| [604] | 1 | English French Notes Complete/Exclude
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| 2 | EVIDENCE OF METASTASIS......: Not documented
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| 3 | 1402 11. DATE OF FIRST TISSUE DIAGNOSIS
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| 4 | 12. DISTANCE IN MILLIMETERS TO CLOSEST MARGIN:
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| 5 | 1429 PROXIMAL MARGIN..............
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| 6 | 1429.1 DISTAL MARGIN................
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| 7 | 1417 13. FROZEN SECTION................
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| 8 | 1418.3 CHEST WALL...................
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| 9 | 15. SCOPE OF OPERATIVE MEDIASTINAL LYMPH NODE ASSESSMENT:
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| 10 | 1419 HIGHEST MEDIASTINAL (level 1)
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| 11 | 1419.1 UPPER PARATRACHEAL (level 2)
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| 12 | 1419.2 PREVASCULAR AND RETROTRACHEAL (level 3)
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| 13 | 1419.3 LOWER PARATRACHEAL (level 4)
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| 14 | 1419.8 PULMONARY LIGAMENT (level 9)
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| 15 | 1430 16. HCT (HEMOCRIT) VALUES BEFORE TRANSFUSION..................
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| 16 | 1420 17. TOTAL PERI-OPERATIVE BLOOD REPLACEMENT..................
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| 17 | 1421 18. PERI-OPERATIVE DEATH..........
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| 18 | FIRST COURSE OF TREATMENT - RADIATION THERAPY
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| 19 | 442 19. REGIONAL DOSE (cGy)...........
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| 20 | 56 20. NUMBER OF TREATMENTS TO THIS VOLUME.......................
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| 21 | 363 21. REGIONAL TREATMENT MODALITY...
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| 22 | 51.3 22. RADIATION/SURGERY SEQUENCE....
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| 23 | 1422 23. BOOST DOSE (cGy)..............
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| 24 | 127 24. INTENT OF RADIATION TREATMENT.
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| 25 | 75 25. REASON FOR NO RADIATION.......
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| 26 | 26. TYPE OF CHEMOTHERAPEUTIC AGENTS ADMINISTERED:
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| 27 | 1424 27. CHEMOTHERAPEUTIC TOXICITY.....
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| 28 | 1425 28. CHEMOTHERAPY/SURGERY SEQUENCE.
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| 29 | Do not answer data items 15-18.
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| 30 | Proceed to data item 19.
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| 31 | 19. REGIONAL DOSE (cGy)...........:
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| 32 | 20. NUMBER OF TREATMENTS TO THIS
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| 33 | 21. REGIONAL TREATMENT MODALITY...:
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| 34 | 22. RADIATION/SURGERY SEQUENCE....:
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| 35 | 23. BOOST DOSE (cGy)..............: Not administered
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| 36 | 24. INTENT OF RADIATION TREATMENT.:
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| 37 | 25. REASON FOR NO RADIATION.......:
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| 38 | Do not answer data items 26-28.
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| 39 | Proceed to data item 29.
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| 40 | COMPLICATION #1 may not be blank
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| 41 | 81 30. INITIALS OF CASE ABSTRACTOR...
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| 42 | 90 31. DATE CASE WAS ABSTRACTED......
