308 lines
12 KiB
Plaintext
308 lines
12 KiB
Plaintext
|
English French Notes Complete/Exclude
|
||
|
|
59. WAS ENTIRE SPECIMEN SUBMITTED
|
||
|
|
TO PATHOLOGY..................: NA
|
||
|
|
60. IF MARGINS ARE FREE, WHAT IS
|
||
|
|
THE DISTANCE..................: NA
|
||
|
|
TO PATHOLOGY..................: Unknown
|
||
|
|
THE DISTANCE..................: Unknown
|
||
|
|
948 59. WAS ENTIRE SPECIMEN SUBMITTED TO PATHOLOGY..................
|
||
|
|
949 60. IF MARGINS ARE FREE, WHAT IS THE DISTANCE..................
|
||
|
|
61. SCOPE OF REGIONAL LYMPH NODE
|
||
|
|
62. NUMBER OF REGIONAL LYMPH NODES
|
||
|
|
63. SURGERY OF OTHER REGIONAL
|
||
|
|
SITE(S), DISTANT SITE(S),
|
||
|
|
OR DISTANT LYMPH NODE(S)......:
|
||
|
|
66. MICROSCOPIC STATUS OF FINAL
|
||
|
|
MARGIN AFTER RESECTION........: NA
|
||
|
|
MARGIN AFTER RESECTION........: Unknown
|
||
|
|
MARGIN AFTER RE-EXCISION......: NA
|
||
|
|
MARGIN AFTER RE-EXCISION......: Unknown
|
||
|
|
951 66. MICROSCOPIC STATUS OF FINAL MARGIN AFTER RE-EXCISION......
|
||
|
|
GO TO ITEM:
|
||
|
|
RADIATION THERAPY
|
||
|
|
67. RADIATION THERAPY.............:
|
||
|
|
68. PRE-RADIATION THERAPY
|
||
|
|
MAMMOGRAM OF PATIENT..........: Not done
|
||
|
|
MAMMOGRAM OF PATIENT..........: Unknown if done
|
||
|
|
952 68. PRE-RADIATION THERAPY MAMMOGRAM OF PATIENT..........
|
||
|
|
69. DATE RADIATION STARTED........:
|
||
|
|
70. DATE RADIATION ENDED..........:
|
||
|
|
71. SITES IRRADIATED..............:
|
||
|
|
72. (F) cGy DOSE TO WHOLE BREAST
|
||
|
|
OR CHEST WALL.................:
|
||
|
|
73. (F) BOOST RADIATION...........:
|
||
|
|
361 70. DATE RADIATION ENDED..........
|
||
|
|
953 71. SITES IRRADIATED..............
|
||
|
|
OR CHEST WALL.................: (Data Item for Females Only)
|
||
|
|
73. (F) BOOST RADIATION...........: (Data Item for Females Only)
|
||
|
|
954 72. (F) cGy DOSE TO WHOLE BREAST OR CHEST WALL.................
|
||
|
|
443 73. (F) BOOST RADIATION...........
|
||
|
|
74. REASON FOR NO RADIATION ......:
|
||
|
|
HORMONE THERAPY
|
||
|
|
75. HORMONE THERAPY...............:
|
||
|
|
76. DATE HORMONE THERAPY STARTED..:
|
||
|
|
77. (M) SPECIFIC HORMONE THERAPY..: (Data Item for Males Only)
|
||
|
|
77. (M) SPECIFIC HORMONE THERAPY...: None
|
||
|
|
77. (M) SPECIFIC HORMONE THERAPY...: Unknown
|
||
|
|
955 77. (M) SPECIFIC HORMONE THERAPY..
|
||
|
|
79. DATE CHEMOTHERAPY STARTED.....:
|
||
|
|
80. CHEMOTHERAPEUTIC REGIME
|
||
|
|
CONTAINING DOXORUBICIN.......: NA, no chemotherapy
|
||
|
|
CONTAINING DOXORUBICIN.......: Unknown
|
||
|
|
956 80. CHEMOTHERAPEUTIC REGIME CONTAINING DOXORUBICIN........
