SEER Inquiry System - Search

Patient is diagnosed with adenocarcinoma documented by the physician as “colorectal cancer.” The medical record does not specify colon, rectosigmoid, rectum, or any specific segment of the large intestine. There is also no imaging, operative, endoscopic, or pathology documentation identifying a more precise site of origin.

Specifically, should the registrar assign:

· C18.9 — Colon NOS - (excludes rectum, NOS C20.9 and rectosigmoid junction C19.9)

· C19.9 — Rectosigmoid junction

· C20.9 — Rectum NOS

· C26.0 — Intestinal tract, NOS

· C26.9 — Gastrointestinal tract, NOS

· or another site

One of the largest hospital systems in our area includes "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" and "FIRST NATIONS" as dropdown items for patients to self-select for race/ethnicity. This hospital system serves 51 hospitals and 1,000 clinics across Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. If "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" is the only item selected with no additional text info available, how should Race 1 and Spanish Surname or Origin be coded? If "FIRST NATIONS" is the only item selected without additional text info available, should Race 1 be coded as 03?

Smoldering multiple myeloma is reportable. However, it is unclear if a diagnosis of borderline smoldering multiple myeloma should be accessioned when no further follow-up with the physician is possible. The physician stated the patient, "most likely has borderline smoldering multiple myeloma, but mostly MGUS," and further noted the definition of smoldering myeloma requires at least 10% of plasma cells involved with the neoplasm and some areas of the patient's bone marrow does meet the 10% plasma cell threshold. The physician noted the patient does not need treatment because of the favorable cytogenetics and lack of organ dysfunction.

Should the term "borderline" be ignored and the case accessioned? Or is a borderline smoldering myeloma non-reportable?

According to the AJCC CAnswer Forum (https://cancerbulletin.facs.org/forums/node/160948), celiac axis nodes are considered regional for the liver. However, for liver primaries, Extent of Disease (EOD) regional lymph nodes list the following as regional lymph nodes:

• Caval
• Hepatic, NOS
  • Hepatic artery
  • Hepatic pedicle
  • Inferior vena cava
  • Porta hepatis (portal) (hilar) [in hilus of liver]
• Periportal
• Portal vein
• Regional lymph node(s), NOS

Based on this information, should celiac axis lymph nodes be considered as regional for liver primaries when coding EOD Regional Nodes?

Patient had a left thigh soft tissue mass excision on 7/24/24 and was diagnosed with superficial CD34 positive fibroblastic tumor. Margins were narrowly free of disease. Tumor size was 5.5 cm x 4.4 cm x 3.9 cm. The diagnosis was confirmed.

The STR states that p16 can be used to code HPV-associated and HPV-independent histologies for selected sites depending on diagnosis year but contains no instructions about how to interpret p16 staining results on pathology reports. These are often stated in various ways in our area, depending on the pathology lab and different pathologists. The SSDI Manual and SEER Coding and Staging Manual each have some instructions and code definitions for p16, including:

- Code 0 for p16 expression of weak intensity or limited distribution

- Code 0: p16 Negative; Nonreactive

- Code 1: p16 Positive; Diffuse, Strong reactivity

- IHC for p16 expression is a surrogate marker for HPV infection

Example: 2023 squamous cell carcinoma of the vulva, partial vulvectomy; pathology states vulvar intraepithelial neoplasia-3, p16 immunohistochemistry demonstrates block-like expression, which supports the diagnosis. The next path report states invasive squamous cell carcinoma, stain for p16 is strong and diffuse in the lesion, supporting the above diagnosis. Neither path report specifically states "HPV-related," so are p16 "expression" and "strong and diffuse" staining enough to code the histology as 8085/3 for this case?

There was a single right fallopian tube tumor with two distinct morphologies. The diagnosis comment states, “The combined morphologic and immunohistochemical features are best classified as primary fallopian tube high grade serous carcinoma with a somatically derived yolk sac tumor.”

CAP Protocol for the Examination of Cystectomy Specimens From Patients With Carcinoma of the Urinary Bladder/Treatment Effect Post Neoadjuvant Chemotherapy (BCG not included) selections

o No known presurgical neoadjuvant therapy

o Complete response: Absence of histologically identifiable residual cancer cells and extensive fibrosis of the tumor bed after presurgical neoadjuvant therapy (TRG1)

o Strong response: Predominant fibrosis of the tumor bed, with residual cancer cells occupying less than 50% of this area (TRG2)

o Weak or no response: Residual cancer cells occupying ≥50% of the tumor bed or absence of regressive changes (TRG3)

o Other (specify): _________________

SEER Coding Instruction for Site-Specific Codes for Neoadjuvant Therapy Treatment Effect - Schemas: All Other Schemas selections

0 Neoadjuvant therapy not given/no known presurgical therapy

1 Complete pathological response

Present: No viable cancer cells/no residual invasive carcinoma identified

Residual in situ carcinoma only

2 Near complete pathological response

Present: Single cells or rare small groups of invasive cancer cells

3 Partial or minimal pathological response

Present: Residual invasive cancer with evident tumor regression, but more than single cells or rare small groups of cancer cells

4 Poor or no pathological response

Absent: Extensive residual cancer with no evident tumor regression

6 Neoadjuvant therapy completed and surgical resection performed, response not documented or unknown

Cannot be determined

7 Neoadjuvant therapy completed and planned surgical resection not performed

9 Unknown if neoadjuvant therapy performed

Unknown if planned surgical procedure performed after completion of neoadjuvant therapy

Death Certificate only (DCO)