ID	Question	Answer
20091095	CS Site Specific Factor--Prostate: Please clarify how SEER registries should use code 40 for site-specific factor 3 on prostate cases. Please see discussion.	Yes, SEER agrees. Code SSF3, code 040 per page C-740 of 2007 SEER manual exactly as stated in Note 4. According to the Inquiry and Response System of the CoC, Note 4 lists specific margins that were once thought to have a prognostic impact. Code 040 in SSF3 should be used only when those margins are involved. Note 4 pertains to code 040, not to code 048.
20091094	Reportability: Are squamous cell carcinomas arising in a condyloma of the rectum reportable or should we assume that the site is skin of anus or perianal and not reportable?	Squamous cell carcinoma arising in a rectal condyloma is reportable. Do not assume the site is skin of anus or perianal.
20091093	Race--How and when is Appendix D – Race and Nationality Descriptions from the 2000 Census and Bureau of Vital Statistics to be used? Please see discussion.	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.
20091092	MP/H Rules-Lung: What is the Diagnosis Date, Diagnostic Confirmation and histology for the left lung mass? Scenario: PET shows a 3 cm mass in the left lung and a 2.9 cm mass in the right lung. No reportable terminology in PET. The right mass is biopsied and shows adenoca. The left mass is not biopsied. Based on rule M6, this should be reported as two primaries. No additional information in medical record, pt expired.	For date of diagnosis, use the date of the PET scan for both primaries. For the left tumor, assign diagnostic confirmation code 8 [Clinical diagnosis only] and assign histology code 8000/3 [malignant neoplasm]. The left lung mass is reported as a separate primary because there is one tumor in each lung. According to Rule M6, when there is one tumor in the left lung and one tumor in the right lung, each tumor is a separate primary. Tumor and mass are equivalent terms for purposes of the multiple primary rules.
20091090	First course treatment--Leukemia: Should an allogeneic stem cell transplant for acute myeloid leukemia be coded to 20 in the Hematologic Transplant and Endocrine Procedures? There is debate as to whether this procedure should be coded as a 12 in order to capture the allogeneic part of the procedure.	Assign code 20 [Stem cell harvest (stem cell transplant) and infusion as first course therapy] for stem cell procedures, even allogeneic procedures.
20091089	Histology--Hematopoietic: The final diagnosis on a bone marrow biopsy was "chronic lymphocytic leukemia with plasmacytic differentiation." Is this coded 9823/3, CLL/SLL or 9733/3, plasma cell leukemia?	Assign histology code 9823/3 [Chronic lymphocytic leukemia]. Plasmacytic differentiation does not indicate a plasma cell or plasmacytic leukemia.
20091085	MP/H Rules/Histology--Breast: What is the correct histology code for this breast cancer case? Final diagnosis says, "Infiltrating duct carcinoma with apocrine features." What rule is used? See also discussion.	Assign histology code 8401/3 [apocrine adenocarcinoma] according to rule H12. Apocrine is a type of duct carcinoma, see table 1. Code 8401 should be listed in Rule H12. Apocrine should be removed from table 3. These corrections will appear in the 2010 version of the rules.
20091084	Primary site--Colon: How do you determine the correct subsite when there is conflicting information in different reports? See discussion for case example. In this case, the Operative report seems more correct. Are there priority rules for this for sites other than Head and Neck?	Use the operative report information to code primary site in this case. It is more accurate. The operative report is usually a better source of location information compared to the pathology report. The pathologist can only reiterate the location as it was reported to him/her. The 2007 SEER manual states "Unless otherwise instructed, use all available information to code the site," page 69.
20091083	Grade/Cell indicator--Lymphoma: For pathology that states "anaplastic large cell lymphoma", is the grade code 4? The SPCM states cell indicator codes take precedence over grade/differentiation codes for lymphoma and leukemia cases.	For this case, since there is no cell indicator information, code 9 [cell type not determined] in the grade/cell indicator field. Do not code grade for lymphoma. For lymphoma and leukemia this field is the cell indicator.
20091082	Behavior--Breast: What is the correct behavior code for these 2 scenarios? 1. Path report for breast cancer has final diagnosis as 'DCIS' but the CAP protocol in the body of the report says 'microinvasion seen, T1mic.' 2. Path report says 'DCIS' in the final diagnosis and microinvasion is identified in the microscopic portion of the report, but it is not in CAP protocol format and not stated in the final diagnosis. These are path reports from lab only cases (not otherwise reported to the central registry).	Code both scenarios /3 [malignant (invasive)]. Information regarding behavior is not limited to the final diagnosis or the CAP protocol. See page 84 in the 2007 SEER manual: Code the behavior as malignant /3 if any portion of the primary tumor is invasive no matter how limited; i.e. microinvasion.
