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Report Produced: 12/19/2025 16:23 PM

Report Question ID Question Discussion Answer Year
20190071

First course treatment/Surgery of Primary Site--Rectum: Please provide the correct surgery code for a laparoscopic transanal abdominal transanal (TATA) procedure with bilateral salpingo-oophorectomy (BSO) for rectal cancer following neoadjuvant chemotherapy. See Discussion.

IMPRESSION/PLAN: Patient is a previously healthy middle aged woman with a diagnosis of adenocarcinoma of the rectum, clinical stage II (T3N0M0). We will proceed with a neoadjuvant course of radiation and concurrent chemotherapy (5-FU) to maximize local regional control and survival, and hopefully facilitate a sphincter-sparing resection in the future. The primary tumor and the pelvic nodes at risk will receive 4500 cGy delivered over 25 treatments. The primary tumor will subsequently receive an additional 1080 cGy delivered over 5 treatments, for a cumulative dose of 580 cGy.

PATHOLOGY: Adenocarcinoma of the rectum, clinical stage II (T3N0M0). The patient is referred by (dr) for a neoadjuvant course of chemoradiotherapy.

HPI: Patient presented recently with rectal bleeding and a change in bowel habits. Colonoscopy revealed an ulcerated mass located 4.0 cm above the anal verge. A biopsy was positive for invasive well-differentiated adenocarcinoma that arose from a tubular adenoma. A staging work-up demonstrated no evidence of metastatic disease.

Code Surgery of Primary Site as 40, Pull through WITH sphincter preservation (colo-anal anastomosis). The TATA procedure is described as transanal abdominal transanal proctosigmoidectomy with coloanal anastomosis.

We are assuming the BSO was not releated to treatment of the rectal cancer. Do not code it. You may document it in a text field.

 2019
20110094

Surgery of Primary Site--Breast: Is a "nipple sparing mastectomy" coded to 30 [subcutaneous mastectomy] or 40 [total (simple) mastectomy] if the nipple/areolar complex was not removed but the pathology specimen indicates some breast skin was removed? See Discussion.

In the past, the SEER Manual indicated that code 30 [subcutaneous mastectomies], which captured nipple-sparing mastectomies, would rarely be used because it was not typically performed as treatment for a malignancy. This note was removed from the 2010 SEER Manual, Appendix C. Code 30 which now states, "A subcutaneous mastectomy is the removal of breast tissue without the nipple and areolar complex or overlying skin." More "nipple-sparing mastectomies" are now being performed at certain facilities.

Should the Surgery of Primary Site field be coded to 30 when a nipple-sparing mastectomy with reconstruction is performed, even if there is skin removal? Or, does the skin removal indicate that this is not a subcutaneous mastectomy, and therefore code 43 [Total (simple) mastectomy with reconstruction, NOS] applies?

Code Surgery of Primary Site to 30 [Subcutaneous mastectomy] for this case.

Assign code 30 when the nipple and areolar complex are NOT removed. Assign code 40 (or higher) when the nipple and areolar complex ARE removed.

2011
20021103 Surgery of Primary Site/First Course Treatment--Liver: If disease progression is so rapid that the initial therapy plan is changed before patient receives any therapy, would "no therapy" be the first course? See discussion. Patient was diagnosed with liver cancer on 8/23 and on 9/6 a hepatectomy was recommended. However, patient was hospitalized on 9/19 with ascites. Patient underwent embolization instead of a hepatectomy during that admission.

Code the "embolization" (or hepatic artery embolization, HAE) in Surgery of Primary Site. Assign code 10 [local tumor destruction, NOS].

The embolization is coded as first course of therapy for this case because it seems that this patient was not adequately staged until 9/19 -- there is no indication on this case of the stage of disease in August or early September. Furthermore, no treatment was started before the embolization. Therefore, the ascites is not "progression of disease" in this case -- it is taken into account as part of the initial stage of disease.

This procedure was previously coded as other therapy, experimental. Code as surgery as of July 2005.

 2002
20041096 Behavior Code--Breast: How is this field coded for a "non-invasive Paget disease of the breast?" See Discussion. Historically, SEER collected Paget Disease of the breast with a behavior code of 3 [invasive]. There is no documentation to support this. The SEER EOD Manual only states that if the code is "05" [Pagets disease (without underlying tumor)], the behavior must be a 2 [in situ] or a 3 [invasive].

Code the behavior as /2 [in situ] for noninvasive Paget disease of breast. Noninvasive is a synonym of in situ.

