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Assign code 500 for EOD Primary Tumor for now.

We have confirmed with AJCC that "invasion of" but not "through" the visceral peritoneum maps to a T2 and not T3. Involvement of the visceral peritoneum for Summary Stage is Regional and does not make a distinction between "invasion of" or "invasion through." Any involvement of the visceral peritoneum is regional.

To correct this situation would require a new code, which would derive a T2/RE. That code will be added to the updates for 2023.

Code 500 will derive the appropriate Summary Stage of 2 (Regional). We are aware that this will derive the incorrect T; however, there is no work around at this time that will derive the correct T and Summary Stage, so we are defaulting to deriving the correct Summary Stage.

Chrondrosarcoma, grade 1 (9222/1) is not reportable according to the Reportability section in the 2021 SEER Manual. The histology (9222/1) is listed in ICD-O-3.2 as a synonym for atypical cartilaginous tumor (preferred term).

In general, the tables do not include non-reportable terms and codes. Registrars should refer to their standard setter (to whom they submit data) for reportable neoplasms. Currently, /0 and /1 neoplasms are reportable for central nervous system sites only. ICD-O-3.2 includes all neoplasms but that does not mean they are reportable. If a facility collects non-malignant neoplasms, use the corresponding ICD-O code in 3.2.

Assign the neoadjuvant therapy data items as if the patient had neoadjuvant therapy.  Neoadjuvant Therapy data item would be coded either code 1 or 2 depending on whether the chemotherapy was completed or not. In this case, they are a surgical candidate by having the chemotherapy with the plan from the beginning to evaluate the chemotherapy after X cycles to see if surgery can be performed. After the patient is evaluated, update the abstract as needed.

Spinal cord tumors (including lipomas) are reportable when they arise in the spinal dura or nerve root. The tumor must be of the spinal cord itself or within the spinal cord dura. Spinal cord tumors are reportable when they arise in the intradural space. A reportable intradural tumor can be either intramedullary or extramedullary. Extramedullary intradural spinal tumors are reportable. A spinal tumor originating in the extradural space is not reportable. If it is outside the dura, it is not reportable because it would be outside the CNS. They are not reportable when they arise in the peripheral nerves.

We found that the term AML with recurrent genetic abnormalities, NOS"was incorrectly included as an alternate name with code 9896/3. We followed back with our expert hematopathologist and he stated that this should have been coded to 9861/3 (AML, NOS), for AML with recurrent genetic abnormalities, NOS. This alternate name has been added to 9861/3. (Note: The same alternate name has been removed from 9896/3).

IDH-2 is not listed as a genetic abnormality for any of the histologies listed in the database. It could be that this is a new genetic marker for one of the AML with recurrent genetic abnormalities that we are not aware of. Without further clarification on which histology the IDH-2 would indicate, you would have to default to 9861/3.

There are several histologies that are grouped as AML with recurrent genetic abnormalities."All of these have specific genetics listed as part of the ICD-O-3 histology name.

9865: Acute myeloid leukemia with t(6;9)(p23;q34.1) DEK-NUP214

9866: Acute promyelocytic leukemia with PML-RARA

9869: Acute myeloid leukemia with inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM

9871: Acute myeloid leukemia with inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11

9877: Acute myeloid leukemia with mutated NPM1 (2021+)

9878: Acute myeloid leukemia with biallelic mutation of CEBPA (2021+)

9879: Acute myeloid leukemia with mutated RUNX1 (2021+)

9896: Acute myeloid leukemia with t(8;21)(q22;q22.1); RUNX1-RUNX1T1

9897: Acute myeloid leukemia with t(9;11)(p21.3;q23.3); KMT2A-MLLT3

9911: Acute myeloid leukemia (megakaryoblastic) with t(1;22)(p13.3;q13.1); RBM15-MKL1

9912: Acute myeloid leukemia with BCR-ABL1 (2021)+

Of note, for the above histologies, since these are diagnosed solely based on genetics, diagnostic confirmation will always be 3. This instruction will be added to the Hematopoietic database for the 2022 update.

Assign code 2 for cases where surgery was planned but ultimately cancelled due to progression in the data item Reason For No Surgery of Primary Site. Code 2 description contains examples and is not exhaustive of reasons for no surgery.

We will add the example for consistency in the next version of the SEER manual.

Always code primary site to the site of origin. Look for information about where the neoplasm originated. Primary site should always be coded to reflect the site of origin according to the medical opinion on the case. Always code the primary site based on where the tumor arose / site of origin. Site of origin may be indicated by terms such as "tumor arose from," "tumor originated in," or similar statements.

Refer to ICD-O-3.2 and ICD-O-3 for topographty codes that are associated with specific histologies whenthe medical documentation does not specify the primary site.

Assign C241. Ampulla (C241) includes both periampullary and intra-ampullary.

Intramucosal carcinoma of the colon is assigned behavior code of /3. Intramucosal is not the same as in situ in terms of behavior. Behavior and staging are separate concepts, although there is some overlap. Use the instructions for coding behavior to code this field. Do not use stage to determine behavior in this case.

For purposes of Summary Stage, intramucosal carcinoma is a localized lesion; however, for purposes of AJCC staging, assign Tis for the stage.

Abstract two primaries, one lobular carcinoma (8520/3) and another one Paget disease of the breast (8540/3) using the 2018 Breast Solid Tumor Rules, Rule M9: Abstract multiple primaries when the diagnosis is Paget disease with underlying tumor which is NOT duct. Example: Paget disease of the nipple with underlying lobular carcinoma are multiple primaries. Additionally, Table 2, Histology Combination Codes, Note 2 states: Lobular carcinoma and Paget are separate primaries (see Lobular carcinoma and any histology in Table 3 with exception of duct carcinoma/carcinoma NST/DCIS (and subtypes/variants) 8500 and Paget disease, in situ and invasive).

While not identified in the pathology of the mastectomy, the lobular carcinoma is likely underlying as it was identified in the axillary lymph nodes. The 2021 SEER Manual states: If the only pathologic specimen is from a metastatic site, code the appropriate histology code and the malignant behavior code (/3). The primary site and its metastatic site(s) have the same histology.