Rosuvastatin

James A. Rowley, M.D.

• Assistant Professor of Medicine
• Division of Pulmonary/Critical Care Medicine
• Wayne State University School of Medicine
• Detroit, MI

Always refer to the respective chapter in the Manual for disease-specific rules for classification is cholesterol in shrimp good order 10mg rosuvastatin, as this form is not representative of all rules cholesterol lowering diet plan chart purchase generic rosuvastatin from india, exceptions and instructions for this disease cholesterol ratio heart disease risk buy generic rosuvastatin line. This form may be used by physicians to record data on T cholesterol guidelines calculator rosuvastatin 10 mg on line, N, and M categories; prognostic stage groups; additional prognostic factors; cancer grade; and other important information. This form may be useful for recording information in the medical record and for communicating information from physicians to the cancer registrar. It is best to use a separate form for each time point staged along the continuum for an individual cancer patient. However, if all time points are recorded on a single form, the staging basis for each element should be identified clearly. Criteria: First therapy is systemic and/or radiation therapy and is followed by surgery. Any of the M categories (cM0, cM1, or pM1) may be used with pathological stage grouping. Intratubular spread of this urothelial carcinoma (involvement of renal collecting tubules without stromal invasion): 7 Histologic Grade (G) For squamous cell carcinoma and adenocarcinoma, the following grading schema is recommended. Urinary Bladder Urothelial Carcinomas, Squamous Cell Carcinoma and Adenocarcinoma arising in the Urinary Bladder have distinct Histologic Grade (G) sections. Urinary Bladder: Urothelial Carcinomas 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Always refer to the respective chapter in the Manual for disease-specific rules for classification, as this form is not representative of all rules, exceptions and instructions for this disease. This form may be used by physicians to record data on T, N, and M categories; prognostic stage groups; additional prognostic factors; cancer grade; and other important information. This form may be useful for recording information in the medical record and for communicating information from physicians to the cancer registrar. It is best to use a separate form for each time point staged along the continuum for an individual cancer patient. However, if all time points are recorded on a single form, the staging basis for each element should be identified clearly. Criteria: First therapy is systemic and/or radiation therapy and is followed by surgery. Any of the M categories (cM0, cM1, or pM1) may be used with pathological stage grouping. Urinary Bladder: Squamous Cell Carcinoma and Adenocarcinoma 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Always refer to the respective chapter in the Manual for disease-specific rules for classification, as this form is not representative of all rules, exceptions and instructions for this disease. This form may be used by physicians to record data on T, N, and M categories; prognostic stage groups; additional prognostic factors; cancer grade; and other important information. This form may be useful for recording information in the medical record and for communicating information from physicians to the cancer registrar. It is best to use a separate form for each time point staged along the continuum for an individual cancer patient. However, if all time points are recorded on a single form, the staging basis for each element should be identified clearly. Criteria: First therapy is systemic and/or radiation therapy and is followed by surgery. Any of the M categories (cM0, cM1, or pM1) may be used with pathological stage grouping. Urethra Urothelial Carcinomas, Squamous Cell Carcinoma and Adenocarcinoma arising in the Urethra have distinct Histologic Grade (G) sections. Additionally, there are different Definitions of Primary Tumor (T) for Male Penile and Female Urethra, and Prostatic Urethra. Please choose the appropriate staging form based on primary site and histologic type. Male Penile Urethra and Female Urethra: Urothelial Carcinomas 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Always refer to the respective chapter in the Manual for disease-specific rules for classification, as this form is not representative of all rules, exceptions and instructions for this disease. This form may be used by physicians to record data on T, N, and M categories; prognostic stage groups; additional prognostic factors; cancer grade; and other important information. This form may be useful for recording information in the medical record and for communicating information from physicians to the cancer registrar. It is best to use a separate form for each time point staged along the continuum for an individual cancer patient. However, if all time points are recorded on a single form, the staging basis for each element should be identified clearly. Criteria: First therapy is systemic and/or radiation therapy and is followed by surgery. Any of the M categories (cM0, cM1, or pM1) may be used with pathological stage grouping. Grade 1?3 for squamous cell carcinoma and adenocarcinoma: 7 Histologic Grade (G) Grade is reported by the