|
||
|
|
81. DATE OF FIRST RECURRENCE
|
||
|
|
82. TYPE OF FIRST RECURRENCE
|
||
|
|
81. TYPE OF FIRST RECURRENCE
|
||
|
|
82. DATE OF FIRST RECURRENCE
|
||
|
|
TABLE VI - FIRST RECURRENCE
|
||
|
|
70 81. DATE OF FIRST RECURRENCE
|
||
|
|
71 82. TYPE OF FIRST RECURRENCE
|
||
|
|
83. DATE OF LAST CONTACT OR DEATH
|
||
|
|
84. VITAL STATUS
|
||
|
|
85. CANCER STATUS
|
||
|
|
86. COMPLETED BY
|
||
|
|
87. REVIEWED BY CANCER COMMITTEE
|
||
|
|
TABLE VII - STATUS AT LAST CONTACT
|
||
|
|
83. DATE OF LAST CONTACT OR DEATH..:
|
||
|
|
15 84. VITAL STATUS...................
|
||
|
|
85. CANCER STATUS..................:
|
||
|
|
81 86. COMPLETED BY...................
|
||
|
|
82 87. REVIEWED BY CANCER COMMITTEE...
|
||
|
|
1. INSTITUTION ID NUMBER............: H6
|
||
|
|
2. ACCESSION NUMBER.................:
|
||
|
|
3. SEQUENCE NUMBER..................:
|
||
|
|
4. POSTAL CODE AT DIAGNOSIS.........:
|
||
|
|
5. DATE OF BIRTH....................:
|
||
|
|
7. SPANISH ORIGIN...................:
|
||
|
|
9. PRIMARY PAYER AT DIAGNOSIS.......:
|
||
|
|
10. FAMILY HISTORY OF BREAST CANCER:
|
||
|
|
MATERNAL AUNT...................:
|
||
|
|
MATERNAL GRANDMOTHER............:
|
||
|
|
ONE SISTER ONLY.................:
|
||
|
|
MORE THAN ONE SISTER............:
|
||
|
|
POSTIVE FAMILY HISTORY, NOS.....:
|
||
|
|
11. (F) PERSONAL HISTORY OF BREAST
|
||
|
|
12. SYNCHRONOUS BREAST CANCER........:
|
||
|
|
13. PERSONAL HISTORY OF OTHER CANCER:
|
||
|
|
14. (F) HORMONE REPLACEMENT THERAPY..:
|
||
|
|
15. (F) HOW MANY YEARS OF HORMONE
|
||
|
|
REPLACEMENT THERAPY..............:
|
||
|
|
TABLE II - INITIAL DIAGNOSIS
|
||
|
|
16. CLASS OF CASE....................:
|
||
|
|
17. DIAGNOSTIC EVALUATION:
|
||
|
|
18. (F) TYPE OF MAMMOGRAM:
|
||
|
|
A. MAMMOGRAM GIVEN, TYPE UNKNOWN:
|
||
|
|
B. SCREENING MAMMOGRAM..........:
|
||
|
|
C. DIAGNOSTIC MAMMOGRAM.........:
|
||
|
|
D. MAGNIFICAITON MAMMOGRAM......:
|
||
|
|
19. (F) PRESENTATION OF MOST
|
||
|
|
DEFINITIVE MAMMOGRAM.............:
|
||
|
|
20. DATE OF INITIAL DIAGNOSIS........:
|
||
|
|
21. DATE OF PATHOLOGIC DIAGNOSIS.....:
|
||
|
|
22. PRIMARY SITE (ICD-O-2)...........:
|
||
|
|
24. BEHAVIOR CODE (ICD-O-2)..........:
|
||
|
|
25. IF INVASIVE DUCTUAL CARCINOMA
|
||
|
|
REPORTED, IS DCIS ALSO PRESENT...:
|
||
|
|
27. ARCHITECTURE PATTERN IF DCIS
|
||
|
|
IS PRESENT.......................:
|
||
|
|
28. NUCLEAR GRADE IF DCIS IS
|
||
|
|
29. DIAGNOSTIC CONFIRMATION..........:
|
||
|
|
30. (M) LEVEL OF INVOLVEMENT:
|
||
|
|
CHEST WALL......................:
|
||
|
|
PECTORAL MUSCLES................:
|
||
|
|
DIAGNOSTIC AND STAGING PROCEDURES
|
||
|
|
31. BIOPSY PROCEDURE.................:
|
||
|
|
33. PALPABILITY OF PRIMARY...........:
|
||
|
|
34. FIRST DETECTED BY................:
|
||
|
|
TABLE III - TUMOR MARKERS AND PROGNOSTIC TESTS
|
||
|
|
35. (M) DNA INDEX/PLOIDY.............:
|
||
|
|
36. ESTROGEN RECEPTOR PROTEIN........:
|
||
|
|
37. PROGESTERONE RECEPTOR PROTEIN....:
|
||
|
|
