308 lines
12 KiB
Plaintext
308 lines
12 KiB
Plaintext
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English French Notes Complete/Exclude
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528 FINE NEEDLE ASPIRATION......
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529 CORE NEEDLE BIOPSY..........
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530 INCISIONAL BIOPSY...........
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531 EXCISIONAL BIOPSY...........
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518OUTSIDE CONFIRMATION OF BIOPSY
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PRIMARY SITE..................:
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HISTOLOGY/BEHAVIOR CODE.......:
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520ADDNL GRADE CODING SYSTEM.....
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521VALUE OF ADDNL CODING SYSTEM..
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26DIAGNOSTIC CONFIRMATION.......
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PRETREATMENT TUMOR SIZE (mm)
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PATHOLOGIC TUMOR SIZE (mm)
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DEPTH OF TUMOR
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29PRETREATMENT TUMOR SIZE (mm)...
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522PATHOLOGIC TUMOR SIZE (mm).....
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523DEPTH OF TUMOR.................
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CONSULTATIONS:
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524 MEDICAL ONCOLOGIST...........
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525 RADIATION ONCOLOGIST.........
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TREATING SURGEON................: Not applicable, no surgery
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ASA CLASS.......................: Class unknown or not applicable
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POSTOPERATIVE DEATH.............: Not applicable, no surgery
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526 TREATING SURGEON................
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527 ASA CLASS.......................
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441 POSTOPERATIVE DEATH.............
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EXTERNAL BEAM RADIATION.........: No
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INTRAOPERATIVE RADIATION........: No
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EXTERNAL BEAM RADIATION.........: Unknown
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INTRAOPERATIVE RADIATION........: Unknown
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532 EXTERNAL BEAM RADIATION.........
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533 NUMBER OF FRACTIONS...........
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534 RADIATION ENERGY (MV).........
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567 DATE THERAPY STARTED..........
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361 DATE THERAPY ENDED............
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535 INTRAOPERATIVE RADIATION........
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537 RADIATION ENERGY (MV).........
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539 NUMBER OF DAYS GIVEN..........
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541 DATE THERAPY STARTED..........
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542 DATE THERAPY ENDED............
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51.3 RADIATION/SURGERY SEQUENCE......
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NUMBER OF FRACTIONS...........: 000
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RADIATION ENERGY (MV).........: 00
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DATE THERAPY STARTED..........: 00/00/0000
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DATE THERAPY ENDED............: 00/00/0000
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NUMBER OF FRACTIONS...........: 999
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RADIATION ENERGY (MV).........: 99
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DATE THERAPY STARTED..........: 99/99/9999
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DATE THERAPY ENDED............: 99/99/9999
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NUMBER OF DAYS GIVEN..........: 000
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NUMBER OF DAYS GIVEN..........: 999
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DATE OF CHEMOTHERAPY............:
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AGENTS ADMINISTERED, METHODS OF DELIVERY AND LOCATIONS:
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CISPLATIN.........: No DOXORUBICIN.......: No
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METHOD OF DELIVERY: Not applicable METHOD OF DELIVERY: Not applicable
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LOCATION..........: Not applicable LOCATION..........: Not applicable
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CYTOXAN...........: No ETOPOSIDE.........: No
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DTIC..............: No IFOSFAMIDE........: No
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METHOD OF DELIVERY..............: Not applicable
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LOCATION........................: Not applicable
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METHOD OF DELIVERY..............: Unknown
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547 METHOD OF DELIVERY..............
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548 METHOD OF DELIVERY..............
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549 METHOD OF DELIVERY..............
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550 METHOD OF DELIVERY..............
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551 METHOD OF DELIVERY..............
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552 METHOD OF DELIVERY..............
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559 COLONY STIMULATING FACTORS......
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560 NATIONAL TREATMENT PROTOCOL.....
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561 OTHER PROTOCOL..................
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562 REFERRED TO REHAB SERVICES......
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563 CONSULT W PHYSICAL THERAPY/REHAB
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564 TRANSFERRED TO REHAB FACILITY...
