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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20220036 | Solid Tumors Rules/Histology--Head and Neck: How is histology coded for head and neck primaries when a tumor is diagnosed as an invasive squamous cell carcinoma with multiple subtypes? See Discussion. |
Example Case 1: 2022 mobile tongue tumor biopsy shows squamous cell carcinoma, basaloid non-keratinizing type. Example Case 2: 2022 base of tongue mass biopsy shows squamous cell carcinoma, basaloid non-keratinizing type, p16 positive. Table 5, Note 2 (Head and Neck Equivalent Terms and Definitions) instructs us to code non-keratinizing squamous cell carcinoma which is p16 positive to 8085 (Squamous cell carcinoma HPV-positive), ignoring the non-keratinizing subtype. Does p16 or HPV positivity also take priority over multiple subtypes (basaloid non-keratinizing type)? |
Assign 8083/3, basaloid squamous cell carcinoma (BSCC), in both examples. It is more important to capture the variant than to code 8085 or 8086. WHO Classification of Head and Neck Tumors, 5th ed., states that BSCC is a distinctive form of SCC, characterized by prominent basaloid morphology, squamous differentiation, and aggressive behavior. Some primary sites capture p16 status as a Site Specific Data Item; you may record the p16 results when that is the case. |
2022 |
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20051075 | CS Extension--Breast: How is this field coded when path describes dermal lymphatic invasion of the nipple? See Discussion. | Example Multicentric infiltrating lobular carcinoma of left breast treated with MRM. Microscopic summary: Blood/lymphatic Vessel Invasion: present. Path final diagnosis: Angiolymphatic invasion present, including dermal lymphatic invasion in nipple. Micro: There is angiolymphatic invasion, including dermal capillary invasion identified in sections of the nipple. The path report describes multiple breast tumors, none of which is located adjacent to the nipple. |
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. Assign CS Extension code 20 [Invasion of subcutaneous tissue...] based on the final diagnosis on the path report. There is "dermal lymphatic invasion in nipple." In this case, the stage will be determined by the tumor size. |
2005 |
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20051063 | Primary Site/CS Tumor Size/CS Extension--Lung: How are these fields coded when a chest CT for lung cancer documents multiple masses in different lobes of the lung? See Discussion. | Example Chest CT: "Almost complete consolidation of RUL and superior segment of RLL, highly suspicious for malignancy and represents primary bronchogenic carcinoma until proven otherwise. Multiple pulmonary masses bilaterally consistent with metastatic disease." The physician describes multiple masses throughout RLL and LLL of lung suspicious for met disease, particularly lesion in LLL measuring 2.5 cm. The 2 cm mass in right lung abuts pleura, another mass in RLL measures 2.5 cm, smaller nodules in RLL and another 1 cm lesion abuts the pleura. Bx of a rt supraclavicular LN is positive for met carcinoma c/w lung primary.
Would primary site be coded to RLL because the scan states that the lesions on the right side represent primary bronchogenic carcinoma until proven otherwise and the 2.5 cm lesion in the RLL is the location of the largest tumor on the right? Or should site be coded to right lung, NOS and size to unknown because there is no clear statement as to which lesion on the right represents the primary tumor? If the site is lung, NOS, would CS Extension be coded to 65 to describe the multiple nodules in the RLL? |
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.Based on the information provided: Code primary site C349 [Lung]. Code laterality 1 [Right]. Code CS Tumor Size 999 [Unknown]. Code CS Extension 65 [Separate tumor nodules, same lobe]. Code CS Mets at Dx 39 [Separate tumor nodule in contralateral lung]. |
2005 |
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20051074 | CS Extension/CS Lymph Nodes--Colon: What codes are used when large vessel invasion (V2 grossly evident) is stated to be present on a pathology report? See Discussion. | Example Cecum, right hemicolectomy: poorly differentiated invasive adenocarcinoma of the cecum. Large vessel invasion (V2-grossly evident) is present. Microscopic description: The grossly described matted lymph node tissue shows an irregular nuclear contour and is classified as V2, grossly evident venous invasion based on staging criteria of the AJCC Cancer Staging Manual, 6th Edition. Per note 2 in the coding scheme for CS-Extension, a nodule with irregular contour in the pericolic adipose tissue should be coded in CS-Extension to code 45. Is the large vessel invasion described in the path report the same process as a tumor nodule in pericolic fat? Should note 2 be used and CS-Extension coded to 45? |
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.The description of large vessel invasion and irregular nuclear contour from the example above describes grossly matted LYMPH NODE tissue. Do not code this in the CS Extension field. Code the CS Lymph Nodes field appropriately based on the rest of the information for this case. When large vessel invasion and irregular nuclear contour is used to describe a "tumor nodule," rather than a recognizable lymph node, code it in the CS extension field. |
