This is a document containing changes only. Do not use in place of the Solid Tumor Rules.

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Changes across all site modules

  • References to "2007 MPH rules" changed to "MPH rules"; "2018 Solid Tumor Rules" changed to "Solid Tumor Rules"
  • References to "WHO 2010" updated to "5th edition"
  • "Site-specific modules" renamed "site groups"
  • All "Changes from 2007 MPH Rules" sections removed. Items in those sections were either deleted entirely or moved to the introduction.
  • Many "New for 2022", "New for 2023" sections removed or moved to introduction, as well as old notes
  • Equivalent or equal terms section: "Synchronous" added as an equivalent term with simultaneous
  • References to "NED" removed
  • Note moved from site groups to General Instructions: "Tables and rules refer to ICD-O rather than ICD-O-3. The version is not specified to allow for updates. Use the currently approved version of ICD-O."
  • Note about biomarkers moved from Introduction to H Rules in all site groups.
  • Note about coding histology from the most representative specimen moved to H rules.
  • Table Names added to headers
  • Coding Histology Section, #3B bullet 1: "pathologist" replaced by "surgeon"

General Instructions

  • Preface simplified
  • Sections added:
    • Cancer PathCHART Site-Morphology Combination Standards
    • Annual Updates
    • Solid Tumor Rules Site Groups by Diagnosis Year
  • Section removed: What You Need to Know About the Solid Tumor Rules (now covered in another section)
  • "How to use the Solid Tumor Rules" section: Redundant information removed; instructions simplified
  • "How to Use the Equivalent Terms and Definitions" section:
    • Bullet removed: Changes from the 2007 Multiple Primary and Histology Rules
    • Bullet added: Information on coding and important changes
  • "Timing Rules" section: 365 days changed to 1 calendar year
  • "Definitions" section: Entries updated: "Overlapping tumor", "unilateral"

Breast

Equivalent Terms and Definitions

  • Table 3: Specific Histologies, NOS/NST, and Subtypes/Variants:
    • "Adenomyoepithelioma with carcinoma 8983" row: Subtype/variant added: "Epithelial-myoepithelial carcinoma 8562"
    • "Metaplastic carcinoma NOS or of no special type (NST) 8575" row: Code for "Low grade adenosquamous carcinoma" corrected to 8570
    • New rows added:
      • "Neuroendocrine carcinoma NOS 8246/3" with subtype/variants:
        • "Carcinoma with neuroendocrine differentiation 8574/3"
        • "Large cell neuroendocrine carcinoma/large cell carcinoma 8013/3"
        • "Small cell neuroendocrine carcinoma/small cell carcinoma 8041/3"
      • "Neuroendocrine tumor NOS 8240/3" with subtype/variant 8249/3"
    • Row deleted: "Small cell carcinoma 8041" and subtype/variants" 8574/3 and 8246/3 (all moved to new NEC row)

Histology Coding Rules

  • Single Tumor: In Situ Only section:
    • "Subtypes/variants" removed from Note 2
    • Note 3 added regarding WHO in situ terms
  • Note added to H Rules that instruct to code the histology when one histology is present.

Colon

Equivalent Terms and Definitions

  • Introduction section: Information about GIST removed from note
  • Equivalent or Equal Terms section:
    • Examples added for "Carcinoma; adenocarcinoma" entry
    • Entries deleted:
      • Intramucosal, etc.
      • Serosa; visceral peritoneum
  • Terms that are not Equivalent or Equal section:
    • Sub-bullet added to "Carcinoma 8010; adenocarcinoma 8140" entry
    • Sub-bullet deleted from "Component…" entry
    • Second sentence deleted from "Exophytic and polypoid" entry
  • Table 1: Specific Histologies, NOS, and Subtypes/Variants: "Gastrointestinal stromal tumor 8936/3" row: Note changed to "Beginning with cases diagnosed 1/1/2021 forward, the word malignant is no longer required in order to be reportable."

Multiple Primary Rules

  • Added notes:
    • "Synchronous tumors are tumors existing at the same time; concurrent; prior to first course treatment, simultaneous"
    • "Separate/non-contiguous tumors are tumors that arise independently of each other"
  • Rule M3: Abstract a single primary when there is adenocarcinoma in situ and/or invasive in at least one polyp AND…
    • New bullet added: "Referred to as polyps carpeting the bowel, small bowel, intestines, etc."

