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| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
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20120093 | MP/H Rules/Multiple primaries -- Ovary: How many primaries are to be accessioned and what rule applies when a patient has a serous carcinoma of the right ovary treated with neoadjuvant chemotherapy followed by a debulking surgery that revealed a serous tubal intraepithelial carcinoma of the left fallopian tube? | For cases diagnosed 2007 or later, accession two primaries, serous carcinoma of the right ovary and serous tubal intraepithelial carcinoma of the left fallopian tube based on the information provided.
The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text) and go to the Other Sites MP rules because neither the ovary nor fallopian tube have site specific rules developed.
Start at the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within a module. The patient has multiple tumors with ICD-O-3 topography codes that are different at the third character (Cxx) and therefore this case should be accessioned as a multiple primary.
It could be helpful to know the extent of involvement noted prior to neoadjuvant therapy and debulking surgery. For example, if the patient had widely metastatic disease throughout the entire pelvis prior to the initiation of treatment, the answer may have been different. |
N/A | N/A | 2012 | |
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20230058 | Solid Tumor Rules/Multiple Primaries--Breast: How many primaries should be accessioned for a patient with known history of right breast carcinoma in 2018 followed by 2022 biopsy proven right and left breast invasive ductal carcinoma if the physician states this is a right breast primary with widespread metastasis including the left breast? See Discussion. |
The patient was initially diagnosed with invasive mammary carcinoma of the right breast in 2018, treated with lumpectomy, sentinel node biopsy, radiation, and hormones. Hormones were discontinued early due to dysfunctional uterine bleeding. |
This is a single primary according to the Solid Tumor Rules.
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Breast | N/A | 2023 |
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20021088 | Multiple Primaries (Pre-2007)--Vulva/Vagina: SEER Program Code Manual rule #3 on page 11 states "If a new cancer of the same histology is diagnosed in the same site after two months, consider this new cancer a separate primary unless stated to be recurrent or metastatic. Should vulva and vagina be exceptions to rule #3, as are prostate and bladder? |
For tumors diagnosed prior to 2007: No. There is no exception for vulva or vagina. 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. |
N/A | N/A | 2002 | |
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20180029 | Reportability--Skin: Is early/evolving lentigo maligna reportable? |
As of 01/01/2021, early or evolving melanoma in situ, or any other early or evolving melanoma, is reportable. |
Skin | N/A | 2018 | |
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20180026 | Solid Tumor Rules (2018)--Breast: How many primaries are accessioned when a prophylactic mastectomy reveals a final diagnosis of invasive tubular carcinoma, but the College of American Pathologists (CAP) Protocol includes ductal carcinoma in situ (DCIS) sized separately and it is not clear if these are different tumors? See Discussion. |
The patient was incidentally diagnosed with cancer on a prophylactic mastectomy, so there are no positive imaging findings to correlate the number of tumors/masses. The final diagnosis was invasive tubular carcinoma, and referred to the CAP Protocol. The CAP notes: However, it does not specify whether the single contiguous focus also includes the in situ component. The CAP goes on to note DCIS was present: The gross description does not provide any indication of either a single or multiple tumors/masses/lesions, though it was referred to as "Lesion 1" in the gross description with no indication of other lesions. The format of the CAP Protocol frequently does not specify whether the DCIS is a separate measured tumor, or if it is a component of the invasive tumor. This makes it difficult to determine whether the DCIS should be a separate primary when the invasive tumor is not also a type of ductal carcinoma. Per both the 2007 MP/H and 2018 Solid Tumor Rules, an invasive tubular carcinoma and a ductal carcinoma in situ would be multiple primaries if they were multiple tumors. Should we default to Rule M1: Abstract a single primary when it is not possible to determine if there is a single or multiple tumors? Or should we assume these are separate tumors because they were both sized, the focality only described a single invasive tumor, and the tumors are not both ductal carcinomas? |
Accession a single primary using Solid Tumor Rule M3. Based on the information provided, this was described as "Lesion 1' with no other lesions noted in the gross description. If the DCIS was a separate tumor, this would have been noted by the pathologist. Reminder, the breast CAP protocol is a checklist for pathologists to note their findings while reviewing the slides and/or specimen. The findings and notes should be consolidated into a final/synoptic report. |
Breast | N/A | 2018 |
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20180002 | MP/H Rules/Multiple primaries--Urinary: Is a renal pelvis diagnosed 5/2016 a separate primary when the first invasive bladder was 12/2011? Per rule M7, the 5/2016 renal pelvis is more than 3 years later. Does Multiple Primary/Histology (MP/H) rule M7 refer back to the original diagnosis date or to the last occurrence? See Discussion. |
