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Report Produced: 11/10/2026 06:22 AM

Report Question ID Question Discussion Answer Cancer Site Category Data Item Category Year
20180030

First Course of Treatment/Surgery of Primary Site--Melanoma: How do you code UVB therapy treatment for melanoma?

Code UVB therapy for melanoma as photodynamic therapy under Surgery of Primary Site for skin. Assign code 11 [Photodynamic therapy (PDT)] if there is no pathology specimen. Assign code 21 [Photodynamic therapy (PDT)] if there is a pathology specimen. Use text fields to document details.

 Melanoma First course treatment, Surgery of Primary Site 2018
20170055

First Course of Treatment/Surgery of Primary Site--Corpus uteri: Do you code total hysterectomy or radical hysterectomy when a specimen indicates the uterus, cervix, ovaries, fallopian tubes, and right and left parametrium were resected, but shows no portion of the vagina. See Discussion.

AFS1-AFS2-frozen section control, endomyometrium; AFS3-frozen section control, subserosal intramural mass; A4-anterior cervix; A5-posterior cervix; A6-anterior cervical endometrial junction; A7-posterior cervical endometrial junction; A8-A10-anterior endomyometrium, including tumor; A11-A13-posterior endomyometrium, including tumor and adjacent mass; A14-random section subserosal mass; A15-left parametrium at margin of resection; A16-right parametrium at margin of resection; A17-A18-left ovary and fallopian tube; A19-A20-right ovary and fallopian tube. The final diagnosis includes Endometrial adenocarcinoma, favor serous carcinoma, with papillary and solid areas. Tumor involves: Cervix present, Right ovary, Left ovary, Right fallopian tube, Left fallopian tube, Right parametrium, Left parametrium.

Assign code 50 for total hysterectomy. According to Appendix C Surgery Codes for Corpus Uteri of the 2016 SEER Coding and Staging Manual, total hysterectomy is surgery to remove the entire uterus, including the cervix; whereas, radical hysterectomy includes the vagina.

 Corpus uteri First course treatment, Surgery of Primary Site 2017
20190023

First course of treatment/Radiation therapy--Kidney: Patient has a CT-guided biopsy of a right renal mass with procedure details under the Interventional Radiology Procedure Note stating "Gelfoam tract embolization." Is this particular embolization treatment?

Gelfoam tract embolization for a CT-guided renal biopsy is not treatment. It is a method to plug the biopsy track to reduce the risk of hemorrhage.

 Kidney, renal pelvis First course treatment, Radiation Therapy 2019
20180031

First Course of Treatment/Other Therapy: Where do you code Optune TTF therapy? What needs to be included in the text portion to document this treatment?

Code OPTUNE in the Other Treatment field. See NovaTTF in SEER*Rx (http://seer.cancer.gov/seertools/seerrx/). NovaTTF is the pre-FDA approval name for OPTUNE.

If OPTUNE was administered for recurrence, be sure NOT to record it in the first course of treatment fields. Check with CoC if you have questions about coding treatment for recurrence.

 N/A First course treatment, Other therapy 2018
20190036

First Course of Treatment/Hormone Therapy--Breast: Is hormone therapy (HT) prescribed for invasive ductal carcinoma of the right breast coded as treatment for lobular carcinoma in situ (LCIS) of the left breast even though the treatment plan for the LCIS was documented as surveillance? See Discussion.

Patient is diagnosed with invasive ductal carcinoma (IDC), right breast, receives HT, radiation therapy, and surgery. The same patient is diagnosed with LCIS, left breast one month later--recommend surveillance only (no surgery). Is the HT for the left breast coded at all? I think for COC/NCCN, we do not, but for SEER what would I do? Treatment in the SEER Manual 2018 states, "Code the treatment on each abstract when a patient has multiple primaries and the treatment given for one primary also affects/treats another primary." The example include bladder/prostate and ovarian/cervix. It also states, "Code the treatments only for the site that is affected when a patient has multiple primaries and the treatment affects only one of the primaries." The example includes colon/tonsil. Breast LCIS treatment appears complicated. Per NCCN guidelines, this condition no longer has recommendations, however it appears as though they still state that if a core biopsy is done and is LCIS, follow up should be ultrasound or surgical excision. Nowhere does it state hormone is recommended.

Do not code the hormone treatment for the LCIS since it was clearly documented that the hormone treatment was given for the IDC and the treatment for the LCIS was documented as "surveillance." Use text fields to record the details on both abstracts.

 Breast First course treatment 2019
20150018

First course of treatment--Immunotherapy:  Should Rituxan be coded to immunotherapy?  See discussion.