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| 43 | 2. DURATION OF TOBACCO USE.......:
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| 44 | 3. PERSONAL HISTORY OF OTHER
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| 45 | 4. SYMPTOMS PRESENT AT INITIAL DIAGNOSIS:
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| 46 | SHORTNESS OF BREATH..........:
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| 47 | PALPABLE LYMPH NODES.........:
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| 48 | 5. SCREENING FOR HIGH RISK/ASYMPTOMATIC PRESENTATION:
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| 49 | CT SCAN......................:
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| 50 | 6. INITIAL DIAGNOSTIC STUDIES (PRE-THERAPY):
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| 51 | HISTORY AND PHYSICAL.........:
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| 52 | THOROCOTOMY/OPEN BIOSPY......:
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| 53 | Print Lung (NSCLC) PCE
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| 54 | TUMOR EVALUATION
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| 55 | 7. PULMONARY FUNCTION TESTS:
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| 56 | FVC (forced vital capacity)..:
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| 57 | FEV (forced expiratory vol)..:
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| 58 | 8. LIVER FUNCTION TESTS..........:
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| 59 | 9. RADIOLOGICAL EVALUATION:
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| 60 | BONE SCAN....................:
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| 61 | VASCULAR INVASION...........:
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| 62 | MEDIASTINAL LYMPH NODES.....:
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| 63 | SIZE OF DOMINANT TUMOR (mm).:
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| 64 | NUMBER OF TUMORS............:
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| 65 | EVIDENCE OF METASTASIS......:
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| 66 | MRI SCAN OF CHEST............:
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| 67 | MRI SCAN OF BRAIN............:
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| 68 | X-RAY OF CHEST...............:
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| 69 | 10. PRE-OP LYMPH NODE MAPPING:
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| 70 | HIGHEST MEDIASTINAL (level 1):
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| 71 | UPPER PARATRACHEAL (level 2):
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| 72 | PREVASCULAR AND RETROTRACHEAL
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| 73 | LOWER PARATRACHEAL (level 4):
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| 74 | PULMONARY LIGAMENT (level 9):
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| 75 | 11. DATE OF FIRST TISSUE DIAGNOSIS:
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| 76 | 12. DISTANCE IN MILLIMETERS TO CLOSEST MARGIN:
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| 77 | 13. FROZEN SECTION................:
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| 78 | CHEST WALL...................:
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| 79 | 15. SCOPE OF OPERATIVE MEDIASTINAL LYMPH NODE ASSESSMENT:
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| 80 | 16. HCT (HEMATOCRIT) VALUES BEFORE
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| 81 | 17. TOTAL PERI-OPERATIVE BLOOD
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| 82 | 18. PERI-OPERATIVE DEATH..........:
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| 83 | 19. REGIONAL DOSE (cGy)...........:
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| 84 | 20. NUMBER OF TREATMENTS TO THIS
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| 85 | 21. REGIONAL TREATMENT MODALITY...:
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| 86 | 22. RADIATION/SURGERY SEQUENCE....:
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| 87 | 23. BOOST DOSE (cGy)..............:
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| 88 | 24. INTENT OF RADIATION TREATMENT.:
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| 89 | 25. REASON FOR NO RADIATION.......:
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| 90 | 26. TYPE OF CHEMOTHERAPEUTIC AGENTS ADMINISTERED:
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| 91 | 27. CHEMOTHERAPEUTIC TOXICITY.....:
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| 92 | 28. CHEMOTHERAPY/SURGERY SEQUENCE.:
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| 93 | COMPLICATION #1..............: 000.00 No complications
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| 94 | 29. INITIALS OF CASE ABSTRACTOR...:
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| 95 | 30. DATE CASE WAS ABSTRACTED......:
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| 96 | The Class of Case is not 0, 1, 2 or 6.
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| 97 | The BEHAVIOR is not 2 (melanoma in situ) or 3 (malignant).
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| 98 | 9:Print Melanoma PCE
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| 99 | This primary does not satisfy the Melanoma PCE eligibility criteria:
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| 100 | 1999 Patient Care Evaluation Study of Melanoma
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| 101 | 10. PERSONAL HISTORY OF MELANOMA
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| 102 | 11. PERSONAL HISTORY OF OTHER CANCER
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| 103 | 12. PREGNANCY AT INITIAL DX
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| 104 | 13. EXOGENOUS HORMONES
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| 105 | 1. INSTITUTION ID NUMBER........:
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| 106 | 2. ACCESSION NUMBER.............:
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| 107 | 3. SEQUENCE NUMBER..............:
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| 108 | 9 4. POSTAL CODE AT DIAGNOSIS.....
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| 109 | 5. DATE OF BIRTH................:
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| 110 | 9 7. SPANISH ORIGIN...............
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| 111 | 18 9. PRIMARY PAYER AT DIAGNOSIS...
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| 112 | 1100 10. PERSONAL HISTORY OF MELANOMA.
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| 113 | 1101 11. PERSONAL HISTORY OF OTHER CA.//
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| 114 | 1ST SITE CODE...............: C88.8
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| 115 | DATE DIAGNOSED..............: 88/8888
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| 116 | 2ND SITE CODE...............: C88.8
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| 117 | 1ST SITE CODE...............: C99.9
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| 118 | DATE DIAGNOSED..............: 99/9999
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| 119 | 2ND SITE CODE...............: C99.9
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| 120 | 1102 1ST SITE CODE...............//
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| 121 | 1103 DATE DIAGNOSED..............//
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| 122 | 1104 2ND SITE CODE...............//
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| 123 | 1105 DATE DIAGNOSED..............//
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| 124 | PREGNANCY AND HORMONES
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| 125 | 12. PREGNANCY AT INITIAL DX......: NA, male
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| 126 | 13. EXOGENOUS HORMONES...........: NA, male patient
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| 127 | 1106 12. PREGNANCY AT INITIAL DX......