12/30/11 Bladder Biopsy: Diffuse carcinoma in situ of bladder, urothelial cancer at trigone (Stage T1) 1/30/2012 Transurethral resection of the bladder was non-papillary, urothelial carcinoma, focal invasion of lamina propria, staged T1 11/10/14, 9/28/15, 9/26/16, 10/19/17 all had positive bladder cytology of urothelial carcinoma 5/16/16 Left renal pelvis aspirate: positive for malignant cells, urothelial carcinoma 9/26/16 Left renal pelvis aspirate: positive for malignant cells, urothelial carcinoma 10/18/16-11/7/16 Bacillus Calmette-Guerin (BCG) x3 administered into the renal collecting system via ureteral catheter |
For cases diagnosed prior to 2018 This case is a single primary. This patient has not had a disease-free interval as demonstrated by the positive cytologies from 2014 through 2017. The MP/H rules cannot be applied in this case. To answer your question about the timing of rule M7, please see slide 6 in the Beyond the Basics MP/H advanced training, General Instructions, https://seer.cancer.gov/tools/mphrules/training_adv/SEER_MPH_Gen_Instruc_06152007.pdf |
N/A | N/A | 2018 |
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20140088 | Reportability--GIST: The 2014 SEER Program Coding and Staging Manual and the answer to SINQ 20100014 appear to conflict with respect to reporting GIST cases. The manual states (p.5, exception 1) that we are to accession the case if the patient is treated for cancer. However, the patient in Example #7 in the SINQ discussion is receiving chemotherapy, but is deemed not reportable. This is a problematic issue in our area, as pathologists prefer using the NCCN “Risk Stratification of Primary GIST by Mitotic Index, Size and Site” table rather than stating whether the tumor is benign or malignant. Although they tell us that moderate or high risk should receive treatment, they will not characterize them as malignant. |
Determining reportability for GIST is problematic because of the reluctance of pathologists to use the term "malignant" for GIST cases. If you can document the pathologist's terminology and case characteristics (e.g. treatment) that correspond to "malignant" for your registry as part of the registry's policies and procedures, you can report those cases as malignant.
The exception cited above in the SEER manual pertains to a clinical diagnosis with a negative pathology report. Normally, the negative pathology report would override the clinical diagnosis and the case would not be reportable. However, if the patient is treated for a malignancy in spite of the negative pathology, report the case.
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N/A | N/A | 2014 | |
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20170054 | MP/H Rules/Multiple primaries--Brain and CNS: How many primaries should be abstracted for a patient with a 2011 diagnosis of oligodendroglioma followed by biopsy of tumor which demonstrated progression in 2016 with pathology report Final Diagnosis indicating WHO grade III anaplastic astrocytoma? See Discussion. |
The clinical documentation clearly identifies residual tumor after the 2011 craniotomy. Scans demonstrated slow enlargement of the tumor over the years, which resulted in a repeat craniotomy. The pathologist noted in the diagnosis comment section of the pathology report that Is this a single primary per MP/H Rule M3 (A single tumor is always a single primary), or an additional brain malignancy per MP/H Rule M8 (Tumors with ICD-O-3 histology codes on different branches in Chart 1 or Chart 2 are multiple primaries)? |
Based on the information provided, this is a single primary. The 2011 tumor was not completely removed and progressed over the years. MP/H Rule M3 for malignant brain cancer applies. Do not change the original histology code. Use text fields to document the later histologic type of anaplastic astrocytoma, WHO grade III. |
Brain and CNS | N/A | 2017 |
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20000549 | EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: How are these fields coded if radiation to the primary site and/or regional lymph nodes is performed prior to surgery? | For cases diagnosed 1998-2003:
Code the EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined fields per the information in the pathology report(s). Radiation to the primary site would not affect the status of the lymph node involvement. Radiation to the regional lymph node region may or may not affect the pathologic status of the lymph nodes. However, for these fields code the best information available about the status of the lymph nodes which is reflected in the pathology report(s). |
N/A | N/A | 2000 | |
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20170051 | Reportability--Liver: Is intraductal papillary mucinous neoplasm (IPMN) of the liver a reportable diagnosis? See Discussion. |
Pathology shows: Right liver lobe, partial hepatectomy " intraductal papillary neoplasm with high grade dysplasia. |
Intraductal papillary mucinous neoplasm (IPMN) of the liver with high grade dysplasia is reportable. While most IPMNs arise from the pancreas, there exists a subset of IPMN of the biliary tract (BT-IPMN). Code as 8453/2. For more details, see the Reportability section of the SEER manual, https://seer.cancer.gov/manuals/2016/SPCSM_2016_maindoc.pdf |
N/A | N/A | 2017 |
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