SE E R Sur vival Monograph 

Cancer Sur vival Among Adults: 

U.S. SEER Program, 1988-2001

Patient and Tumor Characteristics

Edited by:

Lynn A. Gloeckler Ries

John L. Young, Jr.

Gretchen E. Keel

Milton P. Eisner

Yi Dan Lin

Marie-Josephe D. Horner

Suggested Citation:

Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among 

Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH 

Pub. No. 07-6215, Bethesda, MD, 2007 .

Additional information and this monograph in PDF format with any errata are available on the SEER web site:

http://www.seer.cancer.gov
Acknowledgements:

The editors and authors would like to thank Kathleen Cronin, Eric Feuer, Leyda Su Ham, Nadia Howlader, 

Lan Huang, Carol Kosary, Denise Lewis, Angela Mariotto, Barry Miller, Antoinette Percy-Laurry, Marsha 

Reichman, and David Stinchcomb for reviewing this monograph. We are grateful to Peter McCarron, Trish 

Murphy, Hong Vo, and Philip Zimmerman who provided publication assistance. We also thank the SEERfunded organizations for providing high quality cancer survival data for this monograph. 
 

National Cancer Institute iii SEER Survival Monograph 

a dedicated pioneer in the field of cancer registration and surveillance

whose vision helped establish the blueprint for cancer control 

through an understanding of cancer incidence and survival

while caring about the patients behind the numbers.

Dedicated to

Dr. Charles Smart

Lynn & John
 

National Cancer Institute iv SEER Survival Monograph 

Charles R. Smart was a surgeon, innovator and a man to which faith and 

family mattered foremost. He served in the Army in World War II and 

graduated from Temple University School of Medicine. He worked as 

surgeon at UCLA Medical Center and became Chief of Surgery at Latter 

Day Saints Hospital (Salt Lake City) in 1975. He served as Director for 

the Cancer Division of the American College of Surgeons. He founded 

the Utah Cancer Registry, one of the earliest central cancer registries 

in the United States. In 1985, he became chief of the Early Detection 

Branch of National Cancer Institute. He was a founding member of the 

North American Association of Central Cancer Registries (NAACCR). 

He “fathered” cancer registry computer software, and published the 

first national data set standard. He received the 1996 David Rockefeller 

Spirit of Service Award for his volunteer work establishing registries in 

Ecuador and Hungary. 
Table of Contents 

National Cancer Institute v SEER Survival Monograph 

Chapter 1

Introduction

Lynn A. Gloeckler Ries, Marie-Josephe D. Horner, and

 John L. Young, Jr.

Introduction 1

Data Sources 1

Survival Methods 3

Discussion 5

Chapter 2

Cancers of the Head and Neck

Jay F. Piccirillo, Irene Costas, and 

Marsha E. Reichman

Introduction 7

Materials and Methods 7

Results 8

Discussion 20

Chapter 3

Cancers of the Esophagus, Stomach,

and Small Intestine

Charles Key and Angela L.W. Meisner

Introduction 23

Materials and Methods 23

Results 25

Discussion 32

Chapter 4

Cancers of the Colon and Rectum

Kevin C. Ward, John L. Young, Jr., and 

Lynn A. Gloeckler Ries

Introduction 33

Materials and Methods 33

Results 34

Discussion 41

Chapter 5

Cancer of the Anus

Margaret M. Madeleine and Laura M. Newcomer

Introduction 43

Materials and Methods 43

Results 44

Discussion 47

Chapter 6

Cancers of the Liver and Biliary Tract

Charles Key and Angela L.W. Meisner

Introduction 49

Materials and Methods 49

Results 50

Discussion 55

Chapter 7

Cancer of the Pancreas

Charles Key

Introduction 59

Materials and Methods 59

Results 60

Discussion 62

Chapter 8

Cancer of the Larynx

Jay F. Piccirillo and Irene Costas

Introduction 67

Material and methods 67

Results 68

Discussion 71

Chapter 9

Cancer of the Lung

Lynn A. Gloeckler Ries and Milton P. Eisner

Introduction 73

Materials and Methods 73

Results 74

Discussion 77

Chapter 10

Cancers of the Bone and Joint

Denise R. Lewis and Lynn A. Gloeckler Ries

Introduction 81

Materials and Methods 81

Results 82

Discussion 87

Chapter 11

Sarcomas

Lynn A. Gloeckler Ries, Kevin C. Ward, and 

John L. Young, Jr.

Introduction 89

Materials and Methods 89

Results 90

Discussion 91

Chapter 12

Melanoma

Myles Cockburn, David Peng, and Charles Key

Introduction 93

Materials and Methods 94

Results 95

Discussion 100
Table of Contents 

National Cancer Institute vi SEER Survival Monograph 

Chapter 13

Cancer of the Female Breast

Lynn A. Gloeckler Ries and Milton P. Eisner

Introduction 101

Materials and Methods 101

Results 102

Discussion 107

Chapter 14

Cancer of the Cervix Uteri

Carol L. Kosary

Introduction 111

Materials and Methods 111

Results 112

Discussion 121

Chapter 15

Cancer of the Corpus Uteri

Carol L. Kosary

Introduction 123

Materials and Methods 123

Results 124

Discussion 132

Chapter 16

Cancer of the Ovary

Carol L. Kosary

Introduction 133

Materials and Methods 133

Results 134

Discussion 144

Chapter 17

Cancer of the Placenta

Carol L. Kosary

Introduction 145

Materials and Methods 145

Results 145

Discussion 146

Chapter 18

Cancer of the Vulva

Carol L. Kosary

Introduction 147

Materials and Methods 147

Results 147

Discussion 153

Chapter 19

Cancer of the Vagina

Carol L. Kosary

Introduction 155

Materials and Methods 155

Results 156

Discussion 158

Chapter 20

Cancer of the Fallopian Tube

Carol L. Kosary

Introduction 161

Materials and Methods 161

Results 161

Discussion 164

Chapter 21

Cancer of the Testis

Mary L. Biggs and Stephen M. Schwartz

Introduction 165

Materials and Methods 165

Results 166

Discussion 167

Chapter 22

Cancer of the Prostate

Ann Hamilton and Lynn A. Gloeckler Ries

Introduction 171

Materials and Methods 171

Results 173

Discussion 179

Chapter 23

Cancer of the Urinary Bladder

Charles F. Lynch, Jessica A. Davila, and 

Charles E. Platz

Introduction 181

Materials and Methods 181

Results 182

Discussion 190

Chapter 24

Cancers of the Kidney and Renal Pelvis

Charles F. Lynch, Michele M. West,

Jessica A. Davila, and Charles E. Platz

Introduction 193

Materials and Methods 194

Results 194

Discussion 198
Table of Contents 

National Cancer Institute vii SEER Survival Monograph 

Chapter 25

Cancer of the Brain and 

Other Central Nervous System

Jill S. Barnholtz-Sloan, Andrew E. Sloan, and 

Ann G. Schwartz

INTRODUCTION 203

MATERIALS AND METHODS 203

RESULTS 204

DISCUSSION 214

Chapter 26

Cancer of the Thyroid

Carol L. Kosary

INTRODUCTION 217

MATERIALS AND METHODS 217

RESULTS 217

Chapter 27

Hodgkin Lymphoma

Christina Clarke, Cynthia O’Malley, and 

Sally Glaser

INTRODUCTION 227

MATERIALS AND METHODS 227

RESULTS 228

DISCUSSION 233

Chapter 28

Non-Hodgkin Lymphoma

Christina Clarke and Cynthia O’Malley

INTRODUCTION 235

MATERIALS AND METHODS 235

RESULTS 237

DISCUSSION 241

Chapter 29

Leukemia

Marie-Josephe D. Horner and Lynn A. Gloeckler Ries

INTRODUCTION 243

MATERIALS AND METHODS 243

RESULTS 244

DISCUSSION 249

Chapter 30

Cancers of Rare Sites

John L. Young, Jr., Kevin C. Ward, and 

Lynn A. Gloeckler Ries

INTRODUCTION 251

MATERIALS AND METHODS 251

RESULTS 251

DISCUSSION 261

Chapter 31

Race and Ethnicity

Limin X. Clegg and Lynn A. Gloeckler Ries

INTRODUCTION 263

MATERIALS AND METHODS 263

RESULTS 264

DISCUSSION 265
Table of Contents 

National Cancer Institute viii SEER Survival Monograph 
Chapter Contributors and Editors 

National Cancer Institute ix SEER Survival Monograph 

Jill S. Barnholtz-Sloan, PhD, MS

Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine; 

Cleveland, OH

Mary L. Biggs, PhD, MPH

Department of Biostatistics, School of Public 

Health and Community Medicine, 

University of Washington, Seattle, WA

Christina Clarke, PhD

Northern California Cancer Center; Fremont, CA;

Stanford University; Stanford, CA

Myles Cockburn, PhD

Department of Preventive Medicine, University 

of Southern California, Keck School of Medicine; 

Los Angeles, CA

Irene Costas, MPH

Clinical Outcomes Research Office, 

Department of Otolaryngology Head and Neck 

Surgery, Washington University School of Medicine; St. Louis, MO.

Jessica A. Davila, PhD

Section of Health Services Research, 

Department of Medicine, Baylor College of 

Medicine; Houston, TX

Milton P. Eisner, PhD

Cancer Statistics Branch, Surveillance Research 

Program, National Cancer Institute, NIH, DHSS; 

Bethesda, MD

Sally Glaser, PhD 

Northern California Cancer Center; Fremont, CA; 

Stanford University; Stanford, CA

Ann S. Hamilton, PhD

Preventive Medicine, Division of Epidemiology,

University of Southern California, Keck School of 

Medicine; Los Angeles, CA

Marie-Josephe D. Horner, MSPH

Cancer Statistics Branch, Surveillance Research 

Program, National Cancer Institute, NIH, DHSS; 

Bethesda, MD

Gretchen E. Keel, BS, BA

Information Management Services, Inc;

Silver Spring, MD

Charles R. Key, MD, PhD

Department of Pathology and New Mexico Tumor 

Registry, Cancer Research & Treatment Center 

The University of New Mexico School of Medicine; Albuquerque, NM

Carol L. Kosary, MA

Cancer Statistics Branch, Surveillance Research 

Program, National Cancer Institute, NIH, DHSS; 

Bethesda, MD

Denise R. Lewis, PhD

Cancer Statistics Branch, Surveillance Research 

Program, National Cancer Institute, NIH, DHSS; 

Bethesda, MD

Yi Dan Lin

School of Medicine, Monash University; Melbourne, Australia

Charles F. Lynch, MD, PhD

Department of Epidemiology, 

The University of Iowa; Iowa City, IA

Margaret M. Madeleine, PhD, MPH

Program in Epidemiology, Public Health Sciences 

Division, Fred Hutchinson Cancer Research Center; Seattle, WA

Angela L.W. Meisner, MPH

Department of Pathology, and Division of 

Cancer Epidemiology, Cancer Center, 

University of New Mexico School of Medicine; 

Albuquerque, NM

Laura M. Newcomer, PhD

Program in Epidemiology, Public Health Sciences 

Division, Fred Hutchinson Cancer Research 

Center; Seattle, WA

Cynthia O’Malley, PhD

Formerly with Northern California Cancer Center; Fremont, CA; Dr. O’Malley is currently with 

Global Biostatistics and Epidemiology, Amgen, 

Inc.; Thousand Oaks, CA
Chapter Contributors and Editors 

National Cancer Institute x SEER Survival Monograph 

David Peng, MD, MPH

Department of Dermatology, University of 

Southern California, Keck School of Medicine, 

and Norris Cancer Center; Los Angeles, CA

Jay F. Piccirillo, MD

Clinical Outcomes Research Office

Department of Otolaryngology-Head and Neck 

Surgery, Washington University School of Medicine; St. Louis, MO

Charles E. Platz, MD

University of Iowa College of Medicine; 

Department of Epidemiology, College of Public 

Health, University of Iowa; Iowa City, IA

Marsha E. Reichman, PhD, MS

Cancer Statistics Branch, Surveillance Research 

Program, National Cancer Institute, NIH, DHSS; 

Bethesda, MD

Lynn A. Gloeckler Ries, MS

Cancer Statistics Branch, Surveillance Research 

Program, National Cancer Institute, NIH, DHSS; 

Bethesda, MD

Ann G. Schwartz, PhD, MPH

Department of Internal Medicine, Karmanos Cancer Institute, Wayne State University School of 

Medicine; Detroit, MI

Stephen M. Schwartz, PhD

Program in Epidemiology, Division of Public 

Health Sciences, Fred Hutchinson Cancer Research Center; Seattle, WA

Andrew E. Sloan, MD, FACS

Department of Neurosurgery, University Hospital 

of Cleveland-Case Western University Medical 

School; Cleveland, OH

Kevin C. Ward , MPH

Georgia Center for Cancer Statistics, Rollins 

School of Public Health, Emory University; 

Atlanta, GA

Michele M. West, PhD

Department of Epidemiology, The University of 

Iowa; Iowa City, IA

John L. Young, Jr., DrPH, CTR

Georgia Center for Cancer Statistics, Rollins 

School of Public Health, Emory University; 

Atlanta, GA
National Cancer Institute 1 SEER Survival Monograph 

Introduction

The Surveillance, Epidemiology, and End Results (SEER) 

Program of the National Cancer Institute (NCI) has devoted 

this monograph to examining cancer survival by patient 

and tumor characteristics for cancers diagnosed during the 

period 1988-2001. The analyses focus on cancer survival 

in adults aged 20 years and older, with the exceptions of 

acute lymphoblastic leukemia (all ages), placenta (ages 

15+), and Hodgkin lymphoma (ages 15+). This chapter 

describes the sources of the data and the methods used. It 

also provides a summary of the results. Each subsequent 

chapter focuses on a distinct anatomical site and associated histologies. 

Data Sources

Surveillance, Epidemiology, and End Results 

(SEER) Program

The Surveillance, Epidemiology, and End Results (SEER) 

Program was established in 1973 as part of the National 

Cancer Institute (NCI). A sequel to two earlier NCI initiatives (the End Results Program and the Third National 

Cancer Survey), the SEER Program has evolved in response to the mandate of the National Cancer Act of 1971, 

which requires the collection, analysis, and dissemination 

of data relevant to the prevention, diagnosis, and treatment of cancer. The SEER Program (http://seer.cancer.

gov) collects cancer incidence, treatment, and survival 

data which are used to monitor the burden of cancer on 

the population of the United States. The NCI contracts 

with medically-oriented nonprofit institutions, such as 

universities and state health departments, to obtain data 

on all in situ and invasive cancers diagnosed in residents 

of the SEER geographic areas, except for basal cell and 

squamous cell carcinomas of the skin and in situ cervical cancer. 

The analyses in this monograph are based on data from 

12 geographic areas representing approximately 14% of 

the United States population: the States of Connecticut, 

Iowa, New Mexico, Utah, and Hawaii; the metropolitan 

areas of Detroit, Atlanta, San Francisco, San Jose, Los 

Angeles, and Seattle; and ten counties in rural Georgia. 

Cases were diagnosed during the period 1988-2001 and 

followed through 2002. All registries contributed data for 

diagnosis years 1988-2001, except Los Angeles, which 

contributed data for 1992-2001. 

Lynn A. Gloeckler Ries, Marie-Josephe D. Horner, and

 John L. Young, Jr.

Chapter 1

Introduction

Table 1.1: All Cancers: Number of Cases and Exclusions, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number Excluded Reason for Exclusion/Selection

2,246,603 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

1,925,529 321,074 Select first primary only

1,901,067 24,462 Exclude death certificate only or at autopsy

1,874,432 26,635 Exclude unknown race

1,870,229 4,203 Active follow-up and exclude alive with no survival time

1,846,162 24,067 Exclude children (000-019)

1,736,210 109,952 Exclude in situ cancers for all except breast & bladder cancer

1,660,376 75,834 Exclude no or unknown microscopic confirmation

1,629,964 30,412 Exclude sarcomas
Chapter 1 Introduction

National Cancer Institute 2 SEER Survival Monograph 

A total of 1,629,955 primary cancers were used in analyses. 

Survival rates are calculated on demographic and tumor 

information. Cases of second or later primaries, cases 

identified by death certificate or autopsy only, cases of 

unknown race, and those alive with no follow-up were 

excluded from the analysis (Table 1.1). 

The SEER data are available for analyses by researchers. 

See www.seer.cancer.gov for further information.

SEER*Stat Software

The SEER*Stat statistical software, a convenient, intuitive mechanism for the analysis of SEER and other 

cancer-related databases, was used for analyses. It is a 

powerful PC tool to view individual cancer records and 

to produce statistics for studying the impact of cancer 

on a population. It is available at the following website: 

http://seer.cancer.gov/seerstat/

Tumor Information

The SEER program collects the month and year of diagnosis, primary tumor site, behavior, histology, extent of 

disease at diagnosis, and, starting in 1990, breast cancer 

receptor status. The International Classification of Diseases for Oncology, 2nd edition (ICD-O-2) (1) was the 

standard reference for classifying primary site, histology, 

behavior and grade. The ICD-O-2 tumor site and morphology codes allow for precise coding of tumor location 

(including sub-location within an organ) and histology. 

For 2001 cases, the third edition of ICD-O (ICD-O-3) 

was used and all prior histology data were converted to 

ICD-O-3 (2).

The histologic grade of malignant tumors is also collected: 

grade I is well differentiated; grade II is moderately differentiated; grade III is poorly differentiated, and grade 

IV is undifferentiated or anaplastic (1, 2). For leukemias 

and lymphomas, the grade code can reflect T-cell, B-cell, 

and N-K cell phenotype.

Extent of Disease

SEER has collected extent of disease (EOD) information 

on all cancers since the inception of the program. Extent 

of disease information since 1988, consists of five data 

items: tumor size where applicable, extension (within 

the primary site or contiguous or metastatic), highest involved lymph node chain, number of regional lymph nodes 

found positive (with certain exceptions), and number of 

regional nodes examined (with certain exceptions). The 

extension and lymph node fields are specific to the site of 

the primary tumor. The detail and amount of information 

collected for EOD have varied over time. 

Stage

Stage of disease is determined from EOD information. 

In this monograph several different staging systems were 

used depending on the extent of disease information available. The American Joint Committee on Cancer’s (AJCC) 

Staging Manual for the third edition (3), the fifth edition 

(4), and sixth edition (5) TNM: tumor size/extent (T), 

node involvement (N), and distant metastases (M) and 

then combines TNM into stages. Sometimes additional 

information is needed such as grade. 

Since 1988, the tumor extension information in EOD is 

collected utilizing only one variable (except for prostate 

since 1995) and is based on the best information available 

on the furthest extension of the tumor. For some AJCC 

schemas, there is both a clinical T and a pathologic T. 

Therefore, in the conversion from EOD to AJCC, the T 

information is based on a combination of clinical and 

pathologic information. If there are distant metastases, 

the SEER EOD conversion will be TX M1, i.e. the T 

information is not recorded. Similarly, if distant nodes 

are involved, the information on regional nodes is not 

recorded in SEER. For many primary sites AJCC tumor 

extension classifications can range from T0 to T4 with 

subcategories, node involvement classifications can range 

from N0 to N3 with subcategories, and metastasis classifications can range from M0 to M1. The AJCC T, N, 

and M are then combined into stage ranging from Stage 

0 through Stage IV. There are some primary sites for 

which there is no TNM and/or no AJCC stage. For all 

cancer sites except bladder and breast, in situ lesions 

were excluded from the analyses. For most cancer sites, 

this means that Stage 0 is excluded, but for breast and 

colon/rectum, Stage 0 includes more than in situ alone. 

For colon/rectum, Stage 0 also includes cases confined 

to the lamina propria with no nodes and for breast, Paget 

disease with no underlying tumor. 

To perform the analyses in this monograph covering data 

from 1988-2001, it was necessary to achieve consistency of 

the stage variable over time. Changes to EOD were made 

in 1988 to be compatible with the AJCC third edition. 

In 1998, some of the EOD schemas were changed to be 

compatible with the fifth edition of AJCC so that SEER 

EOD information could be easily converted into the TNM 

staging classifications based on the fifth edition of the 

AJCC Manual for Staging of Cancer. Therefore, depending 
Chapter 1 Introduction

National Cancer Institute 3 SEER Survival Monograph 

on the cancer site and the changes between the third and 

fifth editions of AJCC, some chapters present data according to the AJCC third, AJCC fifth, or a different stage 

definitions (see below). Except for lymphomas, the AJCC 

staging criteria were applied to all histologies for each 

primary site. In some chapters, a SEER modified AJCC

stage was used. The main difference between the SEER 

modified and AJCC versions, is that NX was combined 

with N0 in the conversion of TNM to AJCC stage. 

SEER has also used a more simplistic stage with five levels: 

In situ tumors are those that have not yet broken through 

the adjacent basement membrane. For most cancer sites 

treated in this monograph, in situ tumors are excluded 

from the analysis; the urinary bladder and the female 

breast are exceptions. The term localized describes tumors, 

regardless of size, that are confined to the organ of origin. 

Regional tumors are those that have metastasized to the 

regional lymph nodes or have extended directly from the 

organ of origin. Distant describes a tumor whose metastases have traveled to other parts of the body. (Leukemia 

and myeloma are considered distant at diagnosis.) When 

information is not sufficient to assign a stage, a cancer is 

said to be Unstaged or Unknown. Most of the chapters 

which use stages of localized, regional, and distant are 

based on the SEER Summary Stage (1977) (6). Based 

on the same principles as Summary Stage 1977, SEER 

has used more historical definitions that are more consistent over time for historical trends back to 1973. In a 

few places the SEER historic stage is used. The SEER 

Summary Staging Manual 2000 lists the definitions for 

SEER Summary Stage 2000 and in the footnotes for each 

site describes how the SEER Summary Stage 1977 and 

the SEER historic stage differ from it (7).

Survival Methods

The observed survival rate, obtained using the actuarial 

(life table) method, is the proportion of cancer patients 

surviving for a specified time interval after diagnosis. 

The expected survival rate for a hypothetical cohort of 

persons of the same sex, age, and race as the patient 

cohort is the proportion, based on the 1990 life table, of 

the given cohort that will survive to the end of the given 

time interval. For some sites, median survival times are 

presented. The median survival time is based on the observed survival rate and is defined as the point at which 

50% have died and 50% are alive.

Most of the survival analyses in this monograph is based 

on the relative survival rate (8), except in Chapter 31 

on race and ethnicity, where the cause-specific survival 

rate (9) is used. 

Relative survival is a net survival measure representing 

cancer survival in the absence of other causes of death. 

Relative survival is defined as the ratio expressed as a 

percent, of the proportion of observed survivors in a coTable 1.2: Ten Most Common Cancer Sites: 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival Rates by Site, Ages 20+, 12 SEER Areas, 

1988-2001

Site Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Percent Percent Percent Percent Percent Percent

All sites (except male and 

female breast in situ) 1,584,884 100.0 79.5 72.3 68.7 64.4 60.6 58.6

Prostate 275,280 17.4 100.0 99.5 98.9 97.6 94.5 91.7

Breast (female, in situ) 44,875 2.8 100.0 100.0 100.0 100.0 100.0 100.0

Breast (female, invasive) 257,888 16.3 97.8 94.8 91.9 87.1 81.9 79.2

Lung 201,067 12.7 42.6 25.9 20.0 15.5 12.4 11.0

Colon/Rectum 182,589 11.5 83.3 75.1 69.9 63.6 59.2 57.7

Melanoma 55,039 3.5 97.1 94.4 92.4 90.0 88.2 87.9

Urinary Bladder 67,528 4.3 91.5 87.1 84.8 81.9 78.9 77.4

Non-Hodgkin Lymphoma 65,932 4.2 74.2 66.3 62.1 56.3 49.9 47.0

Uterine Corpus 48,642 3.1 93.5 89.5 87.0 84.7 83.1 82.6

Leukemia (all ages) 42,678 2.7 67.0 58.0 53.4 47.2 40.7 38.1

Kidney and Renal Pelvis 32,583 2.1 80.8 73.8 70.4 65.5 60.9 57.9
Chapter 1 Introduction

National Cancer Institute 4 SEER Survival Monograph 

relative survival rates are presented for some sites conditioned on specific times after diagnosis. For some sites 

where survival is very poor, the eight year survival rate 

may obscure that for the small group of patients who have 

already survived 3 years, their probability of surviving the 

next 5 years may be quite high.

For certain racial and ethnic groups, the life tables that 

are typically used for calculating expected survival do not 

accurately represent the experience of that specific racial/

ethnic population. Since the calculation of relative survival 

rates needs accurate life tables, the relative survival rates 

are not shown for race/ethnic groups other than white or 

black in the individual site chapters. In order to present 

information for race/ethnic groups other than white patients 

or black patients, a cause-specific (c-s) survival rate was 

used. Since survival calculated under different methods 

can not be compared to one another, the survival rates for 

more specific racial/ethnic groups were put in a special 

chapter on race-and-ethnicity, Chapter 31. The c-s rate is 

dependent on knowledge not only of the date of death but 

also accurate information on the cause of death. The c-s 

rate is similar to the observed survival rate except that only 

patients who died of their cancer are considered as deaths 

and patients who died of other causes are ‘censored’ at the 

time of death. This method avoids problems of finding appropriate expected survival rates which are needed for the 

relative survival rate, but is dependent on which cause of 

deaths are considered due to the cancer. The cause-specific 

rate, however, is dependent on accurate cause of death (COD) 

information. When the population used in calculating the 

expected survival is similar to the population of cancer 

patients except for the latter’s cancer experience, the relative survival rate and the cause-specific survival rate will 

hort of cancer patients (the observed survival rate defined 

above) to the proportion of expected survivors (the expected 

survival rate defined above). Thus, a relative survival of 

100% means that a cancer patient cohort is just as likely 

to survive the given interval as a cohort in the general 

population of the same sex, age, and race. It does not mean 

that everyone will survive their cancer. For example, in 

a group of screening found cancers, many of the people 

seek medical care on a more routine basis than the general 

population and may have better non-cancer survival than 

the general population. In this case the expected life table 

is too low which makes the relative rate too high. On the 

other hand, lung cancer patients who smoke may be at 

excess risk of dying of other smoking related causes than 

the general population and the calculated expected rate 

would be too high which means that the relative survival 

rate may be lower than it would be if life tables based on 

smoking could be used.

While many times 5-year relative survival rates are presented, a five year rate may be less informative than a 

survival rate over a shorter time frame for a site or group 

with poor survival or over a longer time frame for a site or 

characteristic with good survival. Up to 10-year survival 

rates are shown for many sites. 

The conditional survival rate, while difficult to explain, 

may be the most clinically informative of the survival rates. 

Instead of evaluating survival from diagnosis, for example 

a 5-year relative survival rate from diagnosis, the conditional survival rate can start anytime after diagnosis, i.e., it 

is conditioned on the cohort surviving to that point of time 

and then a survival rate is calculated for the patients who 

have survived to that point. For this monograph, 5-year 

Table 1.3: Ten Most Common Cancer Sites: Five-Year Relative Survival Rates by Sex and Race, Ages 20+, 12 SEER Areas, 

1988-2001

Site Total Male Female

White 

Male

White 

Female

Black 

Male

Black 

Female

All sites (except male and female Breast in 

situ) 64.4 63.6 65.3 65.3 66.5 55.8 52.9

Prostate 97.6 97.6 n/a 98.4 n/a 93.5 n/a

Breast (female, in situ) 100.0 n/a 100.0 n/a 100.0 n/a 100.0

Breast (female, invasive) 87.1 n/a 87.1 n/a 88.3 n/a 74.5

Lung 15.5 13.6 18.0 13.9 18.4 10.9 15.0

Colon/Rectum 63.6 63.7 63.5 64.6 64.4 55.3 54.9

Melanoma 90.0 88.2 92.1 88.4 92.4 70.1 76.3

Urinary Bladder 81.9 84.0 75.9 84.8 77.3 69.3 55.4

Non-Hodgkin Lymphoma 56.3 52.5 60.9 53.4 61.5 43.4 54.8

Uterine Corpus 84.7 n/a 84.7 n/a 86.4 n/a 61.8

Leukemia (ages 0-19 and 20+) 47.2 48.0 46.2 49.6 47.6 37.2 37.9

Kidney and Renal Pelvis 65.5 65.2 66.0 65.9 66.2 61.4 64.8
Chapter 1 Introduction

National Cancer Institute 5 SEER Survival Monograph 

be nearly equal. That is, the relative survival rate closely 

indicates the probability that a patient will not die due to 

cancer-related causes within the given time interval. When 

the population used for the expected survival is dissimilar 

to the population of cancer patients, the relative survival 

may differ from the cause-specific survival rate by tumor 

and patient characteristics. Comparisons of survival rates 

should be based on the same survival method for calculating rates. 

Results

Relative survival up to 10 years after diagnosis of invasive 

cancer is shown in Table 1.2 for patients diagnosed in the 

12 SEER catchment areas during 1988-2001. Survival rates 

vary substantially according to the cancer site. Among 

the most frequently diagnosed cancers, the sites with the 

highest 10-year relative survival rates are prostate, female 

breast in situ, uterine corpus, and melanoma, which have 

10-year relative survival rates of 83% (uterine corpus) to 

100% (female breast in situ). Lung cancer has the least 

favorable survival across the 10-year period following diagnosis (11%). 

Survival by sex and race is presented in Table 1.3 for select 

cancer sites. For all cancers combined, excluding male 

and female breast in situ, there is only a small difference 

by sex in terms of 5-year relative survival rates. However, a survival advantage by sex varies by cancer site as 

well as within race groups. For example, five-year survival 

for non-Hodgkin lymphoma among white women is 62% 

compared to 53% in white males. Among black women 

the non-Hodgkin lymphoma 5-year survival rate (55%) is 

twelve percentage points higher than in black men (43%).

Among white males, the 5-year relative survival rate for 

urinary bladder is 85% compared to 77% in white females. 

Blacks seem to fare worse with this disease, where the 

5-year survival rate is 69% among black males and 55% 

among black females. 

Survival by summary stage is presented in Table 1.4 for 

select cancers. The differences in 5-year survival by stage 

are notable. The earlier the stage at diagnosis, the more favorable is the 5-year survival. For screenable cancer sites, 

survival ranges from 91% at localized stage to 9% at distant 

stage for colorectal cancer, and 97% at localized stage to 

24% at distant stage for female invasive breast cancer. Other 

cancer sites are as extreme in terms of survival by stage of 

diagnosis (urinary bladder, melanoma). 

Discussion

Many times in population-based statistics the emphasis 

is on incidence and mortality statistics. While these are 

important in measuring cancer, they are not as relevant to 

the medical community concerned about prognosis. The 

focus of this monograph is to present descriptive analyses 

of cancer survival by patient and tumor characteristics. 

Since the emphasis is on the influence of patient and tumor 

characteristics on survival and not on how survival rates 

have changed over time, a discussion of biases in survival 

trends is not presented here. See the introduction of the 

SEER Cancer Statistics Review for a discussion of survival 

biases (10). In comparing any two groups, one should 

consider whether any differences in survival may be due 

to the two groups being different by some other characteristic than the comparison. For example, in a cohort of 

patients over 85 years of age, due to co-morbid conditions 

some may not have had as extensive staging work-up as a 

younger age group.

Table 1.4: Number of Cases by Leading Cancer Site and Stage at Diagnosis, 5-Year Relative Survival Rates, Ages 20+, 12 SEER 

Areas, 1988-2001

Site

Relative Survival

Localized

5-year 

percent 

(localized) Regional 

5-year 

percent 

(regional) Distant

5-year 

percent 

(distant) Unstaged

Prostate @ @ 236,377 100.0 17,953 35.8 20,950

Breast (female, invasive) 160,105 97.4 78,299 79.2 14,359 24.4 5,125

Lung 32,709 50.5 75,551 15.8 78,510 1.9 14,297

Colon/Rectum 70,343 90.6 69,942 66.2 34,756 9.4 7,548

Melanoma 44,969 97.2 5,869 61.1 1,931 14.6 2,270

Urinary Bladder 50,331 93.9 12,686 48.5 2,166 5.8 2,345

Non-Hodgkin Lymphoma 19,971 69.4 9,098 61.1 30,468 44.3 6,395

Uterine Corpus 35,646 95.7 7,237 66.2 3,993 26.0 1,766

Kidney and Renal Pelvis 17,591 90.4 7,316 60.2 6,598 8.2 1,078

 @ Local combined with Regional for Prostate
Chapter 1 Introduction

National Cancer Institute 6 SEER Survival Monograph 

The analyses presented in this monograph did not test for 

statistical significance of observed differences between 

population groups, therefore neither confidence intervals 

nor p- values are provided. Any comparisons of survival 

rates between age, sex, race groups, or tumor characteristics are based on point estimates, and thus, issues related 

to small case numbers need to be considered when making or interpreting comparisons. The numbers of cases are 

given in most cases so that one has a general idea about 

the variability of the point estimates. Survival rates were 

not calculated for fewer than 25 cases.

An attempt was made to include all cancer sites. A chapter 

on rare cancers contains information on cancers not included 

in the site-specific chapters.

REFERENCES

1. Percy C, Van Holten V, Muir C, editors. International 

classification of diseases for oncology, 2nd ed. Geneva: World 

Health Organization; 1990.

2. Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin 

DM, Whelan S. International Classification of Diseases for 

Oncology--Third Edition. Geneva: World Health Organization, 

2000.

3. Beahrs, OH, Henson DE, Hutter RVP, Myers MH (eds). AJCC 

Cancer Staging Manual, Third edition. American Joint Committee 

on Cancer. Philadelphia: Lippincott, 1988.

4. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy BJ, 

Murphy, GP, O’Sullivan, B, Sobin LH and Yarbro, JW (eds) 

AJCC Cancer Staging Manual, Fifth Edition, Lippincott-Raven, 

Philadelphia, 1998.

5. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller 

DG, Morrow M (eds). AJCC Cancer Staging Manual, Sixth 

edition. American Joint Committee on Cancer. New York: 

Springer 2002.

6. Shambaugh, EM, Weiss, MA. Axtell, LM (eds), The 1977 

Summary Staging Guide for the Cancer Surveillance, 

Epidemiology and End Results Reporting Program. National 

Cancer Institute, SEER Program, Bethesda, MD, April 1977.

7. Young JL Jr, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA (eds). 

SEER Summary Staging Manual – 2000; Codes and Coding 

Instructions, National Cancer Institute, NIH Pub. No. 01-4969, 

Bethesda, MD, 2001.

8. Ederer F, Axtell LM, Cutler SJ. The relative survival rate: a 

statistical methodology. J Natl Cancer Inst Monogr 1961;6:101 

121.

9. Clegg LX, Li FP, Hankey BF, Chu K, Edwards BK. Cancer 

survival among US whites and minorities: a SEER (Surveillance, 

Epidemiology, and End Results) Program population-based study. 

Arch Intern Med 2002;162:1985-1993.

10. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer 

EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, 

Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

submission, posted to the SEER web site, 2006.
National Cancer Institute 7 SEER Survival Monograph 

Introduction

This chapter provides survival analyses for 40,811 histologically confirmed adult cases of cancers of the head and 

neck obtained from the Surveillance, Epidemiology, and 

End Results (SEER) Program of the NCI. These cases 

included cancers of the lip, oral cavity, oropharynx, hypopharynx, tonsil, salivary glands, nasopharynx, nose, paranasal sinus, and middle ear. The tumors in this chapter all 

originate from the lining of the upper aerodigestive tract. 

The cell type of origin for the vast majority of patients is 

squamous cell. However, this is not the case for cancers 

of the paranasal sinus and salivary gland cancers, which 

are primarily of mixed cell types. Head and neck cancers 

can be divided into several groups. Epidemiologists often 

treat cancers of the tongue, gum, floor, and other parts of 

the mouth and of the pharynx as a single group referred 

to as oral cancer. However, some differences exist among 

these cancers in terms of epidemiology. Cancers of the 

lip have very different epidemiologic characteristics from 

the oral cancers and are generally considered separately. 

Cancers of the nose and paranasal sinuses have a low risk 

in the general population and have been associated with 

occupational and chemical exposures. The most frequently 

occurring cancers in the head and neck group (1) were 

tongue (21%), gum and other mouth sites (15%), tonsil 

(11%), and salivary gland (10%). 

Tobacco and alcohol are major risk factors for many of 

these tumors (2). Prolonged exposure to sunlight, as occurs with farmers and others with outdoor occupations, 

is a clear contributor to carcinomas of the lip. In India 

and other parts of Asia, betel nut (arecoline) use and habitual reverse smoking in which the lighted end of the 

cigarette is held within the oral cavity are other etiologic 

agents (1).

Materials and Methods

The NCI SEER Program contracts individually with central 

cancer registries, based in organizations such as universities 

and state health departments, to obtain data on all cancers 

diagnosed in residents of the registry’s catchment area. 

SEER collects data on all invasive and in situ cancers 

except basal cell and squamous cell carcinomas of the 

skin and in situ carcinomas of the uterine cervix.

SEER cancer registries are selected on the basis of two 

criteria: the registry’s ability to operate and maintain a 

population-based cancer reporting system and the epidemiologic significance of their population subgroups. While 

some cancer registries have remained in the SEER Program since it began, others have left; additional registries 

have joined at a later date or left for a period of time and 

rejoined the Program later. This analysis is based on data 

from 12 geographic areas, which collectively represent 

approximately 14% of the total US population and include 

Jay F. Piccirillo, Irene Costas, and Marsha E. Reichman

Chapter 2

Cancers of the Head and Neck

Table 2.1: Cancer of the Head and Neck: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number Excluded Reason for Exclusion/Selection

53,251 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

43,661 9,590 Select first primary only

43,413 248 Exclude death certificate only or at autopsy

43,047 366 Exclude unknown race

42,966 81 Exclude alive with no survival time

42,598 368 Exclude children (Ages 0-19)

41,501 1,097 Exclude in situ cancers for all except breast & bladder cancer

41,090 411 Exclude no or unknown microscopic confirmation

40,811 279 Exclude sarcomas
Chapter 2 Cancers of the Head and Neck 

National Cancer Institute 8 SEER Survival Monograph 

the States of Connecticut, Iowa, New Mexico, Utah, and 

Hawaii, and the metropolitan areas of Detroit, Atlanta, 

San Francisco, Seattle, San Jose, and Los Angeles, plus 

10 counties in rural Georgia. Los Angeles contributed 

data for diagnosis years 1992 to 2001, while other areas 

for diagnosis years from 1988 to 2001.

Survival analyses performed here are based on relative 

survival rates, defined as observed survival divided by 

expected survival. Relative survival the effect of the 

cancer in the cohort, while observed survival takes into 

account deaths due to all causes. When 5-year relative 

survival is 100%, a patient has the same chance to live 5 

years as a demographically similar cancer-free person.

This chapter used SEER modified American Joint Committee on Cancer (AJCC) staging, 5th edition (3) to classify 

cancers of the head and neck, with the exception of cancers of the nose, nasal cavity, and middle ear which used 

SEER historic staging. SEER historic staging categories 

include in situ, localized, regional, distant and unstaged. 

Epidemiologists classify an invasive neoplasm confined 

entirely to the organ of origin as localized. They define 

a neoplasm that has extended either beyond the organ 

or into regional lymph nodes as regional. Distant stage 

describes a neoplasm that has spread to parts of the body 

remote from the primary tumor. Unstaged denotes cancers 

that lack sufficient information to assign stage.

As shown in Table 2.1, this study excluded the following 

types of cancer cases: head and neck cancer not the first 

primary cancer, autopsy or death certificate only (no determination of diagnosis date makes survival impossible 

to calculate), patients of unknown race, patients alive 

with no survival time, patients less than 20 years of age, 

in situ cases, cases without microscopic confirmation, 

and sarcomas.

Results

Table 2.2 shows the site distribution and ICD-O code (4) 

of the 40,811 adult cancers in this study. As mentioned 

previously, the majority of cancers are from the tongue 

(21%), gum and other mouth sites (15%), tonsil (11%), 

and salivary gland (10%).

Table 2.3 displays the site-specific demographic characteristics of the patients. Head and neck cancers tend to be 

diagnosed at older ages. Nasopharynx shows a younger 

age at diagnosis than other cancers described here, with 

40% of cases diagnosed at ages younger than 50. Cancer of the lip is diagnosed more frequently at older ages 

than cancers at other head and neck sites described here, 

with approximately 70% of cases diagnosed at age 60 

or older. While cancers at all sites are diagnosed more 

frequently among males, the percentages for males and 

females are closest for gum and other mouth cancers (54% 

male) and for salivary gland cancers (56% male). The 

distribution by sex is most extreme for cancers of the lip 

(81% male) and hypopharynx (78% male). The racial 

distribution tends to reflect the general population from 

these geographic regions (whites 81%, blacks 11%, and 

other 9%) with the exception of cancer of the lip, found 

overwhelmingly in whites (98%), and “other cancers of 

the oral cavity and pharynx,” cancers of the hypopharynx, and cancers of the oropharynx and tonsil, where 

the percentage of black patients was somewhat elevated 

(17%, 16%, and 15%, respectively). Although not shown 

in these data, a significantly larger proportion of patients 

with nasopharyngeal cancer are of Asian/Pacific Islander, 

specifically Chinese, origin. These racial differences in 

nasopharyngeal cancer incidence have been previously 

noted (5,6). Population data on Asian/Pacific Islanders 

are available for this data set from 1990 forward. Over 

this period the makeup of the population is white 79%, 

black 10%, Asian/Pacific Islanders 10% and American 

Table 2.2: Cancers of the Head and Neck: Number and Distribution of Cases by Primary Site, Ages 20+, 12 SEER Areas, 1988-2001

Primary Site ICD-O Cases Percent

Lip C00.0-C00.9 3,982 9.8

Tongue C01.9-C02.9 8,637 21.2

Gum & Other Mouth C03.0-C03.9, C05.0-C06.9 5,946 14.6

Floor of Mouth C04.0-C04.9 3,286 8.1

Salivary Gland C07.9-C08.9 4,058 9.9

Oropharynx C10.0-C10.9 1,081 2.6

Tonsil C09.0-C09.9 4,420 10.8

Nasopharynx C11.0-C11.9 2,819 6.9

Hypopharynx C12.9-C13.9 3,273 8.0

Other Oral Cavity & Pharynx C14.0, C14.2-C14.8 1,010 2.5

Nose and Middle Ear C30.0-C30.1 1,091 2.7

Paranasal Sinus C31.0-C31.9 1,208 3.0

Total 40,811 100.0
Chapter 2 Cancers of the Head and Neck

National Cancer Institute 9 SEER Survival Monograph 

Table 2.3: Cancer of the Head and Neck: Number and Distribution of Cases by Primary Site, Age (20+), Sex and Race, 12 

SEER Areas, 1988-2001

Primary

 Site Lip Tongue Floor of Mouth Gum & Other Mouth

Oropharynx & 

Tonsil

Characteristics Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Age (years)

 20-29 45 1.1 106 1.2 5 0.2 86 1.4 12 0.2

 30-39 200 5.0 425 4.9 55 1.7 203 3.4 164 3.0

 40-49 363 9.1 1,309 15.2 425 12.9 616 10.4 1,060 19.3

 50-59 602 15.1 2,134 24.7 872 26.5 1,176 19.8 1,599 29.1

 60-69 1,013 25.4 2,191 25.4 1,048 31.9 1,519 25.5 1,488 27.0

 70-79 1,064 26.7 1,721 19.9 660 20.1 1,437 24.2 924 16.8

 80+ 695 17.5 751 8.7 221 6.7 909 15.3 254 4.6

Sex

 Male 3,232 81.2 5,764 66.7 2,261 68.8 3,188 53.6 4,111 74.7

 Female 750 18.8 2,873 33.3 1,025 31.2 2,758 46.4 1,390 25.3

Race

 White 3,892 97.7 7,123 82.5 2,741 83.4 4,891 82.3 4,457 81.0

 Black 40 1.0 904 10.5 429 13.1 691 11.6 803 14.6

 Other 50 1.3 610 7.1 116 3.5 364 6.1 241 4.4

Indian/Alaskan Natives 1%. Thus the very high percentage of other (49%) for nasopharyngeal cancer is likely to 

reflect primarily Asian/Pacific Islanders (7).

Figure 2.1 shows relative survival curves for cancers of 

various head and neck sites. Table 2.4 provides corresponding numeric data. Patients with lip cancer had the best 

prognosis, with 5-year relative survival approximately 94%. 

Cancer of the salivary gland also shows a 5-year relative 

survival rate (74%) higher than most other head and neck 

cancers. On the other hand, cancers of the hypopharynx 

(5-year relative survival rate 30%) and “other cancers of 

the oral cavity and pharynx” (5-year relative survival rate 

30%) have the worst prognoses in terms of relative survival 

rates. Figure 2.1 and Table 2.4 display a rapidly decreasing 

slope in relative survival until sometime between 18 and 

36 months followed by a leveling off for many head and 

neck cancer sites. Thus, the usually quoted 5-year relative 

survival figures may be less significant for patient prognosis 

than a 2- or 3-year relative survival figure.

Figure 2.2 provides a more detailed look at relative survival 

curves for several sites that have 5-year relative survival 

approximately 50 to 60%. Among this group, cancers of 

the tonsil and oropharynx have the worst relative survival, 

the only site in this group dipping slightly below 50% at 5 

Table 2.3 (continued)

Primary 

Site Hypopharynx Salivary Gland Nasopharynx Nose, Paranasal Sinus & Middle Ear

Other Oral Cavity 

& Pharynx

Characteristics Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Age (years)

 20-29 <5 180 4.4 127 4.5 53 2.3 <5

 30-39 25 0.8 351 8.6 341 12.1 136 5.9 11 1.1

 40-49 320 9.8 576 14.2 661 23.4 287 12.5 90 8.9

 50-59 819 25.0 667 16.4 648 23.0 417 18.1 233 23.1

 60-69 1,117 34.1 883 21.8 603 21.4 561 24.4 336 33.3

 70-79 774 23.6 840 20.7 335 11.9 519 22.6 257 25.4

 80+ 217 6.6 561 13.8 104 3.7 326 14.2 81 8.0

Sex

 Male 2,560 78.2 2,281 56.2 1,961 69.6 1,329 57.8 701 69.4

 Female 713 21.8 1,777 43.8 858 30.4 970 42.2 309 30.6

Race

 White 2,508 76.6 3,412 84.1 1,203 42.7 1,842 80.1 805 79.7

 Black 536 16.4 318 7.8 226 8.0 223 9.7 176 17.4

 Other 229 7.0 328 8.1 1,390 49.3 234 10.2 29 2.9
Chapter 2 Cancers of the Head and Neck 

National Cancer Institute 10 SEER Survival Monograph 

years. Cancers of the gum and other mouth have the best 

relative survival, almost 60% at 5 years. 

Overall, the 5-year relative survival rate for all patients with 

head and neck cancers was 57% (Table 2.4). The 5-year 

relative survival rate for head and neck cancers for whites 

was 60% and for blacks was 40%. The 5-year relative 

survival rate for males was 45%, for females 55%. Table 

2.5 examines relative survival by site, race, and sex. As 

a function of race and sex, 5-year relative survival rates 

tended to be higher for white males and females than black 

males and females. However, differences in survival rates 

according to race and sex must be interpreted in light of 

differences in types of tumors and stage of presentation. 

In addition, the distribution of other important prognostic 

factors like comorbidities are not even across race and 

sex categories and will impact the interpretation of these 

results (8, 13). 

In general, a strong correlation existed between stage at 

diagnosis and relative survival, with cancers that tend to be 

diagnosed at more localized stages having higher relative 

survival. In accord with this, as Table 2.6 shows, cancers 

of the lip have the highest percentage of cases diagnosed 

at stage I (83%), which had the highest relative survival 

at one (100%), three (99%) and five (96%) years after 

diagnosis. Other cancers in the head and neck group have 

a much lower percentage of cases diagnosed at stage I. 

Following lip cancer, cancers of the floor of the mouth, 

gum and other mouth cancers, and cancers of the salivary 

gland have between 36% and 40% of cases diagnosed at 

stage I. Diagnosis of hypopharyngeal cancers occurred at 

stage I less than 10% of the time, and these cancers have 

among the lowest relative survival rates of head and neck 

cancers. Table 2.6 also provides some insight into the 

unstaged group of cancers in terms of relative survival as 

compared to cancers diagnosed at various stages.

Table 2.7 shows 1-, 2- 3-, 5-, 8-, and 10-year relative survival 

rates by grade for each of the head and neck cancer sites. 

In most cases, at each time point survival increases with 

increasing level of differentiation. Exceptions occur for 

hypopharynx, nasopharynx, oropharynx/tonsil, and “other 

oral cavity and pharynx” cancers. For some of the head 

and neck sites, the survival of the unknown group of cancers is between that of grade II and grade III-IV, although 

for four sites (nasopharynx, other oral cavity and pharynx, 

hypopharynx, oropharynx/tonsil) it is worse than grade 

III-IV. For salivary cancer, 39% of cancers do not have a 

grade assigned. The percentage is also high for lip and for 

nose, nasal cavity, and middle ear. For these three sites 

the unknown group as a whole shows survival better than 

that associated with diagnosis at stages III-IV, and in the 

case of nose, nasal cavity, and middle ear better than that 

associated with diagnoses at grade II. In general, relative 

survival decreases more rapidly with time for grades II and 

for III-IV than for grade I.

Table 2.8 shows 1-, 2-, 3-, 5-, 8-, and 10-year relative 

survival by size of tumor for each of the head and neck 

cancer sites. In general, relative survival decreases at each 

time point with increasing tumor size. This is less clear 

cut for cancers of the oropharynx and tonsil and those 

of the nasopharynx. Cancers at the following sites had 

40% or more with unknown tumor size: lip; oropharynx 

and tonsil; hypopharynx; nasopharynx; nose, nasal cavity, 

and middle ear; and other oral cavity and pharynx. As is 

observed for grade, survival decreases more rapidly with 

time for increasing tumor size.

90

100 Lip

70

80

te (%)

Tongue

Floor of Mouth

60

70

rvival Rat

Gum, Other Mouth

O h

40

50

elative Su

Oropharynx, 

Tonsil

Hypopharynx

20

R

30 e

Salivary Gland

Nasopharynx

0

10

Nose, Nasal 

Cavity, Middle Ear 0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Ca ty, dd e a

Other Oral 

Cavity, Pharynx

Figure 2.1: Cancer of the Head and Neck: Relative Survival 

Rate (%) by Primary Site, Ages 20+, 12 SEER Areas, 1988-

2001

100

Tongue

80

90

Rate (%)

Floor of Mouth

70

Survival R

Gum and Other 

Mouth

50

60

Relative S

Oropharynx and 

tonsil

40

R

50

Nasopharynx

30

0 12 24 36 48 60 72 84 96 108 120

Nose, Nasal 

Cavity and Middle 

Ear

Months after diagnosis

Figure 2.2: Cancer of the Head and Neck: Relative Survival 

Rate (%) by Primary Site, Ages 20+, 12 SEER Areas, 1988-2001
Chapter 2 Cancers of the Head and Neck

National Cancer Institute 11 SEER Survival Monograph 

Table 2.4: Cancer of the Head and Neck: Number and Distribution of Cases, and 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival 

Rates (%) by Primary Site, Ages 20+, 12 SEER Areas, 1988-2001

Primary Site Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total Head & Neck 40,811 100.0 82.5 70.3 64.0 57.1 50.5 46.6

Lip 3,982 9.8 99.6 97.7 96.2 93.5 90.4 88.0

Tongue 8,637 21.2 80.8 65.9 59.4 53.1 46.3 42.1

Gum & Other Mouth 5,946 14.6 82.8 71.6 65.8 59.5 51.9 48.1

Floor of Mouth 3,286 8.1 82.8 69.2 61.7 52.7 43.3 37.7

Oropharynx & Tonsil 5,501 13.5 79.8 65.9 58.8 49.8 43.5 39.3

Hypopharynx 3,273 8.0 67.4 47.9 38.3 29.5 22.0 18.2

Salivary Gland 4,058 9.9 90.0 82.1 77.7 73.9 70.7 68.5

Nasopharynx 2,819 6.9 84.1 73.2 65.3 56.6 48.3 44.7

Nose, Nasal Cavity & 

 Middle Ear 2,299 5.6 79.8 67.7 61.9 54.0 50.3 46.4

Other Oral Cavity & Pharynx 1,010 2.5 63.8 46.3 38.9 29.8 23.6 21.5

Tongue 

Median survival for tongue cancer is 48 months (Table 

2.6). This varies from 95 months for patients diagnosed 

with stage I cancer to 22 months for those diagnosed with 

stage IV cancer. Figure 2.4 shows survival of tongue 

cancers by stage of diagnosis. Five year relative survival rates for tongue cancers diagnosed at stage I is 

71%, stage II is 59%, stage III 47%, and stage IV 37%. 

Approximately 34% of tongue cancers are diagnosed at 

stage I. This figure has not changed appreciably in three 

decades, nor has the 5-year relative survival rate. The 

survival curve for unstaged cancers lies between those 

diagnosed at stages III and IV. 

Tongue cancers are divided into those of the anterior and 

of the basal portions of the tongue. Cancers of the anterior tongue represent 56% of tongue cancers. Table 2.9 

provides data on the stage at diagnosis for cancers of the 

basal and anterior tongue. Cancers of the anterior tongue 

A discussion of patient relative survival characteristics 

for individual head and neck sites follows. 

Lip 

The median survival for cancer of the lip is greater than 

120 months (Table 2.6). This is also the case for patients 

with cancers diagnosed at stage I. Patients diagnosed with 

cancers at stage II had a median survival of 99 months, 

stage III had a median survival of 50 months, and those 

with stage IV diagnoses a median survival time of 37 

months (Table 2.6). Figure 2.3 shows relative survival 

for lip cancer by stage at diagnosis. Even for lip cancers 

diagnosed at stage IV, relative survival is nearly 50% at 

5 years. Only 4% of lip cancers are diagnosed at stages 

III or IV, while 6% are diagnosed at stage II. The vast 

majority of lip cancers, 83%, are diagnosed at stage I. 

Lip cancers of unknown stage show survival patterns 

only slightly worse than those for all stages combined, 

indicating a lack of substantial bias. 

90

100

70

80

ate (%)

60

70

urvival Ra

All stages

I

II

40

50

elative Su

II

III

IV

20

R

30 e

Unstaged

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 2.3: Cancer of the Lip: Relative Survival Rate (%) by 

Stage, Ages 20+, 12 SEER Areas, 1988-2001

Figure 2.4: Cancer of the Tongue: Relative Survival Rate (%) 

by Stage, Ages 20+,12 SEER Areas, 1988-2001

90

100

70

80

e (%)

50

60

70

vival Rate

All stages

I

II

30

40

50

ative Surv

II

III

IV

Unstaged

10

20

30

Rela

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 2 Cancers of the Head and Neck 

National Cancer Institute 12 SEER Survival Monograph 

are much more likely to be diagnosed at an earlier stage 

than cancers of the basal tongue. While 48% of cancers 

of the anterior tongue are diagnosed at stage I, only 16% 

of cancers of the base of tongue are diagnosed at stage I. 

By comparison, 19% of cancers of the anterior tongue are 

diagnosed at stage IV, while 46% of cancers of the base 

of tongue are diagnosed at stage IV. A similar percentage of anterior and basal tongue cancers are unstaged: 

7% and 6%, respectively. Table 2.10 shows 1-, 2-, 3-, 

5-, 8-, and 10-year relative survival rates for cancers of 

the basal and anterior tongue by stage at diagnosis. For 

all stages combined, cancers of the anterior tongue have 

a higher relative survival rate at each time point, with a 

growing differential as time increases. Although cancers 

of the anterior tongue have better survival rates when diagnosed at stage I, this does not appear to be the case for 

cancers diagnosed at stages II, III, or IV. This suggests 

that the overall differences in survival between cancers 

of the anterior and basal tongue may be due primarily to 

the larger percentage of cases of cancer of the anterior 

tongue diagnosed at stage I.

Floor of Mouth 

Median survival for all cancers of the floor of the mouth 

is 50 months (Table 2.6). This varies from 94 months 

for those diagnosed with stage I to 19 months for those 

diagnosed with stage IV cancers. Five-year relative survival rates decrease from 73% for patients with cancers 

diagnosed at stage I to 30% for patients with cancers 

diagnosed at stage IV. Figure 2.5 shows relative survival 

curves for cancer of the floor of the mouth by SEER 

modified AJCC stage. Unstaged cancers have relative 

survival rates somewhat between stages III and IV, lower 

than those for all cancers combined. 

Gum and Other Mouth 

Median survival for all patients with cancers of the “gum 

and other mouth” category is 59 months. This decreases 

from 113 months for patients diagnosed with stage I disease 

to 22 months for patients diagnosed with stage IV disease 

(Table 2.6). Similarly, five-year relative survival rates 

Table 2.5: Cancer of the Head and Neck: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates (%) by Site, Race, and Sex, Ages 20+, 12 SEER Areas, 1988-2001

Site/Race/Sex Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Lip 3,982 100.0 99.6 97.7 96.2 93.5 90.4 88.0

 White Female 708 17.8 99.7 96.7 96.4 93.1 90.0 89.9

 White Male 3,184 80.0 99.9 98.2 96.4 93.9 90.6 87.7

 Black Female 22 0.6 ~ ~ ~ ~ ~ ~

 Black Male 18 0.5 ~ ~ ~ ~ ~ ~

Tongue 8,637 100.0 80.8 65.9 59.4 53.1 46.3 42.1

 White Female 2,382 27.6 82.4 68.8 63.0 57.9 49.2 44.5

 White Male 4,741 54.9 82.2 67.4 61.0 54.0 48.3 44.5

 Black Female 230 2.7 71.2 54.0 46.1 37.8 28.8 27.8

 Black Male 674 7.8 66.6 47.1 37.2 30.6 22.7 14.2

Floor of Mouth 3,286 100.0 82.8 69.2 61.7 52.7 43.3 37.7

 White Female 882 26.8 83.2 72.4 66.8 59.3 50.2 43.2

 White Male 1,859 56.6 84.5 71.7 63.5 53.1 42.9 37.3

 Black Female 104 3.2 78.5 57.5 55.1 51.5 35.6 35.6

 Black Male 325 9.9 72.6 49.9 39.7 32.0 27.1 23.3

Gum & Other Mouth 5,946 100.0 82.8 71.6 65.8 59.5 51.9 48.1

 White Female 2,331 39.2 83.9 75.5 71.0 66.4 61.5 58.1

 White Male 2,560 43.1 83.4 71.1 64.5 57.3 47.4 41.9

 Black Female 263 4.4 78.8 68.8 65.1 60.2 49.9 47.5

 Black Male 428 7.2 74.8 56.8 47.7 38.1 29.8 27.6

Oropharynx & Tonsil 5,501 100.0 79.8 65.9 58.8 49.8 43.5 39.3

 White Female 1,151 20.9 81.0 68.2 60.5 51.0 44.4 37.3

 White Male 3,306 60.1 81.7 68.4 61.8 53.4 47.0 43.2

 Black Female 175 3.2 72.6 52.6 44.9 34.0 29.5 26.9

 Black Male 628 11.4 68.3 48.7 38.4 27.8 21.1 18.9
Chapter 2 Cancers of the Head and Neck

National Cancer Institute 13 SEER Survival Monograph 

Figure 2.5: Cancer of the Floor of Mouth: Relative Survival 

Rate (%) by Stage, Ages 20+, 12 SEER Areas, 1988-2001

Figure 2.6: Cancer of Gum and Other Mouth: Relative 

Survival Rate (%) by Stage, Ages 20+, 12 SEER Areas, 

1988-2001

Table 2.5 (continued)

Site/Race/Sex Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Hypopharynx 3,273 100.0 67.4 47.9 38.3 29.5 22.0 18.2

 White Female 591 18.1 70.8 50.5 42.2 33.3 24.2 20.3

 White Male 1,917 58.6 68.3 49.9 39.9 30.6 23.1 19.2

 Black Female 97 3.0 56.5 33.2 26.6 19.7 15.6 12.6

 Black Male 439 13.4 58.8 38.4 27.9 19.9 14.7 11.9

Salivary Gland 4,058 100.0 90.0 82.1 77.7 73.9 70.7 68.5

 White Female 1,455 35.9 92.2 85.8 82.5 79.3 75.5 74.2

 White Male 1,957 48.2 88.3 78.5 73.9 68.9 65.4 62.3

 Black Female 159 3.9 91.5 86.4 80.5 77.4 76.4 76.0

 Black Male 159 3.9 82.5 73.2 65.3 64.1 63.6 61.3

Nasopharynx 2,819 100.0 84.1 73.2 65.3 56.6 48.3 44.7

 White Female 379 13.4 72.4 59.1 51.2 45.7 39.6 34.0

 White Male 824 29.2 78.6 66.5 58.9 49.8 43.2 41.1

 Black Female 68 2.4 83.6 68.8 53.9 42.9 35.0 35.0

 Black Male 158 5.6 80.3 63.6 55.4 45.8 32.2 31.7

Nose, Nasal Cavity and 

Middle Ear 2,299 100.0 79.8 67.7 61.9 54.0 50.3 46.4

 White Female 774 33.7 79.4 68.0 62.9 56.3 53.7 47.1

 White Male 1,068 46.5 81.2 70.1 63.9 56.5 50.8 48.6

 Black Female 104 4.5 66.4 47.1 45.0 35.7 31.6 23.3

 Black Male 119 5.2 73.9 56.8 49.0 37.2 36.0 36.0

Other Oral Cavity and 

Pharynx 1,010 100.0 63.8 46.3 38.9 29.8 23.6 21.5

 White Female 260 25.7 64.5 49.1 40.6 30.4 26.7 25.8

 White Male 545 54.0 67.3 49.0 41.9 32.5 25.1 21.6

 Black Female 47 4.7 47.8 23.5 16.7 14.8 7.9 7.9

 Black Male 129 12.8 50.4 33.8 26.2 19.3 15.2 12.0

 ~Statistic not displayed due to less than 25 cases.

decrease from 81% for those diagnosed with stage I disease 

to 40% for those diagnosed with stage IV disease. Figure 

2.6 shows relative survival curves by stage at diagnosis for 

those with “gum and other mouth” cancers. For all stages 

combined, the 1-, 3-, and 5-year relative survival rates are 

83%, 66%, and 60%, respectively.

Oropharynx and Tonsil 

Table 2.6 presents survival of cancers of the oropharynx 

and tonsil stratified by stage at diagnosis. The overall 1-, 

3-, and 5-year relative survival rates are 80%, 59%, and 

90

100

70

80

ate (%)

60

70

urvival Ra

All stages

I

40

50

elative Su

II

III

IV

20

R

30 e

Unstaged

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

e (%) 60

70

vival Rate

All stages

I

II

40

50

ative Surv

II

III

IV

Unstaged

20

Rel

30

a

g

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 2 Cancers of the Head and Neck 

National Cancer Institute 14 SEER Survival Monograph 

Table 2.6: Cancer of the Head and Neck: Number and Distribution of Cases, Median Survival Time (Months) and 1-, 2-, 3-, 5-, 

8-, & 10-Year Relative Survival Rates (%) by AJCC Stage (5th Edition) and Site, Ages 20+, 12 SEER Areas, 1988-2001

Site/AJCC Stage Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Lip 3,982 100.0 > 120 99.6 97.7 96.2 93.5 90.4 88.0

 Stage I 3,314 83.2 > 120 100.0 99.5 98.5 96.3 93.2 90.1

 Stage II 221 5.5 98.6 98.0 93.4 90.2 82.7 74.6 72.5

 Stage III 58 1.5 44.9 83.1 65.5 60.1 56.7 56.7 56.2

 Stage IV 87 2.2 37.2 75.4 65.0 57.0 48.1 40.0 40.0

 Unstaged 302 7.6 > 120 98.1 95.4 92.8 88.3 83.9 83.9

Tongue 8,637 100.0 47.6 80.8 65.9 59.4 53.1 46.3 42.1

 Stage I 2,927 33.9 95.4 92.9 82.7 77.0 70.7 63.2 58.8

 Stage II 1,081 12.5 58.4 87.3 72.2 65.2 58.6 51.0 44.9

 Stage III 1,416 16.4 32.7 76.8 58.7 52.6 47.3 40.3 35.7

 Stage IV 2,647 30.6 22.1 69.1 50.8 43.3 36.7 30.9 27.3

 Unstaged 566 6.6 26.6 70.1 56.1 48.7 41.7 35.0 32.2

Floor of Mouth 3,286 100.0 49.7 82.8 69.2 61.7 52.7 43.3 37.7

 Stage I 1,324 40.3 93.6 95.8 87.6 82.0 72.5 60.8 53.2

 Stage II 435 13.2 63.7 90.2 78.7 71.0 60.1 50.1 44.0

 Stage III 326 9.9 29.2 79.5 58.8 47.0 35.8 29.4 26.1

 Stage IV 982 29.9 18.9 65.1 45.6 37.7 29.7 22.8 20.0

 Unstaged 219 6.7 28.8 73.8 58.4 47.7 41.4 30.0 23.5

Gum & Other Mouth 5,946 100.0 59.2 82.8 71.6 65.8 59.5 51.9 48.1

 Stage I 2,244 37.7 112.7 95.8 90.5 86.6 80.9 73.2 68.8

 Stage II 712 12.0 66.4 90.7 80.8 72.0 62.2 54.3 48.9

 Stage III 394 6.6 30.9 76.5 63.3 52.5 45.1 31.6 28.2

 Stage IV 2,075 34.9 22.1 70.0 51.8 45.9 40.0 32.5 29.4

 Unstaged 521 8.8 33.1 71.9 61.3 55.0 49.3 44.2 39.7

Oropharynx & Tonsil 5,501 100.0 45.4 79.8 65.9 58.8 49.8 43.5 39.3

 Stage I 1,035 18.8 55.2 84.7 73.0 66.6 56.0 48.4 41.9

 Stage II 506 9.2 62.9 91.0 77.1 70.8 58.3 51.0 46.1

 Stage III 1,236 22.5 58.9 83.7 70.5 64.1 55.4 48.6 43.5

 Stage IV 2,350 42.7 32.0 74.1 58.6 50.9 43.4 38.8 36.5

 Unstaged 374 6.8 33.1 75.1 61.8 52.2 43.8 35.4 31.6

50%, respectively. The majority of tumors were diagnosed 

at stage IV (43%). Approximately equal numbers were 

diagnosed at stage III (23%) and stage I (19%), with 9% 

diagnosed at stage II. The median survival for patients 

diagnosed at stages I to III was between 55 and 63 months, 

while for those diagnosed with stage IV disease the median 

survival was 32 months (Table 2.6). Figure 2.7 shows 

survival curves for cancers of the oropharynx and tonsil 

by SEER modified AJCC stage at diagnosis.

Hypopharynx 

Figure 2.8 illustrates the survival of cancer of the hypopharynx by SEER modified AJCC stage at diagnosis. The 

majority of patients were diagnosed at stage IV (56%), while 

17% were diagnosed at stage III, 12% at stage II and 10% 

at stage I (Table 2.6). Overall 1-, 3-, and 5-year relative 

survival, as reported in Table 2.6 was 67%, 38%, and 30%, 

respectively. Five-year relative survival by stages varies 

from 49% for stage I to 23% for stage IV. The median 

survival for stage I tumors was 42 months, 25 months at 

stage II, 25 months at stage III, and 17 months at stage IV. 

The survival pattern for unstaged cancers was similar to 

that for stage IV.

Salivary Gland 

For cancer of the salivary gland, the overall 1-, 3-, and 

5-year relative survival rates were 90%, 78%, and 74%, 

respectively (Table 2.6). Table 2.11 and Figure 2.9 show 

the relative survival rates for salivary gland cancers by cell 

type. Patients with mucoepidermoid well differentiated carcinomas and acinar cell carcinomas had the best prognosis, 
Chapter 2 Cancers of the Head and Neck

National Cancer Institute 15 SEER Survival Monograph 

Table 2.6 (continued)

Site/AJCC Stage Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Hypopharynx 3,273 100.0 19.7 67.4 47.9 38.3 29.5 22.0 18.2

 Stage I 315 9.6 41.5 80.6 67.0 58.5 48.7 32.4 26.7

 Stage II 389 11.9 25.3 73.6 55.4 47.0 38.6 31.7 24.9

 Stage III 568 17.4 24.9 72.0 55.6 42.7 34.1 24.5 18.8

 Stage IV 1,819 55.6 16.5 63.1 41.3 32.2 23.2 17.8 15.0

 Unstaged 182 5.6 14.8 59.3 42.2 32.3 26.3 18.4 16.8

Salivary Gland 4,058 100.0 112.2 90.0 82.1 77.7 73.9 70.7 68.5

 Stage I 1,457 35.9 > 120 99.4 98.0 96.2 95.7 92.4 91.6

 Stage II 630 15.5 106.8 92.0 84.1 81.2 76.7 73.9 67.4

 Stage III 188 4.6 98.8 92.1 84.6 80.8 72.6 68.5 57.5

 Stage IV 1,032 25.4 27.7 77.1 58.1 47.7 37.2 30.0 27.5

 Unstaged 751 18.5 109.3 86.4 80.6 77.5 74.1 73.6 73.6

Nasopharynx 2,819 100.0 67.8 84.1 73.2 65.3 56.6 48.3 44.7

 Stage I 424 15.0 > 120 93.5 86.8 81.3 78.4 68.2 62.6

 Stage II 189 6.7 76.4 89.8 78.9 71.7 63.7 51.6 51.6

 Stage III 615 21.8 72.8 86.5 74.7 67.7 59.5 49.8 46.2

 Stage IV 1,276 45.3 46.8 78.2 65.9 57.3 46.7 40.9 37.1

 Unstaged 315 11.2 72.3 86.9 77.9 67.9 57.8 47.1 44.6

Nose, Nasal Cavity 

and Middle Ear 2,299 100.0 47.9 79.8 67.7 61.9 54.0 50.3 46.4

 Localized 594 25.8 > 120 95.1 90.2 88.2 82.5 79.8 77.4

 Regional 1,181 51.4 37.0 77.7 63.6 55.8 47.3 43.0 37.7

 Distant 325 14.1 15.5 59.5 41.9 34.9 25.3 24.8 21.7

 Unstaged 199 8.7 47.7 79.4 67.6 63.4 55.5 49.7 45.3

Other Oral Cavity 

and Pharynx 1,010 100.0 18.1 63.8 46.3 38.9 29.8 23.6 21.5

 Stage I 169 16.7 26.7 73.9 55.8 48.6 40.8 36.1 36.1

 Stage II 70 6.9 43.2 74.8 69.4 58.7 46.2 33.3 28.2

 Stage III 148 14.7 18.0 69.4 43.4 36.8 23.2 21.9 21.0

 Stage IV 478 47.3 14.4 56.4 39.0 31.7 22.3 17.8 13.4

 Unstaged 145 14.4 20.1 65.2 50.9 43.8 39.3 26.0 23.3

while patients with squamous call and adenocarcinoma had 

the worst prognosis. 

Nasopharynx 

As shown in Table 2.6, the 1-, 3-, and 5-year relative survival rates for cancer of the nasopharynx were 84%, 65%, 

and 57%, respectively. Figure 2.10 presents the survival 

of cancer of the nasopharynx by stage. Among patients 

diagnosed with cancer of the nasopharynx, 15% were diagnosed at stage I, 6.7% at stage II, 22% at stage III, and 

45% at stage IV. The median survival for patients presenting at stage I was over 120 months. This decreased 

to 47 months for patients presenting at stage IV. Relative 

survival at 5 years varied from 78% for stage I to 47% for 

stage IV. Unstaged cases show a survival curve similar to 

that for all stages.

Figure 2.7: Cancer of the Oropharynx and Tonsil: Relative 

Survival Rate (%) by Stage, Ages 20+ 12 SEER Areas, 1988-

2001

90

100

70

80

e (%)

60

70

vival Rate

All stages

I

40

50

ative Surv

II

III

IV

20

30

Rela

Unstaged

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 2 Cancers of the Head and Neck 

National Cancer Institute 16 SEER Survival Monograph 

Table 2.7: Cancer of the Head and Neck: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) 

by Primary Site and Grade, Ages 20+, 12 SEER Areas, 1988-2001

Site/Grade Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Lip 3,982 100.0 99.6 97.7 96.2 93.5 90.4 88.0

 Grade I 1,531 38.4 100.0 99.2 98.1 96.2 94.0 90.3

 Grade II 971 24.4 99.1 97.2 95.1 91.3 85.8 84.0

 Grades III-IV 186 4.7 93.6 88.1 79.8 73.5 65.3 62.2

 Unknown 1,294 32.5 99.2 97.4 96.7 94.2 91.6 88.6

Tongue 8,637 100.0 80.8 65.9 59.4 53.1 46.3 42.1

 Grade I 1,428 16.5 86.9 76.4 71.0 65.8 59.1 53.9

 Grade II 3,506 40.6 80.7 64.3 57.1 49.8 42.9 38.7

 Grades III-IV 2,314 26.8 78.1 61.5 54.3 48.0 41.7 37.9

 Unknown 1,389 16.1 79.0 66.8 61.8 56.9 49.4 45.4

Floor of Mouth 3,286 100.0 82.8 69.2 61.7 52.7 43.3 37.7

 Grade I 568 17.3 89.5 78.9 72.5 63.4 53.0 45.1

 Grade II 1,586 48.3 83.2 68.9 60.5 51.4 41.1 35.4

 Grades III-IV 563 17.1 73.4 56.9 49.3 40.1 33.7 30.1

 Unknown 569 17.3 84.6 72.5 66.5 58.0 48.4 43.1

Gum & Other Mouth 5,946 100.0 82.8 71.6 65.8 59.5 51.9 48.1

 Grade I 1,258 21.2 86.9 79.0 73.8 69.6 63.9 57.4

 Grade II 2,557 43.0 83.3 71.3 65.7 59.5 51.2 47.0

 Grades III-IV 880 14.8 74.1 56.7 47.9 38.9 31.7 29.1

 Unknown 1,251 21.0 84.0 75.3 70.8 64.4 56.0 54.1

Oropharynx & Tonsil 5,501 100.0 79.8 65.9 58.8 49.8 43.5 39.3

 Grade I 341 6.2 78.2 65.5 59.7 50.3 39.2 32.8

 Grade II 2,132 38.8 78.8 64.9 57.2 47.0 40.7 37.4

 Grades III-IV 2,208 40.1 83.5 70.1 63.5 55.2 50.2 46.1

 Unknown 820 14.9 73.4 57.4 49.4 42.1 35.1 29.4

Hypopharynx 3,273 100.0 67.4 47.9 38.3 29.5 22.0 18.2

 Grade I 173 5.3 66.5 44.6 36.2 25.9 23.2 19.6

 Grade II 1,326 40.5 68.3 49.3 40.0 31.0 20.8 17.5

 Grades III-IV 1,297 39.6 67.9 48.1 37.7 29.2 23.5 18.7

 Unknown 477 14.6 63.6 44.9 35.6 26.6 19.2 16.7

Salivary Gland 4,058 100.0 90.0 82.1 77.7 73.9 70.7 68.5

 Grade I 357 8.8 97.4 96.3 94.8 94.6 93.6 93.6

 Grade II 897 22.1 95.6 90.7 87.6 86.1 85.9 84.2

 Grades III-IV 1,239 30.5 80.8 64.7 57.3 47.8 40.3 34.6

 Unknown 1,565 38.6 92.2 87.2 83.3 80.3 76.5 74.9

Nasopharynx 2,819 100.0 84.1 73.2 65.3 56.6 48.3 44.7

 Grade I 59 2.1 50.5 46.1 41.4 38.3 31.3 31.3

 Grade II 269 9.5 70.7 54.5 48.6 39.6 30.1 25.1

 Grades III-IV 1,874 66.5 86.7 76.3 68.0 59.1 51.1 47.7

 Unknown 617 21.9 85.0 74.2 66.3 57.5 48.3 44.5

Nose, Nasal Cavity and Middle Ear 2,299 100.0 79.8 67.7 61.9 54.0 50.3 46.4

 Grade I 261 11.4 87.0 77.7 74.8 67.2 64.0 60.7

 Grade II 475 20.7 80.7 67.7 63.4 56.8 54.3 51.7

 Grades III-IV 770 33.5 74.0 60.8 51.8 42.0 38.1 33.3

 Unknown 793 34.5 82.4 71.1 66.6 59.8 55.5 50.6

Other Oral Cavity and Pharynx 1,010 100.0 63.8 46.3 38.9 29.8 23.6 21.5

 Grade I 65 6.4 63.4 45.7 38.2 30.5 28.4 27.1

 Grade II 392 38.8 65.2 43.0 33.9 24.9 20.3 16.6

 Grades III-IV 323 32.0 60.9 46.2 41.2 32.2 26.0 24.1

 Unknown 230 22.8 65.7 52.7 44.6 34.5 24.1 22.6
Chapter 2 Cancers of the Head and Neck

National Cancer Institute 17 SEER Survival Monograph 

Table 2.8: Cancer of the Head and Neck: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by 

Primary Site and Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

Primary Site/Grade Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Lip 3,982 100.0 99.6 97.7 96.2 93.5 90.4 88.0

 <1 cm 879 22.1 100.0 100.0 99.6 97.3 95.3 92.0

 1.0-1.9 cm 901 22.6 100.0 97.1 94.1 91.1 86.5 82.2

 2.0-2.9 cm 267 6.7 98.5 92.5 89.9 82.6 80.9 80.8

 3.0-3.9 cm 99 2.5 93.8 84.4 82.5 76.0 65.2 60.0

 4.0+ cm 87 2.2 79.8 67.1 63.0 63.0 62.7 60.1

 Unknown 1,749 43.9 100.0 99.2 98.9 96.3 93.4 91.1

Tongue 8,637 100.0 80.8 65.9 59.4 53.1 46.3 42.1

 <1 cm 498 5.8 99.8 92.2 87.6 81.5 74.4 70.0

 1.0-1.9 cm 1,329 15.4 94.2 82.8 77.2 71.6 62.4 58.2

 2.0-2.9 cm 1,434 16.6 88.2 71.2 64.4 55.8 47.1 41.4

 3.0-3.9 cm 1,084 12.6 80.2 63.5 56.1 49.2 42.8 40.1

 4.0+ cm 1,459 16.9 67.2 48.2 40.8 34.9 29.0 22.6

 Unknown 2,833 32.8 74.5 60.6 54.1 48.6 42.9 39.7

Floor of Mouth 3,286 100.0 82.8 69.2 61.7 52.7 43.3 37.7

 <1 cm 214 6.5 97.2 92.6 90.4 81.8 70.4 59.2

 1.0-1.9 cm 555 16.9 94.1 86.3 79.6 70.0 57.0 51.8

 2.0-2.9 cm 593 18.0 91.6 75.5 66.4 54.8 44.0 38.2

 3.0-3.9 cm 404 12.3 83.8 63.9 53.4 42.9 34.4 30.9

 4.0+ cm 546 16.6 63.3 46.7 39.2 32.7 25.7 20.4

 Unknown 974 29.6 78.5 65.2 58.2 50.2 42.1 36.5

Gum & Other Mouth 5,946 100.0 82.8 71.6 65.8 59.5 51.9 48.1

 <1 cm 311 5.2 98.1 93.9 91.3 84.5 78.2 72.3

 1.0-1.9 cm 895 15.1 96.2 89.9 85.4 79.8 74.9 70.9

 2.0-2.9 cm 982 16.5 87.9 77.3 70.8 64.0 55.0 51.7

 3.0-3.9 cm 709 11.9 81.3 65.8 57.9 49.9 40.5 35.6

 4.0+ cm 907 15.3 67.8 50.5 43.2 36.7 28.2 23.2

 Unknown 2,142 36.0 79.5 68.6 63.5 57.8 49.9 46.9

Oropharynx & Tonsil 5,501 100.0 79.8 65.9 58.8 49.8 43.5 39.3

 <1 cm 110 2.0 93.1 84.4 81.1 62.9 62.0 54.1

 1.0-1.9 cm 398 7.2 93.9 87.5 83.8 72.0 68.9 64.1

 2.0-2.9 cm 728 13.2 89.3 77.4 69.1 58.4 51.4 48.1

 3.0-3.9 cm 713 13.0 88.2 73.7 68.5 58.1 50.9 42.8

 4.0+ cm 1,075 19.5 73.6 56.3 49.3 42.4 34.4 30.9

 Unknown 2,477 45.0 74.5 60.1 51.9 43.8 37.8 34.2

Nose, Paranasal Sinus, and Middle Ear 

Figure 2.12 shows the survival of patients with nose, nasal 

cavity, or middle ear cancer according to SEER historic 

stage. The overall 1-, 3-, and 5-year relative survival rates, 

as presented in Table 2.6, were 80%, 62%, and 54%, respectively. Among patients diagnosed with cancer of the nose, 

nasal cavity, or middle ear, 26% had localized tumors, 51% 

regional, and 14% distant. The median survival for patients 

with localized disease at presentation was greater than 120 

months; for regional disease it was 37 months, and for distant 

disease, 16 months. Five-year relative survival by stage 

varied from 83% for local to 25% for distant disease.

Paranasal Sinus 

Table 2.12 and Figure 2.11 show the relative survival rates 

for paranasal sinus cancers according to cell type. Patients 

with adenoid cystic carcinomas had the best 5-year relative 

survival (61%), while patients with epithelial neoplasms 

had the worst 5-year relative survival (32%).
Chapter 2 Cancers of the Head and Neck 

National Cancer Institute 18 SEER Survival Monograph 

Table 2.8 (continued): Cancer of the Head and Neck: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival 

Rates (%) by Site and Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

Site/Grade Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Hypopharynx 3,273 100.0 67.4 47.9 38.3 29.5 22.0 18.2

 <1 cm 45 1.4 86.1 73.3 65.9 50.3 45.8 30.3

 1.0-1.9 cm 198 6.0 83.4 67.5 57.6 46.2 38.7 24.6

 2.0-2.9 cm 416 12.7 81.5 67.1 55.6 42.6 29.1 24.8

 3.0-3.9 cm 409 12.5 78.2 53.5 44.5 35.4 30.4 27.2

 4.0+ cm 666 20.3 63.7 42.7 32.5 22.0 17.2 12.3

 Unknown 1,539 47.0 59.6 40.2 30.9 24.6 16.3 14.7

Salivary Gland 4,058 100.0 90.0 82.1 77.7 73.9 70.7 68.5

 <1 cm 152 3.7 100.0 100.0 99.2 99.2 97.1 88.9

 1.0-1.9 cm 830 20.5 98.6 96.6 95.0 92.5 88.5 85.3

 2.0-2.9 cm 884 21.8 96.0 90.0 84.1 80.6 78.0 76.1

 3.0-3.9 cm 526 13.0 92.8 82.9 75.9 71.0 63.7 62.8

 4.0+ cm 728 17.9 77.3 61.3 56.1 49.4 44.3 38.9

 Unknown 938 23.1 82.9 73.6 69.1 63.9 63.3 63.3

Nasopharynx 2,819 100.0 84.1 73.2 65.3 56.6 48.3 44.7

 <1 cm 35 1.2 89.6 84.2 81.7 72.3 64.6 43.5

 1.0-1.9 cm 95 3.4 95.0 86.9 80.2 74.1 69.8 45.4

 2.0-2.9 cm 201 7.1 90.1 84.8 81.7 77.7 65.9 62.7

 3.0-3.9 cm 161 5.7 88.6 76.4 70.3 58.2 53.6 49.4

 4.0+ cm 379 13.4 84.8 73.0 61.1 51.3 44.5 43.8

 Unknown 1,948 69.1 82.3 70.8 62.9 54.1 45.1 42.4

Nose, Nasal Cavity and Middle Ear 2,299 100.0 79.8 67.7 61.9 54.0 50.3 46.4

 <1 cm 55 2.4 97.1 89.9 89.4 89.4 81.5 74.5

 1.0-1.9 cm 125 5.4 91.7 87.3 84.5 82.1 81.5 77.0

 2.0-2.9 cm 183 8.0 88.2 75.6 72.3 57.1 53.9 53.9

 3.0-3.9 cm 136 5.9 84.1 75.4 67.5 62.2 55.7 55.7

 4.0+ cm 384 16.7 77.4 59.8 51.6 43.3 36.8 27.2

 Unknown 1,416 61.6 77.2 65.4 59.5 51.5 48.0 44.0

Other Oral Cavity and Pharynx 1,010 100.0 63.8 46.3 38.9 29.8 23.6 21.5

 <1 cm 11 1.1 ~ ~ ~ ~ ~ ~

 1.0-1.9 cm 44 4.4 78.8 61.6 57.4 40.7 38.6 36.1

 2.0-2.9 cm 84 8.3 83.3 66.2 65.0 39.5 34.5 34.5

 3.0-3.9 cm 100 9.9 78.0 63.8 47.3 36.9 25.8 23.5

 4.0+ cm 208 20.6 59.8 43.3 34.9 27.0 21.1 13.6

 Unknown 563 55.7 58.0 39.7 33.0 26.5 20.3 18.7

 ~ Statistic not displayed due to less than 25 cases.

Figure 2.9: Cancer of the Salivary Gland: Relative Survival 

Rate (%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001 Figure 2.8: Cancer of the Hypopharynx: Relative Survival 

Rate (%) by Stage, Ages 20+, 12 SEER Areas, 1988-2001

90

100

70

80

te (%)

60

70

rvival Ra

All stages

I

II

40

50

elative Su

III

IV

U t d

20

R

30 e

Unstaged

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

80

90

100

%) 50

60

70

al Rate (

% 20

30

40

ve Surviva

0

10

0

0 12 24 36 48 60 72 84 96 108 120

Relativ

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Mucoepidermoid Carcinoma, Low

Acinic Cell Carcinoma

Mucoepidermoid Carcinoma, High

Adenoid Cystic Carcinoma

Carcinoma in Pleomorphic Adenoma

Mucoepidermoid Carcinoma, Other

Adenocarcinoma

Squamous Cell Carcinoma
Chapter 2 Cancers of the Head and Neck

National Cancer Institute 19 SEER Survival Monograph 

Table 2.11: Cancer of the Salivary Gland: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) 

by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology ICD-O-3 Code Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 4,058 100.0 90.0 82.1 77.7 73.9 70.7 68.5

Squamous Cell Carcinoma 8050-8089 695 17.1 76.7 61.1 53.0 45.6 38.0 36.9

Adenocarcinoma

8140-8147,8190, 

8255,8260- 8263, 

8290,8310,8480,8481, 

8560,8570-8574

616 15.2 86.6 73.5 65.5 59.9 54.4 48.5

Adenoid Cystic Carcinoma 8200 546 13.5 97.5 91.9 87.9 84.1 74.8 70.8

Mucoepidermoid Carcinoma, Poorly 

Differentiated 8430-8439 537 13.2 95.9 93.3 92.1 90.4 90.2 84.9

Acinic (Acinar) Cell Carcinoma 8550-8559 505 12.4 99.9 98.0 96.4 95.8 93.5 93.5

Mucoepidermoid Carcinoma (Other) 8430-8439 273 6.7 86.3 76.8 71.2 66.1 64.4 64.4

Carcinoma in Pleomorphic Adenoma 

(Malignant Mixed Tumor) 8940-8949 213 5.2 95.7 90.3 85.7 82.2 78.7 71.1

Mucoepidermoid Carcinoma, Well 

Differentiated 8430-8439 132 3.3 99.0 99.0 99.0 98.6 98.6 98.6

Other All Others 541 13.3 ~ ~ ~ ~ ~ ~

~ Survival statistics not reported due to heterogeneous composition of remaining cell types

Table 2.12: Cancer of the Paranasal Sinus: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year (Yr) Relative Survival Rates 

(%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology ICD-O-3 Code Cases Percent

Relative Survival Rate (%)

1-Yr 2-Yr 3-Yr 5-Yr 8-Yr 10-Yr

Total 1,208 100.0 72.0 57.6 50.3 42.0 38.1 34.7

Squamous Cell Carcinoma

8050-8052,8070-8078, 

8082-8084 649 53.7 66.4 51.1 42.7 36.3 33.3 30.6

Epithelial Neoplasms 8010-8049 134 11.1 69.6 55.3 47.0 32.1 25.5 25.5

Adenoid Cystic Carcinoma (Cylindroma) 8200 124 10.3 91.1 80.0 76.0 61.1 51.0 45.2

Adenocarcinoma

8140-8147,8255,826082

63,8290,8310,8480-8481, 

8560,8570-8574 108 8.9 81.7 68.7 63.2 51.0 50.6 45.8

Other All Others 193 16.0 74.5 59.2 53.1 48.4 43.9 38.0

Table 2.10: Cancer of the Base and Anterior Tongue: 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by AJCC Stage (5th Edition), 

Ages 20+, 12 SEER Areas, 1988-2001

Stage at 

Diagnosis

Relative Survival Rate (%)

Base of Tongue Anterior Tongue

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year 1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 77.8 62.3 55.3 47.5 40.9 36.8 83.1 68.8 62.6 57.5 50.6 46.2

Stage I 84.3 69.6 62.2 51.5 40.6 35.7 95.2 86.1 80.9 75.9 69.4 65.1

Stage II 89.4 75.1 68.9 60.2 54.7 51.8 86.3 70.8 63.5 57.5 48.7 40.8

Stage III 79.7 64.1 58.0 52.7 46.9 41.4 72.3 50.2 44.0 38.8 30.5 26.8

Stage IV 72.8 56.6 49.3 41.9 36.1 32.5 61.8 39.5 31.7 26.5 20.9 17.3

Unstaged 74.4 59.6 52.0 41.4 35.5 33.1 66.8 53.4 46.2 42.0 34.5 31.1

Table 2.9: Cancer of the Base and Anterior of Tongue: Number and Distribution of Cases by AJCC Stage at Diagnosis (5th Edition, 

Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Base of Tongue Anterior of Tongue

Cases Percent Cases Percent

Total 3,796 100.0 4,841 100.0

Stage I 605 15.9 2,322 48.0

Stage II 346 9.1 735 15.2

Stage III 859 22.6 557 11.5

Stage IV 1,745 46.0 902 18.6

Unstaged 241 6.3 325 6.7
Chapter 2 Cancers of the Head and Neck 

National Cancer Institute 20 SEER Survival Monograph 

Figure 2.11: Cancer of the Paranasal Sinus: Relative Survival 

Rate (%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Figure 2.12: Cancer of the Nose, Paranasal Sinus, and Middle 

Ear: Relative Survival Rate (%) by SEER Historic Stage, Ages 

20+, 12 SEER Areas, 1988-2001

Figure 2.10: Cancer of the Nasopharynx: Relative Survival 

Rate (%) by Stage, Ages 20+, 12 SEER Areas, 1988-2001 Discussion

Head and neck cancers consist of a heterogeneous collection 

of anatomic sites and cell types. The majority of head and 

neck cancers are in the oral cavity. In men, cancers of the 

oral cavity and pharynx account for 3% of all new cancer 

cases and are the 8th most common cancer site (5). 

While 5-year relative survival is most frequently quoted, 

the survival curves shown here indicate that survival may 

level off for some head and neck sites before the 5-year 

time point. Relative survival at 2 or 3 years may convey 

as much if not more meaning for patient prognosis.

A major limitation of the data is the lack of additional 

host-based prognostic factors. Several researchers have 

identified comorbidities (9-16) and performance status (15) 

as important prognostic factors for patients with head and 

neck cancers. Since SEER does not routinely collect this 

information, it is not available for inclusion in this monograph. 

References

1. Mayne ST, Morse DE, Winn DM. Cancers of the oral cavity 

and pharynx. In: Schottenfeld D, Fraumeni FJ, eds. Cancer 

epidemiology and prevention, 3rd edition. Oxford Univ Press, 

2006.

2. Alvi A, Myers EN, Johnson JT: Cancer of the Oral Cavity, 

in myers EN, Suen JY, eds: Cancer of the Head and Neck. 

Philadelphia, W.B. Saunders Company; 1996: 321-361.

3. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy BJ, 

Murphy GP, O’Sullivan B, Sobin LH, Yarbro, JW (eds). AJCC 

Cancer Staging Manual, Fifth edition, American Joint Committee 

on Cancer. Philadelphia: Lippincott-Raven, 1997.

4. International Classification of Diseases for Oncology, Geneva. 

World Health Organization, 2000.

5. American Cancer Society. Cancer Facts and Figures 2006. 

Atlanta: American Cancer Society; 2006.

6. Jemal A, Thomas A, Murray T, Thun MJ: Cancer Statistics, 2002. 

CA.A Cancer Journal for Clinicians 2002; 52: 23-47.

7. Marks JE, Phillips JL, Menck HR: The National Cancer Data 

Base report on the relationship of race and national origin to the 

histology of nasopharyngeal carcinoma. Cancer 1998; Aug 1; 83: 

582-588.

8. Dominitz JA, Samas GP, Landsman P, Provenzale D: Race, 

treatment, and survival among colorectal carcinoma patients in an 

equal-access medical system. Cancer 1998; 82: 2312-2320.

9. Piccirillo JF: Purposes, problems, and proposals for progress 

in cancer staging. Arch Otolaryngol Head Neck Surg. 1995 

Feb;121(2):145-9.

10. Singh B, Bhaya M, Zimbler M, et al: Impact of comorbidity on 

outcome of young patients with head and neck squamous cell 

carcinoma. Head and Neck surgery 1998; 20: 1-7.

11. Ribeiro KC, Kowalsik LP, Latorre MR: Impact of comorbidity, 

symptoms and patient’s characteristics on the prognosis of oral 

carcinoma. Arch. Otolaryngol. Head Neck surg. 2000; 126: 

1079-1085.

90

100

70

80

e (%)

60

70

vival Rate

All 

stages

I

40

50

ative Surv

II

III

20

30

Rela

IV

Unstaged

0

10

0 12 24 36 48 60 72 84 96 108 120

g

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

60

70

80

Rate (%)

40

50

60

Survival 

20

30

40

Relative 

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Adenoid Cystic Carcinoma Adenoid Cystic Carcinoma

Adenocarcinoma

Epithelial Neoplasms

Squamous Cell Carcinoma

100

70

80

90

(%)

All

50

60

70

vival Rate 

All stages

Localized

30

40

50

ative Surv

Regional

Distant

10

20

30

Rela

Unstaged

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 2 Cancers of the Head and Neck

National Cancer Institute 21 SEER Survival Monograph 

12. Piccirillo JF: Impact of comorbidity and symptoms on the 

prognosis of patients with oral carcinoma. Arch Otolaryngol 

Head Neck Surg 2000; 126: 1086-1087.

13. Piccirillo JF: Importance of comorbidity in head and neck cancer. 

Laryngoscope 2000; 110: 5923-602.

14. Hall SF, Groome PA, Rothwell D: The impact of comorbidity on 

the survival of patients with squamous cell carcinoma of the head 

and neck. Head & Neck 2000; 22: 317-322.

15. Reid BC, Alberg AJ, Klassen AC, et al: Comorbidity and survival 

of elderly head and neck carcinoma patients. Cancer 2001; 

92:2109-2116.

16. Baatenburg de Jong RJ, Hermans J, Molenaar J, Briaire JJ, le 

Cessie S: Prediction of survival in patients with head and neck 

cancer. Head & Neck 2001; 23: 718-724.
Chapter 2 Cancers of the Head and Neck 

National Cancer Institute 22 SEER Survival Monograph 
National Cancer Institute 23 SEER Survival Monograph 

Introduction

Cancers of the esophagus, stomach, and small intestine 

together account for a approximately 3% of the malignant 

neoplasms diagnosed in the United States each year. Approximately 43,000 people were diagnosed with one of 

these cancers in 2006 (1). About one-third will be cancer of the esophagus (14,550), one-half will be cancer of 

the stomach (22,280) and the remainder will be cancer 

of the small intestine (6,170) (1). However, because as 

a group they have relatively poor survival rates, these 

upper gastrointestinal cancers are responsible for about 

4.7% of the annual U.S. cancer deaths, 26,270 estimated 

deaths in 2006 (1). 

In the 14 year period 1988-2001, the SEER Program recorded 19,410 cancers of the esophagus, 39,623 stomach 

cancers and 6,879 malignant neoplasms of the small intestine (including 2,202 carcinoids). 

The tables and text in this chapter address some of the 

patient characteristics (sex, race, and age) and tumor characteristics (tumor stage, grade, size, subsite location, and 

histology) that may be associated with differences in patients’ prognosis and outcome.

The text primarily cites 5-year relative survival rates as 

the primary outcome measure because of its wide general 

use. However, for cancers associated with poor survival, 

readers may find the tabulations of 1-, 2-, and 3-year relative survival rates to be more informative.

Materials and Methods

The NCI contracts with medically-oriented, nonprofit institutions located in specific geographic areas to obtain 

data on all cancers diagnosed in residents of the SEER 

geographic areas. SEER collects data on all invasive 

and in situ cancers except basal cell and squamous cell 

carcinomas of the skin (of non-genital anatomic sites) and 

in situ carcinomas of the uterine cervix. SEER actively 

follows all previously diagnosed patients on an annual 

basis to obtain vital status allowing the calculation of 

observed and relative survival rates.

This analysis is based on data from 12 SEER geographic 

areas which collectively cover about 14% of the total US 

Charles Key and Angela L.W. Meisner

Chapter 3

Cancers of the Esophagus, Stomach, 

and Small Intestine

Table 3.1: Cancers of the Esophagus, Stomach, and Small Intestine: Number of Cases and Exclusions, 12 SEER Areas, 1988-

2001

Esophagus Stomach Small Intestine

Reason for Exclusion/Selection

Number

Selected/

Remaining

Number 

Excluded

Number

Selected/

Remaining

Number 

Excluded

Number

Selected/

Remaining

Number 

Excluded

19,410 0 39,623 0 6,879 0 Select 1988-2001 diagnosis (Los Angeles for 1992-

2001 only)

15,934 3,476 33,871 5,752 5,210 1,669 Select first primary only

15,702 232 33,356 515 5,101 109 Exclude death certificate only or at autopsy

15,668 34 33,269 87 5,084 17 Exclude unknown race

15,650 18 33,198 71 5,073 11 Exclude alive with no survival time

15,644 6 33,170 28 5,061 12 Exclude children (000-019)

15,446 198 32,839 331 5,023 38 Exclude in situ cancers

14,999 447 31,996 843 4,945 78 Exclude no or unknown microscopic confirmation

14,959 40 31,045 951 4,264 681 Exclude sarcomas (including stromal 8930-8939)

14,932 27 30,382 663 2,062 2,202 Exclude Carcinoids
Chapter 3 Cancers of the Esophagus, Stomach, and Small Intestine

National Cancer Institute 24 SEER Survival Monograph 

Table 3.2: Cancer of the Esophagus (Excluding carcinoids): Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival 

Rates by Sex, Race, Age, Historic Stage, Grade, Primary Site and Tumor Size, 12 SEER Areas, 1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Percent Percent Percent Percent Percent Percent

All Cases 14,932 100.0 9.2 42.1 24.3 18.2 13.6 10.9 9.8

Sex

 Male 11,168 74.8 9.2 42.4 24.3 18.2 13.5 11.0 9.8

 Female 3,764 25.2 9.0 41.1 24.3 18.5 13.7 10.6 9.6

Race

 White 11,561 77.4 9.5 43.7 25.9 19.5 14.6 11.8 10.5

 Black 2,412 16.2 8.0 35.8 17.5 13.0 9.4 6.9 6.6

 Other 959 6.4 8.6 ~ ~ ~ ~ ~ ~

Age

20-49 1,272 8.5 11.1 46.9 27.4 21.9 18.0 15.7 14.7

50-64 4,948 33.1 10.8 47.0 27.5 20.4 14.8 11.6 9.9

65+ 8,712 58.3 8.0 38.4 21.8 16.2 11.9 9.2 8.4

Historic Stage

Localized 3,828 25.6 17.0 62.7 44.5 36.1 28.5 23.2 21.1

Regional 4,260 28.5 11.0 48.1 26.0 18.8 13.0 9.5 8.4

Distant 4,037 27.0 5.1 19.5 6.3 3.6 2.3 1.6 1.5

Unstaged 2,807 18.8 8.0 37.4 20.0 14.4 10.8 9.7 9.3

Grade

Well 722 4.8 12.5 53.6 36.2 30.5 25.9 22.2 18.9

Moderate 4,861 32.6 10.0 45.0 26.4 19.5 13.9 10.5 9.8

Poor 6,341 42.5 8.5 38.9 20.4 15.0 11.1 8.7 7.9

Undifferentiated 405 2.7 7.1 36.5 20.4 13.8 8.0 6.1 6.1

Unknown 2,603 17.4 9.0 42.1 27.2 21.3 16.4 13.9 12.2

Primary Site 

Cervical 431 2.9 10.0 44.6 27.8 19.6 14.9 10.8 7.8

Thoracic 463 3.1 8.8 39.3 22.8 17.6 14.7 12.3 9.8

Abdominal 179 1.2 9.1 42.8 27.6 22.3 15.3 13.9 13.9

Upper third 963 6.4 8.3 38.6 21.7 15.9 10.9 8.0 8.0

Middle third 3,467 23.2 9.1 41.0 22.3 16.3 11.6 7.9 6.7

Lower third 7,400 49.6 9.9 44.8 26.4 20.1 15.2 12.9 11.8

Overlapping lesion 807 5.4 7.1 36.6 20.0 13.1 8.8 6.1 5.9

Esophagus, NOS 1,222 8.2 7.0 34.6 20.6 16.6 13.2 11.4 10.1

Tumor Size

≤ 2 cm 903 6.0 19.0 64.5 48.2 39.9 32.7 26.1 23.6

2.1-5 cm 3,556 23.8 11.3 49.7 28.5 21.2 15.8 12.3 10.4

5.1-10 cm 3,003 20.1 8.5 37.6 19.5 13.6 10.2 7.6 7.2

>10 cm 449 3.0 7.5 35.3 18.9 13.3 7.6 5.8 5.2

Unknown 7,021 47.0 7.9 37.7 21.5 16.3 11.8 9.8 9.0

~ Not calculated.

population. The areas are the States of Connecticut, Iowa, 

New Mexico, Utah, and Hawaii; the metropolitan areas of 

Detroit, Michigan; Atlanta, Georgia; San Francisco, San 

Jose, and Los Angeles, California; Seattle, Washington; 

and 10 counties in rural Georgia. Los Angeles contributed 

data for diagnosis years 1992 to 2001, all other areas for 

1988-2001.
Chapter 3 Cancers of the Esophagus, Stomach, and Small Intestine

National Cancer Institute 25 SEER Survival Monograph 

The following cases were excluded from this survival 

analysis: patients for whom the upper gastrointestinal 

cancer was not the first primary, cases diagnosed at autopsy 

or by death certificate only, persons of unknown race, 

patients alive with no recorded survival time, patients less 

than 20 years old, and cases without microscopic confirmation. Gastrointestinal sarcomas and lymphomas are 

excluded here, but appear in the Sarcoma and Lymphoma 

chapters of this monograph. Remaining cases (including 

carcinoids) available for analysis are as follows: 14,959 

esophageal cancers; 31,045 stomach cancers; 4,264 small 

intestine cancers (Table 3.1). Because the 5-year relative 

survival for carcinoids of the stomach and small intestine 

exceeds 70%, they are shown separately in the relative 

survival tables.

Survival analysis is based on relative survival rates calculated by the life-table (actuarial) method. Relative 

survival, defined as observed survival in the cohort divided 

by expected survival in the cohort, adjusts for the expected 

mortality that the cohort would experience from other 

causes of death. Expected survival is based on decennial 

life tables for the United States in 1990.

The staging definitions utilized in this chapter are SEER 

historic stage: localized – confined to the primary site; regional – spread to regional lymph nodes or by direct extension beyond the primary; distant – metastatic spread. 

Results

The relative survival curves for esophagus, stomach, and 

small intestine cancer are shown in Figure 3.1.

Esophagus

Overall short median survival time (9.2 months) and low 

5-year relative survival rates (14%) serve as baseline 

measures for the following esophageal cancer tables and 

text. Five-year relative survival rates are presented graphically in Figure 3.2.

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Esophagus

Stomach

Small Intestine

Figure 3.1: Relative Survival Rates (%) by Primary Site 

(Esophagus, Stomach, Small Intestine) and Months after 

Diagnosis, Ages 20+, 12 SEER Areas, 1988-2001

0 10 20 30 40 50

All Cases

Sex

Male

Female

Race

White

Black

Age

20-49

50-64

65+

Historic Stage Localized

Regional Distant

Unstaged

Grade

Well

Moderate

Poor

Undifferentiated

Unknown

Primary Site Cervical

Thoracic

Abdominal

Upper third

Middle third

Lower third

Overlapping lesion Esophagus, NOS

Tumor Size

<=2 cm

2.1-5 cm

5.1-10 cm

>10 cm

Unknown

Histologic Type

Squamous cell Adenocarcinoma

(Carcinoid)

5-Year Relative Survival (%)

Figure 3.2: Cancer of the Esophagus: 5-Year Relative Survival 

Rates by Sex, Race, Age, Stage, Grade, Primary Site, Tumor 

Size and Histology, Ages 20+, 12 SEER Areas, 1988-2001
Chapter 3 Cancers of the Esophagus, Stomach, and Small Intestine

National Cancer Institute 26 SEER Survival Monograph 

Sex, Race, and Age

Among 14,932 esophageal cancers cases eligible for this 

analysis, males outnumbered females by a factor of 3 to 

1. However, the observed sex-specific median survival 

times (9.2 and 9.0 months) and 5-year relative survival 

rates (14%) were virtually identical. Survival experience 

of white patients was slightly better than the experience 

of black patients. Fifty-eight percent of the patients were 

65 years and older and their survival experience was 

worse than that of patients in the younger age groups 

(Table 3.2).

Tumor Stage, Grade, and Size

Localized tumor stage, well differentiated tumor grade 

and small tumor size (2 cm or less) were associated with 

5-year relative survival rates of 26% to 33%, whereas for 

distant stage, undifferentiated grade and large tumor size 

(more than 10 cm) rates were 2% to 8% (Table 3.2).

Esophageal Subsite and Histology 

Squamous cell carcinoma is the predominant histologic 

type of esophageal carcinoma worldwide, but in recent 

decades there has been a striking increase of adenocarcinoma, especially in U.S. white males. Squamous cell 

carcinomas moderately outnumber adenocarcinomas in 

total, but adenocarcinomas predominate in the lower third 

of the esophagus. Relative 5-year survival was 12% for 

patients with squamous cell carcinoma and only slightly 

better (15%) for adenocarcinoma patients (Table 3.3). 

Patients whose cancers were coded to locations in the 

lower third of the esophagus or abdominal esophagus had 

relative 5-year survival of about 15%.

Carcinoid tumors are not very common in the esophagus 

when compared to other parts of the upper gastrointestinal 

tract. In this series, the ones that did occur had much 

poorer relative 5-year survival (10%) than those in the 

stomach (71%) or small intestine (77%). Five-year relative survival rates by tumor and patient characteristics 

are presented graphically in Figure 3.2.

Table 3.3: Cancer of the Esophagus: Distribution, Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival 

Rates (%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology (ICD-O code) Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year

10-

Year

All Cases excluding carcinoids 14,932 100.0 9.2 42.1 24.3 18.2 13.6 10.9 9.8

Carcinoma excluding 

carcinoids

 8010-8231, 8247-8572

14,839 99.4 9.2 42.1 24.2 18.2 13.5 10.8 9.8

 Squamous-cell carcinoma

 8050-8076 7,465 50.0 8.9 40.2 22.4 16.6 12.1 9.4 8.3

 Adenocarcinoma

 8140-8141,8191-8231,

 8260-8263,8310,8430,

 8480-8490,8560,

 8570-8572

6,514 43.6 10.0 45.4 26.9 20.1 15.0 12.4 11.3

 Other specified carcinomas 178 1.2 8.8 40.5 22.8 17.3 9.8 5.2 5.2

 Unspecified carcinoma

 8010-8034 682 4.6 6.0 31.1 19.7 16.9 14.3 14.3 13.4

Unspecified Cancer

 8000-8004 75 0.5 8.8 40.7 34.7 34.7 34.3 25.9 21.5

Other specified cancer 18 0.1 ~ ~ ~ ~ ~ ~ ~

Carcinoids

 8240-8246 27 0.2 12.5 53.6 24.1 10.1 10.1 10.1 10.1

 ~ Statistic not displayed due to less than 25 cases.
Chapter 3 Cancers of the Esophagus, Stomach, and Small Intestine

National Cancer Institute 27 SEER Survival Monograph 

Stomach

Short median survival time (10 months) and low 5-year 

relative survival rates (21%) are the overall baseline measures for the stomach cancer tables and text. Five-year 

relative survival rates by tumor and patient characteristics 

are presented graphically in Figure 3.3.

Sex, Race, and Age

There were a total of 30,382 stomach cancer cases available for this analysis with male cancers exceeding female 

by about 1.7 to 1. Female patients experienced a slight 

relative survival advantage at each follow-up interval 

between 1 year and 10 years, but median survival time for 

both sexes was less than 10 months from initial diagnosis. 

Survival for black patients was similar to that for white 

patients. While relative survival rates are not shown for 

other races, it should be noted that most of the “Other” 

races are Asian/Pacific Islanders, whose incidence rate of 

stomach cancer is high; their median survival time (13.5 

months) is higher than for blacks or whites. Almost 2/3 

of the eligible stomach cancer patients in this analysis 

were 65 years old or older. During the first year after 

diagnosis, persons 65 years of age and older had lower 

relative survival (44%) than those 20-49 years of age 

(52%) and 50-64 years (49%). However, at intervals 

between 2 and 10 years the survival rates were remarkably similar (Table 3.4).

Tumor Stage, Grade, and Size

About 20% had cancers that had not spread beyond the 

stomach and their 5-year relative survival was 59%. 

About 1/3 of the patients exhibited extension of tumor to 

adjacent structures or metastasis to regional lymph nodes 

and their 5-year relative survival dropped to 21%. Another 

1/3 of the cases had recognized tumor spread to distant 

organs or lymph nodes at the time of diagnosis and they 

experienced only 2% relative survival at 5 years. Tumors 

measuring 2 cm or less were associated with far better 

5-year relative survival rate (57%) than tumors measuring 

2.1-5.0 cm (30%) or 5.1-10 cm (22%) or greater than 10 

cm (10%). Tumors assigned a histologic grade of “well 

differentiated” were associated with better 5-year relative 

survival rate (42%) than the less differentiated grades, but 

they accounted for only about 4% of the cases (Table 3.4).

Figure 3.3: Cancer of the Stomach: 5-Year Relative Survival 

Rates by Sex, Race, Age, Stage, Grade, Primary Site, Tumor 

Size and Histology, Ages 20+, 12 SEER Areas, 1988-2001

0 10 20 30 40 50 60 70 80 90 100

All Cases

Sex

Male

Female

Race

White

Black

Age

20-49

50-64

65+

Historic Stage Localized

Regional Distant

Unstaged

Grade

Well

Moderate

Poor

Undifferentiated

Unknown

Primary Site 

Cardia, NOS Fundus

Body Gastric antrum

Pylorus Lesser curvature

Greater curvature

Overlapping lesion Stomach, NOS

Tumor Size

<=2 cm

2.1-5 cm

5.1-10 cm

>10 cm

Unknown

Histologic Type

Adenocarcinoma

(Carcinoid)

5-Year Relative Survival (%)
Chapter 3 Cancers of the Esophagus, Stomach, and Small Intestine

National Cancer Institute 28 SEER Survival Monograph 

Table 3.4: Cancer of the Stomach (Excluding Carcinoids): Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival 

Rates by Sex, Race, Age (20+), Historic Stage, Grade, Primary Site and Tumor Size, 12 SEER Areas, 1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases 30,382 100.0 9.6 46.0 31.4 25.4 21.0 18.0 16.9

Sex

 Male 19,034 62.6 9.7 45.9 30.9 24.8 19.9 16.8 15.5

 Female 11,348 37.4 9.5 46.0 32.1 26.4 22.6 20.0 19.0

Race

 White 21,276 70.0 9.0 44.0 29.2 23.2 18.7 15.7 14.4

 Black 3,519 11.6 8.8 44.1 30.4 24.8 20.2 16.8 15.8

 Other 5,587 18.4 13.5 ~ ~ ~ ~ ~ ~

Age

20-49 3,270 10.8 13.0 52.2 33.5 26.6 21.9 18.3 17.5

50-64 7,179 23.6 11.5 49.3 32.8 25.8 20.4 17.3 16.7

65+ 19,933 65.6 8.4 43.6 30.4 25.1 21.1 18.5 17.0

Historic Stage

Localized 6,085 20.0 45.5 78.5 69.1 63.7 58.6 54.0 51.8

Regional 10,272 33.8 15.3 59.7 38.4 28.8 21.4 17.2 15.9

Distant 10,401 34.2 4.3 17.7 6.3 3.7 2.3 1.7 1.6

Unstaged 3,624 11.9 6.2 33.8 20.3 15.1 12.2 10.5 10.2

Grade

Well 1,232 4.1 22.6 65.2 53.8 47.2 41.9 37.3 36.3

Moderate 7,014 23.1 13.2 54.8 39.7 33.0 27.7 23.6 21.5

Poor 16,687 54.9 9.0 43.9 28.5 22.6 18.4 16.0 15.0

Undifferentiated 894 2.9 7.6 38.6 24.9 18.7 13.2 10.4 10.4

Unknown 4,555 15.0 6.6 36.2 24.2 19.8 16.3 14.0 13.3

Primary Site 

Cardia, NOS 7,760 25.5 10.0 45.2 27.4 20.3 15.2 12.0 11.2

Fundus 1,241 4.1 7.3 38.5 24.9 20.2 16.5 12.8 12.0

Body 2,240 7.4 9.1 45.6 33.1 28.0 24.8 22.2 21.8

Gastric antrum 6,282 20.7 12.9 54.3 40.2 34.1 29.2 25.6 24.8

Pylorus 964 3.2 14.6 58.4 42.3 34.7 30.3 25.4 21.5

Lesser curvature, NOS 2,996 9.9 16.8 60.4 46.1 39.9 34.9 31.8 29.9

Greater curvature, 

NOS 1,306 4.3 11.7 51.4 39.5 33.2 28.1 23.9 22.8

Overlapping lesion 2,967 9.8 6.8 34.9 20.0 14.8 11.3 10.0 8.9

Stomach, NOS 4,626 15.2 5.6 31.8 20.3 16.0 12.6 10.5 9.5

Tumor Size

≤ 2 cm 2,056 6.8 46.4 77.6 68.9 62.7 56.8 50.0 48.0

2.1-5 cm 6,986 23.0 17.1 61.8 44.3 36.2 29.5 26.0 23.9

5.1-10 cm 5,842 19.2 12.6 53.4 35.4 27.5 21.9 17.6 15.8

>10 cm 2,584 8.5 7.5 36.4 18.9 13.0 9.5 7.9 7.4

Unknown 12,914 42.5 5.6 30.8 18.9 15.1 12.4 10.7 10.3

- Not calculated.
Chapter 3 Cancers of the Esophagus, Stomach, and Small Intestine

National Cancer Institute 29 SEER Survival Monograph 

Table 3.5: Cancer of the Stomach: Distribution, Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by 

Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology (ICD-O code) Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases excluding carcinoids 30,382 100.0 9.6 46.0 31.4 25.4 21.0 18.0 16.9

Carcinoma excluding carcinoids

 8010-8231,8247-8572 30,156 99.3 9.6 46.0 31.3 25.3 20.8 17.9 16.8

 Squamous-cell carcinoma

 8050-8076 256 0.8 7.4 34.2 23.4 18.4 15.2 14.3 14.3

 Adenocarcinoma

 8140-8141,8191-8231,

 8260-8263,8310,8430,

 8480-8490,8560,

 8570-8572

25,322 83.3 9.5 45.4 30.7 24.8 20.4 17.3 16.2

 Other specified carcinomas 3,635 12.0 13.5 54.7 39.4 32.2 26.8 23.9 22.2

 Unspecified carcinoma

 8010-8034 943 3.1 4.5 28.9 18.5 14.8 11.8 11.2 10.5

Unspecified Cancer

 8000-8004 212 0.7 9.1 47.8 41.9 38.5 37.9 36.5 30.9

Other specified cancer 14 0.0 ~ ~ ~ ~ ~ ~ ~

Carcinoids

 8240-8247 663 2.1 103.8 84.5 77.5 74.4 71.0 67.4 66.0

 ~ Statistic not displayed due to less than 25 cases.

Stomach Subsite and Histology

Cancers arising in proximal regions (cardia, fundus) of the 

stomach are associated with lower relative survival than 

those arising in the greater and lesser curvatures, antrum, 

and pylorus. Adenocarcinomas (of many subtypes) account 

for a large majority of stomach cancer histologic diagnoses 

(Table 3.5). In addition, there are about 3,400 patients with 

primary gastric lymphomas and about 950 patients with soft 

tissue tumors (sarcomas, stromal tumors) of the stomach 

discussed elsewhere in this monograph. 

In this analysis, the 663 eligible patients with carcinoid 

tumors of the stomach had a median survival time of 104 

months, 5-year relative survival of 71%, and 10-year relative survival of 66%. 
Chapter 3 Cancers of the Esophagus, Stomach, and Small Intestine

National Cancer Institute 30 SEER Survival Monograph 

Small Intestine

Short median survival time (14.0 months) and 5-year relative 

survival (27%) are the overall baseline outcome measures 

for cancers (mostly adenocarcinomas) of the small intestine 

that are included in this analysis. The small intestine is 

remarkable for the relative rarity of malignant neoplasms 

occurring in such a large (surface area) organ. Five-year 

relative survival rates are presented graphically in Figure 

3.4. 

Sex, Race, and Age

Of 2,062 small intestine cancers included in this analysis, 

a little more than half (52.6%) occurred in males. This 

contrasts with the much stronger male predominance observed for cancers of the esophagus and stomach. Males 

exhibit slightly better relative survival at years 1 and 2 after 

diagnosis; relative survival is virtually equal at years 3 and 

5; and there is a slight female advantage at years 8 and 10. 

Beginning at year 3, white patients maintain a consistent 

survival advantage over patients who are black. A larger 

percent of small intestine cancer patients (17.0%) are in the 

youngest age group than for the other upper gastrointestinal 

cancers (esophagus 8.5%, stomach 10.8%) and a smaller 

percent in the oldest age group. The younger patients have 

an early survival advantage that diminishes by 10 years 

after diagnosis (Table 3.6).

Tumor Stage, Grade, and Size

About 21% of the cancers were confined to the small intestine 

at the time of diagnosis and they were associated with more 

favorable 5-year relative survival (57%), compared to those 

with regional (34%) or distant spread (3%). Tumor grades 

of well and moderate differentiation were associated with 

similar survival outcomes (35% and 35%, respectively) in 

contrast to poor differentiation (21%). Smaller tumors (2 

cm or less) have moderately better outcomes than larger 

tumors, but the gradient associated with increasing tumor 

size is less striking than the gradient for cancers of the 

esophagus and stomach.

The 2,202 patients with small intestine carcinoid tumors 

in this series experienced a median survival time of 97.6 

months and 5- and 10-year relative survival rates of 77% 

and 62%, respectively (Table 3.7).

Carcinoid tumors outnumber carcinomas in this series by 

a factor of 1.11 (2,202/1,985). Additionally, about 681 

sarcomas and 1,367 primary lymphomas of the small intestine are excluded from this analysis, but are discussed 

in other chapters of this monograph.

0 10 20 30 40 50 60 70 80 90 100

All Cases

Sex

Male

Female

Race

White

Black

Age

20-49

50-64

65+

Historic Stage Localized

Regional

Distant

Unstaged

Grade

Well

Moderate

Poor

Unknown

Primary Site Duodenum

Jejunum Ileum (excl. valve) Small intestine

Tumor Size

<=2 cm

2.1-5 cm

5.1-10 cm

>10 cm

Unknown

Histologic Type

Adenocarcinoma

(Carcinoid)

5-Year Relative Survival (%)

Figure 3.4: Cancer of the Small Intestine: 5-Year Relative 

Survival Rates by Sex, Race, Age, Stage, Grade, Primary Site, 

Tumor Size and Histology, Age 20+, 12 SEER Areas, 1988-

2001
Chapter 3 Cancers of the Esophagus, Stomach, and Small Intestine

National Cancer Institute 31 SEER Survival Monograph 

Table 3.6: Cancer of the Small Intestine (Excluding Carcinoids): Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year 

Relative Survival Rates by Sex, Race, Age, Historic Stage, Grade, Primary Site and Tumor Size, 12 SEER Areas, 1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases 2,062 100.0 14.0 55.1 39.3 32.6 27.5 24.8 24.3

Sex

 Male 1,084 52.6 14.4 56.7 40.1 32.7 27.8 23.8 23.8

 Female 978 47.4 13.3 53.3 38.3 32.7 27.2 25.4 24.8

Race

 White 1,561 75.7 13.7 54.8 39.7 33.5 28.1 25.9 25.6

 Black 348 16.9 15.8 57.6 40.7 31.3 25.8 21.0 19.5

 Other 153 7.4 12.2 ~ ~ ~ ~ ~ ~

Age

20-49 350 17.0 22.2 67.5 48.0 41.4 34.9 31.5 28.7

50-64 546 26.5 18.6 61.6 46.5 38.7 32.9 29.5 28.4

65+ 1,166 56.5 10.0 48.0 32.7 26.4 21.5 18.4 18.0

Historic Stage

Localized 438 21.2 49.8 79.7 70.1 62.5 57.2 54.5 54.0

Regional 784 38.0 22.2 69.7 51.0 41.4 33.6 28.5 27.9

Distant 660 32.0 5.1 25.7 9.6 5.6 3.3 2.6 2.6

Unstaged 180 8.7 6.8 39.2 22.1 20.4 15.9 13.7 12.0

Grade

Well 178 8.6 19.4 66.3 47.3 40.3 35.3 34.2 34.2

Moderate 790 38.3 20.9 65.8 50.0 41.3 34.8 29.6 27.9

Poor 658 31.9 9.3 45.4 30.3 24.5 20.5 18.7 18.2

Undifferentiated 45 2.2 3.1 16.1 4.8 4.8 ! ! !

Unknown 391 19.0 10.7 33.0 28.6 23.1 21.6 21.4

Primary Site 

Duodenum 1,140 55.3 10.8 49.4 34.1 28.0 24.5 22.0 21.7

Jejunum 394 19.1 21.2 68.1 49.3 39.6 32.2 26.6 26.2

Ileum (excl. valve) 255 12.4 18.6 60.9 48.9 43.4 35.1 32.2 30.1

Meckels diverticulum 8 0.4 ~ ~ ~ ~ ~ ~ ~

Overlapping lesion 20 1.0 ~ ~ ~ ~ ~ ~ ~

Small intestine, NOS 245 11.9 13.1 53.7 36.2 29.6 24.4 21.5 21.5

Tumor Size

<2 cm 165 8.0 24.0 76.4 53.4 47.3 39.9 37.7 35.7

2.1-5 cm 641 31.1 21.7 67.3 51.2 42.8 36.0 29.8 29.8

5.1-10 cm 370 17.9 19.2 64.8 48.7 41.4 34.3 31.0 28.2

>10 cm 67 3.2 11.6 50.0 36.7 29.4 24.4 24.4 24.4

Unknown 819 39.7 7.0 37.0 22.8 17.6 14.8 13.8 13.4

 ! Not enough intervals to produce rate.