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565 NO OF HOSPITALIZATIONS W/I 6 MO.
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566 TOTAL LENGTH OF STAYS...........
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DISTANT SITE(S) OF RECURRENCE
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SUBSEQUENT TREATMENT FOR RECURRENCE OR PROGRESSION
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TABLE V - FIRST RECURRENCE AND SUBSEQUENT TREATMENT
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NO SUBSEQUENT TREATMENT
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.07 HORMONE THERAPY
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ACCESSION NUMBER..................:
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SEQUENCE NUMBER...................:
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POSTAL CODE AT DIAGNOSIS..........:
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DATE OF BIRTH.....................:
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RACE..............................:
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SPANISH ORIGIN....................:
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SEX...............................:
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PRIMARY PAYER AT DIAGNOSIS........:
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FAMILY HIST OF SOFT TISSUE SARCOMA:
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PERSONAL HISTORY OF ANY CANCER....:
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CLASS OF CASE.....................:
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ANGIOGRAM OF PRIMARY............:
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BONE MARROW ASPIRATE/BIOPSY.....:
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BONE SCAN.......................:
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CT SCAN OF CHEST................:
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CT SCAN OF PRIMARY..............:
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LIVER FUNCTION STUDIES..........:
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MRI OF PRIMARY..................:
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MRI OF OTHER....................:
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ELECTRON MICROSCOPY.............:
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FLOW CYTOMETRY..................:
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IN SITU HYBRIDIZATION...........:
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BIOPSIES: HISTOLOGY/BEHAVIOR/GRADE
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FINE NEEDLE ASPIRATION..........:
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CORE NEEDLE ASPIRATION..........:
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INCISIONAL BIOPSY...............:
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EXCISIONAL BIOPSY...............:
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OUTSIDE CONFIRMATION OF BIOPSY....:
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DATE OF INITIAL DIAGNOSIS.........:
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PRIMARY SITE......................:
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SUBSITE...........................:
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HISTOLOGY/BEHAVIOR CODE...........:
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GRADE.............................:
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ADDNL GRADE CODING SYSTEM.........:
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VALUE OF ADDNL CODING SYSTEM......:
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DIAGNOSTIC CONFIRMATION...........:
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PRETREATMENT TUMOR SIZE (mm)......:
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PATHOLOGIC TUMOR SIZE (mm)........:
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DEPTH OF TUMOR....................:
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MULTIFOCAL........................:
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REGIONAL NODES EXAMINED...........:
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REGIONAL NODES POSITIVE...........:
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SITE OF DISTANT METASTASIS #1...:
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SITE OF DISTANT METASTASIS #2...:
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SITE OF DISTANT METASTASIS #3...:
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AJCC STAGE......................:
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CLINICAL STAGED BY..............:
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PATHOLOGIC STAGED BY............:
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MEDICAL ONCOLOGIST..............:
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RADIATION ONCOLOGIST............:
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Print Soft Tissue Sarcoma PCE
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PCE Study of Soft Tissue Sarcoma
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FIRST COURSE TREATMENT DATE.......:
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RESIDUAL PRIMARY TUMOR..........:
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TREATING SURGEON................:
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ASA CLASS.......................:
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POSTOPERATIVE DEATH.............:
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EXTERNAL BEAM RADIATION...:
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BRACHYTHERAPY...........:
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NUMBER OF FRACTIONS.......:
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NUMBER OF DAYS GIVEN....:
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DOSE....................:
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RADIATION ENERGY (MV).....:
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DATE THERAPY STARTED....:
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DATE THERAPY STARTED......:
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DATE THERAPY ENDED......:
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DATE THERAPY ENDED........:
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INTRAOPERATIVE RADIATION..:
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RADIATION/SURGERY SEQUENCE:
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DATE OF CHEMOTHERAPY:
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AGENT ADMINISTERED METHOD OF DELIVERY LOCATION
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COLONY STIMULATION FACTOR........:
