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| Report | Question ID | Question | Discussion | Answer | Year |
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20031017 | Reason for No Surgery of Primary Site: Does code 2 [Contraindicated due to other conditions; autopsy only case] or code 1 [ Cancer-directed surgery not recommended] have priority when coding this field for extensive tumors not surgically treated because of existing comorbidities? See discussion. | Example: Patient has Stage IVA carcinoma of the tongue. The physician states that patient is not felt to be a good surgical candidate secondary to multiple medical frailties. Patient is treated with beam radiation. In this case, how do we code Reason for No Site Specific Surgery? Do we use code 2 because surgery was contraindicated due to co-existing medical conditions or do we use code 1 because the tumor is very extensive and surgery would probably not be done anyway? |
SEER has not established a priority for assigning the Reason for No Surgery of Primary Site codes. Assign the code which best describes the reason surgery was not performed. Example: Assign code 2, Contraindicated due to patient risk factors. According to the physician, this is the reason that surgery was not performed. |
2003 |
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20230026 | Solid Tumor Rules/Multiple Primaries--Prostate: How many primaries should be abstracted, and which M rule applies when a patient is diagnosed with intraductal carcinoma of the prostate on biopsy followed by invasive adenocarcinoma on radical prostatectomy more than 60 days later? See Discussion. |
Example: A prostate core biopsy showed intraductal carcinoma in 09/2022, which is an in situ tumor. A core biopsy again showed intraductal carcinoma in 12/2022. The subsequent radical prostatectomy in 04/2023, revealed multiple foci of invasive prostate adenocarcinoma with extensive intraductal carcinoma. Per Solid Tumor Rules, Other Sites, Rule M3, acinar adenocarcinoma of the prostate is always a single primary. Note 4, this rule applies to subtype variants of acinar adenocarcinoma listed in Table 3, which has intraductal/ductal as a variant subtype of acinar adenocarcinoma. Does rule M3 apply to incidence cases (an invasive tumor following an in situ tumor)? |
Rule M1 applies because we don't know if there are separate tumors or separate foci within a single tumor. This is a single primary coded 8140/3. The prostate rules will be reviewed for an addition to cover this situation. |
2023 |
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20000280 | Primary Site--Breast: Is there a hierarchy for coding subsite for breast cases when there is conflicting information in the physical exam, mammogram, operative and pathology reports as to the exact location of the primary? See discussion. | Example: Two mammograms were performed. One report indicates the lesion is at 12:00 and the other indicates it is in the upper central quadrant. However, the pathology report from the modified radical mastectomy specimen indicates the mass is in the UIQ.
According to one of our physicians, when a pathologist has a mastectomy specimen with attached axillary contents, the location of the lesion (subsite) is very accurate. |
Code the Primary Site field to C50.2 [upper inner quadrant]. In general, the priority for using information is pathologic, operative, and clinical findings. The pathology report would take precedence in this case. The 2004 SEER Program Code manual will include the following instructions for determining breast subsite. Priority Order for Coding Subsites Use the information from reports in the following priority order to code a subsite when the medical record contains conflicting information: 1 Pathology report 2 Operative report 3 Physical examination 4 Mammogram, ultrasound If the pathology proves invasive tumor in one subsite and insitu tumor in all other involved subsites, code to the subsite involved with invasive tumor. |
2000 |
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20210077 | First Course Therapy/Neoadjuvant Treatment: How are Neoadjuvant Therapy--Clinical Response and Neoadjuvant Therapy--Treatment Effect coded when the neoadjuvant therapy was not completed? Does the entire course of neoadjuvant therapy need to be completed before we can code these fields? See Discussion. |
Example: The neoadjuvant therapy was started, the patient progressed, the treatment plan was altered, and a new course of systemic therapy was started; surgery was cancelled. 01/25/21 Bile duct brushing: Malignant cells present, adenocarcinoma 01/26/21 Surgical oncology consult: Currently unresectable; recommend neoadjuvant chemo 02/22/21-3/29/21 Neoadjuvant Gemzar & Abraxane, two cycles, discontinued due to disease progression 04/17/21 Surgical oncology re-eval: CT positive for disease progression, need to change Rx 04/26/21 Second change of treatment due to progression: Irinotecan, Oxaliplatin, and 5FU 07/16/21 Surgical oncology re-eval: Unresectable, advise 4-6 months of chemo followed by radiation |
Assign code 3 (Progressive disease (PD)(per managing/treating physician statement) for Neoadjuvant Treatment--Clinical Response and code 7 (Neoadjuvant therapy completed and planned surgical resection not performed) for Neoadjuvant Treatment--Treatment Effect. These are the best choices under the circumstances. Use text fields to record the details. |
2021 |
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20190041 | Reportability/Primary Site--Gastrointestinal (GI) Tract: Is a gastrointestinal stromal tumor (GIST) with a single nodule in the small intestine (C17_) and a nodule in the stomach (C16_) reportable per the 2018 SEER Coding Manual reporting instructions for GIST due to the multiple foci or do the multiple foci need to be in the same organ to be reportable? See Discussion. |
