05-23-2025
Neoadjuvant or Not
| Scans: 3-1-2025 CT Ab/Pelvis: 7.5cm bladder wall thickening/mass lower right lateral aspect bladder, *no lymphadenopathy or distant mets noted | Tumor Size Summary 070 STORE/SEER-Record the size from the op note over the size on the imaging [use size from TURB] *Substantiates coding of cN0 cM0 03-26-2025 Surgery Code A270 SEER Appendix C: SEER Note: Code TURB as A270] |
| Operative Text & Path: 3-26-2025 TURB: 7cm large bladder tumor over right lateral bladder wall extending to anterior bladder wall and to lateral aspect of right trigone. Transurethral resection/debulking of large bladder tumor performed with resection clinically into muscle proper. Path: invasive poorly differentiated urothelial carcinoma, invades muscle propria | |
| Stage: Muscle Invasive Bladder Cancer, no regional lymph node mets or distant mets noted on scans | EOD Primary Tumor 370 Muscle (muscularis propria) invaded, NOS of bladder only *Cannot assign codes 200,250,300,350 based on TURB-those codes require a cystectomy. [Our patient did have a Cystectomy after neoadjuvant therapy and there was no residual, so we will base the depth of invasion on the TURB, assign code 370.] EOD Regional Nodes 000 EOD Mets 00 Summary Stage 1 Localized Clinical Stage (Based on TURB & Scans prior) cT2 cN0 cM0 Stage 2 *Cannot assign a cT2a or cT2b based on TURB-a cystectomy must be performed to make that determination. |
| Chemo: 4-29-2025 to 06-16-2025 Neoadjuvant Chemotherapy w/ DDMVAC (dose-dense methotrexate, vinblastine, doxorubicin, cisplatin) | 04-29-2025 Chemo Code 03 DD means Dose Dense, look up regimen MVAC in SEER*RX for the drugs used and instructions on how to code |
| Operative Text & Path: 07-18-2025 Radical Cystoprostatectomy and bilateral pelvic lymph node dissection & ileal conduit-extravesical disease not noted, no mets disease Path: No residual, 4 left pelvic lymph nodes (-) 4 right pelvic lymph nodes (-) | 07-18-2025 Surgery Code A710 07-18-2025 [SEER Note: Use code A710 for Cystoprostatectomy] |
Question: Is the patient eligible for Post Therapy Path (yp) Stage?
- Yes
- No
Answer & Rationale: Yes, this patient is eligible for Post Therapy yp Stage.
Although the TURB was coded as a surgical procedure code of A270, a TURB is not considered definitive treatment in this case. After TURB, the patient was treated with neoadjuvant chemotherapy and subsequent Radical Cystoprostatectomy. The yp Stage will be assigned ypT0 {no evidence of any residual primary tumor} ypN0 {8 nodes-} cM0 {No evidence of distant mets on scans} Stage 99.
AJCC 8th Edition
Chapter 1
Chapter 62 Urinary Blader
NCCN Guidelines for Bladder Cancer
PRINCIPLES OF SYSTEMIC THERAPY
Neoadjuvant Chemotherapy (preferred for bladder)
