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Welcome to the SEER Inquiry System (SINQ). SINQ is a collection of questions that cancer registrars have had while coding cancer cases. Click Search to look for specific questions or to select questions for a Report.

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First Course Treatment: Should the definition in the 2016 SEER Coding Manual be revised for first course of treatment following disease progression for patients who complete the initial first course treatment plan without alteration but had one or more treatment modalities given after disease progression was identified? See Discussion.

Final Nov 16 2017

MP/H Rules/Histology--Brain and CNS: Is meningioma with atypical features coded as meningioma (9530/0) or atypical meningioma (9539/1)?  See Discussion.

Final Nov 14 2017

MP/H Rules/Behavior--Breast:  How many primaries are to be abstracted for a patient with a history of left breast ductal carcinoma in situ (DCIS) diagnosed in 2014 and bone lesions showing metastatic carcinoma consistent with a breast primary in 2017?  See Discussion.

Final Nov 09 2017

Reportability--Kidney: Is a renal cell neoplasm stated to be multilocular clear cell renal cell neoplasm of low malignant potential a reportable tumor if the physician refers to the tumor as renal cell carcinoma in a follow-up note after surgery? If reportable, how is histology coded? See Discussion.

Final Nov 06 2017

Histology/Behavior--Brain and CNS: How are histology and behavior coded for a diagnosis of pineal anlage tumor in an infant? See Discussion.


Final Oct 26 2017

Reportability--Heme & Lymphoid Neoplasms: Is the diagnosis of large granular lymphocyte syndrome or large granular lymphocyte disorder a reportable synonym for T-cell large granular lymphocytic leukemia? See Discussion.

Final Oct 25 2017

Reportability/Brain and CNS: Is incidentaloma reportable from brain and central nervous system (CNS) imaging? See Discussion.

Final Oct 25 2017

Primary Site/Histology--Urinary:  Is a urethral lesion showing intraductal carcinoma of the prostate reportable?  What is the primary site and histology code? See discussion.

Final Oct 20 2017

MP/H Rules/Histology--Lung:  What is the histology of a lung tumor described as solid predominant with mucin production, 8230/3 (Multiple Primaries/Histology (MP/H) Rule 5) or 8255/3 (MP/H Rule 6)?  See Discussion.

Final Oct 16 2017

Primary Site/Corpus uteri: Is the primary site C541 (endometrium) or C543 (uterine fundus) when the histology states endometrial adenocarcinoma, endometrioid type, but tumor site states fundus?  See Discussion.

Final Oct 10 2017

MP/H Rules/Histology--Thyroid: How should histology be coded for a single tumor with final diagnosis undifferentiated (anaplastic) carcinoma arising in association with papillary thyroid carcinoma and the Summary Cancer Data states Histologic type: Undifferentiated (anaplastic) carcinoma only? See Discussion.


Final Oct 03 2017

Grade/Histology--Rectum: How should histology and grade be coded for high grade neuroendocrine tumor (NET) (WHO Grade 3) of the rectum? See Discussion.


Final Sep 28 2017

Reportability/Behavior--Ovary: Is adult granulosa cell tumor a reportable malignant tumor if the primary ovarian tumor ruptured intraoperatively, the peritoneum was contaminated, and the patient underwent adjuvant treatment with chemotherapy given the increased risk of recurrence due to intraoperative tumor spill? See Discussion.


Final Sep 27 2017

Race, ethnicity:  How do you code race for someone from New Zealand?

Final Sep 21 2017

MP/H Rules/Histology--Thyroid: What is the correct histology when final diagnosis of a thyroidectomy includes the descriptor "papillary and follicular architecture?" See Discussion.

Final Sep 18 2017

MP/H Rules/Histology/Grade--Unknown & ill-defined sites: What is the correct histology and grade of a liver biopsy with metastatic neuroendocrine carcinoma low to intermediate grade if primary site is unknown? See Discussion.