20091081	Reportability/Histology--Brain and CNS: Histology code 8825/1 (Inflammatory Myofibroblastic Tumor) is not listed in the ICD-0-3 Primary Brain and CNS Site/Histology listing for reportable Brain/CNS tumors. It seems this might be a reportable tumor?	If the inflammatory myofibroblastic tumor is primary in one of the sites specified below and diagnosed 1/1/2004 or later, it is reportable. Reportable brain and CNS tumors are any benign and borderline primary intracranial and CNS tumors with a behavior code of /0 or /1 in ICD-O-3 diagnosed 1/1/2004 and later, of the following sites: Cerebral meninges C700, Spinal meninges C701, Meninges, NOS C709, Cerebrum C710, Frontal lobe C711, Temporal lobe C712, Parietal lobe C713, Occipital lobe C714, Ventricle, NOS C715, Cerebellum, NOS C716, Brain stem C717, Overlapping lesion of brain C718, Brain, NOS C719, Spinal cord C720, Cauda equine C721, Olfactory nerve C722, Optic nerve C723, Acoustic nerve C724, Cranial nerve, NOS C725, Overlapping lesion of brain and central nervous system C728, Nervous system, NOS C729, Pituitary gland C751, Craniopharyngeal duct C752, Pineal gland C753.
20091079	Primary site--Bladder: What is the correct subsite for interureteric ridge? Description: 4 mm nodule at base of bladder near interureteric ridge.	For this case, assign code C670 [Trigone of bladder]. The description for this case states that the tumor location is the base of the bladder. Base is a synonym for trigone. The interureteric ridge (or interureteric crest, or interureteric fold) is a fold of mucous membrane extending accross the bladder between the two ureteric orifices. The trigone is located below the interureteric ridge.
20091078	MP/H Rules--Head & Neck: Is the following one or two separate primaries? Originally diagnosed with an invasive squamous cell ca. of the right mandibular body (C06.9) in 2004, and treated with surgery and radical neck dissection. In 2007, patient was then diagnosed with an invasive squamous cell ca. of the left buccal mucosa (C06.0). Please see discussion.	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.
20091077	CS Site Specific Factor--Head & Neck: Can SSF 1-6 be coded using clinical information only, or does the source of information for lymph nodes need to pathological?	CS Site Specific Factors 1 through 6 for head and neck sites may be coded using either clinical or pathologic information.
20091072	Histology--Brain and CNS: What histology code is used for a rosette-forming glioneuronal tumor of the fourth ventricle?	Assign histology code 9505/1 [Ganglioglioma, NOS]. Rosette-forming glioneuronal tumor of the 4th ventricle is a new WHO entity. There is no current ICD-O-3 code for this. The best code available at this time is 9505/1.
20091069	CS Extension--Bladder: What is the correct CS Ext code? Path states “Iinfiltrating high grade urothelial ca with focal micropapillary features and invasion of lamina propria. NOTE - There is INVASIVE CA FOCALLY INVOLVING THIN MUSCLE BUNDLES...difficult to distinguish whether muscularis propria or muscularis mucosae.	Assign CS extension code 15 [Invasive tumor confined to subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma)]. The information provided confirms invasion of the lamina propria (code 15) but is not definitive enough to assign a code higher than 15.
20091068	Primary site--Bladder: What is the appropriate subsite for “adjacent to the bladder neck"?	Assign code C679 [Bladder, NOS]. It is not possible to determine the location of the tumor from the description. A tumor that is "adjacent to bladder neck" could be located in the trigone or on the bladder wall (anterior, posterior or lateral).
20091067	Grade--Bladder: In papillary urothelial cancers of the the bladder most pathology reports state low grade, high grade, Grade II, Grade III, etc. Are these terms used to code the 6th digit? Please see discussion.	For NON-invasive bladder tumors, assign code 9 [unknown] to the Grade field. WHO grades are applied to urothelial tumors ranging from dysplasia to non-invasive urothelial carcinoma. For invasive urothelial carcinoma, if terms such as low grade, high grade, Grade II, Grade III are used, assign the appropriate code in the grade field. See the 2007 SEER Manual instructions on page C-844 for converting a three-grade value to a SEER grade code.
20091066	Multiplicity Counter--Lung: How is this field coded when there is no evidence of the primary tumor? Please see discussion.	Assign code 99 [Unknown].
