[604] | 1 | English French Notes Complete/Exclude
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| 2 | DATE OF LAST CONTACT:
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| 3 | TUMOR STATUS:
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| 4 | ICD Revision:
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| 5 | Place of Death:
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| 6 | Care Center at Death:
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| 7 | Autopsy:
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| 8 | Autopsy Date/Time:
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| 9 | Autopsy No:
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| 10 | ICD Cause of Death:
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| 11 | Cause of Death/Cancer:
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| 12 | Date of Death:
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| 13 | Path/autopsy:
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| 14 | Religion:
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| 15 | Marital Status at Dx:
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| 16 | Occupation:
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| 17 | Last Date:
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| 18 | Type of Tobacco user:
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| 19 | YR. Quit Tobacco Use:
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| 20 | Yrs. of Alcohol Use:
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| 21 | Drinks per-day:
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| 22 | Yr. Quit Drinking:
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| 23 | Family Member with Cancer:
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| 24 | Cancer:
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| 25 | Primary Surgeon:
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| 26 | Managing Physician:
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| 27 | Following Physician:
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| 28 | Other Physician 3:
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| 29 | Other Physician 4:
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| 30 | DX Date:
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| 31 | Class of Case:
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| 32 | Type of Reporting Source:
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| 33 | Histology:
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| 34 | Dx Facility:
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| 35 | Text Histology:
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| 36 | Grade:
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| 37 | Tumor Marker 2:
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| 38 | ICDO-Site:
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| 39 | Referring Facility:
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| 40 | Laterality:
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| 41 | Transfer Facility:
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| 42 | DX Confirmation:
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| 43 | Primary Payer at Diagnosis:
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| 44 | IP/OP status:
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| 45 | Screening Result:
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| 46 | Screening Date:
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| 47 | Presentation at Cancer Conference:
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| 48 | Date of Cancer Conference:
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| 49 | Referral to Support Services:
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| 50 | Site/Gp:
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| 51 | Primary Sequence No:
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| 52 | Text-Primary Site Title:
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| 53 | Text-Dx Proc-PE:
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| 54 | Text-Dx Proc-X-ray/scan:
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| 55 | Text-Dx Proc-Op:
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| 56 | Text-Dx Proc-Lab Tests:
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| 57 | Text-Dx Proc-Scopes:
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| 58 | Text-Dx Proc-Path:
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| 59 | Text Primary Site:
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| 60 | Text Dx Proc-Phys.Exam:
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| 61 | Text Dx Proc-Xray/Scan:
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| 62 | Text Dx Proc-Operation:
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| 63 | Text Dx Proc-Lab Tests:
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| 64 | Text Dx Proc-Endoscopy:
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| 65 | Text Dx Proc-Path/Cyto:
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| 66 | Clinical TNM:
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| 67 | Clinical T:
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| 68 | Pathologic T:
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| 69 | Clinical N:
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| 70 | Pathologic N:
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| 71 | Clinical M:
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| 72 | Pathologic M:
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| 73 | Clinical Stage Group:
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| 74 | Staged By (Clin):
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| 75 | Other Stage:
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| 76 | Size of Tumor:
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| 77 | Positive nodes:
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| 78 | Peripheral Blood Inv.:
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| 79 | Nodes Examined:
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| 80 | Associated with HIV:
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| 81 | Extension:
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| 82 | Metastasis-1:
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| 83 | Lymph Nodes:
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| 84 | Metastasis-2:
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| 85 | General Summary Stage:
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| 86 | Metastasis-3:
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| 87 | Dx/Stging/Palliative Proc:
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| 88 | Surgery of Primary Site Date:
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| 89 | Surgical Approach:
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| 90 | Reconstruction/Restoration:
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| 91 | - Text Rx-Surgery/No Surgery:
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| 92 | - Text Rx-Other Cancer Directed Surgery:
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| 93 | Surgical Margins:
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| 94 | Reason for No Surgery:
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| 95 | Radiation Date:
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| 96 | Regional Dose:
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| 97 | Radiation tx not administered
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| 98 | NA, brachytherapy/radioisotopes administered
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| 99 | Dose unknown/unknown if administered
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| 100 | Regional Treatment Modality:
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| 101 | Reason for No Radiation:
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| 102 | Sequence:
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| 103 | Radiation Treatment - (either radiation or prophylactic)
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| 104 | Target Place:
