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SEER ProgramCoding and Staging Manual 2018Effective with cases diagnosed January 1, 2018Data Quality, Analysis, and Interpretation BranchSurveillance Research ProgramDivision of Cancer Control and Population SciencesNational Institutes of HealthPublic Health ServiceU.S. Department of Health and Human ServicesSuggested citation: Adamo M, Dickie L, Ruhl J. (January 2018). SEER Program Coding and Staging Manual2018. 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 2018SEER ProgramCoding and Staging Manual 2018AcknowledgementsSuzanne Adams, BS, CTRJudy Andrews BA, CTRRobin Billett, MA, CTRCarolyn Callaghan, BS, CTRJacque Clarken, BS, CTREileen Elido, CTRCarmela Groves, RN, MS, CTRStephanie Hill, MPHLoretta Huston, BS, CTRTiffany Janes, BA, CTRBobbi Jo Matt, BS, RHIT, CTRPatrick Nicolin, BA, CTRNektarios Pappas, MD, CTRLisa A. Pareti, BS, RHIT, CTRCathryn R. Phillips, BA, CTRElizabeth Ramirez-Valdez, CTRWinny Roshala, BA, CTRFrances E. Ross, BA, CTRCandis Sanders, BS, CTRChristina Schwarz, BA, CTRSteve Scoppa, BSSheree Serrian, BBA, RN, CTRLaine Suggs, CTRTaina Valone, RHIA, CTRKacey Wigren, RHIT, CTRInformation Management Services, IncSEER Georgia Cancer RegistrySEER Georgia Cancer RegistrySEER Seattle Cancer RegistrySEER Utah Cancer RegistrySEER Hawaii Cancer RegistryWestat, Inc.New Jersey State Cancer RegistrySEER Utah Cancer RegistrySEER Seattle Cancer RegistrySEER Iowa Cancer RegistryDetroit Metropolitan Cancer RegistrySEER Louisiana Cancer RegistrySEER Louisiana Cancer RegistrySEER Connecticut Cancer RegistrySEER New Mexico Cancer RegistrySEER Greater California Cancer RegistrySEER Kentucky Cancer RegistrySEER Georgia Cancer RegistrySEER Greater Bay Area Cancer RegistryInformation Management Services, IncSEER Georgia Cancer RegistrySEER New Mexico Cancer RegistrySEER Greater California Cancer RegistrySEER Utah Cancer RegistryCopyright Information: All material in this manual is in the public domain and may be reproduced or copiedwithout permission. We do request that you use a source citation.Acknowledgementsii

SEER Program Coding and Staging Manual 2018Table of ContentsPreface to the 2018 SEER Program Coding and Staging Manual1Effective Date1Summary of Changes1Submitting Questions3Collection and Storage of Date Fields4Transmission Instructions for Date Fields4SEER Site-Specific Factors 1 – 64Introduction5SEER Program5SEER Coding And Staging Manual Contents5Reportability6Dates of Diagnosis/Residency6Reportable Diagnosis List6Diagnosis Prior to Birth8Disease Regression8Reportable Examples8Non-Reportable Examples9Instructions for Reporting Solid Tumors9Cases Diagnosed Clinically Are Reportable9Brain or CNS Neoplasms9Casefinding Lists9Ambiguous Terminology10How to Use Ambiguous Terminology for Case Ascertainment11Instructions for Hematopoietic and Lymphoid Neoplasms13Changing Information on the Abstract14Determining Multiple Primaries15Solid Tumors15Hematopoietic and Lymphoid Neoplasms15Transplants15Section I Basic Record Identification17SEER Participant18Patient ID Number20Record Type21SEER Record Number22SEER Coding System--Original23SEER Coding System--Current24Table of Contentsiii

