SEER Inquiry System - Search

Code Other Therapy to 6 (Other-Unproven) since Metformin is not included in oncology guidelines and studies show controversial results at this time.

Code as Other Therapy, code 2 (other-experimental). Endoxifen is currently in phase 2 studies and not FDA approved standard treatment at present.

Code dubodencel to Other Therapy, code 2 (other-experimental). Dubodencel is not technically Dendritic Cell/Tumor Cell Electrofusion Cancer Vaccine, though close. However, both are in early stages of clinical development. We updated the coding instructions for Dendritic Cell/Tumor Cell Electrofusion Cancer Vaccine in SEER*Rx.

Code treatment as first course of treatment, even though there was an 8-month delay. The patient's treatment plan was to delay the cancer treatment due to another health condition. When that health condition was resolved, then the cancer treatment was given. Patients do delay treatment for many different reasons, but most of them would not be 8 months. This fits the new rule which is all treatment is first course until remission.

This is different from active surveillance, where the patient is being monitored for symptoms/disease progression. We have a clarification coming out in the 2027 updates that states if Active Surveillance is the planned treatment until symptoms appear, that any treatment received after active surveillance is second course. That is not the situation here. This is delayed therapy.

Code sodium iodine (I 131) therapy in Radiation Treatment Modality as code 13 (Radioisotopes, NOS). Code Radiation External Beam Planning Technique as code 88 (not applicable). Do not code if used in diagnostic procedures.

Radioactive I 131 should be coded when given in therapeutic doses (usually 30-50mCi but could be higher in high risk patients). The same agent is used for diagnostic imaging, but the dose is very small (1-3mCi).

We will update SEER*Rx.

Code ATG/Cyclosporine as biological response modifier (BRM)/Immunotherapy as first course of treatment using the current Heme Manual. Based on changes to the 2026 Heme rules for coding treatment, heme and lymphoid neoplasms are now treated differently than Solid Tumors when it comes to treatment failure.

It can be used for treatment of selected MDS cases particularly those with low-risk disease, HLA-DR15 histocompatibility type, bone marrow hypoplasia. Prednisone should not be coded as it is not disease modifying agent in MDS. It is usually given to reduce/treat infusion reactions/serum sickness associated with ATG infusion.

We will update SEER*Rx.

Assign a second primary as Acute Myeloid Leukemia, NOS (9861/3), per Rule M10, the first being polycythemia vera (9950/3). The physician states “consistent with transformation of the patient's known polycythemia vera to acute myeloid leukemia.” This is not the same thing as “Acute myeloid leukemia with myelodysplasia-related changes.”

The Heme DB states:

Do not automatically assign this histology (Acute myeloid leukemia with myelodysplasia-related changes (9895/3) if patient has a history of a myeloproliferative neoplasm (Myelodysplastic Syndrome [MDS], or Myeloproliferative Neoplasm [MPN]). Note: Polycythemia Vera is a Myeloproliferative Neoplasm (MPN). The pathologist must make the diagnosis of being myelodysplasia-related.

Assign 9522/3 (olfactory neuroblastoma) as a single histology to this case based on the initial pathology and managing physician’s diagnosis. World Health Organization Classification Head and Neck Tumors, 5th edition defines olfactory neuroblastoma as a malignant neuroectodermal neoplasm derived from the specialized sensory olfactory neuroepithelium.

Report this ovarian tumor as histology 8442/3. Our subject matter expert, a specialized pathologist who deems this case reportable, advises if a rupture occurs, the presence of borderline tumor cells in peritoneal fluid is considered true tumor spread and malignant. Both ICD-O-3.2 and ICD-O-4 classify this as behavior /1 (Serous borderline tumor, NOS); however, based on the matrix rule, you should be able to update the behavior to /3. If you cannot override or enter it into your software, please contact your vendor.

Cancer PathCHART guidance for 8442/3 in the ovary recommends using 8460/3 (Low-grade serous carcinoma) or 8461/3 (High-grade serous carcinoma). Code 8442/3 should be used only when the grade cannot be determined.

Armour thyroid is listed under "Thyroid" in SEER*Rx and in Appendix C Thyroid Coding Guidelines of the 2026 SEER Program Coding and Staging Manual. Code natural thyroid products as hormonal therapy in papillary, follicular, or oncocytic thyroid carcinoma. Thyroid histology must be known as coding depends on histology. Do not code if it is medullary or anaplastic thyroid carcinoma. If histology is unknown, assign Hormone Therapy as code 99.

In papillary, follicular, and oncocytic carcinoma, natural or synthetic thyroid hormone products have a dual role:

1. Suppression of thyroid stimulating hormone (TSH): This is cancer directed therapy since the tumor cells of the above mentioned morphologies express TSH receptor. TSH is a trophic hormone that can promote tumor growth.

2. Hormonal replacement therapy to treat post-surgical or post-radiation hypothyroidism. C-cells in medullary carcinoma do not express TSH receptor, thus, TSH suppression would not be indicated. However, replacement hormonal therapy with synthetic or natural thyroid hormones post surgery is given to treat the post-surgical hypothyroidism. In operable thyroid anaplastic carcinoma, the goal of levothyroxine therapy is hormone replacement.

The Thyroid Coding Guidelines are being updated to include oncocytic thyroid cancer in the 2027 release of the SEER Manual.