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NATIONAL TREATMENT PROTOCOL......:
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OTHER PROTOCOL...................:
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REFERRED TO REHAB SERVICES.......:
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CONSULT W PHYSICAL THERAPY/REHAB.:
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TRANSFERRED TO REHAB FACILITY....:
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NO OF HOSPITALIZATIONS W/I 6 MO..:
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TOTAL LENGTH OF STAYS............:
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TYPE OF FIRST RECURRENCE..........:
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OTHER TYPE OF FIRST RECURRENCE....:
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DISTANT SITE(S) OF FIRST RECURRENCE:
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RECURRENCE SITE 1.................:
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RECURRENCE SITE 2.................:
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RECURRENCE SITE 3.................:
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NO SUBSEQUENT TREATMENT
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HORMONE THERAPY:
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SURGERY OF PRIMARY SITE DATE...:
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SCOPE OF LYMPH NODE SURGERY...:
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RECON/RESTORE - DELAYED.......:
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RECON/RESTORE - DELAYED DATE..:
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too long:
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Text should not exceed NAACCR length of
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Do you want to re-edit this field
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Patient Care Evaluation Study of Thyroid Cancer
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FAMILY HISTORY OF THYROID CANCER
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PERSONAL HISTORY OF NON-THYROID CANCER
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PRIOR EXPOSURE TO RADIATION
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PERSONAL HISTORY OF GOITER
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FAMILY HISTORY OF THYROID DISEASE
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PERSONAL HISTORY OF GRAVES DISEASE
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PERSONAL HISTORY OF THYROIDITIS
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FAMILY HISTORY OF GOITER OR OTHER THYROID DISEASE
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9POSTAL CODE AT DIAGNOSIS..........
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9SPANISH ORIGIN....................
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18PRIMARY PAYER AT DIAGNOSIS........
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400FAMILY HISTORY OF THYROID CANCER..
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PERSONAL HISTORY OF NON-THYROID CANCER:
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402 CHILDHOOD MALIGNANCY............
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403PRIOR EXPOSURE TO RADIATION.......
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404PERSONAL HISTORY OF GOITER........
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405FAMILY HISTORY THYROID DISEASE....
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406PERSONAL HISTORY OF GRAVES DISEASE
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407PERSONAL HISTORY OF THYROIDITIS...
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SYMPTOMS/SIGNS PRESENT
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DIAGNOSTIC/SURGICAL WORKUP
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HISTOLOGY/BEHAVIOR CODE (ICD-O-2)
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BLOOD VESSEL INVASION
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EXTRA-THYROID EXTENSION
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SYMPTOMS/SIGNS PRESENT:
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409 HOARSENESS OR VOICE CHANGE.....
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410 NECK NODAL MASS................
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413 PATHOLOGIC FRACTURE............
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414 STRIDOR OR DIFFICULTY BREATHING
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415 THYROID MASS...................
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416 WEIGHT LOSS....................
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DIAGNOSTIC/SURGICAL WORKUP:
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418 BONE SCAN......................
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420 CT SCAN OF NECK................
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422 INCISIONAL BIOPSY..............
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425 NEEDLE ASPIRATION OF NECK NODE.
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426 NEEDLE ASPIRATION OF THYROID...
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427 MRI OF NECK....................
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428 THYROID SCAN...................
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429 ULTRASOUND OF THYROID..........
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HISTOLOGY/BEHAVIOR CODE (ICD-O-2):
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431BLOOD VESSEL INVASION............
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432EXTRA-THYROIDAL EXTENSION........
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SIZE OF TUMOR
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LOCATION OF POSITIVE NODES
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29SIZE OF TUMOR..................
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434LOCATION OF POSITIVE NODES.....
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19CLINICAL STAGE..................
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89PATHOLOGIC STAGE................
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DATE OF FIRST COURSE TREATMENT.......:
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DATE OF NON CANCER-DIRECTED SURGERY:
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NON CANCER-DIRECTED SURGERY........:
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DATE OF SURGERY OF PRIMARY SITE....:
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DATE OF DISCHARGE AFTER SURGERY....: 00/00/0000
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435 DATE OF DISCHARGE AFTER SURGERY....
