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A separate abstract is generally prepared for each independent
cancer. Specific rules may modify that general rule for selected
sites. For example, in the SEER Program multiple neoplasms
of the urinary bladder are represented by a single summary
abstract since multiple tumors frequently occur in this site.
Skin cancers are also handled in this manner. However, for
most multiple primary tumors, each unrelated malignancy is
abstracted on a separate form.
The registry number for patients with multiple primary tumors
usually remains the same; a higher sequence number is assigned
for each new primary cancer. Sequence number indicates the
order in which a primary tumor is discovered in relation to
the total number of primaries for a given patient. For example,
the sequence number for the first of two primaries is 1; the
sequence number for the second of two primaries is 2. Each
primary is recorded on a separate abstract.
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Hospitals with cancer programs
approved by the Commission on Cancer of the American College
of Surgeons are required to register all carcinomas, sarcomas,
melanomas, leukemias, and lymphomas, i.e. all malignancies
with a behavior code of 2 or higher in the International
Classification of Diseases for Oncology, Third Edition,
(ICD-O-3). In situ cancers of the cervix are not reportable.
Basal and squamous cell cancers of the skin are also not
reportable, unless they are beyond localized at the time
of diagnosis. |
Benign tumors and borderline malignancies (behavior codes 0
and 1) also may be included in the registry. These diagnosis
are referred to as " reportable-by-agreement" cases.
Inconclusive diagnosis
To assist with vague or inconclusive diagnostic terms the
following terms indicate involvement. For example a probable
carcinoma of the lung.
| apparent(ly) |
appears to |
compatible with |
| consistent with |
favor(s) |
malignant appearing |
| most likely |
presumed |
probable |
| suspect(ed) |
suspicious (for) |
typical of |
The following terms are not to be interpreted as involvement:
| cannot be ruled out |
equivocal |
possible |
| potentially malignant |
questionable |
rule out |
| suggests |
worrisome |
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For example, a diagnosis of probable carcinoma
of the left lung would be abstracted as a lung primary. A
diagnosis of questionable carcinoma of the left lung with
brain metastasis would be abstracted, and the primary site
would be coded to an unknown primary. A possible carcinoma
is not reportable.
Changing the diagnosis
Over time, information may be added to the patient's
medical chart that was missing in the original record. Therefore,
it is the practice to accept the thinking and information
about the case based on the latest or most complete information.
Thus, it is acceptable to change the primary site, and histology,
as information becomes more complete, as long as the info
is supplementing the original diagnosis ie: site, histology
and stage is not changed as the tumor progresses.
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