| 1 | English French Notes Complete/Exclude
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| 2 | CISPLATIN..........: NA INTERFERON.........: NA
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| 3 | BCNU...............: NA CYTARABINE (ARA-C).: NA
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| 4 | BCNU WAFER IMPLANT.: NA OTHER..............: NA
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| 5 | 1383 BCNU WAFER IMPLANT...........
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| 6 | 81. OTHER TYPE OF SUBSEQUENT TX FOR RECURRENCE/PROGRESSION...: None
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| 7 | 1393 81. OTHER TYPE OF SUBSEQUENT TX FOR RECURRENCE/PROGRESSION...
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| 8 | 82. DATE OF LAST CONTACT OR DEATH
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| 9 | 83. VITAL STATUS
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| 10 | 84. CANCER STATUS
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| 11 | STATUS AT LAST CONTACT
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| 12 | 82. DATE OF LAST CONTACT OR DEATH..:
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| 13 | 15 83. VITAL STATUS...................
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| 14 | 84. CANCER STATUS..................:
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| 15 | 1. FACILITY ID NUMBER (FIN)......:
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| 16 | 2. ACCESSION NUMBER..............:
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| 17 | 3. SEQUENCE NUMBER...............:
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| 18 | 4. POSTAL CODE AT DIAGNOSIS......:
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| 19 | 5. DATE OF BIRTH.................:
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| 20 | 7. SPANISH ORIGIN................:
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| 21 | 10. PRIOR EXPOSURE TO RADIATION...:
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| 22 | 11. PRIMARY PAYER AT DIAGNOSIS....:
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| 23 | 12. PRIOR MEDICAL CONDITIONS:
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| 24 | MULTIPLE SCLEROSIS (MS)......:
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| 25 | MYOCARDIAL INFARCTION (MI)...:
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| 26 | CEREBROVASCULAR DISEASE......:
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| 27 | MALIGNANT MELANOMA...........:
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| 28 | OTHER SKIN CANCER............:
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| 29 | COLON OR OTHER GI CANCERS....:
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| 30 | 14. GENETIC PREDISPOSITION:
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| 31 | VON HIPPEL-LINDAU DISEASE....:
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| 32 | TUBEROUS SCLEROSIS...........:
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| 33 | TURCOT SYNDROME..............:
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| 34 | LI-FRAUMENI SYNDROME.........:
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| 35 | KOWDEN DISEASE...............:
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| 36 | NEVOID BASAL CELL CARCINOMA
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| 37 | 15. USUAL OCCUPATION.............:
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| 38 | 16. USUAL INDUSTRY...............:
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| 39 | 17. CLASS OF CASE.................:
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| 40 | CHANGE IN SENSE OF SMELL AND/
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| 41 | OR TASTE....................:
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| 42 | ALTERED ALERTNESS............:
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| 43 | SPEECH DISTURBANCE...........:
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| 44 | PERSONALITY CHANGES..........:
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| 45 | MEMORY LOSS..................:
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| 46 | LACK OF CONCENTRATION........:
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| 47 | DOUBLE VISION................:
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| 48 | OTHER VISUAL DISTURBANCE.....:
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| 49 | DECREASED HEARING............:
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| 50 | WEAKNESS OR PARALYSIS........:
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| 51 | DIFFICULTY IN COORDINATION/
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| 52 | GENERALIZED SEIZURE..........:
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| 53 | FOCAL SEIZURE................:
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| 54 | BLADDER INCONTINENCE.........:
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| 55 | BOWEL INCONTINENCE...........:
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| 56 | PAIN (OTHER THAN HEADACHE)...:
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| 57 | WEIGHT CHANGE................:
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| 58 | Print Intracranial & CNS PCE
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| 59 | 19. NEUROLOGICAL FINDINGS:
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| 60 | MEMORY OR JUDGEMENT..........:
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| 61 | VISUAL ACUITY................:
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| 62 | VISUAL FIELDS................:
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| 63 | EYE MOVEMENTS (EOM)..........:
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| 64 | FACIAL SENSATION.............:
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| 65 | FACIAL MOVEMENT..............:
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| 66 | GAG REFLEX...................:
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| 67 | SHRUG STRENGTH..............:
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| 68 | ARTICULATION OR ENUNCIATION..:
