308 lines
12 KiB
Plaintext
308 lines
12 KiB
Plaintext
English French Notes Complete/Exclude
|
|
24. REGIONAL NODES EXAMINED.........:
|
|
25. REGIONAL NODES POSITIVE.........:
|
|
26. EXTRANODAL EXTENSION............:
|
|
SATELLITE NODULES OF SKIN OR SUBCUTANEOUS TISSUE
|
|
28. NUMBER OF SATELLITE NODULES.....:
|
|
29. LOCATION OF IN-TRANSIT NODULES..:
|
|
31. CLARK'S LEVEL OF INVASION.......:
|
|
32. ANGIOLYMPHATIC INVASION.........:
|
|
33. PERINEURAL INVASION.............:
|
|
34. GENERAL SUMMARY STAGE...........:
|
|
35. AJCC CLINICAL STAGE (cTNM):
|
|
AJCC STAGE.....................:
|
|
37. CLINICALLY AMELANOTIC...........:
|
|
38. AJCC PATHOLOGIC STAGE (pTNM):
|
|
39. STAGED BY:
|
|
CLINICAL STAGE.................:
|
|
PATHOLOGIC STAGE...............:
|
|
40. PROTOCOL ELIGIBILITY STATUS.....:
|
|
41. PROTOCOL PARTICIPATION..........:
|
|
42. DATE OF FIRST COURSE TREATMENT..:
|
|
43. DATE OF NON CA-DIRECTED SURGERY.:
|
|
44. NON CANCER-DIRECTED SURGERY.....:
|
|
45. TYPE OF BIOSPY..................:
|
|
46. DATE OF CANCER-DIRECTED SURGERY.:
|
|
47. SURGICAL APPROACH...............:
|
|
48. SURGERY OF PRIMARY SITE.........:
|
|
49. SURGICAL MARGINS................:
|
|
50. DISTANCE FROM TUMOR TO EDGE OF
|
|
51. SCOPE OF LYMPH NODE SURGERY.....:
|
|
52. NUMBER OF LYMPH NODES REMOVED...:
|
|
53. SURGERY OF OTHER REGIONAL SITE(S), DISTANT SITE(S),
|
|
OR DISTANT LYMPH NODE(S)........:
|
|
55. SURGICAL CLOSURE................:
|
|
56. REASON FOR NO SURGERY...........:
|
|
57. PRE-OP LYMPHOSCINTIGRAPHY.......:
|
|
58. SENTINEL NODES DETECTED BY......:
|
|
59. SENTINEL NODE BIOPSY............:
|
|
60. SENTINEL NODES EXAMINED.........:
|
|
61. SENTINEL NODES POSITIVE.........:
|
|
62. HOW WAS SENTINEL NODE
|
|
PATHOLOGICALLY EXAMINED.........:
|
|
63. IF SENTINEL NODE(S) POSITIVE:
|
|
WAS COMPLETE LYMPH NODE
|
|
DISSECTION PERFORMED..........:
|
|
NUMBER OF BASINS DETECTED.....:
|
|
NUMBER OF BASINS POSITIVE.....:
|
|
64. DATE RADIATION STARTED..........:
|
|
65. RADIATION THERAPY...............:
|
|
66. REASON FOR NO RADIATION ........:
|
|
67. DATE CHEMOTHERAPY STARTED.......:
|
|
69. INTRAVENOUS THERAPY.............:
|
|
70. DATE HORMONE THERAPY STARTED....:
|
|
71. HORMONE THERAPY.................:
|
|
IMMUNOTHERAPY THERAPY
|
|
72. DATE IMMUNOTHERAPY STARTED......:
|
|
74. IMMUNOTHERAPEUTIC AGENTS ADMINISTERED:
|
|
VACCINE THERAPY................:
|
|
GENE THERAPY...................:
|
|
COLONY STIMULATING FACTORS.....:
|
|
OTHER GIVEN, TYPE UNKNOWN......:
|
|
OTHER THERAPY
|
|
75. DATE OTHER TREATMENT STARTED....:
|
|
76. OTHER TREATMENT.................:
|
|
77. DATE OF FIRST RECURRENCE........:
|
|
78. TYPE OF FIRST RECURRENCE........:
|
|
79. OTHER TYPE OF FIRST RECURRENCE..:
|
|
80. DATE OF LAST CONTACT OR DEATH...:
|
|
81. VITAL STATUS....................:
|
|
82. CANCER STATUS...................:
|
|
TABLE VII - OTHER INFORMATION
|
|
83. COMPLETED BY....................:
|
|
84. REVIEWED BY CANCER COMMITTEE....:
|
|
The BEHAVIOR code is not 3 (malignant).
