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Report Produced: 02/21/2026 22:57 PM

Report Question ID Question Discussion Answer Year
20031096 Radiation: How would this field be coded for treatment with quadramet [radioactive samarium]? See Description. Paitent is receiving quadramet for treatment of lung metastases. Code Quadramet in the RX Summ-Radiation field as 3 [Radioisotopes]. Quadramet is a radioisotope used to palliate bone pain. The instructions in the SEER manual state: "Record all radiation that is given, even if it is palliative." 2003
20031080 Behavior Code/EOD-Extension--Bladder: How are these fields coded for a bladder tumor in which the pathologist states, "there is no definite invasion identified" but the urologist states the case as T1? See Description.

Patient presents with four bladder tumors, described as "each measuring close to 2 cm." A specimen was taken of only one of the tumors. The tops of the tumors were fulgurated, then vaporized methodically. No obvious tumor or residual was noted on re-inspection.

Pathology revealed papillary urothelial carcinoma, high grade, with no definite invasion identified. Small segments of muscularis propria were present. A comment read..."it is difficult to determine if lamina propria invasion is present due to marked necrosis and tissue fragmentation." Urologist staged this as AJCC cT2a, but based on the pathology findings changed it to cT1. The urologist insists this is invasive.

For cases diagnosed 1998-2003: Because of the damage to the specimen from cautery and the insistence of the urologist that the tumor was invasive, code extension for this case to 15 based on the physician's TNM category of T1.

A T1 is invasive--code the behavior /3. The urologist is confident it is invasive, and will likely treat the patient accordingly.

 2003
20031196 EOD-Pathological Extension--Prostate: How is this field coded when biopsy findings differ from prostatectomy findings? See Description. Needle biopsy of prostate clearly states cancer arising in the apex. Clinical extension would then be 33. After prostatectomy, the path report states only one lobe involved with cancer and the apex was negative for cancer. Would the pathological extension then be coded to a 20 to truly reflect the surgical findings? For cases diagnosed 1998-2003: Combine the information from the needle biopsy and the prostatectomy and code the pathologic EOD to 34 [Extending to the prostatic apex]. The case example above is very similar to Example 4 on page 2 of the Prostate EOD Coding Guidelines. 2003
20031007 EOD Extension--Lung: Do we ignore pericardial effusion seen on a CXR if a subsequent lobectomy reveals only a localized tumor? See discussion. Note 6 in the lung EOD scheme instructs us to assume that a pleural effusion is negative if a resection is done. Does this also apply to a pericardial effusion? For example, if a pericardial effusion is seen on CXR, and a subsequent lobectomy reveals only a localized tumor, should the effusion be ignored? For cases diagnosed 1998-2003: Ignore pericardial effusion which is negative for tumor. Assume that a pericardial effusion is negative if a resection is done and the tumor is pathologically confirmed to be localized. 2003
20031100

Date of diagnosis: Can a positive VMA:HVA test be used as a date of diagnosis for neuroblastoma? See Description.

Rubin's Clinical Oncology states: Both the catecholamines and their metabolites are used as markers for neuroblastoma, with vanillylmandelic acid (VMA) and homovanillic acid (HVA) being the most commonly used. While their absolute values are not of prognostic significance, a higher VMA:HVA ratio suggests a better prognosis for patients with disseminated disease.

Updated answer July 2024

No. Do not code the neuroblastoma diagnosis date from only the date of an elevated urine catecholamine test (VMA or HVA). Neuroblastoma diagnosis should be made on the basis of tissue biopsy or bone marrow aspiration along with elevated urinary catecholamines. Elevated urinary catecholamines alone are not diagnostic of neuroblastoma.

 2003
20031115 EOD-Lymph Nodes/EOD-Extension: Does extracapsular lymph node extension into adjacent tissue or organs affect EOD coding? See Description.

For a lung primary a PET scan showed marked uptake in the right hilum consistent with metastatic disease. A radical pneumonectomy was performed and the operative findings showed that the pulmonary artery was involved with a mass.

Pathology: Small cell carcinoma in the lung parenchyma. The distal bronchi showed obstructive pneumonitis. There were mets found on 02/05 on the hilar lymph nodes and 00/02 peribronchial nodes. The mets in the hilar nodes extended beyond the lymph node capsule into the pulmonary artery.

 For cases diagnosed 1998-2003: Extracapsular lymph node extension does not affect the extent of disease. Code the extent of regional lymph node involvement in EOD lymph nodes. 2003
20031173

First Course Treatment/Hormone Therapy--Thyroid: Is hormone replacement therapy such as levothyroxine (Synthroid) for thyroid carcinoma coded as first course of treatment? See Discussion.

Examples:

Patient was admitted for thyroidectomy with a diagnosis of probable thyroid cancer. Patient's history stated that patient received work-up for hypothyroidism and was found to have thyroid nodule. Fine needle aspirate suggested carcinoma. Patient's medications included Cytomel and Synthroid.

Patient was given levothyroxine after thyroidectomy for medullary thyroid carcinoma.

Updated December 2025

Do not code levothyroxine given to treat hypothyroidism or as cancer treatment for medullary carcinoma when given as replacement therapy and not as thyroid stimulating hormone (TSH) suppression therapy. Thyroid hormone therapy is generally coded as treatment for follicular, papillary, and oncocytic thyroid carcinomas.

 2003
20031039

EOD-Clinical Extension--Liver: How do the segments of the liver described by AJCC Manual correspond to the lobes of the liver described by the SEER EOD Manual? See Description.

CT described hepatocellular ca involvement of the liver with nodules identified in segments 5 and 7. Would EOD-extension be coded to 30 [multiple tumors (one lobe)]?

Segments 2, 3, and 4 correspond to the left lobe of the liver. Segments 5, 6, 7 and 8 correspond to the right lobe of the liver. Segment 1 is the caudate lobe, which has completely different drainage and vascularization, is separate from the larger right and left lobes.

For cases diagnosed 1998-2003: Since segments 5 and 7 are both in the right lobe, assign EOD-extension code 30 for the case above, unless there is mention of vascular invasion. Be sure to record the size of the largest primary tumor.

Tumor size and vascular invasion are the most important factors for AJCC 6th edition staging.

 2003
20031152 Ambiguous Terminology/Histology (Pre-2007): How do we code histology when there is a difference between the histology mentioned on a suspicious cytology and the clinical diagnosis by the treating physician? See Description. An FNA of pancreas is stated as "highly atypical cells present, suspicious for pancreatic ductal carcinoma." The attending physician states the patient has pancreatic carcinoma. Can histology be coded 8500/3 [infiltrating duct carcinoma, NOS] or should it be 8010/3 [carcinoma, NOS]?

For tumors diagnosed prior to 2007:

Code the histology from a suspicious cytology when this histology is supported by the clinical diagnosis.

Code the example above to 8010/3 [Carcinoma, NOS].

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2003
20031049 Histology (Pre-2007)--Stomach: What code is used to represent the histology of "mucin-secreting adenocarcinoma, intestinal type "for a stomach primary?

For tumors diagnosed prior to 2007:

For this specific example, code histology to 8481 [Mucin-producing adenocarcinoma] as it is a more specific cell type with inherent prognostic information.

Code 8255/3 [Adenocarcinoma with mixed subtypes] is not appropriate for this case because "intestinal type" is a more specific description of this cancer and not another type of cancer. There are two broad categories of gastrointestinal adenocarcinomas: Intestinal and Diffuse.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2003