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Report Produced: 02/14/2026 00:27 AM

Report Question ID Question Discussion Answer Year
20020002 Date Therapy Initiated: What date should be entered in Date Therapy Initiated when treatment follows a surgical procedure that is not coded under Surgery of Primary Site? See discussion. If a patient has a surgical procedure that is not coded in the Surgery of Primary Site field and then the patient undergoes additional first course of treatment, such as radiation therapy, how should the Date Therapy Initiated field be coded? In this example, code the Date Therapy Initiated field to the date of the first surgical procedure. If a SEER edit is triggered, please notify us. 2002
20021030 Grade, Differentiation--All Sites: Why was the decision made not to code all "3-component differentiation systems" the same way that Bloom-Richardson is coded? For example, SEER codes a low grade BR to 1 for the Differentiation field and a low grade for other grading systems to 2. See discussion. Our Pathologist Consultant agrees with SEER's guideline to code the Bloom-Richardson and B&R modifications of low, intermediate and high to 1, 2 and 3 respectively and thinks all 3-component systems should be coded that same way because it better represents the differentiation of the tumor. In his opinion, coding all other 3-component systems to a differentiation of 2, 3 and 4 respectively, is overstating the degree of differentiation. The rules for coding histology are approved and used by all of the major standard setters through agreements reached in the NAACCR Uniform Data Standards Committee. This issue is under review by our medical advisors and a special committee. Changes will be taken to the Uniform Data Standards Committee for review and approval. 2002
20020053 EOD-Extension--Meninges: How do you code extension for a malignant meningioma that invades into the adjacent brain tissue?

For cases diagnosed 1998-2003:

Code the EOD-Extension field to 60. Code 60 is defined as a brain tumor that extends into the meninges. It is also the appropriate code to use for a tumor that extends from the meninges to the brain.

 2002
20021112 Multiple Primaries/Histology--Hematopoietic, NOS: The subsequent primary table for 2001 and later indicates that 9863/3 [acute myelogenous leukemia (AML)] followed by 9980/3 [refractory anemia (RAEB)] is a new primary, but 9989/3 [myelodysplastic syndrome, NOS (MDS)] is not. Is the case below two primaries? See discussion. Bone marrow bx states: The morphologic blast count of 7% exceeds 5%, traditionally used to define relapse in the setting of acute leukemia. Given the clinical hx that the pt's peripheral blood counts had initially normalized after induction therapy, the recent fall in counts is worrisome for the possibility of early relapse. Alternatively, therapy may have simply reverted the pt's marrow from AML to a precursor myelodysplastic syndrome (such as RAEB given the blast count) from which the AML arose, with the falling counts being progression of the underlying MDS. The identification of significant dysplasia in the bone marrow at the time of diagnosis would tend to support the possibility of an underlying MDS. Clinically, it is unlikely to make a difference whether one regards the present situation as early relapse or progression of an underlying MDS. The final clinical diagnosis is "Myelodysplasia, classified as RAEB."

For cases diagnosed prior to 1/1/2010:

This case demonstrates a relapse of AML. The original classification of Histology as 9863/3 [AML] is correct. There is no second primary based on the information provided for this case.

For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

 2002
20021165 EOD-Size of Primary Tumor--All Sites: Is there a hierarchy for using information from clinical tests (scans, radiography) to determine clinical tumor size? When the size on a radiographic report prior to pathologic diagnosis is smaller than the size of the tumor on the radiographic report that is post pathologic diagnosis, which tumor size should be used? See discussion.

Which size should be used for these examples?

1) Tumor size on a mammogram is smaller than the tumor size on an ultrasound.

2) CT of the lung reveals a 2.5 cm RUL malignancy in June. A biopsy in July confirms a malignancy. A CT is done in August prior to initiating RT which reveals a 3.1 cm RUL nodule.

For cases diagnosed 1998-2003:

Generally, code the EOD-Size of Primary Tumor field to the largest size identified in any scan. Use the largest tumor size for most cases. There is no hierarchy for multiple imaging studies, with the exception of the two situations represented in the question examples.

1). Code the size stated on the mammogram, even if that size is smaller than the one specified on the ultrasound. Generally the mammogram size is more accurate for breast cases than ultrasound.

2). Code the EOD-Size of Primary Tumor field to 2.5 cm. In this example, the second scan was the same type as the first. Usually there is not that much of a difference in size between the same tests, unless the tumor has an aggressive histology. The example does not mention the histology. With certain histologies, such as small cell of the lung, a rapid growth in a short amount of time is the normal process. The fact that the size increased that much in a short period of time, using the same type of scan, is an indication of a rapidly growing tumor. It would be better to use the size on the initial scan to code the EOD-Size of Primary Tumor.