2005 |
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20240025 | Update to the current manual/Reportability--Esophagus: Is high grade dysplasia of the esophagus reportable? The 2024 Seer Program Manual, page 21, has an example that states it is not reportable. See Discussion. |
Example 4: Esophageal biopsy with diagnosis of “focal areas suspicious for adenocarcinoma in situ.” Diagnosis on partial esophagectomy specimen “with foci of high grade dysplasia; no invasive carcinoma identified.” Do not accession the case. The esophagectomy proved that the suspicious biopsy result was false. Appendix E2 #32 of the SEER Manual states high grade dysplasia in site other than stomach, small intestines, and esophageal primary sites are not reportable. Does this mean high grade dysplasia is reportable for esophagus primaries? |
High grade dysplasia of the esophagus is reportable. The example will be corrected in the next edition of the SEER manual. |
2024 |
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20180104 | Reportability--Ambiguous terminology: Are the following terms reportable: almost certainly and until proven otherwise? See Discussion. |
Example 1: Physician states patient has an almost certain melanoma. Due to the patient's age, there is no plan to for any treatment or further workup. Almost certain is not listed as a reportable phrase, so typically we would not accession this case. Example 2: Imaging states a diagnosis of renal cell carcinoma until proven otherwise. No additional workup is available at this facility. This terminology is also not seen on the ambiguous reportable terminology list but we are seeing it more often and wanted confirmation. |
Use the ambiguous terminology list as a last resort. Consult with the physician and search for further information to assist with the decision. If no further information can be obtained, use the ambiguous terms list to decide; in this case, the terms are not on the list and these examples would not be reportable. |
2018 |
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20051046 | Reportability/Diagnostic Confirmation--Leukemia: What is the diagnostic confirmation if a positive BCR/ABL result is diagnostic of a malignancy in a patient suspected to have chronic myelogenous leukemia? See Discussion. |
Example 1: Peripheral smear states: "No morphologic evidence of chronic myelogenous leukemia." Addendum: Molecular diagnostic studies showed a positive rearrangement for the BCR gene with the M-bcr (CML type) and of bcr-abl transcript expression". Example 2: Hematopathology is negative. Molecular diagnostic study: "fluorescent in situ hybridization (FISH) studies exceeded the limits established by the XXX Cytogenetics Laboratory for this probe set, and thus, demonstrated statistical evidence of BCR/ABL fusion." |
For cases diagnosed prior to 1/1/2010: Do not determine reportablility using cytogenetics or molecular studies alone. Since these are not routine screening tests, we suggest that you query the physician and review the medical record to see what prompted the study and what is being done with the result, but the test alone is not in and of itself sufficient to report the case. For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ. |
2005 |
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20041009 | Diagnostic Confirmation--Lymphoma: Can lymphoma be diagnosed clinically? See Description. | Example 1: Patient with B symptoms. Physical exam reveals large neck mass. Physician impression is lymphoma. Example 2: CT scans show lymphadenopathy consistent with lymphoma. In both cases, patient does not return for biopsies. |
Yes, lymphoma can be accessioned based on a clinical diagnosis. Code Diagnostic Confirmation in Example 1 as 8 [Clinical diagnosis only]. Code Diagnostic Confirmation in Example 2 as 7 [Radiography and other imaging techniques without microscopic confirmation]. |
2004 |
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20021089 | Primary Site--Ovary/Peritoneum: When ovaries are not found on a resection or if the ovaries removed are negative for malignancy, but the clinician refers to the adenocarcinoma in the pelvis as being an "ovarian" primary, should the primary site be coded as ovary, pelvic peritoneum or unknown? See discussion. | Example 1: Patient has a history of a BSO without an indication that it was done for malignancy. Pt has a resection. No ovarian tissue found. No site is mentioned in the pathology report. The clinician refers to the diagnosis of adenocarcinoma in the pelvis as an "ovarian" primary.
Example 2: Resected ovaries are negative. No specific site of origin is mentioned in the path. Again, the clinician refers to the diagnosis of adenocarcinoma in the pelvis as an "ovarian" primary. |
Code the Primary Site for both examples to peritoneum [C48.2]. When the physician refers to a case as "ovarian" even though the ovaries are negative or when the histology is an ovarian histology, such as papillary serous ca, the primary site should be coded to the peritoneum. Code the Primary Site to where it appears the disease is arising. | 2002 |