38. (M) ANDROGEN RECEPTOR PROTEIN....:
|
||
|
|
39. TYPE OF TEST.....................:
|
||
|
|
Print Breast Cancer PCE
|
||
|
|
(Data Item for Females Only)
|
||
|
|
(Data Item for Males Only)
|
||
|
|
TABLE IV - EXTENT OF DISEASE AND AJCC STAGE
|
||
|
|
40. SIZE OF TUMOR (mm)...............:
|
||
|
|
41. SIZE OF DCIS TUMOR (mm)..........:
|
||
|
|
42. REGIONAL NODES EXAMINED..........:
|
||
|
|
43. REGIONAL NODES POSITIVE..........:
|
||
|
|
SENTINEL NODES
|
||
|
|
44. SENTINEL NODES BIOPSY............:
|
||
|
|
45. NUMBER OF SENTINEL NODES
|
||
|
|
46. NUMBER OF SENTINEL NODES
|
||
|
|
47. SENTINEL NODE DETECTED BY........:
|
||
|
|
48. AJCC CLINICAL STAGE (cTNM):
|
||
|
|
AJCC STAGE......................:
|
||
|
|
49. AJCC PATHOLOGIC STAGE (pTNM):
|
||
|
|
50. STAGED BY:
|
||
|
|
CLINICAL STAGE..................:
|
||
|
|
PATHOLOGIC STAGE................:
|
||
|
|
TABLE V - FIRST COURSE OF TREATMENT
|
||
|
|
51. DATE OF FIRST COURSE TREATMENT...:
|
||
|
|
52. DATE OF NON CANCER-DIRECTED
|
||
|
|
53. NON CANCER-DIRECTED SURGERY......:
|
||
|
|
54. DATE OF (FIRST) CANCER-
|
||
|
|
DIRECTED SURGERY.................:
|
||
|
|
55. SURGICAL APPROACH................:
|
||
|
|
56. SURGERY OF PRIMARY SITE..........:
|
||
|
|
57. SPECIMEN RADIOGRAPH..............:
|
||
|
|
58. SURGICAL MARGINS.................:
|
||
|
|
59. WAS ENTIRE SPECIMEN SUBMITTED
|
||
|
|
TO PATHOLOGY.....................:
|
||
|
|
60. IF MARGINS ARE FREE, WHAT IS
|
||
|
|
THE DISTANCE.....................:
|
||
|
|
61. SCOPE OF REGIONAL LYMPH NODE
|
||
|
|
62. NUMBER OF REGIONAL LYMPH NODES
|
||
|
|
63. SURGERY OF OTHER REGIONAL
|
||
|
|
SITE(S), DISTANT SITE(S),
|
||
|
|
OR DISTANT LYMPH NODE(S).........:
|
||
|
|
66. MICROSCOPIC STATUS OF FINAL
|
||
|
|
MARGIN AFTER RE-EXCISION.........:
|
||
|
|
67. RADIATION THERAPY................:
|
||
|
|
68. PRE-RADIATION THERAPY
|
||
|
|
MAMMOGRAM OF PATIENT.............:
|
||
|
|
69. DATE RADIATION STARTED...........:
|
||
|
|
70. DATE RADIATION ENDED.............:
|
||
|
|
71. SITES IRRADIATED.................:
|
||
|
|
72. (F) cCy DOSE TO WHOLE BREAST
|
||
|
|
OR CHEST WALL....................:
|
||
|
|
73. BOOST RADIATION..................:
|
||
|
|
74. REASON FOR NOT RADIATION.........:
|
||
|
|
HORMONE THERAPY
|
||
|
|
75. HORMONE THERAPY..................:
|
||
|
|
76. DATE HORMONE THERAPY STARTED.....:
|
||
|
|
77. (M) SPECIFIC HORMONE THERAPY.....:
|
||
|
|
79. DATE CHEMOTHERAPY STARTED........:
|
||
|
|
80. CHEMOTHERAPEUTIC REGIME
|
||
|
|
CONTAINING DOXORUBICIN...........:
|
||
|
|
TABLE VI - FIRST RECURRENCE
|
||
|
|
81. DATE OF FIRST RECURRENCE.........:
|
||
|
|
82. TYPE OF FIRST RECURRENCE.........:
|
||
|
|
TABLE VII - STATUS AT LAST CONTACT
|
||
|
|
83. DATE OF LAST CONTACT OR DEATH....:
|
||
|
|
84. VITAL STATUS.....................:
|
||
|
|
85. CANCER STATUS....................:
|
||
|
|
86. COMPLETED BY.....................:
|
||
|
|
87. REVIEWED BY CANCER COMMITTEE.....:
|
||
|
|
The Accession Year is not 1997.