 ~ Statistic not displayed due to less than 25 cases.
Chapter 3 Cancers of the Esophagus, Stomach, and Small Intestine

National Cancer Institute 32 SEER Survival Monograph 

Table 3.7: Cancer of the Small Intestine: Distribution, Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival 

Rates (%) by Histology, ages 20+, 12 SEER Areas, 1988-2001

Histology (ICD-O code) Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases excluding

carcinoids 2,062 100.0 14.0 55.1 39.3 32.6 27.5 24.8 24.3

Carcinoma excluding

carcinoids

 8010-8572

1,985 96.3 13.4 54.3 38.4 31.6 26.5 24.1 23.7

 Squamous-cell carcinoma

 8050-8076 7 0.3 ~ ~ ~ ~ ~ ~ ~

 Adenocarcinoma

 8140-8141,8191-8231,

 8260-8263,8310,8430,

 8480-8490,8560,

 8570-8572

1,852 89.8 13.9 55.1 38.7 31.7 26.6 24.1 23.6

 Other specified carcinomas 40 1.9 41.3 69.7 62.5 56.4 41.3 41.3 41.3

 Unspecified carcinoma

 8010-8034 86 4.2 5.4 33.8 24.4 20.5 19.5 14.7 14.7

Unspecified Cancer

 8000-8004 66 3.2 52.4 73.1 63.4 61.5 54.8 43.1 22.7

Other specified cancer 11 0.5 ~ ~ ~ ~ ~ ~ ~

Carcinoids 2,202 51.6 97.6 89.9 87.5 84.8 76.5 67.1 61.5

 ~ Statistic not displayed due to less than 25 cases.

Discussion

Survival rates for these three sites were generally poor. 

Overall the 5-year relative survival rates were 14% for 

esophageal, 21% for stomach, and 28% for small intestine 

cancers. Even though survival rates were higher for localized disease, well differentiated tumors, and small sized 

tumors, the survival rates were still lower than those for 

many primary sites such as breast, prostate, and colon/rectum. Carcinoids of the stomach and small intestine had the 

highest 5-year survival rates, 71% and 77%, respectively.

Reference

1. American Cancer Society. Cancer Facts and Figures 2006. 

Atlanta: American Cancer Society, 2006.
National Cancer Institute 33 SEER Survival Monograph 

Introduction

Cancers of the colon and rectum are the third most common cancer among both men and women in the United 

States and the second leading cause of cancer death (1). 

Fifty-three percent of colorectal cancers occur in either 

the lower (sigmoid) colon or the rectum and should be 

easy to detect at an early stage.

Materials and Methods

The NCI contracts with medically-oriented, nonprofit institutions located in specific geographic areas to obtain 

data on all cancers diagnosed in residents of the SEER 

geographic areas. SEER collects data on all invasive 

and in situ cancers except basal cell and squamous cell 

carcinomas of the skin (of non-genital anatomic sites) and 

in situ carcinomas of the uterine cervix. SEER actively 

follows all previously diagnosed patients on an annual 

basis to obtain vital status allowing the calculation of 

observed and relative survival rates.

This analysis is based on data from 12 SEER geographic 

areas which collectively cover about 14% of the total US 

population. The areas are the States of Connecticut, Iowa, 

New Mexico, Utah, and Hawaii; the metropolitan areas of 

Detroit, Michigan; Atlanta, Georgia; San Francisco, San 

Jose, and Los Angeles, California; Seattle, Washington; 

and 10 counties in rural Georgia. Los Angeles contributed 

data for diagnosis years 1992 to 2001, all other areas for 

1988-2001.

In situ diagnoses have been excluded, except as noted in 

the staging section. Cases diagnosed in children and adolescents aged 0-19 have also been excluded. Some patients 

have more than one diagnosis of cancer, but only the first 

diagnosis of cancer has been included. Death certificate 

only cases, autopsy only cases, and all other cases with no 

survival time have been excluded. Further, cases with no 

microscopic confirmation have been excluded. Finally, 

sarcomas arising in the colon and rectum have also been 

excluded from this analysis as they have been included 

in Chapter 11 of this monograph. Table 4.1 shows the 

numbers of cases excluded by category.

Survival analysis is based on relative survival rates calculated by the life-table (actuarial) method. Relative survival, 

defined as observed survival in the cohort divided by 

expected survival in the cohort, adjusts for the expected 

mortality that the cohort would experience from other 

causes of death. Expected survival is based on decennial 

life tables for the United States in 1990.

Kevin C. Ward, John L. Young, Jr., and Lynn A. Gloeckler Ries

Chapter 4

Cancers of the Colon and Rectum

Table 4.1: Cancers of the Colon and Rectum: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number Excluded Reason for Exclusion/Selection

247,671 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

201,637 46,034 Select first primary only

199,425 2,212 Exclude death certificate only or at autopsy

198,521 904 Exclude unknown race

198,331 190 Exclude alive with no survival time

198,242 89 Exclude children (Ages 0-19)

187,201 11,041 Exclude in situ cancers

182,752 4,449 Exclude no or unknown microscopic confirmation

182,589 163 Exclude sarcomas
Chapter 4 Cancers of the Colon and Rectum

National Cancer Institute 34 SEER Survival Monograph 

Results

Table 4.2 shows the case distribution by subsite and by 

sex, race, and 5th edition American Joint Committee on 

Cancer (AJCC) Stage (2) for the 182,589 cases included 

in this analysis. There were slightly more females included in the colon category while males predominated 

the rectum and rectosigmoid category. Blacks comprised 

9.2% of the cases while races other than white or black 

accounted for 8.3% of the cases. With the exceptions of 

cases arising in the colon “not otherwise specified” or 

cases overlapping two colon subsites, more than 50% of 

the cases were diagnosed at an early stage (I or II). For 

the unknown colon subsite, the percentage of cases with 

unknown stage was large which contributed to the percentage of early stage being low. The percentage of stage 

I cases was greatest for the sigmoid colon, the rectum, 

and the rectosigmoid junction.

Table 4.3 shows the 1-, 3-, 5-, and 10-year relative survival 

rates by subsite of the colon and rectum and by sex. With 

the exception of a cancer which overlapped two subsites 

or a lesion which arose in an unidentified subsite of the 

colon, 5-year survival rates differed little by subsite or 

between the colon (64%) and the rectum (63%). The other 

two subsites (overlapping and NOS) had much poorer 

survival. There was essentially no difference by subsite 

or overall in survival of men and women, both 64%.

Table 4.4 shows the relative survival by subsite for whites 

and blacks. As has been noted, with the exception of 

overlapping or unspecified subsites, there was little variation by subsite within race. However, whites had a clear 

survival advantage (65% overall after 5 years) over blacks 

(55%). 

Relative survival rates for the four age groups 20-49, 50-

64, 65-74, and 75+ are shown in Table 4.5. Interestingly, 

roughly one-third of the cases occurred in each of the 

age groups 20-64, 65-74, and 75+. Overall, there was a 

slight increase in the 5-year relative rate with increasing 

age before age 75, however, these differences are small 

(63%-65%). Again, with the exception of the overlapping 

and unspecified subsites, there was very little difference 

in survival rates across subsites for cases within the same 

age group.

Table 4.6 shows relative survival rates by subsite for the 

three time periods 1988-1991, 1992-1996 and 1997-2001. 

It should be noted that there was a higher percentage of 

cases included in the later two time periods due to the 

inclusion of the Los Angeles County data beginning in 

1992. Surprisingly, there was no change in the survival 

rates for first two time periods, 63% vs. 63% overall 

at 5 years with a slight increase to 65% in the last time 

period.

The distribution by stage categories as defined in the 5th 

Edition of the AJCC Staging Handbook (2) and subsite is 

shown in Table 4.7. While in situ lesions were excluded 

from this analysis, the AJCC considers invasion of the 

lamina propria to be equivalent to in situ or non-invasive 

disease. Thus while cancers which meet these criteria are 

Table 4.2: Cancers of the Colon and Rectum: Distribution by Subsite, Sex, Race and 5th Edition AJCC Stage Group, 

Ages 20+, 12 SEER Areas, 1988-2001

Primary Site/Subsite

Sex Race AJCC Stage (%)

Total Male Female White Black Other 0/I II III IV Unknown

Colon and rectum 182,589 92,880 89,709 150,522 16,830 15,237 26.3 28.5 23.3 17.4 4.4

 Colon 129,445 62,825 66,620 106,695 12,732 10,018 22.8 31.1 23.9 18.5 3.6

 Cecum 30,203 13,186 17,017 25,528 3,166 1,509 17.3 31.9 27.9 20.4 2.5

 Appendix 1,455 726 729 1,210 146 99 18.4 36.7 11.3 31.1 2.5

 Ascending 19,236 8,682 10,554 15,966 1,961 1,309 19.9 35.0 26.0 16.0 3.0

 Hepatic flexure 6,998 3,361 3,637 5,782 655 561 17.0 37.9 24.9 16.7 3.5

 Transverse 11,142 5,012 6,130 9,231 1,073 838 16.1 38.3 24.9 18.1 2.5

 Splenic flexure 5,045 2,725 2,320 4,012 689 344 14.5 36.8 26.4 19.7 2.5

 Descending 8,194 4,248 3,946 6,380 994 820 25.4 33.4 21.8 16.4 3.0

 Sigmoid 43,016 22,767 20,249 35,220 3,520 4,276 32.8 26.3 21.6 16.4 2.9

 Overlapping 1,129 584 545 911 135 83 11.5 32.7 26.4 25.6 3.8

 Colon, NOS 3,027 1,534 1,493 2,455 393 179 6.5 6.9 4.8 45.2 36.7

 Rectum and rectosigmoid 53,144 30,055 23,089 43,827 4,098 5,219 34.8 22.0 21.9 14.8 6.5

 Rectosigmoid 17,984 9,967 8,017 14,897 1,403 1,684 27.1 26.1 25.7 17.5 3.6

 Rectum 35,160 20,088 15,072 28,930 2,695 3,535 38.7 20.0 19.9 13.4 7.9
Chapter 4 Cancers of the Colon and Rectum

National Cancer Institute 35 SEER Survival Monograph 

considered to be malignant neoplasms, with respect to 

AJCC stage they are classified as Stage 0. Thus, in the 

tables containing information by AJCC stage category, 

Stage 0 is limited only to those patients whose tumor 

had extended to the lamina propria. For stage 0/I with 

the exception of patients whose cancer overlapped two 

subsites and rectal cancers, all other colorectal subsites 

had 5-year relative survival rates of 90% or higher. For 

stage II cancers, with the exception of colon not otherwise 

Table 4.3: Cancers of the Colon and Rectum: 1-, 3- ,5- and 10-Year (Yr) Relative Survival Rates (%) by Subsite and Sex,

Ages 20+, 12 SEER Areas, 1988-2001

Primary Site/Subsite

Relative Survival Rate (%)

Total Male Female

1-Yr 3-Yr 5-Yr 10-Yr 1-Yr 3-Yr 5-Yr 10-Yr 1-Yr 3-Yr 5-Yr 10-Yr

Colon and rectum 83.3 69.9 63.6 57.7 84.2 70.6 63.7 57.8 82.4 69.1 63.5 57.5

 Colon 82.0 69.3 64.0 58.9 83.0 70.4 64.7 60.0 81.1 68.3 63.4 57.9

 Cecum 79.8 65.7 61.2 56.7 80.9 66.2 60.7 56.6 78.9 65.4 61.6 56.7

 Appendix 85.0 68.2 59.3 50.4 84.3 68.4 59.1 49.2 85.6 68.1 59.2 51.3

 Ascending 81.7 70.3 66.0 60.7 82.8 70.6 66.0 60.6 80.8 70.0 66.0 60.8

 Hepatic flexure 78.6 66.6 62.1 55.0 78.7 66.1 61.1 55.0 78.4 67.0 62.9 54.8

 Transverse 79.7 67.2 62.4 56.6 80.9 69.2 63.6 58.6 78.7 65.6 61.4 54.9

 Splenic flexure 80.1 64.9 59.6 53.3 81.0 66.3 60.3 54.6 79.1 63.3 58.7 51.4

 Descending 84.8 72.4 65.5 58.3 85.9 74.0 66.8 60.1 83.6 70.8 64.1 56.5

 Sigmoid 86.9 74.8 68.7 64.0 87.4 75.8 69.7 65.5 86.4 73.6 67.7 62.5

 Overlapping 74.3 60.1 54.7 50.9 74.6 58.2 52.9 43.9 73.9 62.2 55.9 55.9

 Colon, NOS 50.1 34.6 29.2 23.4 52.5 38.3 33.7 28.4 47.7 30.9 24.5 17.9

 Rectum and rectosigmoid 86.5 71.3 62.7 55.0 86.7 71.1 61.9 53.8 86.1 71.5 63.7 56.5

 Rectosigmoid 86.3 71.4 62.8 55.6 86.4 71.0 61.6 53.2 86.2 72.0 64.3 58.1

 Rectum 86.5 71.2 62.6 54.7 86.9 71.2 62.1 54.1 86.1 71.3 63.3 55.5

Table 4.4: Cancers of the Colon and Rectum: 1-, 3- ,5- and 10-Year Relative Survival Rates (%) by Subsite 

and Race, Ages 20+, 12 SEER Areas, 1988-2001

Primary Site/Subsite

Relative Survival Rate (%)

White Black

1-Year 3-Year 5-Year 10-Year 1-Year 3-Year 5-Year 10-Year

Colon and rectum 83.5 70.5 64.5 58.7 78.9 62.5 55.1 48.7

 Colon 82.2 70.0 65.0 60.1 77.7 61.7 55.2 49.3

 Cecum 80.1 66.5 62.2 57.6 76.6 59.1 52.7 49.0

 Appendix 84.2 67.9 59.9 52.0 89.9 69.7 55.5 43.9

 Ascending 82.0 71.0 67.0 62.5 76.7 63.1 56.4 47.6

 Hepatic flexure 78.3 67.3 63.2 56.0 79.5 62.1 55.1 49.5

 Transverse 79.4 67.6 62.7 57.0 76.9 58.9 52.9 46.7

 Splenic flexure 80.6 66.1 61.2 55.9 75.5 57.5 51.2 39.6

 Descending 85.1 73.1 66.5 58.9 80.0 67.1 59.1 52.8

 Sigmoid 87.2 75.6 69.8 65.3 82.1 66.7 60.5 54.4

 Overlapping 75.2 61.7 56.6 52.7 64.7 50.7 43.1 38.8

 Colon, NOS 49.8 34.6 29.3 23.5 48.5 31.1 25.5 17.4

 Rectum and rectosigmoid 86.5 71.7 63.2 55.7 82.6 64.7 54.7 47.0

 Rectosigmoid 86.6 72.1 63.5 56.5 80.2 62.7 52.8 42.8

 Rectum 86.5 71.5 63.1 55.2 83.9 65.8 55.7 49.2

specified, there was a distinct survival advantage (83% 

overall) for colon versus rectum and rectosigmoid (70% 

overall). Among persons with Stage III disease there 

were no notable differences among the colon or rectal 

subsites with the exception of the appendix and the unspecified colon, both of which had much poorer relative 

survival rates at five years. For stage IV cancers, 5-year 

survival rates were less than 8% for all subsites with the 
Chapter 4 Cancers of the Colon and Rectum

National Cancer Institute 36 SEER Survival Monograph 

Table 4.5: Cancers of the Colon and Rectum: 1-, 3- ,5- and 10-Year Relative Survival Rates (%) by Subsite and Age Group 

(Ages 20+), 12 SEER Areas, 1988-2001

Subsite/Age Group (Years) Total Percent

Relative Survival Rate (%)

1-Year 3 -Year 5-Year 10-Year

Colon and rectum 182,589 100.0

20-49 15,670 8.6 87.6 70.0 62.8 56.7

50-64 44,949 24.6 87.4 72.2 64.9 59.0

65-74 54,379 29.8 85.0 71.7 65.0 59.3

75+ 67,591 37.0 77.9 66.2 61.3 55.1

Colon 129,445 100.0

20-49 9,834 7.6 85.9 68.4 61.7 56.4

50-64 29,344 22.7 85.7 70.5 64.3 59.4

65-74 38,563 29.8 84.0 71.2 65.4 60.6

75+ 51,704 39.9 77.5 66.9 63.1 57.5

Cecum 30,203 100.0

20-49 1,808 6.0 84.8 66.0 60.3 55.0

50-64 5,722 18.9 81.5 63.3 57.7 53.4

65-74 8,654 28.7 81.0 66.5 61.4 58.2

75+ 14,019 46.4 77.5 66.4 63.4 59.3

Appendix 1,455 100.0

20-49 487 33.5 93.2 74.6 68.1 61.1

50-64 442 30.4 85.0 67.5 56.4 46.5

65-74 284 19.5 82.6 65.6 56.1 40.1

75+ 242 16.6 69.9 57.0 44.7 37.4

Ascending 19,236 100.0

20-49 1,125 5.8 83.1 66.6 61.7 56.5

50-64 3,744 19.5 83.7 67.3 61.8 57.8

65-74 5,662 29.4 84.2 72.3 67.4 61.7

75+ 8,705 45.3 78.8 70.9 68.1 64.1

Hepatic flexure 6,998 100.0

20-49 476 6.8 80.1 65.8 62.6 58.4

50-64 1,317 18.8 80.9 66.9 62.9 57.8

65-74 2,029 29.0 81.1 67.7 61.4 53.9

75+ 3,176 45.4 75.5 65.6 61.8 51.0

Transverse 11,142 100.0

20-49 838 7.5 82.5 65.0 58.4 53.5

50-64 2,319 20.8 82.4 66.7 61.6 56.2

65-74 3,243 29.1 83.0 69.9 64.1 58.7

75+ 4,742 42.6 75.3 65.8 62.3 54.0

Splenic flexure 5,045 100.0

20-49 482 9.6 87.8 67.6 60.2 55.0

50-64 1,176 23.3 84.7 66.4 59.6 53.9

65-74 1,518 30.1 82.1 68.4 62.8 56.5

75+ 1,869 37.0 73.2 59.4 55.8 45.3
Chapter 4 Cancers of the Colon and Rectum

National Cancer Institute 37 SEER Survival Monograph 

Table 4.5 (continued): Cancers of the Colon and Rectum: 1-, 3- ,5- and 10-Year Relative Survival Rates (%) by Subsite and 

Age Group (Ages 20+), 12 SEER Areas, 1988-2001

Subsite/Age Group (Years) Total Percent

Relative Survival Rate (%)

1-Year 3 -Year 5-Year 10-Year

Descending 8,194 100.0

20-49 742 9.1 87.3 71.4 62.3 57.0

50-64 2,139 26.1 88.7 74.5 67.4 60.2

65-74 2,506 30.6 87.1 75.1 67.8 61.1

75+ 2,807 34.3 78.6 68.1 62.1 52.2

Sigmoid 43,016 100.0

20-49 3,463 8.1 89.4 72.0 64.2 58.9

50-64 11,577 26.9 90.9 78.2 71.5 66.7

65-74 13,558 31.5 90.9 78.2 71.5 66.7

75+ 14,418 33.5 81.5 70.1 65.1 60.3

Overlapping 1,129 100.0

20-49 122 10.8 74.7 53.5 47.9 47.9

50-64 263 23.3 75.7 58.8 49.8 40.4

65-74 285 25.2 76.6 62.0 58.0 55.4

75+ 459 40.7 71.7 61.8 57.5 55.1

Colon, NOS 3,027 100.0

20-49 291 9.6 67.5 48.5 42.2 33.4

50-64 645 21.3 56.0 36.7 31.8 26.6

65-74 824 27.2 52.8 36.4 28.1 22.0

75+ 1,267 41.9 40.6 27.9 23.7 16.2

Rectum & rectosigmoid 53,144 100.0

20-49 5,836 11.0 90.3 72.9 64.7 57.0

50-64 15,605 29.4 90.7 75.3 65.9 58.2

65-74 15,816 29.8 87.5 72.8 64.2 56.2

75+ 15,887 29.9 79.4 64.0 55.6 47.7

Rectosigmoid 17,984 100.0

20-49 1,663 9.2 89.6 70.1 61.5 52.8

50-64 5,211 29.0 89.9 74.5 65.0 57.9

65-74 5,654 31.4 87.6 72.7 64.5 57.5

75+ 5,456 30.3 80.1 66.9 58.4 50.2

Rectum 35,160 100.0

20-49 4,173 11.9 90.6 74.0 66.0 58.7

50-64 10,394 29.6 91.1 75.7 66.3 58.3

65-74 10,162 28.9 87.4 72.9 63.9 55.2

75+ 10,431 29.7 79.1 62.5 54.1 46.1
Chapter 4 Cancers of the Colon and Rectum

National Cancer Institute 38 SEER Survival Monograph 

Table 4.6: Cancers of the Colon and Rectum: 1-, 3- , and 5-Year Relative Survival Rates (%) by Subsite and Sex, Ages 20+, 12 

SEER Areas, 1988-2001

Primary Site/Subsite

Relative Survival Rate (%)

Diagnosis Year 1988-1991 Diagnosis Year 1992-1996 Diagnosis Year 1997-2001

1-Year 3 -Year 5-Year 1-Year 3 -Year 5-Year 1-Year 3 -Year 5-Year

Colon and rectum 83.0 69.0 62.6 82.9 69.1 62.9 83.9 71.3 65.2

 Colon 81.8 68.8 63.6 81.8 68.6 63.3 82.4 70.2 65.0

 Cecum 79.2 64.9 60.6 78.9 64.4 60.0 81.0 67.7 62.3

 Appendix 82.0 67.7 61.0 86.5 67.4 57.8 85.0 68.9 59.2

 Ascending 80.3 69.5 65.1 81.9 69.8 65.4 82.3 70.9 66.8

 Hepatic flexure 78.2 66.4 60.0 78.2 66.4 62.6 79.1 66.6 62.9

 Transverse 79.3 65.2 61.2 79.0 66.6 61.6 80.6 69.1 63.2

 Splenic flexure 78.8 63.7 58.6 79.6 63.6 58.6 81.5 67.0 60.9

 Descending 85.4 73.9 66.6 84.6 72.3 64.6 84.6 71.2 66.9

 Sigmoid 86.5 73.8 67.9 86.9 74.3 68.0 87.2 76.1 70.7

 Overlapping 72.8 60.4 56.1 75.0 60.1 53.9 74.2 60.0 54.8

 Colon, NOS 56.1 40.2 35.4 50.9 36.2 31.2 45.7 29.4 20.2

 Rectum & rectosigmoid 86.0 69.3 60.2 85.8 70.1 62.0 87.4 73.9 65.5

 Rectosigmoid 86.0 69.8 60.8 85.6 70.6 62.3 87.3 73.8 65.3

 Rectum 85.9 69.1 59.9 85.8 69.9 61.8 87.5 74.0 65.6

Table 4.7: Cancers of the Colon and Rectum: 1-, 5-, and 10-Year Relative Survival Rates (%) by Subsite and AJCC Stage (5th 

Edition), Ages 20+, 12 SEER Areas, 1988-2001

 

Primary Site/Subsite

AJCC Stage

Stage 0,I Stage II Stage III Stage IV

1-Yr 5-Yr 10-Yr 1-Yr 5-Yr 10-Yr 1-Yr 5-Yr 10-Yr 1-Yr 5-Yr 10-Yr

Colon and rectum 96.9 92.7 89.0 93.0 79.7 71.8 88.6 58.3 50.5 43.6 6.9 4.8

 Colon 96.7 94.8 92.6 93.2 82.7 75.9 87.2 59.1 52.7 41.8 7.0 5.0

 Cecum 95.5 94.4 91.4 94.0 85.8 81.0 85.4 56.9 51.7 39.1 6.8 5.1

 Appendix 97.4 89.9 83.2 92.6 73.9 63.9 89.2 48.3 37.0 65.9 25.4 16.2

 Ascending 95.4 93.0 89.0 94.3 87.5 80.8 84.6 58.8 54.2 36.6 5.9 3.4

 Hepatic flexure 94.6 93.2 89.7 91.3 81.0 72.4 83.5 54.8 46.0 31.5 5.5 4.0

 Transverse 95.0 89.9 86.3 92.0 83.3 76.4 83.8 56.3 49.2 37.6 7.4 6.2

 Splenic flexure 94.2 89.9 87.4 91.3 78.6 70.7 86.9 59.7 49.7 42.7 6.6 5.9

 Descending 96.5 92.4 84.9 93.0 81.5 72.8 89.1 58.4 50.2 48.7 7.1 5.3

 Sigmoid 98.0 96.8 95.1 93.4 79.4 72.1 91.9 63.3 55.8 51.0 7.5 4.9

 Overlapping 93.2 81.6 80.0 94.0 84.9 79.2 85.5 57.0 49.0 31.1 4.9 4.4

 Colon, NOS 94.9 90.2 82.5 78.1 57.9 49.7 67.0 40.7 28.9 19.8 2.1 0.8

 Rectum and rectosigmoid 97.3 89.5 84.0 92.5 69.7 59.2 92.2 56.4 44.9 49.0 6.9 4.2

 Rectosigmoid 97.8 93.4 89.9 93.4 74.3 64.7 92.4 59.4 47.8 52.0 7.6 4.8

 Rectum 97.1 88.1 81.6 91.9 66.7 55.2 92.0 54.4 43.0 47.0 6.4 3.7
Chapter 4 Cancers of the Colon and Rectum

National Cancer Institute 39 SEER Survival Monograph 

Table 4.8: Cancers of the Colon and Rectum: 1-, 3- ,5- and 10-Year Relative Survival Rates (%) for AJCC (5th Edition) Stage 0/I 

Cancers by Extension, Ages 20+, 12 SEER Areas, 1988-2001

ExtensionInvasive tumor confined to:

Relative Survival Rate (%)

Colon Rectum and rectosigmoid

1-Year 3-Year 5-Year 10-Year 1-Year 3-Year 5-Year 10-Year

Mucosa, NOS 96.6 94.5 93.6 92.9 97.4 92.4 90.0 88.6

Lamina propria* 96.5 95.6 94.2 91.9 98.3 95.3 93.0 89.5

Muscularis mucosae 96.6 95.0 94.1 93.9 98.1 94.9 92.6 85.7

Head of polyp 98.4 98.4 98.2 96.3 99.3 99.3 99.2 86.0

Stalk of polyp 98.8 98.4 96.5 93.8 98.3 95.8 92.6 90.9

Polyp, NOS 96.5 94.9 93.5 91.7 98.5 95.8 92.7 85.8

Submucosa 97.5 97.4 96.2 94.3 98.6 96.7 93.4 89.3

Muscularis propria invaded 97.0 97.0 96.2 92.1 97.9 95.0 89.4 81.3

* Considered Stage 0

Table 4.9: Cancers of the Colon and Rectum: 1-, 3- ,5- and 10-Year Relative Survival Rates (%) for AJCC Stage II (5th Edition) 

Cancers by Extension, Ages 20+, 12 SEER Areas, 1988-2001

Extension

Relative Survival Rate (%)

Stage II Colon Cancers

1-Year 3-Year 5-Year 10-Year

Invasion through muscularis propria or muscularis, NOS 95.5 92.5 89.3 81.6

Fat, NOS 93.3 90.8 ~ ~

Extension to adjacent (connective) tissue 95.0 89.0 84.2 77.5

Invasion of/through serosa 93.4 87.8 82.8 76.6

Invasion of/through serosa with extension to fat, NOS or adjacent tissue 88.5 78.4 71.4 66.7

Greater omentum, spleen, pelvic wall, small intestine 74.9 60.0 55.9 49.8

Abdominal wall, retroperitoneum 72.4 52.1 44.9 39.0

Ureter, kidney 67.1 37.0 26.2 18.0

Uterus, ovary, fallopian tube 75.2 52.8 44.2 38.6

Urinary bladder, adrenal gland, diaphragm, other segments of colon via serosa 76.7 59.6 49.3 43.2

Further contiguous direct extension 60.9 38.5 29.7 26.3

Stage II - Rectum/Rectosigmoid Cancers

1-Year 3-Year 5-Year 10-Year

Invasion through muscularis propria or muscularis, NOS 96.1 89.2 79.4 67.6

Fat, NOS 98.5 90.3 ~ ~

Extension to adjacent (connective) tissue 94.1 82.5 71.6 61.5

Invasion of/through serosa 92.5 81.5 69.2 60.2

Invasion of/through serosa with extension to fat, NOS or adjacent tissue 92.9 78.2 61.1 48.9

Greater omentum, spleen, pelvic wall, small intestine 77.0 49.3 38.3 28.4

Uterus, ovary, fallopian tube 71.9 41.1 30.7 18.4

Further contiguous direct extension 71.2 35.6 29.4 21.4

 ~ Statistic not displayed due to less than 25 cases.
Chapter 4 Cancers of the Colon and Rectum

National Cancer Institute 40 SEER Survival Monograph 

Table 4.10: Cancers of the Colon and Rectum: 1-, 3- ,5- and 10-Year Relative Survival Rates (%) by Subsite and Histology, Ages 

20+, 12 SEER Areas, 1988-2001

Histology (ICD-O code)

Relative Survival Rate (%)

Colon Rectum and Rectosigmoid

1-Year 3-Year 5-Year 10-Year 1-Year 3-Year 5-Year 10-Year

Unspecified (8000-8004) 56.2 35.1 31.2 25.6 65.5 52.3 43.6 32.9

Carcinoma, NOS (8010) 57.1 42.8 38.6 30.5 60.6 43.0 32.7 24.8

Undifferentiated carcinoma (8012-8032,8230-

8231,8510) 46.7 35.9 33.2 28.4 26.9 10.7 10.7 10.7

Small cell carcinoma (8041-8044) 29.3 18.6 18.6 15.6 49.2 19.1 16.6 ~

Other and unspecified carcinoma (8050-8130,8141-

8201,8310-8460,8550,8570) 70.5 57.9 48.7 39.2 81.8 62.4 56.3 45.7

Adenocarcinoma, NOS (8140) 80.5 66.2 60.3 54.8 84.9 67.6 57.8 49.2

Adenocarcinoma in adenomatous polyp (8210-8211) 95.9 93.5 91.8 91.0 96.7 90.9 86.6 79.8

Adenocarcinoma in adenomatous polyposis coli 

(8220-8221) 91.4 81.1 74.0 55.5 78.5 71.1 63.3 63.3

Carcinoid (8240-8246) 80.9 72.8 69.6 65.1 97.0 95.9 94.1 91.8

Papillary adenocarcinoma, NOS (8260) 84.4 76.2 70.0 65.3 89.2 79.2 67.8 59.6

Adenocarcinoma in villous adenoma (8261) 91.1 84.3 80.1 75.0 91.6 82.7 76.0 70.0

Villous adenocarcinoma (8262) 89.5 83.0 81.8 71.2 90.7 78.5 70.6 60.2

Adenocarcinoma in tubulovillous adenoma (8263) 93.7 89.3 86.8 84.1 95.3 89.2 84.8 82.3

Mucinous adenocarcinoma (8470-8480) 81.9 67.3 61.5 54.4 84.1 63.0 52.8 41.6

Mucin producing adenocarcinoma (8481) 78.0 63.0 58.3 51.9 81.1 57.8 47.4 40.9

Signet ring cell carcinoma (8490) 61.5 37.3 28.2 21.3 60.1 33.0 23.9 18.0

Adenosquamous carcinoma (8560) 42.5 27.7 26.7 24.2 66.0 36.5 33.4 30.0

Melanoma (8720-8772) ~ ~ ~ ~ 79.9 30.0 22.8 22.8

Other (8930-9100) 66.8 42.5 25.9 ~ 88.6 78.6 78.6 ~

 ~ Statistic not displayed due to less than 25 cases.

Figure 4.1: Cancer of the Colon: Relative Survival Rates (%) 

for the Five Most Common Histologic Types by Months Since 

Diagnosis, Age 20+, 12 SEER Areas, 1988-2001

Figure 4.2: Cancer of the Rectum: Relative Survival Rates (%) 

for the Five Most Common Histologic Types by Months Since 

Diagnosis, Age 20+, 12 SEER Areas, 1988-2001

90

100

70

80

e (%)

Adenocarcinoma,

NOS

60

70

vival Rate

NOS

Cystadenoca and 

cystadenoma

40

50

ative Surv

Adenoca in 

tubulovillous 

adenoma

Adenoca in 

20

30

Rela

adenomatous 

polyp

Mucin producing 

adenoca

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

e (%)

Ad i

60

70

rvival Rate

Adenocarcinoma, 

NOS

Adenoca in 

t b l ill

40

50

lative Sur

tubulovillous 

adenoma

Adenoca in 

adenomatous 

20

Re

30

l

polyp

Adenoca in villous 

adenoma

C i id

0

10 Carcinoid

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 4 Cancers of the Colon and Rectum

National Cancer Institute 41 SEER Survival Monograph 

exception of cases with appendix cancer whose 5-year 

relative rate was 25%. 

Stage 0/I cancers are those cancers which are clearly confined to the colon, i.e. cancers which have not extended 

through the wall of the colon or of the rectum. These 

cancers can be further subdivided into the depth of penetration into the wall based on SEER Extent of Disease 

(EOD) extension codes. Table 4.8 shows survival rates 

for Stage 0/I cancers by depth of extension for colon 

and for rectal cancers separately. For cancers arising in 

the colon, all categories experienced five-year survival 

rates of 94% or better, and for cancers of the rectum and 

rectosigmoid junction, all had survival of 89% or better 

after five-years. The highest relative survival occurred 

among those patients whose disease was limited to the 

head of a polyp, 98% for colon and 99% for rectum. 

Interestingly, patients whose tumor had extended to the 

lamina propria (AJCC Stage 0) had no better survival 

than patients included in Stage 1.

Stage II tumors are tumors which have extended deeper 

into the wall of the colon or directly extended through the 

colon wall into adjacent structures but are node negative 

and have no discontinuous metastases. Table 4.9 shows 

survival rates by SEER extension codes. Clearly, once the 

tumor has penetrated the serosa, survival becomes much 

poorer, with the poorest survival occurring among patients 

whose tumor has extended to the ureter or kidney.

Table 4.10 shows survival rates for colon and rectal cancers 

separately by histology. As might be expected, cancers 

of the rectum arising in a polyp or an adenoma and carcinoid tumors had the best 5-year relative survival 85-90%. 

The poorest survival rates, i.e. less than 30% survival 

at 5-years, were experienced by patients with small cell 

carcinoma, signet ring carcinoma, and adenosquamous 

carcinoma of the colon. Among patients with rectal cancer, 

undifferentiated carcinoma, small cell carcinoma, signet 

ring cell carcinoma, and melanoma histologic groups all 

had survival rates under 30% at 5-years. Persons with 

adenocarcinoma not otherwise specified which represented 

the majority of the cases (69%) had a five-year relative 

rate of 58-60%.

Ten-year survival curves for the five most common histologies for colon cancers are shown in Figure 4.1 and for 

rectal cancers in Figure 4.2. For colon cancer patients the 

best survival was experienced by patients whose cancer 

arose in either an adenomatous polyp or in a tubulovillous adenoma while the poorest survival was experienced 

by those with mucin-producing adenocarcinomas. By 

contrast, for rectal cancers persons with malignant carcinoid tumors had the highest survival while those with 

non-specific adenocarcinomas had the lowest relative 

survival.

Discussion

The lack of substantial variation in survival rates by subsites of the colon and rectum is interesting. This is best 

explained by the fact that each subsite had a similar stage 

distribution at diagnosis with 50-60% in each group being diagnosed early, Stage 0/I or II. The poorer survival 

among patients whose subsite could not be determined is 

probably explained by the fact that many of these patients 

had multifocal colon cancer, i.e. simultaneous lesions 

arising in multiple polyposis; or else occurred in patients 

whose disease was so extensive within the colon at the 

time of diagnosis that the point of origin could not be 

determined.

There was no difference in survival between males and 

females, but the disparity among race groups was once 

again noted with whites having higher survival rates than 

blacks for each subsite.

Since most analyses based on stage 0 would include both 

in situ and confined to the lamina propria, it is interesting 

that when only the confined to the lamina propria group 

are shown, the patients had no better survival than those 

whose cancer arose in a polyp or extended to the submucosa. Further, one component of stage II had poor survival, 

node negative patients whose tumors had extended from 

the colon to the kidney and/or ureter. 

References

1. American Cancer Society, Facts and Figures, 2006, American 

Cancer Society, Atlanta, Georgia.

2. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy BJ, 

Murphy, GP, O’Sullivan, B, Sobin LH and Yarbro, JW (eds) 

AJCC Cancer Staging Manual, Fifth Edition, Lippincott-Raven, 

Philadelphia, 1998.
Chapter 4 Cancers of the Colon and Rectum

National Cancer Institute 42 SEER Survival Monograph 
National Cancer Institute 43 SEER Survival Monograph 

Introduction

Anal cancer includes tumors of the anus, anal canal, and 

anorectum. The anal canal extends from the rectum to 

the perianal skin and it is lined by a mucous membrane 

that covers the interior anal sphincter (1, 2). It is a rare 

disease, with an annual age-adjusted incidence rate of 1.5 

per 100,000 people in the U.S. (3). Approximately 4,660 

new cases and 660 deaths from anal cancer are expected 

in the U.S. annually (4). Although both sexes have seen 

an increase in incidence in recent years, this rise has been 

more pronounced in men.

Oncogenic human papillomavirus (HPV) types, the same 

HPV types found to cause cervical cancer, have been detected in the majority of anal tumors (5). Epidemiologic 

studies suggest that in addition to infection with HPV, 

smoking is a major risk factor for anal cancer in men 

and women; also, men who have sex with men are at a 

particularly increased risk of anal cancer (6-8).

Small tumors of the anal margin not including the anal 

sphincter are usually treated by wide local incision; however, tumors of the anal canal that involve the anal sphincter 

or that are too large for excision are treated by radiation 

or combination chemotherapy and radiation (9). In this 

report we use U.S. SEER registry data to explore the 

impact of demographic and tumor characteristics on anal 

cancer survival. 

Materials and Methods

Between 1988 and 2001, 6,411 patients with primary 

invasive anal cancer were diagnosed in the SEER catchment area. The following cases were excluded from the 

analysis: patients for whom anal cancer was not the first 

primary cancer, cases identified through autopsy or death 

certificate only, those with unknown race, cases without 

active follow-up or alive with no survival time, patients 

less than 20 years old, cases without microscopic confirmation, and tumors identified as in situ lesions, sarcomas, 

or carcinoids. After these exclusions, 4,296 adult cases 

remained for analysis (Table 5.1). 

This relative survival analysis focused on demographic 

descriptors of the patients and tumor characteristics. The 

demographics of interest included age at diagnosis (20-

49, 50-64, 65+), sex, race (white, black), and geographic 

location. Key tumor characteristics, specifically histology, grade, size, site, and stage, are described in detail 

below.

Anal cancer histology was identified by using ICD-O-2/

ICD-O-3 histology codes as follows: squamous cell cancer 

Number Selected/Remaining

Number 

Excluded Reason for Exclusion/selection

6,411 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

5,243 1,168 Select first primary only

5,232 11 Exclude death certificate only or at autopsy

5,162 70 Exclude unknown race

5,148 14 Exclude alive with no survival time and children (Ages 0-19)

4,329 819 Exclude in situ cancers

4,302 27 Exclude no or unknown microscopic confirmation

4,296 6 Exclude sarcomas

Margaret M. Madeleine and Laura M. Newcomer

Chapter 5

Cancer of the Anus

Table 5.1 Cancer of the Anus: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001.
Chapter 5 Cancer of the Anus

National Cancer Institute 44 SEER Survival Monograph 

Chapter 5 Cancer of the Anus

(coded as 8010-8089), cloacogenic or basaloid tumors 

(8123-8124), adenocarcinomas (8140-8263 and 8480-

8481), melanomas (8720), and other for the remainder 

of the histologic types. Due to a small number of cases, 

melanoma of the anus was combined with other for black 

patients.

The amount of microscopically determined cell differentiation at diagnosis is described as grade 1 or well-differentiated tumors, grade 2 or moderately well-differentiated 

tumors, grade 3 or poorly differentiated tumors, and grade 

4 or undifferentiated or anaplastic tumors. Information 

on grade was available for 69% of the tumors. 

Tumor size is based on the length in the greatest dimension 

and was categorized as ≤ 2 cm, 2-5 cm, and >5 cm. When 

the site of the anal cancer was specified, it was described 

as occurring in the anal canal, as an overlapping lesion of 

the rectum, anus, and anal canal, or as in the cloacogenic 

zone. Cancers of the perianal skin are classified with skin 

cancers and are not included in this analysis. 

The stage of disease is compiled from information on 

the size the tumor, extent of invasion, and lymph node 

involvement according to guidelines of the American 

Joint Committee on Cancer and the International Union 

Against Cancer, 5th edition (1, 2). Localized stage is 

defined as an invasive neoplasm confined entirely to the 

anal site. Regional stage is defined as a neoplasm that 

has extended either beyond the anal site or into regional 

lymph nodes. Distant stage is defined as a neoplasm that 

has spread to parts of the body remote from the primary 

tumor. Unstaged cancers lack sufficient information to 

assign stage. Staging for localized, regional, and distant 

was available for 87% of the anal cancer tumors. 

Results

Demographic characteristics: Effect of age, 

gender, race, and geographic location

Table 5.2 shows the distribution of cases by race, sex 

and age, and the specific 5-year relative survival rates 

by these characteristics. The overall relative survival for 

men with anal cancer was 58% compared with 69% for 

women. Among women, the percent surviving decreased 

with increasing age: 76% for women 20-49 years old, 72% 

for women 50-64 years old, and 64% for women over 

64 years old. In contrast, the worst prognosis for men 

was for the youngest age group, with better prognosis 

for middle-aged men. It should be noted that the case 

distribution among black men is younger, with 49% of 

black males falling in the 20-49 age group, compared to 

28% of white males. 

Relative survival was also markedly different by race, 

with 66% of white patients surviving at 5 years post diTable 5.2: Cancer of the Anus: Number and Distribution of Cases and 5-Year Relative Survival Rates (%) by Race, Age (20+) 

and Sex,12 SEER Areas, 1988-2001.

Race/Age Group (Years)

Sex

Total Male Female

Cases Percent

Relative

Survival 

5-Year

Percent Cases Percent

Relative 

Survival 

5-Year 

Percent Cases Percent

Relative 

Survival 

5-Year 

Percent

All Races 4,296 100.0 64.0 1,824 100.0 57.9 2,472 100.0 68.5

20-49 1,031 24.0 63.8 569 31.2 54.0 462 18.7 75.7

50-64 1,294 30.1 67.6 617 33.8 63.3 677 27.4 71.5

65+ 1,971 45.9 61.7 638 35.0 56.2 1,333 53.9 64.1

White 3,636 100.0 65.7 1,486 100.0 60.2 2,150 100.0 69.5

20-49 800 22.0 66.7 418 28.1 56.4 382 17.8 78.0

50-64 1,090 30.0 68.8 515 34.7 65.7 575 26.7 71.5

65+ 1,746 48.0 63.2 553 37.2 57.8 1,193 55.5 65.5

Black 471 100.0 52.5 248 100.0 47.0 223 100.0 58.5

20-49 183 38.9 52.6 122 49.2 46.3 61 27.4 65.3

50-64 156 33.1 57.8 77 31.0 49.3 79 35.4 65.2

65+ 132 28.0 44.0 49 19.8 43.1 83 37.2 43.7
Chapter 5 Cancer of the Anus

National Cancer Institute 45 SEER Survival Monograph 

Race/Histology (ICD-O code)

Sex

Total Male Female

Cases Percent

Relative

Survival 

5-Year

Percent Cases Percent

Relative 

Survival 

5-Year 

Percent Cases Percent

Relative 

Survival 

5-Year 

Percent

All Races 4,296 100.0 64.0 1,824 100.0 57.9 2,472 100.0 68.5

Squamous Cell (8010-8089) 2,594 60.4 67.0 1,129 61.9 60.3 1,465 59.3 72.3

Cloacogenic or Basaloid (8123-8124) 771 17.9 70.2 229 12.6 62.4 542 21.9 73.2

Adenocarcinoma (8140-8263,8480-

8481) 757 17.6 53.4 387 21.2 52.9 370 15.0 54.2

Melanoma (8720) 75 1.7 26.9 23 1.3 ~ 52 2.1 22.0

Other 99 2.3 37.3 56 3.1 29.3 43 1.7 45.9

White 3,636 100.0 65.7 1,486 100.0 60.2 2,150 100.0 69.5

Squamous Cell (8010-8089) 2,226 61.2 68.1 946 63.7 62.1 1,280 59.5 72.6

Cloacogenic or Basaloid (8123-8124) 689 18.9 71.5 199 13.4 64.4 490 22.8 74.2

Adenocarcinoma (8140-8263,8480-

8481) 580 16.0 55.6 280 18.8 54.9 300 14.0 56.4

Melanoma (8720) 64 1.8 27.4 19 1.3 ~ 45 2.1 20.2

Other 77 2.1 40.9 42 2.8 32.5 35 1.6 48.7

Black 471 100.0 52.5 248 100.0 47.0 223 100.0 58.5

Squamous Cell (8010-8089) 296 62.8 57.3 155 62.5 50.3 141 63.2 65.2

Cloacogenic or Basaloid (8123-8124) 57 12.1 53.8 24 9.7 ~ 33 14.8 57.7

Adenocarcinoma (8140-8263,8480-

8481) 104 22.1 40.8 60 24.2 43.4 44 19.7 35.5

Other 14 2.9 ~ 9 3.6 ~ 5 2.2 ~

 ~Statistic not displayed due to less than 25 cases.

agnosis compared to 53% for black patients. Black patients 

had worse survival than white patients in every age group; 

markedly worse survival was reported for black men and 

women in the oldest age group. 

Geographic differences as represented by the 12 contributing 

tumor registries were not assessable due to small numbers 

of patients by registry. 

Tumor characteristics: effect of primary site, 

histology, size, stage, and differentiation

Tumors of the anus, anal canal, cloacogenic zone, and 

overlapping lesions of the rectum and anus are reported 

separately. The distribution of cases by site of diagnosis 

was 38.8% anus, 29.5% anal canal, 7.8% cloacogenic zone, 

and 23.9% overlapping lesions. Overall, 5-year relative 

survival did not differ substantially by site, ranging from 

a high of 68% for anal canal tumors to a low of 56% for 

overlapping lesions. 

The largest proportion of invasive anal cancer cases had 

squamous cell histology (60.4%), followed by cloacogenic 

(or basaloid) tumors (17.9%), adenocarcinomas (17.6%), 

melanomas (1.7%), and other histologies (2.3%). The distribution of histologic types varies with sex, with more adenocarcinomas among males and more cloacogenic cancers 

among females. The 5-year relative survival by histology 

was 67% for squamous cell cancers, 70% for cloacogenic 

cancers, 53% for adenocarcinomas, 27% for melanoma, 

and 37% for other histologies. Survival rates were higher 

for females than for males especially for squamous cell 

carcinomas and cloacogenic carcinomas (Table 5.3). 

Table 5.3: Cancer of the Anus: Number and Distribution of Cases and 5-Year Relative Survival Rates (%) by Race, Histology

and Sex, Ages 20+, 12 SEER Areas, 1988-2001.
Chapter 5 Cancer of the Anus

National Cancer Institute 46 SEER Survival Monograph 

Chapter 5 Cancer of the Anus

Figure 5.4: Cancer of the Anus: Relative Survival Rate (%) by 

Sex and Stage, Ages 20+, 12 SEER Areas, 1988-2001

For anus, NOS, the relative survival rate at 5 years post 

diagnosis decreased with increasing size: 80% for ≤ 2 cm, 

66% for 2-5 cm, and 45% for >5 cm for all races and both 

genders. Figure 5.1 shows relative survival by site and size 

of tumor, with less than 50% survival for tumors larger than 

5 cm for each site. 

The amount of cell differentiation or grade of disease at 

diagnosis was unknown for 31% of the tumors, but tumors 

with unknown grade had a relatively high survival rate 

(69%). For tumors with a known grade, the 5-year relative 

survival ranged from 77% for well-differentiated grade I 

lesions, 62% for moderately differentiated grade II lesions 

to a low of 55% for poorly differentiated, undifferentiated 

or anaplastic grade III and IV lesions. Men had slightly 

better prognosis for well-differentiated tumors only, and 

women had better prognosis for the other grades especially 

for grade III/IV (Figure 5.2, Table 5.4).

The 5-year relative survival by grade also differed strongly 

by race, with consistently lower survival for every grade 

of tumors for black as compared to white patients (Figure 

5.3). There were fewer than 25 black patients with grade IV 

tumors and therefore, the survival rate was not calculated 

for this group.

Figure 5.1: Cancer of the Anus: 5-Year Relative Survival Rate 

(%) by Tumor Size and Subsite, Ages 20+, 12 SEER Areas, 

1988-2001

Figure 5.2: Cancer of the Anus: 5-Year Relative Survival Rate 

(%) by Grade and Sex, Ages 20+, 12 SEER Areas, 1988-2001

Figure 5.3: Cancer of the Anus: 5-Year Relative Survival (%) by 

Grade and Race, Ages 20+, 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

2 cm 2-5 cm >5 cm

Relative Survival Rate (%)

Tumor Size

Anus, NOS Anal Canal Cloacogenic Zone Overlapping Lesion

0

10

20

30

40

50

60

70

80

90

100

Grade I Grade II Grade III Grade IV Unknown

Relative Survival Rate (%)

Grade

Male Female

0

10

20

30

40

50

60

70

80

90

100

Grade I Grade II Grade III Grade IV Unknown

Relative Survival Rate (%)

Grade

White Black

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Male, Localized Male, Regional Male, Distant

Female, Localized Female, Regional Female, Distant
Chapter 5 Cancer of the Anus

National Cancer Institute 47 SEER Survival Monograph 

Stage of disease was the most important single predictor 

of survival. Overall, local disease had an 80% 5-year relative survival rate, regional disease had 57% survival rate, 

and distant disease had only a 17% survival rate. About 

13% of the tumors were unstaged, and their survival rate 

was 55% (Table 5.5). 

Stage was an important prognostic factor for men and 

women of all races, with women having better survival at 

every stage of disease (Figure 5.4). Among patients with 

distant disease, 5-year relative survival was only 10% for 

men compared to 22% for women. Stage and sex together 

predict outcome at 5 years that is similar to the outcome 

at 10 years post-diagnosis (data not shown). 

Discussion

The major prognostic factors are stage, sex (females have 

better prognosis at every stage of disease), and race. Blacks 

have worse prognosis than whites overall, and black men 

have the worst prognosis at all tumor stages. There were 

Race/Grade

Sex

Total Male Female

Cases Percent

Relative

Survival 

5-Year

Percent Cases Percent

Relative 

Survival 

5-Year 

Percent Cases Percent

Relative 

Survival 

5-Year 

Percent

Total 4,296 100.0 64.0 1,824 100.0 57.9 2,472 100.0 68.5

Well differentiated (I) 459 10.7 76.5 257 14.1 76.8 202 8.2 75.3

Moderately differentiated (2) 1,355 31.5 62.4 634 34.8 54.5 721 29.2 69.5

Poorly/undifferentiated (3/4) 1,159 27.0 55.1 396 21.7 40.7 763 30.9 62.5

Unknown 1,323 30.8 68.7 537 29.4 64.5 786 31.8 71.5

White 3,636 100.0 65.7 1,486 100.0 60.2 2,150 100.0 69.5

Well differentiated (I) 388 10.7 78.4 217 14.6 77.3 171 8.0 78.8

Moderately differentiated (2) 1,124 30.9 64.1 506 34.1 56.8 618 28.7 70.1

Poorly/undifferentiated (3/4) 998 27.4 57.4 326 21.9 45.4 672 31.3 63.2

Unknown 1,126 31.0 69.9 437 29.4 65.8 689 32.0 72.5

Black 471 100.0 52.5 248 100.0 47.0 223 100.0 58.5

Well differentiated (I) 48 10.2 59.7 31 12.5 62.5 17 7.6 ~

Moderately differentiated (2) 171 36.3 53.3 93 37.5 45.6 78 35.0 62.0

Poorly/undifferentiated (3/4) 115 24.4 37.7 52 21.0 20.2 63 28.3 51.8

Unknown 137 29.1 59.7 72 29.0 60.8 65 29.1 58.7

 ~Statistic not displayed due to less than 25 cases.

Table 5.4: Cancer of the Anus: Number and Distribution of Cases and 5-Year Relative Survival Rates (%) by Race, Grade and Sex, 

Ages 20+, 12 SEER Areas, 1988-2001

also differences in prognosis predicted by two components 

of stage: tumor size and differentiation. Primary tumors 

2 centimeters or less in size have a better prognosis than 

larger tumors, and well-differentiated tumors are more 

favorable than poorly differentiated tumors. 

The worse prognosis for men less than 50 years old was 

seen consistently across races, stage of disease, anal cancer 

sites, grades, and tumor size. It may be that this worse 

survival is due to the toll of HIV/AIDS on young men. 

Although anal cancer is not an AIDS-defining illness, 

there is an increased risk for anal dysplasia and cancer 

among men who have sex with men that is increased more 

strongly among HIV positive men who have sex with 

men (10). This increased risk has led to higher cytologic 

surveillance of this group, which may have affected the 

survival trends for anal cancer. 
Chapter 5 Cancer of the Anus

National Cancer Institute 48 SEER Survival Monograph 

Race/Historic Stage

Sex

Total Male Female

Cases Percent

Relative

Survival 

5-Year

Percent Cases Percent

Relative 

Survival 

5-Year 

Percent Cases Percent

Relative 

Survival 

5-Year 

Percent

All Races 4,296 100.0 64.0 1,824 100.0 57.9 2,472 100.0 68.5

Localized 2,031 47.3 79.9 899 49.3 74.2 1,132 45.8 84.5

Regional 1,342 31.2 56.6 550 30.2 49.4 792 32.0 61.7

Distant 384 8.9 16.8 173 9.5 9.6 211 8.5 22.4

Unstaged 539 12.5 54.7 202 11.1 47.6 337 13.6 58.7

White 3,636 100.0 65.7 1,486 100.0 60.2 2,150 100.0 69.5

Localized 1,735 47.7 81.3 748 50.3 75.6 987 45.9 85.6

Regional 1,130 31.1 58.4 436 29.3 51.7 694 32.3 62.8

Distant 296 8.1 17.4 128 8.6 9.5 168 7.8 23.0

Unstaged 475 13.1 54.7 174 11.7 50.1 301 14.0 57.1

Black 471 100.0 52.5 248 100.0 47.0 223 100.0 58.5

Localized 198 42.0 66.9 108 43.5 63.3 90 40.4 70.3

Regional 150 31.8 51.9 81 32.7 46.7 69 30.9 58.3

Distant 73 15.5 17.2 37 14.9 11.9 36 16.1 21.9

Unstaged 50 10.6 45.1 22 8.9 ~ 28 12.6 66.9

 ~Statistic not displayed due to less than 25 cases.

Table 5.5: Cancer of the Anus: Number and Distribution of Cases and 5-Year Relative Survival Rates (%) by Race, Historic Stage 

and Sex, Ages 20+, 12 SEER Areas, 1988-2001

References

1. Anal canal. In: American Joint Committee on Cancer: AJCC 

Cancer Staging Manual. Philadelphia, Pa: Lippincott-Raven 

Publishers, 5th ed., 1997, pp 91-95. 

2. Anal canal. In: Sobin LH, Wittekind C, eds.: TNM: Classification 

of Malignant Tumours. New York, NY: Wiley-Liss, Inc., 5th ed., 

1997, pp 70-73. 

3. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer 

EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, 

Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

submission, posted to the SEER web site, 2006.

4. Cancer Facts and Figures 2006, American Cancer Society, Inc., 

2006.

5. Carter JJ, Madeleine MM, Shera K, Schwartz SM, CushingHaugen KL, Wipf GC, Daling JR, McDougall JK, Galloway DA. 

Human papillomavirus 16 and 18 L1 serology compared across 

anogenital cancer sites. Cancer Res. 2001:61;1934-1940.

6. Daling J, Weiss N, Hislop G, et al. Sexual practices, sexually 

transmitted diseases and the incidence of anal cancer. N Engl J 

Med 1987;317:973-977.

7. Daling J, Sherman K, Hislop G, et al. Smoking and the risk of 

anogenital cancer. Am J Epidemiol 1992;135:180-189.

8. Palefsky J, Holly E, Gonzales J, Berline J, Ahn DK, Greenspan 

J. Detection of human papillomavirus DNA in anal intraepithelial 

neoplasia and anal cancer. Cancer Res 1991;51:1014-1019.

9. Ryan DP, Compton CC, Mayer RJ: Carcinoma of the anal canal. N 

Engl J Med 342 (11): 792-800, 2000. 

10. Palefsky JM, Holly EA, Hogeboom CJ, Raltson ML, DaCosta 

MM, Botts R, Berry JM, Jay N, Darragh TM. Virologic, 

immunologic, and clinical parameters in the incidence and 

progression of anal squamous intraepithelial lesions in HIVpositive and HIV-Negative Homosexual Men. J AIDS Human 

Retrovirology 1998:17:314-319.
National Cancer Institute 49 SEER Survival Monograph 

Introduction

In the 14 year period, 1988-2001, the SEER Program 

recorded 22,065 cancers of the liver and intrahepatic bile 

ducts, 5,723 gallbladder cancers, 2,474 cancers of the 

ampulla of Vater and 3,908 other biliary cancers (mostly 

cancers of the extrahepatic bile duct). 

The tables and text in this chapter address some of the 

patient characteristics (Sex, Race and Age) and tumor 

characteristics (Tumor Stage, Grade, Size, Subsite Location 

and Histology) that may be associated with differences in 

patients’ prognosis and outcome.

The text primarily cites 5-year relative survival as the 

primary outcome measure because of its wide general use. 

However, for cancers associated with poor survival, readers may find the tabulations of 1-, 2-, and 3-year relative 

survivals to be more informative.

Materials and Methods

The NCI contracts with medically-oriented, nonprofit institutions located in specific geographic areas to obtain 

data on all cancers diagnosed in residents of the SEER 

geographic areas. SEER collects data on all invasive 

and in situ cancers except basal cell and squamous cell 

carcinomas of the skin (of non-genital anatomic sites) and 

in situ carcinomas of the uterine cervix. SEER actively 

follows all previously diagnosed patients on an annual 

basis to obtain vital status allowing the calculation of 

observed and relative survival rates.

This analysis is based on data from 12 SEER geographic 

areas which collectively cover about 14% of the total US 

population. The areas are the States of Connecticut, Iowa, 

New Mexico, Utah, and Hawaii; the metropolitan areas of 

Detroit, Michigan; Atlanta, Georgia; San Francisco, San 

Jose, and Los Angeles, California; Seattle, Washington; 

and 10 counties in rural Georgia. Los Angeles contributed 

data for diagnosis years 1992 to 2001, all other areas for 

1988-2001.

Table 6.1: Liver and Biliary Tract Cancer: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Liver & Intrahepatic 

Bile Duct Gallbladder Other Biliary Ampulla of Vater

Number

Selected/

Remaining

Number 

Excluded

Number

Selected/

Remaining

Number 

Excluded

Number

Selected/

Remaining

Number 

Excluded

Number

Selected/

Remaining

Number 

Excluded Reason for Exclusion/selection

22,065 0 5,723 0 3,908 0 2,474 0 Select 1988-2001 diagnosis (Los 

Angeles for 1992-2001 only)

19,717 2,348 5,041 682 3,344 564 2,050 424 Select first primary only

18,747 970 4,962 79 3,271 73 2,039 11 Exclude death certificate only 

or at autopsy

18,657 90 4,945 17 3,266 5 2,032 7 Exclude unknown race and alive 

with no survival time

18,364 293 4,755 190 3,239 27 1,995 37 Exclude children (000-019) and 

in situ cancers

13,622 4,742 4,458 297 2,660 579 1,873 122 Exclude no or unknown 

microscopic confirmation

13,409 213 4,392 66 2,640 20 1,832 41 Exclude sarcomas (including 

stromal 8930-8939) and 

carcinoids

Charles Key and Angela L.W. Meisner

Chapter 6

Cancers of the Liver and Biliary Tract
Chapter 6 Cancers of the Liver and Biliary Tract

National Cancer Institute 50 SEER Survival Monograph 

The following cases were excluded from this survival 

analysis: patients for whom liver or biliary tract cancer 

was not the first primary, cases diagnosed at autopsy or 

by death certificate only, persons of unknown race, alive 

with no recorded survival time, patients less than 20 years 

old, and cases without microscopic confirmation. Since 

some of the exclusions had very small cell sizes, some 

of the reasons for exclusion were combined. Sarcomas, 

lymphomas and carcinoids are excluded here from this 

analysis which focuses primarily on the cancers of epithelial origin (carcinomas). Remaining cases available for 

analysis are as follows: 13,409 liver & intrahepatic bile 

duct cancers; 4,392 gallbladder cancers; 2,640 other biliary 

(mostly extrahepatic bile duct) cancers, and 1,832 cancers 

of the ampulla of Vater (Table 6.1). Carcinoids are shown 

separately in the relative survival tables by histologic type 

but they are not included in the total cases.

Survival analysis is based on relative survival rates calculated by the life-table (actuarial) method. Relative 

survival, defined as observed survival in the cohort divided 

by expected survival in the cohort, adjusts for the expected 

mortality that the cohort would experience from other 

causes of death. Expected survival is based on decennial 

life tables for the United States in 1990.

The staging definitions utilized in this chapter are SEER 

historic stage: localized – confined to the primary site; regional – spread to regional lymph nodes or by direct extension beyond the primary; distant – metastatic spread. 

Figure 6.1: Relative Survival Rates (%) by Primary Site (Liver 

& Intrahepatic Bile Duct, Extrahepatic Bile Duct, Gallbladder, 

Ampulla of Vater) and Months after Diagnosis, Ages 20+, 12 

SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Liver & Intrahepatic Bile Duct

Extrahepatic Bile Duct

Gallbladder

Ampulla of Vater

0 10 20 30 40 50

All Cases

Sex

Male

Female

Race

White

Black

Age

20-49

50-64

65+

Historic Stage Localized

Regional Distant

Unstaged

Grade

Well

Moderate

Poor

Undifferentiated

Unknown

Primary Site Liver

Intrahepatic Bile Duct

Tumor Size

<=2 cm

2.1-5 cm

5.1-10 cm

>10 cm

Unknown

Histology Hepatocellular Cholangiocarcinoma (Carcinoids)

5-Year Relative Survival (%)

Figure 6.2: Cancer of the Liver and Intrahepatic Bile Duct: 

5-Year Relative Survival Rates by Sex, Race, Age, Historic 

Stage, Grade, Primary Site, Tumor Size, and Histology, Ages 

20+, 12 SEER Areas, 1988-2001

Results

Cancers of the liver & intrahepatic bile duct, gallbladder 

and extrahepatic bile duct all have low survival rates. The 

survival rates decrease rapidly during the first 3 years after 

diagnosis and then the rates plateau after about 5-years 

(Figure 6.1). The survival rates for ampulla of Vater are 

much higher than the other 3 cancers.

Cancers of the Liver and Intrahepatic Ducts

Sex, Race and Age

Among 13,409 adult cases of liver or intrahepatic bile duct 

cancer, almost twice as many cases occurred in males (69%) 

over females (31%). However, relative survival rates are 

consistently at least one percentage point higher for females 
Chapter 6 Cancers of the Liver and Biliary Tract

National Cancer Institute 51 SEER Survival Monograph 

Table 6.2: Cancer of the Liver and Intrahepatic Bile Duct (excluding carcinoids): Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-

Year Relative Survival Rates by Sex, Race, Age, Historic Stage, Grade, Primary Site and Tumor Size, Ages 20+, 12 SEER Areas, 

1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival Rates (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases 13,409 100.0 4.6 28.2 17.0 12.2 8.0 6.1 5.3

Sex

 Male 9,224 68.8 4.3 27.2 16.3 11.7 7.5 5.9 4.7

 Female 4,185 31.2 5.3 30.5 18.7 13.3 8.9 6.5 6.3

Race

 White 8,619 64.3 4.3 26.8 16.2 11.6 7.7 5.9 5.3

 Black 1,497 11.2 3.5 22.1 11.4 7.6 2.7 1.5 1.5

 Other 3,293 24.6 6.0 - - - - - -

Age

 20-49 2,030 15.1 5.5 32.3 20.7 15.6 11.5 9.0 8.3

 50-64 4,235 31.6 5.0 30.8 19.0 14.3 8.7 6.5 5.3

 65+ 7,144 53.3 4.1 25.4 14.7 9.9 6.3 4.6 4.0

Historic Stage

 Localized 4,021 30.0 9.8 46.9 33.0 25.4 18.1 14.4 12.5

 Regional 3,487 26.0 4.8 27.5 14.1 9.8 6.1 4.2 3.3

 Distant 3,299 24.6 2.8 12.3 5.4 3.2 1.8 1.1 1.1

 Unstaged 2,602 19.4 3.7 20.5 11.3 6.9 3.2 2.2 2.0

Grade

 Well 1,717 12.8 10.3 47.5 32.0 24.3 15.8 13.1 10.7

 Moderate 1,860 13.9 7.0 38.0 24.9 19.2 12.9 9.0 7.5

 Poor 1,904 14.2 3.4 20.7 11.2 7.3 5.4 3.0 2.7

 Undifferentiated 273 2.0 2.7 18.2 9.9 6.6 5.7 5.7 3.4

 Unknown 7,655 57.1 4.0 23.7 13.5 9.3 5.7 4.4 4.0

Primary Site 

 Liver 11,598 86.5 4.4 28.2 17.5 12.9 8.5 6.5 5.6

 Intrahepatic Bile 

Duct 1,811 13.5 5.6 27.9 14.5 8.5 4.8 3.4 3.2

Tumor Size

 <=2 cm 489 3.6 18.8 59.0 47.0 39.4 28.8 23.8 17.3

 2.1-5 cm 2,077 15.5 10.2 47.5 33.3 24.7 16.7 13.0 10.9

 5.1-10 cm 2,386 17.8 6.4 36.2 21.2 15.5 10.8 7.9 6.4

 >10 cm 1,236 9.2 5.4 30.1 16.7 11.8 8.9 7.3 6.8

 Unknown 7,221 53.9 3.2 17.5 9.1 5.9 3.0 2.0 1.8

 ! Not enough intervals to produce rate.

- Not calculated.

(31% at 1 year, 19% at 2 years, 13% at 3 years, 9% at 5 

years, 7% at 8 years and 6% at 10 years) than males (27%, 

16%, 12%, 8%, 6% and 5% for 1-,2-,3-,5-,8-, and 10-year 

relative survival rates, respectively).

Other races had a higher median survival with 6 months, 

followed by whites with 4 months and then blacks with 3 

months. Younger age had better relative survival rates, with 

a 5 year relative survival rate of 12% amongst 20-49 year 

olds, compared to 6% amongst those patients 65 and over 

(Table 6.2, Figure 6.2)).

Tumor Stage, Grade and Size

Localized tumor stage, well differentiated tumor grade and 

moderate differentiated tumor grade were associated with 

5-year relative survival rates greater than 10%. Tumor size 

less or equal to 2 cm had a 5-year relative survival rate of 

29%. Tumor size was unknown for more than half of the 
Chapter 6 Cancers of the Liver and Biliary Tract

National Cancer Institute 52 SEER Survival Monograph 

Table 6.3: Cancer of the Liver and Intrahepatic Bile Duct: Histologic Distribution and Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 

10-Year Relative Survival Rates (%) by Histology, Ages 20+,12 SEER Areas, 1988-2001

Histology Cases Percent

Median 

Survival

(Months)

Relative Survival Rates (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases excluding

carcinoids 13,409 100.0 4.6 28.2 17.0 12.2 8.0 6.1 5.3

Carcinomas excluding

carcinoids

 8010-8572 13,290 99.1 4.6 28.3 17.1 12.3 8.0 6.1 5.3

 Hepatocellular carcinoma

 8170-8171 9,981 74.4 4.6 29.3 18.3 13.5 9.0 7.0 6.0

 Cholangiocarcinoma 

 8050,8140-8141,

 8160-8161,8260,

 8440,8480-8500,

 8550,8560,8570-8572 2,463 18.4 4.6 24.6 12.9 7.9 4.5 2.9 2.6

 Other specified carcinoma 453 3.4 7.4 38.4 23.1 15.4 9.8 6.9 6.9

 Unspecified carcinoma 

 8010-8034 393 2.9 2.8 15.2 6.5 4.3 2.4 1.3 !

Hepatoblastoma 

 8970 <5 0.0 ~ ~ ~ ~ ~ ~ ~

Unspecified cancer

 8000-8004 112 0.8 2.6 16.9 8.2 8.2 5.9 4.4 !

Other specified cancer 

9064,9364,9500 <5 0.0 ~ ~ ~ ~ ~ ~ ~

Carcinoids

 8240-8246 77 - 12.8 55.0 40.9 35.5 25.0 7.3 !

 ! Not enough intervals to produce rate.

- Not calculated.

 ~ Statistic not displayed due to less than 25 cases.

cases and the 5-year relative survival rates was only 3% 

(Table 6.2, Figure 6.2)

Liver Subsite and Histology

Histologic classification separates hepatocellular carcinomas 

(liver cell origin) from adenocarcinomas arising from ductal 

or glandular structures (grouped here as cholangiocarcinomas, probably arising from intrahepatic bile ducts). 

The histologic designation seems preferable to the subsite 

designation for distinguishing between these two major liver 

cancer types because many adenocarcinomas (cholangiocarcinomas) are included under the liver site code. Hepatocellular carcinomas were four times more common and 5-year 

relative survival rates were double that of cholangiocarcinomas (9% vs. 5% respectively), although median survival 

time for both is less than 5 months (Table 6.3).

The 77 cases of primary carcinoid tumors arising in the liver 

had a median survival time of about 12 months and 25% 

relative survival at 5 years. 

Cancers of the Gallbladder

Sex, Race and Age

Cases of cancer of the gallbladder were three times more 

common in females than males, with survival about equal. 

More than 70% of patients were diagnosed at 65 years of 

age or older. Their median survival time (5.5 months) was 

about half of that characterized in the younger age groups 

(10 and 9 months for ages 20-49 and 50-64 years, respectively). At five years, the relative survival for ages 50-64 

years (15%) was more comparable to the older (14%) rather 

than the younger age group (22%; Table 6.4) Five year 

relative survival rates were similar for whites and blacks 

(14 and 13%; Table 6.4).

Tumor Stage, Grade and Size

The 5-year relative survival rate was over 40% for cases 

with localized tumor stage. Well differentiated tumors and 

tumors ≤ 2 cm had 5-year relative survival rates greater 

than 30%, whilst distant stage, poor differentiation, and 

tumors > 10 cm had 5-year relative survival rate between 

0-7% (Table 6.4, Figure 6.3).
Chapter 6 Cancers of the Liver and Biliary Tract

National Cancer Institute 53 SEER Survival Monograph 

Table 6.4: Cancer of the Gallbladder (excluding carcinoids): Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates by Sex, Race, Age, Historic Stage, Grade, and Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival Rates (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases 4,392 100.0 6.5 36.3 23.4 18.9 15.1 13.7 12.8

Sex

 Male 1,131 25.8 6.2 35.5 23.2 18.0 14.9 12.8 12.0

 Female 3,261 74.2 6.6 36.6 23.5 19.2 15.1 13.9 13.0

Race

 White 3,511 79.9 6.4 35.9 22.9 18.5 14.3 13.1 12.2

 Black 329 7.5 5.5 32.0 19.1 14.6 13.1 11.7 9.7

 Other 552 12.6 8.4 - - - - - -

Age

20-49 287 6.5 10.4 46.8 30.9 27.1 22.3 18.8 17.8

50-64 954 21.7 9.1 41.3 25.2 19.1 15.0 12.7 12.7

65+ 3,151 71.7 5.5 33.8 22.1 17.9 14.2 13.4 12.0

Historic Stage

Localized 943 21.5 24.8 71.3 55.7 48.7 41.7 39.5 36.8

Regional 1,752 39.9 8.4 41.4 24.5 18.3 13.6 11.4 10.8

Distant 1,578 35.9 3.2 10.4 2.8 2.0 1.2 0.9 0.9

Unstaged 119 2.7 6.0 30.6 26.3 17.8 13.1 10.9 10.6

Grade

Well 492 11.2 21.0 62.8 50.5 41.8 33.7 31.5 30.0

Moderate 1,288 29.3 9.9 46.3 31.4 24.6 19.7 17.2 16.5

Poor 1,526 34.7 4.9 25.6 12.0 9.4 6.9 5.4 5.3

Undifferentiated 120 2.7 3.6 24.1 13.7 11.7 7.9 7.9 3.2

Unknown 966 22.0 4.7 28.1 18.3 15.4 12.8 12.8 11.3

Tumor Size

<=2 cm 449 10.2 18.3 62.5 46.6 40.1 34.7 31.9 29.5

2.1-5 cm 627 14.3 10.3 48.1 29.2 24.2 19.0 16.2 14.5

5.1-10 cm 271 6.2 4.8 26.4 12.6 11.4 10.7 10.7 10.7

>10 cm 40 0.9 3.8 18.0 2.7 2.7 0.0 ! !

Unknown 3,005 68.4 5.5 31.1 20.0 15.5 12.0 10.9 10.2

 ! Not enough intervals to produce rate.

- Not calculated.

Gallbladder Histology

The histologic type was almost all adenocarcinomas (91%). 

The relative survival rate was similar between squamous 

cell carcinomas and adenocarcinomas (Table 6.5).

Other Biliary Cancers

Sex, Race and Age

Slightly more cases occurred in males (52%) than females 

and they had better 5-year relative survival rates (14% vs. 

10%). Whites had better 5-year relative survival rates of 

13% compared with blacks (8%) and there was an age gradient with patients between 20-49 years old having 5-year 

survival rates three times of those 65 and older, 24% and 

8%, respectively (Table 6.6, Figure 6.4).

Tumor Stage, Grade, and Size

Five-year survival was over 20% for localized tumors, well 

differentiated tumors, and tumors ≤2 cm. Tumor grade was 

very prognostic. For example, the gradient of relative survival at 2 years ranged from 40% for well differentiated 

tumors down to 10% for undifferentiated tumors. The tumor 

size was unknown for most of these cancers, but there was 

a survival differential for those with known tumor size from 

30% at 5 years for small tumors and only 11% for 5.1-10 

cm tumors (Table 6.6, Figure 6.4). 
Chapter 6 Cancers of the Liver and Biliary Tract

National Cancer Institute 54 SEER Survival Monograph 

0 10 20 30 40 50

All Cases

Sex

Male

Female

Race

White

Black

Age

20-49

50-64

65+

Historic Stage Localized

Regional

Distant

Unstaged

Grade

Well

Moderate

Poor

Undifferentiated

Unknown

Tumor Size

<=2 cm

2.1-5 cm

5.1-10 cm

>10 cm

Unknown

Histology Adenocarcinoma

(Carcinoids)

5-Year Relative Survival (%)

Figure 6.3: Cancer of the Gallbladder: 5-Year Relative Survival 

Rates by Sex, Race, Age, Historic Stage, Grade, Tumor Size, 

and Histology, Ages 20+, 12 SEER Areas, 1988-2001

0 10 20 30 40 50

All Cases

Sex

Male

Female

Race

White

Black

Age

20-49

50-64

65+

Historic Stage Localized

Regional

Distant

Unstaged

Grade

Well

Moderate

Poor

Undifferentiated

Unknown

Primary Site Extrahepatic bile ... Overlapping lesion

Biliary tract, NOS

Tumor Size

<=2 cm

2.1-5 cm

5.1-10 cm

>10 cm

Unknown

Histology

Carcinoma

5-Year Relative Survival (%)

Too few cases for valid survival rate for >10 cm tumors.

Figure 6.4: Cancer of Other Biliary Sites: 5-Year Relative 

Survival Rates by Sex, Race, Age, Historic Stage, Grade, 

Primary Site, Tumor Size, and Histology, Ages 20+, 12 SEER 

Areas, 1988-2001

Other Biliary Subsite and Histology

Most of the cancers described under ‘Other biliary’ were 

in the extrahepatic bile duct (86%). Almost all of the cases 

were carcinomas and of these the majority were adenocarcinoma (Table 6.7). There were very few carcinoids in 

other biliary (Table 6.7). 

Cancers of the Ampulla of Vater

Cancers of the Ampulla of Vater showed better survival than 

the other cancers in this chapter (Figure 6.1). But these 

cancers are less common, only 8% of the liver and biliary 

tract cancers. Five-year relative survival rates by tumor 

and patient characteristics are summarized in Figure 6.5.

Sex, Race, and Age

There were slightly more males (55%) than females (45%) 

and males had slightly better survival rates after 2 years 

after diagnosis (Table 6.8). Survival rates are higher for 

white patients than black patients but the survival advantage narrowed over time since diagnosis. At 2 years after 

diagnosis, 51% of white patients survived compared to only 

38% for blacks, but at 10-years after diagnosis, the rates 

were 29 and 26%, respectively.

Tumor Stage, Grade and Size

There were survival gradients for stage, grade, and size. 

Five-year relative survival was over 50% for localized tumors and well differentiated tumors. Survival rates were 
Chapter 6 Cancers of the Liver and Biliary Tract

National Cancer Institute 55 SEER Survival Monograph 

Table 6.5: Cancer of the Gallbladder: Distribution and Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology/ ICD-O code Cases Percent

Median 

Survival

(Months)

Relative Survival Rates (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases excluding

carcinoids 4,392 100.0 6.5 36.3 23.4 18.9 15.1 13.7 12.8

Carcinoma excluding

carcinoids

 8010-8231,8247-8572 4,369 99.5 6.5 36.4 23.4 18.9 15.1 13.7 12.8

 Squamous-cell carcinoma

 8050-8076 78 1.8 4.6 22.0 16.6 16.6 16.5 15.6 11.4

 Adenocarcinoma

 8140-8141,8191-8231,

 8260-8263,8310,8430,

 8480-8490,8560,

 8570-8572 4,000 91.1 6.9 37.7 24.5 19.7 15.8 14.2 13.2

 Other specified carcinomas 81 1.8 8.4 40.5 9.6 5.9 5.9 ! !

 Unspecified carcinoma

 8010-8034 210 4.8 3.0 14.9 9.7 7.1 4.9 4.9 4.9

Unspecified Cancer

 8000-8004 18 0.4 ~ ~ ~ ~ ~ ~ ~

Other specified cancer 

8720,8940 5 0.1 ~ ~ ~ ~ ~ ~ ~

Carcinoids

 8240-8246 46 - 21.4 62.9 49.9 49.9 49.5 49.5 49.5

 ! Not enough intervals to produce rate.

- Not calculated.

 ~ Statistic not displayed due to less than 25 cases.

very poor for those with distant disease with the 3-year 

survival rate of less than 1%. However, less than 10% 

of the patients had distant spread at the time of diagnosis 

(Table 6.8). 

Histology

Nearly all of the tumors were carcinomas and most of those 

were adenocarcinomas. There were few carcinoids but the 

survival rates for those with carcinoids was much higher 

even after only 1-year, 76%, compared to those with carcinomas (67%) (Table 6.9).

Discussion

Overall survival rates were similar for liver, gallbladder, 

and other biliary cancers. Survival rates were higher for 

cancer of the ampulla of Vater, behaving more like those 

of the small intestine (1).

References

1. Key C and Meisner A. Cancers of the Esophagus, Stomach, and 

Small Intestine. In Ries LAG, Young JL, Keel GE, Eisner MP, 

Lin YD, Horner, M-J (editors). SEER Survival Monograph: 

Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, 

Patient and Tumor Characteristics. National Cancer Institute, 

SEER Program. NIH Pub. No. 07-6215, 2007.
Chapter 6 Cancers of the Liver and Biliary Tract

National Cancer Institute 56 SEER Survival Monograph 

Table 6.6: Other Biliary Cancer (excluding ampulla & carcinoids): Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates by Sex, Race, Age, Historic Stage, Grade, Primary Site and Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival Rates (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases 2,640 100.0 8.4 40.6 23.3 16.0 11.7 8.9 8.6

Sex

 Male 1,376 52.1 9.4 44.2 25.3 17.1 13.6 10.7 10.7

 Female 1,264 47.9 7.3 36.7 21.2 14.9 9.7 7.0 6.3

Race

 White 2,082 78.9 8.3 40.2 23.5 16.5 12.5 10.1 10.0

 Black 177 6.7 6.4 38.1 20.6 12.7 7.8 3.5 !

 Other 381 14.4 9.1 - - - - - -

Age

20-49 217 8.2 15.1 53.8 34.4 28.2 24.3 16.8 16.8

50-64 632 23.9 12.3 51.2 31.3 23.0 16.0 12.3 11.9

65+ 1,791 67.8 6.6 35.0 18.7 11.5 7.8 5.3 4.7

Historic Stage

Localized 445 16.9 15.2 58.2 41.3 33.2 24.3 19.5 19.5

Regional 1,100 41.7 12.0 51.6 29.1 19.3 13.3 9.7 8.8

Distant 645 24.4 3.4 14.3 4.9 2.5 2.4 1.1 1.1

Unstaged 450 17.0 6.8 33.7 17.3 9.8 8.4 6.1 6.1

Grade

Well 315 11.9 16.2 59.1 40.2 32.4 21.0 14.9 12.8

Moderate 675 25.6 12.7 53.8 32.7 22.9 17.9 12.5 12.5

Poor 509 19.3 7.8 37.5 20.8 13.3 8.7 5.3 4.3

Undifferentiated 43 1.6 5.4 33.9 10.1 7.7 4.0 4.0 !

Unknown 1,098 41.6 5.3 28.6 14.0 8.1 6.5 6.1 6.1

Primary Site 

Extrahepatic bile duct 2,270 86.0 9.4 43.7 25.4 17.5 12.8 9.8 9.7

Overlapping lesion 42 1.6 8.3 45.3 30.6 22.8 17.2 14.1 7.6

Biliary tract, NOS 328 12.4 3.1 18.5 7.7 4.6 2.7 1.3 1.3

Tumor Size

<=2 cm 373 14.1 20.1 67.6 48.6 37.3 29.9 26.2 25.1

2.1-5 cm 356 13.5 11.1 47.4 25.6 17.1 13.6 8.9 7.9

5.1-10 cm 58 2.2 8.5 41.0 11.4 11.4 11.4 4.5 4.5

>10 cm 9 0.3 ~ ~ ~ ~ ~ ~ ~

Unknown 1,844 69.8 6.4 33.7 18.0 11.5 7.5 5.2 5.1

 ! Not enough intervals to produce rate.

- Not calculated.

 ~ Statistic not displayed due to less than 25 cases.
Chapter 6 Cancers of the Liver and Biliary Tract

National Cancer Institute 57 SEER Survival Monograph 

Table 6.7: Other Biliary Cancer (excluding Ampulla): Distribution and Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year 

Relative Survival Rates (%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology/ICD-O Code Cases Percent

Median 

Survival

(Months)

Relative Survival Rates (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases excluding carcinoids 2,640 100.0 8.4 40.6 23.3 16.0 11.7 8.9 8.6

Carcinoma excluding

carcinoids: 8010-8572 2,596 98.3 8.4 40.6 23.2 16.0 11.6 8.7 8.4

 Squamous-cell carcinoma

 8050-8076 23 0.9 ~ ~ ~ ~ ~ ~ ~

 Adenocarcinoma

 8140-8141,8191-8231,

 8260-8263,8310,8430,

 8480-8490,8560, 8570-8572 2,039 77.2 8.5 41.0 23.4 16.7 11.8 9.0 8.6

 Other specified carcinomas 401 15.2 9.2 42.5 24.7 14.0 11.6 7.4 7.4

 Unspecified carcinoma

 8010-8034 133 5.0 4.9 30.4 14.3 6.7 4.0 4.0 4.0

Unspecified Cancer: 8000-8004 44 1.7 6.3 38.3 32.0 18.8 18.8 18.8 !

Carcinoids: 8340-8246 16 - ~ ~ ~ ~ ~ ~ ~

 ! Not enough intervals to produce rate.

- Not calculated.

 ~ Statistic not displayed due to less than 25 cases.

Table 6.8: Cancer of the Ampulla of Vater (excluding Carcinoids): Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates by Sex, Race, Age, Historic Stage, Grade, Primary Site, and Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival Rates (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases 1,832 100.0 20.3 67.3 50.0 39.9 32.0 30.0 28.4

Sex

 Male 1,002 54.7 20.8 67.1 50.6 41.7 33.6 32.2 29.6

 Female 830 45.3 19.7 67.5 49.2 37.7 29.9 27.1 26.8

Race

 White 1,458 79.6 20.6 67.1 51.0 40.6 32.3 30.6 29.1

 Black 107 5.8 14.3 58.7 37.7 32.3 29.7 25.7 25.5

 Other 267 14.6 22.4 - - - - - -

Age

20-49 171 9.3 34.6 81.2 61.5 49.4 41.0 36.4 31.5

50-64 445 24.3 34.5 79.5 60.2 50.7 36.1 31.2 28.2

65+ 1,216 66.4 15.3 60.5 44.0 33.7 28.4 27.4 27.0

Historic Stage

Localized 396 21.6 34.3 76.2 64.7 57.1 51.7 49.7 47.7

Regional 1,068 58.3 24.9 74.5 55.2 43.0 32.7 30.5 28.3

Distant 165 9.0 5.5 26.4 5.5 0.8 ! ! !

Unstaged 203 11.1 8.6 44.2 27.1 17.7 8.6 4.0 !

Grade

Well 289 15.8 43.2 78.4 67.1 60.1 52.2 42.8 38.4

Moderate 748 40.8 24.1 72.6 54.5 42.3 35.5 34.9 32.1

Poor 425 23.2 16.8 63.1 42.5 31.0 19.9 19.6 19.3

Undifferentiated 24 1.3 ~ ~ ~ ~ ~ ~ ~

Unknown 346 18.9 12.2 53.4 36.2 29.7 22.6 20.7 20.7

Tumor Size

<=2 cm 570 31.1 35.9 82.4 65.5 54.8 43.2 41.2 38.8

2.1-5 cm 477 26.0 24.0 71.2 53.3 41.1 34.0 31.2 29.5

5.1-10 cm 47 2.6 19.5 70.0 45.2 31.3 24.0 14.6 !

>10 cm <5 - ~ ~ ~ ~ ~ ~ ~

Unknown 735 40.1 11.9 52.7 35.5 27.2 20.9 18.4 17.9

! Not enough intervals to produce rate.

- Not calculated.

~ Statistic not displayed due to less than 25 cases.
Chapter 6 Cancers of the Liver and Biliary Tract

National Cancer Institute 58 SEER Survival Monograph 

Table 6.9: Cancer of the Ampulla of Vater: Distribution and Median Survival Time and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival 

Rates (%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology/ ICD-O Code Cases Percent

Median 

Survival

(Months)

Relative Survival Rates (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases excluding carcinoids 1,832 100.0 20.3 67.3 50.0 39.9 32.0 30.0 28.4

Carcinoma excluding

carcinoids: 8010-8231,8247-8572 1,823 99.5 20.4 67.4 50.0 39.9 32.0 30.1 28.7

 Squamous-cell carcinoma

 8050-8076 9 0.5 ~ ~ ~ ~ ~ ~ ~

 Adenocarcinoma

 8140-8141,8191-8231,

 8260-8263,8310,8430,

 8480-8490,8560,

 8570-8572 1,686 92.0 21.3 68.3 51.1 40.7 33.0 31.2 29.6

 Other specified carcinomas 49 2.7 19.1 70.0 41.5 33.0 12.0 ! !

 Unspecified carcinoma: 8010-8034 79 4.3 10.5 46.6 31.9 27.5 17.0 16.1 16.1

Unspecified Cancer: 8000-8004 9 0.5 ~ ~ ~ ~ ~ ~ ~

Carcinoids: 8240-8246 35 - 98.2 76.0 71.3 65.3 59.0 59.0 59.0

 ! Not enough intervals to produce rate.

- Not calculated.

~ Statistic not displayed due to less than 25 cases.

0 10 20 30 40 50 60 70 80 90 100

All Cases

Sex

Male

Female

Race

White

Black

Age

20-49

50-64

65+

Historic Stage Localized

Regional

Distant

Unstaged

Grade

Well

Moderate

Poor

Undifferentia... Unknown

Tumor Size

<=2 cm

2.1-5 cm

5.1-10 cm

>10 cm

Unknown

Histology

Carcinoma

(Carcinoids)

5-Year Relative Survival (%)

Figure 6.5 (at right): Cancer of the Ampulla of Vater: 5-Year 

Relative Survival Rates by Sex, Race, Age, Historic Stage, 

Grade, Tumor Size, and Histology, Ages 20+, 12 SEER Areas, 

1988-2001
National Cancer Institute 59 SEER Survival Monograph 

Introduction

Cancer of the pancreas is one of the most rapidly fatal of 

all cancers, and most cases are first recognized at a far 

advanced clinical stage. The American Cancer Society 

estimates that there will be 33,730 new cases of pancreatic 

cancer in 2006 and 32,300 deaths. Only cancers of the lung, 

colon, and breast cause more deaths than pancreatic cancer 

each year. (1) Currently there are few definitive recommendations for prevention and early detection. Cigarette 

smoking is probably the most consistently identified causal 

risk factor. Treatment is often limited to supportive care, 

palliation and pain control.

The lifetime risk of being diagnosed with pancreatic cancer 

is 1.29% for white males and 1.18% for black males. For 

white and black females the lifetime risks are 1.25% and 

1.46% respectively (2). Because survival rates are low 

and survival times are short, the lifetime risks of dying 

from pancreatic cancer are only slightly lower than the 

risks of being diagnosed.

The pancreas is a complex organ, with exocrine components 

(acinar glands and ducts) that produce and deliver digestive enzymes and fluids to the small intestine. Endocrine 

components (islets of Langerhans) secrete hormones (including insulin) into the blood stream. Both components 

can give rise to malignant neoplasms, but the vast majority 

of all pancreatic cancers are exocrine adenocarcinomas 

arising from cells of the pancreatic ducts. Acinar cells 

comprise at least 80% of the cells of the pancreas (3), 

however, acinar cell carcinomas were less than 1% of the 

total pancreatic cancers in this series. 

Endocrine carcinomas of the pancreas represent about 3% 

of all pancreatic cancers. They tend to occur at younger 

ages and have a better prognosis. 

Materials and Methods

Between 1988 and 2001, 46,968 cases of cancer of the 

pancreas were diagnosed within the Surveillance, Epidemiology, and End Results (SEER) Program of the National 

Cancer Institute (NCI). Please see the introductory chapter 

of this monograph for a full explanation of materials and 

methods. Table 7.1 shows the number of cases excluded, by 

reason, leaving 29,729 microscopically confirmed cases of 

cancer of the pancreas diagnosed between 1988 and 2001 

in patients 20 years of age and older. The largest number 

of exclusions was for no microscopic confirmation. The 

AJCC Cancer Staging Manual (sixth edition) (4) coding 

scheme excludes endocrine and carcinoid tumors. Subsites 

were defined according to the International Classification 

of Diseases for Oncology, 2nd edition (ICD-O-2) (5).

Table 7.1: Cancer of the Pancreas: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number Excluded Reason for Exclusion/selection

46,968 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

40,241 6,727 Select first primary only

38,681 1,560 Exclude death certificate only or at autopsy

38,625 56 Exclude unknown race

38,586 39 Exclude alive with no survival time

38,553 33 Exclude children (Ages 0-19)

38,500 53 Exclude in situ cancers

29,765 8,735 Exclude no or unknown microscopic confirmation

29,729 36 Exclude sarcomas

Charles Key

Chapter 7

Cancer of the Pancreas
Chapter 7 Cancer of the Pancreas

National Cancer Institute 60 SEER Survival Monograph 

The analysis described herein addresses demographic 

factors, histologic classification, extent of disease, and 

stage classification as they affect survival of patients 

with pancreatic cancer.

Results

Cancers of the pancreas rank at or near the bottom of 

the list of all cancers in relation to patient survival following diagnosis. For the pancreatic cancers that arose 

from the exocrine pancreas, the 5-year relative survival 

rate was 4%. Cancers arising from endocrine elements 

of the pancreas were much less common and the 5-year 

survival rate was 42% (Figure 7.1.).

Sixty-month (5-year) relative survival rates were 5% for 

the histologically confirmed cancers analyzed in this report 

and were similar to the survival for those that weren’t 

microscopically confirmed. 

Anatomic Subsite

Table 7.2 outlines invasive cancers of the pancreas by 

subsite within the pancreas. More than half of the cancers 

were located in the head of the pancreas and 8.5% and 

10.1% were in the body and tail respectively. Very few 

(0.2%) were in the Islets of Langerhans and pancreatic 

duct (0.6%). The remaining, nearly 30% of the cancers, 

were not assigned to a specific pancreatic region. Cancers of the head of the pancreas had a modest survival 

advantage over the body of pancreas at 12 months after 

diagnosis, but the advantage disappeared after 5 years 

after diagnosis. 

Race and Sex

Overall survival rates were 23% at one year following 

diagnosis, and declined to 7%, 5%, and 4% at 3, 5, 10 

years, respectively (Table 7.3). Twelve-month survival 

rates were poorer among blacks compared to whites, but 

at 36, 60 and 120 months following diagnosis, survival 

was fairly uniform across categories of race and sex. 

Age Group

More than three fourths of cancers of the pancreas were 

diagnosed in patients over 60 years of age, whereas less 

than 2% of cases were diagnosed in adults less than 40 

years of age. (Table 7.4) Survival rates were lowest for 

patients over age 60 and were higher for the younger 

patients who tend to have relatively greater proportions 

of the less lethal endocrine and neuroendocrine tumors. 

All age groups experienced dramatic overall decreases 

in survival as time since diagnosis increased. 

Figure 7.1: Cancer of the Pancreas: Relative Survival Rates 

(%) by Histologic Subtype, Ages 20+, 12 SEER Areas, 1988-

2001

Table 7.2: Cancer of the Pancreas: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival Rates (%) by 

Primary Site, Ages 20+, 12 SEER Areas, 1988-2001

Primary Site Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 29,729 100.0 22.8 10.0 6.7 4.8 3.9 3.6

Head of Pancreas 15,440 51.9 27.2 11.6 7.3 5.1 4.1 3.7

Body of Pancreas 2,525 8.5 19.0 7.8 5.7 4.8 4.2 3.7

Tail of Pancreas 2,995 10.1 19.0 11.3 8.9 7.2 6.4 6.0

Pancreatic Duct 189 0.6 49.7 28.2 19.8 15.4 8.2 8.2

Islets of Langerhans 50 0.2 79.2 68.0 54.9 47.8 22.1 22.1

Other Specified Parts of Pancreas 111 0.4 25.9 12.5 9.4 9.4 ! !

Overlapping Lesion of Pancreas 2,277 7.7 17.5 6.4 4.4 3.2 2.3 2.2

Pancreas, NOS* 6,142 20.7 15.7 6.7 4.4 2.9 2.2 1.8

! Not enough intervals to produce rates.

* NOS: Not Otherwise Specified

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Endocrine Exocrine
Chapter 7 Cancer of the Pancreas

National Cancer Institute 61 SEER Survival Monograph 

Histologic Classification

Cancers of the pancreas are aggregated into histologic 

categories and listed in decreasing order of frequency in 

Table 7.5 by the endocrine vs. exocrine pancreas. About 

97% were carcinomas of the exocrine pancreas with overall survival rates of 21%, 5%, 4%, and 3% at 1, 3, 5, 10 

years, respectively. The exocrine carcinomas with the 

best prognosis were cystadenocarcinomas and acinar cell 

carcinomas, but together these histologic categories accounted for less than 2% of the cases. Most of the exocrine 

tumors were adenocarcinomas not otherwise specified 

with a 5-year relative survival rate of only 2%.

One-year relative survival rates were higher for islet cell 

carcinomas, neuroendocrine carcinomas and carcinoid 

tumors; however, these histologic types only comprised 

1.7%, 1.4% and 0.2% of all cancers of the pancreas. 

Histology and Age

The most frequent histologic types of cancers of the pancreas are tabulated by age group in Table 7.6; the histologic types are listed in descending order according to 

their relative percentages. Above age 80, almost all of 

the cancers arose from the exocrine pancreas, whereas at 

20-29 years of age the percentage was only 59%.

Extent of Disease

Tables 7.7 through 7.9 present survival by extent of disease (EOD) by the following classifications defined in the 

SEER Extent of Disease Codes and Coding Instructions: 

tumor size, extension, and lymph node involvement (6). 

As expected, survival rates declined as extent of disease 

increased.

For the majority of tumors of the pancreas, tumor size 

was unknown or not stated (53%) (Table 7.7). Survival 

was best for cancers that were 2.0 cm or less at the time 

of diagnosis, but above 2 cm, the relation of tumor size 

to outcome was inconsistent (data not shown). Distant 

Table 7.3: Cancer of the Pancreas: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates (%) by Race and Sex, Ages 20+, 12 SEER Areas, 1988-2001

Race/Sex Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Races 29,729 100.0 22.8 10.0 6.7 4.8 3.9 3.6

 Male 15,015 50.5 22.1 9.7 6.5 4.6 3.6 3.1

 Female 14,714 49.5 23.4 10.4 6.9 5.1 4.3 4.0

White 23,937 80.5 23.2 10.1 6.7 4.9 3.9 3.5

 Male 12,169 40.9 22.8 9.8 6.7 4.8 3.7 3.2

 Female 11,768 39.6 23.5 10.3 6.7 4.9 4.1 3.8

Black 3,471 11.7 19.2 8.7 5.5 3.7 3.4 3.3

 Male 1,665 5.6 17.3 7.5 4.9 2.9 2.6 2.1

 Female 1,806 6.1 21.0 9.8 6.0 4.3 4.1 4.1

Table 7.4: Cancer of the Pancreas: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8- & 10-Year Relative 

Survival Rates (%) by Age (20+), SEER 1988-2001

Age (Years) Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total (20+) 29,729 100.0 22.8 10.0 6.7 4.8 3.9 3.6

20-29 69 0.2 71.1 55.8 49.2 43.6 41.6 35.2

30-39 472 1.6 44.8 29.4 25.3 19.5 17.3 15.8

40-49 2,010 6.8 31.8 17.1 12.7 9.8 7.0 6.0

50-59 4,792 16.1 28.5 12.9 9.0 6.5 4.9 4.2

60-69 8,430 28.4 23.6 10.1 6.2 4.0 3.1 2.7

70-79 9,650 32.5 19.8 7.7 4.7 3.1 2.3 2.1

80+ 4,306 14.5 12.9 4.7 2.6 1.8 1.6 1.2
Chapter 7 Cancer of the Pancreas

National Cancer Institute 62 SEER Survival Monograph 

Table 7.5: Cancer of the Pancreas: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, 10-Year Relative Survival Rates (%) by 

Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology ICD-O Code Cases Percent Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 8000-9970 29,729 100.0 22.8 10.0 6.7 4.8 3.9 3.6

Cancers of the Endocrine Pancreas 8150-8155,

8240-8246 975 3.3 72.3 61.7 53.0 42.1 31.9 27.1

 Islet Cell Carcinoma 8150-8155 494 1.7 80.7 70.0 59.3 47.7 37.8 32.5

 Neuroendocrine Carcinoma 8246 411 1.4 61.5 50.3 43.7 32.2 20.9 18.4

 Carcinoid Tumor 8240-8245 70 0.2 76.3 68.7 61.8 55.1 43.2 25.8

Cancers of the Exocrine Pancreas

8000-8149,

8156-8239,

8247-9970

28,754 96.7 21.1 8.2 5.0 3.5 2.8 2.6

 Adenocarcinoma, NOS* 8140-8149 20,829 70.1 19.2 6.5 3.6 2.3 1.7 1.5

 Carcinoma, NOS* 8010-8011 2,404 8.1 17.5 6.9 4.2 3.1 2.3 2.1

 Mucin-Producing Adenocarcinoma 8480-8481 1,814 6.1 21.5 9.6 6.7 4.6 3.5 2.5

 Infiltrating Duct Carcinoma 8500-8503 1,820 6.1 40.1 18.8 11.5 7.1 6.1 5.9

 Malignant Neoplasm, NOS* 8000-8004 512 1.7 19.5 10.5 8.6 6.5 5.5 5.1

 Cystadenocarcinoma 8440-8479 243 0.8 64.7 52.7 48.4 47.3 44.6 43.0

 Carcinoma, Undifferentiated 8020-8039,

8230-8231 200 0.7 12.5 8.0 6.9 5.1 5.1 5.1

 Adenosquamous Carcinoma 8560-8570 186 0.6 16.7 6.9 4.0 3.3 2.6 1.5

 Papillary Adenocarcinoma 8050-8260 138 0.5 35.0 19.8 15.8 13.8 13.8 10.6

 Signet Ring Cell Carcinoma 8490 155 0.5 17.5 9.7 3.3 2.3 ! !

 Large Cell Carcinoma 8012 121 0.4 7.7 1.8 ! ! ! !

 Small Cell Carcinoma 8040-8045 98 0.3 24.5 9.4 5.6 2.9 1.7 1.7

 Squamous Cell Carcinoma 8051-8082 75 0.3 15.1 7.9 6.4 6.4 6.4 6.4

 Acinar Cell Carcinoma 8550 76 0.3 61.4 44.5 33.7 28.3 26.6 24.4

 Other Histologies 83 0.3 39.9 24.9 21.9 13.6 11.5 11.5

* NOS: Not Otherwise Specified

 ! Not enough intervals to produce rate.

metastasis at the time of diagnosis was documented in 

nearly half of the histologically confirmed cases (Table 

7.8). Additionally, for the majority of cancers of the pancreas, lymph node involvement was unknown or not stated 

(Table 7.9). 

AJCC Stage Classification (6th Edition)

Survival by AJCC stage classifications (6th Edition) (4) for 

carcinomas of the exocrine pancreas is presented in Table 

7.10. The majority of cancers of the pancreas were diagnosed 

at Stage IV (49.5%) or the stage of disease was unknown 

(18.8%); whereas very few cancers of the pancreas were 

diagnosed in early stages: Stage IA and Stage IB comprise 

only 0.7% and 2.7% of diagnoses, respectively. 

Figure 7.2 illustrates relative survival rate curves for AJCC 

Stages IA – IV (6th Edition). The unstaged cases, which 

represent about one-fifth of the total, most closely match 

the Stage III group. Table 7.11 shows the components of 

stage based on SEER Extent of Disease (EOD) codes for 

Tumor Size, Extension, and Lymph Node Involvement. 

Discussion

Survival rates for cancers of the pancreas are very poor. 

The relative survival rate for all cases was only 23% at 

one year with dramatic decreases shown at 3 years (7%), 

5 years (5%) and 10 years (4%). The majority of cancers 

of the pancreas were adenocarcinomas of the exocrine 

pancreas that occurred in patients 60 years of age and 

older. Malignant endocrine tumors arising from the islets 

of Langerhans, neuroendocrine carcinomas and carcinoid 

tumors had relatively better survival rates (48%, 32%, and 

55%, respectively at 5 years). 

Most cancers of the pancreas were diagnosed in late stages 

of disease. Frequently, information was incomplete re-
Chapter 7 Cancer of the Pancreas

National Cancer Institute 63 SEER Survival Monograph 

garding tumor size and lymph node involvement, but 

evidence of distant metastasis permitted the cases to be 

classified as Stage IV.

Pancreatic cancers present huge challenges for future 

research across the entire cancer continuum (cause and 

prevention; screening and early detection; imaging and 

diagnosis; investigational therapeutics; standard treatment 

and management; quality of life; pain management and 

other end of life issues).

References

1. American Cancer Society. Cancer facts & figures 2006, The 

American Cancer Society, Atlanta, (GA), 2006.

2. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, 

Feuer EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat 

M, Hankey BF, Edwards BK (eds). SEER Cancer Statistics 

Review, 1975-2003, National Cancer Institute. Bethesda, MD, 

http://seer.cancer.gov/csr/1975_2003/, based on November 2005 

SEER data submission, posted to the SEER web site, 2006.

3. Solicia E, Capella C, Kloppel G. Tumors of the pancreas. In: 

Atlas of tumor pathology, 3rd series, fascicle 20. Washington 

(DC): Armed Forces Institute of Pathology, 1995.

4. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller 

DG, Morrow M (eds). AJCC Cancer Staging Manual, Sixth 

edition. American Joint Committee on Cancer. New York: 

Springer 2002.

5. International Classification of Diseases for Oncology, 2nd ed. 

Geneva: World Health Organization, 1990. 

6. SEER extent of disease – codes and coding instructions, 2nd 

ed, Cancer Statistics Branch, Surveillance Program, Division 

of Cancer Prevention and Control, National Cancer Institute, 

National Institutes of Health, NIH Publication 92-2313, June 

1992. 

Table 7.6: Cancer of the Pancreas: Histologic Type Distribution by Age (20+), 12 SEER Areas, 1988-2001

Histology

Age (Years)

Total (20+) 20-29 30-39 40-49 50-59 60-69 70-79 80+

Cases Percent Cases Cases Cases Cases Cases Cases Cases

Total 29,729 100.0 69 472 2,010 4,792 8,430 9,650 4,306

Cancers of the Endocrine Pancreas 975 3.3 28 92 171 213 226 195 50

 Islet Cell Carcinoma 494 1.7 14 54 93 110 119 93 11

 Neuroendocrine Carcinoma 411 1.4 13 29 68 91 93 87 30

 Carcinoid Tumor 70 0.2 <5 9 10 12 14 15 9

Cancers of the Exocrine Pancreas 28,754 96.7 41 380 1,839 4,579 8,204 9,455 4,256

 Adenocarcinoma, NOS* 20,829 70.1 19 246 1,275 3,329 6,075 6,860 3,025

 Carcinoma, NOS* 2,404 8.1 <5 34 142 334 573 826 493

 Mucin-Producing Adenocarcinoma 1,814 6.1 <5 24 147 299 548 577 217

 Infiltrating Duct Carcinoma 1,820 6.1 <5 22 122 345 545 607 177

 Malignant Neoplasm, NOS* 512 1.7 5 9 27 52 108 170 141

 Cystadenocarcinoma 243 0.8 <5 15 31 38 53 72 32

 Carcinoma, Undifferentiated 200 0.7 <5 6 17 40 49 62 25

 Adenosquamous Carcinoma 186 0.6 0 <5 17 30 45 65 26

 Papillary Adenocarcinoma 138 0.5 5 6 9 16 32 42 28

 Signet Ring Cell Carcinoma 155 0.5 0 <5 14 30 41 46 22

 Large Cell Carcinoma 121 0.4 0 <5 13 21 32 36 16

 Small Cell Carcinoma 98 0.3 <5 <5 7 12 26 30 20

 Squamous Cell Carcinoma 75 0.3 0 <5 <5 6 29 25 10

 Acinar Cell Carcinoma 76 0.3 0 5 8 11 23 16 13

 Other Histologies 83 0.3 <5 <5 6 16 25 21 11

* NOS: Not Otherwise Specified
Chapter 7 Cancer of the Pancreas

National Cancer Institute 64 SEER Survival Monograph 

Table 7.7: Cancer of the Pancreas: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by 

Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

Tumor Size Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 29,729 100.0 22.8 10.0 6.7 4.8 3.9 3.6

0 - 2 cm 1,404 4.7 45.7 26.1 20.0 14.9 12.7 12.0

> 2 cm 12,696 42.7 26.7 12.6 8.6 6.4 5.2 4.7

Unknown 15,629 52.6 17.5 6.5 4.0 2.7 2.1 1.9

Table 7.8: Cancer of the Pancreas: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by 

Extension, Ages 20+, 12 SEER Areas, 1988-2001

Extension (Code) Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 29,729 100.0 22.8 10.0 6.7 4.8 3.9 3.6

Confined to Pancreas (10-30) 3,011 10.1 44.8 26.8 20.2 17.7 16.5 16.3

Limited Extension (40-52) 4,769 16.0 41.5 19.0 12.6 8.5 6.8 6.0

Further Extension (54-80) 4,234 14.2 28.0 9.4 5.0 3.2 2.2 1.9

Metastasis (85) 14,468 48.7 9.9 3.9 2.6 1.7 0.9 0.6

Unknown (99) 3,247 10.9 25.4 9.7 6.0 3.9 3.5 3.1

Table 7.9: Cancer of the Pancreas: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by 

Lymph Node Involvement, Ages 20+, 12 SEER Areas, 1988-2001

Nodal Status (Code) Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 29,729 100.0 22.8 10.0 6.7 4.8 3.9 3.6

No Positive Nodes (0) 6,720 22.6 35.9 18.7 13.5 11.1 9.7 8.9

Positive Regional Nodes (1) 5,747 19.3 31.5 14.1 9.1 6.1 4.4 4.3

Positive Distant Nodes (7) 929 3.1 14.0 3.8 1.2 1.2 0.8 0.8

Positive Nodes, NOS (8) 158 0.5 17.6 7.7 4.3 4.3 3.7 2.7

Unknown (9) 16,175 54.4 14.7 5.3 3.3 2.0 1.5 1.2

Figure 7.2: Carcinomas of the Exocrine Pancreas: 

Relative Survival Rates (%) by AJCC Stage, 6th Edition, 

Ages 20+, 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

IA IB IIA IIB III IV Unstaged
Chapter 7 Cancer of the Pancreas

National Cancer Institute 65 SEER Survival Monograph 

Table 7.10: Carcinomas of the Exocrine Pancreas: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates (%) by AJCC Stage (6th Edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 28,754 100.0 21.1 8.2 5.0 3.5 2.8 2.6

IA (T1, N0, M0) 201 0.7 75.5 54.7 43.0 37.3 30.9 30.6

IB (T2, N0, M0) 788 2.7 49.1 31.2 23.4 21.0 20.0 19.2

IIA (T3, N0, M0) 1,617 5.6 48.1 23.8 16.7 12.3 9.9 8.6

IIB (T1-3, N1, M0) 2,472 8.6 45.0 19.5 11.3 6.3 4.1 3.9

III (T4, any N, M0) 4,043 14.1 27.5 8.5 4.0 2.3 1.7 1.4

IV (any T, any N, M1) 14,230 49.5 8.1 2.2 1.1 0.8 0.4 0.3

Unstaged/Unknown 5,403 18.8 25.2 9.1 5.6 3.7 3.4 3.2

Table 7.11: Carcinomas of the Exocrine Pancreas: Number of Cases and 5-Year Relative Survival Rates (RSR) (%) by TNM Values, 

Ages 20+, 12 SEER Areas, 1988-2001

T Values

N Values

Total

No Positive 

Nodes (N0)

Positive 

Regional 

Nodes (N1)

Positive 

Distant 

Nodes (M1)

Positive 

Nodes, NOS 

(NX) Unknown (NX)

Cases

5-Yr 

RSR 

(%) Cases

5-Yr 

RSR 

(%) Cases

5-Yr 

RSR 

(%) Cases

5-Yr 

RSR 

(%) Cases

5-Yr 

RSR 

(%) Cases

5-Yr 

RSR 

(%)

Total 28,754 3.5 6,465 8.8 5,515 3.8 898 0.7 157 3.6 15,719 1.3

Confined to Pancreas (Ext. 10-30) 2,842 13.4 1,428 20.9 712 6.1 34 ! <5 ~ 664 5.6

 0 - 2 cm (T1) 315 27.4 201 37.3 74 14.8 0 ~ 0 ~ 40 4.2

 > 2 cm (T2) 1,542 14.0 788 21.0 423 6.7 17 ~ <5 ~ 311 6.0

 Unknown Size (TX) 985 7.7 439 12.7 215 1.9 17 ~ <5 ~ 313 5.0

Limited Extension (Ext. 40-52 - T3) 4,682 7.2 1,617 12.3 1,760 6.4 80 ! 18 ~ 1,207 1.3

Further Extension (Ext. 54-80 - T4) 4,136 2.2 1,337 3.1 1,005 2.3 93 ! 23 ~ 1,678 1.5

Metastasis (Ext. 85 - M1) 13,926 0.8 1,895 1.3 1,790 1.2 594 0.6 98 1.1 9,549 0.6

Unknown (Ext. 99 - TX/MX) 3,168 2.6 188 3.1 248 3.0 97 ! 14 ~ 2,621 2.6

~ Statistic not displayed due to less than 25 cases.

 ! Not enough intervals to produce rate.
Chapter 7 Cancer of the Pancreas

National Cancer Institute 66 SEER Survival Monograph 
National Cancer Institute 67 SEER Survival Monograph 

Introduction

The larynx, positioned in the neck slightly below the point 

where the pharynx divides into separate respiratory and 

digestive tracts, is critical to breathing, swallowing, and 

speaking. The glottis is the portion of the larynx where 

the vocal cords are located. The area above the vocal 

cords is referred to as the supraglottis and that below the 

vocal cords as the subglottis. 

This chapter provides survival analyses for 14,950 histologically confirmed adult cases of cancer of the larynx. 

Cases were obtained from the Surveillance, Epidemiology, 

and End Results (SEER) Program of the National Cancer 

Institute (NCI). Cancer of the larynx is second only to 

oral cavity cancer as the most common cancer of the upper aerodigestive tract (1). Tobacco and alcohol use are 

widely recognized as the key causative factors for many 

of these tumors (2). The cell type of origin for the vast 

majority of these tumors is squamous cell (3).

Materialand methods

The NCI contracts with medically oriented nonprofit institutions, such as universities and state health departments, 

to obtain data on all cancers diagnosed in residents of the 

SEER geographic areas. SEER collects data on all invasive and in situ cancers except basal cell and squamous 

cell carcinomas of the skin and in situ carcinoma of the 

uterine cervix.

SEER selects participating institutions on the basis of two 

criteria: their ability to operate and maintain a populationbased cancer reporting system and the epidemiologic significance of their population subgroups. At times, registries 

will withdraw; at times, registries will be added. This 

analysis is based on data from 12 geographic areas, that 

collectively contain about 14% of the total US population. The areas are the States of Connecticut, Iowa, New 

Mexico, Utah, and Hawaii; the metropolitan areas of Detroit, Atlanta, San Francisco, Seattle, San Jose, and Los 

Angeles; and 10 counties in rural Georgia. Los Angeles 

contributed data for diagnosis years 1992 to 2001, the 

others for 1988 to 2001.

To ensure maximal ascertainment of cancer cases, each registry abstracts the records of all cancer patients in hospitals, 

laboratories, and all other health service units that provide 

diagnostic services. Data collected by SEER registries 

on each patient include patient demographics, primary 

tumor site, tumor morphology, diagnostic methods, extent 

of disease, and first course of cancer-directed therapy. 

A separate record is coded for each primary cancer. All 

patients are followed from diagnosis to death, allowing 

detailed survival analysis.

Jay F. Piccirillo and Irene Costas

Chapter 8

Cancer of the Larynx

Table 8.1: Cancer of the Larynx: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number Excluded Reason for Exclusion/Selection

19,807 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

16,660 3,147 Select first primary only

16,516 144 Exclude death certificate only or at autopsy

16,445 71 Exclude unknown race

16,433 12 Exclude alive with no survival time

16,428 5 Exclude children (Ages 0-19)

15,145 1,283 Exclude in situ cancers for all except breast & bladder cancer

15,007 138 Exclude no or unknown microscopic confirmation

14,950 57 Exclude sarcomas
Chapter 8 Cancer of the Larynx

National Cancer Institute 68 SEER Survival Monograph 

SEER has collected extent of disease (EOD) information 

on all cancers since the inception of the program. The 

detail and amount of information collected, however, have 

varied over time. 

Relative Survival

The survival analysis is based largely on relative survival 

rates calculated by the life-table method. The relative 

rate is used to estimate the effect of cancer on the survival 

of the cohort. Relative survival, defined as observed 

survival divided by expected survival, adjusts for the 

expected mortality that the cohort would experience from 

other causes of death. When relative survival is 100%, 

a patient has the same chance to live 5 more years as a 

cancer-free person of the same age and sex. 

Stage Classification

SEER historic stage is used in this chapter to classify the 

extent of cancer within and beyond the larynx. Categories 

include in situ, localized, regional, distant, and unstaged. 

The cases with a SEER stage of in situ are excluded from 

this study, as seen in Table 8.1. An invasive neoplasm 

confined entirely to the organ is classified as localized. 

A neoplasm that has extended either beyond the organ or 

into regional lymph nodes is defined as regional. Distant 

stage is defined as a neoplasm that has spread to parts of 

the body remote from the primary tumor. Cancers that 

lack sufficient information to assign stage are defined 

as unstaged. 

Exclusions

As shown in Table 8.1, patients were excluded from this 

study for any of the following reasons: larynx cancer was 

not the first primary, cases identified through autopsy or 

death certificate only, persons of unknown race, cases 

without active follow-up, patients less than 20 years old, 

in situ cases, cases without microscopic confirmation, 

and sarcomas.

Results

The demographic characteristics of the patient and morphologic characteristics of the tumors are displayed in 

Table 8.2. About 66% of the people in this sample are 

aged 60 years or older. The majority of patients are 

white and male. The majority of tumors were based in 

the glottis while approximately one-third of the tumors 

were supraglottic. At the time of diagnosis, one-half of 

the tumors were localized.

Table 8.2: Cancer of the Larynx: Number and Distribution 

of Cases by Age (20+), Sex, Race, Primary Site, Historic 

Stage and Grade, 12 SEER Areas,

 1988-2001

Characteristics Cases Percent

Total 14,950

 Age 20+ (Years) 14,950

 20-29 29 0.2

 30-39 228 1.5

 40-49 1,360 9.1

 50-59 3,485 23.3

 60-69 5,128 34.3

 70-79 3,623 24.2

 80+ 1,097 7.3

Sex

 Male 11,975 80.1

 Female 2,975 19.9

Race

 White 12,190 81.5

 Black 2,148 14.4

 Other 612 4.1

Primary Site

 Glottis (ICD-O C32.0) 8,160 54.6

 Supraglottis (ICD-O C32.1) 4,920 32.9

 Subglottis (ICD-O C32.2) 211 1.4

 Laryngeal Cartilage (ICD-O 

 C32.3) 80 0.5

 Overlapping Lesion (ICD-O 

 C32.8) 650 4.3

 Larynx, NOS (ICD-O C32.9) 929 6.2

SEER Historic Stage

 Localized 7,472 50.0

 Regional 6,373 42.6

 Distant 538 3.6

 Unstaged 567 3.8

Grade (Differentiation)

 Well differentiated; Grade I 2,501 16.7

 Moderately differentiated; 

 Grade II 6,775 45.3

 Poorly differentiated; Grade III 2,916 19.5

 Undifferentiated; anaplastic; 

 Grade IV 140 0.9

 Unknown 2,618 17.5
Chapter 8 Cancer of the Larynx

National Cancer Institute 69 SEER Survival Monograph 

Race and Sex

The 1-, 3-, 5-, 8- and 10-year relative survival rates by 

race and gender are shown in Table 8.3 and Figure 8.1. 

The 5-year relative survival rate for whites was 65% and 

for blacks was 53%. The 5-year relative survival rate 

was 61% for males and 57% for females. White males 

had the best 5-year relative survival at 68%, followed 

by white females, black males, and black females. The 

median observed survival for both white males and white 

females was 79 months, while for black males it was 48 

months and for black females 50 months. 

Stage at Diagnosis.

In Table 8.4 and Figure 8.2 survival is stratified by SEER 

historic stage at diagnosis. Localized tumors account 

for 50% of larynx tumors followed by regional (42.6%), 

unstaged (3.8%) and distant (3.6%). Five-year relative 

survival rate varies by stage from 83% for localized to 

19% for distant. The median observed survival for patients 

with localized disease was 115 months, regional disease 

was 43 months, and distant disease was 11 months. 

Grade at Diagnosis

Table 8.5 presents the 1-, 3-, 5-, 8- and 10-year relative 

survival rates by grade at diagnosis for all cancers of 

the larynx. At each time interval shown there is a clear 

survival gradient as tumor grade goes from well differentiated to undifferentiated.

Table 8.6 presents 5-year relative survival rates by race, 

sex, and stage. For patients with localized disease, white 

males had the best survival at 85%, followed by white 

females 78%, black males 75%, and black females 68%. 

For patients with regional disease white males and females 

had a 5-year relative survival of about 50%, while that of 

black males and females was approximately 42%.

Site at Diagnosis

Relative survival for patients with tumors of the glottis, 

supraglottis, and subglottis is shown in Figure 8.3. The 

median observed survival for patients with glottic cancer at 

presentation was 111 months, for supraglottic tumors was 

43 months, and for subglottic tumors was 30 months. 

Table 8.3: Cancer of the Larynx: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by Race and Sex, Ages 20+, 12 SEER Areas, 1988-2001

Race/Sex Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total* 14,338 100.0 87.8 78.3 72.5 65.0 57.3 52.8

White Male 9,761 68.1 89.3 80.6 75.1 68.2 61.0 56.6

White Female 2,429 16.9 85.8 76.0 70.4 62.1 54.2 48.6

Black Male 1,686 11.8 83.3 70.5 62.9 54.5 45.2 41.2

Black Female 462 3.2 81.4 69.8 63.2 51.2 41.5 38.9

* Relative survival not computed for Other Race

Figure 8.1: Cancer of the Larynx: Relative Survival Rates 

(%) by Race and Sex, Ages 20+, 12 SEER Areas, 1988-2001

Figure 8.2: Cancer of the Larynx: Relative Survival Rates (%) 

by Historic Stage, Ages 20+, 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

White, Male

White, Female

Black, Female

Black, Male

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Localized

Regional

Distant
Chapter 8 Cancer of the Larynx

National Cancer Institute 70 SEER Survival Monograph 

Table 8.4: Cancer of the Larynx: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates by 

Historic Stage, Ages 20+, 12 SEER Areas, 1988-2001

Historic Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 14,950 100.0 87.9 78.4 72.7 65.2 57.6 53.1

Localized 7,472 50.0 96.6 92.5 88.5 82.5 76.0 71.9

Regional 6,373 42.6 81.4 66.7 59.1 49.3 40.5 35.3

Distant 538 3.6 49.9 31.9 25.1 19.1 14.4 11.1

Unstaged 567 3.8 81.7 69.5 63.5 58.2 47.6 46.2

Table 8.5: Cancer of the Larynx: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates by Grade, 

Ages 20+, 12 SEER Areas, 1988-2001

Grade Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 14,950 100.0 87.9 78.4 72.7 65.2 57.6 53.1

Well differentiated; Grade I 2,501 16.7 94.0 89.2 85.4 79.3 71.0 66.0

Moderately differentiated; Grade II 6,775 45.3 89.3 79.4 73.2 66.3 58.9 54.1

Poorly differentiated; Grade III 2,916 19.5 80.2 65.7 57.4 47.6 39.3 34.6

Undifferentiated; anaplastic; Grade IV 140 0.9 75.1 56.5 53.0 37.6 31.4 22.7

Unknown 2,618 17.5 87.4 80.9 77.3 70.1 62.9 60.1

Table 8.6: Cancer of the Larynx: Number of Cases and 5-Year Relative Survival Rates (RSR) (%) by Historic Stage, Race 

and Sex, Ages 20+, 12 SEER Areas, 1988-2001

Historic Stage/Race

Total

Sex

Male Female

Cases Cases

5-Year 

RSR(%) Cases

5-Year 

RSR(%)

Local:

 White 6,321 5,186 85.0 1,135 77.6

 Black 854 672 75.1 182 67.5

Regional:

 White 4,988 3,874 50.6 1,114 50.0

 Black 1,107 870 42.2 237 42.1

Distant:

 White 411 333 19.5 78 15.5

 Black 106 84 20.1 22 ~

 ~ Statistic not displayed due to less than 25 cases.

