| Report | Question ID | Question | Discussion | Answer | Year |
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20250030 | First Course of Therapy/Hormone Therapy--Meningioma: Should Sandostatin be coded as treatment for a Grade 1 meningioma? Patient had surgery and was somatostatin receptor 2 (SSTR2) positive by immunohistochemistry. |
Code Sandostatin (octreotide acetate) as hormonal therapy when given including: · SSTR 2 positive meningioma (NCCN, 2025: smaller studies support the use of targeted therapy including somatostatin) · Neuroendocrine tumor (NET) (NCCN, 2025: Tumor control: antitumor effect is supported by studies for well-differentiated G1/G2 gastro-entero-pancreatic NET. In lung/thymic NET, somatostatin analogues may be considered if metastatic or SSTR positive). The SEER*Rx entry for Octreotide Acetate was updated as studies showed somatostatin analogs may shrink tumors or inhibit further growth. |
2025 | |
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20250006 | Reportability/Histology--Appendix: Is carcinoid of the appendix reportable? If yes, when did this take effect? |
Report carcinoid, NOS of the appendix. As of 01/01/2015, the ICD-O-3 behavior code changed from /1 to /3. |
2025 | |
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20250029 | EOD 2018/EOD Regional Nodes--Oropharynx: Is code 550 missing “< equal to 6 cm” in the data item EOD Regional Nodes for Oropharynx HPV-Associated, Version 9? Otherwise, bilateral or contralateral lymph nodes with extranodal extension (ENE) that are >6 cm could fit into 550 OR 650. |
Code 550 is missing “< equal to 6 cm.” In addition, code 650 should include ipsilateral lymph nodes as well. Revised codes: Code 550 CLINICAL ASSESSMENT only Bilateral or contralateral lymph nodes, < equal to 6 cm WITH clinical evidence of ENE Code 650 CLINICAL ASSESSMENT only Ipsilateral, Bilateral or Contralateral lymph nodes > 6 cm WITH or WITHOUT clinical evidence of ENE These changes will be implemented in Version 3.4 (October 2026). We apologize for the error. |
2025 | |
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20250026 | Solid Tumor Rules/Histology--Esophagus: Are SMARCA4- deficient malignant neoplasms (8020/3) valid for esophagus or other sites besides lung? See Discussion. |
SINQ 20200057 states to use SMARCA4-deficient malignant neoplasms newly identified to use 8020/3 in this example for lung. The annotated histology list shows this histology followed by (C34._) for 2023 forward. An esophagus pathology states the following, "The histologic features and immunohistochemical profile are those of a SMARCA2/SMARCA4-deficient malignant neoplasm." Is the 8020/3 histology valid for esophagus or other sites? |
Assign 8020/3 for SMARCA4- deficient malignant neoplasms of the esophagus. The WHO Classification of Digestive System Tumors, 5th edition, lists undifferentiated carcinoma as 8020/3. Undifferentiated carcinoma of the esophagus is characterized by the frequent loss of SMARCA4 or SMARCA2 by immunohistochemistry. SINQ 20200057 was updated in August 2025 and assigns code 8044/3 for Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT). The 2025 Solid Tumor Manual includes SMARCA4-deficient or SMARCB1-deficient tumors for thoracic and sinonasal sites (8044/3). Assigning histology to other individual sites should be on a case-by-case basis. |
2025 |
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20250025 | EOD 2018/Regional Nodes--Liver: Are the celiac axis lymph nodes considered regional lymph nodes or distant lymph nodes for a 2025 liver primary? |
According to the AJCC CAnswer Forum (https://cancerbulletin.facs.org/forums/node/160948), celiac axis nodes are considered regional for the liver. However, for liver primaries, Extent of Disease (EOD) regional lymph nodes list the following as regional lymph nodes:
Based on this information, should celiac axis lymph nodes be considered as regional for liver primaries when coding EOD Regional Nodes? |
Code celiac axis lymph nodes as regional in EOD Regional Nodes for liver primaries. |
2025 |
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20250014 | Race/Spanish Surname or Origin: How are Race 1 and Spanish Surname or Origin coded for the following race/ethnicity statements: "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" and "FIRST NATIONS"? See Discussion. |
One of the largest hospital systems in our area includes "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" and "FIRST NATIONS" as dropdown items for patients to self-select for race/ethnicity. This hospital system serves 51 hospitals and 1,000 clinics across Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. If "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" is the only item selected with no additional text info available, how should Race 1 and Spanish Surname or Origin be coded? If "FIRST NATIONS" is the only item selected without additional text info available, should Race 1 be coded as 03? |