Histology Coding Rules

  • "Coding Histology" section: Bullet added to Instruction #4: "Phenotype"
  • H Rule: Code low grade appendiceal mucinous neoplasm (LAMN) and high grade appendiceal mucinous neoplasm (HAMN) 8480/2 when…: Note 4 added

Head and Neck

Equivalent Terms and Definitions

  • "Equivalent or Equal Terms" section: Example added to "adenocarcinoma" bullet
  • Table 1: Tumors of Nasal Cavity, Paranasal Sinuses and Skull base
    • Rows added:
      • "HPV-related multiphenotypic sinonasal carcinoma 8483/3"
      • "SMARCB1-deficient sinonasal carcinoma 8044"
    • "Lymphoepithelial carcinoma 8082" row: Synonym added: "Sinonasal lymphoepithelial carcinoma"
    • "Mucosal melanoma 8720" row:
      • Note added
      • Subtype/variants added:
        • "Desmoplastic mucosal melanoma 8745/3"
        • "Mucosal lentiginous melanoma 8746/3"
        • "Nodular melanoma 8721/3"
    • "Squamous cell carcinoma 8070" row:
      • Subtype/variants added:
        • "HPV-associated squamous cell carcinoma 8085"
        • "HPV-independent squamous cell carcinoma 8086"
      • "DEK-AFF2 SCC" added as a synonym for 8072
      • "Carcinoma cuniculatum" added as a synonym for 8051
  • Table 2: Tumors of Nasopharynx
    • "Nasopharyngeal papillary adenocarcinoma 8260" row: Synonym added: "Low-grade nasopharyngeal papillary adenocarcinoma"
    • "Squamous cell carcinoma NOS 8070" row: Synonym added: "Nasopharyngeal carcinoma"
  • Table 3: Tumors of Pyriform Sinus, Hypopharynx, Larynx, Trachea, and Parapharyngeal Space
    • "Chondrosarcoma 9220/3" row: Subtype/variants added:
      • "Clear cell chondrosarcoma 9242/3"
      • "Dedifferentiated chondrosarcoma 9243/3"
    • "Squamous cell carcinoma (SCC) 8070" row: Synonym added: "Hybrid verrucous carcinoma"
  • Table 4: Tumors of Oral Cavity and Mobile Tongue
    • Rows added:
      • "Adenosquamous carcinoma 8560"
      • "Granular cell tumor 9580"
    • "Mucosal melanoma 8720" row:
      • Column 1 term updated from "Oral mucosal melanoma"
      • Synonym added: "Oral mucosal melanoma"
      • Subtype/variants added:
        • "Desmoplastic mucosal melanoma 8745/3"
        • "Mucosal lentiginous melanoma 8746/3"
        • "Nodular melanoma 8721/3"
    • "Squamous cell carcinoma 8070" row
      • Subtype/variants added:
        • "Basaloid squamous cell carcinoma 8083"
        • "Lymphoepithelial carcinoma 8082"
        • "Papillary squamous cell carcinoma 8052"
        • "Spindle cell squamous cell carcinoma 8074"
      • "Carcinoma cuniculatum" added as a synonym for 8051
  • Table 5: Tumors of the Oropharynx, Base of Tongue, Tonsils, Adenoids
    • "lateral wall of mesopharynx" added to C102
    • "posterior wall of mesopharynx" added to C103
  • Table 6: Tumors of Salivary Glands
    • "Acinic cell carcinoma 8550" row: Synonym deleted: "ACC"
    • "Adenocarcinoma 8140" row:
      • The term "Malignant dermal analogue tumor" removed from 8147
      • Subtype/variants removed:
        • "Cribriform adenocarcinoma 8201
        • "Large cell carcinoma NOS/large cell undifferentiated carcinoma 8012"
        • "Lobular carcinoma 8520"
        • "Mucinous cystadenocarcinoma 8470"
        • "Salivary duct carcinoma 8500" and all synonyms (moved to its own row)
        • "Undifferentiated carcinoma 8020" (moved to its own row)
    • "Secretory carcinoma 8502" row: "Microsecretory adenocarcinoma" added as a synonym
    • Rows added:
      • "Polymorphous adenocarcinoma 8525"
      • "Salivary duct carcinoma 8500" along with subtype/variants:
        • "Micropapillary salivary duct carcinoma 8265/3"
        • "Mucin-rich salivary duct carcinoma 8481/3"
        • "Oncocytic salivary duct carcinoma 8290/3"
        • "Sarcomatoid salivary gland carcinoma 8033/3"
      • "Undifferentiated carcinoma 8020/3"
  • Table 7: Tumors of Odontogenic and Maxillofacial Bone (Mandible, Maxilla)
    • "Ameloblastic carcinoma-primary type 9270/3" row: Synonym added: "Central intraosseous mucoepidermoid carcinoma"
    • "Sarcoma NOS 8800/3" row:
      • Note 1 updated
      • Subtype/variants added:
        • "Ameloblastic fibrosarcoma/ Ameloblastic fibrodentinosarcoma 9330/3"
        • "Chondrosarcoma, grade 1 9222/3"
        • "Chondrosarcoma, periosteal 9221/3"
        • "Clear cell chondrosarcoma 9242/3"
        • "Dedifferentiated chondrosarcoma 9243/3"
        • "Conventional osteosarcoma 9186/3"
        • "High-grade surface osteosarcoma 9194/3"
        • "Radiation-induced osteosarcoma 9184/3"
        • "Small cell osteosarcoma 9185/3"
        • "Telangiectatic osteosarcoma 9183/3"
        • "Rhabdomyosarcoma with TFCP2 rearrangement 8900/3"
  • Table 8: Tumors of Ear
    • Rows added:
      • "Ceruminous adenocarcinoma 8420/3"
      • "Middle ear neuroendocrine tumor 8240/3"
    • "Endolymphatic sac tumor 8140" row: Synonym added: "Middle ear adenocarcinoma"

