308 lines
12 KiB
Plaintext
308 lines
12 KiB
Plaintext
English French Notes Complete/Exclude
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ABDOMINAL INFECTION..............: NA, no treatment
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ABSCESS..........................: NA, no treatment
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ADMISSION FOR NEUTROPENIA........: NA, no treatment
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ANASTOMOTIC DEHISCENCE...........: NA, no treatment
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BLEEDING/HEMATOMA................: NA, no treatment
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DEHYDRATION......................: NA, no treatment
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DIARRHEA.........................: NA, no treatment
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EARLY BOWEL OBSTRUCTION..........: NA, no treatment
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PERINEAL INFECTION...............: NA, no treatment
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PNEUMONIA........................: NA, no treatment
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PROCTITIS........................: NA, no treatment
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PULMONARY EMBOLISM...............: NA, no treatment
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RADIATION ENTERITIS..............: NA, no treatment
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STOMA COMPLICATION...............: NA, no treatment
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URINARY TRACT INFECTION..........: NA, no treatment
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POSTOPERATIVE DEATH W/I 30 DAYS: NA, no surgery
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763 ADDITIONAL SURGICAL PROCEDURES..
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764 LAPAROSCOPY USED DURING SURGERY.
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765 METHOD OF ANASTOMOSIS...........
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766 DIST OF ANASTOMOSIS FROM DENTATE
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59 RESIDUAL PRIMARY TUMOR..........
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769 PATHOLOGICAL STATUS...........
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770 ABDOMINAL INFECTION...........
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772 ADMISSION FOR NEUTROPENIA.....
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773 ANASTOMOTIC DEHISCENCE........
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776 EARLY BOWEL OBSTRUCTION.......
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777 PERINEAL INFECTION............
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780 PULMONARY EMBOLISM............
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781 RADIATION ENTERITIS...........
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782 STOMA COMPLICATION............
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783 URINARY TRACT INFECTION.......
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441 POSTOPERATIVE DEATH W/I 30 DAYS.
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DATE RADIATION STARTED..........:
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DATE RADIATION THERAPY ENDED....: 00/00/0000
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ENDOCAVITARY RADIATION..........: None
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INTRA-OPERATIVE RAD THERAPY.....: No
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PRIMARY TUMOR RAD DOSE W BOOST..: No radiation therapy
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NUMBER OF RADIATION TREATMENTS..: None
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DATE RADIATION THERAPY ENDED....: 99/99/9999
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ENDOCAVITARY RADIATION..........: Unknown
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INTRA-OPERATIVE RAD THERAPY.....: Unknown
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PRIMARY TUMOR RAD DOSE W BOOST..: Unknown if received radiation therapy
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NUMBER OF RADIATION TREATMENTS..: Unknown if radiation given
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361 DATE RADIATION THERAPY ENDED....
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784 ENDOCAVITARY RADIATION..........
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785 INTRA-OPERATIVE RAD THERAPY.....
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786 PRIMARY TUMOR RAD DOSE W BOOST..
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787 NUMBER OF RADIATION TREATMENTS..
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DATE CHEMOTHERAPY STARTED.......:
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ADJUVANT CHEMO W BEAM RADIATION.: No concomitant treatment
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ADJUVANT THERAPY:
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DURATION OF ADJUVANT THERAPY....: No adjuvant therapy
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COMPLETED DURATION OF THERAPY...: No (0-1 cycle)
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ADJUVANT CHEMO W BEAM RADIATION.: Unknown if therapy concomitant
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DURATION OF ADJUVANT THERAPY....: Unknown if therapy given
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COMPLETED DURATION OF THERAPY...: Unknown if therapy given
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788 ADJUVANT CHEMO W BEAM RADIATION.
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794 DURATION OF ADJUVANT THERAPY....
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795 COMPLETED DURATION OF THERAPY...
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WERE OTHER REFERRALS MADE
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TABLE V - QUALITY OF LIFE
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WERE OTHER REFERRALS MADE:
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796 NUTRITIONAL CONSULTATION
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797 OCCUPATIONAL THERAPY....