grade value. Definition of primary tumor (T) for Ta, Tis, T1, and T2 with depth of invasion ranging from the epithelium to the urogenital diaphragm. Definition of primary tumor (T) for Ta, Tis, T1, T2, and T3 with depth of invasion ranging from the epithelium to the urogenital diaphragm. Male Penile and Female Urethra: Squamous Cell Carcinoma and Adenocarcinoma 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Always refer to the respective chapter in the Manual for disease-specific rules for classification, as this form is not representative of all rules, exceptions and instructions for this disease. This form may be used by physicians to record data on T, N, and M categories; prognostic stage groups; additional prognostic factors; cancer grade; and other important information. This form may be useful for recording information in the medical record and for communicating information from physicians to the cancer registrar. It is best to use a separate form for each time point staged along the continuum for an individual cancer patient. However, if all time points are recorded on a single form, the staging basis for each element should be identified clearly. Criteria: First therapy is systemic and/or radiation therapy and is followed by surgery. Any of the M categories (cM0, cM1, or pM1) may be used with pathological stage grouping. Definition of primary tumor (T) for Ta, Tis, T1, and T2 with depth of invasion ranging from the epithelium to the urogenital diaphragm. Definition of primary tumor (T) for Ta, Tis, T1, T2, and T3 with depth of invasion ranging from the epithelium to the urogenital diaphragm. Prostatic Urethra: Urothelial Carcinomas 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Always refer to the respective chapter in the Manual for disease-specific rules for classification, as this form is not representative of all rules, exceptions and instructions for this disease. This form may be used by physicians to record data on T, N, and M categories; prognostic stage groups; additional prognostic factors; cancer grade; and other important information. This form may be useful for recording information in the medical record and for communicating information from physicians to the cancer registrar. It is best to use a separate form for each time point staged along the continuum for an individual cancer patient. However, if all time points are recorded on a single form, the staging basis for each element should be identified clearly. Criteria: First therapy is systemic and/or radiation therapy and is followed by surgery. Any of the M categories (cM0, cM1, or pM1) may be used with pathological stage grouping. Grade 1?3 for squamous cell carcinoma and adenocarcinoma: 7 Histologic Grade (G) Grade is reported by the grade value. Prostatic Urethra: Squamous Cell Carcinoma and Adenocarcinoma 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Always refer to the respective chapter in the Manual for disease-specific rules for classification, as this form is not representative of all rules, exceptions and instructions for this disease. This form may be used by physicians to record data on T, N, and M categories; prognostic stage groups; additional prognostic factors; cancer grade; and other important information.

In addition cholesterol enhancing foods order rosuvastatin 10 mg free shipping, all studies that are judged to be methodo logically sound should be consistent with a relative risk of unity for any observed level of exposure and cholesterol ranges hdl ldl cheap rosuvastatin 10mg free shipping, when considered together definition du cholesterol cheap 10mg rosuvastatin overnight delivery, should provide a pooled estimate of relative risk which is at or near unity and has a narrow confidence interval cholesterol lowering foods in hindi discount rosuvastatin amex, due to sufficient popu lation size. Moreover, no individual study nor the pooled results of all the studies should show any consistent tendency for the relative risk of cancer to increase with increasing level of exposure. It is important to note that evidence of lack of carcinogenicity obtained in this way from several epidemiological studies can apply only to the type(s) of cancer studied and to dose levels and intervals between first exposure and observation of disease that are the same as or less than those observed in all the studies. Experience with human cancer indicates that, in some cases, the period from first exposure to the development of clinical cancer is seldom less than 20 years; latent periods substantially shorter than 30 years cannot provide evidence for lack of carcinogenicity. For several agents (aflatoxins, 4-aminobiphenyl, azathio prine, betel quid with tobacco, bischloromethyl ether and chloromethyl methyl ether (technical grade), chlorambucil, chlornaphazine, ciclosporin, coal-tar pitches, coal-tars, combined oral contraceptives, cyclophosphamide, diethylstilboestrol, melphalan, 8 methoxypsoralen plus ultraviolet A radiation, mustard gas, myleran, 2-naphthylamine, nonsteroidal estrogens, estrogen replacement therapy/steroidal estrogens, solar radiation, thiotepa and vinyl chloride), carcinogenicity in experimental animals was established or highly suspected before epidemiological studies confirmed their carcinogenicity in humans (Vainio et al. Although this association cannot