Download Bladder Anatomy and Cancer Coding Guidelines and more Lecture notes Pathology in PDF only on Docsity!
Coding Guidelines BLADDER C670–C
Primary Site
C670 Trigone of bladder Base of bladder Floor Below interureteric ridge (interureteric crest, or interureteric fold)
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) Fundus
C679 Bladder, NOS Lateral posterior wall (no hyphen)
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
Multifocal Tumors
Invasive tumor in more than one subsite
Assign site code C679 when the tumor is multifocal (separate tumors in more than one subsite of the bladder).
If the TURB or pathology proves invasive tumor in one subsite and in situ tumor in all other involved subsites, code to the subsite involved with invasive tumor.
HISTOLOGY^1
Most bladder cancers are transitional cell carcinomas. Other types include squamous cell carcinoma and adenocarcinoma. Adenocarcinomas tend to occur in the urachus or, frequently, the trigone of the bladder^2 Other bladder histologic types include sarcoma, lymphoma, and small cell carcinoma. Rhabdomyosarcoma occurs in children.
Behavior Code
Code the behavior as malignant /3, not in situ /2, when
- the only surgery performed is a transurethral resection of the bladder (TURB) documenting that depth of invasion cannot be measured because there is no muscle in the specimen and
- the physician’s TNM designation is not available
Code the behavior as in situ /2 when the TNM designation is Ta for TURB with no muscle in the specimen.
Grade
Note: These guidelines pertain to the data item Grade. Refer to the Collaborative Stage Data Collection Manual for instructions on coding site-specific factors.
Code grade from the original primary. Do not code grade from recurrence.
Non-invasive papillary urothelial (transitional) carcinoma
Code grade 1 (well differentiated) for non-invasive papillary urothelial carcinoma, low grade
Code grade 3 (poorly differentiated) for non-invasive papillary urothelial (transitional) carcinoma, high grade
Urothelial carcinoma in situ
Code grade 9 for urothelial carcinoma in situ
Invasive Tumors Three-Grade System (Nuclear Grade)
There are several sites for which a three-grade system is used. The patterns of cell growth are measured on a scale of 1, 2, and 3 (also referred to as low, medium, and high grade). This system measures the proportion of cancer cells that are growing and making new cells and how closely they resemble the cells of the host tissue. Thus, it is similar to a four-grade system, but simply divides the spectrum into three rather than four categories (see conversion table below). The expected outcome is more favorable for lower grades.
(^1) PDQ (^2) Clinical Oncology, 8 th (^) edition
If a grade is written as 2/3 that means this is a grade 2 of a three-grade system. Do not simply code the numerator. Use the following table to convert the grade to SEER codes.
Term Grade SEER Code 1/3, 1/2 Low grade 2 2/3 Intermediate grade 3 3/3, 2/2 High grade 4
FIRST COURSE TREATMENT
TREATMENT MODALITIES (most common treatments)
TURB with fulguration TURB with fulguration followed by intravesical BCG (bacillus Calmette-Guerin) is usually used for patients with multiple tumors or for high-risk patients. TURB with fulguration followed by intravesical chemotherapy Photodynamic therapy (PDT) using laser light and chemotherapy Segmental cystectomy (rare) Radical cystectomy in patients with extensive or refractory superficial tumor Internal irradiation (needles, seeds, wires, or catheters placed into or near the tumor) with or without external-beam irradiation Chemotherapy Immunotherapy/biologic therapy
