Abstracting/Coding Flashcards
Clinical and Pathological Grade cannot be left blank.
True or False?
True.
Grade can only be assigned based on the primary tumor.
True or False?
True.
If tissue from the primary site is not available, you may code grade from a contiguous adjacent site.
True or False?
True
If tissue from the primary site is unavailable, and the only tissue you have is from a lymph node, the grade code MUST be _____
9 Unknown
If there are invasive and in situ components involved in the specimen, which portion should you grade?
Grade the invasive portion only.
Dysplasia is coded for grade.
True or False?
False.
If a tumor is in situ only, can you assign grade?
Yes, as long as there is no invasive component.
SBR (Scarf-Bloom-Richardson) staging system is synonymous with what other breast cancer staging system?
Nottingham.
yC and yP are left blank when…
No neoadjuvant therapy has been given.
If grade is not documented anywhere in the patient’s records, what is the grade code should you use?
9 Unknown
If you don’t know if a documented grade is clinical or pathological, how do you code the grade?
Enter the documented grade as the Clinical grade, and enter 9 Unknown as the Pathological grade.
If a patient has neoadjuvant treatment prior to resection of the tumor, the Pathological grade MUST be ____
9 Unknown
The pathology results of a TURP can only be used for
A. Pathological grade.
B. Clinical grade.
C. Post-therapy grade.
D. Both A and B.
B. Clinical grade.
A free online application that has full copies of the STORE manual, Collaborative Staging, Multiple Primary and Histology coding manuals, the NAACCR data dictionary, the SEER manual and the intro and histology section of the ICD-O-3 is called ____
Registry Plus Online
How many digits are in SEER’s Extent of Disease coding system?
10
Combination codes such as 8523/3 (infiltrating duct mixed with other types of carcinoma) and 8524/3 (infiltrating lobular mixed with other types of carcinoma) are used when
A. Two types of carcinomas are intermixed within one tumor.
B. Two tumors exist in the same primary site - one tumor is infiltrating ductal and the other tumor is infiltrating lobular.
C. Two tumors with the different histologies “overlap” each other (collision tumors).
D. None of the above
A. Two types of carcinomas are intermixed within one tumor.
Which term is used by pathologists to describe a group of cells that can be seen only by a microscope?
A. Focal tumor
B. Tumor focus
C. Overlapping tumor
D. Contiguous tumor
B. Tumor focus
The Solid Tumor Rules state that when there is more than one pathology report, use the report from the most representative specimen. The most representative specimen is
A. The specimen from the most extensive surgery.
B. The specimen with the most specific diagnosis.
C. The specimen with the greatest amount of tumor.
D. None of the above
C. The specimen with the greatest amount of tumor.
How many main stage groups exist in the Summary Staging classification system?
A. 3
B. 4
C. 5
D. 9
C. 5
Which tumor marker is commonly used to determine whether specific targeted therapy is appropriate for colorectal cancer?
A. AFP
B. CA-125
C. ER/PR
D. KRAS mutation analysis
D. KRAS mutation analysis
Which tumor marker is used to predict response to therapy for cutaneous melanoma and colorectal cancer?
A. ALK gene rearrangements
B. BRAF mutation V600E
C. CD20
D. EGFR mutation analysis
B. BRAF mutation V600E
Prednisone is considered a
A. Hormone.
B. Adrenocorticoid.
C. Immunotherapy.
D. Both (a) and (b)
D. Both (a) and (b)
Radiofrequency ablation is a type of treatment that uses
A. Heat energy.
B. Ultraviolet light.
C. Radioactive rays.
D. Specialized radio wave
A. Heat energy.
What type of transplant involves the transplant of cells from the body of the transplant recipient?
A. Allogeneic transplant
B. Syngeneic transplant
C. Cord blood
D. Autologous
D. Autologous
Approximately what percentage of cancer cases are confirmed following the gross and microscopic examination of organs, tissues, cells, and bodily fluids removed from patients?