Final Sep 18 2017

MP/H Rules/Histology--Lung:  What is the correct histology code for an initial biopsy of non-small cell carcinoma with neuroendocrine phenotype, possible large cell neuroendocrine carcinoma with a subsequent re-biopsy showing poorly differentiated small cell carcinoma after chemotherapy with no response? See discussion.

Final Sep 07 2017

Grade:  If the biopsy site is a higher grade, is the grade of the biopsy used over the grade of the surgical resection?  See Discussion.

Final Sep 05 2017

Reportability/Histology--Skin:  Is 'skin, left temporal scalp, low grade adnexal carcinoma, probable sweat gland origin' reportable as 8400/3, skin of temple?

Final Sep 05 2017

First Course of Treatment/Surgery of Primary Site--Corpus uteri:  Do you code total hysterectomy or radical hysterectomy when a specimen indicates the uterus, cervix, ovaries, fallopian tubes, and right and left parametrium were resected, but shows no portion of the vagina.  See Discussion.

Final Sep 01 2017

MP/H Rules/Multiple primaries--Brain and CNS: How many primaries should be abstracted for a patient with a 2011 diagnosis of oligodendroglioma followed by biopsy of tumor which demonstrated progression in 2016 with pathology report Final Diagnosis indicating WHO grade III anaplastic astrocytoma?  See Discussion.


Final Aug 31 2017

MP/H Rules/Histology--Bladder:  Is urothelial carcinoma, high-grade, predominantly solid type, coded as 8120/3 or 8230/3? See Discussion.

Final Aug 18 2017

Reportability--Liver:  Is intraductal papillary mucinous neoplasm (IPMN) of the liver a reportable diagnosis? See Discussion.

Final Aug 17 2017

First course of treatment/Other therapy--How do you code medical marijuana when given as "treatment?"  See Discussion.

Final Aug 02 2017

MP/H Rules/Histology--Pancreas:  What is the histology code of invasive adenocarcinoma, non-mucinous with intraductal tubulopapillary features, moderately differentiated, from the pathology report final diagnosis of the pancreas?  Does 'intraductal" refer to a non-invasive/in-situ component or describe the pattern of growth?

Final Jul 20 2017

MP/H Rules/Multiple primaries--Bladder: Is recurrence of bladder cancer the same primary if the patient has had multiple recurrences each within 3 years of recurrences but 3 years has passed since initial diagnosis date?

Final Jul 20 2017

MP/H Rules/Histology--Brain and CNS: What is the histology code for a patient with a pathology report Final Diagnosis indicating, mucin-rich neuroepithelial neoplasm, favor low-grade? See Discussion.

Final Jul 14 2017

Reportability--Brain and CNS: Is meningioangiomatosis reportable as meningiomatosis (9530/1) or angiomatous meningioma (9534/0)?  See Discussion.

Final Jul 05 2017

Histology--Sarcoma:  What is the histology code for epithelioid angiosarcoma?

Final Jul 05 2017

Reportability--Ovary:  Is ovarian mucinous borderline tumor of intestinal type with microinvasion reportable? If reportable, what is the histology? See Discussion.

Final Jul 05 2017

Reportability--Heme & Lymphoid Neoplasms: Is a diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) with large cell transformation equivalent to a diagnosis of diffuse large B-cell lymphoma (DLBCL) without mention of Richter transformation or Richter Syndrome?  See Discussion.

Final Jun 30 2017

MP/H Rules/Histology--Thyroid: How should histology be coded for a thyroidectomy final diagnosis of papillary thyroid carcinoma, favor cribriform-morula variant? See Discussion.


Final Jun 30 2017

MP/H Rules/Histology--Lung:  What is the histology code for lung cancer case identified pathologically from a metastatic site that differs from the histology stated by the physician?  See Discussion.

Final Jun 09 2017

Histology--Heme & Lymphoid Neoplasms: How should histology be coded for final bone marrow diagnosis of myelodysplastic syndrome with excess blasts?  See Discussion.

Final Jun 05 2017

Primary site--Other and Unspecified Urinary Organs:  What is the topography code for a Skene's gland adenocarcinoma?

