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| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
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20051021 | Primary Site--Breast: If a patient has multifocal tumors all in the upper outer quadrant of the breast, is the primary site coded to C-504 because all of the tumors are in UOQ or would the site be coded to C509 to reflect the fact that multiple tumors exist? | Code the primary site to C504 [Upper outer quadrant]. All disease is located in one quadrant, code that quadrant. When disease involves two or more quadrants and the point of origin cannot be determined, code C509 [Breast, NOS]. See 2004 SEER manual, page C-470 for instructions about invasive and in situ in different quadrants. | Breast | Primary site | 2005 | |
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20130105 | Primary Site--Heme & Lymphoid Neoplasms: How is the primary site coded for a B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma when a biopsy of the paraspinal muscle and epidural tissue is positive, but there is no indication of lymph node involvement in the chart? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Code the primary site to soft tissue of the back, NOS [C496] per Rule PH24 and the Abstractor Notes in the Heme DB for B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. Code the primary site to the organ when lymphoma is present only in an organ. The lesion is described as epidural (tissue surrounding the dura) and involving paraspinal muscle, NOS. Both are connective or other soft tissues of the trunk, NOS [C496]. B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is a synonym for DLBCL 9680/3. When there is no primary site listed in the Heme DB, go to the Abstractor Notes. In the Abstractor Notes section it states that patients present with lymphadenopathy OR mass lesions in extranodal sites. SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
Heme & Lymphoid Neoplasms | Primary site | 2013 | |
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20240077 | 2024 SEER Manual/Primary Site--Retroperitoneum: What is the primary site code for a final diagnosis of endometrioid adenocarcinoma from a biopsy of a right retroperitoneal mass? See Discussion. |
An 80-year-old post-menopausal female (status post hysterectomy for benign reasons) presents with a retroperitoneal mass on imaging. The pre-operative imaging shows the cervix and uterus are absent. Patient undergoes a robotic left salpingo-oophorectomy with biopsy of the retroperitoneal mass. |
Code Primary Site to C480 (retroperitoneum). Endometrial tissue may "break away” from the uterus and implant throughout the pelvic and abdominal cavities. This can occur in patients who suffer from endometriosis. This tissue remains behind when surgical removal of the uterus is done. Common sites of implantation are colon, peritoneum, retroperitoneum, and bladder. These cells may become malignant. When the uterus is no longer present (patient had surgical removal), code the site where the carcinoma was identified. The site-morphology combination of C480 and 8380/3 was designated as an unlikely site-morphology combination by the Cancer PathCHART expert pathologist review, as this is a rare type of tumor. Assign a value of 1 in the Over-ride Site/Type [2030] data item in order to pass the Primary Site, Morphology-Type, Beh ICDO3, 2024 (SEER) edit. |
Corpus uteri | Primary site | 2024 |
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20031185 | Primary Site: How is this field coded for a mass involving the gastroesophageal junction and lower third of the esophagus? See Description. | We have an EGD report describing an ulcerated and infiltrative circumferential non-bleeding 10 cm. mass of malignant appearance found at the gastro-esophageal junction and lower third of the esophagus. The mass caused a partial obstruction. Biopsies were taken from the the gastroesophageal junction and lower third of esophagus. Pathologic diagnosis: Adenocarcinoma. Would this be coded C26.8? | Search for a statement indicating the site of origin. If the site of origin cannot be determined, and there is evidence of Barrett's esophagus, code the topography in the example above to C15.5 [Lower third of esophagus]. If there is no evidence of Barrett's esophagus, assign code C16.0 [Gastroesophageal junction]. Either C15.5 or C16.0 would be preferable to C26.8, which is very non-specific and includes GI tract, pancreas and biliary tract. | N/A | Primary site | 2003 |
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20091084 | Primary site--Colon: How do you determine the correct subsite when there is conflicting information in different reports? Are there priority rules for coding subsite for sites other than Head and Neck? See Discussion. | The path report for a hemicolectomy says, " Specimen: left colon..." and the microscopic says, "...received in formalin designated left colon..." The Operative procedure report says, "Postoperative diagnosis - splenic flexure tumor." The text of this report says, "Mobilizing the splenic flexure mass was incredibly difficult..." and then goes on to describe exactly how and where it was resected. The discharge summary says adenosquamous carcinoma of the splenic flexure. SINQ20051010 says to use the pathology report first, but this was written before the new MP/H rules. | Use the operative report information to code primary site in this case. It is more accurate. The operative report is usually a better source of location information compared to the pathology report. The pathologist can only reiterate the location as it was reported to him/her. The 2007 SEER manual states "Unless otherwise instructed, use all available information to code the site," page 69. |