Multiple Primary Rules

  • M Rule: Abstract multiple primaries when there are separate/non-contiguous tumors in any two of the following sites: Bullet added: "Aortic body C755 AND carotid body C754"

Histology Coding Rules

  • NEW H Rule in both Single Tumor and Multiple Tumors Abstracted as a Single Primary modules: When the diagnosis is carcinoma ex pleomorphic adenoma AND the histologic type of the malignant component is provided, code the malignant component.

Kidney

Equivalent Terms and Definitions

  • Introduction: Note 3 regarding urothelial carcinoma rewritten
  • Terms that are NOT Equivalent or Equal: Note 2 added to "Component is not equivalent to subtype/type/variant"
  • Table 1: Specific Histologies, NOS, and Subtypes/Variants
    • Row added: "Paraganglioma 8700/3"
    • "Renal cell carcinoma NOS 8312" row: "Renal cell spindle cell carcinoma" added as a synonym
  • Table 2: Neoplasms which are Not Reportable
    • "Oncocytic tumor, NOS (no code)" row: "Oncocytic tumor, low grade" added as a synonym

Lung

Equivalent Terms and Definitions

  • Equivalent or Equal Terms: Definition of NSCLC updated
  • Table 1: Coding Primary Site
    • Information in the intro text about lung anatomy moved to the table
    • "Lung NOS C349" row: Note updated
  • Table 2: Combination/Mixed Histology Codes
    • "Combined small cell carcinoma 8045" row: "NET" removed from "Small cell carcinoma"
    • "Adenocarcinoma with mixed subtypes 8255/3" row: Notes 3 and 4 added
  • Table 3: Specific Histologies, NOS, and Subtype/Variants
    • Important Note 1: Definition of NSCLC updated
    • "Epithelioid hemangioendothelioma 9133" row: "hemangioepithelioma" corrected to "hemangioendothelioma"
    • "Neuroendocrine tumor, NOS (NET) 8240" row: Synonym "Typical carcinoma" corrected to "Typical carcinoid"

Multiple Primary Rules

  • M Rule: Abstract multiple primaries when there is NEC/NET and small cell carcinoma: Rule rewritten
  • M Rule: Abstract a single primary when there are simultaneous multiple tumors in both lungs, same lung…: Note 3 rewritten as an exception

Histology Coding Rules

  • H Rule (in both Single Tumor and Multiple Tumors Abstracted as a Single Primary): Code the histology when only one histology is present: Note 5 added regarding carcinoma in situ NOS
  • H Rule: Code adenocarcinoma with mixed subtypes 8255…: Note 3 added regarding Cancer PathCHART
  • H Rule: Code the appropriate combination code when all tumors have multiple histologies…: Note 2 added regarding Cancer PathCHART

Malignant CNS

Equivalent Terms and Definitions

  • Table 3: Specific Histologies, NOS, and Subtypes/Variants
    • "Glioma, NOS 9380" row: Note 2 added
    • "Meningeal melanoma 8720" row: Subtype/variant removed: "Meningeal Melanomatosis 8728"
    • "Sarcoma NOS 8800" row:
      • Note 2 added
      • Subtype/variants added:
        • "Myxoid pleomorphic liposarcoma 8859"
        • "Round cell sarcoma with EWSR1-non-ETS fusion 9366"
        • "Sarcoma with BCOR genetic alterations 9268"
    • "Solitary fibrous tumor grade 3 8815/3" row: "/3" added to histology code 8815