A. 75
B. 85
C. 95
D. 100
C. 95
Which statement(s) is true regarding the Solid Tumor Rules?
A. If there is bilateral involvement, assume the patient has multiple primaries.
B. When a tumor has separate microscopic foci, ignore the foci and use the “Single Tumor” module.
C. Both (a) and (b)
B. When a tumor has separate microscopic foci, ignore the foci and use the “Single Tumor” module.
The 2007 MP/H Rules are only to be used for cases diagnosed 1/1/2007 through 12/31/2017. From 1/1/2018 forward, the Solid Tumor Rules are used.
True or False?
True
Which tumor marker is commonly used to assess stage, prognosis and response to treatment for choriocarcinoma and testicular cancer?
A. Beta-hCG
B. HER2/neu
C. LDH
D. None of the above
A. Beta-hCG
Which tumor marker is used to help diagnose multiple myeloma?
A. BCR-ABL fusion gene
B. Immunoglobulins
C. CgA
D. CEA
B. Immunoglobulins
What type of agents enhance the effects of cancer-directed treatment but do not directly affect the cancer?
A. Immunotherapy
B. Chemotherapy
C. Hormonal therapy
D. Ancillary drugs
D. Ancillary drugs
What reference is used by registrars in North America to determine the number of primaries to report for a patient?
A, International Agency for Research on Cancer’s (IARC) Multiple Primary Rules Guide
B. Surveillance, Epidemiology, and End Results Program (SEER) Program Coding Manual
C. Commission on Cancer (CoC) FORDS Manual
D. SEER Multiple Primary and Histology Coding Rules
D. SEER Multiple Primary and Histology Coding Rules
When abstracting a case, the first step is to
A. Review the site-specific multiple primary rules.
B. Determine the primary site(s) by reading the medical record.
C. Read the site-specific Equivalent Terms and Definitions.
D. None of the above
B. Determine the primary site(s) by reading the medical record.
What factor(s) is used to determine stage for the majority of malignancies?
A. Location of the original tumor
B. Whether or not the cancer spread to distant areas in the body
C. The class of case
D. Both (a) and (b)
D. Both (a) and (b)
What is the prefix used in the AJCC TNM staging system that indicates the stage was determined at autopsy?
A. c
B. p
C. r
D. a
D. a
What is the general AJCC staging guideline when the clinician cannot decide between two stages for a single disease process?
A. Assign the lower (lesser) stage.
B. Assign the higher (greater) stage.
C. Assign an unknown stage for only solid tumors.
D. Assign an unknown stage for all primaries.
A. Assign the lower (lesser) stage.
Which tumor marker is used to determine whether treatment with trastuzumab (Herceptin) is appropriate?
A. Beta-hCG
B. LDH
C. PSA
D. HER2/neu
D. HER2/neu
Which tumor marker is commonly used to confirm the diagnosis of chronic myeloid leukemia?
A. Immunoglobulins
B. CgA
C. CEA
D. BCR-ABL fusion gene
D. BCR-ABL fusion gene
Herceptin is coded as
A. Chemotherapy.
B. Immunotherapy.
C. Hormonal therapy.
D. Radiotherapy.
B. Immunotherapy.
What resource is used to determine the number of primaries to be accessioned by the registrar?
The Solid Tumor Rules
The ICD-O-2 and ICD-O-3 topography codes are based on
A. ICD-9.
B. ICD-9-CM.
C. ICD-10
D. None of the above.
C. ICD-10
Per the Multiple Primary and Solid Tumor rules, recurrence is defined as
A. The reappearance of disease that was thought to be cured or inactive.
B. A new occurrence of cancer arising from cells that have nothing to do with the earlier (first) cancer.
C. The spread of a previously diagnosed cancer to a distant site.
D. Both A and B.
D. Both A and B.
Per the Solid Tumor Rules, when counting the number of primary tumors described in the medical record do not count
A. Metastatic lesions.
B. Microscopic tumor foci.
C. Tumors described as likely to be malignant.
D. Both (a) and (b)
D. Both (a) and (b)
What factor(s) is used to determine stage for brain and spinal cord malignancies?