Table 8.7 presents 5–year relative survival rates as a function of site, sex, and race. For glottic tumors, white males 

fared best with 82% survival. For supraglottic tumors, white 

females had the best 5-year relative survival (53%). 

In Table 8.8 and Figure 8.4 the survival of patients with 

glottic cancer as a function of morphologic stage at diagnosis 

is shown. Localized tumors accounted for 67.3% of glottic 

tumors followed by regional (28.7%), unstaged (2.9%) and 

distant (1.2%). At each time point shown relative survival 

varies by stage with the highest relative survival for localized disease and the lowest for distant disease at diagnosis. 

The median observed survival for patients with localized 

disease at presentation was greater than 120 months, while 

patients with regional tumors had a median survival of 63 

months, and those with distant disease 18 months.

In Table 8.9 and Figure 8.5 the survival of patients with 

supraglottic cancer as a function of morphologic stage at 

diagnosis is shown. Localized tumors account for 30.4% 

of glottic tumors, regional for 61.1%, distant for 5.5% and 

unstaged for 3.0%. At each time point shown relative survival decreases from diagnosis at localized to distant stage. 

The median observed survival for patients with localized 

disease at presentation was 73 months, regional disease was 

36 months, and for distant disease was 11 months. 
Chapter 8 Cancer of the Larynx

National Cancer Institute 71 SEER Survival Monograph 

Discussion

Cancer of the larynx is closely related to tobacco and 

alcohol use. It remains primarily a disease of white men, 

although the number of women with this disease is increasing. For example, DeRienzo, Greenberg, and Fraire 

(4) found that the male-to-female ratio was 5.6 to 1 for 

the years of 1959-1973 and 4.5 to 1 for 1974-1988. In 

the population reported here, the male-to-female ratio 

in 1988-1998 decreased to 4 to 1. Small differences in 

relative survival by race were observed in this data. However, other researchers (5) have shown that these racial 

disparities disappear after controlling for other prognostic 

factors, including: treatment delay, type of therapy, and 

quality of care. 

The vast majority (> 95%) of tumors are of squamous 

cell origin. The overall prognosis is good and sub-site 

survival rates are much better for patients with glottic 

cancer than supraglottic or subglottic. This difference in 

survival may be due to the fact that the larynx is anatomically and clinically divided into these three distinct subsites. Anatomically, the glottis has much fewer lymphatic 

channels and vascular support than either the supraglottis or subglottis. Clinically, patients with glottic cancer 

will develop symptoms, such as hoarseness, earlier in 

the course of their disease than patients with tumors of 

the supraglottis or subglottis. The paucity of lymphatic 

and vascular supply and the development of symptoms 

earlier in the course of glottic cancer may explain why 

patients with glottic tumors generally present with local, 

rather than regional, disease. For all sub-sites, survival 

was strongly related to morphologic extent of disease at 

the time of diagnosis. Survival was also related to the 

degree of differentiation; as the degree of differentiation 

decreased survival worsened.

It would be informative to be able to include in analyses 

of larynx cancer survival host factors like comorbidity 

(6, 7) and performance status (8); socioeconomic factors 

like income and education; and tumor biology factors 

like p53 and epidermal growth factor receptor. However, many of these variables are not routinely found in 

medical records and are not generally part of the SEER 

analytic files.

Figure 8.3: Cancer of the Larynx: Relative Survival Rates (%) 

by Subsite, Ages 20+, 12 SEER Areas, 1988-2001

Table 8.7: Cancer of the Larynx: Number of Cases and 5-Year Relative Survival Rates (RSR) (%) by Race, Primary Site and 

Sex, Ages 20+, 12 SEER Areas, 1988-2001

Primary Site/Race

Total Male Female

Cases Cases

5-Year 

RSR(%) Cases

5-Year 

RSR(%)

Glottis

 White 6,849 5,887 82.2 962 78.0

 Black 956 830 72.8 126 69.9

Supraglottis

 White 3,956 2,765 48.5 1,191 52.7

 Black 798 533 36.9 265 45.7

Subglottis

 White 163 118 46.5 45 37.7

 Black 35 25 30.3 10 ~

 ~ Statistic not displayed due to less than 25 cases.

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Glottis

Supraglottis

Subglottis
Chapter 8 Cancer of the Larynx

National Cancer Institute 72 SEER Survival Monograph 

References

1. Jemal A, Thomas A, Murray T, Thun MJ. Cancer Statistics, 

2002. CA A Cancer Journal for Clinicians 2002; 52(1):23-47.

2. Shaha A, Strong EW. Cancer of the Head and Neck. In: Murphy 

GP, Lawrence W, Lenhard REJr, editors. Clinical Oncology. 

Atlanta, GA: American Cancer Society, 1995: 355-377.

3. Sinard RJ, Netterville JL, Garrett CG, Ossoff RH. Cancer of 

the Larynx. In: Myers EN, Suen JY, editors. Cancer of the Head 

and Neck. Philadelphia: W.B.Saunders Company, 1996: 381-

421.

4. DeRienzo DP, Greenberg SD, Fraire AE. Carcinoma of 

the larynx. Changing incidence in women. Archives of 

Otolaryngology -- Head & Neck Surgery 1991; 117(6):681-684.

5. Roach M, Alexander M, Coleman JL. The prognostic 

significance of race and survival from laryngeal carcinoma. 

Journal of the National Medical Association 1992; 84:668-674.

6. Piccirillo JF, Wells CK, Sasaki CT, Feinstein AR. New clinical 

severity staging system for cancer of the larynx. Five-year 

survival rates. Annals of Otology, Rhinology & Laryngology 

1994; 103(2):83-92.

7. Piccirillo JF. Inclusion of comorbidity in a staging system for 

head and neck cancer. Oncology 1995; 9:831-836.

8. Stell PM. Prognosis in laryngeal carcinoma: host factors. Clin 

Otolaryngol 1990; 15(2):111-119.

Table 8.8: Cancer of the Glottis: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival Rates (%) by 

Historic Stage, Ages 20+, 12 SEER Areas, 1988-2001

Historic Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 8,160 100.0 94.8 90.2 86.1 80.6 74.8 71.2

Localized 5,489 67.3 98.9 96.5 93.5 89.5 84.8 82.0

Regional 2,338 28.7 87.0 77.5 70.9 61.3 52.9 46.8

Distant 95 1.2 60.0 40.5 37.0 34.3 25.3 22.2

Unstaged 238 2.9 91.7 85.4 80.9 77.0 68.1 67.9

Figure 8.4: Cancer of the Glottis: Relative Survival Rates 

(%) by Historic Stage, Ages 20+, 12 SEER Areas, 1988-2001

Figure 8.5: Cancer of the Supraglottis: Relative Survival 

Rates (%) by Historic Stage, Ages 20+, 12 SEER Areas, 1988-

2001

Table 8.9: Cancer of the Supraglottis: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival Rates (%) 

by Historic Stage, Ages 20+, 12 SEER Areas, 1988-2001

Historic Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 4,920 100.0 81.8 66.8 58.9 48.5 38.6 33.1

Localized 1,494 30.4 90.8 81.9 75.4 64.1 52.0 44.5

Regional 3,008 61.1 80.6 62.7 54.1 43.8 34.5 29.7

Distant 270 5.5 49.6 31.7 22.4 15.4 12.0 9.8

Unstaged 148 3.0 76.3 59.4 54.9 45.8 35.9 30.6

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Localized

Regional

Distant

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Localized

Regional

Distant
National Cancer Institute 73 SEER Survival Monograph 

Introduction

This study provides survival analyses for 201,067 histologically confirmed adult cases of lung cancer diagnosed 

from 1988 through 2001. Cases were obtained from the 

Surveillance, Epidemiology, and End Results (SEER) 

Program of the National Cancer Institute (NCI). The 

SEER Program -- a sequel to two earlier NCI initiatives, 

the End Results Program and the Third National Cancer 

Survey -- has evolved in response to the National Cancer 

Act of 1971, which requires the collection, analysis, and 

dissemination of data relevant to the prevention, diagnosis, and treatment of cancer. This chapter focuses on 

the influence of extent of disease, histologic grade, and 

demographic factors on lung cancer survival.

Materials and Methods

The NCI contracts with medically oriented nonprofit institutions -- such as universities and state health departments 

-- to obtain data on all cancers diagnosed in residents of 

the SEER geographic areas. SEER collects data on all 

invasive and in situ cancers except basal cell and squamous 

cell carcinomas of the skin and in situ carcinoma of the 

uterine cervix.

SEER selects participating institutions on the basis of two 

criteria: their ability to operate and maintain a populationbased cancer reporting system and the epidemiologic significance of their population subgroups. At times, registries will withdraw; at times, registries will be added. 

This analysis is based on data from 12 geographic areas, 

which collectively contain about 14% of the total US 

population. The areas are the States of Connecticut, Iowa, 

New Mexico, Utah, and Hawaii; the metropolitan areas of 

Detroit, Atlanta, San Francisco, Seattle, San Jose, and Los 

Angeles; and 10 counties in rural Georgia. Los Angeles 

contributed data for diagnosis years 1992 to 2001, the 

others for 1988 to 2001.

To ensure maximal ascertainment of cancer cases, each registry abstracts the records of all cancer patients in hospitals, 

laboratories, and all other health service units that provide 

diagnostic services. Data collected by SEER registries 

on each patient include patient demographics, primary 

tumor site, tumor morphology, diagnostic methods, extent 

of disease, and first course of cancer-directed therapy. 

A separate record is coded for each primary cancer. All 

patients are followed from diagnosis to death, allowing 

detailed survival analysis.

SEER has collected extent of disease (EOD) information 

on all cancers since the inception of the program. The 

detail and amount of information collected, however, have 

varied over time. In 1988, there were revisions to the lung 

cancer EOD scheme allowing the SEER EOD information to be collapsed into the TNM classification described 

in the third edition of the American Joint Committee on 

Cancer (AJCC) Manual for Staging of Cancer (1). The 

AJCC TNM classification for lung cancer is the same as 

that of the International Union Against Cancer.

Relative Survival

The survival analysis is based on relative survival rates 

calculated by the life-table method. The relative rate is 

used to estimate the effect of cancer on the survival of the 

cohort. Relative survival, defined as observed survival 

divided by expected survival, adjusts for the expected 

mortality that the cohort would experience from other 

causes of death. When relative survival is 100%, a patient 

has the same chance to live 5 more years as a cancer-free 

person of the same age and sex. For lung cancer, the 

relative rate may underestimate survival slightly, since 

the expected mortality tables are based on the entire US 

population, whose expected survival is greater than the 

smoking population’s expected survival.

Exclusions

The following were excluded from the analysis: patients for 

whom lung cancer was not the first primary; cases identified through autopsy or death certificate only; persons of 

unknown race; cases without active follow-up; patients 

Lynn A. Gloeckler Ries and Milton P. Eisner

Chapter 9

Cancer of the Lung
Chapter 9 Cancer of the Lung

National Cancer Institute 74 SEER Survival Monograph 

less than 20 years old; in situ cases; cases without microscopic confirmation; and sarcomas. Table 9.1 details the 

exclusions. There were 201,067 cases for analysis.

Results

Overall, the relative survival rate was poor; only 15% 

survived 5 years. In most of the following tables, each 

prognostic factor is presented both individually and in 

relation to a second factor.

Race and Sex

Overall, the 5-year relative survival rate for whites was 

16% and for blacks was 12%. The overall 5-year relative 

survival rates were 14% for males and 18% for females 

(Table 9.2).

Geographic Location

Five-year relative survival rates in the 12 SEER areas 

represented in this study ranged from 13% in New Mexico 

and Rural Georgia to 17% in Connecticut (Table 9.3). 

Stage of Disease

Lung cancer was seldom found (only 13.4%) when it 

was still confined to the lung. Rather, over 60% of the 

patients had stage III or IV disease at diagnosis. Twentyone percent of the cases did not have enough diagnostic 

information to be staged. The stage distributions for 

males and females were similar (Table 9.4). 

Stage of disease was a strong predictor of survival, as 

was expected. The 5-year relative survival rates ranged 

from a high of 57% for stage I to a low of 2% for stage 

IV (Table 9.4). Table 9.4 shows the survival rates for 

males and females by stage. Females had higher survival 

rates at all stages.

Sex, Stage, and Histology

Table 9.5 shows that the histologic type distributions of 

lung cancers in males and females are somewhat different. Adenocarcinomas comprise 41% of female cases but 

only 33% of male cases, while squamous cell carcinomas 

comprise 15% of female cases but 24% of male cases. The 

other types are roughly equal in males and in females.

Based on 5-year relative survival rates for both sexes 

combined, patients with adenocarcinoma survived longer 

than those with squamous cell, large cell, or small cell 

carcinoma for all stages combined and for stage I (Table 

9.5). For stage II, however, patients with squamous cell 

carcinoma had a slightly better survival rate than those 

with adenocarcinoma.

For males, relative survival rates were similar for adenocarcinoma and squamous cell carcinoma for all stages, 

but for stage I adenocarcinoma had higher survival and 

for stage II squamous cell carcinoma had higher survival 

(Figure 9.1). For females, relative survival rates were 

higher for adenocarcinomas for stage I and II (Figure 

9.2). Survival rates were more influenced by stage than 

by histology. For non-small cell carcinoma and small cell 

carcinoma, survival curves by stage are shown in figure 

9.3 and 9.4, respectively. Survival rates are lower for 

Table 9.1: Cancer of the Lung: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number Excluded Reason for Exclusion/Selection

273,521 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

225,617 47,904 Select first primary only

220,264 5,353 Exclude death certificate only or at autopsy

219,919 345 Exclude unknown race

219,768 151 Active follow-up and exclude alive with no survival time

219,713 55 Exclude children (Ages 0-19)

219,577 136 Exclude in situ cancers for all except breast & bladder cancer

201,502 18,075 Exclude no or unknown microscopic confirmation

201,067 435 Exclude sarcomas

Table 9.2: Cancer of the Lung: Number of Cases and 5-Year 

Relative Survival Rates (RSR) (%) by Race and Sex, Ages 

20+, 12 SEER Areas,1988-2001

Race

Male and 

Female Male Female

Cases

5-Year 

RSR

% Cases

5-Year 

RSR

% Cases

5-Year 

RSR

%

All 

Races 201,067 15.5 117,472 13.6 83,595 18.0

White 165,487 15.9 94,728 13.9 70,759 18.4

Black 22,219 12.5 14,120 10.9 8,099 15.0

Other 13,361 ~ 8,624 ~ 4,737 ~

~ Rate not shown.
Chapter 9 Cancer of the Lung

National Cancer Institute 75 SEER Survival Monograph 

small cell carcinoma, but even within small cell carcinoma, 

survival rates vary by stage (Figure 9.4).

Sex, Stage, and Age

Table 9.6 presents the survival statistics by sex, stage, 

and age at diagnosis. Females had better relative survival 

rates than males. The largest differences were for stage I 

cancers and very young or older patients. Females under 

45 with stage I disease had a 72% 5-year relative survival 

rate; in contrast, the rate was 41% for females 85 and 

over. In general, younger patients survived better than 

older patients for stage I and II disease. Survival rates 

were poor for stage IV at all ages.

Laterality

Tumors were more frequently diagnosed in the right lung 

than the left lung. But, survival rates were nearly identical for patients whose tumors arose in the right lung as 

compared to the left lung (Table 9.7). ‘Other’ category 

includes not a paired site, only one side - side unspecified, bilateral - single primary, and paired site (but no 

information concerning laterality).

Subsite

Over 40% of the lung cancers originated in the upper 

lobe no matter at which stage they were diagnosed. For 

stage I, 61.6% of the cancers originated in the upper lobe 

and 28.9% in the lower lobe. For stage II, 53.9% of the 

cancers originated in the upper lobe and 34.1% in the 

lower lobe. For stages III, IV, and unknown, the origin 

Table 9.3: Cancer of the Lung: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by 

SEER Area, Ages 20+, 12 SEER Areas, 1988-2001

SEER Geographic Area Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 201,067 100.0 42.6 25.9 20.0 15.5 12.4 11.0

Atlanta and Rural Georgia 13,754 6.8 42.6 26.4 20.5 15.9 13.1 11.4

 Atlanta (Metropolitan) - 1988+ 12,956 6.4 42.9 26.7 20.8 16.1 13.3 11.6

 Rural Georgia - 1988+ 798 0.4 38.0 21.5 16.2 13.0 10.2 8.8

California

 Los Angeles - 1992+ 30,677 15.3 41.3 25.1 19.4 14.8 11.8 10.1

 Greater Bay Area 33,987 16.9 42.1 25.6 19.5 15.2 12.2 10.8

 San Francisco-Oakland SMSA - 1988+ 23,746 11.8 41.8 25.0 19.0 14.7 11.6 10.3

 San Jose-Monterey - 1988+ 10,241 5.1 42.7 26.9 20.8 16.5 13.7 11.9

Connecticut - 1988+ 26,207 13.0 45.0 28.1 21.9 17.2 14.0 12.3

Detroit (Metropolitan) - 1988+ 33,074 16.4 43.1 26.3 20.6 15.8 12.7 11.3

Hawaii - 1988+ 6,480 3.2 44.3 26.8 20.6 16.1 13.1 12.3

Iowa - 1988+ 21,548 10.7 41.9 24.5 18.6 14.0 10.7 9.3

New Mexico - 1988+ 7,159 3.6 38.4 22.3 17.3 13.0 10.4 9.3

Seattle (Puget Sound) - 1988+ 23,799 11.8 43.7 26.6 20.9 16.3 12.6 11.6

Utah - 1988+ 4,382 2.2 38.4 22.6 17.7 13.9 11.9 11.1

Table 9.4: Cancer of the Lung: Number of Cases, Stage Distribution, and 5-Year Relative Survival Rates (%) by AJCC 

Stage (3rd edition) and Sex, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage (3rd edition)

Male and Female Male Female

Cases Percent

5-Year 

Relative 

Survival

Percent Cases Percent

5-Year 

Relative 

Survival

Percent Cases Percent

5-Year 

Relative 

Survival

Percent

All Stages 201,067 100.0 15.5 117,472 100.0 13.6 83,595 100.0 18.0

I 26,879 13.4 56.9 14,598 12.4 53.5 12,281 14.7 60.8

II 5,635 2.8 33.7 3,402 2.9 32.4 2,233 2.7 35.7

III 50,254 25.0 9.4 29,863 25.4 9.0 20,391 24.4 10.1

IV 75,057 37.3 1.8 44,783 38.1 1.6 30,274 36.2 2.2

Unknown 43,242 21.5 18.0 24,826 21.1 15.0 18,416 22.0 21.9
Chapter 9 Cancer of the Lung

National Cancer Institute 76 SEER Survival Monograph 

Table 9.5: Cancer of the Lung: Number of Cases and 5-Year Relative Survival Rates (RSR) (%) by Sex, Histology and AJCC Stage 

(3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Sex/Histology

AJCC Stage (3rd edition)

Total I II III IV Unknown

Cases

5-Year 

RSR % Cases

5-Year 

RSR % Cases

5-Year 

RSR % Cases

5-Year 

RSR % Cases

5-Year 

RSR % Cases

5-Year 

RSR %

Male and Female 201,067 15.5 26,879 56.9 5,635 33.7 50,254 9.4 75,057 1.8 43,242 18.0

 Squamous cell 41,212 16.8 7,196 51.3 1,698 35.1 12,061 9.9 10,263 1.9 9,994 12.7

 Adenocarcinoma 73,535 20.3 14,432 63.8 2,802 34.4 17,587 10.2 27,593 2.2 11,121 20.2

 Small Cell 33,008 6.0 953 31.4 270 19.3 8,213 8.4 16,962 1.5 6,610 10.7

 Large Cell 14,945 12.1 1,705 50.2 365 33.7 3,931 9.5 6,014 1.7 2,930 12.2

 Others 38,367 14.5 2,593 46.6 500 33.1 8,462 8.1 14,225 1.6 12,587 26.0

Male 117,472 13.6 14,598 53.5 3,402 32.4 29,863 9.0 44,783 1.6 24,826 15.0

 Squamous cell 28,463 16.3 4,734 50.5 1,281 35.3 8,516 10.0 7,116 1.6 6,816 12.4

 Adenocarcinoma 39,303 17.1 6,865 59.2 1,406 30.8 9,562 9.1 15,584 1.9 5,886 18.0

 Small Cell 17,827 5.1 488 29.4 134 18.9 4,166 7.9 9,579 1.2 3,460 8.6

 Large Cell 9,033 11.4 965 49.4 239 32.9 2,361 9.6 3,753 1.6 1,715 11.3

 Others 22,846 11.7 1,546 46.6 342 32.0 5,258 7.6 8,751 1.4 6,949 19.3

Female 83,595 18.0 12,281 60.8 2,233 35.7 20,391 10.1 30,274 2.2 18,416 21.9

 Squamous cell 12,749 18.0 2,462 52.8 417 34.7 3,545 9.8 3,147 2.6 3,178 13.3

 Adenocarcinoma 34,232 23.7 7,567 67.7 1,396 37.8 8,025 11.4 12,009 2.5 5,235 22.5

 Small Cell 15,181 7.1 465 33.4 136 19.7 4,047 9.0 7,383 1.8 3,150 12.9

 Large Cell 5,912 13.1 740 51.1 126 34.6 1,570 9.4 2,261 1.9 1,215 13.4

 Others 15,521 18.4 1,047 46.7 158 35.1 3,204 8.9 5,474 1.9 5,638 33.6

0

10

20

30

40

50

60

70

All Hist. Squamous Adeno Small Large Other

Relative Survival Rate (%)

Histology

All Stages I II III IV Unstaged

0

10

20

30

40

50

60

70

All Hist. Squamous Adeno Small Large Other

Relative Survival Rate (%)

Histology

All Stages I II III IV Unstaged

Figure 9.1: Male Lung Cancer: 5-Year Relative Survival 

Rates (%) by Histology and AJCC Stage, Ages 20+, 12 SEER 

Areas, 1988-2001

Figure 9.2: Female Lung Cancer: 5-Year Relative Survival 

Rates (%) by Histology and AJCC Stage, Ages 20+, 12 SEER 

Areas, 1988-2001

of the cancer was not specified 16.8%, 24.7%, and 17.9%, 

respectively. Overall, the 5-year relative survival rates were 

lower for patients whose tumor originated in the main stem 

bronchus (a category that includes the carina and hilum) 

than for those whose tumor originated in the upper, middle, 

or lower lobe (Table 9.8). If the lobe was not specified, 

the 5-year relative survival rate was 5%. For tumors that 

crossed lobe boundaries, survival rates were intermediate. 

For patients diagnosed at stage I, those whose tumor had 

originated in the upper lobe had a survival rate (60%) more 

than double that of those whose tumors originated in the 

main bronchus, carina, or hilum (23%) (Table 9.9).

Extent of Disease

Only cases with no lymph nodes involved (approximately 

one-fourth of the cases) were used to investigate the influence of extent of disease on survival (Table 9.10). Five-year 
Chapter 9 Cancer of the Lung

National Cancer Institute 77 SEER Survival Monograph 

Table 9.6: Cancer of the Lung: Number of Cases and 5-Year Relative Survival Rates (%) by Sex, Age (20+), and AJCC Stage (3rd 

edition) at Diagnosis, 12 SEER Areas, 1988-2001

Sex/Age 

(Years)

AJCC Stage (3rd edition)

Total I II III IV Unknown

Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent

Male and 

Female 201,067 15.5 26,879 56.9 5,635 33.7 50,254 9.4 75,057 1.8 43,242 18.0

 20-44 6,148 21.6 497 69.7 132 52.5 1,450 14.8 2,734 2.4 1,335 46.7

 45-49 7,995 17.5 759 64.9 234 42.5 1,934 13.6 3,681 2.3 1,387 32.4

 50-54 13,789 17.6 1,549 66.5 470 42.3 3,361 13.2 6,029 2.5 2,380 24.9

 55-59 20,684 17.0 2,620 62.1 626 36.8 5,048 12.2 8,733 2.2 3,657 22.4

 60-64 29,038 16.4 3,829 61.2 910 36.8 7,090 11.2 11,677 1.7 5,532 19.1

 65-69 36,469 16.2 5,443 57.6 1,102 32.3 8,872 9.7 13,518 1.8 7,534 16.9

 70-74 36,666 14.8 5,512 53.9 1,130 27.2 9,166 7.6 12,745 1.7 8,113 14.7

 75-79 28,228 12.3 4,074 48.9 713 26.0 7,101 5.6 9,391 1.0 6,949 11.5

 80-84 15,235 10.2 1,963 42.6 251 24.6 4,114 3.7 4,637 1.5 4,270 10.2

 85+ 6,815 6.6 633 33.9 67 16.9 2,118 2.1 1,912 0.7 2,085 7.6

Male 117,472 13.6 14,598 53.5 3,402 32.4 29,863 9.0 44,783 1.6 24,826 15.0

 20-44 3,378 18.4 240 67.1 73 47.6 836 14.7 1,565 2.4 664 39.5

 45-49 4,603 14.8 359 66.1 133 41.1 1,167 11.8 2,185 1.5 759 27.8

 50-54 8,124 14.9 787 61.0 284 43.9 2,053 12.7 3,648 1.9 1,352 19.2

 55-59 12,245 14.7 1,397 58.5 373 36.3 3,137 11.5 5,250 2.1 2,088 17.3

 60-64 17,738 14.6 2,169 58.1 545 34.4 4,405 10.2 7,275 1.3 3,344 16.8

 65-69 21,847 14.4 3,061 54.3 699 32.0 5,336 9.1 8,260 1.5 4,491 14.3

 70-74 21,536 13.0 3,028 50.5 679 25.1 5,467 7.2 7,670 1.6 4,692 12.2

 75-79 16,043 10.9 2,209 45.4 441 21.2 4,130 5.2 5,343 0.8 3,920 10.1

 80-84 8,384 8.1 1,007 35.4 138 25.3 2,243 3.4 2,594 1.4 2,402 7.5

 85+ 3,574 4.9 341 26.4 37 14.4 1,089 1.0 993 0.4 1,114 5.4

Female 83,595 18.0 12,281 60.8 2,233 35.7 20,391 10.1 30,274 2.2 18,416 21.9

 20-44 2,770 25.5 257 71.9 59 58.5 614 14.9 1,169 2.5 671 53.6

 45-49 3,392 21.1 400 63.8 101 44.5 767 16.3 1,496 3.4 628 37.8

 50-54 5,665 21.4 762 72.2 186 39.5 1,308 13.9 2,381 3.2 1,028 32.1

 55-59 8,439 20.3 1,223 66.1 253 37.7 1,911 13.4 3,483 2.4 1,569 29.1

 60-64 11,300 19.3 1,660 65.2 365 40.1 2,685 12.6 4,402 2.3 2,188 22.3

 65-69 14,622 18.6 2,382 61.7 403 32.6 3,536 10.6 5,258 2.1 3,043 20.6

 70-74 15,130 17.1 2,484 57.9 451 30.0 3,699 8.1 5,075 1.8 3,421 17.8

 75-79 12,185 13.9 1,865 52.5 272 32.7 2,971 5.9 4,048 1.3 3,029 13.1

 80-84 6,851 12.4 956 48.9 113 23.5 1,871 4.1 2,043 1.3 1,868 13.1

 85+ 3,241 8.1 292 40.6 30 17.2 1,029 2.8 919 1.1 971 9.6

relative survival ranged from a high of 60% for cases in 

which the cancer was confined to one lung down to 4% for 

those with metastases. For nearly every category, women 

fared better than men. For those patients whose tumor was 

confined to one lung, women had a 64% 5-year relative 

survival rate compared to 56% for men.

Grade

Nearly 40% of the cases did not have histologic grade. But 

for stage I, only 18% were not graded. For all stages combined, survival was four times higher for grade 1 compared 

to grade 4. Within stages, the survival differences by grade 

were not as pronounced (Table 9.11). For stage I, grade 1 

cases had better survival (73%) than grade 4 cases (48%). 

Stage I adenocarcinomas had a similar range (Table 9.12). 

For adenocarcinomas, grade III and IV had similar survival 

and for stage IV, the survival was less than 4% no matter 

which grade (Table 9.12).

Discussion

While lung cancer survival rates overall are generally poor, 

lung cancer survival rates vary by patient and tumor charac-
Chapter 9 Cancer of the Lung

National Cancer Institute 78 SEER Survival Monograph 

Table 9.7: Cancer of the Lung: Number of Cases and 5-Year Relative Survival Rates (%) by AJCC Stage (3rd edition) and 

Laterality, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Laterality

Total Right Left Other

Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent

All Stages 201,067 15.5 109,776 16.2 79,276 16.2 12,015 4.0

I 26,879 56.9 15,554 57.5 11,311 56.1 14 ~

II 5,635 33.7 2,994 32.2 2,637 35.5 <5 ~

III 50,254 9.4 28,596 9.5 20,287 9.6 1,371 5.2

IV 75,057 1.8 38,949 1.7 28,041 1.9 8,067 2.0

Unstaged/Unknown 43,242 18.0 23,683 18.9 17,000 18.1 2,559 9.4

 ~ Statistic not displayed due to less than 25 cases.

Table 9.8: Cancer of the Lung: Number of Cases and 5-Year Relative Survival Rates (%) by Subsite and Sex, Ages 20+, 

12 SEER Areas, 1988-2001

Subsite

Male and Female Male Female

Cases

5-Year Relative 

Survival

Percent Cases

5-Year Relative 

Survival

Percent Cases

5-Year Relative 

Survival

Percent

All Subsites 201,067 15.5 117,472 13.6 83,595 18.0

Main bronchus 11,384 7.0 6,620 6.4 4,764 7.8

Upper lobe 97,916 19.0 57,830 16.9 40,086 21.8

Middle lobe 8,496 19.7 4,632 16.5 3,864 23.2

Lower lobe 44,106 17.8 25,390 15.2 18,716 21.0

Overlapping 3,940 14.7 2,346 14.2 1,594 15.3

NOS 35,225 4.7 20,654 3.7 14,571 5.9

Table 9.9: Cancer of the Lung: Number of Cases and 5-Year Relative Survival Rates (%) by Subsite and AJCC Stage (3rd edition), 

Ages 20+, 12 SEER Areas, 1988-2001

Subsite

AJCC Stage (3rd edition)

Total I II III IV Unknown

Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent Cases

5-Year 

Relative 

Survival

Percent

All Subsites 201,067 15.5 26,879 56.9 5,635 33.7 50,254 9.4 75,057 1.8 43,242 18.0

Main bronchus 11,384 7.0 303 23.1 149 27.4 4,130 8.0 4,597 1.1 2,205 13.9

Upper lobe 97,916 19.0 16,567 59.9 3,036 38.3 24,834 11.6 32,845 2.2 20,634 18.7

Middle lobe 8,496 19.7 1,351 55.4 248 30.1 1,877 8.7 2,898 1.5 2,122 29.7

Lower lobe 44,106 17.8 7,763 53.5 1,921 28.1 9,756 8.5 14,813 1.7 9,853 20.9

Overlapping 3,940 14.7 478 50.0 183 33.5 1,219 9.8 1,353 1.3 707 19.9

NOS 35,225 4.7 417 34.9 98 20.7 8,438 4.7 18,551 1.5 7,721 10.4
Chapter 9 Cancer of the Lung

National Cancer Institute 79 SEER Survival Monograph 

Table 9.10: Cancer of the Lung without lymph node involvement: Number and Distribution of Cases and 5-Year Relative Survival 

Rates (%) by Extension and Sex, Ages 20+, 12 SEER Areas, 1988-2001

Extension

Male and Female Male Female

Cases Percent 5-Year 

RSR Cases Percent 5-Year RSR Cases Percent 5-Year RSR

All Cases without Lymph Node Involvement 49,758 100.0 41.5 27,861 100.0 37.3 21,897 100.0 46.5

10-One lung 22,200 44.6 59.7 11,683 41.9 55.7 10,517 48.0 64.0

20-Involving MSB, away from carina 1,206 2.4 56.0 715 2.6 49.1 491 2.2 65.3

30-Localized, NOS 3,261 6.6 38.7 1,860 6.7 36.0 1,401 6.4 42.1

40-Atelectasis/obs. pneumonitis < entire lung, 

w/o pleural effusion 6,459 13.0 51.6 3,629 13.0 47.3 2,830 12.9 56.7

50-Involving MSB, close to carina 344 0.7 24.8 223 0.8 25.2 121 0.6 23.8

60-Atelectasis/obstructive pneumonitis of 

entire lung 1,765 3.5 27.1 1,143 4.1 25.2 622 2.8 30.4

65-Multiple masses - same lobe 293 0.6 + 137 0.5 + 156 0.7 +

70-Carina/trachea 1,837 3.7 17.5 1,207 4.3 17.2 630 2.9 17.9

71-Heart 135 0.3 13.6 94 0.3 11.9 41 0.2 16.8

72-Malignant pleural effusion 2,569 5.2 9.4 1,500 5.4 8.4 1,069 4.9 10.7

73-Adjacent rib 632 1.3 16.2 405 1.5 16.1 227 1.0 16.3

75-Sternum/vertebrae 304 0.6 14.7 193 0.7 14.3 111 0.5 15.2

77-Separate lobes (same lung) 255 0.5 ! 120 0.4 ! 135 0.6 !

78-Contralateral 494 1.0 11.2 258 0.9 7.8 236 1.1 14.4

80-Further extension 68 0.1 10.9 43 0.2 3.0 25 0.1 23.9

85-Metastasis 6,994 14.1 4.3 4,097 14.7 3.7 2,897 13.2 4.9

99-Unknown 885 1.8 16.2 519 1.9 14.7 366 1.7 18.1

Bases on 49,758 cases with no lymph node involvement. Extensions with fewer than 50 cases excluded.

 + The statistic could not be calculated.

 ! Not enough intervals to produce rate.

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

I II III IV

Figure 9.3: Non-small-cell Lung Cancer: Relative Survival 

Rates (%) by AJCC Stage, Ages 20+, 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

I II III IV

Figure 9.4: Small-cell Lung Cancer: Relative Survival Rates (%) 

by AJCC Stage, Ages 20+, 12 SEER Areas, 1988-2001
Chapter 9 Cancer of the Lung

National Cancer Institute 80 SEER Survival Monograph 

Table 9.11: Cancer of the Lung: Number of Cases and 5-Year Relative Survival Rates (%) by Grade and AJCC Stage (3rd edition), 

Ages 20+, 12 SEER Areas, 1988-2001

Grade

AJCC Stage (3rd edition)

Total I II III IV Unknown

Cases

5-Year 

RSR

Percent Cases

5-Year 

RSR

Percent Cases

5-Year 

RSR

Percent Cases

5-Year 

RSR

Percent Cases

5-Year 

RSR

Percent Cases

5-Year 

RSR

Percent

All Grades 201,067 15.5 26,879 56.9 5,635 33.7 50,254 9.4 75,057 1.8 43,242 18.0

1 6,831 41.4 2,645 73.3 237 39.3 1,143 15.9 1,187 3.6 1,619 33.9

2 25,993 29.8 8,000 63.0 1,685 37.7 6,086 12.8 5,319 2.8 4,903 22.2

3 61,072 15.8 9,364 54.3 2,467 33.7 16,349 11.4 22,116 1.9 10,776 14.1

4 27,991 9.4 1,940 47.8 533 30.6 7,270 9.5 12,632 1.6 5,616 11.9

Unknown 79,180 10.4 4,930 46.4 713 24.7 19,406 6.1 33,803 1.6 20,328 19.7

Table 9.12: Adenocarcinoma of the Lung: Number of Cases and 5-Year Relative Survival Rates (%) by Grade and AJCC Stage 

(3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Grade

AJCC Stage (3rd edition)

Total I II III IV Unknown

Cases

5-Year 

RSR

Percent Cases

5-Year 

RSR

Percent Cases

5-Year 

RSR

Percent Cases

5-Year 

RSR

Percent Cases

5-Year 

RSR

Percent Cases

5-Year 

RSR

Percent

Total 73,535 20.3 14,432 63.8 2,802 34.4 17,587 10.2 27,593 2.2 11,121 20.2

1 4,915 46.5 2,248 76.2 174 36.8 625 19.9 906 3.9 962 34.7

2 13,284 35.7 4,915 67.5 992 37.0 2,446 15.9 3,080 3.1 1,851 29.1

3 26,197 17.6 4,567 56.3 1,226 33.4 6,762 12.3 10,053 2.0 3,589 16.9

4 1,470 16.2 218 50.5 84 35.8 413 11.1 545 3.4 210 16.0

Unknown 27,669 10.8 2,484 60.3 326 28.4 7,341 5.1 13,009 1.8 4,509 16.3

teristics. For lung cancer, stage had the most prognosis, 

but other factors such as grade, age, sex, and histologic 

type also played a role. Many of these results expand on 

similar analyses performed on earlier SEER data (2).

While females have somewhat better survival than males, 

it does not appear to be due to more cases with a favorable extent of disease; the differential also exists within 

most of the detailed EOD categories. 

Lung cancer is a major disease in the US for both males 

and females; survival of lung cancer is worse than survival 

of most other types of cancer. While overall survival was 

poor, the 5-year relative survival rate for stage I patients 

was 57%.

Females had better survival than males for most lung 

cancer histologic types, even though females had a higher 

proportion of small cell carcinoma (18% in women and 

15% in men in our data set), which has a much worse 

prognosis than the other tumor types (Table 9.5).

Although the prognosis for lung cancer is dismal for most 

patients, there are some groups that are exceptional. For 

instance, females under age 45 with stage I lung cancer 

had a 5-year relative survival rate of 72%.

Since relative survival rates are higher for younger persons than for older, some of the female-male survival 

differential may be due to a greater proportion of younger 

patients in the female group. However, even within age 

groups, females tended to survive better than males.

TNM stage was a good predictor of survival even when 

analyzed by various demographic and tumor factors. There 

were, however, wide ranges of survival possible within 

a particular stage, especially for stage I. For instance, 

as mentioned above, young females with stage I lung 

cancer had a 5-year relative survival rate of 72%; for 

females aged 85 and over, the corresponding rate was 

only 41%.

REFERENCES

1. Beahrs, OH, Henson DE, Hutter RVP, Myers MH (eds). 

AJCC Cancer Staging Manual, Third edition. American Joint 

Committee on Cancer. Philadelphia: Lippincott, 1988.

2. Ries LAG. Influence of extent of disease, histology, and 

demographic factors on lung cancer survival in the SEER 

population-based data. Semin Surg Oncol 1994;10:21-30.
National Cancer Institute 81 SEER Survival Monograph 

Introduction

Cancer of the bone and joint is a rare form of cancer. The 

most recent annual incidence rate among the SEER sites in 

the United States is 0.9 cases per 100,000 between 2000 

and 2003 (1). In the U.S., incidence trends have mostly 

fluctuated, however there has been a slight decrease in 

incidence since 1994 (1). Bone and joint cancer mortality 

in the U.S. has decreased since 1969, with a large decrease 

reported in the late 1970’s. U.S. mortality was reported 

at 0.4 deaths per 100,000 in 2006 (1). Survival statistics 

indicate better survival and quality of life, as surgery for 

these malignancies can incorporate limb sparing options. 

The 5-year survival rate for bone and joint cancer was 54% 

for patients diagnosed between 1975 and 1977 and 68% 

for patients diagnosed between 1996 and 2002. 

Materials and Methods

Between 1988 and 2001, there were 4,062 cases of bone 

and joint cancer diagnosed and reported to the SEER program (Table 10.1). Table 10.1 shows the exclusion of bone 

and joint cases from the initial number with the reason 

given for the exclusion. Cases from the Los Angeles registry were contributed for the years 1992 through 2001. 

Nearly 1,093 cases (27%) of the original cases were in 

children aged 0 to 19 years old, and were excluded from 

further analysis. More than half of the remaining cases 

were available for analysis (N=2,273), as they represent 

histologically confirmed, first primary adult cases of bone 

and joint cancer reported to the SEER program between 

1988 and 2001. 

Histologic Classification

Bone cancers have three major histologic types: osteosarcomas, chondrosarcomas, and Ewing sarcoma (2). These 

three types arise in the growing ends of long bones, cartilage, and the axial skeleton, respectively. In addition, 

there are numerous other histologic types that arise due to 

the precise location of the tumor and whether the tumor 

involves a combination of other tissue types including 

bone, joint and even muscle tissues (2). Of the major 

histologic types of bone and joint cancer, most in our 

analysis were chondrosarcomas (n=944), followed by osteosarcomas (n=625), and Ewing sarcoma (n=187; Table 

10.2). Histologic classification for the current analysis 

was achieved using the ICD-O-2/ICD-O-3 morphology 

codes into the following categories of ICD-O M-9260, 

9364, and 9473 for Ewing sarcoma; ICD-O M-9180-9185, 

9192, 9193 for osteosarcoma; and ICD-O M-9220, 9221, 

9231, 9240, 9242, and 9243 for chondrosarcoma. TwentyDenise R. Lewis and Lynn A. Gloeckler Ries

Chapter 10

Cancers of the Bone and Joint

Table 10.1: Cancer of the Bone and Joint: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001 

Number Selected/Remaining

Number Excluded Reason for Exclusion/selection

4,062 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

3,665 397 Select first primary only

3,633 32 Exclude death certificate only or at autopsy

3,600 33 Exclude unknown race

3,590 10 Exclude alive with no survival time

2,497 1,093 Exclude children (Ages 0-19)

2,497 0 Exclude in situ cancers for all except breast & bladder cancer

2,427 70 Exclude no or unknown microscopic confirmation

2,273 154 Exclude selected histologies*

* The following histologies were excluded from the present analysis due to small case numbers (n<30): Neoplasm, malignant (8000/3), Tumor cells, malignant (8801/3); Malignant tumor, small cell type (8002/3); Malignant tumor, giant cell type (8003/3); Squamous cell carcinoma (8070/3); Squamous cell carcinoma, keratinizing, not otherwise specified (8071/3); Paraganglioma, malignant (8680/3); Sarcoma, not otherwise specified (8800/3); Spindle cell sarcoma (8801/3); Giant cell sarcoma (8802/3); Small cell sarcoma 

(8803/3); Liposarcoma, not otherwise specified (8850/3); Leiomyosarcoma, not otherwise specified (8890/3); Rhabdoid sarcoma (8963/3); Mesenchymoma, malignant (8990/3); 

Synovial sarcoma, not otherwise specified (9040/3); Synovial sarcoma, spindle cell (9041/3); Ependymoma, not otherwise specified (9391/3); Meningioma, not otherwise specified (9530/3); Neurofibrosarcoma (9540/3); Neurilemmoma, malignant (9560/3). 
Chapter 10 Cancers of the Bone and Joint

National Cancer Institute 82 SEER Survival Monograph 

two additional categories were included in the ‘other’ 

histology category.

Stage

Bone and joint cancers are staged according to SEER 

historical stage as localized, regional, distant, or unstaged. 

The staging categories are derived from the 10-digit Extent 

of Disease (EOD) codes. Codes are assigned based on the 

clinical, operative, and pathologic diagnosis of cancer. 

Bone and joint cancer stages are designated according to 

localized defined as confined to the primary site, regional 

defined as spreading directly beyond the primary site 

or involving regional lymph nodes, distant defined as 

metastatic. Unstaged tumors are also included.

Other Tumor Characteristics

Bone and joint cancers are also categorized according 

to grade (well, moderate or poorly differentiated, undifferentiated, and unknown), primary site (limbs or other 

site), and tumor size (0 to 8 centimeters, greater than 8 

centimeters, or unknown size). 

Age and Race

To investigate median and relative survival among bone 

and joint cancer cases, age was categorized as 20-39, 

40-59, and 60 or more years of age. Two age categories, 

40-59 and 60+ were combined for the analysis of Ewing 

sarcoma. Race-specific survival was calculated for whites, 

blacks, and other race, except for Ewing sarcoma where 

a separate analysis of race was not performed.

Results

Table 10.2 shows the histology frequency distributions for 

adult bone and joint cancer. Of the 2,273 cases included 

in the analysis, 187 (8.2%) were classified as Ewing sarcoma, 625 (27.5%) were osteosarcoma, and 944 (41.5%) 

were chondrosarcoma. The remainder were classified 

in ‘other’ histologies, where chordoma was the most 

frequent type (219 cases; 9.6%), followed by malignant 

fibrous histiocytoma (72 cases; 3.2%). Within Ewing 

sarcoma, the majority (92.5%) was Ewing sarcoma, not 

otherwise specified (NOS). Within osteosarcoma, the 

majority were osteosarcoma, NOS (59.8%) followed by 

chondroblastic osteosarcoma (13.9%) and parosteal osteosarcoma (10.1%). Chondrosarcoma, NOS contributed 

to the majority of chondrosarcoma (89.8%) followed by 

myxoid chondrosarcoma (7.3%).

Demographic and Tumor Characteristics

Table 10.3 shows the demographic and tumor characteristics for bone and joint cancer at the time of diagnosis. 

For each of the histologic categories, a majority were 

diagnosed in males (69% for Ewing sarcoma, 54.1% for 

osteosarcoma, and 53.6% for chondrosarcoma). Bone and 

joint cancer of ‘other’ histologic types were also more 

frequent in males (57.6%). Bone and joint cancers were 

mostly diagnosed among whites, which is a reflection of 

the racial distribution within the SEER population.

Interestingly, the distribution of bone cancer histologies 

varied by race. Among whites, the most common histologies were chondrosarcoma (42.9% of cases), followed 

by osteosarcoma (25.1%), ‘other’ histologies (21.9%), 

and Ewing sarcoma (9.2%). In contrast, osteosarcoma 

represented 40.0% of black cases, followed by chondrosarcoma at 31.5%. Ewing sarcoma was rare, representing 

less than 5.0% of black cases. 

Ewing sarcoma and osteosarcoma were mostly diagnosed 

in the 20-39 year age group (82.9% and 51.8% respectively), while chondrosarcoma was mostly diagnosed in 

the 40-59 year age group (38.6%). Bone and joint cancer 

in the ‘other’ histologic group was mostly diagnosed in 

the 60+ year age group (36.2%).

Historic stage frequencies indicate that cases were diagnosed in the regional stage most often for Ewing sarcoma 

(39.0%), osteosarcoma (41.3%), and in ‘other’ histologic 

types (39.8%). Chondrosarcoma was most often diagnosed 

in the localized stage (50.7%).

Chondrosarcomas were more often moderately differentiated at the time of diagnosis (39.8%), while osteosarcoma 

was mostly undifferentiated at diagnosis (35.7%). Ewing 

sarcoma and ‘other’ histologic types had a majority of unknown grade. Osteosarcoma and chondrosarcoma tended to 

be diagnosed in the limbs (63.5% and 54.3% respectively), 

while Ewing sarcoma was more frequently diagnosed in 

locations other than the limbs. When information about 

tumor size at diagnosis was available, most were in the 0 

to 8 centimeter range (23.5% for Ewing sarcoma, 37.1% 

for osteosarcoma, 41.9% for chondrosarcoma, and 32.3% 

for ‘other’ histologic type).

Overall Survival

Table 10.4 shows the median survival time and the 1-, 

2-, 3-, 5-, 8-, and 10-year relative survival rates by histologic type for 12 SEER registries from 1988 through 

2001. For the 2,273 cases in the analysis, the median 

survival (in months) indicates that chondrosarcoma had 
Chapter 10 Cancers of the Bone and Joint

National Cancer Institute 83 SEER Survival Monograph 

Table 10.2: Cancer of the Bone and Joint: Histology Distribution, Age 20+, 12 SEER Areas, 1988-2001

Histology Group Histology/ICD-O Code Cases

Percent of 

Category

Percent of 

Total

Total 2,273 100.0

Ewing Sarcoma 187 100.0 8.2

Ewing sarcoma, NOS* (9260) 173 92.5 7.6

Other (9364, 9473) 14 7.5 0.6

Osteosarcoma 625 100.0 27.5

Osteosarcoma, NOS* (9180) 374 59.8 16.5

Chondroblastic osteosarcoma (9181) 87 13.9 3.8

Fibroblastic osteosarcoma (9182) 56 9.0 2.5

Telangiectatic osteosarcoma (9183) 15 2.4 0.7

Osteosarcoma in Paget’s disease of bone (9184) 21 3.4 0.9

Parosteal osteosarcoma (9192) 63 10.1 2.8

Other (9185, 9193) 9 1.4 0.4

Chondrosarcoma 944 100.0 41.5

Chondrosarcoma, NOS* (9220) 848 89.8 37.3

Juxtacortical chondrosarcoma (9221) 7 0.7 0.3

Myxoid chondrosarcoma (9231) 69 7.3 3.0

Mesenchymal chondrosarcoma (9240) 14 1.5 0.6

Other (9242, 9243) 6 0.6 0.3

Other Histologies 517 100.0 22.7

Fibrosarcoma, NOS* (8810) 21 4.1 0.9

Fibrous histiocytoma, malignant (8830) 72 13.9 3.2

Hemangiosarcoma (9120) 26 5.0 1.1

Hemangioendothelioma, malignant (9130) 13 2.5 0.6

Epithelioid hemangioendothelioma, malignant (9133) 8 1.5 0.4

Chondroblastoma, malignant (9230) 8 1.5 0.4

Giant cell tumor of bone, malignant (9250) 52 10.1 2.3

Adamantinoma of long bones (9261) 18 3.5 0.8

Odontogenic tumor, malignant (9270) 29 5.6 1.3

Ameloblastoma, malignant (9310) 36 7.0 1.6

Chordoma (9370) 219 42.4 9.6

Other (8072, 8805, 8811, 8823, 8851, 8910, 9043, 

9150, 9321, 9330, 9371)

15 2.9 0.7

* NOS: Not Otherwise Specified

the longest median survival at more than 120 months, followed by bone and joint cancer of ‘other’ histology with a 

median survival of over 106 months, osteosarcoma with a 

median survival of 84.5 months and Ewing sarcoma with a 

median survival of 59 months. Relative survival indicated 

that those with bone and joint cancer had relative survival 

percentages of 88 percent at 1 year. Ewing sarcoma and 

osteosarcoma tended to have relative survival rates that 

were below the relative survival for chondrosarcoma (Table 

10.4 and Figure 10.1). Bone and joint cancer with ‘other’ 

histologies had relative survival rates that were lower than 

chondrosarcoma.

Sex

Median survival for Ewing sarcoma was greater in females at 

more than 120 months compared with males at 53.8 months 

(Table 10.5). Relative survival among females with Ewing 

sarcoma was also greater than among males at the 3-, 5-, 

8- and 10- year intervals. Females also had a higher median 

survival for osteosarcoma ( 93.7 months) compared to males 

(83.3 months; Table 10.6). Relative survival for 1- and 

2- year interval was higher among males, and similar at 

3-, 5-, and 8-years after diagnosis. Relative survival rates 

at 10-years were higher among females. Median survival 

was the same for males and females for chondrosarcoma at 

more than 120 months. The relative survival percentages 

for chondrosarcoma for females started slightly higher than 

for males at one year post-diagnosis. Females continued to 

have more favorable relative survival percentages through 

10-years after diagnosis. Median survival for ‘other’ types 

of bone sarcoma was higher among females at greater than 

120 months and 96.9 months for males (Table 10.8). For 

‘other’ types, relative survival rates were higher for females 

after 5-years.
Chapter 10 Cancers of the Bone and Joint

National Cancer Institute 84 SEER Survival Monograph 

Table 10.3: Cancer of the Bone and Joint: Distributions by Sex, Race, Age (20+), Historic Stage, Grade, Primary Site, 

Tumor Size, and Histology, Ages 20+,12 SEER Areas, 1988-2001

Characteristics

Histology

Ewing Sarcoma Osteosarcoma Chondrosarcoma Other

Cases Percent Cases Percent Cases Percent Cases Percent

All Cases 187 100.0 625 100.0 944 100.0 517 100.0

Sex

 Male 129 69.0 338 54.1 506 53.6 298 57.6

 Female 58 31.0 287 45.9 438 46.4 219 42.4

Race

 White 178 95.2 504 80.6 832 88.1 425 82.2

 Black <6 <5.0 76 12.2 60 6.4 51 9.9

 Other <6 <5.0 45 7.2 52 5.5 41 7.9

Age at Diagnosis (years)

 20-39 155 82.9 324 51.8 293 31.0 167 32.3

 40-59 26 13.9 153 24.5 364 38.6 163 31.5

 60+ 6 3.2 148 23.7 287 30.4 187 36.2

Historic Stage

 Localized 34 18.2 200 32.0 479 50.7 176 34.0

 Regional 73 39.0 258 41.3 343 36.3 206 39.8

 Distant 58 31.0 108 17.3 61 6.5 79 15.3

 Unstaged 22 11.8 59 9.4 61 6.5 56 10.8

Grade

 Well 0 0.0 46 7.4 354 37.5 21 4.1

 Moderate 0 0.0 61 9.8 376 39.8 36 7.0

 Poor 18 9.6 105 16.8 57 6.0 36 7.0

 Undifferentiated 41 21.9 223 35.7 55 5.8 43 8.3

 Unknown 128 68.4 190 30.4 102 10.8 381 73.7

Primary Site

 Limbs 71 38.0 397 63.5 513 54.3 163 31.5

 Other 116 62.0 228 36.5 431 45.7 354 68.5

Tumor Size

 <= 8 cm 44 23.5 232 37.1 396 41.9 167 32.3

 > 8 cm 42 22.5 126 20.2 192 20.3 68 13.2

Unknown 101 54.0 267 42.7 356 37.7 282 54.5

Age

The different types of cancer have very different survival 

time depending on the age of the patient. As seen in Table 

10.5, younger Ewing sarcoma patients between 20 and 39 

years old had better short term survival but not long-term 

survival. Relative survival rate tended to be lower in the 60+ 

age group for osteosarcoma, chondrosarcoma and ‘other’ 

bone sarcomas (Tables 10.6, 10.7, 10.8).

Race

Race information is not shown for Ewing sarcoma since 

there were few cases among non-white patients. Median 

survival for osteosarcoma varied by race, with whites having a higher median survival (82.6 months) than blacks 

(65.7 months, Table 10.6). For chondrosarcoma, blacks and 

whites shared a median survival greater than 120 months. 

Only slight survival differences were seen at the 10-year 

mark between whites (78%) and blacks (83%; Table 10.7). 

Median survival for ‘other’ bone cancer histologies was 

slightly higher in blacks (>120 months) than in whites 

(104.6 months; Table 10.8). 

Historic Stage

Median survival was highest for each of the bone and joint 

cancers that had localized historic stage (Tables 10.6, 10.7, 

10.8; median survival greater than 120 months). Tumors 

that were identified as regional historic stage also had long 

median survival times of greater than 120 months for Ewing 

sarcoma and chondrosarcoma. Osteosarcoma and ‘other’ 

bone sarcoma both had median survival of more than 90 

months for regional historic stage, 93.6 months and 91.7 

months, respectively. Tumors classified as distant historic 

stage had lower median survival times of 21.9 months for 

Ewing sarcoma, 9.9 months for osteosarcoma, 17 months 
Chapter 10 Cancers of the Bone and Joint

National Cancer Institute 85 SEER Survival Monograph 

Table 10.4: Cancer of the Bone and Joint: Number and Distribution of Cases, Median Survival Time (Months) and 1-, 2-, 3-, 5-, 

8-, & 10-Year Relative Survival Rates (%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 2,273 100.0 >120 88.0 79.9 75.7 70.2 65.5 63.6

Ewing Sarcoma 187 8.2 59.0 83.2 68.9 60.3 48.4 44.6 44.6

Osteosarcoma 625 27.5 84.5 82.2 67.9 65.0 59.2 54.5 51.8

Chondrosarcoma 944 41.5 >120 93.0 88.9 85.4 81.6 79.1 78.5

Other Histologies 517 22.7 106.6 87.6 82.0 76.9 70.7 61.6 58.3

Table 10.5: Ewing Sarcoma: Number and Distribution of Cases, Median Survival Time (Months) and 1-, 2-, 3-, 5-, 8-, & 10-Year 

Relative Survival Rates (%) by Sex, Age (20+), Historic Stage, Primary Site and Tumor Size, 12 SEER Areas, 1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases 187 100.0 59.0 83.2 68.9 60.3 48.4 44.6 44.6

Sex

 Male 129 69.0 53.8 83.3 69.3 59.2 45.7 41.5 41.5

 Female 58 31.0 >120 82.8 68.1 62.4 53.6 50.9 50.9

Age (years)

 20-39 155 82.9 59.5 84.5 69.4 60.4 48.9 44.5 44.5

 40+ 32 17.1 39.8 76.7 66.4 59.7 46.7 46.7 46.7

Historic Stage

 Localized 34 18.2 >120 98.4 79.0 72.4 60.4 60.4 60.4

 Regional 73 39.0 >120 90.6 81.8 73.5 66.6 61.3 61.3

 Distant 58 31.0 21.9 63.9 47.8 41.9 24.7 24.7 24.7

 Unstaged 22 11.8 ~ ~ ~ ~ ~ ~ ~

Primary Site

 Limbs 71 38.0 53.6 88.1 72.0 62.0 45.7 39.5 39.5

 Other 116 62.0 59.4 80.1 67.1 59.2 49.9 47.1 47.1

Tumor Size

 <= 8 cm 44 23.5 >120 91.0 88.4 82.7 68.7 63.5 63.5

 > 8 cm 42 22.5 34.7 69.1 52.0 49.3 36.2 32.6 32.6

Unknown 101 54.0 47.0 85.7 68.1 55.9 45.5 42.2 42.2

 ~ Statistic not displayed due to less than 25 cases.

for chondrosarcoma, and 16.5 months for ‘other’ bone 

sarcoma. 

Grade

Grade classification was not shown for Ewing sarcoma 

cases. In general, median survival was highest in the well 

and moderately differentiated cases for osteosarcoma and 

chondrosarcoma (median survival was greater than 120 

months in these groups). A majority of cases of osteosarcoma had poor, undifferentiated, or unknown grade, and 

had median survival of 78.2 months, 46.6 months, and 43.4 

months, respectively (Table 10.6). In contrast, approximately 

23% of all chondrosarcoma cases had poor, undifferentiated, and unknown grade (Table 10.7). These cases had 

median survival times of 60.9 months, 15.4 months, and 

more than 120 months, respectively. Most of the ‘other’ 

bone sarcoma cases had unknown grade (74%; Table 10.8). 

Relative survival rates for osteosarcoma exceeded 85% at 

each of the 1-year, 2-year, 3-year, 5-year, 8-, and 10-year 

intervals for cases with well and moderate grades. Poor, 

undifferentiated, and unknown grade osteosarcoma relative survival ranged from 82% for 1-year relative survival 

for cases with poor or undifferentiated grade to 38% for 

undifferentiated cases at 10-years after diagnosis.

Relative survival rates for well or moderately differentiated chondrosarcoma exceeded 75% for the 1-year, 2-year, 

3-year, 5-year, 8-, and 10-year relative survival intervals. 

Chondrosarcomas with unknown differentiation had relative survival percentages that remained above 71%. Poor 

and undifferentiated chondrosarcoma had lower relative 

survival percentages that ranged from 77 percent (1-year 

relative survival for poor grade) to 30 percent (8- and 10-

year relative survival for undifferentiated). Most of the 

‘other’ bone sarcomas had unknown differentiation and the 

10 year relative survival rate was 62%. 
Chapter 10 Cancers of the Bone and Joint

National Cancer Institute 86 SEER Survival Monograph 

Table 10.6: Osteosarcoma: Number and Distribution of Cases, Median Survival Time (Months) and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates (%) by Sex, Race, Age (20+), Historic Stage, Grade, Primary Site and Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases 625 100.0 84.5 82.2 67.9 65.0 59.2 54.5 51.8

Sex

 Male 338 54.1 83.3 83.4 68.4 64.6 59.9 54.3 50.6

 Female 287 45.9 93.7 81.0 67.4 65.4 58.3 54.5 53.1

Race

 White 504 80.6 82.6 81.2 67.0 63.8 58.4 54.0 52.0

 Black 76 12.2 65.7 85.0 68.7 67.7 61.1 47.4 47.4

 Other 45 7.2 >120 89.1 77.7 72.5 63.9 63.9 52.3

Age (years)

 20-39 324 51.8 >120 92.4 80.8 77.4 70.3 63.4 58.8

 40-59 153 24.5 103.3 84.7 67.7 64.1 60.2 53.4 47.8

 60+ 148 23.7 14.2 56.4 37.8 35.1 27.9 25.6 25.6

Historic Stage

 Localized 200 32.0 >120 96.3 88.0 84.7 81.2 79.6 76.4

 Regional 258 41.3 93.6 86.5 70.9 67.6 60.2 54.4 50.8

 Distant 108 17.3 9.9 48.8 24.8 22.4 14.9 3.7 !

 Unstaged 59 9.4 38.9 76.4 63.8 61.1 51.8 46.1 42.9

Grade

 Well 46 7.4 >120 100.0 100.0 100.0 96.2 96.2 86.7

 Moderate 61 9.8 >120 97.1 90.7 90.7 87.3 85.3 85.3

 Poor 105 16.8 78.2 81.7 67.9 65.1 56.6 51.7 51.7

 Undifferentiated 223 35.7 46.6 81.1 61.9 56.6 50.5 39.3 37.7

 Unknown 190 30.4 43.4 74.6 59.2 56.7 51.1 47.9 44.4

Primary Site

 Limbs 397 63.5 >120 88.9 77.1 74.6 67.6 62.5 60.7

 Other 228 36.5 24.0 70.5 51.8 48.0 43.8 39.7 34.5

Tumor Size

 <= 8 cm 232 37.1 > 120 92.1 81.8 79.5 73.1 65.6 62.7

 > 8 cm 126 20.2 31.3 73.3 54.6 51.4 45.9 43.8 41.4

Unknown 267 42.7 56.5 77.9 62.0 58.5 52.8 48.8 46.2

 ! Not enough intervals to produce rate.

Primary Site

Primary site classification was available for each of the 

subtypes of bone and joint cancer. Bone and joint cancer 

with the primary site reported in the limbs had median 

survival that exceeded 120 months for osteosarcoma, chondrosarcoma, and ‘other’ bone sarcoma. Median survival 

for Ewing sarcoma in the limbs was 53.6 months. Median 

survival for ‘other’ primary site varied at 59.4 months, 

24.0 months, greater than 120 months, and 89.4 months 

for Ewing sarcoma, osteosarcoma, chondrosarcoma, and 

‘other’ bone sarcoma, respectively. At 10 years after 

diagnosis, relative survival was highest for chondrosarcoma of the limbs (83%) and lowest for osteosarcoma of 

sites other than limbs (35%). Relative survival rates for 

Ewing sarcoma exceeded 80% for limbs primary site and 

‘other’ primary site at the 1-year mark, then declined for 

both primary sites to 40% and 47% for limbs and ‘other’ 

primary site respectively at the 10-year mark. Relative 

survival for osteosarcoma ranged from 89% at 1 year to 

61% at 10 years for limbs as the primary site, and 71% at 

1-year for 35% at 10 years for ‘other’ primary site.

Tumor Size

Each of the bone and joint cancer subtypes of tumor size 

0 to 8 centimeters had a median survival that exceeded 

120 months, with the exception of ‘other’ bone sarcoma 

which had a median survival of 116.3 months. Median 

survival for bone and joint cancers that were greater than 

8 centimeters varied with subtype, as Ewing sarcoma had 

a median survival of 34.7 months, osteosarcoma had a 

median survival of 31.3 months, chondrosarcoma had a 

median survival of more than 120 months, and ‘other’ 

bone sarcoma had a median survival of 56.8 months. 
Chapter 10 Cancers of the Bone and Joint

National Cancer Institute 87 SEER Survival Monograph 

Table 10.7: Chondrosarcoma: Number and Distribution of Cases, Median Survival Time (Months) and 1-, 2-, 3-, 5-, 8-, & 10-Year 

Relative Survival Rates (%) by Sex, Race, Age (20+), Historic Stage, Grade, Primary Site and Tumor Size, Ages 20+, 12 SEER 

Areas, 1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases 944 100.0 >120 93.0 88.9 85.4 81.6 79.1 78.5

Sex

 Male 506 53.6 >120 92.5 87.6 83.5 77.8 74.3 73.7

 Female 438 46.4 >120 93.6 90.5 87.6 86.0 84.1 84.0

Race

 White 832 88.1 >120 92.8 89.0 85.8 81.9 78.7 77.7

 Black 60 6.4 >120 96.0 89.8 86.5 83.0 83.0 83.0

 Other 52 5.5 >120 92.7 86.7 74.8 72.8 72.8 72.8

Age (years)

 20-39 293 31.0 >120 95.7 91.9 89.3 87.8 83.5 83.0

 40-59 364 38.6 >120 96.6 91.2 88.7 86.4 83.5 81.6

 60+ 287 30.4 80.8 85.5 82.6 76.7 68.5 67.2 67.2

Historic Stage

 Localized 479 50.7 >120 98.9 98.3 94.9 93.8 92.0 91.8

 Regional 343 36.3 >120 90.4 83.5 79.3 71.8 67.2 64.7

 Distant 61 6.5 17.0 62.8 44.5 40.9 34.3 34.3 34.3

 Unstaged 61 6.5 >120 91.3 89.2 85.6 82.6 77.0 77.0

Grade

 Well 354 37.5 >120 98.6 98.2 97.0 95.1 92.3 92.2

 Moderate 376 39.8 >120 95.9 91.3 87.5 80.2 75.9 75.9

 Poor 57 6.0 60.9 77.1 69.3 63.8 58.6 52.7 50.7

 Undifferentiated 55 5.8 15.4 65.0 40.7 30.1 30.1 29.9 29.9

 Unknown 102 10.8 >120 86.4 82.4 76.7 74.3 71.8 71.2

Primary Site

 Limbs 513 54.3 >120 94.8 92.1 88.3 86.2 84.2 83.0

 Other 431 45.7 >120 90.9 85.1 81.7 76.2 72.5 72.4

Tumor Size

 <= 8 cm 396 41.9 > 120 97.2 95.2 92.1 87.6 84.3 82.4

 > 8 cm 192 20.3 > 120 91.8 83.7 79.0 74.7 74.1 74.1

 Unknown 356 37.7 > 120 89.0 84.7 81.2 78.6 74.5 74.5

populations, there has been no improvement in survival 

among patients of all ages in the U.S. or among children 

in Europe over the past 15 years. [Note: cell types differ 

for Ewing sarcoma and osteosarcoma, perhaps indicating 

different origins. Chondrosarcoma is epidemiologically 

dissimilar to osteosarcoma.]

A case-control study of 88 bone cancer cases aged 8 to 25 

years and 3 matched control groups from Austria evaluated 

a variety of exposures to previous illness, bone injury or 

disease, nutrition, social and emotional factors and risk of 

bone cancer (3). Previous viral illnesses including chickenpox and mumps significantly increased the risk for bone 

cancer. Exposure to repeated polio vaccinations also were 

associated with elevated risk. Difficulties at school were 

associated with in an increased risk for bone cancer in both 

univariate and multivariate analyses. In a separate analyTumors of unknown size had median survival times of 47 

months and 56.5 months for Ewing sarcoma and osteosarcoma respectively, while median survival for both chondrosarcoma and ‘other’ bone sarcoma of unknown tumor 

size was greater than 120 months. Relative survival rates 

were highest for tumor sizes of 0 to 8 centimeters (all were 

greater than 59% at 10-years after diagnosis). 

Discussion

A review by Miller et al. (2) discussed various environmental 

factors, including exposure to ionizing radiation, chemicals, 

viruses, trauma, and metal implants as potential risk factors 

for bone and joint cancer. Host factors of importance for 

bone and joint cancer include pre-existing bone defects and 

familial aggregation of these cancers along with reports 

of multiple neoplasms. This review noted that in various 
Chapter 10 Cancers of the Bone and Joint

National Cancer Institute 88 SEER Survival Monograph 

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Ewing Sarcoma

Osteosarcoma

Chondrosarcoma

Other Histologies

Figure 10.1: Cancer of the Bone & Joint: Relative Survival 

Rates (%) by Histology, Ages 20+,12 SEER Areas, 1988-2001

Table 10.8: Other Bone Sarcoma: Number and Distribution of Cases, Median Survival Time (Months) and 1-, 2-, 3-, 5-, 8-, & 10-Year 

Relative Survival Rates (%) by Sex, Age (20+), Historic Stage, Grade, Primary Site and Tumor Size, 12 SEER areas 1988-2001

Characteristics Cases Percent

Median 

Survival

(Months)

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Cases 517 100.0 106.6 87.6 82.0 76.9 70.7 61.6 58.3

Sex

 Male 298 57.6 96.9 86.7 83.4 77.0 69.3 59.5 55.7

 Female 219 42.4 >120 88.5 79.8 76.7 71.9 64.5 61.6

Race

 White 425 82.2 104.6 86.3 81.9 77.3 71.4 61.1 57.3

 Black 51 9.9 >120 94.8 83.6 79.8 76.1 74.3 74.3

 Other 41 7.9 68.1 90.6 80.6 69.5 56.5 44.9 37.0

Age (years)

 20-39 167 32.3 >120 95.9 91.6 86.2 81.7 81.0 77.0

 40-59 163 31.5 >120 90.0 86.0 82.1 76.6 62.2 58.8

 60+ 187 36.2 44.7 77.6 69.1 63.0 52.7 35.0 28.1

Historic Stage

 Localized 176 34.0 >120 94.1 88.7 85.3 79.5 75.4 75.4

 Regional 206 39.8 91.7 94.2 87.8 81.6 71.9 57.7 52.3

 Distant 79 15.3 16.5 54.3 46.3 41.1 41.1 26.6 24.3

 Unstaged 56 10.8 >120 88.8 88.7 83.1 78.3 73.7 66.4

Grade

 Well 21 4.1 ~ ~ ~ ~ ~ ~ ~

 Moderate 36 7.0 >120 95.6 88.6 86.2 78.1 78.1 74.5

 Poor 36 7.0 33.6 78.7 59.0 51.5 43.8 30.3 !

 Undifferentiated 43 8.3 12.5 52.4 45.5 41.4 30.9 23.1 23.1

 Unknown 381 73.7 >120 91.2 87.2 82.2 76.6 66.1 62.2

Primary Site

 Limbs 163 31.5 >120 84.9 76.9 73.6 72.6 69.4 69.4

 Other 354 68.5 89.4 88.7 84.2 78.2 69.3 56.0 51.1

Tumor Size

<= 8 cm 167 32.3 116.3 89.6 85.4 77.5 75.5 65.6 59.6

> 8 cm 68 13.2 56.8 87.9 74.1 71.1 51.6 38.8 33.6

Unknown 282 54.5 > 120 86.1 81.7 77.5 71.9 63.8 61.1

 ~ Statistic not displayed due to less than 25 cases.

 ! Not enough intervals to produce rate.

sis of osteosarcoma cases, having more than one lifetime 

residence was associated with increased risk, along with 

difficulties at school (3). 

 REFERENCES

1. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer 

EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, 

Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

submission, posted to the SEER web site, 2006.

2. Miller RW, Boice JD, Jr., Curtis RE. Bone cancer. In: Cancer 

Epidemiology and Prevention, 3rd edition. Schottenfeld D, and 

Fraumeni JF, Jr., Eds. New York: Oxford University Press, 1996, 

pp. 946-958.

3. Frentzel-Beyme R, Becher H, Salzer-Kuntschik M, Kotz R, Salzer 

M. Factors affecting the incident juvenile bone tumors in an 

Austrian case-control study. Cancer Detection and Prevention 

2004; 28: 159-169.
National Cancer Institute 89 SEER Survival Monograph 

Introduction

Sarcomas are tumors of diverse cell types which are mostly 

of mesodermal origin. They primarily arise in the soft 

tissues of the body including the retroperitoneum and peritoneum, pleura, heart, mediastinum and spleen but can also 

arise in the structural cells or parenchyma of specialized 

organs such as the stomach and kidney. The classification 

of tumors according to both the anatomic site in which 

they arose and the morphology of the tumor itself using 

the International Classification of Disease for Oncology 

(1) allows these tumors to be analyzed together as a group. 

Consequently, authors of other chapters in this monograph 

may have elected to exclude the sarcomas from their analyses knowing that they would be included here.

Materials and Methods

The NCI contracts with medically-oriented, nonprofit institutions located in specific geographic areas to obtain 

data on all cancers diagnosed in residents of the SEER 

geographic areas. SEER collects data on all invasive and 

in situ cancers except basal cell and squamous cell carcinomas of the skin (of non-genital anatomic sites) and in 

situ carcinomas of the uterine cervix. SEER actively follows all previously diagnosed patients on an annual basis 

to obtain vital status allowing the calculation of observed 

and relative survival rates.

This analysis is based on data from 12 geographic areas 

which collectively cover about 14% of the total US population. The areas are the States of Connecticut, Iowa, 

New Mexico, Utah, and Hawaii; the metropolitan areas of 

Detroit, Michigan; Atlanta, Georgia; San Francisco, San 

Jose, and Los Angeles, California; Seattle, Washington; 

and 10 counties in rural Georgia. Los Angeles contributed 

data for diagnosis years 1992 to 2001, all other areas for 

1988-2001.

Cases diagnosed in children and adolescents aged 0-19 

have been excluded. Some patients have more than one 

diagnosis of cancer, but only the first diagnosis of cancer 

has been included. Death certificate only cases, autopsy 

only cases, and all other cases with no survival time have 

been excluded. Further, cases with no microscopic confirmation have been excluded. Finally, sarcomas arising in 

bone (osteosarcomas) have also been excluded from this 

analysis but are included in the bone chapter (2). Table 

11.1 shows the numbers of cases excluded by category.

Survival analysis is based on relative survival rates calculated by the life-table (actuarial) method. Relative survival, 

defined as observed survival in the cohort divided by 

expected survival in the cohort, adjusts for the expected 

mortality that the cohort would experience from other 

causes of death. Expected survival is based on unabridged 

life tables for the United States in 1990. Although the 

American Joint Committee on Cancer’s Staging Manual 

Lynn A. Gloeckler Ries, Kevin C. Ward, and John L. Young, Jr.

Chapter 11

Sarcomas

Table 11.1: Sarcomas: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number selected/

remaining

Number 

excluded Reason for exclusion/selection

41,408 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

37,314 4,094 Select first primary only

36,979 335 Exclude death certificate only or at autopsy

36,425 554 Exclude unknown race

36,337 88 Active follow-up and exclude alive with no survival time

33,820 2,517 Exclude children (000-019)

33,820 0 Exclude in situ cancers

30,183 3,637 Exclude no or unknown microscopic confirmation

28,758 1,425 Exclude cancer of the bone (C40.0-C41.9)
Chapter 11 Sarcomas

National Cancer Institute 90 SEER Survival Monograph 

does contain a staging scheme for sarcomas, the scheme 

only applies to those sarcomas arising in soft tissues. 

Since this analysis is based on all sarcomas including 

those arising in any anatomic site except bone, the staging 

definitions utilized in this chapter are those of the 1977 

Summary Staging Guide (3) whose staging categories are 

generally equivalent across the spectrum of anatomic sites. 

For simplicity, all categories of regional disease in the 

summary staging scheme have been added together into a 

single group. Finally, the sarcomas have been categorized 

into 11 subgroups roughly following the recommended 

classification of the World Health Organization (4) as 

shown below based on ICD-O-3 codes:

Perivascular Sarcomas 8680-8713

Liposarcomas 8850-8858

Dermatofibrosarcomas 8832-8833

Other fibrosarcomas 8810-8811,8813-8814,8825

Fibrohistiocytic sarcoma 8830

Leiomyosarcomas 8890-8891,8894,8896

Rhabdosarcomas 8900-8902,8910,8912,8920

Kaposi sarcoma 9140

Vascular sarcomas excluding Kaposi 9120,9133,9161

Chondro-oseous sarcomas 9180-9185,9192-9193,9221, 

9230,9240,9243,9250

Sarcomas of uncertain differentiation 8800-8806,8823,8930-

8936,8963,8990-8991,9040-9044,9231,9260-9261, 9364,9370-

9371,9560-9561,9571,9580-9581.

Results

Table 11.2 shows the distribution by sex, race, and summary stage for eleven categories of sarcomas. The largest 

category by far is Kaposi sarcoma (33%) with the smallest 

being the chondro-oseous (extraosseous) sarcomas (0.3%). 

Sarcomas occur more commonly among males, especially 

Kaposi of which only 3% of the cases occurred among 

females. Since there was no specific summary staging 

scheme for Kaposi, 100% of these cases were classified 

as “unstaged.” Almost 30% of perivascular sarcomas 

and rhabdosarcomas were already staged as distant at 

the time of diagnosis.

Table 11.3 presents 5-year relative survival rates by anatomic site, histology and sex. Patients with sarcomas 

arising in soft tissues had much better survival than did 

patients whose tumors arose in other non-parenchymous 

sites (pleura, mediastinum, heart, retroperitoneum, peritoneum, and spleen) or in other organs, 68% vs. 43% 

and 44%, respectively. For Kaposi sarcoma, survival 

for those tumors arising in the soft tissue vs. other sites 

(primarily skin) was more than double – 53% vs. 25%. 

The best survival, regardless of site was among patients 

with dermatofibrosarcoma, 99.9%.

The 1-, 3-, 5- and 10-year relative survival rates for each 

subgroup are shown for males and for females in Table 

11.4. The relative survival rates for dermatofibrosarcomas 

were almost 100% across all years being 98% at 10 years 

for males and 99.9% for females.

The poorest 10-year relative survival rate among males 

was experienced by patients with Kaposi sarcoma, 18%, 

followed closely by patients with other vascular sarcomas, 

24%. Among females, the poorest relative survival at 

both 5 and 10 years was among those with a diagnosis 

of rhabdosarcoma.

A comparison of 1-,3-,5-, and 10-year relative survival 

rates for whites and for blacks is shown in Table 11.5. 

Overall, whites had higher survival rates at each interval 

compared to blacks, but the advantage diminished with 

time since diagnosis with the advantage being small at 10 

years, 44% for whites compared to 41% for blacks. For 

the category of “other fibrosarcomas”, blacks had much 

Table 11.2: Sarcomas: Number and Distributions by Sex, Race, SEER Summary Stage 1977 and Histology Group, Ages 20+, 12 SEER 

Areas, 1988-2001

Histology Group

Sex Race Stage Percent

Total Male Female White Black Localized Regional Distant Unstaged

Total 28,758 18,226 10,532 23,195 3,588 37.5 12.6 10.5 39.4

Perivascular sarcomas 174 95 79 130 31 28.2 28.2 28.2 15.5

Liposarcomas 2,368 1,413 955 1,986 190 65.9 21.3 5.7 7.1

Dermatofibrosarcomas 2,142 996 1,146 1,612 366 84.8 5.2 0.5 9.5

Other fibrosarcomas 511 250 261 391 71 57.1 23.9 9.2 9.8

Fibrohistiocytic sarcoma 3,063 1,823 1,240 2,626 218 61.2 21.1 9.9 7.8

Leiomyosarcomas 4,486 1,625 2,861 3,516 544 51.0 18.6 21.9 8.5

Rhabdosarcomas 299 178 121 223 49 27.8 28.8 29.8 13.7

Kaposi sarcoma 9,513 9,208 305 7,849 1,374 0.0 0.0 0.0 100.0

Vascular sarcomas excluding Kaposi 614 332 282 513 44 41.5 18.9 24.1 15.5

Chondro-oseous sarcomas 93 42 51 76 11 45.2 32.3 15.1 7.5

Sarcomas of uncertain differentiation 5,495 2,264 3,231 4,273 690 45.9 20.3 22.5 11.3
Chapter 11 Sarcomas 

National Cancer Institute 91 SEER Survival Monograph 

better survival than did whites with the 10-year relative 

survival rate being 79% for blacks compared to only 61% 

for whites. For rhabdosarcomas, the opposite was true 

with whites having much higher survival at each interval 

with the 10-year rate being 35% for whites compared to 

only 19% for blacks. The 10-year rate for patients with 

Kaposi sarcoma was almost equal among the two groups 

– 19% for whites and 18% for blacks.

Table 11.6 presents 5- and 10-year survival rates by summary stage. Patients with distant disease had uniformly 

poor survival (11% overall) at 10-years while survival for 

patients diagnosed at a localized stage was 78%. Among 

patients with localized disease, those with rhabdosarcoma 

had the poorest survival with rates of 59% at 5 years and 

53% at 10 years.

Discussion

In order to have sufficient numbers of cases for analyses 

the classification of sarcomas suggested by the World 

Health Organization (4) was utilized. Even so, several of 

the categories contained very few cases. Whenever possible, major subgroups were examined separately, namely, 

dermatofibrosarcomas from the fibrosarcoma group and 

Kaposi sarcoma from the vascular sarcoma group. In other 

categories, some interesting differences may have been 

obscured by the grouping of categories. For example, 

among the rhabdosarcomas, there were enough cases of 

alveolar rhabdosarcoma to examine separately.

Mack (5) has described in detail the heterogeneity of 

sarcomas and the various ways of classifying them over 

Table 11.4: Sarcomas: 1-, 3- ,5- and 10-Year (Yr) Relative Survival Rates (%) by Histology Group and Sex, Ages 20+, 12 SEER 

Areas, 1988-2001

Histology Group

Relative Survival Rate (%)

Total Male Female

1-Yr 3-Yr 5-Yr 10-Yr 1-Yr 3-Yr 5-Yr 10-Yr 1-Yr 3-Yr 5-Yr 10-Yr

Total 77.7 56.8 50.3 43.9 74.8 49.8 42.6 35.7 82.8 69.2 64.0 58.6

Perivascular sarcomas 90.2 75.1 63.3 47.5 88.5 71.1 62.0 38.4 92.2 80.0 64.9 58.8

Liposarcomas 93.4 85.8 82.8 74.4 93.9 85.8 82.4 76.4 92.8 85.9 83.1 71.0

Dermatofibrosarcomas 100.0 99.9 99.9 99.3 100.0 99.6 99.6 98.2 100.0 100.0 100.0 99.9

Other fibrosarcomas 87.2 77.8 72.4 65.4 86.3 76.8 68.5 63.1 88.1 78.6 75.5 66.5

Fibrohistiocytic sarcoma 85.0 71.2 67.0 64.0 85.4 72.5 67.9 63.5 84.3 69.4 65.7 63.2

Leiomyosarcomas 80.6 60.8 51.9 43.1 81.9 63.0 55.7 47.5 79.9 59.5 49.9 40.8

Rhabdosarcomas 65.6 42.6 35.0 30.5 70.4 43.9 35.9 32.3 58.5 40.5 33.9 27.2

Kaposi sarcoma 66.9 32.9 24.7 18.8 66.4 31.9 23.9 18.2 80.9 65.4 54.9 47.2

Vascular sarcomas excluding Kaposi 60.2 40.6 36.3 29.5 55.9 35.8 32.1 23.7 65.3 46.2 40.9 35.5

Chondro-osseous sarcomas 83.3 65.7 54.7 48.0 78.1 62.3 46.8 44.0 87.5 68.1 59.4 50.9

Sarcomas of uncertain differentiation 76.0 60.4 55.6 50.5 73.8 55.2 49.1 40.7 77.6 63.8 59.9 56.0

Table 11.3: Sarcomas: 5-Year Relative Survival Rates (5) by Histology Group, Site, and Sex, Ages 20 +, 12 SEER Areas, 1988-2001

Histology Group

Site

Total Soft Tissue Other Non-parenchymous All Other

All Male Female All Male Female All Male Female All Male Female

Total 50.3 42.6 64.0 68.0 68.1 67.9 42.6 39.8 45.3 43.9 34.7 64.4

Perivascular sarcomas 63.3 62.0 64.9 ~ ~ ~ 69.6 ~ ~ 61.8 60.1 63.5

Liposarcomas 82.8 82.4 83.1 85.9 84.8 87.1 65.1 60.0 70.2 94.4 97.0 81.9

Dermatofibrosarcomas 99.9 99.6 100.0 98.4 96.6 99.3 ! ! ! 99.9 99.7 100.0

Other fibrosarcomas 72.4 68.5 75.5 79.8 79.0 80.3 38.6 ~ ~ 61.1 40.4 70.7

Fibrohistiocytic sarcoma 67.0 67.9 65.7 67.6 67.6 67.6 25.4 26.4 24.2 77.7 79.5 72.9

Leiomyosarcomas 51.9 55.7 49.9 62.0 67.4 57.0 36.4 32.7 38.6 50.3 52.8 49.4

Rhabdosarcomas 35.0 35.9 33.9 40.4 40.1 39.7 ~ ~ ~ 31.0 32.6 29.4

Kaposi sarcoma 24.7 23.9 54.9 52.6 45.9 ~ ~ ~ ! 24.5 23.8 53.4

Vascular sarcomas 

excluding Kaposi 36.3 32.1 40.9 37.9 42.0 33.4 12.9 12.3 ~ 40.0 30.9 48.6

Chondro-oseous sarcomas 54.7 46.8 59.4 53.6 ~ 54.4 ~ ~ ~ 60.8 ~ ~

Sarcomas of uncertain 

differentiation 55.6 49.1 59.9 57.4 56.0 58.9 35.4 34.0 36.0 57.8 43.9 63.0

~ Statistic not displayed due to less than 25 cases.

! Not enough intervals to produce rate
Chapter 11 Sarcomas

National Cancer Institute 92 SEER Survival Monograph 

Table 11.5: Sarcomas: 1-, 3- ,5- and 10-Year Relative Survival Rates (%) by Histology Group and Race, Ages 20+, 12 SEER Areas, 

1988-2001

Histology Group

Relative Survival Rate (%)

White Black

1-Year 3-Year 5-Year 10-Year 1-Year 3-Year 5-Year 10-Year

Total 78.5 57.1 50.4 43.9 71.5 51.4 46.4 40.8

Perivascular Sarcomas 88.9 74.7 62.8 47.2 94.3 75.0 66.6 49.0

Liposarcomas 93.1 85.1 82.5 73.4 94.8 88.2 83.3 79.7

Dermatofibrosarcomas 100.0 99.8 99.8 99.8 100.0 100.0 100.0 97.7

Other fibrosarcomas 85.5 75.4 69.4 61.3 98.3 90.9 87.2 79.4

Fibrohistiocytic sarcoma 85.6 73.1 69.0 65.6 78.5 55.1 53.7 52.4

Leiomyosarcomas 81.8 62.0 53.2 44.4 73.2 52.1 45.6 37.9

Rhabdosarcomas 68.1 46.1 39.1 35.0 51.5 21.4 21.4 18.6

Kaposi sarcoma 68.5 33.2 24.6 18.9 58.5 31.2 24.9 17.9

Vascular sarcomas excluding Kaposi 61.0 42.2 37.4 29.0 58.5 43.3 39.5 37.0

Chondro-osseous sarcomas 84.6 66.8 56.5 49.4 ~ ~ ~ ~

Sarcomas of uncertain differentiation 76.5 61.5 56.7 51.6 70.3 51.5 47.4 41.3

~ Statistic not displayed due to less than 25 cases.

Table 11.6: Sarcomas: 5- & 10-Year (Yr) Relative Survival Rates (%) by Histology Group and SEER Summary Stage, 12 SEER Areas, 

1988-2001

Histology Group

Stage

Total Local Regional Distant Unstaged

Relative 

Survival

Relative 

Survival

Relative 

Survival

Relative 

Survival

Relative 

Survival

5-Yr 10-Yr 5-Yr 10-Yr 5-Yr 10-Yr 5-Yr 10-Yr 5-Yr 10-Yr

% % % % % % % % % %

Total 50.3 43.9 83.1 78.1 54.0 46.1 16.2 11.1 28.8 22.2

Perivascular Sarcomas 63.3 47.5 82.1 59.3 82.6 73.5 43.0 21.0 37.3 21.0

Liposarcomas 82.8 74.4 90.9 81.5 74.4 65.4 30.8 15.4 70.1 66.9

Dermatofibrosarcomas 99.9 99.3 99.9 99.3 100.0 100.0 ~ ~ 99.4 97.3

Other fibrosarcomas 72.4 65.4 88.3 83.0 54.3 44.4 24.2 19.5 67.3 56.0

Fibrohistiocytic sarcoma 67.0 64.0 81.4 79.1 55.2 49.8 11.8 9.3 53.8 43.7

Leiomyosarcomas 51.9 43.1 71.8 61.4 44.4 35.3 13.6 8.9 45.4 32.4

Rhabdosarcomas 35.0 30.5 58.6 52.6 40.2 34.5 6.3 6.3 34.8 27.1

Kaposi sarcoma 24.7 18.8 ! ! ! ! ! ! 24.7 18.8

Vascular sarcomas excluding Kaposi 36.3 29.5 57.6 52.2 31.7 24.2 12.9 7.3 25.4 15.5

Chondro-osseous sarcomas 54.7 48.0 62.3 53.5 65.5 57.1 ~ ~ ~ ~

Sarcomas of uncertain differentiation 55.6 50.5 80.3 76.0 48.5 39.5 17.1 13.4 41.0 31.8

~ Statistic not displayed due to less than 25 cases.

! Not enough intervals to produce rate

time. He has also described the genetic determinants as 

well as the environmental agents believed to play a role in 

the etiology of sarcomas. It is not unreasonable that these 

factors might influence survival as well, particularly among 

patients with certain chromosomal abnormalities.

References

1. Percy C, Van Holten V, and Muir C (eds). International 

Classification of Diseases for Oncology – Second Edition, World 

Health Organization, Geneva, 1990

2. Lewis DR and Ries LAG. Cancers of the Bone and Joint. In: Ries 

LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner, M-J 

(editors). SEER Survival Monograph: Cancer Survival Among 

Adults: U.S. SEER Program, 1988-2001, Patient and Tumor 

Characteristics. National Cancer Institute, SEER Program. NIH 

Pub. No. 07-6215, 2007.

3. Shambaugh EM and Weiss MA (eds). The 1977 Summary Staging 

Guide, National Cancer Institute, Bethesda, MD 1977.

4. Christopher DM, Fletcher KU and Fredrik M (eds), World Health 

Organization Classification of Tumors: Pathology and Genetics 

of Tumours of Soft Tissue and Bone, World Health Organization, 

Geneva, 2002

5. Mack TM, Sarcomas and Other Malignancies of Soft Tissue, 

Retroperitoneum, Peritoneum, Pleura, Heart, Mediastinum, and 

Spleen, Supplement to Cancer, 75:211-244, 1995.
National Cancer Institute 93 SEER Survival Monograph 

Introduction

In general, it is considered that mortality from melanoma 

is in most cases preventable, because the disease is characterized by an easily recognizable lesion (unusual moles 

or nevi), and early intervention appears to guarantee an 

excellent prognosis with limited recurrence (1). While the 

incidence of melanoma has been rising in most countries 

and populations worldwide since the 1960s (2), there is 

some evidence that at least part of this increase can be 

attributed to wider reaching screening programs that attempt to capitalize on the benefit of early detection (3). 

Were this true we would expect to see improvements in 

survival through time; indeed, this has been observed in 

the white populations of Sweden (4, 5) and Switzerland 

(6), particularly among females, who overall have better chances of survival from melanoma than males (6), 

but among whom one might first expect to see improvements in survival due to self-screening and general health 

awareness.

The documentation of improved melanoma survival over 

time has been limited to these two populations, whose 

rates of melanoma are not very high by world standards 

– the highest rates in the world are found in Australia, 

New Zealand, and in the Southwest of the United States, 

particularly Los Angeles (7). Among these populations, 

whose high rates of melanoma are attributed to excessive childhood sun exposure, little is known about the 

factors related to survival. In the Swedish and Swiss 

populations, females have uniformly better survival rates 

than males, survival is substantially better with thinner 

lesions (which presumably represent tumors diagnosed at 

an earlier stage of development, and therefore are more 

amenable to intervention), but no differences are observed 

in survival among the major histologic types of melanoma. 

The majority of melanomas can be regarded as having 

either an invasive, infiltrating histologic type (nodular 

melanomas, NM) or a less invasive, thinner form which 

is more likely to spread radially across the skin’s surface 

rather than vertically into the dermis (superficial spreading melanoma, SSM). Given the relationship between 

lesion thickness and melanoma prognosis, SSM ought to 

have better survival than NM. While there is conflicting 

evidence on whether or not these two main types of lesion 

are biologically distinct (8), data from Sweden indicate an 

increase in the incidence of SSM that might signify a role 

of earlier detection in the overall increase in melanoma 

incidence in most developed countries worldwide (5, 9). A 

third form of melanoma, Hutchinson’s melanotic freckle, 

represents a distinct histologic entity whose prognosis 

is unclear, because in most data sets they are too rare to 

draw firm conclusions.

Finally, there are substantial differences in the incidence 

of melanomas at differing anatomical locations of the 

body, which in part support (and in fact were responsible 

for the development of) the hypothesis that sunlight exMyles Cockburn, David Peng, and Charles Key

Chapter 12

Melanoma

Table 12.1: Melanoma: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number Excluded Reason for Exclusion/selection

103,334 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

85,854 17,480 Select first primary only

85,733 121 Exclude death certificate only or at autopsy

81,246 4,487 Exclude unknown race

80,633 613 Exclude alive with no survival time

79,954 679 Exclude children (Ages 0-19)

55,173 24,781 Exclude in situ cancers for all except breast & bladder cancer

55,039 134 Exclude no or unknown microscopic confirmation
Chapter 12 Melanoma

National Cancer Institute 94 SEER Survival Monograph 

posure plays a role in melanoma – in males, melanomas 

are more common on the trunk and ears or head than in 

females, who have melanomas more frequently on their 

lower legs and their arms (10). These findings coincide 

roughly with the differences in sun protection afforded 

males and females by virtue of their clothing choices and 

hairstyles. Whether or not these site-specific differences 

are reflected in differing survival is of interest given the 

increased likelihood that lesions will be recognized earlier on sun-exposed skin surfaces. Swiss data show that 

survival is greater at every anatomic location for females 

than males, but that observation is based on very few 

data points (6).

Materials and Methods

Case selection

Cases were selected from those reported to the NCI SEER 

Program with a diagnosis occurring between 1988 and 

2001 (except for those cases obtained from the Los Angeles Cancer Surveillance Program which included the 

years 1992-2001 only). Cases were followed for vital 

status until 2003. Further descriptions of the NCI SEER 

Program, data selection and relative survival analysis can 

be found in Chapter 1: “Materials and Methods”. We 

used the first primary diagnosis of melanoma only, and 

excluded those cases whose report was obtained solely 

from a death certificate or from report at autopsy, or those 

with no microscopic confirmation of diagnosis. In order 

to complete race-specific analyses, we excluded those 

with an unknown race, and in order to obtain complete 

data on survival time, we excluded those cases for whom 

active follow-up continued, but for whom there was no 

available survival time (that is, follow-up date was the 

same as diagnosis date, and no further follow-up data 

had been obtained). All cases under the age of 20 years 

were excluded both because melanoma is extremely rare 

in this age group, and because separate monographs have 

been published for childhood and adolescent/young adult 

cancers.

We conducted age- and sex-specific analyses, using 10-year 

age groups to ensure sufficient sample sizes in each age/

sex group, as previous reports indicated a more favorable 

survival among both the young, and among females (11). 

Despite the comparative rarity of melanoma among blacks, 

we had sufficient data to consider sex-specific survival 

rates among both blacks and whites (but not age-specific 

rates for blacks). In all subsequent analyses (anatomic 

site, tumor thickness and histology, as detailed below) we 

Table 12.2: Melanoma: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by Race and 

Sex, Ages 20+, 12 SEER Areas, 1988-2001

Race/Sex Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

White 54,197 100.0 97.2 94.6 92.6 90.2 88.4 88.1

Male 29,785 55.0 96.6 93.5 91.0 88.4 86.5 86.3

Female 24,412 45.0 97.8 95.9 94.4 92.4 90.4 90.0

Black 305 100.0 88.6 82.9 79.7 73.4 70.3 70.3

Male 155 50.8 85.2 78.4 75.0 70.1 69.6 69.6

Female 150 49.2 92.1 87.4 84.4 76.3 69.8 69.8

Table 12.3: Melanoma (Among Whites): Age Distribution (20+) by Sex, 12 SEER Areas, 1988-2001

Sex Male Female

Age Group (Years) Cases Percent Cases Percent

Total 29,785 100.0 24,412 100.0

 20-29 1,179 4.0 2,079 8.5

 30-39 3,445 11.6 4,570 18.7

 40-49 5,766 19.4 5,251 21.5

 50-59 6,067 20.4 4,035 16.5

 60-69 6,142 20.6 3,473 14.2

 70-79 4,980 16.7 3,030 12.4

 80+ 2,206 7.4 1,974 8.1
Chapter 12 Melanoma

National Cancer Institute 95 SEER Survival Monograph 

focus on whites only, as data for blacks were too sparse. 

In all these subsequent analyses we separate analyses for 

males and females.

Anatomic site classification

Few data sources provide the opportunity to investigate 

melanoma survival by anatomic site of the lesion, yet there 

is substantial evidence that risk of developing melanoma 

is related to anatomic site, and it is fair to assume that, 

because melanoma can be prevented by the early recognition of lesions, those occurring on more exposed body sites 

would have the most favorable prognosis and a higher rate 

of survival. We classified the site of melanomas according to ICDO-2 site coding: C44.0 (lip); C44.1 (eyelid); 

C44.2 (ear); C44.3 (face excluding eyelid); C44.4 (scalp 

and neck excluding ear); C44.5 (trunk); C44.6 (upper 

limb and shoulder); C44.7 (lower limb and hip); C44.8 

(overlapping site); C44.9 (site not specified).

Tumor thickness classification

Likewise, one of the strongest predictors of melanoma 

prognosis from case series and the few survival studies 

with sufficient data to investigate the same is the thickness of the tumor at diagnosis, with tumors of the greatest 

depth having the worst prognosis and survival. Thickness 

of melanomas is recorded as the depth in millimeters of 

the lesion, and we categorized the thicknesses in the same 

groups as found in Levi et al (1998), for comparative 

purposes – these thickness groupings (<0.75mm, 0.75-1

.49mm, 1.50-2.49mm, 2.50-3.99mm, >3.99mm and unknown) also represent the levels most commonly used to 

describe the changing incidence of melanoma, as they are 

considered representative of the severity of disease: those 

<0.75mm rarely recur after removal, those 0.75-1.49mm 

have a greater chance of recurrence but a small chance of 

mortality, and those >3.99mm have an almost universal 

prognosis of multiple recurrence and short survival time 

in clinical series.

Histologic type classification

We categorized melanomas on the basis of ICDO-2 histology code: superficial spreading melanoma (SMM): 

8743; nodular melanoma (NM): 8721; acral lentiginous 

melanoma (ALM): 8744; Hutchinson’s melanotic freckle 

(HMF): 8742. The remainder of histologic types comprised those recorded simply as ‘malignant melanoma’ 

(MM): 8720, and those recorded as ‘other or not specified’ 

(8722-8741, 8745-8790).

Results

Case selection

Between 1988 and 2001, 103,334 melanomas cases were diagnosed and reported to SEER. We removed from analysis 

17,480 cases which were not first primaries, a further 5,355 

cases because they were obtained from death certificate 

only, had no microscopic confirmation of diagnosis, had 

an unknown race, or no follow-up data (see Table 12.1 

for details); 679 cases aged between 0 and 19 years; and 

finally, 24,781 cases reported as in situ cancers. There 

were 55,039 adult cases remaining for analysis.

Figure 12.1: Melanoma (Among Whites): Relative Survival 

Rates (%) for Males by Age (20+), 12 SEER Areas, 1988-2001

Figure 12.2: Melanoma (Among Whites): Relative Survival 

Rates (%) for Females by Age (20+), 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

20-29

30-39

40-49

50-59

60-69

70-79

80+

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

20-29

30-39

40-49

50-59

60-69

70-79

80+
Chapter 12 Melanoma

National Cancer Institute 96 SEER Survival Monograph 

Table 12.4: Melanoma (Among Whites): Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by Sex and Anatomic Site, Ages 20+, 12 SEER Areas, 1988-2001

Sex/Anatomic Site Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Male 29,785 100.0 96.6 93.5 91.0 88.4 86.5 86.3

 Lip 56 0.2 91.3 85.0 81.7 71.9 69.1 69.1

 Eyelid 81 0.3 100.0 99.2 99.2 91.1 82.2 81.5

 Ear 1,336 4.5 99.0 96.8 95.3 94.5 91.2 90.8

 Face 2,825 9.5 99.3 96.3 93.5 90.4 89.4 89.4

 Scalp & Neck 2,347 7.9 97.4 92.0 86.9 82.2 77.4 76.2

 Trunk 12,340 41.4 98.4 96.0 93.8 91.4 89.4 88.9

 Upper Limb/Shoulder 6,378 21.4 99.2 97.0 95.5 93.5 93.5 93.5

 Lower Limb/Hip 2,852 9.6 98.8 95.9 93.1 89.7 86.5 85.6

 Overlapping 41 0.1 98.7 94.9 90.8 90.2 77.2 70.4

 NOS 1,529 5.1 59.3 48.0 43.6 39.8 37.3 36.2

Female 24,412 100.0 97.8 95.9 94.4 92.4 90.4 90.0

 Lip 37 0.2 96.4 87.2 81.8 81.8 81.8 81.8

 Eyelid 79 0.3 100.0 95.2 93.3 89.5 84.4 78.5

 Ear 185 0.8 99.0 98.5 97.6 93.5 83.3 80.8

 Face 1,916 7.8 99.1 97.2 95.6 93.6 90.8 90.8

 Scalp & Neck 918 3.8 98.0 93.5 89.8 83.4 79.5 78.6

 Trunk 6,240 25.6 98.4 96.8 95.2 93.0 90.6 90.3

 Upper Limb/Shoulder 6,266 25.7 99.1 98.0 96.8 95.6 94.4 93.3

 Lower Limb/Hip 7,930 32.5 99.2 97.5 96.4 94.8 93.1 92.5

 Overlapping 20 0.1 ~ ~ ~ ~ ~ ~

 NOS 821 3.4 65.9 55.8 51.9 46.6 45.2 44.1

 ~ Statistic not displayed due to less than 25 cases.

Table 12.5: Melanoma (Among Whites): Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by Sex and Tumor Thickness, Ages 20+, SEER 1988-2001

Sex/Tumor Thickness Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Male 29,785 100.0 96.6 93.5 91.0 88.4 86.5 86.3

 < 0.75 mm 12,948 43.5 100.0 100.0 100.0 100.0 100.0 100.0

 0.75 - 1.49 mm 5,545 18.6 100.0 98.7 97.2 94.8 92.6 92.0

 1.50 - 2.49 mm 2,729 9.2 99.0 95.0 89.5 81.6 75.4 74.4

 2.50 - 3.99 mm 1,558 5.2 96.4 87.5 79.2 67.4 58.9 58.2

 4.00+ mm 1,633 5.5 90.0 73.9 62.8 54.0 46.9 45.9

 Unknown 5,372 18.0 84.8 78.3 75.0 71.8 69.2 68.2

Female 24,412 100.0 97.8 95.9 94.4 92.4 90.4 90.0

 < 0.75 mm 12,201 50.0 100.0 100.0 100.0 99.7 99.2 99.2

 0.75 - 1.49 mm 4,458 18.3 99.9 99.0 97.8 95.6 93.3 92.0

 1.50 - 2.49 mm 1,867 7.6 98.3 94.5 91.0 86.0 80.0 77.8

 2.50 - 3.99 mm 1,002 4.1 97.1 90.3 83.6 75.8 70.1 68.0

 4.00+ mm 965 4.0 93.1 79.9 70.5 61.3 51.2 49.9

 Unknown 3,919 16.1 89.2 84.7 82.7 79.7 77.8 77.2
Chapter 12 Melanoma

National Cancer Institute 97 SEER Survival Monograph 

Age, sex and race

Even though melanoma is rare among the black population, it is clear that black patients have a far poorer 

prognosis of melanoma than white patients (Table 12.2). 

This was true both overall, and separately for males and 

females. While white females experienced increasingly 

better survival rates than white males from 12 months 

all the way to 10 years beyond diagnosis, the same was 

not true for black females – black females experienced 

substantially better survival than black males up to 5 

years, but 8- and 10-year survival rates were similar in 

black males and females. 

Age-specific data were too sparse among blacks for meaningful analysis, but among whites (Table 12.3), the age 

distribution was younger for females (Table 12.3) and the 

relative survival rates were substantially worse among the 

older (particularly among those aged 80 years and over) 

than the younger (Figures 12.1 and 12.2). Older men 

had the poorest survival. For the younger age groups, 

there appeared to be more of a survival differential for 

females by age than males (Figures 12.1 (males) and 

12.2 (females)).

Figure 12.3: Melanoma (Among Whites): Relative Survival 

Rates (%) For Males by Tumor Thickness, Ages 20+, 

12 SEER Areas, 1988-2001

Figure 12.4: Melanoma (Among Whites): Relative Survival 

Rates (%) for Females by Tumor Thickness, Ages 20+, 

12 SEER Areas, 1988-2001

Table 12.6: Melanoma (Among Whites): Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by Sex and Histology, Ages 20+, 12 SEER Areas, 1988-2001

Sex/Histology (ICD-O code) Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Male 29,785 100.0 96.6 93.5 91.0 88.4 86.5 86.3

 Superficial Spreading (8743) 11,510 38.6 100.0 99.0 98.0 96.6 95.3 95.2

 Nodular (8721) 2,671 9.0 93.7 84.4 77.0 68.4 63.0 61.6

 Acral Lentiginous (8744) 242 0.8 98.8 91.9 87.8 75.7 67.9 61.5

 Other and Not Specified 1,185 4.0 94.9 88.7 83.7 80.5 79.5 78.2

 Malignant Melanoma, NOS (8720) 12,019 40.4 93.2 89.2 86.2 83.4 81.1 80.8

 Hutchinson’s Melanotic Freckle (8742) 2,158 7.2 100.0 100.0 100.0 100.0 100.0 100.0

Female 24,412 100.0 97.8 95.9 94.4 92.4 90.4 90.0

 Superficial Spreading (8743) 10,780 44.2 100.0 99.7 99.0 98.0 96.8 96.6

 Nodular (8721) 1,739 7.1 95.2 87.6 82.0 74.6 68.8 67.4

 Acral Lentiginous (8744) 302 1.2 99.4 96.1 93.5 89.1 79.1 79.1

 Other and Not Specified 794 3.3 94.5 90.2 84.9 83.3 81.4 77.7

 Malignant Melanoma, NOS (8720) 9,591 39.3 95.5 92.8 91.3 88.9 86.9 85.9

 Hutchinson’s Melanotic Freckle (8742) 1,206 4.9 100.0 100.0 100.0 99.4 96.1 95.5

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

< 0.75 mm

0.75 - 1.49 mm

1.50 - 2.49 mm

2.50 - 3.99 mm

4.00+ mm

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

< 0.75 mm

0.75 - 1.49 mm

1.50 - 2.49 mm

2.50 - 3.99 mm

4.00+ mm
Chapter 12 Melanoma

National Cancer Institute 98 SEER Survival Monograph 

Anatomic site

While the majority of melanomas occurred on the trunk 

and upper limbs, there were sufficient cases at all recorded 

anatomic sites to determine that the site-specific distribution and survival of melanoma differs substantially 

between males and females (Table 12.4). For males over 

40% of the melanomas were on the trunk contrasted to 

26% for females. For females, 32% were on the lower 

limb/hip contrasted to less than 10% for males. Overall 

the worst site-specific survival rate occurred for melanomas with an unspecified site, and among those of the 

scalp and neck. Melanomas occurring on the limbs and at 

overlapping sites had relatively better survival. Notable 

sex-specific differences in relative survival rates were 

seen for melanomas occurring on the ear, where males 

experienced better survival to 10 years than females, 

and the lower limbs, where females experienced better 

survival than males (relative to other sites).

Thickness of tumor

While a large proportion (18.0% for males and 16.1% for 

females) of cases had no reported thickness data (Table 

12.5), survival clearly worsened with increasing tumor 

thickness (Figure 12.3 and Figure 12.4). Thin lesions (less 

than 0.75 mm) experienced almost negligible mortality 

even at ten years, but thick lesions (4 mm and over) had a 

relative survival rate 46% for males and 50% for females 

by 10 years, and there was a clear ‘dose-response’ relation 

between thickness and survival, making lesion thickness 

easily the most predictive aspect of melanoma survival. 

This was true for both males and females, although males 

experienced worse survival for each thickness level. Survival for people with tumors of an unknown thickness 

paralleled survival experienced by the median lesion thickness (data not shown), indicating that the group with an 

unknown thickness did not differ substantially from the 

group with reported lesion thickness.

Histologic type

For both males and females, the majority of tumors were 

evenly divided between superficial spreading melanomas (SSM) and malignant melanomas with no further 

specified histology (MM), with small percentages of the 

other histologic types (Table 12.6). Survival rates for 

SSM were only slightly better in females than in males, 

whereas nodular (NM) tumors had a worse prognosis in 

males (Figures 12.5 and 12.6). Ten year relative survival 

rates under 65% were seen for males with NM or acral 

lentiginous melanomas. Ten year rates more than 95% 

were seen for superficial spreading and Hutchinson’s 

melanotic freckle (Figures 12.5 and 12.6).

Geographic location

Substantial differences appeared to exist between sexspecific survival rates across registries in the SEER program (Table 12.7). Hawaii experienced the highest overall 

survival for both males and females, and also appeared to 

have one of the smallest differences in survival between 

the sexes of any registry (Table 12.7). While relative 

survival rates were lower 5 years after diagnosis in Rural 

Georgia, this observation was based on very small numbers. 

Iowa had lower melanoma survival rates for males than 

most of the other registries, and the largest difference in 

survival rates between males and females.

Figure 12.5: Melanoma (Among Whites): Relative Survival 

Rates (%) for Males by Histology, Ages 20+, 12 SEER Areas, 

1988-2001

Figure 12.6: Melanoma (Among Whites): Relative Survival 

Rates (%) for Females by Histology, Ages 20+, 12 SEER 

Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Superficial Spreading (8743)

Nodular (8721)

Acral Lentiginous (8744)

Other and Not Specified

Malignant Melanoma, NOS (8720)

Hutchinsons Melanotic Freckle (8742) 0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Superficial Spreading (8743)

Nodular (8721)

Acral Lentiginous (8744)

Other and Not Specified

Malignant Melanoma, NOS (8720)

Hutchinsons Melanotic Freckle (8742)
Chapter 12 Melanoma

National Cancer Institute 99 SEER Survival Monograph 

Table 12.7: Melanoma (Among Whites): Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by SEER Geographic Area and Sex (Ages 20+), 12 SEER Areas, 1988-2001

Sex/SEER Geographic Area Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 54,197 100.0 97.2 94.6 92.6 90.2 88.4 88.1

Atlanta and Rural Georgia 4,394 8.1 97.8 96.2 94.6 92.6 91.0 90.3

 Atlanta (Metropolitan) - 1988+ 4,282 7.9 97.9 96.2 94.7 92.8 91.3 90.6

 Rural Georgia - 1988+ 112 0.2 95.9 93.9 89.3 84.0 79.4 76.5

California

 Los Angeles - 1992+ 7,496 13.8 96.5 93.0 90.5 87.6 84.9 84.0

 Greater Bay Area 9,483 17.5 97.5 94.9 92.7 90.2 87.5 86.6

 San Francisco-Oakland SMSA - 1988+ 6,147 11.3 97.6 95.1 92.9 90.3 88.2 87.5

 San Jose-Monterey - 1988+ 3,336 6.2 97.3 94.6 92.4 90.0 86.1 85.0

Connecticut - 1988+ 7,263 13.4 97.6 94.8 92.6 90.4 89.6 89.6

Detroit (Metropolitan) - 1988+ 5,644 10.4 97.3 95.0 93.1 91.0 89.2 88.8

Hawaii - 1988+ 1,381 2.5 98.2 96.2 95.2 94.8 94.5 94.5

Iowa - 1988+ 4,871 9.0 95.7 92.2 89.7 87.0 83.5 83.3

New Mexico - 1988+ 2,599 4.8 96.4 93.4 92.0 89.1 88.4 86.3

Seattle (Puget Sound) - 1988+ 7,755 14.3 97.9 96.1 94.3 92.4 90.9 90.7

Utah - 1988+ 3,311 6.1 96.3 94.0 92.0 89.3 87.3 86.4

Male 29,785 100.0 96.6 93.5 91.0 88.4 86.5 86.3

Atlanta and Rural Georgia 2,407 8.1 97.3 95.0 93.2 90.1 88.1 87.8

 Atlanta (Metropolitan) - 1988+ 2,351 7.9 97.3 95.1 93.2 90.3 88.1 87.9

 Rural Georgia - 1988+ 56 0.2 98.6 93.0 91.6 82.5 82.2 75.7

California

 Los Angeles - 1992+ 4,252 14.3 96.4 92.2 89.1 86.0 83.2 81.9

 Greater Bay Area 5,345 17.9 96.9 93.7 90.9 87.6 85.7 84.6

 San Francisco-Oakland SMSA - 1988+ 3,473 11.7 96.9 93.9 91.3 87.8 85.9 84.8

 San Jose-Monterey - 1988+ 1,872 6.3 97.0 93.4 90.0 87.4 84.9 84.5

Connecticut - 1988+ 3,984 13.4 97.4 94.3 91.6 89.9 89.4 89.4

Detroit (Metropolitan) - 1988+ 3,138 10.5 96.9 94.2 92.1 89.5 87.5 87.4

Hawaii - 1988+ 853 2.9 97.7 95.5 94.5 94.2 93.6 93.6

Iowa - 1988+ 2,516 8.4 94.9 90.6 87.5 83.7 79.6 79.2

New Mexico - 1988+ 1,456 4.9 95.6 91.2 89.7 86.5 86.0 84.6

Seattle (Puget Sound) - 1988+ 4,035 13.5 97.0 94.9 92.5 90.7 88.3 87.5

Utah - 1988+ 1,799 6.0 95.5 93.0 90.3 87.3 85.5 83.9

Female 24,412 100.0 97.8 95.9 94.4 92.4 90.4 90.0

Atlanta and Rural Georgia 1,987 8.1 98.4 97.5 96.2 95.5 93.9 92.9

 Atlanta (Metropolitan) - 1988+ 1,931 7.9 98.6 97.6 96.4 95.8 94.5 93.4

 Rural Georgia - 1988+ 56 0.2 93.1 93.1 85.6 84.5 74.2 74.2

California

 Los Angeles - 1992+ 3,244 13.3 96.7 94.0 92.2 89.5 86.7 85.7

 Greater Bay Area 4,138 17.0 98.2 96.5 95.1 93.4 89.6 88.9

 San Francisco-Oakland SMSA - 1988+ 2,674 11.0 98.4 96.7 95.0 93.5 90.9 90.7

 San Jose-Monterey - 1988+ 1,464 6.0 97.8 96.1 95.4 93.2 87.1 85.5

Connecticut - 1988+ 3,279 13.4 97.9 95.4 93.8 90.9 89.6 89.6

Detroit (Metropolitan) - 1988+ 2,506 10.3 97.8 96.0 94.4 92.7 91.2 90.2

Hawaii - 1988+ 528 2.2 98.8 97.2 96.3 95.0 95.0 95.0

Iowa - 1988+ 2,355 9.6 96.5 93.9 91.8 90.3 87.2 86.8

New Mexico - 1988+ 1,143 4.7 97.3 95.9 94.7 92.1 89.9 87.9

Seattle (Puget Sound) - 1988+ 3,720 15.2 98.9 97.4 96.2 94.1 93.4 93.3

Utah - 1988+ 1,512 6.2 97.2 95.3 94.0 91.5 89.2 88.9
Chapter 12 Melanoma

National Cancer Institute 100 SEER Survival Monograph 

Discussion

Clearly the factor most predictive of melanoma survival is 

thickness of the tumor at diagnosis, which reinforces the 

notion that there is much that can be achieved in preventing melanoma mortality, by early detection. However, 

we noted that the often observed survival differential that 

favors females over males also occurs within strata of tumor 

thickness. In addition, the melanomas among females were 

not as thick as those for males.

Melanoma among blacks, while rare, is a more lethal disease than it is among whites, and therefore deserves special 

attention and particularly more research into why blacks 

have lower survival rates. The only reports of melanoma 

survival among blacks come from case series (12) largely 

because melanoma among blacks is rare. We have identified sufficient cases of melanoma among blacks to be able 

to compare their survival to that of whites, and notice that 

blacks have far poorer melanoma survival than whites. This 

could be attributable to access to care, or could reflect the 

relative lack of knowledge of the risk of melanoma/skin 

cancer in black populations. Black populations may not be 

as carefully or regularly screened, and consequently may 

not benefit from improved survival due to early detection 

of lesions. One hint in future investigation of poor survival 

among blacks may come from the unusual observation that 

after 5 years there is no longer a survival difference between 

males and females, although the statistical significance of 

this finding needs to be established.

The only previous data presented on anatomical site-specific 

survival found as we have that survival varies with site in 

a manner similar to the incidence of melanoma (6). This 

observation is consistent with a ‘visible skin’ hypothesis 

(i.e. sun exposure is greater on visible skin areas, and 

visible skin is an easy place to detect lesions early), and 

argues again for a substantial role of early detection in 

improved survival. Overlapping lesions presumably have 

more favorable survival because they have spread outwards 

rather than downwards, and are therefore less invasive. We 

hypothesize that lesions of an unspecified anatomic site 

experience poor survival because they are discovered at an 

advanced stage when it is unclear where they started.

Similarly, the most vertically invasive histologic type (NM) 

has one of the poorest survival. However, the magnitude 

of the difference in survival between SSM and NM is substantial, and may provide further evidence that the two 

histologic types are quite separate disease processes. We 

present sufficient data on other forms of melanoma, Hutchinson’s melanotic freckle and acral lentiginous melanoma 

to estimate their survival relative to the more common 

NM and SSM, which had not been presented elsewhere, 

to our knowledge, due to the comparative rarity of their 

presentation.

Substantial geographic variation in melanoma survival 

exists, which probably reflects access to care (it does not 

reflect racial or sex differences in survival), socioeconomic 

status (which is certainly related to melanoma incidence but 

which we were unable to measure), availability of screening, 

or awareness of melanoma as a problem. We do not find 

much evidence that the areas most likely to have active skin 

screening programs in place, such as Los Angeles, have 

substantially better survival than the median.

References

1. MacKie, R.M., et al., Cutaneous malignant melanoma in 

Scotland: incidence, survival, and mortality, 1979-94. The 

Scottish Melanoma Group. Bmj., 1997. 315(7116): p. 1117-21.

2. Armstrong, B.K. and A. Kricker, Cutaneous melanoma. Cancer 

Surveys., 1994. 19-20: p. 219-40.

3. Koh, H.K., et al., Evaluation of the American Academy of 

Dermatology’s National Skin Cancer Early Detection and 

Screening Program. Journal of the American Academy of 

Dermatology, 1996. 34(6): p. 971-8.

4. Stenbeck, M., M. Rosen, and L.E. Holm, Cancer survival in 

Sweden during three decades, 1961-1991. Acta Oncologica., 

1995. 34(7): p. 881-91.

5. Masback, A., et al., Cutaneous malignant melanoma in southern 

Sweden 1965, 1975, and 1985. Prognostic factors and histologic 

correlations. Cancer., 1997. 79(2): p. 275-83.

6. Levi, F., et al., Prognostic factors for cutaneous malignant 

melanoma in Vaud, Switzerland. International Journal of Cancer., 

1998. 78(3): p. 315-9.

7. Parkin, D., et al., Cancer Incidence in Five Continents, Volume 

VI. Vol. 120. 1992, Lyon: IARC Scientific Publications.

8. Langholz, B., et al., Skin characteristics and risk of superficial 

spreading and nodular melanoma (United States). Cancer Causes 

& Control, 2000. 11(8): p. 741-50.

9. Thorn, M., et al., Trends in tumour characteristics and survival 

of malignant melanoma 1960-84: a population-based study in 

Sweden. British Journal of Cancer., 1994. 70(4): p. 743-8.

10. Bulliard, J.L., B. Cox, and J.M. Elwood, Comparison of the 

site distribution of melanoma in New Zealand and Canada. 

International Journal of Cancer, 1997. 72(2): p. 231-5.

11. Gordon, L.G., et al., Poor prognosis for malignant melanoma 

in Northern Ireland: a multivariate analysis. British Journal of 

Cancer., 1991. 63(2): p. 283-6.

12. Crowley, N.J., et al., Malignant melanoma in black Americans. 

A trend toward improved survival. Archives of Surgery., 1991. 

126(11): p. 1359-64; discussion 1365.
National Cancer Institute 101 SEER Survival Monograph 

Introduction 

This study presents survival analyses for female breast 

cancer based on 302,763 adult cases from the Surveillance, 

Epidemiology, and End Results (SEER) Program of the 

National Cancer Institute (NCI). This chapter focuses on 

the influence of extent of disease (extension of tumor, size, 

nodal involvement, number of nodes involved), histology, 

histologic grade, receptor status, and demographic factors 

on female breast cancer survival.

Materials and Methods

The NCI contracts with medically oriented nonprofit institutions -- such as universities and state health departments 

-- to obtain data on all cancers diagnosed in residents of 

the SEER geographic areas except basal cell and squamous 

cell carcinomas of the skin and in situ cervical cancer.

SEER selects areas on the basis of their ability to operate 

and maintain a population-based cancer reporting system 

and the epidemiologic significance of their population subgroups. The analysis in this article is from 12 geographic 

areas representing approximately 14% of the United States 

population. The geographic areas include the States of 

Connecticut, Iowa, New Mexico, Utah, and Hawaii; the 

metropolitan areas of Detroit, Atlanta, San Francisco, San 

Jose, Los Angeles, and Seattle; Alaska Natives; and ten 

counties in rural Georgia. All registries contributed data 

for diagnosis years 1988-2001 except Los Angeles, which 

contributed data for 1992-2001.

