SEER Inquiry System - Search

Example 1. Patient was diagnosed with right breast cancer in 1999 and underwent lumpectomy followed by radiation therapy. In 2001, patient was again found to have right breast cancer and was admitted for mastectomy. The surgeon stated that this was recurrence. The patient's primary care physician stated the patient had a new primary. Is there a priority order if the multiple physicians involved in a patient's care do not agree on the diagnosis?

Example 2. Patient was diagnosed in 1998 with left breast cancer. In 2000, the patient again was diagnosed with left breast cancer. There was no mention of recurrence so case was accessioned as a second primary. In 2003, patient was again admitted for an unrelated disease. In the H&P, the physician stated that the patient had recurrent breast cancer in 2000. Do we remove the second primary from our file based on this statement three years later?

Example 3. Patient was diagnosed with Paget's disease with intraductal carcinoma, left breast, in 1997. In August 2002, patient underwent left mastectomy for DCIS, left breast. In November 2002, patient's oncologist stated that patient had been on Evista for 5 years and had recurrent cancer despite Evista. Do we accession this as one or two primaries?

Example 1. Patient underwent excision and re-excision of lentigo maligna in 1998. Final path showed close but negative margins. In 1999 a biopsy of a brown patch (over the scar) in the same location was done. Pathology reported residual lentigo maligna. Is the 1999 melanoma a new primary because it was diagnosed more than two months after the first melanoma and there is no mention of recurrence? Or is the term "residual" another way of saying recurrence?

Example 2. In 1999, patient underwent excisonal biopsy of intraductal carcinoma of the right breast, followed by radiation therapy. In 2000, mammogram showed calcifications in right breast. Biopsy was done with path showing residual ductal carcinoma in situ. There is no mention of recurrence. Is this one or two primaries?

Example #1: Cervix loop electrocautery excision procedure (LEEP) pathology: Histologic Type: Squamous cell carcinoma, HPV-associated. Histologic Type Comments: High-risk HPV testing on previous Pap test sample reported as positive for high-risk HPV. The prior Pap diagnosis was HSIL only with molecular results positive for high-risk HPV.

Example #2: Cervix endocervical curettage and biopsy with CIN 3, p16 diffusely positive. Subsequent LEEP with superficially invasive squamous carcinoma (no HPV or p16 testing done). This was followed by an additional cone excision that was negative for residual malignancy and p16 testing was also negative.

Evaluation of Malignancy and Prognosis of Gastrointestinal Stromal Tumors: A Review. Miettinen, M. et al, Human Pathology 2002 May; 33(5) 478-83). This article states there is an increasing number of GISTs because the majority of tumors previously diagnosed as gastrointestinal smooth muscle tumors (leiomyomas, leiomyoblastomas and leiomyosarcomas) are now classified as GISTs. It states that gastrointestinal autonomic nerve tumors (GANTs) are also GISTs based on their KIT positivity and presence of KIT-activating mutations. This article also states that a GIST is probably malignant if it meets the following criteria: 1) Intestinal tumors: Maximum diameter >5 cm or more than 5 mitoses per 50 HPFs. 2) Gastric tumors: Maximum diameter >10 cm or more than 5 mitoses per 50 HPFs.

Some of the path reports that meet these criteria use the word "malignant", and others do not. Some of the cases that are not called "malignant" in the path diagnosis are signed out clinically as "malignant."

Endometrial primary confirmed by biopsy on 10/26/06. Pelvic washing on 11/14/06 was 'suspicious for malignancy.' Resection path the same day stated the primary tumor invades the inner 1/3 of the myometrium.

Can we use the pelvic washing cytology & code CS extension 61 or should CS extension be coded 12?

Endocrine mucin-producing sweat gland carcinoma (EMPSCG) is a rare type of low-grade sweat gland carcinoma. Some journal articles indicate that most patients with EMPSCG have coexisting mucinous carcinomas, suggesting that EMPSCG is a precursor to invasive mucinous carcinoma of the skin. Sweat gland carcinoma has its own histology code per the ICD-O-3 (8400/3); should an endocrine mucin-producing sweat gland carcinoma also be coded as 8400/3? If so, would the correct histology for the skin case above be mucinous carcinoma (8480/3) per Rule H17? Conversely, if the terms "mucin-producing" are referring to mucin-producing carcinoma, and not referring to the sweat gland carcinoma, would the histology be coded 8481/3 (mucin-producing carcinoma)?

Does the rule on page 111 of the SEER Program Coding Manual, 3rd Edition, for code 1 apply to myelomas (in the same way it applies to leukemias)?

Does the Other Sites MP/H Rule H17 apply in this case, which results in coding the higher histology 8805/3 (undifferentiated sarcoma)? Or does the "undifferentiated" statement only refer to grade, which results in coding histology to 8802/3 (pleomorphic sarcoma)?

Does ductal carcinoma with tubular features qualify for Breast MP/H Rule H28? Or, is it more appropriate to strictly follow Table 2 (not a type of ductal tumor) and apply Rule H29, thus losing the lobular component?

Does Rule M5 only apply if both diseases are present at the original diagnosis, or does it also take into account a recurrence of an old disease? The answer to this question makes a difference between stopping at rule M5 and abstracting as one disease, or going on to rule M15 to query the Hematopoietic Database to determine whether the patient has two separate primaries.

Example: Patient had Stage II Hodgkin disease in 2005 (all lymph nodes above diaphragm, supraclavicular LN biopsied at diagnosis), treated and patient achieved complete remission. In 2010, the patient is admitted for suspected recurrence. A supraclavicular lymph node biopsy showed, "Recurrent Hodgkin" AND "EBV+ Diffuse Large B-cell Lymphoma," both in the same lymph node. Applying rule M5, this is a single primary and states not to query the DB. However, this doesn't seem correct as it does not account for the new DLBCL.