SEER Program Coding and Staging Manual 2018Section II Information Source25Type of Reporting Source26CoC Accredited Flag29Section III Demographic Information30First Name31Last Name32Place of Residence at Diagnosis33County35County at Diagnosis Geocode 1970/80/9036County at Diagnosis Geocode 200037County at Diagnosis Geocode 201038County at Diagnosis Analysis39Address at Diagnosis--State40State at Diagnosis Geocode 1970/80/9041State at Diagnosis Geocode 200042State at Diagnosis Geocode 201043Census Tract 201044Census Tract Certainty 201045Census Tract Poverty Indicator47Rural Urban Continuum 201348Rural Urban Commuting Area--Tract Level 200049Rural Urban Commuting Area--Tract-Level 201050Urban Rural Indicator Code--Tract Level 200051Urban Rural Indicator Code--Tract Level 201052Birthplace--State53Birthplace--Country54Date of Birth55Date of Birth Flag57Place of Death--State58Place of Death--Country59Age at Diagnosis60Race 1, 2, 3, 4, 561Race--NAPIIA66IHS Link68Spanish Surname or Origin69Computed Ethnicity71Computed Ethnicity Source72NHIA Derived Hispanic Origin73Table of Contentsiv

SEER Program Coding and Staging Manual 2018Sex74Marital Status at Diagnosis75Primary Payer at Diagnosis76Section IV Description of this Neoplasm78Date of Diagnosis79Date of Diagnosis Flag84Sequence Number--Central85Primary Site88Laterality92Diagnostic Confirmation95Morphology98Histologic Type ICD-O-399Behavior Code101Grade Clinical104Grade Pathological105Grade Post Therapy106Tumor Size--Clinical107Tumor Size--Pathologic110ICD-O-2 Conversion Flag114ICD-O-3 Conversion Flag115Section V Stage of Disease at Diagnosis116Stage Data Items117Lymphovascular Invasion118Mets at Diagnosis--Bone124Mets at Diagnosis--Brain126Mets at Diagnosis--Liver128Mets at Diagnosis--Lung130Mets at Diagnosis--Distant Lymph Node(s)132Mets at Diagnosis--Other134Extent of Disease Data Items136Extent of Disease Primary Tumor137Extent of Disease Regional Nodes138Extent of Disease Metastases139Summary Stage140Summary Stage 2018141Derived Summary Stage 2018142Section VI Stage-related Data Items143SEER Site-specific Factor 1144Table of Contentsv

SEER Program Coding and Staging Manual 2018Additional Stage-related Data Items for 2018145Section VII First Course of Therapy147First Course of Therapy148Date Therapy Initiated152Date Therapy Initiated Flag155Treatment Status156Date of First Surgical Procedure157Date of First Surgical Procedure Flag158Date of Most Definitive Surgical Resection of the Primary Site159Date of Most Definitive Surgical Resection of the Primary Site Flag160Surgery of Primary Site161Surgical Margins of the Primary Site163Scope of Regional Lymph Node Surgery165Date of Sentinel Lymph Node Biopsy169Date of Sentinel Lymph Node Biopsy Flag170Sentinel Lymph Nodes Examined171Sentinel Lymph Nodes Positive172Date of Regional Lymph Node Dissection174Date of Regional Lymph Node Dissection Flag175Regional Nodes Positive176Regional Nodes Examined179Surgical Procedure of Other Site182Reason for No Surgery of Primary Site184Date Radiation Started187Date Radiation Started Flag188Radiation Treatment Modality--Phase I, II, III189Radiation External Beam Planning Technique--Phase I, II, III190Radiation Sequence With Surgery193Reason for No Radiation195Date Systemic Therapy Started196Date Systemic Therapy Started Flag197Date Chemotherapy Started198Date Chemotherapy Started Flag199Chemotherapy200Date Hormone Therapy Started206Date Hormone Therapy Started Flag207Hormone Therapy208Date Immunotherapy Started211Table of Contentsvi

