Report | Question ID | Question | Discussion | Answer | Year |
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20220004 | First Course Treatment/Cancer-directed Treatment: What information can registrars use to determine disease progression and whether treatment counts as first course treatment? See Discussion. |
Is a physician’s statement of progressive disease adequate to determine disease progression in coding first vs. second course treatment? Can an increase in tumor burden (i.e., a change in overall stage) be used by the registrar to determine disease progression? Often, determining disease progression is difficult as there are no guidelines in the SEER Manual related to this topic. It seems a physician’s statement of progressive disease should always be accepted. However, that statement is not always available. While it seems an increase in tumor size alone would not be “progressive disease” as tumors will continue to grow, can registrars use an increase in tumor burden to make this determination? The instructions for coding first vs. second course treatment are clear when a treatment plan is changed, but determining whether there has been disease progression, recurrence, or treatment failure can be difficult without a physician’s assessment. For example, a patient was diagnosed with a newly diagnosed resectable pancreatic cancer; the documented treatment plan was for upfront chemotherapy, followed by repeat staging, followed by pancreatectomy. The patient completed 3 cycles of FOLFIRINOX, but the physician noted that the CT scan shows progressive disease, and the plan was to start a new treatment regimen with Abraxane, Gemzar, and stereotactic body radiation (SBRT) (Cyberknife). The patient completed the additional chemotherapy, radiation, and proceeded to the initially planned surgery. The pathologist staged this as yp disease, but the surgery appears to be second course treatment, and we would not code the surgery, or collect the staging (yp staging) since the physician stated this was progressive disease. The classification as yp staging can be misleading, since the resection is technically after neoadjuvant treatment, but is not collected per our guidelines. In this case, is it correct to code first course treatment as FOLFIRINOX only? |
Determining first course treatment is based on knowing the treatment plan and its course as to whether it was completed as initially planned. Read the medical record, scans, labs, and physician notes. First course of therapy ends when the treatment plan is completed as planned. Alternatively, first course of therapy ends when there is documented disease progression, recurrence, or treatment failure. A change to a drug in a different group or a change to a different treatment modality indicates the end of the first course of treatment. While a physician/clinician statement of progression, additional imaging, or other procedures that assess treatment efficacy, or increase in tumor burden can be used to denote progression, recurrence, or failure, a change to the initial treatment plan is a signal to to the registrar to suspect the end of first course of therapy. Once the initial treatment plan is changed, everything after the change is subsequent treatment. In the scenario provided, code FOLFIRINOX as first course of treatment. Based on the information provided, the Abraxane, Gemzar, and SBRT are second course and everything that followed that is second or subsequent course. The physician noted progressive disease and a new treatment regimen was started -- this is a clear indication of the end of the first course of treatment. The planned treatment course was FOLFINOX and surgery. Once that initial treatment plan is changed, everything after the change is no longer first course of treatment. Use text fields to document the details. |
2022 |
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20220046 | First Course Treatment/Immunotherapy--Other Therapy: Should IMC-A12 (Cixutumumab) be coded as Immunotherapy/Biological Response Modifier (BRM) treatment? See Discussion. |
IMC-A12 (Cixutumumab) is listed as a BRM agent in SEER*Rx, but the Remarks section indicates it should be coded as Other Therapy until there is FDA approval. It is unclear if FDA approval was ever given for this agent. We are mainly seeing it given for prostate primaries. |
Code Cixutumumab as Other Therapy. Cixutumumab is still in clinical trials and not approved by FDA yet. Though it is classified as an immunotherapy agent, it is not approved. |
2022 |
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20220010 | EOD 2018/Heme & Lymphoid Neoplasms--Myeloid Sarcoma: How is Extent of Disease (EOD) Primary Tumor coded for a myeloid sarcoma with multifocal skin involvement? See Discussion. |
Patient has a diagnosis of myeloid sarcoma presenting as multiple erythematous papules and nodules on back, chest, right arm & shoulder. Oncologist did not mention any evidence or suspicion of an associated AML diagnosis. HemeRetic schema EOD Primary Tumor Note 1 states that myeloid sarcoma can be coded as localized (code 100) or systemic (code 700). It is not clear what would qualify as systemic disease for myeloid sarcoma. |
Assign code 100, localized, using the 2018 EOD Primary Tumor, HemeRetic schema, for the myeloid sarcoma with skin involvement since only the skin is involved. Use code 700, distant or disseminated, when multiple organs are involved. |
2022 |
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20220018 | Solid Tumor Rules/Histology--Thyroid: What is the correct histology code for the following thyroid primary with multiple tumors abstracted as one primary diagnosed prior to 2021? See Discussion. |
2016 Total thyroidectomy, Multifocal -Dominant Tumor: Right Lobe, Papillary thyroid carcinoma (8260/3) -Tumors two through five: Three tumors Papillary thyroid carcinoma (8260/3), and one tumor Papillary thyroid carcinoma, follicular variant (8340/3) -An additional tumor: Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (8343/2) |