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| 69 | TONGUE FASCICULATIONS OR
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| 70 | DECREASE IN SENSATION OF ANY
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| 71 | CORTICAL SENSORY DEFICIT.....:
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| 72 | WEAKNESS, ATROPHY OR
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| 73 | FASCICULATION OF ANY SITE...:
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| 74 | ATAXIA OF GAIT...............:
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| 75 | TRUNCAL ATAXIA...............:
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| 76 | RAPID ALTERNATING MOVEMENTS..:
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| 77 | FINGER TO FINGER NOSE TESTING:
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| 78 | HEEL TO KNEE TO SHIN TESTING.:
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| 79 | DEEP TENDON REFLEXES IN UPPER
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| 80 | DEEP TENDON REFLEXES IN LOWER
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| 81 | BABINSKI SIGN................:
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| 82 | HOFFMAN REFLEX...............:
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| 83 | OTHER ABNORMAL REFLEXES......:
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| 84 | 20. PRE-THERAPY DIAGNOSTIC STUDIES:
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| 85 | CT SCAN OF BRAIN.............:
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| 86 | CT SCAN OF SPINE.............:
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| 87 | ISOTOPE BRAIN SCAN...........:
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| 88 | SPECT SCAN...................:
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| 89 | MRI OF BRAIN.................:
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| 90 | MRI OF SPINE.................:
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| 91 | FUNCTIONAL MRI...............:
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| 92 | 21. TUMOR LOCATION/INVOLVEMENT:
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| 93 | FRONTAL LOBE.................:
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| 94 | TEMPORAL LOBE................:
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| 95 | PARIETAL LOBE................:
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| 96 | OCCIPITAL LOBE...............:
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| 97 | OPTIC NERVES.................:
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| 98 | PITUITARY GLAND..............:
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| 99 | PINEAL GLAND.................:
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| 100 | BRAIN STEM...................:
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| 101 | SKULL BASE...................:
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| 102 | OTHER SKULL..................:
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| 103 | SPINAL CORD..................:
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| 104 | CEREBRAL SPINAL FLUID........:
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| 105 | CRANIAL MENINGES.............:
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| 106 | SPINAL MENINGES..............:
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| 107 | 23. NUMBER OF TUMORS..............:
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| 108 | 24. DATE OF FIRST SYMPTOMS........:
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| 109 | 25. DATE OF INITIAL DIAGNOSIS.....:
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| 110 | 26. DATE OF PATHOLOGIC DIAGNOSIS..:
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| 111 | 27. PRIMARY SITE (ICD-O-2)........:
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| 112 | 28. WHO HISTOLOGICAL CLASSIFI-
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| 113 | CATION OF TUMOR..............:
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| 114 | 29. BEHAVIOR CODE (ICD-O-2).......:
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| 115 | 31. DIAGNOSTIC CONFIRMATION.......:
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| 116 | 32. MOLECULAR MARKERS.............:
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| 117 | 33. TUMOR SIZE....................:
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| 118 | 34. TUMOR SIZE (SOURCE)...........:
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| 119 | 35. KARNOFSKY'S RATING PRIOR TO TX:
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| 120 | 36. PROTOCOL PARTICIPATION........:
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| 121 | 37. PROTOCOL PHASE................:
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| 122 | 38. DATE OF FIRST COURSE TREATMENT:
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| 123 | 39. DATE OF INPATIENT ADMISSION...:
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| 124 | 40. DATE OF INPATIENT DISCHARGE...:
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| 125 | 41. DATE OF NON CANCER-DIRECTED
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| 126 | NONE, NO NON CA-DIRECTED
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| 127 | SURGICAL PROCEDURE..........:
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| 128 | VENTRICULOSTOMY, OR EXTERNAL
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| 129 | VENTRICULAR DRAIN...........:
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| 130 | CSF SHUNT,
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| 131 | THIRD VENTRICULOSTOMY.......:
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| 132 | STEREOTACTIC BIOPSY..........:
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| 133 | OPEN BRAIN BIOPSY............:
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| 134 | OPEN BIOPSY OF SPINAL CORD
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| 135 | LAMINECTOMY FOR SPINAL CORD
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| 136 | TUMOR, W/O TUMOR RESECTION,
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| 137 | W/O OPENING DURA...........:
