Section II.1, Determining Reportability

II.1.3 Single and Multiple Primaries

The CCR has adopted the SEER policy for reporting whether lesions are single or multiple primaries. The policy states:

The determination of how many primary cancers a patient has is, of course, a medical decision, but operational rules are needed in order to ensure consistency of reporting by all participants. Basic factors include the site of origin, the date of diagnosis, the histologic type, the behavior of the neoplasm (i.e., in situ vs. malignant), and laterality....In some neoplasms...one must be careful since different histologic terms are used to describe progressive stages or phases of the same disease process.

Therefore, for purposes of statewide reporting, the following operational rules take precedence over the physician's determination of the number of primaries. Refer to Section V.1.2 for the rules for determining site. For determining histology, remember that differences in histologic type are based on the first three digits of the histology code except for lymphatic and hematopoietic cancers.

For cases diagnosed January 1, 2005 through December 31, 2006, apply the SEER Multiple Primary and Histology Rules as written in the SEER Program Coding and Staging Manual, 2004, pages 7-19 and 84-87. http://www.seer.cancer.gov/manuals/2004Revision 1/SPM_2004_maindoc.r1.pdf

Beginning with cases diagnosed 1/1/2007 forward, the CCR requires the use of the 2007 Multiple Primary and Histology Coding Rules. The 2007 Multiple Primary and Histology rules replace all previous multiple primary rules except those for benign brain/CNS and hematopoietic neoplasms. The rules are effective for cases diagnosed on or after January 1, 2007. Do not use these rules to abstract cases diagnosed prior to January 1, 2007. If there is a previously diagnosed cancer primary before January 1, 2007, do not change the previous primary based on the new rules. Use the new rules for any new tumor diagnosed after January 1, 2007, to determine if it is an additional primary. Refer to the SEER Multiple Primary and Histology Coding Rules Manual for specific instructions. http://www.seer.cancer.gov/tools/mphrules/mphrules_manual_01012007.pdf

Note: Use the 2007 Multiple Primary and Histology rules to determine the number of primaries to be abstracted. Do not use the Multiple Primary and Histology Rules to determine reportability, to stage or to assign grade.

II.1.3.1 Single Primaries.

For cases diagnosed prior to January 1, 2005, the following are to be considered single primaries:

A single lesion of one histologic type, even if the lesion crosses site boundaries (for definitions of site boundaries and histologic types, see Sections V.1 and V.3 respectively).
A single lesion with multiple histologic types (see Section V.3.3.3 for coding instructions).
A new cancer with the same histology as an earlier one, if diagnosed in the same site within two months.
Multiple lesions of the same histologic type, if diagnosed in the same site within two months. Furthermore, if one lesion has a behavior code of in situ and another a malignant behavior code, they are to be reported as a single primary whose behavior is malignant. (For definition of behavior codes, see Section V.3.4.)
Two lesions occurring within two months of each other in a single site are considered a single primary if one is reported as (adeno)carcinoma, NOS, and the other is a more specific type of (adeno)carcinoma. (For coding instructions, see Section V.3.3.3.2 .)

II.1.3.2 Multiple Primaries.

For cases diagnosed prior to January 1, 2005, the following are to be considered separate primaries:

A new cancer with the same histology and behavior as an earlier one, if diagnosed in the same site after two months, unless stated to be recurrent or metastatic.

Exception #1: For bladder cancers with site codes C67.0-C67.9 and morphology codes 8120 8130 and adenocarcinomas of the prostate (C61.9), a single report of the first invasive lesion only is required.

Exception #2: If there is an in situ followed by an invasive cancer in the same site more than two months apart, report as two primaries even if noted to be a recurrence. The invasive case must be diagnosed 1/1/95 or later. Effective with cases diagnosed January 1, 1998, and later, this also applies to bladder and prostate sites. For these two sites, the first invasive case must be diagnosed 1/1/98 and later. The purpose of this guideline is to ensure that a case is counted as an incidence case, i.e., invasive, when data are analyzed by the regional and central registry.

Multiple lesions of different histologic types in the same site, whether occurring simultaneously or at different times. (Note: Different histologic terms are sometimes used to describe progressive stages or phases of the same disease process.)
Multiple lesions of different histologic types in different sites.