 2002
20021096 Grade, Differentiation--Bladder: What codes are used to represent this field for the four bladder cases described in the discussion section that have a combination of grades mentioned in the pathology reports? See discussion.

1) Final path diagnosis: papillary transitional cell carcinoma, high grade. Micro description states: High grade, poorly differentiated carcinoma.

2) Well to moderately differentiated papillary transitional cell carcinoma, grade 1-2/3.

3) Urothelial carcinoma, high grade (poorly differentiated, grade 3 of 3).

4) High grade papillary urothelial carcinoma (papillary transitional cell carcinoma, grade 3 out of 4).

For cases diagnosed January 2004 and forward:

1) Grade 4. High grade is coded 4. Code the grade stated in the final diagnosis.

2) Grade 3. Grade 1-2/3 is coded 3. Use the three-grade conversion table in the 2004 SEER manual.

3) Grade 4. Grade 3 of 3 is coded 4. Use the three-grade conversion table in the 2004 SEER manual.

4) Grade 3. "Grade 3 out of 4" is coded 3 and is more precise than "high grade."

 2002
20021055 EOD-Extension--Liver: Can we use CT scan descriptions such as "portal vein thrombosis" or "extensive infiltration of the liver" or "diffuse infiltration of the liver" to code extension for liver primaries? See discussion.

1. Would you code portal vein involvement for a CT scan description of "portal vein thrombosis"?

2. Would you code more than one lobe of the liver as involved for CT scan descriptions of "extensive infiltration of the liver" or "diffuse infiltration of the liver"?

For cases diagnosed 1998-2003:

1. No. Thrombosis can be caused by non-cancerous conditions.

2. Yes. Code the EOD-Extension field to 65 [Multiple (satellite) nodules in more than one lobe of the liver] when "extensive infiltration" or "diffuse infiltration" is stated.

 2002
20021185 Surgery of Primary Site--Major salivary gland: How do you code Surgery of Primary Site for a submandibular gland primary when the operative report refers only to an excision of the submandibular "tumor" while the pathology report states the submandibular "gland" was removed? See discussion. The gross description on the pathology report indicates that the specimen consists of a "submandibular gland." A further description on the pathology report included, "the specimen was sectioned exposing a focally cystic mass that nearly replaces the entire specimen." For cases diagnosed on 1/1/2003 or after: Code the Surgery of Primary Site field to 40 [Total parotidectomy, NOS; total removal of major salivary gland, NOS], per the pathology report's gross description of the specimen unless the operative report description of procedure indicates that the removal was less than total. 2002
20021046 Behavior Code/EOD-Extension--Bladder: If an in situ lesion of the urinary bladder involves the von Brunn nests, is it still in situ? See discussion.

Von Brunn nests: Compact, rounded aggregates of urothelial (transitional) cells in the lamina propria, with or without connection to the surface epithelium.

Urothelial (transitional cell) carcinoma in situ...may involve von Brunn nests...

Histologic Typing of Urinary Bladder Tumours, Second Edition, WHO, pp 12 & 21

For cases diagnosed 1998-2003:

Code the Behavior Code and the EOD-Extension field according to the pathology report.

If the pathology report states the tumor to be noninvasive or in situ, whether or not von Brunn nests are involved, code behavior as 2 [in situ] and extension as in situ.

If the tumor is described as invasive and involves the von Brunn nests, code the EOD-Extension field to 15 [invasive tumor confined to subepithelial connective tissue] because code 15 includes extension to the lamina propria and von Brunn nests are within the lamina propria.

 2002
20021162

Chemotherapy: Should radiosensitizing chemotherapy agents (i.e., drugs typically coded as treatment for cancer) be coded as treatment when they are given in combination with radiation therapy with the intention of enhancing that treatment? See discussion.

Per our consultant, these drugs are given at a lower dose than that typically given to treat cancer patients.

Do not code radiosensitizers and radioprotectants as cancer-directed therapy. Drugs typically classified as chemotherapy agents would be "ancillary drugs" for the purpose of coding cancer-directed therapy because the drugs are given at a much lower dosage than that typically given to treat cancer patients. Per Book 8, ancillary drugs are not to be coded as cancer-directed therapy. Radiosensitizers and radioprotectants do not work directly on the cancer and are not coded under any of the systemic therapy fields.

 2002