Assign code 01 (White) for Race 1 when described as Indigenous-Latino/a or Indigenous-Latinx. Indigenous-Latinx is an umbrella term for Indigenous migrants to the United States from Latin America including South and Central America, the Caribbean, and Mexico (for example, Maya, Mixteco, Purépecha, Taino, Zapoteco, etc.). Latin America is listed in Appendix D of the 2025 SEER Manual as White. Assign code 6 (Spanish, NOS; Hispanic, NOS; Latino, NOS) for Spanish Surname or Origin for Indigenous-Latino/a or Indigenous-Latinx in the absence of more specific information. Code 6 description includes the statement, There is evidence, other than surname or birth surname (maiden name), that the person is Hispanic but he/she cannot be assigned to any of the categories 1-5. Assign code 03 (American Indian or Alaska Native) when described as First Nations. First Nations usually refers to Indigenous peoples for ethnic groups who are the original or earliest known inhabitants of an area. The term ‘First Nations’ can be applied to individuals, but technically refers only to those who have Indian status under Canadian law as part of a recognized community. Within Canada, the term First Nations is generally used for Indigenous peoples other than Inuit and Métis. Outside Canada, the term can refer to Indigenous Australians, U.S. tribes within the Pacific Northwest, as well as supporters of the Cascadian independence movement. |
2025 |
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20250019 | SEER Manual/Tumor Size Summary--Breast: Can the size of a non-mass enhancement (NME) be used if it represents the largest size within the appropriate time frame to code tumor size summary when neoadjuvant therapy is administered? Clinical and pathologic tumor sizes are no longer collected for 2024 and 2025 cases. See Discussion. |
In the SEER Program Coding and Staging Manual 2023, under clinical tumor size (page 115, item #12), it states: “For breast tumors, clinical size may be recorded based on the size of a non-mass enhancement (NME). NME is defined as an enhancing abnormality that is not associated with the three-dimensional volume of a mass, shape, and outlining, and it is separate from Background Parenchymal Enhancement (BPE).” This guidance does not appear to have been carried forward into the Tumor Size Summary coding instructions. |
Do not use the NME size from magnetic resonance imaging (MRI) to code tumor size when both tumor size and NME size are stated or if NME is the only size available. The size of the solid tumor mass takes priority over the size of the NME when provided separately and the NME is larger. The American College of Radiology, Breast Imaging Reporting and Data System (BI-RADS) defines NME as an area of enhancement on MRI that does not belong to a 3D mass or have distinct features of a mass. It is a separate descriptor from size that includes modifiers describing enhancement patterns with a specific MRI pattern. |
2025 |
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20250023 | First Course Treatment/Hormone Therapy--Multiple Myeloma: How is dexamethasone coded when given for multiple myeloma? See Discussion. |
The treatment regimen consisting of carfilzomib, lenalidomide, and dexamethasone (KRd) in SEER*Rx says not to code dexamethasone. I have a patient with multiple myeloma who received the KRd protocol in 2018 and the treatment regimen consisting of carfilzomib, daratumumab, and dexamethasone (KdD) (not in SEER Rx) in 2025. SEER RX says to code dexamethasone when it is given for multiple myeloma but also not to code dexamethasone when given as part of the KRd regimen (which is for multiple myeloma). I can follow the KRd instructions if that is what should take priority, but then would I code dexamethasone for the KdD regimen? KdD is not in SEER*Rx and it seems counterintuitive to code it for KdD and not for KRd. |
Code dexamethasone in KRd regimen (and any other regimen for multiple myeloma containing dexamethasone) as hormonal therapy. Please note that majority of the regimens for multiple myeloma are not in SEER*Rx currently. The SEER*Rx entry for KRd regimen was updated to indicate that dexamethasone should be coded. The change was done to correct the contradiction with the SEER manual which states, "Code the hormonal agent given as part of combination chemotherapy (e.g., R-CHOP), whether it affects the cancer cells or not" and the SEER*Rx entry for dexamethasone which directs to code it for multiple myeloma. |
2025 |
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20250005 | Reportability/Behavior--Ovary: Is ovarian mucinous borderline tumor with foci of multifocal intraepithelial carcinoma reportable? |
Report ovarian mucinous borderline tumor with foci of multifocal intraepithelial carcinoma. The foci of intraepithelial carcinoma makes this reportable. See the list of synonyms for in situ in the SEER Manual, Behavior Code data item. |
2025 | |
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20250011 | Reportability--Liver: Is a 2023 cholangiocarcinoma case with Liver Imaging Reporting And Data System (LI-RADS) M (LR-M) lesion on imaging reportable? |
Report LR-M unless there is information to the contrary. The American College of Radiology defines LR-M as "probably or definitely malignant, not necessarily hepatocellular carcinoma (HCC)." |
2025 |
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