Final May 23 2017

Grade--Prostate: How are the prostate-related fields completed when documentation in pathology reports only includes one of the new grade groups? See Discussion.

Final Aug 10 2017

MP/H Rules/Histology: What is the histology code of serous tubal intraepithelial (in situ) carcinoma (STIC), bilateral fallopian tubes?

Final May 22 2017

Surgery codes, NOS/Reconstruction--Breast: Would you code a unilateral breast simple mastectomy with tissue expanders and AlloDerm or an acellular dermal matrix as Code 45, Reconstruction with Implant, or Code 46, Reconstruction with Combined Tissue and Implant? See Discussion.

Final May 22 2017

Grade--Appendix:   What is the code and term to use for the grade/differentiation field for well differentiated, Grade 2 neuroendocrine tumor (NET)?  See Discussion.

Final May 04 2017

MP/H Rules/Multiple primaries--Penis: How many primaries should be reported for a diagnosis of invasive squamous cell carcinoma (SCC) of the penis in 6/2011, treated with excision and fulguration followed by 10/2014 penile lesion found to be SCC with basaloid features focally highly suspicious for invasion? Clinically, the 2014 tumor is stated to be in situ and recurrent penile cancer and follow-up in 2/2015 indicates there was no evidence of tumor following treatment. Subsequently, in 3/2016 the patient has another penile lesion biopsy showing SCC in situ suspicious for invasion, clinically stated to be recurrent. See Discussion.

Final May 03 2017

Surgery Primary Site--Melanoma: How should Surgery of Primary Site be coded for a melanoma diagnosed on punch or shave biopsy followed by a wide excision that shows no residual disease and the gross wide excision specimen size showing no residual is greater than 1 cm in all dimensions (length, width and depth)?  See Discussion.

Final Apr 26 2017

Reportability--Bone: Are giant cell tumors (GCT) of the bone that metastasize to the lung reportable?  See Discussion.

Final Apr 24 2017

MP/H Rules/Histology--Kidney: How should histology be coded for a clear cell renal cell carcinoma when the CAP protocol indicates sarcomatoid features are present?  See Discussion.

Final Apr 24 2017

MP/H Rules/Multiple primaries--Melanoma: Is a melanoma with an unknown laterality a different laterality for the purposes of applying Multiple Primaries/Histology Rule M4?  See Discussion.

Final Apr 24 2017

Multiple Primaries/Histology Rules/Multiple primaries--Kidney, renal pelvis:  Are tumors diagnosed more than three years apart multiple primaries according to Rule M7 in a case with metastasis?  See Discussion.

Final Apr 24 2017

MP/H Rules/Multiple primaries--Breast:  Is this the same primary per MP/H Rule M10?  Ductal carcinoma of the left breast in 2013, treated with a lumpectomy. New tumor with ductal and lobular carcinoma in the same breast in 2016. 

Final Apr 14 2017

Reportability/Histology--Colon:  Is tubular adenoma with high grade dysplasia and focal invasion from a pathology report of a colon biopsy reportable?; if so, what is the histology code?

Final Apr 10 2017

Reportability/Date of Diagnosis--Prostate: Is PI-RADS 5 diagnostic of prostate cancer, and if so, can we use the date of the impression on the scan that states PI-RADS category 5 as the diagnosis date?  See Discussion.

Final Apr 04 2017

MP/H Rules/Histology--Brain and CNS:  What is the code for an embryonal tumor with multilayered rosettes. WHO shows the code as 9478/3, but this code is not available for use in the United States.

Final Mar 29 2017

Size of tumor--Breast:  Please clarify guideline #7 if the only size you have is from a CORE biopsy specimen and imaging only states nonspecific sizes, like "architectural distortion" or "calcifications" and a core biopsy pathology reports invasive tumor spans 5mm. Do you use the core biopsy size, or use 999 for clinical tumor size? See discussion.

Final Mar 24 2017

MP/H Rules/Histology--Testis: How should histology be coded for a mixed germ cell tumor that also includes choriocarcinoma now that non-seminomatous mixed germ cell tumors (9065) and seminomatous mixed germ cell tumors (9085) are collapsed for analysis? See Discussion.

