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