establish that all agents and mixtures that cause cancer in experimental animals also cause cancer in humans, nevertheless, in the absence of adequate data on humans, it is biologically plausible and prudent to regard agents and mixtures for which there is sufficient evidence (see p. The possibility that a given agent may cause cancer through a species specific mechanism which does not operate in humans (see p. The nature and extent of impurities or contaminants present in the chemical or mixture being evaluated are given when available. Animal strain, sex, numbers per group, age at start of treatment and survival are reported. For experimental studies of mixtures, consideration is given to the possibility of changes in the physicochemical properties of the test substance during collection, storage, extraction, concentration and delivery. Chemical and toxicological interactions of the components of mixtures may result in nonlinear dose?response relationships. The relevance of results obtained, for example, with animal viruses analogous to the virus being evaluated in the monograph must also be considered. They may provide biological and mechanistic information relevant to the understanding of the process of carcinogenesis in humans and may strengthen the plausibility of a conclusion that the biological agent under evaluation is carcinogenic in humans. Guidelines for conducting adequate long-term carcinogenicity experiments have been outlined. Considerations of importance to the Working Group in the interpretation and eva luation of a particular study include: (i) how clearly the agent was defined and, in the case of mixtures, how adequately the sample characterization was reported; (ii) whether the dose was adequately monitored, particularly in inhalation experiments; (iii) whether the doses and duration of treatment were appropriate and whether the survival of treated animals was similar to that of controls; (iv) whether there were adequate numbers of animals per group; (v) whether animals of each sex were used; (vi) whether animals were allocated randomly to groups; (vii) whether the duration of observation was adequate; and (viii) whether the data were adequately reported. When benign tumours occur together with and originate from the same cell type in an organ or tissue as malignant tumours in a particular study and appear to represent a stage in the progression to malignancy, it may be valid to combine them in assessing tumour incidence (Huff et al. The occurrence of lesions presumed to be pre neoplastic may in certain instances aid in assessing the biological plausibility of any neo plastic response observed. If an agent or mixture induces only benign neoplasms that appear to be end-points that do not readily progress to malignancy, it should nevertheless be suspected of being a carcinogen and requires further investigation. Evidence of an increased incidence of neoplasms with increased level of exposure strengthens the inference of a causal association between the exposure and the develop ment of neoplasms. The form of the dose?response relationship can vary widely, depending on the particular agent under study and the target organ. Since many chemicals require metabolic activation before being converted into their reactive intermediates, both metabolic and pharmacokinetic aspects are important in determining the dose?response pattern. The statistical methods used should be clearly stated and should be the generally accepted techniques refined for this purpose (Peto et al. When there is no difference in survival between control and treatment groups, the Working Group usually compares the proportions of animals developing each tumour type in each of the groups. Otherwise, consideration is given as to whether or not appropriate adjustments have been made for differences in survival. Several survival-adjusted methods have been developed that do not require this distinction (Gart et al. The nature of the information selected for the summary depends on the agent being considered. For chemicals and complex mixtures of chemicals such as those in some occupa tional situations or involving cultural habits. Concise information is given on absorption, distribution (including placental transfer) and excretion in both humans and experimental animals. Studies that indicate the metabolic fate of the agent in humans and in experimental animals are summarized briefly, and comparisons of data on humans and on animals are made when possible. Comparative information on the relationship between exposure and the dose that reaches the target site may be of particular importance for extrapolation between species. Data are given on acute and chronic toxic effects (other than cancer), such as organ toxicity, increased cell proliferation, immunotoxicity and endocrine effects. Effects on reproduction, teratogenicity, fetotoxicity and embryotoxicity are also summarized briefly. Tests of genetic and related effects are described in view of the relevance of gene mutation and chromosomal damage to carcinogenesis (Vainio et al. The adequacy of the reporting of sample characterization is considered and, where necessary, commented upon; with regard to complex mixtures, such comments are similar to those described for animal carcinogenicity tests on p. The concentrations employed are given, and