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| 128 | 1107 13. EXOGENOUS HORMONES...........
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| 129 | 14. CLASS OF CASE
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| 130 | 15. DATE OF INITIAL DIAGNOSIS
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| 131 | 16. PRIMARY SITE (ICD-O-2)
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| 132 | 17. LOCATION OF DISEASE PRESENTATION
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| 133 | 20. BEHAVIOR CODE(ICD-O-2)
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| 134 | 20. BEHAVIOR CODE (ICD-O-2)
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| 135 | 14. CLASS OF CASE................:
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| 136 | 15. DATE OF INITIAL DIAGNOSIS....:
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| 137 | 16. PRIMARY SITE (ICD-O-2).......:
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| 138 | 17. LOC OF DISEASE PRESENTATION..: NA, primary site known
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| 139 | 1108 17. LOC OF DISEASE PRESENTATION..
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| 140 | 20. BEHAVIOR CODE (ICD-O-2)......:
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| 141 | 26 22. DIAGNOSTIC CONFIRMATION......
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| 142 | 23. SIZE OF TUMOR (MELANOMA)
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| 143 | 26. EXTRANODAL EXTENSION
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| 144 | 28. NUMBER OF SATELLITE NODULES
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| 145 | 29. LOCATION OF IN-TRANSIT NODULES
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| 146 | 31. CLARK'S LEVEL OF INVASION
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| 147 | 32. ANGIOLYMPHATIC INVASION
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| 148 | 33. PERINEURAL INVASION
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| 149 | 34. GENERAL SUMMARY STAGE
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| 150 | 35. AJCC CLINICAL STAGE (cTNM)
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| 151 | 37. CLINICALLY AMELANOTIC
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| 152 | 38. AJCC PATHOLOGIC STAGE (pTNM)
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| 153 | 39. STAGED BY
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| 154 | TABLE III- EXTENT OF DISEASE AND AJCC STAGE
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| 155 | 1132 23. SIZE OF TUMOR (MELANOMA).....
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| 156 | 33 24. REGIONAL NODES EXAMINED......
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| 157 | 32 25. REGIONAL NODES POSITIVE......
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| 158 | 1110 26. EXTRANODAL EXTENSION.........
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| 159 | SATELLITE NODULES OF SKIN OR SUBCUTANEOUS TISSUE
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| 160 | 28. NUMBER OF SATELLITE NODES....: No satellite nodules
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| 161 | 28. NUMBER OF SATELLITE NODES....: NA, non-cutaneous melanoma
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| 162 | 28. NUMBER OF SATELLITE NODES....: Unknown
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| 163 | 1112 28. NUMBER OF SATELLITE NODULES..
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| 164 | 1113 29. LOC OF IN-TRANSIT NODULES....
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| 165 | 31. CLARK'S LEVEL OF INVASION....: NA, primary site unknown
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| 166 | 1115 31. CLARK'S LEVEL OF INVASION....
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| 167 | 32. ANGIOLYMPHATIC INVASION......: NA, site unknown or ocular
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| 168 | 1116 32. ANGIOLYMPHATIC INVASION......
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| 169 | 33. PERINEURAL INVASION..........: NA, site unknown or ocular
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| 170 | 1117 33. PERINEURAL INVASION..........
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| 171 | 35 34. GENERAL SUMMARY STAGE........
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| 172 | 35. AJCC CLINICAL STAGE (cTNM):
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| 173 | 36. ULCERATION,,,,,,,,,..........: NA, site unknown or ocular
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| 174 | 37. CLINICALLY AMELANOTIC........: NA, site unknown or ocular
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| 175 | 1119 37. CLINICALLY AMELANOTIC........
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| 176 | 38. AJCC PATHOLOGIC STAGE (pTNM):
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| 177 | 39. STAGED BY:
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| 178 | 19 CLINICAL STAGE...............
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| 179 | 89 PATHOLOGIC STAGE.............
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| 180 | SENTINEL NODES
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| 181 | TABLE IV - FIRST COURSE OF TREATMENT
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| 182 | 346 40. PROTOCOL ELIGIBILITY STATUS...
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| 183 | 41. PROTOCOL PARTICIPATION........: Not on/NA
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| 184 | 41. PROTOCOL PARTICIPATION........: Unknown
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| 185 | 560 41. PROTOCOL PARTICIPATION........