A. Location of the tumor
B. Size of the tumor
C. Grade and cell type of the tumor
D. None of the above
C. Grade and cell type of the tumor
What does the code TX mean in the TNM staging system?
A. There is no evidence of a primary tumor.
B. Tumor has not spread to neighboring tissues.
C. Tumor is noninfiltrating.
D. Tumor cannot be evaluated.
D. Tumor cannot be evaluated.
Which tumor marker is commonly used as part of the work-up for liver primaries?
A. AFP
B. CA-125
C. ER/PR
D. KRAS mutation analysis
A. AFP
Which tumor marker is used to determine whether treatment with a targeted therapy is appropriate for non-Hodgkin lymphoma?
A. ALK gene rearrangements
B. BRAF mutation V600E
C. CD20
D. EGFR mutation analysis
C. CD20
What staging system(s) is considered to have clinical relevance?
A. AJCC TNM Stage
B. Summary Stage
C. Both (a) and (b)
D. Neither (a) nor (b)
A. AJCC TNM Stage
For papillary and/or follicular thyroid cancer patients treated surgically, Levothyroxine is coded as
A. Chemotherapy.
B. Immunotherapy.
C. Hormone therapy.
D. Biologic therapy
C. Hormone therapy.
Physical therapy is considered a
A. Alternative therapy.
B. Complementary therapy.
C. Neoadjuvant therapy.
D. Support service.
D. Support service.
Brachytherapy is given
A. Orally.
B. Intracavitarily.
C. Intraperitoneally.
D. Externally.
B. Intracavitarily.
Antiandrogens are primarily used to treat
A. Metastatic testicular cancer
B. Metastatic prostate cancer
C. Both (a) and (b)
D. Neither (a) nor (b)
B. Metastatic prostate cancer
Are sentinel lymph nodes included in the Regional Lymph Nodes Examined and Regional Lymph Nodes positive fields?
Yes.
The Regional Lymph Nodes Examined and Regional Lymph Nodes Positive fields are cumulative fields and should include all lymph nodes removed through the completion of the first course of treatment.
True or False?
True
If the primary tumor cannot be found, and a patient is diagnosed through biopsy of a regional lymph node, how do you code the size of the primary tumor?
000
If the patient has neoadjuvant therapy prior to surgery, how do you code the pathological tumor size?
999
If there is missing TNM information, what is the code for stage?
You cannot assign stage with missing TNM information.
If a tumor size is given as between two sizes, such as 10-12 cm, how do you code the size?
Record the size as the midpoint of the two sizes given.
If there are discrepancies in the stated size of the tumor in the clinical workup, how do you code the clinical size?
Record the largest stated size of the tumor from the physical exams and imaging reports.
What is recorded in the Tumor Size Summary field?
The most accurate measurements of a solid primary tumor, usually from the surgical specimen.
For breast tumors only, how do you code tumor sizes between 1.1 mm and 2.4 mm?
Round them up or down to 2 mm
Presurgical embolization of hypervascular tumors with particles, coils, or alcohol is typically performed to make resection of the tumor easier, and is not coded.
True or False?
True
An intra-axial mass is located in the ______
Brain
The hematopoietic and lymphoid neoplasm rules went into effect for cases diagnosed
A. January 1, 2007 and after
B. January 1, 2009 and after
C. January 1, 2010 and after
D. January 1, 2012 and after
C. January 1, 2010 and after
Classification of the extent of disease is known as _____
Staging
The pathology report of a radical mastectomy is reported as infiltrating ducal carcinoma with cancer at the nipple, 6:00, 9:00, and 12:00. How many primaries are there?