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SURGERY OF PRIMARY SITE............:
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RESIDUAL PRIMARY TUMOR.............: NA
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AIRWAY PROBLEM REQ TRACHEOSTOMY..: Not applicable, no surgery
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BLEEDING HEMATOMA................: Not applicable, no surgery
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HYPOCALCEMIA.....................: Not applicable, no surgery
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RECURRENT NERVE INJURY...........: Not applicable, no surgery
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WOUND INFECTION..................: Not applicable, no surgery
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POSTOPERATIVE DEATH WITH 30 DAYS.: Not applicable, no surgery
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59 RESIDUAL PRIMARY TUMOR.............
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436 AIRWAY PROBLEM REQ TRACHEOSTOMY..
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437 BLEEDING HEMATOMA................
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439 RECURRENT NERVE INJURY...........
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440 WOUND INFECTION..................
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441 POSTOPERATIVE DEATH WITHIN 30 DAYS.
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RADIATION:
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DATE RADIATION STARTED.............:
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REGIONAL RAD (cGy) DOSE............: 00000
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BOOST DOSAGE.......................: 00000
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TOTAL MILLICURIES (mCi) OF RADIOIODINE:
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INITAL DOSE........................: 00000
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SECOND DOSE........................: 00000
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REGIONAL RAD (cGy) DOSE............: 99999
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BOOST DOSAGE.......................: 99999
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INITAL DOSE........................: 99999
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SECOND DOSE........................: 99999
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442 REGIONAL RAD (cGy) DOSE............
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443 BOOST DOSAGE.......................
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444 INITIAL DOSE.......................
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445 SECOND DOSE........................
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ADJUVANT CHEMO W BEAM RADIATION....: No concomitant treatment
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ADJUVANT CHEMO W BEAM RADIATION....: Unknown if therapy concomitant
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446 ADJUVANT CHEMO W BEAM RADIATION....
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THYROID HORMONE THERAPY............:
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FAMILY HISTORY OF THYROID CANCER..:
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CHILDHOOD MALIGNANCY............:
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PRIOR EXPOSURE TO RADIATION.......:
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PERSONAL HISTORY OF GOITER........:
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FAMILY HISTORY OF THYROID DISEASE.:
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PERSONAL HISTORY OF GRAVES DISEASE:
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PERSONAL HISTORY OF THYROIDITIS...:
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TABLE II - INITIAL DIAGNOSIS/CANCER IDENTIFICATION
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HOARSENESS OR VOICE CHANGE......:
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NECK NODAL MASS.................:
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PATHOLOGIC FRACTURE.............:
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STRIDOR/DIFFICULTY BREATHING....:
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THYROID MASS....................:
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WEIGHT LOSS.....................:
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DIAGNOISTIC/SURGICAL WORKUP:
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CT SCAN OF NECK.................:
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NEEDLE ASPIRATION OF NECK NODE..:
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NEEDLE ASPIRATION OF THYROID....:
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MRI OF NECK.....................:
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THYROID SCAN....................:
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ULTRASOUND OF THYROID...........:
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PRIMARY SITE (ICD-O-2)............:
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HISTOLOGY/BEHAVIOR CODE (ICD-O-2).:
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BLOOD VESSEL INVASION.............:
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EXTRA-THYROIDAL EXTENSION.........:
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SIZE OF TUMOR (mm)................:
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LOCATION OF POSITIVE NODES........:
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CLINICAL STAGE................:
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PATHOLOGIC STAGE..............:
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Print Thyroid PCE
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PCE Study of Thyroid Cancer
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DISCHARGE AFTER SURGERY DATE....:
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AIRWAY PROBLEM W TRACHEOSTOMY.:
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BLEEDING HEMOTOMA.............:
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RECURRENT NERVE INJURY........:
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WOUND INFECTION...............:
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POSTOPERATIVE DEATH W/I 30 DAYS.:
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REGIONAL RAD (cGy) DOSE.........:
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BOOST DOSAGE....................:
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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