Multiple Primary Rules

  • M Rule: Abstract a single primary when separate, non-contiguous tumors are Glioma NOS and a subtype/variant of Glioma NOS: Note 1 added

Histology Coding Rules

  • Priority Order for Using Documents to Identify Histology section: "imaging, histology from incisional biopsy" added to gray exception box

Melanoma

Equivalent Terms and Definitions

  • Introduction: Note 2 updated ("vulva" added to list)
  • Table 2: Specific Histologies, NOS, and Subtype/Variants
    • "Melanoma NOS 8720" row: Note 2 added

Multiple Primary Rules

  • M Rule: Abstract multiple primaries when melanomas are diagnosed more than 60 days apart: Example added

Non-Malignant CNS

Equivalent Terms and Definitions

  • Table 4: Non-Reportable Neoplasms: "Glomus tympanicum, glomus jugulare" row: Definitions and Sites updated.
  • Table 6: Specific Histologies, NOS, and Subtypes/Variants:
    • Row deleted: "Angiocentric glioma 9431/1" (moved to 9421 row as a subtype/variant)
    • Row added: "Low Grade glioma 9380/1"
    • "Diffuse astrocytoma, MYB- or MYBL1altered 9421/1" row: Subtype/variant added: "Angiocentric glioma / Angiocentric neuroepithelial tumor/ Monomorphous angiocentric glioma 9431/1"
    • "Hemangioma 9120/0" row: "Cavernous angioma" added as a synonym
    • "Papillary glioneuronal tumor 9509/1" row: "diffuse" added to Note 2
    • "Paraganglioma 8693/1" row: Note added
    • "Solitary fibrous tumor Grade 1 8815/1" row:
      • behavior code /1 added to histology code
      • Synonym added: "Solitary fibrous tumor/hemangiopericytoma Grade 2"

Multiple Primary Rules

  • New M Rule in both Single Tumor and Multiple Tumors sections: Abstract a single primary when a neoplasm is originally diagnosed as low-grade glioma and subsequently recurs in residual tumor with a more specific histology.

Histology Coding Rules

  • Priority Order for Using Documentation to Identify Histology: "imaging, histology from incisional biopsy" added to gray exception box

Other Sites

Equivalent Terms and Definitions

  • Equivalent or Equal Terms section: Deleted: "Basal cell carcinoma; basal cell adenocarcinoma (Prostate primaries only, both are coded 8147)"
  • Table 1: Paired Organs and Sites with Laterality: C413, C414 removed
  • Table 2: Mixed and Combination Codes: Row added: "Mixed acinar-ductal carcinoma 8552"
  • Table 4: Testis Histologies: "Germ cell tumor NOS 9064" row: "spermatocytic tumor NOS" added as a synonymous term for the subtype/variant 9063
  • Table 5: Esophagus Histologies: Row added: "Mucosal melanoma 8720/3"
  • Table 6: Stomach Histologies
    • Row added: "Intestinal-type adenoma, high grade 8144/2"
    • "Adenomatous polyp, high grade 8210/2" row: "Adenocarcinoma in situ in adenomatous polyp" added as a synonym
  • Table 7: Small Intestine and Ampulla of Vater Histologies
    • Row added: "Intestinal-type adenoma, high grade 8144/2"
    • Adenomatous polyp, high grade 8210/2 row: "Adenocarcinoma in situ in adenomatous polyp" added as a synonym
  • Table 8: Anus Histologies
    • Coding Note added
    • Row added: "Mucosal melanoma 8720/3"
  • Table 9: Liver and Intrahepatic Bile Duct Histologies: Coding Note added
  • Table 9a: Guidelines for Assigning Primary Site for Liver and Intrahepatic Bile Duct
    • Statement added: "Registrars are not required to review and re-code cases abstracted prior to 1/1/2024."
  • Table 10: Gallbladder and Extrahepatic Bile Duct Histologies: "Bile duct carcinoma 8160" row: Synonyms added:
    • "Adenocarcinoma, biliary type (extrahepatic cholangiocarcinoma)"
    • "Extrahepatic cholangiocarcinoma"
  • Table 11: Pancreas Histologies
    • "Intraductal oncocytic papillary neoplasm 8455/2" row: "/2" added to 8455
    • "Intraductal papillary mucinous neoplasm 8453" row: Note added
    • "Mucinous cystic neoplasm 8470" row: Note added
  • Table 17: Uterine Cervix Histologies: Coding note added
  • Table 18: Vagina Histologies
    • Coding note added
    • Row added: "Mucosal melanoma 8720/3"
  • Table 19: Vulva Histologies
    • Coding note added
    • Row added: "Mucosal melanoma 8720/3"
    • "Squamous cell carcinoma NOS 8070" row: Subtype/variants added:
      • "Differentiated vulvar intraepithelial neoplasm 8071/2; Squamous cell carcinoma keratinizing 8071/3"
      • "Squamous cell carcinoma, non-keratinizing 8072"
      • "Vulvar intraepithelial neoplasm grade 2/vulvar intraepithelial neoplasm grade 3 8077/2"
  • Table 22: Thymus Histologies
    • "Adenocarcinoma, NOS 8140" row:
      • "/3" behavior code added to subtype/variants 8144 and 8200
      • "/2" behavior code added to subtype/variant 8260
    • "Adenosquamous carcinoma 8560/3" row: "/3" behavior code added to histology
    • "Clear cell carcinoma 8310/3" row: "/3" behavior code added to histology
    • "Mucoepidermoid carcinoma 8430/3" row: "/3" behavior code added to histology
    • "Sarcomatoid carcinoma 8033/3" row: "/3" behavior code added to histology
    • "Squamous cell carcinoma NOS 8070" row: "/3" behavior code added to all subtype/variants
    • "Thymoma, NOS 8580/3" row: "/3" behavior code added to histology in column 1 and all subtype/variants
  • Table 23: Penis and Scrotum Histologies
    • C630 added
    • Coding note added
    • Row added: "Mucosal melanoma 8720/3"
    • "Squamous cell carcinoma, NOS 8070" row:
      • Note 3 added
      • Subtype/variant added: "Warty-basaloid carcinoma/Warty carcinoma 8054 (C60._ only)"
      • "Warty carcinoma" removed from 8051 and added to 8054