A. One
B. Two
C. Three
D. Four
A. One
The date of diagnosis for an autopsy only case is
A. Date of death
B. Date the tissue was examined
C. Date of autopsy
D. None of the above
A. Date of death
What surgical procedure MUST be performed in order to qualify for assignment of pathological TNM for cancer of the prostate?
A total prostatectomy.
The 2018 Solid Tumor Rules are based on the WHO Classification of Tumors, which are also known as the _____ books.
Blue
The 2007 Multiple Primary and Histology (MPH) Coding Rules have been revised and are now referred to as the ______
2018 Solid Tumor Rules
Biomarkers can be used to determine multiple primaries.
True or False?
False.
What is the current preferred term for duct or ductal carcinoma of the breast?
Carcinoma NST
Subtypes, variants, architecture, pattern, and features of DCIS or Carcinoma NST of the breast ______
A. Are coded.
B. Are not coded.
B. Are not coded.
The majority of breast in situ DCIS will be coded to ______
8500/2
In the breast, an invasive subtype/variant is coded ONLY when it comprises greater than ____% of the tumor.
90%
For coding purposes, terms such as “greater than 50%,””majority,” “major,” and “predominantly” qualify as describing that a histology comprises the majority of the tumor.
True or False?
True
In the breast, if two or more histologies are present, but the predominant histology is unknown, use a _____ code from Table 2.
Combination
In a breast tumor, apocrine differentiation or features, which are frequently present in carcinoma NST and lobular carcinoma NOS,
A. Are coded.
B. Are not coded.
B. Are not coded.
Bilateral breast cancer (cancer in both breasts) is a _______ primary, regardless if the histologies in each breast are the same or different.
Multiple
When the diagnosis is inflammatory carcinoma of the breast, whether in multiple quadrants of the same breast or in bilateral breasts, it is a ________ primary.
Single
Ninety-eight percent of colon cancers are _______ and its subtypes.
Adenocarcinoma.
In the colon, transmural describes
A. Extension through all layers of the bowel wall but not past the wall.
B. Extension through the serosa into the mesentery.
C. Extension within the mucosal layer of the bowel.
D. A and B
D. A and B
In a colon case, histology is coded from
A. The most representative specimen.
B. The most specific specimen.
C. The most specific specimen unless the biopsy and resection have different histologies, in which case code the most representative specimen.
C. The most specific specimen unless the biopsy and resection have different histologies, in which case code the most representative specimen.
Colon dysplasia, which is assigned an in situ behavior code of /2
A. Is reportable in the US
B. Is not reportable US
B. Is not reportable in the US
Adenocarcinoma in a colon polyp is coded as
A. Adenocarcinoma arising in a polyp.
B. Adenocarcinoma.
B. Adenocarcinoma
The serosa is synonymous with the visceral peritoneum.
True or False?
True
Polypoid adenocarcinoma is synonymous to adenocarcinoma in a polyp.
True or False?
False.
Also known as Brinton’s Disease, this subtype of adenocarcinoma arises from the glandular cells lining the stomach.
Lintis plastica
What part of the colon is not enveloped in protective serosa?
The rectum
What type of colon tumors arise separately in close proximity, then increase in size to merge or overlap each other, and are counted as two separate tumors (multiple primaries)?
Collision tumors
The presence of multiple or “too numerous to count” polyps in the colon is diagnostic of Familial Polyposis (FAP)
True or False?
False.
Code the histology and ignore the polyp when colon cancer arises in a polyp.
True or False?
True
In head and neck cancers, P16 positive is synonymous with HPV positive.
True or False?
False.
Anatomically, the base of the tongue is part of the
Oropharynx
The first date a physician or pathologist states the patient has a malignancy is called the date of
Diagnosis
The most recent point in time that a patient’s health status is known is the
Date of last contact
The date a cancer reappears after a disease free interval is called the
Date of first recurrence
For analytic cases, the date of first contact is the date the patient first
A. Presents to the reporting facility.
B. Becomes analytic for the reporting facility.
B. Becomes analytic for the reporting facility
A large tumor involving the apex of the lung is called a ______ tumor.