Each registry is responsible for abstracting the records 

of all cancer patients who reside in the given area. To 

ensure maximal ascertainment of cancer cases, registries 

seek records from hospitals, laboratories, and all other 

health service units that provide diagnostic services. Data 

collected on each patient include patient demographics, 

primary tumor site, morphology, diagnostic methods, extent 

of disease, and first course of cancer-directed therapy. A 

separate record is coded for each primary cancer. With 

the exception of cases of in situ carcinoma of the uterine 

cervix, all patients are followed from diagnosis to death, 

allowing for detailed survival analysis.

SEER has collected extent-of-disease (EOD) information 

on all cancers since the inception of the program. The 

detail and amount of information collected, however, have 

varied over time. In 1988, there were some minor reviTable 13.1: Cancer of the Female Breast: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number Excluded Reason for Exclusion/selection

365,042 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

309,467 55,575 Select first primary only

307,746 1,721 Exclude death certificate only or at autopsy

305,757 1,989 Exclude unknown race

305,483 274 Active follow-up and exclude alive with no survival time

305,455 28 Exclude children (Ages 0-19)

303,045 2,410 Exclude no or unknown microscopic confirmation

302,763 282 Exclude sarcomas

Lynn A. Gloeckler Ries and Milton P. Eisner

Chapter 13

Cancer of the Female Breast
Chapter 13 Cancer of the Female Breast

National Cancer Institute 102 SEER Survival Monograph 

sions to the breast cancer EOD scheme so that SEER 

EOD information could be easily converted into the TNM 

staging classifications based on the third edition of the 

American Joint Committee on Cancer (AJCC) Manual 

for Staging of Cancer (1). (The AJCC TNM schemes are 

the same as those published by the International Union 

Against Cancer.) 

The term localized refers to tumors that are confined to 

breast tissue only. Regional refers to tumors that have 

metastasized to the regional lymph nodes or have extended 

directly from the breast to the pectoral fascia, subcutaneous 

tissue, chest wall, ribs, or skin (peau d’orange, satellite 

nodules, etc.). Distant refers to distant metastases or 

further direct extension.

Analysis

The survival analysis was based on 5-year relative survival 

rates calculated by the life-table method. The relative 

survival rate was used to estimate the effect of cancer on 

the survival of the cohort. Relative survival is observed 

survival divided by survival that would be expected in 

the absence of cancer; thus, relative survival adjusts for 

the normal mortality that the cohort would experience 

from other causes of death. When relative survival is 

100%, a patient cohort has the same chance to live 5 

more years as a cancer-free cohort based on the same 

age, race, and sex.

Exclusions

The following were excluded from the analysis: male 

breast cancers, cases in which the breast cancer was not 

the first primary, cases identified through autopsy and 

death certificate only, cases with unknown race, cases with 

unknown survival time, cases where the age at diagnosis 

was less than 20, cases with no microscopic confirmation, 

and sarcomas. After exclusions, 302,763 adult female 

breast cancers diagnosed from 1988 to 2001 were available for analysis (Table 13.1). Of these 44,875 (14.8%) 

were in situ and 257,888 (85.2%) were malignant. Note 

that 45,033 cases were Stage 0 which includes in situ plus 

Paget disease of the nipple with no underlying tumor.

Results

This analysis is based on prognostic factors for breast 

cancer, with an emphasis on extent of disease at diagnosis 

especially the role of tumor size, extension of the primary 

tumor, and lymph node status. Survival rates were also 

calculated by demographic characteristics such as age 

and race (white, black). In most tables, each prognostic 

factor is presented both individually and in relation to a 

second factor. 

Stage

As expected, survival rates varied by stage (Table 13.2). 

For patients of all ages, patients diagnosed in stages 0 and 

I had a 100% 5-year relative survival rate. The five-year 

relative survival rate for stage II was 86%; for stage III, 

Table 13.2: Cancer of the Female Breast: Number of Cases and 5-Year Relative Survival Rates (RSR) (%) by Age (20+) and AJCC 

Stage (3rd edition), 12 SEER Areas, 1988-2001

Age 

(Years)

AJCC Stage

Total 0 I II III IV Unknown

Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%)

Total 302,763 89.3 45,033 100.0 108,346 100.0 91,989 86.2 16,928 57.2 11,222 19.9 29,245 83.4

20-34 6,802 77.8 563 98.7 1,565 94.5 3,042 77.6 649 50.5 291 17.5 692 74.4

35-39 12,827 83.5 1,665 99.7 3,343 95.1 5,231 82.1 1,021 55.8 384 19.4 1,183 79.4

40-44 24,914 88.0 4,615 99.9 7,127 97.0 8,790 86.3 1,667 59.4 683 25.8 2,032 83.0

45-49 33,784 89.5 6,382 100.0 10,400 97.6 11,427 87.8 2,132 62.6 968 25.4 2,475 85.2

50-54 34,868 89.5 6,462 100.0 12,023 98.3 10,857 86.7 1,943 59.2 1,147 20.5 2,436 85.4

55-59 32,701 89.6 5,496 100.0 12,029 99.0 9,920 87.5 1,636 57.5 1,234 19.5 2,386 84.6

60-64 32,680 90.1 4,930 100.0 12,949 100.0 9,306 86.7 1,587 57.3 1,308 18.9 2,600 86.3

65-69 34,435 91.0 4,986 100.0 14,194 100.0 9,404 87.8 1,542 57.6 1,374 20.3 2,935 84.6

70-74 32,686 91.8 4,363 100.0 13,731 100.0 8,697 87.2 1,408 57.8 1,299 17.7 3,188 86.9

75-79 27,134 91.4 3,141 100.0 11,101 100.0 7,295 86.2 1,335 54.8 1,147 15.6 3,115 82.4

80-84 17,475 90.7 1,683 100.0 6,461 100.0 4,684 87.0 999 52.5 792 20.7 2,856 77.6

85+ 12,457 86.6 747 100.0 3,423 100.0 3,336 83.9 1,009 41.5 595 14.8 3,347 78.9
Chapter 13 Cancer of the Female Breast

National Cancer Institute 103 SEER Survival Monograph 

57%. For stage IV, the relative survival rate was poor: 

20%. The 5-year relative survival rate for unknown stage 

was just below that for stage II.

Stage at diagnosis and age at diagnosis

For all stages combined, the survival rates increased by 

age group from 78% for 20-34 to 92% for 70-74 and 

then decreased to 87% for 85 years and over. For stage 

I, relative survival increased with age, approaching 100% 

for those aged 60 and older. For Stage III, survival rates 

ranged from 41 to 63% with the youngest and oldest age 

groups experiencing the worst survival rates. Stage IV 

cases had the worst survival for each age group (Table 

13.2).

Stage and race

The overall 5-year relative survival rates were 90% for 

whites and 78% for blacks (Table 13.3). The fact that black 

women had a less favorable stage distribution than white 

women does not fully explain the survival differential, 

since even within each stage grouping except Stage 0, 

blacks had poorer survival. “All Races” category includes 

22,397 cases that are races other than white or black.

Stage and Grade (Adenocarcinoma)

For adenocarcinomas, 5-year relative survival rates decreased by stage at diagnosis as expected (Table 13.4). 

Patients diagnosed with stage I cancer had a 5-year relative 

survival rate of 100%; those diagnosed with stage IV had 

a rate of 21%. Histologic grade was also a predictor of 

outcome except for grades 3 and 4; survival was highest 

for grade 1 and lowest for grade 3 or 4 and intermediary for grade 2. Survival ranged from 100% for grade 1 

stage I down to 14% for grade 4 stage IV. In stages II-IV, 

histologic grade played an important prognostic role.

Stage and Histology

Table 13.5 contains a similar breakdown by stage and histology. The highest relative survival rates were for tubular 

and adenoid cystic adenocarcinomas (100%) and the lowest was for inflammatory carcinoma (34%). Even within 

stage IV disease, there were wide variations in survival by 

histology from 11% for inflammatory to 34% mucinous 

adenocarcinoma or papillary adenocarcinoma.

Size and Stage

The effect of tumor diameter (size) on survival is shown 

for all stages in Table 13.6. Size is categorized by 5-mm 

groups. The size groupings were chosen so that the middle 

size in each group was 0.5, 1.0, 1.5, 2.0, 2.5,..., 9.5 cm, 

respectively; the sizes most frequently cited in the hospital medical record. Five-year relative survival rates 

ranged from 100% for <8 mm tumors to 34% for diffuse 

tumors.

Due to the interrelationship of tumor size and extent of 

disease, results are given by size category for different 

extension groups: tumors localized to the breast, those 

regional by nodes, those regional by extension (peau 

d’orange, pectoral fascia, chest wall, extensive skin involvement, etc.), those with distant metastasis, and those 

with unknown extension. 

Within each extension category, tumor size played an 

important prognostic role (Table 13.6). Patients with small 

tumors and either regional nodal involvement or direct 

extension of the tumor survived as well or better than 

those with large tumors confined to the breast. It should 

be noted, however, that there was a relationship between 

size and extension of the tumor. Tumors confined to the 

breast were smaller in general than tumors with distant 

metastases. For example, 59.5% of the localized tumors 

measured 17 mm or less compared to less than 7% for 

those with distant metastases. For those with distant 

disease 39% had tumors that measured over 57 mm or 

were diffuse (Table 13.7).

Table 13.3: Cancer of the Female Breast: Number of Cases and 5-Year Relative Survival Rates (RSR) (%) by Race and AJCC Stage 

(3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Race

AJCC Stage

Total 0 I II III IV Unknown

Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%)

All Races 302,763 89.3 45,033 100.0 108,346 100.0 91,989 86.2 16,928 57.2 11,222 19.9 29,245 83.4

White 254,919 90.4 37,397 100.0 94,023 100.0 76,296 87.1 13,467 60.0 8,970 21.2 24,766 84.8

Black 25,467 78.4 3,782 100.0 6,448 97.5 8,564 78.5 2,270 40.1 1,532 12.6 2,871 71.7

“Total” category includes 22,377 cases that are neither white nor black.
Chapter 13 Cancer of the Female Breast

National Cancer Institute 104 SEER Survival Monograph 

Table 13.5: Cancer of the Female Breast (Non Stage 0): Number of Cases and 5-Year Relative Survival Rates (%) by Histology and 

AJCC Stage (3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Histology

AJCC Stage 

Total I II III IV Unknown

Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%)

Total 257,730 87.1 108,346 100.0 91,989 86.2 16,928 57.2 11,222 19.9 29,245 83.4

Adeno, NOS 5,559 62.2 1,137 99.0 1,341 81.4 453 49.4 1,460 15.3 1,168 64.9

Tubular adeno 3,771 100.0 2,939 100.0 286 95.8 13 ~ 8 ~ 525 99.7

Infiltrating duct 183,122 87.5 79,900 100.0 68,437 85.1 10,597 57.5 6,493 20.3 17,695 83.6

Scirrhous adeno 456 81.7 172 94.3 188 83.9 16 ~ 30 13.5 50 71.7

Mucinous adeno 6,476 98.3 3,643 100.0 1,665 94.8 176 75.0 120 33.8 872 95.7

Comedo 5,020 89.9 2,218 99.3 1,653 82.7 223 51.3 82 19.4 844 96.0

Lobular 20,140 91.6 7,640 100.0 7,594 93.0 1,600 72.6 921 30.5 2,385 87.9

Infiltrating duct & lobular 16,060 92.9 6,801 100.0 6,564 91.4 1,013 69.8 375 29.0 1,307 89.5

Inflammatory carcinoma 2,668 34.1 <5 ~ 25 49.5 2,003 40.9 570 11.2 67 21.6

Paget 1,937 82.6 498 95.8 524 77.7 193 46.3 66 14.3 656 93.0

Papillary adeno 1,646 94.5 741 100.0 463 92.3 67 85.7 43 34.2 332 92.6

Adenoid cystic/

cribriform 712 100.0 409 100.0 177 95.3 14 ~ 6 ~ 106 96.3

Other adeno 4,261 89.1 1,494 98.7 2,077 88.8 208 57.7 96 21.2 386 84.6

Medullary 3,122 89.5 1,037 98.2 1,703 88.8 131 63.2 33 29.6 218 75.1

Other Non-adeno 5,785 64.8 699 99.2 945 80.1 348 42.4 952 13.8 2,841 70.1

Excludes 45,033 stage 0 cases.

~ Statistic not displayed due to less than 25 cases.

NOS: Not Otherwise Specified; adeno: adenocarcinoma

Table 13.4: Adenocarcinoma of the Female Breast (Non Stage 0): Number of Cases and 5-Year Relative Survival Rates (%) by 

Histologic Grade and AJCC Stage (3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Grade

AJCC Stage

Total I II III IV Unknown

Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%)

Total 251,828 87.6 107,595 100.0 90,994 86.3 16,576 57.5 10,270 20.5 26,393 84.9

1 32,620 100.0 21,588 100.0 7,173 98.7 599 79.4 325 31.1 2,935 97.6

2 80,761 93.2 38,784 100.0 29,435 91.4 3,956 69.3 2,110 26.9 6,476 89.3

3 74,165 77.6 22,096 96.8 34,322 79.6 8,028 50.9 3,947 17.1 5,772 71.7

4 5,946 78.6 1,888 98.2 2,545 80.2 667 53.8 329 13.8 517 72.3

Unknown 58,336 87.1 23,239 100.0 17,519 87.5 3,326 57.2 3,559 20.2 10,693 86.6

Excludes 45,033 stage 0 cases and 5,902 non-adenocarcinomas not in stage 0.

Adenocarcinoma defined as histologies 8050,8140-8147,8160-8162,8180,8190-8191,8200-8202,8204,8210-8215,8220-8221,8250-8255,8260-8264,8270-8272,8280-

8281,8290,8300,8310-8325,8330-8337,8340-8347,8350,8360-8361,8370-8375,8380-8384,8390-8392,8400-8410,8413,8420,8430,8440-8444,8450-8454,8460-8463,8470-

8473,8480-8482,8490,8500-8506,8510,8520-8525,8530,8540-8543,8550,8560,8570-8574,8576,8940-8941.

Extension of tumor and nodal involvement

The SEER data allow for the extension categories presented 

in Tables 13.6 and 13.7 to be evaluated in greater detail. 

The localized extension category is limited to those tumors 

confined to breast tissue. Regional by direct extension cases 

can be further divided into those involving subcutaneous 

tissue, those involving the pectoral fascia, those involving 

the chest wall, ribs, and muscles versus those with extensive 

skin involvement (skin edema, peau d’orange, ulceration 

of the skin of breast, satellite nodules in skin, etc.). The 

AJCC (5th edition) T-categories of T1-T3a include tumors 

confined to breast tissue, those involving subcutaneous tissue and those involving the pectoral fascia and the specific 

T-category is assigned based on the size of tumor. Table 
Chapter 13 Cancer of the Female Breast

National Cancer Institute 105 SEER Survival Monograph 

Table 13.6: Malignant Cancer of the Female Breast: Number of Cases and 5-Year Relative Survival Rates (%) by Tumor Size 

(mm) and Extension, Ages 20+, 12 SEER Areas, 1988-2001

Tumor Size (mm)

Extension

Total Localized Regional by 

Nodes

Regional by 

Extension

Distant Unknown

Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%)

All sizes 257,888 87.1 160,105 97.4 64,224 82.3 14,075 64.7 14,359 24.4 5,125 62.9

Micro focus 4,439 98.9 4,016 100.0 332 88.2 59 74.9 20 ~ 12 ~

Mammography only 944 97.9 842 99.9 77 81.1 13 ~ <5 ~ 8 ~

3-7 21,231 100.0 19,261 100.0 1,635 94.8 166 88.9 102 30.3 67 93.8

8-12 47,548 99.8 39,561 100.0 6,879 94.3 624 87.3 349 34.7 135 84.3

13-17 43,576 95.8 31,659 98.9 10,202 91.0 1,046 86.9 509 29.2 160 80.2

18-22 37,530 90.3 23,347 95.2 11,728 86.4 1,497 78.2 766 32.6 192 60.2

23-27 22,163 85.9 11,985 92.1 8,177 83.1 1,284 75.1 622 29.6 95 65.5

28-32 17,160 78.9 8,220 89.4 6,605 75.8 1,355 67.3 822 23.5 158 52.2

33-37 7,791 76.0 3,318 87.2 3,321 73.0 763 64.4 353 26.5 36 49.3

38-42 8,346 71.5 3,212 83.3 3,394 72.7 973 61.2 664 24.7 103 47.4

43-47 3,397 69.7 1,168 84.0 1,492 69.5 493 54.4 223 27.5 21 ~

48-52 5,303 65.9 1,615 83.4 2,160 68.1 829 55.9 621 24.1 78 57.9

53-57 1,638 67.6 481 87.2 701 67.5 320 54.6 131 25.2 5 ~

58-62 3,221 60.7 788 82.8 1,249 64.9 656 54.8 468 20.2 60 55.5

63-67 875 60.9 214 86.2 373 58.4 187 50.3 96 32.4 5 ~

68-72 1,953 57.5 431 86.0 703 64.5 432 47.3 349 19.6 38 48.6

73-77 484 61.4 108 88.9 197 65.8 113 46.0 63 23.2 <5 ~

78-82 1,675 51.8 308 83.4 519 63.5 429 49.7 385 13.7 34 32.2

83-87 272 62.6 56 82.4 90 71.9 72 60.1 53 25.9 <5 ~

88-92 760 55.5 141 81.9 237 71.2 205 48.5 167 20.6 10 ~

93-97 164 51.1 33 90.3 43 51.2 55 51.6 33 3.9 0 ~

>97 2,510 45.2 378 79.1 516 64.8 760 48.4 806 15.1 50 26.4

Diffuse 3,686 34.1 67 79.3 109 63.4 311 45.7 3,174 30.7 25 37.5

Unknown 21,222 72.7 8,896 96.9 3,485 79.2 1,433 55.6 3,579 18.2 3,829 63.0

Excludes 44,875 in situ cases.

Unknown size category includes Paget disease of the nipple with no demonstrable tumor.

~ Statistic not displayed due to less than 25 cases.

13.8 shows that patients with tumors confined to the breast 

survived better at 5 years than patients whose tumor had 

invaded the subcutaneous tissue or the pectoral fascia (93% 

vs. 72% to 69%). Invasion of the subcutaneous tissue and 

involvement of the pectoral fascia had similar 5-year survival 

rates. Within stage IIIB (AJCC/UICC staging classification, 

5th edition) and with regional by direct extension (LRD 

staging classification), extensive skin involvement had a 

less favorable outcome than involvement of the chest wall, 

ribs, etc. For each extension category, involvement of the 

lymph nodes still remained a predictor of survival. Even 

for cases with distant metastases, 5-year survival ranged 

from 32% when regional lymph nodes are negative to only 

12% when distant lymph nodes were involved.

Size of tumor and nodal involvement

In data from 1988-2001, the size of the tumor has first 

been taken from the pathology report and then from radiology reports if there was no path or no size information 

on path. If there was no size given on either report, the 

clinical size was used. Figure 13.1 shows the relationship 

of tumor size to the percentage of women who have lymph 

node involvement. The curve shown on the graph shows 

the logistic regression fit. The size of the primary tumor 
Chapter 13 Cancer of the Female Breast

National Cancer Institute 106 SEER Survival Monograph 

correlated with the percentage of women who had lymph 

node involvement in that the larger the tumor the higher 

the percentage of cases with lymph node involvement. 

While few women with very small tumors had lymph 

node involvement, over 60% of women with tumors over 

54 mm had regional lymph nodes involved at the time 

of diagnosis. Five-year relative survival rates were high 

for women with small tumors and positive lymph nodes; 

they were lower for women with large tumors and positive 

lymph nodes. Survival rates decreased as size of tumor 

increased even when nodal involvement is divided into 

no positive lymph nodes, 1-3 lymph nodes positive, and 

4 or more lymph nodes positive (Figure 13.2, Table 13.9). 

There were few cases with 4 or more nodes involved that 

had small tumors; therefore, the survival rate is not shown 

for the smallest size categories. This is consistent with 

the data from Table 13.7, which show that only a small 

proportion of women with regional lymph nodes involved 

had tumors less than 8 mm in diameter.

Receptor Status

Information on estrogen receptor (ER) and progesterone 

receptor (PR) status has been collected since 1990. Table 

13.10 shows the 3-year relative survival rates by estrogen 

receptor status (ER) and progesterone receptor status (PR). 

ER positive tumors had better relative survival rates than 

Table 13.7: Malignant Cancer of the Female Breast: Tumor Size (mm) Distribution by Extension, Ages 20+, 12 SEER Areas, 1988-

2001

Tumor Size (mm)

Extension

Total Localized Regional by 

Nodes

Regional by 

Extension

Distant Unknown

Cases % Cases % Cases % Cases % Cases % Cases %

All sizes 257,888 100.0 160,105 100.0 64,224 100.0 14,075 100.0 14,359 100.0 5,125 100.0

Micro focus 4,439 1.7 4,016 2.5 332 0.5 59 0.4 20 0.1 12 0.2

Mammography 

only 944 0.4 842 0.5 77 0.1 13 0.1 <5 0.0 8 0.2

3-7 21,231 8.2 19,261 12.0 1,635 2.5 166 1.2 102 0.7 67 1.3

8-12 47,548 18.4 39,561 24.7 6,879 10.7 624 4.4 349 2.4 135 2.6

13-17 43,576 16.9 31,659 19.8 10,202 15.9 1,046 7.4 509 3.5 160 3.1

18-22 37,530 14.6 23,347 14.6 11,728 18.3 1,497 10.6 766 5.3 192 3.7

23-27 22,163 8.6 11,985 7.5 8,177 12.7 1,284 9.1 622 4.3 95 1.9

28-32 17,160 6.7 8,220 5.1 6,605 10.3 1,355 9.6 822 5.7 158 3.1

33-37 7,791 3.0 3,318 2.1 3,321 5.2 763 5.4 353 2.5 36 0.7

38-42 8,346 3.2 3,212 2.0 3,394 5.3 973 6.9 664 4.6 103 2.0

43-47 3,397 1.3 1,168 0.7 1,492 2.3 493 3.5 223 1.6 21 0.4

48-52 5,303 2.1 1,615 1.0 2,160 3.4 829 5.9 621 4.3 78 1.5

53-57 1,638 0.6 481 0.3 701 1.1 320 2.3 131 0.9 5 0.1

58-62 3,221 1.2 788 0.5 1,249 1.9 656 4.7 468 3.3 60 1.2

63-67 875 0.3 214 0.1 373 0.6 187 1.3 96 0.7 5 0.1

68-72 1,953 0.8 431 0.3 703 1.1 432 3.1 349 2.4 38 0.7

73-77 484 0.2 108 0.1 197 0.3 113 0.8 63 0.4 <5 0.1

78-82 1,675 0.6 308 0.2 519 0.8 429 3.0 385 2.7 34 0.7

83-87 272 0.1 56 0.0 90 0.1 72 0.5 53 0.4 <5 0.0

88-92 760 0.3 141 0.1 237 0.4 205 1.5 167 1.2 10 0.2

93-97 164 0.1 33 0.0 43 0.1 55 0.4 33 0.2 0 0.0

>97 2,510 1.0 378 0.2 516 0.8 760 5.4 806 5.6 50 1.0

Diffuse 3,686 1.4 67 0.0 109 0.2 311 2.2 3,174 22.1 25 0.5

Unknown 21,222 8.2 8,896 5.6 3,485 5.4 1,433 10.2 3,579 24.9 3,829 74.7

Excludes 44,875 in situ cases.

Unknown size category includes Paget disease of the nipple with no demonstrable tumor.
Chapter 13 Cancer of the Female Breast

National Cancer Institute 107 SEER Survival Monograph 

ER negative for each PR group. Women with ER+ and 

PR+ had a 97% 3-year relative survival rate compared 

with only 83% for women with PR- and ER-.

Table 13.11 shows the 3-year relative survival rates by 

ER status, historic stage, and age. Within each stage, ER 

status is an important prognostic variable. Even within 

distant stage, the 5 year relative survival rate was 28% 

for ER negative but much higher, 50% for ER positive 

women. Younger women have a higher percentage of cases 

that are ER negative than older women. This contributes 

towards the younger women having poorer survival than 

older women.

 Laterality and Tumor Location

Table 13.12 shows the relationship between relative survival rates with respect to left or right breast and location 

within the breast. Laterality, left or right side, did not 

have any noticeable effect on survival. It should be noted 

that left or right designates the side where the tumor 

originated. The location of the tumor within the breast 

did not seem to be of prognostic value except when it 

was not specified.

Discussion

While breast cancer survival rates overall are generally 

good, they vary by patient and tumor characteristics. Although stage has a large impact on survival, other factors 

such as tumor size, histology, ER status, PR status, grade, 

age, race, and number of positive nodes also played a role 

in prognosis. Some of these results expand on an earlier 

analysis performed on earlier SEER data (2).

Breast cancer is the number one cancer among U.S. women 

and it is expected that 212,920 women will be diagnosed 

with breast cancer in 2006 (3). Although breast cancer is 

a major disease in the US for women, its survival rates are 

better overall than those for many other types of cancer 

(4). The 5-year relative survival rate for localized invasive disease (all tumor sizes combined) was 97%. For 

patients diagnosed in stage I (tumor size < 20 mm), the 

5-year relative survival rate was 100%. Some groups, 

however, especially young women, had a less favorable 

outcome. For women diagnosed in stage I, those 20-34 

years of age had a 94% 5-year relative survival rate, 

compared to 100% for those over age 60. Differences 

by age are even greater for stage II patients.

Table 13.8: Malignant Cancer of the Female Breast: Number of Cases and 5-Year Relative Survival Rates (%) by Tumor 

Extension and Lymph Node Status, Ages 20+, 12 SEER Areas, or 13 1988-2001

Extension

Nodes Involved

Total Negative 

Regional

Positive 

Regional

Fixed 

Regional

Distant Unknown

Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%)

Total 257,888 87.1 154,918 97.2 73,153 77.5 5,009 55.2 1,719 22.9 23,089 61.4

Confined to breast 223,777 93.0 149,125 98.2 60,249 83.3 3,088 68.2 335 48.0 10,980 86.7

Subcutaneous tissue 7,481 71.7 2,320 87.7 4,036 68.5 317 51.5 47 26.5 761 51.2

Pectoral fascia 1,916 69.2 724 84.7 899 62.0 95 49.4 16 ~ 182 61.5

Chest wall, ribs, muscles 897 62.2 289 79.8 371 56.6 63 30.7 12 ~ 162 56.6

Extensive skin involvement 3,994 47.3 777 66.7 1,946 48.8 411 35.1 138 14.8 722 37.0

Inflammatory 3,173 39.9 343 60.5 1,603 41.6 269 34.7 131 19.3 827 34.0

Distant metastasis 10,500 18.7 1,038 32.3 3,247 21.2 681 17.0 902 12.3 4,632 15.5

Unknown 6,150 62.7 302 77.4 802 67.4 85 49.9 138 35.2 4,823 62.0

Excludes 44,875 in situ cases.

~Statistic not displayed due to less than 25 cases.

Figure 13.1: Cancer of the Female Breast: Existence of Positive 

Nodes by Tumor Size, 12 SEER Areas, 1988-2001 

100

80

s 60

ve Node 40

with Positiv 20 Percent w

Logistic regression curve

P20 656107594  .

. . y e x  

656107594

1 8 336998433 0 1005638804

0

3 7 11 15 19 23 27 31 35 39 43 47 51 55 59 63 67 71 75 79 83 87 91 95 99

Tumor Size (mm)
Chapter 13 Cancer of the Female Breast

National Cancer Institute 108 SEER Survival Monograph 

Relative survival, like the name implies, is relative to the 

general population. When relative survival is 100%, the 

correct interpretation is that the cohort of patients has the 

same chance to live 5 more years as cancer-free persons of 

the same age and sex. This does not mean that no woman 

will die of breast cancer but rather that they may be under 

better medical surveillance than the general population and 

that their excess risk of breast cancer deaths is offset by their 

lower excess risk of dying from other non-cancer causes.

Even though relative survival rates increased with age at 

diagnosis until age 70, then decreased for the oldest age 

groups (Table 13.2), the survival differences by age were 

not due to differences in the stage distribution. Except for 

older patients having a higher proportion of unstaged disease, the stage distribution was similar for all age groups. 

Also, understaging of disease probably occurred with greater 

frequency among older patients, since many older patients 

did not have axillary node dissections. Since the relative 

survival rate adjusts for other causes of death, the differences in survival rates by age should not be attributed to 

the older patients dying from causes other than cancer at 

a higher rate than the younger cohorts. While for most 

other cancer sites, relative survival rates decreased with 

increasing age, this was not true of breast cancer except 

for the oldest age group.

There was a correlation between tumor size and percentage 

of women with positive lymph nodes (Figure 13.1). The 

survival rates generally decreased as the tumor size and 

the number of lymph nodes involved increased (Figure 

13.2).

These data show that the evaluation of regional and distant 

lymph nodes should not be ignored when a patient has distant 

metastases. For patients with distant metastases, involvement of lymph nodes still plays an important prognostic 

role (Table 13.8). Those with no lymph node involvement 

have a 5-year relative survival rate of 32%; in contrast, the 

corresponding rate was 12% for those with distant lymph 

nodes involved.

While this analysis shows the value of the TNM system of 

staging, both tumor size and extent of disease influence the 

survival rates. Figure 13.3 shows the survival curves by the 

T, N, and M components of AJCC stage, 5th edition. Even 

though T1 (< 20 mm) N0 M0 has a distinct survival curve 

from T2 (20-50 mm) N0 M0, which in turn has a distinct 

survival curve from T3 (> 50 mm) N0 M0, other size groupings would also have produced distinct survival curves. 

The size groupings in any staging scheme are artificial and 

a matter of convenience. As shown (Table 13.6), survival 

rates vary by small changes in the tumor size. This points 

out that there was significant variation in survival within 

each TNM size category. Similarly, this chapter also points 

out that within extension (of tumor) groupings in TNM or 

within N1, there are survival variations when these groups 

are further subdivided by how far the tumor has extended 

(Table 13.8) or by the number of lymph nodes involved 

(Table 13.9), respectively. 

Based on a large cohort, the probability of lymph node 

involvement directly correlates with the size of the primary 

tumor. Further, there is a survival relationship among tumor size, extension of tumor, and number of lymph nodes 

involved. 

Figure 13.2: Cancer of the Female Breast: 5-Year Relative 

Survival Rate (%) by Tumor Size & Number of Nodes, Ages 20+, 

12 SEER Areas, 1988-2001

Figure 13.3: Cancer of the Female Breast: Relative Survival 

Rates (%) of Breast Cancer by Combinations of T, N, and M, 

Ages 20+, 12 SEER Areas, 1988-2001

100

%)

80

al Rate (

60

ve Surviva

40

yr Relativ

20

5-

0

<5 5-9 10-14 20-29 30-39 40-49 50-99 100+

Tumor Size (mm) Tumor Size (mm)

Negative 1-3 Pos 4+ Pos

100

80

%)

T1N0M0

T2N0M0

T3N0M0

60

al Rate (

%

T2N1M0

T3N1M0

T123N2M0

40

ve Surviv

T4M0

M1

20

-yr Relativ

0

5

0 1 2 3 4 5

Years after Diagnosis
Chapter 13 Cancer of the Female Breast

National Cancer Institute 109 SEER Survival Monograph 

REFERENCES

1. Beahrs, OH, Henson DE, Hutter RVP, Myers MH (eds). AJCC 

Cancer Staging Manual, Third edition. American Joint Committee 

on Cancer. Philadelphia: Lippincott, 1988.

2. Ries LAG, Henson DE, Harras A. Survival from breast cancer 

according to tumor size and nodal status. Surg Oncol Clin N Am 

1994;3:35-53. 

3. American Cancer Society. Cancer Facts and Figures 2006. 

Atlanta: American Cancer Society, 2006.

4. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer 

EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, 

Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

submission, posted to the SEER web site, 2006.

Table 13.10: Malignant Cancer of the Female Breast: Number of Cases and 3-Year Relative Survival Rates (%) by Progesterone 

Receptor (PR) and Estrogen Receptor (ER) Status, Ages 20+, 12 SEER Areas, 1990-2001

PR Status

ER Status

Total Positive Negative Other/Unknown

Cases

3-Year 

Relative 

Survival 

Rate (%) Cases

3-Year 

Relative 

Survival 

Rate (%) Cases

3-Year 

Relative 

Survival 

Rate (%) Cases

3-Year 

Relative 

Survival 

Rate (%)

Total (1990+) 230,922 92.1 140,857 96.4 43,030 83.6 47,035 87.2

Positive 118,718 96.6 112,352 97.1 5,618 88.5 748 90.7

Negative 59,375 86.5 22,623 92.7 36,204 82.9 548 83.1

Other/Unknown 52,829 88.2 5,882 96.8 1,208 83.2 45,739 87.2

Table 13.9: Cancer of the Female Breast : Number of Cases and 5-Year Relative Survival Rates (%) by Tumor Size (mm) and Regional 

Lymph Nodes Involved, Ages 20+, 12 SEER Areas, 1988-2001

Tumor Size (mm)

Nodes Involved

Total 0 Nodes 1-3 Nodes 4+ Nodes Unknown Number

Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%)

Total 302,763 89.3 148,192 98.8 43,418 86.8 26,923 65.5 84,230 81.2

1-4 21,530 100.0 9,721 100.0 563 89.9 197 76.6 11,049 100.0

5-9 37,075 100.0 23,816 100.0 2,261 98.1 541 81.1 10,457 100.0

10-19 93,875 97.2 58,654 100.0 14,035 94.5 4,475 80.1 16,711 91.8

20-29 54,610 88.0 27,139 95.4 12,194 87.9 6,440 72.7 8,837 75.7

30-39 23,880 78.1 9,497 91.0 5,704 79.0 4,412 63.8 4,267 61.3

40-49 11,786 72.1 3,866 88.2 2,692 76.0 2,753 60.2 2,475 54.2

50-99 17,015 63.2 4,120 88.8 3,135 72.5 5,054 52.7 4,706 45.7

100+ 2,580 46.8 382 83.0 290 59.6 670 46.6 1,238 32.6

Diffuse 3,734 35.1 218 84.0 350 51.1 907 39.6 2,259 27.0

Unknown 36,678 84.9 10,779 100.0 2,194 81.8 1,474 63.1 22,231 78.4

Unknown size category includes Paget disease of the nipple with no demonstrable tumor.
Chapter 13 Cancer of the Female Breast

National Cancer Institute 110 SEER Survival Monograph 

Table 13.11: Female Malignant Breast Cancer: 3-Year Relative Survival Rates (%) by Age (20+), SEER Historic Stage and ER 

Status, 12 SEER Areas, 1990-2001

Age/Historic Stage

ER Status

Total Positive Negative Borderline Other/Unknown

Cases

3-Year 

Relative 

Survival 

Rate (%) Cases

3-Year 

Relative 

Survival 

Rate (%) Cases

3-Year 

Relative 

Survival 

Rate (%) Cases

3-Year 

Relative 

Survival 

Rate (%) Cases

3-Year 

Relative 

Survival 

Rate (%)

All Ages (1990+) 230,922 92.1 140,857 96.4 43,030 83.6 1,502 86.5 45,533 87.2

 Localized 144,309 99.2 91,097 100.0 24,698 95.2 877 94.5 27,637 98.2

 Regional 69,408 88.3 43,208 93.7 14,978 76.3 540 79.8 10,682 84.4

 Distant 12,814 38.6 5,700 50.0 3,001 27.6 72 40.1 4,041 30.8

 Unstaged 4,391 73.0 852 81.2 353 57.4 13 ~ 3,173 72.6

Ages 20-49 (1990+) 58,630 90.5 31,200 95.4 16,020 83.8 574 88.2 10,836 86.6

 Localized 32,123 97.2 17,271 98.9 8,624 94.5 318 94.0 5,910 96.4

 Regional 22,424 87.7 12,624 93.9 6,274 77.4 225 85.4 3,301 84.3

 Distant 3,068 44.0 1,157 59.7 1,001 33.6 27 42.6 883 35.5

 Unstaged 1,015 77.9 148 87.6 121 59.6 <5 ~ 742 79.0

Ages 50-64 (1990+) 75,173 92.3 46,305 96.2 14,540 84.5 479 87.7 13,849 88.2

 Localized 46,733 98.8 29,446 100.0 8,471 95.3 279 95.5 8,537 98.2

 Regional 23,080 89.7 14,724 94.4 4,952 78.0 173 81.0 3,231 87.1

 Distant 4,275 39.7 1,913 51.6 1,013 26.9 21 ~ 1,328 32.4

 Unstaged 1,085 76.4 222 76.8 104 62.5 6 ~ 753 78.0

Ages 65+ (1990+) 97,119 93.0 63,352 97.2 12,470 82.4 449 82.8 20,848 87.0

 Localized 65,453 100.0 44,380 100.0 7,603 95.9 280 94.0 13,190 99.1

 Regional 23,904 87.5 15,860 92.8 3,752 71.7 142 68.0 4,150 82.3

 Distant 5,471 34.2 2,630 43.9 987 21.5 24 ~ 1,830 26.9

 Unstaged 2,291 68.5 482 81.2 128 50.2 <5 ~ 1,678 66.4

~Statistic not displayed due to less than 25 cases.

Table 13.12: Cancer of the Female Breast: Number of Cases and 5-Year Relative Survival Rates (%) by Subsite and 

Laterality, Ages 20+, 12 SEER Areas, 1988-2001

Subsite

Laterality

Total Right Left

Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%)

Total (With Distinct Laterality) 301,375 89.5 147,546 89.6 153,829 89.4

Nipple 3,089 90.1 1,507 90.1 1,582 90.2

Central 18,567 88.9 8,996 88.6 9,571 89.1

Upper Inner 26,847 93.0 12,875 93.3 13,972 92.7

Lower Inner 15,494 92.3 7,242 92.5 8,252 92.0

Upper Outer 106,575 91.9 53,103 91.8 53,472 91.9

Lower Outer 18,788 91.2 8,909 91.6 9,879 90.8

Axillary Tail 2,159 86.9 1,076 86.3 1,083 87.4

Overlapping 58,813 88.9 29,039 89.1 29,774 88.6

Other/unknown 51,043 82.4 24,799 82.6 26,244 82.2

Excludes 1,388 cases classified as only one (unknown) side, bilateral, or paired site/no information.
National Cancer Institute 111 SEER Survival Monograph 

Introduction

Despite the existence of effective screening through the 

use of Pap smears since the 1950’s, there were 9,710 estimated cases of invasive cervical cancer and 3,700 deaths 

in 2006 (1). This makes cervical cancer the 14th leading 

cancer in women and the 15th leading cancer death in 

2006 (1). The cervical uterine cancer incidence rates for 

white women are lower than those for black women (2). 

The incidence rates for both blacks and whites have been 

decreasing for many years (2). The three most common 

histologic types are squamous, adenocarcinoma, and adenosquamous. Five-year survival of cancers of the cervix 

uteri have increased slightly over time (2). 

Materials and Methods

The NCI contracts with medically-oriented, nonprofit institutions located in specific geographic areas to obtain 

data on all cancers diagnosed in residents of the SEER 

geographic areas. SEER collects data on all invasive 

and in situ cancers except basal cell and squamous cell 

carcinomas of the skin (of non-genital anatomic sites) and 

in situ carcinomas of the uterine cervix. SEER actively 

follows all previously diagnosed patients on an annual 

basis to obtain vital status allowing the calculation of 

observed and relative survival rates.

This analysis is based on data from 12 SEER geographic 

areas which collectively cover about 14% of the total US 

population. The areas are the States of Connecticut, Iowa, 

New Mexico, Utah, and Hawaii; the metropolitan areas of 

Detroit, Michigan; Atlanta, Georgia; San Francisco, San 

Jose, and Los Angeles, California; Seattle, Washington; 

and 10 counties in rural Georgia. Los Angeles contributed 

data for diagnosis years 1992 to 2001, all other areas for 

1988-2001.

Between 1988-2001, there were 95,353 cases of cancer of 

the cervix uteri diagnosed in SEER. The following were 

excluded from the analysis: patients for whom cervical 

cancer was not the first primary, cases identified through 

autopsy or death certificate only, persons of unknown race, 

alive with no survival time, patients less than 20 years 

old, in situ cases, cases without microscopic confirmation, 

sarcomas and carcinoids. After these exclusions, 21,431 

cases remained for analysis (Table 14.1).

Table 14.1: Cancer of the Cervix Uteri: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining

Number 

Excluded Reason for Exclusion/selection

95,353 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

91,957 3,396 Select first primary only

91,824 133 Exclude death certificate only or at autopsy

83,929 7,895 Exclude unknown race

36,272 47,657 Exclude alive with no survival time

35,764 508 Exclude children (Ages 0-19)

21,789 13,975 Exclude in situ cancers

21,622 167 Exclude no or unknown microscopic confirmation

21,533 89 Exclude sarcomas

21,467 66 Exclude carcinoids

21,431 36 Exclude stromal sarcomas

Carol L. Kosary

Chapter 14

Cancer of the Cervix Uteri
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 112 SEER Survival Monograph 

Staging

Uterine cervical cancer staging by the Federation Internationale de Gynecologie et d’Obstetrique (FIGO) and 

the American Joint Committee on Cancer (AJCC) third 

edition are in the AJCC 3rd edition (3): 

Stage I is carcinoma strictly confined to the cervix; extension to the 

uterine corpus should be disregarded

Stage IA: Invasive cancer identified only microscopically. Invasion 

is limited to measured stromal invasion with a maximum depth 

of 5 mm and no wider than 7 mm. 

Stage IB: Clinical lesions confined to the cervix or preclinical 

lesions greater than stage IA. 

Stage II is carcinoma that extends beyond the cervix but has not 

extended onto the pelvic wall. The carcinoma involves the 

vagina, but not as far as the lower third.

Stage IIA: No obvious parametrial involvement. Involvement of up 

to the upper two thirds of the vagina. 

Stage IIB: Obvious parametrial involvement, but not onto the pelvic 

sidewall. 

Stage III is carcinoma that has extended onto the pelvic sidewall. 

On rectal examination, there is no cancer-free space between 

the tumor and the pelvic sidewall. The tumor involves the 

lower third of the vagina. All cases with a hydronephrosis or 

nonfunctioning kidney should be included, unless they are 

known to be due to other causes.

Stage IIIA: No extension onto the pelvic sidewall but involvement 

of the lower third of the vagina. 

Stage IIIB: Extension onto the pelvic sidewall or hydronephrosis or 

nonfunctioning kidney

Stage IV is carcinoma that has extended beyond the true pelvis 

or has clinically involved the mucosa of the bladder and/or 

rectum. 

Stage IVA: Spread of the tumor onto adjacent pelvic organs. 

Stage IVB: Spread to distant organs

Since the emphasis is on extension, a SEER modified 

version of stage was used in which positive lymph nodes 

went to N1 and Stage IIIB but unknown lymph node 

involvement was ignored, i.e. treated like N0.

Results

Age and Race 

Of the 21,431 adult cases, 56.9% were diagnosed under 

age 50 (Table 14.2). Almost 50% were between the ages 

of 30-49 years. The age distribution for white women 

Table 14.3: Cancer of the Cervix Uteri: Number of Cases, 5-Year Survival Rates (%) and Median Survival Time (Months) by 

Race and Age (20+), 12 SEER Areas, 1988-2001

Race and Age Group Cases

Median 

Survival Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

All Races, 20+ 21,431 > 120 67.6 94.5 71.5

White, 20+ 16,196 > 120 69.0 94.9 72.8

Black, 20+ 2,798 99.8 56.8 91.6 61.9

All Races, 20-49 12,188 > 120 78.5 99.1 79.2

White, 20-49 9,568 > 120 80.5 99.3 81.1

Black, 20-49 1,480 > 120 65.5 98.2 66.7

All Races, 50-69 6,360 116.0 61.2 94.9 64.5

White, 50-69 4,572 113.7 61.2 95.1 64.3

Black, 50-69 865 69.8 52.7 91.7 57.4

All Races, 70+ 2,883 29.8 36.5 74.3 49.0

White, 70+ 2,056 27.8 34.5 73.9 46.8

Black, 70+ 453 27.6 36.3 70.0 51.2

Table 14.2: Cancer of the Cervix Uteri: Age Distribution by Race, 12 SEER Areas, 1988-2001

Age Group (Years)

Total White Black Other

Cases Percent Cases Percent Cases Percent Cases Percent

Total 21,431 100.0 16,196 100.0 2,798 100.0 2,437 100.0

20-29 1,586 7.4 1,332 8.2 183 6.5 71 2.9

30-39 5,060 23.6 4,074 25.2 576 20.6 410 16.8

40-49 5,542 25.9 4,162 25.7 721 25.8 659 27.0

50-59 3,487 16.3 2,527 15.6 465 16.6 495 20.3

60-69 2,873 13.4 2,045 12.6 400 14.3 428 17.6

70-79 1,876 8.8 1,326 8.2 284 10.2 266 10.9

80+ 1,007 4.7 730 4.5 169 6.0 108 4.4
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 113 SEER Survival Monograph 

Table 14.4: Cancer of the Cervix: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates (%) by SEER Geographic Area, Ages 20+, 12 SEER Areas, 1988-2001

SEER Geographic Area Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year

10-

Year

Total 21,431 100.0 89.2 80.6 76.1 71.5 68.7 67.2

Atlanta and Rural Georgia 1,707 8.0 89.8 82.2 77.2 73.5 72.4 70.8

 Atlanta (Metropolitan) - 1988+ 1,598 7.5 90.4 83.0 78.2 74.3 73.0 71.7

 Rural Georgia - 1988+ 109 0.5 81.1 69.9 63.1 61.3 61.3 58.3

California

 Los Angeles - 1992+ 5,091 23.8 89.4 79.6 74.1 68.6 66.1 62.0

 Greater Bay Area 3,613 16.9 89.9 80.9 77.0 71.6 68.3 66.8

 San Francisco-Oakland SMSA

 - 1988+ 2,294 10.7 88.9 80.1 76.4 71.6 67.9 65.8

 San Jose-Monterey - 1988+ 1,319 6.2 91.6 82.2 78.0 71.5 68.8 68.4

Connecticut - 1988+ 1,926 9.0 87.1 79.0 75.3 71.3 68.1 67.7

Detroit (Metropolitan) - 1988+ 2,688 12.5 86.1 76.7 71.7 66.6 62.5 59.8

Hawaii - 1988+ 762 3.6 89.5 82.7 78.6 72.4 70.4 69.9

Iowa - 1988+ 1,732 8.1 91.1 83.2 79.2 74.8 71.2 70.1

New Mexico - 1988+ 1,083 5.1 89.7 81.9 76.9 73.0 70.5 69.0

Seattle (Puget Sound) - 1988+ 1,967 9.2 90.7 83.3 79.4 76.6 74.7 73.9

Utah - 1988+ 862 4.0 89.0 83.5 79.3 76.8 73.7 73.1

Table 14.5: Cancer of the Cervix Uteri: Number and Distribution of Cases and 5-Year Relative Survival by Histology, Ages 20+, 

12 SEER Areas, 1988-2001

Histology ICD-O Code Cases Percent

5-Year 

Relative 

Survival 

Rate(%)

Total 8000-9989 21,431 100.0 71.5

Squamous 8050-8130 15,579 72.7 71.5

 Keratinizing 8071 1,959 9.1 65.8

 Non-keratinizing 8072 2,399 11.2 68.2

 Microinvasive 8076 2,156 10.1 98.3

 All Other Squamous 8050-8070,8073-8075,8077-8130 9,065 42.3 66.9

Adenocarcinoma 8140-8147,8160-8162,8180-8221,8250-8506,8520-

8550,8570-8573,8940-8941 3,656 17.1 75.0

Adenosquamous 8560 1,034 4.8 64.5

Other Specified Carcinomas 8030-8045,8150-8155,8170-8171,8230-8248,8510-

8512,8561-8562,8580-8671 149 0.7 32.9

 Small Cell Carcinomas 8041 140 0.7 34.7

 All Other Specified Carcinomas 8030-8040,8042-8045,8150-8155,8170-8171,8230-

8248,8510-8512,8561-8562,8580-8671 9 0.0 ~

Carcinoma, NOS* 8010-8022 875 4.1 73.5

Other Specified Types 8720-8790,8935,8950-8982,9000-9030,9060-

9110,9350-9364,9380-9512,9530-9539 56 0.3 49.0

Unspecified 8000-8004 82 0.4 70.3

 ~ Statistic not displayed due to less than 25 cases.

* NOS: Not Otherwise Specified
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 114 SEER Survival Monograph 

was slightly younger than that for black women or women 

of other races.

For all women, survival declines with age. In women ages 

20-49, the 5-year relative survival rate is 79% compared 

to 65% in women 50-69 and 49.0% in women aged 70 

and older. Survival is also lower for black women compared to white women in all age groups presented with 

the exception of ages over 70 (Table 14.3).

Geographic Location

There is some evidence of geographic variation in survival. Five-year relative survival rates in the 12 SEER 

areas represented in this study ranged from 77% in Utah 

and Seattle to 61% in Rural Georgia (Table 14.4). 

Histology

Distribution by histology is presented in Table 14.5. 

Tumors classified as squamous comprise 72.7% of all 

cancers of the cervix uteri. Among squamous histologies 

12.6% were keratinizing, 15.4% non-keratinizing, and 

13.8% microinvasive. Tumors classified as adenocarcinoma comprised 17.1% of the total with adenosquamous 

making up slightly less than 5%. Survival rates were 

highest for microinvasive squamous cell carcinoma, 98%, 

but survival rates were similar for keratinizing and nonkeratinizing squamous cell carcinoma, 66 and 68%, respectively (Table 14.5).

Table 14.6: Squamous Carcinoma of the Cervix Uteri: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates (%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 15,579 100.0 89.9 81.0 76.2 71.5 68.5 66.7

Stage I 8,492 54.5 98.6 95.8 93.8 91.3 88.7 86.9

 IA 3,776 24.2 99.7 99.1 98.6 98.1 96.8 95.5

 IB 3,293 21.1 98.5 94.6 92.0 88.2 85.3 83.1

 I NOS* 1,423 9.1 95.8 89.8 85.4 80.3 75.9 73.2

Stage II 2,439 15.7 92.2 79.3 70.5 60.7 54.8 52.9

 IIA 726 4.7 91.8 81.8 75.1 67.2 62.6 60.9

 IIB 1,713 11.0 92.4 78.3 68.5 57.9 51.4 49.6

Stage III 2,526 16.2 80.5 62.6 53.9 46.8 43.4 41.2

 IIIA 290 1.9 73.7 53.1 43.3 38.6 33.9 29.6

 IIIB 2,236 14.4 81.4 63.8 55.2 47.7 44.4 42.4

Stage IV 1,362 8.7 51.6 30.2 22.0 15.8 13.5 12.0

 IVA 296 1.9 56.0 32.8 23.5 19.9 17.5 13.6

 IVB 1,064 6.8 50.4 29.6 21.7 14.6 12.2 11.7

 IV NOS* <5 0.0 ~ ~ ~ ~ ~ ~

Unknown/Unstaged 760 4.9 84.6 70.9 64.5 56.5 52.2 45.9

 ~ Statistic not displayed due to less than 25 cases.

* NOS: Not Otherwise Specified

SQUAMOUS

Stage

Table 14.6 and Figure 14.1 show the contrast in survival 

rates across stage at diagnosis over time since diagnosis 

for squamous cell carcinoma. In stages II-IV, the steepest declines in survival are observed within 2-3 years of 

diagnosis. Survival continues to decline throughout the 

10 years observed in these stages.

Age and Stage

Of the 15,579 cases of squamous, enough information to 

establish stage at diagnosis was available for 14,819 (95%). 

Across all age groups, 54.5% were diagnosed in Stage I. 

The percent diagnosed in stage I declines with age, from 

64.9% in ages 20-49, 44.2% in ages 50-69, and 34.5% in 

ages 70+. At the same time the percent diagnosed in stage 

IV increases from 5.9% in ages 20-49 to 14.4% in ages 

70+ (Table 14.7).

A survival differential across age exists for all stages except stage II, particularly for women aged 70+ compared 

to women ages 20-69. (Table 14.6, Figure 14.2).
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 115 SEER Survival Monograph 

Table 14.7: Squamous Carcinoma of the Cervix Uteri: Number, Distribution of Cases, and 5-Year Relative Survival Rates by 

AJCC Stage (SEER modified 3rd edition) and Age (20+), 12 SEER Areas, 1988-2001

AJCC Stage

Age (Years)

Total 20-49 50-69 70+

Cases Percent

5-Year 

Relative 

Survival 

Rate(%) Cases Percent

5-Year 

Relative 

Survival 

Rate(%) Cases Percent

5-Year 

Relative 

Survival 

Rate(%) Cases Percent

5-Year 

Relative 

Survival 

Rate(%)

Total 15,579 100.0 71.5 8,730 100.0 78.3 4,792 100.0 64.9 2,057 100.0 53.4

Stage I 8,492 54.5 91.3 5,666 64.9 93.0 2,117 44.2 88.3 709 34.5 85.0

 IA 3,776 24.2 98.1 2,810 32.2 98.3 749 15.6 96.9 217 10.5 98.4

 IB 3,293 21.1 88.2 2,112 24.2 89.4 904 18.9 86.4 277 13.5 83.8

 I NOS* 1,423 9.1 80.3 744 8.5 83.6 464 9.7 78.6 215 10.5 70.0

Stage II 2,439 15.7 60.7 1,002 11.5 61.2 980 20.5 63.4 457 22.2 52.6

 IIA 726 4.7 67.2 252 2.9 70.7 293 6.1 68.4 181 8.8 58.9

 IIB 1,713 11.0 57.9 750 8.6 57.9 687 14.3 61.1 276 13.4 48.5

Stage III 2,526 16.2 46.8 1,221 14.0 50.9 893 18.6 46.0 412 20.0 32.5

 IIIA 290 1.9 38.6 77 0.9 44.1 113 2.4 44.4 100 4.9 25.6

 IIIB 2,236 14.4 47.7 1,144 13.1 51.4 780 16.3 46.2 312 15.2 34.7

Stage IV 1,362 8.7 15.8 515 5.9 20.9 550 11.5 12.8 297 14.4 10.2

 IVA 296 1.9 19.9 96 1.1 28.6 117 2.4 16.2 83 4.0 13.6

 IVB 1,064 6.8 14.6 419 4.8 19.1 433 9.0 11.7 212 10.3 8.8

 IV NOS* <5 0.0 ~ 0 0.0 ~ 0 0.0 ~ <5 0.1 ~

Unknown/

Unstaged 760 4.9 56.5 326 3.7 66.3 252 5.3 50.5 182 8.8 43.4

* NOS: Not Otherwise Specified

0

20

40

60

80

100

IA IB IIA IIB IIIA IIIB IVA IVB

Relative Survival Rate (%)

AJCC Stage

20-49 50-69 70+

Figure 14.2: Squamous Cell Carcinoma of the Cervix Uteri: 

5-Year Relative Survival Rate (%) by AJCC Stage and Age (20+), 

12 SEER Areas, 1988-2001

Figure 14.1: Squamous Cell Carcinoma of the Cervix Uteri: 

Relative Survival Rate (%) by AJCC Stage, Ages 20+,

12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

IA

IB

IIA

IIB

IIIA

IIIB

IVA

IVB
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 116 SEER Survival Monograph 

Subtype and Stage

Microinvasive cases show a positive survival advantage 

compared to the other subtypes in stage I. Little difference exists between the other three subtypes in stages 

I-IV (Table 14.8).

Stage and Grade 

Table 14.9 shows survival rates by AJCC Stage and histologic grade. With the exception of cases diagnosed 

in stages I and II, no consistent relationship is observed 

between stage and grade (Table 14.9 & Figure 14.3).

Table 14.8: Squamous Carcinoma of the Cervix Uteri: Number of Cases and 5-Year Relative Survival Rates (%) by Histology and 

AJCC Stage (SEER modified 3rd edition), Ages 20+,SEER 1988-2001

Histology

AJCC Stage

Total I II III IV Unknown/

Unstaged

Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%)

Total Squamous 15,579 71.5 8,492 91.3 2,439 60.7 2,526 46.8 1,362 15.8 760 56.5

Keratinizing 1,959 65.8 890 88.5 366 61.5 416 46.3 203 18.1 84 46.1

Non-keratinizing 2,399 68.2 1,165 88.5 422 63.8 493 47.4 222 19.4 97 51.8

Microinvasive 2,156 98.3 2,100 98.8 15 ~ 13 ~ 7 ~ 21 ~

All Other 

Squamous 9,065 66.9 4,337 88.8 1,636 59.6 1,604 46.5 930 14.3 558 57.2

 ~ Statistic not displayed due to less than 25 cases.

Figure 14.3: Squamous Cell Carcinoma of the Cervix Uteri: 

5-Year Relative Survival Rate (%) by AJCC Stage and Grade, 

Ages 20+, 12 SEER Areas, 1988-2001

Figure 14.4: Stage I & II Squamous Cell Carcinoma of the 

Cervix Uteri: 5-Year Relative Survival Rate (%) by AJCC Stage 

and Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

0

20

40

60

80

100

IA IB IIA IIB IIIA IIIB IVA IVB

Relative Survival Rate (%)

AJCC Stage

Well Differentiated Moderately Differentiated Poorly/Undifferentiated

0

20

40

60

80

100

IA IB IIA IIB

Relative Survival Rate (%)

AJCC Stage

< 3 cm 3+ cm

Tumor Size (Stage I and II)

In stages IB-IIB, survival is higher for those tumors less 

than 3 cm in size when compared to those 3 cm or greater 

(Table 14.10, Figure 14.4). A very small difference by 

tumor size was seen for stage IA.
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 117 SEER Survival Monograph 

Table 14.10: Squamous Carcinoma of the Cervix Uteri (Stage I and II ): Number of Cases and 5-Year Relative Survival Rates (%) 

by AJCC Stage (SEER modified 3rd edition) and Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Tumor Size

Total No/Microscopic 

Mass

< 3 cm 3+ cm Unknown

Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%)

Total I & II 10,931 84.6 923 98.3 1,754 93.2 2,114 69.6 6,140 85.4

Stage I 8,492 91.3 914 98.5 1,608 95.4 1,067 79.2 4,903 91.3

 IA 3,776 98.1 847 99.1 545 98.8 54 97.2 2,330 97.5

 IB 3,293 88.2 38 84.3 953 94.2 825 79.4 1,477 89.5

 I NOS* 1,423 80.3 29 94.6 110 87.3 188 73.3 1,096 80.2

Stage II 2,439 60.7 9 ~ 146 69.9 1,047 59.3 1,237 60.6

 IIA 726 67.2 5 ~ 77 75.3 268 62.6 376 68.7

 IIB 1,713 57.9 <5 ~ 69 63.5 779 58.1 861 57.0

 ~ Statistic not displayed due to less than 25 cases.

* NOS: Not Otherwise Specified

Table 14.9: Squamous Carcinoma of the Cervix Uteri: Number of Cases and 5-Year Relative Survival Rates (%) by AJCC Stage 

(SEER modified 3rd edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Grade

Total Well Differentiated Moderately 

Differentiated

Poorly/ 

Undifferentiated

Unknown

Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%)

Total 15,579 71.5 720 76.9 3,930 68.6 4,542 59.7 6,387 80.7

Stage I 8,492 91.3 437 93.2 1,892 88.3 1,852 84.5 4,311 95.1

 IA 3,776 98.1 238 96.8 442 95.6 249 96.1 2,847 98.7

 IB 3,293 88.2 136 89.9 1,075 89.7 1,205 85.3 877 90.0

 I NOS* 1,423 80.3 63 86.1 375 76.3 398 75.1 587 85.3

Stage II 2,439 60.7 113 66.2 717 62.2 890 56.7 719 63.1

 IIA 726 67.2 31 73.5 213 66.2 264 65.3 218 69.2

 IIB 1,713 57.9 82 63.4 504 60.6 626 53.1 501 60.3

Stage III 2,526 46.8 96 44.6 823 50.3 1,002 45.7 605 44.1

 IIIA 290 38.6 12 ~ 103 39.7 96 38.0 79 36.4

 IIIB 2,236 47.7 84 44.2 720 51.7 906 46.4 526 45.1

Stage IV 1,362 15.8 40 11.9 337 18.9 609 13.9 376 16.2

 IVA 296 19.9 11 ~ 85 26.7 124 12.9 76 23.0

 IVB 1,064 14.6 29 10.2 250 16.1 485 14.1 300 14.3

 IV NOS* <5 ~ 0 ~ 2 ~ 0 ~ 0 ~

Unknown/Unstaged 760 56.5 34 61.1 161 53.2 189 41.6 376 64.9

 ~ Statistic not displayed due to less than 25 cases.

* NOS: Not Otherwise Specified
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 118 SEER Survival Monograph 

Table 14.11: Squamous Carcinoma of the Cervix Uteri: 5-Year Relative Survival Rates (%) , Conditioned on Years Since 

Diagnosis by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

5-Year Relative Survival Rate (%)

Years Since Diagnosis

0 1 2 3 4 5

Total 71.5 77.7 85.1 88.9 91.3 92.2

Stage I 91.3 91.7 93.5 94.5 95.0 95.1

 IA 98.1 98.0 98.2 98.3 97.9 97.4

 IB 88.2 88.4 90.8 92.6 93.7 94.2

 I NOS 80.3 82.4 86.6 88.3 89.9 90.8

Stage II 60.7 63.3 71.9 77.2 83.5 86.6

 IIA 67.2 70.4 78.4 82.5 85.4 89.5

 IIB 57.9 60.3 68.8 74.6 82.4 85.1

Stage III 46.8 55.6 70.0 79.1 83.8 86.5

 IIIA 38.6 47.3 62.0 76.7 73.9 73.5

 IIIB 47.7 56.5 70.7 79.3 84.8 87.6

Stage IV 15.8 27.7 45.9 59.5 66.8 72.4

 IVA 19.9 32.6 51.8 72.1 66.3 65.0

 IVB 14.6 26.1 43.8 54.9 67.2 76.1

 IV NOS ~ ~ ~ ~ ~ ~

Unknown/Unstaged 56.5 63.0 73.4 79.0 82.1 79.5

* NOS: Not Otherwise Specified

~ Statistic not displayed due to less than 25 cases.

0

20

40

60

80

100

IA IB IIA IIB IIIA IIIB IVA IVB

Relative Survival Rate (%)

AJCC Stage

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years

Figure 14.5: Squamous Cell Carcinoma of the Cervix Uteri: 

5-Year Relative Survival Rate (%), Conditioned on Years Since 

Diagnosis, by AJCC Stage, Ages 20+, 12 SEER Areas, 

1988-2001

Conditional Survival 

Five-year relative survival rates, conditioned on years since 

diagnosis, are presented in Table 14.11 and Figure 14.5. 

For stages IB-IV, the probability of surviving through the 

next 5 years generally increases as time since diagnosis 

increases. This is most marked for the 5-year relative survival rates starting from one to three years after diagnosis 

for the stage IVA & IVB cases. For stage IVA, five years 

survival rate from time of diagnosis is 20%. For those 

individuals who survive 1 year post diagnosis, the 5-year 

survival rate increases to 33%. This increases to 72% for 

those individuals who survived 3years. For stage IVB, 

five year survival rate from time of diagnosis is 15%. For 

those individuals who survive 1 year post diagnosis, 5-year 

survival rate increases to 26%. This increases to 67% for 

those individuals who survived 4 years.

ADENOCARCINOMA

Stage

Of the 3,656 cases of adenocarcinoma, enough information to establish stage at diagnosis was available for 3,446 

(94%). 65.1% of the cases were diagnosed in Stage I, with 

the remaining cases distributed almost evenly among stages 

II-IV (Table 14.12).

A five year survival difference between stage IA and IB is 

observed, with 5 year relative survival rate at 99% for stage 

IA and 90% for IB. Five-year survival decreases to 54% 

in stage II cases (Table 14.12). The stage distribution is 

slightly better for adenocarcinoma compared to squamous. 

For example, 65.1% of adenocarcinomas are staged as stage 

I in comparison to only 54.5% of squamous. Survival for 

adenocarcinoma, however, exhibits few differences by stage 
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 119 SEER Survival Monograph 

Table 14.12: Adenocarcinoma of the Cervix Uteri: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates (%) AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 3,656 100.0 90.3 82.8 78.6 75.0 72.3 71.2

Stage I 2,379 65.1 98.6 95.8 94.0 91.9 90.3 89.0

 IA 630 17.2 99.7 99.4 99.3 99.3 98.7 97.1

 IB 1,150 31.5 99.1 95.9 93.6 90.3 87.3 86.9

 I NOS* 599 16.4 96.6 91.9 89.2 86.9 86.7 84.8

Stage II 356 9.7 87.7 73.7 64.0 54.3 47.4 45.2

Stage III 353 9.7 80.8 59.8 49.2 38.6 30.4 28.1

Stage IV 358 9.8 49.3 27.5 20.0 14.2 9.5 9.5

Unknown/Unstaged 210 5.7 85.7 78.8 71.1 67.0 63.0 57.9

* NOS: Not Otherwise Specified

when compared to squamous of the cervix uteri (Tables 

14.6 and 14.12).

Figure 14.6 show the contrast in the relative survival rates 

between stage at diagnosis and years since diagnosis. In 

stages II-IV, the steepest declines in survival are observed 

within 2-3 years of diagnosis. Survival continues to decline 

throughout the 10 years observed in these stages.

Stage and Grade 

The 3,656 cases of adenocarcinoma are shown by histologic grade (Table 14.13 & Figure 14.7). Within stage, 

5-year relative survival declines as grade increases from 

well differentiated to poorly/anaplastic. Within stage I, 

the 5-year survival rates vary from 97% for well differentiated tumors to 77% for poorly/undifferentiated tumors. 

Squamous cell carcinoma showed less variation by grade 

within stage.

Conditional Survival 

Five year relative survival rates, conditioned on years since 

diagnosis, are presented in Table 14.14 and Figure 14.8. 

For stages IB-IV, the probability of surviving through the 

next 5 years increases as time since diagnosis increases. 

This is most marked for the stage IV cases. The 5-year 

survival rate from time of diagnosis was 14%. For those 

individuals who survive 1 year post diagnosis, survival 

over the next 5-years increased to 26%. This increased 

to 57% for the group of individuals who survived 4 years 

after diagnosis. 

0

20

40

60

80

100

IA IB II III IV

Relative Survival Rate (%)

AJCC Stage

Well Differentiated Moderately Differentiated Poorly/Undifferentiated

Figure 14.7: Adenocarcinoma of the Cervix Uteri: 5-Year 

Relative Survival Rate (%) by AJCC Stage and Grade, Ages 20+, 

12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

IA

IB

II

III

IV

Figure 14.6: Adenocarcinoma of the Cervix Uteri: Relative 

Survival Rate (%) by AJCC Stage, Ages 20+, 12 SEER Areas, 

1988-2001
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 120 SEER Survival Monograph 

Table 14.13: Adenocarcinoma of the Cervix Uteri: 5-Year Relative Survival Rates (%) by AJCC Stage (SEER modified 3rd edition) 

and Grade, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Grade

Total Well Differentiated Moderately 

Differentiated

Poorly/ 

Undifferentiated

Unknown

Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%)

Total 3,656 75.0 877 89.7 1,100 75.9 779 49.2 900 80.6

Stage I 2,379 91.9 711 96.9 707 92.8 345 77.0 616 93.1

 IA 630 99.3 198 99.3 143 98.5 48 94.0 241 99.5

 IB 1,150 90.3 351 96.2 396 93.0 217 78.7 186 86.6

 I NOS* 599 86.9 162 94.1 168 86.1 80 62.2 189 90.5

Stage II 356 54.3 58 69.9 140 52.5 86 42.9 72 55.6

Stage III 353 38.6 51 53.0 111 41.1 141 31.8 50 34.3

Stage IV 358 14.2 32 22.3 92 21.9 174 5.9 60 20.9

Unknown/Unstaged 210 67.0 25 70.7 50 58.7 33 53.7 102 73.1

* NOS: Not Otherwise Specified

Table 14.14: Adenocarcinoma of the Cervix Uteri: 5-Year Relative Survival Rates (%), Conditioned on Years Since Diagnosis by 

AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

5-Year Relative Survival Rate(%)

Years Since Diagnosis

0 1 2 3 4 5

Total 75.0 80.6 86.1 90.2 92.5 92.9

Stage I 91.9 92.2 94.0 95.7 96.6 96.4

 IA 99.3 99.5 99.3 99.1 97.8 97.2

 IB 90.3 89.8 91.0 93.2 95.5 96.0

 I NOS* 86.9 89.0 93.3 96.1 96.9 96.3

Stage II 54.3 55.5 63.4 72.0 77.4 81.0

Stage III 38.6 43.9 50.3 58.9 64.0 68.6

Stage IV 14.2 25.8 36.5 45.8 57.2 65.5

Unknown/Unstaged 67.0 73.0 79.2 84.9 85.4 82.5

* NOS: Not Otherwise Specified

Table 14.15: Adenosquamous Cancer of the Cervix Uteri: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year 

Relative Survival Rates (%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Relative Survival Rate (%)

AJCC Stage Cases Percent 1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 1,034 100.0 85.3 76.1 70.6 64.5 61.0 60.1

Stage I 550 53.2 97.2 92.2 88.9 84.1 80.3 80.1

 IA 110 10.6 99.2 98.7 98.7 97.0 92.4 92.4

 IB 310 30.0 97.5 92.1 85.6 81.1 77.4 75.5

 I NOS* 130 12.6 94.7 86.8 86.8 79.7 76.9 76.9

Stage II 127 12.3 89.2 74.0 66.3 60.2 51.0 43.5

Stage III 168 16.2 77.0 65.0 55.3 43.3 40.8 40.8

Stage IV 140 13.5 47.9 31.6 20.4 15.6 15.6 15.6

Unknown/Unstaged 49 4.7 75.7 61.7 59.7 54.3 46.0 41.3

* NOS: Not Otherwise Specified
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 121 SEER Survival Monograph 

ADENOSQUAMOUS

Stage

Of the 1,034 cases of adenosquamous, enough information to establish stage at diagnosis was available for 985 

(95%). 53% of the cases were diagnosed in Stage I, with 

the remaining cases distributed almost evenly stages II-IV 

(Table 14.15).

A five year survival difference between stage IA and IB was 

observed, with 5 year relative survival rate at 97% for stage 

IA and 81% for IB. Survival decreased to 60% in stage II 

cases (Table 14.15). Survival for adenosquamous may be 

slightly lower in stages IA and IB compared to squamous 

and adenocarcinoma, however, survival in stages II-IV is 

similar for all three histologies.

Figure 14.9 and Table 14.15 show the contrast in survival 

across stage at diagnosis over time since diagnosis. In 

stages IB-IV, the steepest declines in survival are observed 

within 2-4 years of diagnosis. Survival continues to decline 

throughout the 10 years observed only for stage II. The 

survival rates for the other stages appear to plateau.

Conditional Survival 

Five year relative survival rates, conditioned on years since 

diagnosis, are presented in Table 14.16 and Figure 14.10. 

For stages IB-IV, the probability of surviving through the 

next 5 years increases as time since diagnosis increases. 

This is most marked for the stage IV cases. Five years 

survival from time of diagnosis was 16%. For those individuals who survived 1 year post diagnosis, 5-year survival 

rate increased to 32%. This increased to 100% for those 

individuals who survived 5 years. 

Discussion

Five-year relative survival rates declined with age at diagnosis, with women 70 years or older having less than 50% 

survival. Black women tended to fare worse than white 

women in all age groups, except those 70 years or older. By 

histology, squamous carcinomas represented approximately 

three-quarters of all cases. The proportion of squamous cases 

diagnosed at stage IV increased with age. There is an age 

differential in survival rates across all stages of squamous 

tumors, except stage II, with older women faring slightly 

worse than younger women. There is little difference in 

survival between adenocarcinoma histologies and squamous 

histologies by stage. For all stages combined, women with 

adenocarcinoma had a slightly better survival rate since 

there was a higher proportion of stage I among the women 

with adenocarcinoma compared to squamous. Women with 

0

20

40

60

80

100

IA IB II III IV

Relative Survival Rate (%)

AJCC Stage

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

IA

IB

II

III

IV

Figure 14.8: Adenocarcinoma of the Cervix Uteri: 5-Year 

Relative Survival Rate (%), Conditioned on Years Since 

Diagnosis by AJCC Stage, Ages 20+, 12 SEER Areas, 1988-2001

Figure 14.9: Adenosquamous Carcinoma of the Cervix Uteri: 

Relative Survival Rate (%) by AJCC Stage, Ages 20+, 12 SEER 

Areas, 1988-2001

0

20

40

60

80

100

IA IB II III IV

Relative Survival Rate (%)

AJCC Stage

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years

Figure 14.10: Adenosquamous Carcinoma of the Cervix Uteri: 

5-Year Relative Survival Rate (%), Conditioned on Years Since 

Diagnosis by AJCC Stage, Ages 20+, 12 SEER Areas, 1988-2001
Chapter 14 Cancer of the Cervix Uteri

National Cancer Institute 122 SEER Survival Monograph 

Table 14.16: Adenosquamous Cancer of the Cervix Uteri: 5-Year Relative Survival Rates (%), Conditioned on Years Since 

Diagnosis by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

5-Year Relative Survival Rate (%)

Years Since Diagnosis

0 1 2 3 4 5

Total 64.5 73.3 81.1 85.7 89.9 92.5

Stage I 84.1 85.4 88.5 90.1 93.1 95.4

 IA 97.0 97.5 93.7 93.4 95.4 95.0

 IB 81.1 81.8 85.6 90.1 92.0 93.3

 I NOS* 79.7 82.3 90.1 87.2 93.1 95.8

Stage II 60.2 61.5 72.9 76.2 71.8 71.7

Stage III 43.3 53.8 62.3 73.3 85.8 93.6

Stage IV 15.6 32.4 49.2 76.1 93.6 100.0

Unknown/Unstaged 54.3 64.2 79.6 76.6 72.7 76.0

* NOS: Not Otherwise Specified

References

1. American Cancer Society. Cancer Facts and Figures 2006. 

Atlanta: American Cancer Society, 2006.

2. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer 

EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, 

Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

submission, posted to the SEER web site, 2006.

3. Beahrs, OH, Henson DE, Hutter RVP, Myers MH (eds). AJCC 

Cancer Staging Manual, Third edition. American Joint Committee 

on Cancer. Philadelphia: Lippincott, 1988.

adenosquamous histologies have a slightly lower survival in 

stage I tumors compared to adenocarcinoma and squamous 

histologies, but all three histologies were similar for stages 

II-IV. Advanced tumor grade for adenocarcinomas, was 

associated with poorer survival within stage. 
National Cancer Institute 123 SEER Survival Monograph 

Introduction

Cancer of the endometrium, the lining of the uterus, is 

the most common gynecologic malignancy. It is the 4th 

leading cancer in women (behind breast, lung and colorectal) and accounts for approximately 6% of all cancers in 

women (1). Uterine sarcomas are rare, comprising less 

than 8% of all uterine malignancies. These tumors arise 

primarily from two distinct tissues: 1) leiomyosarcoma 

from myometrial muscle and 2) mesodermal (Mullerian) 

and stromal sarcomas from endometrial epithelium.

Materials and Methods

The NCI contracts with medically-oriented, nonprofit institutions located in specific geographic areas to obtain 

data on all cancers diagnosed in residents of the SEER 

geographic areas. SEER collects data on all invasive 

and in situ cancers except basal cell and squamous cell 

carcinomas of the skin (of non-genital anatomic sites) and 

in situ carcinomas of the uterine cervix. SEER actively 

follows all previously diagnosed patients on an annual 

basis to obtain vital status allowing the calculation of 

observed and relative survival rates.

This analysis is based on data from 12 SEER geographic 

areas which collectively cover about 14% of the total US 

population. The areas are the States of Connecticut, Iowa, 

New Mexico, Utah, and Hawaii; the metropolitan areas of 

Detroit, Michigan; Atlanta, Georgia; San Francisco, San 

Jose, and Los Angeles, California; Seattle, Washington; 

and 10 counties in rural Georgia. Los Angeles contributed 

data for diagnosis years 1992 to 2001, all other areas for 

1988-2001.

Between 1988-2001, there were 57,769 cases of cancer 

of the corpus uteri diagnosed in SEER. Note: cancer of 

the corpus uteri does not include uterus, not otherwise 

specified (NOS). The following were excluded from the 

analysis: patients for whom cancer of the corpus uteri 

was not the first primary, cases identified through autopsy 

or death certificate only, persons of unknown race, alive 

cases with no survival time, patients less than 20 years 

old, cases of in situ cancers, cases without microscopic 

confirmation, and carcinoids. Unlike other chapters, sarcomas were included. After these exclusions, 48,642 adult 

cases remained for analysis (see Table 15.1).

Carol L. Kosary

Chapter 15

Cancer of the Corpus Uteri

Table 15.1: Cancer of the Corpus Uteri: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number Excluded Reason for Exclusion/selection

57,769 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

50,570 7,199 Select first primary only

50,453 117 Exclude death certificate only or at autopsy

50,144 309 Exclude unknown race

50,083 61 Exclude alive with no survival time

50,073 10 Exclude children (Ages 0-19)

48,877 1,196 Exclude in situ cancers

48,661 216 Exclude no or unknown microscopic confirmation

48,642 19 Exclude carcinoids
Chapter 15 Cancer of the Corpus Uteri

National Cancer Institute 124 SEER Survival Monograph 

Results

Age and Race

Of the 48,642 cases, 63.5% of adults with cancer of the 

corpus uteri were diagnosed after age 60 years and older 

(Table 15.2). Over 50% were between the ages of 60-79 

years. Eighty-seven percent were white. Little difference 

exists in age distribution for white and black women, 

but the age distribution for women of other races was 

younger. 

For all women, relative survival declines with age. In 

women 20-49 year of age, the 5-year relative survival 

rate is 90% compared to 87% in women 50-69 and 79% 

in women aged 70 and older. Survival is also lower for 

black women compared to white women in all age groups 

presented (Table 15.3). The largest survival difference 

was for age group 70+ where the 5-year relative survival 

rate was 49% for black females compared to 81% for 

white females.

Geographic Location

There is little variation in survival by geographic area. 

Five-year relative survival rates in the 12 SEER areas 

presented in this study ranged from 89% in Seattle to 

81% in Detroit (Table 15.4). 

Histology

Distribution by histology is presented in Table 15.5. Tumors classified as adenocarcinoma comprise over 90% of 

all cancers of the corpus uteri. Of these, the most common 

subclassification was adenocarcinoma, NOS, which accounted for slightly more than 53% of all adenocarcinomas registered. Endometrioid adenocarcinoma was the 

next most common adenocarcinoma, at 30% followed by 

papillary serous (3.5%), adenosquamous (2.9%), papillary 

(2.3%), squamous metaplasia (2.6%), mucinous (1.9%), 

and clear cell (1.6%). 

Sarcomas and Other Specified Types comprise 7.7% of 

the total. Of these 34% are Mullerian, 25% leiomyosarcoma, 19% carcinosarcoma and 16% endometrial stromal 

sarcoma.

The 5-year relative survival rates vary greatly by histology 

from over 90% for adenocarcinoma, NOS, mucinous/mucin 

producing adenocarcinoma, and endometrioid adenocarcinoma to less than 50% for papillary serous adenocarcinoma, leiomyosarcoma, and Mullerian mixed tumor.

Staging

Uterine corpus cancer staging by the Federation Internationale de Gynecologie et d’Obstetrique (FIGO) and the 

American Joint Committee on Cancer (AJCC) are in the 

AJCC Manual for Staging of Cancer, 3rd edition (2):

Stage I tumor confined to the corpus uteri. 

Stage IA: tumor limited to endometrium 

Stage IB: tumor invades less than one half of the 

myometrium 

Stage IC: tumor invades one half or more of the myometrium 

Stage II tumor invades the cervix, but has not extended 

outside the uterus.

Stage III tumor extends outside of the uterus but is confined 

to the true pelvis.

Stage IV tumor involves the bladder or bowel mucosa or 

has metastasized to distant sites (including abdominal 

lymph nodes other than para-aortic, and/or inguinal lymph 

nodes; excludes metastasis to vagina, pelvic serosa, or 

adnexa).

Since the emphasis is on extension, a SEER modified 

version of stage was used in which positive lymph nodes 

went to N1 and Stage III but unknown lymph node involvement was ignored, i.e. treated like N0.

ADENOCARCINOMA

Stage

Table 15.6 and Figure 15.1 show the contrast across stage 

over time since diagnosis. In stages II-IV, the steepest 

declines in survival are observed within 1-3 years of diagnosis. Survival continues to decline throughout the 10 

years observed for stage III.

Age and Stage

Of the 44,059 cases of adenocarcinoma, enough information to establish stage at diagnosis was available for 

42,589 (96.7%). Across all age groups, 70% or more of 

all cancers were diagnosed in Stage I. The percent of 

tumors limited to the endometrium or invading less than 

half of the myometrium (Stages IA and IB) declines from 

64% in women age 20-49 to 46% in women 70 and over. 

Stage IV disease rises from 5% in women age 20-49 to 

9% in women 70 and over. (Table 15.7).

Across all age groups, a slight survival advantage is seen 

in Stage IA and IB disease compared to Stage IC. For all 

women, this translates to 99% 5-year survival for Stages 

IA & IB versus 92% for stage IC. Median survival time 

is over 10 years for all ages within Stage I, with the 

exception of women aged 70 and older diagnosed with 

Stage IC, where median survival time was found to be 
Chapter 15 Cancer of the Corpus Uteri

National Cancer Institute 125 SEER Survival Monograph 

Table 15.4: Cancer of the Corpus Uteri: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by SEER Geographic Area, Ages 20+, 12 SEER Areas, 1988-2001

Relative Survival Rate (%)

SEER Geographic Area Cases Percent 1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 48,642 100.0 93.5 89.5 87.0 84.7 83.1 82.6

Atlanta and Rural Georgia 2,646 5.4 93.1 88.3 85.4 82.9 80.1 79.6

 Atlanta (Metropolitan) - 1988+ 2,508 5.2 93.0 88.1 85.5 82.9 80.3 79.8

 Rural Georgia - 1988+ 138 0.3 95.0 91.1 84.1 81.5 76.8 72.1

California

 Los Angeles - 1992+ 7,978 16.4 92.1 87.2 84.6 81.7 80.4 79.0

 Greater Bay Area 8,591 17.7 93.8 89.7 87.6 85.6 83.8 83.6

 San Francisco-Oakland SMSA - 1988+ 5,882 12.1 93.8 89.6 87.5 85.9 83.6 83.2

 San Jose-Monterey - 1988+ 2,709 5.6 93.8 90.1 87.7 85.0 84.3 84.0

Connecticut - 1988+ 6,198 12.7 94.6 90.8 88.7 86.5 85.2 84.2

Detroit (Metropolitan) - 1988+ 6,451 13.3 91.8 86.7 83.6 81.0 79.2 78.4

Hawaii - 1988+ 1,585 3.3 93.9 89.7 87.4 84.1 81.5 81.0

Iowa - 1988+ 5,266 10.8 93.8 90.2 87.7 85.7 84.6 84.1

New Mexico - 1988+ 1,837 3.8 94.4 91.0 87.8 85.4 82.8 82.6

Seattle (Puget Sound) - 1988+ 5,860 12.0 95.4 92.6 90.6 89.2 88.1 88.1

Utah - 1988+ 2,230 4.6 94.0 90.4 88.0 85.1 83.2 82.1

Table 15.2: Cancer of the Corpus Uteri: Age (20+) and Race Distributions, 12 SEER Areas, 1988-2001

Total White Black Other

Age Group (Years) Cases Percent Cases Percent Cases Percent Cases Percent

Total 48,642 100.0 42,220 100.0 3,065 100.0 3,357 100.0

20-29 218 0.4 154 0.4 25 0.8 39 1.2

30-39 1,542 3.2 1,145 2.7 146 4.8 251 7.5

40-49 5,254 10.8 4,198 9.9 309 10.1 747 22.3

50-59 10,740 22.1 9,226 21.9 576 18.8 938 27.9

60-69 13,816 28.4 12,032 28.5 1,016 33.1 768 22.9

70-79 11,972 24.6 10,792 25.6 700 22.8 480 14.3

80+ 5,100 10.5 4,673 11.1 293 9.6 134 4.0

Table 15.3: Cancer of the Corpus Uteri: Number of Cases, Median Survival Time (Months) and 5-Year Survival Rates (%) by Race 

and Age (20+), 12 SEER Areas, 1988-2001

Median Survival 

Time

5-Year Survival Rates (%)

Race/Age Cases (Months) Observed Expected Relative

All Races, 20+ 48,642 > 120 75.1 88.6 84.7

White, 20+ 42,220 > 120 76.3 88.2 86.4

Black, 20+ 3,065 72.1 53.2 86.1 61.8

All Races, 20-49 7,014 > 120 88.7 98.9 89.7

White, 20-49 5,497 > 120 90.0 98.9 91.0

Black, 20-49 480 > 120 76.5 97.8 78.1

All Races, 50-69 24,556 > 120 82.1 94.3 87.0

White, 50-69 21,258 > 120 83.9 94.4 88.9

Black, 50-69 1,592 99.8 57.4 90.6 63.4

All Races, 70+ 17,072 89.0 59.8 76.1 78.6

White, 70+ 15,465 92.2 61.3 76.0 80.6

Black, 70+ 993 28.4 35.6 73.3 48.6
Chapter 15 Cancer of the Corpus Uteri

National Cancer Institute 126 SEER Survival Monograph 

Table 15.5: Cancer of the Corpus Uteri: Number and Distribution of Cases and 5-Year Relative Survival Rate (%) by Histology, 

Ages 20+, 12 SEER Areas, 1988-2001

Histology ICD-O Code Cases Percent

5-Year 

RSR (%)

All Values 8000-9989 48,642 100.0 84.7

Epidermoid 8051-8130 132 0.3 61.1

Adenocarcinoma 8050,8140-8147,8160-8162,8180-8221,8250-8506,8520-

8550,8560,8570-8573,8940-8941 44,059 90.6 87.9

 Adenocarcinoma, NOS* 8140 23,489 48.3 90.8

 Papillary 80508260 1,035 2.1 70.3

 Clear Cell 8310 704 1.4 64.8

 With Squamous Metaplasia 8570 1,151 2.4 93.8

 Mucinous & Mucin 

 Producing 8480-8481 824 1.7 95.0

 Adenosquamous 8560 1,256 2.6 74.0

 Endometrioid 8380 13,258 27.3 91.2

 Papillary Serous 8460 1,555 3.2 44.7

 All Other Adenocarcinoma 8141-8147,8160-8162,8180-8221,8250-8259,8261-8309,8311-

8379,8381-8459,8461-8479,8482-8506,8520-8550,8571-

8573,8940-8941 787 1.6 68.5

Other Specified Carcinomas 8030-8045,8150-8155,8170-8171,8230-8248,8510-8512,8561-

8562,8580-8671 24 0.0 ~

Carcinoma, NOS* 8010-8022 608 1.2 58.4

Sarcomas and Other 

 Specified Types

8680-8713,8720-8790,8800-8920,8930-8933,8950-8982,8990-

8991,9000-9030,9040-9055,9060-9110,9120-9134,9141-

9340,9350-9364,9380-9512,9530-9581 3,742 7.7 53.3

 Leiomyosarcoma 8890-8897 939 1.9 48.2

 Carcinosarcoma 8933,8980-8981 706 1.5 53.7

 Endometrial Stromal 8930 610 1.3 74.6

 Mullerian 8950-8951 1,264 2.6 45.3

 All Other 8680-8713,8720-8790,8800-8889,8898-8920,8931-

8932,8935,8952-8979,8982,8990-8991,9000-9030,9040-

9055,9060-9110,9120-9134,9141-9340,9350-9364,9380-9512,-

9530-9581 230 0.5 53.9

Unspecified 8000-8004 70 0.1 55.1

 ~ Statistic not displayed due to less than 25 cases.

* NOS: Not Otherwise Specified

Table 15.6: Adenocarcinoma of the Corpus Uteri: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates (%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate(%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 44,059 100.0 95.2 92.1 89.9 87.9 86.4 86.0

Stage I 33,179 75.3 99.7 99.1 98.3 97.4 96.3 95.7

 IA 9,528 21.6 99.9 99.8 99.5 99.3 99.0 99.0

 IB 15,084 34.2 100.0 100.0 99.7 99.2 98.3 97.5

 IC 4,142 9.4 99.1 97.2 95.0 91.9 88.4 86.2

 I NOS* 4,425 10.0 97.8 95.8 93.8 92.1 90.5 90.2

Stage II 3,475 7.9 94.8 89.7 85.1 80.2 77.2 76.5

Stage III 2,651 6.0 87.5 75.8 68.2 59.6 53.4 50.5

Stage IV 3,284 7.5 61.5 44.4 35.8 28.6 25.3 25.3

Unknown/Unstaged 1,470 3.3 83.5 72.5 66.8 63.5 60.3 59.6

* NOS: Not Otherwise Specified
Chapter 15 Cancer of the Corpus Uteri

National Cancer Institute 127 SEER Survival Monograph 

Table 15.8: Adenocarcinoma of the Corpus Uteri: Number of Cases and 5-Year Relative Survival Rates (RSR) (%) by AJCC Stage 

(SEER modified 3rd edition) and Age (20+), 12 SEER Areas, 1988-2001

AJCC Stage

Total 20-49 50-69 70+

Cases

5-Year 

RSR 

(%)

Median 

Survival 

Time 

(Months) Cases

5-Year 

RSR 

(%)

Median 

Survival 

Time 

(Months) Cases

5-Year 

RSR 

(%)

Median 

Survival 

Time 

(Months) Cases

5-Year 

RSR 

(%)

Median 

Survival 

Time 

(Months)

Total 44,059 87.9 > 120 5,931 93.2 > 120 22,606 89.7 > 120 15,522 82.5 96.5

Stage I 33,179 97.4 > 120 4,604 98.2 > 120 17,679 97.2 > 120 10,896 97.8 > 120

 IA 9,528 99.3 > 120 2,040 98.9 > 120 5,224 99.4 > 120 2,264 99.3 > 120

 IB 15,084 99.2 > 120 1,723 98.1 > 120 8,500 98.2 > 120 4,861 100.0 > 120

 IC 4,142 91.9 > 120 193 94.8 > 120 1,789 90.4 > 120 2,160 93.3 107.4

 I NOS 4,425 92.1 > 120 648 97.4 > 120 2,166 93.8 > 120 1,611 86.6 102.4

Stage II 3,475 80.2 > 120 481 91.1 > 120 1,592 84.1 > 120 1,402 70.3 64.7

Stage III 2,651 59.6 66.6 352 76.0 > 120 1,250 65.3 102.3 1,049 45.5 32.9

Stage IV 3,284 28.6 17.8 317 46.0 42.4 1,539 31.9 21.2 1,428 19.3 12.6

Unknown/

Unstaged 1,470 63.5 62.8 177 83.3 > 120 546 77.3 > 120 747 42.2 23.3

Table 15.7: Adenocarcinoma of the Corpus Uteri: Distribution by AJCC Stage (SEER modified 3rd edition) and Age (20+), 

12 SEER Areas, 1988-2001

AJCC Stage

Age (Years)

Total 20-49 50-69 70+

Cases Percent Cases Percent Cases Percent Cases Percent

Total 44,059 100.0 5,931 100.0 22,606 100.0 15,522 100.0

Stage I 33,179 75.3 4,604 77.6 17,679 78.2 10,896 70.2

 IA 9,528 21.6 2,040 34.4 5,224 23.1 2,264 14.6

 IB 15,084 34.2 1,723 29.1 8,500 37.6 4,861 31.3

 IC 4,142 9.4 193 3.3 1,789 7.9 2,160 13.9

 I NOS* 4,425 10.0 648 10.9 2,166 9.6 1,611 10.4

Stage II 3,475 7.9 481 8.1 1,592 7.0 1,402 9.0

Stage III 2,651 6.0 352 5.9 1,250 5.5 1,049 6.8

Stage IV 3,284 7.5 317 5.3 1,539 6.8 1,428 9.2

Unknown/Unstaged 1,470 3.3 177 3.0 546 2.4 747 4.8

* NOS: Not Otherwise Specified

90

100

70

80

ate (%)

50

60

Survival R

20

30

40

Relative S

0

10

R

20

IA IB IC II III IV

AJCC Stage

20-49 50-69 70+

90

100

)

70

80

l Rate (%)

IA

IB

50

60

70

ve Survival

IC

II

30

40

50

Relativ

II

III

10

20

30 IV

0

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 15.2: Adenocarcinoma of the Corpus Uteri: 5-Year 

Relative Survival Rate (%) by AJCC Stage (SEER modified 3rd 

edition) and Age Group (20+), 12 SEER Areas, 1988-2001

Figure 15.1: Adenocarcinoma of the Corpus Uteri: Relative 

Survival Rate (%) by AJCC Stage (SEER modified 3rd edition), 

Ages 20+, 12 SEER Areas, 1988-2001
Chapter 15 Cancer of the Corpus Uteri

National Cancer Institute 128 SEER Survival Monograph 

107 months. A survival differential across age exists for 

Stages II-IV. Women ages 20-49 diagnosed with Stage 

II disease experience a 5-year relative survival rate of 

91%. This falls to 84% for women age 50-69 and 70% 

for women ages 70 and older. For Stage III, survival is 

76% in women 20-49, 65% in those 50-69 and 45% for 

those aged 70 and over. For Stage IV, survival is 46% in 

women under 50, 32% in those 50-69 and 19% for those 

aged 70 and over (Table 15.8, Figure 15.2). 

Table 15.9: Adenocarcinoma of the Corpus Uteri: Number of Cases and 5-Year Relative Survival Rates (%) by Histology and AJCC 

Stage (SEER modified 3rd edition) , Ages 20+, 12 SEER Areas, 1988-2001

Histology

AJCC Stage

Total I II III IV Unknown/

Unstaged

Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%)

Total 44,059 87.9 33,179 97.4 3,475 80.2 2,651 59.6 3,284 28.6 1,470 63.5

Adenocarcinoma, NOS* 23,489 90.8 18,775 98.0 1,602 81.3 965 59.8 1,272 30.1 875 66.6

Papillary 1,035 70.3 634 91.0 107 56.8 80 49.4 162 17.0 52 23.4

Clear Cell 704 64.8 338 88.4 90 67.3 94 47.8 139 17.9 43 54.1

With Squamous Metaplasia 1,151 93.8 952 97.2 82 84.6 47 84.6 46 51.7 24 ~

Mucinous & Mucin Producing 824 95.0 621 99.9 53 95.7 63 83.9 60 43.3 27 73.1

Adenosquamous 1,256 74.0 730 89.9 161 78.4 136 57.0 191 24.8 38 55.1

Endometrioid 13,258 91.2 10,149 98.4 1,149 85.7 904 66.9 727 36.8 329 65.4

Papillary Serous 1,555 44.7 531 73.9 163 55.8 258 33.3 542 18.3 61 34.4

All Other Adenocarcinoma 787 68.5 449 92.5 68 46.7 104 42.5 145 14.5 21 ~

 ~ Statistic not displayed due to less than 25 cases.

* NOS: Not Otherwise Specified

Figure 15.3: Adenocarcinoma of the Corpus Uteri: 5-Year 

Relative Survival Rate (%) by Histology and AJCC Stage (SEER 

modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Figure 15.4: Adenocarcinoma of the Corpus Uteri: 5-Year 

Relative Survival Rate (%) by Grade and AJCC Stage (SEER 

modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

e100 (%)

70

80

90

100

val Rat e 30

40

50

60

ve Surviv

0

10

20

30

Relativ

0

IA IB IC II III IV

AJCC Stage

Grade I Grade II Grade III Grade IV

90

100

te (%)

50

60

70

80

vival Rat 20

30

40

50

tive Surv

0

10

20

Stage I Stage II Stage III Stage IV

Relat

Stage I Stage II Stage III Stage IV

AJCC Stage

Adenocarcinoma, NOS Papillary

Clear Cell Clear Cell With Squamous Metaplasia With Squamous Metaplasia

Mucinous & Mucin Producing Adenosquamous

Endometroid Papillary Serous

Subtype and Stage

Survival by subtype and stage is presented in Table 15.9 

and Figure 15.3. A survival disadvantage is seen in tumors 

of the papillary serous subtype across all stages. These tumors are histologically similar to those found in the ovary. 

Similar but smaller differentials are observed for clear cell 

and papillary subtypes. Adenosquamous may have a slight 

survival disadvantage in Stage I. This may be due to more 

of these tumors being diagnosed in Stage IC and fewer 

in Stage IA (Table 15.10). Tumors exhibiting squamous 

metaplasia exhibit higher survival, particularly in stages III 
Chapter 15 Cancer of the Corpus Uteri

National Cancer Institute 129 SEER Survival Monograph 

Table 15.10: Stage I Adenocarcinoma of the Corpus Uteri: Distribution by Histology and Detailed AJCC Stage (SEER modified 

3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Histology

AJCC Stage

Total Stage I IA IB IC I NOS

Cases

Row 

Percent Cases

Row 

Percent Cases

Row 

Percent Cases

Row 

Percent Cases

Row 

Percent

Total 33,179 100.0 9,528 28.7 15,084 45.5 4,142 12.5 4,425 13.3

Adenocarcinoma, NOS* 18,775 100.0 5,327 28.4 8,352 44.5 2,239 11.9 2,857 15.2

Papillary 634 100.0 180 28.4 249 39.3 77 12.1 128 20.2

Clear Cell 338 100.0 107 31.7 140 41.4 42 12.4 49 14.5

With Squamous Metaplasia 952 100.0 277 29.1 461 48.4 101 10.6 113 11.9

Mucinous & Mucin Producing 621 100.0 199 32.0 268 43.2 73 11.8 81 13.0

Adenosquamous 730 100.0 125 17.1 345 47.3 153 21.0 107 14.7

Endometrioid 10,149 100.0 2,944 29.0 4,888 48.2 1,353 13.3 964 9.5

Papillary Serous 531 100.0 193 36.3 211 39.7 69 13.0 58 10.9

All Other Adenocarcinoma 449 100.0 176 39.2 170 37.9 35 7.8 68 15.1

* NOS: Not Otherwise Specified

Table 15.11: Adenocarcinoma of the Corpus Uteri: Number of Cases and 5-Year Relative Survival Rates (%) by AJCC Stage (SEER 

modified 3rd edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Grade

Total Well 

Differentiated

Moderately 

Differentiated

Poorly 

Differentiated

Anaplastic Unknown

Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%) Cases

5-Year 

RSR 

(%)

Total 44,059 87.9 17,429 99.2 15,002 90.8 7,544 64.9 1,294 54.8 2,790 72.9

Stage I 33,179 97.4 15,472 100.0 11,492 97.2 4,061 86.6 557 79.7 1,597 93.0

 IA 9,528 99.3 5,517 99.9 2,599 99.2 741 90.9 114 83.3 557 95.3

 IB 15,084 99.2 6,631 100.0 5,741 98.7 1,895 92.5 261 88.9 556 95.7

 IC 4,142 91.9 1,161 99.4 1,813 95.3 899 77.0 124 63.6 145 88.0

 I NOS* 4,425 92.1 2,163 98.4 1,339 89.9 526 75.3 58 60.9 339 85.2

Stage II 3,475 80.2 847 93.1 1,399 84.7 835 66.7 150 51.3 244 68.3

Stage III 2,651 59.6 370 82.7 898 68.0 970 48.3 210 46.4 203 45.0

Stage IV 3,284 28.6 269 59.9 801 45.1 1,426 16.9 323 19.9 465 21.1

Unknown/Unstaged 1,470 63.5 471 79.4 412 63.1 252 36.3 54 38.3 281 62.8

* NOS: Not Otherwise Specified

and IV. Clear cell and papillary types show lower survival 

in stages II-IV.

Stage and Grade

Five-year relative survival rates for adenocarcinoma are 

shown by tumor grade in Table 15.11 and Figure 15.4. 

Within stage, 5-year relative survival rates declined as grade 

increases with the exception of poorly differentiated and 

anaplastic Stage IV tumors.

Conditional Survival 

Five year relative survival rates, conditioned on years since 

diagnosis, are presented in Table 15.12 and Figure 15.5. 

For stages IC-IV, the probability of surviving the next 5 

years increases as time since diagnosis increases. This is 

most marked for the stage IV cases. Five year survival 

from time of diagnosis is 29%. For those individuals who 

survive 1 year post diagnosis, 5-year survival increases 

to 43%. This increases to 86% for those individuals who 

survived 5 years.
Chapter 15 Cancer of the Corpus Uteri

National Cancer Institute 130 SEER Survival Monograph 

Table 15.12: Adenocarcinoma of the Corpus Uteri: 5-Year Relative Survival Rates (%), Conditioned on Years Since Diagnosis, by 

AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

5-Year Relative Survival Rate (%)

Years Since Diagnosis

0 1 2 3 4 5

Total 87.9 91.2 93.9 95.5 96.9 97.4

Stage I 97.4 97.3 97.9 98.1 98.7 98.7

 IA 99.3 99.3 99.6 99.6 99.8 99.9

 IB 99.2 98.6 99.0 99.0 99.3 99.1

 IC 91.9 92.0 92.9 93.3 94.4 94.3

 I NOS* 92.1 93.2 94.6 95.7 97.1 97.2

Stage II 80.2 81.6 85.0 89.4 91.1 93.6

Stage III 59.6 64.2 71.0 76.7 80.1 83.0

Stage IV 28.6 43.2 57.8 68.1 78.6 86.0

Unknown/Unstaged 63.5 71.5 79.4 84.2 86.0 87.5

* NOS: Not Otherwise Specified

SARCOMA AND OTHER SPECIFIED TYPES

Subtype and Stage

Of the 3,742 cases of sarcoma and other specified types, 

enough information to establish stage at diagnosis was available for 3,580 (96%). Fifty six percent were diagnosed in 

Stage I, while 22% were Stage IV (Table 15.13).

Survival by stage for sarcomas overall is presented in Figure 

15.6. Survival by subtype and stage is presented in Table 

15.14. Despite some data sparseness in Stage II, it is observed that endometrial stromal tumors experience a better 

survival across stage than do either tumors categorized as 

leiomyosarcoma, carcinosarcoma, or Mullerian, which had 

similar survival rates. 

Stage and Grade

Despite data sparseness in well differentiated, within stage, 

5-year relative survival declines as grade increases (Table 

15.15).

Conditional Survival

Five year relative survival, conditioned on years since diagnosis, is presented in Table 15.16 and Figure 15.7 for 

sarcomas and other specific types. For all stages, the probability of surviving the next 5 years increased as time since 

Figure 15.5: Adenocarcinoma of the Corpus Uteri: 5-Year 

Relative Survival Rate (%), Conditioned on Years Since 

Diagnosis, by AJCC Stage (SEER modified 3rd edition), Ages 

20+, 12 SEER Areas, 1988-2001

100 IA

80

90

ate (%)

IB

50

60

70

urvival Ra

IC

II

30

40

50

elative Su

II

III

10

20

30 Re

IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 15.6: Sarcoma and Other Specified Types of Cancer of 

the Corpus Uteri: Relative Survival Rates (%) by AJCC Stage 

(SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-

2001

90

100

70

80

te (%)

50

60

vival Rat 30

40

tive Surv 10

20

Rela

0

IA IB IC II III IV

AJCC St AJCC Stage

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years
Chapter 15 Cancer of the Corpus Uteri

National Cancer Institute 131 SEER Survival Monograph 

Table 15.13: Sarcoma & Other Specified Types of Corpus Uterine Cancer: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, 

& 10-Year Relative Survival Rates (%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Percent Percent Percent Percent Percent Percent

Total 3,742 100.0 78.4 64.4 58.4 53.3 50.0 49.1

Stage I 2,081 55.6 92.2 81.4 76.3 70.8 66.2 64.5

 IA 397 10.6 94.4 90.0 86.4 84.3 81.2 76.0

 IB 558 14.9 91.1 78.2 73.7 68.2 64.9 63.7

 IC 280 7.5 90.7 75.9 69.4 62.1 59.0 56.7

 I NOS 846 22.6 92.4 81.3 75.4 68.7 61.7 61.0

Stage II 277 7.4 81.0 56.4 49.7 43.6 39.8 39.0

Stage III 394 10.5 69.7 52.2 45.2 38.8 34.5 33.4

Stage IV 828 22.1 50.1 32.0 23.9 19.8 19.6 19.6

Unknown/Unstaged 162 4.3 62.0 49.2 44.8 39.7 35.9 34.6

* NOS: Not Otherwise Specified

Table 15.14: Sarcoma & Other Specified Types of Corpus Uterine Cancer: Number of Cases and 5-Year Relative Survival Rates 

(%) by Histology and AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Histology

AJCC Stage

Total I II III IV Unknown/

Unstaged

Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%)

Total 3,742 53.3 2,081 70.8 277 43.6 394 38.8 828 19.8 162 39.7

Leiomyosarcoma 939 48.2 623 60.0 28 35.1 64 27.7 185 14.9 39 51.6

Carcinosarcoma 706 53.7 401 73.7 62 43.3 97 26.2 122 13.6 24 ~

Endometrial Stromal 610 74.6 372 89.8 27 40.0 85 64.3 106 37.0 20 ~

Mullerian 1,264 45.3 570 66.7 147 45.7 132 34.8 353 18.2 62 19.4

All Other 223 53.6 115 74.3 13 ~ 16 ~ 62 21.4 17 ~

 ~ Statistic not displayed due to less than 25 cases.

Table 15.15: Sarcoma & Other Specified Types of Corpus Uterine Cancer: Number of Cases and 5-Year Relative Survival Rates 

(%) by AJCC Stage (SEER modified 3rd edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Grade

Total Well Differentiated Moderately 

Differentiated

Poorly/ 

Undifferentiated

Unknown

Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%)

Total 3,742 53.3 218 86.1 593 79.2 1,351 35.8 1,580 52.8

Stage I 2,081 70.8 167 92.6 435 84.8 603 54.8 876 69.8

 IA 397 84.3 37 96.2 80 88.8 60 71.6 220 82.8

 IB 558 68.2 32 88.0 93 84.0 215 58.6 218 66.7

 IC 280 62.1 10 ~ 48 84.6 118 47.6 104 63.3

 I NOS* 846 68.7 88 90.4 214 83.1 210 49.9 334 64.4

Stage II 277 43.6 8 ~ 26 78.6 124 36.0 119 39.2

Stage III 394 38.8 14 ~ 59 68.6 177 28.2 144 35.8

Stage IV 828 19.8 20 ~ 58 47.9 407 13.2 343 20.7

Unknown/Unstaged 162 39.7 9 ~ 15 ~ 40 9.1 98 44.3

 ~ Statistic not displayed due to less than 25 cases.

* NOS: Not Otherwise Specified
Chapter 15 Cancer of the Corpus Uteri

National Cancer Institute 132 SEER Survival Monograph 

Table 15.16: Sarcoma & Other Specified Types of Corpus Uterine Cancer: 5-Year Relative Survival Rates (%), Conditioned on 

Years Since Diagnosis, by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

5-Year Relative Survival Rate(%)

Years Since Diagnosis

0 1 2 3 4 5

Total 53.3 64.8 77.8 83.2 87.2 89.5

Stage I 70.8 73.8 82.6 85.6 88.2 90.0

 IA 84.3 87.7 91.3 93.3 91.6 90.3

 IB 68.2 72.2 83.2 86.3 88.3 91.0

 IC 62.1 64.9 77.2 84.1 89.5 90.1

 I NOS* 68.7 70.6 78.4 81.1 84.9 88.2

Stage II 43.6 53.1 71.1 76.1 83.1 86.5

Stage III 38.8 51.3 66.7 72.8 77.7 82.9

Stage IV 19.8 38.3 59.6 80.8 91.4 95.4

Unknown/Unstaged 39.7 56.5 67.1 69.9 73.7 74.5

* NOS: Not Otherwise Specified

older women is compounded by advanced stage. In later 

stages, particularly stages III and IV, survival declines 

rapidly over time since diagnosis.

Overall, all histologies in stage I had a favorable 5-year 

survival. The papillary serous histology had the worst 

survival across all stages, while papillary metaplasia had 

the highest survival in stages II-IV. In the group of sarcoma histologies, endometrial stromal sarcomas had a 

better survival across stage than other sarcomas.

Across all stages, survival declined with advanced stage 

of disease, with the exception of poorly differentiated 

and anaplastic tumors where there is little difference in 

survival for adenocarcinomas.

References

1. American Cancer Society. Cancer Facts and Figures 2006. 

Atlanta: American Cancer Society, 2006.

2. Beahrs, OH, Henson DE, Hutter RVP, Myers MH (eds). 

AJCC Cancer Staging Manual, Third edition. American Joint 

Committee on Cancer. Philadelphia: Lippincott, 1988.

Figure 15.7: Sarcoma and Other Specified Types of Cancer 

of the Corpus Uteri: 5-Year Relative Survival Rate (%), 

Conditioned on Years Since Diagnosis, by AJCC Stage (SEER 

modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

90

100

70

80

Rate (%)

50

60

urvival R 30

40

lative Su 10

20

Rel

0

IA IB IC II III IV

AJCC Stage

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years

diagnosis increased. This is most marked for the stage IV 

cases. Five year survival from time of diagnosis was 20%. 

For those individuals who survived 1 year post diagnosis, 

5-year survival increased to 38%. This increased to 91% 

for those individuals who survived 4 years.

Discussion

Survival is lower for blacks compared to whites regardless 

of age, and is most pronounced in women over 70 years of 

age. The majority of corpus uteri tumors are adenocarcinomas. Of these, more than 70% are diagnosed in stage I and 

have a median survival greater than 10 years for women 

of all age groups, except in women over 70 years of age 

with stage IC where the median survival is slightly less 

than 10 years. There exists a differential in survival by age 

and across stage of disease II-IV. The poorer survival in 
National Cancer Institute 133 SEER Survival Monograph 

Introduction

Epithelial carcinoma of the ovary is one of the most common gynecologic malignancies. It is also the fifth most 

frequent cause of cancer death in women (behind lung, 

breast, colorectal, and pancreas). A little over 15% of 

epithelial ovarian tumors are of low malignant potential. 

These “borderline” tumors were classified as malignant 

in the International Classification of Diseases for Oncology second edition (ICD-O-2) (1) and were classified 

as non-malignant with the 2001 implementation of the 

third edition, ICD-O-3 (2), and they are different from 

the frank malignant invasive carcinomas. Uncommon 

tumors include germ cell tumors of the ovary, seen most 

often in younger women. 

Materials and Methods

The NCI contracts with medically-oriented, nonprofit institutions located in specific geographic areas to obtain 

data on all cancers diagnosed in residents of the SEER 

geographic areas. SEER collects data on all invasive 

and in situ cancers except basal cell and squamous cell 

carcinomas of the skin (of non-genital anatomic sites) and 

in situ carcinomas of the uterine cervix. SEER actively 

follows all previously diagnosed patients on an annual 

basis to obtain vital status allowing the calculation of 

observed and relative survival rates.

This analysis is based on data from 12 SEER geographic 

areas which collectively cover about 14% of the total US 

population. The areas are the States of Connecticut, Iowa, 

New Mexico, Utah, and Hawaii; the metropolitan areas of 

Detroit, Michigan; Atlanta, Georgia; San Francisco, San 

Jose, and Los Angeles, California; Seattle, Washington; 

and 10 counties in rural Georgia. Los Angeles contributed 

data for diagnosis years 1992 to 2001, all other areas for 

1988-2001.

Between 1988-2001, there were 40,250 cases of cancer of 

the ovary reported to SEER. The following were excluded 

from the analysis: patients for whom ovarian cancer was 

not the first primary, cases identified through autopsy or 

death certificate only, persons of unknown race, patients 

who were alive with no survival time, patients less than 20 

years old, cases without microscopic confirmation, in situ 

tumors, sarcomas including stromal, mesenchymoma, and 

embryonal sarcomas, and carcinoids. After these exclusions, 32,019 cases remained for analysis (Table 16.1).

Table 16.1: Cancer of the Ovary: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining

Number 

Excluded Reason for Exclusion/Selection

40,250 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

35,047 5,203 Select first primary only

34,607 440 Exclude death certificate only or at autopsy

34,468 139 Exclude unknown race

34,401 67 Exclude alive with no survival time

33,880 521 Exclude children (ages 0-19)

33,804 76 Exclude in situ cancers 

32,374 1,430 Exclude no or unknown microscopic confirmation

32,160 214 Exclude sarcomas

32,040 120 Exclude carcinoids

32,019 21 Exclude stromal, mesenchymoma, and embryonal sarcomas

Carol L. Kosary

Chapter 16

Cancer of the Ovary
Chapter 16 Cancer of the Ovary

National Cancer Institute 134 SEER Survival Monograph 

Staging

Ovarian cancer staging by the Federation Internationale 

de Gynecologie et d’Obstetrique (FIGO) and the American Joint Committee on Cancer (AJCC) are in the AJCC 

Manual for Staging of Cancer, 3rd edition (3):

Stage I ovarian cancer is growth limited to the ovaries. 

Stage IA: growth limited to one ovary; no ascites. No tumor on the 

external surface; capsule intact. 

Stage IB: growth limited to both ovaries; no ascites. No tumor on 

the external surfaces; capsules intact. 

Stage IC: tumor either stage IA or IB, but with tumor on the surface 

of one or both ovaries; or with capsule ruptured; or with ascites 

present containing malignant cells or with positive peritoneal 

washings.

Stage II ovarian cancer is growth involving one or both ovaries with 

pelvic extension. 

Stage IIA: extension and/or metastases to the uterus and/or tubes. 

Stage IIB: extension to other pelvic tissues. 

Stage IIC: tumor either stage IIA or stage IIB, but with tumor on the 

surface of one or both ovaries; or with capsule(s) ruptured; or 

with ascites present containing malignant cells or with positive 

peritoneal washings. 

Stage III ovarian cancer is tumor involving one or both ovaries 

with peritoneal implants outside the pelvis and/or positive 

retroperitoneal or inguinal nodes. Superficial liver metastasis 

equals stage III. Tumor is limited to the true pelvis but with 

histologically verified malignant extension to small bowel or 

omentum. 

Stage IIIA: tumor grossly limited to the true pelvis with negative 

nodes but with histologically confirmed microscopic seeding of 

abdominal peritoneal surfaces. 

Stage IIIB: tumor of one or both ovaries with histologically 

confirmed implants of abdominal peritoneal surfaces, none 

exceeding 2 centimeters in diameter. Nodes negative. 

Stage IIIC: abdominal implants greater than 2 centimeters in 

diameter and/or positive retroperitoneal or inguinal nodes. 

Stage IV ovarian cancer is growth involving one or both ovaries 

with distant metastasis. If pleural effusion is present, there must 

be positive cytologic test results to allot a case to stage IV. 

Parenchymal liver metastasis equals stage IV.

Since the emphasis is on extension, SEER modified version 

of stage was used in which positive lymph nodes were 

N1 and Stage IIIC but unknown lymph node involvement 

was ignored, i.e. treated like N0.

Results

Age and Race

Of the 32,019 eligible adult cases, approximately half occurred before age 60 (Table 16.2). Eighty-six percent of 

eligible patients were white. White women were slightly 

older than black women with ovarian cancer. 

For all women, relative survival declines with age. In 

adult women under age 50, 5-year relative survival is 

76.6% compared to 50.2% in women 50-69 and 31.6% 

in women aged 70 and older. Survival is lower for black 

women compared to white women in all age groups presented, especially ages 50-69 (Table 16.3).

Geographic Location

There was little variation in survival by geographic area. 

Five-year relative survival rates in the 12 SEER areas represented in this study ranged from 57.0% in Los Angeles 

to 48.4% in Rural Georgia (Table 16.4). 

Histology

Distribution by histology is presented in Table 16.5. Tumors classified as adenocarcinoma comprise almost 90% 

of all cancers of the ovary. Of these, the most common 

subclassification was papillary serous cystadenocarcinoma, 

which accounted for slightly more than one fourth of 

all cancers and 29% of all adenocarcinomas registered. 

“Borderline” adenocarcinoma was the next most common, 

at 15.9%, which is slightly underestimated since it wasn’t 

collected prior to 1991 or after 2000. Adenocarcinoma, Not 

Otherwise Specified (12.6%), endometrioid (9.8%), serous 

cystadenocarcinoma (5.8%), papillary (5.5%), mucinous 

cystadenocarcinoma (4.2%), clear cell (4.0%), mucinous 

adenocarcinoma (3.4%) and cystadenocarcinoma (1.3%) 

were also observed. 

Table 16.2: Cancer of the Ovary: Age Distribution by Race, Ages 20+, 12 SEER Areas, 1988-2001 

Age Group (Years)

Total White Black Other

Cases Percent Cases Percent Cases Percent Cases Percent

Total 32,019 100.0 27,595 100.0 2,035 100.0 2,389 100.0

20-29 1,292 4.0 1,009 3.7 122 6.0 161 6.7

30-39 2,736 8.5 2,243 8.1 196 9.6 297 12.4

40-49 5,081 15.9 4,231 15.3 345 17.0 505 21.1

50-59 6,226 19.4 5,299 19.2 376 18.5 551 23.1

60-69 6,954 21.7 6,036 21.9 466 22.9 452 18.9

70-79 6,525 20.4 5,837 21.2 370 18.2 318 13.3

80+ 3,205 10.0 2,940 10.7 160 7.9 105 4.4
Chapter 16 Cancer of the Ovary

National Cancer Institute 135 SEER Survival Monograph 

Table 16.4: Cancer of the Ovary: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by SEER 

Geographic Area, Ages 20+, 12 SEER Areas, 1988-2001

SEER Geographic Area Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 32,019 100.0 80.3 69.3 61.8 53.8 49.4 48.5

Atlanta and Rural Georgia 2,007 6.3 80.0 71.1 65.1 56.5 51.9 50.8

 Atlanta (Metropolitan) - 1988+ 1,911 6.0 80.3 71.7 65.7 56.9 52.1 50.9

 Rural Georgia - 1988+ 96 0.3 74.5 59.8 52.5 48.4 46.3 46.3

California

 Los Angeles - 1992+ 5,593 17.5 81.9 72.0 65.4 57.0 52.9 51.9

 Greater Bay Area 5,723 17.9 80.1 69.7 61.3 52.9 48.0 46.6

 San Francisco-Oakland SMSA - 1988+ 3,814 11.9 79.0 68.2 59.4 51.5 47.8 46.6

 San Jose-Monterey - 1988+ 1,909 6.0 82.2 72.8 65.2 55.5 48.5 46.5

Connecticut - 1988+ 3,580 11.2 80.7 68.2 60.2 51.7 46.0 45.3

Detroit (Metropolitan) - 1988+ 4,092 12.8 77.2 66.6 58.1 51.1 46.8 45.3

Hawaii - 1988+ 943 2.9 82.8 72.7 65.9 56.5 51.4 50.0

Iowa - 1988+ 3,278 10.2 77.7 65.4 59.2 52.1 49.0 48.7

New Mexico - 1988+ 1,341 4.2 78.7 67.6 59.0 50.2 46.8 45.2

Seattle (Puget Sound) - 1988+ 4,012 12.5 83.0 70.8 63.6 55.6 51.2 51.0

Utah - 1988+ 1,450 4.5 80.1 68.9 60.8 53.8 51.5 49.6

Table 16.3: Cancer of the Ovary: Number of Cases, Median Survival Time (Months) and 5-year Survival Rates (%) by Race and Age 

(20+), 12 SEER Areas, 1988-2001

Race/Age (years) Cases

Median 

Survival Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

All Races, 20+ 32,019 54.5 48.4 89.9 53.8

 White, 20+ 27,595 53.7 48.0 89.6 53.6

 Black, 20+ 2,035 38.0 43.1 88.6 48.5

All Races, 20-49 9,109 > 120 75.8 99.1 76.6

 White, 20-49 7,483 > 120 76.7 99.1 77.4

 Black, 20-49 663 > 120 71.4 98.1 72.7

All Races, 50-69 13,180 53.2 47.5 94.5 50.2

 White, 50-69 11,335 54.1 47.9 94.6 50.6

 Black, 50-69 842 30.7 35.1 91.1 38.6

All Races, 70+ 9,730 18.7 23.8 75.2 31.6

 White, 70+ 8,777 18.8 23.5 74.9 31.3

 Black, 70+ 530 13.5 20.6 72.8 27.7
Chapter 16 Cancer of the Ovary

National Cancer Institute 136 SEER Survival Monograph 

Table 16.5: Cancer of the Ovary: Number and Distribution of Cases and 5-Year Relative Survival Rate (RSR) (%) by Histology, Ages 

20+, 12 SEER Areas, 1988-2001

Histology ICD-O Code Cases Percent

5-Year 

RSR (%)

Total 8000-9989 32,019 100.0 53.8

Epidermoid 8051-8130 174 0.5 51.3

Adenocarcinoma 8050,8140-8147,8160-8162,8180-8221,8250-

8506,8520-8550,8560,8570-8575,8940-8941,9110 28,728 89.7 54.4

 Adenocarcinoma NOS* 8140 4,021 12.6 18.3

 Papillary 8050,8260 1,750 5.5 21.0

 Clear Cell 8310,9110 1,291 4.0 61.5

 Endometrioid 8380-8381,8570 3,133 9.8 70.9

 Serous Cystadenocarcinoma 8441 1,863 5.8 44.2

 Cystadenocarcinoma 8440,8450 427 1.3 50.7

 Papillary Serous

 Cystadenocarcinoma 8460-8461 8,458 26.4 39.6

 Mucinous Cystadenocarcinoma 8470-8471 1,346 4.2 77.7

 Mucinous Adenocarcinoma 8480-8481 1,089 3.4 49.1

 “Borderline” 8442,8451,8462,8472-8473 5,094 15.9 98.2

 All Other Adenocarcinomas 8141-8147,8160-8162,8180-8221,8250-

8259,8261-8309,8311-8379,8382-8439,8443-

8449,8452-8459,8463-8469,8474-8479,8482-

8506,8520-8550,8560,8571-8575,8940-8941 256 0.8 44.2

Other Specified Carcinomas 8030-8046,8150-8155,8170-8171,8230-

8231,8247-8248,8510-8512,8561-8562,8580-

8671 460 1.4 76.5

 Stromal Cell 8620-8631,8650 353 1.1 87.8

 All Other Specified Carcinomas 8030-8046,8150-8155,8170-8171,8230-

8231,8247-8248,8510-8512,8561-8562,8580-

8619,8632-8649,8651-8671 107 0.3 37.3

Carcinoma NOS 8010-8022 1,299 4.1 26.8

Other Specified Types 8240-8246,8720-8790,8935,8950-8982,9000-

9030,9060-9104,9350-9364,9380-9512,9530-

9539 1,153 3.6 61.4

 Mullerian 8950-8951,8980 547 1.7 29.8

 Brenner 9000 69 0.2 67.9

 Germ Cell 9060-9090,9102 486 1.5 91.0

 Dysgerminoma 9060 153 0.5 96.8

 Teratoma 9080-9085,9102 248 0.8 89.1

 All Other Germ Cells 9061-9079,9086-9090 85 0.3 85.1

 All Other Specified Types 8240-8246,8720-8790,8935,8952-8979,8981-

8982,9001-9030,9091-9101,9103-9104,9350-

9364,9380-9512,9530-9539 51 0.2 71.7

Unspecified 8000-8004 205 0.6 23.0

* NOS: Not Otherwise Specified

Germ cell was observed in 1.5% of all cases. Of these 31% 

were dysgerminoma and 51% teratoma. Tumors classified 

as Mullerian comprised 1.7% of all cases.