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| 138 | W OPENING DURA.............:
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| 139 | UNKNOWN IF SURGERY DONE......:
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| 140 | 43. DATE OF CA-DIRECTED SURGERY...:
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| 141 | 44. SURGICAL APPROACH.............:
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| 142 | 45. EXTENT OF SURGICAL RESECTION..:
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| 143 | 46. SIZE OF RESIDUAL PRIMARY TUMOR
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| 144 | AFTER CA-DIR SURGERY.........:
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| 145 | 47. SIZE OF RESIDUAL PRIMARY TUMOR
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| 146 | AFTER CA-DIR SURGERY (SOURCE):
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| 147 | ANESTHETIC PROBLEM...........:
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| 148 | HEMORRHAGE AT OPERATIVE SITE.:
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| 149 | DVT (DEEP VENOUS THROMBOSIS).:
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| 150 | PERSISTENT NEUROLOGICAL
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| 151 | WORSENING > 4 DAYS POST-OP..:
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| 152 | 49. REASON FOR NO SURGERY.........:
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| 153 | 50. RADIATION THERAPY.............:
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| 154 | 51. DATE RADIATION STARTED........:
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| 155 | 52. DATE RADIATION ENDED..........:
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| 156 | 53. TOTAL RADIATION DOSE (cGy)....:
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| 157 | 54. NUMBER OF TREATMENTS TO THIS
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| 158 | 55. TYPE OF EXT BEAM RADIATION....:
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| 159 | 56. INTERSTITIAL RAD/BRACHYTHERAPY:
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| 160 | 57. STEREOTACTIC RADIOSURGERY.....:
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| 161 | 58. RADIATION/SURGERY SEQUENCE....:
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| 162 | 59. RADIATION COMPLICATIONS:
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| 163 | SKIN REACTIONS...............:
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| 164 | NAUSEA OR VOMITING...........:
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| 165 | NEUROLOGIC WORSENING.........:
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| 166 | 60. REASON FOR NO RADIATION.......:
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| 167 | 61. DATE CHEMOTHERAPY STARTED.....:
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| 168 | BCNU, WAFER IMPLANT..........:
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| 169 | 64. CHEMOTHERAPEUTIC ROUTE........:
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| 170 | 65. CHEMOTHERAPY COMPLICATIONS:
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| 171 | HEARING LOSS.................:
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| 172 | NAUSEA AND VOMITING REQUIRING
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| 173 | CESSATION OF CHEMOTHERAPY...:
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| 174 | PERIPHERAL BLOOD COUNT DROP/
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| 175 | /BLEEDING/CESSATION OF CHEMO
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| 176 | AND/OR TRANSFUSION..........:
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| 177 | PERIPHERAL NEUROPATHY........:
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| 178 | RENAL FAILURE................:
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| 179 | PULMONARY TOXICITY...........:
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| 180 | 66. REASON FOR NO CHEMOTHERAPY....:
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| 181 | 67. DATE OTHER TREATMENT STARTED..:
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| 182 | 68. OTHER TREATMENT...............:
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| 183 | 69. KARNOFSKY'S RATING AT TIME OF
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| 184 | RECURRENCE/PROGRESSION
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| 185 | 70. DATE OF FIRST RECURRENCE......:
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| 186 | 71. TYPE OF FIRST RECURRENCE......:
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| 187 | 72. DATE OF PROGRESSION...........:
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| 188 | 73. TYPE OF PROGRESSION...........:
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| 189 | 75. KARNOFSKY'S RATING AT TIME OF
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| 190 | SUBSEQUENT TREATMENT
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| 191 | 76. DATE OF SUBSEQUENT TREATMENT
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| 192 | FOR RECURRENCE/PROGRESSION...:
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| 193 | 77. PROTOCOL PARTCIPATION
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| 194 | (SUBSEQUENT TREATMENT).......:
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| 195 | 78. TYPE OF SUBSEQUENT SURGICAL TX
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| 196 | 79. TYPE OF SUBSEQUENT RADIATION
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| 197 | TX FOR RECURRENCE/PROGRESSION:
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| 198 | 81. OTHER TYPE OF SUBSEQUENT TX
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| 199 | STATUS AT LAST CONTACT
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| 200 | 82. DATE OF LAST CONTACT OR DEATH.:
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| 201 | 83. VITAL STATUS..................:
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| 202 | 84. CANCER STATUS.................:
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| 203 | 2001 Patient Care Evaluation Study of Non-Small Cell Lung Carcinoma
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| 204 | 1400 CO-MORBID CONDITION #1.......