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| 105 | Target Site:
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| 106 | Radiation Source:
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| 107 | Total due to target:
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| 108 | Predominant FXN size:
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| 109 | Start Date:
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| 110 | Stop Date:
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| 111 | - Text Rx-Rad (BEAM):
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| 112 | - Text Rx-Rad-Other:
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| 113 | Radiation Therapy to CNS DAte:
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| 114 | Chemotherapy Date:
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| 115 | Reason for No Chemotherapy:
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| 116 | Text-Rx-Chemo:
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| 117 | Hormone Therapy Date:
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| 118 | Reason for No Hormone Therapy:
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| 119 | Text-Rx-Hormone:
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| 120 | Immunotherapy Date:
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| 121 | Text-RX-Immunotherapy:
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| 122 | Other Therapy Date:
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| 123 | Text-Rx-Other:
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| 124 | Protocol Eligibility Status:
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| 125 | Protocol Participation:
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| 126 | Text Remarks:
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| 127 | Physician's Staging:
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| 128 | MD:
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| 129 | QA Selected:
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| 130 | QA Review:
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| 131 | QA Date:
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| 132 | Recurrence Date:
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| 133 | Distant Site 1:
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| 134 | Type of 1st Recurrence:
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| 135 | Distant Site 2:
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| 136 | Distant Site 3:
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| 137 | Subsequent Recurrence Date:
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| 138 | Type of Subsequent Recurrence:
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| 139 | ********** Print Abstract-Brief **********
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| 140 | Reporting Hospital:
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| 141 | Date of First Contact:
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| 142 | Histology:
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| 143 | Acc/Seq Number:
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| 144 | Medical Record Number:
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| 145 | Telephone:
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| 146 | Type of Reporting Source:
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| 147 | Class of Case:
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| 148 | Age at Dx:
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| 149 | Birthplace:
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| 150 | Facility referred from:
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| 151 | Facility referred to:
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| 152 | Date Dx:
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| 153 | Following physician:
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| 154 | Primary surgeon:
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| 155 | Physician #3:
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| 156 | Physician #4:
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| 157 | Laterality:
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| 158 | Diagnostic confirmation:
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| 159 | Tumor size:
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| 160 | Extension:
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| 161 | Regional lymph nodes positive:
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| 162 | Regional lymph nodes examined:
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| 163 | Lymph nodes:
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| 164 | SEER Summary Stage 2000:
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| 165 | Sites of metastases:
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| 166 | Clinical TNM:
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| 167 | AJCC Stage (Clin):
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| 168 | AJCC Stage (Path):
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| 169 | FIRST COURSE OF TREATMENT SUMMARY:
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| 170 | Dx/Staging/Palliative Proc:
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| 171 | Surgery of primary site:
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| 172 | Reason for no surgery:
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| 173 | Radiation:
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| 174 | Reason for no radiation:
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| 175 | Hormone Therapy:
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| 176 | Immunotherapy:
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| 177 | Other treatment:
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| 178 | Abstract Date:
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| 179 | Abstracter:
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| 180 | Date of Last Patient Contact:
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| 181 | AVAILABLE CONTACTS
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| 182 | ***********DEATH INFORMATION**********
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| 183 | Date:
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| 184 | Cause of Death/Cancer:
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| 185 | ICD Cause:
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| 186 | Care Center:
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| 187 | ICD Revision:
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| 188 | Path/Autopsy (Gross & Micro):
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| 189 | State Hospital No:
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| 190 | IDCO SITE:
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| 191 | GRADE:
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| 192 | Sequence Number:
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| 193 | DATE of LAST CONTACT:
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| 194 | VITAL STATUS:
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| 195 | ABSTRACTER:
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| 196 | ABSTRACT DATE:
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| 197 | Spanish origin:
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| 198 | CONTACT NAME
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| 199 | Follow-up Status:
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| 200 | DATE LAST
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| 201 | Site/Gp:
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| 202 | PATIENT SUMMARY
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| 203 | Date of Last Contact or Death:
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| 204 | Autopsy Date/Time:
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| 205 | Autopsy #:
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| 206 | Cause of Death:
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| 207 | Abstract Status:
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| 208 | Date Case Completed:
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| 209 | Primary Site:
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| 210 | Patient Summary/Abstract for:
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| 211 | ** PATIENT IDENTIFICATION **
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| 212 | Address at Dx:
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| 213 | Accession No:
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| 214 | Hospital No:
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| 215 | Accession Yr:
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| 216 | Primary Sequence No:
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| 217 | Phone Residence:
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| 218 | Marital Status DX:
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| 219 | Agent Orange Exp:
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| 220 | Ionizing Rad Exp:
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| 221 | Chemical Exp:
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| 222 | Asbestos Exp:
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| 223 | Persian Gulf Svc:
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| 224 | Middle East Svc:
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| 225 | Somalia Svc:
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| 226 | Comorbidity/Complication #1:
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| 227 | Comorbidity/Complication #2:
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| 228 | Comorbidity/Complication #3:
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| 229 | Comorbidity/Complication #4:
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| 230 | Comorbidity/Complication #5:
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| 231 | Comorbidity/Complication #6:
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| 232 | Primary Surgeon:
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| 233 | Following Physician:
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| 234 | ** CANCER IDENTIFICATION **
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| 235 | Date DX:
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| 236 | Histology:
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| 237 | AFIP Submission:
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| 238 | Primary Site:
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| 239 | ** STAGE OF DISEASE AT DIAGNOSIS **
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| 240 | Clinical TNM:
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| 241 | Pathologic TNM:
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| 242 | Clinical Stage Group:
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| 243 | Pathologic Stage Group:
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| 244 | Staged By (Clinical Stage):
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| 245 | Staged By (Pathologic Stage):
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| 246 | Other Stage:
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| 247 | Pathologic Extension:
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| 248 | Lymph Nodes:
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| 249 | General Summary Stage:
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| 250 | Metastasis-1:
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| 251 | Metastasis-2:
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| 252 | Metastasis-3:
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| 253 | ** FIRST COURSE OF TREATMENT **
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| 254 | First Course of Treatment Date:
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| 255 | Date of No Treatment:
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| 256 | Surgery of Primary (F):
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| 257 | Surgery of Primary @Fac (F):
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| 258 | Surgical Margins:
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| 259 | Scope of LN Surgery (F):
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| 260 | Scope of LN Surgery @Fac (F):
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| 261 | Surg Proc/Other Site (F):
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| 262 | Surg Proc/Other Site @Fac (F):
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| 263 | Reason for No Surgery:
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| 264 | Regional Dose:
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| 265 | Regional Treatment Modality:
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| 266 | Chemotherapy:
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| 267 | Chemotherapy @Fac:
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| 268 | Hormone Therapy:
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| 269 | Hormone Therapy @Fac:
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| 270 | Immunotherapy:
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| 271 | Immunotherapy @Fac:
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| 272 | Other Treatment:
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| 273 | Other Treatment @Fac:
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| 274 | Year Put on Protocol:
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| 275 | ** SUBSEQUENT THERAPY **
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| 276 | Subsequent Treatment Date:
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| 277 | Surgery of Primary Site:
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| 278 | Hema Trans/Endocrine Proc:
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| 279 | ** FOLLOW-UP HISTORY **
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| 280 | Cause of Death:
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| 281 | 1998 Patient Care Evaluation Study of Prostate Cancer
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| 282 | 1998 Patient Care Evaluation Study of Prostate Cancer
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| 283 | 8. PRIMARY PAYER AT DIAGNOSIS
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| 284 | 9. FAMILY HISTORY OF PROSTATE CANCER
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| 285 | 8. PRIMARY PAYER AT DIAGNOSIS
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| 286 | 9. FAMILY HISTORY OF PROSTATE CANCER
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| 287 | TABLE I - GENERAL INFORMATION
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| 288 | 9 4. POSTAL CODE AT DIAGNOSIS.........
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| 289 | 9 7. SPANISH ORIGIN...................
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| 290 | 18 8. PRIMARY PAYER AT DIAGNOSIS.......
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| 291 | 657 9. FAMILY HISTORY OF PROSTATE CANCER
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| 292 | 10. CLASS OF CASE
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| 293 | 11. SYMPTOMS PRESENT AT INITIAL DIAGNOSIS
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| 294 | 12. INITIAL METHODS OF DIAGNOSIS
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| 295 | 13. DIAGNOSTIC EVALUATION
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| 296 | 14. RESULTS OF MOST RECENT PRE-TREATMENT PSA TEST
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| 297 | 18. BEHAVIOR CODE(ICD-O-2)
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| 298 | 20. BIOPSY PROCEDURE
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| 299 | 21. GUIDANCE OF BIOPSY TO PRIMARY
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| 300 | 22. BIOPSY APPROACH FOR PRIMARY
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| 301 | 23. BIOPSY OF OTHER THAN PRIMARY
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| 302 | 24. DIAGNOSTIC CONFIRMATION
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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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