cannot be assigned

The grade was stated to be low grade. Low grade is not listed in Grade Table 2; therefore, the grade cannot be assigned.

This question pertains to the Breast Case Study. Assign the histology and behavior code. 8140/3 8500/3 8523/3 8501/3 8501/2

The histology and behavior code is 8500/3. There was a 2.0 cm infiltrating duct carcinoma and a separate 3.0 cm DCIS, cribriform and comedo types. Use the Solid Tumor Rules for breast, multiple tumors abstracted as a single primary module. The first rule that applies is H22. If one tumor is invasive and one tumor is in situ (and it is considered a single primary after going through the Multiple Primary rules), assign the histology of the invasive tumor. The invasive histology was infiltrating duct carcinoma (8500/3).

The staging scheme used for lymphoma is guided by which of the following? The primary site of the lymphoma The morphology code The site that was first biopsied All of the above

The staging scheme for lymphomas is guided by the morphology code. Use the lymphoma staging scheme for all lymphomas regardless of what site code is assigned. The site first biopsied is not necessarily the primary site. There may be other areas of lymph node involvement.

This question pertains to the Lung Case Study. What is the AJCC clinical T? cTX cT1a cT1b cT2a cT2b cT3 cT4

The tumor measured 4cm on clinical evaluation. Tumors that measure greater than 3cm and less than or equal to 5cm, in greatest dimension, are coded to T2a.

This question pertains to the Breast Case Study. What should be entered for Reg LN Pos? 00 02 05 07 95 97 98 99

Two sentinel nodes were positive.

This question pertains to the Hematopoietic Case Study. What is the histology code and behavior code? 9823/3 9670/3 9820/3 9800/3 9590/3 9591/3 9680/3

When you look up chronic lymphocytic leukemia/small lymphocytic lymphoma in the Hematopoietic Database, the morphology is stated to be 9823/3.

This question pertains to the Lung Case Study. What is the AJCC clinical N? cNX cN0 cN1 cN2

cN0 There was no lymphadenopathy noted on imaging studies.

This question pertains to the Colon Case Study. What is the AJCC clinical T? cTX cT0 cTis cT1 cT2

cTX There is not enough information on the clinical evaluation to determine extent through the bowel wall and assign the clinical T category.

This question pertains to the Colon Case Study. What is the best code and classification for the AJCC pathological M? cM1 pM1 cM1a pM1a cM1b pM1b

pM1a There was a biopsy of liver that was positive for metastatic adenocarcinoma consistent with colonic primary. The metastasis was confined to one organ. A biopsy was done and was positive which meets the requirements for pathological assignment.

This question pertains to the Lung Case Study. What is the AJCC pathological N? pNX pN0 pN1 pN2 pN3

pN0 Sixteen lymph nodes were examined and all were negative for tumor.

This question pertains to the Colon Case Study. What is the AJCC pathological N? pN1a pN1b pN1c pN2a pN2b

pN1b Three of eight regional nodes are positive for metastatic adenocarcinoma. A report of two to three positive nodes is assigned to N1b.

This question pertains to the Breast Case Study. What is the AJCC pathologic N? pNX pN0 pN1mi pN1a pN1b pN2a

pN1mi There were 2 lymph nodes positive and the greatest size of the mets within the node was 2mm. pNmi includes mets measuring >0.2mm and <= 2.0mm. Mets measuring exactly 2mm would fall under pNmi.

This question pertains to the Lung Case Study. What is the AJCC pathological T? pT1b pT2a pT2b pT3

pT2a The tumor measured 4cm on pathologic examination of the resected specimen (right upper lobectomy). Tumors that measure more than 3cm and less than or equal to 4cm are coded to T2a.

This question pertains to the Colon Case Study. What is the AJCC pathological T? pT1 pT2 pT3 pT4a pT4b

pT4a On the resection, the tumor extended through the bowel wall and into the serosa. The serosa is another term for visceral peritoneum.

Complete the following sentence to make a true statement. Carcinomas are composed of epithelial cells that make up the __________. blood vessels and lines the lymphatics of most organs skin and lines the walls of hollow organs skin and lines the body completely All of the above could complete the sentence to make a true statement None of the above could complete the sentence to make a true statement

skin and lines the walls of hollow organs Carcinomas arise in epithelial cells that make up the skin and line the walls of hollow organs. Lung, breast and colon are the most frequent types of carcinomas in the US.