|
|
8:Print Non-Hodgkin's Lymphoma PCE
|
|
Patient Care Evaluation Study of Non-Hodgkin's Lymphoma
|
|
AGE AT DIAGNOSIS
|
|
PERSONAL HISTORY OF ANY CANCER
|
|
PRE-EXISTING CONDITIONS
|
|
PREVIOUS CHEMOTHERAPY/RADIATION THERAPY
|
|
AIDS RISK CATEGORY
|
|
AIDS RISK CATEGOR
|
|
AGE AT DIAGNOSIS.....................:
|
|
313 OTHER CANCER.......................
|
|
PERSONAL HISTORY OF ANY CANCER:
|
|
803 1ST PRIMARY SITE...................
|
|
803 1ST PRIMARY SITE...................//
|
|
804 1ST PRIMARY HISTOLOGY..............
|
|
804 1ST PRIMARY HISTOLOGY..............//
|
|
805 2ND PRIMARY SITE...................
|
|
805 2ND PRIMARY SITE...................//
|
|
806 2ND PRIMARY HISTOLOGY..............
|
|
806 2ND PRIMARY HISTOLOGY..............//
|
|
PRE-EXISTING CONDITIONS:
|
|
807 ORGAN TRANSPLANT...................
|
|
808 HIV POSITIVE.......................
|
|
809 CROHN'S DISEASE/ULCERATIVE COLITIS.
|
|
811 SYSTEMIC LUPUS ERYTHEMATOSUS.......
|
|
812 RHEUMATOID ARTHRITIS/SJOGREN'S SYN.
|
|
813 PNEUMOCYSTIS CARINII...............
|
|
814 CMV INFECTION......................
|
|
816 MYCOBACTERIUM AVIUM................
|
|
817 OTHER PARASITIC INFECTIONS.........
|
|
818 OTHER CONGENTIAL DISEASES..........
|
|
819 OPPORTUNISTIC DISEASE (W/I 2 YEARS)
|
|
PREVIOUS CHEMOTHERAPY/RADIATION THERAPY:
|
|
821 RADIATION THERAPY..................
|
|
822AIDS RISK CATEGORY...................
|
|
DIAGNOSTIC WORKUP
|
|
RESULTS OF LABORATORY TESTS
|
|
ADDITIONAL TESTS
|
|
REVIEW OF PATHOLOGY/OTH INST
|
|
DIAGNOSTIC BIOPSIES
|
|
SYSTEMIC SYMPTOMS
|
|
DIAGNOSTIC TEST SPECIFICALLY RELATED TO HIV DISEASE
|
|
HIV VIRAL LOADS
|
|
SPECIFIC HISTOLOGIC INFORMATION
|
|
CELL TYPE OF LYMPHOMA
|
|
PATIENT STATUS AT DIAGNOSIS
|
|
CLASS OF CLASS..............:
|
|
26DIAGNOSTIC CONFIRMATION.....
|
|
DIAGNOSTIC WORKUP:
|
|
823 CT SCAN OF BRAIN..........
|
|
506 CT SCAN OF CHEST..........
|
|
824 CT SCAN OF ABDOMEN/PELVIS.
|
|
825 MRI OF BRAIN..............
|
|
826 MRI OF CHEST..............
|
|
827 MRI OF ABDOMEN/PELVIS.....
|
|
504 BONE SCAN.................
|
|
828 GALLIUM SCAN..............
|
|
829 PET SCAN..................
|
|
830 LUMBAR PUNCTURE...........
|
|
RESULTS OF LABORATORY TESTS:
|
|
832 WHITE COUNT...............
|
|
833 PLATELET COUNT............
|
|
834 LACTIC DEHYDROGENASE (LDH)
|
|
835 LIVER FUNCTION STUDIES....
|
|
836 TOTAL PROTEIN/ALBUMIN.....
|
|
ADDITIONAL TESTS:
|
|
516 TUMOR SURFACE MARKER......
|
|
514 CYTOGENETIC TESTING.......
|
|
837 GENE REARRANGEMENTS.......
|
|
838REVIEW OF PATHOLOGY/OTH INST
|
|
DIAGNOSTIC BIOPSIES:
|
|
839 LYMPH NODE................
|
|
840 BONE MARROW...............
|
|
841 CSF CYTOLOGY..............
|
|
842 OTHER SITE................
|
|
843SYSTEMIC SYMPTOMS...........
|
|
DIAGNOSTIC TESTS SPECIFICALLY RELATED TO HIV DISEASE:
|
|
845 HIV VIRAL LOADS...........
|
|
DATE OF INITIAL DIAGNOSIS...:
|
|
PRIMARY SITE................:
|
|
HISTOLOGY/BEHAVIOR CODE.....:
|
|
846SPECIFIC HISTOLOGIC INFO....
|
|
847CELL TYPE OF LYMPHOMA.......
