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Report Produced: 02/22/2026 12:37 PM

Report Question ID Question Discussion Answer Year
20091106 Multiple Primaries--Urinary: How many primaries should be coded for an 8/9/07 invasive transitional cell carcinoma of right ureter; 7/9/08 non-invasive urothelial carcinoma of bladder; 11/18/08 non-invasive urothelial carcinoma of left ureter; 6/20/09 invasive urothelial carcinoma of left ureter? One primary. This is a good example of how the field effect occurs in the urinary system. From 2007 to 2008, Rule M8 says bladder and ureter tumors are not new primaries and would be documented as recurrences. Because other urinary sites are involved by 11/08 and by 06/09, do not make second primary of left ureter (Rule M4 does not apply). 2009
20091087 Reportability--Appendix: Is a metastatic low-grade appendiceal mucinous neoplasm reportable if the pathologist states that it is a borderline tumor of the appendix? See Discussion. Low-grade appendiceal mucinous neoplasm; Lt ovary, cul-de-sac, omentum, and small bowel: Metastatic low-grade appendiceal mucinous neoplasm. Per pathologist this is a borderline tumor of the appendix. Borderline tumors (other than brain and CNS) are not reportable to SEER. In the case of borderline tumors, the term "metastatic" does not automatically make them reportable. When the "metastatic deposits" are also borderline, the case is not reportable. For this case in particular, the "metastases" are actually (benign) implants and not malignant or invasive mets. 2009
20091131 Multiplicity Counter/Type of Multiple Tumors--Breast: How are these fields coded when a patient underwent a lumpectomy demonstrating two measured foci of invasive ductal carcinoma (1.5 cm and 3 mm) and "focally seen" in situ ductal carcinoma (DCIS) followed by a re-excision that is positive for 1.5 mm focus of residual invasive carcinoma? See Discussion.

Lumpectomy path shows two foci of invasive ductal carcinoma, 1.5 cm & 3 mm sizes, and CAP summary lists "DCIS: focally seen", no further description. The re-excision pathology specimen finds a 1.5 mm focus of residual invasive carcinoma, very close to the new inferior margin (so registrar assumed this was probably not part of the previously excised mass), and no mention of any more in situ.

Can we assume the DCIS was associated with/part of the invasive tumors because it was not measured or described separately? If we say there are 3 tumors (for the measured invasive foci), should Type of Multiple Tumors be coded 30 [In situ and invasive] or 40 [Multiple invasive]?

Code 03 [3 tumors] in the multiplicity counter. Do not count the "focally seen" DCIS because it was not measured.

Code 30 [In situ and invasive] in Type of Multiple Tumors Reported as One Primary. The single primary reported for this case is a combination of in situ and invasive tumors.

2009
20091059 CS Tumor Size--Breast: How is this field coded for DCIS that is present in scattered small foci over five of eight slides, and the greatest aggregate dimension measures 0.5 cm? See Discussion. Breast biopsy was prompted by abnormality seen on mammography. Would this be an example of when to code 996 (mammographic/xerographic diagnosis only, no size given; clinically not palpable) applies for the CS Tumor Size field?

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Assign code 005 [0.5 cm] in this case. According to the General Instructions for CS tumor size, it is acceptable to code an aggregate size stated by the pathologist (see instruction 4.i).

 2009
20091093

Race--How and when is Appendix D, Race and Nationality Descriptions from the 2000 Census and Bureau of Vital Statistics, to be used? See Discussion.

For example, if race is recorded as unknown on the facesheet of a hardcopy medical record or in the race field of an electronic medical record, how should race be coded for the following descriptions found in the history and physical or consultation reports submitted by clinicians?

1) Patient is Czechoslovakian

2) Patient is born in Czechoslovakia

3) Patient is Ethiopian

4) Patient is born in Ethiopia

5) Patient is Japanese

6) Patient is born in Japan

7) Patient is Brazilian

8) Patient is born in Brazil

Would you code these cases any differently if these descriptions were actually used in the race fields in the medical record or on a death certificate?

