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Report Produced: 04/29/2026 15:08 PM

Report Question ID Question Discussion Answer Year
20021130

EOD-Extension--Breast: If a negative bone scan is followed by a bone marrow biopsy that is positive for metastatic disease, is the bony involvement used when coding extension [85] or as progression of disease (ignore mets when coding extension)? See discussion.

Pt diagnosed with ductal carcinoma of the breast in May. On June 1, oncologist recommended chemo and XRT and planned a metastatic workup. A June 6 marrow MR consistent with mets. June 8 bone scan showed scoliosis of the L-spine with scattered focal areas of increased activity probably related to degenerative changes in the spine. On June 29, biopsies were done of the T2 vertebra with path diagnosis of metastatic adenocarcinoma consistent with breast primary. Chemo started July 15.

For cases diagnosed 1998-2003, is EOD extension code 85 correct? We felt that the bone mets was found within 4 months of diagnosis and is not progression of disease.

For cases diagnosed 1998-2003: Code the EOD-Extension field to 85 [metastasis]. Bone metastasis was documented during the original metastatic workup. Metastasis to the bone was suspected soon after diagnosis and confirmed prior to the start of treatment. The length of time between the diagnosis and the confirmation of the bone metastasis was not used to code extension on this case. The pt was still being worked up as evidenced by the fact that treatment had not yet started.

 2002
20021156 Primary Site/Histology (Pre-2007): What codes are used to represent site and histology for BSO specimen with a diagnosis, "Left and right adnexa: poorly differentiated serous carcinoma. Comment: The carcinoma occurs as multiple nodules within adnexal soft tissues. Direct involvement of ovaries is not seen, supporting an extraovarian origin." See discussion. Per our pathologist consultant, the site should be pelvic peritoneum [C481] and the histology is primary serous papillary carcinoma of peritoneum [8461/3]. Does SEER agree?

For tumors diagnosed prior to 2007:

Code the Primary Site to C481 [Specified parts of peritoneum] and the Histology field to 8461/3 [primary serous papillary carcinoma of peritoneum].

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002
20021133

First Course Treatment--All Sites: The patient has undergone part of the planned first course of treatment when a metastatic deposit is identified. If the patient continues with the planned first course of treatment, should the modalities of treatment given after the metastatic deposit is discovered be included in the coding of the first course of cancer-directed treatment fields?

Yes, those modalities should be counted as part of first course of cancer-directed treatment if the patient continues with the planned first course. For example, if patient has the originally planned type of surgery, radiation, or drug protocol, then code the given treatment as first course.

Caution: It is not a change in the treatment plan if the drugs are changed but the action of the drugs remains the same. This is still first course. However, if the treatment is changed from a chemotherapy drug to a hormonal drug following the discovery of the mets, do not code the hormonal therapy as first course.

 2002
20021159 Histology (Pre-2007)--Breast: What code is used to represent the histology "mucinous carcinoma with Paget disease"?

For tumors diagnosed prior to 2007:

Code the Histology field to 8480/3 [mucinous carcinoma]. This answer assumes the patient presented with a single tumor. There is no combination code that includes these two entities. According to the rules for Coding Complex Morphologic Diagnoses, it would appear that the case should be coded to 8540 [Paget disease] because it is the higher code. However, this combination of histologies represents an exception to that rule. The prognosis for mucinous carcinoma is worse than the prognosis for Paget disease. As a result, it would be more appropriate to the histology to mucinous carcinoma.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002
20021158 Multiple Primaries/Histology--Lymphoma: What is the primary site(s) for a patient who had a lymph node biopsy with the histology of "large B cell lymphoma arising in the setting of low grade B cell lymphoma c/w marginal zone B cell lymphoma with plasmacytic features"? See discussion. This patient also had a bone marrow biopsy that demonstrated "low grade B cell lymphoma." Per the clinician, "Pt with discordant lymphoma. We will be approaching his lymphoma as two different diseases. The large B cell had cleared after chemotherapy and radiation therapy. The low grade lymphoma is incurable."

For cases diagnosed prior to 1/1/2010:

Code as two primaries with each arising in lymph nodes [C77._]. The histology for the first primary is 9699/3 [marginal zone B cell lymphoma]. The histology for the second primary is 9680/3 [large B cell lymphoma].

For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

 2002
20021140 EOD-Extension--Head & Neck: How do you code extension for a supraglottic larynx primary with "pre-epigolottic space" invasion?

For cases diagnosed 1998-2003:

Code the EOD-Extension field to 65 [Pre-epiglottic tissues]. Extension to "pre-epiglottic space" is equivalent to extension to "pre-epiglottic tissue."

 2002
20020060 Terminology/EOD-Size of Primary Tumor--Lung: Can the term "opacity" be used to code the size of the primary lung tumor when it is given a size in an imaging study but the "opacity" is not referred to as being suspicious for cancer? See discussion. Example: How do you code tumor size for a lung primary in which the patient had a CT of the chest that describes a "4 cm opacity in the RUL of the lung." A biopsy of the RUL lung is positive for carcinoma? Would your answer be different if the opacity was described as being "suspicious for carcinoma"?

For cases diagnosed 1998-2003:

Code the EOD-Size of Primary Tumor field to 999 [Not stated] for the example given above. However, if the opacity was described as a "mass" or as "suspicious for cancer," the size could be coded to 040 [4 cm].

 2002
20021082

Multiple Primaries (Pre-2007)/Primary site/EOD-Extension--Head & Neck: How many primaries are represented by an invasive squamous cell carcinoma of the floor of mouth with in situ squamous cell carcinoma involvement of the frenulum?

For tumors diagnosed prior to 2007:

Code the Primary Site field to C04.9 [floor of mouth]. Because the cancer did not INVADE into a neighboring site (through wall, through soft tissue), it just spread along the mucosa (in situ) to involve the frenulum, this is one primary.

For cases diagnosed 1998-2003, in situ extension via mucosal spread to the frenulum is ignored for purposes of coding EOD-Extension.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002
20020018 EOD-Lymph Nodes/EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Cervix: What codes are used to represent these fields for a cervix primary when the only information on lymph nodes is a CT of the pelvis showing "pelvic adenopathy" (no surgery was done)? Code the EOD-Lymph Nodes field to 9 [unknown]. Code the Pathologic Review of Number of Regional Lymph Nodes Positive field to 98 [No nodes examined] and the Lymph Nodes Examined to 00 [No nodes examined] because there was no resection of the primary organs. Adenopathy, NOS, per SEER guidelines, is not coded as lymph node involvement 2002
20021027

EOD-Size of Primary Tumor: Should a 2.0 cm ulcerated mass be coded to 020 or 999 for tumor size? See discussion.

With regard to tumor size, how would SEER interpret "2.0 cm ulcerated mass"? Should this be interpreted as an ulcer, or is it a gross description of the appearance of a mass and therefore acceptable to code tumor size to it?

For cases diagnosed 1998-2003:

If this ulcerated mass is pathologically confirmed to be malignant, code the EOD-Size of Primary Tumor field to 020 [2.0 cm] based on the size of this mass in the absence of a more precise tumor size description.

 2002