SEER Program Coding and Staging Manual 2018Date Immunotherapy Started Flag212Immunotherapy213Hematologic Transplant And Endocrine Procedures216Systemic Treatment/Surgery Sequence219Date Other Treatment Started221Date Other Treatment Started Flag222Other Therapy223Section VIII Follow Up Information226Death Clearance Instructions227Date of Last Follow-Up or of Death228Date of Last Follow-Up or Death Flag231Vital Status232ICD Code Revision Used for Cause of Death233Underlying Cause of Death234Type of Follow-Up236Survival Data Items237Section IX Administrative Codes238Site/Type Interfield Review239Histology/Behavior Interfield Review240Age/Site/Histology Interfield Review241Sequence Number/Diagnostic Confirmation Interfield Review242Site/Histology/Laterality/Sequence Interrecord Review243Surgery/Diagnostic Confirmation Interfield Review244Type of Reporting Source/Sequence Number Interfield Review245Sequence Number/Ill-Defined Site Interfield Review246Leukemia or Lymphoma/Diagnostic Confirmation Interfield Review247Over-ride Flag for Name/Sex248Over-ride Flag for Site/Behavior (IF39)249Over-ride Flag for Site/EOD/Diagnosis Date (IF40)250Over-ride Flag for Site/Laterality/EOD (IF41)251Over-ride Flag for Site/Laterality/Morphology (IF42)252Over-ride Flag for TNM Tis253Over-ride Flag for Site/TNM-Stage Group254Table of Contentsvii

SEER Program Coding and Staging Manual 2018Preface to the 2018 SEER Program Coding and Staging ManualThe 2018 Surveillance, Epidemiology and End Results (SEER) Program Coding and Staging Manual may bedownloaded in electronic format from the SEER website: ective DateThe 2018 SEER Program Coding and Staging Manual is effective for cases diagnosed January 1, 2018 andforward. Previous editions of this manual are available on the SEER website.Summary of ChangesExtent of Disease and Summary StageBeginning in 2018, Extent of Disease (EOD) and Summary Stage data items are being incorporated intocancer staging.Site-Specific Data ItemsData items formerly referred to as site-specific factors (SSFs) were assigned to specific cancer sites. SSFshave been transitioned to individual data items called site-specific data items (SSDIs) that can be utilizedacross cancer sites in 2018.Solid Tumor RulesThe 2018 SEER Multiple Primary/Histology Rules are referred to as the Solid Tumor Rules.The major changes and additions to the 2018 SEER Program Coding and Staging Manual includeReportabilityReportable and non-reportable examples moved to Appendix EAppendix E.1: Reportable ExamplesAppendix E.2: Non-reportable ExamplesAmbiguous Terminology Lists: Reference of Last Resort addedSections addedChanging Information on the AbstractSection VI: Stage-related Data ItemsData items addedSection II: Information SourceCoC Accredited FlagSection III: Demographic InformationCounty at Diagnosis AnalysisState at Diagnosis Geocode 1970/80/90State at Diagnosis Geocode 2000State at Diagnosis Geocode 2010Rural Urban Commuting Area--Tract Level 2000Rural Urban Commuting Area--Tract Level 2010Preface1

SEER Program Coding and Staging Manual 2018Urban Rural Indicator Code--Tract Level 2000Urban Rural Indicator Code--Tract Level 2010Place of Death--StatePlace of Death--CountrySection IV: Description of this NeoplasmGrade ClinicalGrade PathologicalGrade Post TherapySection V: Stage of Disease at DiagnosisExtent of Disease Primary TumorExtent of Disease Regional NodesExtent of Disease MetastasesSummary Stage 2018Derived Summary Stage 2018Section VII: First Course of TherapyDate of Most Definitive Surgical Resection of the Primary SiteDate of Most Definitive Surgical Resection of the Primary Site FlagDate of Sentinel Lymph Node BiopsyDate of Sentinel Lymph Node Biopsy FlagSentinel Lymph Nodes ExaminedSentinel Lymph Nodes PositiveDate of Regional Lymph Node DissectionDate of Regional Lymph Node Dissection FlagRadiation Treatment Modality--Phase I, II, IIIRadiation External Beam Planning Technique--Phase I, II, IIIReason for No RadiationSection VIII: Administrative CodesOver-ride Flag for Name/SexOver-ride Flag for TNM TisOver-ride Flag for Site/TNM-Stage GroupData items movedMoved from Stage of Disease at Diagnosis (separate 2016 document) to Description of this Neoplasm(main document)Tumor Size--ClinicalTumor Size--PathologicMoved from Stage of Disease at Diagnosis (separate 2016 document) to Stage of Disease at Diagnosis(main document)Lymphovascular InvasionMets at Diagnosis--BoneMets at Diagnosis--BrainMets at Diagnosis--LiverMets at Diagnosis--LungMets at Diagnosis--Distant Lymph Node(s)Mets at Diagnosis--OtherPreface2