SEER Inquiry System - Search

For cases diagnosed 1/1/03 and later:

1. Code Surgery of Primary Site to 30 and Scope of Regional Lymph Node Surgery to 3.

2. Code Surgery of Primary Site to 41.

3. Code Surgery of Primary Site to 40 and Scope of Regional Lymph Node Surgery to 3.

4. Code Surgery of Primary Site to 40.

5. Code Surgical Procedure of Other Site to 4.

The following statement "Any mention of the terms including fixed, matted, mass in the hilum, mediastinum, retroperitoneum, and/or mesentery, palpable, enlarged, shotty, lymphadenopathy are all regarded as involvement for lymphomas when determining appropriate code," is included in EOD Primary Tumor and is applicable to Summary Stage 2018.

The statement will be added as note 4 to the Lymphoma Summary Stage chapter. This will be included in the 2019 update (estimated release January 2019).

Note 5 was changed in Version 2.0.

Per Note 5 of the 2018 SEER Summary Stage Prostate chapter: Imaging is not used to determine the clinical extension. If a physician incorporates imaging findings into their evaluation (including the clinical T category), do not use this information.

This note was changed in Version 2.0 (2021 changes) to be in line with how AJCC stages; therefore, AJCC and Summary Stage agree.

Assign code 4, Regional by BOTH direct extension AND regional lymph node(s) involved. In this case, the Regional component for Summary Stage 2018 is based on Note 6, under Colon and Rectum where Regional is defined as:

-Mesentery

-Peritonealized pericolic/perirectal tissues invaded [Ascending Colon/Descending Colon/Hepatic Flexure/Splenic Flexure/Upper third of rectum: anterior and lateral surfaces; Cecum; Sigmoid Colon; Transverse Colon; Rectosigmoid; Rectum: middle third anterior surface]

-Pericolic/Perirectal fat

Code as Localized using the SEER Summary Stage Manual, Colon and Rectum, Note 6.

Localized is for subsites that are not peritonealized, including the posterior side of the ascending colon, or when the pathologist does not further describe the "pericolic/perirectal tissues" as either "non-peritonealized pericolic/perirectal tissues" vs "peritonealized pericolic/perirectal tissues" fat and the gross description does not describe the tumor relation to the serosa/peritoneal surface, and it cannot be determined whether the tumor arises in a peritonealized portion of the colon.

Refer to the coding instructions in both EOD and Summary Stage for a list of sites that are nonperitonealized or peritonealized.

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For purposes of Summary Stage, intramucosal, NOS is a localized lesion. Intramucosal carcinoma is coded SEER Summary Stage 1 (localized) and (behavior code 3). The involvement of the following are assigned localized in Summary Stage and assigned a behavior code of 3.

Intramucosal, NOS

Lamina propria

Mucosa, NOS

Confined to, but not through the muscularis mucosa

The Exception you cite may need to be reworded. We will review for the next version of the Summary Stage manual.

Code 200 derives Regional Extension (RE) for Summary Stage; however, based on the information you provided, thymus primary with mediastinal fat invasion without mediastinal pleural involvement, EOD Primary Tumor would be coded to 100: Confined to thymus (encapsulated tumor), which includes extension into the mediastinal fat; No mediastinal or pleura involvement. This derives "Localized" for Summary Stage. Per AJCC T1, extension into the mediastinal fat is separate from involvement of the mediastinal pleura.

For Summary Stage 2018, this would be code 1, Localized only (localized, NOS): Confined to thymus, NOS; No mediastinal or pleura involvement or UNKNOWN if involved.

We will note that "extension into the mediastinal fat" is included in code 100 for the next release (September 2020).

To clear this edit of the derived Summary Stage (based on EOD) and the manually assigned Summary Stage (based on Summary Stage 2018), assign the manually assigned Summary Stage to 7.

For this particular case, EOD Primary Tumor 700 (which is correct based on the information received) derives Distant; however, for Summary Stage 2018, this description is under Code 2 for Regional by direct extension. This is an error. For 2022, Summary Stage for Lymphoma Ocular Adnexa description under Code 2 (Regional by direct extension) will be moved to Distant. No changes will be done to EOD.

Code SEER Summary Stage 2018 to Localized, Code 1. Per consult with AJCC and noted in the Primary Peritoneal Chapter in AJCC 8th edition, an intraoperative rupture is coded as a surgical spill. 

A capsule rupture is when the capsule ruptures prior to the surgery (Summary Stage Regional, Code 2). 

Do not assume that ground glass presentation is consistent with a neoplasm. There are numerous causes of a ground glass lung condition such as sarcoidosis or pulmonary fibrosis. A ground glass lung opacity may also be observed in conditions such as alveolar proteinosis, desquamative pneumonitis, hypersensitive pneumonitis, and drug-induced or radiation-induced lung disease. If an area of ground glass opacity persists in the lung, it is usually classified as an adenocarcinoma, a classification that ranges from premalignant lesions to invasive disease. This is in line with AJCC that states to stage based on the largest tumor determined to be positive for cancer.

To Summary Stage the case example provided, ignore the lesions in the contralateral lung (do not assume that they are malignant). There are multiple lesions in the left lung, but once again, do not assume that those not biopsied are malignant. This leaves us with the lesion confirmed to be malignant, making this a Localized (code 1) tumor.