Scenario:
3/25/2022 Presented to ER w/ scrotal pain swelling. A scrotal U/S identifies 0.6cm area in the left testicle suspicious for neoplasm. No CT or any other imaging done to assess regional lymph nodes prior to Orchiectomy. AFP elevated 40,000 ng/mL, LDH 398 elevated [upper limit of normal 271], HCG <2 within normal limits
4/1/2022 Radical Orchiectomy: 1.0cm Germ Cell Neoplasia, pTis pNX
4/10/2022 CT: 14cm Lt retroperitoneal mass displacing the left kidney suspicious for mets adenopathy
04-11-2022 AFP elevated 40,000 ng/mL, HCG <2 within normal limits, no LDH done
4/15/2022 Oncologist stage: cTis cN3 cM0 S3 and is started on adjuvant chemotherapy BEP
8/10/2022 Para-aortic LND: 8 LN’s negative
| Field(s) | Value | Rationale |
| S Category Clinical | 3 | S3 Only one elevated test is needed LDH greater than 10 x N* OR hcG (mIU/mL) greater than 50,000 OR AFP (ng/mL) greater than 10,000 1.LDH is elevated but you need to determine if LDH is less than 1.5 X N or greater than 10 X N to determine if < 1.5 x N value calculate 1.5 x upper limits of normal. In this example that would be 1.5 x 271= 406.5] to determine if >10 x N value calculate 10 x upper limits of normal. In this example that would be 10 x 271=2710 Lab value was 398 thus LDH <1.5 x N 2. hcG within normal limits 3. AFP elevated >10,000 [pre-orchiectomy it was 40,000] |
| S Category Pathological | 3 | S3: Only one elevated test is needed LDH greater than 10 x N* OR hcG (mIU/mL) greater than 50,000 OR AFP (ng/mL) greater than 10,000 Post Orchiectomy LDH Unknown hcG within normal limits AFP 40,000 which is >10,000 |
| AFP Pre-Orchiectomy Lab Value | 40000.0 | Note 2: Record the lab value of the highest AFP test result documented in the medical record prior to orchiectomy or prior to any systemic treatment. |
| AFP Pre-Orchiectomy Range | 3 | Greater than 10,000 ng/mL |
| hCG Pre-Orchiectomy Lab Value | 1.9 | Medical record list hCG as <2 per SSDI manual General Instructions Record the value as one less than stated when a value is reported as “less than X,” and as one more than stated when a value is reported as “more than X.” One less or one more may refer to a whole number (1), or a decimal (0.1), depending on the code structure of the field. Thus, we would record as 1.9 |
| hCG Pre-Orchiectomy Range | 0 | Within normal limits |
| LDH Pre-Orchiectomy Range | 1 | Less than 1.5 x N (Less than 1.5 times the upper limit of normal for LDH) • Pre-orchiectomy lab value is 398 which is elevated to determine if < 1.5 x N value calculate 1.5 x upper limits of normal. In this example that would be 1.5 x 271= 406.5] Our value is <1.5 x N |
| AFP Post-Orchiectomy Lab Value | 40000.0 | Note 2: Record the lab value of the AFP test results documented in the medical record after orchiectomy but prior to adjuvant therapy. |
| AFP Post-Orchiectomy Range | 3 | Greater than 10,000 ng/mL |
| hCG Post-Orchiectomy Lab Value | 1.9 | Medical record list hCG as <2 per SSDI manual General Instructions Record the value as one less than stated when a value is reported as “less than X,” and as one more than stated when a value is reported as “more than X.” One less or one more may refer to a whole number (1), or a decimal (0.1), depending on the code structure of the field. Thus, we would record as 1.9 |
| hCG Post-Orchiectomy Range | 0 | Within normal limits |
| LDH Post-Orchiectomy Range | 9 | LDH (Lactate Dehydrogenase) Post-Orchiectomy Range not assessed or unknown if assessed |
| Surgical Procedure of Primary Site | 40 | Per STORE/SEER Excision of testicle WITH cord or cord not mentioned (radical orchiectomy) [SEER Note: Orchiectomy with or without spermatic cord] |
| Scope of Regional Lymph Node Surgery | 5 | Per STORE Scope of Regional Lymph Nos Surgery Code 5 if 4 or more regional lymph nodes removed |
| Chemotherapy | 03 | Look up BEP Regimen SEER*Rx Interactive Antineoplastic Drugs Database [BEP Drug regimen=Etoposide, Cisplatin, Bleomycin all 3 drugs are recorded as chemotherapy] |
| Systemic/Surgery Sequence | 7 | STORE Surgery both before and after systemic therapy Systemic therapy was administered between two separate surgical procedures to the primary site; regional lymph nodes; surgery to other regional site(s), distant site(s), or distant lymph node(s). Surgery to primary site-Orchiectomy Chemo Surgery to regional lymph nodes- Para-aortic LND |