Pancoast
Classes of Case 00-14 are for cases where diagnosis was made
A. At the reporting facility.
B. At a staff physician’s office or the reporting facility.
B. At a staff physician’s office or the reporting facility.
What is the Class of Case range for cases diagnosed elsewhere and all or part of the first course of treatment is done at the reporting facility?
A. 10-14
B. 20-22
C. 30-38
B. 20-22
Which Class of Case is used for a pathology or other lab specimen case only?
43
What Class of Case is a death certificate only case?
49
Which Class of Case codes are used when the diagnosis was made a staff physician’s office?
A. 11 and 12
B. 13 and 14
A. 11 and 12
What Class of Case codes are used for cases that were diagnosed the reporting facility?
A. 11 and 12.
B. 13 and 14.
B. 13 and 14
Which Class of Case code is used when the patient was diagnosed either at the reporting facility or a staff physician’s office and all or part of first course of treatment was done at the reporting facility?
10
What is the Class of Case code for a patient diagnosed at the reporting facility by autopsy only, and the cancer was not suspected prior to death?
38
What Class of Case code range is for analytic cases?
A. 00-22
B. 30-38
C. 40-99
D. 30-99
A. 00-22
What Class of Case code range is for non-analytic cases?
A. 00-22
B. 30-99
C. 30-38
D. 40-99
B. 30-99
Ann Arbor staging is a specialized staging system for malignant _____
Lymphoma
When there are discrepancies between the final diagnosis and synoptic CAP report, use ______ to code the histology.
A. The CAP report.
B. The final diagnosis.
C. Whichever is the more specific histology.
D. The histology noted in the op report.
C. Whichever is the more specific histology.
When may neoadjuvant chemotherapy be given?
A. Prior to surgery.
B. Prior to radiation therapy.
C. Both A and B
C. Both A and B
What standard setting organization oversees and manages Extent of Disease staging and Summary Stage?
SEER
What is the most commonly used staging system in the world?
TNM staging
ACTH is a tumor marker for what kind of cancer?
Small cell carcinoma of the lung
CEA is a tumor markers in what three types of cancer?
Colon, breast, and small cell lung
CA-125 is a tumor marker for what cancer of the female reproductive system?
Ovarian cancer
CA-19-9 is a tumor marker for what cancer of the digestive system?
Pancreatic cancer
LDH is a tumor marker for what two kinds of cancer?
Testicular and melanoma
CA-15-3 is a tumor marker for what kind of cancer, mostly occurring in women?
Breast cancer
What is the site code for the small intestine?
C17
What is the site code for the colon?
C18
What is the site code for the rectum?
C20
What is the site code for the liver
C22
What is the site code for the pancreas?
C25
What is the site code for the lungs?
C34
What is the site code for bone marrow?
C42.1
What is the site code for lymph nodes?
C77
What is the site code for the skin?
C44
What is the site code for the ovaries?
C56
What is the site code for the prostate?
C61
What is the site code for the bladder?
C67
What is the site code for the kidney?
C64
What is the site code for the brain?
C71
What is the site code for the meninges?
C70
What is the site code for the nipple?
C50.0
What is the site code for the subareolar/retroareolar area of the breast?
C50.1
What is the site code for the upper inner quadrant of the breast?
C50.2
What is the site code for the lower inner quadrant of the breast?
C50.3
What is the site code for the upper outer quadrant of the breast?
C50.4
What is the site code for the lower outer quadrant of the breast?
C50.5
What is the site code for the central lines of the breast, 12:00, 3:00, 6:00 and 9:00?
C50.8
What is the site code when cancer is located in more than one site of the breast, or the specific site is not documented?