Example: Small intestine wedge resection with GIST, 1.8 cm in mid small intestine, single nodule. Stomach nodule biopsy: GIST, 0.3 cm. Pathology report comment section indicates the gastric GIST is not staged due to the small size and incidental nature. |
Report the GIST in the small intestine. The 2018 SEER Manual says to report GIST when there are multiple foci and to code the primary site to the site where the malignancy originated. Use text fields to record the details, including the stomach nodule. |
2019 |
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20000269 | Multiple Primaries (Pre-2007): Is an in situ tumor followed by another in situ tumor in the same location a new primary? See discussion. |
Example: Six months after an in situ lesion was excised from the buccal mucosa, another in situ lesion was excised from the same area of the buccal mucosa with no mention of it being recurrent. |
For tumors diagnosed prior to 2007: Code as a second primary if the second in situ tumor occurred more than 2 months after the first, and it is not referred to as recurrent by the clinician or pathologist. There are no special rules for determining the number of primaries when an in situ lesion follows an in situ. 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 |
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20190042 | Solid Tumor Rules (2018)/Multiple Primaries--Breast: Is a breast resection showing invasive mucinous carcinoma in a single tumor with associated ductal carcinoma in situ and additional findings of a background of lobular carcinoma in situ single or multiple primaries and which M rule applies? See Discussion |
Example: Right breast core biopsy found ductal carcinoma in situ in the upper outer quadrant. Subsequent resection has a final diagnosis of invasive mucinous carcinoma, grade 1, measuring approximately 7 mm, with close margins. See staging summary. Gross description mentions only the primary tumor with associated marker clip from previous biopsy. Breast Cancer Staging Summary lists (testing and margins removed for brevity): Procedure type: Lumpectomy. Specimen laterality: Right. Tumor size: 7mm. Histologic type: Invasive mucinous carcinoma. Histologic grade (Nottingham histologic score): Grade 1, (score 5/9). Tumor focality: Single focus. Lymph-vascular invasion: Not identified. Treatment effect: No known therapy. Ductal carcinoma in situ (DCIS): Present. Architectural pattern: Cribriform. Nuclear grade: Grade 1. Necrosis: Not identified. Calcifications: Not identified. Estimated size/extent of DCIS: Spanning an area measuring 15mm. Pathologic stage: pT1b, pNx. (AJCC 8th ed). Distant metastasis: Not applicable. Additional findings: Background lobular carcinoma in situ (LCIS), flat epithelial atypia (FEA), and atypical ductal hyperplasia (ADH). |
Apply Breast Solid Tumor Rule M3, abstract a single tumor when there is a single tumor, as there is reference to the primary, single 7 mm tumor. Apply Rule H7 and code the invasive histology only, mucinous carcinoma, when both invasive and in situ components are present. The rules state: Do not use Table 2 Histology Combination Codes for tumors with both invasive and in situ behavior. |
2019 |
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20051127 | Reportability--Brain and CNS: Is an "intradural extramedullary schwannoma (neurilemoma)" of the spine reportable? See Discussion. | Example: Pt underwent laminectomy and excision of intradural extramedullary tumor. Is there a default decision for tumors described as intradural extramedullary tumors, NOS? |
For cases diagnosed 2011 and later: A spinal "intradural extramedullary schwannoma (neurilemoma)" is reportable. This schwannoma originated in the spinal nerve root, C720.
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 |
2005 |
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20200042 | Solid Tumor Rules (2018)/Histology--Brain and CNS: How is the histology coded when the diagnosis comment for a posterior fossa tumor resection states: Taken together, these findings are indicative of medulloblastoma with extensive nodularity? See Discussion. |
Example: Posterior fossa tumor resection final diagnosis was medulloblastoma, WHO Grade IV. The diagnosis comment notes the current tumor resection reveals large irregular reticulin-free nodules with streams of neoplastic cells in a fibrillary background in association with narrow reticulin-rich internodular strands of poorly differentiated neoplastic cells. Taken together, these findings are indicative of medulloblastoma with extensive nodularity. The diagnosis comment provided only one histology. Per the 2018 Solid Tumor Manual, Malignant CNS, Priority Order for Using Documentation to Identify Histology instructions, an addendum or comment has priority over the final diagnosis. Although indicative is not listed on any ambiguous terminology list, is this an ambiguous diagnosis that must be ignored? Or does the diagnosis comment in this case provide a single, specific diagnosis of medulloblastoma with extensive nodularity? |
Code as medulloblastoma, nodular (9471/3) based on the findings from both the comment and final diagnosis. |
2020 |
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20200065 | Tumor Size/Corpus uteri--Endometrium: Is clinical tumor size coded to the endometrial stripe measurement or thickening in the endometrium. See Discussion. |
Example: Pelvic ultrasound-19 mm thickened endometrium; bilateral ovaries unremarkable. Case was coded to 19 mm for clinical tumor size. I have always been taught NOT to use "endometrial stripe" or "thickening" measurements for clinical size. Can you confirm. Also, is this noted on any of the SEER resources such as SEER training or in the SEER tumor size guidelines? I wanted to point them out to a reference if it is available. |
We consulted with an expert GYN pathologist. He confirmed our thinking that endometrial stripe or thickening does not represent clinical tumor size. We will add this to a future edition of the SEER manual for reference. |
2020 |
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