|
||
|
|
The Diagnostic Confirmation code is not 1, 2 or 4.
|
||
|
|
There is no HISTOLOGY for this primary.
|
||
|
|
The BEHAVIOR code is not 2 (in situ) or 3 (malignant).
|
||
|
|
The Histology of
|
||
|
|
is not eligible.
|
||
|
|
9:Print Colorectal Cancer PCE
|
||
|
|
Patient Care Evaluation Study of Colorectal Cancer
|
||
|
|
ACCESSION NUMBER
|
||
|
|
SEQUENCE NUMBER
|
||
|
|
POSTAL CODE AT DIAGNOSIS
|
||
|
|
FAMILY HISTORY OF COLORECTAL CANCER
|
||
|
|
PERSONAL HISTORY OF COLORECTAL CANCER
|
||
|
|
MULTIPLE COLON/RECTUM PRIMARIES 1997
|
||
|
|
PERSONAL HISTORY OF NON-COLORECTAL CANCER
|
||
|
|
PREVIOUS TAH/BSO
|
||
|
|
OTHER PRIOR CONDITIONS
|
||
|
|
ACCESSION NUMBER.....................:
|
||
|
|
SEQUENCE NUMBER......................:
|
||
|
|
9POSTAL CODE AT DIAGNOSIS.............
|
||
|
|
DATE OF BIRTH........................:
|
||
|
|
9SPANISH ORIGIN.......................
|
||
|
|
18PRIMARY PAYER AT DIAGNOSIS...........
|
||
|
|
700FAMILY HISTORY OF COLORECTAL CANCER..
|
||
|
|
701PERSONAL HISTORY OF COLORECTAL CANCER
|
||
|
|
702MULTIPLE COLON/RECTUM PRIMARIES 1997.
|
||
|
|
PERSONAL HISTORY OF NON-COLORECTAL CANCER:
|
||
|
|
706 OVARIAN CARCINOMA, PERITONEAL SITE.
|
||
|
|
710PREVIOUS TAH/BSO.....................
|
||
|
|
OTHER PRIOR CONDITIONS:
|
||
|
|
714 PRIOR POLYPS.......................
|
||
|
|
DURATION OF SIGNS/SYMPTOMS PRESENT AT INITIAL DIAGNOSIS (months)
|
||
|
|
INITIAL METHODS OF DIAGNOSIS
|
||
|
|
REASON LEADING TO EVENTUAL DX
|
||
|
|
DIAGNOSTIC EVALUATION
|
||
|
|
LEVEL OF TUMOR BY ENDOSCOPIC EXAM
|
||
|
|
LEVEL OF RECTAL TUMOR
|
||
|
|
PRIMARY SITE
|
||
|
|
HISTOLOGY/BEHAVIOR CODE
|
||
|
|
DIAGNOSTIC CONFIRMATION
|
||
|
|
TABLE II- INITIAL DIAGNOSIS
|
||
|
|
CLASS OF CLASS...................:
|
||
|
|
717 BOWEL OBSTRUCTION..............
|
||
|
|
718 CHANGE IN BOWEL HABIT..........
|
||
|
|
719 EMER PRESENTATION-OBSTRUCTION..
|
||
|
|
722 OCCULT BLOOD ONLY IN STOOL.....
|
||
|
|
725 RECTAL BLEEDING (MELENA).......
|
||
|
|
INITIAL METHODS OF DIAGNOSIS:
|
||
|
|
729 SCREENING DIGITAL RECTAL EXAM..
|
||
|
|
730 SCREENING PHYSICAL EXAM........
|
||
|
|
732REASON LEADING TO EVENTUAL DX....