Histology Coding Rules

  • H Rule: Code the histology when only one histologic type is identified: Exceptions added

Urinary

Equivalent Terms and Definitions

  • "Multifocal/Multicentric Tumors of Urinary Sites section" simplified
  • Table 2: Specific Histologies, NOS, and Subtypes/Variants:
    • "Adenocarcinoma NOS 8140" row
      • Synonyms added:
        • "Carcinoma of Cowper glands"
        • "Carcinoma of Skene glands"
        • "Littre gland adenocarcinoma"
      • Synonym deleted: "Mixed adenocarcinoma" (moved to its own row)
    • "Malignant melanoma 8720/3" row:
      • Synonym added: "Mucosal melanoma"
      • Subtype/variants added:
        • "Mucosal lentiginous melanoma 8746/3"
        • "Nodular melanoma 8721/3"
    • "Urothelial carcinoma 8120" row:
      • Synonym added: "Diverticular carcinoma 8120/3"
      • Note added to synonym "Plasmacytoid urothelial carcinoma" to limit to cases dx’d prior to 2024
      • Note added to subtype/variant "Plasmacytoid urothelial carcinoma" to apply to cases dx’d 2024 forward
    • Rows added:
      • "Mixed adenocarcinoma 8323/3"
      • "Mixed neuroendocrine-non-neuroendocrine carcinoma 8154/3"
      • "Paraganglioma 8693/3"
  • Table 3: Non-Reportable Urinary Tumors: "Paraganglioma 8693/1" row: Note added: "(Cases diagnosed prior to 1/1/2021)"

Multiple Primary Rules

  • M Rule: Abstract multiple primaries when the patient has micropapillary urothelial carcinoma 8131/3 AND a urothelial carcinoma 8120/3: Rule now applies to all urinary sites (previously limited to bladder)
  • M Rule: Abstract a single primary when there are urothelial carcinomas in multiple urinary organs: "(with the exception of micropapillary)" added to Note 1
  • M Rule: Abstract multiple primaries when separate/non-contiguous tumors are two or more different subtypes/variants…: Note 2 added

Histology Coding Rules

  • Coding Histology section: Instruction #1, Example 2 removed (subsequent example renumbered)
  • H Rules: Code the subtype/variant when there is a NOS and a single subtype/variant of that NOS such as the following…
    • Bullet removed: "Small cell neuroendocrine carcinoma"
    • Bullets added: "Neuroendocrine carcinoma" and "Neuroendocrine tumor"
  • H Rule: Code mixed small cell carcinoma 8045 when the final diagnosis small cell neuroendocrine mixed with any other type of carcinoma (does not apply to sarcoma): References to subtype/variants of small cell carcinoma removed
  • NEW H Rule added to both Single Tumor and Multiple Tumors Abstracted as a Single Primary modules: Code combined large cell carcinoma 8013 when the final diagnosis is large cell neuroendocrine carcinoma and any other type of carcinoma (does not apply to sarcoma).