SEER Program Coding and Staging Manual 2018 Effective with cases diagnosed January 1, 2018 Data Quality, Analysis, and Interpretation Branch Surveillance Research Program Division of Cancer Control and Population Sciences National Institutes of Health Public Health Service U.S. Department of Health and Human Services Suggested citation: Adamo M, Dickie L, Ruhl J. (January 2018). SEER Program Coding and Staging Manual 2018. National Cancer Institute, Bethesda, MD 20892. U.S. Department of Health and Human Services National Institutes of Health National Cancer Institute SEER Program Coding and Staging Manual 2018 SEER Program Coding and Staging Manual 2018 Acknowledgements Suzanne Adams, BS, CTR Information Management Services, Inc Judy Andrews BA, CTR SEER Georgia Cancer Registry Robin Billett, MA, CTR SEER Georgia Cancer Registry Carolyn Callaghan, BS, CTR SEER Seattle Cancer Registry Jacque Clarken, BS, CTR SEER Utah Cancer Registry Eileen Elido, CTR SEER Hawaii Cancer Registry Carmela Groves, RN, MS, CTR Westat, Inc. Stephanie Hill, MPH New Jersey State Cancer Registry Loretta Huston, BS, CTR SEER Utah Cancer Registry Tiffany Janes, BA, CTR SEER Seattle Cancer Registry Bobbi Jo Matt, BS, RHIT, CTR SEER Iowa Cancer Registry Patrick Nicolin, BA, CTR Detroit Metropolitan Cancer Registry Nektarios Pappas, MD, CTR SEER Louisiana Cancer Registry Lisa A. Pareti, BS, RHIT, CTR SEER Louisiana Cancer Registry Cathryn R. Phillips, BA, CTR SEER Connecticut Cancer Registry Elizabeth Ramirez-Valdez, CTR SEER New Mexico Cancer Registry Winny Roshala, BA, CTR SEER Greater California Cancer Registry Frances E. Ross, BA, CTR SEER Kentucky Cancer Registry Candis Sanders, BS, CTR SEER Georgia Cancer Registry Christina Schwarz, BA, CTR SEER Greater Bay Area Cancer Registry Steve Scoppa, BS Information Management Services, Inc Sheree Serrian, BBA, RN, CTR SEER Georgia Cancer Registry Laine Suggs, CTR SEER New Mexico Cancer Registry Taina Valone, RHIA, CTR SEER Greater California Cancer Registry Kacey Wigren, RHIT, CTR SEER Utah Cancer Registry Copyright Information: All material in this manual is in the public domain and may be reproduced or copied without permission. We do request that you use a source citation. Acknowledgements ii SEER Program Coding and Staging Manual 2018 Table of Contents Preface to the 2018 SEER Program Coding and Staging Manual 1 Effective Date 1 Summary of Changes 1 Submitting Questions 3 Collection and Storage of Date Fields 4 Transmission Instructions for Date Fields 4 SEER Site-Specific Factors 1 – 6 4 Introduction 5 SEER Program 5 SEER Coding And Staging Manual Contents 5 Reportability 6 Dates of Diagnosis/Residency 6 Reportable Diagnosis List 6 Diagnosis Prior to Birth 8 Disease Regression 8 Reportable Examples 8 Non-Reportable Examples 9 Instructions for Reporting Solid Tumors 9 Cases Diagnosed Clinically Are Reportable 9 Brain or CNS Neoplasms 9 Casefinding Lists 9 Ambiguous Terminology 10 How to Use Ambiguous Terminology for Case Ascertainment 11 Instructions for Hematopoietic and Lymphoid Neoplasms 13 Changing Information on the Abstract 14 Determining Multiple Primaries 15 Solid Tumors 15 Hematopoietic and Lymphoid Neoplasms 15 Transplants 15 Section I Basic Record Identification 17 SEER Participant 18 Patient ID Number 20 Record Type 21 SEER Record Number 22 SEER Coding System--Original 23 SEER Coding System--Current 24 Table of Contents iii SEER Program Coding and Staging Manual 2018 Section II Information Source 25 Type of Reporting Source 26 CoC Accredited Flag 29 Section III Demographic Information 30 First Name 31 Last Name 32 Place of Residence at Diagnosis 33 County 35 County at Diagnosis Geocode 1970/80/90 36 County at Diagnosis Geocode 2000 37 County at Diagnosis Geocode 2010 38 County at Diagnosis Analysis 39 Address at Diagnosis--State 40 State at Diagnosis Geocode 1970/80/90 41 State at Diagnosis Geocode 2000 42 State at Diagnosis Geocode 2010 43 Census Tract 2010 44 Census Tract Certainty 2010 45 Census Tract Poverty Indicator 47 Rural Urban Continuum 2013 48 Rural Urban Commuting Area--Tract Level 2000 49 Rural Urban Commuting Area--Tract-Level 2010 50 Urban Rural Indicator Code--Tract Level 2000 51 Urban Rural Indicator Code--Tract Level 2010 52 Birthplace--State 53 Birthplace--Country 54 Date of Birth 55 Date of Birth Flag 57 Place of Death--State 58 Place of Death--Country 59 Age at Diagnosis 60 Race 1, 2, 3, 4, 5 61 Race--NAPIIA 66 IHS Link 68 Spanish Surname or Origin 69 Computed Ethnicity 71 Computed Ethnicity Source 72 NHIA Derived Hispanic Origin 73 Table of Contents iv SEER Program Coding and Staging Manual 2018 Sex 74 Marital Status at Diagnosis 75 Primary Payer at Diagnosis 76 Section IV Description of this Neoplasm 78 Date of Diagnosis 79 Date of Diagnosis Flag 84 Sequence