Five-year relative survival rates varied by histologic type. 

The highest rates were seen for “borderline” tumors, 98%, 

but “borderline” tumors were only considered reportable 

and malignant for 1991-2000. The germ cell tumors also 

had survival rates over 85%. Survival rates under 25% were 

seen for unspecified malignant tumors, adenocarcinomas 

NOS, and papillary adenocarcinomas (Table 16.5).

ADENOCARCINOMA (NON-BORDERLINE)

The histologies used for adenocarcinoma are in Table 16.5 

in the category “Adenocarcinoma” (28,728 cases) excluding the “Borderline” cases (5,094). There were a total of 

23,634 adenocarcinomas excluding borderline.
Chapter 16 Cancer of the Ovary

National Cancer Institute 137 SEER Survival Monograph 

Stage

Table 16.6 and Figure 16.1 show the contrast between 

stage at diagnosis and months/years since diagnosis. In 

stages II-IV, the steepest declines in survival are observed 

within 3-5 years of diagnosis. Survival continues to decline 

throughout the 10 years observed in these stages.

Age and Stage

Of the 23,634 cases of non-borderline adenocarcinoma, 

enough information to establish stage at diagnosis was 

available for 22,893 (97%). Across all age groups, 31.7% 

of all cancers were diagnosed in Stage IV. Stage IV disease 

occurs in 19.4% among women ages 20-49 to 38.5% in 

women over age 70, while Stage I declines from 39.6% 

to 13.1% in these same age groups (Table 16.7).

For all ages combined, little difference is seen between 

survival in stages IA & IB (Table 16.8, Figure 16.2). No 

survival differential with increased age is present. Stages 

IA & IB both involve tumor confined to the ovary, with an 

intact capsule. However, a difference does exist between 

Stages IA & IB and Stage IC with stage IC having much 

poorer survival than IA or IB.

Stage IC also involves tumor limited to the ovary, however, 

capsule rupture, external invasion or ascites also exist. 

For stages IC and higher, a survival differential by age 

is observed, with declining survival with increasing age 

(Table 16.8 & Figure 16.2). 

Table 16.6: Adenocarcinoma of the Ovary (excluding Borderline Tumors): Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-

Year Relative Survival Rates (%) for Cases (Ages 20+) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-

2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 23,634 100.0 77.5 64.0 54.4 43.9 37.8 36.4

I 5,215 22.1 96.8 94.3 92.1 89.3 85.6 84.1

 IA 3,108 13.2 98.9 97.3 96.1 94.0 91.1 88.9

 IB 337 1.4 98.0 94.5 93.2 91.1 82.4 78.7

 IC 1,548 6.5 92.4 88.1 84.5 79.8 76.0 76.0

 I NOS* 222 0.9 94.8 92.8 88.2 84.7 77.0 73.7

II 1,833 7.8 87.1 78.9 73.2 65.5 58.4 55.7

 IIA 485 2.1 96.4 89.5 84.7 76.4 69.0 66.8

 IIB 587 2.5 88.3 80.6 73.6 66.9 63.2 57.4

 IIC 699 3.0 80.4 70.7 65.1 57.0 47.0 45.9

 II NOS* 62 0.3 78.0 71.0 68.8 58.9 50.2 38.8

III 8,346 35.3 78.8 62.0 48.9 33.5 24.4 22.2

 IIIA 469 2.0 86.4 71.6 61.8 45.3 34.1 31.4

 IIIB 660 2.8 81.5 66.8 54.0 38.6 27.2 26.1

 IIIC 4,596 19.4 82.2 65.5 51.2 35.2 25.3 22.6

 III NOS* 2,621 11.1 70.5 52.8 40.8 26.9 20.0 17.9

IV 7,499 31.7 61.7 42.5 30.1 17.9 11.6 10.4

Unknown/Unstaged 741 3.1 61.8 49.3 41.5 29.5 24.2 20.2

* NOS = Not Otherwise Specified

Figure 16.1: Adenocarcinoma of the Ovary (excluding 

Borderline Tumors): Relative Survival Rates (%) by AJCC 

Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 

1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

IA

IB

IC

IIA

IIB

IIC

IIIA

IIIB

IIIC

IV
Chapter 16 Cancer of the Ovary

National Cancer Institute 138 SEER Survival Monograph 

Figure 16.2: Adenocarcinoma of the Ovary (excluding 

Borderline Tumors): 5-Year Relative Survival Rate (%) by 

AJCC Stage (SEER modified 3rd edition) and Age Group 

(20+), 12 SEER Areas, 1988-2001

Histology and Stage

Tumors of the papillary subtype and adenocarcinoma 

NOS are associated with poor survival. Mucinous cystadenocarcinoma has the highest five-year survival rate 

(77.7%) for all stages combined, due to a high percentage 

of cases diagnosed in Stage I. Tumors of the endometrioid 

type have better prognosis in each stage (Table 16.9 & 

Figure 16.3).

0

10

20

30

40

50

60

70

80

90

100

IA IB IC IIA IIB IIC IIIA IIIB IIIC IV

Relative Survival Rate (%)

AJCC Stage

20-49 50-69 70+

Table 16.7: Adenocarcinoma of the Ovary (excluding Borderline Tumors): Number and Distribution of Cases by AJCC Stage (SEER 

modified 3rd edition) and Age (20+), 12 SEER Areas, 1988-2001

AJCC Stage

Age (Years)

Total 20-49 50-69 70+

Cases Percent Cases Percent Cases Percent Cases Percent

Total 23,634 100.0 5,090 100.0 10,576 100.0 7,968 100.0

I 5,215 22.1 2,016 39.6 2,156 20.4 1,043 13.1

 IA 3,108 13.2 1,300 25.5 1,223 11.6 585 7.3

 IB 337 1.4 118 2.3 156 1.5 63 0.8

 IC 1,548 6.5 506 9.9 695 6.6 347 4.4

 I NOS* 222 0.9 92 1.8 82 0.8 48 0.6

II 1,833 7.8 446 8.8 815 7.7 572 7.2

 IIA 485 2.1 144 2.8 222 2.1 119 1.5

 IIB 587 2.5 135 2.7 257 2.4 195 2.4

 IIC 699 3.0 153 3.0 313 3.0 233 2.9

 II NOS* 62 0.3 14 0.3 23 0.2 25 0.3

III 8,346 35.3 1,540 30.3 3,896 36.8 2,910 36.5

 IIIA 469 2.0 103 2.0 216 2.0 150 1.9

 IIIB 660 2.8 146 2.9 319 3.0 195 2.4

 IIIC 4,596 19.4 901 17.7 2,301 21.8 1,394 17.5

 III NOS* 2,621 11.1 390 7.7 1,060 10.0 1,171 14.7

IV 7,499 31.7 988 19.4 3,445 32.6 3,066 38.5

 Unknown/ Unstaged 741 3.1 100 2.0 264 2.5 377 4.7

* NOS: Not Otherwise Specified

 

 

Figure 16.3: Adenocarcinoma of the Ovary (excluding 

Borderline Tumors): 5-Year Relative Survival Rate (%) by 

Histology and AJCC Stage (SEER modified 3rd edition), Ages 

20+, 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

Stage I Stage II Stage III Stage IV

Relative Survival Rate (%)

AJCC Stage, 5th Edition

Papillary Clear Cell

Endometroid Serous Cystadenocarcinoma

Cystadenocarcinoma Papiliary Serous Cystadenocarcinoma

Mucinous Cystadenocarcinoma Mucinous Adenocarcinoma
Chapter 16 Cancer of the Ovary

National Cancer Institute 139 SEER Survival Monograph 

Table 16.8: Adenocarcinoma of the Ovary (excluding Borderline Tumors): Number of Cases and 5-Year Relative Survival Rates (RSR) 

(%) for Patients with by AJCC Stage (SEER modified 3rd edition) and Age (20+), 12 SEER Areas, 1988-2001

AJCC Stage

Total 20-49 50-69 70+

Cases

5-Year 

RSR (%) Cases

5-Year 

RSR (%) Cases

5-Year 

RSR (%) Cases

5-Year 

RSR (%)

Total 23,634 43.9 5,090 63.3 10,576 44.0 7,968 27.5

I 5,215 89.3 2,016 91.2 2,156 89.2 1,043 83.8

 IA 3,108 94.0 1,300 93.5 1,223 93.9 585 94.3

 IB 337 91.1 118 91.4 156 88.8 63 93.1

 IC 1,548 79.8 506 86.4 695 81.5 347 62.4

 I NOS 222 84.7 92 85.1 82 82.9 48 85.6

II 1,833 65.5 446 78.7 815 68.9 572 45.5

 IIA 485 76.4 144 83.1 222 74.9 119 68.4

 IIB 587 66.9 135 76.7 257 72.3 195 47.5

 IIC 699 57.0 153 76.7 313 61.9 233 30.6

 II NOS 62 58.9 14 ~ 23 ~ 25 39.3

III 8,346 33.5 1,540 45.9 3,896 35.3 2,910 21.8

 IIIA 469 45.3 103 54.6 216 48.0 150 32.0

 IIIB 660 38.6 146 62.5 319 36.7 195 19.7

 IIIC 4,596 35.2 901 44.0 2,301 36.3 1,394 25.4

 III NOS 2,621 26.9 390 42.1 1,060 30.1 1,171 16.3

IV 7,499 17.9 988 27.2 3,445 20.0 3,066 10.9

Unknown/Unstaged 741 29.5 100 56.0 264 33.5 377 16.1

* NOS: Not Otherwise Specified

 ~ Statistic not displayed due to less than 25 cases.

Table 16.9: Adenocarcinoma of the Ovary (excluding Borderline Tumors): Number of Cases and 5-Year Relative Survival Rates 

(%) by Histology and AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Histology

AJCC Stage

Total I II III IV Unknown/

Unstaged

Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%) Cases

5-Year 

Relative 

Survival 

Rate(%)

Total Adenocarcinoma 23,634 43.9 5,215 89.3 1,833 65.5 8,346 33.5 7,499 17.9 741 29.5

Adenocarcinoma NOS* 4,021 18.3 276 61.7 233 35.2 1,189 21.2 2,021 8.9 302 14.5

Papillary 1,750 21.0 84 68.3 83 40.3 649 21.6 845 13.9 89 20.3

Clear Cell 1,291 61.5 708 85.6 145 57.0 271 28.0 151 12.5 16 ~

Endometrioid 3,133 70.9 1,404 93.7 454 82.1 743 46.9 483 32.5 49 56.3

Serous 

Cystadenocarcinoma 1,863 44.2 331 87.5 147 75.0 786 34.3 567 23.2 32 24.9

Cystadenocarcinoma 427 50.7 131 86.3 33 61.5 137 41.1 111 17.6 15 ~

Papillary Serous 

Cystadenocarcinoma 8,458 39.6 885 89.8 570 68.6 3,999 36.4 2,829 21.9 175 41.0

Mucinous 

Cystadenocarcinoma 1,346 77.7 953 93.1 68 51.6 175 40.7 126 18.3 24 ~

Mucinous 

Adenocarcinoma 1,089 49.1 378 90.6 74 63.9 299 26.1 301 14.1 37 30.1

All Other 

Adenocarcinomas 256 44.2 65 87.7 26 60.1 98 27.5 65 12.6 <5 ~

* NOS: Not Otherwise Specified

 ~ Statistic not displayed due to less than 25 cases.
Chapter 16 Cancer of the Ovary

National Cancer Institute 140 SEER Survival Monograph 

Table 16.10: Adenocarcinoma of the Ovary (excluding Borderline Tumors): Number of Cases and 5-Year Relative Survival Rates (%) by 

AJCC Stage (SEER modified 3rd edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Grade

Total Well Differentiated Moderately 

Differentiated

Poorly/ 

Undifferentiated

Unknown

Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%)

Total 23,634 43.9 2,071 82.6 4,505 54.9 10,511 35.3 6,547 36.3

I 5,215 89.3 1,277 95.1 1,451 92.6 1,051 82.6 1,436 85.1

 IA 3,108 94.0 896 95.9 872 94.9 494 88.8 846 93.3

 IB 337 91.1 75 90.7 84 91.9 101 90.4 77 89.5

 IC 1,548 79.8 253 92.3 439 88.2 409 74.3 447 68.2

 I NOS^ 222 84.7 53 95.3 56 88.1 47 71.8 66 80.3

II 1,833 65.5 179 85.8 421 73.9 781 62.8 452 52.8

 IIA 485 76.4 54 94.4 131 80.5 201 70.8 99 69.9

 IIB 587 66.9 61 75.4 148 73.4 261 65.3 117 55.2

 IIC 699 57.0 62 87.2 131 66.1 288 56.2 218 42.0

 II NOS^ 62 58.9 <5 ~ 11 ~ 31 45.2 18 ~

III 8,346 33.5 370 62.3 1,473 36.4 4,720 33.0 1,783 25.2

 IIIA 469 45.3 51 79.1 100 52.4 202 40.5 116 30.0

 IIIB 660 38.6 40 62.7 142 36.5 360 40.5 118 25.2

 IIIC 4,596 35.2 173 63.4 777 35.1 2,851 34.8 795 30.1

 III NOS^ 2,621 26.9 106 51.6 454 34.6 1,307 26.2 754 19.3

IV 7,499 17.9 212 37.7 1,083 21.0 3,769 19.6 2,435 11.6

Unknown/

Unstaged 741 29.5 33 79.4 77 41.8 190 25.6 441 24.4

 ~ Statistic not displayed due to less than 25 cases.

^ NOS: Not Otherwise Specified

Figure 16.4: Adenocarcinoma of the Ovary (excluding 

Borderline Tumors): 5-Year Relative Survival Rate (%) by 

Grade and AJCC Stage (SEER modified 3rd edition), Ages 20+, 

12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

IA IB IC IIA IIB IIC IIIA IIIB IIIC IV

Relative Survival Rate (%)

AJCC Stage

Grade I Grade II Grade III/IV

Stage and Grade

Of the 23,634 cases of non-borderline adenocarcinoma, 

17,087 (72%) had information on tumor grade (Table 16.10 

& Figure 16.4). Within stage, 5-year relative survival generally declines as grade increases with the exception of stage 

IB tumors, where little difference is seen by grade (possibly 

due to the small number of cases).
Chapter 16 Cancer of the Ovary

National Cancer Institute 141 SEER Survival Monograph 

Table 16.11: Adenocarcinoma of the Ovary (excluding Borderline Tumors): 5-Year Relative Survival Rates (%), Conditioned on 

Years Since Diagnosis by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Surviving the Next 5 Years

From 

Diagnosis After 1 Year After 2 Years After 3 Years After 4 Years After 5 years

Total 43.9 51.5 59.3 66.8 73.6 79.2

I 89.3 90.5 91.8 92.6 94.1 94.1

 IA 94.0 94.3 95.1 95.0 95.8 95.1

 IB 91.1 90.5 90.8 88.7 89.1 86.5

 IC 79.8 82.8 85.5 88.6 91.5 94.3

 I NOS 84.7 85.5 84.0 87.2 88.9 87.4

II 65.5 70.5 74.4 77.4 79.6 82.4

 IIA 76.4 74.7 78.6 80.7 82.6 86.7

 IIB 66.9 73.5 77.8 83.1 84.0 83.4

 IIC 57.0 63.5 67.0 69.3 73.5 76.2

 II NOS 58.9 73.8 80.5 70.9 62.4 62.9

III 33.5 36.1 41.9 48.2 54.9 63.2

 IIIA 45.3 45.6 51.5 53.2 61.9 66.5

 IIIB 38.6 40.0 43.4 49.0 54.7 65.2

 IIIC 35.2 36.5 41.2 48.2 55.2 62.2

 III NOS 26.9 32.1 40.0 46.5 52.1 62.3

IV 17.9 23.0 28.6 36.6 45.2 54.5

Unknown/

Unstaged 29.5 40.8 49.0 53.4 60.1 62.2

Figure 16.5: Adenocarcinoma of the Ovary (excluding 

Borderline Tumors): 5-Year Relative Survival Rate (%), 

Conditioned on Years Since Diagnosis, by AJCC Stage (SEER 

modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

IA IB IC IIA IIB IIC IIIA IIIB IIIC IV

Relative Survival Rate (%)

AJCC Stage

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years

Conditional Survival

Five year relative survival, conditioned on years since diagnosis, is presented in Table 16.11 and Figure 16.5. Except for stages IA and IB, the probability of surviving for 

5 years increases as time since diagnosis increases. This 

is most marked for the stage IV cases. For stage IV, five 

year survival from time of diagnosis is 18%. For those 

individuals who survived 1 year post diagnosis, 5-year survival increased to 23%. This increased to 55% for those 

individuals who survived 5 years after they had already 

survived 5 years.
Chapter 16 Cancer of the Ovary

National Cancer Institute 142 SEER Survival Monograph 

Table 16.12: Borderline Tumors of the Ovary: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2000

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total (1988-2000 only) 5,092 100.0 99.3 99.1 98.8 98.2 97.2 96.1

I 4,176 82.0 99.6 99.5 99.3 99.1 98.8 98.0

 IA 3,131 61.5 99.8 99.7 99.6 99.5 99.4 99.1

 IB 329 6.5 99.7 99.2 99.2 97.9 94.0 90.8

 IC 520 10.2 98.7 98.6 97.9 97.4 95.8 95.7

 I NOS^ 196 3.8 98.5 98.5 98.1 97.9 95.4 94.2

II 290 5.7 99.2 99.1 98.2 98.2 95.4 93.6

 IIA 92 1.8 100.0 99.8 97.8 96.6 94.9 90.3

 IIB 94 1.8 98.5 98.5 98.1 97.5 92.5 92.5

 IIC 98 1.9 98.4 98.0 98.0 98.0 97.1 95.2

 II NOS^ 6 0.1 ~ ~ ~ ~ ~ ~

III 449 8.8 99.1 98.9 98.4 95.7 90.2 88.1

 IIIA 112 2.2 98.9 98.6 98.6 97.1 91.0 88.5

 IIIB 50 1.0 100.0 100.0 100.0 97.3 91.4 91.4

 IIIC 139 2.7 97.7 97.1 96.9 96.6 89.8 85.3

 III NOS^ 148 2.9 99.5 99.5 97.5 93.2 88.6 86.9

IV 114 2.2 90.1 84.7 82.7 76.9 74.7 70.0

Unknown/Unstaged 63 1.2 97.7 93.5 92.4 91.0 84.7 84.7

~ Statistic not displayed due to less than 25 cases.

^ NOS: Not Otherwise Specified

ADENOCARCINOMA (“BORDERLINE”)

Stage 

“Borderline” adenocarcinoma is of low malignant potential. 

These tumors are no longer reportable as malignant with the 

implementation of ICD-O-3, but were reportable during the 

years 1988-2000. Eighty-two percent of these tumors were 

diagnosed in stage I (Table 16.12) compared to 22% in the 

non-borderline adenocarcinomas (Table 16.7). Survival is 

quite high across all stages with five-year relative survival 

in the high 90% range in stages IA-IIIC, and 77% at stage 

IV (Table 16.12).
Chapter 16 Cancer of the Ovary

National Cancer Institute 143 SEER Survival Monograph 

Table 16.13: Germ Cell Cancer of the Ovary: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) 

by Age (20+), 12 SEER Areas, 1988-2001

Age (Years) Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 486 100.0 94.6 92.7 91.6 91.0 90.3 90.3

20-29 241 49.6 98.0 97.6 96.7 96.2 95.6 95.6

30-39 161 33.1 96.3 92.4 92.4 91.8 91.8 91.8

40-49 46 9.5 87.1 84.9 82.7 82.7 82.7 82.7

50-69 29 6.0 75.1 67.8 63.8 53.1 46.9 46.9

70+ 9 1.9 ~ ~ ~ ~ ~ ~

 ~ Statistic not displayed due to less than 25 cases.

Table 16.14: Germ Cell Cancer of the Ovary: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 486 100.0 94.6 92.7 91.6 91.0 90.3 90.3

Stage I 326 67.1 98.9 98.4 98.2 97.7 96.6 96.6

Stage II 35 7.2 91.5 80.0 80.0 80.0 80.0 80.0

Stage III 79 16.3 86.1 84.8 83.6 83.6 83.6 83.6

Stage IV 36 7.4 75.5 67.4 57.9 54.5 54.5 54.5

Unknown/Unstaged 10 2.1 ~ ~ ~ ~ ~ ~

 ~ Statistic not displayed due to less than 25 cases.

GERM CELL

Stage

Germ cell tumors are seen in younger women. Of the 486 

reported in 12 SEER areas, between 1988-2001, almost 

83% were diagnosed in women under the age of 40 (Table 

16.13). For germ cell tumors, survival decreased as age 

increased (Table 16.13).

For germ cell tumors, 67.1% were diagnosed in stage I 

(Table 16.14). Table 16.14 and Figure 16.6 show stage 

at diagnosis for germ cell by years since diagnosis. After 

two years from diagnosis, stage III survival is slightly better than stage II survival. Survival rates level off for each 

stage but at different times. In stages I and IV, survival 

begins to level later than for stages II and III: 8 years for 

stage I, 2 years for stage II, 3 years for stage III, and 5 

years for stage IV.

Figure 16.6: Germ Cell Cancer of the Ovary: Relative Survival 

Rate (%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 

12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Stage I

Stage II

Stage III

Stage IV
Chapter 16 Cancer of the Ovary

National Cancer Institute 144 SEER Survival Monograph 

Figure 16.7: Germ Cell Cancer of the Ovary: 5-Year Relative 

Survival Rate (%), Conditioned on Years Since Diagnosis, By 

AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER 

Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

Stage I Stage II Stage III Stage IV

Relative Survival Rate (%)

AJCC Stage, 5th Edition

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years

Table 16.15: Germ Cell Cancer of the Ovary: By AJCC Stage (SEER modified 3rd edition): Surviving the Next Five Years From 

Diagnosis, 1, 2, 3, 4 and 5 Years After Diagnosis, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Surviving the Next 5 Years

From 

Diagnosis After 1 Year After 2 Years After 3 Years After 4 Years After 5 Years

Total 91.0 95.0 97.2 98.2 98.1 99.1

Stage I 97.7 97.5 98.0 98.2 98.1 98.7

Stage II 80.0 87.2 100.0 100.0 100.0 100.0

Stage III 83.6 97.0 98.4 100.0 100.0 100.0

Stage IV 54.5 70.8 79.5 92.8 92.6 100.0

Unknown/Unstaged ~ ~ ~ ~ ~ ~

~ Statistic not displayed due to less than 25 cases.

Conditional Survival

Five year relative survival, conditioned on years since diagnosis, is presented in Table 16.15 and Figure 16.7. For 

stages II-IV, the probability of surviving the next five years 

after diagnosis increases as time since diagnosis increases. 

This is most marked for the stage IV cases. For stage IV, 

five year survival from time of diagnosis is 55%. For stage 

IV, for those individuals who survive 1 year post diagnosis, 

5-year survival increases to 71%. This increases to 94% for 

those individuals who survive 4 years and approximately 

100% for those who have already survived 5 years. Five-year 

relative survival reaches approximately 100% for stage II 

patients who have already survived two years; for stage III 

patients who have already survived 3 years; and is over 98% 

for stage I patients who have already survived 2 years.

Discussion

Survival rates were presented for three groups of ovarian 

cancer: non-borderline adenocarcinoma, borderline adenocarcinoma, and germ cell tumors. Women with cancer 

of the ovary have poorer survival than women with other 

gynecologic cancers. While overall 5-year relative survival 

is under 50% for adenocarcinoma of the ovary, the 5-year 

relative survival rates were better for stage I (89%), younger 

women (63%) and well-differentiated tumors (83%). For 

borderline tumors, survival rates were very high. Even the 

10-year relative survival rate was over 95%. For germ cell 

tumors, a larger percentage (67.1%) were found as stage 

I at diagnosis which yielded a high overall 5-year relative 

survival rate, 91%.

References

1. Percy, C., Van Holten, V., and Muir, C. International 

Classification of Diseases for Oncology--second edition. Geneva: 

World Health Organization, 1990.

2. Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin 

DM, Whelan S. International Classification of Diseases for 

Oncology--Third Edition. Geneva: World Health Organization, 

2000.

3. Beahrs, OH, Henson DE, Hutter RVP, Myers MH (eds). AJCC 

Cancer Staging Manual, Third edition. American Joint Committee 

on Cancer. Philadelphia: Lippincott, 1988.
National Cancer Institute 145 SEER Survival Monograph 

Introduction

Cancers of the placenta are rare tumors arising from the 

products of conception in the uterus. The most common 

antecedent pregnancy is that of a hydatidiform mole, usually 

a genetic disorder of pregnancy in which only placental-like 

tissue is present. Cancer of the placenta most commonly 

follows a molar pregnancy. It can, however, also follow 

a normal pregnancy, ectopic pregnancy, or abortion. 

Materials and Methods

Between 1988-2001, there were 249 cases of cancer of the 

placenta diagnosed in SEER. The following were excluded 

from the analysis: patients for whom placental cancer was 

not the first primary, cases identified through autopsy or 

death certificate only, persons of unknown race, cases 

without active follow-up or alive with no survival time, 

patients less than 15 years old, sarcomas and carcinoids. 

After these exclusions, 244 cases remained for analysis 

(Table 17.1).

Results

Age

85% of all cases were diagnosed in women under age 40 

and 10% were in women ages 15-19. No cases were seen 

in women age 70 and older and few cases in women age 

50 and over (Table 17.2).

Histology

The majority of these cases were categorized as choriocarcinoma (over 90%) (Table 17.3). 

Staging

The Federation Internationale de Gynecologie et 

d’Obstetrique (FIGO) and the American Joint Committee 

Carol L. Kosary

Chapter 17

Cancer of the Placenta

 Table 17.1: Cancer of the Placenta: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number 

Excluded Reason for Exclusion/selection

249 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

249 0 Select first primary only

244 5 Exclude death certificate only or at autopsy, unknown race, and children (<15)

 Table 17.2: Cancer of the Placenta: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, 10-Year Relative Survival by 

Age (15+), 12 SEER Areas, 1988-2001

Age Group (Years) Cases Percent Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total (15+) 244 100.0 95.9 93.1 92.1 91.7 89.8 89.0

15-19 25 10.2 100.0 95.5 95.5 95.5 95.5 95.5

20-29 107 43.9 99.1 96.2 96.2 95.1 91.7 89.1

30-39 75 30.7 94.7 92.1 90.6 90.6 90.6 90.6

40-49 29 11.9 86.3 82.9 78.9 78.9 73.0 73.0

50-69 8 3.3 ~ ~ ~ ~ ~ ~

70+ 0 0.0 ~ ~ ~ ~ ~ ~

 ~ Statistic not displayed due to less than 25 cases.
Chapter 17 Cancer of the Placenta

National Cancer Institute 146 SEER Survival Monograph 

on Cancer (AJCC) have designated staging for cancers 

of the placenta. Cancer of the placenta was staged using SEER modified AJCC staging, 3rd edition. This was 

combined with staging for the corpus uteri:

Stage I tumor is confined to the uterus. 

Stage II tumor invades the cervix, but has not extended 

outside the uterus.

Stage III tumor extends outside of the uterus but is confined to the true pelvis. 

Stage IV tumor involves the bladder or bowel mucosa or 

has metastasized to distant sites (including abdominal 

lymph nodes other than para-aortic, and/or inguinal lymph 

nodes; excludes metastasis to vagina, pelvic serosa, or 

adnexa).

Survival by Stage

Over half of the cases were diagnosed at stage IV (55.3%), 

which is indicative of tumor metastasis to distant sites. 

Almost 27% of cases were stage I. Stage II and III were 

rarely observed (Table 17.4).

Cancer of the placenta is highly curable even at advanced 

stages. The 5-year relative survival for stage IV cases is 

86% and stage I survival is 99%. 

Discussion

Ten percent of cases of cancer of the placenta occur in 

women under the age of 20, while 85% occur in women 

under 40. Choriocarcinoma is the predominant histologic 

type. Over half of the patients were diagnosed at stage 

IV. Despite late staging, placental cancer is a highly curable disease. 

REFERENCE

1. Beahrs, OH, Henson DE, Hutter RVP, Myers MH (eds). 

AJCC Cancer Staging Manual, Third edition. American Joint 

Committee on Cancer. Philadelphia: Lippincott, 1988.

Table 17.3: Cancer of the Placenta: Number and Distribution of Cases and 5-Year Relative Survival Rates (%) by Histology, 

Ages 15+, 12 SEER Areas, 1988-2001

Histology ICD-O Code Cases Percent

5-Year 

Relative 

Survival 

Rate(%)

Total 8000-9989 244 100.0 91.7

Epidermoid 8051-8130 0 0.0 ~

Adenocarcinoma 8140-8147,8160-8162,8180-8221,8250-8506,8520-

8550,8560,8570-8573,8940-8941 0 0.0 ~

Other Specified Carcinomas 8030-8045,8150-8155,8170-8171,8230-8248,8510-8512,8561-

8562,8580-8671 0 0.0 ~

Carcinoma, NOS 8010-8022 0 0.0 ~

Other Specified Types 8720-8790,8931-8932,8950-8979,8982,9000-9030,9060-

9110,9350-9364,9380-9512,9530-9539 242 99.2 91.7

 Choriocarcinoma 9100-9101 221 90.6 91.3

 All Other Specified Types 8720-8790,8931-8932,8950-8979,8982,9000-9030,9060-

9099,9102-9110,9350-9364,9380-9512,9530-9539 21 8.6 ~

Unspecified 8000-8004 <5 ~ ~

 ~ Statistic not displayed due to less than 25 cases.

Table 17.4: Cancer of the Placenta: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) 

by AJCC Stage (SEER modified, 3th Edition), Ages 15+, 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 244 100.0 95.9 93.1 92.1 91.7 89.8 89.0

I 65 26.6 100.0 98.5 98.5 98.5 98.5 98.5

II <5 ~ ~ ~ ~ ~ ~ ~

III <8 ~ ~ ~ ~ ~ ~ ~

IV 135 55.3 92.6 88.9 87.2 86.3 85.1 83.2

Unknown/Unstaged 34 13.9 100.0 100.0 100.0 100.0 96.4 96.4

 ~ Statistic not displayed due to less than 25 cases.
National Cancer Institute 147 SEER Survival Monograph 

Introduction

Cancers of the vulva are relatively rare; they account for 

slightly less than 5% of all cancers of the female genital 

organs. Approximately 3,740 women are diagnosed with 

cancer of the vulva in the United States each year (1).

Materials and Methods

Between 1988 and 2001, there were 13,949 cases of cancer of the vulva diagnosed in SEER. The following were 

excluded from the analysis: patients for whom vulvar 

cancer was not the first primary, cases identified through 

autopsy or death certificate only, persons of unknown race, 

cases without active follow-up or alive with no survival 

time, patients less than 20 years old, cases without microscopic confirmation, sarcomas, and carcinoids. There 

were 6,280 in situ cancers of the vulva excluded from 

analyses. After these exclusions, 4,098 cases remained 

for analysis (Table 18.1).

 Results

Age and Race

Of the 4,098 adult patients, 18.3% were diagnosed in 

adults under age 50 (Table 18.2). Over 52% of all cases 

were diagnosed in women age 70 and over. Almost 89% 

of the patients were white. The percentage of adult black 

women diagnosed before the age of 50 is twice that of white 

women (35% vs. 17%). A slight difference is observed in 

the percent of black women diagnosed between the ages 

of 50 and 59 compared to white women (16% vs. 12%). 

Thirty-two percent of the black women were diagnosed at 

age 70 or older, compared to 55% of white women.

For all women, survival declined with age (Table 18.3). 

In 5-year relative survival rates, only minor differences 

between white and black women (Table 18.3) were observed. The largest survival differential was seen for ages 

70+, where white women had a 5-year relative survival 

rate of 67%, compared to 60% for black females.

Geographic Location

Five-year relative survival rates in the 12 SEER areas 

included in this chapter ranged from 84.7% in Hawaii to 

71.5% in Los Angeles (Table 18.4). 

Histology

Distribution by histology is presented in Table 18.5. Tumors classified as squamous comprise 82.7% of all invasive cancers of the vulva with 50.6% Not Otherwise 

Specified (NOS), 14.2% keratinizing, 9.8% basal cell, and 

Carol L. Kosary

Chapter 18

Cancer of the Vulva

Table 18.1: Cancer of the Vulva: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number 

Excluded Reason for Exclusion/selection

13,949 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

11,226 2,723 Select first primary only

11,199 27 Exclude death certificate only or at autopsy

10,671 528 Exclude unknown race

10,619 52 Exclude alive with no survival time

10,486 133 Exclude children (Ages 0-19)

4,206 6,280 Exclude in situ cancers

4,169 37 Exclude no or unknown microscopic confirmation

4,098 71 Exclude sarcomas and carcinoids
Chapter 18 Cancer of the Vulva

National Cancer Institute 148 SEER Survival Monograph 

8.1% other specified epidermoid types. Tumors classified 

as adenocarcinoma comprised 8.5% of the total, while 

melanoma comprised 5.9%. These three histology groups 

are the ones analyzed here.

Staging

The Federation Internationale de Gynecologie et 

d’Obstetrique (FIGO) and the American Joint Committee 

on Cancer (AJCC) have designated staging for cancers of 

the vulva excluding melanoma. Lack of specificity in the 

SEER data prevents a detailed breakdown of Stages IA-B 

and IVA-B for all years. SEER modified AJCC staging, 

5th edition, was used for analyses in this chapter. The 

5th edition AJCC staging (2) states:

Stage I vulvar cancer is defined as lesions 2 cm or 

less confined to the vulva or perineum. There are 

no lymph node metastases

Stage II vulvar cancer is defined as tumor either 

confined to the vulva and/or perineum or more 

than 2 cm in the greatest dimension with no nodal 

metastases.

Stage III vulvar cancer is defined as tumor of any size 

arising on the vulva and/or perineum with either 

adjacent spread to the lower urethra, the vagina, 

or the anus, or unilateral regional lymph node 

metastases.

Stage IV vulvar cancer is defined as tumor invading 

any of the following: upper urethra, bladder 

mucosa, rectal mucosa, pelvic bone and/or bilateral 

regional nodal metastases or any distant metastasis 

including pelvic lymph nodes. 

Vulvar melanoma used the SEER modified AJCC 5th 

edition staging for melanoma. 

Squamous

Survival by Age and Stage

Of the 3,390 patients with squamous cell carcinoma, 

enough information to establish stage at diagnosis was 

available for 3,171 (94%). The percent diagnosed in 

stage I declines with age, from 56% in ages 20-69 to 

38% in ages 70+. Stages II and III show increases with 

age. Percent of stage IV cases is almost equal across age 

groups (Table 18.6).

Table 18.2: Cancer of the Vulva: Age (20+) and Race Distributions, 12 SEER Areas, 1988-2001

Age Group (Years)

Total White Black Other

Cases Percent Cases Percent Cases Percent Cases Percent

Total (20+) 4,098 100.0 3,637 100.0 296 100.0 165 100.0

20-29 51 1.2 40 1.1 7 2.4 4 2.4

30-39 215 5.2 177 4.9 29 9.8 9 5.5

40-49 486 11.9 400 11.0 69 23.3 17 10.3

50-59 508 12.4 443 12.2 46 15.5 19 11.5

60-69 675 16.5 590 16.2 49 16.6 36 21.8

70-79 1,104 26.9 1,002 27.6 53 17.9 49 29.7

80+ 1,059 25.8 985 27.1 43 14.5 31 18.8

Table 18.3: Cancer of the Vulva: Number and Distribution of Cases, Median Survival Time (Months) and 5-year Survival 

Rates (%) by Race and Age (20+), 12 SEER Areas, 1988-2001

Race/Age (Years) Cases

Median 

Survival Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

All Races, 20+ 4,098 104.2 62.3 81.6 76.4

White, 20+ 3,637 99.7 61.5 81.0 76.0

Black, 20+ 296 107.7 65.0 86.0 75.3

All Races, 20-69 1,935 > 120 81.6 96.0 85.0

White, 20-69 1,650 > 120 81.8 96.1 85.1

Black, 20-69 200 > 120 77.5 94.6 81.6

All Races, 70+ 2,163 51.6 46.0 68.8 66.8

White, 70+ 1,987 50.7 45.5 68.4 66.5

Black, 70+ 96 42.8 41.1 68.0 59.9
Chapter 18 Cancer of the Vulva

National Cancer Institute 149 SEER Survival Monograph 

Table 18.4: Cancer of the Vulva: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) 

by SEER Geographic Area, Ages 20+, 12 SEER Areas, 1988-2001

Relative Survival Rate (%)

SEER Geographic Area Cases Percent 1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 4,098 100.0 89.5 82.9 79.8 76.4 73.0 69.7

Atlanta and Rural Georgia 286 7.0 91.6 84.2 82.5 78.3 72.1 68.1

 Atlanta (Metropolitan) - 1988+ 265 6.5 91.1 83.7 81.8 77.9 70.6 66.0

 Rural Georgia - 1988+ 21 0.5 ~ ~ ~ ~ ~ ~

California

 Los Angeles - 1992+ 596 14.5 84.9 78.6 75.5 71.5 65.4 61.5

 Greater Bay Area 624 15.2 91.7 85.9 80.8 78.4 73.7 69.9

 San Francisco-Oakland SMSA - 1988+ 408 10.0 90.9 85.0 80.2 76.7 72.2 66.0

 San Jose-Monterey - 1988+ 216 5.3 93.1 87.6 82.1 80.6 76.2 76.2

Connecticut - 1988+ 616 15.0 87.3 78.5 74.8 73.3 70.3 70.3

Detroit (Metropolitan) - 1988+ 592 14.4 88.5 80.3 76.1 72.3 69.2 63.6

Hawaii - 1988+ 95 2.3 93.6 93.0 88.0 84.7 80.9 65.9

Iowa - 1988+ 519 12.7 92.3 85.3 84.3 80.5 77.2 72.2

New Mexico - 1988+ 162 4.0 91.5 86.3 84.4 74.1 69.6 69.6

Seattle (Puget Sound) - 1988+ 461 11.2 90.2 85.9 83.6 78.6 77.8 75.1

Utah - 1988+ 147 3.6 91.3 84.1 81.3 81.3 80.5 72.1

 ~ Statistic not displayed due to less than 25 cases.

Table 18.5: Cancer of the Vulva: Number and Distribution of Cases and 5-Year Relative Survival Rates (%) by 

Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology ICD-O Code Cases Percent

5-Year 

Relative

Survival

Rate (%)

Total 8000-9970 4,098 100.0 76.4

Squamous 8050-8130 3,390 82.7 75.9

 Squamous, NOS 8070 2,073 50.6 73.7

 Squamous, Keratinizing 8071 582 14.2 60.2

 Basal Cell 8090-8110 403 9.8 99.4

 Other Epidermoid 8050-8069,8072-8089,8111-8130 332 8.1 84.8

Adenocarcinoma 8140-8147,8160-8162,8180-8221,8250-8506,8520-

8550,8560,8570-8573,8940-8941 347 8.5 91.9

 Paget, Extramammary 8542 238 5.8 99.0

 All Other Adenocarcinoma 8140-8147,8160-8162,8180-8221,8250-8506,8520-

8541,8543-8550,8560,8570-8573,8940-8941 109 2.7 68.2

Other Specified Carcinomas 8030-8045,8150-8155,8170-8171,8230-8248,8510-

8512,8561-8562,8580-8671 <5 ~ ~

Carcinoma, NOS 8010-8022 105 2.6 77.1

Other Specified Types 8720-8790,8931-8932,8950-8979,8982,9000-

9030,9060-9110,9350-9364,9380-9512,9530-9539 244 6.0 58.9

 Melanoma 8720-8790 240 5.9 58.9

 All Other Specified Types 8931-8932,8950-8979,8982,9000-9030,9060-

9110,9350-9364,9380-9512,9530-9539 <5 ~ ~

Unspecified 8000-8004 11 0.3 ~

 ~ Statistic not displayed due to less than 25 cases.
Chapter 18 Cancer of the Vulva

National Cancer Institute 150 SEER Survival Monograph 

A survival differential across age exists for Stages II-IV 

and unknown stage with women aged 70 and older exhibiting lower survival compared to women aged 20-69. 

No difference by age is observed in stage I (Table 18.7, 

Figure 18.1). 

Survival by Stage

Table 18.8 and Figure 18.2 show the survival by stage 

and time since diagnosis for squamous cell carcinoma. 

In stages III-IV, the steepest declines in survival are observed within the first and second years since diagnosis. 

Survival continues to decline throughout the 10 years 

observed in these stages.

Survival by Histology and Stage

Basal cell carcinoma shows a positive survival advantage 

compared to the other squamous histologic subtypes in 

stage I and II. Keratinizing has the least favorable survival 

for these stages. Little difference exists between the other 

two squamous subtypes in stages I-IV (Table 18.9).

Table 18.6: Squamous Cell Carcinoma of the Vulva: Number and Distribution of Cases by AJCC Stage (SEER modified, 5th 

Edition) and Age (20+), 12 SEER Areas, 1988-2001

AJCC Stage

Age (Years)

Total 20+ 20-69 70+

Cases Percent Cases Percent Cases Percent

Total 3,390 100.0 1,566 100.0 1,824 100.0

Stage I 1,567 46.2 882 56.3 685 37.6

Stage II 650 19.2 253 16.2 397 21.8

Stage III 744 21.9 275 17.6 469 25.7

Stage IV 210 6.2 90 5.7 120 6.6

Unknown/Unstaged 219 6.5 66 4.2 153 8.4

Table 18.7: Squamous Cell Carcinoma of the Vulva: Number of Cases and 5-Year Relative Survival Rates (%) by AJCC Stage 

(SEER modified, 5th Edition) and Age (20+), 12 SEER Areas, 1988-2001

AJCC Stage

Age (Years)

Total 20+ 20-69 70+

Cases

5-Year 

Relative

Survival

Rate (%) Cases

5-Year 

Relative

Survival

Rate (%) Cases

5-Year 

Relative

Survival

Rate (%)

Total 3,390 75.9 1,566 84.8 1,824 66.4

Stage I 1,567 93.3 882 94.0 685 92.9

Stage II 650 78.7 253 86.0 397 73.1

Stage III 744 52.7 275 70.0 469 39.7

Stage IV 210 28.7 90 40.6 120 16.9

Unknown/Unstaged 219 57.0 66 74.5 153 44.5

90

100

)

70

80

l Rate (%

50

60

e Survival

30

40

Relative

10

20

0

Stage I Stage II Stage III Stage IV

AJCC Stage

20-69 Years 70+ Years

Figure 18.1: Squamous Cell Carcinoma of the Vulva: 5-Year 

Relative Survival Rate (%) by Age (20+) and AJCC Stage (SEER 

modified, 5th Edition), 12 SEER Areas, 1988-2001
Chapter 18 Cancer of the Vulva

National Cancer Institute 151 SEER Survival Monograph 

Survival by Stage and Grade 

Five-year relative survival rates are shown by stage and 

grade for the 3,390 patients with squamous cell carcinoma in Table 18.10 & Figure 18.3. Within stage, 5-year 

relative survival declines as grade increases from well 

differentiated to poorly differentiated/undifferentiated/

anaplastic. In stages II and IV, little difference is seen 

between well- and moderately-differentiated tumors. In 

Stage III, little difference is seen between moderately 

differentiated and poorly differentiated/undifferentiated/

anaplastic tumors.

Survival by Tumor Size and Nodal Status for Stage 

III

In stage III tumors, both lymph node status and tumor 

size are prognostic, with both larger tumors (those greater 

than 2 cm) and positive regional lymph nodes predicting 

poorer survival (Table 18.11 and Figure 18.4).

Conditional Survival

Five-year relative survival rates, conditioned on years 

since diagnosis, are presented in Table 18.12 and Figure 

18.5 for squamous cell carcinoma of the vulva. For stage 

III, the probability of surviving the next 5 years increases 

Table 18.8: Squamous Cell Carcinoma of the Vulva: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates (%) by AJCC Stage (SEER modified, 5th Edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 3,390 100.0 89.1 82.6 79.6 75.9 72.1 69.4

Stage I 1,567 46.2 99.5 98.0 95.9 93.3 89.9 87.2

Stage II 650 19.2 93.8 87.5 85.5 78.7 74.3 69.0

Stage III 744 21.9 76.4 62.1 57.4 52.7 46.8 45.5

Stage IV 210 6.2 52.1 39.1 31.0 28.7 22.4 15.6

Unstaged 219 6.5 77.5 65.9 61.8 57.0 51.4 51.1

Table 18.9: Squamous Cell Carcinoma of the Vulva: Number of Cases and 5-Year Relative Survival Rates (RSR) by 

Histology and AJCC Stage (SEER modified, 5th Edition), Ages 20+, 12 SEER Areas, 1988-2001

Histology

AJCC Stage

Total I II III IV Unknown/

Unstaged

Cases

5-Year 

RSR

(%) Cases

5-Year 

RSR

(%) Cases

5-Year 

RSR 

(%)

Cases

5-Year 

RSR

(%)

Cases

5-Year 

RSR

(%)

Cases

5-Year 

RSR 

(%)

Total 3,390 75.9 1,567 93.3 650 78.7 744 52.7 210 28.7 219 (%)

Squamous, NOS* 2,073 73.7 900 91.5 376 77.8 510 54.7 142 27.6 145 49.1

Squamous, Keratinizing 582 60.2 186 82.7 145 64.4 187 43.7 45 23.9 19 ~

Basal Cell 403 99.4 292 100.0 61 97.7 5 ~ <5 ~ 43 85.2

Other Epidermoid 332 84.8 189 94.7 68 88.3 42 57.5 21 ~ 12 ~

 ~ Statistic not displayed due to less than 25 cases.

* NOS: Not Otherwise Specified

90

100

70

80

(%)

Stage I

60

70

ival Rate 

Stage II

40

50

tive Surv

Stage III

Stage IV

20

30

Rela

Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 18.2: Squamous Cell Carcinoma of the Vulva: Relative 

Survival Rates (%) by AJCC Stage (SEER modified, 5th Edition), 

Ages 20+, 12 SEER Areas, 1988-2001
Chapter 18 Cancer of the Vulva

National Cancer Institute 152 SEER Survival Monograph 

as time since diagnosis increases. For stage IV cases, 

the 5-year relative survival rate from time of diagnosis 

is 29%, but for those individuals who survive one year 

post-diagnosis, 5-year survival increases to 54%. This 

increases to 71% for those individuals who survive 4 

years. However, 5-year survival decreases to 46% for 

those who have already survived five years after diagnosis. Stage I, which has a 93% 5-year survival rate from 

diagnosis, exhibits little gain in 5-year survival several 

years after diagnosis.

Adenocarcinoma 

Survival by Stage

Survival by stage at diagnosis is shown for the 347 cases 

of adenocarcinoma. The most common stage at diagnosis 

was stage I, with nearly half of the cases. Over 70% were 

diagnosed in stages I-II (Table 18.13). Very few adult 

women were diagnosed with stage IV (5%).

Both stages I and II show 5-year relative survival rates of 

92% or higher. Five-year relative survival falls to 74.1% 

at stage III. There are not enough cases to calculate 

survival at stage IV, (Table 18.13)

Melanoma 

Survival by Stage

Melanoma of the vulva has been staged using the melanoma 

staging scheme (2). Of the 240 cases of melanoma, enough 

information to analyze stage at diagnosis was available 

for 223 (93%). The most common stage at diagnosis was 

stage I with 40% of the cases. Twenty-nine percent of 

the adult women were diagnosed with stage III and 19% 

were diagnosed with stage II (Table 18.14).

The Stage I five-year survival rate is 83%. Survival falls 

to 64% at stage II and 35% at stage III (Table 18.14).

Table 18.10: Squamous Cell Carcinoma of the Vulva: Number of Cases and 5-Year Relative Survival Rates (%) by AJCC Stage 

(SEER modified, 5th Edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Grade

Total Well Differentiated Moderately 

Differentiated

Poorly/ 

Undifferentiated Unknown

Cases

5-Year 

Relative

Survival

Rate (%) Cases

5-Year 

Relative

Survival

Rate (%) Cases

5-Year 

Relative

Survival

Rate (%) Cases

5-Year 

Relative

Survival

Rate (%) Cases

5-Year 

Relative

Survival

Rate (%)

Total 3,390 75.9 746 83.6 1,045 66.0 494 49.2 1,105 90.9

Stage I 1,567 93.3 403 95.5 337 86.9 107 77.4 720 96.4

Stage II 650 78.7 167 79.8 242 75.8 87 51.1 154 94.5

Stage III 744 52.7 110 64.6 332 46.6 202 43.4 100 76.2

Stage IV 210 28.7 29 33.7 85 32.0 65 18.5 31 31.3

Unknown/Unstaged 219 57.0 37 41.1 49 50.2 33 43.6 100 68.9

90

100

%)

70

80

al Rate (

%

50

60

ve Surviva

30

40

Relativ

10

20

0

Stage I Stage II Stage III Stage IV

AJCC Stage AJCC Stage

Well Differentiated Moderately Differentiated

Poorly Differentiated/Anaplastic

Figure 18.3: Squamous Cell Carcinoma of the Vulva: 5-Year 

Relative Survival Rate (%) by AJCC Stage (SEER modified, 5th 

Edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001

90

100

%)

70

80

90

al Rate (

%

40

50

60

ve Surviva

20

30

40

Relativ

0

10

0-2cm > 2cm

AJCC Stage

Negative Positive

Figure 18.4: Stage III Squamous Cell Carcinoma of the Vulva: 

5-Year Relative Survival Rate (%) by Nodal Status and Tumor 

Size, Ages 20+, 12 SEER Areas, 1988-2001
Chapter 18 Cancer of the Vulva

National Cancer Institute 153 SEER Survival Monograph 

Discussion

A larger proportion of black women than of white women 

are diagnosed with vulvar cancer at younger ages. The 

proportion of adult black women diagnosed before the 

age of 50 (35%) is nearly double that of whites (17%). 

Overall, there are no major differences in survival between blacks and whites for cancer of the vulva. For 

older women, 70 years and over, however, white women 

have better survival. By stage, there is little difference 

in survival by age groups (20-69 years compared to 70+ 

years) for women with stage I (2). In contrast, women 

over 70 years of age have increasingly worse survival 

across stages II to IV, compared to women 20-69 years 

of age with the same stage. 

Early stage of disease is associated with the most favorable survival. Among adenocarcinomas, stages I and II 

have the most favorable survival among this histologic 

category. Among squamous histologies, representing 83% 

of all cancers of the vulva, basal cell has a distinct survival advantage in stage I and II over other squamous 

cell carcinomas. Survival declines with advanced stage 

of disease.

Table 18.11: Stage III Squamous Cell Carcinoma of the Vulva: Number of Cases and 5-Year Relative Survival Rates (%) by 

Nodal Status and Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

Nodal Status

Tumor Size

Total <= 2cm > 2cm Unknown

Cases

5-Year 

Relative

Survival

Rate (%) Cases

5-Year 

Relative

Survival

Rate (%) Cases

5-Year 

Relative

Survival

Rate (%) Cases

5-Year 

Relative

Survival

Rate (%)

Total 744 52.7 111 67.4 488 48.1 145 54.8

Negative 179 71.9 23 ~ 114 69.1 42 71.1

Positive 476 43.1 76 61.2 337 39.2 63 39.2

Unknown 89 59.6 12 ~ 37 52.7 40 57.2

 ~ Statistic not displayed due to less than 25 cases.

Table 18.12: Squamous Cell Carcinoma of the Vulva: 5-Year Relative Survival Rates (%) , Conditioned on Years Since Diagnosis, 

by AJCC Stage (SEER modified, 5th Edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

5-Year Relative Survival Rate (%)

Years Since Diagnosis

0 1 2 3 4 5

Total 75.9 83.2 87.4 88.5 89.4 89.3

Stage I 93.3 93.6 93.5 93.7 94.8 93.8

Stage II 78.7 81.1 85.8 85.7 84.6 86.0

Stage III 52.7 64.3 75.0 78.2 79.0 82.1

Stage IV 28.7 53.8 70.1 66.9 71.2 45.8

Unstaged 57.0 68.6 75.1 77.3 78.8 82.9

90

100

(%)

60

70

80

90

ival Rate (

30

40

50

60

tive Survi

0

10

20

30

Relat

0

Stage I Stage II Stage III Stage IV

AJCC Stage

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years

Figure 18.5: Squamous Cell Carcinoma of the Vulva: 5-Year 

Relative Survival Rate (%), Conditioned on Years Since 

Diagnosis, by AJCC Stage (SEER modified, 5th Edition), Ages 

20+, 12 SEER Areas, 1988-2001
Chapter 18 Cancer of the Vulva

National Cancer Institute 154 SEER Survival Monograph 

Table 18.13: Adenocarcinoma of the Vulva: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival 

Rates (%) by AJCC Stage (SEER modified, 5th Edition), Ages 20+, 12 SEER Areas, 1988-2001

 AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 347 100.0 96.2 95.1 93.1 91.9 89.9 82.5

Stage I 172 49.6 100.0 100.0 100.0 100.0 97.5 88.5

Stage II 75 21.6 98.6 98.6 94.1 92.2 86.7 72.0

Stage III 51 14.7 97.6 86.5 83.3 74.1 74.1 70.9

Stage IV 18 5.2 ~ ~ ~ ~ ~ ~

Unstaged 31 8.9 91.0 91.0 90.9 84.8 84.8 84.8

 ~ Statistic not displayed due to less than 25 cases.

Table 18.14: Melanoma of the Vulva: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) 

by AJCC Stage (SEER modified, 5th Edition - Melanoma Staging Used), Ages 20+, 12 SEER Areas, 1988-2001 

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 240 100.0 89.1 72.3 63.5 58.9 53.0 46.6

I 96 40.0 99.4 91.8 84.5 83.0 76.5 71.3

II 45 18.8 96.2 76.9 76.4 64.3 64.3 57.4

III 69 28.8 81.1 55.7 39.7 35.1 27.0 21.5

IV 13 5.4 ~ ~ ~ ~ ~ ~

Unknown/Unstaged 17 7.1 ~ ~ ~ ~ ~ ~

 ~ Statistic not displayed due to less than 25 cases.

References

1. American Cancer Society, Cancer Facts and Figures 2006, 

American Cancer Society, #500806, 2006.

2. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy 

BJ, Murphy GP, O’Sullivan B, Sobin LH, Yarbro, JW (eds). 

AJCC Cancer Staging Manual, Fifth edition, American Joint 

Committee on Cancer. Philadelphia: Lippincott-Raven, 1997.
National Cancer Institute 155 SEER Survival Monograph 

Introduction

Cancers of the vagina are extremely rare, accounting for 

approximately 1% of all cancers of the female genital 

organs. Nearly 50% of cancers of the vagina cases are 

diagnosed in women age 70 and over. The most common histologic types of vaginal cancer are squamous cell 

carcinoma and adenocarcinoma. The 5-year relative survival rate for squamous cell carcinoma is 54%. The 5-year 

relative survival rate for patients with adenocarcinoma is 

nearly 60%. 

Materials and Methods

Exclusions

Between 1988 and 2001, there were 3,471 cases of cancer 

of the vagina diagnosed in SEER. The following were 

excluded from the analysis: patients for whom vaginal 

cancer was not the first primary, cases identified through 

autopsy or death certificate only, persons of unknown race, 

cases without active follow-up or alive with no survival 

time, patients less than 20 years old, cases without microscopic confirmation, sarcomas and carcinoids. After 

these exclusions, 1,041 adult cases remained for analysis 

(Table 19.1).

AJCC Staging

The Federation Internationale de Gynecologie et 

d’Obstetrique (FIGO) and the American Joint Committee 

on Cancer (AJCC) have designated staging for cancers of 

the vagina. SEER modified AJCC staging, 3rd edition, 

was used for analyses in this chapter. The 3th Edition 

AJCC staging (1) states:

Stage I vaginal cancer is defined as tumor confined to 

vagina with no lymph node metastases. 

Stage II vaginal cancer is defined as tumor which invades 

paravaginal tissues but not to pelvic wall with no lymph 

node metastases.

Stage III vaginal cancer is defined as tumor extending 

to pelvic wall, or either tumor confined to the vagina or 

tumor with lymph note metastases invading paravaginal 

tissues.

Stage IV vaginal cancer is defined as either tumor invasion of the mucosa of the bladder or rectum or extension 

beyond the true pelvis. 

Carol L. Kosary

Chapter 19

Cancer of the Vagina

Table 19.1: Cancer of the Vagina: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number 

Excluded Reason for Exclusion/Selection

3,471 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

2,249 1,222 Select first primary only

2,241 8 Exclude death certificate only or at autopsy

2,140 101 Exclude unknown race

2,131 9 Exclude alive with no survival time

2,082 49 Exclude children (Ages 0-19)

1,104 978 Exclude in situ cancers

1,082 22 Exclude no or unknown microscopic confirmation

1,041 41 Exclude sarcomas, stromal sarcomas, and carcinoids
Chapter 19 Cancer of the Vagina

National Cancer Institute 156 SEER Survival Monograph 

Results

Age 

Nearly half of eligible adult cases were diagnosed in 

women ages 70 and over. Only 15% of all adult cases were 

diagnosed in women 20-49 years of age (Table 19.2).

Eight-year and 10-year relative survival rates following 

diagnosis of vaginal cancer were found to decline with 

age at diagnosis (Table 19.2).

Race and Age

Survival rates were lower for black females. The largest 

survival difference was for age groups 20-69 where the 

5-year relative survival rate was 47% for black females 

compared to 56% for white females 20-69 years of age 

(Table 19.3).

Geographic Location

Five-year relative survival rates in the 12 SEER areas 

included in this study ranged from 56% in San FranciscoOakland to 34% in Hawaii. However, small numbers 

of cases within most registries makes survival rates by 

geographic area difficult to compare (Table 19.4). 

Histology

Approximately 68% of the vaginal cancer cases are 

squamous, with an additional 17% adenocarcinoma, 9% 

melanoma, and the remainder consisting of various other 

histologies. Patients with melanoma of the vagina had the 

lowest 5-year relative survival rates, 13% (Table 19.5). 

Survival by Age and Stage

Little difference in stage distribution is seen for women 

under 70 compared to those over the age of 70, with 62% 

 Table 19.2: Cancer of the Vagina: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) 

by Age (20+), 12 SEER Areas, 1988-2001

Age (Years) Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 20+ 1,041 100.0 75.5 62.1 56.4 49.4 43.6 40.7

20-29 10 1.0 ~ ~ ~ ~ ~ ~

30-39 43 4.1 81.3 69.1 66.5 63.0 63.0 51.9

40-49 108 10.4 84.5 68.4 60.2 54.2 51.1 51.1

50-59 157 15.1 82.5 70.9 66.1 57.0 50.4 49.0

60-69 210 20.2 83.8 70.6 62.3 51.8 42.4 41.8

70-79 261 25.1 74.7 61.3 53.1 45.4 36.8 29.3

80+ 252 24.2 57.4 42.3 38.6 34.1 28.1 22.7

 ~ Statistic not displayed due to less than 25 cases.

Table 19.3: Cancer of the Vagina: Number of Cases, Median Survival Time (Months) and 5-Year Survival Rates (%) by Race 

and Age (20+), 12 SEER Areas, 1988-2001

Race and Age Group (Years) Cases

Median 

Survival Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

All Races, 20+ 1,041 36.8 40.5 82.1 49.4

White, 20+ 834 38.3 41.2 81.9 50.3

Black, 20+ 135 24.0 34.9 79.9 43.5

All Races, 20-69 528 69.2 52.9 95.5 55.4

White, 20-69 424 72.2 54.0 95.7 56.4

Black, 20-69 67 45.1 44.0 93.4 46.7

All Races, 70+ 513 19.5 28.2 68.4 41.3

White, 70+ 410 19.9 28.3 67.6 41.7

Black, 70+ 68 14.5 26.4 66.6 39.1
Chapter 19 Cancer of the Vagina

National Cancer Institute 157 SEER Survival Monograph 

Table 19.4: Cancer of the Vagina: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) 

by SEER Geographic Area, Ages 20+, 12 SEER Areas, 1988-2001

SEER Geographic Area Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 1,041 100.0 75.5 62.1 56.4 49.4 43.6 40.7

Atlanta and Rural Georgia 90 8.6 77.2 59.1 57.0 47.3 42.0 36.9

 Atlanta (Metropolitan) - 1988+ 86 8.3 77.3 59.7 57.5 47.7 42.5 37.4

 Rural Georgia - 1988+ 4 0.4 ~ ~ ~ ~ ~ ~

California

 Los Angeles - 1992+ 186 17.9 78.0 63.7 56.6 52.7 46.5 22.5

 Greater Bay Area 178 17.1 82.0 67.7 63.1 55.1 46.3 43.8

 San Francisco-Oakland SMSA - 1988+ 107 10.3 78.6 66.8 63.6 56.0 45.1 41.6

 San Jose-Monterey - 1988+ 71 6.8 87.0 69.1 62.0 52.9 45.2 45.2

Connecticut - 1988+ 129 12.4 72.3 64.0 57.9 47.0 32.3 32.3

Detroit (Metropolitan) - 1988+ 161 15.5 73.3 58.5 51.1 41.2 38.3 38.3

Hawaii - 1988+ 29 2.8 63.3 48.9 37.4 33.8 ! !

Iowa - 1988+ 83 8.0 73.5 61.5 53.0 47.0 44.5 43.4

New Mexico - 1988+ 47 4.5 74.4 53.3 48.8 43.0 39.5 37.3

Seattle (Puget Sound) - 1988+ 104 10.0 68.8 60.9 56.8 54.1 53.0 43.5

Utah - 1988+ 34 3.3 81.2 67.4 57.9 47.7 39.0 39.0

 ~ Statistic not displayed due to less than 25 cases.

 ! Not enough intervals to produce rate.

Table 19.5: Cancer of the Vagina: Number and Distribution of Cases and 5-Year Relative Survival by Histology,

 Ages 20+, 12 SEER Areas, 1988-2001

Histology ICD-O Code Cases Percent

5-Year 

Relative 

Survival 

Rate(%)

Total 8000-9989 1,041 100.0 49.4

Squamous 8050-8130 705 67.7 53.6

 Squamous, NOS* 8070 530 50.9 52.4

 All Other Squamous 8050-8069,8071-8130 175 16.8 56.8

Adenocarcinoma 8140-8147,8160-8162,8180-8221,8250-8506,8520-

8550,8560,8570-8573,8940-8941 172 16.5 59.0

 Clear Cell 8310 20 1.9 ~

 All Other Adenocarcinoma 8140-8147,8160-8162,8180-8221,8250-8309,8311-

8506,8520-8550,8560,8570-8573,8940-8941 152 14.6 58.5

Other Specified Carcinomas 8030-8045,8150-8155,8170-8171,8230-8248,8510-

8512,8561-8562,8580-8671 13 1.2 ~

Carcinoma, NOS* 8010-8022 40 3.8 32.9

Other Specified Types 8720-8790,8935,8950-8979,8982,9000-9030,9060-

9110,9350-9364,9380-9512,9530-9539 106 10.2 16.9

 Melanoma 8720-8790 92 8.8 13.3

 All Other Specified Types 8935,8950-8979,8982,9000-9030,9060-9110,9350-

9364,9380-9512,9530-9539 14 1.3 ~

Unspecified 8000-8004 5 0.5 ~

 ~ Statistic not displayed due to less than 25 cases.

* NOS : Not Otherwise Specified
Chapter 19 Cancer of the Vagina

National Cancer Institute 158 SEER Survival Monograph 

and 54% of cases diagnosed in stages I-II, respectively 

(Table 19.6).

Somewhat lower survival is seen in stages I, II, IV, and 

unknown for women ages 70 and above compared to 

younger women. Small numbers, however, make comparisons difficult (Table 19.7 & Figure 19.1).

Survival by Stage

Table 19.8 and Figure 19.2 show the contrast across stage 

over time since diagnosis. In stages II-IV, the steepest 

declines in survival are observed within 2 years of diagnosis. Survival continues to decline throughout the 

10years observed in stages I-III, but somewhat stabilizes 

5 years after diagnosis in stage IV.

Survival by Stage and Grade

Stages I and II had more well/moderately differentiated 

tumors and stages III and IV had more poorly/undifferentiated tumors. Grade is found to impact survival 

in cases diagnosed in stage I, II, and IV (Table 19.9 & 

Figure 19.3). 

Conditional Survival

Five-year relative survival rates, conditioned on years 

since diagnosis, are presented in Table 19.10 and Figure 

19.4. For stages I-IV, the probability of surviving the 

next 5 years increases as time since diagnosis increases. 

This is most marked for the stage IV cases. The 5-year 

relative survival rate from time of diagnosis is 20%. For 

those individuals who survive 1 year post-diagnosis, 5-year 

survival increases to 37%. This increases to 91% for 

those individuals who survive 5 years, albeit few cases 

survive the first five years to be able to survive the next 

five years. 

Discussion

Cancer of the vagina is a very rare cancer. The comparisons of survival rates between subgroups presented in this 

Table 19.6: Cancer of the Vagina: Number and Distribution of Cases by AJCC Stage (SEER modified, 3rd edition) and Age 

(20+), 12 SEER Areas, 1988-2001

AJCC Stage

Age (Years)

Total 20+ 20-69 70+

Cases Percent Cases Percent Cases Percent

Total 1,041 100.0 528 100.0 513 100.0

I 368 35.4 204 38.6 164 32.0

II 236 22.7 124 23.5 112 21.8

III 120 11.5 66 12.5 54 10.5

IV 164 15.8 70 13.3 94 18.3

Unknown/Unstaged 153 14.7 64 12.1 89 17.3

Table 19.7: Cancer of the Vagina: Number of Cases and 5-Year Relative Survival Rates (%) by AJCC Stage (SEER modified, 3rd 

edition) and Age (20+), 12 SEER Areas, 1988-2001

AJCC Stage

Age (Years)

Total 20+ 20-69 70+

Cases

5-Year 

Relative 

Survival 

Rate(%)

Cases

5-Year 

Relative 

Survival 

Rate(%)

Cases

5-Year 

Relative 

Survival 

Rate(%)

Total 1,041 49.4 528 55.4 513 41.3

I 368 68.4 204 72.9 164 61.9

II 236 54.3 124 61.7 112 43.3

III 120 35.5 66 33.0 54 37.0

IV 164 20.3 70 23.6 94 17.4

Unknown/Unstaged 153 31.7 64 43.5 89 20.0

 ~ Statistic not displayed due to less than 25 cases.
Chapter 19 Cancer of the Vagina

National Cancer Institute 159 SEER Survival Monograph 

Table 19.8: Cancer of the Vagina: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates by 

Stage (SEER modified AJCC, 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 1,041 100.0 75.5 62.1 56.4 49.4 43.6 40.7

I 368 35.4 91.0 82.8 76.6 68.4 60.4 55.2

II 236 22.7 83.2 67.1 62.8 54.3 45.2 42.8

III 120 11.5 69.9 54.6 44.7 35.5 27.6 24.8

IV 164 15.8 47.5 31.2 25.5 20.3 18.7 18.4

Unknown/Unstaged 153 14.7 59.5 41.5 35.6 31.7 28.6 28.6

 ~ Statistic not displayed due to less than 25 cases.

90

100

(%)

70

80

val Rate (

50

60

ive Surviv

20

30

40

Relat

0

10

20

Stage I Stage II Stage III Stage IV

AJCC Stage

20-69 Years 70+ Years

Figure 19.1: Cancer of the Vagina: 5-Year Relative Survival 

Rate (%) by Age (20+) and Stage (SEER modified AJCC, 3rd 

edition), 12 SEER Areas, 1988-2001

Figure 19.2: Cancer of the Vagina: Relative Survival Rates 

(%) by Stage (SEER modified AJCC, 3rd edition), Ages 20+, 12 

SEER Areas, 1988-2001

Table 19.9: Cancer of the Vagina: Number of Cases and 5-Year Relative Survival Rates (%) by Stage (SEER modified AJCC, 3rd 

edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

Grade

Total Well/Moderately 

Differentiated Poorly/ Undifferentiated Unknown

Cases

5-Year 

Relative 

Survival 

Rate(%)

Cases

5-Year 

Relative 

Survival 

Rate(%)

Cases

5-Year 

Relative 

Survival 

Rate(%)

Cases

5-Year 

Relative 

Survival 

Rate(%)

Total 1,041 49.4 338 58.7 349 42.5 354 46.6

I 368 68.4 131 76.6 95 60.0 142 65.4

II 236 54.3 97 60.3 81 54.7 58 41.5

III 120 35.5 41 36.3 54 33.0 25 34.6

IV 164 20.3 37 30.0 66 18.7 61 15.7

Unknown/Unstaged 153 31.7 32 30.0 53 24.0 68 37.8

90

100

70

80

Rate (%)

Stage I

50

60

70

Survival R

Stage II

Stage III

30

40

50

Relative S

Stage III

Stage IV

10

20

30 R

0

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 19 Cancer of the Vagina

National Cancer Institute 160 SEER Survival Monograph 

chapter are for descriptive purposes only. As confidence 

intervals were not included here, interpretation of differences between groups should be made with caution, 

especially given the rarity of this cancer. 

In terms of histologic distribution, approximately twothirds of these cancers are squamous, 17% are adenocarcinoma, and less than 10% are melanoma. Melanomas have 

the lowest 5-year survival rate. Black women exhibit a 

lower survival rate than white women, especially in the 

age group of 20-69 years.

Over half of cancers of the vagina are diagnosed in stage 

I and II. Lower survival is seen in women 70 years or 

older with stages I and II. The steepest decline in relative 

survival for all stages is during the first 2 to 3 years after 

Table 19.10: Cancer of the Vagina: 5-Year Relative Survival Rates (%), Conditioned on Years Since Diagnosis, by AJCC Stage 

(SEER modified, 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

5-Year Relative Survival Rate (%)

Years Since Diagnosis

0 1 2 3 4 5

Total 49.4 59.5 69.7 73.8 77.0 79.6

I 68.4 71.5 75.4 77.0 78.8 79.9

II 54.3 60.2 70.1 69.5 73.5 75.1

III 35.5 42.4 51.1 58.9 63.9 70.2

IV 20.3 36.9 57.7 69.7 82.2 91.1

Unknown/Unstaged 31.7 44.9 61.8 73.7 74.9 79.2

90

100

e (%)

70

80

vival Rate

50

60

ative Surv

20

30

40

Rela

0

10

20

Stage I Stage II Stage III Stage IV

AJCC Stage AJCC Stage

Well/Moderately Differentiated Poorly Differentiated/Anaplastic

90

100

(%)

70

80

val Rate (

40

50

60

tive Surviv

20

30

40

Relat

0

10

20

Stage I Stage II Stage III Stage IV

AJCC Stage

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years

Figure 19.3: Cancer of the Vagina: 5-Year Relative Survival 

Rate (%) by AJCC Stage (SEER modified, 3rd edition) and 

Grade, Ages 20+, 12 SEER Areas, 1988-2001

Figure 19.4: Cancer of the Vagina: 5-Year Relative Survival 

Rate (%), Conditioned on Years Since Diagnosis, by AJCC 

Stage (SEER modified, 3rd edition), Ages 20+, 12 SEER 

Areas, 1988-2001

diagnosis. The negative impact of advanced tumor grade 

is seen primarily for stage I, II, and IV survival rates.

REFERENCES

1. Beahrs, OH, Henson DE, Hutter RVP, Myers MH (eds). AJCC 

Cancer Staging Manual, Third edition. American Joint Committee 

on Cancer. Philadelphia: Lippincott, 1988.
National Cancer Institute 161 SEER Survival Monograph 

Introduction

Cancer of the fallopian tube is very rare, accounting for 

fewer than 1% of all cancers of the female genital organs. 

In this cancer, tumor develops from cells inside the fallopian tubes. It is much more common for a tumor to 

metastasize to the fallopian tube from either the ovary or 

endometrium than for a primary cancer to develop inside 

the fallopian tube. Even major medical centers may see 

no more than a handful of cases of fallopian tube cancer 

over several years. The majority of the cases are diagnosed 

in women age 50 and older. 

Materials and Methods

Between 1988 and 2001, there were 1,033 cases of cancer 

of the fallopian tube diagnosed in SEER. The following 

were excluded from the analysis: patients for whom fallopian tube cancer was not the first primary, cases identified through autopsy or death certificate only, persons 

of unknown race, cases without active follow-up or alive 

with no survival time, patients less than 20 years old, 

cases without microscopic confirmation, in situ cancers, 

sarcomas, and carcinoids. After these exclusions, 769 

adult cases remained for analysis (Table 20.1).

Results

Age

Among adults, 84% of the cases were diagnosed in women 

aged 50 and older, with 33% diagnosed in women aged 

70 and older (Table 20.2).

Only slight differences are observed in 5-year survival 

rate by age for ages 50+ (Table 20.2). The 40-49 age 

group had better survival than the other age groups (Table 

20.3). When broader age groups are used, there is a slight 

decrease in survival as age increases. While the survival 

rates for black females are based on few cases, the 5-year 

relative survival rate (73%) was higher than for white 

females (65%) (Table 20.3).

Geographic Location

Five-year relative survival rates in the 12 SEER areas represented in this study ranged from 76% in San FranciscoOakland to 50% in San Jose-Monterey, both part of the 

Greater Bay area (Table 20.4). 

Histology

Eighty-seven percent of the cases were categorized as 

adenocarcinoma (Table 20.5). There is not a substantial 

difference in survival by histology. 

Carol L. Kosary

Chapter 20

Cancer of the Fallopian Tube

Table 20.1: Cancer of the Fallopian Tube: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number Excluded Reason for Exclusion/Selection

1,033 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

816 217 Select first primary only

810 6 Exclude death certificate only or at autopsy

802 8 Exclude unknown race; children (<20); no microscopic confirmation, 

carcinoids

802 0 Exclude alive with no survival time

788 14 Exclude in situ cancers

769 19 Exclude sarcomas
Chapter 20 Cancer of the Fallopian Tube

National Cancer Institute 162 SEER Survival Monograph 

Staging

The Federation Internationale de Gynecologie et 

d’Obstetrique (FIGO) and the American Joint Committee on Cancer (AJCC) have designated staging for cancers 

of the Fallopian Tube. The fifth edition of AJCC staging 

comprises (1): 

Stage I: Tumor limited to one or both tubes, with or without ascites

Stage II: Tumor involves one or both tubes with pelvic 

extension and/or metastasis to the uterus or ovary or extension to other pelvic tissues.

Stage III: Tumor involves one or both tubes with peritoneal 

implants outside the pelvis and/or regional nodes.

Stage IV: Distant metastasis outside the peritoneal cavity.

Survival by Stage

Women diagnosed at age 60 or older are more likely to 

be diagnosed in stages III or IV (57%) than are women 

diagnosed under the age of 60 (42%) (Table 20.6).

Sparse numbers make it difficult to examine survival by 

stage and age. Five-year survival rates (%) are observed 

to decline with increased stage at diagnosis from 93% for 

stage I versus 40% for stage IV (Table 20.7 and Figure 

20.1). Within stage, survival generally declines as years 

since diagnosis increases. 

Conditional Survival

Five year relative survival rates, conditioned on years 

since diagnosis, are presented in Table 20.8 and Figure 

20.2. For stages II-IV, increases in the 5-year survival 

rate are observed between diagnosis and 5 years past 

diagnosis. That is, the probability of surviving through 

the next 5 years generally increases as time since diagnosis increases. For women who have already survived 

five years, the survival rate for the next five years shows 

Table 20.2: Cancer of the Fallopian Tube: Number and Distribution fo Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival 

Rates (%) by Age (20+), 12 SEER Areas, 1988-2001

Age (Years) Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 20+ 769 100.0 93.4 85.1 76.7 64.7 56.7 54.8

20-29 6 0.8 ~ ~ ~ ~ ~ ~

30-39 17 2.2 ~ ~ ~ ~ ~ ~

40-49 98 12.7 99.1 91.6 90.5 73.9 66.6 63.4

50-59 171 22.2 98.2 91.9 78.8 61.8 59.0 52.0

60-69 221 28.7 93.1 80.4 71.7 64.6 56.3 56.3

70-79 192 25.0 86.9 79.8 71.6 58.8 42.6 36.6

80+ 64 8.3 88.1 81.2 73.1 61.2 56.3 56.3

Table 20.3: Cancer of the Fallopian Tube: Number of Cases, Median Survival Time (Months) and 5-Year Survival Rates (%) by 

Race and Age (20+), 12 SEER Areas, 1988-2001

Race/Age (Years) Cases

Median 

Survival Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

All Races, 20+ 769 78.2 58.0 89.7 64.7

White, 20+ 677 76.0 58.0 89.5 64.8

Black, 20+ 49 > 120 66.4 88.2 72.7

All Races, 20-59 292 > 120 66.7 97.6 68.3

White, 20-59 248 > 120 65.9 97.7 67.5

Black, 20-59 21 ~ ~ ~ ~

All Races, 60-69 221 84.9 59.5 92.2 64.6

White, 60-69 189 102.5 60.2 92.5 65.1

Black, 60-69 21 ~ ~ ~ ~

All Races, 70+ 256 53.7 47.1 78.6 60.0

White, 70+ 240 58.2 48.4 78.6 61.5

Black, 70+ 7 ~ ~ ~ ~

 ~ Statistic not displayed due to less than 25 cases.
Chapter 20 Cancer of the Fallopian Tube

National Cancer Institute 163 SEER Survival Monograph 

Table 20.4: Cancer of the Fallopian Tube: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by SEER Geographic Area, Ages 20+, 12 SEER Areas, 1988-2001

SEER Geographic Area Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 769 100.0 93.4 85.1 76.7 64.7 56.7 54.8

Atlanta and Rural Georgia 50 6.5 91.8 82.0 72.8 62.7 60.8 55.2

California

 Los Angeles - 1992+ 131 17.0 90.9 86.1 83.5 73.0 68.5 68.5

 Greater Bay Area 140 18.2 97.3 89.6 83.3 69.5 57.5 57.5

 San Francisco-Oakland SMSA - 1988+ 99 12.9 99.2 92.7 85.9 76.0 64.2 64.1

 San Jose-Monterey - 1988+ 41 5.3 91.3 81.9 76.6 49.8 39.1 39.1

Connecticut - 1988+ 119 15.5 94.5 84.7 72.4 58.4 49.7 44.6

Detroit (Metropolitan) - 1988+ 73 9.5 89.4 81.7 69.8 65.4 52.2 44.5

Hawaii - 1988+ 15 2.0 ~ ~ ~ ~ ~ ~

Iowa - 1988+ 68 8.8 87.3 76.7 72.1 51.2 40.1 34.0

New Mexico - 1988+ 45 5.9 96.5 91.0 79.6 67.0 61.8 60.3

Seattle (Puget Sound) - 1988+ 108 14.0 94.2 84.3 73.6 64.6 56.0 56.0

Utah - 1988+ 20 2.6 ~ ~ ~ ~ ~ ~

 ~ Statistic not displayed due to less than 25 cases.

Table 20.5: Cancer of the Fallopian Tube: Number and Distribution of Cases and 5-Year Relative Survival Rates (RSR) (%) by 

Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology ICD-O Code Cases Percent 5-Year 

RSR (%)

Total 8000-9989 769 100.0 64.7

Squamous 8050-8130 15 2.0 ~

Adenocarcinoma 8140-8147,8160-8162,8180-8221,8250-8506,8520-

8550,8570-8573,8940-8941 672 87.4 64.3

Other Specified Carcinomas 8030-8045,8150-8155,8170-8171,8230-8248,8510-

8512,8560-8562,8580-8671 8 1.0 ~

Carcinoma, NOS 8010-8022 44 5.7 72.3

Other Specified Types 8720-8790,8931-8932,8950-8979,8982,9000-9030,9060-

9110,9350-9364,9380-9512,9530-9539 27 3.5 67.7

 Choriocarcinoma 9100-9101 <6 ~ ~

 All Other Specified Types 8720-8790,8931-8932,8950-8982,9000-9030,9060-

9099,9102-9110,9350-9364,9380-9512,9530-9539 22 2.9 ~

Unspecified 8000-8004 <6 ~ ~

 ~ Statistic not displayed due to less than 25 cases.

* NOS: Not Otherwise Specified

Table 20.6: Cancer of the Fallopian Tube: Number and Distribution of Cases by AJCC Stage (5th Edition) and Age (20+), 

12 SEER Areas, 1988-2001

AJCC Stage

Age (Years)

Total 20+ 20-59 60+

Cases Percent Cases Percent Cases Percent

Total 769 100.0 292 100.0 477 100.0

I 204 26.5 107 36.6 97 20.3

II 102 13.3 43 14.7 59 12.4

III 81 10.5 30 10.3 51 10.7

IV 259 33.7 69 23.6 190 39.8

Unstaged 123 16.0 43 14.7 80 16.8
Chapter 20 Cancer of the Fallopian Tube

National Cancer Institute 164 SEER Survival Monograph 

Table 20.8: Cancer of the Fallopian Tube: 5-Year Relative Survival Rates (%), Conditioned on Years Since Diagnosis, by AJCC 

Stage (5th Edition), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage

5-Year Relative Survival Rate (%)

Years Since Diagnosis

0 1 2 3 4 5

Total 64.7 63.5 66.6 73.5 77.5 84.2

I 92.9 89.1 88.2 90.1 93.1 93.0

II 74.1 65.5 66.2 69.6 77.2 86.0

III 66.4 70.9 70.2 81.6 77.3 79.9

IV 40.2 42.2 49.6 58.7 59.1 73.8

Unstaged 62.4 56.1 54.5 59.7 66.9 71.1

much less variation by stage (93% for stage I to 74% for 

stage IV) than for females at diagnosis whose 5-year 

relative survival rates ranged from 93% (stage I) to 40% 

(stage IV).

Discussion

Cancer of the fallopian tube is a very rare cancer. Women 

40-49 have better survival than older women. Only small 

differences in survival between blacks and whites are 

observed with black females having the better survival. 

These differences are based on few cases for black females. 

Stages III and IV are more common in women 60 years 

and older compared to women less than 60. 

REFERENCE

 1. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy 

BJ, Murphy GP, O’Sullivan B, Sobin LH, Yarbro, JW (eds). 

AJCC Cancer Staging Manual, Fifth edition, American Joint 

Committee on Cancer. Philadelphia: Lippincott-Raven, 1997.

Table 20.7: Cancer of the Fallopian Tube: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by AJCC Stage (5th Editon), Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 769 100.0 93.4 85.1 76.7 64.7 56.7 54.8

I 204 26.5 99.3 98.3 96.6 92.9 87.0 85.7

II 102 13.3 98.6 96.7 92.1 74.1 64.6 64.6

III 81 10.5 90.3 83.4 72.8 66.4 57.8 54.0

IV 259 33.7 86.3 68.5 54.8 40.2 32.7 29.8

Unstaged 123 16.0 94.2 88.6 79.1 62.4 47.8 44.3

Figure 20.1: Cancer of the Fallopian Tube: Relative Survival 

Rates (%) by AJCC Stage (5th Edition), Ages 20+, 12 SEER 

Areas, 1988-2001

Figure 20.2: Cancer of the Fallopian Tube: 5-Year Relative 

Survival Rate (%), Conditioned on Years Since Diagnosis, by 

AJCC Stage (5th Edition), Ages 20+, 12 SEER Areas, 1988-

2001

100

e (%)

70

80

90

vival Rate

I

50

60

70

elative Surv

II

30

40

50

Re

III

IV

10

20

0

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

e (%)

70

80

90

vival Rate

40

50

60

ative Surv

10

20

30

Rela

0

10

I II III IV

AJCC Stage

0 Years 1 Year 2 Years 3 Years 4 Years 5 Years
National Cancer Institute 165 SEER Survival Monograph 

Introduction

Testicular cancer is a relatively rare cancer, with an estimated 8,250 new cases diagnosed in U.S. men in 2006 

(1). Despite the fact that it accounts for only 1% of all 

malignancies in males, it is the most common malignancy 

in men aged 20-34, and in the U.S. and most western 

countries the incidence has more than doubled since the 

1940s (2,3). Survival of patients with testicular, particularly 

those with metastatic disease, has improved significantly 

since the early 1970’s as the result of the development 

and wide-spread use of cisplatin-containing combination 

chemotherapy. The 5-year survival rate for testicular cancer 

patients, including all stages, was 72% in 1970-1973, and 

91% for patients diagnosed in 1983-1985 (4). For men diagnosed with testicular cancer during 1992-1998, the 5-yr 

survival rate was 95% (4), and today, testicular cancer is 

considered one of the most curable solid neoplasms (5). 

Materials and Methods

There were 12,978 adult cases of testicular cancer (other 

than testicular lymphomas) diagnosed from 1988 through 

2001 and reported to the SEER program. A detailed description of the source of these data is given in the introductory 

chapter of this monograph. Table 21.1 shows the numbers 

of cases excluded from the present analysis, by reason. 

This chapter describes survival analysis of the remaining 

11,606 histologically confirmed, first primary cases of 

adult testicular cancer diagnosed from 1988 through 2001 

and reported to the SEER Program. 

Histologic Classification

Germ cell carcinomas comprise the overwhelming majority (98.9%) of adult testicular carcinomas (6). Because 

non-germ cell testis tumors are uncommon and comprise 

a heterogeneous group, the focus of the analysis was on 

germ cell carcinomas. Within the germ cell neoplasms, 

tumors can be classified, based on pathologic and clinical 

features, into two broad histologic groups: seminomas and 

non-seminomas. Seminomas tend to grow more slowly 

and are very sensitive to radiation therapy, compared to 

non-seminomas which are more clinically aggressive and 

do not respond well to radiotherapy (7). Approximately 

61% of testicular germ cell carcinomas are pure seminomas with the remainder comprised of non-seminomas 

(teratomas, embryonal carcinomas, choriocarcinomas, yolk 

sac tumors), and mixtures of two or more types (8). Germ 

cell carcinomas were classified using ICD-O-2/ICD-O-3 

morphology codes into broad categories of seminoma (ICD 

9060-9064) and non-seminoma (ICD 9070-9101), or more 

narrowly into specific histologic groups: seminoma (ICD 

9060-9064), embryonal carcinoma (ICD 9070), yolk sac 

tumor (ICD 9071), teratoma (ICD 9080, 9082-9084), mixed 

Mary L. Biggs and Stephen M. Schwartz

Chapter 21

Cancer of the Testis

Table 21.1: Cancer of the Testis: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number 

Excluded Reason for Exclusion/Selection

12,978 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

12,528 450 Select first primary only

12,511 17 Exclude death certificate only or at autopsy

12,394 117 Exclude unknown race

12,366 28 Exclude alive with no survival time

11,707 659 Exclude children (Ages 0-19)

11,699 8 Exclude in situ cancers

11,651 48 Exclude no or unknown microscopic confirmation

11,606 45 Exclude sarcomas
Chapter 21 Cancer of the Testis

National Cancer Institute 166 SEER Survival Monograph 

germ cell tumor (ICD 9081, 9085, 9101), and choriocarcinoma (ICD 9100). 

Stage 

Testicular cancers are staged within the SEER data using 

the categories in situ, localized, regional, distant, and unstaged. Staging information on the cancer is also contained 

within the 10-digit Extent of Disease (EOD) code, which 

is based on clinical, operative, and pathologic diagnoses of 

the cancer. The EOD code encodes tumor size, extension 

of the tumor into surrounding tissues, and lymph node involvement. We used EOD coding to stage tumors according to the American Joint Committee on Cancer (AJCC) 

classification system, 5th Edition (9). The SEER modified AJCC stages (5th edition) for testicular cancer are 

as follows: Stage I (no spread to lymph nodes or distant 

organs), Stage II (the cancer has spread to regional lymph 

nodes but not to lymph nodes in other parts of the body 

or to distant organs), and Stage III (the cancer has spread 

to non regional lymph nodes and/or to distant organs). 

We were not able to further subclassify stages (ie., A, B, 

C) because substaging relies on serum tumor marker data 

which was not collected by the SEER program prior to 

1998.

Tumor Size 

Information on tumor size is contained within the 10-digit 

Extent of Disease (EOD) code. We examined the influence of tumor size (< 5 cm vs. 5+ cm) on relative survival 

among patients diagnosed with Stage I testicular cancer.

Age & Race 

To investigate the impact of age at diagnosis on relative 

survival, testicular cancer cases were grouped into the 

following age groups: 20-29, 30-39, 40-49, 50-59, 60-69, 

70+. To examine race-specific survival, patients were classified into 3 groups: black, white and all (includes blacks, 

whites, and all other races).

Results

Table 21.2 shows the frequency of testicular cancer cases 

classified by histology and age at diagnosis. Seminomas 

comprised the largest histologic group (61.1%). Germ cell 

tumors of mixed histologic types comprised the next largest group (23.2%). Non-germ cell and unspecified tumors 

comprised 1% of eligible tumors. More than 72% of the 

testicular cancer cases were diagnosed between the ages 

of 20-39. For men diagnosed with seminomas, the peak 

frequency occurred in the 30-39 year age group, while 

for men diagnosed with non-seminomas it was among 

20-29 year olds.

Three-quarters of all men with testicular carcinomas were 

diagnosed in Stage I (Table 21.3). However, the proportion 

of tumors diagnosed at early and late stages varied with 

the histologic type of the tumor. The largest proportion 

of testis tumors diagnosed in Stage I were seminomas 

(85.8%). Choriocarcinomas had the smallest proportion 

of Stage I tumors (20.7%) and the largest proportion of 

Stage III tumors (74.1%).

Overall Survival 

Overall, survival among men diagnosed with testicular 

cancer was very high. Relative survival rate was 98% at 1 

year following diagnosis, 97% at 2 years, 96% at 5 year, 

and 95% at 10 years after diagnosis (Table 21.4). 

Histology 

The relative survival rate varied with the histologic type of 

the tumor (Figure 21.1). The highest survival rate was observed for men diagnosed with pure seminomas; 10-year 

relative survival was 98. The 10-year relative survival 

Table 21.2: Cancer of the Testis: Number and Distribution of Cases by Histology and Age (20+), 12 SEER Areas, 1988-2001

Histology

Age (Years)

Total 20-29 30-39 40-49 50-59 60-69 70+

Cases Percent Cases Cases Cases Cases Cases Cases

Total 11,606 100.0 3,663 4,746 2,329 581 196 91

Germ Cell 11,480 98.9 3,639 4,710 2,307 563 183 78

 Seminomas 7,086 61.1 1,471 3,137 1,802 455 153 68

 Non-seminomas 4,394 37.9 2,168 1,573 505 108 30 10

 Embryonal 1,315 11.3 624 479 164 36 8 <5

 Yolk Sac 126 1.1 56 46 17 <5 <5 <5

 Teratoma 203 1.7 117 62 21 <5 0 <5

 Mixed Germ Cell 2,692 23.2 1,344 968 294 65 17 <5

 Choriocarcinoma 58 0.5 27 18 9 <5 <5 0

Non-Germ Cell and Unspecified 126 1.1 24 36 22 18 13 13
Chapter 21 Cancer of the Testis

National Cancer Institute 167 SEER Survival Monograph 

rate for non-seminomas was lower, 91% (Table 21.4), but 

varied by histologic type from 46% for choriocarcinoma 

to 92% for embryonal tumors and mixed germ cell tumors 

(Figure 21.1).

Stage and histology 

Testicular cancer relative survival decreased with increasing stage at diagnosis. Ten-year relative survival rates 

were over 95% for both Stage I and Stage II. When comparing tumors diagnosed at the same stage, survival rates 

for seminomas and non-seminomas were similar, with the 

exception of tumors diagnosed at Stage III (Table 21.4). 

Among men diagnosed with advanced disease, those 

diagnosed with seminomas had substantially better 2-, 3-, 

5-, 8-, and 10- year survival rates than men diagnosed with 

non-seminomas.

Tumor size 

Relative survival of patients diagnosed with Stage I 

testicular cancer was higher for those with tumors smaller 

than 5 cm compared to patients diagnosed with tumors 

that were 5 cm or larger (Table 21.5). Size accounted for 

more of a survival difference for non-seminomas than 

seminomas, but 10-year survival rates were over 92% 

even for non-seminomas 5 cm and over. 

Age at Diagnosis 

Among men diagnosed with seminomas, those aged 20-49 

had similar, though slightly higher, survival to those over 

50 years (Fig. 21.2). Among men with non-seminomas, 

the difference in survival between the two age groups was 

more pronounced: 2-year survival rate was 95% in the 

younger age group versus 84% in the older one; 5-year 

survival rate was 93% in the 20-49 age group versus 79% 

in those over 50 years of age. The distribution of stage 

at diagnosis of testicular tumors was similar among men 

aged 20-49 and those aged 50+ (results not shown).

Race 

For seminomas, survival was slightly less among black 

men than among white men (Fig. 21.3). The disparity was 

more marked among men diagnosed with non-seminomas; 

5-year relative survival rate was 93% among white men 

diagnosed with non-seminomas compared to 75% among 

black men. The distribution of specific histologic types did 

not vary appreciably by race (results not shown).

Race and Stage 

Black men were more likely to be diagnosed with higher 

stage germ cell carcinomas compared to white men (Table 

21.6). For any given stage, the relative survival rate among 

black men was poorer than survival rate among white men 

(Table 21.7). The racial disparity was most pronounced 

among patients diagnosed in Stage III; 5-year relative 

survival rate among white men was 75% compared to 58% 

among black men. Black men had larger tumors, on average, than white men diagnosed at the same stage (results 

not shown). 

Discussion

Overall, the survival rates for patients diagnosed with 

testicular cancer during 1988-2001 was excellent, with 

95% surviving 10 years. Improvements in treatment, the 

most dramatic resulting from the introduction of cisplatincontaining combination chemotherapy in the 1970’s, have 

Table 21.3: Cancer of the Testis: Number and Distribution of Cases by Histology and AJCC Stage (SEER modified 5th Edition), 

Ages 20+, 12 SEER Areas, 1988-2001

Histology

AJCC Stage

Total I II III Unknown/ 

Unstaged

Cases Percent Cases

Row 

Percent Cases

Row 

Percent Cases

Row 

Percent Cases

Row 

Percent

Total 11,606 100.0 8,847 76.2 1,343 11.6 1,214 10.5 202 1.7

Germ Cell 11,480 100.0 8,781 76.5 1,340 11.7 1,175 10.2 184 1.6

 Seminomas 7,086 100.0 6,077 85.8 507 7.2 393 5.5 109 1.5

 Non-seminomas 4,394 100.0 2,704 61.5 833 19.0 782 17.8 75 1.7

 Embryonal 1,315 100.0 728 55.4 339 25.8 226 17.2 22 1.7

 Yolk Sac 126 100.0 72 57.1 18 14.3 34 27.0 <5 1.6

 Teratoma 203 100.0 145 71.4 27 13.3 24 11.8 7 3.4

 Mixed Germ Cell 2,692 100.0 1,747 64.9 449 16.7 455 16.9 41 1.5

 Choriocarcinoma 58 100.0 12 20.7 0 0.0 43 74.1 <5 5.2

Non-Germ Cell and 

Unspecified 126 100.0 66 52.4 <5 2.4 39 31.0 18 14.3
Chapter 21 Cancer of the Testis

National Cancer Institute 168 SEER Survival Monograph 

Figure 21.1: Cancer of the Testis: Relative Survival Rates (%) 

by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Figure 21.2: Cancer of the Testis: Relative Survival Rates (%) 

Histology and Age Group (20+), 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Seminomas Embryonal

Mixed Germ Cell Yolk Sac

Teratoma Choriocarcinoma

Non-Germ Cell & Unspecified

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Seminomas, 

20-49

Seminomas, 

50+

Non-seminomas, 

20-49

Non-seminomas, 

50+

Table 21.5: Stage I Germ Cell Carcinoma of the Testis: Number of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative 

Survival Rates (%) by Histology and Tumor Size, Ages 20+, 12 SEER Areas, 1988-2001

Relative Survival Rate (%)

Histology/Tumor Size Cases 1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Germ Cell 8,781 99.8 99.4 99.0 99.0 98.6 98.5

 < 5 cm 5,166 100.0 99.8 99.8 99.8 99.8 99.8

 5+ cm 2,321 99.6 98.8 97.9 97.6 96.8 96.4

 Unknown 1,294 99.3 98.4 97.3 97.0 96.0 95.5

Seminomas 6,077 100.0 99.7 99.5 99.5 99.4 99.4

 < 5 cm 3,497 100.0 100.0 100.0 100.0 100.0 100.0

 5+ cm 1,671 99.8 99.3 98.6 98.4 97.9 97.8

 Unknown 909 99.4 98.9 98.3 98.1 96.9 96.6

Non-seminomas 2,704 99.5 98.5 97.8 97.5 96.8 96.5

 < 5 cm 1,669 99.7 99.2 99.1 99.1 98.9 98.9

 5+ cm 650 99.1 97.6 96.0 95.3 93.0 92.4

 Unknown 385 98.8 97.3 95.0 94.0 93.7 92.5

Table 21.4: Germ Cell Carcinoma of the Testis: Number of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by 

AJCC Stage (SEER modified 5th Edition) and Histology, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage/Histology Cases

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 11,480 98.2 96.8 96.2 96.0 95.4 95.3

 Seminomas 7,086 99.0 98.4 98.1 98.0 97.7 97.7

 Non-seminomas 4,394 96.8 94.2 93.2 92.6 91.8 91.3

Stage I 8,781 99.8 99.4 99.0 99.0 98.6 98.5

 Seminomas 6,077 100.0 99.7 99.5 99.5 99.4 99.4

 Non-seminomas 2,704 99.5 98.5 97.8 97.5 96.8 96.5

Stage II 1,340 98.5 97.0 96.5 96.1 95.5 95.2

 Seminomas 507 98.4 96.8 96.3 95.9 95.1 95.1

 Non-seminomas 833 98.5 97.1 96.6 96.0 95.7 94.9

Stage III 1,175 85.8 78.1 75.3 74.0 71.5 71.1

 Seminomas 393 85.9 81.9 79.3 78.5 75.2 74.7

 Non-seminomas 782 85.7 76.2 73.3 71.7 69.7 68.7

Unknown/Unstaged 184 97.4 94.9 93.9 93.1 93.1 93.1

 Seminomas 109 96.5 94.0 93.2 93.2 93.2 93.2

 Non-seminomas 75 98.7 96.2 95.0 92.2 92.2 92.2
Chapter 21 Cancer of the Testis

National Cancer Institute 169 SEER Survival Monograph 

led to improved survival and declining mortality over 

the past 30 years (5).

Survival of patients with testicular cancer varied by the 

histologic type of the tumor, and differences in stage at 

diagnosis are likely to have contributed to this variation. 

Patients diagnosed with pure seminomas (predominantly 

diagnosed in Stage I) had the best survival; 10-year survival 

was 98%. Compared to those with seminomas, patients 

diagnosed with non-seminomas tended to be diagnosed 

with a more advanced stage of disease and had poorer 

survival, reflecting the more clinically aggressive nature 

of non-seminomas. Patients diagnosed with choriocarcinomas (largely diagnosed in Stage III) had the poorest 

survival. 

Among non-seminoma testicular cancer patients diagnosed 

at Stage I, tumor size was related to survival. Patients 

diagnosed with tumors smaller than 5 cm experienced 

better relative survival than those diagnosed with tumors 

that were 5 cm or larger. For Stage I non-seminomas, 

the five-year survival among those with smaller tumors 

(< 5 cm) was 99% compared to 95% for patients diagnosed 

with larger tumors ( 5+ cm).

The age at diagnosis of testicular cancer had an impact on 

survival, particularly among men diagnosed with non-seminomas. Men diagnosed with non-seminomas between the 

ages of 20 and 49 had a 5-year survival of 93%, compared 

to 79% for those aged 50 and above. Stage at diagnosis 

was similar between younger and older men and could 

not account for the difference in survival observed.

Testicular cancer survival also depended on the race of 

the patient, with black men experiencing poorer survival 

than white men. The differences in race-specific survival 

were partially explained by disease stage at diagnosis; 

compared to whites, a higher proportion of black men 

were diagnosed with advanced-stage disease. However, 

even when comparing men diagnosed at the same stage, 

survival was worse among black men compared to white 

men. The disparity in survival was particularly apparent 

among patients diagnosed with Stage III cancer; 5-year 

survival among men diagnosed with Stage III testicular 

cancer was 75% in white men compared to 58% in black 

men. The survival differential may be related to the larger 

average tumor size in black men, reflecting more advanced 

disease not captured in the 3-category staging classification that we used. Using these data, we were unable to 

explore the possible reasons for black men presenting 

with more advanced disease, nor whether this fully accounted for the survival differential between black and 

white testicular cancer patients.

Table 21.6: Germ Cell Carcinoma of the Testis: Number and 

Distribution of Cases by AJCC Stage (SEER modified 5th 

Edition) and Race, Ages 20+, 12 SEER Areas, 1988-2001

AJCC 

Stage

Race

Total White Black

Cases Percent Cases Percent Cases Percent

Total 11,480 100.0 10,711 100.0 250 100.0

Stage I 8,781 76.5 8,208 76.6 181 72.4

Stage II 1,340 11.7 1,253 11.7 30 12.0

Stage III 1,175 10.2 1,073 10.0 36 14.4

Unknown/

Unstaged 184 1.6 177 1.7 3 1.2

Table 21.7: Germ Cell Carcinoma of the Testis: Number of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by 

AJCC Stage (SEER modified 5th Edition) and Race, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage/Race

Relative Survival Rate (%)

Cases 1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Germ Cell 11,480 98.2 96.8 96.2 96.0 95.4 95.3

 White 10,711 98.4 97.0 96.4 96.2 95.7 95.6

 Black 250 95.8 93.5 90.2 89.7 89.7 89.7

Stage I 8,781 99.8 99.4 99.0 99.0 98.6 98.5

 White 8,208 99.8 99.4 99.1 99.0 98.7 98.6

 Black 181 99.3 99.1 95.6 95.6 95.6 95.6

Stage II 1,340 98.5 97.0 96.5 96.1 95.5 95.2

 White 1,253 98.8 97.4 96.9 96.6 96.1 95.6

 Black 30 97.1 93.8 90.3 86.1 86.1 86.1

Stage III 1,175 85.8 78.1 75.3 74.0 71.5 71.1

 White 1,073 86.5 79.0 76.1 74.9 72.8 72.2

 Black 36 75.5 63.7 60.6 57.5 54.2 54.2

Unknown/Unstaged 184 97.4 94.9 93.9 93.1 93.1 93.1

 White 177 97.3 94.7 93.6 92.7 92.7 92.7

 Black 3 ~ ~ ~ ~ ~ ~

 ~ Statistic not displayed due to less than 25 cases.
Chapter 21 Cancer of the Testis

National Cancer Institute 170 SEER Survival Monograph 

While survival of patients with testicular cancer is quite 

favorable in the 10 years following diagnosis, recent reports describe the occurrence of adverse health effects in 

long-term survivors more than 10 years after diagnosis. 

These include an increased risk of secondary malignant 

neoplasms (10) and cardiovascular events (11), some of 

which have been attributed to the radiation and chemotherapy treatments received by patients. Circulating levels 

of cisplatin may be detectable up to 20 years following 

treatment (12), for example. Given the early age of diagnosis and long life expectancy of most testicular cancer 

patients, consideration of these late effects is particularly 

important. Concern over long-term health effects, as well 

as more immediate quality-of-life issues (for instance, 

preservation of fertility) has led to the adoption of more 

conservative treatment regimens to minimize treatmentrelated morbidity. While in the past, patients with Stage 

I testis tumors routinely received additional treatment 

following orchiectomy, surgery followed by active surveillance alone is now a standard treatment option (13). 

Five-year survival rates for patients placed under active 

surveillance after orchiectomy as treatment for clinical 

Stage I seminomas appear to be comparable to those of 

patients treated with adjuvant radiation therapy (14-16). 

Similarly, 5-year survival does not appear to differ between patients undergoing retroperitoneal lymph node 

dissection (RPLND) and those entering a surveillance 

protocol after orchiectomy as treatment for clinical Stage 

I nonseminomatous testicular cancer (16,17).

In summary, testicular carcinoma remains one of the most 

highly curable malignant neoplasms. Additional research 

is needed to understand the reasons for the differences 

in the stage distribution of tumors according to race and 

the poorer survival of black patients and older patients, 

so that approaches to eliminating survival differences 

can be developed.

REFERENCES

1. American Cancer Society. Cancer Facts & Figures 2006. 2006.

2. Brown LM, Pottern LM, Hoover RN, Devesa SS, Aselton P, 

Flannery JT. Testicular cancer in the United States: trends in 

incidence and mortality. Int J Epidemiol 1986; 15:164-70.

3. Bergstrom R, Adami HO, Mohner M, Zatonski W, Storm H, 

Ekbom A, et al. Increase in testicular cancer incidence in six 

European countries: a birth cohort phenomenon. J Natl Cancer 

Inst 1996; 88:727-33.

4. Ries LAG, Kosary CL, Hankey BF, Miller BA, Clegg L, 

Edwards BK, eds. SEER Cancer Statistics Review, 1973-1999. 

Bethesda, MD: National Cancer Institute, 2002.

5. Einhorn LH. Curing metastatic testicular cancer. Proc Natl 

Acad Sci U S A 2002; 99:4592-5.

6. Schottenfeld D. Testicular cancer. In: Schottenfeld D, Fraumeni 

JF Jr., eds. Cancer Epidemiology and Prevention. New York: 

Oxford University Press, 1996: 1207-19.

7. Cotran RS, Kumar V, Collins T. Robbins Pathologic Basis of 

Disease. Philadelphia, PA: W.B. Saunders Company, 1999: 

1023.

8. Bosl GJ, Motzer RJ. Testicular germ-cell cancer [published 

erratum appears in N Engl J Med 1997 Nov 6;337(19):1403]. N 

Engl J Med 1997; 337:242-53.

9. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy 

BJ, Murphy GP, et al. Eds. AJCC Cancer Staging Manual. 5th 

edition. Philadelphia: Lippincott-Raven, 1997.

10. Travis LB, Curtis RE, Storm H, Hall P, Holowaty E, Van 

Leeuwen FE, et al. Risk of second malignant neoplasms among 

long-term survivors of testicular cancer. J Natl Cancer Inst 

1997; 89:1429-39.

11. Meinardi MT, Gietema JA, van der Graaf WT, van Veldhuisen 

DJ, Runne MA, Sluiter WJ, et al. Cardiovascular morbidity 

in long-term survivors of metastatic testicular cancer. J Clin 

Oncol 2000; 18:1725-32.

12. Gietema JA, Meinadi MT, Messerschmidt J, Gelevert T, Alt 

F, Uges DRA, et al. Citrlating plasma platinum more than 10 

years after cisplatin treatment for testicular cancer. Lancet 

2000; 355:1075-6.

13. National Cancer Institute. Physician Data Query(PDQ). 

(TM). Available at: http://www.nci.nih.gov/cancerinfo/pdq/. 

Updated August 14, 2002.

14. Warde P, Gospodarowicz MK, Banerjee D, Panzarella T, Sugar 

L, Catton CN, et al. Prognostic factors for relapse in stage I 

testicular seminoma treated with surveillance. J Urol 1997; 

157:1705-9; discussion 1709-10.

15. Gospodarwicz MK, Sturgeon JF, Jewett MA. Early stage and 

advanced seminoma: role of radiation therapy, surgery, and 

chemotherapy. Semin Oncol 1998; 25:160-73.

16. Francis R, Bower M, Brunstrom G, Holden L, Newlands ES, 

Rustin GJ, et al. Surveillance for stage I testicular germ cell 

tumours: results and cost benefit analysis of management 

options. Eur J Cancer 2000; 36:1925-32.

17. Spermon JR, Roeleveld TA, van der Poel HG, Hulsbergen-van 

de Kaa CA, Ten Bokkel Huinink WW, van de Vijver M, et al. 

Comparison of surveillance and retroperitoneal lymph node 

dissection in Stage I nonseminomatous germ cell tumors. 

Urology 2002; 59:923-9.

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Seminomas, 

Whites

Seminomas, 

Blacks

Non-seminomas, 

Whites

Non-seminomas, 

Blacks

Figure 21.3: Cancer of the Testis: Relative Survival Rates (%) 

by Histology and Race, Ages 20+, 12 SEER Areas, 1988-2001
National Cancer Institute 171 SEER Survival Monograph 

Introduction

This study provides survival analyses for 275,280 histologically confirmed adult cases of prostate cancer diagnosed 

from 1988 through 2001. Cases were obtained from the 

Surveillance, Epidemiology, and End Results (SEER) 

Program of the National Cancer Institute (NCI). The 

SEER Program -- a sequel to two earlier NCI initiatives, 

the End Results Program and the Third National Cancer 

Survey -- has evolved in response to the National Cancer 

Act of 1971, which requires the collection, analysis, and 

dissemination of data relevant to the prevention, diagnosis, and treatment of cancer. This study analyzes the 

influence of clinical extent of disease, histologic grade, 

age at diagnosis, race/ethnicity, SEER registry, and type 

of therapy on prostate cancer survival.

Materials and Methods

The NCI contracts with medically oriented nonprofit institutions -- such as universities and state health departments 

-- to obtain data on all cancers diagnosed in residents of 

the SEER geographic areas. SEER collects data on all 

invasive and in situ cancers except basal cell and squamous 

cell carcinomas of the skin and in situ carcinoma of the 

uterine cervix.

SEER selects participating institutions on the basis of two 

criteria: their ability to operate and maintain a populationbased cancer reporting system and the epidemiologic significance of their population subgroups. At times, registries will withdraw; at times, registries will be added. 

This analysis is based on data from 12 SEER geographic 

areas, which collectively contain about 14% of the total 

US population. The areas are the States of Connecticut, 

Iowa, New Mexico, Utah, and Hawaii; the metropolitan 

areas of Detroit, Atlanta, San Francisco, Seattle, San Jose, 

and Los Angeles; and 10 counties in rural Georgia. Los 

Angeles contributed data for diagnosis years 1992 to 2001, 

the others for 1988 to 2001

To ensure maximal ascertainment of cancer cases, each registry abstracts the records of all cancer patients in hospitals, 

laboratories, and all other health service units that provide 

diagnostic services. Data collected by SEER registries 

on each patient include patient demographics, primary 

tumor site, tumor morphology, diagnostic methods, extent 

of disease, and first course of cancer-directed therapy. 

A separate record is coded for each primary cancer. All 

patients are followed from diagnosis to death, allowing 

detailed survival analysis.

SEER has collected site-specific extent of disease (EOD) 

information on all cancers since the inception of the program in 1973. Major changes to EOD were made in 1988 

to be compatible with the American Joint Committee on 

Cancer (AJCC) Manual for Staging of Cancer, third edition (1). For prostate cancer, this meant that the extension 

information was based mainly on results from transurethral 

resection of the prostate (TURP) and clinical information. 

In 1994, the prostate EOD schema underwent a major 

rewrite to attempt to capture both clinical and pathologic 

assessment of the extension of the tumor to be compatible 

with the AJCC 4th edition (2). The 4th edition introduced 

“T1c, tumor identified by a needle biopsy (e.g., because 

of elevated PSA)” (2). Since the 1994 EOD extension 

codes were so complicated, it was decided to split the 

extension information into two fields: one a clinical assessment and the other a pathologic assessment based only 

on prostatectomy results beginning with cases diagnosed 

in 1995. In 1998, the AJCC published the 5th edition of 

the AJCC staging manual (3). Even though there were 

changes between the 4th and 5th editions, the SEER EOD 

schemas had enough detail to be converted to either the 

4th or 5th edition for cases diagnosed 1995 and forward. 

The prostate EOD codes can be translated to other staging schemes (AUS, AJCC) and a mapping for extension 

codes of the EOD is presented in Table 22.1. Therefore, 

for staging data comparable to AJCC 5th edition, the 

analyses was limited to only 1995-2001 but for tables/

figures which did not contain AJCC 5th edition stage, 

Ann Hamilton and Lynn A. Gloeckler Ries

Chapter 22

Cancer of the Prostate
Chapter 22 Cancer of the Prostate

National Cancer Institute 172 SEER Survival Monograph 

Table 22.1: SEER Prostate EOD codes for Clinical Stage, by Year of Diagnosis

SEER Description of Extent of Disease

Approximate 

correspondence to 

SEER EOD Codes used 

for cases diagnosed 

during:

AUS

AJCC T 

category, 5th 

ed.

1988-

93 1994 1995-2001

Local Disease

Clinically inapparent tumor not palpable by imaging; incidentally found 

microscopic carcinoma in one or both lobes

Number of foci or % of involved tumor not specified A, NOS T1x 10 10 10

< 3 microscopic foci A1 focal 11 11 11

> 3 microscopic foci A1 diffuse 12 12 12

Incidental histologic finding in 5% or less of tissue resected T1a -- 13 13

Incidental histologic finding in more than 5% of tissue resected. T1b -- 14 14

Tumor identified by needle bx, e.g. for elevated PSA T1c -- 15 15

Clinically/radiographically apparent

Involvement of one lobe, NOS B T2a 20 20,23 20

1⁄2 or less of one lobe involved B T2a 21,24 21

More than 1⁄2 of one lobe involved, not both lobes B T2b 22,26 22

More than one lobe involved B2

T2b ,

T2c (6th 25 25,28 23

edition)

Clinically apparent tumor confined to prostate, NOS B,NOS T2,NOS 27,29 24

Localized, Unknown if apparent or inapparent

Localized, NOS confined to prostate (not stated if clinically apparent or 

inapparent) A,B T1,T2 30 30,31 30

Into capsule/apex, but still localized

Into prostatic apex/ arising in apex 48,49 31,33

Extension into apex/arising elsewhere 34

Invasion into (but not beyond) prostatic capsule 40 40,41 32

Regional Disease

Extension to periprostatic tissue, extracapsular extension (beyond 

prostatic capsule) NOS, Through capsule, NOS C1 T3, NOS 50 50 41

Unilateral extracapsular extension T3a 50 51 42

Bilateral extracapsular extension T3b 50 52 43

Extraprostatic urethra 50 53 44

Extension to seminal vesicles C2 T3c 55 55 45

Periprostatic extension , NOS 56 56 49

Extension to or fixation to adjacent structures other than seminal 

vesicles T4, NOS 60 60 50

Extension to bladder neck T4a 61 51

Extension to rectum, external sphincter of rectum T4a 62 52

Distant Disease

Extension to levator muscles, skeletal muscle T4b 65 53

Extension to or fixation to pelvic wall or bone T4b 70 60

Extension to of fixation to other skeletal muscle 61

Further extension to bone, soft tissue, or other organs D2 80 70

Metastasis, NOS D2 85 85 85

Unknown if extension or metastasis 99 99 90
Chapter 22 Cancer of the Prostate

National Cancer Institute 173 SEER Survival Monograph 

the analyses used 1988-2001 data. For 1988-2001, the 

EOD data were converted to a more simplistic staging 

system of localized (confined to the prostate); regional 

(extension beyond the prostate by direct extension and/

or involvement of regional nodes), and distant disease 

(metastasis). A comparison of the three sets of EOD 

codes and stage is shown in Table 22.1.

Relative Survival

The survival analysis is based on relative survival rates 

calculated by the life-table method. The relative rate is 

used to estimate the effect of cancer on the survival of the 

cohort. Relative survival, defined as observed survival 

divided by expected survival, adjusts for the expected 

mortality that the cohort would experience from other 

causes of death. When the 5-year relative survival is 

100%, for example, a patient has the same chance to live 

5 more years as a cancer-free person of the same race, 

age and sex. 

Exclusions

The following cases were excluded from the analysis (as 

shown in Table 22.2): patients for whom prostate cancer 

was not the first primary, cases identified through autopsy 

or death certificate only, persons of unknown race, cases 

without active follow-up, patients less than 20 years old, 

in situ cases, cases without microscopic confirmation, 

and sarcomas. After the exclusions, there were 275,280 

prostate cases for analysis.

Results

Characteristics of Cases

During the 14-year period (1988-2001) during which these 

cases were diagnosed, 42% were aged 65-74 at diagnosis 

compared to 29% 20-64 and 29% aged 75 or over (Table 

22.3). Blacks had a higher proportion of cases in the 

youngest age group compared to whites. Eighty-eight 

percent of all cases were diagnosed with localized disease, 3% had regional disease, 4% had distant disease, 

and another 4% had unknown stage of disease. Blacks 

had a higher proportion with distant disease and unknown 

stage than did whites (Table 22.4). The majority of all 

cases (60%), had tumors that were graded as moderately 

differentiated (Gleason Score 5-7) (Table 22.3). 

Relative Survival by Stage of Disease

Stage of disease at diagnosis is a critical determinant of 

relative survival among prostate cancer cases. Among 

all cases, there is 100% relative survival rate at 1, 2, 3, 

4, and 5 years after diagnosis (Table 22.4). Blacks fared 

slightly worse than whites after 3 years from diagnosis. 

The distribution of cases by stage at diagnosis, will affect 

the overall group’s relative survival rate and blacks had 

a higher proportion of distant disease cases than whites 

(Table 22.3), which may contribute to their slightly lower 

survival. For localized disease, white males and black 

males had 100% survival through the first 5-years after 

diagnosis. A 100% relative survival rate does not mean 

that no men will die from prostate cancer but rather that 

they do not have excess mortality compared to comparably aged men of the same race. For regional disease, 

there is a 6 percentage point difference between whites 

(90%) and blacks (84%) at 5 years. Among those with 

distant disease, both groups did poorly, approximately 

35% survived 5-years (Table 22.4). Figure 22.1 shows 

the continuous relative survival curve by stage of disease 

by race over the years after diagnosis.

Relative survival by stage of disease is shown by age at 

diagnosis in Table 22.5. Men diagnosed under 65 years of 

age tended to have worse survival for distant disease, than 

did those diagnosed between 65 and 74 years of age. 

Table 22.2: Cancer of the Prostate: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number 

Excluded Reason for Exclusion/Selection

318,776 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

290,881 27,895 Select first primary only

288,213 2,668 Exclude death certificate only or at autopsy

282,703 5,510 Exclude unknown race

282,412 291 Exclude alive with no survival time

282,392 20 Exclude children (Ages 0-19)

282,219 173 Exclude in situ cancers for all except breast & bladder cancer

275,327 6,892 Exclude no or unknown microscopic confirmation

275,280 47 Exclude sarcomas
Chapter 22 Cancer of the Prostate

National Cancer Institute 174 SEER Survival Monograph 

Table 22.3: Cancer of the Prostate: Number and Distribution of Cases by Age (20+), Clinical Stage, Grade, and Geographic Area 

by Race, 12 SEER Areas, 1988-2001

Characteristics

Total

Race

White Black

Cases Percent Cases Percent Cases Percent

Total 275,280 100.0 227,239 100.0 33,010 100.0

 Age (Years)

 20-64 79,778 29.0 64,029 28.2 12,728 38.6

 65-74 116,555 42.3 96,869 42.6 13,157 39.9

 75+ 78,947 28.7 66,341 29.2 7,125 21.6

 Clinical Stage of Disease (1995-2001)

 All Stages 1995-2001 150,949 100.0 122,047 100.0 19,686 100.0

 All Localized Disease 133,163 88.2 108,522 88.9 16,802 85.3

 Clinically inapparent, detected by PSA (T1c) 44,371 29.4 35,781 29.3 6,008 30.5

 Other clinically inapparent 8,733 5.8 7,299 6.0 946 4.8

 Clinically apparent but confined to prostate 39,884 26.4 32,813 26.9 4,534 23.0

 Localized but unknown if apparent or 

 inapparent 17,187 11.4 14,753 12.1 1,939 9.8

 Into capsule/apex, but still localized 22,988 15.2 17,876 14.6 3,375 17.1

 Regional Disease 5,076 3.4 4,021 3.3 645 3.3

 Distant Disease 6,660 4.4 4,864 4.0 1,162 5.9

 Unknown Stage 6,050 4.0 4,640 3.8 1,077 5.5

 Grade

 Well differentiated; Grade I 34,012 12.4 28,932 12.7 3,276 9.9

 Moderately differentiated; Grade II 166,041 60.3 138,415 60.9 19,679 59.6

 Poorly differentiated; Grade III 57,270 20.8 45,481 20.0 7,368 22.3

 Undifferentiated; anaplastic; Grade IV 1,675 0.6 1,403 0.6 200 0.6

 Unknown Grade 16,282 5.9 13,008 5.7 2,487 7.5

 Geographic Area

 Atlanta and Rural Georgia 17,681 6.4 12,179 5.4 5,352 16.2

 Atlanta (Metropolitan) 16,855 6.1 11,703 5.2 5,004 15.2

 Rural Georgia 826 0.3 476 0.2 348 1.1

 California

 Los Angeles 45,893 16.7 34,930 15.4 7,624 23.1

 Greater Bay Area 44,628 16.2 36,158 15.9 4,418 13.4

 San Francisco-Oakland SMSA 30,417 11.0 23,517 10.3 3,984 12.1

 San Jose-Monterey 14,211 5.2 12,641 5.6 434 1.3

 Connecticut 30,029 10.9 27,542 12.1 2,294 6.9

 Detroit (Metropolitan) 42,550 15.5 30,917 13.6 11,401 34.5

 Hawaii 8,469 3.1 2,690 1.2 94 0.3

 Iowa 25,919 9.4 25,527 11.2 357 1.1

 New Mexico 13,002 4.7 12,436 5.5 241 0.7

 Seattle (Puget Sound) 32,812 11.9 30,764 13.5 1,151 3.5

 Utah 14,297 5.2 14,096 6.2 78 0.2

Total includes other races in addition to White and Black; Based on year of diagnosis and EOD code as shown in Table 22.1
Chapter 22 Cancer of the Prostate

National Cancer Institute 175 SEER Survival Monograph 

Relative Survival by Geographic Area

The SEER Registries contributing over 15% of the cases 

each included Detroit and Los Angeles (which included 

cases from 1992-2001), followed by Seattle, San Francisco-Oakland SMSA, Connecticut, and Iowa contributing 

between 10-12% each, and then by Atlanta, Utah, San 

Jose-Monterey, and New Mexico with 5-6% each. In 

addition, 3% of the cases were from Hawaii and 0.3% 

from rural Georgia. The black cases were largely from 4 

registries including Detroit, Los Angeles, Atlanta, and San 

Francisco-Oakland SMSA (Table 22.6). Table 22.6 shows 

relative survival by stage of disease by SEER Registry. 

