--- In cancerregistrargroup@yahoogroups.com, loril_ga <no_reply@y...>
wrote:
> I have a case that was dxd early 03 w/dcis breast. Then in 7/03
> found to have liver mets. The oncologist note says that it is
> unusual to develop liver mets from dcis and that a bx should be
done
> but the lesions are too small to bx at this time. So, my
> question.... I was told at a training that if you have an in situ
> bladder cancer and later find an invasive bladder cancer you should
> code two primaries so that if the patient were to die from the
cancer
> it would not look like he died from in situ bladder cancer. So, is
> this two primaries or just one with a recurrence?

Concerning the liver mets...I would be very skeptical that these are
from this breast dcis. What type of surgery did the lady have? If it
were only a lumpectomy, then she may have other breast pathology that
is contributing to the development of mets, or she may have mets from
another primary, I would call this unknown primary until a biopsy or
add w/u could be done to find the primary source. Then, concerning
the bladder cancers, I would not code this to 2 primaries, but to
recurrence of the original cancer noting the progression, if you have
good f/u, you can document disease progression that could ultimately
lead to someone'e death over time...