Is the instruction under #4.b. on page 114 of the 2014 SEER Program Coding and Staging Manual incorrect? It says to code Rituxan as chemotherapy.  

Rituxan changed categories from chemotherapy to a biologic therapy/Immunotherapy agent effective with cases diagnosed January 1, 2013. See page 150 or page 164 in the 2015 SEER manual. The instruction in the 2014 SEER manual was incorrect regarding Rituxan.

N/A First course treatment, Immunotherapy 2015
20260012

First Course of Therapy/Hormone Therapy--Thyroid: Is Thyrogen (thyrotropin alpha) coded as hormone therapy when a patient is given Thyrogen as part of planned 2-day Thyrogen Stimulated I-131 treatment for a papillary or follicular cancer? See Discussion.

SEER*Rx categorizes Thyrogen as Hormones and hormonal mechanisms/Thyroid stimulating hormone. Probably not cancer directed–verify with attending MD.

Do not code Thyrogen as hormone therapy when given as a stimulating agent in I-131 therapy. The therapeutic agent is I-131.

The Thyrogen/thyroid stimulating hormone (TSH) is sensitizing the gland to absorb more I-131. Thyrogen/TSH is a trophic hormone so it can cause growth of cancer cells. Thyroid hormones are given in follicular and papillary thyroid cancers to suppress TSH. Although Thyrogen can promote cancer growth its use in Thyrogen stimulated I-131 radioactive therapy is justified (benefits exceed the risk), since the use is short (2 days) and the high amount of I-131 would kill cancer cells in addition to majority of thyroid tissue.

We will update the Thyrogen entry in SEER*Rx and clarify in the next release of the SEER manual, Appendix C Coding Guidelines for Thyroid.

 Thyroid First course treatment, Hormone Therapy 2026
20250030

First Course of Therapy/Hormone Therapy--Meningioma: Should Sandostatin be coded as treatment for a Grade 1 meningioma? Patient had surgery and was somatostatin receptor 2 (SSTR2) positive by immunohistochemistry.

Code Sandostatin (octreotide acetate) as hormonal therapy when given including:

· SSTR 2 positive meningioma (NCCN, 2025: smaller studies support the use of targeted therapy including somatostatin)

· Neuroendocrine tumor (NET) (NCCN, 2025: Tumor control: antitumor effect is supported by studies for well-differentiated G1/G2 gastro-entero-pancreatic NET. In lung/thymic NET, somatostatin analogues may be considered if metastatic or SSTR positive).

The SEER*Rx entry for Octreotide Acetate was updated as studies showed somatostatin analogs may shrink tumors or inhibit further growth.

 Brain and CNS Hormone Therapy 2025
20260006

First Course of Therapy--Heme & Lymphoid Neoplasms: How is first course of treatment coded for hematopoietic and lymphoid neoplasm (heme) cases who are put on surveillance for years while asymptomatic and then start chemotherapy or other treatment years later once they become symptomatic? See Discussion.

Patient was diagnosed with smoldering myeloma in October 2021 and put on surveillance. In May 2024, the patient became symptomatic and started chemotherapy.

Is the date of diagnosis in 2021, with date of first treatment with chemotherapy in 2024? Or is active surveillance first course and treatment with chemotherapy as second course in 2024?

Updated June 2026

Code the first course of treatment as active surveillance. Chemotherapy is second course of treatment based on this scenario due to progression.

We will be adding clarification about this type of scenario to the treatment rules in the 2027 updates, which will be released October 2026.

Heme & Lymphoid Neoplasms N/A 2026
20230074

Extent of Disease/EOD Regional Nodes--Small Intestine: For an ileal/jejunal neuroendocrine primary, how should mesenteric soft tissue deposits (less than 2 cm) be collected in Extent of Disease (EOD) Staging? See Discussion.

Example: Patient is diagnosed with grade 1 well-differentiated neuroendocrine tumor of the ileum, confirmed on ileocolic resection in 2023. The final diagnosis is a 2.8 cm ileal mass, with focal lymph-vascular invasion and a single 0.6 cm tumor deposit within mesenteric fat; primary tumor completely resected with widely negative margins and 10 regional nodes negative for malignancy.

According to AJCC, mesenteric masses less than 2 cm should be stated in the pathology report as being present and collected by registrars but do not affect stage. EOD Regional Nodes has a code for large mesenteric masses greater than 2 cm only. How should we record these smaller tumor deposits if they are not supposed to affect stage?

Do not code 500 for involvement of the mesentery unless the mesentery is specifically stated to be involved (and we don't have that information). We need more information on this case to assign EOD primary tumor.

EOD Regional Nodes would be 000 per AJCC.

Small intestine EOD Primary Tumor, EOD Regional Nodes 2023