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Report Produced: 01/01/2026 17:36 PM

Report Question ID Question Discussion Answer Year
20081047 Reason no surgery of primary site/First course treatment: If the Reason no Surgery of Primary Site field is coded as 7 (refused), must the other treatment options (radiation, chemo, hormone) also be coded as 7? See Discussion. Coding instruction #5 in the SEER manual states: "Assign code 7 (refused) if the patient refused recommended surgery or made a blanket statement that he/she refused all treatment."

Refused [code 7] means this modality was specifically recommended by the physician and the patient refused. If two treatment alternatives were offered and surgery was refused, code Reason no surgery of primary site 1 [Surgery of the primary site was not performed because it was not part of the planned first-course treatment].

Refusal of surgery does not necessarily mean that all treatment was refused. Coding Surgery of Primary Site as "refused" does not affect the coding of Radiation, Chemotherapy, Hormone Therapy, etc.

 2008
20081085 MP/H Rules/Histology--Colon: Per MP/H rule H3 for colon, code 8144/3 [Adenocarcinoma, intestinal type] should not be used with C180-C189 [colon]. However, page 58 of the ICD-O-3 SEER Site/Histology Validation list of February 9, 2001 lists code 8144/3 as a valid histology for large intestine. See Discussion. None of the errata have this site/histo combination. It is causing problems with researchers because pathologists still use the term: Adenocarcinoma, intestinal type for tumors of the large bowel. Please clarify or print errata.

For cases diagnosed 2007 or later:

This issue has been presented to the Edits work group. The preliminary response is that 8144/3 will be removed from the valid site/histology list for large intestine, small intestine, and rectum.

The edits based on the site/type list are used by many organizations. Any change to the site/type list is taken to the Edits work group.

 2008
20081029 Multiple Primaries--Brain and CNS: Multiple cavernous hemangiomas diagnosed in 1995 are treated with radiation and steroids in 1996. A 1999 MRI states there is no interval change with the lesions in selected location since 1995. How many new primaries should be reported if a 2006 MRI states there are additional cavernous hemangiomas in other parts of the brain? See Discussion.

7-03-97 PE: Past history significant for cavernous hemangiomas. Has had radiation and was on high-dose steroids in early 1996. Patient reports subsequent MRI done and neurologist gave "clean bill of health."

1-26-99 MRI BRAIN. Clinical information: history of intracranial cavernous hemangiomas. Comparison with prior brain MRI in 12/15/95. IMP: Upper medullary, right parieto-occipital, left frontal cavernous hemangiomas without interval change in size as compared to 12/15/95.

1-25-06 MRI BRAIN. Clinical info: history of prior radiation for cavernous angiomas. Comparison made with prior exam on 1/26/99. Impression: Multiple, variable sized cavernous angiomas within medulla, pontomedullary junction, midbrain, & cerebral hemispheres. Dominant lesion centered within posterior pontomedullary junction. FINDINGS: 8mm lesion in posterior pontomedullary junction. 2mm lesion within right paracentral portion of medulla. Several less than 5mm lesions noted within brain stem bilateral. Two, less than 1-2mm, areas within right inferior aspect of right and left cerebellar hemispheres. 1cm lesion centered within white matter within right posterior parietal/occipital region. Several small, less than 1-2mm, lesion within surrounding white matter. 3rd dominant lesion within left frontal lobe equal 6mm. Several 1-2mm foci of susceptibility artifact within subcortical white matter of high right and left cerebral hemispheres consistent with small cavernous angiomas.

Benign and borderline brain and CNS tumors diagnosed January 1, 2004 and later are reportable. Multiple tumors in different brain and CNS sites are separate primaries. Different sites are those with ICD-O-3 topography codes that differ at the first, second, third or fourth character.

There are four reportable primaries in the scenario described above.

  • Brain stem, C717 (medulla, pontomedullary junction, midbrain)

  • Cerebrum, C710 (right cerebral hemisphere)

  • Cerebrum, C710 (left cerebral hemisphere)

  • Parietal/Occipital region, C718

    		• 2008
    		20081118 Surgery of Primary Site--Brain and CNS: How is this field to be coded when a patient undergoes stereotactic biopsy of a brain tumor? Path specimen consists of four fragments of tissue measuring .7, .6 and .3 cm. Assign code 20 [Local excision (biopsy) of lesion or mass. Specimen sent to pathology from surgical event 20]. 2008
    		20081073

    CS Extension/Ambiguous terminology--Pancreas: Should an exception be made for "abuts" or "encased/encasing" regarding CS pancreas extension? See Discussion.