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| 186 | 42. DATE OF FIRST COURSE TREATMENT:
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| 187 | 43. DATE OF NON CA-DIR SURGERY....:
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| 188 | 44. NON CANCER-DIRECTED SURGERY...:
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| 189 | 1109 45. TYPE OF BIOPSY................
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| 190 | 46. DATE OF CANCER-DIR SURGERY....:
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| 191 | 47. SURGICAL APPROACH.............:
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| 192 | 48. SURGERY OF PRIMARY SITE.......:
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| 193 | 49. SURGICAL MARGINS..............:
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| 194 | 50. DISTANCE FROM TUMOR TO EDGE OF SPECIMEN......................: 998 NA, surgery not performed
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| 195 | 1120 50. DISTANCE FROM TUMOR TO EDGE OF SPECIMEN......................
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| 196 | 51. SCOPE OF LYMPH NODE SURGERY...:
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| 197 | 52. NUMBER OF LYMPH NODES REMOVED.:
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| 198 | 53. SURGERY OF OTHER REGIONAL SITE(S), DISTANT SITE(S),
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| 199 | 55. SURGICAL CLOSURE..............: NA, surgery not performed
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| 200 | 55. SURGICAL CLOSURE..............: Unknown
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| 201 | 1121 55. SURGICAL CLOSURE..............
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| 202 | 56. REASON FOR NO SURGERY.........:
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| 203 | 57. PRE-OP LYMPHOSCINTIGRAPHY.....: NA, ocular site
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| 204 | 1122 57. PRE-OP LYMPHOSCINTIGRAPHY.....
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| 205 | 58. SENTINEL NODES DETECTED BY....: NA, not done, ocular site
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| 206 | 59. SENTINEL NODE BIOPSY..........: NA, not done, ocular site
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| 207 | 60. SENTINEL NODES EXAMINED.......: NA, not done, ocular site
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| 208 | 58. SENTINEL NODES DETECTED BY....: Unknown
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| 209 | 59. SENTINEL NODE BIOPSY..........: Unknown
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| 210 | 60. SENTINEL NODES EXAMINED.......: Unknown
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| 211 | 1123 58. SENTINEL NODES DETECTED BY....
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| 212 | 943 59. SENTINEL NODE BIOPSY..........
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| 213 | 1124 60. SENTINEL NODES EXAMINED.......
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| 214 | 61. SENTINEL NODES POSITIVE.......: NA, not done, no exam, ocular site
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| 215 | 62. HOW WAS SENTINEL NODE PATHOLOGICALLY EXAMINED.......: NA, not done, ocular site
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| 216 | 61. SENTINEL NODES POSITIVE.......: Unknown
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| 217 | 1125 61. SENTINEL NODES POSITIVE.......
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| 218 | 1126 62. HOW WAS SENTINEL NODE PATHOLOGICALLY EXAMINED.......
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| 219 | 63. IF SENTINEL NODE(S) POSITIVE:
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| 220 | WAS COMPLETE LYMPH NODE DISSECTION PERFORMED..........: NA, not done, no + nodes, ocular site
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| 221 | NUMBER OF BASINS DETECTED.....: NA, not done, no + nodes, ocular site
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| 222 | NUMBER OF BASINS POSITIVE.....: NA, not done, no basins dissected, ocular
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| 223 | NUMBER OF BASINS DETECTED.....: Unknown
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| 224 | NUMBER OF BASINS POSITIVE.....: Unknown
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| 225 | 1127 WAS COMPLETE LYMPH NODE DISSECTION PERFORMED..........
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| 226 | NUMBER OF BASINS DETECTED....: NA, not done, no + nodes, ocular site
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| 227 | NUMBER OF BASINS POSITIVE....: NA, not done, no basins dissected, ocular
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| 228 | NUMBER OF BASINS DETECTED....: Unknown
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| 229 | NUMBER OF BASINS POSITIVE....: Unknown
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| 230 | 1128 NUMBER OF BASINS DETECTED.....
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| 231 | 1129 NUMBER OF BASINS POSITIVE.....
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| 232 | 64. DATE RADIATION STARTED........:
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| 233 | 65. RADIATION THERAPY.............:
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| 234 | 66. REASON FOR NO RADIATION.......:
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| 235 | 67. DATE CHEMOTHERAPY STARTED.....:
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| 236 | 69. INTRAVENOUS THERAPY...........: NA, chemotherapy not administered
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| 237 | 69. INTRAVENOUS THERAPY...........: Unknown if administered
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| 238 | 1130 69. INTRAVENOUS THERAPY...........