mention is made of whether use of an exogenous metabolic system in vitro affected the test result. Positive results in tests using prokaryotes, lower eukaryotes, plants, insects and cultured mammalian cells suggest that genetic and related effects could occur in mammals. Results from such tests may also give information about the types of genetic effect produced and about the involvement of metabolic activation. In-vitro tests for tumour-promoting activity and for cell transformation may be sensitive to changes that are not necessarily the result of genetic alterations but that may have specific relevance to the process of carcinogenesis. Genetic or other activity manifest in experimental mammals and humans is regarded as being of greater relevance than that in other organisms. The demonstration that an agent or mixture can induce gene and chromosomal mutations in whole mammals indi cates that it may have carcinogenic activity, although this activity may not be detectably expressed in any or all species. Relative potency in tests for mutagenicity and related effects is not a reliable indicator of carcinogenic potency. Negative results in tests for mutagenicity in selected tissues from animals treated in vivo provide less weight, partly because they do not exclude the possibility of an effect in tissues other than those examined. Moreover, negative results in short-term tests with genetic end-points cannot be considered to provide evidence to rule out carcinogenicity of agents or mixtures that act through other mechanisms. Factors that may lead to misleading results in short-term tests have been discussed in detail elsewhere (Montesano et al. When available, data relevant to mechanisms of carcinogenesis that do not involve structural changes at the level of the gene are also described. The adequacy of epidemiological studies of reproductive outcome and genetic and related effects in humans is evaluated by the same criteria as are applied to epidemio logical studies of cancer. Structure?activity relationships that may be relevant to an evaluation of the carcino genicity of an agent are also described. For biological agents?viruses, bacteria and parasites?other data relevant to carcinogenicity include descriptions of the pathology of infection, molecular biology (integration and expression of viruses, and any genetic alterations seen in human tumours) and other observations, which might include cellular and tissue responses to infection, immune response and the presence of tumour markers. Inadequate studies are generally not summarized: such studies are usually identified by a square-bracketed comment in the preceding text. Exposure to biological agents is described in terms of transmission and prevalence of infection. For each animal species and route of administration, it is stated whether an increased incidence of neoplasms or preneoplastic lesions was observed, and the tumour sites are indicated. If the agent or mixture produced tumours after prenatal exposure or in single dose experiments, this is also indicated. Toxi cological information, such as that on cytotoxicity and regeneration, receptor binding and hormonal and immunological effects, and data on kinetics and metabolism in experimental animals are given when considered relevant to the possible mechanism of the carcinogenic action of the agent. The results of tests for genetic and related effects are summarized for whole mammals, cultured mammalian cells and nonmammalian systems. When available, comparisons of such data for humans and for animals, and parti cularly animals that have developed cancer, are described. Thus, for example, the action of an agent on the expression of relevant genes could be summarized under both the first and second dimensions, even if it were known with reasonable certainty that those effects resulted from genotoxicity. It is recognized that the criteria for these evaluations, described below, cannot encompass all of the factors that may be relevant to an evaluation of carcinogenicity. In considering all of the relevant scientific data, the Working Group may assign the agent, mixture or exposure circumstance to a higher or lower category than a strict inter pretation of these criteria would indicate.

This includes cases of purely in situ carcinoma quitting cholesterol medication discount rosuvastatin 10mg on line, which biologically have no access to lymphatic or vascular channels below the basement membrane cholesterol formula purchase rosuvastatin no prescription. This field may be defaulted to a 9 or left blank for sites which do not require it to be collected cholesterol test in blood order generic rosuvastatin on line. Leaving the default as 9 for Lymphoma and Hematopoietic will create an edit error cholesterol lowering foods red yeast rice cheap rosuvastatin uk. The percentage of solid tumors that are clinically diagnosed only is an indication of whether casefinding includes sources beyond pathology reports. Complete casefinding must include both clinically and pathologically confirmed cases. Always code the procedure with the lower numeric value when presence of cancer is confirmed with multiple diagnostic methods. If diagnosed elsewhere, copies of the previous pathology or radiology reports included in the medical record may be used to code this field. All diagnostic reports