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563 PHYSICAL THERAPY........
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798 OSTOMY CONSULTATION.....
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70DATE OF FIRST RECURRENCE......
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71TYPE OF FIRST RECURRENCE......
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DATE OF LAST CONTACT OR DEATH:
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15VITAL STATUS.................
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CANCER STATUS................:
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81COMPLETED BY.................
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82REVIEWED BY CANCER COMMITTEE.
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10. FAMILY HISTORY OF COLORECTAL CA..:
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11. PERSONAL HISTORY OF COLORECTAL CA:
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12. MULTI 1997 COLON/RECTUM PRIMARIES:
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13. PERSONAL HISTORY OF NON-COLORECTAL CANCER:
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PROSTATE.........:
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STOMACH..........:
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THYROID..........:
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UTERUS...........:
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OVARIAN CARCINOMA:
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OTHER............:
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14. PREVIOUS TAH/BSO.................:
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15. OTHER PRIOR CONDITIONS:
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PRIOR POLYPS.....:
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POLYPS...........:
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17. DURATION OF SIGNS/SYMPTOMS PRESENT AT INITIAL DIAGNOSIS (months):
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BOWEL OBSTRUCTION..............:
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CHANGE IN BOWEL HABIT..........:
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EMER PRESENTATION-OBSTRUCTION..:
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OCCULT BLOOD ONLY IN STOOL.....:
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RECTAL BLEEDING (MELENA).......:
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18. INITIAL METHODS OF DIAGNOSIS:
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SCREENING DIGITAL RECTAL EXAM..:
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SCREENING PHYSICAL EXAM........:
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19. REASON LEADING TO EVENTUAL DX....:
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20. DIAGNOSTIC EVALUATION:
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BARIUM ENEMA, DOUBLE CONTRAST..:
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BARIUM ENEMA, SINGLE CONTRAST..:
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BARIUM ENEMA, NOS..............:
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BIOPSY OF PRIMARY SITE.........:
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BIOPSY OF METASTATIC SITE......:
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CT SCAN OF CHEST...............:
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CT SCAN OF LIVER...............:
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CT SCAN OF PRIMARY SITE........:
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CHEST ROENTGENOGRAM............:
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DIGITAL RECTAL EXAM............:
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FLEXIBLE SIGMOIDOSCOPY.........:
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INTRAVENOUS PYELOGRAM..........:
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SERUM-LIVER FUNCTION TEST......:
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STOOL GUAIAC (OCCULT BLOOD)....:
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21. LEVEL OF TUMOR BY ENDOSCOPIC EXAM:
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22. LEVEL OF RECTAL TUMOR............:
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23. DATE OF INITIAL DIAGNOSIS........:
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24. PRIMARY SITE.....................:
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25. HISTOLOGY/26. BEHAVIOR CODE......:
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28. DIAGNOSTIC CONFIRMATION..........:
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Print Colorectal Cancer PCE
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PCE Study of Colorectal Cancer
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29. SIZE OF TUMOR (mm)...............:
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30. REGIONAL NODES EXAMINED..........:
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31. REGIONAL NODES POSITIVE..........:
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32. AJCC CLINICAL STAGE (cTNM):
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AJCC STAGE.....................:
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33. AJCC PATHOLOGIC STAGE (pTNM):
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34. STAGED BY:
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CLINICAL STAGE.................:
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PATHOLOGIC STAGE...............:
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35. MARGIN OF RESECTION:
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PROXIMAL MARGIN................:
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DISTAL MARGIN..................:
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RADIAL MARGIN..................:
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36. DISTANCE TO MUCOSAL MARGIN.......:
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37. DISTANCE TO RADIAL MARGIN........:
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38. BLOOD VESSEL/LYMPHATIC INVASION..:
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39. EXTRAMURAL VENOUS INVASION.......:
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40. PROMINENT LYMPHOID INFILTRATE....:
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41. PHYSICIAN PROVIDING TREATMENT....:
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42. FIRST COURSE OF TREATMENT DATE...:
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43. DATE OF INPATIENT ADMISSION......:
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44. DATE OF INPATIENT DISCHARGE......:
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45. NON CANCER-DIRECTED SURGERY DATE.:
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46. NON CANCER-DIRECTED SURGERY......:
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47. SURGERY OF PRIMARY SITE DATE.....:
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48. SURGERY OF PRIMARY SITE..........:
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49. ADDITIONAL SURGICAL PROCEDURES...:
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50. LAPAROSCOPY USED DURING SURGERY..:
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51. METHOD OF ANASTOMOSIS............:
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52. DIST OF ANASTOMOSIS FROM DENTATE.:
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53. RESIDUAL PRIMARY TUMOR...........:
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54. OTHER SURGERY:
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PATHOLOGICAL STATUS............:
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55. COMPLICATIONS AFTER FIRST COURSE OF TREATMENT:
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ABDOMINAL INFECTION......:
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PERINEAL INFECTION.......:
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PNEUMONIA................:
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ADMISSION FOR NEUTROPENIA:
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PROCTITIS................:
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ANASTOMOTIC DEHISCENCE...:
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PULMONARY EMBOLISM.......:
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RADIATION ENTERITIS......:
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STOMA COMPLICATION.......:
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URINARY TRACT INFECTION..:
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EARLY BOWEL OBSTRUCTION..:
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56. POSTOPERATIVE DEATH W/I 30 DAYS:
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57. DATE RADIATION STARTED...........:
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58. DATE RADIATION THERAPY ENDED.....:
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59. ENDOCAVITARY RADIATION...........:
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60. INTRA-OPERATIVE RAD THERAPY......:
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61. PRIMARY TUMOR RAD DOSE W BOOST...:
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62. NUMBER OF RADIATION TREATMENTS...:
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64. DATE CHEMOTHERAPY STARTED........:
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65. ADJUVANT CHEMO W BEAM RADIATION..:
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66. ADJUVANT THERAPY:
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CPT 11.............:
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TAXOL..............:
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OTHER..............:
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67. DURATION OF ADJUVANT THERAPY.....:
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68. COMPLETED DURATION OF THERAPY....:
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69. WERE OTHER REFERRALS MADE:
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NUTRITIONAL CONSULTATION.......:
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OCCUPATIONAL THERAPY...........:
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PHYSICAL THERAPY...............:
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OSTOMY CONSULTATION............:
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70. DATE OF FIRST RECURRENCE..........:
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71. TYPE OF FIRST RECURRENCE..........:
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72. DATE OF LAST CONTACT OR DEATH....:
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73. VITAL STATUS.....................:
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74. CANCER STATUS....................:
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75. COMPLETED BY.....................:
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76. REVIEWED BY CANCER COMMITTEE.....:
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Deleting data from the following fields...
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SURGICAL DX/STAGING PROC
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SURGICAL DX/STAGING PROC DATE
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SURGERY OF PRIMARY (R)
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SURGICAL APPROACH (R)
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SURGERY OF PRIMARY (F)
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SURGERY OF PRIMARY DATE
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SURGICAL MARGINS
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DATE OF SURGICAL DISCHARGE
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REASON FOR NO SURGERY
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SURGERY OF PRIMARY SITE
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SURGERY OF PRIMARY SITE DATE
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SCOPE OF LN SURGERY (R)
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NUMBER OF LN REMOVED (R)
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SCOPE OF LN SURGERY (F)
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SCOPE OF LYMPH NODE SURG DATE
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SURG PROC/OTHER SITE (R)
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SURG PROC/OTHER SITE (F)
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SURG PROC/OTHER SITE DATE
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DATE RADIATION STARTED
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LOCATION OF RADIATION TX
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RADIATION TREATMENT VOLUME
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REGIONAL TREATMENT MODALITY
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REGIONAL DOSE:cGy
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BOOST TREATMENT MODALITY
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BOOST DOSE:cGy
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NUMBER OF TXS TO THIS VOLUME
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RADIATION/SURGERY SEQUENCE
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DATE RADIATION ENDED
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REASON FOR NO RADIATION