    According to the CS Manual regarding ambiguous terminology, we do not accept "abuts" or "encased/encasing" as involvement. According to the March/April 2008 issue of "CA, A Cancer Journal for Clinicians", vol 58, number 2, an article concerning Pancreas staging by M.D. Anderson researchers/clinicians recommends defining unresectable involvement of the celiac axis/mesenteric artery with the terms "abutment" as involvement of 180 degrees or less of the circumference of the vessel, and "encasement" as more than 180 degree involvement. A large comprehensive cancer center in our area has already adopted these guidelines.

    This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Follow the current CS instructions regarding ambiguous terminology. "Abuts" and "encased/encasing" are not involvement.

    The American College of Surgeons Commission on Cancer provided the following in response to this question: This concept can be considered for CS version 2, but it would need to be made in conjunction with acceptance of that same theory in AJCC 7th Edition so that the stage can be derived. Many times what can be defined and accepted in a closed environment of a single institution research project cannot be duplicated and accepted across the nation and in every community facility. Would pathologists specify the > or < 180 degree involvement in every pathology report? It would also have to be reviewed to see if this idea has been accepted by the larger oncology community, or just the idea of a single institution.

    		 2008
    		20081086 Reportability: Is a case reportable if a benign diagnosis is obtained on a resection that follows a positive needle aspiration? See Discussion. Fine needle aspiration of the thyroid diagnosis was "positive for malignant cells, favor medullary carcinoma." Subsequent thyroidectomy was reported as benign. This case is reportable. The cytology is positive. Report as medulary carcinoma of the thyroid. 2008
    		20081005

    Histology/Behavior--Brain and CNS: How are these fields coded for an "anaplastic glioneuronal neoplasm with spongioblastic architecture"? See Discussion.

    Scenario: Addendum from Mayo Clinic review, IHC and consultation made dx of "anaplastic glioneuronal neoplasm with spongioblastic architecture". The original micro states 'high grade glial neoplasm w/o characteristic features of glioblastoma multiforme in that it lacks areas of significant necrosis, no nuclear palisading nor endothelial vascular proliferation...."

    The best code available according to our pathologist consultant is 9505/3 [Ganglioglioma, anaplastic]. According to our consultant, while ganglioglioma is traditionally a benign tumor, anaplastic ganglioglioma is classified as malignant by WHO (page 103), and comes as close to fitting the description of this tumor as any other term.

    		 2008
    		20081139 Date Multiple Tumors--Prostate: For a prostate biopsy done 10/20/08, both lobes involved with tumor, unknown how many tumors, what would be coded in date of multiple tumors? In this case, code the date of the biopsy in Date of Multiple Tumors [10202008]. When the number of tumors is unknown, code the date of diagnosis as the Date of Multiple Tumors. This is the date on which it was determined that there were an unknown number of tumors. This instruction will be added to next edition of the MP/H manual. 2008
    		20081122 MP/H Rules/Histology--Breast: Patient has single invasive left breast tumor diagnosed in 2008. Final pathology diagnosis is "Invasive solid papillary carcinoma". No mention of ductal in report. What is histology?

    For cases diagnosed 2007 or later:

    As of July 2010:

    Code the histology 8503 [Infiltrating papillary adenocarcinoma].

    This is solid papillary, not solid AND papillary carcinoma. Solid is an adjective modifying papillary, in other words, a subtype of papillary. We do not have a code for solid papillary, so we code to the NOS, papillary using rule H14.

    		 2008
    		20081107 Multiplicity Counter/Ambiguous terminology: How should these fields be coded for cases with an unknown date of diagnosis? If the date of diagnosis is unknown, it is likely that you have little information for this case. Both multiplicity counter and ambiguous terminology fields would probably be coded as unknown. However, if information on the number of tumors and the diagnostic confirmation are available, code these fields as specified in the manual. 2008