in the medical record must be reviewed to determine the most definitive method used to confirm the diagnosis of cancer. If diagnosed prior to admission to the reporting facility, review the history section of the record to identify information regarding previous diagnostic tests and treatments. If the information in the medical record indicates a biopsy or resection of the tumor has been performed, assume the diagnostic confirmation is histological even if the pathology report is not available. Example: A patient comes in for a bone scan for staging of a known prostate cancer. It is noted 137 Texas Cancer Registry 2018/2019 Cancer Reporting Handbook Version 1. Examination of cells (rather than tissue) including but not limited to: sputum smears, bronchial brushings, bronchial washings, prostatic secretions, breast secretions, gastric fluid, spinal fluid, peritoneal fluid, pleural fluid, urinary sediment, cervical smears and vaginal smears. Assign code 4 when there is information that the diagnosis of cancer was microscopically confirmed, but the type of confirmation is unknown. Assign code 5 when the diagnosis of cancer is based on laboratory tests or marker studies with a clinical diagnosis for that specific cancer. The patient has elevated alpha-fetoprotein with a clinical diagnosis of liver cancer. Assign code 8 when the case was diagnosed by any clinical method not mentioned in preceding codes. Note: the diagnostic code must be changed to the lower (more specific) code if a more definitive code confirms the diagnosis during the course of the disease, regardless of time frame. A thoracentesis is performed for a patient who is found to have a large pleural effusion. Biopsy and later resection of the colon lesion revealed mucin-producing adenocarcinoma. Positive laboratory test/marker study Note: Includes cases with positive immunophenotyping or genetic studies and no histological confirmation 6 Direct visualization the tumor was visualized during a surgical/endoscopic procedure without microscopic only confirmation with no tissue resected for microscopic exam. Most commonly the bone marrow provides several provisional diagnoses and the specific histologic type is determined through immunophenotyping or genetic testing. For cases diagnosed January 1, 2010 and later see the Hematopoietic and Lymphoid Neoplasm Database and Coding Manual at seer. Do not use code 1 if the provisional diagnosis was based on tissue, bone marrow, or blood and the immunophenotyping or genetic testing on that same tissue, bone marrow, or blood identified the specific disease (See code 3). Do not use diagnostic confirmation code 3 for cases diagnosed prior to January 1, 2010. Code 1: Positive histology Code 1 includes a provisional diagnosis and/or several provisional (differential) diagnoses which may or may not be preceded by approved ambiguous terminology. Tissue from lymph node(s), organ(s) or other tissue specimens from biopsy, frozen section, surgery or autopsy; 2. Bone marrow specimens (aspiration and biopsy) 140 Texas Cancer Registry 2018/2019 Cancer Reporting Handbook Version 1. Can be used as a histological diagnosis for any of the hematopoietic histologies (9590/3 9992/3) 4. Code 2: Positive cytology Code 2 is rarely used for Hematopoietic and Lymphoid neoplasms. Paraffin block specimens from concentrated spinal fluid, peritoneal fluid, or pleural fluid 3. Identifies a more specific histology (not preceded by ambiguous terminology) 141 Texas Cancer Registry 2018/2019 Cancer Reporting Handbook Version 1. Identifying a more specific histology: Bone marrow biopsy positive for acute myeloid leukemia (9861/3). Code Diagnostic Confirmation code 3, positive histology and positive genetic testing, which identified a more specific histology. Code Diagnostic Confirmation code 3, positive histology and positive immunophenotyping testing which identified a more specific histology. Confirming the histologic diagnosis: Bone marrow biopsy diagnosis is plasma cell dyscrasia. Code Diagnostic Confirmation 3, positive histology and positive genetic testing/immunophenotyping. Ambiguous terminology used with immunophenotyping: Bone marrow biopsy shows B lymphoblastic leukemia. Tip: Alphabet Soup Method for Genetics Data When determining whether to use Code 3 for Hematopoietic or Lymphoid Neoplasm, think about alphabet soup. Those letters, numbers, and plus signs would not be in the diagnosis documentation unless immunophenotyping or genetic testing was done. Code 4: Positive microscopic confirmation, method not specified Code 4 is rarely used for Hematopoietic and Lymphoid neoplasms. Assign code 4 when there is information that the diagnosis of cancer was microscopically confirmed, but the type of confirmation is unknown. Code 5: Positive laboratory test/marker study Assign code 5 when the diagnosis of cancer is based on laboratory tests, tumor marker studies, genetics or immunophenotyping that are clinically diagnostic for that specific cancer. Laboratory tests are listed under Definitive Diagnostic Methods in the Hematopoietic Database. Assign code 5 because the diagnosis is based on the positive Bence-Jones and there is no histologic confirmation in this case. Code 6: Direct visualization without microscopic confirmation Code 6 is rarely used for Hematopoietic and Lymphoid neoplasms. The operative