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