Code this multifocal thyroid carcinoma, single primary, as papillary thyroid carcinoma, follicular variant (8340/3) using Solid Tumor Rules, Other Sites, Rule H13 that says to code the most specific histologic term. We consulted with our endocrine specialty pathologist and when there is a mix of papillary and follicular variants, assign 8340. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features is coded as 8349/1 beginning in 2021. According to the WHO Classification of Endocrine Organs, 4th edition, it was formerly classified as non-invasive encapsulated follicular variant of PTC (FVPTC) (8343/2) but was reclassified based on extremely low malignant potential. |
2022 |
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20220042 | First Course Treatment/Radiation Therapy: How should Lutathera be coded? CoC states XRT- Radioisotopes and SEER states Other Treatment. |
Lutathera is a radioconjugate consisting of the tyrosine-containing somatostatin analog Tyr3-octreotate (TATE) conjugated with the bifunctional, macrocyclic chelating agent tetra-azacyclododecanetetra-acetic acid (DOTA) and radiolabeled with the beta-emitting radioisotope lutetium Lu 177 with potential antineoplastic activities. |
Update to the current manual: Code Lutathera as radiation (isotopes NOS code 13). We will make this change in the next version of the SEER manual. |
2022 |
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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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20220008 | Reportability/Histology--Soft Tissue: Is atypical spindle cell neoplasm, primitive myxoid mesenchymal tumor of infancy (PMMTI) from the soft tissue of the leg in August of 2019, reportable? |
Primitive myxoid mesenchymal tumor of infancy (PMMTI) is reportable. PMMTI is listed in the new WHO 5th edition Classification of Soft Tissue and Bone Tumors under round cell sarcomas. This is a variant of BCOR sarcomas. There is a new ICD-O histology code assigned for cases diagnosed in 2022 or later (9368/3). Code this 2019 case to round cell sarcoma, undifferentiated 8803/3. Use text fields to explain the details. |
2022 | |
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20220002 | Solid Tumor Rules (2018, 2021)/Histology--Cervix: For cases diagnosed 1/1/2022 and later, how is histology coded for the following three cervix cases relating to p16? See Discussion. |
The 2022 SEER Manual indicates the p16 status (positive or negative) can be used to code more the specific histology for squamous cell carcinoma, human papilloma virus (HPV) positive (8085) and squamous cell carcinoma, HPV negative (8086). However, the histology coding instructions in the Other Sites schema have not been updated and the 2022 SEER Manual does not cover all situations commonly encountered in the registry. Does the clarification regarding p16 apply to these other situations?
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For cases diagnosed beginning 1/1/2022, assign histology based on new codes and terms for the examples of cervical cancer using the available p16 results as follows. 1. Adenocarcinoma, HPV-independent, NOS (C53._) (8484/3) 2. Carcinoma, squamous cell, HPV-associated (C53._) (8085/3) 3. Carcinoma, squamous cell, HPV-independent (C53._) (8086/3) The 2022 SEER Manual states: Beginning with cases diagnosed 01/01/2022 forward, p16 test results can be used to code squamous cell carcinoma, HPV positive (8085) and squamous cell carcinoma, HPV negative (8086). Use the available results as the rules for Other Sites have not been updated yet. The SSDI Manual data item p16 for Cervix schema also states that p16 is based on testing results and not a physician statement. We can address these situations in a future version of the Solid Tumor Rules. The Other Sites rules will provide document priority when coding hsitology: biopsy vs. resection, cytology vs. histology, primary site vs. mets or regional site. |
2022 |
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20220003 | Reportability/Histology--Anus: Are 2021 diagnoses of anal intraepithelial neoplasia (AIN) II or AIN II-III reportable in patients with a known history of AIN II or AIN II-III diagnosed prior to 2021? See Discussion. |
Patient has a history of AIN I/low-grade squamous intraepithelial lesion (LSIL) dating back to at least 2015, was diagnosed with AIN II-III in 12/2019, and then diagnosed again with AIN II-III in 08/2021. There is no indication of treatment or a disease-free interval for this patient. SINQ 20210015, while not an exact match to this case, implies there is no clear disease-free interval for these AIN diagnoses, so it is the same non-reportable neoplasm diagnosed prior to reportability (12/2019). However, there was a diagnosis of a reportable neoplasm in 2021, so it also seems possible this would be accessioned as a reportable tumor based on a diagnosis of reportable tumor diagnosis in 2021. With the reportability changes for these intraepithelial neoplasia II/II-III tumors, these situations will arise more frequently. |
Report AIN II and AIN II-III cases when initially diagnosed in 2021 or later. Do not report retrospective cases; that is, cases with diagnoses prior to 2021 with continuation of AIN II or AIN II-III extending into the reportable period. |
2022 |
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20220007 | Histology: Is there any guidance on using STRATA Oncology testing (molecular tumor profiling tests), such as StrataNGS and StrataEXP, to code SSDIs, histology, etc? I do not see anything in STR, SEER Program Manual, SINQ, or CAnswerForum. We are seeing the testing with our 2021 paths. |
We recommend that you do not use information from these molecular tumor profiling tests until they become a standard diagnostic tool. If/when that happens, we will add information to the various manuals. |
2022 |