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| Report | Question ID | Question | Discussion | Answer | Year |
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20000280 | Primary Site--Breast: Is there a hierarchy for coding subsite for breast cases when there is conflicting information in the physical exam, mammogram, operative and pathology reports as to the exact location of the primary? See discussion. | Example: Two mammograms were performed. One report indicates the lesion is at 12:00 and the other indicates it is in the upper central quadrant. However, the pathology report from the modified radical mastectomy specimen indicates the mass is in the UIQ.
According to one of our physicians, when a pathologist has a mastectomy specimen with attached axillary contents, the location of the lesion (subsite) is very accurate. |
Code the Primary Site field to C50.2 [upper inner quadrant]. In general, the priority for using information is pathologic, operative, and clinical findings. The pathology report would take precedence in this case. The 2004 SEER Program Code manual will include the following instructions for determining breast subsite. Priority Order for Coding Subsites Use the information from reports in the following priority order to code a subsite when the medical record contains conflicting information: 1 Pathology report 2 Operative report 3 Physical examination 4 Mammogram, ultrasound If the pathology proves invasive tumor in one subsite and insitu tumor in all other involved subsites, code to the subsite involved with invasive tumor. |
2000 |
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20230026 | Solid Tumor Rules/Multiple Primaries--Prostate: How many primaries should be abstracted, and which M rule applies when a patient is diagnosed with intraductal carcinoma of the prostate on biopsy followed by invasive adenocarcinoma on radical prostatectomy more than 60 days later? See Discussion. |
Example: A prostate core biopsy showed intraductal carcinoma in 09/2022, which is an in situ tumor. A core biopsy again showed intraductal carcinoma in 12/2022. The subsequent radical prostatectomy in 04/2023, revealed multiple foci of invasive prostate adenocarcinoma with extensive intraductal carcinoma. Per Solid Tumor Rules, Other Sites, Rule M3, acinar adenocarcinoma of the prostate is always a single primary. Note 4, this rule applies to subtype variants of acinar adenocarcinoma listed in Table 3, which has intraductal/ductal as a variant subtype of acinar adenocarcinoma. Does rule M3 apply to incidence cases (an invasive tumor following an in situ tumor)? |
Rule M1 applies because we don't know if there are separate tumors or separate foci within a single tumor. This is a single primary coded 8140/3. The prostate rules will be reviewed for an addition to cover this situation. |
2023 |
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20031017 | Reason for No Surgery of Primary Site: Does code 2 [Contraindicated due to other conditions; autopsy only case] or code 1 [ Cancer-directed surgery not recommended] have priority when coding this field for extensive tumors not surgically treated because of existing comorbidities? See discussion. | Example: Patient has Stage IVA carcinoma of the tongue. The physician states that patient is not felt to be a good surgical candidate secondary to multiple medical frailties. Patient is treated with beam radiation. In this case, how do we code Reason for No Site Specific Surgery? Do we use code 2 because surgery was contraindicated due to co-existing medical conditions or do we use code 1 because the tumor is very extensive and surgery would probably not be done anyway? |
SEER has not established a priority for assigning the Reason for No Surgery of Primary Site codes. Assign the code which best describes the reason surgery was not performed. Example: Assign code 2, Contraindicated due to patient risk factors. According to the physician, this is the reason that surgery was not performed. |
2003 |
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20031022 | Surgery of Primary Site--Head & Neck: Is a composite resection performed for an oral cavity primary coded to 40 [Radical excision of tumor, NOS], 41 [Radical excision of tumor only], 42 [Combination of 41 with resection in continuity with mandibles (marginal, segmental, hemi-, or total resection], 43 [Combination of 41 with resection in continuity with maxilla (partial, subtotal, or total resection)]? See discussion. |