|
|
848PATIENT STATUS AT DIAGNOSIS.
|
|
AJCC CLINICAL STAGE GROUP
|
|
CLINICALLY STAGED BY
|
|
AJCC PATHOLOGIC STAGE GROUP
|
|
PATHOLOGICALLY STAGED BY
|
|
TYPE OF STAGING SYSTEM (PEDIATRIC)
|
|
PEDIATRIC STAGE
|
|
STAGED BY (PEDIATRIC STAGE)
|
|
EXTRANODAL SITES
|
|
AJCC CLINICAL STAGE GROUP......:
|
|
19CLINICALLY STAGED BY...........
|
|
AJCC PATHOLOGIC STAGE GROUP ...:
|
|
89PATHOLOGICALLY STAGED BY.......
|
|
849TYPE OF STAGING SYS (PEDIATRIC)
|
|
850PEDIATRIC STAGE................
|
|
851STAGED BY (PEDIATRIC STAGE)....
|
|
EXTRANODAL SITES:
|
|
852 EXTRANODAL SITE 1............
|
|
853 EXTRANODAL SITE 2............
|
|
854 EXTRANODAL SITE 3............
|
|
DATE OF FIRST COURSE OF TREATMENT
|
|
SYSTEMIC CHEMOTHERAPY
|
|
INTRATHECAL CHEMOTHERAPY
|
|
DATE OF FIRST COURSE OF TREATMENT.:
|
|
EXTRANODAL SURGERY SITE.........: None
|
|
EXTRANODAL SURGICAL PROCEDURE...: 00 No additional surgical procedures
|
|
855 EXTRANODAL SURGERY SITE.........
|
|
856 EXTRANODAL SURGICAL PROCEDURE...
|
|
RADIATION DATE..................:
|
|
IRRADIATED FIELDS:
|
|
LYMPH NODES ABOVE DIAPHRAGM...: Not irradiated
|
|
LYMPH NODES BELOW DIAPHRAGM...: Not irradiated
|
|
BRAIN.........................: Not irradiated
|
|
OTHER EXTRANODAL SITE(S)......: Not irradiated
|
|
TOTAL BODY....................: Not irradiated
|
|
RADIATION/CHEMOTHERAPY SEQUENCE.: NA, no radiation and/or no chemo given
|
|
LYMPH NODES ABOVE DIAPHRAGM...: NA, unknown if radiation therapy given
|
|
LYMPH NODES BELOW DIAPHRAGM...: NA, unknown if radiation therapy given
|
|
BRAIN.........................: NA, unknown if radiation therapy given
|
|
OTHER EXTRANODAL SITE(S)......: NA, unknown if radiation therapy given
|
|
TOTAL BODY....................: NA, unknown if radiation therapy given
|
|
RADIATION/CHEMOTHERAPY SEQUENCE.: Unknown if radiation and/or chemo given
|
|
857 LYMPH NODES ABOVE DIAPHRAGM...
|
|
858 LYMPH NODES BELOW DIAPHRAGM...
|
|
860 OTHER EXTRANODAL SITE(S)......
|
|
861 TOTAL BODY....................
|
|
862 RADIATION/CHEMOTHERAPY SEQUENCE.
|
|
864 SYSTEMIC CHEMOTHERAPY...........
|
|
SYSTEMIC CHEMOTHERAPY DATE......: 00/00/0000
|
|
NUMBER OF PLANNED CYCLES........: NA
|
|
AGENT ADMINISTERED DURING SYSTEMIC CHEMOTHERAPY:
|
|
SINGLE-AGENT CHEMOTHERAPY:
|
|
CHLORAMBUCIL.....: NA DOXORUBICIN......: NA
|
|
CYCLOPHOSPHAMIDE.: NA FLUDARABINE......: NA
|
|
COMBINATION CHEMOTHERAPY:
|
|
CVP..............: NA PRO-MACE-Cyta BOM: NA
|
|
COMLA............: NA OTHER............: NA
|
|
HIGH DOSE W STEM CELL RESCUE..: No
|
|
NUMBER OF PLANNED CYCLES........: Unknown if chemotherapy given
|
|
CHLORAMBUCIL.....: Unknown if given DOXORUBICIN......: Unknown if given
|
|
CYCLOPHOSPHAMIDE.: Unknown if given FLUDARABINE......: Unknown if given
|
|
CHOP.............: Unknown if given M-BACOD..........: Unknown if given
|
|
CVP..............: Unknown if given PRO-MACE-Cyta BOM: Unknown if given
|
|
COMLA............: Unknown if given OTHER............: Unknown if given
|
|
MACOP-B..........: Unknown if given
|
|
HIGH DOSE W STEM CELL RESCUE..: Unknown if given
|
|
865 SYSTEMIC CHEMOTHERAPY DATE......
|
|
866 NUMBER OF PLANNED CYCLES........
|
|
876 PRO-MACE-Cyta BOM...........
|
|
878 HIGH DOSE W STEM CELL RESCUE....
|
|
879 INTRATHECAL CHEMOTHERAPY........
|
|
PURPOSE.........................: NA, not administered
|
|
PURPOSE.........................: Unknown if administered
|
|
883 MONOCLONAL ANTIBODIES...........
|
|
884 VACCINE THERAPY.................
|
|
OTHER TYPE OF FIRST RECURRENCE
|
|
71.4OTHER TYPE OF FIRST RECURRENCE
|
|
1. INSTITUTION ID NUMBER...........: H6
|
|
6. AGE AT DIAGNOSIS................:
|
|
8. SPANISH ORIGIN..................:
|
|
10. PRIMARY PAYER AT DIAGNOSIS......:
|
|
11. FAMILY HISTORY OF CANCER:
|
|
OTHER CANCER..................:
|
|
12. PERSONAL HISTORY OF ANY CANCER:
|
|
1ST PRIMARY SITE..............:
|
|
1ST PRIMARY HISTOLOGY.........:
|
|
2ND PRIMARY SITE..............:
|
|
2ND PRIMARY HISTOLOGY.........:
|
|
13. PRE-EXISTING CONDITIONS:
|
|
ORGAN TRANSPLANT..............:
|
|
HIV POSITIVE..................:
|
|
CROHN'S DIS/ULCERATIVE COLITIS:
|
|
SYSTEMIC LUPUS ERYTHEMATOSUS..:
|
|
RHEUMATOID ARTHRITIS/SJOGREN'S:
|
|
PNEUMOCYSTIS CARINII..........:
|
|
CMV INFECTION.................:
|
|
MYCOBACTERIUM AVIUM...........:
|
|
OTHER PARASITIC INFECTIONS....:
|
|
OTHER CONGENITAL DISEASES.....:
|
|
OPPORTUNISTIC DISEASE.........:
|
|
14. PREVIOUS CHEMOTHERAPY/RADIATION THERAPY:
|
|
RADIATION THERAPY.............:
|
|
15. AIDS RISK CATEGORY..............:
|
|
Print Non-Hodgkin's Lymphoma PCE
|
|
PCE Study of Non-Hodgkin's Lymphoma
|
|
16. CLASS OF CASE...................:
|
|
17. DIAGNOSTIC CONFIRMATION.........:
|
|
18. DIAGNOSTIC WORKUP:
|
|
CT SCAN OF BRAIN..............:
|
|
CT SCAN OF CHEST..............:
|
|
CT SCAN OF ABDOMEN/PELVIS.....:
|
|
MRI OF BRAIN..................:
|
|
MRI OF CHEST..................:
|
|
MRI OF ABDOMEN/PELVIS.........:
|
|
BONE SCAN.....................:
|
|
GALLIUM SCAN..................:
|
|
PET SCAN......................:
|
|
LUMBAR PUNCTURE...............:
|
|
19. RESULTS OF LABORATORY TESTS:
|
|
WHITE COUNT...................:
|
|
PLATELET COUNT................:
|
|
LACTIC DEHYDROGENASE (LDH)....:
|
|
LIVER FUNCTION STUDIES........:
|
|
TOTAL PROTEIN/ALBUMIN.........:
|
|
20. ADDITIONAL TESTS:
|
|
TUMOR SURFACE MARKER..........:
|
|
CYTOGENETIC TESTING...........:
|
|
GENE REARRANGEMENTS...........:
|
|
21. REVIEW OF PATHOLOGY/OTH INST....:
|
|
22. DIAGNOSTIC BIOPSIES:
|
|
LYMPH NODE....................:
|
|
BONE MARROW...................:
|
|
CSF CYTOLOGY..................:
|
|
OTHER SITE....................:
|
|
23. SYSTEMIC SYSTEMS................:
|
|
24. DIAGNOSTIC TESTS SPECIFICALLY RELATED TO HIV DISEASE:
|
|
HIV VIRAL LOADS...............:
|
|
25. DATE OF INITIAL DIAGNOSIS.......:
|
|
26. PRIMARY SITE....................:
|
|
27. HISTOLOGY/29. BEHAVIOR CODE.....:
|
|
28. SPECIFIC HISTOLOGIC INFO........:
|
|
30. CELL TYPE OF LYMPHOMA...........:
|
|
31. PATIENT STATUS OF DIAGNOSIS.....:
|
|
32. AJCC CLINICAL STAGE GROUP.......:
|
|
33. CLINICALLY STAGED BY............:
|
|
34. AJCC PATHOLOGIC STAGE GROUP.....:
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|