Tumor Tip of the Week-09-15-2023 Update to 2018 EOD Manual/EOD Primary Tumor-Bladder

Scenario: 2023

• Operative Text: TURB: 6cm Right Lateral wall papillary tumor. Both superficial and deep resections were performed with the attempt to obtain muscle in the specimens. The resected areas were then fulgurated, and satisfactory hemostasis was obtained. The case was made difficult by extensive bulky tumor burden with hyper vascularity and concern for likely muscle invasion.
• Path Text: TURB:
  • Superficial bladder tumor:
    • High-grade invasive papillary urothelial carcinoma.
    • Muscularis propria invasion is present.
  • Deep bladder tumor:
    • Invasive high-grade papillary urothelial carcinoma.
    • Muscularis propria invasion is present.

Question: How would you code EOD Primary Tumor?

• 200 Muscle (muscularis propria) of bladder only
  • Superficial muscle – inner half
• 250 Extension to distal ureter
  • Superficial muscle of bladder and/or distal ureter
• 300 Muscle (muscularis propria) of bladder only
  • Deep muscle–outer half
  • Extension through full thickness of bladder wall BUT still contained within bladder wall
• 350 Extension to distal ureter
  • Deep muscle or extension through wall of bladder and/or distal ureter
• 370 Muscle (muscularis propria) invaded, NOS of bladder only
• 400 Extension to distal ureter
  • Muscle (muscularis propria) invaded, NOS of bladder and/or distal ureter

Answer: 370 Muscle (muscularis propria) invaded, NOS of bladder only

Rationale:

SINQ 20230035 https://seer.cancer.gov/seer-inquiry/inquiry-detail/20230035/ 

Question:

Update to Current Manual/2018 EOD Manual/EOD Primary Tumor–Bladder: According to the American Joint Commission on Cancer (AJCC), a transurethral resection of the bladder (TURB) cannot make a distinction between involvement of the superficial muscle-inner half (Stage T2a) and the deep muscle-outer half (Stage T2b).  Is this same criteria applied to Extent of Disease (EOD)? 

Answer:

EOD follows AJCC criteria in this situation and we have confirmed with AJCC that Stage T2a (superficial muscle) and Stage T2b (deep muscle) cannot be assigned when only a TURB is done. 

For EOD Primary Tumor, Bladder, codes 200, 250, 300, 350, can only be used when

Cystectomy is performed

Muscularis propria is involved, AND

Pathology report states superficial muscle (200, 250) or deep muscle (300, 350) is involved 

If a TURB is done and there is mention of the muscularis propria invasion (superficial muscle or deep muscle), use EOD codes 370 or 400. If a TURB is done and the pathology report states superficial or deep muscle, ignore and coded as “invasion of muscularis propria, NOS” (EOD codes 370 or 400). 

Instructions and code descriptions for EOD Primary Tumor have been updated to indicate this. These updated instructions and code descriptions will be available when SEER*RSA is updated for 2024, Version 3.1 (Sept/Oct 2023). These updates are included here for reference and can be applied for cases diagnosed 2018+.