report states the patient had lymphoma, but no biopsy or cytology was done 2. The diagnosis is determined by gross autopsy findings (no tissue or cytologic confirmation) 143 Texas Cancer Registry 2018/2019 Cancer Reporting Handbook Version 1. While clinical diagnosis is seldom used for solid tumors, it is a valid diagnostic method for certain hematopoietic neoplasms. For these neoplasms, biopsy, immunophenotyping, and genetic testing do not confirm the neoplasm. Code 9: Unknown whether or not microscopically confirmed; death certificate only Assign code 9 when it is unknown if the diagnosis was confirmed microscopically: 1. This code includes examination of fluid such as spinal fluid, peritoneal fluid, or pleural fluid. This code also includes paraffin block specimens from concentrated spinal fluid, peritoneal fluid, or pleural fluid. If there no provisional diagnosis or clinical suspicion of cancer, immunophenotyping or genetic testing would not be done. Code 1 and 3 do not apply because there is no histologic confirmation and positive immunophenotyping and or genetic studies in this example. The operative report may state that the patient had confirmation lymphoma but no biopsy or cytology was done or the the diagnosis is determined by gross autopsy findings (no tissue or cytologic confirmation). Assign code 7 when the diagnosis is confirmed by without microscopic radiology or other imaging techniques only. For these neoplasms, the biopsy, immunophenotyping, and genetic testing do not confirm the neoplasm. Changing Abstract Information There are some circumstances under which the information originally coded in the abstract should be updated. At the time of diagnosis a patient is diagnosed with liver metastasis but primary site cannot be determined and the abstract is submitted as an unknown primary.

This data item can be used to more accurately assess the number of positive sentinel lymph nodes biopsied separate from the number of positive lymph nodes identified during additional subsequent regional node dissection procedures low cholesterol diet chart generic 10mg rosuvastatin visa, if performed cholesterol lowering food today tonight order rosuvastatin 10mg overnight delivery. If cholesterol levels percentage buy discount rosuvastatin 10mg on-line, during a sentinel node biopsy procedure bad cholesterol foods list best 10 mg rosuvastatin, a few non-sentinel nodes happen to be sampled and are positive, document the total number of positive nodes identified during the sentinel node procedure in this data item. As a result, when the sentinel lymph node biopsy is performed during the same procedure as the regional node dissection, only the overall total number of positive regional nodes (both sentinel and regional) is recorded; the number of positive sentinel nodes is not captured. Determination of the exact number of sentinel lymph nodes positive may require assistance from the managing physician for consistent coding. This data item is required for CoC-accredited facilities as of cases diagnosed 01/01/2018 and later. Rationale It is a known fact that sentinel lymph node biopsies have been under-reported. Additionally, the timing and results of sentinel lymph node biopsy procedures are used in quality of care measures. This data item can be used to more accurately assess the date of regional node dissection separate from the date of sentinel lymph node biopsy if performed. Record the date of regional lymph node dissection documented in the Regional Lymph Nodes Examined [830]. In order that registry data can be interoperable with other data sources, dates are transmitted in a format widely accepted outside of the registry setting. However, this does not necessarily mean that the way dates are entered in any particular registry software product has changed. Software providers can provide the best information about data entry in their own systems. The Date Regional Lymph Node Dissection Flag [683] is used to explain why Date of Regional Lymph Node Dissection is not a known date. See Date Regional Lymph Node Dissection Flag [683] for an illustration of the relationship among these items. This data item is required for CoC-accredited facilities as of cases diagnosed 01/01/2018 and later. Rationale As part of an initiative to standardize date fields, date flag fields were introduced to accommodate non date information that had previously been transmitted in date fields. Leave this item blank if Date of Regional Lymph Node Dissection [682] has a full or partial date recorded. Code Label 10 No information whatsoever can be inferred from this exceptional value (that is, unknown if any regional lymph node dissection was performed) 11 No proper value is applicable in this context (for example, no regional lymph node dissection was performed; autopsy only cases) A proper value is applicable but not known. Rationale this data item serves as a quality measure of the pathologic and surgical evaluation and treatment of the patient. This field is to be recorded regardless of whether the patient received preoperative treatment. Record the total number of regional lymph nodes removed and examined by the pathologist. Use code 95 when the only procedure for regional lymph nodes is a needle aspiration (cytology) or core biopsy (tissue). Other terms for removal of a limited number of nodes