C50.9
“Colon Anatomy Always Harder Than Several Disease Sites” is a mnemonic for what colon sites?
Cecum, Appendix, Ascending, Hepatic flexure, Transverse colon, Splenic flexure, Descending colon, Sigmoid
In situ can only be diagnosed microscopically.
True or False?
True
“The Dog Left A Poo Not Urine” is a mnemonic for which sites of the bladder?
Trigone, Dome, Lateral wall, Anterior wall, Posterior wall, Neck, Ureteral orifice
What information is required in order to assign stage in a breast case?
TNM, Grade, ER, PR, HER2.
For Nottingham Grade, what three values must be documented?
Tubular differentiation
Nuclear pleomorphism
Mitotic count
For the purposes of coding and staging, lymph nodes, Waldeyer’s ring, the thymus, and the spleen are considered
A. Extranodal (extralymphatic) sites
B. Nodal (lymphatic) sites
B. Nodal (lymphatic) sites
In lymphoma, any liver involvement by contiguous or non contiguous spread should be recorded as Stage ____
IV
What is the histology code for invasive ductal carcinoma?
8500/3
What is the histology code for invasive carcinoma, NOS
8010/3
What’s the histology code for invasive adenocarcinoma, NOS?
8140/3
What is the histology code for ductal carcinoma in situ?
8500/2
What is the histology code for invasive urothelial carcinoma. NOS?
8120/3
What information is required to assign stage in a breast case?
TNM, Grade, ER,PR, HER2
If there is microscopic confirmation of metastasis, it should be coded as _______ metastasis.
Pathological (even in the clinical category - pM1)
If there are multiple simultaneous tumors in the same organ, code the tumor with the
A. Largest size
B. Highest T category
B. Highest T category
If a bone marrow biopsy is positive in a lymphoma patient, the stage is automatically a Stage
IV
In a lymphoma patient, lymph node involvement on both sides of the diaphragm is automatically a Stage
III
Follicular small cleaved cell and large cell is a classification of what cancer?
Non-Hodgkin’s lymphoma
A sarcoma is a malignancy arising from what type of tissue?
Mesodermal
What kind of blood does the pulmonary artery carry?
A. Oxygenated
B. Deoxygenated
B. Deoxygenated
A hepaticholangioduodenostomy connects
A. The bile duct and duodenum
B. The hepatic duct and duodenum
C. The liver and duodenum
B. The hepatic duct and the duodenum
Which method of staging provides a more precise description of the patient’s disease?
A. Summary stage
B. Extent of disease
C. Pathological
D. TNM
C. Pathological
The complete code for a neoplasm, including topography and morphology, contains how many characters?
10
The date of diagnosis for a patient diagnosed in utero is
A. The date the baby is delivered
B. The actual date of diagnosis
C. Cannot be coded
B. The actual date of diagnosis
Which form of chemoembolization is not coded as treatment?
A. Embolization of sites other than the liver.
B. Embolization using alcohol
C. Presurgical embolization of hypervascular tumors
C. Presurgical embolization of hypervascular tumors.
Which of the following is the correct format for a morphology code?
A. 8500
B. C50.4, 8500
C. 8500/3
C. 8500/3
8000/3
Malignant neoplasm
8140/3
Adenocarcinoma
8500/3,
8500/2
Invasive ductal carcinoma
DCIS
8070/3
Squamous cell carcinoma
8120/3
Urothelial cell carcinoma
8041/3
Small cell carcinoma
8720/3
Malignant melanoma
9823/3
CLL
9591/3
Non-Hodgkin’s Lymphoma
Aggressive and rapidly spreading cancer of the lung, most common in smokers.
Small cell carcinoma
The visceral peritoneum and the serosa are synonymous.
True or False?
True
Melanoma arises from what layer of the skin?
The epidermis
The parietal peritoneal lines which organ or part of the body?
The abdominal and pelvic walls
The visceral peritoneum lines what structures?
Internal organs