Survival differences by geographic area were minimal 

within each stage group (Table 22.6).

Relative Survival by Tumor Grade

In addition to stage at diagnosis, tumor grade plays an 

important role in prostate cancer survival. Tumor grade 

reflects the cell differentiation and/or Gleason score. 

Grade I is well differentiated and/or Gleason scores of 

2-4; grade II is moderately differentiated and/or Gleason 

scores of 5-7; grade III is poorly differentiated and/or 

Gleason scores of 8-10; and grade IV is undifferentiated 

or anaplastic. Figure 22.2 shows the relative survival 

Table 22.4: Cancer of the Prostate: Number and Distribution of Cases and 1-, 2-, 3-, 4-, & 5-Year Relative Survival Rates (%) by 

Clinical Stage and Race, Ages 20+, 12 SEER Areas, 1995-2001

Race/Stage

Cases Percent Relative Survival Rate (%)

1-Year 2-Year 3-Year 4-Year 5-Year

All Races 150,949 100.0 100.0 100.0 100.0 100.0 100.0

 All Localized Disease 133,163 88.2 100.0 100.0 100.0 100.0 100.0

 Clinically inapparent, detected by PSA (T1c) 44,371 29.4 100.0 100.0 100.0 100.0 100.0

 Other clinically inapparent 8,733 5.8 99.9 99.9 99.7 98.2 97.9

 Clinically apparent by confined to prostate 39,884 26.4 100.0 100.0 100.0 100.0 100.0

 Local but unknown if apparent or inapparent 17,187 11.4 100.0 100.0 100.0 100.0 100.0

 Into capsule/apex, but still localized 22,988 15.2 100.0 100.0 100.0 100.0 100.0

 Regional Disease 5,076 3.4 99.8 96.9 94.4 91.7 88.7

 Distant Disease 6,660 4.4 81.7 61.5 50.1 42.5 36.5

 Unknown 6,050 4.0 97.5 94.3 91.9 90.0 87.1

White 122,047 100.0 100.0 100.0 100.0 100.0 100.0

 All Localized Disease 108,522 88.9 100.0 100.0 100.0 100.0 100.0

 Clinically inapparent, detected by PSA (T1c) 35,781 29.3 100.0 100.0 100.0 100.0 100.0

 Other clinically inapparent 7,299 6.0 100.0 100.0 99.8 98.4 98.0

 Clinically apparent by confined to prostate 32,813 26.9 100.0 100.0 100.0 100.0 100.0

 Local but unknown if apparent or inapparent 14,753 12.1 100.0 100.0 100.0 100.0 100.0

 Into capsule/apex, but still localized 17,876 14.6 100.0 100.0 100.0 100.0 100.0

 Regional Disease 4,021 3.3 99.9 97.0 94.8 92.3 89.6

 Distant Disease 4,864 4.0 81.2 61.1 49.6 42.2 35.5

 Unknown 4,640 3.8 97.7 95.1 93.0 91.5 88.4

Black 19,686 100.0 100.0 99.3 99.1 98.5 98.1

 All Localized Disease 16,802 85.3 100.0 100.0 100.0 100.0 100.0

 Clinically inapparent, detected by PSA (T1c) 6,008 30.5 100.0 100.0 100.0 100.0 100.0

 Other clinically inapparent 946 4.8 99.4 99.4 99.2 96.6 96.6

 Clinically apparent by confined to prostate 4,534 23.0 100.0 100.0 100.0 100.0 100.0

 Local but unknown if apparent or inapparent 1,939 9.8 100.0 100.0 100.0 100.0 100.0

 Into capsule/apex, but still localized 3,375 17.1 100.0 100.0 100.0 100.0 100.0

 Regional Disease 645 3.3 98.6 95.7 90.3 88.3 83.8

 Distant Disease 1,162 5.9 80.5 58.9 46.7 38.4 35.1

 Unknown 1,077 5.5 97.0 91.8 88.1 84.6 81.3
Chapter 22 Cancer of the Prostate

National Cancer Institute 176 SEER Survival Monograph 

by tumor grade for up to 10 years after diagnosis. There 

was 100% relative survival rate at 10 years for grade I 

(with Gleason scores of 2-4). Those with grade II tumors 

(Gleason scores 5-7) did well through 10 years with a 10 

year survival rate of 99%. (Note: the Grade II survival 

curve is on top of the Grade I curve in Figure 22.2). The 

largest declines in survival with increasing time after 

diagnosis are seen for those with poorly differentiated, 

undifferentiated, or unknown tumor grade. By 10 years 

after diagnosis, relative survival was 73% for those with 

unknown tumor grade, 69% for those with grade IV (Gleason scores of 8-10) and 50% for those with undifferentiated 

or anaplastic tumors.

Table 22.5: Cancer of the Prostate: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by 

Clinical Stage and Age (20+), 12 SEER Areas, 1988-2001

Stage/Age (Years)

Cases Percent Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Localized Disease 214,858 100.0 100.0 100.0 100.0 100.0 100.0 99.5

 20-64 66,381 30.9 100.0 100.0 100.0 100.0 100.0 100.0

 65-74 92,156 42.9 100.0 100.0 100.0 100.0 100.0 100.0

 75+ 56,321 26.2 100.0 100.0 100.0 100.0 100.0 98.2

Regional Disease 21,448 100.0 100.0 99.6 98.4 96.0 93.5 92.1

 20-64 6,107 28.5 100.0 98.8 97.3 93.5 89.1 86.8

 65-74 10,304 48.0 100.0 100.0 100.0 99.0 97.2 96.9

 75+ 5,037 23.5 99.5 97.3 94.9 91.7 88.4 85.8

Distant Disease 17,374 100.0 82.8 62.5 49.9 35.4 23.4 19.0

 20-64 3,623 20.9 85.4 62.0 47.7 31.9 20.4 16.6

 65-74 6,318 36.4 85.5 64.8 51.6 36.6 25.1 20.9

 75+ 7,433 42.8 79.1 60.6 49.5 36.8 24.7 20.4

Unknown 21,600 100.0 99.0 97.0 94.8 90.5 83.7 79.7

 20-64 3,667 17.0 98.8 96.1 93.5 89.5 84.8 81.4

 65-74 7,777 36.0 98.8 97.0 94.9 91.8 85.9 83.1

 75+ 10,156 47.0 99.2 97.4 95.4 90.0 81.3 76.0

Figure 22.1: Cancer of the Prostate: Relative Survival Rates 

(%) by Clinical Stage and Race, Ages 20+, 12 SEER Areas, 

1988-2001

Figure 22.2: Cancer of the Prostate: Relative Survival Rates 

(%) by Grade, Ages 20+, 12 SEER Areas, 1988-2001

90

100

70

80

%)

Loc-White

60

70

val Rate (

%

Loc-Black

Reg-White

Reg-Black

40

50

ive Surviv

Dis-White

Dis-Black

Unk-White

20

30

Relati

Unk-Black

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

%)

Grade I

60

70

val Rate (

%

Grade II

Grade III

40

50

ive Surviv

Grade III

Grade IV

Unknown

20

30

Relati

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 22 Cancer of the Prostate

National Cancer Institute 177 SEER Survival Monograph 

Table 22.6: Cancer of the Prostate: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival Rates (%) 

by Clinical Stage and SEER Geographic Area, Ages 20+, 12 SEER Areas, 1988-2001

Stage/Geographic Area

Cases Percent Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Stages 275,280 100.0 100.0 99.5 98.9 97.6 94.5 91.7

 Atlanta and Rural Georgia 17,681 6.4 99.7 99.0 98.1 96.5 93.1 90.2

 Atlanta (Metropolitan) 16,855 6.1 99.9 99.1 98.4 97.0 94.0 91.1

 Rural Georgia 826 0.3 97.0 95.9 91.8 86.4 72.9 68.6

 California

 Los Angeles 45,893 16.7 100.0 100.0 100.0 99.6 97.1 95.1

 Greater Bay Area 44,628 16.2 100.0 99.4 98.8 97.3 94.1 91.4

 San Francisco-Oakland SMSA 30,417 11.0 100.0 99.1 98.4 96.9 93.7 90.5

 San Jose-Monterey 14,211 5.2 100.0 100.0 99.6 98.2 95.0 93.2

 Connecticut 30,029 10.9 99.9 98.9 97.7 96.2 92.3 87.4

 Detroit (Metropolitan) 42,550 15.5 99.7 99.0 98.3 96.5 93.1 90.3

 Hawaii 8,469 3.1 99.4 98.1 96.7 94.8 89.9 85.4

 Iowa 25,919 9.4 99.9 99.0 97.9 95.6 92.0 88.7

 New Mexico 13,002 4.7 99.9 99.3 98.3 97.3 94.2 91.9

 Seattle (Puget Sound) 32,812 11.9 100.0 100.0 100.0 100.0 97.8 96.4

 Utah 14,297 5.2 100.0 100.0 100.0 99.4 98.9 97.7

Localized Disease 214,858 100.0 100.0 100.0 100.0 100.0 100.0 99.5

 Atlanta and Rural Georgia 13,057 6.1 100.0 100.0 100.0 100.0 100.0 98.2

 Atlanta (Metropolitan) 12,509 5.8 100.0 100.0 100.0 100.0 100.0 98.9

 Rural Georgia 548 0.3 99.8 99.8 98.9 95.4 84.6 79.7

 California

 Los Angeles 36,067 16.8 100.0 100.0 100.0 100.0 100.0 100.0

 Greater Bay Area 33,957 15.8 100.0 100.0 100.0 100.0 100.0 100.0

 San Francisco-Oakland SMSA 23,141 10.8 100.0 100.0 100.0 100.0 100.0 100.0

 San Jose-Monterey 10,816 5.0 100.0 100.0 100.0 100.0 100.0 100.0

 Connecticut 24,213 11.3 100.0 100.0 100.0 100.0 99.4 94.2

 Detroit (Metropolitan) 33,968 15.8 100.0 100.0 100.0 100.0 99.8 97.1

 Hawaii 6,599 3.1 100.0 100.0 100.0 100.0 98.0 93.9

 Iowa 19,204 8.9 100.0 100.0 100.0 100.0 100.0 97.2

 New Mexico 11,004 5.1 100.0 100.0 100.0 100.0 99.8 96.9

 Seattle (Puget Sound) 25,691 12.0 100.0 100.0 100.0 100.0 100.0 100.0

 Utah 11,098 5.2 100.0 100.0 100.0 100.0 100.0 100.0

Note: table continued on next page

Relative survival rates for blacks were lower than for whites 

for each tumor grade category, except for grade I where the 

differences were on the order of only 0.2% (Figure 22.3). 

(Note: The survival curves for grade I and II for whites 

and grade I for blacks were so similar that only the line for 

grade II for whites is visible in Figure 22.3).

Relative Survival by Stage of Disease and Tumor 

Grade

With both stage at diagnosis and tumor grade affecting relative survival, Figures 22.4-22.7 show relative survival rates 

for each of the four stages of disease (localized, regional, 

distant, and unknown) separately by tumor grade. For 

both localized and regional disease (Figures 22.4 and 22.5) 

there is little difference in relative survival rates between 

those with well differentiated (grade I) and moderately 

differentiated tumors (grade II). (Note: For Figures 22.4 

and 22.5, the survival curve for grade I is hidden by the 

survival curve for grade II). Those with poorly differentiated (grade III) and undifferentiated/anaplastic (grade IV) 

tumors showed marked declines in relative survival over 

time, with the latter group declining to 72% for those with 

localized disease and to 51% in those with regional disease 
Chapter 22 Cancer of the Prostate

National Cancer Institute 178 SEER Survival Monograph 

Table 22.6 (continued): Cancer of the Prostate: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival 

Rates (%) by Clinical Stage and SEER Geographic Area, Ages 20+, 12 SEER Areas, 1988-2001

Stage/Geographic Area

Cases Percent Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Regional Disease 21,448 100.0 100.0 99.6 98.4 96.0 93.5 92.1

 Atlanta and Rural Georgia 1,052 4.9 99.9 99.6 96.5 94.5 93.3 88.5

 Atlanta (Metropolitan) 1,004 4.7 99.7 99.4 96.5 94.4 93.1 88.5

 Rural Georgia 48 0.2 100.0 100.0 96.3 93.9 87.9 81.6

 California

 Los Angeles 3,316 15.5 100.0 99.8 99.3 98.8 97.1 97.1

 Greater Bay Area 4,537 21.2 100.0 99.8 99.2 96.6 94.3 92.3

 San Francisco-Oakland SMSA 3,182 14.8 100.0 99.8 99.0 96.8 93.6 90.5

 San Jose-Monterey 1,355 6.3 100.0 99.9 99.7 96.0 94.8 94.8

 Connecticut 1,587 7.4 99.4 97.3 96.2 92.7 89.8 86.5

 Detroit (Metropolitan) 2,307 10.8 99.4 97.8 94.4 91.5 88.8 87.6

 Hawaii 753 3.5 99.9 98.6 96.8 92.6 85.7 83.3

 Iowa 2,516 11.7 100.0 99.9 98.7 95.9 93.4 91.7

 New Mexico 918 4.3 100.0 100.0 98.9 96.0 94.7 94.6

 Seattle (Puget Sound) 3,244 15.1 100.0 100.0 100.0 97.0 92.9 91.6

 Utah 1,218 5.7 99.8 99.8 99.8 99.3 98.0 96.6

Distant Disease 17,374 100.0 82.8 62.5 49.9 35.4 23.4 19.0

 Atlanta and Rural Georgia 993 5.7 79.3 58.6 47.3 32.6 22.5 16.9

 Atlanta (Metropolitan) 914 5.3 80.1 59.2 47.7 33.7 23.4 18.2

 Rural Georgia 79 0.5 70.1 51.5 42.6 19.9 11.0 3.4

 California

 Los Angeles 2,619 15.1 82.7 63.2 52.6 38.6 25.6 20.0

 Greater Bay Area 3,314 19.1 84.5 63.4 49.2 36.0 23.5 19.4

 San Francisco-Oakland SMSA 2,345 13.5 84.1 63.2 48.8 35.7 23.2 18.2

 San Jose-Monterey 969 5.6 85.4 63.9 50.1 36.4 24.4 22.4

 Connecticut 1,930 11.1 81.1 60.4 46.5 32.0 20.3 16.8

 Detroit (Metropolitan) 2,489 14.3 76.1 56.0 45.7 32.2 21.6 17.6

 Hawaii 796 4.6 87.7 71.2 60.5 45.8 35.3 28.5

 Iowa 2,106 12.1 86.2 65.7 51.3 34.5 22.4 18.3

 New Mexico 721 4.1 81.0 60.3 47.6 31.6 16.6 11.8

 Seattle (Puget Sound) 1,620 9.3 86.9 65.5 51.1 35.7 21.8 17.6

 Utah 786 4.5 85.9 66.1 53.2 39.3 29.4 24.6

at 10 years after diagnosis. For those with distant disease 

(Figure 22.6), even those with grade I tumors had only a 

45% relative survival rate by 10 years after diagnosis while 

those with grade IV tumors experienced a relative survival 

rate of 3% at 10 years. Cases with unknown stage (Figure 

22.7) displayed a pattern that appeared to be intermediate 

between those with regional disease and distant disease. 

For unknown stage (Figure 22.7), those with grade I tumors 

did well, with a relative survival of 100% by 10 years, but 

those with grade II experienced a decline to 89% by 10 

years, unlike cases with comparable tumor grade who had 

regional disease. For unknown stage, the survival rates for 

grade III and grade IV were similar. While men with grade 

III regional disease had a relative survival rate of 51% at 

10 years, the comparable figure was 58% for those with 

unknown stage. The difference in relative survival for the 

grade IV was the most extreme between those diagnosed with 

localized disease and those with distant disease. Among the 

former, the relative survival was 72% at 10 years compared 

to 3% among the latter. Thus, the importance of diagnosing 

aggressive tumors at an early stage is critical.
Chapter 22 Cancer of the Prostate

National Cancer Institute 179 SEER Survival Monograph 

Relative Survival by Year of Diagnosis

During this time period there have been major changes in 

the treatment and diagnosis of prostate cancer, including the 

use of anti-androgens in the late 1980’s, the advent of PSA 

testing and screening beginning in 1986, and the increasing 

use of surgery to treat the disease (4). Figure 22.8 shows 

the dramatic improvement in survival that occurred from 

1988-89 to 1990-91 and then again from 1990-91 to 1992-93. 

Since that time survival has remained relatively constant at 

a very high level. (Note: the survival rates are so similar 

after 1996, that it is hard to distinguish the curves in Figures 

22.8 and 22.9). Similar trends are seen for whites (Figure 

22.9) and blacks (Figure 22.10), although improvement 

for blacks has continued to be seen from 1992-93, 1994-95 

and in 1996-97. This continuation of the survival increase 

for black men has had the result of putting their survival 

on par with those of white men. This is in contrast to the 

large survival gap that existed in 1988-89 when the 10-year 

relative survival rate for white men was 81% compared to 

only 62% for black men.

Discussion

Overall, relative survival for prostate cancer has continued 

to improve over time (5). In 1986, for example, 5- and 

10-year relative survival rates were 78% and 68%, respectively, whereas they hover near 100% at 5 years since 1994. 

Prognosis is excellent for those with early stage disease 

and especially for those with well differentiated (grade I) 

tumors. 

Many of the survival rates were 100% or close to 100%. 

The survival is being measured relative to the general population matched on race and age. These high rates do not 

mean that the men don’t have any deaths due to prostate 

Figure 22.3: Cancer of the Prostate: Relative Survival Rates 

(%) by Grade and Race, Ages 20+, 12 SEER Areas, 1988-2001

Figure 22.4: Localized Cancer of the Prostate: Relative 

Survival Rates (%) by Grade, Ages 20+, 12 SEER Areas, 1988-

2001

Figure 22.5: Regional Cancer of the Prostate: Relative 

Survival Rates (%) by Grade, Ages 20+, 12 SEER Areas, 1988-

2001

Figure 22.6: Distant Cancer of the Prostate: Relative 

Survival Rates (%) by Grade, Ages 20+, 12 SEER Areas, 1988-

2001

90

100

I - White

70

80

%)

I - Black

II - White

60

70

val Rate (

%

II - Black

III - White

III Bl k

40

50

ive Surviv

III - Black

IV - White

IV - Black

20

30

Relati

IV - Black

Unk - White

Unk - Black

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

%)

Grade I

60

70

val Rate (

%

Grade II

Grade III

40

50

ive Surviv

Grade III

Grade IV

Unknown

20

30

Relati

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

%)

Grade I

60

70

val Rate (

%

Grade II

Grade III

40

50

ive Surviv

Grade III

Grade IV

20

30

Relati

Unknown

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

%)

Grade I

60

70

val Rate (

%

Grade II

Grade III

40

50

ive Surviv

Grade III

Grade IV

Unknown

20

30

Relati

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 22 Cancer of the Prostate

National Cancer Institute 180 SEER Survival Monograph 

Figure 22.7: Cancer of the Prostate with Unknown Stage: 

Relative Survival Rates (%) by Grade, Ages 20+, 12 SEER 

Areas, 1988-2001

Figure 22.8: Cancer of the Prostate: Relative Survival Rates 

(%) for All Races by Year of Diagnosis, Ages 20+, 12 SEER 

Areas, 1988-2001

Figure 22.9: Cancer of the Prostate: Relative Survival Rates 

(%) for Whites by Year of Diagnosis, Ages 20+, 12 SEER 

Areas, 1988-2001

Figure 22.10: Cancer of the Prostate: Relative Survival Rates 

(%) for Blacks by Year of Diagnosis, Ages 20+, 12 SEER 

Areas, 1988-2001

cancer but rather when their cancer and non-cancer deaths 

are taken together, their survival profile was similar to 

the general population. They may be under more medical surveillance than the general population and therefore, 

have a better overall survival from non-cancer causes than 

the general population which offsets the excess prostate 

cancer mortality.

Survival for those diagnosed with distant disease and with 

poorly and undifferentiated tumors is poor, pointing to the 

benefit of earlier diagnosis. Even within stage, grade was 

an important prognostic factor. Relative survival is poorer 

for blacks than whites, even within stage and tumor grade 

categories. Since survival has continued to improve among 

blacks and there have only been slight additional incremental improvements in relative survival among whites, 

the survival gap between white men and black men has 

lessened considerably. 

REFERENCE

1. Beahrs, OH, Henson DE, Hutter RVP, Myers MH (eds). AJCC 

Cancer Staging Manual, Third edition. American Joint Committee 

on Cancer. Philadelphia: Lippincott, 1988. 

2. Beahrs, OH, Henson DE, Hutter RVP, Kennedy BJ (eds). 

AJCC Cancer Staging Manual, Fourth edition. American Joint 

Committee on Cancer. Philadelphia: Lippincott, 1992.

3. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy BJ, 

Murphy GP, O’Sullivan B, Sobin LH, Yarbro, JW (eds). AJCC 

Cancer Staging Manual, Fifth edition, American Joint Committee 

on Cancer. Philadelphia: Lippincott-Raven, 1998.

4. Hankey, BF, Feuer, EJ, Clegg, LX, Hayes, RB, Legler, JM, 

Prorok, PC, Ries, LA, Merrill, RM, and Kaplan, RS. Cancer 

surveillance series: Interpreting trends in prostate cancer Part 

I: Evidence of the effects of screening in recent prostate cancer 

incidence, mortality, and survival rates. JNCI 91:1017-24, 1999.

5. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer 

EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, 

Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

1975-2003, National Cancer Institute. Bethesda, MD.

90

100

70

80

%)

Grade I

60

70

val Rate (

%

Grade II

Grade III

40

50

ive Surviv

Grade III

Grade IV

U k

20

30

Relati

Unknown

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

%)

1988-89

60

70

val Rate (

%

1990-91

1992-93

1994-95

40

50

ive Surviv

1996-97

1998-99

2000 01

20

30

Relati

2000-01

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

%)

1988-89

60

70

val Rate (%

1990-91

1992-93

1994 95

40

50

ive Surviv

1994-95

1996-97

1998-99

20

30

Relati

2000-01

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

ate (%)

1988-89

1990 91

60

70

urvival Ra

1990-91

1992-93

1994-95

40

50

elative Su

1994-95

1996-97

1998-99

20

R

30 e

2000-01

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
National Cancer Institute 181 SEER Survival Monograph 

Introduction

Cancer of the urinary bladder most commonly originates 

in the urothelium, the epithelium that lines the bladder. 

During 2006, this is reported as the 4th most common 

incident cancer among males (estimated 44,690 new cases) 

and the 9th most common incident cancer among females 

(estimated 16,730 new cases) (1).

Racial and sex variation in the incidence and mortality 

for urinary bladder cancer has been observed previously 

using SEER data (2-4). Bladder cancer incidence is significantly higher in males than females, and in whites 

compared with blacks. However, the incidence in white 

females has been steadily increasing, while no significant 

changes have occurred in white males, black males, or 

black females (3).

In addition, average annual mortality rates for urinary bladder cancer are higher in white males compared with black 

males, white females, and black females (3,4). Secular 

trends in mortality rates have been decreasing for black 

males, black females, and white males and have been flat 

for white females (3).

Five-year relative survival rates are generally higher for 

males than females, regardless of stage of disease. Blacks 

diagnosed with bladder cancer have consistently lower 

survival than whites (5). Extent of disease at time of 

diagnosis has been found to be significantly greater for 

blacks than whites and helps to explain the lower survival 

that persists among blacks (6).

There are three major histologic types of urinary bladder cancer: transitional cell carcinoma, squamous cell 

carcinoma, and adenocarcinoma. Overwhelmingly, the 

most common type is transitional cell carcinoma. There 

are two common histologic subtypes of early, noninvasive 

transitional cell carcinoma, papillary and nonpapillary 

(flat), terms that describe both the gross and histologic 

appearances of these cancers (7). Nonpapillary (flat) carcinoma in situ lesions are by definition high-grade. Papillary 

lesions, which are also “in situ” though not specifically 

designated as such, can be low-grade or high-grade. High 

grade lesions are comprised of cells with large, irregular 

hyperchromatic nuclei that are present over the entire 

thickness of the epithelium, while low grade lesions are 

comprised of cells with nuclei that more closely resemble 

the nuclei seen in normal urothelial cells. High grade lesions are typically associated with more aggressive tumor 

behavior. 

Materials and Methods

The materials and methods are those provided in the introductory chapter with one noteworthy exception, the 

inclusion of in situ cancers. Since the 1985 Annual Cancer 

Statistics Review, the SEER Program has combined in 

situ and invasive bladder cancers when reporting incidence and survival rates, because of a perceived difficulty 

in identifying the presence or absence of superficial or 

early invasion in pathology reports (8). In great part this 

occurred because urologists and pathologists understood 

the term papillary transitional carcinoma to mean a noninvasive process unless invasion was specifically stated, 

in contrast to the conventional terminology understood for 

most sites (9). Incidence trends for this group of tumors 

were based on information obtained primarily from the 

hospital medical record, and were not subjected to secondary pathology review, and varied significantly from one 

SEER area to another (9). This practice of combining 

in situ and invasive bladder cancers has persisted to the 

present. Nevertheless, we will separate them in this report 

by including stage 0 cases (which include both Ta and Tis 

non-invasive cases) in the tables and discussion. 

The number of persons with cancers of the urinary bladder from this population for the period from 1988 to 2001 

is provided in Table 23.1, accompanied by the numbers 

and reasons for those excluded for this survival analysis. 

Charles F. Lynch, Jessica A. Davila, and Charles E. Platz

Chapter 23

Cancer of the Urinary Bladder
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 182 SEER Survival Monograph 

Survival by histology

Of the 67,528 cases, over 95% were diagnosed with 

transitional cell carcinoma (Table 23.4). Among transitional cell carcinomas, papillary neoplasms accounted 

for a much higher percentage (73.4%) than nonpapillary 

neoplasms (26.6%). The second most common histologic type was squamous cell carcinoma, diagnosed in 

only 1.4%. Adenocarcinoma accounted for only 1.2%. 

Small cell carcinoma and related neuroendocrine tumor 

histologic types were very rarely diagnosed, together accounting for only 0.2% of observed histologies. In the 

“other” histology category, malignant neoplasm (ICD-O 

M-8000) (112 cases), carcinoma, not otherwise specified 

(NOS) (ICD-O M-8010) (705 cases), and undifferentiated 

carcinoma (ICD-O M-8020) (39) accounted for 85% of 

all the 1,004 “other” cancers (Table 23.4).

90

100

e (%)

70

80

90

vival Rate

40

50

60

ative Surv

20

30

40

Rel

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

White Male White Female Black Male Black Female

Figure 23.1: Cancer of the Urinary Bladder: Relative Survival 

Rates (%) by Race and Sex, Ages 20+, 12 SEER Areas, 1988-

2001

Staging is based on American Joint Committee on Cancer 

Staging, Fifth Edition (10).

Results

All Bladder Cancers

Distribution and survival by age, sex, and race

Of the 67,528 adult bladder cancers, 79.3% were diagnosed 

at 60 years of age or older (Table 23.2). The greatest 

frequency occurred in the 70-79 age group, and 59.4% 

were between the ages of 60-79 years. Most were male 

and the overwhelming majority (> 90%) were white.

Overall, males had greater relative survival rates compared 

with females, while whites had greater relative survival 

rates than blacks. White males had the greatest 5-year 

relative survival rate (85%), followed in order by white 

females (77%), black males (69%), and black females 

(55%). The median survival times were 103 months for 

white males and 102 for white females compared with 67 

months for black males and 40 months for black females 

(Table 23.3, Figure 23.1). 

White males and females diagnosed between the ages of 

20 and 49 years had the greatest observed and relative 

survival percentages compared with blacks (Table 23.3). 

The median survival time was greater than 10 years for 

white males and females and black males and females. 

For persons over age 50, white males had the greatest 

observed and relative 5-year survival rate, while black 

females had the lowest. As anticipated, differences between observed and relative survival percentages were 

greatest in the 50+ age group.

Table 23.1: Cancer of the Urinary Bladder: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number 

Excluded Reason for Exclusion/Selection

86,187 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

69,302 16,885 Select first primary only

68,934 368 Exclude death certificate only or at autopsy

68,475 459 Exclude unknown race

68,409 66 Exclude alive with no survival time

68,344 65 Exclude children (Ages 0-19)

67,746 598 Exclude no or unknown microscopic confirmation

67,581 165 Exclude sarcomas

67,528 53 Exclude carcinoids
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 183 SEER Survival Monograph 

Table 23.3: Cancer of the Urinary Bladder: Number of 

Cases, Median Survival Time (Months) and 5-Year Survival 

Rates (%) by Race, Sex, and Age Group, Ages 20+, 12 SEER 

Areas, 1988-2001

Race, Sex, and Age 

Group (Years) Cases

Median 

Survival 

Time

(Months)

5-Year Survival 

Rate (%)

Obs Exp Rel

White Females, 

20-49 1,045 > 120 88.9 99.0 89.8

White Males, 20-49 3,396 > 120 89.4 97.9 91.2

Black Females, 

20-49 73 > 120 58.5 97.7 59.7

Black Males, 20-49 239 > 120 72.9 95.1 76.6

White Females, 50+ 14,251 93.0 60.3 79.1 76.2

White Males, 50+ 42,946 94.8 63.1 75.0 84.2

Black Females, 50+ 1,012 36.9 42.1 76.5 55.0

Black Males, 50+ 1,721 58.0 49.5 72.6 68.0

White Females, 20+ 15,296 101.7 62.2 80.4 77.3

White Males, 20+ 46,342 102.8 65.1 76.7 84.8

Black Females, 20+ 1,085 39.5 43.2 77.9 55.4

Black Males, 20+ 1,960 66.7 52.4 75.3 69.3

Table 23.2: Cancer of the Urinary Bladder: Number and Distribution of Cases by Age (20+), Race, and Sex, 12 SEER Areas, 

1988-2001

Age Group (Years)

Total

Race/Sex

White Black

Male Female Male Female

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 67,528 100.0 46,342 100.0 15,296 100.0 1,960 100.0 1,085 100.0

20-39 1,318 2.0 846 1.8 322 2.1 60 3.1 21 1.9

40-49 3,661 5.4 2,550 5.5 723 4.7 179 9.1 52 4.8

50-59 9,059 13.4 6,388 13.8 1,840 12.0 352 18.0 118 10.9

60-69 17,864 26.5 12,840 27.7 3,519 23.0 530 27.0 255 23.5

70-79 22,198 32.9 15,466 33.4 4,853 31.7 560 28.6 357 32.9

80+ 13,428 19.9 8,252 17.8 4,039 26.4 279 14.2 282 26.0

Table 23.4: Cancer of the Urinary Bladder: Number and 

Distribution of Cases by Histology, Ages 20+, 12 SEER Areas, 

1988-2001

ICD-O-3 Histology Cases Pct

Total 67,528 100.0

Papillary transitional cell carcinoma 47,399 70.2

 Papillary carcinoma, NOS (8050) 610 0.9

 Papillary trans. cell carcinoma ( 8130) 46,779 69.3

 Other Pap. Trans. (8121,8131) 10 0.0

Nonpapillary transitional cell carcinoma 17,211 25.5

 Transitional cell carcinoma, NOS (8120) 17,167 25.4

 Trans. cell carcinoma, spindle cell ( 8122) 44 0.1

Squamous cell carcinoma 918 1.4

 Squamous cell carcinoma, NOS (8070) 697 1.0

 Sq. cell carcinoma, keratinizing, NOS (8071) 193 0.3

 Other Sq. Cell (8051-8052,8072,8074,8076) 28 0.0

Adenocarcinoma 838 1.2

 Adenocarcinoma, NOS ( 8140) 480 0.7

 Mucinous adenocarcinoma (8480) 89 0.1

 Mucin-producing adenocarcinoma (8481) 80 0.1

 Signet ring cell carcinoma (8490) 94 0.1

 Other Adeno (8141,8144,8255,8260,8310,

 8320,8323,8440,8470,8472,8570) 95 0.1

Small cell carcinoma and related 

neuroendocrine tumors (8041-8042) 158 0.2

Other 1,004 1.5

 Neoplasm, malignant (8000) 112 0.2

 Carcinoma, NOS (8010) 705 1.0

 Carcinoma, undifferentiated type, NOS

 (8020) 39 0.1

 Other (8001-8002,8004,8012,8021-8022,

 8030,8032-8033,8044,8046,8082-8083, 

 8230,8262,8560,8700,8720,8933,8935,8940,

 8950-8951,9064,9100,9364)

148 0.2
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 184 SEER Survival Monograph 

Table 23.6: Cancer of the Urinary Bladder: Number and 

Distribution of Cases, Median Survival Time (Months) and 

5-Year Survival Rates (%) by AJCC Stage (5th Edition), 12 

SEER Areas, 1988-2001

AJCC 

Stage (5th 

Edition) Cases Percent

Median 

Survival 

Time

(Months)

5-Year Relative 

Survival Rate 

(%)

Obs Exp Rel

Total 67,528 100.0 101.1 63.7 77.8 81.9

Stage 0 29,638 43.9 > 120 78.0 79.3 98.4

Stage I 8,611 12.8 108.3 68.1 77.7 87.7

Stage II 4,541 6.7 54.6 47.7 76.2 62.6

Stage III 2,496 3.7 28.3 35.8 78.7 45.5

Stage IV 3,775 5.6 9.7 11.8 79.9 14.8

Unknown 18,467 27.3 80.6 57.4 75.3 76.3

Five-year observed and relative survival rates and median 

survival time were greatest for papillary transitional cell 

carcinoma compared with other histologic types (Table 

23.5). Squamous cell carcinoma had the lowest median 

survival time, of 9.5 months.

Survival by stage

Observed and relative 5-year survival rates decreased 

through the progression of urinary bladder cancer to later 

stages (Table 23.6). Median survival times were greater 

than 10 years for stage 0 but less than 5 years for all other 

stages except stage I. Patients with unknown stage of 

disease had observed and relative 5-year survival rates 

and a median survival time that was higher than all other 

stages, except stages 0 and I. This finding suggests that 

a substantial proportion of patients with unknown stage 

had in situ (stage 0) or superficially invasive (stage I) 

disease.

Transitional Cell Carcinoma

Survival by histology, age, sex, and race

Of those diagnosed with transitional cell carcinoma, the 

male to female ratio for whites was 3.2:1 and for blacks 

was 2.3:1. Seventy-eight percent of the cases occurred 

after 60 years and older (Table 23.7). Persons in the 

60-79 age groups alone accounted for 59% of all these 

cancers. The greatest percent of 60-79 year olds occurred 

in white males (69.3%). The 20-59 age group accounted 

for 22.1% of all papillary transitional cell carcinomas, 

but only 17.1% of the nonpapillary transitional cell carcinomas. Black males and females accounted for 6.0% 

of all nonpapillary transitional cell carcinomas, but only 

3.6% of papillary transitional cell carcinomas.

90

100

70

80

e (%)

Papillary 

White Male

Papillary

60

70

vival Rate

p y

White Female

Papillary 

Black Male

Papillary

40

50

ative Surv

Black Female

Nonpapillary 

White Male

Nonpapillary

20

Rel

30 White Female

Nonpapillary 

Black Male

Nonpapillary

0

10 Black Female

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 23.2: Transitional Cell Carcinoma of the Urinary 

Bladder: Relative Survival Rates (%) by Histology, Race and 

Sex, Ages 20+, 12 SEER Areas, 1988-2001

Table 23.5: Cancer of the Urinary Bladder: Number and Distribution of Cases, Median Survival Time (Months) and 5-Year 

Survival Rates (%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology Cases Percent

Median 

Survival 

Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

Total 67,528 100.0 101.1 63.7 77.8 81.9

Papillary transitional cell carcinoma 47,399 70.2 > 120 71.8 78.5 91.5

Nonpapillary transitional cell carcinoma 17,211 25.5 50.3 46.6 76.1 61.2

Squamous cell carcinoma 918 1.4 9.5 23.7 76.7 30.9

Adenocarcinoma 838 1.2 31.3 34.5 79.7 43.3

Small cell carcinoma and related 

neuroendocrine tumors 158 0.2 13.3 21.8 77.9 26.2
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 185 SEER Survival Monograph 

Table 23.7: Transitional Cell Carcinoma of the Urinary Bladder: Number and Distribution of Cases by Histology, Age 

(20+), Race and Sex, 12 SEER Areas, 1988-2001

Histology

Age 

Group 

(Years)

Total

Race/Sex

White Black

Male Female Male Female

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Papillary

Total 47,399 100.0 33,465 100.0 10,427 100.0 1,188 100.0 527 100.0

20-39 1,071 2.3 711 2.1 262 2.5 39 3.3 11 2.1

40-49 2,754 5.8 2,001 6.0 533 5.1 103 8.7 19 3.6

50-59 6,648 14.0 4,753 14.2 1,363 13.1 217 18.3 65 12.3

60-69 12,708 26.8 9,355 28.0 2,461 23.6 321 27.0 122 23.1

70-79 15,466 32.6 11,043 33.0 3,285 31.5 347 29.2 178 33.8

80+ 8,752 18.5 5,602 16.7 2,523 24.2 161 13.6 132 25.0

Nonpapillary

Total 17,211 100.0 11,320 100.0 3,940 100.0 604 100.0 423 100.0

20-39 177 1.0 100 0.9 45 1.1 13 2.2 6 1.4

40-49 715 4.2 460 4.1 134 3.4 52 8.6 23 5.4

50-59 2,055 11.9 1,434 12.7 389 9.9 102 16.9 36 8.5

60-69 4,456 25.9 3,086 27.3 863 21.9 166 27.5 95 22.5

70-79 5,851 34.0 3,929 34.7 1,291 32.8 173 28.6 153 36.2

80+ 3,957 23.0 2,311 20.4 1,218 30.9 98 16.2 110 26.0

For papillary transitional cell carcinoma, relative survival 

rates for both males and females were higher for white 

than black adults (Figure 23.2). Between the ages of 20 

and 49 years, white males and females had the highest 

five-year relative survival rates (Table 23.8). In this age 

range, median survival times were greater than 10 years 

for males and females and both races. For persons 50 

and older, white males had the highest 5-year relative 

survival rate of 92%, while black females had the lowest percentage (76%). The median survival times were 

higher for whites than blacks in both sexes. 

For nonpapillary transitional cell carcinoma, relative survival rates were highest for white males, followed by white 

females and black males with black females having the 

lowest rates (Figure 23.2). Between the ages of 20 and 49 

years, whites had the highest five-year relative survival 

rates (Table 23.8). Black females in this age group had 

a very low median survival time of 33 months, but this 

should be interpreted with caution since there were only 

29 cases. For persons 50 and older, white males had the 

highest 5-year relative survival rate of 65%, while black 

females had the lowest rate (38%). For ages 20+, the 

median survival times were higher for whites than blacks 

in both sexes and were three times as long in white males 

than black females. 

Survival rates in adults were substantially higher in both 

races and sexes for papillary transitional cell carcinoma 

compared with nonpapillary transitional cell carcinoma. 

This was especially true for the 50+ age group. 

Survival by histology, stage, and grade

For papillary transitional cell carcinoma in each race and 

sex group, the greatest number of cases was diagnosed 

at stage 0 and accounted for 57% among white females, 

56% among white males, 46% among black males, and 

44% among black females (Table 23.9). The percentage 

of stage IV papillary transitional cell carcinomas was highest among black females (5.1%) followed by black males 

(2.4%), white females (2.1%), and white males (1.5%). 

Blacks and whites with stage 0 disease had median survival 

times greater than 10 years. However, for stage I disease, 

the median survival time for black males and females was 

lower than for whites. For stages II, III, and IV, median 

survival times were higher among males compared with 

females in each race group (Table 23.9). 

Relative survival curves for papillary transitional cell carcinoma by stage and sex were generally higher in whites 

than blacks. This was particularly so for stage III and stage 

IV (Figures 23.3 (males) and 23.4 (females)). In Figure 

23.4, the survival curve for stage III black females is not 

shown due to insufficient case numbers.

For nonpapillary transitional cell carcinoma in each race 

and sex group, the greatest number of cases was diagnosed 
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 186 SEER Survival Monograph 

Table 23.9: Papillary Transitional Cell Carcinoma of the Urinary Bladder: Number and Distribution of Cases and Median 

Survival Time (Months) by AJCC Stage (5th Edition), Race, and Sex, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage 

(5th Edition)

Race/Sex

White Black

Male Female Male Female

Cases Percent

Median 

Survival 

Time

(Months) Cases Percent 

Median 

Survival 

Time

(Months) Cases Percent

Median 

Survival 

Time

(Months) Cases Percent

Median 

Survival 

Time

(Months)

Total 33,465 100.0 > 120 10,427 100.0 > 120 1,188 100.0 102.4 527 100.0 88.6

Stage 0 18,628 55.7 > 120 5,997 57.5 > 120 551 46.4 > 120 233 44.2 > 120

Stage I 4,655 13.9 112.8 1,322 12.7 110.4 186 15.7 90.3 79 15.0 94.6

Stage II 1,174 3.5 65.2 371 3.6 58.9 60 5.1 67.6 40 7.6 33.3

Stage III 502 1.5 34.5 93 0.9 22.3 36 3.0 14.8 10 1.9 ~

Stage IV 514 1.5 14.0 223 2.1 10.6 28 2.4 14.0 27 5.1 9.2

Unknown 7,992 23.9 105.1 2,421 23.2 114.1 327 27.5 81.5 138 26.2 78.5

 ~ Statistic not displayed due to less than 25 cases.

Table 23.8: Transitional Cell Carcinoma of the Urinary Bladder: Number of Cases, Median Survival Time (Months) and 5-Year 

Survival Rates (%) by Histology, Race, Sex, and Age (20+), 12 SEER Areas, 1988-2001

Histology Race, Sex, and Age Group (Years) Cases

Median 

Survival 

Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

Papillary

All 47,399 > 120 71.8 78.5 91.5

White Females, 20-49 795 > 120 97.0 99.0 98.0

White Males, 20-49 2,712 > 120 94.7 98.0 96.7

Black Females, 20-49 30 > 120 88.7 97.9 90.2

Black Males, 20-49 142 > 120 85.7 95.1 89.4

White Females, 50+ 9,632 > 120 71.2 80.0 89.0

White Males, 50+ 30,753 111.7 69.7 75.5 92.3

Black Females, 50+ 497 85.2 58.5 77.1 75.5

Black Males, 50+ 1,046 87.0 61.0 72.9 83.4

White Females, 20+ 10,427 > 120 73.2 81.5 89.8

White Males, 20+ 33,465 > 120 71.7 77.3 92.7

Black Females, 20+ 527 88.6 60.2 78.3 76.6

Black Males, 20+ 1,188 102.4 63.9 75.6 84.2

Nonpapillary

All 17,211 50.3 46.6 76.1 61.2

White Females, 20-49 179 > 120 69.7 98.9 70.4

White Males, 20-49 560 > 120 72.5 97.8 74.1

Black Females, 20-49 29 32.9 43.3 97.5 44.2

Black Males, 20-49 65 > 120 55.9 95.0 58.5

White Females, 50+ 3,761 32.6 39.8 77.2 51.5

White Males, 50+ 10,760 54.3 47.9 73.8 64.9

Black Females, 50+ 394 17.8 29.1 76.2 38.2

Black Males, 50+ 539 27.0 34.6 71.7 47.7

White Females, 20+ 3,940 34.7 41.1 78.2 52.6

White Males, 20+ 11,320 57.2 49.1 75.0 65.4

Black Females, 20+ 423 19.0 30.1 77.6 38.7

Black Males, 20+ 604 29.2 37.0 74.2 49.3
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 187 SEER Survival Monograph 

90

100

70

80

(%)

White, Stage 0

60

70

ival Rate 

, g

White, Stage I

White, Stage II

White, Stage III

White Stage IV

40

50

tive Survi

White, Stage IV

Black, Stage 0

Black, Stage I

Black, Stage II

20

30

Relat

, g

Black, Stage III

Black, Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 23.3: Male Papillary Transitional Cell Carcinoma of the 

Urinary Bladder: Relative Survival Rates (%) by AJCC Stage 

(5th Edition) and Race, Ages 20+, 12 SEER Areas, 1988-2001

90

100

70

80

(%)

White, Stage 0

60

70

ival Rate 

White, Stage I

White, Stage II

White, Stage III

Whi S IV

40

50

tive Surv

White, Stage IV

Black, Stage 0

Black, Stage I

Black Stage II

20

30

Rela

Black, Stage II

Black, Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 23.4: Female Papillary Transitional Cell Carcinoma 

of the Urinary Bladder: Relative Survival Rates (%) by AJCC 

Stage (5th Edition) and Race, Ages 20+, 12 SEER Areas, 1988-

2001

Table 23.10: Nonpapillary Transitional Cell Carcinoma of the Urinary Bladder: Number and Distribution of Cases and Median 

Survival Time (Months) by AJCC Stage (5th edition), Race, and Sex, Ages 20+, 12 SEER Areas, 1988-2001

AJCC 

Stage (5th 

Edition)

Race/Sex

White Black

Male Female Male Female

Cases Percent

Median 

Survival 

Time

(Months) Cases Percent 

Median 

Survival 

Time

(Months) Cases Percent

Median 

Survival 

Time

(Months) Cases Percent

Median 

Survival 

Time

(Months)

Total 11,320 100.0 57.2 3,940 100.0 34.7 604 100.0 29.2 423 100.0 19.0

Stage 0 2,138 18.9 > 120 540 13.7 > 120 74 12.3 > 120 34 8.0 76.3

Stage I 1,303 11.5 93.1 385 9.8 85.6 54 8.9 96.9 45 10.6 57.0

Stage II 1,606 14.2 53.3 620 15.7 40.0 80 13.2 32.8 66 15.6 23.5

Stage III 988 8.7 28.2 319 8.1 23.4 53 8.8 18.9 37 8.7 11.1

Stage IV 1,303 11.5 10.6 642 16.3 8.6 101 16.7 7.4 92 21.7 8.0

Unknown 3,982 35.2 54.1 1,434 36.4 28.5 242 40.1 35.6 149 35.2 20.1

as unstaged. Among those with known stage, the greatest 

number was stage IV for white females, black males, and 

black females and stage 0 for white males (Table 23.10). 

Stage I accounted for approximately 10% of all cancers 

in each race and sex group (Table 23.10). The percentage of stage IV nonpapillary transitional cell carcinomas 

was highest among black females (21.7%) compared with 

black males (16.7%), white females (16.3%) or white males 

(11.5%). Median survival times were higher among males 

compared with females in each race group, except for stage 

0 in whites where they were both >10 years and stage IV 

for blacks (Table 23.10). 

Relative survival curves for nonpapillary transitional cell 

carcinoma by stage and sex were also higher for whites 

than blacks in each sex (Figures 23.5 (males) and 23.6 

(females)). Among males at each stage, white males had 

better survival than black males (Figure 23.5). The rates 

for black females were lower than those for white females 

except for stage IV after 7 years (Figure 23.6). Note, that 

the rates for blacks are based on small numbers of cases 

and therefore, have more variability.

Among males at each stage, the papillary subtype had better relative survival rate than the nonpapillary subtype in 

each race; however, in females this was less apparent for 

stage II disease and higher. 

When histologic subtypes of transitional cell carcinoma 

were stratified by tumor grade, 5-year relative survival 
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 188 SEER Survival Monograph 

90

100

e (%)

Stage 0 Papillary, 

Grade I & II

70

80

vival Rate

Stage 0 Papillary, 

Grade III & IV

Stage I Papillary

60

70

ative Surv

Stage I Papillary, 

Grade I & II

Stage I Papillary, 

Grade III & IV

40

50

Rela

Grade III & IV

Stage 0 

Nonpapillary, 

Grade I & II

20

30

Grade I & II Stage 0 

Nonpapillary, 

Grade III & IV

Stage I Nonpapillary,

0

10

Stage I Nonpapillary,

Grade I & II

Stage I Nonpapillary, 

Grade III & IV 0

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Grade III & IV

Figure 23.7: Early Stage Transitional Cell Carcinoma of the 

Urinary Bladder: Relative Survival Rates (%) by AJCC Stage 0 

and I, Histology, and Grade, Ages 20+, 12 SEER Areas, 1988-

2001

90

100

70

80

(%)

White, Stage 0

60

70

ival Rate 

, g

White, Stage I

White, Stage II

White, Stage III

White Stage IV

40

50

tive Surv

White, Stage IV

Black, Stage 0

Black, Stage I

Black, Stage II

S

20

30

Rela

Black, tage III

Black, Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 23.5: Male Nonpapillary Transitional Cell Carcinoma 

of the Urinary Bladder: Relative Survival Rates (%) by AJCC 

Stage (5th Edition) and Race, Ages 20+, 12 SEER Areas, 1988-

2001

Figure 23.6: Female Nonpapillary Transitional Cell Carcinoma 

of the Urinary Bladder: Relative Survival Rates (%) by AJCC 

Stage (5th Edition) and Race, Ages 20+, 12 SEER Areas, 1988-

2001

rates were higher for papillary carcinomas than nonpapillary at each stage and grade (Table 23.11). In general 

for each histologic subtype within each stage, survival 

decreased as tumor grade increased except grade IV where 

survival was similar to grade III and sometimes slightly 

higher by stage.

When early stage transitional cell carcinomas were separated into papillary and nonpapillary histologic subtypes 

by tumor grade, 5-year relative survival rates were lower 

among the high-grade nonpapillary carcinomas for each 

race and sex group (Table 23.12). Although these highgrade nonpapillary carcinomas comprised a small proportion of very early transitional cell carcinomas in whites, 

they comprised a higher percentage for black males and 

black females which contributed to the lower survival rates 

seen in Figures 23.3 through 23.6 for blacks compared 

with whites at early stages. 

Survival curves for early stage transitional cell carcinoma 

showed all stage 0 and stage I and low grade, papillary, 

lesions with 10-year relative survival rates above 85%. In 

contrast, high grade, nonpapillary, stage I lesions had a 10-

year relative survival rate of only 67% (Figure 23.7). 

Squamous Cell Carcinoma

Survival by age, sex, and race

Over 80% of the squamous cell carcinomas were diagnosed in persons at least 60 years of age or older (Table 

23.13). The male to female ratio for all races was 1.1:1 

for whites and 1.0:1 for blacks. White females had the 

highest proportion of 80+ year olds (32.1%).

Relative survival curves were similar for males and females (Figure 23.8). A significant decline in survival was 

observed within the first 12 months after diagnosis.

Survival by stage

The stage distribution for squamous cell carcinoma was 

similar for males and females (Table 23.14). For stage 

0/I disease, males had a much higher median survival 

time than females. For females, stage 0/I had low median survival time but it was based on a small number 

of cases. Overall, median survival times were relatively 

low for squamous cell stages II-IV compared with other 

histologies. 

90

100

70

80

te (%)

White, Stage 0

Whit St I

60

70

rvival Rat

White, Stage I

White, Stage II

White, Stage III

White Stage IV

40

50

elative Sur

White, Stage IV

Black, Stage 0

Black, Stage I

Black, Stage II

20

R

30 e

Black, Stage III

Black, Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 189 SEER Survival Monograph 

Table 23.11: Transitional Cell Carcinoma of the Urinary Bladder: Number of Cases and 5-Year Relative Survival Rates (RSR) 

(%) of White and Blacks by Histology, AJCC Stage (5th Edition) and Tumor Grade, Ages 20+, 12 SEER Areas, 1988-2001

Histology

AJCC 

Stage (5th 

Edition)

Tumor Grade

Total I II III IV Unknown

Cases

5-Yr 

RSR 

(%) Cases

5-Yr 

RSR 

(%) Cases

5-Yr 

RSR 

(%) Cases

5-Yr 

RSR 

(%) Cases

5-Yr 

RSR 

(%) Cases

5-Yr 

RSR 

(%)

Papillary

Total 45,607 91.6 9,553 99.3 21,410 95.5 10,329 79.0 2,437 71.6 1,878 93.5

Stage 0 25,409 99.1 7,036 100.0 13,500 98.7 3,249 95.9 535 91.5 1,089 98.7

Stage I 6,242 90.0 757 96.2 2,737 92.2 2,101 84.7 464 84.0 183 94.9

Stage II 1,645 66.5 25 81.2 318 72.1 916 63.2 357 67.5 29 61.0

Stage III 641 49.1 10 ~ 122 57.6 348 43.1 149 49.2 12 ~

Stage IV 792 21.1 13 ~ 116 24.0 452 19.6 193 22.8 18 ~

Unknown 10,878 86.9 1,712 95.2 4,617 92.7 3,263 76.0 739 70.2 547 85.9

Nonpapillary

Total 16,287 60.9 970 95.1 2,589 83.4 7,245 49.6 3,367 48.0 2,116 74.8

Stage 0 2,786 93.9 526 97.5 820 94.5 344 92.3 131 90.6 965 90.1

Stage I 1,787 80.9 129 91.9 485 87.4 766 74.8 295 75.8 112 82.6

Stage II 2,372 61.1 11 ~ 161 68.0 1,404 59.7 744 61.7 52 68.0

Stage III 1,397 43.8 7 ~ 78 45.4 840 40.9 433 50.1 39 35.2

Stage IV 2,138 13.7 7 ~ 89 16.3 1,218 12.7 698 16.4 126 7.3

Unknown 5,807 60.8 290 92.2 956 83.3 2,673 51.9 1,066 45.4 822 67.9

 ~ Statistic not displayed due to less than 25 cases.

Table 23.12: Stage 0 & I Transitional Cell Carcinoma of the Urinary Bladder (with Known Grade): Number of Cases and 5-Year 

Relative Survival Rates (%) by Race, Sex, Histology, and Grade, Ages 20+, 12 SEER Areas, 1988-2001

Race/Sex

Histology

Papillary Nonpapillary

Grade Grade

Low-Grade (I & II) High-Grade (III & IV) Low-Grade (I & II) High-Grade (III & IV)

Cases

5-Year 

Relative 

Survival 

Rate (%)

Cases

5-Year 

Relative 

Survival 

Rate (%)

Cases

5-Year 

Relative 

Survival 

Rate (%)

Cases

5-Year 

Relative 

Survival 

Rate (%)

Total (White & Black) 24,030 98.6 6,349 91.1 1,960 93.9 1,536 81.2

White Male 17,472 99.5 4,870 93.3 1,452 94.2 1,153 83.7

White Female 5,774 96.9 1,256 83.7 440 92.9 300 74.3

Black Male 555 92.8 155 88.8 43 87.5 47 76.4

Black Female 229 92.4 68 74.8 25 72.8 36 56.9

Table 23.13: Squamous Cell Carcinoma of the Urinary Bladder: Number and Distribution of Cases by Age (20+), Race, and Sex, 

12 SEER Areas, 1988-2001

Age Group (Years)

Total

Race/Sex

White Black

Male Female Male Female

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 918 100.0 398 100.0 377 100.0 56 100.0 55 100.0

20-59 176 19.2 83 20.9 55 14.6 17 30.4 11 20.0

60-69 220 24.0 92 23.1 85 22.5 14 25.0 19 34.5

70-79 278 30.3 127 31.9 116 30.8 16 28.6 10 18.2

80+ 244 26.6 96 24.1 121 32.1 9 16.1 15 27.3
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 190 SEER Survival Monograph 

Table 23.14: Squamous Cell Carcinoma of the Urinary 

Bladder: Number and Distribution of Cases and Median 

Survival Time (Months) by AJCC Stage (5th Edition) and Sex, 

Ages 20+, 12 SEER Areas, 1988-2001

AJCC 

Stage 

(5th 

Edition)

Male Female

Cases %

Median 

Survival 

Time

(Months) Cases %

Median 

Survival 

Time

(Months)

Total 470 100.0 10.0 448 100.0 9.1

Stage 0/I 29 6.2 > 120 35 7.8 24.4

Stage II 87 18.5 46.4 72 16.1 30.4

Stage III 86 18.3 16.9 73 16.3 23.6

Stage IV 130 27.7 4.8 129 28.8 5.3

Unknown 138 29.4 7.3 139 31.0 6.6

Survival curves for males were higher than females for 

stages 0/I and II squamous cell carcinoma (Figure 23.9). In 

contrast, for stages III and IV, females had higher survival 

for most years.

Adenocarcinoma

Survival by age, sex, and race

Overall, less than 30% of all cases were diagnosed when 

younger than 60 years (Table 23.15). Black males and 

females had a younger age distribution than white males 

and females. The male to female ratio for whites was 1.9 

and for blacks was 1.5.

Overall, males had a slightly higher 5-year relative survival 

rate (48%) compared with females (36%) diagnosed with 

adenocarcinoma (Figure 23.10).

Survival by stage

Later stage (III and IV) adenocarcinoma was more frequent 

in females compared with males (Table 23.16), which contributed to an all stage median survival time that was higher 

in males compared with females. The survival curves, 

however, were not consistently higher for males compared 

to females within stage (Figure 23.11).

Discussion

For the 67,528 cases presented herein, the greatest number 

of bladder cancers was diagnosed between the ages of 60 

and 79 years of age. Among adults, the 5-year relative 

survival rate was greatest for white males (85%) followed 

by white females (77%), black males (69%), and black 

females (55%). Transitional cell carcinoma was the most 

common histologic type, accounting for over 95% of all 

bladder cancers. Within this type, papillary transitional cell 

carcinoma was the most common subtype, accounting for 

70.2% of all bladder cancers and nonpapillary transitional 

cell carcinoma accounting for an additional 25.5% of the 

bladder cases. The next most frequent histologic type was 

squamous cell carcinoma, which comprised 1.4% of all urinary bladder cancers, followed by adenocarcinoma, which 

accounted for 1.2%. Papillary transitional cell carcinoma 

had the highest median survival time (> 10 years) followed 

by nonpapillary transitional cell carcinoma, adenocarcinoma, 

and squamous cell carcinoma. The male to female ratio 

was greatest for transitional cell carcinoma and least for 

squamous cell carcinoma. For papillary transitional cell 

carcinoma, most were diagnosed at stages 0 and I. When 

early stage transitional cell carcinomas were stratified by 

histologic subtype and tumor grade, high-grade nonpapillary lesions had the poorest survival. 

We know there is inherent misclassification in the SEER data 

involving separation of in situ/noninvasive and superficially 

invasive carcinomas as well as papillary and nonpapillary 

lesions (9). Because of this, it is likely the differences 

we have reported here are somewhat inaccurate. For example, the number of low grade nonpapillary transitional 

cell carcinomas probably includes misclassifications since 

the usual histologic criteria for nonpapillary carcinoma in 

situ are flat, noninvasive, high grade lesions. In fact the 

low grade stage 0 nonpapillary transitional cell carcinomas 

likely consist of low grade stage 0 papillary carcinomas 

in which the papillary component was not clearly defined 

in the pathology report. In addition, the percentage of 

stage 0 may be under-reported since additional terms to 

determine non-invasion based on the study (9) were not 

added to the extent of disease coding systems until 1991. 

The pathology community recognizes the need to more 

consistently specify grade, level of invasion, and histologic type (7,11) and this continues to be a challenge (12). 

Registry abstractors need to record findings from the pathology report correctly and coders need to classify this 

information accurately. This can be accomplished in part 

by recognizing that, in contrast to many other tumor sites, 

the absence of a statement of invasion is taken to indicate 

a noninvasive process by pathologists and urologists, and 

should be done so by abstractors and coders as well. As 

these deficiencies are addressed, SEER data will be able 

to delineate survival differences better within the common 

subtypes of transitional cell carcinoma.

The median survival times presented are based on the observed survival rate. Any characteristic that implies better 

survival in the general population such as young age will 

influence the median survival time. If the relative survival 

rates were similar between males and females and they 
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 191 SEER Survival Monograph 

90

100

70

80

e (%)

60

70

vival Rate

Male Stage 0/I

Male Stage II

40

50

ative Surv

Male Stage III

Male Stage IV

Female Stage 0/I

20

Rel

30

a

Female Stage 0/I

Female Stage II

Female Stage III

0

10 Female Stage IV

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 23.9: Squamous Cell Carcinoma of the Urinary 

Bladder: Relative Survival Rates (%) by Sex and AJCC Stage 

(5th Edition), Ages 20+, 12 SEER Areas, 1988-2001

Table 23.15: Adenocarcinoma of the Urinary Bladder: Number and Distribution of Cases by Age (20+), Race, and Sex, 12 SEER 

Areas, 1988-2001

Age Group (Years)

Total

Race/Sex

White Black

Male Female Male Female

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 838 100.0 454 100.0 242 100.0 60 100.0 41 100.0

20-59 244 29.1 120 26.4 61 25.2 29 48.3 15 36.6

60-69 203 24.2 122 26.9 47 19.4 16 26.7 10 24.4

70+ 391 46.7 212 46.7 134 55.4 15 25.0 16 39.0

90

100

70

80

ate (%)

50

60

urvival Ra

30

40

elative Su

10

R

20

0

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Male Female

Figure 23.8: Squamous Cell Carcinoma of the Urinary 

Bladder: Relative Survival Rates (%) by Sex, Ages 20+, 12 

SEER Areas, 1988-2001

Figure 23.10: Adenocarcinoma of the Urinary Bladder: Relative 

Survival Rates (%) by Sex, Ages 20+, 12 SEER Areas, 1988-2001

90

100

70

80

e (%)

50

60

70

vival Rate

30

40

ative Surv

10

Rel

20

a

0

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis Months after diagnosis

Male Female

90

100

80

(%)

Male Stage 0/I

60

70

vival Rate 

Male Stage II

Male Stage III

40

50

ative Surv

Male Stage IV

Female Stage 0/I

S

20

Rel

30

a

Female Stage II

Female Stage III

Female Stage IV

0

10

Female Stage IV

0

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 23.11: Adenocarcinoma of the Urinary Bladder: Relative 

Survival Rates (%) by Sex and AJCC Stage (5th Edition), 12 

SEER Areas, 1988-2001
Chapter 23 Cancer of the Urinary Bladder

National Cancer Institute 192 SEER Survival Monograph 

Table 23.16: Adenocarcinoma of the Urinary Bladder: 

Number and Distribution of Cases and Median Survival Time 

(Months) by AJCC Stage (5th Edition) and Sex, Ages 20+, 12 

SEER Areas, 1988-2001

AJCC 

Stage 

(5th 

Edition)

Male Female

Cases %

Median 

Survival 

Time

(Months)

Cases % 

Median 

Survival 

Time

(Months)

Total 540 100.0 36.1 298 100.0 24.9

Stage 0/I 78 14.4 75.4 30 10.1 > 120

Stage II 77 14.3 57.3 34 11.4 56.4

Stage III 63 11.7 48.4 53 17.8 43.2

Stage IV 132 24.4 11.6 80 26.8 12.7

Unknown 190 35.2 43.4 101 33.9 18.4

8. Hankey BF, Edwards BK, Ries LA, Percy CL, Shambaugh E. 

Problems in cancer surveillance: delineating in situ and invasive 

bladder cancer. J Natl Cancer Inst 1991;83:384-385.

9. Lynch CF, Platz CE, Jones MP, Gazzaniga JM. Cancer registry 

problems in classifying invasive bladder cancer. J Natl Cancer 

Inst 1991;83:433-437.

10. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy BJ, 

Murphy GP, O’Sullivan B, Sobin LH, Yarbro, JW (eds). AJCC 

Cancer Staging Manual, Fifth edition, American Joint Committee 

on Cancer. Philadelphia: Lippincott-Raven, 1997.

11. Murphy WM. The term ‘superficial bladder cancer’ should be 

abandoned. Eur Urol 2000;38:597-599.

12. Maruniak NA, Takezawa K, Murphy WM. Accurate pathological 

staging of urothelial neoplasms requires better cystoscopic 

sampling. J Urol 2002;167(6):2404-2407. 

had approximately the same age distribution, the median 

survival times may be longer for the females since women 

have longer life expectancy than men. 

Squamous cell carcinomas and adenocarcinomas were rare. 

Overall survival rates among males for adenocarcinoma 

were 3 times higher than for squamous cell carcinoma, 

while among females it was 2.5 times higher. The survival 

advantage typically associated with early stage disease was 

less apparent for squamous cell carcinoma.

REFERENCES

1. American Cancer Society. Cancer facts & figures 2006, The 

American Cancer Society, Atlanta, (GA), 2006.

2. Miller BA, Kolonel LN, Bernstein L, Young, Jr. JL, Swanson GM, 

West D, Key CR, Liff JM, Glover CS, Alexander GA, et al. (eds). 

Racial/Ethnic Patterns of Cancer in the United States 1988-1992, 

National Cancer Institute. NIH Pub. No. 96-4104. Bethesda, 

MD, 1996.Lynch CF, Cohen MB. Urinary System. Cancer 

1995;75:316-329.

3. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer 

EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, 

Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

submission, posted to the SEER web site, 2006.

4. Mungen NA, Aben KK, Schoenberg MP, Visser O, Coebergh JW, 

Witjes JA, Kiemeney LA. Gender differences in stage-adjusted 

bladder cancer survival. Urology 2000; 55(6):876-880. 

5. Underwood W, Dunn RL, Williams C, Lee CT. Gender and 

geographic influence on the racial disparity in bladder cancer 

mortality in the US. J Am Coll Surg 2006; 2002 (2):284-290. 

6. Prout GR Jr, Wesley MN, Greenberg RS, Chen VW, Brown CC, 

Miller AW, Weinstein RS, Robboy SJ, Haynes MA, Blacklow 

RS, Edwards BK. Bladder cancer: Race differences in extent of 

disease at diagnosis. Cancer 2000; 89(6)1349-1358. 

7. Epstein JI, Amin MB, Reuter VR, Mostofi FK, and the 

Bladder Consensus Conference Committee. The World Health 

Organization/International Society of Urologic Pathology 

consensus classification of urothelial (transitional cell) neoplasms 

of the urinary bladder. Am J Surg Pathol 1998;22(12):1435-1448.
National Cancer Institute 193 SEER Survival Monograph 

Introduction

Cancers of the kidney arise primarily from cells that compose the renal tubules and are most often designated as 

renal cell carcinomas or clear cell adenocarcinomas (1). 

Cancers of the renal pelvis and calyces arise in the transitional epithelium that lines these structures and are most 

often designated as nonpapillary or papillary transitional 

cell carcinomas. Over 80% of these cancers arise in the 

renal parenchyma, while less than 20% arise in the renal 

pelvis (2). 

In 2006, cancer of the kidney and renal pelvis was the 

9th most common incident malignancy (estimated 38,890 

new cancers) and the 12th most common cause of cancer 

death (estimated 12,840 deaths) in the United States (3). 

However, increasing incidence rates of renal cell and renal 

pelvis carcinoma have been reported during more recent 

years (1,4,5,6). Although the use of abdominal imaging 

has increased, leading to more renal cancers being detected 

at local or regional stages of disease, the incidence of 

cancer presenting at a distant stage has not declined (6). 

This finding suggests that a true increase in renal cancer 

has occurred that cannot be solely attributed to changes 

in diagnostic practices.

Regardless of race, age-adjusted incidence rates have 

remained higher in males compared with females (4). 

Among cancers of the kidney, age-adjusted incidence 

rates in white males and females have remained lower 

compared with black males and females (4). However, 

among renal pelvis carcinomas, white males and females 

have higher age-adjusted incidence rates compared with 

black males and females.

Rising mortality rates from cancers of the kidney and 

renal pelvis have also been observed (4). During more 

recent years, similar age-adjusted mortality rates have 

been reported in white males and black males, as well 

as in white females and white males. In both white and 

blacks, mortality rates were significantly higher in males 

compared with females.

Although incidence and mortality from cancers of the 

kidney and renal pelvis have increased, 5-year relative 

survival rates in whites have improved over time (4). 

However, significant changes in survival among blacks 

have not been observed.

Charles F. Lynch, Michele M. West, 

Jessica A. Davila, and Charles E. Platz

Chapter 24

Cancers of the Kidney and Renal Pelvis

Table 24.1: Cancer of the Kidney and Renal Pelvis : Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number 

Excluded Reason for Exclusion/Selection

47,220 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

38,329 8,891 Select first primary only

37,583 746 Exclude death certificate only or at autopsy

37,443 140 Exclude unknown race

37,392 51 Exclude alive with no survival time

36,431 961 Exclude children (Ages 0-19)

35,786 645 Exclude in situ cancers for all except breast & bladder cancer

32,755 3,031 Exclude no or unknown microscopic confirmation

32,603 152 Exclude sarcomas

32,583 20 Exclude carcinoids
Chapter 24 Cancers of the Kidney and Renal Pelvis

National Cancer Institute 194 SEER Survival Monograph 

Materials and Methods

The material and methods follow the description provided 

in the introductory chapter. Topographic codes used at 

this site within the SEER Program permit separation of 

kidney (C64) and renal pelvis (C65). The number of persons with cancers of the kidney and renal pelvis from this 

population for the period from 1988 to 2001 is provided 

in Table 24.1, accompanied by the numbers and reasons 

for those excluded for this survival analysis. 

Results

All Kidney and Renal Pelvis Cancers

Distribution and survival by age, sex and race 

Eighty-two percent of adults were diagnosed at age 50 

and older (Table 24.2). The greatest numbers occurred in 

the 60-69 age group, and the 50-79 age group contained 

73.8% of all kidney and renal pelvis cancers. The male 

to female ratio was 1.7:1 for whites and 1.5:1 for blacks. 

White males alone accounted for 52.9% of all eligible 

persons. Whereas 15.2% of the cancers occurred under 

age 50 in white females, 26.3% occurred under age 50 

in black females. 

Relative survival curves were similar by race and sex 

(Figure 24.1). Five to ten years after diagnosis, black 

males have the poorest relative survival rates. The fiveyear relative survival rates ranged from a low of 59% for 

black males aged 50+ to a high of 78% for white females 

aged 20-49 (Table 24.3). Under age 50, median survival 

times were greater than 10 years for both races and sexes. 

For ages 50 and older, median survival times and 5-year 

relative survival rates were lowest for black males and 

highest for white females. Overall for ages 20+, fiveyear relative survival rates varied by age, race, and sex. 

Survival by histology

Of the 32,583 adult cases, 87.7% were diagnosed with 

adenocarcinoma (Table 24.4). Pathologists specify adenocarcinoma through several different terms, which relate 

to histologic features representing the different cells of 

origin recapitulated in differentiation. The most common 

coded term was renal cell carcinoma (ICD-O-3 M-8312, 

Table 24.2: Cancer of the Kidney and Renal Pelvis: Number and Distribution of Cases by Age (20+), Race and Sex, 

12 SEER Areas, 1988-2001

Age Group (Years)

Total

Race/Sex

White Black

Male Female Male Female

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 32,583 100.0 17,221 100.0 10,228 100.0 1,876 100.0 1,268 100.0

20-29 228 0.7 78 0.5 81 0.8 22 1.2 28 2.2

30-39 1,263 3.9 607 3.5 366 3.6 111 5.9 91 7.2

40-49 4,209 12.9 2,271 13.2 1,108 10.8 351 18.7 214 16.9

50-59 7,200 22.1 4,006 23.3 1,962 19.2 525 28.0 272 21.5

60-69 8,845 27.1 4,879 28.3 2,638 25.8 470 25.1 293 23.1

70-79 8,006 24.6 4,109 23.9 2,833 27.7 323 17.2 280 22.1

80+ 2,832 8.7 1,271 7.4 1,240 12.1 74 3.9 90 7.1

90

100

)

70

80

l Rate (%

40

50

60

e Surviva

20

30

40

Relative

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

White Male White Female Black Male Black Female

Figure 24.1: Cancer of the Kidney & Renal Pelvis: Relative 

Survival Rates (%) by Race and Sex, Ages 20+, 12 SEER Areas, 

1988-2001
Chapter 24 Cancers of the Kidney and Renal Pelvis

National Cancer Institute 195 SEER Survival Monograph 

8316-8319) followed by clear cell adenocarcinoma (ICDO-3 M-8310). The second most common histologic type, 

accounting for nearly 10% of all cancers, was transitional 

cell carcinoma. Most of these cancers were coded as papillary transitional cell carcinoma (ICD-O-3 M-8130) or 

transitional cell carcinoma (ICD-O-3 M-8120). Squamous 

cell carcinoma was rare and most commonly was reported 

as having arisen in the renal pelvis, where it has been 

often associated with squamous metaplasia, renal calculi, 

and chronic infection (7). Oxyphilic adenocarcinoma, 

also known as oncocytic carcinoma, in the ICD-O coding 

scheme, probably consists largely of renal oncocytoma, a 

tumor distinct from renal cell carcinoma because it typically has a benign behavior (8). The occasional malignant 

cases are thought to be most likely chromophobe renal 

cell carcinomas (ICD-O-3 M-8270) (9). Nephroblastoma, 

also known as Wilms tumor, rarely occurs in adults, but 

is the most common form of renal cancer in children 

(10). Oxyphilic adenocarcinoma and nephroblastoma 

arose only in the kidney. We classified 2.4% of kidney 

and renal pelvis cancers to an “other” category. Within 

this category, carcinoma not otherwise specified (ICD-O-3 

M-8010) was the most common histologic type. 

Five-year relative survival rates were greatest for oxyphilic 

adenocarcinoma followed by nephroblastoma/Wilms tumor 

(Table 24.5). Squamous cell carcinoma had the poorest 

survival rate. Median survival rates for these histologic 

types followed a similar pattern. The two most common 

histologic types, adenocarcinoma and transitional cell 

carcinoma, had observed survival rates that were about 10 

percentage points lower than their corresponding relative 

rates. Median survival for adenocarcinoma (92 months) 

was more than double that for transitional cell carcinoma 

(45 months). 

Relative survival curves for each of these histologic types 

showed oxyphilic adenocarcinoma with the best survival 

and squamous cell carcinoma with the worst (Figure 24.2). 

Eighteen or more months after diagnosis, the relative 

survival rates for adenocarcinoma was significantly better 

than transitional cell carcinoma. 

Adenocarcinoma

Survival by age, race, sex, and laterality

Of the 28,560 persons with adenocarcinoma, 81.3% were 

diagnosed when at least 50 years old (Table 24.6). Persons in the 50-79 year age groups were diagnosed with 

almost three-quarters of all adenocarcinomas. The male 

to female ratio was 1.75:1. White males alone accounted 

for 53.4% of all adenocarcinomas. Whereas 17.6% of 

adenocarcinomas occurred in whites under age 50, 26.8% 

occurred in blacks under age 50. 

Over 99% of adenocarcinomas with classifiable laterality 

(n = 28,078) were coded as arising in the kidney (Table 

24.7). Right kidney was a slightly more common location 

(50.7%). The median survival time was slightly higher 

for adenocarcinomas of the right kidney compared with 

the left kidney. 

In the 20-49, 50+ and 20+ age groups, five-year observed 

and relative survival rates were highest among white females and lowest among black males (Table 24.8). In 

each of these age groups, five-year survival rates for white 

males and black females were similar. For each race-sex 

group, survival rates were highest in the 20-49 age group. 

Relative survival curves for adenocarcinoma by race and 

Table 24.3: Cancer of the Kidney and Renal Pelvis: Number of Cases, Median Survival Time (Months) and 5-Year Survival 

Rates (%) by Race, Sex, and Age Group (20+), 12 SEER Areas, 1988-2001

Race, Sex and Age Group

Cases

Median 

Survival Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

White Females, 20-49 1,555 > 120 77.4 99.0 78.3

White Males, 20-49 2,956 > 120 71.1 97.9 72.6

Black Females, 20-49 333 > 120 70.5 97.9 71.4

Black Males, 20-49 484 > 120 63.4 95.2 66.4

White Females, 50+ 8,673 77.2 54.7 85.8 63.8

White Males, 50+ 14,265 67.6 52.6 81.8 64.3

Black Females, 50+ 935 70.4 52.3 84.6 61.8

Black Males, 50+ 1,392 51.7 47.2 79.7 59.2

White Females, 20+ 10,228 92.6 58.1 87.8 66.2

White Males, 20+ 17,221 79.8 55.7 84.6 65.9

Black Females, 20+ 1,268 91.9 57.1 88.1 64.8

Black Males, 20+ 1,876 64.4 51.4 83.7 61.4
Chapter 24 Cancers of the Kidney and Renal Pelvis

National Cancer Institute 196 SEER Survival Monograph 

Table 24.4: Cancer of the Kidney and Renal Pelvis: 5-Year Relative Survival Rate (RSR) and Distribution of Cases by Histology, 

Ages 20+, 12 SEER Areas, 1988-2001

Histology/ICD-O Code Cases Percent 5-Year

RSR (%)

Total 32,583 100.0 65.5

Adenocarcinoma 28,560 87.7 67.5

 Renal Cell Carcinoma (8312,8316-8319) 20,045 61.5 65.6

 Adenocarcinoma, NOS (8140) 684 2.1 39.1

 Tubular Adenocarcinoma (8211) 96 0.3 79.5

 Papillary Adenocarcinoma (8260) 371 1.1 74.1

 Clear Cell Adenocarcinoma, NOS (8310) 6,445 19.8 75.4

 Granular Cell Carcinoma (8320) 748 2.3 72.2

 Other Adeno (8141,8190,8200,8251,8255,8270,8280,8323,8370,8440,8450,

 8480-8481,8490,8500,8504,8510,8521,8550,8570,8940) 171 0.5 68.6

Transitional Cell Carcinoma 3,049 9.4 57.5

 Transitional Cell Carcinoma, NOS (8120) 1,495 4.6 38.2

 Papillary Transitional Cell Carcinoma (8130) 1,550 4.8 75.4

 Other Transitional (8121-8122) <5 ~ ~

Squamous Cell Carcinoma 93 0.3 4.0

 Squamous Cell Carcinoma, NOS (8070) 78 0.2 4.7

 Other Squamous (8052,8071) 15 0.0 ~

Oxyphilic Adenocarcinoma (8290) 65 0.2 94.9

Nephroblastoma/Wilms Tumor (8960) 42 0.1 78.1

Other Histologies (8000-8001,8004,8010,8012,8020-8022,8030,8032-8033,

 8041,8046,8050,8560,8933,8935,8963-8964,8990,9082,9364,9473) 774 2.4 23.8

 ~ Statistic not displayed due to less than 25 cases.

Table 24.5: Cancer of the Kidney and Renal Pelvis: Number and Distribution of Cases, Median Survival Time (Months) 

and 5-Year Relative Survival Rates (%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001

Histology

Cases Percent

Median 

Survival 

Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

Total 32,583 100.0 83.3 56.3 86.0 65.5

Adenocarcinoma 28,560 87.7 91.9 58.6 86.9 67.5

Transitional cell carcinoma 3,049 9.4 45.4 45.5 79.1 57.5

Squamous cell carcinoma 93 0.3 5.2 3.2 80.7 4.0

Oxyphilic adenocarcinoma 65 0.2 > 120 81.1 79.9 94.9

Nephroblastoma/Wilms tumor 42 0.1 > 120 76.9 97.5 78.1

Other Histologies 774 2.4 6.7 19.3 81.2 23.8

sex (Figure 24.3) were almost identical to those for all 

histologic types combined (Figure 24.1). 

Survival by stage 

Staging information for adenocarcinoma was available for 

78.3% of the 26,824 patients in the comparison of stage for 

white patients and black patients (Table 24.9). For each of 

these race and sex subgroups, the greatest percentages of 

adenocarcinomas were diagnosed at stage I, 30.6% among 

white males, 35.0% among black males, 35.5% among 

white females, and 35.6% among black females (Table 

24.9). Overall, 40.4% of adenocarcinomas in white males, 

45.2% in black males, 45.3% in white females, and 47.3% 

in black females were diagnosed at AJCC stages I & II. 

The percentages of stage III adenocarcinomas ranged from 

9.5% in black females to 15.6% in white males, whereas 

for stage IV adenocarcinomas the percentages were in a 

much tighter range of 19.1% in black females to 22.7% in 

white males.
Chapter 24 Cancers of the Kidney and Renal Pelvis

National Cancer Institute 197 SEER Survival Monograph 

Transitional Cell Carcinoma

Survival by age, race, sex, and laterality

Among persons with transitional cell carcinoma, 92.9% 

occurred in patients at least 50 years old (Table 24.10). 

The male to female ratio was 1.2:1. The under 60 age 

group comprised only 14.5% in white females, whereas 

23.4%, 26.3%, and 31.4% occurred in white males, black 

females, and black males, respectively. 

About 99% (n = 3,019) of the transitional cell carcinomas 

were coded as arising in the right or left kidney and right 

or left renal pelvis (Table 24.11). Most of these (80.3%) 

were classifiable to renal pelvis with the right renal pelvis 

being the preferred side (50.8%). The median survival 

times were similar between the right and left renal pelves. 

Median survival times for transitional cell carcinomas 

that arose in the kidney were less than half that of those 

arising in the renal pelvis. 

Age-specific five-year relative survival rates ranged from 

a low of 36% for black males aged 70+ to a high of 64% 

for white males in the 20-69 age group (Table 24.12). 

Observed and relative survival rates were greater for 

Figure 24.2: Cancer of the Kidney & Renal Pelvis: Relative 

Survival Rates (%) by Histology, Ages 20+, 12 SEER Areas, 

1988-2001

Table 24.6: Adenocarcinoma of the Kidney and Renal Pelvis: Number and Distribution of Cases by Age (20+), Race and Sex, 

12 SEER Areas, 1988-2001

Age Group 

(Years)

Total

Race/Sex

White Black

Male Female Male Female

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 28,560 100.0 15,252 100.0 8,707 100.0 1,723 100.0 1,142 100.0

20-29 198 0.7 63 0.4 74 0.8 20 1.2 23 2.0

30-39 1,179 4.1 561 3.7 347 4.0 100 5.8 88 7.7

40-49 3,964 13.9 2,126 13.9 1,048 12.0 335 19.4 202 17.7

50-59 6,648 23.3 3,713 24.3 1,785 20.5 493 28.6 249 21.8

60-69 7,860 27.5 4,369 28.6 2,310 26.5 425 24.7 274 24.0

70-79 6,652 23.3 3,472 22.8 2,282 26.2 287 16.7 235 20.6

80+ 2,059 7.2 948 6.2 861 9.9 63 3.7 71 6.2

Table 24.7: Adenocarcinoma of the Kidney and Renal Pelvis: 5-Year Relative Survival Rate (RSR), Distribution of Cases with 

Classifiable Laterality and Median Survival Time (Months) by Laterality and Subsite, Ages 20+, 12 SEER Areas, 1988-2001

Laterality

Kidney Renal Pelvis

Cases Percent

Median 

Survival 

Time

(Months)

5-Year

RSR (%) Cases Percent 

Median 

Survival 

Time

(Months)

5-Year

RSR (%)

Total (with classifiable laterality) 28,014 100.0 95.1 68.4 64 100.0 34.5 47.7

Right 14,217 50.7 99.8 69.5 37 57.8 34.4 46.0

Left 13,797 49.3 89.7 67.2 27 42.2 47.1 47.0

For Stages I and II, 5-year relative survival varied more 

by race than stage for males. Relative survival curves 

were higher for white males compared with black males for 

Stages I, II, and III but similar for Stage IV (Figure 24.4). 

Analogous curves for females were different at stage III up 

until 10 years but similar for other stages (Figure 24.5).

90

100

70

80

Rate (%)

Oxyphilic 

adenocarcinoma

50

60

70

Survival R

Nephroblastoma/

Wilms tumor

Adenocarcinoma

40

50

Relative S

Transitional cell 

carcinoma

20

30 R

Squamous cell 

carcinoma

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 24 Cancers of the Kidney and Renal Pelvis

National Cancer Institute 198 SEER Survival Monograph 

males than females in each of these age groups except 

blacks 70+. Survival rates were higher for the younger 

age group by race and sex. 

Black and white males had the best relative survival rates 

2 to 6 years after diagnosis (Figure 24.6). Thereafter, 

relative survival rates in black males tailed off and were 

similar to black and white females. Overall, black and 

white males had better relative survival rates than black 

and white females and higher median survival times.

Survival by sex, stage, and grade

Staging information was available for 65.0% of the 3,049 

transitional cell carcinomas. AJCC (5th edition) stage I 

transitional cell carcinomas were slightly more frequent in 

males (17.2%) compared with females (14.5%), whereas 

stage IV transitional cell carcinomas were slightly more 

frequent in females (29.1%) than males (25.4%) (Table 

24.13). AJCC (5th edition) stage distribution was similar 

for blacks and whites except blacks had a higher percentage unknown, 41.5% and 35.2%, respectively. Survival 

rates for blacks with stages II and III could not be calculated due to insufficient case numbers for analysis (Table 

24.13, Figure 24.8).

Males had slightly better relative survival rates than females for each stage of disease with the exception of 

stage II and III (Figure 24.7). Coupled with the slightly 

larger percentage of tumors in the early stage, this, at 

least in part, explained the overall better survival rates 

for males compared with females (Figure 24.6). Relative 

survival differences between blacks and whites were not 

substantial, in part due to low numbers of blacks at each 

stage (Figure 24.8). 

Within both sexes, low grade (grades I & II) transitional 

cell carcinomas had better survival than high grade (grades 

III & IV) at each stage (Figures 24.9 & 24.10). 

Discussion

During 2006, cancers of the kidney and renal pelvis were 

the 9th most common incident malignant cancer and the 

12th most common cause of cancer death. Of the 32,583 

patients, 84.2% were white, 9.6% black, and 6.2% other 

races. The greatest number of these cancers was diagnosed in the 60-69 age group. Adenocarcinoma was the 

most common histologic type, accounting for 87.7% of 

Table 24.8: Adenocarcinoma of the Kidney and Renal Pelvis: Number and Distribution of Cases, Median Survival Time (Months) 

and 5-Year Survival Rates (%) by Race, Sex and Age (20+), 12 SEER Areas, 1988-2001

Race, Sex and Age Group (Years)

Cases Percent

Median 

Survival 

Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

All 28,560 100.0 91.9 58.6 86.9 67.5

White Females, 20-49 1,469 5.1 > 120 78.3 99.0 79.1

White Males, 20-49 2,750 9.6 > 120 71.7 97.9 73.2

Black Females, 20-49 313 1.1 > 120 71.8 97.9 72.8

Black Males, 20-49 455 1.6 > 120 64.6 95.1 67.7

White Females, 50+ 7,238 25.3 89.6 58.3 87.0 67.0

White Males, 50+ 12,502 43.8 73.5 54.4 82.7 65.8

Black Females, 50+ 829 2.9 75.7 54.8 85.3 64.3

Black Males, 50+ 1,268 4.4 54.8 48.3 80.0 60.4

White Females, 20+ 8,707 30.5 105.0 61.6 89.0 69.2

White Males, 20+ 15,252 53.4 86.1 57.5 85.4 67.3

Black Females, 20+ 1,142 4.0 104.7 59.5 88.7 67.1

Black Males, 20+ 1,723 6.0 66.0 52.6 84.0 62.6

90

100

%)

70

80

al Rate (

%

40

50

60

ve Surviva

20

30

40

Relativ

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

White Male White Female Black Male Black Female

Figure 24.3: Adenocarcinoma of the Kidney & Renal Pelvis: 

Relative Survival Rates (%) by Race and Sex, Ages 20+, 

12 SEER Areas, 1988-2001
Chapter 24 Cancers of the Kidney and Renal Pelvis

National Cancer Institute 199 SEER Survival Monograph 

for adenocarcinoma and 1.2:1 for transitional cell carcinoma. 

For adenocarcinomas, blacks had a slighly higher percentage of stage I & II disease than whites. Nevertheless, 

their overall relative survival was slightly less than whites 

because of lower survival rates by stage. Females had 

a slightly higher relative survival percentage than males 

except for stage III. Part of the explanation for this was a 

higher percentage of stages I & II adenocarcinomas in females compared with males for both blacks and whites. 

For transitional cell carcinoma, low grade tumors had better 

relative survival rates than high grade tumors within each 

stage. Overall, relative survival was higher among males 

than females. This was, at least in part, explained by males 

1) having a greater percentage diagnosed under age 60, 

2) having a lower percentage of stage IV cancers, and 3) 

having a higher percentage of low grade cancers. 

90

100

70

80

Rate (%)

White, Stage I

White, Stage II

50

60

Survival R

g

White, Stage III

White, Stage IV

Black Stage I

30

40

Relative S

Black, Stage I

Black, Stage II

Black, Stage III

10

20 Black, Stage IV

0

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

Rate (%)

White, Stage I

White Stage II

50

60

70

Survival R

White, Stage II

White, Stage III

White, Stage IV

30

40

50

Relative S

Black, Stage I

Black, Stage II

20

30 R

Black, Stage III

Black, Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 24.4: Male Adenocarcinoma of the Kidney & Renal 

Pelvis: Relative Survival Rates (%) by AJCC Stage (5th Edition) 

and Race, Ages 20+, 12 SEER Areas, 1988-2001

Figure 24.5: Female Adenocarcinoma of the Kidney & Renal 

Pelvis: Relative Survival Rates (%) by AJCC Stage (5th Edition) 

and Race, Ages 20+, 12 SEER Areas, 1988-2001

Table 24.9: Adenocarcinoma of the Kidney and Renal Pelvis: Number and Distribution of Cases, 5-Year Relative Survival Rates 

(%), and Median Survival Time (Months) by AJCC Stage (5th Edition), Race, and Sex, Ages 20+, 12 SEER Areas, 1988-2001

AJCC Stage 

Race/Sex

White Black

Male Female Male Female

Cases Percent

5-Year

Relative

Survival 

Rate (%) Cases Percent 

5-Year

Relative

Survival 

Rate (%) Cases Percent

5-Year

Relative

Survival 

Rate (%) Cases Percent

5-Year

Relative

Survival 

Rate (%)

Total 15,252 100.0 67.3 8,707 100.0 69.2 1,723 100.0 62.6 1,142 100.0 67.1

Stage I 4,674 30.6 94.6 3,088 35.5 93.3 603 35.0 84.9 407 35.6 91.0

Stage II 1,490 9.8 86.1 856 9.8 88.2 175 10.2 79.8 134 11.7 88.8

Stage III 2,372 15.6 66.5 1,137 13.1 62.1 188 10.9 60.2 109 9.5 48.2

Stage IV 3,460 22.7 11.1 1,723 19.8 9.4 381 22.1 9.5 218 19.1 8.1

Unstaged/

Unknown 3,256 21.3 80.2 1,903 21.9 80.0 376 21.8 73.0 274 24.0 74.3

Median Survival Time (Months)

AJCC Stage

White 

Males

White 

Females

Black 

Males

Black 

Females

Total 86.1 105.0 66 104.7

Stage I > 120 > 120 116.4 > 120

Stage II > 120 > 120 112.5 > 120

Stage III 76.6 74.9 58.7 35.9

Stage IV 8.1 7.0 5.6 5.8

Unstaged/

Unknown 116.6 > 120 99.7 110.1

all cancers, followed by transitional cell carcinoma, which 

accounted for 9.4%. Squamous cell carcinoma, oxyphilic 

adenocarcinoma, and nephroblastoma/Wilms tumor accounted for less than 1%. Oxyphilic adenocarcinoma had 

the highest 5-year relative survival rate (95%), followed 

by nephroblastoma/Wilms tumor (78%), adenocarcinoma 

(68%), transitional cell carcinoma (58%), and squamous 

cell carcinoma (4%). The male:female ratio was 1.75:1 
Chapter 24 Cancers of the Kidney and Renal Pelvis

National Cancer Institute 200 SEER Survival Monograph 

Table 24.10: Transitional Cell Carcinoma of the Kidney and Renal Pelvis: Number and Distribution of Cases by Age (20+), Race 

and Sex, 12 SEER Areas, 1988-2001

Age Group (Years)

Total

Race/Sex

White Black

Male Female Male Female

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 3,049 100.0 1,501 100.0 1,192 100.0 83 100.0 76 100.0

20-49 216 7.1 144 9.6 46 3.9 11 13.3 6 7.9

50-59 383 12.6 207 13.8 126 10.6 15 18.1 14 18.4

60-69 766 25.1 385 25.6 269 22.6 29 34.9 14 18.4

70-79 1,069 35.1 512 34.1 444 37.2 20 24.1 29 38.2

80+ 615 20.2 253 16.9 307 25.8 8 9.6 13 17.1

Table 24.11: Transitional Cell Carcinoma of the Kidney and Renal Pelvis: 5-Year Relative Survival, Distribution of Cases with 

Classifiable Laterality and Median Survival Time (Months) by Laterality and Subsite, Ages 20+, 12 SEER Areas, 1988-2001

Laterality

Kidney Renal Pelvis

Cases Percent

Median 

Survival 

Time

(Months)

5-Year

Relative

Survival

Cases Percent 

Median 

Survival 

Time

(Months)

5-Year

Relative

Survival

Total 596 100.0 25.3 44.4 2,423 100.0 54.9 60.9

Right 302 50.7 25.9 44.2 1,230 50.8 56.0 61.6

Left 294 49.3 23.6 44.0 1,193 49.2 54.1 60.2

Table 24.12: Transitional Cell Carcinoma of the Kidney and Renal Pelvis: Number and Distribution of Cases, Median Survival 

Time (Months) and 5-Year Survival Rates (%) by Race, Sex, and Age (20+), 12 SEER Areas, 1988-2001

Race, Sex and Age Group (Years)

Cases Percent

Median 

Survival Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

All 3,049 100.0 45.4 45.5 79.1 57.5

White Females, 20-69 441 14.5 85.9 53.5 94.2 56.6

White Males, 20-69 736 24.1 94.7 58.4 91.1 64.0

Black Females, 20-69 34 1.1 > 120 52.3 92.0 55.8

Black Males, 20-69 55 1.8 81.4 54.8 86.8 63.1

White Females, 70+ 751 24.6 29.7 36.5 72.0 50.6

White Males, 70+ 765 25.1 33.8 37.3 64.2 58.1

Black Females, 70+ 42 1.4 21.0 36.3 70.7 46.9

Black Males, 70+ 28 0.9 30.0 23.1 62.0 35.9

White Females, 20+ 1,192 39.1 39.3 42.7 80.2 53.3

White Males, 20+ 1,501 49.2 50.8 47.7 77.4 61.5

Black Females, 20+ 76 2.5 44.0 43.4 80.2 51.7

Black Males, 20+ 83 2.7 43.9 43.9 78.5 56.0
Chapter 24 Cancers of the Kidney and Renal Pelvis

National Cancer Institute 201 SEER Survival Monograph 

90

100

)

70

80

l Rate (%

40

50

60

e Surviva

20

30

40

Relative

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

White Male White Female Black Male Black Female

90

100

70

80

Rate (%)

Male, Stage I

Male, Stage II

Male Stage III

50

60

70

Survival R

Male,Stage III

Male, Stage IV

Female, Stage I

30

40

50

Relative S

, g

Female, Stage II

Female, Stage III

20

30 R

Female, Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 24.6: Transitional Cell Carcinoma of the Kidney & Renal 

Pelvis: Relative Survival Rates (%) by Race and Sex, Ages 20+, 

12 SEER Areas, 1988-2001

Figure 24.7: Transitional Cell Carcinoma of the Kidney & 

Renal Pelvis: Relative Survival Rates (%) by AJCC Stage (5th 

Edition) and Sex, Ages 20+, 12 SEER Areas, 1988-2001

90

100

70

80

Rate (%)

White, Stage I

50

60

70

Survival R

White, Stage II

White, Stage III

30

40

50

Relative S

White, Stage IV

Black, Stage I

20

30

Black, Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

Rate (%)

Low Grade, Stage I

Low Grade Stage II

60

70

Survival R

Low Grade, Stage II

Low Grade, Stage III

Low Grade, Stage IV

40

50

Relative S

High Grade, Stage I

High Grade, Stage II

20

30

R

High Grade, Stage III

High Grade, Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 24.8: Transitional Cell Carcinoma of the Kidney & Renal 

Pelvis: Relative Survival Rates (%) by AJCC Stage (5th Edition) 

and Race, Ages 20+, 12 SEER Areas, 1988-2001

Figure 24.9: Male Transitional Cell Carcinoma of the Kidney & 

Renal Pelvis: Relative Survival Rates (%) by AJCC Stage (5th 

Edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001

Figure 24.10: Female Transitional Cell Carcinoma of the Kidney 

& Renal Pelvis: Relative Survival Rates (%) by AJCC Stage (5th 

Edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001

90

100

(%) 70

80

90

val Rate (

Low Grade, Stage I

Low Grade, Stage II

60

70

ive Surviv

Low Grade, Stage III

Low Grade, Stage IV

40

50

Relat

High Grade, Stage I

High Grade, Stage II

20

30 High Grade, Stage III

High Grade, Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 24 Cancers of the Kidney and Renal Pelvis

National Cancer Institute 202 SEER Survival Monograph 

Table 24.13: Transitional Cell Carcinoma of the Kidney and Renal Pelvis: Number and Distribution of Cases, 5-Year 

Relative Survival Rates (%), and Median Survival Time (Months) by AJCC Stage (5th Edition), Sex, and Race, Ages 20+, 12 SEER 

Areas, 1988-2001

AJCC 

Stage (5th 

Edition)

Sex Race

Male Female White Black

Cases Percent

5-Year

Relative

Survival 

Rate (%) Cases Percent 

5-Year

Relative

Survival 

Rate (%) Cases Percent

5-Year

Relative

Survival 

Rate (%) Cases Percent

5-Year

Relative

Survival 

Rate (%)

Total 1,704 100.0 61.1 1,345 100.0 53.2 2,693 100.0 57.9 159 100.0 55.0

Stage I 293 17.2 90.4 195 14.5 79.7 422 15.7 87.7 25 15.7 77.1

Stage II 97 5.7 77.3 62 4.6 82.4 143 5.3 82.2 6 3.8 ~

Stage III 298 17.5 56.8 215 16.0 61.2 459 17.0 58.7 24 15.1 ~

Stage IV 432 25.4 21.9 391 29.1 15.1 722 26.8 18.7 38 23.9 5.3

Unstaged/

Unknown 584 34.3 72.1 482 35.8 64.3 947 35.2 69.0 66 41.5 67.5

Median Survival Time (Months)

AJCC 

Stage

White 

Males

White 

Females

Black 

Males

Black 

Females

Total 51.6 39.9 45.1 43.8

Stage I > 120 > 120 > 120 116.0

Stage II 77.9 104.0 97.2 ~

Stage III 50.2 65.0 53.1 ~

Stage IV 11.2 9.3 10.3 9.0

Unstaged/

Unknown 79.9 65.2 74.0 91.3

~Statistic not displayed due to less than 25 cases.

10. Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, 

Bunin GR (eds). Cancer Incidence and Survival among Children 

and Adolescents: United States SEER Program 1975-1995, 

National Cancer Institute, SEER Program. NIH Pub. No. 99-

4649. Bethesda, MD, 1999. 

REFERENCES

1. Lynch CF, Cohen MB. Urinary system. Cancer 1995; 

75(1Suppl):316-29.

2. Devesa SS, Silverman DT, McLaughlin JK, Brown CC, 

Connelly RR, Fraumeni JF Jr. Comparison of the descriptive 

epidemiology of urinary tract cancers. Cancer Causes Control 

1990;1:1133-1141.

3. American Cancer Society. Cancer facts & figures 2006, The 

American Cancer Society, Atlanta, (GA), 2006.

4. Chow, WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising 

incidence of renal cell carcinoma in the United States. JAMA 

1999; 281:1628-31

5. McCredie M. Bladder and kidney cancers. Cancer Surv. 

1994;19:343-368.

6. Hock LM, Lynch J, Balaji KC. Increasing incidence of all 

stages of kidney cancer in the last 2 decades in the United 

States: An analysis of surveillance, epidemiology, and end 

results program data. J Urol 2002;167:57-60.

7. Peterson RO. Renal pelvis. In: Urologic Pathology, 2nd ed. 

Philadelphia: JB Lippincott Co., 1992, pp. 170-212.

8. Eble JN. Neoplasms of the kidney. In: Urologic Surgical 

Pathology, Bostwick DG and Eble JN (eds). Mosby-Year Book, 

Inc., 1997, pp. 83-148.

9. Lieber MM, Hosaka Y, Tsukamato T. Renal oncocytoma. 

World J Urol 1987; 5:71-9.
National Cancer Institute 203 SEER Survival Monograph 

Introduction

This study provides survival analysis for 19,774 histologically confirmed first primary brain and other central nervous system (CNS) cancers diagnosed from 1988 

through 2001 from the Surveillance, Epidemiology, and 

End Results (SEER) Program of the National Cancer 

Institute (NCI). The analysis performed in this study attempts to better understand the influence of morphologic 

and demographic factors on survival. Other CNS cancers 

include cancers of the central nervous system and malignant meningiomas of the brain. Benign and borderline 

tumors are not included in these analyses.

Brain and other CNS cancers are considered to be rare 

compared to prostate, lung, breast, or colon cancer. It is 

estimated there will be 18,820 new cases diagnosed of 

and 12,820 deaths from brain and other CNS cancer in 

the United States each year (1). The average annual ageadjusted incidence rate for brain and other CNS cancer 

in the United States is 7.6 per 100,000 for males and 5.4 

per 100,000 for females (white males: 8.3 per 100,000; 

white females: 5.9 per 100,000; black males: 4.9 per 

100,000; black females: 3.5 per 100,000) (2). The average 

annual age-adjusted mortality rate is approximately 4.5 

per 100,000 for all races combined, with males having a 

higher mortality rate as compared to females (2). 

Histologic type of tumor, age at diagnosis, race and treatment are all important predictors of survival, with a large 

variation in survival by histologic type of tumor (3, 4, 5, 

6). The most common histologic subtypes of brain cancer 

are astrocytoma and glioblastoma multiforme (GBM), 

while the most common histologic subtypes of other CNS 

cancer are meningioma and ependymoma (3, 4, 7, 8, 9). 

Patients with GBM have the worst survival compared to 

any other histologic subtype (8). 

No risk factor accounting for a large number of brain and 

other CNS cancers has been identified. There has been 

some evidence for inherited factors, with approximately 

16% of families studied having a family history of cancer 

(5, 10, 11). The only known risk factor for primary brain 

and other CNS cancers is exposure to therapeutic ionizing radiation. Other factors have been shown to cause 

increased risk, including exposure to synthetic rubber 

manufacturing, to vinyl chloride, to petroleum refining/

production work, or to pesticides and consumption of 

cured foods, but the data are inconsistent (5). Exposure 

to filtered cigarettes, diagnostic ionizing radiation, residential electromagnetic fields, formaldehyde, cell phone 

use and active or passive maternal tobacco smoking are 

not proven risk factors (5). The most common presenting symptoms, progressive neurological deficit, motor 

weakness, headache and seizure, do not appear to be 

independent risk factors (5, 11). 

Materials and Methods 

Exclusions

Between 1988 and 2001, 29,335 adult cases of malignant 

brain and other CNS cancer were diagnosed and reported 

to the NCI SEER Program. Children (aged less than 

20) were excluded because brain and other CNS cancer 

are different in children compared to adults in terms of 

incidence and survival (8, 12). Patients were followed 

for vital status until 2001. The survival analysis was 

based on relative survival rates calculated by the life-table 

method (13). The relative rate was used to estimate the 

effect of cancer on the survival of the cohort. Relative 

survival, defined as observed survival divided by expected 

survival, adjusts for the expected mortality that the cohort 

would experience. Further descriptions of the NCI SEER 

program, data selection and relative survival analysis can 

be found in Chapter 1. Table 25.1 details the exclusions 

from this group of patients that resulted in a final group 

of 19,774 total patients, 18,669 brain cancer and 1,105 

other CNS cancer.

Jill S. Barnholtz-Sloan, Andrew E. Sloan, and Ann G. Schwartz

Chapter 25

Cancer of the Brain and 

Other Central Nervous System
Chapter 25 Cancer of the Brain and Nervous System

National Cancer Institute 204 SEER Survival Monograph 

Brain Other CNS

Reason for Exclusion/selection

Number Selected/

Remaining

Number 

Excluded

Number Selected/

Remaining

Number 

Excluded

27,479 0 1,856 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

25,159 2,320 1,680 176 Select first primary only

24,647 512 1,656 24 Exclude death certificate only or at autopsy

24,562 85 1,644 12 Exclude unknown race

24,502 60 1,639 5 Active follow-up and exclude alive with no survival time

20,937 3,565 1,306 333 Exclude children (000-019)

20,937 0 1,306 0 Exclude in situ cancers

18,740 2,197 1,196 110 Exclude no or unknown microscopic confirmation

18,674 66 1,118 78 Exclude sarcomas

18,669 5 1,105 13 Exclude Melanomas

Table 25.1: Cancer of the Brain & Other Central Nervous System: Number of Cases and Exclusions, 12 SEER Areas, 1988-2001

NOS, C716 - Cerebellum, NOS, C717 - Brain Stem, 

C718 - Overlapping lesion of brain and C719 - Brain, 

NOS; SPINE: C701 - Spinal meninges, C720 - Spinal 

Cord and C721 - Cauda equine and OTHER: C723 - 

Optic nerve, C724 - Acoustic nerve, C725 - Cranial 

nerve, NOS, C728 - Overlapping lesion of brain and 

CNS and C729 – Nervous system, NOS.

Stage Classification

Stage is not presented for brain cancer; however, stage is 

presented for other CNS cancer. In the SEER database, 

the categories for SEER stage are in situ, localized, regional, distant and unstaged. In situ cases are excluded 

from this study as seen in Table 25.1. Localized stage 

is defined as an invasive neoplasm confined entirely to 

the organ. Regional stage is defined as a neoplasm that 

has extended either beyond the organ or into regional 

lymph nodes. Distant stage is defined as a neoplasm 

that has spread to parts of the body remote from the 

primary tumor. Unstaged cancers lack sufficient information to assign stage. The American Joint Committee 

on Cancer (AJCC) TNM staging system, 5th Edition, 

(14) is also used. 

Results

In general, 24% and 69% of patients survived 5 years for 

brain cancer and other CNS cancer, respectively (Table 

25.2). Figure 25.1 shows the 10-year relative survival 

curves for these two distinct types of cancer. 

Histologic Type of Tumor Classification

For brain and other CNS cancer, histologic type is one 

of three important clinical factors (the others are age at 

diagnosis and grade). In the SEER database, histologic 

classification for years of diagnosis 1988-2001 follows 

the ICD-O-2 and ICD-O-3 morphology codes. For the 

brain cancer cases, the histologic types were coded in the 

following manner: 9380, 9381, 9382 – glioma; 9390, 9443, 

9473 – glioma, other; 9391, 9392, 9393 – ependymoma; 

9400-9430 – astrocytoma; 9440-9442 – glioblastoma; 

9450-9460 – oligodendroglioma; 9470-9472 – medulloblastoma; 9060-9085, 9490-9506, 8000-8002, 8680, 

9364, 9370 – Other. For the other CNS cancer cases, 

the histologic types were coded in the following manner: 

9391-9394 – ependymoma; 9400-9421 – astrocytoma; 

9380-9382, 9473, 9440, 9450 – glioma; 9530-9539 – 

meningioma; 9490-9522, 8680-8693, 800-8001, 8990, 

9064, 9364, 9370 – other.

Primary Site Classification

For brain cancers, primary site of tumor is classified as 

the following: C710 – Cerebrum, C711 - Frontal Lobe, 

C712 - Temporal Lobe, C713 - Parietal Lobe, C714 - Occipital Lobe, C715 – Ventricle, Not Otherwise Specified 

(NOS), C716 - Cerebellum, NOS, C717 - Brain Stem, 

C718 - Overlapping lesion of brain and C719 - Brain, 

NOS. For other CNS cancers, primary site of tumor is 

classified as the following: BRAIN: C700 - Cerebral 

meninges, C709 - Meninges, NOS, C710 – Cerebrum, 

C711 - Frontal Lobe, C712 - Temporal Lobe, C713 - 

Parietal Lobe, C714 - Occipital Lobe, C715 - Ventricle, 
National Cancer Institute 205 SEER Survival Monograph 

Chapter 25 Cancer of the Brain and Nervous System

other. For all race specific analyses, only white and black 

patients are used because the other category is made up 

of a mix of racial groups. In general, whites will develop 

brain cancer more often than blacks and survival in blacks 

was similar to whites (5-year relative survival rate: 23%). 

Males generally had a slightly higher incidence of brain 

cancer as compared to females, and females had better 

survival than males (5-year relative survival rate: 25% 

versus 23%). 5-year relative survival rate was highest 

for black males. Tables 25.3 and 25.4 show the relative 

survival rates for brain cancer by race and gender. 

Age at Diagnosis

The average age of onset for adult brain cancer is in the 

mid-fifties, although this does vary by histologic subtype of 

tumor. As with most other cancer sites, survival decreased 

as age at diagnosis increased. The 5-year relative survival 

rates (%) for brain cancer by age at diagnosis categories 

20-29, 30-39, 40-49, 50-59, 60-69, 70-79 and 80+ were 

64%, 55%, 33%, 14%, 6%, 2% and 1%, respectively (Table 

25.3). Figure 25.2 shows the 10-year relative survival 

curves by age at diagnosis.

Site Cases

% of 

Cases

Relative Survival Rate (%)

1-Year

%

2-Year

%

3-Year

%

5-Year

%

8-Year

%

10-Year

%

Total 19,774 100.0 51.8 34.9 30.5 26.2 23.2 21.6

Brain 18,669 94.4 49.7 32.1 27.8 23.6 20.7 19.2

Other Central Nervous System 1,105 5.6 87.7 81.2 76.7 69.5 63.7 60.6

Table 25.2: Cancer of the Brain & Other CNS : 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by Site, Ages 20+, 

12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Brain

Other 

CNS

For all analyses, brain cancer and other CNS cancer are 

analyzed separately because of the distinct differences 

between these two groups in clinical presentation, treatment patterns, response to treatment, and survival (12). In 

some of the tables, 1-, 2-, 3-, 5-, 8-, and 10-year relative 

survival rates are presented and in the figures, they are 

presented annually.

Brain Cancer

The prognostic factors of interest for the brain cancer 

analysis were: race, sex, age at diagnosis, histologic type, 

grade and primary site. The combinations of particular 

interest were: race and sex, histologic type and sex and 

histologic type and race. Size of tumor information was 

not analyzed because of the large amount of missing data 

(46.8%) (Table 25.3). 

Race and Sex

For the analyses of relative survival, SEER classifies patients by race in three basic categories: white, black and 

Figure 25.1: Brain & Other Central Nervous System Cancer: 

Relative Survival by Primary Site, Ages 20+, 12 SEER Areas, 

1988-2001
Chapter 25 Cancer of the Brain and Nervous System

National Cancer Institute 206 SEER Survival Monograph 

Characteristics Cases % of Cases

Relative 

Survival Rate 

 5-Year (%)

Total Brain 18,669 100.0 23.6

Race

 White 16,824 90.1 23.4

 Black 924 4.9 22.8

 Other 921 4.9 29.2

Sex

 Male 10,701 57.3 22.9

 Female 7,968 42.7 24.6

Age

 20-29 1,504 8.1 64.4

 30-39 2,469 13.2 55.2

 40-49 3,011 16.1 32.8

 50-59 3,521 18.9 13.6

 60-69 3,854 20.6 5.8

 70-79 3,388 18.1 1.9

 80+ 922 4.9 1.3

Grade (Differentiation)

 Well differentiated; Grade I 478 2.6 77.0

 Moderately differentiated; Grade II 1,885 10.1 62.4

 Poorly differentiated; Grade III 1,642 8.8 18.3

 Undifferentiated; anaplastic; Grade IV 7,442 39.9 13.1

 Unknown 7,222 38.7 21.1

Size of tumor

 <=2cm 1,110 5.9 31.5

 2-5 cm 6,201 33.2 19.8

 >5 cm 2,619 14.0 20.8

 Unknown 8,739 46.8 26.1

Table 25.3: Cancer of the Brain: Race, Sex, Age (20+), Grade and Tumor Size, 12 SEER Areas, 

1988-2001
National Cancer Institute 207 SEER Survival Monograph 

Chapter 25 Cancer of the Brain and Nervous System

Sex/Race Cases

Relative Survival Rate (%)

% of 1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Cases % % % % % %

All 18,669 100.0 49.7 32.1 27.8 23.6 20.7 19.2

Male 10,701 57.3 50.5 31.7 27.2 22.9 19.8 18.3

 White 9,670 51.8 49.9 31.0 26.7 22.5 19.5 18.0

 Black 491 2.6 54.1 34.4 29.7 24.8 20.8 20.8

Female 7,968 42.7 48.6 32.7 28.4 24.6 21.9 20.3

 White 7,154 38.3 47.9 32.3 28.2 24.5 21.9 20.3

 Black 433 2.3 49.3 31.3 25.4 20.7 19.1 16.6

Table 25.4: Cancer of the Brain: 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival Rates (%) by Race and Sex, Ages 20+, 12 SEER Areas, 

1988-2001

Figure 25.2: Brain Cancer: Relative Survival Rates by Age 

Group, Ages 20+, 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

20-29

30-39

40-49

50-59

60-69

70-79

80+

Grade

Tumors are graded as Grades 1, 2, 3, 4, and unknown. 

Grade 1 tumors are well differentiated, grade 2 tumors 

are moderately differentiated, grade 3 tumors are poorly 

differentiated and grade 4 tumors are undifferentiated. A 

tumor that has an unknown grade means that there was 

insufficient information to grade the tumor. It is important 

to note that for brain cancer, grade is directly correlated 

with the histologic type of tumor classification.

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Grade I

Grade II

Grade III

Grade IV

Unknown

Figure 25.3: Brain Cancer: Relative Survival Rates by Grade, 

Ages 20+, 12 SEER Areas, 1988-2001

Survival for patients with brain cancer decreased from 

grade 1 to grade 4. The 5-year relative survival rates (%) 

for grade 1, grade 2, grade 3, grade 4 and unknown were 

77%, 62%, 18%, 13% and 21%. However, it is important to 

note that 39% of patients had unknown grade in this study 

sample. Figure 25.3 shows the 10-year relative survival 

curves by grade.
Chapter 25 Cancer of the Brain and Nervous System

National Cancer Institute 208 SEER Survival Monograph 

Histology and Sex

Males had similar proportions of astrocytomas (26-27%) 

and glioblastomas (53-54%) as compared to females. Survival rates by histologic type were similar or slightly higher 

for females compared to males except for ependymoma 

where males had a 5-year relative survival rate of 75% 

compared to 68% for females. Figures 25.5 and 25.6 show 

the 10-year relative survival rate (%) by histologic type 

and sex (males and females, respectively).

Histology and Race

Whites had a higher frequency of oligodendrogliomas and 

glioblastomas as compared to blacks (oligodendroglioma: 

9.5% vs. 8.2% and glioblastoma: 54.3% vs. 49.6%, respectively) and a lower frequency of astrocytoma as compared 

to blacks (astrocytoma: 26.5% vs. 28.5%). Relative survival rates (%) did differ by race for each histologic type. 

Table 25.5 shows the relative survival rates for invasive 

brain cancer by histologic type and race.

Primary Site

Brain cancer occurring in the frontal lobes (25.8% of total), temporal lobe (20.1% of total), parietal lobe (14.6% 

of total) and overlapping lesions of the brain (19.8% of 

total) were the most common. Relative survival rates (%) 

did differ by primary site, with tumors in the cerebrum, 

parietal lobe, occipital lobe, brain NOS, and overlapping 

lesions of the brain having the poorest survival, less than 

20% at 5 years.

Histology

An individual’s course of treatment, response to treatment 

and expected survival are all highly dependent on histologic 

type. Relative survival rates (%) varied greatly by histologic 

type (Table 25.5). The categories of histologic types of 

tumor used in this analysis (for brain cancer cases) were: 

glioma, glioma (other), ependymoma, astrocytoma, glioblastoma, oligodendroglioma, medulloblastoma, and other 

(germ cell neoplasms, neuroepitheliomatous neoplasms, 

other). Figure 25.4 shows the 10-year relative survival 

curves by histologic type.

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Glioma

Glioma, Other

Ependymoma

Astrocytoma

Glioblastoma

Oligodendroglioma

Medulloblastoma

Other

Figure 25.4: Brain Cancer: Relative Survival Rates by 

Histology, Ages 20+, 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Glioma

Glioma, Other

Ependymoma

Astrocytoma

Glioblastoma

Oligodendroglioma

Medulloblastoma

Other

Figure 25.5: Male Brain Cancer: Relative Survival Rates by 

Histology, Ages 20+, 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Glioma

Glioma, Other

Ependymoma

Astrocytoma

Glioblastoma

Oligodendroglioma

Medulloblastoma

Other

Figure 25.6: Female Brain Cancer: Relative Survival Rates by 

Histology, Ages 20+, 12 SEER Areas, 1988-2001
National Cancer Institute 209 SEER Survival Monograph 

Chapter 25 Cancer of the Brain and Nervous System

Race/

Histology Cases % of Cases

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

All Races 18,669 100.0 49.7 32.1 27.8 23.6 20.7 19.2

Glioma 1,076 5.8 69.4 57.6 51.8 45.2 39.8 36.7

Glioma, Other 100 0.5 69.2 54.4 46.2 36.3 32.8 27.6

Ependymoma 282 1.5 84.6 81.2 73.7 71.6 64.3 62.4

Astrocytoma 4,972 26.6 62.3 48.4 42.7 35.8 30.7 27.8

Glioblastoma 10,037 53.8 31.7 8.7 4.9 2.9 2.3 2.1

Oligodendroglioma 1,796 9.6 88.9 81.7 77.6 68.2 57.4 50.9

Medulloblastoma 216 1.2 89.2 84.6 78.4 66.4 56.8 52.5

Other 190 1.0 70.5 58.6 55.4 50.3 45.2 44.0

White 16,824 100.0 49.1 31.6 27.4 23.4 20.5 19.0

Glioma 966 5.7 68.5 57.3 51.2 44.9 39.4 36.3

Glioma, Other 85 0.5 69.9 55.2 47.3 37.5 35.6 29.5

Ependymoma 238 1.4 85.8 82.7 75.2 73.0 65.9 63.5

Astrocytoma 4,465 26.5 61.7 47.9 42.6 35.9 30.5 27.6

Glioblastoma 9,135 54.3 31.3 8.4 4.6 2.8 2.2 2.0

Oligodendroglioma 1,590 9.5 89.1 81.7 77.9 68.8 58.7 52.2

Medulloblastoma 195 1.2 89.6 85.5 79.2 65.5 57.2 52.2

Other 150 0.9 71.0 59.9 57.2 53.0 47.2 45.4

Black 924 100.0 51.8 32.9 27.7 22.8 20.0 19.4

Glioma 60 6.5 67.8 49.1 43.6 31.0 31.0 31.0

Glioma, Other 9 1.0 ~ ~ ~ ~ ~ ~

Ependymoma 22 2.4 ~ ~ ~ ~ ~ ~

Astrocytoma 263 28.5 64.4 48.1 40.6 33.3 29.5 27.5

Glioblastoma 458 49.6 33.9 10.1 7.1 5.3 3.0 3.0

Oligodendroglioma 76 8.2 79.6 71.9 63.1 50.2 37.6 28.5

Medulloblastoma 12 1.3 ~ ~ ~ ~ ~ ~

Other 24 2.6 ~ ~ ~ ~ ~ ~

~ Statistic not displayed due to less than 25 cases.

Table 25.5: Cancer of the Brain: 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival Rates (%) by Race and Histology, Ages 20+, 

12 SEER Areas, 1988-2001
Chapter 25 Cancer of the Brain and Nervous System

National Cancer Institute 210 SEER Survival Monograph 

Age at Diagnosis

Survival for patients diagnosed with other CNS cancer 

decreased as age at diagnosis increased except for ages 

20-29 which had poorer survival than 30-39, 40-49 and 

50-59 year olds and 80+ which had better survival than 

70-79 years of age. The 5-year relative survival rate 

(%) for other CNS cancer by age at diagnosis categories 

20-29, 30-39, 40-49, 50-59, 60-69, 70-79 and 80+ were 

70%, 81%, 77%, 72%, 66%, 41% and 58%, respectively 

(Table 25.7). Figure 25.7 shows the 10-year relative 

survival curves by age at diagnosis.

Grade

Survival for patients with other CNS cancer decreased 

from grade 1 to grade 4. The 5-year relative survival rate 

(%) for grade 1, grade 2, grade 3, grade 4 and unknown 

were 86%, 80%, 43%, 35% and 72%. However, it is 

important to note that 71.0% of patients had unknown 

grade in this study sample. Figure 25.8 shows the 10-

year relative survival curves by grade.

Other CNS Cancer 

The prognostic factors of interest for the other CNS cancer 

analysis were: race, sex, age at diagnosis, histologic type, 

grade, SEER stage of disease and primary site. Size of 

tumor information was not analyzed because of the large 

amount of missing data (65.9%) (Table 25.7).The combinations of interest were: race and sex, SEER stage and sex, 

SEER stage and grade, histologic type, race and sex and 

histologic type and SEER stage.

Race and Sex

For all race specific analyses of the 1,105 patients, only 

white and black patients (91%) are used, because the other 

category is made up of a mix of racial groups. As with 

the brain cancer group, the proportion of whites with other 

CNS cancer was much higher than the proportion of blacks 

with the same disease. However, survival was worse in 

blacks than in whites with other CNS cancer (5-year relative 

survival rate: 59% vs. 72%). Males and females develop 

other CNS cancer in comparable proportions and the relative survival rate was the same (69.5%). 5-year relative 

survival rate was shortest for black males. Table 25.7 and 

25.8 show the relative survival rates for other CNS cancer 

by race and sex.