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TEXT-RX-RADIATION OTHER
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CHEMOTHERAPY DATE
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REASON FOR NO CHEMOTHERAPY
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HORMONE THERAPY
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HORMONE THERAPY DATE
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REASON FOR NO HORMONE THERAPY
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IMMUNOTHERAPY DATE
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HEMA TRANS/ENDOCRINE PROC
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HEMA TRANS/ENDOCRINE PROC DATE
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OTHER TREATMENT
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OTHER TREATMENT DATE
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PALLIATIVE PROCEDURE @FAC
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SURGICAL DX/STAGING @FAC
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SURGICAL DX/STAGING @FAC DATE
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SURGERY OF PRIMARY @FAC (R)
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SURGERY OF PRIMARY @FAC (F)
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SURGERY OF PRIMARY @FAC DATE
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SCOPE OF LN SURGERY @FAC (R)
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NUMBER OF LN REMOVED @FAC (R)
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SCOPE OF LN SURGERY @FAC (F)
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SCOPE OF LN SURGERY @FAC DATE
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SURG PROC/OTHER SITE @FAC (R)
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SURG PROC/OTHER SITE @FAC (F)
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SURG PROC/OTHER SITE @FAC DATE
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RADIATION @FAC DATE
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CHEMOTHERAPY @FAC DATE
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HORMONE THERAPY @FAC
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HORMONE THERAPY @FAC DATE
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IMMUNOTHERAPY @FAC DATE
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OTHER TREATMENT @FAC
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OTHER TREATMENT @FAC DATE
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STATE AT DX = YY (
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POSTAL CODE AT DX must be 888888888
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STATE AT DX = ZZ (
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POSTAL CODE AT DX must be 999999999
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REPORTING HOSPITAL = FACILITY REFERRED FROM
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REPORTING HOSPITAL = FACILITY REFERRED TO
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CLASS OF CASE =
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FACILITY REFERRED FROM may not be blank
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DATE OF FIRST CONTACT..:
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later than
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SURGERY OF PRIMARY SITE DATE.:
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RADIATION DATE...............:
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RADIATION THERAPY TO CNS DATE:
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CHEMOTHERAPY DATE............:
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HORMONE THERAPY DATE.........:
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IMMUNOTHERAPY DATE...........:
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OTHER TREATMENT DATE.........:
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earlier than
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DATE DX......................:
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TYPE OF REPORTING SOURCE = 6 (
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CLASS OF CASE must be 5 (Dx at autopsy)
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CLASS OF CASE = 5 (
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TYPE OF REPORTING SOURCE must be 6 (Autopsy only)
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TYPE OF REPORTING SOURCE = 7 (
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DIAGNOSTIC CONFIRMATION must be 9 (Unk if microscopically confirmed)
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DIAGNOSTIC CONFIRMATION must be 1 (Pos histology) or
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6 (Direct visualization)
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is a paired site
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LATERALITY must be provided for specified paired organs/sites
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NOTE: If NASAL CARTILAGE or NASAL SEPTUM, override this warning.
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NOTE: If CARINA, override this warning.
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NOTE: If STERNUM, override this warning.
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NOTE: If SACRUM, COCCYX or SYMPHYSIS PUBIS, override this warning.
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is an unpaired site
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LATERALITY must be 0 (Not a paired site)
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BEHAVIOR CODE = 2 (In situ)
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SUMMARY STAGE =
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BEHAVIOR CODE and SUMMARY STAGE confict
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BEHAVIOR CODE = 3 (Malignant)
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SUMMARY STAGE = 0 (In situ)
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HISTOLOGY =
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TYPE OF REPORTING SOURCE =
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SUMMARY STAGE must be 7 (Distant Mets/systemic disease)
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GRADE/DIFFERENTIATION must be 1 (Grade I)
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GRADE/DIFFERENTIATION must be 2 (Grade II)
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GRADE/DIFFERENTIATION must be 4 (Grade IV)
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GRADE/DIFFERENTIATION must be: 3 (Grade III)
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7 (Null cell)
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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