20091065	Primary Site/CS Extension--Lymphoma: How are these fields coded for a non-Hodgkins lymphoma case with scans that show non-specific parenchymal lung nodules and a large mediastinal mass? Please see discussion.	Assign code C779 [Lymph node, NOS]. In this case, there is no statement that lymphoma involves the lung. "Nonspecific parenchymal lung nodules" are not indicative of lymphoma involvement. Consequently, this cannot be assumed to be an extra-nodal lymphoma. Additionally, it is not clear whether or not the "borderline" pelvic lymph nodes are invovled. If the physician cannot provide more information, follow instruction 4.e in the SEER manual on page 72.
20091064	Radiation Sequence with Surgery--Head & Neck- How is this field coded for a tonsil primary diagnosed on 4/16/07 by a regional lymph node FNA who later has radiation start on 5/8/07 and a 7/30/07 tonsillectomy with neck dissection?	The best way to handle this situation is to assign code 2 [Radiation before surgery] in Radiation Sequence with Surgery. Code 2 provides the best description of the sequence of events in this case. Radiation was delivered prior to the resection of the primary site.
20091062	CS Site Specific Factor--Head & Neck: How is Site Specific Factor 2 field coded when the pathologist describes regional lymph nodes as “matted”? Please see discussion.	"Matted" is not a synonym for "Fixed" in the CS schema for Head and Neck. "Matted" is not indicative of extracapsular extension for the Head and Neck schema.
20091061	Multiplicity Counter--Head & Neck: How is this field coded when a patient has carcinoma in the same location as a previous primary but it is unknown if there was a disease-free interval? Please see discussion.	Assign code 01 [one tumor only] for the example provided (see discussion). Given the information provided, there is no reason to suspect that the February 2009 diagnosis represents new tumor; therefore, it does not affect the multiplicity counter. It appears that this was the treatment plan for the original diagnosis in May 2008: radiation and chemo followed by excision of the mass.
20091060	MP/H Rules- Head and Neck: How many primaries are to be accessioned for a case in which a second tumor occurs in an area previously involved by direct extension from a prior primary located in an adjacent site? Please see discussion.	The May 2008 diagnosis is not a new primary. Base of tongue involvement was originally present in August 2007. The May 2008 diagnosis does not represent new tumor. The 2007 rules apply to new tumors only; therefore, the 2007 rules do not apply to this case.
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? Please see discussion.	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).
20091058	MP/H Rules--Kidney: How is histology coded when it is described in the pathology report as “Histologic type: Clear cell (conventional) renal cell carcinoma. Percent of sarcomatoid component: 10 %”? Please see discussion.	Assign code 8310 [clear cell adenocarcinoma] according to rule H5. Renal cell, clear cell and sarcomatoid are mentioned in the diagnosis. Sarcomatoid is refered to as a component. Component is not one of the terms listed in rule H5 that indicate a more specific type. Ignore sarcomatoid in this case. Use table 1 to identify clear cell as a specific renal cell type. Code the specific type (clear cell) according to rule H5.
20091057	CS Site Specific Factor--Lymphoma: Can the term “intermediate risk” be used to code IPI score? Please see discussion	Code SSF 3 for lymphoma based on the IPI score stated in the record. Do not attempt to interpret statements or terms in order to assign a code to SSF 3. If no further information is available for this case, code SSF 3 999 [Unknown].
20091056	MP/H Rules/Histology--Ovary: How is this field coded for an ovarian tumor diagnosed as an “ovarian clear cell cystadenocarcinoma”? Please see discussion.	Assign code 8310 [Clear cell adenocarcinoma] according to rule H13. Ignore "cyst" when determining the histologic type for ovarian malignancies. For this case, the only histology is clear cell. The histologies for the common ovarian epithelial malignancies are serous, mucinous, endometrioid, clear cell, and transitional cell/Brenner. This clarification will be added to the rules in the next revision.
20091055	Date therapy initiated/Systemic/Surgery Sequence--Breast: How are these fields coded when a patient has chemotherapy after a sentinel lymph node biopsy and has a lumpectomy after completing chemotherapy? Please see discussion.	For this case, code Date Therapy Initiated to the date of the sentinel lymph node biopsy [04102008]. Assign code 3 [Systemic therapy after surgery] in Systemic/Surgery Sequence.
20091054	First course treatment--Liver: Is planned therapy considered to be second course therapy if it is administered after documented progression of disease? Please see discussion.	In this case, neither the chemoembolization nor the liver transplant are part of the first course of therapy. The documented treatment plan was changed after disease progression. Chemoembolization was not part of the original treatment plan. First course therapy ends at this point.