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| 205 | 1400.1 CO-MORBID CONDITION #2.......
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| 206 | 1400.2 CO-MORBID CONDITION #3.......
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| 207 | 1400.3 CO-MORBID CONDITION #4.......
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| 208 | 1400.4 CO-MORBID CONDITION #5.......
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| 209 | 1400.5 CO-MORBID CONDITION #6.......
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| 210 | 1401 2. DURATION OF TOBACCO USE.......
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| 211 | 1403 3. PERSONAL HISTORY OF OTHER INVASIVE MALIGNANCIES PRIOR TO THIS CANCER DIAGNOSIS....//^S X=PHDEF
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| 212 | This item describes the patient's prior history of other invasive
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| 213 | malignancies. If the patient has a history of other malignancies
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| 214 | report the ICD-O-3 site code for the most recently diagnosed disease.
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| 215 | If the patient has no personal history of other cancer, code C88.8. If
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| 216 | the patient's personal history of other invasive malignancies is not
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| 217 | Allowable Codes: C00.0 thru C80.9 - valid ICD-0-3 site (topography) codes
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| 218 | C88.8 - no personal history of other cancer
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| 219 | C99.9 - personal history of other cancer not documented
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| 220 | This patient has no other primaries.
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| 221 | Other primaries for this patient:
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| 222 | Date DX
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| 223 | TUMOR IDENTIFICATION AND DIAGNOSIS
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| 224 | 4. SYMPTOMS PRESENT AT INITIAL DIAGNOSIS:
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| 225 | 1404.1 SHORTNESS OF BREATH..........
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| 226 | 1404.2 WEIGHT LOSS..................
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| 227 | 1404.4 PALPABLE LYMPH NODES.........
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| 228 | 5. SCREENING FOR HIGH RISK/ASYMPTOMATIC PRESENTATION:
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| 229 | 1405.1 CT SCAN......................
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| 230 | 6. INITIAL DIAGNOSTIC STUDIES (PRE-THERAPY):
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| 231 | 1406 HISTORY AND PHYSICAL.........
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| 232 | 1406.4 THOROCOTOMY/OPEN BIOPSY......
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| 233 | TUMOR EVALUATION
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| 234 | 7. PULMONARY FUNCTION TESTS:
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| 235 | 1407 FVC (forced vital capacity)..
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| 236 | 1407.1 FEV (forced expiratory vol)..
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| 237 | 1408 8. LIVER FUNCTION TESTS..........
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| 238 | 9. RADIOLOGIC EVALUATION:
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| 239 | BONE SCAN:
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| 240 | 1409 BONE SCAN....................
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| 241 | 1409.2 VASCULAR INVASION...........
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| 242 | 1409.3 MEDIASTINAL LYMPH NODES.....
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| 243 | 1409.4 SIZE OF DOMINANT TUMOR (mm).
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| 244 | 1409.5 NUMBER OF TUMORS............
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| 245 | 1409.6 EVIDENCE OF METASTASIS......
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| 246 | CT SCAN OF CHEST:
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| 247 | 1410 CT SCAN OF CHEST.............
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| 248 | 1410.2 VASCULAR INVASION...........