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| 239 | 70. DATE HORMONE THERAPY STARTED..:
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| 240 | 71. HORMONE THERAPY...............:
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| 241 | 72. DATE IMMUNOTHERAPY STARTED....:
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| 242 | 74. IMMUNOTHERAPEUTIC AGENTS ADMINISTERED:
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| 243 | VACCINE THERAPY...............: NA
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| 244 | GENE THERAPY..................: NA
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| 245 | COLONY STIMULATING FACTORS....: NA
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| 246 | OTHER GIVEN, TYPE UNKNOWN.....: NA
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| 247 | VACCINE THERAPY...............: Unknown
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| 248 | GENE THERAPY..................: Unknown
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| 249 | COLONY STIMULATING FACTORS....: Unknown
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| 250 | OTHER GIVEN, TYPE UNKNOWN.....: Unknown
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| 251 | 884 VACCINE THERAPY...............
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| 252 | 1131 GENE THERAPY..................
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| 253 | 559 COLONY STIMULATING FACTORS....
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| 254 | 386 OTHER GIVEN, TYPE UNKNOWN.....
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| 255 | 75. DATE OTHER TREATMENT STARTED..:
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| 256 | 76. OTHER TREATMENT...............:
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| 257 | 77. DATE OF FIRST RECURRENCE
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| 258 | 78. TYPE OF FIRST RECURRENCE
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| 259 | 79. OTHER TYPE OF FIRST RECURRENCE
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| 260 | 77. TYPE OF FIRST RECURRENCE
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| 261 | 78. DATE OF FIRST RECURRENCE
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| 262 | TABLE V - FIRST RECURRENCE
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| 263 | 70 77. DATE OF FIRST RECURRENCE......
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| 264 | 71 78. TYPE OF FIRST RECURRENCE......
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| 265 | 71.4 79. OTHER TYPE OF 1ST RECURRENCE..
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| 266 | 80. DATE OF LAST CONTACT OR DEATH
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| 267 | 81. VITAL STATUS
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| 268 | 82. CANCER STATUS
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| 269 | TABLE VI - STATUS AT LAST CONTACT
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| 270 | 80. DATE OF LAST CONTACT OR DEATH.:
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| 271 | 15 81. VITAL STATUS..................
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| 272 | 82. CANCER STATUS.................:
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| 273 | 83. COMPLETED BY
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| 274 | 84. REVIEWED BY CANCER COMMITTEE
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| 275 | TABLE VII - OTHER INFORMATION
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| 276 | 81 83. COMPLETED BY..................
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| 277 | 82 84. REVIEWED BY CANCER COMMITTEE..
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| 278 | 1. INSTITUTION ID NUMBER...........:
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| 279 | 2. ACCESSION NUMBER................:
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| 280 | 3. SEQUENCE NUMBER.................:
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| 281 | 4. POSTAL CODE AT DIAGNOSIS........:
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| 282 | 5. DATE OF BIRTH...................:
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| 283 | 7. SPANISH ORIGIN..................:
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| 284 | 9. PRIMARY PAYER AT DIAGNOSIS......:
|
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| 285 | 10. PERSONAL HISTORY OF MELANOMA....:
|
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| 286 | 11. PERSONAL HISTORY OF OTHER CA....:
|
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| 287 | 1ST SITE CODE..................:
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| 288 | DATE DIAGNOSED.................:
|
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| 289 | 2ND SITE CODE..................:
|
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| 290 | PREGNANCY AND HORMONES
|
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| 291 | 12. PREGNANCY AT INITIAL DX.........:
|
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| 292 | 13. EXOGENOUS HORMONES..............:
|
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| 293 | 14. CLASS OF CASE...................:
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| 294 | 15. DATE OF INITIAL DIAGNOSIS.......:
|
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| 295 | 16. PRIMARY SITE (ICD-O-2)..........:
|
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| 296 | 17. LOC OF DISEASE PRESENTATION.....:
|
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| 297 | 20. BEHAVIOR CODE (ICD-O-2).........:
|
|---|
| 298 | 22. DIAGNOSTIC CONFIRMATION.........:
|
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| 299 | Print Melanoma PCE
|
|---|
| 300 | 1999 Patient Care Evaluation Study of Melanoma
|
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| 301 | TABLE III - EXTENT AND STAGE OF DISEASE
|
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| 302 | 23. SIZE OF TUMOR (mm)..............:
|
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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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