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Report Produced: 12/24/2025 19:59 PM

Report Question ID Question Discussion Answer Year
20200074

Solid Tumor Rules (2018)/Histology--Head & Neck: What specific table(s) in the 2021 Head and Neck Solid Tumor Rules if any, apply to tumors of the lip? See Discussion.

Lip has not been added to any of the site-specific histology tables, nor has any other instruction been provided for coding tumors in this site.

Coding histology for lip primaries is difficult because registrars do not know where to look first. The Solid Tumor Rules indicate one should use the tables first, but then do not inform registrars what table to use for a lip primary (i.e., a specific table, any table, no table).

This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales.

The tables are based on WHO H&N chapters which do not include lip. There are inherent issues in determining reportability for lip primaries based on site and histology. The decision was made prior to release of the 2018 rules to exclude a histology table for lip. We are consulting both our dermatology and H&N pathology experts to explore adding a lip site-specific table to the rules.

 2020
20180110

Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of a 2018 lung case whose pathology states adenocarcinoma, acinar predominant?

The Solid Tumor Rules for Lung rule H4 applies. Per Table 3, page 12, third column on adenocarcinoma row, adenocarcinoma, acinar predominant is coded to 8551/3.

 2018
20230066

Solid Tumor Rules/Histology--Lung: Table 3 in Lung Solid Tumor Rules, 2023 Update, lists neuroendocrine carcinoma, NOS 8246 as a specific subtype/variant for small cell carcinoma 8041/3. Should the table be updated? See Discussion.

Small cell carcinoma is a specific type of neuroendocrine carcinoma for the lung. However, Table 3 lists neuroendocrine carcinoma, NOS as the more specific subtype/variant in Column 3.

Using Lung Solid Tumor Rules, Rule H6, a diagnosis of poorly differentiated neuroendocrine carcinoma (small cell carcinoma)” would be coded as 8246, instead of 8041, because there are two histologies under consideration (an NOS and a subtype/variant in Table 3), and the rule tells us to code the subtype/variant. However, small cell carcinoma is more specific than the NOS diagnosis (neuroendocrine carcinoma, NOS). Should Table 3 be updated to reflect which histology is the NOS and which is the more specific?

The Solid Tumor Rules for Lung have been updated for 2024. The row for Small cell carcinoma 8041/3 has been deleted and new separate rows have been added for Neuroendocrine carcinoma (NEC) 8246 and Neuroendocrine tumor, NOS (NET) 8240. This change is based on the WHO Classification of Thoracic Tumors, 5th edition, and current concepts. In addition, Table 3 now reflects that Small cell carcinoma/small cell neuroendocrine carcinoma 8041 (located in Column 3) is a subtype/variant of neuroendocrine carcinoma, NEC 8246 (Column 1). As a result, application of Rule H6 to a diagnosis of poorly differentiated neuroendocrine carcinoma (small cell carcinoma)” would be coded as 8041, instead of 8246. Please note: the 2024 updates may be used for cases diagnosed prior to 1/1/2024 unless otherwise noted in the rules.

 2023
20200078

Solid Tumor Rules (2018)/Histology--Brain and CNS: Should the new malignant term pituitary blastoma be added to Table 3 of the 2018 Malignant Central Nervous System (CNS) and Peripheral Nerves Solid Tumor Rules? See Discussion.

Pituitary blastoma was not added to Table 3 (Specific Histologies, NOS, and Subtypes/Variants) of the 2018 Malignant CNS and Peripheral Nerves Solid Tumor Rules as part of the December 2020 update. This is a new malignant CNS histology for 2021 and later. Not including this histology in Table 3 results in the registrars being required to check another source to correctly code this histology. If this histology cannot be used for cases diagnosed prior to 2021, should that diagnosis year clarification be included in the STR?

This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales.

The Solid Tumor Malignant CNS tables do not list pituitary specific histologies at this time. Registrars will need to refer to ICD-O and/or updates until the decision to add malignant pituitary neoplasms is made. Pituitary blastoma is a rare tumor which occurs in children.

 2020
20110015 Primary site/Histology: Do the 4/1/09 changes in the ICD-O-3 Site/Type Validation table regarding the coding of primary site for intestinal type adenocarcinoma mean that the former valid site/histology combinations are now impossible and require review from a given diagnosis date forward? See Discussion.

Per the SEER Errata for ICD-O-3 Site/Type Validation List, April 1, 2009, adenocarcinoma, intestinal type, was removed as a valid site/histology combination for the following primary sites: C150-C155, C158-C159, C170-C173, C178-C179, C180-C189, C199, C209, C210-C212, C218.

  • Does this mean that these combinations cannot be used? If so, then why is an override allowed for these site/type combinations? Shouldn't these site/type combinations be added to the impossible site/type combinations table?

  • SINQ 20081085 states that "8144/3 will be removed from the valid site/histology list for large intestine, small intestine, and rectum." It appears from the Site/Type Validation table that a decision was made to also remove esophagus sites as a valid combination with histology code of 8144. Please explain the rationale.

  • Cases that were miscoded to 8144/3 will need to be identified for correction. What date of diagnosis should be the reference point used in making the necessary corrections related to this change? Do we only need to review cases diagnosed 1/1/2009 forward or should all cases be corrected regardless of date of diagnosis?

    • The site/type edit identifies unlikely combinations of primary site and histologic type.