20091049	MP/H Rules--Lung/Breast: Can we assume that a current tissue specimen is a recurrence of previous primary if a pathologist states that he has compared the specimen with the slides from the prior tumor and concludes that the current tumor is “similar” to a previous tumor? Please see discussion.	All pathologists do not use words in the same way. Therefore, we will not provide a list of specific words to accept or not to accept in order to determine recurrence. Do not base your decision about recurrence on words such as "similar," or "resembles." If the pathologist believes two or more tumors are the same or believes one is a recurrence of another after comparison, accept it. When pathologists believe that two or more tumors are not the same or believe that one is not a recurrence of another, there is usually a strong statement indicating that opinion.
20091046	CS Lymph Nodes/CS Site Specific Factor--Melanoma: When CS lymph nodes is coded 13, 14 or 15, why must CS SSF 3 be coded 000? See discussion.	When CS lymph nodes is coded 13-15, SSF 3 must be coded 000. Follow the instruction in the SSF 3 Note: Use code 000, No lymph node metastases, if ... there are satellite nodules or in-transit metastases, but no regional lymph node metastases, i.e., CS Lymph Nodes is coded 13-15. For this case, assign CS lymph node code 15 [Satellite nodule(s) or in-transit metastases greater than 2cm from primary tumor WITHOUT regional lymph node involvement or involvement of regional nodes not stated]. The arm lesion is more than 2cm from the leg lesion.
20091045	CS Tumor Size/CS Site Specific Factor--Breast: Regarding SEER Edit IF218, when tumor size is unknown, but it is known that both in situ and invasive components are present, how should CS tumor size and SSF6 be coded? Please see discussion.	Code CS tumor size 990 [Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm] and CS SSF6 050 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated AND proportions of in situ and invasive not known]. This combination of codes captures the information available for this case.
20091040	MP/H Rules/Histology--Breast: Which histology code, 8050 or 8260, is used for an infiltrating papillary carcinoma of the breast? There is no mention of ductal or adenoca in the path report.	Assign histology code 8503 [Papillary adenocarcinoma]. Rule H14 applies. ICD-O-3 code 8050 does not apply in this case. Refer to the numeric listing in ICD-O-3. 8050 is a squamous cell neoplasm. Papillary carcinoma of the breast is NOT a squamous cell neoplasm. It is a neoplasm of the breast parenchyma - ducts, lobules or connective tissue. 8503 is the correct code in this case.
20091039	CS Tumor Size--Lung: Per SPCSM 2007 'Coding Instructions for CS Staging Data Items-CS Tumor Size' item 5c states that code 998 (diffuse, entire lung) for lung & main stem bronchus takes precedence over any mention of size. Does this statement also apply to code 997 (diffuse, entire lobe) for lung and main stem bronchus or would a stated tumor size be used over code 997?	Code the stated tumor size rather than 997. Code 997 does not take presidence over tumor size at this time. According to CoC, the instructions on pI-27 5c are to alert the user to special circumstances. Code 997 isn't included because it isn't diffuse for all of the sites listed. The site-specific rules and codes in the schema always take precedence. Further instructions and clarifications will be added to the lung schema pII-317 in the next version of CS.
20091021	Behavior/Reportability--GIST: Our pathologists NEVER use the term Malignant to describe GIST. How can we get SEER to address this issue? Please see discussion.	Do not report the case to SEER if it does not satisfy the criteria for reportability. According to the current reportability criteria, malignant GIST (8936/3)is reportable to SEER. GIST coded to 8936/0 or 8936/1 is not reportable. If your pathologist will not indicate "malignant" or "benign," code 8936/1 applies according to ICD-O-3 and, therefore, these are not reportable to SEER.
20081126	MP/H Rules--Brain and CNS: Are stigmata of neurofibromatosis in the brain considered to represent reportable neurofibromatosis lesions? Please see discussion.	Accession NF (9540/1) when there is CNS tumor -- a glioma or some other intracranial/intraspinal tumor, or one of the "stigmata" on MRI or some other CNS study. Do NOT accession NF (9540/1) when there is only peripheral nerve/nervous system involvement. Accession the neurofibromatosis itself only once per patient. Accession any initial neoplasm in the CNS separately. Abstract and code any subsequent CNS neoplasms according to the multiple primary brain rules. Accession three primaries for the case described above. 1. Neurofibromatosis (C729 9540/1) 2. Optic nerve glioma (C723 9421/3)--> see below. 3. Hypothalamus glioma (C710 9380/0) --> Optic nerve gliomas associated with NF are pilocytic astrocytomas. Code pilocytic astrocytoma as 9421/3 in North America.
20071015	CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded if a sentinel lymph node biopsy reveals no malignancy but there is an aggregate of melanoma cells in the lumen of a large vein immediately adjacent to the lymph nodes?	This question was answered by the CoC: Do not count this as regional metastatic disease since there is no evidence it is an established tumor. Stage this as a N0.