Example: Patient underwent composite resection of left soft palate, tonsillar fossa, medial pterygoid and lateral tongue for a primary of the retromolar trigone. There was no mention of an excision of the mandible; however, the procedure included the application of a mandibular reconstruction plate. |
Use surgery codes 40-43 for composite resection of an oral cavity primary. In the case example, code Site-Specific surgery as 42 [Combination of 41 WITH resection in continuity with mandible]. Even though excision of mandible was not mentioned, there was mention of a mandibular reconstruction plate. Since the retromolar trigone is ON the mandible, resection of the mandible is likely. | 2003 |
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20220009 | First Course Therapy/Reason for No Surgery of Primary Site: What code should be used for Reason for No Surgery of Primary Site in 2020 in situations affected by the pandemic when abstracting all sites? See Discussion. |
Example: Patient scheduled for left nephrectomy on 3/10/20 due to left renal papillary renal cell carcinoma diagnosed on 2/11/20 via needle core biopsy. Abstract indicated surgery was cancelled due to the pandemic. Abstract also indicated the surgery was not rescheduled. |
There is no available code that fits this situation. We recommend assigning code 6 (Surgery of the primary site was not performed; it was recommended by the patient’s physician, but was not performed as part of the first course of therapy. No reason was noted in patient record.) and documenting the situation in a text field. |
2022 |
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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 |
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20200013 | Solid Tumor Rules (2018)/Multiple primaries--Colon: Solid Tumor Rules 2018, Colon Rule M7, bullet 3 indicates that (if neither bullet 1 or 2 apply) a new tumor at the anastomotic site must be stated to arise in the mucosa (confirmed in SINQ 20190096) to qualify as a new primary. However, there is often no clear statement of tumor arising from or involving mucosa (unless the new tumor is limited to the mucosa) noted by pathologists in our region. Do any of the following examples imply a new tumor arising in mucosa per Rule M7, bullet 3? See Discussion. |
Examples: 1) New tumor at the ileocolic anastomosis, described as a, Circumferential centrally ulcerated mass with raised borders. Tumor extension: Tumor invades through muscularis propria into subserosal adipose tissue, no involvement of the serosal surface identified. The only mention of mucosa on the resection is the uninvolved enteric mucosa or uninvolved colonic mucosa in the otherwise uninvolved portions of the ileum/colon. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3? 2) Right colon with anastomosis site. Tumor site: Anastomosis. Tumor extension: Tumor invades through the muscularis propria. Gross description does not describe mucosa, only noting, at the central area of anastomosis is an ill-defined, slightly raised, tan-brown to purple mass measuring 2.2 x 2 cm, which is nearly circumferential, causing obstruction at the site of anastomosis. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3? 3) Polyp at ileocolonic anastomosis, polyp biopsy final diagnosis was, Invasive moderately differentiated colonic adenocarcinoma in association with adenoma. No mention of mucosa on the biopsy final diagnosis or gross description. Clinical info indicates, There is an ulcerated 5 cm mass at the ileo-colonic anastomosis that was biopsied. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3? |
Following the 2018 Colon Solid Tumor Rules M7 and M8: Example 1: Assuming the first and second tumors are not different histologies or they occurred less than or equal to 24 months apart (M7 Bullets 1 and 2 do not apply), abstract a single primary as the pathology states uninvolved enteric mucosa or uninvolved colonic mucosa (no involvement noted). Example 2: Assuming the first and second tumors are not different histologies or they occurred less than or equal to 24 months apart (M7 bullets 1 and 2 do not apply), abstract a single primary as there is no mention of mucosal involvement. Example 3: Assuming the first and second polyps/tumors are not different histologies or they occurred less than or equal to 24 months apart (M7 bullets 1 and 2 do not apply), abstract a single primary as there is no mention of mucosal involvement. Of note in the case of the polyp, tumors coded as adenocarcinoma in a polyp, should be treated as adenocarcinoma (8140) for cases prior to 2018. Also, if the pathologist states the new tumor/polyp originated in the mucosa, it is a new primary. The rules which address "recurrence or new tumor at the anastomosis were created with the input of several gastrointestinal expert pathologists (CAP, AJCC, and WHO). Pathologists should be following CAP reporting guidelines and include information such as mucosal involvement in the final diagnosis and/or synoptic report. We can revisit this question that all polyps start in the mucosa and if needed, revise the rules to state this. |