include lymph node biopsy, berry picking, sentinel lymph node procedure, sentinel node biopsy, selective dissection. A lymph node dissection is removal of most or all of the nodes in the lymph node chain(s) that drain the area around the primary tumor. Other terms include lymphadenectomy, radical node dissection, lymph node stripping. Use code 97 when more than a limited number of lymph nodes are removed and the number is unknown. If both a lymph node sampling and a lymph node dissection are performed and the total number of lymph nodes examined is unknown, use code 97. For the following schemas, the Regional Nodes Examined field is always coded as 99. Rationale this data item is necessary for pathological staging, and it serves as a quality measure for pathology reports and the extent of the surgical evaluation and treatment of the patient. This field is to be recorded regardless of whether the patient received preoperative treatment. Record the total number of regional lymph nodes removed and found to be positive by pathologic examination. In other words, if there are positive regional lymph nodes in a lymph node dissection, do not count the core needle biopsy or the fine needle aspiration if it is in the same chain. If no further information is available, code the nodes as positive for all primaries. For all primary sites except cutaneous melanoma and Merkel cell carcinoma of skin, count only lymph nodes that contain micrometastases or larger (metastases greater than 0. If the path report indicates that nodes are positive but the size of metastasis is not stated, assume the metastases are larger than 0. Use code 95 when the only procedure for regional lymph nodes is a needle aspiration (cytology) or core biopsy (tissue). Use code 97 for any combination of positive aspirated, biopsied, sampled or dissected lymph nodes if the number of involved nodes cannot be determined on the basis of cytology or histology. For the following primary sites and histologies, the Regional Nodes Positive field is always coded as 99. Tumor size that is independent of stage is also useful for quality assurance efforts. Size measured on the surgical resection specimen, when surgery is administered as the first definitive treatment, i. If only a text report is available, use: final diagnosis, microscopic, or gross examination, in that order. If neoadjuvant therapy followed by surgery, do not record the size from the pathologic specimen. Code the largest size of tumor prior to neoadjuvant treatment; if unknown code size as 999. If no surgical resection, then largest measurement of the tumor from physical exam, imaging, or other diagnostic procedures prior to any other form of treatment (See Coding Rules below). If 1, 2, and 3 do not apply, the largest size from all information available within four months of the date of diagnosis, in the absence of disease progression. If tumor size is reported as less than x mm or less than x cm, the reported tumor size should be 1 mm less; for example if size is <10 mm, code size as 009. Often these are given in cm such as < 1 cm which is coded as 009, < 2 cm is coded as 019, < 3 cm is coded as 029, < 4 cm is coded as 039, < 5 cm is coded as 049. If tumor size is reported as more than x mm or more than x cm, code size as 1 mm more; for example if size is >10 mm, size should be coded as 011. Often these are given in cm such as > 1 cm, which is coded as 011, > 2 cm is coded as 021, > 3 cm is coded as 031, > 4 cm is coded as 041, > 5 cm is coded as 051. If tumor size is reported to be between two sizes, record tumor size as the midpoint between the two: i. Rounding: Round the tumor size only if it is described in fractions of millimeters. If tumor size is greater than 1 millimeter, round tenths of millimeters in the 1-4 range down to the nearest whole millimeter, and round tenths of millimeters in the 5 9 range up to the nearest whole millimeter. Do not round tumor size expressed in centimeters to the nearest whole centimeter (rather, move the decimal point one space to the right, converting the measurement to millimeters). Priority of imaging/radiographic techniques: Information on size from imaging/radiographic techniques can be used to code size when there is no more specific size information from a pathology or operative report, but it should be taken as low priority, over a physical exam. Tumor size discrepancies among imaging and radiographic reports: If there is a difference in reported tumor size among imaging and radiographic techniques, unless the physician specifies which imaging is most accurate, record the largest size in the record, regardless of which imaging technique reports it. Always code the size of the primary tumor, not the size of the polyp, ulcer, cyst, or distant metastasis. However, if the tumor is described as a cystic mass, and only the size of the entire mass is given, code the size of the entire mass, since the cysts are part of the tumor itself. If both an in situ and an invasive component are present and the invasive component is measured, record the size of the invasive component even if it is smaller. If the size of the invasive component is not given, record the size of the entire tumor from the surgical report, pathology report, radiology report or clinical examination.

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