Surgery of Primary Site/Immunotherapy--Bladder: Is administration of BCG coded as both surgery and immunotherapy?
Yes, code as both surgery and immunotherapy. The CoC included immunotherapy/BCG under surgery and also under immunotherapy by request of the clinical advisor for bladder, reflecting the mixed-modality nature of the treatments. [Answer from CoC I & R]
SEER Manual/Reportability--Vulva: Is vulvar intraepithelial neoplasia (VIN II) alone reportable? An example is a final diagnosis from a pathology report that states only 'VIN II' with no additional details/wording.
Report VIN II. The 2024 SEER Manual lists this as a separate diagnosis in the Reportability section under Malignant Histologies 1.a.x.
Race: How is race coded for a patient who self-reports as white? In the Family History portion of the genetics consult, it states the maternal family is of mixed European and Cherokee descent; the paternal side is of mixed German/mixed European descent. Is race coded as Race 1: 03-American Indian and Race 2: 01-White, or as 01-White according to self-report by the patient?
Self-reported information is the highest priority for coding race. That is because the race information for the U.S. population comes from census data and that information is self-reported. For national cancer statistics, in order for the numerator (cancer cases) and the denominator (population) to be comparable, use self-reported race information whenever it is available. We will add this clarification to the SEER manual.
Reportability/Behavior--Ovary: Is ovarian mucinous
borderline tumor with foci of multifocal intraepithelial carcinoma reportable?
Report ovarian mucinous borderline tumor with foci of
multifocal intraepithelial carcinoma. The foci of intraepithelial carcinoma
makes this reportable. See the list of synonyms for in situ in the SEER Manual,
Behavior Code data item.
MP/H Rules/Histology--Kidney, renal pelvis: How would you code this histology: Renal cell carcinoma, clear and eosinophilic cell type?
Kidney rule H5 applies, code the more specific histology which is clear cell renal cell carcinoma (8310/3). Per the WHO Tumors of the Urinary System, clear cell renal cell carcinoma contains both clear and eosinophilic cytoplasm. Eosinophilic is not a type or variant of renal cell carcinoma.
Multiplicity Counter: Are in situ tumors diagnosed more than 60 days after invasive tumors of the same site and histology included in the Multiplicity Counter?
If an in situ tumor following an invasive tumor is a single primary according to the multiple primary rules for that particular site, include the in situ and the invasive tumors in the multiplicity counter.
EOD-Extension/EOD-Lymph Nodes--Bladder: Are "perivesical nodules" coded in the EOD-Lymph Nodes field or are they discontinuous extension and coded in the EOD-Extension field?
For cases diagnosed 1998-2003:
Code "perivesical nodules" in the EOD-Lymph Nodes field as involvement of regional lymph nodes. Each gross nodule of metastatic carcinoma in the fat surrounding an organ is counted as one positive regional lymph node.
Reportability--Head & Neck: Are high-grade squamous dysplasia / “severe” squamous dysplasia or glandular intraepithelial neoplasia reportable for all Head & Neck subsites? If so, what year did they become reportable? In reviewing SINQ 20240003, 20230047, and 20230046, it appears that at least the larynx, mandible, and tongue have been reportable since 2021. However, 8077/2 and 8148/2 histology codes are not included in the Solid Tumor Rules (STRs) (2025 update) for Head and Neck, either in Tables 1-9 or the H Rules.
High grade squamous dysplasia (8077/2) is reportable for head and neck sites for cases diagnosed as of 01/01/2021. High grade glandular intraepithelial neoplasia / glandular intraepithelial neoplasia grade III (8148/2) and high grade squamous intraepithelial neoplasia / squamous intraepithelial neoplasia grade III (8077/2) are reportable for head and neck sites for cases diagnosed as of 01/01/2001. Refer to other standard setters’ criteria for reportability as appropriate.
Tumor Size/Bladder: The 2018 SEER Coding and Staging Manual says to use imaging over physical exam as priority for determining tumor size. If a bladder tumor is 4 cm visualized on cystoscopy, and is 2.8 cm on CT scan, which should be used as the clinical size? Is cystoscopy (endoscopy) a clinical exam or imaging?
For the case described here, use the size from the CT scan. Physical exam includes what can be seen by a clinician either directly or through a scope. A tumor size obtained visually via cystoscopy is part of a physical exam. Therefore, the imaging (CT) tumor size is preferred. Use text fields to describe the details.
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