Colon | Primary site | 2009 |
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20190041 | Reportability/Primary Site--Gastrointestinal (GI) Tract: Is a gastrointestinal stromal tumor (GIST) with a single nodule in the small intestine (C17_) and a nodule in the stomach (C16_) reportable per the 2018 SEER Coding Manual reporting instructions for GIST due to the multiple foci or do the multiple foci need to be in the same organ to be reportable? See Discussion. |
Example: Small intestine wedge resection with GIST, 1.8 cm in mid small intestine, single nodule. Stomach nodule biopsy: GIST, 0.3 cm. Pathology report comment section indicates the gastric GIST is not staged due to the small size and incidental nature. |
Report the GIST in the small intestine. The 2018 SEER Manual says to report GIST when there are multiple foci and to code the primary site to the site where the malignancy originated. Use text fields to record the details, including the stomach nodule. |
N/A | Primary site | 2019 |
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20130210 | Primary site--Heme & Lymphoid Neoplasms: Does Rule PH27 apply meaning that primary site is coded to C809 or would it be more appropriate to code to C269 GI Tract NOS since all disease involves the GI tract and this is more specific?
Extranodal lymphoma first diagnosed in the stomach (fundus and antrum) which upon further investigation also involved the small bowel (MALT Lymphoma) in the absence of lymph node findings. MD staged this IIE. Initial thought was Gastric, but PET/CT indicated abnormal uptake involving loop of distended small bowel in the pelvis. |
Assign C269 for Gastrointestinal tract, NOS. Apply Rule PH24, code to the organ when only an organ is involved. This rule can be used for NOS sites such as GI tract, NOS.
Based on the information provided, this lymphoma is confined to the GI tract -- stomach and small bowel. |
Heme & Lymphoid Neoplasms | Primary site | 2013 | |
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20110071 | Primary site: How is this field coded for an adenocarcinoma arising in a chronic perianal fistula without extension to the anal canal, but stated to arise in "ectopic rectal tissue"? See Discussion. | The patient underwent a resection of a perineal mass. Per review of slides it was stated to be "primary mucinous adenocarcinoma arising in a chronic perianal fistula." The adenocarcinoma was invasive into the dermal connective tissue and skeletal muscle, but there was no extension into the anal canal. The discharge diagnosis from the reporting facility called this adenocarcinoma of "ectopic rectal tissue in perianal area."
Should the primary site be coded to skin based on the dermal involvement and lack of anal or rectal involvement? Or, should the primary site be coded to rectum based on the physician's assessment that this adenocarcinoma arose in ectopic rectal tissue? |
For cases diagnosed 2007-2014: Code the Primary Site field to C210 [Anus, NOS]. This is an unusual and rare presentation. According to our expert pathologist, "There is no ideal site code [for] this case. I would code to C210. In this location it can at least be located by anyone who wants to get a look at such lesions. Because of the unusual location of this tumor, I would like to be able to code it to perineum, but it will be totally lost in those site codes as they represent extensive areas beyond perianal (skin of trunk, soft tissue of pelvis, and pelvis, respectively)... I would not code to rectum [because it would be] lost among too many primary rectal carcinomas." |
N/A | Primary site | 2011 |
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20091006 | Primary site--Lung: What primary site code is used for bronchus intermedius? |
Assign code C340 [main bronchus].
The bronchus intermedius is the lower part of the main bronchus on the right side. The bronchus intermedius begins just below the point where the upper lobe bronchus branches off from the main bronchus. The bronchus intermedius branches into the middle lobe bronchus and the lower lobe bronchus.
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Lung | Primary site | 2009 | |
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20150015 | Primary Site--Testis: What is the prmary site for a 38 y/o male diagnosed with testicular cancer in a formerly undescended testis that was treated with orchiopexy at age 10-11? See discussion. |
Should it be coded to where the testis was physically at the time of diagnosis (C621), or should it be coded to C620 to reflect the increased risk for developing malignancy in an undescended testis? |
Code the primary site C621 (descended testis). The primary site of this neoplasm is a scrotal (descended) testis. The history of orchiopexy can be noted in a text field, but does not change the primary site in this case. |
N/A | Primary site | 2015 |
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