Code the patient's stated race when possible. Refer to Appendix D, Race and Nationality Descriptions from the 2000 Census and Bureau of Vital Statistics, for guidance.

Use the lists in Appendix D when race is not stated but other information is provided in the medical record. The cases you provide are good examples of the use of Appendix D. They would be coded the same if the descriptions were used in the medical record or death certificate race fields.

 2009
20091122 MP/H Rules/Multiple primaries-Brain: Does a glioblastoma multiforme following a low grade glioma (oligodendroglioma) represent a new primary? See Discussion.

In 2/08 patient underwent resection of tumor of right frontal lobe. Path diagnosis showed a low grade glioma, favor low grade oligodendroglioma (WHO grade II). In 02/09 biopsy of a left thalamic mass showed glioblastoma mutiforme. Per rule M6 glioblastoma multiforme following a glial tumor is a single primary. Per path diagnosis, the first tumor represented a low grade glioma. However, oligodendroglioma is not on the glial branch of chart 1 in the MP/H rules.

For cases diagnosed 2007 or later, glioblastoma multiforme following oligodendroglioma are multiple primaries according to rule M8. Rule M6 does not apply. M6 applies only to glial tumors as listed in chart 1. Chart 1 is based on the WHO classification. The WHO classification separates oligodendroglial tumors from glial tumors. 2009
20091125

Ambiguous terminology/Reportability--Thyroid: Should a thyroid case be accessioned based only on a cytology that is consistent with papillary carcinoma? See Discussion.

Instructions in the 2007 SPCSM state that we are not to accession a case based only on a suspicious cytology. Does this rule apply only to the term "suspicious" or does it apply to all ambiguous terms? Example: FNA of thyroid nodule is consistent with papillary carcinoma.

 Do not accession the case if the cytology is the only information in the medical record. The phrase "Do not accession a case based only on suspicious cytology" means that the cytology is the only information in the record. If there is other information that supports the suspicion of cancer (radiology reports, physician statements, surgery), then accession the case. The phrase "suspicious cytology" includes all of the ambiguous terms. 2009
20091050 Date of Multiple Tumors--Breast: How is this field coded when a second breast tumor is found at mastectomy two months after the original breast cancer was diagnosed, but during initial workup and treatment? See Discussion. Breast cancer was diagnosed on core biopsy on 02-27-07. It was not known that the breast was harboring 2 tumors until mastectomy was done on 4-01-07. Both tumors are counted as one primary. Code "Date of Multiple Tumors" field to the date of the mastectomy. That is the date that multiple tumors were discovered. 2009
20091078 MP/H Rules/Multiple Primaries--Head & Neck: How many primaries should be reported when an invasive squamous cell carcinoma of the right mandibular body (C06.9) was diagnosed in 2004 (treated with surgery and radical neck dissection), and an invasive squamous cell carcinoma of the left buccal mucosa (C06.0) was diagnosed in 2007? See Discussion. According to the MP/H Rules, it appears Rule M12 would apply since none of the others fit and these would be a single primary.

For cases diagnosed 2007-2014:

Based on the information provided, the primary site code for the 2004 primary should be C031 [mandibular gingiva, lower alveolar mucosa, etc.].

The 2007 diagnosis would be a separate primary according to rule M7 because the patient was disease free following treatment for the 2004 diagnosis. C031 and C060 are different at the third character.

 2009
20091031 MP/H Rules/Histology--Thyroid: How is histology coded for a thyroid tumor described as "predominantly papillary carcinoma, tall cell variant, follicular type"?

For cases diagnosed 2007 or later, assign code 8340 [Papillary carcinoma, follicular variant] according to rule H15 for Other Sites.

"Predominantly" and "type" indicate specific histologies. "Variant" does not. See rule H13. The histology in this case is papillary and follicular. Tall cell variant is ignored.

 2009