2020 |
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20220035 |
Solid Tumor Rules/Histology--Bladder: How is histology coded for a transurethral resection of the bladder (TURB) diagnosis with multiple components? See Discussion. |
Examples: Bladder TURB: Invasive high grade urothelial carcinoma with poorly differentiated (40%), lipoid (5%), and sarcomatoid (55%) components. Bladder tumor base TURB: Invasive high grade urothelial carcinoma with poorly differentiated (65%) and sarcomatoid (30%) components. The Urinary Sites Solid Tumor Rules, histology coding rules, say to code the most specific histology or subtype/variant, regardless of whether it is described as majority, minority, or component. Poorly differentiated (8020) and sarcomatoid (8122) are both urothelial subtypes, but there is no rule to instruct how to code a tumor/tumors with multiple urothelial subtypes. |
Code histology as 8120/3 in the two examples using Note 1 in the Urinary Sites Solid Tumor Rules, instruction 1 of the Coding Histology section. The subtypes/variants or components must describe a carcinoma or sarcoma in order to code a histology described by those terms. |
2022 |
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20031192 | EOD-Extension--Breast: How is this field coded when the diagnosis includes both invasive and in situ disease, and the pathology report stated the tumor size may or may not include the size of the in situ portion of the tumor? See Description. | Examples:
1. Invasive ductal carcinoma well differentiated, 1.2 cm, gross tumor size, ductal carcinoma in situ.
2. Gross tumor size 3.2 x 2.5 x 2.3 cm. well differentiated to moderately differentiated invasive ductal ca, accompanying component well differentiated ductal carcinoma in situ, solid, cribiform. |
For cases diagnosed 1998-2003: Use extension codes 16, 26, or 36 depending on extent of involvement. These codes indicate that invasive and in situ components are present, the size of the entire tumor is coded in Tumor Size, the size of the invasive component is not stated, and the proportions of in situ and invasive are not known. Both examples above measure the entire tumor including invasive and in situ components. Assign extension code 16, unless there is evidence of further involvement. |
2003 |
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20180095 | Solid Tumor Rules (2018)/Histology--Lung: How is histology coded when the term "predominant" is used to describe solid adenocarcinoma, acinar adenocarcinoma, etc.? Pathology reports often say "See Synoptic" (also known as the College of American Pathologists (CAP) protocol) included in the Final Diagnosis rather than including all the detail. Based upon the new Solid Tumor Rules for lung, predominant/predominantly is no longer a subtype/variant and should not be coded unless there is a specific code/subtype-variant for the NOS in Table 3, e.g., adenocarcinoma, lepidic predominant. See Discussion. |
Examples Example #1: CAP histology type: Adenocarcinoma, solid predominant, Final diagnosis states that Adenocarcinoma, poorly differentiated, solid predominant (80%) and cribriform (20%) subtype (see lung carcinoma synoptic report) Example #2: CAP histology type : Invasive adenocarcinoma, solid predominant, Other Subtypes Present (specify subtype(s), may also include percentages): acinar (45%) and micropapillary (5%) Final diagnosis : adenocarcinoma of the lung, please see Synoptic Report Example #3: CAP histology type: Adenocarcinoma, acinar predominant , Adenocarcinoma, solid predominant Final diagnosis: Adenocarcinoma, poorly differentiated, solid predominant (60%), papillary (30%) and acinar (10%) subtype (see lung carcinoma synoptic report) |
The lung H rules and tables have been updated to include histologies that CAP identifies using the term "predominant" in the diagnosis. Example: Code adenocarcinoma, lepidic predominant, to 8250/3 rather than 8140/3. When the final pathology diagnosis includes more than one "predominant" adenocarcinoma subtype such as acinar, solid, or lepidic, then code the type with the greatest percentage according to Lung Solid Tumor Rule H7. |
2018 |
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