Primary Site Cases % of Cases

Relative Survival Rate

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 18,669 100.0 49.7 32.1 27.8 23.6 20.7 19.2

Cerebrum 844 4.5 37.5 21.8 16.3 12.7 11.6 9.9

Frontal Lobe 4,812 25.8 58.9 42.9 37.9 32.4 27.8 25.6

Temporal Lobe 3,759 20.1 50.8 28.1 24.2 20.4 18.1 17.1

Parietal Lobe 2,735 14.6 43.5 23.9 19.8 16.1 13.8 12.8

Occipital Lobe 584 3.1 42.8 19.9 14.6 13.4 12.3 10.7

Ventricle, NOS 227 1.2 66.8 57.8 55.4 50.3 45.0 43.2

Cerebellum, NOS 545 2.9 82.4 74.6 68.4 62.9 58.0 55.4

Brain Stem 374 2.0 68.8 59.2 55.6 50.7 45.2 43.8

Overlapping lesion of brain 3,695 19.8 40.5 23.4 19.0 15.2 12.3 10.6

Brain, NOS 1,094 5.9 38.4 26.3 23.1 19.8 16.8 15.4

* NOS, Not Otherwise Specified

Table 25.6: Cancer of the Brain: 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival Rates (%) by Primary Site, Ages 20+, 12 SEER Areas, 1988-2001
National Cancer Institute 211 SEER Survival Monograph 

Chapter 25 Cancer of the Brain and Nervous System

Characteristics Cases

% of 

Cases

Relative 

Survival 

Rate 

5-Year (%)

All Cases 1,105 100.0 69.5

Race

 White 886 80.2 71.5

 Black 120 10.9 59.1

 Other 99 9.0 62.9

Sex

 Male 565 51.1 69.5

 Female 540 48.9 69.5

Age

 20-29 114 10.3 70.1

 30-39 167 15.1 80.8

 40-49 248 22.4 77.1

 50-59 202 18.3 72.4

 60-69 164 14.8 66.2

 70-79 154 13.9 40.7

 80+ 56 5.1 57.5

Grade (Differentiation)

 Well differentiated; Grade I 73 6.6 85.5

 Moderately differentiated; 

Grade II 113 10.2 79.7

 Poorly differentiated; Grade III 40 3.6 43.3

 Undifferentiated; anaplastic; 

Grade IV 95 8.6 35.4

 Unknown 784 71.0 72.3

Size of tumor

 <=2cm 78 7.1 89.2

 2-5 cm 198 17.9 71.2

 >5 cm 101 9.1 58.3

 Unknown 728 65.9 68.1

Table 25.7: Cancer of the Other Central Nervous System: 

Distributions and 5-Year Relative Survival Rates (%) by Race, 

Age(20+), Grade, and Tumor Size, 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

20-29

30-39

40-49

50-59

60-69

70-79

80+

Figure 25.7: Other Central Nervous System Cancer: Relative 

Survival Rates by Age Group (20+), 12 SEER Areas, 1988-2001

0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Grade I

Grade II

Grade III

Grade IV

Unknown

Figure 25.8: Other Central Nervous System Cancer: Relative 

Survival Rates by Grade, Ages 20+, 12 SEER Areas, 1988-2001

Table 25.8: Cancer of the Other Central Nervous System Cancer: 1-, 2-, 3-, 5-, 8- & 10-Year Relative Survival Rates (%) by Race and Sex, 

Ages 20+, 12 SEER Areas, 1988-2001

Sex/Race Cases % of Cases

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year 

All 1,105 100.0 87.7 81.2 76.7 69.5 63.7 60.6

Male 565 51.1 88.0 82.5 77.6 69.5 66.6 64.0

 White 476 43.1 88.9 85.3 80.3 72.4 69.2 67.0

 Black 49 4.4 87.1 65.4 63.9 57.9 57.2 49.5

Female 540 48.9 87.3 79.9 75.7 69.5 60.1 56.9

 White 410 37.1 88.2 81.6 76.9 70.5 61.4 60.4

 Black 71 6.4 83.2 68.1 67.3 59.7 53.9 47.5
Chapter 25 Cancer of the Brain and Nervous System

National Cancer Institute 212 SEER Survival Monograph 

Stage Cases % of Cases

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year 

Total 1,105 100.0 87.7 81.2 76.7 69.5 63.7 60.6

Localized 680 61.5 90.8 85.1 80.4 75.1 70.2 66.6

Regional 192 17.4 79.2 71.3 67.3 57.0 45.9 45.2

Distant 81 7.3 76.6 70.9 69.4 60.2 53.5 53.5

Unstaged 152 13.8 90.0 81.5 74.9 65.0 60.0 52.4

Table 25.9: Cancer of the Other Central Nervous System Cancer: 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by SEER Historic 

Stage, Ages 20+, 12 SEER Areas, 1988-2001

SEER Stage

Total

Race/Sex

White Black

Male Female Male Female

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 1,105 100.0 476 100.0 410 100.0 49 100.0 71 100.0

Localized 680 61.5 303 63.7 257 62.7 30 61.2 40 56.3

Regional 192 17.4 77 16.2 65 15.9 11 22.4 9 12.7

Distant 81 7.3 35 7.4 28 6.8 <5 - 7 9.9

Unstaged 152 13.8 61 12.8 60 14.6 <5 - 15 21.1

Table 25.10: Cancer of the Other Central Nervous System : Distribution of Cases by SEER Stage, Race and Sex, Ages 20+, 

12 SEER Areas, 1988-2001

Histology

Total

Race/Sex

White Black

Male Female Male Female

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 1,105 100.0 476 100.0 410 100.0 49 100.0 71 100.0

Ependymoma 355 32.1 190 39.9 130 31.7 7 14.3 11 15.5

Astrocytoma 167 15.1 75 15.8 53 12.9 13 26.5 13 18.3

Glioma 65 5.9 28 5.9 21 5.1 <5 - <8 -

Meningioma 456 41.3 152 31.9 182 44.4 23 46.9 38 53.5

Other 62 5.6 31 6.5 24 5.9 <5 - <5 -

Table 25.11: Cancer of the Other Central Nervous System: Distribution of Cases by Histology, Race and Sex, Ages 20+,

12 SEER Areas, 1988-2001
National Cancer Institute 213 SEER Survival Monograph 

Chapter 25 Cancer of the Brain and Nervous System

SEER Stage of Disease

SEER classifies invasive stage of disease into 4 categories: localized, regional, distant and unstaged. Survival 

decreased as the staging category progressed from localized 

to regional to distant. The 5-year relative survival rates 

(%) for other CNS cancer patients with localized, regional, 

distant and unknown stages of disease were 75%, 57%, 60% 

and 65%, respectively. It is also important to note that the 

majority of the other CNS patients were in the localized 

SEER stage category. Relative survival rates for other 

CNS cancer are shown by stage (Table 25.9) and stage by 

race/sex (Table 25.10). 

Histology

As previously noted, relative survival varied greatly by 

histology. The categories of histology of tumor used in 

this analysis, for other CNS cancer patients only, were: 

glioma, ependymoma, astrocytoma, meningioma and other 

(other, neuroepitheliomatous neoplasms, paragangliomas, 

and glomus tumors). Figure 25.9 shows the 10-year relative survival curves by histologic type. Tables 25.11 and 

25.12 show the distribution of patients by histology, race 

and sex and by histology and SEER stage of disease, respectively. 0

10

20

30

40

50

60

70

80

90

100

0 12 24 36 48 60 72 84 96 108 120

Relative Survival Rate (%)

Months after diagnosis

Ependymoma

Astrocytoma

Glioma

Meningioma

Other

Figure 25.9: Other Central Nervous System Cancer: Relative 

Survival Rates by Histology, Ages 20+, 12 SEER Areas, 1988-

2001

Histology

SEER Summary Stage

Total Local Regional Distant Unstaged

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 1,105 100.0 680 100.0 192 100.0 81 100.0 152 100.0

Ependymoma 355 32.1 287 42.2 25 13.0 14 17.3 29 19.1

Astrocytoma 167 15.1 127 18.7 10 5.2 8 9.9 22 14.5

Glioma 65 5.9 37 5.4 11 5.7 5 6.2 12 7.9

Meningioma 456 41.3 208 30.6 136 70.8 40 49.4 72 47.4

Other 62 5.6 21 3.1 10 5.2 14 17.3 17 11.2

Table 25.12: Cancer of the Other Central Nervous System: Distribution of Cases by Histology and SEER Summary Stage, Ages 20+, 12 

SEER Areas, 1988-2001

Primary Site Cases % of Cases

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year 

Total 1,105 100.0 87.7 81.2 76.7 69.5 63.7 60.6

Brain 456 41.3 83.0 73.8 68.2 56.9 48.0 41.7

Spine 596 53.9 92.1 87.9 83.5 78.8 74.8 73.0

Other 53 4.8 77.9 68.8 68.8 65.1 57.9 57.9

Table 25.13: Cancer of the Other Central Nervous System: 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by Primary Site,

 Ages 20+, 12 SEER Areas, 1988-2001

Primary Site

For patients with other CNS cancer, the spine was the most 

common primary site (53.9% of total), followed by the 

brain (41.3% of total) and other (4.8% of total). Other 

CNS cancers in the brain (malignant meningiomas) had 

worse survival compared to other CNS cancers in the spine 

(Table 25.13).
Chapter 25 Cancer of the Brain and Nervous System

National Cancer Institute 214 SEER Survival Monograph 

Discussion

Brain and other CNS cancer are rare, occurring at an incidence rate of approximately 6 cases per 100,000 per year. 

Malignant brain cancer cases excluding malignant meningiomas comprised 94% of the sample used for this analysis 

(18,669 patients out of 19,774 total combined patients). 

Five-year relative survival rate after diagnosis with brain 

cancer or other CNS cancer was 24% and 69%, respectively. Hence, individuals with brain cancer have a very 

poor prognosis as compared to individuals with other CNS 

cancer. These relative survival estimates show the distinct 

difference between the two types of cancer even though 

they both affect the central nervous system; therefore, brain 

cancer and other CNS cancer were analyzed separately.

For the brain cancer patients, survival varied only slightly by 

race and sex. Blacks had a similar 5-year relative survival 

rate as compared to whites and females had a slightly better 

5-year relative survival rate as compared to males. Black 

males had a 5-year relative survival rate of 25%, which is 

higher than black females (21%) or white males (23%) and 

similar to white females (25%). Survival differed the most 

by age at diagnosis, grade, and histologic type. As age 

increased the 5-year relative survival rate decreased from 

64% for ages 20-29 to 1% for ages 80+, with the highest 

proportion of patients diagnosed at age 60-69 (20.6% of 

total). Relative survival decreased as the grade of the tumor 

progressed from 1 to 4. Most of the patients had grade 4 or 

grade unknown tumors (39.9% and 38.7%). 

For brain cancer patients, survival also differed by histologic type of tumor and race, although most differences 

were small. Glioblastomas had the worst 5-year relative 

survival rate of 3% and ependymomas had the best 5-year 

relative survival rate of 74%. Fifty-four percent had glioblastomas and 1.5% had ependymomas. The distribution 

of histologic type by race differed slightly for whites and 

blacks. Malignant brain tumors in the temporal, frontal, 

parietal lobes and overlapping lesions of the brain were the 

most common locations in the brain. Malignant tumors in 

cerebrum and tumors in the occipital lobe had the worst 

survival at 5 years. 

For the other CNS cancer patients, survival varied more 

by race than by sex. Whites had a better 5-year relative 

survival rate as compared to blacks (72% vs. 59%), and 

males and females had the same 5-year relative survival 

rate (70%). Black males had a 5-year relative survival 

rate of 58%, which was lower than black females (60%), 

or white males (72%) or females (71%). Survival differed 

most by age at diagnosis, grade, histologic type and SEER 

stage. As age increased the 5-year relative survival rate 

decreased from 81% for ages 30-39 to 41% for ages 70-79, 

with the highest proportion of patients being diagnosed at 

age 40-49 (22.4% of total). Relative survival decreased as 

the grade of the tumor progressed from 1 to 4. However, 

over 70% of the 1,103 total patients had unknown grade 

information. Five-year relative survival rate decreased 

as SEER stage of disease became more advanced (localized 75%; regional 57% and distant 60%). There was no 

difference in the distribution of SEER stage by race and 

sex. Patients in the glioma category had the worst 5-year 

relative survival rate of 33% and ependymoma patients had 

the best 5-year relative survival rate of 95%. Less than 6% 

had glioma tumors and 32.1% had ependymomas. Black 

males and females had a higher proportion of astrocytomas 

and meningiomas as compared to white males and females. 

Whites had a much higher proportion of ependymomas. 

Tumors of the spine were the most common site with 

other CNS cancers, although malignant meningiomas of 

the brain had worse survival than those with malignant 

tumors in the spine.

Hence, race, age at diagnosis, grade, histologic type and 

primary site for both brain and other CNS cancers, and 

SEER stage (for other CNS cancers only) are all important 

predictors of survival, concurring with previous literature 

studying survival in brain and other CNS cancer patients 

(3, 4, 5, 6, 15). These variables are all used to determine 

one’s course of treatment and prognosis after diagnosis. 

The slight differences in survival by race and by race and 

histologic type of tumor for brain and other CNS cancers 

could be due to access to health care and/or socioeconomic 

status differences. However, recent studies suggest that 

these differences by race cannot be completely attributed to 

access to health care and/or diagnostic practices (6, 9) and 

may in fact be caused by biological differences. Older men 

and women would be more likely to have competing risks 

of death as compared to younger individuals with the same 

diagnosis, which would negatively affect their survival. 

Though competing risk information was unavailable for 

this analysis, performing relative survival analysis rather 

than absolute survival analysis allows for the adjustment 

of the expected mortality that the cohort would experience. 

Having a higher grade of tumor or a higher stage of cancer 

directly correlates with worse survival for almost every 

type of cancer (2). The patterns seen in this analysis for 

survival by histologic type for brain and other CNS cancers 

have been shown previously (3, 4, 6, 8), where brain cancer 

patients with GBM have the poorest survival, patients with 

oligodendroglioma have the best survival compared to any 

other histologic subtype, and other CNS cancer patients 

with ependymoma have the best survival compared to any 

other histologic subtype. Similar patterns by primary site 

of tumor have been seen previously also (8, 4, 15). 
National Cancer Institute 215 SEER Survival Monograph 

Chapter 25 Cancer of the Brain and Nervous System

REFERENCES

1. American Cancer Society. Cancer Facts and Figures 2006. 

Atlanta: American Cancer Society; 2006.

2. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer 

EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, 

Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

submission, posted to the SEER web site, 2006.

3. Davis FG, Freels S, Grutsch J, Barlas S, Brem S. Survival rates 

in patients with primary malignant brain tumors stratified by 

patient age and tumor histological type: an analysis based on 

Surveillance, Epidemiology, and End Results (SEER) data, 1973-

1991. J Neurosurg 1998;88:1-10

4. Surawicz TS, Davis F, Freels S, Laws ER Jr, Menck HR. Brain 

tumor survival: results from the National Cancer Data Base. J 

Neurooncol 1998; 40:151-60.

5. Wrensch M, Minn Y, Chew T, Bondy M, Berger MS. 

Epidemiology of primary brain tumors: current concepts and 

review of the literature. Neuro-oncol 2002; 4:278-99.

6. Barnholtz-Sloan JS, Sloan AE, Schwartz AG. Racial differences 

in survival after diagnosis with primary malignant brain tumor. 

Cancer 98:603-609, 2003a.

7. Polednak AP, Flannery BS. Brain, other central nervous system 

and eye cancer. Cancer Suppl 1995; 75:330-337.

8. Central Brain Tumor Registry of the United States (CBTRUS). 

Statistical Report: Primary Brain Tumors in the United States, 

1992-1997, Central Brain Tumor Registry of the United States 

(CBTRUS), www.cbtrus.org, 2003.

9. Surawicz TS, McCarthy BJ, Kupelian V, Jukich PJ, Bruner JM, 

Davis FG. Descriptive epidemiology of primary brain and CNS 

tumors: results from the Central Brain Tumor Registry of the 

United States, 1990-1994. Neuro-oncol. 1999; 1:14-25.

10. Mahaley MS Jr, Mettlin C, Natarajan N, Laws ER Jr, Peace BB. 

National survey of patterns of care for brain-tumor patients. J 

Neurosurg 1989; 71:826-36

11. Mahaley MS Jr, Mettlin C, Natarajan N, Laws ER Jr, Peace BB. 

Analysis of patterns of care of brain tumor patients in the United 

States: a study of the Brain Tumor Section of the AANS and the 

CNS and the Commission on Cancer of the ACS. Clin Neurosurg 

1990;36:347-52.

12. Gurney JG, Smith MA, Bunin GR. Chapter III: CNS and 

Miscellaneous Intracranial and Intraspinal Neoplasms. In: Ries 

LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, 

Bunin GR (eds). Cancer Incidence and Survival among Children 

and Adolescents: United States SEER Program 1975-1995, 

National Cancer Institute, SEER Program. NIH Pub. No. 99-4649. 

Bethesda, MD, 1999.

13. Kaplan EL, Meier P. Nonparametric estimation from incomplete 

observations. J Am Stat Assoc 1958; 53:457-481.

14. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy BJ, 

Murphy GP, O’Sullivan B, Sobin LH, Yarbro, JW (Eds.) AJCC 

Cancer Staging Manual, 5th edition. American Joint Committee 

on Cancer. Philadelphia: Lippincott-Raven, 1997.

15. Barnholtz-Sloan JS, Sloan AE, Schwartz AG. Relative survival 

and patterns of diagnosis by time period for individuals 

with primary malignant brain tumor 1973-1997. Journal of 

Neurosurgery 99:458-466, 2003b.

Acknowledgements

This work was supported by NCI contract number 

N01 PC35145 to the Metropolitan Detroit Cancer Surveillance System (Detroit SEER Registry).

We would like to thank Jennifer Brooks, Huong Do, and 

William Cheng for their assistance in preparing this chapter. 
Chapter 25 Cancer of the Brain and Nervous System

National Cancer Institute 216 SEER Survival Monograph 
National Cancer Institute 217 SEER Survival Monograph 

Introduction

Cancers of the thyroid are rare, accounting for approximately 2% of all diagnosed cancers, but account for over 

93% of all cancers of the endocrine system (1). Approximately 30,180 cases and 1,500 deaths occur each year in 

the United States (1). Thyroid cancer is nearly 3 times 

more common in women than men (1). Differentiated 

tumors, predominantly diagnosed as either papillary or 

follicular, are the most commonly diagnosed. Poorly or 

undifferentiated tumors, predominantly diagnosed as either medullary or anaplastic, are much less common, are 

aggressive with a tendency for early metastasis, and have 

a much poorer prognosis.

Results

Exclusions

Between 1988-2001, there were 29,345 thyroid cancers 

diagnosed in SEER . The following were excluded from 

the analysis: patients for whom thyroid cancer was not 

the first primary, cases identified through autopsy or death 

certificate only, persons of unknown race, cases without 

active follow-up or alive with no survival time, patients less 

than 20 years old, cases without microscopic confirmation, 

sarcomas and carcinoids. After these exclusions, 25,396 

adult cases remained for analysis (Table 26.1).

Age and Sex

Cancers of the thyroid were three times more likely to be 

diagnosed in women than in men (19,162 cases versus 

6,234) during the time frame examined. Almost 54% of 

the cancers in women were diagnosed between the ages 

of 20 to 44 compared to nearly 40% of those diagnosed 

in men while a higher percentage of men were diagnosed 

in the older age groups (Table 26.2).

For both sexes, together and separately, survival declines 

slightly with age. In women under age 45, 5-year relative survival rate is nearly 100% compared to 97% in 

women 45-64 and 84% in women aged 65 and older. In 

men under age 45, 5-year relative survival rate is 98% 

compared to 92% in men 45-64 and 83% in men aged 65 

and older (Table 26.3).

Carol L. Kosary

Chapter 26

Cancer of the Thyroid

Table 26.1: Cancer of the Thyroid: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number 

Excluded Reason for Exclusion/selection

29,345 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

26,812 2,533 Select first primary only

26,521 291 Exclude death certificate only or at autopsy

26,271 250 Exclude unknown race

26,195 76 Exclude alive with no survival time

25,509 686 Exclude children (Ages 0-19)

25,485 24 Exclude in situ cancers

25,416 69 Exclude no or unknown microscopic confirmation

25,403 13 Exclude sarcomas

25,396 7 Exclude carcinoids
Chapter 26 Cancer of the Thyroid

National Cancer Institute 218 SEER Survival Monograph 

Geographic Location

Five-year relative survival rates in the 12 SEER regions 

represented in this study ranged from 98% in Seattle (Puget 

Sound) to 89% in Rural Georgia (Table 26.4). 

Histology

Distribution by histology, overall and by sex, is presented 

in Table 26.5. In both males and females, a majority of the 

tumors are classified as papillary, although the percent is 

higher in females (83.7% ) than males (76.5%). Males are 

slightly more likely to be diagnosed with tumor classified 

as follicular (14.1% versus 11.0%), medullary (0.5% vs 

0.3%) and anaplastic (2.5% versus 1.3%) 

Similar comparisons between the sexes can be made when 

histology distribution is examined by age (Table 26.6). A 

higher percent of tumors are classified as papillary in both 

males and females under the age of 45 years compared 

to those over the age of 45 years (83.4% for males and 

88.5% for females under the age of 45 versus 71.9% for 

males and 78.3% for females ages 45 and older). Opposite 

findings are seen for those tumors classified as follicular 

and medullary. For ages under 45, 10.8% of the tumors 

are classified as follicular in males and 8.7% in females 

compared to 16.3% in males ages 45 and older and 13.7% 

in females. Tumors classified as medullary account for 

0.4% in males under age 45 and 0.2% in females versus 

0.6% in males ages 45 and older and 0.4% in females. 

Of the 399 cases of anaplastic tumors, 95% were seen in 

individuals ages 45 and older. For males 45 and older, 

3.8% of all tumors were classified as anaplastic compared 

to 2.7% in females. 

Staging

The American Joint Committee on Cancer (AJCC) has 

designated staging for cancers of the thyroid (2). Separate stage groupings are recommended for papillary, follicular, medullary and anaplastic cell types. In addition, 

within papillary and follicular, separate stage groupings 

are recommended based on age at diagnosis (20-44 and 

45+). The SEER modified fifth edition AJCC staging 

comprises:

Primary tumor (T):

TX: Primary tumor cannot be assessed

T0: No evidence of primary tumor

T1: Tumor 1 cm or less in greatest dimension 

limited to the thyroid

T2: Tumor more than 1 cm but not more than 4 cm 

in greatest dimension limited to the thyroid 

T3: Tumor more than 4 cm in greatest dimension 

limited to the thyroid

T4: Tumor of any size extending beyond the 

thyroid capsule 

Table 26.2: Cancer of the Thyroid: Number and Distributions of Cases by Age (20+) and Sex, 12 SEER Areas, 1988-2001

Age Group (Years)

Total Male Female

Cases Percent Cases Percent Cases Percent

Total 20+ 25,396 100.0 6,234 100.0 19,162 100.0

20-44 12,730 50.1 2,469 39.6 10,261 53.5

45-64 8,536 33.6 2,499 40.1 6,037 31.5

65+ 4,130 16.3 1,266 20.3 2,864 14.9

Table 26.3: Cancer of the Thyroid: Number of Cases, Median Survival Time (Months) and 5-year Survival Rates (%) by Sex 

and Age (20+), 12 SEER Areas, 1988-2001

Sex and Age Group (Years) Cases

Median 

Survival Time

(Months)

5-Year Survival Rate (%)

Observed Expected Relative

Both sexes, 20-44 12,730 > 120 98.6 99.3 99.3

Male, 20-44 2,469 > 120 96.9 98.7 98.1

Female, 20-44 10,261 > 120 99.0 99.5 99.6

Both sexes, 45-64 8,536 > 120 92.4 96.3 95.9

Male, 45-64 2,499 > 120 87.2 94.5 92.2

Female, 45-64 6,037 > 120 94.5 97.1 97.3

Both Sexes, 65+ 4,130 114.2 66.4 79.2 83.8

Male, 65+ 1,266 92.7 62.4 74.9 83.3

Female, 65+ 2,864 > 120 68.2 81.1 83.9
Chapter 26 Cancer of the Thyroid

National Cancer Institute 219 SEER Survival Monograph 

Table 26.4: Cancer of the Thyroid: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by SEER Geographic Area, Ages 20+, 12 SEER Areas, 1988-2001

SEER Geographic Area Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 25,396 100.0 97.0 96.5 96.4 96.0 95.8 95.6

Atlanta and Rural Georgia 1,666 6.6 97.7 97.2 96.5 95.5 95.1 95.1

 Atlanta (Metropolitan) - 1988+ 1,614 6.4 97.6 97.1 96.7 95.7 95.2 95.2

 Rural Georgia - 1988+ 52 0.2 98.9 97.9 92.3 89.4 89.4 88.2

California

 Los Angeles - 1992+ 4,762 18.8 96.9 96.3 95.8 95.0 94.4 93.7

 Greater Bay Area 4,437 17.5 96.7 96.3 96.3 95.9 95.7 95.4

 San Francisco-Oakland SMSA - 1988+ 2,832 11.2 96.5 96.3 96.1 95.5 95.1 95.1

 San Jose-Monterey - 1988+ 1,605 6.3 97.2 96.2 96.2 96.2 96.2 95.4

Connecticut - 1988+ 2,521 9.9 94.8 94.2 94.0 93.9 93.6 93.6

Detroit (Metropolitan) - 1988+ 2,916 11.5 96.6 96.4 96.1 95.6 95.3 94.5

Hawaii - 1988+ 1,164 4.6 96.9 96.4 96.2 95.2 94.1 92.8

Iowa - 1988+ 2,158 8.5 97.6 96.9 96.7 96.6 96.6 96.6

New Mexico - 1988+ 1,375 5.4 97.4 97.1 97.1 96.8 96.8 96.7

Seattle (Puget Sound) - 1988+ 2,842 11.2 98.3 98.0 97.9 97.7 96.8 96.4

Utah - 1988+ 1,555 6.1 97.4 97.1 97.1 96.9 96.9 96.8

Table 26.5: Cancer of the Thyroid: Number and Distribution of Cases by Histology and Sex, Ages 20+, 12 SEER Areas, 1988-2001

Histology ICD-O Code

Total Male Female

Cases Percent Cases Percent Cases Percent

Total 8000-9989 25,396 100.0 6,234 100.0 19,162 100.0

Epidermoid 8051-8130 58 0.2 26 0.4 32 0.2

Adenocarcinoma

8050,8140-8147,8160-8162,8180-

8221,8250-8506,8520-

8550,8560,8570-8573,8940-8941 

24,587 96.8 5,935 95.2 18,652 97.3

 Papillary 8050,8260,8340,8350,8450 20,814 82.0 4,767 76.5 16,047 83.7

 Follicular 8290,8330-8332 2,991 11.8 880 14.1 2,111 11.0

 All Other Adenocarcinoma

8140-8147,8160-8164,8180-

8221,8250-8259,8261-8289,8291-

8329,8333-8339,8341-8349,8351-

8449,8451-8506,8520-

8550,8560,8570-8573,8940-8941 

782 3.1 288 4.6 494 2.6

Other Specified Carcinomas

8033-8045,8150-8155,8170-

8171,8230-8248,8510-8512,8561-

8562,8580-8671 

95 0.4 41 0.7 54 0.3

 Medullary 8510-8511 86 0.3 34 0.5 52 0.3

 All Other Specified Carcinomas

8033-8045,8150-8155,8170-

8171,8230-8248,8512,8561-

8562,8580-8671 

9 0.0 7 0.1 <5 0.0

Carcinoma, NOS* 8004,8010-8022,8030-8032 613 2.4 218 3.5 395 2.1

 Anaplastic 8004,8012,8020-8021,8030-8032 399 1.6 155 2.5 244 1.3

 All Other Carcinoma, NOS* 8010-8011,8013-8019,8022 214 0.8 63 1.0 151 0.8

Unspecified Other Specified 

Types

8000-8003, 8720-8790,8932-

8933,8950-8982,9000-

9030,9060-9110,9350-

9364,9380-9512,9530-9539 

 

43 0.2 14 0.2 29 0.1

* NOS: Not Otherwise Specified
Chapter 26 Cancer of the Thyroid

National Cancer Institute 220 SEER Survival Monograph 

Table 26.8: Thyroid Papillary Adenocarcinoma (with Established Stage) : Number of Cases and 5-Year Relative Survival Rates 

(%) by AJCC Stage (SEER modified 5th Edition) and Age (20+), 12 SEER Areas, 1988-2001

AJCC Stage

Age (Years)

Total 20-44 45-64 65+

Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%) Cases

5-Year 

Relative 

Survival 

Rate (%)

Total w/ Established Stage 19,607 98.7 10,822 99.7 6,374 98.3 2,411 94.2

Stage I 13,289 99.8 10,740 99.8 1,961 99.3 588 98.1

Stage II 3,195 99.9 82 86.7 2,368 99.9 745 100.0

Stage III 2,870 93.3 * * 1,923 96.3 947 86.6

Stage IV 253 46.4 * * 122 57.0 131 33.6

* Under 45 Age Group Only Staged at I or II

Table 26.6: Cancer of the Thyroid: Number and Distribution of Cases by Histology, Age (20+) and Sex, 

12 SEER Areas, 1988-2001

Histology

Age (Years)

20-44 45+

Male Female Male Female

Cases Percent Cases Percent Cases Percent Cases Percent

Total 2,469 100.0 10,261 100.0 3,765 100.0 8,901 100.0

Epidermoid <5 ~ 5 0.0 22 0.6 27 0.3

Adenocarcinoma 2,425 98.2 10,176 99.2 3,510 93.2 8,476 95.2

 Papillary 2,059 83.4 9,078 88.5 2,708 71.9 6,969 78.3

 Follicular 266 10.8 894 8.7 614 16.3 1,217 13.7

 All Other Adenocarcinoma 100 4.1 204 2.0 188 5.0 290 3.3

Other Specified Carcinomas 10 0.4 19 0.2 31 0.8 35 0.4

 Medullary 10 0.4 19 0.2 24 0.6 33 0.4

 All Other Specified Carcinomas 0 0.0 0 0.0 7 0.2 <5 ~

Carcinoma, NOS* 25 1.0 55 0.5 193 5.1 340 3.8

 Anaplastic 11 0.4 7 0.1 144 3.8 237 2.7

 All Other Carcinoma, NOS* 14 0.6 48 0.5 49 1.3 103 1.2

Other Specified Types <5 ~ <5 ~ 0 0.0 0 0.0

Unspecified <5 ~ 5 0.0 9 0.2 23 0.3

* NOS: Not Otherwise Specified

 ~ Statistic not displayed.

Table 26.7: Thyroid Papillary Adenocarcinoma (with Established Stage): Number and Distribution of Cases by Age (20+) and 

AJCC Stage (SEER modified 5th Edition), 12 SEER Areas, 1988-2001

Age Group (Years)

AJCC Stage

Total with

 Established 

Stage

I II III IV

Cases Row 

Percent Cases Row Percent Cases Row Percent Cases Row Percent Cases Row Percent

Total w/ Established Stage 19,607 100.0 13,289 67.8 3,195 16.3 2,870 14.6 253 1.3

20-44 10,822 100.0 10,740 99.2 82 0.8 * * * *

45-64 6,374 100.0 1,961 30.8 2,368 37.2 1,923 30.2 122 1.9

65+ 2,411 100.0 588 24.4 745 30.9 947 39.3 131 5.4

* Under 45 Age Group Only Staged at I or II
Chapter 26 Cancer of the Thyroid

National Cancer Institute 221 SEER Survival Monograph 

Regional lymph nodes (N) (Note: Regional lymph nodes 

are the cervical and upper mediastinal lymph nodes.)

NX: Regional lymph nodes cannot be assessed

N0: No regional lymph node metastasis

N1: Regional lymph node metastasis

 N1a: Metastasis in ipsilateral cervical lymph 

node(s)

 N1b: Metastasis in bilateral, midline, or 

contralateral cervical or mediastinal lymph node(s) 

Distant metastases (M) 

MX: Distant metastasis cannot be assessed 

M0: No distant metastasis

M1: Distant metastasis 

Papillary or follicular

Under 45 years

 Stage I: Any T, any N, M0 

 Stage II: Any T, any N, M1 

45 years and older

 Stage I : T1, N0, M0

 Stage II : T2, N0, M0 

 T3, N0, M0

 Stage III : T4, N0, M0 

 Any T, N1, M0

 Stage IV: Any T, any N, M1

Medullary

 Stage I: T1, N0, M0 

 Stage II: T2, N0, M0 

 T3, N0, M0

 T4, N0, M0 

 Stage III: Any T, N1, M0

 Stage IV: Any T, any N, M1 

Anaplastic [Note: All cases are stage IV ]

 Stage IV: Any T, any N, any M 

Papillary

Survival by Age and Stage

Of the 20,814 cases of papillary, enough information to 

establish stage at diagnosis was available for 19,607 (94%). 

The staging scheme for individuals diagnosed under the age 

of 45 places individuals in either stage I or II depending in 

the presence or absence of metastasis. Most of the cases 

diagnosed in this age group were stage I (99.2%).

For ages 45 and older, the percent diagnosed in stage I 

declines with age, from 30.8% in ages 45-64 to 24.4% in 

ages 65+. At the same time the percent diagnosed stage 

IV increases from 1.9% in ages 45-64 to 5.4% in ages 65+ 

(Table 26.7).

90

100

%)

*

70

80

al Rate (

%

*

50

60

ve Surviva

30

40

Relativ

0

10

20

Stage I Stage II Stage III Stage IV

AJCC Stage

20-44 45-64 65+

Figure 26.1: Papillary Cancer of the Thyroid: 5-Year Relative 

Survival Rate (%) by AJCC Stage (5th Edition) and Age Group 

(20+), 12 SEER Areas, 1988-2001

90

100

70

80

%)

Stage I

60

70

val Rate (

%

Stage II, <45

Stage II, 45+

40

50

ive Surviv

Stage II, 45

Stage III

Stage IV

20

30

Relati

Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 26.2: Papillary Cancer of the Thyroid: Relative Survival 

Rates (%) by AJCC Stage (5th Edition), Ages 20+, 12 SEER 

Areas, 1988-2001

* Under 45 age group only staged at I or II 
Chapter 26 Cancer of the Thyroid

National Cancer Institute 222 SEER Survival Monograph 

No survival differentials by age are seen in both stages I 

and II, with the exception of those diagnosed 20-44 years 

of age, where stage II consists of those with metastasis 

at the time of diagnosis. Higher survival in both stages 

III and IV is observed in those diagnosed in the 45-64 

age group compared to those 65+. Since stage II in those 

diagnosed 20-44 years of age is equivalent to a stage IV 

diagnosis in those 45 and older, a large survival differential is observed in those with metastases at diagnosis 

who are 20-44 years of age compared to those 45 and 

older. (Table 26.8 and Figure 26.1)

Survival by Stage

Table 26.9 and Figure 26.2 show the contrast between 

stage at diagnosis and years since diagnosis (with stage 

II broken out for those 20-44 versus 45+). The steepest 

declines in survival rates are observed within 5 years of 

Table 26.9: Thyroid Papillary Adenocarcinoma (with Established Stage): Number and Distribution of Cases and 1-, 2-, 

3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by AJCC Stage (SEER modified 5th Edition), Ages 20+, 12 SEER Areas, 

1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total with Established 

Stage 19,607 100.0 99.1 99.0 99.0 98.7 98.4 98.2

Stage I 13,289 67.8 99.8 99.8 99.8 99.8 99.8 99.8

Stage II, 20-44 82 0.4 92.7 91.5 90.3 86.7 76.4 76.4

Stage II, 45+ 3,113 15.9 99.9 99.9 99.9 99.9 99.9 99.9

Stage III 2,870 14.6 97.2 96.0 95.4 93.3 90.7 87.8

Stage IV 253 1.3 71.7 65.9 59.5 46.4 41.3 40.7

Table 26.10: Thyroid Follicular Adenocarcinoma (with Established Stage): Number of Distribution of Cases by Age (20+) and 

AJCC Stage (5th Edition), 12 SEER Areas, 1988-2001

Age Group (Years)

AJCC Stage

Total with

 Established Stage I II III IV

Cases Row 

Percent Cases Row Percent Cases Row Percent Cases Row Percent Cases Row Percent

Total 20+ 2,718 100.0 1,205 44.3 1,032 38.0 299 11.0 182 6.7

20-44 1,143 100.0 1,129 98.8 14 1.2 * * * *

45-64 911 100.0 54 5.9 658 72.2 135 14.8 64 7.0

65+ 664 100.0 22 3.3 360 54.2 164 24.7 118 17.8

* Under 45 Age Group Only Staged at I or II

Table 26.11: Thyroid Follicular Adenocarcinoma (with Established Stage): Number of Cases and 5-Year Relative Survival Rates 

(%) by AJCC Stage (5th Edition) and Age (20+), 12 SEER Areas, 1988-2001

AJCC Stage

Age (Years)

Total 20-44 45-64 65+

Cases

5-Year 

Relative 

Survival 

Rate (%)

Cases

5-Year 

Relative 

Survival 

Rate (%)

Cases

5-Year 

Relative 

Survival 

Rate (%)

Cases

5-Year 

Relative 

Survival 

Rate (%)

Total with Established 

Stage 2,718 95.6 1,143 99.2 911 95.9 664 86.8

Stage I 1,205 99.6 1,129 99.5 54 100.0 22 ~

Stage II 1,032 99.9 14 ~ 658 99.6 360 99.8

Stage III 299 83.7 * * 135 87.8 164 79.1

Stage IV 182 45.5 * * 64 54.0 118 40.4

* Under 45 Age Group Only Staged at I or II

 ~ Statistic not displayed due to less than 25 cases.
Chapter 26 Cancer of the Thyroid

National Cancer Institute 223 SEER Survival Monograph 

diagnosis for those diagnosed in stage IV. The favorable 

outcome for stage II in those diagnosed under the age 

of 45 is evident when compared to the outcome of the 

comparable stage IV in those age 45 and older.

Follicular

Survival by Age and Stage

Of the 2,991 cases of follicular, enough information to 

establish stage at diagnosis was available for 2,718 (91%). 

The staging scheme for individuals diagnosed under the 

age of 45 places individuals in either stage I or II depending in the presence or absence of metastasis. Most of the 

cases diagnosed in this age group were stage I (98.8%).

For ages 45 and older, the percent diagnosed in stages 

I and II declines with age from 5.9% for ages 45-64 to 

3.3% for ages 65+ in stage I and 72.2% for ages 45-64 

to 54.2% for ages 65+ in stage II. At the same time the 

percent diagnosed stage III & IV increases from 14.8% 

for ages 45-64 to 24.7% for ages 65+ in stage III and 

7.0% for ages 45-64 to 17.8% for ages 65+ in stage IV 

(Table 26.10).

No survival differentials by age are seen in both stage 

I and II between those age groups where enough cases 

are available for analysis. Higher survival rates in both 

stages III and IV is observed in those diagnosed in the 

45-64 age group compared to those 65+. Unfortunately, 

not enough cases are available to make any observations 

concerning stage II in individuals under the age of 45 

or stage I on individuals ages 65 and older (Table 26.11 

and Figure 26.3)

Survival by Stage

Table 26.12 shows the contrast between stage at diagnosis 

and years since diagnosis. A steady decline in survival 

rate is observed in stage IV throughout most of the 10 

years observed. The favorable outcome for stages I-III is 

also evident. Figure 26.4 shows 5-year relative survival 

rates by stage and time since diagnosis.

Medullary

Survival by Stage

Of the 86 cases of medullary, enough information to establish stage at diagnosis was available for 80 (93%). Most 

cases were diagnosed in either stage II or III (42.5% and 

43.8% respectively) (Table 26.13).

Only small differentials in 5-year relative survival rates 

are observed between stages II and III (Table 26.14 and 

Figure 26.5). This is also evident for longer survival 

periods (Table 26.14 and Figure 26.5).

Anaplastic

Survival by Age

All anaplastic tumors are categorized as stage IV. Of the 

399 cases observed, approximately 67% were diagnosed 

in individuals ages 65 and older (Table 26.15). Five-year 

relative survival rates could be calculated for ages 45 and 

older only (accounting for 96% of the cases). Survival 

rates were higher for those diagnosed between the ages of 

45-65 compared to those aged 65 and older (Table 26.15). 

This was also evident for shorter and longer periods of 

survival (Table 26.16 and Figure 26.6).

References

1. American Cancer Society, Cancer Facts and Figures, 2006, 

American Cancer Society, Atlanta, 2006.

2. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy 

BJ, Murphy GP, O’Sullivan B, Sobin LH, Yarbro, JW (eds). 

AJCC Cancer Staging Manual, Fifth edition, American Joint 

Committee on Cancer. Philadelphia: Lippincott-Raven, 1997.

90

100

(%)

*

** **

70

80

vival Rate 

*

40

50

60

ative Surv

20

30

40

Rela

0

10

20

Stage I Stage II Stage III Stage IV

AJCC Stage

20-44 45-64 65+

Figure 26.3: Follicular Cancer of the Thyroid: 5-Year Relative 

Survival Rate (%) by AJCC Stage (SEER modified 5th Edition) 

and Age Group (20+), 12 SEER Areas, 1988-2001

* Under 45 age group only staged at I or II 

** Statistic not displayed due to less than 25 cases for ages 20-44 

Stage II and age 65+ Stage II 
Chapter 26 Cancer of the Thyroid

National Cancer Institute 224 SEER Survival Monograph 

Table 26.12: Thyroid Follicular Adenocarcinoma (with Established Stage): Number and Distribution of Cases and 1-, 2-, 3-, 5-, 

8-, & 10-Year Relative Survival Rates (%) by AJCC Stage (5th Edition), 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total with Established Stage 2,718 100.0 97.4 96.7 96.1 95.6 94.2 94.0

Stage I 1,205 44.3 99.6 99.6 99.6 99.6 99.6 99.3

Stage II 1,032 38.0 100.0 99.9 99.9 99.9 99.3 98.8

Stage III 299 11.0 90.0 87.5 86.1 83.7 80.3 80.3

Stage IV 182 6.7 77.7 70.3 61.1 45.5 32.8 24.5

Table 26.13: Thyroid Medullary Carcinoma (with Established 

Stage): Number, Distribution, and 5-Year Relative Survival 

Rates (%) by AJCC Stage (SEER modified 5th Edition), 

12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

5-Year 

Relative 

Survival 

Rate (%)

Total with Established 

Stage 80 100.0 82.1

Stage I <7 - ~

Stage II 34 42.5 89.6

Stage III 35 43.8 82.3

Stage IV <5 - ~

 ~ Statistic not displayed due to less than 

25 cases.

Table 26.14: Thyroid Medullary Carcinoma: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival 

Rates (%) by AJCC Stage (SEER modified 5th Edition), 12 SEER Areas, 1988-2001

AJCC Stage Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total with Established 

Stage 80 100.0 97.0 91.5 83.9 82.1 81.3 77.9

Stage I <5 - ~ ~ ~ ~ ~ ~

Stage II 34 42.5 97.5 94.5 89.6 89.6 86.3 77.1

Stage III 35 43.8 100.0 95.4 89.8 82.3 82.3 82.3

Stage IV <8 - ~ ~ ~ ~ ~ ~

 ~ Statistic not displayed due to less than 25 cases.

Table 26.15: Thyroid Anaplastic Carcinoma: Number, 

Distribution, and 5-Year Relative Survival Rates (%) by Age 

(20+), 12 SEER Areas, 1988-2001

Age (Years) Cases Percent

5-Year 

Relative 

Survival 

Rate (%)

Total 20+ 399 100.0 9.1

20-44 18 4.5 ~

45-64 113 28.3 13.7

65+ 268 67.2 4.0
Chapter 26 Cancer of the Thyroid

National Cancer Institute 225 SEER Survival Monograph 

Table 26.16: Thyroid Anaplastic Carcinoma: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year 

Relative Survival Rates (%) by Age (20+), 12 SEER Areas, 1988-2001

Age (Years) Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year

Total 20+ 399 100.0 19.4 13.0 11.1 9.1 9.1 9.1

20-44 18 4.5 ~ ~ ~ ~ ~ ~

45-64 113 28.3 24.4 20.8 19.0 13.7 13.7 13.7

65+ 268 67.2 14.7 7.2 5.0 4.0 3.5 3.5

 ~ Statistic not displayed due to less than 25 cases.

90

100

70

80

te (%) 60

70

rvival Ra

45-64

40

50

elative Su

65+

20

R

30 e

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 26.6: Anaplastic Cancer of the Thyroid: Relative Survival 

Rates (%) by Age Group (20+), 12 SEER Areas, 1988-2001

90

100

70

80

%)

Stage I

60

70

val Rate (

%

Stage I

Stage II

40

50

ive Surviv

Stage III

Stage IV

20

30

Relati

Stage IV

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 26.4: Follicular Cancer of the Thyroid: Relative Survival 

Rates (%) by AJCC Stage (SEER modified 5th Edition), Ages 

20+, 12 SEER Areas, 1988-2001

90

100

70

80

%) 60

70

val Rate (

%

Stage II

40

50

ive Surviv

Stage III

20

30

Relati

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 26.5: Medullary Cancer of the Thyroid: Relative Survival 

Rates (%) by AJCC Stage (SEER modified 5th Edition), Ages 

20+, 12 SEER Areas, 1988-2001
Chapter 26 Cancer of the Thyroid

National Cancer Institute 226 SEER Survival Monograph 
National Cancer Institute 227 SEER Survival Monograph 

Introduction

Hodgkin Lymphoma (HL) is a cancer of the lymphoid cells 

with which an estimated 7,800 persons are diagnosed each 

year in the United States (1). Although it is a relatively 

rare cancer in the general population, it is one of the most 

common cancers diagnosed in young persons. A hallmark 

feature of HL epidemiology is its bimodal age-specific 

incidence pattern, in which incidence is highest between 

the ages of 15 and 34 years, declines between ages 35 

and 54 years and increases again after age 55 years. Indeed, HL is unique among cancers in that over two-thirds 

of patients are diagnosed before 50 years of age. HL is 

also notable among cancers for the availability of curative therapy, which has resulted in relatively favorable 

outcomes. Despite its relatively low level of occurrence 

and high curability, it is the propensity of HL to occur 

in the productive years of life that makes it a significant 

source of cancer-related morbidity and mortality in the 

US. In fact, HL ranks third behind childhood cancers and 

testicular cancer in the average years of life lost to a cancer 

(2). This chapter examines survival characteristics in a 

large, population-based cohort of patients diagnosed with 

HL between 1988 and 2001 and reported to the National 

Cancer Institute’s Surveillance, Epidemiology, and End 

Results (SEER) program. 

Materials and Methods

Patients

Analyses included all patients aged 15 years or over diagnosed with HL between 1988 and 2001 and reported 

to the SEER program. Patients were followed for vital 

status until 2002. Table 27.1 details exclusions, resulting 

in a final series of 11,720 patients. The majority of the 

eligible patients were young adults, defined as ages 15-44 

at diagnosis (n=8,001, 68%), and of white race/ethnicity 

(n=10,154, 87%). In addition, there were slightly more 

male (n= 6,428, 55%) than female patients. 

Stage classification

HL tumors almost always develop in a lymph node or other 

lymphoid structure and spread contiguously to nearby 

nodes (3). In the SEER database, classification of stage 

of disease at diagnosis for HL follows the Ann Arbor 

guidelines (4). In brief, the Ann Arbor system provides 

four stages of tumor spread relative to the diaphragm: 

I--involvement of a single lymph node region, II-- involvement of two or more lymph node regions on one 

side of the diaphragm, III--involvement of lymph node 

regions on both sides of the diaphragm, IV--disseminated 

Christina Clarke, Cynthia O’Malley, and Sally Glaser

Chapter 27

Hodgkin Lymphoma

Table 27.1: Hodgkin Lymphoma: Number of Cases and Exclusions by Reason, 

12 SEER Areas, 1988-2001

Number selected/remaining Number excluded Reason for exclusion/selection

13,302 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

12,560 742 Select first primary only

12,498 62 Exclude death certificate only or at autopsy

12,384 114 Exclude unknown race

12,361 23 Exclude alive with no survival time

11,777 584 Exclude children (Ages 0-14)

11,777 0 Exclude in situ cancers for all except breast & bladder cancer

11,720 57 Exclude no or unknown microscopic confirmation

11,720 0 Exclude sarcomas
Chapter 27 Hodgkin Lymphoma

National Cancer Institute 228 SEER Survival Monograph 

disease. Each stage can be subclassified as AA” or AB” 

type according to the absence or presence of B-symptoms, 

respectively; these include fever, night sweats, generalized pruritus or weight loss of greater than 10 percent 

of total body mass. In these analyses, stage information 

was incomplete for 485 patients (4%), while information 

regarding B-symptoms was incomplete for 3,188 patients 

with known stage, or 27% of the total. Patients with incomplete stage or B-symptom information were excluded 

only from analyses addressing those variables.

Histologic classification

HL is distinguished from other lymphomas by the histologic presence of malignant Hodgkin and Reed-Sternberg 

(HRS) cells. The relative proportion of HRS cells to reactive cells and fibrosis within the tumor define the main 

histologic subtypes of HL. In this analysis, we defined 

histologic subtypes according to the WHO classification 

system (5): nodular sclerosing (NS), mixed cellularity 

(MC), nodular lymphocyte predominance (nodular LP) 

and lymphocyte depletion (LD). Beginning with 2001 

data, lymphocyte rich (LR) could not be separated out. 

The subtypes were assigned using ICD-O-2 morphology 

codes (6): NS (M-9663-9667), MC (M-9652), nodular LP 

(M-9659) and LD (M-9653-9655). Patients with unknown 

histologic subtype were described as HL, not otherwise 

specified (NOS), ICD-O-2 code M-9650, and included 

in all analyses. 

Statistical methods

Survival over time was measured by the relative survival 

rate, which measures the percentage of cancer patients 

surviving a given time from diagnosis adjusted for the 

survival experience of an age-, sex-, race-, and calendar year-matched cohort as determined from US vital 

statistics life tables. Detailed information regarding the 

calculation of the relative survival rate is provided in the 

introduction to this monograph.

Results

Between 1988 and 2001, the availability of effective therapy for HL is reflected in the favorable relative survival 

rates for patients diagnosed in SEER areas. Ninety-two 

percent of all patients survived beyond one year after 

diagnosis, relative to the general population. However, 

this rate decreased steadily with time since diagnosis. 

Relative survival rate was 83% at five years and 78% at 

ten years (Table 27.2). As detailed below, relative survival 

for HL varies by age, sex, race/ethnicity, and stage of 

disease (Table 27.2). Relative survival was not observed 

to vary substantially by SEER region (data not shown). 

Table 27.2: Hodgkin Lymphoma: Number and Distribution of Cases and Relative Survival Rates (%) by Sex, Race, Age 

(15+), Ann Arbor Stage, and Symptoms, 12 SEER Areas, 1988-2001

Characteristics Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year 

Total 11,720 100.0 92.0 88.3 86.2 83.0 79.1 78.1

Sex

 Male 6,428 54.8 91.2 87.0 84.5 80.8 76.3 75.5

 Female 5,292 45.2 92.9 89.9 88.2 85.6 82.3 81.1

Race

 White 10,154 86.6 92.2 88.6 86.5 83.7 80.2 79.3

 Black 1,129 9.6 90.3 85.8 83.9 77.5 70.7 69.4

Age (Years)

 15-44 8,001 68.3 97.3 94.5 92.8 89.9 86.6 85.4

 45-64 2,165 18.5 89.1 83.5 79.9 74.8 67.4 64.9

 65+ 1,554 13.3 67.6 60.2 56.3 50.6 40.4 36.6

Ann Arbor 

Stage

 I 2,778 23.7 95.9 93.4 91.7 89.0 85.1 84.7

 II 4,344 37.1 96.6 93.7 92.1 89.3 85.5 84.4

 III 2,220 18.9 90.4 86.4 84.1 80.8 77.5 75.7

 IV 1,893 16.2 77.7 71.0 67.4 62.6 57.3 56.0

 Unknown 485 4.1 90.0 85.4 82.3 78.4 74.0 74.0

Symptoms

 A 4,015 34.3 96.4 94.5 93.2 91.1 87.7 87.2

 B 4,139 35.3 88.0 83.1 80.1 76.2 71.9 69.9

 Unknown 3,566 30.4 91.6 87.3 85.1 81.5 77.5 76.8
Chapter 27 Hodgkin Lymphoma

National Cancer Institute 229 SEER Survival Monograph 

In general, young-adult female patients with early stage 

disease were observed to have the most favorable relative 

survival, while older, male patients with late stage disease 

had the least favorable survival rates.

Age at diagnosis

Age at diagnosis substantially impacted relative survival. 

Figure 27.1 shows five and ten-year relative survival rates 

by detailed age at diagnosis. Both five and ten-year estimates 

declined with advancing age at diagnosis. Ten-year relative 

survival rates generally exceeded 80% for persons 15-24, 

25-34, and 35-44 years at diagnosis, but were substantially 

lower in older age groups. For persons diagnosed at age 

75 or older, relative survival was poor, 38% at five years 

and 21% at 10 years. 

Based both on observations from Figure 27.2 as well as 

epidemiologic features, the data were stratified into three 

age groups for further analysis: young adults (ages 15-44 

at diagnosis), middle-aged adults (ages 45-64), and older 

adults (ages 65+). Figure 27.2 shows relative survival over 

time for patients diagnosed in these age groupings. In the 

first two years after diagnosis, relative survival decreased 

more sharply for older adults (65+) than young or middleaged adults. At six months after diagnosis, the relative 

survival rates for older adults was lower than 80%, and at 

24 months, had decreased further to nearly 60%. In contrast, relative survival rate exceeded 80% for young-adult 

patients across the entire ten-year follow-up period. Figure 

27.2 also shows that relative survival does not stabilize but 

rather declines continuously over the ten-year follow-up 

period irrespective of age at diagnosis.

Sex

Figure 27.2 also shows that sex differentially impacts relative survival rate among young, middle-aged, and older 

adults. In young adults, females exhibit more favorable 

survival across the entire ten-year follow-up period, while 

male-female relative survival differences are smaller for 

middle-aged HL patients. These patterns are also evident 

in the five-year relative survival rates for males and females by age group. In young adults, five-year relative 

survival rate was 87% for males and 93% for females. In 

middle-aged adults, five-year rates were 74% for males 

and 77% for females, and females continued to exhibit 

better survival than males between five and ten years after 

diagnosis (Figure 27.2). There was little evidence of an 

influence by sex on relative survival among older adult 

patients aged 65 across the follow-up period, particularly 

at 48 months (males, 53%; females, 53%).

Race

The small numbers of non-white patients diagnosed with 

HL (total n=1,566) hinders detailed comparison of relative 

survival rates between racial/ethnic groups, particularly 

within older age groups. Regardless, relative survival rates 

was generally lower for persons of black race than for 

persons of white or “other” race/ethnicity. Among young 

adults aged 15-44 years at diagnosis, five-year relative 

survival rate for black males was 76%, substantially 

lower than the 88% rate observed in white males These 

racial/ethnic differences appeared to be independent of 

sex (Figure 27.3).

Figure 27.1: Hodgkin Lymphoma: 5- and 10-Year Relative 

Survival Rates (%) by Age at Diagnosis (15+), 12 SEER Areas, 

1988-2001

90

100

%)

70

80

val Rate (

%

50

60

ive Surviv

20

30

40

Relati

0

10

20

15-24 25-34 35-44 45-54 55-64 65-74 75+

Age at Diagnosis Age at Diagnosis

5-Year Rates 10-Year Rates

Figure 27.2: Hodgkin Lymphoma: Relative Survival Rates 

(%) by Age Group (15+) and Sex, 12 SEER Areas, 1988-2001

90

100

70

80

50

60

Rate (%)

Males, 15-44

Males, 45-64

M l 65+

30

40

Survival R

Males, 65+

Females, 15-44

Females, 45-64

10

20

Relative S

Females, 45 64

Females, 65+

0

0 12 24 36 48 60 72 84 96 108 120

R

Months after diagnosis
Chapter 27 Hodgkin Lymphoma

National Cancer Institute 230 SEER Survival Monograph 

Table 27.3 (continued): Hodgkin Lymphoma: Number of Cases and 5-Year (Yr) Relative Survival Rates (RSR) (%) by Sex, Age 

(15+) and Ann Arbor Stage, 12 SEER Areas, 1988-2001 (Patients with Complete Stage Information: 8,047 Cases)

Sex/Age 

(Years)

Stage

 Stages I-IV IIIA IIIB IVA IVB

Cases 5-Yr 

RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%)

Total 8,047 83.7 622 88.0 1,109 77.3 259 75.7 1,093 60.1

 15-44 5,618 90.3 436 95.6 736 87.1 158 88.2 594 71.0

 45-64 1,463 74.1 121 73.8 201 63.6 53 60.6 272 52.5

 65+ 966 51.5 65 53.5 172 39.7 48 42.5 227 33.5

Male 4,464 81.9 332 87.8 690 76.8 142 72.6 726 58.2

 15-44 3,030 87.7 230 94.7 461 84.9 83 85.3 417 66.8

 45-64 927 73.6 69 77.1 139 66.2 32 60.4 184 50.5

 65+ 507 53.0 33 51.0 90 40.6 27 35.7 125 32.2

Female 3,583 86.0 290 88.1 419 77.7 117 79.1 367 63.8

 15-44 2,588 93.3 206 96.6 275 90.7 75 91.3 177 80.9

 45-64 536 75.0 52 69.6 62 58.3 21 ~ 88 56.5

 65+ 459 49.2 32 53.6 82 38.2 21 ~ 102 34.2

 ~ Statistic not displayed due to less than 25 cases.

Table 27.3: Hodgkin Lymphoma: Number of Cases and 5-Year (Yr) Relative Survival Rates (RSR) (%) by Sex, Age (15+) and Ann 

Arbor Stage, 12 SEER Areas, 1988-2001 (Patients with Complete Stage Information: 8,047 Cases)

Sex/Age 

(Years)

Stage

 Stages I-IV IA IB IIA IIB

Cases 5-Yr 

RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%)

Total 8,047 83.7 1,125 93.5 424 81.2 1,957 92.9 1,458 85.7

 15-44 5,618 90.3 705 96.8 274 88.0 1,564 95.8 1,151 89.4

 45-64 1,463 74.1 271 90.7 86 72.0 272 87.3 187 77.2

 65+ 966 51.5 149 79.1 64 56.9 121 58.5 120 52.2

Male 4,464 81.9 685 94.1 252 77.0 856 93.4 781 84.1

 15-44 3,030 87.7 424 96.9 163 84.6 663 94.4 589 88.3

 45-64 927 73.6 186 89.2 51 66.0 142 90.4 124 76.0

 65+ 507 53.0 75 84.1 38 52.2 51 73.5 68 49.9

Female 3,583 86.0 440 92.6 172 86.6 1,101 92.4 677 87.4

 15-44 2,588 93.3 281 96.5 111 92.7 901 96.7 562 90.6

 45-64 536 75.0 85 94.0 35 80.3 130 83.6 63 79.1

 65+ 459 49.2 74 71.7 26 61.0 70 43.2 52 52.9

 ~ Statistic not displayed due to less than 25 cases.
Chapter 27 Hodgkin Lymphoma

National Cancer Institute 231 SEER Survival Monograph 

Stage and B-symptoms

Certain clinical presentations of HL had substantially worse 

five-year survival than others. Patients diagnosed with 

disseminated disease, stage IV (n=1,893) had markedly 

worse outcome than those with earlier stage disease, stage 

I (n= 2,778), stage II (n=4,344), and stage III (n=2,220), 

as captured by five-year relative survival rates (63% vs. 

89%, 89%, and 81%, respectively) (Table 27.2). However, the presence of B-symptoms was a potent modifier of 

stage-specific survival, particularly for stage IV. Among 

the 8,047 patients with known stage and B-symptom status, comprising 69% of the HL patients in this analysis, 

patients with B-symptoms showed poorer survival across 

the ten-year follow-up period when compared to patients 

with similarly staged disease but without B-symptoms 

(Figure 27.4). In fact, patients with stage IIIA disease 

showed better survival than patients with stages IB and 

IIB disease. Survival curves for patients with stage IIIB 

disease were similar to those for patients with IVA, and 

survival time was substantially worse for patients with 

stage IVB than any of the other stages. Relative survival 

rate for patients with stage IVB was 76% at one year, 

60% at five years, and 53% at ten years.

Figure 27.3: Hodgkin Lymphoma: 5-Year Relative Survival 

Rate (%) for Ages 15-44 by Race and Sex, 

12 SEER Areas, 1988-2001

Table 27.4: Hodgkin Lymphoma: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival 

Rates (%) by Age (15+) and Histology, 12 SEER Areas, 1988-2001

Age (Years) /Histology (ICD-O Code) Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year 

All Ages 11,720 100.0 92.0 88.3 86.2 83.0 79.1 78.1

 Unknown HD, NOS (9650-9651,9661-9662) 1,666 14.2 84.9 80.4 77.8 74.0 69.5 68.3

 HD MC (9652) 2,097 17.9 87.0 82.0 79.5 74.7 69.5 68.1

 HD LD (9653-9655) 209 1.8 57.1 52.2 51.0 48.6 46.1 44.0

 HD NS (9663-9667) 7,435 63.4 95.6 92.4 90.4 87.6 84.1 83.2

 Nodular LP (9659) 313 2.7 98.1 96.9 95.0 91.2 88.4 85.7

Ages 15-44 8,001 100.0 97.3 94.5 92.8 89.9 86.6 85.4

 Unknown HD, NOS (9650-9651,9661-9662) 908 11.3 92.3 88.6 86.4 83.5 79.5 78.5

 HD MC (9652) 986 12.3 95.2 92.6 90.9 86.4 81.9 80.7

 HD LD (9653-9655) 71 0.9 80.5 74.8 71.9 67.1 65.3 65.3

 HD NS (9663-9667) 5,833 72.9 98.5 95.9 94.2 91.7 88.6 87.4

 Nodular LP (9659) 203 2.5 97.7 96.8 95.9 92.5 90.9 89.8

90

100

%)

70

80

val Rate (

%

50

60

ive Surviv

20

30

40

Relati

0

10

20

White Black Other

Race

Male Female

Figure 27.4: Hodgkin Lymphoma: Relative Survival Rates 

(%) by Stage and B-Symptoms, Ages 15+, 12 SEER Areas, 

1988-2001 (Patients with Complete Stage & B Symptom 

Information: 8,047)

90

100

70

80

60

Rate (%)

IA

IB

IIA

IIB

40

50

Survival R

IIIA

IIIB

IVA

IVB

20

30

Relative S

IVB

10

R

20

0

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis
Chapter 27 Hodgkin Lymphoma

National Cancer Institute 232 SEER Survival Monograph 

Figure 27.6: Hodgkin Lymphoma: Relative Survival Rates (%) 

by Histologic Subtype, Ages 15+, 12 SEER Areas, 1988-2001

However, like most features of HL, stage-specific survival 

is influenced strongly by age at diagnosis. Relative survival curves for young, middle-aged, and older adult HL 

patients by stage are shown in Figure 27.5. These curves 

show that stage at diagnosis modifies relative survival 

differently in young adults as compared to middle-aged 

and older adults. For young adults, there was little difference in relative survival rate over time for stages I, II, or 

III disease, but substantially poorer survival for persons 

with stage IV disease. For middle-aged and older adults, 

survival patterns were well-differentiated by stage and 

tended to show steeper declines in the first two years after 

diagnosis. Figure 27.5 also shows that relative survival 

did not level off but rather continually declined over 

time for nearly all age and stage groups, with the possible exception of stage IV disease in older adults. When 

B-symptoms are considered in addition to age and stage, 

it is additionally evident that age generally influences 

relative survival independently of these factors. Matched 

for stage and B-symptom status, relative survival rate 

decreased with increasing age at diagnosis. The survival 

deficit experienced by older adult patients became more 

profound with increasing disease spread. In patients with 

stage IA, five-year relative survival rate was 18 percentage 

points lower in older adults (79%) than in young adults 

(97%), but was 31-37 percentage points lower for patients with stages IB (57% vs. 88%), IIA (59% vs. 96%), 

and IIB (52% vs. 89%), and 37-47% lower for stages 

IIIA (54% vs. 96%), IIIB (40% vs. 87%), IVA (43% vs. 

88%) and IVB (34% vs. 71%) (Table 27.3). Table 27.3 

also shows five-year relative survival rates by stage and 

B-symptom status by age and sex. These data show that 

five-year relative survival rate were generally lower for 

males than females matched for stage/B-symptom status 

and age, although male-female differences were more 

pronounced for some age/stage combinations than for 

others. For example, relative survival rates for young adult 

males with stage IA or IIA disease were nearly equivalent 

to those for young adult females, but the rate for young 

adult males with stage IVB disease was 14 percentage 

points lower than that for young adult females. Overall, 

the range of five-year relative survival rates was wide; 

with the most favorable survival rates (97%) observed 

in young adult females and males with stage IA disease, 

and the poorest rates observed in older adult males with 

stage IVB (32%). 

Histology

Histologic subtype additionally influences relative survival 

rates, although the relative rarity of some subtypes and 

the strong association of subtype with other prognostic 

factors (e.g., age, sex, race) make this influence difficult to examine. As shown in Table 27.4, NS comprised 

73% of all young-adult cases and 63% of all ages, while 

the second most common subtype, MC, was observed in 

only 12% of young-adult patients, and 18% overall. The 

other specific subtypes, nodular LP, and LD, together 

comprised less than 5% of all cases. Across all ages, 

five-year relative survival was higher for NS (88%) and 

nodular LP (91%) subtypes and was intermediate for the 

MC subtype (75%) and non-specified types (74%). These 

patterns were additionally evident when limiting the series 

to young adults only (Table 27.3). The LD histologic subtype represented less than 2% of all cases but exhibited a 

substantially poorer five-year relative survival rate than 

other subtypes both in young adults (67%) and across all 

ages (49%). Figure 27.6 shows relative survival rates for 

Figure 27.5: Hodgkin Lymphoma: Relative Survival Rates 

(%) by Age Group (15+) and Stage, 12 SEER Areas, 1988-2001 

(Patients with Complete Stage & B Symptom Information: 

8,047)

90

100 15-44 Stage I

15-44 Stage II

70

80 15-44 Stage III

15-44 Stage IV

50

60

70

Rate (%)

g

45-64 Stage I

45-64 Stage II

40

50

Survival R

g

45-64 Stage III

45-64 Stage IV

20

30

Relative S

g

65+ Stage I

65+ Stage II

0

10

R

65+ Stage III

65+ Stage IV

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

%) 50

60

al Rate (

% 30

40

ve Surviva 10

20

Relativ

0

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

HD, NOS HD MC HD LD

HD NS Nodular LP
Chapter 27 Hodgkin Lymphoma

National Cancer Institute 233 SEER Survival Monograph 

histologic subtypes across the ten-year follow-up period. 

The starkly different survival profile of the LD subtype 

is evident throughout the ten years. 

Discussion

Compared to other cancers, the one-year relative survival rate for HL was generally favorable at 92%. This 

relatively good survival rate reflects the availability of 

curative therapies for HL, including radiation or combination chemotherapeutic regimens, the introduction of 

which in the 1960’s resulted in immediate reductions in 

HL mortality rates (2). Additionally, the 5-year relative 

survival rate after diagnosis has improved markedly from 

40% in the early 1960’s to 84 % in 1999 (2).

However, unlike some other cancers, relative survival 

rates after HL declined steadily with time since diagnosis, 

to 83% at five years and 78% at ten years. The fact that 

relative survival does not level off for most groups likely 

reflects ongoing risks of disease recurrence and long-term 

complications of treatment. Because most HL patients are 

young adults at the time of diagnosis, exposure to radiation and chemotherapy intended to cure HL at young ages 

has been shown to substantially increase risks of second 

or later malignancies (7) particularly breast cancer in 

young women (8). Other second malignancies observed 

in cohorts treated for HL include acute leukemias and 

non-Hodgkin’s lymphomas (9). Within the first 15 years 

after diagnosis, HL is the major cause of death among HL 

patients, but soon after this time, cumulative mortality 

from second malignancies exceeds cumulative mortality 

from HL (10). Long-term risks of treatment-associated 

heart disease (11) and reproductive sterility are additionally important quality-of-life issues for HL survivors.

We observed substantial variation in relative survival 

rates by age at diagnosis. Most epidemiologic and clinical features of HL differ between young and older-adults 

(12), and relative survival is no different. The relative 

ten-year survival rate was nearly 90% for ages 15-24, but 

only 21% for persons diagnosed at age 75 or older. Age 

differences in survival patterns have been examined in 

detail by other authors and have also been interpreted as 

further evidence of the “two-disease” theory holding that 

young-adult and older-adult HL are etiologically distinct 

diseases (13).

As is the case with most cancers, stage or degree of disease 

spread at time of diagnosis profoundly impacts survival 

after HL, as patients with stage IVB disseminated disease 

had significantly shorter 5-year survival rate (60%) than 

those with less advanced disease, regardless of age (76-

94%). The impact of stage on survival, however, was 

modified by age, reflecting the clinically more aggressive 

nature of the disease in older adults.

In these data, B-symptom status clearly altered survival, 

and like age, it modified the impact of stage on survival. 

Patients with no B-symptoms but diagnosed with stage 

III disease had higher survival rates than those diagnosed 

with early stage (I and II) disease with B-symptoms. 

B-symptom status has been long associated with poor 

prognosis in lymphoma patients and may be caused by 

tumor-related dysregulation of certain cytokines. 

HL survival also varied by histology. Histologic subtypes were strongly associated with age, with younger 

patients more likely to have NS, the subtype associated 

with the most favorable survival rate. However, within 

histologic categories, younger patients consistently had 

higher survival rates than older patients. Patients with the 

LD subtype had considerably worse survival than patients 

with other subtypes, as described previously (14). 

In this relatively large, population-based series of patients, we were able to examine the influences of demographic characteristics like race and sex. The poorer 

survival rates observed for blacks than whites have been 

reported previously and appear to be independent of stage 

and other prognostic factors (15). We also observed intriguing differences by sex in survival after HL. Males 

exhibited poorer relative survival rates than females in 

young adults across nearly all stages of disease, but not 

in persons over 45 years of age. In young adults, male 

sex has been shown to be associated with HL survival 

independently of other factors in previous analyses using 

SEER data (13). 

In summary, survival following HL is relatively favorable, 

and the 83% five-year relative survival rate observed in this 

population-based cohort is comparable to those reported 

in clinical settings. However, relative survival rate was 

observed to vary substantially with sex, stage at diagnosis, B-symptom status, histology, and, especially, age at 

diagnosis. Indeed, the generally good average survival 

rates for HL largely represent the outcome of patients 

diagnosed at ages 45 and younger, who comprise the 

majority of patients in the US. However, the relatively 

young average age of the HL patient amplifies the effect 

of this cancer on the overall cancer burden; it ranks third 

in the average years of life lost to a cancer. Although substantial progress has been made against HL, the current 

challenges facing HL clinicians and researchers include 

reducing treatment-related side effects to improve the 

quality-of-life for long-term HL survivors and improving 

outcomes for older patients. 
Chapter 27 Hodgkin Lymphoma

National Cancer Institute 234 SEER Survival Monograph 

REFERENCES

1. American Cancer Society. Cancer facts and figures 2006. Atlanta: 

American Cancer Society, 2006.

2. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer 

EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, 

Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

submission, posted to the SEER web site, 2006.

3. Mauch, P. M., Kalish, L. A., Kadin, M., Coleman, C. N., Osteen, 

R., and Hellman, S. Patterns of presentation of Hodgkin disease. 

Implications for etiology and pathogenesis [see comments]. 

Cancer, 71: 2062-71, 1993.

4. Carbone, P. P., Kaplan, H. S., Musshoff, K., Smithers, D. W., 

and Tubiana, M. Report of the committee on Hodgkin’s disease 

staging classification. Cancer Research, 31: 1860-1861, 1971.

5. Harris, N. L., Jaffe, E. S., Diebold, J., Flandrin, G., MullerHermelink, H. K., Vardiman, J., Lister, T. A., and Bloomfield, C. 

D. World Health Organization classification of neoplastic diseases 

of the hematopoietic and lymphoid tissues: report of the Clinical 

Advisory Committee meeting-Airlie House, Virginia, November 

1997. Journal of Clinical Oncology, 17: 3835-49, 1999.

6. Percy, C., Van Holten, V., and Muir, C. International classification 

of diseases for oncology--second edition. Geneva: World Health 

Organization, 1990.

7. Hodgson DC, Gilbert ES, Dores GM, Schonfeld SJ, Lynch CF, 

Storm H, Hall P, Langmark F, Pukkala E, Andersson M, Kaijser 

M, Joensuu H, Fossa SD, Travis LB. Long-term solid cancer risk 

among 5-year survivors of Hodgkin’s lymphoma. J Clin Oncol. 

2007 Apr 20;25(12):1489-97. 

8. Aisenberg, A. C., Finkelstein, D. M., Doppke, K. P., Koerner, F. 

C., Boivin, J. F., and Willett, C. G. High risk of breast carcinoma 

after irradiation of young women with Hodgkin’s disease. Cancer, 

79: 1203-10, 1997.

9. Boivin, J. F., Hutchison, G. B., Zauber, A. G., Bernstein, L., 

Davis, F. G., Michel, R. P., Zanke, B., Tan, C. T., Fuller, L. M., 

Mauch, P., and et al. Incidence of second cancers in patients 

treated for Hodgkin’s disease. Journal of the National Cancer 

Institute, 87: 732-41, 1995.

10. Mauch, P. M., Kalish, L. A., Marcus, K. C., Shulman, L. N., 

Krill, H., Tarbell, N. J., Silver, B., Weinstein, H., Come, S., and 

Canellos, G. P. Long term survival in Hodgkin’s disease: relative 

impact of mortality, second tumors, infection and cardiovascular 

disease. The Cancer Journal from Scientific American, 1: 33-42, 

1995.

11. Swerdlow AJ, Higgins CD, Smith P, Cunningham D, Hancock 

BW, Horwich A, Hoskin PJ, Lister A, Radford JA, Rohatiner AZ, 

Linch DC. Myocardial infarction mortality risk after treatment 

for Hodgkin disease: a collaborative British cohort study. J Natl 

Cancer Inst. 2007 Feb 7;99(3):206-14.

12. Glaser, S. L., and Jarrett, R. F. The epidemiology of Hodgkin’s 

disease. Baillieres Clinical Haematology, 9: 401-16, 1996.

13 Clarke, C. A., Glaser, S. L., and Prehn, A. W. Age and patterns of 

survival after Hodgkin’s disease. Cancer Causes and Control, in 

press, 2001.

14. Medeiros, L. J., and Greiner, T. C. Hodgkin’s disease. Cancer, 75: 

357-69, 1995.

15. Zaki, A., Natarajan, N., and Mettlin, C. J. Early and late survival 

in Hodgkin disease among whites and blacks living in the United 

States. Cancer, 72: 602-6, 1993.

acknowledgementS

The authors would like to acknowledge Angela Prehn Ph.D 

and Erin Eberle for their contributions to this chapter.
National Cancer Institute 235 SEER Survival Monograph 

INTRODUCTION

Lymphomas are malignancies of the lymphoid cells and 

can be divided on the basis of pathologic features into 

Hodgkin and non-Hodgkin lymphomas (NHL), the latter an 

umbrella designation for at least 30 types of distinct B- and 

T-cell neoplasms. Although it was recently determined to 

be a B-cell lymphoma, Hodgkin lymphoma or Hodgkin’s 

disease differs substantially from other lymphomas with 

respect to epidemiologic and survival characteristics, and 

so it is discussed in a separate chapter. Altogether, NHLs 

are substantially more common and, when grouped together 

as a single entity, represent one of the top five sources of 

cancer morbidity and mortality in the US population. 

NHLs are also a growing component of the cancer burden; 

incidence rates increased over 80% between 1973 and 

1999, one of the most rapid increases observed among all 

cancers. Some of the rapid increase in NHL incidence can 

be attributed to improvements in diagnostic practice and 

disease classifications, as well as to the HIV epidemic, 

as NHL is at least 100-times more likely to occur in the 

context of HIV-related immunosuppression. However, 

other reasons for the increasing incidence remain unclear. 

The extraordinary heterogeneity of NHLs has hindered our 

progress in its description and study. We took advantage 

of this unique opportunity to use the large, populationbased SEER registry to examine survival patterns for NHLs 

considered together as a single entity as well as by separate 

histologic subtypes. 

MATERIALS AND METHODS

Patients

Analyses included all patients aged 20 or over diagnosed 

with NHL (ICD-O-2 codes 9590-9595, 9670-9717) between 1988 and 2001 and reported to the SEER program. 

Patients were followed for vital status until 2002. Table 

28.1 details exclusions from the case series, which resulted 

in a final series of 65,932 patients. Patients without histologic confirmation of lymphoma diagnosis were excluded 

from analysis.

Presence of HIV/AIDS

Persons with HIV infection have substantially elevated 

risks of developing and dying from NHL. In addition 

to its poorer prognosis, HIV/AIDS-related NHL differs 

from unrelated NHL with respect to epidemiologic, histologic, and clinical characteristics to be elucidated below. Although the SEER program has formally collected 

information regarding HIV/AIDS as part of the extent 

of disease information for lymphoma cases diagnosed in 

1990 and beyond, this information tends to be somewhat 

incomplete in the SEER database. Therefore, all cases 

with evidence of positive HIV/AIDS status based on the 

extent of disease information or underlying cause of death 

(ICD-9 codes 0420-0449 or ICD-10 codes B020-B024) 

were separated from cases without any evidence of HIV 

for stratified analyses (1).

Christina Clarke and Cynthia O’Malley

Chapter 28

Non-Hodgkin Lymphoma

Table 28.1: Non-Hodgkin Lymphoma: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number Selected/Remaining Number 

Excluded Reason for Exclusion/Selection

81,867 0 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only)

70,531 11,336 Select first primary only

69,699 832 Exclude death certificate only or at autopsy

69,020 679 Exclude unknown race

68,920 100 Active follow-up and exclude alive with no survival time

67,568 1,352 Exclude children (Ages 0-19)

67,568 0 Exclude in situ cancers for all except breast & bladder cancer

65,932 1,636 Exclude no or unknown microscopic confirmation

65,932 0 Exclude sarcomas
Chapter 28 Non-Hodgkin Lymphoma

National Cancer Institute 236 SEER Survival Monograph 

Stage classification

NHL tumors usually begin in lymph nodes or other lymphoid tissue but spread to extranodal sites, including organs. In the SEER database, classification of stage of 

disease at diagnosis for all lymphomas follows guidelines 

set forth at the 1971 Ann Arbor conference (2). In brief, 

it provides four stages of tumor spread relative to the 

diaphragm: I--involvement of a single lymph node region, 

II--involvement of two or more lymph node regions on one 

side of the diaphragm, III--involvement of lymph node 

regions on both sides of the diaphragm, IV--disseminated 

disease. Each stage can be subclassified as A or B type 

according to the absence or presence, respectively, of 

symptoms such as fever, night sweats, pruritus or weight 

loss of greater than 10 percent of total body mass. In 

the analyses below, stage information was complete for 

90% and B-symptom information for 46% of the cohort 

without evidence of HIV/AIDS (Table 28.2). 

Histologic classification

NHL has long been recognized as a heterogeneous group 

of lymphoid malignancies, and multiple classification 

schemes have been developed over the past several decades. In 1994 an international group of expert hematoTable 28.2: Non-Hodgkin Lymphoma: Number of Cases, Distribution and 5-Year Relative Survival Rates (RSR) (%) by Sex, Race, 

Age (20+), Ann Arbor Stage, and HIV/AIDS Status, Ages 20+12 SEER Areas, 1988-2001

Characteristics 

Total non-HIV/AIDS HIV/AIDS

Cases Percent

5-Year 

RSR (%) Cases Percent

5-Year 

RSR (%) Cases Percent

5-Year 

RSR (%)

Total 65,932 100.0 56.3 61,214 100.0 60.0 4,718 100.0 14.8

 Sex

 Male 36,354 55.1 52.5 31,982 52.2 58.7 4,372 92.7 13.8

 Female 29,578 44.9 60.9 29,232 47.8 61.3 346 7.3 27.2

 Race

 White 56,851 86.2 57.1 53,040 86.6 60.6 3,811 80.8 15.0

 Black 4,502 6.8 48.2 3,724 6.1 56.2 778 16.5 13.2

 Race/sex

 White male 31,232 47.4 53.4 27,620 45.1 59.4 3,612 76.6 14.3

 White female 25,619 38.9 61.5 25,420 41.5 61.8 199 4.2 29.7

 Black male 2,605 4.0 43.4 1,955 3.2 55.0 650 13.8 11.6

 Black female 1,897 2.9 54.8 1,769 2.9 57.5 128 2.7 20.5

 Age (20+)

 20-34 4,522 6.9 53.6 3,246 5.3 69.8 1,276 27.0 12.8

 35-49 11,646 17.7 59.7 9,090 14.8 72.4 2,556 54.2 14.1

 50-64 16,925 25.7 63.6 16,196 26.5 65.7 729 15.5 17.4

 65-79 23,591 35.8 53.7 23,453 38.3 53.8 138 2.9 35.2

 80+ 9,248 14.0 37.9 9,229 15.1 37.9 19 0.4 ~

Ann Arbor Stage

 I 19,971 30.3 69.4 18,463 30.2 74.5 1,508 32.0 15.7

 IA 7,238 11.0 77.5 6,781 11.1 81.6 457 9.7 24.5

 IB 1,926 2.9 50.7 1,592 2.6 60.4 334 7.1 10.6

 II 9,098 13.8 61.1 8,685 14.2 63.0 413 8.8 25.4

 IIA 3,357 5.1 68.1 3,256 5.3 69.2 101 2.1 34.6

 IIB 2,018 3.1 50.5 1,858 3.0 53.4 160 3.4 20.9

 III 7,910 12.0 49.7 7,407 12.1 51.9 503 10.7 21.6

 IIIA 2,573 3.9 59.5 2,452 4.0 61.2 121 2.6 28.1

 IIIB 2,240 3.4 38.3 2,001 3.3 41.5 239 5.1 15.0

 IV 22,558 34.2 42.4 20,610 33.7 46.0 1,948 41.3 9.5

 IVA 5,119 7.8 51.2 4,781 7.8 53.8 338 7.2 17.9

 IVB 6,203 9.4 30.0 5,328 8.7 34.1 875 18.5 7.9

 Unstaged 6,395 9.7 65.7 6,049 9.9 68.9 346 7.3 17.8
Chapter 28 Non-Hodgkin Lymphoma

National Cancer Institute 237 SEER Survival Monograph 

pathologists proposed the first international consensus 

classification system, now known as the WHO classification. The WHO system has been incorporated into 

the newest (third) edition of the coding system used by 

all cancer registries: the International Classification of 

Diseases—Oncology (ICD-O). However, data available for 

analysis were collecting using the more obsolete ICD-O, 

second edition (ICD-O-2) system. We used the ICD-O-2 

to ICD-O-3 conversion tables to create histologic groupings base on ICD-O-2 that are more reflective of the WHO 

concepts. These groupings, with their associated ICD-O-2 

codes, are as follows: small B-lymphocytic lymphoma 

(9670,9823), lymphoplasmacytic lymphoma (9671), mantle 

cell lymphoma (9673, 9674, 9677), mixed small/large 

cell diffuse lymphoma (9675-76), large B-cell diffuse 

lymphoma (9680-81, 9683-84, 9688, 9712), Burkitt’s lymphoma (9687), follicular grade 2 (9691), follicular grade 

1 (9695, 9696), follicular grade 3 (9697-9698, 9693), all 

follicular combined (9690-9693, 9695-9698), marginal 

zone (9710-9711, 9715), mycosis fungoides/Sezary’s 

syndrome (9700-9701), other mature T-cell lymphomas 

(9702-04, 9706-08, 9716), angioblastic T-cell (9705), cutaneous T-cell (9709), anaplastic T-cell (9714), other T-cell 

(9708, 9716-9718,9827), NK/null cell (9713), precursor 

B-cell lymphoma/leukemias (9685,9821), and unspecified 

lymphomas (9590-9592, 9672,9682,9694).

Results

Patients with evidence of HIV/AIDS

Of the 65,932 adult patients with NHL in this analysis, 

4,718 (over 7%) had some evidence of HIV/AIDS on the 

basis of the medical record or cause of death information. 

These patients were more likely than patients without 

evidence of HIV/AIDS to be male (93% vs. 52%), aged 

20-50 at diagnosis (81% vs. 20%) and black (17% vs. 

6%). Survival was very poor for these patients, with 

relative survival rate of 15% at five years (Table 28.2). 

Figure 28.1 shows the relative survival curves for black 

and white male patients with and without evidence of 

HIV/AIDS.

Patients without evidence of HIV/AIDS

Patients without evidence of HIV/AIDS numbered 61,214; 

80% were aged 50 years or older at diagnosis, 52% were 

male, and 87% were of white race. Overall, survival rates 

for these patients were moderate, with 78% surviving one 

year after diagnosis relative to the general population, 

but this rate declined to 60% at five years and 51% at 

ten years. Relative survival after NHL is influenced by 

age, sex, race/ethnicity, stage of disease, and histologic 

type and the relative survival curves for NHL patients 

continue to decline as years since diagnosis increases 

irrespective of these factors.

Age, sex and race

Table 28.2 shows survival by age, sex, and race. Overall, 

females had somewhat higher five-year relative survival 

rates (61%) than males (59%), and whites (61%) had 

slightly higher rates than blacks (56%). Assessing survival 

jointly by sex and race shows that these factors influence 

survival subtly but independently. Relative survival rates 

for white females (62%) were slightly higher than those 

for white males (59%), black females (58%), and black 

males (55%). Without consideration of factors possibly 

associated with race and sex like stage at diagnosis, whites 

90

100

70

80

te (%) 50

60

urvival Rat 30

40

elative Su

HIV+ White Males

HIV+ Black Males

White Males

10

20

Re

Black Males

0

0 12 24 36 48 60 72 84 96 108 120

M th ft di i Months after diagnosis

Figure 28.1: Non-Hodgkin Lymphoma: Relative Survival 

Rates (%) for Males by Race and HIV Status, Ages 20+, 12 

SEER Areas, 1988-2001
Chapter 28 Non-Hodgkin Lymphoma

National Cancer Institute 238 SEER Survival Monograph 

Table 28.3: Non-Hodgkin Lymphoma: Number of Cases and 5-Year Relative Survival Rates (RSR) (%) by Age (20+) and Ann 

Arbor Stage, 12 SEER Areas, 1988-2001 (Patients with Complete Stage Information and No Evidence of HIV/AIDS: 28,049 Cases)

Age Group 

(Years)

Ann Arbor Stage

Total IA IB IIA IIB

Cases 5-Yr 

RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%)

All Ages (20+) 28,049 58.6 6,781 81.6 1,592 60.4 3,256 69.2 1,858 53.4

20-34 1,758 69.0 368 86.7 141 70.5 222 83.3 183 68.9

35-49 4,617 70.4 1,142 87.1 264 75.0 487 81.5 323 61.5

50-64 7,632 63.8 1,821 86.2 350 68.7 908 74.0 474 57.8

65-79 10,243 51.3 2,479 78.6 589 50.0 1,173 63.8 648 44.4

80+ 3,799 36.7 971 62.9 248 38.1 466 41.0 230 31.5

Table 28.3 (continued)

Age Group 

(Years)

Ann Arbor Stage

Total IIIA IIIB IVA IVB

Cases 5-Yr 

RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%) Cases 5-Yr RSR (%)

All Ages (20+) 28,049 58.6 2,452 61.2 2,001 41.5 4,781 53.8 5,328 34.1

20-34 1,758 69.0 116 78.3 137 67.8 242 58.5 349 45.5

35-49 4,617 70.4 407 79.2 326 63.1 740 68.1 928 46.2

50-64 7,632 63.8 712 67.3 532 41.4 1,377 60.7 1,458 38.9

65-79 10,243 51.3 874 48.8 716 31.2 1,795 45.7 1,969 25.2

80+ 3,799 36.7 343 35.7 290 14.5 627 28.0 624 13.7

Stage of disease at diagnosis

Like most other cancers, outcome after NHL is impacted 

largely by the extent of disease spread at time of diagnosis. Figure 28.3 shows relative survival curves for younger 

(ages 20-64 years) and older (ages 65+) patients by Ann 

Arbor stage of disease. Younger and older patients had essentially similar distributions of stage at diagnosis (Stage 

I: 30% vs. 30%, Stage II: 14% vs. 14%, Stage III: 12% vs. 

12%, Stage IV: 34 % vs. 34%, unknown: 10% vs. 10%). 

Relative survival rates decreased incrementally with increasing stage, with the exception of older patients, for 

whom survival patterns were similar in stages III and IV, 

with equivalent survival in the long-term (10 years after 

diagnosis). Additionally important to outcome was the 

presence or absence of B-symptoms. Although B-symptom 

status was unknown for a large proportion of patients, we 

examined stage and B-symptom specific survival curves 

for the patients with complete information (Figure 28.4). 

Stage for stage, patients with B-symptoms had substantially 

poorer survival than patients without symptoms. For example, the 5-year relative survival rate for patients with 

stage IA was 82%, compared to the 60% for patients with 

stage IB (Table 28.2).

demonstrated better survival rates than blacks, and females 

survived better than males.

Patient age at diagnosis strongly influences survival patterns after NHL diagnosis. Figure 28.2 shows survival 

curves by sex for detailed age groups over time, showing 

generally linear associations of increasing age with poorer 

survival, particularly as regards survival in the first 5 years 

after diagnosis. 

The female survival advantage was also apparent across age 

groups. Figure 28.2 shows that females generally have better survival than males over time. Some of the differences 

by sex observed in persons aged 20-49 years may relate to 

HIV/AIDS-related lymphoma that could not be identified in 

the SEER database. In addition, all age groups individually 

demonstrated consistently declining relative survival with 

time since diagnosis. As described below, age at diagnosis 

additionally impacted relative survival regardless of stage 

of disease spread and symptomatology.
Chapter 28 Non-Hodgkin Lymphoma

National Cancer Institute 239 SEER Survival Monograph 

lar diagnostic tools become available. Table 28.4 shows 

counts and five-year relative survival rates for distinct NHL 

subtypes as recorded by the SEER database. Seventeen 

percent of patients were reported as having lymphoma, 

not otherwise specified (NOS) and were not assigned a 

histologic subtype, which limits the interpretability of 

the distribution of other specified subtypes. Regardless, 

large B-cell lymphoma (36.6%) and follicular lymphoma 

(19.3%) were the two most common subtypes. Five-year 

relative survival rates for follicular lymphomas, particularly grades 1 (80%) and 2 (76%) were substantially higher 

than that for large B-cell lymphomas (50%). In general, 

lymphoma subtypes can be grouped into indolent subtypes 

with more favorable survival features, or as aggressive 

lymphomas with poorer outcomes.

90

100

70

80

%)

Stage I 20-64

St I 65

60

70

val Rate (

%

Stage I 65+

Stage II 20-64

Stage II 65+

40

50

ive Surviv

Stage III 20-64

Stage III 65+

Stage IV 20-64

20

30

Relati

Stage IV 65+

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 28.3: Non-Hodgkin Lymphoma: Relative Survival 

Rates (%) by Stage and Age Group (20+), 12 SEER Areas, 

1988-2001 (Patients with Complete Stage Information and No 

Evidence of HIV/AIDS)

90

100

70

80

%)

IA

60

70

val Rate (

%

IB

IIA

IIB

40

50

ive Surviv

IIIA

IIIB

IVA

20

30

Relati

IVB

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 28.4: Non-Hodgkin Lymphoma: Relative Survival 

Rates (%) by Stage and B-Symptoms, Ages 20+, 12 

SEER Areas, 1988-2001 (Patients with Complete Stage 

Information and No Evidence of HIV/AIDS)

90

100

70

80

%)

Males, 20-34

Males 35 49

60

70

val Rate (

%

Males, 35-49

Males, 50-64

Males, 65-79

Males, 80+

40

50

ive Surviv

Females, 20-34

Females, 35-49

Females, 50-64

Females, 65-79

20

30

Relati

Females, 65 79

Females, 80+

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 28.2: Non-Hodgkin Lymphoma: Relative Survival Rates 

(%) by Age Group (20+) and Sex, 12 SEER Areas, 1988-2001 

(Patients with No Evidence of HIV/AIDS: 61,214)

Stage, age, and B-symptom status

Table 28.3 shows the relationship of age to NHL survival, 

within stage and B-symptom strata. For patients diagnosed 

at age 50 or older, survival decreased with age within each 

stage/ B-symptom category. The poorer survival of patients 

with B-symptoms is observed across all age groups and 

stages. Sex did not appear to appreciably modify these 

differences (data not shown).

Histology

As described above, NHL is a category blanketing more 

than 30 different B and T-cell malignancies, many of which 

are still being distinguished and described as new molecu-
Chapter 28 Non-Hodgkin Lymphoma

National Cancer Institute 240 SEER Survival Monograph 

Table 28.5: Non-Hodgkin Lymphoma: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by Predominant Extranodal NHL Sites, Ages 20+, 12 SEER Areas, 1988-2001

(Patients with No Evidence of HIV/AIDS: 61,214 Cases)

Primary Site (ICD-O Code) Cases Percent

Relative Survival Rate (%)

1-Year 2-Year 3-Year 5-Year 8-Year 10-Year 

Total 61,214 100.0 77.5 69.9 65.8 60.0 53.5 50.8

Nodes (C770-C779) 40,797 66.6 76.1 67.3 62.6 56.0 49.0 46.0

Skin (C440-C449) 3,879 6.3 94.1 91.2 88.7 84.9 80.6 78.9

Stomach (C160-C169) 3,233 5.3 74.4 70.8 69.2 67.4 63.3 62.3

Small Intestine (C170-C179) 1,220 2.0 72.6 66.7 64.7 62.6 61.0 59.0

Brain (C710-C719) 1,014 1.7 50.6 38.0 30.8 21.2 13.5 10.4

Lung (C340-C349) 705 1.2 75.5 69.8 65.8 61.6 50.9 50.9

Colon (C180-C189, C260) 728 1.2 73.8 67.4 65.7 61.4 56.6 53.3

Bone Marrow (C421) 542 0.9 69.3 62.5 56.8 45.2 40.5 40.3

Spleen (C422) 610 1.0 81.8 74.7 71.8 67.5 60.8 57.7

Liver (C220) 224 0.4 49.7 45.3 43.6 40.0 33.9 33.4

Mediastinum (C380-C389) 211 0.3 75.2 67.2 63.4 59.6 57.5 57.5

Table 28.4: Non-Hodgkin Lymphoma: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates 

(%) by Histologic Subtype, Ages 20+, 12 SEER Areas, 1988-2001

(Patients with No Evidence of HIV/AIDS: 61,214 Cases)

Histology (ICD-O Code)

Relative Survival Rate (%)

Cases Percent 1-Year 2-Year 3-Year 5-Year 8-Year 10-Year 

Total 61,214 100.0 77.5 69.9 65.8 60.0 53.5 50.8

Small B Lymphocytic (9670,9823) 4,586 7.5 87.8 82.1 77.2 67.9 55.4 49.5

Lymphoplasmacytic (9671) 802 1.3 86.0 80.5 74.9 64.6 50.6 45.5

Mantle cell (9673) 1,558 2.5 83.9 72.6 65.2 51.1 37.4 34.3

Mixed small/large diffuse (9675) 2,219 3.6 77.5 68.1 62.4 55.5 49.4 47.7

Large B-cell diffuse, NOS* (9679,9680,9684) 22,390 36.6 67.0 57.1 53.8 50.4 47.3 45.9

Burkitts (9687) 508 0.8 53.5 47.8 47.4 45.4 45.1 45.1

Follicular grade 2 (9691) 3,701 6.0 94.6 88.5 83.2 75.7 67.1 61.6

Follicular grade 1 (9695) 4,649 7.6 95.9 92.2 88.1 79.8 68.4 63.8

Follicular grade 3 (9698) 2,170 3.5 88.5 81.5 76.2 69.2 61.9 60.8

All follicular combined (9690-9691, 9695-9698) 11,784 19.3 93.6 88.2 83.6 75.8 66.3 61.6

Marginal zone (9689,9699) 2,646 4.3 93.8 91.6 88.7 83.7 80.6 64.2

Mycosis fungoides, Sezary (9700-9701) 1,815 3.0 97.1 95.1 92.4 88.4 84.5 82.6

Mature T-cell, NOS* or other (9702) 725 1.2 61.9 48.8 43.6 38.1 34.3 32.5

Angioblastic T (9705) 144 0.2 61.1 55.4 49.0 38.3 28.4 28.4

Cutaneous T (9709) 738 1.2 92.7 88.8 86.6 84.4 79.8 77.8

Anaplastic T (9714) 605 1.0 69.0 59.8 56.6 53.9 52.7 43.9

Other specified T (9708,9716-9718,9827) 66 0.1 67.7 64.2 56.1 42.5 33.4 0.0

NK/null T (9719) 75 0.1 53.1 48.1 47.3 40.6 32.2 32.2

Precursor cells (9727-9729) 394 0.6 66.8 49.6 45.6 40.3 38.5 38.0

Lymphoma, NOS* (9590-9591,9596) 10,159 16.6 70.6 62.9 58.3 51.6 44.7 42.5

* NOS: Not Otherwise Specified

 ~ Statistic not displayed due to less than 25 cases.

! Not enough intervals to produce rate.
Chapter 28 Non-Hodgkin Lymphoma

National Cancer Institute 241 SEER Survival Monograph 

Figure 28.5 shows relative survival curves for indolent 

lymphomas, including the cutaneous lymphomas like mycosis fungoides, while Figure 28.6 shows relative survival 

curves for aggressive lymphomas. Indolent lymphomas, 

particularly follicular, small B-lymphocytic, and lymphoplasmacytic lymphomas, were observed to have nearly 

linear declines in relative survival over time, while relative 

survival curves for aggressive lymphomas, particularly 

large –cell and most T cell lymphomas, were observed 

to level off with time. 

Extranodal site of diagnosis for extranodal 

lymphoma

Nodal or extranodal site at primary diagnosis of lymphoma influences survival outcomes. More than 20% of 

NHL patients in this series were observed to have some 

extranodal presentation (n=12,366). Table 28.5 shows 

counts and five-year survival rates for nodal or common 

extranodal sites of presentation. Lymphoma present in 

the central nervous system (CNS) or brain had the worst 

five-year relative survival rate (21%) while skin, the 

most common site of extranodal presentation, had the 

most favorable (85%). About 5.3% of all lymphomas 

presented in the stomach and had a five-year relative 

survival rate of 67%. 

Discussion

Overall, more than half of the patients diagnosed with 

NHL survive five years after diagnosis. However, relative 

survival rates after most types of NHL declined consistently 

90

100 Mixed 

Small/Large 

Diff

70

80

90

%)

Diffuse

Large B-cell 

Diffuse, NOS

60

70

val Rate (

%

Burkitts

P C ll

40

50

ve Surviv

Precursor Cells

Mantle Cell

20

30

Relativ

Mature T-cell

0

10 NK/Null T-Cell

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 28.6: Aggressive Non-Hodgkin Lymphoma Relative 

Survival Rates (%) by Histology, Ages 20+, 12 SEER 

Areas, 1988-2001 

(Patients with No Evidence of HIV/AIDS: 61,214)

90

100

80

%)

Follicular Grade 1

Follicular Grade 2

60

70

val Rate (

%

Follicular Grade 2

Small B 

Lymphocytic

Lymphoplasmacytic

40

50

ve Surviv

Marginal Zone

MF/S

20

30

Relati

ezary

Cutaneous T-Cell

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 28.5: Indolent Non-Hodgkin Lymphoma: Relative 

Survival Rates (%) by Histology, Ages 20+, 12 SEER 

Areas, 1988-2001 

(Patients with No Evidence of HIV/AIDS: 61,214)

over time, rather than leveling off as do survival curves for 

some solid tumors. Decreasing relative survival over time 

reflects the ongoing risks of disease recurrence, treatment 

sequelae, and health outcomes noted to follow treatment 

for lymphoma.

Survival patterns after NHL are heterogeneous and vary 

enormously by HIV status, age at diagnosis, stage, presence of B-symptoms, histologic type, and to a lesser extent, 

sex and race. This substantial variation is demonstrated 

by five-year survival rates ranging from 82% with Stage 

IA disease to 8% in patients with HIV-associated NHL and 

Stage IVB. 

Over 7% of the patients that were eligible for this survival 

analysis had some evidence of HIV-associated disease, which 

was shown to prognosticate extremely poor survival. This 

proportion is probably not reflective of the overall contribution of HIV/AIDS-associated lymphoma to the total 

burden of NHL, as many patients with evidence of HIV/

AIDS were diagnosed without histologic confirmation and 

were excluded from analysis. In addition, there is an under 

ascertainment of the HIV/AIDS cases. HIV-associated NHL 

is considerably more aggressive than sporadic NHL, and 

treatment choices are constrained by the weakened immune system, causing poor survival. A further limitation 

of this analysis is the assessment of outcomes over a time 

period when highly active antiretroviral therapies were introduced for treatment of HIV/AIDS. These therapies have 

been shown to improve survival after HIV/AIDS related 

lymphoma substantially (3). While caution must be used 

in interpreting these results, the main point is that for total 

NHL survival is heavily influenced by HIV/AIDS.
Chapter 28 Non-Hodgkin Lymphoma

National Cancer Institute 242 SEER Survival Monograph 

the considerable variation in survival patterns for NHL 

patients, reflecting the incredible heterogeneity of this 

disease entity.

REFERENCES

1. Clarke CA, Glaser SL. Population-based surveillance of HIVassociated cancers: utility of cancer registry data. J Acquir 

Immune Defic Syndr. 2004 Aug 15;36(5):1083-91

2. Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana 

M. Report of the committee on Hodgkin’s disease staging 

classification. Cancer Research 1971;31(11)1860-1861.

3. Diamond C, Taylor TH, Aboumrad T, Anton-Culver H. 

Changes in acquired immunodeficiency syndrome-related nonHodgkin lymphoma in the era of highly active antiretroviral 

therapy: incidence, presentation, treatment, and survival. 

Cancer. 2006 Jan 1;106(1):128-35.

4. Skarin AT, Dorfman DM. Non-Hodgkin’s lymphomas: current 

classification and management. Ca Cancer J Clin 47(6): 351-

372,1997

5. Travis LB, Curtis RE, Glimelius B, et al.: Second cancers 

among long-term survivors of non-Hodgkin’s lymphoma. JNCI 

85(23): 1932-1937, 1993. 

6. Haddy TB, Adde MA, McCalla J, Domanski MJ, Datiles M 

3rd, Meehan SC, Pikus A, Shad AT, Valdez I, Lopez Vivino L, 

Magrath IT Late effects in long-term survivors of high-grade 

non-Hodgkin’s lymphomas. J Clin Oncol; 16(6):2070-9 1998

7. Schulz H, Bohlius JF, Trelle S, Skoetz N, Reiser M, Kober 

T, Schwarzer G, Herold M, Dreyling M, Hallek M, Engert A. 

Immunochemotherapy with rituximab and overall survival in 

patients with indolent or mantle cell lymphoma: a systematic 

review and meta-analysis. J Natl Cancer Inst. 2007 May 

2;99(9):706-14

acknowledgementS

The authors would like to acknowledge Angela Prehn, 

PhD and Erin Eberle for their contributions to this chapter.

Age strongly influenced survival as older persons typically 

experienced poorer survival, and even within stage, older 

persons had lower survival rates. NHL incidence rates were 

higher in males than females across the age spectrum, but 

females had slightly higher survival rates. As with most 

cancers, stage at diagnosis exerted considerable impact 

on survival. The presence of B-symptoms dramatically 

lowered survival within all stage and age groups.

The heterogeneity of NHL is particularly evident when 

considering the different patterns of survival by histologic subtypes. The survival curves of aggressive NHLs 

declined rapidly in the early months following diagnosis, 

but leveled off over time, a pattern similar to that of many 

solid tumors. This pattern contrasted dramatically with 

that of the indolent lymphomas, where a gradual steady 

decline was observed over the entire period of follow-up. 

While rarely cured, patients with indolent lymphomas 

typically have long periods of remission (4). The site of 

extranodal involvement was also observed to strongly 

influence survival.

Standard treatment choices for NHL are determined primarily by histologic subtype and stage and generally include both chemotherapy and radiation therapy. While 

treatment has improved survival after diagnosis with 

lymphoma, it may cause additional health problems. A 

significantly increased risk of second primary cancers has 

been noted in persons surviving 15 years or more after 

diagnosis with NHL (5), and cardiac toxicity has been 

reported (6). The monoclonal antibody rituximab has 

been shown to be helpful in assisting immune responses 

against lymphoma cells, thereby providing a treatment 

choice with fewer side effects than other therapies for a 

subset of NHLs expressing the CD20 antigen (7). Other 

treatment innovations include novel chemotherapy agents 

and regimens including bone marrow or peripheral blood 

stem cell transplantation. The high and increasing incidence of NHLs underscores the importance of continuing 

efforts to develop therapies that will improve survival and 

reduce adverse treatment effects.

These population-based data are based on nearly 66,000 

patients diagnosed between 1988 and 2001. While the 

SEER data provide a large representative sample to examine numerous clinical and demographic predictors of 

survival after diagnosis with NHL, especially for rare 

subtypes, data were not available on treatment differences 

and comorbidity, two additional factors which impact 

survival and could explain some of the observed patterns. These analyses do, however, provide evidence of 
National Cancer Institute 243 SEER Survival Monograph 

Introduction

Leukemias are malignancies that affect the blood-forming 

stem cells found in bone marrow. Myeloid leukemias are 

cancers that arise from myeloid stem cells, which normally 

mature into red blood cells, white blood cells, and platelet-producing cells. Lymphoblastic leukemias are cancers 

that arise from lymphocyte stem cells, which normally 

mature into white blood cells, also known as leukocytes. 

Leukemias are a heterogeneous group of cancers in terms 

of both biological and clinical features. Acute types refer 

to cancers arising in immature stem cells, while chronic 

types refer to cancers arising in mature stem cells. 

Acute leukemias have been linked with several occupational 

and environmental exposures, and certain carcinogenic 

therapies. Radiation from the atom bomb (1) has been 

associated with an increased risk for acute lymphoblastic 

leukemia (ALL) and acute myeloid leukemia (AML), but 

not for chronic leukemias. The risk from low-dose radiation 

seen in occupational settings (2) and from electromagnetic 

fields (3, 4) is controversial. Smoking has been linked to 

acute leukemia (5-7). As much as 20% of AML cases may 

be due to smoking (6). Certain chemotherapy agents are 

associated with an increased risk of secondary leukemias, 

in particular AML, following treatment for ALL (8-10) 

and Hodgkin lymphoma (11). 

The average age-adjusted incidence for leukemia during 

the period 1975-2003 is 12.8 per 100,000 persons (12). 

The American Cancer Society (ACS) estimates that in 2006 

there will be 35,070 leukemias diagnosed in the United 

States: 13,950 lymphoblastic leukemias, 16,430 myeloid 

leukemias, and 5,690 “other” leukemias (13). Leukemias 

considered together are one of the top 10 cancers in the 

United States. 

ACS shows the most common leukemia to be acute myeloid leukemia (AML) (11,930 cases) followed by chronic 

lymphoblastic leukemia (CLL) (10,020 cases) (13). The 

incidence of the different types of leukemia, varies by 

age. When age-adjusted rates were used CLL had the 

highest incidence rate, 4.3 per 100,000 (12), compared to 

3.4 per 100,000 for acute myeloid leukemia (AML), 1.8 

per 100,000 for chronic myeloid leukemia (CML), and 

1.3 per 100,000 for acute lymphoblastic leukemia (ALL) 

in 1975-2003. The 2000-2003 average incidence of all 

leukemias in persons over 65 years of age was 54.8 per 

100,000 compared to 6.0 for persons less than 65 years. 

However, of all types of leukemia, acute lymphoblastic 

leukemia impacted children and young adults the most. 

Acute lymphoblastic leukemia was responsible for more 

deaths in this age group than any other cancer site. The 

median age at diagnosis for ALL was 13 years and 61.1% 

of incident cases for 2000-2003 occurred in children/young 

adults <20 years of age (12).

This chapter provides survival analysis for 42,678 histologically confirmed cases of primary leukemia diagnosed from 1988 through 2001 from the Surveillance, 

Epidemiology, and End Results (SEER) Program of the 

National Cancer Institute (NCI). This chapter highlights 

the influence of type of leukemia, race and ethnicity, age, 

and sex on survival outcomes. 

Materials and Methods

Exclusions

Analyses for all categories of leukemia, with the exception 

of acute lymphoblastic leukemia, included patients aged 

20 years or over diagnosed with leukemia between 1988 

and 2001 and reported to the SEER program. Analysis 

for acute lymphoblastic leukemia also included cases less 

than 20 years of age, since children and young adults 

represent nearly two-thirds of cases for this histological 

type and since their incidence and survival differ from 

those of adults. Patients were followed for vital status 

until 2002. Patients with unknown race, death certificate 

only cases, those without histologic confirmation of a 

leukemia diagnosis, or those alive with no survival time 

were excluded from analysis. Table 29.1 details the counts 

for these exclusions with 42,678 cases for analyses.

Marie-Josephe D. Horner and Lynn A.Gloeckler Ries

Chapter 29

Leukemia
Chapter 29 Leukemia

National Cancer Institute 244 SEER Survival Monograph 

Results

Histology

For each type of leukemia, there was a slightly higher 

proportion of men than women, except for “other” lymphocytic leukemia where nearly three-fourths were men. 

The age distribution at diagnosis for adults with leukemia 

varies widely by type of leukemia. For example, the percentage 75 years of age and over ranged from 14.1% of 

adults with ALL to over 35% for CLL, “other” myeloid/

Table 29.1: Leukemia: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001

Number selected/remaining Number excluded Reason for selection/exclusion

54,899 - Diagnosed 1988-2001 (Los Angeles for 1992-2001 only)

47,631 7,268 Select first primary only

46,486 1,145 Exclude death certificate only or at autopsy

46,083 403 Exclude unknown race

46,009 74 Exclude alive with no survival time

44,667 1,342 Exclude children (Ages 0-19, except for Acute Lymphocytic Leukemia

44,667 0 Exclude in situ cancers

44,667 0 Exclude sarcomas

42,678 1,989 Exclude no or unknown microscopic confirmation

Table 29.2: Leukemia: Number of Cases by Histology, Ages 

20+, 12 SEER Areas, 1988-2001

Histology 

Group

Histology

(ICD-O Code) Cases

Lymphocytic 

Leukemia

Children and young adults 0-19 

years 

Acute Lymphocytic Leukemia 

(9826,9835-9837) 4,418

Adults 20+ years 

Acute Lymphocytic Leukemia 

(9826,9835-9837) 2,312

Chronic Lymphocytic Leukemia 

(9823) 13,145

Other Lymphocytic Leukemia 

(9820,9832-9834, 9940) 1,686

Myeloid and 

Monocytic 

Leukemia

Acute Myeloid Leukemia 

(9840,9861,9866,9867,9871-9874, 

9895-9897, 9910, 9920) 11,459

Acute Monocytic Leukemia (9891) 738

Chronic Myeloid Leukemia 

(9863,9875, 9876, 9945,9946) 6,028

Other Myeloid/Monocytic 

Leukemia (9860,9930) 507

Other 

Leukemia

Other Acute Leukemia (9801, 

9805, 9931) 1,474

Aleukemic, Subleukemic and NOS 

(9733,9742, 9800, 9827,9831, 9870, 

9948, 9963-9964) 911

Total 42,678

The survival analysis was based on relative survival rates 

calculated by the life-table method (14).The relative rate 

was used to estimate the effect of cancer on the survival 

of the cohort. Relative survival, defined as the ratio of 

observed survival to expected survival, adjusts for the expected mortality that the cohort would experience from 

other causes of death. 

Histologic classification

Leukemia is a heterogeneous group of malignancies. Multiple classification schemes have been developed over the 

past several decades. The 1988-2000 data were collected 

using the International Classification of Diseases for Oncology, second edition (ICD-O-2) schema (12) and the 

2001 data use the International Classification of Diseases 

for Oncology, third edition (ICD-O-3) (15). The FrenchAmerican-British (FAB) classification of leukemias uses 

cytogenetic and molecular elements and has been included 

in the latest ICD edition, ICD-O-3, which was implemented 

in 2001 (15). We used the ICD-O-2 to ICD-O-3 conversion 

tables to create histologic groupings that are more reflective 

of the current World Health Organization classification of 

hematopoietic diseases. 

Leukemia subtypes generally fall into one of the major cell 

type groups and will be analyzed as such: acute lymphoblastic leukemia (ALL), chronic lymphoblastic leukemia 

(CLL), “other” lymphoblastic leukemia, acute myeloid 

leukemia (AML), acute monocytic leukemia, chronic myeloid (or granulocytic) leukemia (CML), “other” myeloid/

monocytic leukemia, “other” acute leukemia, and aleukemic, 

subleukemia, not otherwise specified (NOS) leukemia(12). 

Histologic categories, with their associated ICD-O-3 codes, 

are summarized in table 29.2. 
Chapter 29 Leukemia

National Cancer Institute 245 SEER Survival Monograph 

Table 29.3: Number and Distribution of Cases by Sex, Race, Age at Diagnosis (20+, except for Acute Lymphocytic Leukemia) and 

Histology, 12 SEER Areas, 1988-2001

Characteristics

Histology

Acute Lymphocytic Leukemia

Chronic 

Lymphocytic 

Leukemia

Other 

Lymphocytic 

Leukemia

Acute Myeloid 

Leukemia

0-19 years >20 years All Ages 20+

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 4,418 2,312 13,145 1,686 11,459

Sex

Male 2,509 56.8 1,357 58.7 7,801 59.3 1,231 73.0 6,240 54.5

Female 1,909 43.2 955 41.3 5,344 40.7 455 27.0 5,219 45.5

Race*

White 3,681 83.3 1,943 84.0 11,997 91.3 1,548 91.8 9,607 83.8

Black 298 6.7 150 6.5 851 6.5 72 4.3 814 7.1

Age at diagnosis (Years) 

20-39 N/A N/A 887 38.4 143 1.1 139 8.2 1,536 13.4

40-59 N/A N/A 665 28.8 2,754 21.0 645 38.3 2,675 23.3

60-74 N/A N/A 433 18.7 5,611 42.7 523 31.0 3,869 33.8

75+ N/A N/A 327 14.1 4,637 35.3 379 22.5 3,379 29.5

* Relative survival rate for “other” race not calculated

Table 29.3: (continued)

Characteristics

Histology

Acute Monocytic 

Leukemia

Chronic Myeloid 

Leukemia

Other Myeloid/

Monocytic 

Leukemia

Other Acute 

Leukemia

Aleukemic, 

Subleukemic and 

NOS

All Ages

Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent

Total 738 6,028 507 1,474 911

Sex

Male 435 58.9 3,499 58.0 287 56.6 800 54.3 491 53.9

Female 303 41.1 2,529 42.0 223 44.0 674 45.7 420 46.1

Race*

White 646 87.5 5,010 83.1 419 82.6 1,268 86.0 762 83.6

Black 42 5.7 553 9.2 50 9.9 102 6.9 96 10.5

Age at diagnosis (Years) 

20-39 99 13.4 995 16.5 39 7.7 115 7.8 59 6.5

40-59 191 25.9 1,588 26.3 81 16.0 197 13.4 123 13.5

60-74 231 31.3 1,774 29.4 182 35.9 472 32.0 310 34.0

75+ 217 29.4 1,671 27.7 205 40.4 690 46.8 419 46.0

* Relative survival rate for “other” race not calculated
Chapter 29 Leukemia

National Cancer Institute 246 SEER Survival Monograph 

Table 29.4: Acute Lymphocytic Leukemia: Number of Cases 

and 1-, 3-, 5- and 10-Year Relative Survival Rates (%) by 

Sex, Age (20+), and Race, 12 SEER Areas, 1988-2001 

Characteristics

Cases

Relative Survival

1-Yr 3-Yr 5-Yr 10-Yr

Total 6,730 79.8 66.7 62.2 60.1

Sex

Male 3,866 79.9 65.7 60.9 58.6

Female 2,864 79.7 68.1 64.1 61.9

Age (Years)

0-19 4,418 94.5 85.3 80.2 76.5

20-39 887 70.8 43.4 37.3 33.4

40-59 665 55.5 28.0 22.0 17.2

60-74 433 29.4 14.1 9.9 5.9

75+ 327 16.1 5.8 4.0 3.3

Race

White 5,624 80.1 67.3 63.2 60.9

Black 448 77.1 59.1 51.7 49.3

Race/Sex

White males 3,235 80.2 66.3 61.8 59.6

White females 2,389 79.8 68.7 65.1 62.6

Black males 245 78.5 59.6 52.0 47.8

Black females 203 75.3 58.6 51.2 50.1

Table 29.5: Chronic Lymphocytic Leukemia: Number of 

Cases and 1-, 3-, 5- and 10-Year Relative Survival Rates (%) 

by Sex, Age (20+) and Race, 12 SEER Areas, 1988-2001

Characteristics

Cases Relative Survival Rate (%)

1-Yr 3-Yr 5-Yr 10-Yr

Total 13,145 92.3 86.7 74.9 54.2

Sex

Male 7,801 92.3 83.7 75.5 52.5

Female 5,344 91.4 83.4 75.4 56.5

Age (Years)

20-39 143 94.6 86.7 83.4 64.8

40-59 2,754 97.0 90.0 82.6 60.8

60-74 5,611 95.0 86.6 78.0 55.4

75+ 4,637 85.7 74.4 62.0 40.0

Race

White 11,997 92.8 84.7 76.3 56.1

Black 851 86.2 71.4 58.0 30.0

Race/Sex

White males 7,120 93.4 85.1 76.3 54.7

White 

females 4,877 92.0 84.1 76.3 58.0

Black males 490 87.5 68.9 53.1 25.7

Black females 361 84.2 74.9 64.5 35.1

Table 29.6: Acute Myeloid Leukemia: Number of Cases and 

1-, 3-, 5- and 10- Year Relative Survival Rates (%) by Sex, 

Age (20+) and Race, 12 SEER Areas, 1988-2001

 Characteristics

Cases Relative Survival Rate (%)

1-Yr 3-Yr 5-Yr 10-Yr

Total 11,459 34.4 18.9 16.5 16.1

Sex

Male 6,240 33.7 17.7 15.1 14.8

Female 5,219 35.3 20.2 18.0 17.2

Age (Years)

20-39 1,536 67.3 46.2 42.1 38.3

40-59 2,675 50.6 29.6 25.1 21.7

60-74 3,869 29.0 11.0 7.3 5.3

75+ 3,379 11.0 2.9 1.9 0.8

Race

White 9,607 34.1 18.7 16.3 15.8

Black 814 34.7 17.0 14.5 13.1

Race/Sex

White males 5,276 33.6 17.3 15.0 14.6

White females 4,331 34.7 20.2 17.8 17.1

Black males 395 34.6 18.3 14.6 11.1

Black females 419 34.8 15.7 14.2 14.2

Table 29.7: Acute Monocytic Leukemia: Number of Cases 

and 1-, 3-, 5-and 10-Year Relative Survival Rates (%) by 

Sex, Age (20+) and Race, 12 SEER Areas, 1988-2001

Characteristics

Cases Relative Survival Rate (%)

1-Yr 3-Yr 5-Yr 10-Yr

Sex

Male 435 30.8 17.0 15.1 13.6

Female 303 26.2 14.7 13.2 12.1

Age (Years)

20-39 99 43.3 30.9 24.4 24.4

40-59 191 45.3 24.9 22.2 21.4

60-74 231 26.2 11.7 9.0 3.3

75+ 217 9.1 2.9 2.9 !

Race

White 646 29.5 16.4 15.2 13.7

Black 42 24.6 19.8 11.1 11.1

Race/Sex

White males 386 31.9 17.4 16.0 14.0

White females 260 26.1 14.9 13.7 12.7

Black males 19 ~ ~ ~ ~

Black females 23 ~ ~ ~ ~

 ~ Statistic not displayed due to less than 25 cases
Chapter 29 Leukemia

National Cancer Institute 247 SEER Survival Monograph 

monocytic, “other” acute, and aleukemic leukemia (Table 

29.3). One-, three-, five-, and ten-year relative survival 

rates, are presented in tables by type of leukemia: ALL 

(Table 29.4), CLL (Table 29.5), AML (Table 29.6), acute 

monocytic (Table 29.7), CML (Table 29.8) and other leukemias including “other” lymphocytic, “other” myeloid, 

“other” acute, and aleukemic, subleukemic, and not otherwise specified (NOS) (Table 29.9).

Lymphoblastic leukemias, notably CLL, have the most favorable survival outcomes during the first twelve months 

following diagnosis. The 1-year relative survival rates for 

CLL and ALL were 92% and 80%, respectively (Tables 

29.4, 29.5, 29.9; Figure 29.1). Myeloid and monocytic 

leukemias have the least favorable survival rates during 

the first year following diagnosis, with a 1-year relative 

survival rate of 34% for AML, 30% for acute monocytic, 

and 76% for CML (Tables 29.6-29.7; Figure 29.1). 

Five years after diagnosis, patients with CLL and ALL 

still fared better than those diagnosed with myeloid and 

monocytic types of leukemia. The 5-year relative survival 

rates for CLL and ALL were 75% and 62% respectively, 

compared to 38% and 17% for CML and AML (Tables 

29.4-29.8). Figure 29.1 shows the 10-year relative survival 

curves for distinct histological types of leukemia. 

“Other” lymphoblastic leukemia had the most favorable 

among “other” types of leukemia, for 1- and 5- years after 

diagnosis (Table 29.9). The 1-year survival rate for “other” lymphoblastic leukemia is 88%, while that of “other” 

myeloid is 42% and that of aleukemic, subleukemic, and 

90

100

60

70

80

Rate (%) 40

50

60

Survival R 20

30

Relative S 0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Ages <19, Acute Lymphoblastic Ages 20+, Acute Lymphoblastic

Chronic Lymphoblastic Acute Myeloid 

Acute Monocytic Chronic Myeloid 

80

90

100

60

70

te (%) 30

40

50

rvival Rat 10

20

30

elative Su

0

0 12 24 36 48 60 72 84 96 108 120

R

Months after diagnosis

Lymphoid leukemia NOS Lymphoid leukemia, NOS Prolymphocytic leukemia, NOS , B-cell, T-cell

Hairy cell leukemia

Myeloid leukemia, NOS

Myeloid sarcoma

A t l k i NOS (bl t dif t ll) Acute leukemia, NOS (blast, undif, stem cell)

Acute panmyelosis with myelofibrosis

Plasma cell leukemia

Leukemia, NOS (subacute, chronic, aleukemic NOS)

90

100

70

80

te (%)

White male

60

70

rvival Rat

White male

White female

40

50

lative Sur

Black male

Black female

20

Re30

0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

90

100

70

80

%)

White male

60

70

val Rate (

%

White female

Black male

40

50

ve Surviv

Black female

20

30

Relati 0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 29.1: Leukemia: Relative Survival Rates (%) by 

Histology, Ages 20+ plus Acute Lymphoblastic Leukemia for 

Ages 0-19, 12 SEER Areas, 1988-2001

Figure 29.2:”Other” Leukemia: Relative Survival Rates (%) by 

Histology, Ages 20+, 12 SEER Areas, 1988-2001 

Figure 29.3: Acute Lymphocytic Leukemia: Relative Survival 

Rates (%) by Race and Sex, Ages 0-19, 12 SEER Areas, 1988-

2001 

Figure 29.4: Acute Lymphocytic Leukemia: Relative Survival 

Rates (%) by Race and Sex, Ages 20+12 SEER Areas, 1988-

2001 
Chapter 29 Leukemia

National Cancer Institute 248 SEER Survival Monograph 

NOS is 45%. “Other” acute leukemia fares the worst 

1-year after diagnosis, with a 1-year survival rate of 21%. 