|
||
|
|
DIAGNOSTIC EVALUATION:
|
||
|
|
733 BARIUM ENEMA, DOUBLE CONTRAST..
|
||
|
|
734 BARIUM ENEMA, SINGLE CONTRAST..
|
||
|
|
735 BARIUM ENEMA, NOS..............
|
||
|
|
736 BIOPSY OF PRIMARY SITE.........
|
||
|
|
737 BIOPSY OF METASTATIC SITE......
|
||
|
|
421 CT SCAN OF CHEST...............
|
||
|
|
738 CT SCAN OF LIVER...............
|
||
|
|
739 CT SCAN OF PRIMARY SITE........
|
||
|
|
741 CHEST ROENTGENOGRAM............
|
||
|
|
743 DIGITAL RECTAL EXAM............
|
||
|
|
744 FLEXIBLE SIGMOIDOSCOPY.........
|
||
|
|
745 INTRAVENOUS PYELOGRAM (IVP)....
|
||
|
|
746 SERUM-LIVER FUNCTION TEST......
|
||
|
|
749 STOOL GUAIAC (OCCULT BLOOD)....
|
||
|
|
752LEVEL OF TUMOR BY ENDOSCOPIC EXAM
|
||
|
|
753LEVEL OF RECTAL TUMOR............
|
||
|
|
PRIMARY SITE.....................:
|
||
|
|
HISTOLOGY/BEHAVIOR CODE..........:
|
||
|
|
26DIAGNOSTIC CONFIRMATION..........
|
||
|
|
SIZE OF TUMOR (mm)
|
||
|
|
CLINICAL STAGED BY
|
||
|
|
PATHOLOGIC STAGED BY
|
||
|
|
MARGIN OF RESECTION
|
||
|
|
DISTANCE TO CLOSEST MUCOSAL MARGIN
|
||
|
|
DISTANCE TO CLOSEST RADIAL MARGIN
|
||
|
|
BLOOD VESSEL OR LYMPHATIC INVASION
|
||
|
|
EXTRAMURAL VENOUS INVASION
|
||
|
|
PROMINENT LYMPHOID INFILTRATE
|
||
|
|
29SIZE OF TUMOR (mm).............
|
||
|
|
38 AJCC STAGE...................
|
||
|
|
19 CLINICAL STAGED BY...........
|
||
|
|
88 AJCC STAGE...................
|
||
|
|
89 PATHOLOGIC STAGED BY.........
|
||
|
|
MARGIN OF RESECTION:
|
||
|
|
754 PROXIMAL MARGIN..............
|
||
|
|
755 DISTAL MARGIN................
|
||
|
|
756 RADIAL MARGIN................
|
||
|
|
757DISTANCE TO MUCOSAL MARGIN.....
|
||
|
|
758DISTANCE TO RADIAL MARGIN......
|
||
|
|
759BLOOD VESSEL/LYMPHATIC INVASION
|
||
|
|
760EXTRAMURAL VENOUS INVASION.....
|
||
|
|
761PROMINENT LYMPHOID INFILTRATE..
|
||
|
|
PHYSICIAN PROVIDING TREATMENT
|
||
|
|
DATE OF FIRST COURSE TREATMENT
|
||
|
|
DATE OF INPATIENT ADMISSION
|
||
|
|
DATE OF INPATIENT DISCHARGE
|
||
|
|
762PHYSICIAN PROVIDING TREATMENT.....
|
||
|
|
DATE OF FIRST COURSE TREATMENT....:
|
||
|
|
1DATE OF INPATIENT ADMISSION.......
|
||
|
|
1.1DATE OF INPATIENT DISCHARGE.......
|
||
|
|
NON CANCER-DIRECTED SURGERY DATE:
|
||
|
|
NON CANCER-DIRECTED SURGERY.....:
|
||
|
|
SURGERY OF PRIMARY SITE DATE....:
|
||
|
|
SURGERY OF PRIMARY SITE.........:
|
||
|
|
ADDITIONAL SURGICAL PROCEDURES..: NA, none performed
|
||
|
|
LAPAROSCOPY USED DURING SURGERY.: NA
|
||
|
|
METHOD OF ANASTOMOSIS...........: Not done
|
||
|
|
DIST OF ANASTOMOSIS FROM DENTATE: 0
|
||
|
|
RESIDUAL PRIMARY TUMOR..........: NA
|
||
|
|
OTHER SURGERY:
|
||
|
|
PATHOLOGICAL STATUS...........: NA
|
||
|
|
COMPLICATIONS AFTER FIRST COURSE OF TREATMENT:
|
||
|
|
#################### #################### ####################
|
||
|
|
#################### #################### ####################
|
||
|
|
#################### #################### ####################
|
||
|
|
#################### #################### ####################
|
||
|
|
#################### #################### ####################
|