  • Intestinal type adenocarcinoma occurs in the stomach. It would be rare in another primary site, but not impossible.

  • It was decided that all digestive organ sites, except stomach, would be removed from the list. That is why esophagus is not listed as a valid site.

  • The site/type edit is for all years. Cases for all years have to be reviewed for combinations of site and type that are no longer on the list. If it is documented in the medical record that the primary site and histology combination are valid, set the over-ride flag so that the case will not come up for review again.

    		• 2011
    		20000454

    First Course Treatment: If the patient receives no treatment at the time of diagnosis (either because it is not recommended or because the patient refused treatment at that time) but treatment is later instituted after disease progression, should this treatment be coded as part of the first course of treatment?

    The SEER rules changed in 1998 regarding what constitutes First Course of Cancer-Directed Therapy.

    For cases diagnosed on or after 1/1/98: The First Course of Cancer-Directed Therapy fields will all be coded to 0 [None] for these types of cases. The documented disease progression would stop the timeframe for inclusion of any treatment to be part of first course of therapy.

    		 2000
    		20240012

    Solid Tumor Rules/Histology--Other Sites: Should an additional Note be added to Other Sites Solid Tumor Rules, Rule H12, to indicate that if the diagnosis is an NOS histology in a polyp, continue on through the rules or should Other Sites Rule H13 be moved ahead of Rule H12 to capture this specific histology? See Discussion.

    The accuracy rate for SEER Workshop Case 04 (a duodenal invasive adenocarcinoma in an adenomatous polyp) was very low because Rule H13 was either being ignored or users were stopping at Rule H12 to code adenocarcinoma.

    If the presence of an NOS histology in a polyp is still clinically relevant for the Other Sites module, this information will be missed due to the order of the H Rules, or the lack of clarification in Rule H12.

    If a change is made to Rule H12 (Single Tumor: Invasive Only module), then changes must also be made to the Single Tumor: In Situ Only module and the Multiple Tumors Abstracted as a Single Primary module because both these modules include the same polyp coding H Rule.

    The rule order is the same as in the previous MP/H rules. Will keep as is for now.

    Assign codes adenocarcinoma in adenomatous polyp (8210), adenocarcinoma in villous adenoma (8261), and (adenocarcinoma in tubulovillous adenocarcinoma (8263) using Other Sites Solid Tumor Rule H12 or Rule H27 as these are specific invasive histology codes. Rule H13 applies to histology codes associated with polyps but associated with a histology term/code other than adenocarcinoma.

    		 2024
    		20000839

    Multiple Primaries (Pre-2007)--Thyroid: Does the rule in the 3rd Edition of the SEER Program Code Manual apply to cases diagnosed before 1998 that states if there are two separate carcinomas in the thyroid, one papillary and the other follicular, it is one primary and coded to the combination code 8340/3 [Papillary and follicular carcinoma]? See discussion.

    If the rule applies to cases diagnosed before 1998, does SEER plan to ask that cases diagnosed prior to 1998 be recoded?

    The rule applies to tumors diagnosed 1998-2006. The rule is not retroactive. At this time, SEER does not plan to ask that tumors diagnosed prior to 1998 be recoded.

    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.

    		 2000
    		20190026

    Solid Tumor Rules (2018)/Multiple primaries--Bladder: Does Rule M11 in the 04/2019 Solid Tumor Rules Urinary update apply to synchronous/simultaneous tumors only or to multiple tumors with any timing? See Discussion.

    Rule M11 states: Abstract a single primary when there are urothelial carcinomas in multiple urinary organs, but neither the Rule nor the Notes describe the timing of these multiple urinary organ carcinomas. Timing requirements for other rules are clearly stated.

    Does Rule M11 have a timing requirement or is it intended to apply to all urothelial carcinoma tumors regardless of timing (and not already qualifying for application of a previous M rule)?

    The revised Urinary Solid Tumor Rules 2018 Rule M11, updated April 2019, removed the requirement of synchronous. This applies to urothelial carcinoma (8120) and its corresponding subtypes, regardless of behavior, that occur in more than one urinary site in a patient's lifetime. See change log for the April 2019 update to urinary rules.This is the same M/PH rule for multiple sites. Timing does not factor in to this rule.

    		 2019
    		20130023

    Reportability--Brain and CNS: Why has reportability changed for "intradural extramedullary schwannomas"? Are all "spinal" schwannomas reportable or only those stated to be "intradural"? See Discussion.

    If intradural schwannomas are to be collected for cases diagnosed 2011 and later, why were they not included in the 2012 SEER Manual? Should collection of spinal schwannomas be postponed until the next revision of the MP/H Rules?

    The reportability of schwannomas was not initially agreed upon by the standard setters. After the issue was discussed by the CoC, NPCR and SEER Technical Workgroup and an agreement was reached. See #2 under Reportability in the Data Collection Answers from the CoC, NPCR, SEER Technical Workgroup http://www.seer.cancer.gov/registrars/data-collection.html#reportability.

    The most accurate and most current instruction is to report these spinal tumors when they arise within the spinal dura or spinal nerve roots, or when they are stated to be "intradural" or "of the nerve root." Do not report these tumors when they arise in the peripheral nerves. The peripheral nerves are the portion of nerve extending beyond the spinal dura.

    Spinal cord intradural schwannomas originate in spinal nerve roots. Spinal nerve root is best classified as spinal cord, C720.

    		2013