These differences in survival widen 5 and 10 years after 

diagnosis. 

In terms of specific histologies in “other” lymphoblastic 

leukemia, hairy cell leukemia had the most optimistic 

survival rates, 1-year (95%) and 5-years after diagnosis 

(93%), compared to lymphoid leukemia, NOS, and prolymphocytic leukemia, NOS (Table 29.9). Figure 29.2 shows 

the relative survival of specific histologies for “other” 

lymphoblastic, “other” myeloid leukemia, “other” acute 

leukemia, and aleukemic, subacute and NOS leukemia. 

Age at diagnosis

Patient age at diagnosis strongly influences survival patterns after leukemia diagnosis. Increasing age at diagnosis 

had a general linear association with poorer survival over 

10 years after diagnosis for all categories of leukemia. 

These differences in relative survival become more apparent with increasing time since diagnosis. 

Lymphoblastic leukemias

Approximately two-thirds of persons diagnosed with acute 

lymphoblastic leukemia were children and young adults. 

The survival among those less than 20 years of age is 

distinctly higher than the survival in any other age group 

(Table 29.4). As age of diagnosis increases, survival de90

100

70

80

%)

White male

60

70

val Rate (

%

White male

White female

40

50

ve Surviv

Black male

Black female

20

30

Relati 0

10

0 12 24 36 48 60 72 84 96 108 120

Months after diagnosis

Figure 29.5: Chronic Lymphocytic Leukemia: Relative 

Survival Rates (%) by Race and Sex, Ages 20+, 12 SEER 

Areas, 1988-2001 

Table 29.8: Chronic Myeloid Leukemia: Number of Cases and 

1-, 3-, 5-and 10-Year Relative Survival Rates (%) by Sex, Age 

(20+) and Race, 12 SEER Areas, 1988-2001 

Charactersitics Cases

Relative Survival Rate (%)

1-Year 3-Year 5-Year 10-Year

Total 6,028 75.5 50.8 37.7 22.1

Sex

Male 3,499 75.5 50.4 37.4 23.0

Female 2,529 74.6 51.4 38.1 20.8

Age (Years)

20-39 995 89.8 65.3 55.0 41.1

40-59 1,588 86.3 63.1 48.1 29.6

60-74 1,774 71.9 46.7 30.5 8.6

75+ 1,671 55.5 30.0 16.9 2.9

Race

White 5,010 74.2 50.6 37.6 21.7

Black 553 76.6 49.8 36.6 20.9

Race/Sex

White males 2,901 74.1 50.2 37.4 22.9

White females 2,109 74.3 51.2 38.0 20.1

Black males 320 77.0 49.6 34.1 20.0

Black females 233 76.1 50.0 39.8 21.9

Table 29.9: “Other” leukemias: Number of Cases and 1-, 3-, 5- 

and 10-Year Relative Survival Rate (%) by Histology, Ages 20+, 

12 SEER Areas, 1988-2001 

Histology Cases

Relative Survival Rate (%)

1- 

Year

3- 

Year

5- 

Year

10-

Year

“Other” lymphocytic 1,686 87.7 81.8 79.5 77.5

Lymphoid leukemia, 

NOS 238 76.3 65.8 60.0 45.8

Prolymphocytic, NOS 3 249 61.5 33.9 24.3 12.0

Hairy cell leukemia 1,199 95.2 93.7 92.7 92.3

Other myeloid 507 41.7 24.8 20.3 15.8

Myeloid leukemia, NOS * 400 41.3 25.1 20.8 15.1

Myeloid sarcoma 107 43.4 23.5 18.7 17.6

Other acute 1,474 21.1 8.3 6.4 6.2

Acute leukemia, NOS1 1,402 19.4 10.2 5.8 5.5

Acute panmyelosis with 

myelofibrosis 65 55.6 24.0 17.5 13.2

Aleukemic, 

Subleukemic, and NOS* 911 45.1 30.0 27.1 17.3

Leukemia, NOS4 712 47.1 33.6 30.8 19.5

Plasma cell leukemia 103 26.1 9.5 7.1 !

*NOS, not otherwise specified

1 Blast cell, undifferentiated, Stem cell

2 Subacute NOS, Chronic NOS, Aleukemic NOS

3 Includes Prolymphocytic B-cell, Prolymphocytic T-cell

4 Subacute NOS, Chronic NOS, Aleukemic NOS

! Not enough intervals to produce rate
Chapter 29 Leukemia

National Cancer Institute 249 SEER Survival Monograph 

clines. The 1-year relative survival rate in ALL patients 

aged 0-19 years is 95%, while the same 1-year survival rate 

in 20-39 year olds is 71%. In the two oldest age groups, 

60-74 and 75+ years of age, the 1-year survival rate is 

29% and 16%, respectively. These large differences by 

age remain pronounced over the three, five, and ten year 

period following diagnosis.

Chronic lymphoblastic leukemia had the best overall survival for all age groups. At 12 months after diagnosis, 

the difference between the relative survivals among age 

groups is not pronounced until 10 years after diagnosis 

(Table 29.5). The 1-year survival rates for CLL is slightly 

more favorable for patients diagnosed at 40-59 years (97%) 

compared to those diagnosed at 20-39 years (95%), 60-74 

(95%) and 75+ years of age (86%). However, as with 

ALL, the long-term survival patterns favor those diagnosed 

at a younger age. The 5- and 10-year relative survival 

rates were highest among patients diagnosed at 20-39 

years (5-year, 83%; 10-year, 65%) compared to patients 

diagnosed at 75+ years (5-year, 62%; 10-year, 40%). 

Myeloid and monocytic leukemias

The 1-year survival rate for acute myeloid leukemia was 

most favorable for those in the 20-39 years age group 

(67%), compared to those in the 75+ age group (11%). This 

discrepancy persists over 5- and 10-year period following 

diagnosis (Table 29.6). Similarly for acute monocytic, the 

survival rates vary greatly between the youngest age group 

and the oldest; the 1-year relative survival rate was 43% 

for 20-39 and only 9% for those 75 years and older. For 

acute monocytic leukemia the survival rates were similar 

for ages 20-39 and 40-59 (Table 29.7). 

The survival curves for chronic myeloid leukemia were 

very similar for 20-39 and 40-59 age groups for years 

1 through 5, after which they slightly diverge, with the 

40-59 age group faring slightly worse than their younger 

counterparts. Overall, the lowest survival rate was found 

in the age group of 75+, and becomes more pronounced 

over the long-term. The 1-year survival rate for persons 

in age groups 20-39 and 40-59 years was 90% and 86% 

compared to 56% for the 75+ age group. The 5-year relative survival rate for persons in age groups 20-39 and 

40-59 years was 55% and 48% compared to 17% for the 

75+ age group (Table 29.8).

Histology, gender, and race

Lymphoblastic leukemias

Overall, whites had more favorable 5-year survival rates 

for childhood lymphoblastic leukemias (Figure 29.3) than 

black children. Adult lymphoblastic leukemias (5-year 

ALL, 63%; CLL, 76%) had more favorable 5-year survival 

rates than blacks (5-year ALL, 52%; CLL, 58%) (Figures 

29.4 and 29.5, respectively). The gender difference slightly 

favored females diagnosed with ALL (5-year survival rate, 

64%; males 5-year survival 61%) was not seen among 

persons diagnosed with CLL (male 5-year survival rate 

76%; female 5-year survival rate 75%). Within racial 

categories, the female survival advantage in survival became more apparent, but was limited to whites (Tables 

29.4, 29.5). 

Myeloid and monocytic leukemias

Whites diagnosed with myeloid and monocytic leukemias 

had a slight 5-year survival advantage (5-year survival 

rates: AML,16%; acute monocytic, 15%, CML, 38%) compared to blacks (5-year AML, 15%; acute monocytic, 11%; 

CML, 37%). Females also showed a slight 5-year survival 

advantage compared to males (Tables 29.6, 28.7). 

Discussion

These population-based data were based on 42,678 adult 

leukemia cases diagnosed between 1988 and 2001. While 

the SEER data provide a large representative sample to 

examine numerous demographic predictors of survival 

after diagnosis with leukemia, data were not available 

on treatment differences and comorbidity, two additional 

factors that impact survival and could explain some of 

the patterns we observed. These analyses provide evidence of the considerable variation in survival patterns 

for leukemia patients, reflecting the heterogeneity of this 

disease entity.

Leukemia had a combined incidence of 12.2 per 100,000 

per year for the period 2000-2003 (12). Relative survival 

estimates show distinct differences between histologic 

groups. Survival outcome varies widely between groups, 

with the lymphoblastic leukemias having the highest 5- 

year relative survival rates, in particular childhood and 

young adult ALL (80%). There were large differences in 

survival by age-group. The older the patient’s age was 

at diagnosis, the lower the relative survival curve for all 

histology groups. Older patients also had a greater incidence of the cytogenetic abnormalities associated with 

poor prognosis, namely the Philadelphia chromosome 

found in cases of ALL (16). Previous reports on AML 
Chapter 29 Leukemia

National Cancer Institute 250 SEER Survival Monograph 

16. Cancer principles & practice of oncology, fourth edition, ed. T.J. 

DeVita, S. Hellman, and S.A. Rosenbreg. 1993, Philadelphia: J.B. 

Lippencott.

17. Yates, J., et al., Cytosine arabinoside with daunorubicin or 

adriamycin for therapy of acute myelocytic leukemia: a CALGB 

study. Blood, 1982. 60(2): p. 454-62.

18. Rai, K.R., et al., Treatment of acute myelocytic leukemia: a study 

by cancer and leukemia group B. Blood, 1981. 58(6): p. 1203-12.

indicate that age is inversely associated with cancer remission (17, 18). 

The incidence in men is 15.9 per 100,000, while that of 

women is lower, at 9.4 per 100,000. Overall, there is little 

gender difference in survival. By race, whites had a higher 

incidence (12.7 per 100,000) than blacks (10.1 per 100,000). 

Survival varies by race and gender, but these differences were 

most pronounced for lymphoblastic leukemias, especially 

at the 5- and 10-year period after diagnosis. In general, 

black males and black females tended to fare worse than 

white males and females. As with other cancer sites, some 

of these differences in survival outcomes may be due to 

issues related to access to care and socioeconomic status. 

REFERENCES

1. Ron, E., et al. Cancer incidence in atomic bomb survivors. Part 

IV: Comparison of cancer incidence and mortality. Radiat Res, 

1994. 137(2 Suppl): p. S98-112.

2. Sandler, D.P. Recent studies in leukemia epidemiology. Curr Opin 

Oncol, 1995. 7(1): p. 12-8.

3. Feychting, M. and A. Ahlbom. Magnetic fields and cancer in 

children residing near Swedish high-voltage power lines. Am J 

Epidemiol, 1993. 138(7): p. 467-81.

4. Taubes, G. Another blow weakens EMF-cancer link. Science, 

1995. 269(5232): p. 1816-7.

5. Sandler, D.P., et al. Cigarette smoking and risk of acute leukemia: 

associations with morphology and cytogenetic abnormalities in 

bone marrow. J Natl Cancer Inst, 1993. 85(24): p. 1994-2003.

6. Siegel, M. Smoking and leukemia: evaluation of a causal 

hypothesis. Am J Epidemiol, 1993. 138(1): p. 1-9.

7. Kabat, G.C., A. Augustine, and J.R. Hebert, Smoking and adult 

leukemia: a case-control study. J Clin Epidemiol, 1988. 41(9): p. 

907-14.

8. Pui, C.H., et al., Secondary acute myeloid leukemia in children 

treated for acute lymphoid leukemia. N Engl J Med, 1989. 321(3): 

p. 136-42.

9. Pui, C.H., et al., Characterization of childhood acute leukemia 

with multiple myeloid and lymphoid markers at diagnosis and at 

relapse. Blood, 1991. 78(5): p. 1327-37.

10. Tucker, A., Cancers of the haematopoietic and lymphatic systems. 

Br J Hosp Med, 1977. 18(1): p. 95-6.

11. van Leeuwen, F.E., et al., Second cancer risk following Hodgkin’s 

disease: a 20-year follow-up study. J Clin Oncol, 1994. 12(2): p. 

312-25.

12. Ries, L.A.G., et al. (ed), SEER Cancer Statistics Review, 1975-

2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

submission, posted to the SEER web site,2006.

13. (ACS), A.C.S., Cancer Facts & Figures – 2006. 2006, Atlanta, 

Georgia.

14. Kaplan, E.L. and P. Meier, Nonparametric estimation from 

incomlpete observations. J Am Stat Assoc, 1958. 53: p. 457-481.

15. Fritz, A., et al., International Classification of Diseases 

for Oncology, Third Edition. 2000, Geneva: World Health 

Organization.
National Cancer Institute 251 SEER Survival Monograph 

Introduction

There are some anatomic sites in which cancer rarely occurs, for example, the eye, the ureter, the pituitary gland, 

etc. Most of these rare sites have been excluded from 

other chapters in this monograph due to the small number of cases involved. This chapter provides a limited 

analysis of survival for these rare sites and for cancers 

which could not be assigned to a specific anatomic location at the time of diagnosis due to the advanced stage of 

the tumor. Cases were obtained from the Surveillance, 

Epidemiology, and End Results (SEER) Program of the 

National Cancer Institute (NCI).

Materials and Methods

The NCI contracts with medically-oriented, nonprofit institutions located in specific geographic areas to obtain 

data on all cancers diagnosed in residents of the SEER 

geographic areas. SEER collects data on all invasive 

and in situ cancers except basal cell and squamous cell 

carcinomas of the skin (of non-genital anatomic sites) and 

in situ carcinomas of the uterine cervix. SEER actively 

follows all previously diagnosed patients on an annual 

basis to obtain vital status allowing the calculation of 

observed and relative survival rates.

This analysis is based on data from 12 SEER geographic 

areas which collectively cover about 14% of the total US 

population. The areas are the States of Connecticut, Iowa, 

New Mexico, Utah, and Hawaii; the metropolitan areas of 

Detroit, Michigan; Atlanta, Georgia; San Francisco, San 

Jose, and Los Angeles, California; Seattle, Washington; 

and 10 counties in rural Georgia. Los Angeles contributed 

data for diagnosis years 1992 to 2001, all other areas for 

1988-2001.

With the exception of male breast cancers, in situ diagnoses have been excluded. Cases diagnosed in children and 

adolescents aged 0-19 have also been excluded. Some 

patients have more than one diagnosis of cancer, but only 

the first diagnosis of cancer has been included. Death 

certificate only cases, autopsy only cases, and alive cases 

with no survival time have been excluded. All sarcomas 

arising in these rare sites have been excluded since they are 

included in the chapter on sarcomas included elsewhere in 

this monograph (1). Finally, with the exception of cancers 

where the primary site could not be determined, cases with 

no microscopic confirmation have been included.

Survival analysis is based on relative survival rates calculated by the life-table (actuarial) method. Relative survival, 

defined as observed survival in the cohort divided by 

expected survival in the cohort, adjusts for the expected 

mortality that the cohort would experience from other 

causes of death. Expected survival is based on decennial 

life tables for the United States in 1990.

In many of the chapters in this monograph, data on stage 

are presented using the Stage I-IV definitions of the American Joint Committee on Cancer (AJCC) 3rd or 5th Editions. However, for many of the rare tumor sites there 

are no appropriate AJCC staging definitions. Therefore, 

the staging definitions utilized in this chapter are those of 

the 1977 Summary Staging Guide (2). For simplicity, all 

categories of regional disease have been added together 

into a single group. 

Results

Table 30.1 shows the anatomic sites included in this analysis 

along with the numbers of cases diagnosed during 1988-

2001 classified by sex, by race, and by stage of diagnosis. 

The sites have been arranged by body systems and show 

the specific rare cancer sites under the appropriate body 

system. Relative survival rates at 1, 3, 5, and 10 years 

are shown in Table 30.2 for both sexes and for males and 

females separately where appropriate. Table 30.3 presents 

rates for whites and for blacks where the number of cases 

permitted meaningful analyses. Finally, Table 30.4 presents 

relative survival rates by SEER Summary Stage.

John L. Young, Jr., Kevin C. Ward, and Lynn A. Gloeckler Ries

Chapter 30

Cancers of Rare Sites
Chapter 30 Cancers of Rare Sites

National Cancer Institute 252 SEER Survival Monograph 

Table 30.1: Cancers of rare sites: Number and Distribution of Cases by Primary Site, Sex, Race and SEER Summary

Stage 1977 (2), Ages 20+, 12 SEER Areas, 1988-2001

Primary Site Total

Sex Race Stage (%)

Male Female White Black Loc Reg Dis Uns

Respiratory and Intrathoracic Organs

 Nose, Nasal Cavity and Middle Ear 2,299 1,329 970 1,842 223 25.8 51.3 14.1 8.7

 Nasal Cavity 1,009 571 438 868 59 46.2 30.7 12.0 11.1

 Middle Ear 82 38 44 67 8 17.1 50.0 20.7 12.2

 Trachea, Mediastinum and Other Respiratory 573 427 146 474 50 20.8 33.0 24.6 21.6

 Trachea 211 112 99 173 20 24.2 42.2 16.1 17.5

 Squamous Cell 105 65 40 89 12 21.0 41.9 20.0 17.1

 Mediastinum 315 282 33 258 27 21.6 30.5 30.8 17.1

 Mediastinum - Germ 250 236 14 205 20 24.4 28.4 28.8 18.4

 Other Respiratory 47 33 14 43 <5 0.0 8.5 21.3 70.2

 Pleura* 49 28 21 40 <5 16.3 14.3 24.5 44.9

Skin^ 2,793 1,517 1,276 2,539 105 73.4 7.4 5.9 13.4

 Merkel Cell 1,076 617 459 1,021 9 66.5 11.1 8.2 14.2

 Skin Appendage Adenocarcinoma 383 199 184 356 13 77.0 7.6 0.8 14.6

 Sweat Gland Adenocarcinoma 208 125 83 185 13 77.4 6.3 2.9 13.5

 Sebaceous Adenocarcinoma 458 229 229 413 13 79.9 1.7 6.8 11.6

Peritoneum and Retroperitoneum* 1,461 209 1,252 1,300 80 7.3 15.1 70.9 6.6

 Papillary Serous Cystadenocarcinoma 636 <5 635 579 24 1.1 11.3 85.7 1.9

Male Breast (including in situ) 1,905 1,905 0 1,578 232 43.6 37.9 5.2 2.5

 In situ 205 205 0 177 20 0.0 0.0 0.0 0.0

 Invasive 1,700 1,700 0 1,401 212 48.8 42.5 5.9 2.8

Female Genital

 Ligaments and Adnexa 49 0 49 37 8 44.9 10.2 40.8 4.1

 Overlapping 60 0 60 49 7 35.0 21.7 31.7 11.7

 Other and Not Otherwise Specified 192 0 192 160 20 0.5 12.0 50.0 37.5

Male Genital

 Penis 1,132 1,132 0 976 94 61.2 29.9 4.3 4.6

 Penis - Squamous Cell Carcinoma 996 996 0 858 87 60.5 31.1 4.3 4.0

 Scrotum 233 233 0 149 22 69.5 19.3 3.0 8.2

 Scrotum - Squamous Cell Carcinoma 87 87 0 65 18 67.8 21.8 4.6 5.7

 Scrotum - Paget Disease 74 74 0 34 0 70.3 21.6 1.4 6.8

 Other and Not Otherwise Specified 27 27 0 24 0 48.1 18.5 14.8 18.5

* Excludes mesotheliomas and sarcomas

^ Excludes Basal, Squamous, Kaposi sarcoma & Melanoma

Respiratory and Intrathoracic Organs

Cancer of the nose and nasal cavities had the best survival 

among this group of rare sites. Five-year relative survival 

rate was 54% overall and was similar for males and females 

but was better for whites vs. blacks. Cancers of the nasal 

cavity tended to be diagnosed at an earlier stage which 

doubtless contributed to a better overall 5-year relative 

survival rate of 70%. Cancers of the middle ear were 

much rarer (82 cases during the time period) and relative 

survival rate was much poorer, 34% at five years (Table 

30.2). Some additional tables for nose and nasal cavities 

are found in the chapter on head and neck cancer (3).

Relative survival rates for cancers of the trachea and pleura 

were poor (35 % and 28%, respectively, at five years) 

but were better than that for lung cancer (16%) (4). Not 

surprisingly, most cases were diagnosed with regional or 

distant disease. For cancers of the mediastinum, the fiveyear relative survival rate was 48% and was higher among 

males (50%) than among females (30%). For all respiratory 

sites, survival was markedly lower for patients diagnosed 
Chapter 30 Cancers of Rare Sites

National Cancer Institute 253 SEER Survival Monograph 

Table 30.1 (continued): Cancers of Rare Sites: Number and Distribution of Cases by Primary Site, Sex, Race and SEER Summary 

Stage 1977 (2), Ages 20+, 12 SEER Areas, 1988-2001

Primary Site Total

Sex Race Stage (%)

Male Female White Black Loc Reg Dis Uns

Urinary System

 Ureter 1,333 808 525 1,158 42 52.6 28.5 10.4 8.6

 Ureter - Papillary Transitional Cell 1,251 770 481 1,086 37 54.1 28.5 9.4 7.9

 Other Urinary 850 539 311 626 174 27.4 24.8 14.0 33.8

 Other Urinary - Papillary Transitional Cell 445 339 106 355 63 28.8 18.9 12.1 40.2

Eye and Orbit 1,904 1,069 835 1,824 33 77.6 7.2 3.0 12.2

 Eye and Orbit - Squamous Cell Carcinoma 305 240 65 278 7 74.1 9.5 3.3 13.1

 Eye and Orbit - Melanoma 1,504 779 725 1,469 17 80.3 5.3 2.3 12.1

Other Endocrine 1,727 921 806 1,301 184 29.6 36.5 24.8 9.1

 Thymus 826 465 361 558 101 20.0 50.6 20.2 9.2

 Thymus - Thymoma 678 367 311 441 89 18.9 52.1 19.3 9.7

 Adrenal Gland 598 283 315 513 47 37.3 16.9 37.3 8.5

 Adrenal Gland - Adrenal Cortical 387 170 217 340 21 43.4 20.2 31.5 4.9

 Adrenal Gland - Pheochromocytoma 66 34 32 46 15 40.9 12.1 25.8 21.2

 Parathyroid Gland 115 56 59 89 16 51.3 40.0 4.3 4.3

 Pituitary Gland 52 25 27 37 8 26.9 40.4 9.6 23.1

 Pineal Gland 95 68 27 71 8 48.4 27.4 14.7 9.5

Mesothelioma 3,562 2,795 767 3,239 182 10.9 18.5 58.5 12.1

 Mesothelioma - Pleura and Lung 3,148 2,548 600 2,860 160 11.0 19.0 58.4 11.5

 Mesothelioma - Peritoneum and Retroperitoneum 354 212 142 328 15 6.5 14.1 65.3 14.1

Reticuloendothelial System Tumors 1,297 779 779 1,174 51 0.0 0.0 99.7 0.3

 Waldenstrom’s Macroglobulinemia 1,161 709 452 1,050 46 0.0 0.0 100.0 0.0

Myeloma 18,446 9,879 8,567 14,282 3,024 4.5 0.0 95.5 0.0

 Solitary Myeloma 526 328 198 433 54 87.3 0.0 12.7 0.0

 Multiple Myeloma 17,217 9,103 8,114 13,281 2,870 0.0 0.0 100.0 0.0

Unknown or Ill-defined Primary Site 39,140 18,587 20,553 32,097 4,310 0.0 0.0 0.1 99.9

 Microscopically confirmed 30,382 14,917 15,465 24,852 3,334 0.0 0.0 0.1 99.9

 Carcinomas 10,700 6,090 4,610 8,891 1,096 0.0 0.0 0.0 100.0

 Adenocarcinomas 16,654 7,286 9,368 13,494 1,875 0.0 0.0 0.0 100.0

 Other 3,028 1,541 1,487 2,467 363 0.0 0.0 1.3 98.7

 Non-microscopically confirmed 8,758 3,670 5,088 7,245 976 0.0 0.0 0.0 100.0

* Excludes mesotheliomas and sarcomas

^ Excludes Basal, Squamous, Kaposi sarcoma & Melanoma

Loc, Localized; Reg, Regional; Dis, Distant; Uns, Unstaged

with distant disease, especially for patients with tracheal 

cancer (3% at 5 years) (Table 30.4). 

Skin

Basal and squamous cell skin cancers are not reported to the 

SEER program except those of the genital sites. Melanomas 

of the skin and Kaposi sarcoma of the skin and of visceral 

organs are discussed elsewhere in this monograph. Still 

there are other types of cancers which occur, albeit rarely, 

on the skin. The four major types are Merkel cell, skin 

appendage adenocarcinomas, sweat gland adenocarcinomas, and sebaceous adenocarcinomas. Among this group 

of cancers, patients diagnosed with Merkel cell survived 

more poorly than those with other histologic types; there 

were more patients with Merkel cell diagnosed at regional 

or distant stages when compared to the other three groups. 

The overall 5-year relative rates for the various subtypes 

were Merkel cell, 63% ; skin appendage 98%; sweat gland, 

95%; and sebaceous, 95% (Table 30.2). In general, females 
Chapter 30 Cancers of Rare Sites

National Cancer Institute 254 SEER Survival Monograph 

Table 30.2: Cancers of Rare Sites: 1-, 3- ,5- and 10-Year (Yr) Relative Survival Rates (%) by Primary Site and Sex, Ages 20+, 

12 SEER Areas, 1988-2001

Primary Site

Relative Survival Rate (%)

Total Male Female

1-Yr 3-Yr 5-Yr 10-Yr 1-Yr 3-Yr 5-Yr 10-Yr 1-Yr 3-Yr 5-Yr 10-Yr

Respiratory and Intrathoracic Organs

 Nose, Nasal Cavity and Middle Ear 79.8 61.9 54.0 46.4 80.8 62.4 54.4 47.2 78.3 61.1 53.6 44.9

 Nasal Cavity 89.9 77.6 70.1 61.7 89.9 77.6 69.4 62.8 89.9 77.5 70.8 59.7

 Middle Ear 68.7 38.5 33.8 27.7 65.7 36.7 36.7 29.6 71.3 39.9 30.4 27.0

 Trachea, Mediastinum and Other Respiratory 60.6 45.0 42.3 37.0 61.2 46.1 43.9 38.9 59.0 41.8 37.1 30.6

 Trachea 57.7 40.2 34.6 25.5 55.5 36.7 30.5 20.5 60.2 43.8 38.7 28.0

 Squamous Cell 47.4 27.6 20.4 13.2 46.6 28.4 21.2 16.2 48.6 26.4 19.1 7.5

 Mediastinum 65.5 49.9 48.2 44.0 66.7 51.8 50.3 45.6 55.2 32.9 30.1 25.1

 Mediastinum - Germ 69.5 56.8 55.6 51.5 69.4 57.7 56.3 52.0 ~ ~ ~ ~

 Other Respiratory 39.8 31.0 31.0 15.2 31.6 24.1 24.1 8.3 ~ ~ ~ ~

 Pleura * 40.4 29.9 28.2 21.2 30.0 19.6 19.6 0.0 ~ ~ ~ ~

Skin ^ 94.2 85.9 84.0 81.2 93.3 83.5 81.1 79.3 95.2 88.6 87.1 81.9

 Merkel Cell 87.4 68.6 62.8 57.5 87.2 65.1 58.6 55.2 87.6 73.2 67.8 60.0

 Skin Appendage Adenocarcinoma 99.8 99.1 97.5 97.2 99.8 99.8 97.8 97.8 99.0 96.4 95.7 90.5

 Sweat Gland Adenocarcinoma 97.8 94.9 94.5 83.6 95.6 91.8 91.6 78.2 100.0 99.1 97.3 88.9

 Sebaceous Adenocarcinoma 98.2 94.6 94.6 87.3 95.2 90.5 90.5 82.8 100.0 98.7 98.7 91.2

Peritoneum and Retroperitoneum * 78.1 49.0 34.3 28.5 78.8 60.6 54.5 51.4 77.9 46.9 30.4 22.8

 Papillary Serous Cystadenocarcinoma 84.8 49.5 26.9 17.2 ~ ~ ~ ~ 84.8 49.6 26.9 17.3

Male Breast (including in situ) 97.3 93.0 85.6 74.2 97.3 93.0 85.6 74.2 N/A N/A N/A N/A

 In situ 99.1 99.1 99.1 96.9 99.1 99.1 99.1 96.9 N/A N/A N/A N/A

 Invasive 97.0 92.0 83.6 71.3 97.0 92.0 83.6 71.3 N/A N/A N/A N/A

Female Genital

 Ligaments and Adnexa 87.1 72.2 67.1 53.2 N/A N/A N/A N/A 87.1 72.2 67.1 53.2

 Overlapping 70.7 55.2 48.8 33.0 N/A N/A N/A N/A 70.7 55.2 48.8 33.0

 Other and Not Otherwise Specified 50.4 28.8 25.6 19.1 N/A N/A N/A N/A 50.4 28.8 25.6 19.1

Male Genital

 Penis 88.8 79.1 73.5 64.0 88.8 79.1 73.5 64.0 N/A N/A N/A N/A

 Penis - Squamous Cell Carcinoma 87.4 76.7 71.7 62.6 87.4 76.7 71.7 62.6 N/A N/A N/A N/A

 Scrotum 94.7 82.0 77.5 62.5 94.7 82.0 77.5 62.5 N/A N/A N/A N/A

 Scrotum - Squamous Cell Carcinoma 85.4 63.4 58.6 38.5 85.4 63.4 58.6 38.5 N/A N/A N/A N/A

 Scrotum - Paget Disease 100.0 93.0 89.0 82.3 100.0 93.0 89.0 82.3 N/A N/A N/A N/A

 Other and Not Otherwise Specified 73.0 62.1 51.8 34.1 73.0 62.1 51.8 34.1 N/A N/A N/A N/A

* Excludes mesotheliomas and sarcomas

^ Excludes Basal, Squamous, Kaposi sarcoma & Melanoma

~ Statistic not displayed due to less than 25 cases.

had better survival rates at both 5 and 10 years. Overall, 

blacks had higher relative survival rates than whites at 1, 

3, and 5 years, but whites had higher rates after 10 years. 

With the exception of patients with Merkel cell, 5-year 

relative survival was 97% or higher for all other types 

diagnosed while localized to the skin.

Peritoneum and Retroperitoneum 

Over 70% of cancers occurring in the retroperitoneum 

were already distant at the time of diagnosis accounting 

for overall poor relative survival rate, 34% at five-years. 

Over forty percent of these tumors were papillary serous 

cystadenocarcinomas which are probably extra-ovarian 

tumors. Survival from these cancers was even poorer, 

27% at five-years. For peritoneum and retroperitoneum 
Chapter 30 Cancers of Rare Sites

National Cancer Institute 255 SEER Survival Monograph 

Table 30.2 (continued): Cancers of Rare Sites: 1-, 3- ,5- and 10-Year (Yr) Relative Survival Rates (%) by Primary Site and Sex, 

Ages 20+, 12 SEER Areas, 1988-2001

Primary Site

Relative Survival Rate (%)

Total Male Female

1-Yr 3-Yr 5-Yr 10-Yr 1-Yr 3-Yr 5-Yr 10-Yr 1-Yr 3-Yr 5-Yr 10-Yr

Urinary System

 Ureter 82.3 63.4 55.9 49.6 82.4 63.4 55.6 50.2 82.1 63.3 56.0 46.7

 Ureter - Papillary Transitional Cell 83.5 64.6 57.8 51.4 83.4 64.7 57.7 52.1 83.7 64.6 57.5 48.1

 Other Urinary 80.5 67.0 60.5 54.2 82.7 71.4 67.6 60.8 76.8 59.5 48.5 42.2

 Other Urinary - Papillary Transitional Cell 81.4 68.4 63.8 60.0 83.6 71.9 68.2 62.1 74.2 57.3 49.5 46.3

Eye and Orbit 97.4 85.2 75.4 63.1 97.4 85.9 77.1 65.8 97.3 84.3 73.0 59.8

 Eye and Orbit - Squamous Cell Carcinoma 96.5 90.4 86.8 77.3 98.0 91.6 87.7 82.6 90.9 85.2 83.6 54.9

 Eye and Orbit - Melanoma 97.8 84.5 73.6 61.1 97.5 84.9 74.8 62.5 98.1 84.1 72.1 59.4

Other Endocrine 78.2 66.2 58.9 47.2 79.2 66.3 59.6 47.5 77.0 66.0 58.1 46.8

 Thymus 87.4 74.5 66.3 51.3 88.9 75.0 68.5 54.5 85.5 73.9 63.4 46.8

 Thymus - Thymoma 89.0 77.4 70.0 55.7 90.8 76.8 71.4 60.7 86.9 78.3 68.2 49.5

 Adrenal Gland 59.4 45.5 38.7 29.6 55.7 40.9 34.1 22.7 62.6 49.6 42.5 35.4

 Adrenal Gland - Adrenal Cortical 66.0 48.5 41.2 31.3 62.9 43.7 37.9 27.0 68.4 52.1 43.6 34.6

 Adrenal Gland - Pheochromocytoma 84.5 73.0 64.8 44.0 83.9 73.4 67.3 29.7 85.1 72.6 62.4 58.9

 Parathyroid Gland 94.1 94.1 93.1 81.6 93.8 93.8 89.6 71.7 94.0 93.1 93.1 88.4

 Pituitary Gland 83.7 74.9 63.8 41.7 85.5 70.9 52.6 25.7 81.9 78.9 74.4 53.4

 Pineal Gland 87.7 76.2 71.7 63.9 90.1 80.0 75.2 69.8 81.7 66.2 62.4 47.8

Mesothelioma 39.0 12.8 8.2 5.6 37.0 9.8 5.5 3.0 46.1 23.1 17.3 12.9

 Mesothelioma - Pleura and Lung 38.2 10.5 6.4 4.3 36.9 8.5 4.8 2.4 43.7 18.7 12.8 9.9

 Mesothelioma - Peritoneum and 

Retroperitoneum 41.8 25.9 18.4 9.5 34.1 19.0 11.7 5.6 53.1 35.6 28.2 14.7

Reticuloendothelial System Tumors 88.0 78.5 66.6 44.0 88.9 77.3 65.6 45.6 86.6 80.3 67.9 41.9

 Waldenstrom’s Macroglobulinemia 90.2 81.0 69.3 45.6 91.6 80.0 67.9 47.4 88.1 82.6 71.3 43.1

Myeloma 74.7 48.1 31.7 14.2 75.1 49.4 33.4 15.7 74.1 46.7 29.8 12.6

 Solitary Myeloma 90.3 73.7 64.9 44.1 90.4 78.8 69.1 52.8 90.0 65.2 57.5 29.1

 Multiple Myeloma 73.7 46.4 29.4 11.7 74.0 47.2 30.6 12.3 73.4 45.6 28.3 11.1

Unknown or Ill-defined Primary Site 24.2 13.5 11.3 9.8 25.2 14.8 12.8 11.7 23.2 12.4 10.0 8.1

 Microscopically confirmed 27.4 15.0 12.4 10.6 28.4 16.5 14.1 12.7 26.5 13.6 10.7 8.8

 Carcinomas 35.9 23.4 20.9 18.3 39.6 26.6 24.0 21.7 30.9 19.3 16.8 14.0

 Adenocarcinomas 19.4 7.5 5.2 4.1 16.3 5.8 4.0 3.3 21.8 8.7 6.0 4.7

 Other 41.2 26.6 21.8 18.5 40.9 27.1 22.6 19.9 41.5 26.1 21.0 16.7

 Non-microscopically confirmed 12.5 7.7 6.6 5.4 12.0 7.0 5.9 5.4 12.9 8.1 7.1 5.4

* Excludes mesotheliomas and sarcomas

^ Excludes Basal, Squamous, Kaposi sarcoma & Melanoma

~ Statistic not displayed due to less than 25 cases.

combined, males had a survival advantage at 1, 3, 5, and 

10 years, and the relative survival rate for whites was 

considerably higher than that of blacks at five years, 35% 

vs. 24% (Table 30.3).

Male Breast

About one percent of all breast cancers occur among males. 

As among females, some cases are diagnosed at the in 

situ stage. The majority of male breast cancers are ductal 

carcinomas. Relative survival rates for cases diagnosed at 

the in situ stage are quite good, overall, 99% at five-years. 

Among the invasive tumors, almost half were diagnosed 

while still localized. Five-year relative survival for all 

males was 84% (compared to 89% in females) (5) with 

white males having a survival advantage of 86% vs. 67% 

among black males. A similar advantage existed at 10 

years also, 73% among whites vs. 52% among blacks. 

Five-year relative survival for males with localized breast 

cancer was 97%.
Chapter 30 Cancers of Rare Sites

National Cancer Institute 256 SEER Survival Monograph 

Female genital

Survival from cancers of the vagina, vulva, uterus, ovary, 

fallopian tube, and placenta are included in other chapters in this monograph. Among the remaining cases occurring within specific female genital sites – round and 

broad ligaments, parametrium, and adnexa – there were 

too few cases for a separate analysis, so these sites have 

been grouped together. The five-year relative survival 

rate for this group of 67% was intermediate to that for 

ovary (44%) (6) vs. cervix (72%) (7) and corpus uteri 

(85%) (8), this despite the fact that over 40% of the patients were diagnosed at an advanced stage. For those 

women whose cancer overlapped two or more sites within 

the female genital tract, relative survival rate was much 

poorer, 49% at five years, even though only one third of 

these women were diagnosed with distant disease. The 

poorest relative survival rate was experienced by those 

women whose cancer could not be specifically assigned 

to any specific genital site at the time of diagnosis, only 

Table 30.3: Cancers of Rare Sites: 1,3,5 and 10-Year Relative Survival Rates (%) by Site and Race, 12 SEER Areas, 1988-2001

Site

Relative Survival Rate (%)

White Black

1-Year 3-Year 5-Year 10-Year 1-Year 3-Year 5-Year 10-Year

Respiratory and Intrathoracic Organs

 Nose, Nasal Cavity and Middle Ear 80.4 63.5 56.4 48.1 70.4 47.1 36.3 30.5

 Nasal Cavity 90.0 77.9 71.0 61.4 81.3 64.1 59.1 58.4

 Middle Ear 68.8 41.1 39.2 31.5 ~ ~ ~ ~

 Trachea, Mediastinum and Other Respiratory 61.4 45.8 43.5 39.0 51.1 30.2 21.1 17.4

 Trachea 55.8 38.9 35.1 27.8 ~ ~ ~ ~

 Squamous Cell 47.8 29.0 23.5 15.0 ~ ~ ~ ~

 Mediastinum 68.3 52.1 50.0 46.0 52.6 31.6 31.6 22.8

 Mediastinum - Germ 71.1 58.2 56.7 53.3 ~ ~ ~ ~

 Other Respiratory 41.1 31.4 31.3 9.7 ~ ~ ~ ~

 Pleura * 39.0 25.0 22.2 12.8 ~ ~ ~ ~

Skin ^ 94.1 85.4 83.3 81.3 97.1 87.7 87.7 70.9

 Merkel Cell 87.6 68.4 62.5 57.2 ~ ~ ~ ~

 Skin Appendage Adenocarcinoma 99.7 98.8 96.6 96.5 ~ ~ ~ ~

 Sweat Gland Adenocarcinoma 97.8 95.3 94.8 85.4 ~ ~ ~ ~

 Sebaceous Adenocarcinoma 97.8 94.1 94.1 91.2 ~ ~ ~ ~

Peritoneum and Retroperitoneum * 78.1 49.3 35.0 28.9 80.6 45.5 23.5 9.6

 Papillary Serous Cystadenocarcinoma 83.7 48.9 27.0 16.7 ~ ~ ~ ~

Male Breast (including in situ) 98.1 94.5 87.7 75.1 92.6 81.8 70.4 58.1

 In situ 99.2 99.2 99.2 93.2 ~ ~ ~ ~

 Invasive 97.9 93.7 85.9 72.6 92.1 80.2 67.2 52.4

Female Genital

 Ligaments and Adnexa 93.4 72.9 70.5 54.3 ~ ~ ~ ~

 Overlapping 71.6 57.4 51.9 36.3 ~ ~ ~ ~

 Other and Not Otherwise Specified 50.7 30.7 27.4 21.4 47.2 25.7 25.7 16.9

Male Genital

 Penis 90.0 79.9 73.9 64.6 77.3 64.3 64.3 52.4

 Penis - Squamous Cell Carcinoma 88.6 77.6 71.9 62.9 77.3 64.3 64.3 52.4

 Scrotum 97.5 88.3 82.5 67.0 ~ ~ ~ ~

 Scrotum - Squamous Cell Carcinoma 90.4 72.8 67.0 47.5 ~ ~ ~ ~

 Scrotum - Paget Disease 100.0 100.0 94.4 86.8 ~ ~ ~ ~

 Other and Not Otherwise Specified ~ ~ ~ ~ ~ ~ ~ ~

* Excludes mesotheliomas and sarcomas

^ Excludes Basal, Squamous, Kaposi sarcoma & Melanoma

~ Statistic not displayed due to less than 25 cases.
Chapter 30 Cancers of Rare Sites

National Cancer Institute 257 SEER Survival Monograph 

26% at five years. There were too few cases occurring 

among blacks to allow a comparison of white vs. black 

females.

Male genital

Survival from cancers of the prostate and testis are analyzed elsewhere in this monograph. Cancer of the penis 

is indeed rare within the United States, and the majority 

of the tumors occurs on the skin of the penis and is of 

Table 30.3 (continued): Cancers of Rare Sites: 1,3,5 and 10-Year Relative Survival Rates (%) by Site and Race, 12 SEER Areas, 

1988-2001

Site

Relative Survival Rate (%)

White Black

1-Year 3-Year 5-Year 10-Year 1-Year 3-Year 5-Year 10-Year

Urinary System

Ureter 82.8 64.6 57.2 50.7 72.5 53.9 40.3 39.0

 Ureter - Papillary Transitional Cell 84.3 66.2 59.1 52.6 68.3 51.7 44.2 42.5

Other Urinary 81.3 68.9 63.9 58.8 77.2 58.5 48.1 40.3

 Other Urinary - Papillary Transitional Cell 82.3 69.3 64.9 61.9 76.8 60.2 55.6 47.6

Eye and Orbit 97.5 85.1 75.7 63.7 89.7 75.8 41.7 10.1

 Eye and Orbit - Squamous Cell Carcinoma 96.0 89.9 86.4 76.7 ~ ~ ~ ~

 Eye and Orbit - Melanoma 97.9 84.5 74.2 61.7 ~ ~ ~ ~

Other Endocrine 76.5 64.3 57.5 46.4 79.5 70.4 61.5 44.8

 Thymus 86.8 73.6 65.9 49.4 85.5 76.2 66.7 51.1

 Thymus - Thymoma 87.9 77.0 70.1 54.2 90.2 79.4 71.1 54.6

 Adrenal Gland 58.5 45.3 39.1 31.1 64.9 47.6 37.3 13.1

 Adrenal Gland - Adrenal Cortical 65.9 50.0 43.5 33.5 ~ ~ ~ ~

 Adrenal Gland - Pheochromocytoma 81.6 66.9 60.3 44.9 ~ ~ ~ ~

 Parathyroid Gland 94.2 93.7 92.8 86.5 ~ ~ ~ ~

 Pituitary Gland 89.9 78.0 66.3 40.4 ~ ~ ~ ~

 Pineal Gland 87.7 73.3 67.5 60.2 ~ ~ ~ ~

Mesothelioma 39.4 12.8 8.1 5.3 37.9 12.0 11.7 8.6

 Mesothelioma - Pleura and Lung 38.8 10.7 6.3 4.1 37.3 9.4 8.8 6.2

 Mesothelioma - Peritoneum and 

Retroperitoneum 40.7 24.4 17.4 8.4 ~ ~ ~ ~

Reticuloendothelial System Tumors 87.8 78.9 66.7 43.9 95.6 76.1 68.2 46.6

 Waldenstrom’s Macroglobulinemia 90.3 81.5 69.7 45.4 94.9 77.3 71.4 51.6

Myeloma 74.2 48.0 31.2 13.7 76.4 49.5 34.1 15.7

 Solitary Myeloma 89.8 74.1 63.7 42.1 92.9 68.7 68.0 40.3

 Multiple Myeloma 73.2 46.2 28.8 11.0 75.7 48.5 32.6 14.1

Unknown or Ill-defined Primary Site 24.5 13.9 11.6 10.0 21.6 11.0 8.9 7.8

 Microscopically confirmed 28.1 15.7 12.9 11.0 22.2 10.6 8.6 7.7

 Carcinomas 37.4 24.9 22.3 19.4 24.9 13.5 11.4 10.1

 Adenocarcinomas 19.6 7.5 5.2 4.0 16.9 5.7 4.1 3.5

 Other 41.4 26.7 21.6 18.3 40.8 26.2 23.0 19.9

 Non-microscopically confirmed 11.3 6.8 5.9 4.6 19.6 12.6 10.1 8.4

* Excludes mesotheliomas and sarcomas

^ Excludes Basal, Squamous, Kaposi sarcoma & Melanoma

~ Statistic not displayed due to less than 25 cases.

squamous cell origin. Relative survival rates were quite 

high and were better for white males than for black males. 

Similarly, the majority of other cancers occurring in the 

remainder of the male genital system was of the skin of the 

scrotum and was squamous cell in origin. However, men 

with squamous cell carcinoma of the scrotum versus the 

penis survived more poorly at 5 years with relative rates of 

59% vs. 72%, respectively. Men with localized squamous 

cell carcinoma of the scrotum had much poorer 5-year 
Chapter 30 Cancers of Rare Sites

National Cancer Institute 258 SEER Survival Monograph 

Table 30.4: Cancers of Rare Sites: 5- & 10-Year (Yr) Relative Survival Rates (%) by Primary Site and SEER 

Summary Stage 1977 (2), 12 SEER Areas, 1988-2001

Primary Site

Summary Stage

Total Local Regional Distant Unstaged

Relative 

Survival Rate 

(%)

Relative 

Survival Rate 

(%)

Relative 

Survival Rate 

(%)

Relative 

Survival Rate 

(%)

Relative 

Survival Rate 

(%)

5-Yr 10-Yr 5-Yr 10-Yr 5-Yr 10-Yr 5-Yr 10-Yr 5-Yr 10-Yr

Respiratory and Intrathoracic Organs

 Nose, Nasal Cavity and Middle Ear 54.0 46.4 82.5 77.4 47.3 37.6 25.3 21.7 55.6 45.6

 Nasal Cavity 70.1 61.7 86.3 79.4 57.5 47.0 37.6 29.7 73.2 63.6

 Middle Ear 33.8 27.7 ~ ~ 37.7 29.2 ~ ~ ~ ~

 Trachea, Mediastinum and Other Respiratory 42.3 37.0 66.2 60.0 44.2 36.2 17.1 13.6 43.5 35.8

 Trachea 34.6 25.5 59.7 43.5 31.2 20.7 3.4 ! 32.8 21.6

 Squamous Cell 20.4 13.2 ~ ~ 12.4 12.4 ~ ~ ~ ~

 Mediastinum 48.2 44.0 69.9 67.7 54.6 46.0 23.3 17.5 53.0 50.6

 Mediastinum - Germ 55.6 51.5 73.4 70.9 62.0 59.8 29.5 21.5 60.1 57.7

 Other Respiratory 31.0 15.2 ! ! ~ ~ ~ ~ 36.1 18.1

Pleura * 28.2 21.2 ~ ~ ~ ~ ~ ~ ~ ~

Skin ^ 84.0 81.2 91.7 87.6 62.1 58.3 46.4 44.1 70.0 68.8

 Merkel Cell 62.8 57.5 74.7 68.4 38.7 32.4 28.4 28.4 45.6 39.2

 Skin Appendage Adenocarcinoma 97.5 97.2 99.1 98.6 88.2 79.1 ~ ~ 86.8 84.7

 Sweat Gland Adenocarcinoma 94.5 83.6 97.4 87.9 ~ ~ ~ ~ 80.9 73.6

 Sebaceous Adenocarcinoma 94.6 87.3 97.1 84.2 ~ ~ 85.4 85.4 86.0 86.0

Peritoneum and Retroperitoneum * 34.3 28.5 77.7 74.1 52.6 41.5 25.0 18.9 39.5 36.5

 Papillary Serous Cystadenocarcinoma 26.9 17.2 ~ ~ 46.3 ! 23.8 16.4 ~ ~

Male Breast (including in situ) 85.6 74.2 96.9 92.1 78.1 58.1 23.0 5.8 64.2 34.8

 In situ 99.1 96.9 ! ! ! ! ! ! ! !

 Invasive 83.6 71.3 96.9 92.1 78.1 58.1 23.0 5.8 64.2 34.8

Female Genital

 Ligaments and Adnexa 67.1 53.2 ~ ~ ~ ~ ~ ~ ~ ~

 Overlapping 48.8 33.0 ~ ~ ~ ~ ~ ~ ~ ~

 Other and Not Otherwise Specified 25.6 19.1 ~ ~ ~ ~ 13.9 13.1 43.0 31.8

Male Genital

 Penis 73.5 64.0 84.9 74.5 59.2 52.6 11.4 ! 68.2 54.4

 Penis - Squamous Cell Carcinoma 71.7 62.6 84.5 75.9 55.8 47.9 11.9 ! 61.5 40.5

 Scrotum 77.5 62.5 88.5 70.6 56.4 34.3 ~ ~ ~ ~

 Scrotum - Squamous Cell Carcinoma 58.6 38.5 67.0 48.2 ~ ~ ~ ~ ~ ~

 Scrotum - Paget Disease 89.0 82.3 98.3 86.3 ~ ~ ~ ~ ~ ~

Other and Not Otherwise Specified 51.8 34.1 ~ ~ ~ ~ ~ ~ ~ ~

* Excludes mesotheliomas and sarcomas

^ Excludes Basal, Squamous, Kaposi sarcoma & Melanoma

~ Statistic not displayed due to less than 25 cases.

! Not enough intervals to produce rate
Chapter 30 Cancers of Rare Sites

National Cancer Institute 259 SEER Survival Monograph 

Table 30.4 (continued): Cancers of Rare Sites: 5- & 10-Year (Yr) Relative Survival Rates (%) by Primary Site and SEER

Summary Stage 1977 (2), 12 SEER Areas, 1988-2001

Primary Site

Summary Stage

Total Local Regional Distant Unstaged

Relative 

Survival Rate 

(%)

Relative 

Survival Rate 

(%)

Relative 

Survival Rate 

(%)

Relative 

Survival Rate 

(%)

Relative 

Survival Rate 

(%)

5-Yr 10-Yr 5-Yr 10-Yr 5-Yr 10-Yr 5-Yr 10-Yr 5-Yr 10-Yr

Urinary System

Ureter 55.9 49.6 76.6 65.5 35.6 32.6 9.8 9.4 44.7 41.4

 Ureter - Papillary Transitional Cell 57.8 51.4 77.3 66.5 36.3 33.6 10.1 9.7 50.4 46.3

Other Urinary 60.5 54.2 80.1 70.0 50.5 45.2 15.9 12.7 69.2 63.4

 Other Urinary - Papillary Transitional Cell 63.8 60.0 77.6 70.7 52.8 43.3 4.8 ! 73.9 70.2

Eye and Orbit 75.4 63.1 79.6 69.1 56.0 37.3 30.2 24.3 69.2 45.7

 Eye and Orbit - Squamous Cell Carcinoma 86.8 77.3 89.2 82.2 64.3 ! ~ ~ 88.5 57.8

 Eye and Orbit - Melanoma 73.6 61.1 77.3 66.2 57.2 34.2 14.8 14.8 65.7 42.4

Other Endocrine 58.9 47.2 77.6 69.3 68.6 51.2 22.5 15.2 54.7 42.4

 Thymus 66.3 51.3 88.8 82.1 70.5 48.6 35.4 24.3 61.6 51.6

 Thymus - Thymoma 70.0 55.7 87.8 86.1 74.4 52.6 41.4 29.8 65.1 56.3

 Adrenal Gland 38.7 29.6 65.5 52.6 45.7 39.2 8.6 3.4 31.4 19.4

 Adrenal Gland - Adrenal Cortical 41.2 31.3 64.7 51.5 43.9 36.3 7.1 2.0 ~ ~

 Adrenal Gland - Pheochromocytoma 64.8 44.0 83.0 60.5 ~ ~ ~ ~ ~ ~

 Parathyroid Gland 93.1 81.6 95.6 85.8 95.5 82.2 ~ ~ ~ ~

 Pituitary Gland 63.8 41.7 ~ ~ ~ ~ ~ ~ ~ ~

 Pineal Gland 71.7 63.9 81.1 78.5 69.5 49.6 ~ ~ ~ ~

Mesothelioma 8.2 5.6 19.3 16.2 10.3 9.0 4.9 2.1 10.1 5.4

 Mesothelioma - Pleura and Lung 6.4 4.3 15.2 11.9 9.1 7.8 3.7 1.4 6.6 3.3

 Mesothelioma - Peritoneum and Retroperitoneum 18.4 9.5 ~ ~ 24.8 14.3 13.1 5.3 26.6 16.9

Reticuloendothelial System Tumors 66.6 44.0 ! ! ! ! 66.6 43.9 ~ ~

 Waldenstrom’s Macroglobulinemia 69.3 45.6 ! ! ! ! 69.3 45.6 ! !

Myeloma 31.7 14.2 68.4 51.8 ! ! 30.0 12.3 ! !

 Solitary Myeloma 64.9 44.1 64.9 47.1 ! ! 64.0 25.0 ! !

 Multiple Myeloma 29.4 11.7 ! ! ! ! 29.4 11.7 ! !

Unknown or Ill-defined Primary Site 11.3 9.8 ~ ~ ! ! 46.7 41.6 11.2 9.7

 Microscopically confirmed 12.4 10.6 ~ ~ ! ! 47.2 47.2 12.3 10.6

 Carcinomas 20.9 18.3 ! ! ! ! ! ! 20.9 18.3

 Adenocarcinomas 5.2 4.1 ! ! ! ! ! ! 5.2 4.1

 Other 21.8 18.5 ~ ~ ! ! 47.2 47.2 21.4 18.0

 Non-microscopically confirmed 6.6 5.4 ! ! ! ! ~ ~ 6.6 5.4

* Excludes mesotheliomas and sarcomas

^ Excludes Basal, Squamous, Kaposi sarcoma & Melanoma

~ Statistic not displayed due to less than 25 cases.

! Not enough intervals to produce rate
Chapter 30 Cancers of Rare Sites

National Cancer Institute 260 SEER Survival Monograph 

relative survival than men with localized squamous cell 

carcinoma of the penis (67% vs. 85%, respectively).

Urinary System

Cancers of the ureter, urethra, urachus and other urinary 

organs were diagnosed most commonly as localized or 

regional disease and occurred more commonly among 

males. The majority of these cancers were papillary 

transitional cell carcinomas. Five-year relative survival 

rates from cancers of the ureter were similar among males 

vs. females, but for the other rare urinary sites, males 

had a distinct survival advantage at 5 years, 68% vs. 

49%. The survival rates among whites were consistently 

higher than those for blacks. Five-year relative survival 

rates were uniformly poor for patients diagnosed with 

distant disease.

Eye and Orbit

Since children are excluded from this analysis, by definition, retinoblastomas are excluded as well. Among 

adults, nearly 80% of the malignancies of the eye were 

melanomas with most of the remainder being squamous 

cell carcinomas. Over 70% of all eye tumors were diagnosed while still localized, resulting in five-year relative 

survival rates of 87% for squamous cell carcinomas and 

74% for melanomas. For melanomas of the eye 1, 3, 

and 5-year rates were quite similar in males and females 

while for squamous cell carcinomas of the eye, there 

appears to be a male survival advantage. There were 

very few cases among blacks, but for these few, survival 

was much poorer than among whites, especially at 5 and 

10 years. Patients with squamous cell carcinoma of the 

eye had higher relative survival rates than patients with 

melanoma of the eye.

Endocrine System

Cancers of the thymus gland were primarily thymomas 

and patients tended to be diagnosed with regional disease. 

For thymomas, males and females survived similarly 

at 1, 3, and 5 years and the survival rates were similar among whites and blacks at 1, 3, 5, and 10 years. 

Sixty-five percent of adrenal gland malignancies were 

of the adrenal cortical type while another 10 percent 

were malignant pheochromocytomas. Relative 5-year 

survival rates were much better for the pheochromocytomas, 65% than for the adrenal cortical carcinomas, 

41%. Males with pheochromocytomas had a survival 

advantage at 5 years compared to females, but at 10 

years, the advantage was in favor of females, 59% vs. 

30%. There were too few cases of pheochromocytomas 

among blacks to yield meaningful comparisons by race. 

For adrenal cortical carcinomas, females had a survival 

advantage at 1, 3, 5, and 10 years. Malignant tumors of 

the parathyroid, pituitary, and pineal glands were indeed 

rare with too few cases to allow comparisons by race. The 

majority of these tumors were diagnosed at either the localized or regional stage with relative 5-year survival rates of 

93%, 64%, and 72% respectively. For malignancies of the 

parathyroid and the pituitary, females survived better than 

males at 5 and 10 years whereas the opposite was true for 

pineal malignancies. For each stage, patients with adrenal 

gland cancers had much poorer survival than patients with 

other endocrine tumors.

Mesothelioma

Mesotheliomas arose more frequently in the pleura for both 

males (91%) and females (78%) with most of the remaining 

mesotheliomas arising from the (retro)peritoneum. The 

majority of mesotheliomas were diagnosed as distant disease. While uniformly dismal, the 5- and 10-year relative 

survival rates for females were more than triple those for 

males. Survival rates were slightly higher for blacks compared to whites. Interestingly for all races combined and 

both sexes combined, 5-year relative survival rates from 

mesotheliomas which arose in the (retro)peritoneum were 

at least double those which arose in the pleura. This was 

true even for patients diagnosed with regional or distant 

disease (Table 30.2).

Reticuloendothelial System

Survival from leukemias and multiple myeloma are discussed elsewhere. Ninety percent of the remaining tumors 

occurring in the reticuloendothelial system were classified 

as Waldenstrom’s macroglobulinemia, a systemic disease 

always staged as distant at the time of diagnosis. Survival 

rates were similar among males and females (Table 30.2)

and whites versus blacks (Table 30.3).

Myelomas

Multiple myelomas accounted for 93% of the myelomas. 

Patients with multiple myeloma survived much more poorly 

than patients with a solitary myeloma, especially at 5 (29% 

vs. 65%) and 10 (12% vs. 44%) years. For multiple myeloma survival was similar among males and females and 

blacks had slightly higher survival rate compared to whites. 

However, for solitary myeloma, males had a distinct survival 

advantage at 10 years, 53% vs. 29% for females.
Chapter 30 Cancers of Rare Sites

National Cancer Institute 261 SEER Survival Monograph 

Ill-defined and Unknown Sites

Some tumors are so disseminated at the time of diagnosis 

that it is impossible to determine the exact anatomic site 

in which the tumor arose. Sometimes these tumors can be 

ascribed to a body region such as the abdomen, but still, 

an exact primary site cannot be determined with certainty. 

For this group of tumors only, those without microscopic 

confirmation have been included but are shown separately 

in Tables 1-3. Twenty-two percent of these tumors did 

not have microscopic confirmation. By convention, these 

tumors are always classified with an unknown stage.

Not surprisingly, relative survival rates for this group as 

a whole were poor – 11% at five years. Patients whose 

disease was classified as “carcinoma” had a better survival 

than those with “adenocarcinoma” – 21% vs. 5% at five 

years. Patients with non-microscopically confirmed cancers experienced a five-year survival rate of only 7% vs. 

12% for those with microscopic confirmation. Survival 

was essentially equal for males and for females, but whites 

had a slight survival advantage when compared to blacks, 

especially those with a tumor classified as carcinoma, 22% 

vs. 11% at five years.

Discussion

It is not clear as to why there are certain anatomic sites in 

which cancer rarely arises. This is particularly curious in 

systems such as the endocrine system where with the exception of the thyroid gland few tumors arise, particularly 

in the pituitary and pineal glands. However, when cancer 

does arise in one of these rare sites, survival, in general, 

is similar to survival from other primary sites in the same 

system. For example survival from cancers of the pleura 

and from pleural mesotheliomas was very similar to survival 

from lung cancers.

Survival from cancer of the male breast, in general was 

similar to survival among females with breast cancer.

Among females, survival from cystadenocarcinomas of the 

(retro)peritoneum was very similar to survival from cystadenocarcinomas of the ovary. Roffers et al. documented 

that these tumors are actually extra ovarian tumors (9).

The extremely poor survival among patients with unknown 

or ill-defined primary site was probably reflective of the 

fact that the disease was already widely disseminated at 

the time of diagnosis so that the site of origin could not be 

identified. While this group was the largest of the rare site 

groups, overall unknown site accounts for less than 3% of 

all primary cancers.

Because of the small numbers of cases involved, detailed 

analysis of survival by races other than white cannot be 

made. Further, time trends in survival are also difficult due 

to the small numbers involved. As more survival data are 

accumulated from a larger group of registries for a longer 

time period, these analyses should be repeated.

References

1. Ries LAG, Ward KC and Young JL Jr., Chapter 11: Sarcomas in 

Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner, M-J 

(editors). SEER Survival Monograph: Cancer Survival Among 

Adults: U.S. SEER Program, 1988-2001, Patient and Tumor 

Characteristics. National Cancer Institute, SEER Program. NIH 

Pub. No. 07-6215, 2007.

2. Shambaugh, EM, Weiss, MA. Axtell, LM (eds), The 1977 

Summary Staging Guide for the Cancer Surveillance, 

Epidemiology and End Results Reporting (SEER) Program, 

National Cancer Institute, Bethesda, MD, April 1977.

3. Piccirillo JF, Costas I, and Reichman ME, Chapte 2 Cancer of the 

Head and Neck in Ries LAG, Young JL, Keel GE, Eisner MP, Lin 

YD, Horner, M-J (editors). SEER Survival Monograph: Cancer 

Survival Among Adults: U.S. SEER Program, 1988-2001, Patient 

and Tumor Characteristics. National Cancer Institute, SEER 

Program. NIH Pub. No. 07-6215, 2007.

4. Ries LAG, and Eisner MP, Chapter 9: Cancer of the Lung in 

Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner, M-J 

(editors). SEER Survival Monograph: Cancer Survival Among 

Adults: U.S. SEER Program, 1988-2001, Patient and Tumor 

Characteristics. National Cancer Institute, SEER Program. NIH 

Pub. No. 07-6215, 2007.

5. Ries, LAG and Eisner MP, Chapter13: Cancer of the Female 

Breast in Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, 

Horner, M-J (editors). SEER Survival Monograph: Cancer 

Survival Among Adults: U.S. SEER Program, 1988-2001, Patient 

and Tumor Characteristics. National Cancer Institute, SEER 

Program. NIH Pub. No. 07-6215, 2007.

6. Kosary CL, Chapter 16: Cancer of the Ovary in Ries LAG, Young 

JL, Keel GE, Eisner MP, Lin YD, Horner, M-J (editors). SEER 

Survival Monograph: Cancer Survival Among Adults: U.S. SEER 

Program, 1988-2001, Patient and Tumor Characteristics. National 

Cancer Institute, SEER Program. NIH Pub. No. 07-6215, 2007.

7. Kosary CL, Chapter 14: Cancer of the Cervix Uteri in Ries LAG, 

Young JL, Keel GE, Eisner MP, Lin YD, Horner, M-J (editors). 

SEER Survival Monograph: Cancer Survival Among Adults: U.S. 

SEER Program, 1988-2001, Patient and Tumor Characteristics. 

National Cancer Institute, SEER Program. NIH Pub. No. 07-6215, 

2007.

8. Kosary CL, Chapter 15: Cancers of the Corpus Uteri in Ries 

LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner, M-J 

(editors). SEER Survival Monograph: Cancer Survival Among 

Adults: U.S. SEER Program, 1988-2001, Patient and Tumor 

Characteristics. National Cancer Institute, SEER Program. NIH 

Pub. No. 07-6215, 2007.

9. Roffers SD, Wu XC, Johnson CH, and Correa CN. Incidence of 

Extraovarian Primary Cancers in the United States, 1992-1997. 

Cancer; Vol. 15;97(10 Suppl):2643-7; May 2003.
Chapter 30 Cancers of Rare Sites

National Cancer Institute 262 SEER Survival Monograph 
National Cancer Institute 263 SEER Survival Monograph 

Introduction

Cancer is the second leading cause of death in the U.S., 

and accounts for approximately one-fourth of all deaths. 

In 2006, an estimated 1.4 million Americans will be diagnosed with cancer (other than carcinomas of the skin) and 

564,830 people will die of cancer (1). The most common 

cancers among men are carcinomas of the prostate, lung 

(including bronchus), and colon/rectum, whereas women 

are most likely to develop carcinomas of the breast, lung, 

and colon/rectum (1). Published SEER data show that 

for most cancers, including the four major ones (colon/

rectum, lung and bronchus, female breast, and prostate), 

relative survival rates among African-American patients 

were poorer than for white patients, although survival 

improved in recent years for both groups (2). Published 

information on patient survival among other racial/ethnic 

minorities is limited. 

This chapter describes and compares cancer-specific survival rates by racial/ethnic group among adult patients 

(aged 20 or older at disease diagnosis) diagnosed with a 

first malignant neoplasm during the period between 1988 

and 2001 in 12 SEER geographic areas. The cancerspecific survival measure used in this study quantifies 

the likelihood that a cancer patient will not die of the 

neoplasm within a specified time after diagnosis. The 

cancers included in this chapter are all cancers combined 

and individual cancers by body system for 6 race/ethnicity groups (white, black, Asian/Pacific Islander (API), 

American Indian/Alaska Native (AI/AN), Hispanic and 

non-Hispanic). Note that these groupings are not mutually 

exclusive in that Hispanic or non-Hispanic can be of any 

race. For the four major cancers: female breast, colorectal, 

lung (including bronchus), and prostate, the API group is 

broken into Asian and Pacific Islanders with specific Asian 

and Pacific Islander groups shown separately and whites 

are subdivided by Hispanic and non-Hispanic. 

Materials and Methods

Study Populations and Data Sources 

The NCI SEER Program currently collects cancer incidence 

and survival information from 18 geographic areas that 

encompass nearly 26% of the total U.S. population. This 

study utilizes the data from 12 geographic areas that include 

the States of Connecticut, Hawaii, Iowa, New Mexico, and 

Utah; the metropolitan areas of Atlanta, Detroit, SeattlePuget Sound, San Francisco-Oakland, Los Angeles, San 

Jose-Monterey, and Rural Georgia. Data are included 

for adults who resided in these areas and were diagnosed 

with their first invasive cancer between 1988 and 2001, 

except for Los Angeles for which data are only included 

from 1992-2001. These patients were followed for vital 

status through December 31, 2002. 

The first part of this chapter focuses on anatomic systems 

and the major sites within them by race/ethnicity (white, 

black, American Indian/Alaska Native (AI/AN), Asian/

Pacific Islander (API), Hispanic, and non-Hispanic). 

The second part focuses on detailed race/ethnicity for 

cancers of the breast (females), lung (including bronchus), 

prostate, and colon/rectum. These four cancers accounted 

for more than 50% of all incident cancers diagnosed in 

the SEER areas during these years. Since this part of the 

analyses separates Asians from Pacific Islanders, the cases 

used were limited to 1991-2001 years of diagnosis when 

this detail was collected. The race/ethnicity codes used 

were: white; white non-Hispanic, white Hispanic, black, 

AI/AN, Asian, and Pacific Islanders. The Asian group 

was further classified by Asian Indian/Pakistani, Chinese, 

Filipino, Korean, Japanese, Vietnamese, and other Asian. 

The Pacific Islanders were further classified by Hawaiian 

and other Pacific Islander.

Limin X. Clegg and Lynn A. Gloeckler Ries

Chapter 31

Race and Ethnicity
Chapter 31 Race and Ethnicity

National Cancer Institute 264 SEER Survival Monograph 

Excluded from the study were cancer patients whose initial 

diagnosis was found on the death certificate or at autopsy, 

patients who were not under active follow-up or alive with 

no survival time, patients who were diagnosed under age 

20, in situ cancers, and no microscopic confirmation or 

unknown. Unlike other chapters, sarcomas were included 

and cases with unknown or missing cause of death were 

also excluded because it would not be possible to classify 

the case as a death due to the cancer vs. not due to the 

cancer. Cancer site and morphology were coded according 

to the International Classification of Diseases for Oncology, Second edition (ICD-O-2) up to 2001 or Third edition 

(ICD-O-3) for 2001.

Cancer Staging

Cancer stage was determined by extent of cancer spread from 

the site of origin at initial diagnosis. The SEER historic 

staging scheme classified invasive cancers into four stages: 

localized to the primary tumor site, tumor with regional 

spread or metastases to regional lymph node, tumor with 

distant metastases, or unknown stage (when relevant data 

were unavailable, or stage was assigned more than four 

months after initial diagnosis). Data on cancer stage were 

included for breast, colorectal, lung, and prostate cancers. 

For prostate cancer, local and regional stages were combined 

because these two stages were not consistent over time. 

Statistical Analysis 

This analysis utilized cancer-specific survival rates rather 

than relative survival rates (2). The relative survival rate 

was used in the other chapters of this monograph and it is 

defined as the ratio of observed all-cause survival to expected 

survival (3). For this analysis, cause-specific (c-s) survival 

rates were calculated based on the underlying cause of 

death as coded based on the death certificate. Any cancer 

listed as the underlying cause of death was considered a 

death due to the cancer. In addition, some AIDS deaths 

and benign/borderline/in situ and unspecified cancers were 

included as a death due to cancer. Kaposi sarcoma was 

excluded from all sites and the specific diagnoses because 

many times the death certificate is signed out to HIV/AIDS 

or some other cause and rarely is Kaposi sarcoma listed as 

the underlying cause of death. 

The cause-specific (c-s) survival rate uses the actuarial or 

lifetable method with deaths not associated with the cancer 

censored at time of death. Deaths which were considered to 

be attributed to the cancer were treated as deaths and other 

deaths were considered losses to follow-up at the date of 

death. Survival times were measured in months and were 

censored at the date of a patient being lost to follow-up, the 

date of death from causes not considered as deaths due to 

the cancer, or on December 31, 2002, whichever occurred 

first. While c-s rates were calculated monthly, only the 

5-year c-s rates are shown due to lack of space. Survival 

rates are not shown for less than 25 cases and frequencies 

are not shown for under 5 cases.

Results

A total of 1,595,392 adult men and women were included 

who were diagnosed with an incident malignant cancer in 

the 12 SEER areas during the period 1988-2001. Table 

31.1 shows the 5-year cause-specific survival rates by 

anatomic system and major sites within those systems for 

males and females combined by race/ethnicity. Survival 

rates for males are shown in table 31.2 and for females in 

table 31.3. For all sites combined, the 5-year c-s survival 

was highest for white patients (65%) and lowest for AI/AN 

(54%). The overall rates for Hispanics and non-Hispanics 

were similar. While the c-s rate for all sites is interesting 

by race/ethnicity, emphasis should be on evaluating c-s 

rates for individual primary sites among the racial/ethnic 

groups since there is a different distribution of sites for each 

race/ethnicity. Therefore, c-s rates are shown for a very 

detailed list of primary sites. The following four cancers 

represented over half of the cancer diagnoses included for 

study in 1991-2001: lung/bronchus (162,121 cases) (Tables 

31.4, 31.5, and 31.6), female breast (215,368) (Table 31.7), 

prostate (237,138) (Table 31.8), and colon/rectum (147,323) 

(Table 31.9). 

Table 31.4 shows the distributions of cancer stage at diagnosis and 5-year c-s survival by more detailed race/ethnicity 

for males and females diagnosed with lung cancer. Tables 

31.5 and 31.6 show lung cancer for males and females, 

respectively. For males and females combined, the 5-year 

c-s rates ranged from a low of 11.9% for Other Pacific Islanders to a high of 23.0% among Asian Indian/Pakistanis. 

Most of the rates were in the 12-17% range. The overall 

low survival rates were associated with a high proportion 

of regional and distant disease. Asian Indians/Pakistanis 

had the lowest percentage of distant disease, 35%, and the 

highest regional disease, 44%, contributing to their higher 

overall survival rate. While the survival rates were much 

higher for localized disease (41-69%), less than 20% were 

diagnosed while the tumor was confined to the lung for each 

of the race/ethnicities. For most groups, females (Table 31.6) 

had a higher percentage of localized disease compared to 

males (Table 31.5). Even within stage females had higher 

survival rates than males for lung cancer. For females, 

5-year c-s survival rates for localized disease ranged from 

44% for Pacific Islander to 84% for Other Asians (based 

on few cases).
Chapter 31 Race and Ethnicity

National Cancer Institute 265 SEER Survival Monograph 

Table 31.7 shows the distributions of cancer stage at diagnosis and 5-year c-s survival by race/ethnicity for female 

breast cancer. Unlike lung cancer, a high proportion of 

breast cancer cases were localized at diagnosis and a very 

small percentage were distant (under 10% for each group). 

Five-year c-s survival rates were high for localized disease, 

over 90% for all except blacks and AI/AN.

Table 31.8 shows the distributions of cancer stage at diagnosis and 5-year c-s survival by race/ethnicity for prostate 

cancer. Over 80% of the prostate cases were localized/

regional at diagnosis. Survival rates were very high for 

localized/regional disease and ranged from 88% for Other 

Pacific Islander to 97% for Other Asian. Only a small 

percentage of cases were distant and even distant survival 

rates were higher than distant for most other sites. 

Table 31.9 shows the distributions of cancer stage at diagnosis and 5-year c-s survival by race/ethnicity for males and 

females for cancer of the colon and rectum. Since survival 

rates were similar by sex, survival rates are not shown 

separately by sex. There was a fairly even split between 

localized and regional disease for each of the race/ethnicity 

groups. Only a small proportion were unstaged. 

Discussion

This chapter describes racial/ethnic patterns in cancer-specific survival rates by primary site and gender. It expands 

on the findings from an earlier report of population-based 

data on cancer-specific survival for the six major racial/

ethnic groups in the U.S. (4). Many report have focused 

largely on whites and African-Americans (5-8). This study 

was facilitated by the intentional coverage by the SEER 

Program of certain geographic areas with relatively large 

racial/ethnic population subgroups so that information on 

the cancer burden would be available for these groups (9). 

Although geographic areas included in the SEER Program 

were not selected randomly, they include various levels of 

urbanization and socioeconomic status. Thus, descriptive 

studies based on SEER data, which covers large percentages of the populations being studied, provide insights into 

patterns at the national level.

In many of SEER publications, expected survival data were 

calculated using 1970, 1980, and 1990 US decennial life 

tables matched on age, race, and sex. However for these 

years, reliable expected life tables are not available for Hispanic whites, Native-Hawaiians, American Indians/Alaska 

Natives, and Asian Americans and these would be needed 

to generate valid relative survival estimates. Estimation 

of expected life tables depends on US mortality rates from 

all causes. Based on its current research on the quality 

and reliability of US mortality rates (from all causes) by 

race and Hispanic origin, however, the National Center 

for Health Statistics estimates that the published mortality 

rates for the white and African American population are 

overstated in official publications by an estimated 1.0% 

and 5.0%, respectively, resulting principally from undercounts of these population groups in the census. Mortality 

rates for other minority groups are understated in official 

publications, approximately by 21% for American Indians 

and 11% for Asian and Pacific Islanders (10). For these 

reasons, c-s rates were chosen to compare survival patterns 

among racial/ethnic groups, since they do not require race/

ethnicity specific life tables.

To obtain reliable estimates of cancer-specific survival, it 

is essential that classification of the underlying cause of 

death on death certificates is accurate. For colorectal, lung, 

breast, and prostate cancers, levels of accuracy exceed 90% 

for the underlying cause of death (11). There is no definitive answer on what causes of death should be included 

to indicate that an individual died of their cancer based 

on the death certificate. In some instances, the cause of 

death may reflect the site to which the cancer metastasized 

rather than the primary site. There are other primary site/

histology groups where the cause of death may be less 

specific than the original diagnosis such as leukemia on 

the death certificate instead of the more specific diagnosis 

of acute lymphoblastic leukemia. In ICD-10, a cause of 

death ascribed to multiple cancers would go to C97 and 

therefore, for persons with more than one cancer, C97 was 

considered a death due to the cancer. An example of a sitespecific decision would be a diagnosis of primary invasive 

brain tumor but for which the cause of death is brain tumor 

which would place it in the benign or not specified benign 

or malignant category which is generally not considered 

as cancer for mortality data. For brain, one would want to 

include these but for other cancers, one might not want to 

include all in situ and benign cancers as death attributed 

to the invasive cancer. For this analyses, all were included 

no matter what the original cancer site was.

Since expected rate tables are not readily available for races 

other than white or black, other methodology was needed 

to evaluate survival differences by specific race/ethnicity 

groups. Therefore, cause-specific rates were used in this 

chapter. Since there isn’t a standard set of causes of death 

to use as deaths due to the disease under study, a study is 

underway to evaluate which causes would be optimal for 

each individual primary site. For this chapter, a more generic set of causes of death were used, namely, any cancer 

cause of death plus AIDS and benign/borderline/in situ 

cancer deaths. Therefore, the survival rates presented here 

will be slightly lower than if a more site-specific approach 

were used because for persons with multiple primaries, the 

cancer death due to the second primary would be considered 
Chapter 31 Race and Ethnicity

National Cancer Institute 266 SEER Survival Monograph 

Table 31.1: Number of Cases and 5-Year (5-Yr) Cause-Specific (C-S) Survival Rates (%) Using the Actuarial Method by Selected 

Primary Site and Race/Ethnicity, Males & Females, Ages 20+, 12 SEER Areas, 1988-2001.

Primary Site

All races White Black AI/AN

Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%)

All Sites excluding KS 1,595,392 61.7 1,336,148 62.7 147,982 53.1 5,128 52.4

 Oral Cavity and Pharynx 38,367 58.3 30,926 60.5 4,137 39.1 145 46.6

 Lip 3,953 91.0 3,864 91.3 39 74.9 13 ~

 Tongue 8,560 53.9 7,062 56.1 903 34.9 24 ~

 Nasopharynx 2,857 57.0 1,250 49.0 247 48.9 27 48.8

 Digestive System 289,603 44.1 231,220 45.1 29,563 36.7 1,127 31.9

 Esophagus 14,749 13.8 11,438 14.5 2,367 10.5 43 12.0

 Stomach 31,117 22.3 21,851 20.2 3,690 22.3 192 13.8

 Small Intestine 4,817 52.2 3,807 52.8 695 52.0 20 ~

 Colon and Rectum 179,453 59.9 147,992 60.3 16,545 52.3 519 52.7

 Colon excluding Rectum 127,087 60.1 104,792 60.6 12,487 52.3 350 54.0

 Rectum/Rectosigmoid 52,366 59.4 43,200 59.6 4,058 52.2 169 50.2

 Liver/Intrahepatic Bile Duct 13,347 10.2 8,668 9.8 1,491 6.0 103 10.1

 Gallbladder & Other Biliary 8,720 17.4 6,950 17.1 610 16.4 113 13.6

 Pancreas 29,180 4.4 23,565 4.3 3,383 3.8 106 5.1

 Respiratory System 215,839 19.7 177,767 20.1 24,289 16.8 533 14.6

 Larynx 14,788 65.7 12,058 67.3 2,129 55.3 31 42.0

 Lung and Bronchus 197,654 15.6 162,978 16.0 21,823 12.6 482 12.7

 Bones and Joints 3,457 66.5 2,881 66.3 305 68.9 23 ~

 Soft Tissue including Heart 10,070 64.1 8,164 65.0 1,076 58.5 62 62.4

 Skin except Basal/Squamous 60,765 86.1 59,126 86.2 765 84.2 82 77.1

 Melanoma of the Skin 55,137 86.0 54,284 86.2 308 68.6 65 72.6

 Other Non-Epithelial Skin 5,628 87.2 4,842 86.0 457 94.7 17 ~

 Breast 257,436 83.9 217,297 84.9 21,690 72.2 793 74.6

 Female Genital System 103,856 67.7 87,441 68.3 8,250 56.9 466 63.6

 Cervix Uteri 21,240 72.0 16,058 73.1 2,789 63.2 139 69.6

 Corpus and Uterus, NOS 48,820 80.9 42,302 82.2 3,138 60.1 161 77.4

 Ovary 27,275 41.4 23,477 40.7 1,752 38.4 137 40.5

 Male Genital System 286,438 87.2 237,885 87.7 33,108 82.8 676 81.6

 Prostate 272,580 86.9 225,162 87.4 32,681 82.8 600 80.9

 Testis 12,241 95.5 11,379 95.8 293 87.4 65 90.0

 Urinary System 102,313 72.5 90,831 73.2 6,498 64.1 337 66.4

 Urinary Bladder 66,937 77.1 61,113 77.8 3,023 63.0 96 69.1

 Kidney and Renal Pelvis 33,224 64.3 27,961 64.1 3,260 66.0 234 66.1

 Eye and Orbit 2,375 76.4 2,175 75.9 96 79.2 18 ~

 Brain and Other Nervous 23,018 32.7 20,330 31.6 1,415 40.1 90 44.3

 Endocrine System 28,327 91.0 23,107 91.2 1,602 87.7 146 91.9

 Thyroid 25,919 93.9 21,274 94.0 1,352 92.1 132 94.0

 Myeloma 18,044 31.7 13,985 30.7 2,960 34.9 85 21.4

 Leukemia 42,994 47.4 37,011 48.5 3,103 39.7 187 37.0

 Acute Lymphocytic 6,640 63.1 5,549 63.9 442 53.5 59 46.7

 Chronic Lymphocytic 12,903 71.6 11,787 72.5 825 58.5 29 58.7

 Acute Myeloid 12,056 18.5 10,039 18.0 890 19.0 52 19.1

 Chronic Myeloid 6,013 41.1 4,967 41.1 564 39.8 30 28.4

 Mesothelioma 3,488 7.2 3,175 7.0 179 12.1 16 ~

 Miscellaneous 31,032 15.8 25,559 16.4 3,303 11.4 129 10.0

 Hodgkin Lymphoma 12,172 85.1 10,551 85.4 1,170 82.7 21 ~

 Non-Hodgkin Lymphoma 65,798 58.2 56,717 58.4 4,473 57.1 192 46.2

 ~ Statistic not displayed due to less than 25 cases.

AI/AN: American Indian/Alaska Native; API: Asian/Pacific Islander; NOS: Not otherwise specified.
Chapter 31 Race and Ethnicity

National Cancer Institute 267 SEER Survival Monograph 

Table 31.1 (continued): Number of Cases and 5-Year (5-Yr) Cause-Specific (C-S) Survival Rates (%) by 

Selected Site and Race/Ethnicity, Males & Females, Ages 20+, 12 SEER Areas, 1988-2001.

Primary Site

API Hispanic Non-Hispanic

Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%)

All Sites excluding KS 106,134 60.5 109,356 61.7 1,486,036 61.7

 Oral Cavity and Pharynx 3,159 61.6 2,203 57.2 36,164 58.3

 Lip 37 85.3 195 90.7 3,758 91.1

 Tongue 571 56.9 475 50.6 8,085 54.1

 Nasopharynx 1,333 66.1 157 45.0 2,700 57.7

 Digestive System 27,693 44.3 21,249 39.3 268,354 44.5

 Esophagus 901 13.8 824 13.7 13,925 13.8

 Stomach 5,384 30.8 3,787 23.0 27,330 22.2

 Small Intestine 295 46.0 309 51.4 4,508 52.3

 Colon and Rectum 14,397 64.4 10,684 58.4 168,769 60.0

 Colon excluding Rectum 9,458 64.6 7,054 59.0 120,033 60.2

 Rectum/Rectosigmoid 4,939 63.9 3,630 57.2 48,736 59.5

 Liver/Intrahepatic Bile Duct 3,085 12.9 1,713 12.8 11,634 9.8

 Gallbladder & Other Biliary 1,047 20.3 1,253 18.7 7,467 17.2

 Pancreas 2,126 6.0 2,050 6.8 27,130 4.2

 Respiratory System 13,250 19.7 9,622 20.4 206,217 19.7

 Larynx 570 71.6 883 62.9 13,905 65.9

 Lung and Bronchus 12,371 16.3 8,368 14.1 189,286 15.7

 Bones and Joints 248 68.3 511 66.4 2,946 66.5

 Soft Tissue including Heart 768 62.7 1,160 65.5 8,910 63.9

 Skin except Basal/Squamous 792 83.2 1,937 83.3 58,828 86.2

 Melanoma of the Skin 480 76.4 1,581 81.1 53,556 86.2

 Other Non-Epithelial Skin 312 93.2 356 92.8 5,272 86.8

 Breast 17,656 86.9 17,178 81.4 240,258 84.1

 Female Genital System 7,699 72.8 9,985 70.8 93,871 67.4

 Cervix Uteri 2,254 75.4 4,190 76.0 17,050 71.1

 Corpus and Uterus, NOS 3,219 82.8 3,154 79.6 45,666 80.9

 Ovary 1,909 52.9 2,120 48.8 25,155 40.8

 Male Genital System 14,769 87.9 18,288 87.5 268,150 87.2

 Prostate 14,137 87.7 16,538 87.2 256,042 86.9

 Testis 504 94.2 1,537 93.0 10,704 95.8

 Urinary System 4,647 71.3 6,067 69.6 96,246 72.7

 Urinary Bladder 2,705 77.0 2,843 75.0 64,094 77.2

 Kidney and Renal Pelvis 1,769 64.4 3,111 65.4 30,113 64.2

 Eye and Orbit 86 87.4 232 86.3 2,143 75.5

 Brain and Other Nervous 1,183 42.0 2,225 42.9 20,793 31.7

 Endocrine System 3,472 91.4 3,402 91.1 24,925 91.0

 Thyroid 3,161 93.9 3,132 93.7 22,787 93.9

 Myeloma 1,014 39.3 1,408 33.5 16,636 31.6

 Leukemia 2,693 41.6 4,277 51.0 38,717 47.0

 Acute Lymphocytic 590 64.2 1,713 64.6 4,927 62.5

 Chronic Lymphocytic 262 74.0 475 66.6 12,428 71.8

 Acute Myeloid 1,075 23.2 1,141 29.6 10,915 17.3

 Chronic Myeloid 452 43.5 609 46.4 5,404 40.5

 Mesothelioma 118 7.9 309 6.7 3,179 7.3

 Miscellaneous 2,041 15.6 2,427 15.8 28,605 15.8

 Hodgkin Lymphoma 430 81.8 1,362 81.5 10,810 85.5

 Non-Hodgkin Lymphoma 4,416 57.9 5,514 57.6 60,284 58.3
Chapter 31 Race and Ethnicity

National Cancer Institute 268 SEER Survival Monograph 

Table 31.2: Number of Cases and 5-Year (5-Yr) Cause-Specific (C-S) Survival Rates (%) Using the Actuarial Method by Selected 

Primary Site and Race/Ethnicity, Males, Ages 20+, 12 SEER Areas, 1988-2001.

Primary Site

All races White Black AI/AN

Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%)

All Sites excluding KS 828,041 60.4 690,875 61.6 81,571 53.7 2,435 49.7

 Oral Cavity and Pharynx 25,899 56.4 20,770 59.3 2,964 34.8 105 45.5

 Lip 3,210 91.1 3,162 91.1 17 ~ 12 ~

 Tongue 5,700 51.9 4,690 54.5 670 32.5 15 ~

 Nasopharynx 1,980 56.5 848 50.0 176 48.5 19 ~

 Digestive System 154,650 42.1 122,891 43.2 15,234 33.7 605 32.0

 Esophagus 11,028 13.6 8,587 14.4 1,670 9.4 37 14.2

 Stomach 19,281 20.3 13,779 18.3 2,204 19.8 113 14.7

 Small Intestine 2,520 51.5 1,986 51.6 357 52.7 13 ~

 Colon and Rectum 91,330 59.4 75,434 59.8 7,726 51.3 275 53.2

 Colon excluding Rectum 61,761 59.9 51,066 60.4 5,604 51.9 179 55.4

 Rectum/Rectosigmoid 29,569 58.3 24,368 58.7 2,122 49.6 96 49.1

 Liver/Intrahepatic Bile Duct 9,085 9.6 5,765 9.0 1,062 5.5 70 8.6

 Gallbladder & Other Biliary 3,459 18.6 2,709 18.8 234 17.2 35 14.5

 Pancreas 14,719 4.2 11,967 4.2 1,625 3.2 45 5.7

 Respiratory System 129,278 19.3 104,595 19.8 15,715 16.0 330 14.4

 Larynx 11,848 65.9 9,657 67.6 1,673 54.3 26 46.3

 Lung and Bronchus 115,384 13.8 93,290 14.1 13,852 11.0 294 11.3

 Bones and Joints 1,970 65.2 1,650 65.0 162 66.0 10 ~

 Soft Tissue including Heart 5,532 63.8 4,503 64.9 570 57.5 33 56.3

 Skin except Basal/Squamous 33,199 83.1 32,407 83.1 365 82.3 36 75.4

 Melanoma of the Skin 30,143 82.9 29,726 83.1 155 65.8 31 74.6

 Other Non-Epithelial Skin 3,056 84.5 2,681 83.3 210 94.3 5 ~

 Breast 1,680 79.5 1,383 81.6 211 63.6 <5 ~

 Male Genital System 286,438 87.2 237,885 87.7 33,108 82.8 676 81.6

 Prostate 272,580 86.9 225,162 87.4 32,681 82.8 600 80.9

 Testis 12,241 95.5 11,379 95.8 293 87.4 65 90.0

 Urinary System 71,903 73.8 64,453 74.4 3,968 65.7 222 67.6

 Urinary Bladder 49,973 78.4 45,934 78.9 1,943 67.0 81 71.9

 Kidney and Renal Pelvis 20,601 63.4 17,406 63.4 1,912 64.7 138 65.7

 Eye and Orbit 1,307 77.2 1,208 77.1 48 74.8 11 ~

 Brain and Other Nervous 13,066 31.6 11,610 30.6 742 40.7 46 43.8

 Endocrine System 7,632 84.9 6,383 85.4 401 78.1 36 85.9

 Thyroid 6,291 90.2 5,361 90.5 284 83.6 27 88.6

 Myeloma 9,653 32.9 7,634 31.8 1,418 36.0 46 22.7

 Leukemia 24,772 47.6 21,420 48.9 1,676 39.6 102 35.5

 Acute Lymphocytic 3,803 61.8 3,183 62.6 241 55.0 34 45.4

 Chronic Lymphocytic 7,677 70.5 7,014 71.6 477 54.6 14 ~

 Acute Myeloid 6,518 17.2 5,469 16.9 432 19.4 28 21.8

 Chronic Myeloid 3,492 39.7 2,875 39.7 326 36.9 16 ~

 Mesothelioma 2,741 4.8 2,505 4.5 131 10.3 12 ~

 Miscellaneous 15,365 18.0 12,612 19.2 1,646 10.2 53 14.9

 Hodgkin Lymphoma 6,667 83.8 5,799 84.3 630 80.2 10 ~

 Non-Hodgkin Lymphoma 36,289 57.4 31,167 57.7 2,582 56.0 99 40.5

 ~ Statistic not displayed due to less than 25 cases.

AI/AN: American Indian/Alaska Native; API: Asian/Pacific Islander; NOS: Not otherwise specified.
Chapter 31 Race and Ethnicity

National Cancer Institute 269 SEER Survival Monograph 

Table 31.2 (continued): Number of Cases and 5-Year (5-Yr) Cause-Specific (C-S) Survival Rates (%) by 

Selected Site and Race/Ethnicity, Males, Ages 20+, 12 SEER Areas, 1988-2001.

Primary Site

API Hispanic Non-Hispanic

Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%)

All Sites excluding KS 53,160 55.2 53,674 59.6 774,367 60.4

 Oral Cavity and Pharynx 2,060 58.6 1,494 53.2 24,405 56.6

 Lip 19 ~ 159 89.8 3,051 91.2

 Tongue 325 54.0 302 45.2 5,398 52.3

 Nasopharynx 937 63.7 103 43.7 1,877 57.2

 Digestive System 15,920 42.2 11,487 38.2 143,163 42.4

 Esophagus 734 13.3 653 13.4 10,375 13.6

 Stomach 3,185 29.8 2,187 21.1 17,094 20.3

 Small Intestine 164 50.6 158 51.4 2,362 51.6

 Colon and Rectum 7,895 63.4 5,728 57.9 85,602 59.5

 Colon excluding Rectum 4,912 64.4 3,568 59.1 58,193 60.0

 Rectum/Rectosigmoid 2,983 61.8 2,160 56.1 27,409 58.5

 Liver/Intrahepatic Bile Duct 2,188 13.2 1,143 12.0 7,942 9.3

 Gallbladder & Other Biliary 481 18.5 405 18.7 3,054 18.6

 Pancreas 1,082 5.0 965 5.7 13,754 4.1

 Respiratory System 8,638 19.4 5,930 20.7 123,348 19.3

 Larynx 492 72.0 740 63.4 11,108 66.1

 Lung and Bronchus 7,948 15.2 4,933 12.2 110,451 13.9

 Bones and Joints 148 69.5 295 66.3 1,675 65.1

 Soft Tissue including Heart 426 60.7 626 64.4 4,906 63.8

 Skin except Basal/Squamous 391 79.6 814 77.5 32,385 83.2

 Melanoma of the Skin 231 71.5 643 73.8 29,500 83.1

 Other Non-Epithelial Skin 160 91.1 171 91.5 2,885 84.1

 Breast 83 83.2 71 70.0 1,609 79.9

 Male Genital System 14,769 87.9 18,288 87.5 268,150 87.2

 Prostate 14,137 87.7 16,538 87.2 256,042 86.9

 Testis 504 94.2 1,537 93.0 10,704 95.8

 Urinary System 3,260 72.1 3,986 69.7 67,917 74.0

 Urinary Bladder 2,015 78.5 2,079 77.0 47,894 78.5

 Kidney and Renal Pelvis 1,145 62.6 1,839 62.1 18,762 63.6

 Eye and Orbit 40 87.0 136 89.8 1,171 75.9

 Brain and Other Nervous 668 39.6 1,215 41.8 11,851 30.6

 Endocrine System 812 84.7 749 83.2 6,883 85.1

 Thyroid 619 90.4 589 90.4 5,702 90.1

 Myeloma 555 40.8 764 35.0 8,889 32.7

 Leukemia 1,574 40.2 2,435 51.0 22,337 47.3

 Acute Lymphocytic 345 60.6 992 63.2 2,811 61.2

 Chronic Lymphocytic 172 71.1 283 66.6 7,394 70.6

 Acute Myeloid 589 18.7 599 28.3 5,919 16.1

 Chronic Myeloid 275 43.9 361 43.6 3,131 39.2

 Mesothelioma 93 6.1 237 5.5 2,504 4.7

 Miscellaneous 1,054 16.3 1,170 16.7 14,195 18.1

 Hodgkin Lymphoma 228 79.0 803 78.9 5,864 84.4

 Non-Hodgkin Lymphoma 2,441 55.7 3,174 55.9 33,115 57.5
Chapter 31 Race and Ethnicity

National Cancer Institute 270 SEER Survival Monograph 

Table 31.3: Number of Cases and 5-Year (5-Yr) Cause-Specific (C-S) Survival Rates (%) Using the Actuarial Method by Selected 

Primary Site and Race/Ethnicity, Females, Ages 20+, 12 SEER Areas, 1988-2001.

 

Primary Site

All races White Black AI/AN

Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%)

All Sites excluding KS 767,351 63.1 645,273 64.0 66,411 52.5 2,693 54.8

 Oral Cavity and Pharynx 12,468 62.0 10,156 62.8 1,173 49.9 40 50.2

 Lip 743 90.7 702 92.0 22 ~ 1 ~

 Tongue 2,860 57.7 2,372 59.0 233 41.5 9 ~

 Nasopharynx 877 58.2 402 46.8 71 49.9 8 ~

 Digestive System 134,953 46.4 108,329 47.2 14,329 39.9 522 31.9

 Esophagus 3,721 14.6 2,851 14.9 697 13.2 6 ~

 Stomach 11,836 25.5 8,072 23.6 1,486 26.0 79 12.8

 Small Intestine 2,297 52.9 1,821 54.1 338 51.1 7 ~

 Colon and Rectum 88,123 60.4 72,558 60.8 8,819 53.1 244 52.1

 Colon excluding Rectum 65,326 60.2 53,726 60.8 6,883 52.6 171 52.5

 Rectum/Rectosigmoid 22,797 60.8 18,832 60.7 1,936 55.0 73 51.8

 Liver/Intrahepatic Bile Duct 4,262 11.2 2,903 11.5 429 6.6 33 13.7

 Gallbladder & Other Biliary 5,261 16.6 4,241 16.1 376 15.9 78 13.2

 Pancreas 14,461 4.6 11,598 4.4 1,758 4.4 61 4.8

 Respiratory System 86,561 20.3 73,172 20.5 8,574 18.3 203 14.9

 Larynx 2,940 64.8 2,401 65.8 456 58.9 5 ~

 Lung and Bronchus 82,270 18.1 69,688 18.5 7,971 15.4 188 14.4

 Bones and Joints 1,487 68.2 1,231 68.0 143 72.0 13 ~

 Soft Tissue including Heart 4,538 64.4 3,661 65.0 506 59.5 29 69.4

 Skin except Basal/Squamous 27,566 89.8 26,719 89.9 400 85.9 46 78.3

 Melanoma of the Skin 24,994 89.7 24,558 90.0 153 71.4 34 70.7

 Other Non-Epithelial Skin 2,572 90.3 2,161 89.3 247 94.9 12 ~

 Breast 255,756 84.0 215,914 84.9 21,479 72.3 790 74.5

 Female Genital System 103,856 67.7 87,441 68.3 8,250 56.9 466 63.6

 Cervix Uteri 21,240 72.0 16,058 73.1 2,789 63.2 139 69.6

 Corpus and Uterus, NOS 48,820 80.9 42,302 82.2 3,138 60.1 161 77.4

 Ovary 27,275 41.4 23,477 40.7 1,752 38.4 137 40.5

 Urinary System 30,410 69.4 26,378 70.2 2,530 61.7 115 64.1

 Urinary Bladder 16,964 73.0 15,179 74.2 1,080 55.8 15 ~

 Kidney and Renal Pelvis 12,623 65.8 10,555 65.5 1,348 67.8 96 66.5

 Eye and Orbit 1,068 75.5 967 74.4 48 83.4 7 ~

 Brain and Other Nervous 9,952 34.2 8,720 33.1 673 39.4 44 43.6

 Endocrine System 20,695 93.3 16,724 93.4 1,201 91.0 110 93.8

 Thyroid 19,628 95.1 15,913 95.2 1,068 94.4 105 95.4

 Myeloma 8,391 30.5 6,351 29.3 1,542 33.8 39 20.4

 Leukemia 18,222 47.0 15,591 48.0 1,427 39.9 85 38.9

 Acute Lymphocytic 2,837 64.9 2,366 65.7 201 51.7 25 47.8

 Chronic Lymphocytic 5,226 73.3 4,773 73.9 348 63.7 15 ~

 Acute Myeloid 5,538 20.0 4,570 19.2 458 18.6 24 ~

 Chronic Myeloid 2,521 43.1 2,092 43.1 238 44.0 14 ~

 Mesothelioma 747 15.8 670 15.9 48 16.6 4 ~

 Miscellaneous 15,667 13.7 12,947 13.8 1,657 12.5 76 7.1

 Hodgkin Lymphoma 5,505 86.6 4,752 86.8 540 85.4 11 ~

 Non-Hodgkin Lymphoma 29,509 59.2 25,550 59.2 1,891 58.4 93 51.9

 ~ Statistic not displayed due to less than 25 cases.

AI/AN: American Indian/Alaska Native; API: Asian/Pacific Islander; NOS: Not otherwise specified.
Chapter 31 Race and Ethnicity

National Cancer Institute 271 SEER Survival Monograph 

Table 31.3 (continued): Number of Cases and 5-Year (5-Yr) Cause-Specific (C-S) Survival Rates (%) by 

Selected Site and Race/Ethnicity, Females, Ages 20+, 12 SEER Areas, 1988-2001.

 

Primary Site

API Hispanic Non-Hispanic

Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%) Cases

5-Yr C-S 

Rate (%)

All Sites excluding KS 52,974 65.7 55,682 63.7 711,669 63.0

 Oral Cavity and Pharynx 1,099 67.3 709 65.5 11,759 61.8

 Lip 18 ~ 36 93.5 707 90.5

 Tongue 246 60.3 173 59.8 2,687 57.6

 Nasopharynx 396 72.3 54 47.0 823 58.9

 Digestive System 11,773 47.0 9,762 40.6 125,191 46.8

 Esophagus 167 15.8 171 14.9 3,550 14.6

 Stomach 2,199 32.4 1,600 25.7 10,236 25.5

 Small Intestine 131 40.3 151 51.4 2,146 53.0

 Colon and Rectum 6,502 65.5 4,956 58.9 83,167 60.4

 Colon excluding Rectum 4,546 64.9 3,486 58.9 61,840 60.3

 Rectum/Rectosigmoid 1,956 66.9 1,470 58.9 21,327 60.9

 Liver/Intrahepatic Bile Duct 897 12.4 570 14.1 3,692 10.8

 Gallbladder & Other Biliary 566 21.9 848 18.5 4,413 16.3

 Pancreas 1,044 7.1 1,085 7.7 13,376 4.4

 Respiratory System 4,612 20.1 3,692 20.0 82,869 20.3

 Larynx 78 69.4 143 60.3 2,797 65.0

 Lung and Bronchus 4,423 18.2 3,435 16.8 78,835 18.2

 Bones and Joints 100 66.7 216 66.6 1,271 68.5

 Soft Tissue including Heart 342 64.8 534 66.5 4,004 64.1

 Skin except Basal/Squamous 401 86.8 1,123 87.4 26,443 89.9

 Melanoma of the Skin 249 81.2 938 86.0 24,056 89.9

 Other Non-Epithelial Skin 152 95.5 185 93.8 2,387 90.0

 Breast 17,573 86.9 17,107 81.5 238,649 84.1

 Female Genital System 7,699 72.8 9,985 70.8 93,871 67.4

 Cervix Uteri 2,254 75.4 4,190 76.0 17,050 71.1

 Corpus and Uterus, NOS 3,219 82.8 3,154 79.6 45,666 80.9

 Ovary 1,909 52.9 2,120 48.8 25,155 40.8

 Urinary System 1,387 69.5 2,081 69.5 28,329 69.4

 Urinary Bladder 690 72.5 764 69.6 16,200 73.2

 Kidney and Renal Pelvis 624 67.6 1,272 70.3 11,351 65.3

 Eye and Orbit 46 88.6 96 82.0 972 75.0

 Brain and Other Nervous 515 45.4 1,010 44.3 8,942 33.0

 Endocrine System 2,660 93.3 2,653 93.3 18,042 93.3

 Thyroid 2,542 94.7 2,543 94.5 17,085 95.2

 Myeloma 459 37.6 644 31.8 7,747 30.3

 Leukemia 1,119 43.5 1,842 51.1 16,380 46.6

 Acute Lymphocytic 245 69.2 721 66.5 2,116 64.3

 Chronic Lymphocytic 90 79.8 192 66.5 5,034 73.6

 Acute Myeloid 486 28.5 542 31.1 4,996 18.7

 Chronic Myeloid 177 43.1 248 50.5 2,273 42.3

 Mesothelioma 25 16.2 72 10.5 675 16.4

 Miscellaneous 987 15.0 1,257 15.0 14,410 13.6

 Hodgkin Lymphoma 202 85.2 559 85.1 4,946 86.8

 Non-Hodgkin Lymphoma 1,975 60.6 2,340 59.7 27,169 59.2
Chapter 31 Race and Ethnicity

National Cancer Institute 272 SEER Survival Monograph 

a cancer death for the first. Using only the specific cancer as 

the cause of death, however, overestimates the c-s survival 

rates. The main point is that if the same definitions for 

what is considered a ‘cancer’ death are used across all of 

the racial groups, then the survival rates can be compared 

for the racial/ethnic groups. An assumption is that the assignment of the cause of death does not vary across racial/

ethnic groups. Another assumption is that there is access 

to the underlying cause of death for all of the racial/ethnic 

groups. Several years ago, it was difficult to obtain the 

underlying cause of death if the person moved out of the 

state where they were diagnosed and died. However, the 

National Death Index is now being used to obtain these, 

A concern, however, would be if there are subgroups who 

would be more likely than others to return to their original 

or ancestral country to die. Research is on-going to try to 

evaluate differences in follow-up rates and non-access to 

causes of death by race/ethnicity to evaluate the impact on 

survival differences.

Differences in access to and utilization of effective cancer 

screening and treatment services by race/ethnicity might 

explain some of our findings. Other possible explanations 

for the observed racial/ethnic differences in survival include 

differences in access to optimal treatments that reduce cancer 

mortality. In addition, unmeasured biological determinants 

might partly explain our findings. 

Limitations of our study include the relatively small number of cancers diagnosed in some minorities, particularly 

Native-Americans and Native-Hawaiians. In addition, our 

analyses only considered tumor stage at diagnosis and not 

other potential prognostic factors such as tumor size, grade, 

lymph node status, other patient characteristics such as 

age, socioeconomic status, co-morbid diseases, and health 

insurance status. Additional research is needed to clarify 

the role of socioeconomic, medical, biological, cultural and 

other determinants of racial/ethnic differences in cancer 

patient survival described in this report. 

Table 31.4: Cancer of the Lung - Males & Females: 5-Year Cause-Specific Survival Rates (%) by Race/Ethnicity and Historic Stage, 

Ages 20+, 12 SEER Areas, 1991-2001.

Race/Ethnicity Cases

Stage Distribution 5-Year Cause-Specific Survival Rate (%)

Loc Reg Dist Uns All Loc Reg Dist Uns

Percent Percent Percent Percent Rate (%) Rate (%) Rate (%) Rate (%) Rate (%)

All Races 162,121 16.4 38.0 39.2 6.4 15.6 49.9 15.7 1.9 11.2

White 132,779 16.9 37.8 38.9 6.5 16.0 50.5 16.0 1.8 11.1

 White non-Hispanic 125,570 17.0 37.7 38.8 6.4 16.1 50.7 16.2 1.8 10.9

 White Hispanic 7,209 14.2 38.0 40.6 7.2 13.6 47.0 13.1 2.0 14.6

Black 18,202 14.2 38.5 40.8 6.5 12.6 43.4 12.9 1.6 11.0

AI/AN 399 16.8 37.1 40.6 5.5 13.4 41.7 13.5 1.6 ~

Asian 9,490 14.4 40.7 39.1 5.8 17.0 52.8 17.5 3.4 11.6

 Asian Indian/Pakistani 151 16.6 44.4 35.1 4.0 23.0 54.8 18.2 9.7 ~

 Chinese 2,864 13.2 40.1 39.6 7.2 15.5 50.0 16.8 2.7 10.8

 Filipino 2,470 14.6 41.1 38.5 5.8 18.8 53.6 19.1 5.3 11.5

 Korean 753 11.7 43.4 38.5 6.4 13.9 50.0 13.6 3.4 11.7

 Japanese 2,157 16.6 40.4 39.2 3.9 17.5 55.9 17.8 2.0 4.9

 Vietnamese 659 15.2 37.6 42.3 4.9 16.3 43.0 18.2 4.9 22.9

 Other Asian 436 13.8 41.5 37.6 7.1 18.1 68.7 17.0 1.8 14.1

Pacific Islander 1,251 13.2 38.1 43.3 5.4 12.6 43.8 14.0 2.3 8.3

 Hawaiian 1,010 13.8 37.9 42.6 5.7 12.8 44.4 13.7 2.3 9.5

 Other Pacific Islander 241 10.8 39.0 46.5 3.7 11.9 41.0 15.8 ! ~

 ! Not enough intervals to produce rate.

~ Less than 25 cases.

AI/AN: American Indian/Alaska Native; Loc: Localized; Reg: Regional; Dis: Distant; Uns: Unstaged.
Chapter 31 Race and Ethnicity

National Cancer Institute 273 SEER Survival Monograph 

Table 31.5: Cancer of the Lung - Males: 5-Year Cause-Specific Survival Rates (%) by Race/Ethnicity and Historic Stage, Ages 20+, 

12 SEER Areas, 1991-2001.

Race/Ethnicity Cases

Stage Distribution 5-Year Cause-Specific Survival Rate (%)

Loc Reg Dist Uns All Loc Reg Dist Uns

Percent Percent Percent Percent Rate (%) Rate (%) Rate (%) Rate (%) Rate (%)

All Races 93,248 15.0 38.6 40.1 6.4 13.8 45.6 14.6 1.7 9.6

White 74,732 15.4 38.4 39.8 6.4 14.1 46.3 15.0 1.6 9.5

 White non-Hispanic 70,499 15.5 38.4 39.7 6.4 14.2 46.6 15.1 1.5 9.1

 White Hispanic 4,233 12.9 38.1 41.7 7.3 11.9 41.2 12.1 1.9 14.8

Black 11,420 13.1 38.3 42.2 6.3 10.9 39.1 11.7 1.3 9.2

AI/AN 245 16.7 38.4 40.8 4.1 12.5 39.3 13.1 1.2 ~

Asian 6,080 14.1 41.3 38.7 6.0 15.8 47.3 16.4 3.5 12.6

 Asian Indian/Pakistani 97 17.5 49.5 30.9 2.1 25.7 ~ 17.1 ! ~

 Chinese 1,724 14.0 40.6 37.9 7.4 14.9 43.7 15.6 2.8 12.3

 Filipino 1,719 13.7 41.1 39.2 6.0 17.4 49.5 18.3 5.2 14.3

 Korean 485 11.1 46.0 36.3 6.6 11.7 40.0 11.5 2.9 11.6

 Japanese 1,337 14.8 41.1 39.4 4.6 15.4 53.9 16.0 1.4 4.5

 Vietnamese 460 17.2 38.3 40.9 3.7 16.7 35.3 19.8 5.9 ~

 Other Asian 258 12.0 40.3 40.7 7.0 15.2 54.0 14.2 3.2 ~

Pacific Islander 771 12.1 38.7 42.9 6.4 11.4 43.8 11.4 2.8 5.4

 Hawaiian 620 13.1 38.2 41.9 6.8 12.0 44.2 11.5 3.3 6.1

 Other Pacific Islander 151 7.9 40.4 47.0 4.6 8.8 ~ 12.0 0.0 ~

 !Not enough intervals to produce rate.

~Less than 25 cases.

AI/AN: American Indian/Alaska Native; Loc: Localized; Reg: Regional; Dis: Distant; Uns: Unstaged.

Table 31.6: Cancer of the Lung - Females: 5-Year Cause-Specific Survival Rates (%) by Race/Ethnicity and Historic Stage, Ages 

20+, 12 SEER Areas, 1991-2001.

Race/Ethnicity Cases

Stage Distribution 5-Year Cause-Specific Survival Rate (%)

Loc Reg Dist Uns All Loc Reg Dist Uns

Percent Percent Percent Percent Rate (%) Rate (%) Rate (%) Rate (%) Rate (%)

All Races 68,873 18.3 37.3 37.9 6.5 18.1 54.6 17.2 2.2 13.2

White 58,047 18.8 36.9 37.7 6.5 18.4 54.9 17.4 2.2 13.2

 White non-Hispanic 55,071 19.0 36.9 37.6 6.5 18.5 54.9 17.5 2.2 13.1

 White Hispanic 2,976 16.1 37.9 39.0 7.0 16.0 53.8 14.7 2.2 14.0

Black 6,782 15.9 38.9 38.5 6.8 15.5 49.5 14.8 2.1 13.9

AI/AN 154 16.9 35.1 40.3 7.8 14.5 44.5 13.6 ! ~

Asian 3,410 15.0 39.6 39.9 5.5 19.1 61.9 19.5 3.3 10.5

 Asian Indian/Pakistani 54 14.8 35.2 42.6 7.4 21.2 ~ ~ ~ ~

 Chinese 1,140 11.8 39.4 42.0 6.8 16.3 62.0 18.5 2.6 8.5

 Filipino 751 16.8 41.0 36.9 5.3 21.8 60.8 20.8 5.3 8.0

 Korean 268 12.7 38.8 42.5 6.0 18.1 66.0 17.4 4.4 ~

 Japanese 820 19.4 39.1 38.8 2.7 20.8 58.4 20.9 2.9 ~

 Vietnamese 199 10.6 36.2 45.7 7.5 15.6 ~ 14.0 2.5 ~

 Other Asian 178 16.3 43.3 33.1 7.3 22.5 84.1 20.6 0.0 ~

Pacific Islander 480 15.0 37.3 44.0 3.8 14.6 44.1 18.3 ! ~

 Hawaiian 390 14.9 37.4 43.6 4.1 14.2 45.0 17.5 ! ~

 Other Pacific Islander 90 15.6 36.7 45.6 2.2 17.4 ~ 22.5 ! ~

 ! Not enough intervals to produce rate.

~ Less than 25 cases.

AI/AN: American Indian/Alaska Native; Loc: Localized; Reg: Regional; Dis: Distant; Uns: Unstaged.
Chapter 31 Race and Ethnicity

National Cancer Institute 274 SEER Survival Monograph 

Table 31.7: Cancer of the Female Breast: 5-Year Cause-Specific Survival Rates (%) by Race/Ethnicity and Historic Stage, Ages 

20+, 12 SEER Areas, 1991-2001.

Race/Ethnicity Cases

Stage Distribution 5-Year Cause-Specific Survival Rate (%)

Loc Reg Dist Uns All Loc Reg Dist Uns

Percent Percent Percent Percent Rate (%) Rate (%) Rate (%) Rate (%) Rate (%)

All Races 215,368 62.7 30.0 5.5 1.8 84.2 93.2 77.4 22.9 63.1

White 180,640 63.7 29.4 5.2 1.7 85.1 93.5 78.8 24.1 64.8

 White non-Hispanic 165,465 64.4 28.8 5.1 1.7 85.5 93.6 79.2 24.0 64.9

 White Hispanic 15,175 55.7 35.7 6.5 2.1 81.6 92.3 75.7 25.5 64.2

Black 18,539 52.9 35.3 8.7 3.1 72.5 88.3 64.4 15.0 53.4

AI/AN 692 54.0 34.7 8.8 2.5 73.2 89.6 61.8 22.1 ~

Asian 14,027 64.2 30.2 4.3 1.3 87.8 95.2 81.0 28.0 68.6

 Asian Indian/Pakistani 571 53.4 37.8 7.0 1.8 82.3 94.7 75.4 29.9 ~

 Chinese 3,244 63.2 31.2 4.3 1.3 87.9 94.8 83.2 26.3 68.4

 Filipino 3,714 60.4 33.5 4.7 1.3 86.5 95.3 78.7 28.5 74.1

 Korean 781 61.6 32.5 3.7 2.2 86.9 93.7 82.4 19.5 ~

 Japanese 4,004 71.8 23.8 3.5 0.9 90.6 95.9 84.6 29.1 63.1

 Vietnamese 642 57.3 37.1 4.5 1.1 81.7 94.2 68.7 34.7 ~

 Other Asian 1,071 64.1 30.3 4.2 1.3 87.9 94.4 83.7 29.1 ~

Pacific Islander 1,470 59.5 33.1 6.1 1.3 81.9 93.7 76.9 8.4 ~

 Hawaiian 1,209 61.6 32.2 5.4 0.8 83.4 93.7 78.1 9.9 ~

 Other Pacific Islander 261 49.4 37.5 9.6 3.4 74.6 93.8 71.9 4.6 ~

~ Less than 25 cases.

AI/AN: American Indian/Alaska Native; Loc: Localized; Reg: Regional; Dis: Distant; Uns: Unstaged.

References

1. American Cancer Society. Cancer Facts and Figures 2006. 

Atlanta: American Cancer Society, 2006.

2. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer 

EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, 

Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.

cancer.gov/csr/1975_2003/, based on November 2005 SEER data 

submission, posted to the SEER web site, 2006.

3. Ederer F, Axtell LM, Cutler SJ. The relative survival rate: A 

statistical methodology. Natl.Cancer.Inst.Monogr., 6: 101-121.

4. Clegg LX, Li FP, Hankey BF, Chu K, Edwards BK. Cancer 

Survival Among US Whites and Minorities: A SEER 

(Surveillance, Epidemiology, and End Results) Program 

Population-Based Study.PG -. Arch.Intern.Med., 162: 1985-1993.

5. Eley JW, Hill HA, Chen VW et al. Racial differences in survival 

from breast cancer. Results of the National Cancer Institute 

Black/White Cancer Survival Study. JAMA, 272: 947-954.

6. Yood MU, Johnson CC, Blount A et al. Race and differences 

in breast cancer survival in a managed care population. J Natl 

Cancer Inst, 91: 1487-1491.

7. Ragland KE, Selvin S, Merrill DW. Black-white differences in 

stage-specific cancer survival: analysis of seven selected sites. 

Am.J.Epidemiol., 133: 672-682.

8. Optenberg SA, Thompson IM, Friedrichs P, Wojcik B, Stein CR, 

Kramer B. Race, treatment, and long-term survival from prostate 

cancer in an equal-access medical care delivery system. JAMA, 

274: 1599-1605.

9. Hankey BF, Ries LAG, Edwards BK. The SEER Program: A 

national resource. Cancer Epidemiology, 12: 1117-1121.

10. Rosenberg, H. M., Maurer, J. D., Sorlie, P. D., Johnson, N. J., 

MacDorman, M. F., Hoyert, D. L., Spitler, J. F., and Scott, C. 

Quality of Death Rates by Race and Hispanic Origin: a Summary 

of Current Research, 1999. 128. 9-1-1999. Hyattsville, MD, 

DHHS/CDC. Data Evaluation and Methods.

11. Percy C, Stanek E, Gloeckler L. Accuracy of cancer death 

certificates and its effect on cancer mortality statistics. Am J 

Public Health, 71: 242-250.
Chapter 31 Race and Ethnicity

National Cancer Institute 275 SEER Survival Monograph 

Table 31.8: Cancer of the Prostate: 5-Year Cause-Specific Survival Rates (%) by Race/Ethnicity and Historic Stage, 

Ages 20+, 12 SEER Areas, 1991-2001.

Race/Ethnicity

 

Cases

Stage Distribution 5-Year Cause-Specific Survival Rate (%)

Loc/Reg Dist Uns

All 

stages Loc/Reg Dis Uns

Percent Percent Percent Rate (%) Rate (%) Rate (%) Rate (%)

All Races 237,138 87.6 5.4 7.0 88.1 91.9 34.1 83.0

White 194,529 88.3 4.9 6.8 88.6 92.1 33.5 83.7

 White non-Hispanic 179,510 88.4 4.8 6.8 88.7 92.0 33.3 84.1

 White Hispanic 15,019 87.0 6.5 6.5 87.8 92.5 34.8 78.1

Black 29,487 83.5 7.7 8.8 84.5 90.1 31.5 78.9

AI/AN 496 87.5 9.3 3.2 82.9 89.0 20.6 ~

Asian 11,768 86.9 7.5 5.6 89.3 93.2 49.2 83.6

 Asian Indian/Pakistani 485 88.0 6.6 5.4 90.3 93.5 43.2 100.0

 Chinese 2,848 87.3 7.8 5.0 90.6 94.2 47.0 91.9

 Filipino 3,490 84.6 9.1 6.3 87.4 92.5 48.7 77.8

 Korean 371 87.6 6.2 6.2 86.0 91.3 ~ ~

 Japanese 3,741 88.1 6.3 5.6 90.3 93.1 54.6 87.4

 Vietnamese 318 88.7 8.2 3.1 82.2 86.8 35.7 ~

 Other Asian 515 89.9 5.0 5.0 92.1 96.7 47.2 67.6

Pacific Islander 858 85.7 11.3 3.0 81.0 88.5 30.8 69.7

 Hawaiian 639 87.5 10.2 2.3 83.1 88.7 36.1 ~

 Other Pacific Islander 219 80.4 14.6 5.0 74.4 87.7 21.1 ~

~ Less than 25 cases.

AI/AN: American Indian/Alaska Native; Loc: Localized; Reg: Regional; Dis: Distant; Uns: Unstaged.

Table 31.9: Cancer of the Colon/rectum - Males & Females: 5-Year Cause-Specific Survival Rates (%) by Race/Ethnicity and 

Historic Stage, Ages 20+, 12 SEER Areas, 1991-2001.

Race/Ethnicity Cases

Stage Distribution 5-Year Cause-Specific Survival Rate (%)

Loc Reg Dist Uns All Loc Reg Dist Uns

Percent Percent Percent Percent Rate (%) Rate (%) Rate (%) Rate (%) Rate (%)

All Races 147,323 38.7 38.5 18.8 3.9 60.0 85.4 61.6 8.4 41.8

White 120,411 39.0 38.7 18.5 3.8 60.4 85.5 62.1 8.5 41.6

 White non-Hispanic 111,058 39.3 38.6 18.3 3.8 60.6 85.5 62.2 8.3 41.7

 White Hispanic 9,353 35.9 39.7 20.6 3.8 58.5 84.8 61.1 10.9 41.4

Black 14,052 35.3 35.8 23.2 5.7 52.4 81.2 55.0 6.7 42.3

AI/AN 440 32.3 40.0 25.9 1.8 51.3 84.7 52.8 6.7 ~

Asian 11,641 39.6 40.6 16.3 3.5 64.8 88.8 64.6 10.1 42.6

 Asian Indian/Pakistani 235 39.1 40.4 15.3 5.1 73.4 98.1 74.9 10.5 ~

 Chinese 3,385 38.3 41.2 16.4 4.1 63.7 89.3 63.0 8.8 44.6

 Filipino 2,168 37.6 39.7 18.2 4.5 62.5 88.3 62.9 12.9 39.8

 Korean 838 36.5 43.9 15.4 4.2 62.9 82.7 67.7 10.1 31.2

 Japanese 3,881 42.5 39.9 15.3 2.2 65.9 88.9 64.2 8.0 40.4

 Vietnamese 515 38.6 41.6 17.3 2.5 66.9 91.7 66.0 14.8 ~

 Other Asian 619 39.9 40.5 15.3 4.2 69.5 90.3 72.1 12.8 44.0

Pacific Islander 779 37.4 37.1 22.0 3.6 56.0 87.1 56.7 7.0 30.4

 Hawaiian 650 37.5 37.1 21.5 3.8 57.1 87.5 58.7 7.1 33.8

 Other Pacific Islander 129 36.4 37.2 24.0 2.3 50.0 85.1 45.5 6.8 ~

~ Less than 25 cases.

AI/AN: American Indian/Alaska Native; Loc: Localized; Reg: Regional; Dis: Distant; Uns: Unstaged.
Chapter 31 Race and Ethnicity

National Cancer Institute 276 SEER Survival Monograph