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General Instructions

8/2/2018

  • How to Use the Solid Tumor Rules
    • #1: Non-malignant CNS added to list of site-specific rules to use for cases diagnosed 2018+. (It had been erroneously omitted).

Breast

8/20/2018

  • Table 3
    • Comedocarcinoma deleted (term no longer recommended by WHO)
    • Cribriform carcinoma 8201/2 moved to column 3 as a subtype/variant of Carcinoma NST
    • Pleomorphic carcinoma 8022/3 added as a subtype/variant of Carcinoma NST

7/19/2018

  • Changes from 2007 MPH Rules
    • 3A: Added a clarification: "Subtypes/variant, architecture, pattern, and features ARE NOT CODED. The majority of in situ tumors will be coded to DCIS 8500/2."
  • Rule H4: Code comedocarcinoma, in situ/non-infiltrating 8501/2 when the diagnosis is non-infiltrating/in situ comedocarcinoma and any other in situ carcinoma.
    • Rule deleted
  • Rule H5: Code the combination code using Table 2 in the Equivalent Terms and Definitions when two histologies are present within the tumor.
    • Rule deleted

6/25/2018

  • Equivalent or Equal Terms
    • Clarified synonyms of simultaneous
  • Rule M7: Abstract a single primary when the diagnosis is Paget disease with underlying in situ or invasive carcinoma NST (duct/ductal).
    • Second bullet was deleted which stated that "in situ or invasive lobular carcinoma" was included in the rule.
  • Rule M9: Abstract a single primary when simultaneous multiple tumors are carcinoma NST/duct and lobular
    • Note added to clarify that histologies must be the same behavior
  • Rule M11: Abstract a single primary when separate/non-contiguous tumors are on the same row in Table 3 in the Equivalent Terms and Definitions.
    • New rule
  • Rule H9: Code cribriform carcinoma 8201/3 when cribriform is mixed with any other carcinoma AND…
    • Two bullets updated to clarify when to code cribriform carcinoma
  • Rule H12: Code the subtype/variant (specific histology) ONLY when there is a NOS/NST and a subtype/variant AND the subtype/variant is documented to be greater than or equal to 90% of the tumor.
    • Note added which clarifies the use of the term "component"
  • Rule H15: Code a combination code when there are two histologies (two components) within a single tumor and the majority histology is unknown/not documented.
    • Note added which clarifies the use of the term "component"

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Colon

8/8/2018

  • M Rule: Abstract multiple primaries when there are separate, non-contiguous tumors in sites with ICD-O site codes that differ at the second CXxx and/or third CxXx character.
    • Fourth character C18X deleted from this rule
  • M Rule: Abstract multiple primaries when there are separate, non-contiguous tumors in sites with ICD-O site codes that differ at the fourth characters C18X.
    • New rule added after the anastomotic site rules
  • M Rule: Abstract a single primary when separate/non-contiguous tumors are on the same row in Table 1 in the Equivalent Terms and Definitions.
    • Rule moved after the clinically disease-free timing rule

7/3/2018

  • Table 1: GIST behavior code corrected to /3
  • Table 2: GIST (non-reportable) histology code added: 8936/1

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Kidney

7/19/2018

  • Table 1: "Sarcomatoid" added as a synonym for renal cell carcinoma NOS 8312. Two notes added under RCC regarding sarcomatoid carcinoma.

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Lung

10/12/2018

  • Coding Multiple Histologies section: Following clarifications were made:
    • Note 2 was added under term “predominant” to identify histologies which are preceded by the word predominant in the CAP protocol with reference to Table 3 for coding.
    • Note 2 added to define acceptable usage of ambiguous terminology. Examples added.
  • Table 3: Histology terms that include “predominant” were added to Column 3 for Adenocarcinoma, NOS. These include:
    • Adenocarcinoma, acinar predominant 8551
    • Adenocarcinoma, micropapillary predominant 8265
    • Adenocarcinoma, papillary predominant 8260
    • Adenocarcinoma, solid predominant 8230
  • New Histology Rule added to "Single Tumor" and "Multiple Tumors Abstracted as a Single Primary":
      Code the specific histology when the diagnosis is non-small cell lung carcinoma (NSCLC) consistent with (or any other ambiguous term) a specific carcinoma (such as adenocarcinoma, squamous cell carcinoma, etc.) when:

    • Clinically confirmed by a physician (attending, pathologist, oncologist, pulmonologist, etc.)
    • Patient is treated for the histology described by an ambiguous term
    • The case is accessioned (added to your database) based on ambiguous terminology and no other histology information is available/documented

8/23/2018

  • M7 Rule: Abstract a single primary when separate/non-contiguous tumors in the same lung are on the same row in Table 3.
    • Clarification added: Tumors must be in the same lung

6/28/2018

  • 8250/3 removed
  • Removed statement that non-mucinous adenocarcinoma is equivalent to adenocarcinoma

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Malignant CNS and Peripheral Nerves

10/12/2018

  • Added Spinal cord C720 to reportable primary sites list, Table 2, and Rule M8

8/16/2018

  • M Rule: Abstract a single primary when the patient has bilateral optic gliomas/glioblastomas 9440.
    • Rule deleted
  • M Rule: Abstract multiple primaries when there are multiple CNS tumors, one of which is malignant /3 and the other is non-malignant /0 or /1...and there was resection.
    • Rule moved; is now the first rule in the Multiple Tumors Module

Non-Malignant CNS Tumors

10/12/2018

  • Added Spinal cord C720 to reportable primary sites list, Table 2, and Rule M12

8/13/2018

  • Hygroma 9173/0 removed from Table 6 (Specific Histologies) and added to Table 4 (Non-Reportable Histologies). Hygroma is not reportable.

8/8/2018

  • M Rule: Abstract a single primary when there is a NOS and a subtype/variant of that NOS in the same CNS site (same second, third and fourth digit CXXX).
    • Rule deleted
  • M Rule: Abstract a single primary when two or more separate, non-contiguous meningiomas arise in the cranial meninges.
    • Rule moved
  • M Rule: Abstract a single primary when there are separate/non-contiguous tumors in the brain (multicentric/multifocal) with the same histology XXXX.
    • Rule moved

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Other Sites

9/11/2018

  • Rule M13: A frank in situ or malignant adenocarcinoma and an in situ or malignant tumor in a polyp are a single primary
    • Rule was inadvertently deleted. The Other Sites 2018 Rules should match the 2007 MPH version.
    • ACTION: Rule M13 has been reinserted into the M rules. This change resulted in renumbering of previous M13-M17 to current M14-M18 as posted.

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Urinary Sites

8/8/2018

  • M Rule: Abstract a single primary when multifocal/multicentric urothelial carcinoma NOS 8120 OR any subtypes/variants of urothelial carcinoma NOS are diagnosed simultaneously in two or more of the following sites…
    • Rule deleted
  • M Rule: Abstract a single primary when tumors are diagnosed in the bladder C67_ and one or both ureter(s) C669 AND tumors are noninvasive in situ /2 urothelial carcinoma (flat tumor) 8120/2.
    • Removed reference to subtypes of 8120/2
  • M Rule: Abstract a single primary when there is a NOS and a subtype/variant of that NOS
    • Rule deleted

7/31/2018

  • Changes in Hierarchy for all Multiple Primary Rules
    • Refer to updated PDF for changes
  • M Rule: Abstract a single primary when tumors are diagnosed in the bladder C67_ and one or both ureter(s) C669 AND tumors are noninvasive in situ /2 urothelial carcinoma (flat tumor) 8120/2.
    • Removed reference to subtypes of 8120/2
  • M Rule: Abstract a single primary when there is a NOS and a subtype/variant of that NOS
    • Rule deleted

7/19/2018

  • Rule M6: Abstract a single primary when separate/non-contiguous tumors are on the same row in Table 2.
    • Added Note 1: The tumors must be the same behavior. When one tumor is in situ and the other invasive, continue through the rules.

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