Final Mar 23 2017

MPH Rules/Multiple primaries--Melanoma: Does MP/H Rule M7 (diagnosed more than 60 days apart) apply to invasive melanoma cases with margins positive for in situ melanoma, or are these further excision of the original diagnosis and the same primary, even when it appears treatment was complete after the initial excision? See Discussion.

Final Mar 20 2017

MP/H Rules/Multiple primaries--Liver:  How many primaries of the same site and histology are reported if tumors appear years apart but neither is surgically removed?  See Discussion.


Final Mar 20 2017

Reportability/Histology--Heme & Lymphoid Neoplasms: Is a physician statement that a patient has a malignant histiocytic disorder best described as Erdheim-Chester disease reportable? If reportable, should histology be coded to 9751/3? See Discussion.

Final Mar 08 2017

Primary Site/Sarcoma--Breast:  How should the primary site and stage be coded for osteosarcoma of breast?  Is C509 correct or should the code be a different primary site?  When assigning C509, the Collaborative Stage (CS) still pertains to breast cancer and AJCC stages it as a breast cancer and not as a sarcoma. 

Final Mar 07 2017

MP/H Rules/Multiple primaries--Breast: Can we accession two breast primaries when imaging is "suspicious for malignancy" on both breasts but only one biopsy is taken and is histologically confirmed, and assume bilateral complete response to neoadjuvant chemotherapy with bilateral mastectomies negative for residual cancer?  See Discussion.

Final Mar 03 2017

CS Site Specific Factor--Breast:  What estrogen receptor/progesterone receptor (ER/PR) values should be coded in a case with two separate tumors (1 ductal, 1 lobular) diagnosed simultaneously in the same breast (single primary) with differing ER/PR values for each tumor?  One is ER/PR positive; the other is ER/PR negative.

Final Mar 03 2017

MP/H Rules/Multiple primaries--Lung: How many primaries should be accessioned if patient has a LUL lung biopsy with squamous cell carcinoma and subsequently a station 4L node biopsy with small cell carcinoma? See Discussion.

Final Feb 27 2017

MP/H Rules/Histology--Colon:  Is the code for invasive adenocarcinoma in a serrated adenoma 8213/3?  The NAACCR Guidelines for ICD-O-3 Update Implementation, effective 1/1/14, provides new terms including 8213/0 for sessile serrated adenoma/sessile serrated polyp and 8213/3 for serrated adenocarcinoma. This would cause Site/Type and Histology overrides to be set. Coding 8210/3 would allow the case to be reported without overrides.  See Discussion.

Final Feb 15 2017

MP/H Rules/Histology--Urinary System: How should histology be coded when there are multiple bladder, ureter and renal pelvis urothelial tumors including non-invasive papillary urothelial carcinoma in the left ureter, invasive papillary urothelial carcinoma invading the lamina propria in the bladder, and an invasive sarcomatoid urothelial carcinoma of the renal pelvis that invades the muscularis? See Discussion.

Final Feb 09 2017

Heme & Lymphoid Neoplasms/Diagnostic confirmation--Lymphoma: To code "3" in Diagnostic Confirmation, does the genetic testing need to confirm a specific histology or is it enough that is simply rules out others?  See Discussion.

Final Feb 02 2017

Reportability/Histology--Testis: Is neoplasm consistent with carcinoid type of monodermal teratoma reportable as a teratoma, NOS, and if yes, what is the histology code?

Final Jan 31 2017

MP/H Ruels/Histology--Kidney/renal pelvis: How is MiT family translocation renal cell carcinoma (RCC) with Xp11 translocation coded? See Discussion.

Final Jan 31 2017

Reportability/Histology--Brain and CNS: Is epidermoid tumor of the cerebellopontine angle (CPA) and trigeminal vesicle nerve reportable, and if so, what is the correct histology code? See discussion.

Final Jan 31 2017

Reportability--Brain and CNS: Are cavernous sinus meningiomas reportable? See Discussion.