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| 249 | 1410.3 MEDIASTINAL LYMPH NODES.....
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| 250 | 1410.4 SIZE OF DOMINANT TUMOR (mm).
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| 251 | 1410.5 NUMBER OF TUMORS............
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| 252 | 1410.6 EVIDENCE OF METASTASIS......
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| 253 | CT SCAN OF BRAIN:
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| 254 | 1411 CT SCAN OF BRAIN.............
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| 255 | 1411.2 VASCULAR INVASION...........
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| 256 | 1411.3 MEDIASTINAL LYMPH NODES.....
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| 257 | 1411.4 SIZE OF DOMINANT TUMOR (mm).
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| 258 | 1411.5 NUMBER OF TUMORS............
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| 259 | 1411.6 EVIDENCE OF METASTASIS......
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| 260 | MRI SCAN OF CHEST:
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| 261 | 1412 MRI SCAN OF CHEST............
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| 262 | 1412.2 VASCULAR INVASION...........
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| 263 | 1412.3 MEDIASTINAL LYMPH NODES.....
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| 264 | 1412.4 SIZE OF DOMINANT TUMOR (mm).
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| 265 | 1412.5 NUMBER OF TUMORS............
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| 266 | 1412.6 EVIDENCE OF METASTASIS......
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| 267 | MRI SCAN OF BRAIN:
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| 268 | 1413 MRI SCAN OF BRAIN............
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| 269 | 1413.2 VASCULAR INVASION...........
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| 270 | 1413.3 MEDIASTINAL LYMPH NODES.....
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| 271 | 1413.4 SIZE OF DOMINANT TUMOR (mm).
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| 272 | 1413.5 NUMBER OF TUMORS............
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| 273 | 1413.6 EVIDENCE OF METASTASIS......
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| 274 | PET SCAN:
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| 275 | 1414 PET SCAN.....................
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| 276 | 1414.2 VASCULAR INVASION...........
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| 277 | 1414.3 MEDIASTINAL LYMPH NODES.....
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| 278 | 1414.4 SIZE OF DOMINANT TUMOR (mm).
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| 279 | 1414.5 NUMBER OF TUMORS............
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| 280 | 1414.6 EVIDENCE OF METASTASIS......
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| 281 | X-RAY OF CHEST:
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| 282 | 1415 X-RAY OF CHEST...............
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| 283 | 1415.2 VASCULAR INVASION...........
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| 284 | 1415.3 MEDIASTINAL LYMPH NODES.....
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| 285 | 1415.4 SIZE OF DOMINANT TUMOR (mm).
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| 286 | 1415.5 NUMBER OF TUMORS............
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| 287 | 1415.6 EVIDENCE OF METASTASIS......
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| 288 | 10. PRE-OP LYMPH NODE MAPPING:
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| 289 | 1416 HIGHEST MEDIASTINAL (level 1)
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| 290 | 1416.1 UPPER PARATRACHEAL (level 2).
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| 291 | 1416.2 PREVASCULAR AND RETROTRACHEAL (level 3)...................
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| 292 | 1416.3 LOWER PARATRACHEAL (level 4).
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| 293 | 1416.8 PULMONARY LIGAMENT (level 9).
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| 294 | EMPHYSEMA...................: NA, test not performed
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| 295 | VASCULAR INVASION...........: NA, test not performed
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| 296 | MEDIASTINAL LYMPH NODES.....: NA, test not performed
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| 297 | SIZE OF DOMINANT TUMOR (mm).: Test not performed
|
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| 298 | NUMBER OF TUMORS............: Test not performed
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| 299 | EVIDENCE OF METASTASIS......: NA, test not performed
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| 300 | EMPHYSEMA...................: Not documented
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| 301 | VASCULAR INVASION...........: Not documented
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| 302 | MEDIASTINAL LYMPH NODES.....: Not documented
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| 303 | #################### #################### ####################
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| 304 | #################### #################### ####################
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| 305 | #################### #################### ####################
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| 306 | #################### #################### ####################
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| 307 | #################### #################### ####################
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