Number--Central 85 Primary Site 88 Laterality 92 Diagnostic Confirmation 95 Morphology 98 Histologic Type ICD-O-3 99 Behavior Code 101 Grade Clinical 104 Grade Pathological 105 Grade Post Therapy 106 Tumor Size--Clinical 107 Tumor Size--Pathologic 110 ICD-O-2 Conversion Flag 114 ICD-O-3 Conversion Flag 115 Section V Stage of Disease at Diagnosis 116 Stage Data Items 117 Lymphovascular Invasion 118 Mets at Diagnosis--Bone 124 Mets at Diagnosis--Brain 126 Mets at Diagnosis--Liver 128 Mets at Diagnosis--Lung 130 Mets at Diagnosis--Distant Lymph Node(s) 132 Mets at Diagnosis--Other 134 Extent of Disease Data Items 136 Extent of Disease Primary Tumor 137 Extent of Disease Regional Nodes 138 Extent of Disease Metastases 139 Summary Stage 140 Summary Stage 2018 141 Derived Summary Stage 2018 142 Section VI Stage-related Data Items 143 SEER Site-specific Factor 1 144 Table of Contents v SEER Program Coding and Staging Manual 2018 Additional Stage-related Data Items for 2018 145 Section VII First Course of Therapy 147 First Course of Therapy 148 Date Therapy Initiated 152 Date Therapy Initiated Flag 155 Treatment Status 156 Date of First Surgical Procedure 157 Date of First Surgical Procedure Flag 158 Date of Most Definitive Surgical Resection of the Primary Site 159 Date of Most Definitive Surgical Resection of the Primary Site Flag 160 Surgery of Primary Site 161 Surgical Margins of the Primary Site 163 Scope of Regional Lymph Node Surgery 165 Date of Sentinel Lymph Node Biopsy 169 Date of Sentinel Lymph Node Biopsy Flag 170 Sentinel Lymph Nodes Examined 171 Sentinel Lymph Nodes Positive 172 Date of Regional Lymph Node Dissection 174 Date of Regional Lymph Node Dissection Flag 175 Regional Nodes Positive 176 Regional Nodes Examined 179 Surgical Procedure of Other Site 182 Reason for No Surgery of Primary Site 184 Date Radiation Started 187 Date Radiation Started Flag 188 Radiation Treatment Modality--Phase I, II, III 189 Radiation External Beam Planning Technique--Phase I, II, III 190 Radiation Sequence With Surgery 193 Reason for No Radiation 195 Date Systemic Therapy Started 196 Date Systemic Therapy Started Flag 197 Date Chemotherapy Started 198 Date Chemotherapy Started Flag 199 Chemotherapy 200 Date Hormone Therapy Started 206 Date Hormone Therapy Started Flag 207 Hormone Therapy 208 Date Immunotherapy Started 211 Table of Contents vi SEER Program Coding and Staging Manual 2018 Date Immunotherapy Started Flag 212 Immunotherapy 213 Hematologic Transplant And Endocrine Procedures 216 Systemic Treatment/Surgery Sequence 219 Date Other Treatment Started 221 Date Other Treatment Started Flag 222 Other Therapy 223 Section VIII Follow Up Information 226 Death Clearance Instructions 227 Date of Last Follow-Up or of Death 228 Date of Last Follow-Up or Death Flag 231 Vital Status 232 ICD Code Revision Used for Cause of Death 233 Underlying Cause of Death 234 Type of Follow-Up 236 Survival Data Items 237 Section IX Administrative Codes 238 Site/Type Interfield Review 239 Histology/Behavior Interfield Review 240 Age/Site/Histology Interfield Review 241 Sequence Number/Diagnostic Confirmation Interfield Review 242 Site/Histology/Laterality/Sequence Interrecord Review 243 Surgery/Diagnostic Confirmation Interfield Review 244 Type of Reporting Source/Sequence Number Interfield Review 245 Sequence Number/Ill-Defined Site Interfield Review 246 Leukemia or Lymphoma/Diagnostic Confirmation Interfield Review 247 Over-ride Flag for Name/Sex 248 Over-ride Flag for Site/Behavior (IF39) 249 Over-ride Flag for Site/EOD/Diagnosis Date (IF40) 250 Over-ride Flag for Site/Laterality/EOD (IF41) 251 Over-ride Flag for Site/Laterality/Morphology (IF42) 252 Over-ride Flag for TNM Tis 253 Over-ride Flag for Site/TNM-Stage Group 254 Table of Contents vii SEER Program Coding and Staging Manual 2018 Preface to the 2018 SEER Program Coding and Staging Manual The 2018 Surveillance, Epidemiology and End Results (SEER) Program Coding and Staging Manual may be downloaded in electronic format from the SEER website: http://www.seer.cancer.gov/tools/codingmanuals. Effective Date The 2018 SEER Program Coding and Staging Manual is effective for cases diagnosed January 1, 2018 and forward. Previous editions of this manual are available on the SEER website. Summary of Changes Extent of Disease and Summary Stage Beginning in 2018, Extent of Disease (EOD) and Summary Stage data items are being incorporated into cancer staging. Site-Specific Data Items Data items formerly referred to as site-specific factors (SSFs) were assigned to specific cancer sites. SSFs have been transitioned to individual data items called site-specific data items (SSDIs) that can be utilized across cancer sites in 2018. Solid Tumor Rules The 2018 SEER Multiple Primary/Histology Rules are