Final Jan 18 2017

MP/H Rules/Histology--Kidney: How is the histology coded and what rule(s) apply to the classification of succinate dehydrogenase-deficient renal cell carcinoma? See Discussion.

Final Jan 17 2017

First course treatment/Chemotherapy: Is metronomic chemotherapy coded as chemotherapy?

Final Dec 20 2016

First course treatment/Radiation Therapy--Prostate: How do you code fiducial markers for prostate cases?

Final Dec 20 2016

First course treatment/Immunotherapy--Prostate:  Is XGEVA, given for bone mets from prostate cancer, abstracted as immunotherapy, or is it an ancillary drug and not recorded?

Final Dec 20 2016

MP/H Rules/Histology--Brain and CNS: What is the histology code for a tumor originating in the cerebellum and extending into the fourth venrticle described as a glioblastoma with primitive neuroectodermal tumor component (WHO Grade IV)?

Final Nov 21 2016

MP/H Rules/Histology--Breast: What histology code(s) and MP/H rule applies for a breast resection final diagnosis of "undifferentiated sarcoma associated with a malignant phyllodes tumor and a tumor size of approximately 7 x 6.5 x 4 cm"? (The tumor is primarily sarcoma, with the phyllodes tumor measuring 2.8 cm)? See Discussion.

Final Nov 17 2016

MP/H Rules/Histology--Breast: How should histology be coded for a breast primary with resection final diagnosis of "Ductal carcinoma with neuroendocrine features?" See Discussion.

Final Nov 10 2016

MP/H Rules/Multiple primaries/Histology: What histology and how many primaries are coded for a mixed germ cell tumor with a somatic type malignancy (rhabdomysarcoma) if the patient was diagnosed with seminoma of the testis in 2009 followed by a 2015 metastatic germ cell tumor in a retroperitoneal lymph node, stated to be a recurrence of the testicular cancer? See Discussion.

Final Nov 08 2016

SEER Summary Stage 2000--Melanoma: Can Clark's level classification still used to Summary Stage melanoma? It was previously used by AJCC TNM, but was not included in the 7th edition. I see it is still listed in the CAP protocols for melanoma.

Final Nov 01 2016

Primary site/MP/H Rules/Histology: What is the appropriate site and histology code for a tumor described as a "Large mass In suprasellar cistern encroaching into sphenoid & ethmoid sinuses", with the pathology described as "INI-1 deficient sinonasal undifferentiated carcinoma"? Of note, this patient has a history of a pituitary adenoma, resected overseas a few months prior to this diagnosis.

Final Oct 31 2016

Reportability/MP/H Rules/Histology: Do we interpret Endometrial stromal sarcoma / Undifferentiated stromal sarcoma as low grade / high grade still in order to code the correct histology?

And for VIN, if a pathology report comes across as undifferentiated VIN, do we report it as VIN 3, even if that terminology isn't there?

Final Aug 08 2017

Reportability--Brain and CNS: Are sphenoid wing meningiomas reportable? See discussion.

Final Oct 18 2016

MP/H Rules/Histology--Skin: What histology code and MP/H Rule apply to a skin primary with the final diagnosis, Basaloid carcinoma with squamous and neuroendocrine differentiation? See Discussion.

Final Oct 18 2016

MP/H Rules/Histology--Breast: What histology code and MP/H Rule applies to the Histologic Type of "invasive ductal carcinoma with metaplastic stroma" for a single breast tumor? See Discussion.

Final Oct 11 2016

MP/H Rules/Histology--Lung: What histology code and MP/H Rule applies to the Histologic Type described as adenocarcinoma, mixed invasive mucinous and non-mucinous which involves multiple lung tumors present in a single lobe? See Discussion.

Final Oct 07 2016

Behavior--Prostate: What is the correct behavior of intraductal carcinoma from a prostate biopsy with a Gleason score 4+4=8. While highly aggressive, but not suggestive of invasion, coding behavior as /2 seems inappropriate.