If the pathology report documents that the Paget disease is in situ, the matrix principle in ICD-O allows you to change the behavior code to match the pathologist's statement.

 2004
20061032 Behavior--Head & Neck: Should the SEER IF_Morph_3 edit be modified because it does not allow a behavior code 2 with histology 8941 [carcinoma in a pleomorphic adenoma] for a parotid primary?

Code the behavior as 2 and over-ride the edit. The edit is there to flag unusual combinations. Once you have verified that the behavior is coded correctly, over-ride the edit.

The surgeon stage of T2 is based on size of tumor, the TIS is based on behavior. Code according to pathologically confirmed TIS.

 2006
20100036 Behavior--Lung: Can an in situ behavior code be used for a bronchioalveolar carcinoma of the lung when the pathologist appears to use the term bronchioalveolar to describe an in situ pattern of growth exhibited by an adenocarcinoma? Is the use of the term "pattern" in this situation indicative of in situ tumor? See Discussion.

In ICD-O-3, bronchioloalveolar adenocarcinoma is described only by behavior code 3 (invasive). Would the behavior be coded as in situ for the following cases?

Example 1: Left lower lobe, partial resection shows bronchioloalveolar carcinoma with focal areas of fibrosis (see comment). Comment: Although the possibility that these areas represent stromal invasion can not be excluded, we favor the interpretation that these areas do not represent true invasion. Synoptic summary: Minimal pathologic stage: Local Extent.

Example 2: Lung tumor described as adenocarcinoma, predominantly bronchoalveolar pattern. For most sites, the term pattern is used only for in situ cancer and is not a specific term used for invasive tumors. Is the use of the term "pattern" in this situation indicative of in situ tumor?

Code the behavior indicated in the pathology report. If the pathologist states the bronchioloalveolar carcinoma is in situ, apply the ICD-O-3 matrix rule and assign 8250/2. Otherwise, code 8250/3. Do not use the term "pattern" to infer in situ behavior.

Code behavior /3 for both examples based on information provided.

2010
20110154

Behavior--Breast: Is a breast biopsy diagnosis of "ductal carcinoma in situ with focal and very early stromal invasion" an invasive tumor with a behavior code 3?

Code the behavior to /3 [malignant, invasive].

"Stromal invasion" means the cancer is invasive. "Stroma" is the supporting connective tissue around and between ducts. It is outside the duct basement membrane. If the tumor cells extend into the stroma, the proper behavior designation for the tumor is invasive.

 2011
20210020

Behavior--Breast: Should the behavior change to /3, invasive, to get a case to clear edits? The histology of this breast case is ductal carcinoma in situ (DCIS), 8500/2. Lymph nodes are positive for micro-mets (0.2 mm-2 mm). SEER Summary Stage: 3, regional lymph nodes positive. This creates an edit for SEER Summary Stage due to the behavior code of /2, in situ.

Code the behavior to /3, not just to pass edits, but because this is an invasive case based on the positive lymph nodes.

For most cases, behavior is based on the primary tumor, but in situations like this where an invasive component cannot be found and there are positive lymph nodes, the /3 behavior is assigned based on the positive lymph nodes.

 2021
20051010 Primary Site/Priorities--Breast: When there are conflicting references to subsite in different reports, which report has priority? See Discussion. The clinical site of the palpable mass is outer quadrant. The pathologist states inflammatory breast cancer located in the central breast. Should the site be coded to C501 for central breast, C509 for inflammatory breast ca, or C508 for outer quadrant?

Code the breast subsite from the pathology report (C501, central).

The priority order for coding subsite from conflicting reports is

1. Pathology report

2. Operative report

3. Physical examination

4. Mammogram, ultrasound

The primary site of inflammatory breast carcinoma is coded to C509 when there is no palpable tumor.

 2005
20000420 Date of Diagnosis--All Sites: Is it better to estimate the month in the date of diagnosis field using the re-excision pathology report date or code the month to unknown if the only available information is the re-excision date? See discussion.

The only available information is the following pathology report:

On 7/18/00 a wide excision of the primary lesion is done. The report reads, "Lesion approximately 1 cm. Residual superficial spreading malignant melanoma with deepest penetration 4 mm."

Code the Date of Diagnosis field to 07/2000 for this case. Estimate the month of diagnosis whenever possible.

Given the usual delay between the initial excision of the lesion and a wide excision for a melanoma, estimate the month of diagnosis as July.

 2000