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| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
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20031153 | Laterality/Multiple Primaries (Pre-2007)--Ovary: Are ovarian primaries with bilateral involvement always coded to laterality 4 (bilateral)? See Description. | Example: "Right ovary with mass replacing majority of ovarian tissue consistent with serous adenoca. Lt ovary with foci of adenoca." No specific statement of primary. Can we assume that the malignancy originated in the right ovary since it is more extensively involved or should laterality be coded 4 because both ovaries have tumor? | For tumors diagnosed prior to 2007:
If one ovary is listed as the primary site, code laterality to that ovary. The example above is one of those times when you would code to the single ovary. The issue of one or both ovaries being involved is handled in staging.
Abstract the example above as a single primary with code 1 [Right] for laterality.
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. |
Ovary | Laterality | 2003 |
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20061076 | Laterality--Breast: Should laterality be coded to 9 [Paired site but no information concerning laterality] or to the side with the positive lymph nodes for a case in which no breast mass is found but positive axillary lymph nodes are found on only one side? | Code laterality of the primary site to the side with the positive nodes when there are unilateral positive nodes and the laterality of the primary site is otherwise unknown. | Breast | Laterality | 2006 | |
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20110019 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when bilateral testes are involved with lymphoma? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This is a single primary per Rule M2 which indicates to abstract a single primary when there is a single histology. Code the histology to 9590/3 [lymphoma] and the primary site to C629 [testes. Unless your software has edits that prevent coding laterality for lymphomas, code the laterality as bilateral. Up to half of extranodal lymphomas occur in multiple sites, particularly in paired sites.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
Heme & Lymphoid Neoplasms | Laterality | 2011 | |
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20180066 | Solid Tumor Rules (2018)/Laterality--Brain and CNS: How is laterality coded for bilateral non-malignant central nervous system (CNS) or malignant CNS tumors now that laterality is no longer used to identify these tumors as multiple primaries? See Discussion. |
The Equivalent Terms and Definitions sections in the Solid Tumor Rules for these schemas identify which sites must have laterality coded, but there is no instruction for coding laterality when bilateral tumors are a single primary. The SEER Manual currently only indicates code 4 (bilateral) is seldom used (e.g., bilateral ovarian tumors, Wilms tumors, etc.) but does not indicate laterality code 4 should be used for CNS tumors. Is this note going to be updated or should a non-bilateral code be applied? Example: MRI demonstrates multiple left-sided dural-based meningiomas including a 4.4 cm left posterior fossa meningioma, a 0.8 cm left frontal-parietal meningioma and a right posterior frontal meningioma. The large left posterior fossa meningioma was resected and proved atypical meningioma. Should the laterality be 4 (bilateral) as the patient had both left and right-sided meningiomas confirmed to be a single primary? Or should the laterality be coded as 2 (left) since only the large left-sided meningioma was proven to be a borderline tumor (atypical meningioma, 9539/1) and the others were benign? |
Determine whether the CNS tumors are single or multiple primaries. Multiple cerebral meningiomas are a single primary according to the non-malignant CNS Solid Tumor Rules. Assign laterality using the 2018 SEER Manual for select invasive, benign, and borderline primary intracranial and CNS tumors using codes 1-9 for all sites listed in the Sites for Which Laterality Codes Must Be Recorded table. In the example, assign code 4, bilateral involvement at time of diagnosis, lateral origin unknown for a single primary. The solid tumor rules are not a one-stop-shop for all coding. Refer to the appropriate coding manual for laterality. We removed laterality for determining multiple primaries in meningiomas as they were being over-reported according to CBTRUS. |
Brain and CNS | Laterality | 2018 |
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20230004 | SEER Manual/Laterality--Kaposi Sarcoma: If both arms are involved with Kaposi sarcoma and no other sites, how is laterality coded? See Discussion. |
Per Solid Tumor Manual Other Sites Rule M6, despite the number of areas of involvement, any presentation of Kaposi sarcoma is always a single primary. The primary site is skin using the Kaposi Sarcoma for All Sites Coding Guidelines (Appendix C, 2023 SEER Manual). Does SEER Program Coding and Staging Manual Laterality Coding Instruction #4 preclude the use of code 4 [Bilateral involvement at time of diagnosis...] if a patient presents with KS involvement of only both arms or only both sides of the face? |
Assign Laterality code 4 (Bilateral involvement at time of diagnosis, lateral origin unknown for a single primary) in the situations you describe. Skin of upper limb and shoulder and Skin of other and unspecific parts of the face are listed as paired organs in the table Sites for Which Laterality Must Be Recorded In the 2023 SEER Manual. |
N/A | Laterality | 2023 |
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20220040 | Laterality--Brain and CNS: Can Laterality be coded as 5 (midline) for a sella turcica meningioma (or tuberculum sellae meningioma) when no other statement regarding tumor laterality is documented? See Discussion. |
Laterality is often not noted for these sella turcica meningiomas; therefore, Laterality is often coded as 9 (Unknown). Because the sella turcica appears to be a midline structure in the base of the skull, is Laterality code 5 (midline) more appropriate when additional information is unavailable? |
You may assign code 5 (Paired site: midline tumor) for laterality of a meningioma of the sella turcica (C700). The 2022 SEER manual states in Laterality coding instruction 5: Assign Laterality code 5 only when the primary site is C700, C710-C714, C722-C725, C443, C445. Do not assign code 5 to sites not listed in 5.a. Note that code 9 is for paired sites and there is no information concerning laterality. Document laterality information in the appropriate text field. Note: Laterality does not factor into the CNS Solid Tumor rules. |
Brain and CNS | Laterality | 2022 |
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20130195 | Laterality--Heme & Lymphoid Neoplasms: Is laterality coded to 0 [not paired] for all lymphoma cases including paired sites (e.g., breast, lung)? | Updated May 2026 Laterality coding for lymphomas is based on the primary site not histology. Laterality describes the side of a paired organ or side of the body on which the reportable tumor originated. Determine whether laterality should be coded for each primary.
Laterality coding instructions are located in the SEER Program Coding and Staging Manual. |
Heme & Lymphoid Neoplasms | Laterality | 2013 | |
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20081016 | Laterality--Brain and CNS: When a meningioma extends to both right and left sides, is laterality coded 4 for bilateral or 9 for midline? See Discussion. |
Operative Findings: Bilateral frontal craniotomies for excision of giant meningioma which extended onto optic chiasm. Path: Bifrontal tumor, 6.5 cm meningotheliomatous meningioma. |
If it is not possible to determine whether the meningioma originated on the left or the right, assign code 4 [Bilateral involvement, lateral origin unknown; stated to be single primary]. | Brain and CNS | Laterality | 2008 |
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20140079 | Laterality: Why is a code 5 for laterality midline only allowed for certain sites of brain and skin? I have a nasal cavity tumor and the path report specifically says "Tumor laterality: midline". What is the correct laterality code here? |
Assign laterality code 9 for midline nasal cavity tumor. We will investigate this issue further. |
N/A | Laterality | 2014 | |
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20100074 | Laterality--Melanoma: For a melanoma case, does the term "mid" imply that the tumor is in the midline when the site is the skin of back (trunk)? | Yes. When the location is described as mid-back or mid-chest with no indication of left or right, assign laterality code 5 [midline]. | Melanoma | Laterality | 2010 |
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