Do not use the Solid Tumor Rules (STRs) for Tumors Described as Metastases.
The site-specific Solid Tumor Rules (STRs) should not be used for tumors described as metastases when identifying multiple primaries. It emphasizes that metastatic tumors in locations like bone, brain, liver, lung, and distant lymph nodes are not considered new primaries.
STRs should be applied only for recurrences following a disease-free interval, and metastatic lesions should be documented as metastases originating from the primary site, rather than as separate primary tumors.
Each site-specific module in the Solid Tumor Rules provides Multiple Primary Rules for recurrences, which can occur when a patient develops a new tumor after being clinically disease-free for different periods, distinct from being diagnosed with metastases. Do not apply the STRs when a patient shows persistent disease or cancer progression. If there is a recurrence of metastatic disease, document this in your text and include follow-up information about the type of recurrence or metastatic site. Make sure to update the primary abstract with the new findings and follow-up data.
Each site-specific chapter begins with a note that reads, “These rules are NOT used for tumor(s) described as metastases.” This means that a tumor in a metastatic site is not counted when determining if a patient has multiple primaries. Do not use the STR module in the Multiple Primary Rules (Unknown if Single or Multiple Tumors, Single Tumor or Multiple Tumors). If a patient is diagnosed with breast cancer and presents with metastatic cancer, it is not considered a second primary.
Example: A Tumor located in the left lung, diagnosed as metastatic breast cancer, does not count as a second primary. Do not use the Lung Solid Tumor Rules to determine if this is a new primary. If the patient is known to have a breast primary, the lung tumor is recorded as metastasis from that primary. If the patient is unknown to have a breast primary, then refer to the Breast Solid Tumor Rules, as the lung findings are stated to originate in the breast
Example: Liver metastases from breast cancer would not be counted as a second primary.
Do not count metastatic lesions when determining which module to use. Metastatic tumors include, but are not limited to:
• Bone
• Brain
• Chest wall
• Distant lymph nodes as identified in the Summary Staging Manual
• Liver
• Lung
• Peritoneum
· Bone marrow
In summary, when abstracting cancer cases, it is essential to remember that the site-specific Solid Tumor Rules (STRs) are not intended for tumors described as metastases. Metastatic lesions—such as those found in bone, brain, liver, lung, and distant lymph nodes—should be documented as metastases originating from the primary site, not as new primaries. The STRs should only be applied to recurrences following a disease-free interval, not to persistent or progressive disease. By following this guidance, abstractors will ensure accurate reporting and avoid misclassifying metastatic tumors as additional primaries, thereby supporting the integrity of cancer data collection and analysis.
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