Final Sep 28 2016

Grade--Kidney: Should WHO/ISUP grade for renal cell carcinoma be coded for cases diagnosed 2016 and later? See discussion.


Final Sep 14 2016

Reportability/Behavior--Small intestine: Is a carcinoid tumor, described as benign, reportable? See Discussion.

Final Sep 12 2016

Mets at diagnosis fields--Heme & Lymphoid Neoplasms (Lymphoma): How are Mets at Diagnosis -- Bone, Brain, Liver, Lung, Lymph Node, and Other -- to be coded for lymphomas in 2016? Are they always 0 if the TNM Stage is I, II, or III? How is bone marrow involvement coded -- in which Mets at Diagnosis field?

Final Aug 19 2016

First course treatment--Heme & Lymphoid Neoplasms: Are blood thinners, e.g., warfarin, coded as treatment in the Other Therapy data item for polycythemia vera and myelodysplastic syndrome? See Discussion.

Final Jul 05 2016

MP/H Rules/Histology--Prostate: What is the histology code for a prostate case whose histology reads “adenoca with mixed ductal and acinar variants?

Final Jun 23 2016

MP/H Rules/Histology--Testis: How should histology be coded for a testicular primary with a combination of teratoma, yolk sac tumor and embryonal carcinoma? See discussion.


Final Jun 14 2016

Reportability--Bone: Is an "atypical cartilaginous tumor" reportable? See Discussion.

Final Jun 13 2016

MP/H Rules/Multiple primaries--Melanoma: How many melanoma primaries should be abstracted if, during the workup for a metastatic melanoma of an unknown cutaneous site, an in situ melanoma is also discovered? See Discussion.

Final Jun 10 2016

MP/H Rules/Histology: How is the histology coded for an invasive adenocarcinoma arising in a papilloma with high-grade dysplasia? See Discussion.

Final Jun 08 2016

Summary Stage 2000--Lymphoma: How is SEER SS2000 coded for an ocular adnexal lymphoma when it extends from the primary site to adjacent sites that are still orbital structures? See Discussion.

Final Jun 03 2016

Diagnostic confirmation: When a CT guided Fine Needle Aspiration is performed and the pathology report indicates smears and cell block were prepared, if the diagnosis is positive for cancer, can you code diagnostic confirmation as 2 (positive cytology) because of the cell block?

Final Jun 02 2016

Reportability--Appendix: Is a mucinous cystic neoplasm with high grade dysplasia of the appendix reportable? See discussion.

Final Jun 01 2016

Grade/Sarcoma--Breast: Is the correct grade for high grade angiosarcoma of the breast a code 3 or 4? The breast usually uses a three grade system but sarcoma is not a typical histologic type of the breast.

Final May 31 2016

Reportability--Kidney: Is renal cell neoplasm of oncocytosis reportable based on the pathology from a nephrectomy? See Discussion.

Final May 31 2016

Reportability--Eye: Is conjunctival intraepithelial neoplasia (CIN III) from an excision of the left eye conjunctiva reportable?

Final May 31 2016

MP/H Rules/Multiple primaries--Bladder: How many primaries should be reported for the case below? See discussion.

Final May 23 2016

Neoadjuvant treatment/Grade--Prostate: How should the grade/differentiation field be coded when hormone therapy is given prior to radiation for metastatic prostate cancer? Is hormone treatment "neoadjuvant treatment" in this situation?  Per NCCN guidelines, neoadjuvant hormone therapy is strongly discouraged outside of a clinical trial for localized disease. However for metastatic disease, hormone is recommended (gold standard). See discussion.

Final May 20 2016

MP/H Rules/Histology--Sarcoma: What is the appropriate histology code for a final diagnosis of undifferentiated pleomorphic sarcoma and/or pleomorphic sarcoma, undifferentiated? See Discussion.

Final May 18 2016

MP/H Rules/Histology--Bladder: Should the term "dedifferentiation" be used to code sarcomatoid transitional cell carcinoma (8122/3)? Or is this typically referring to the grade, and not the histologic subtype? See Discussion.

Final May 18 2016
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