183





Extent to which conditions negatively influenced treatment.
 Central Nervous
 Cardiovascular
 Pulmonary
 Hemotopoietic
 Kidneys
 Gastrointestinal
 Endocrine
 Musculo-skeletal
 Genital
 Total

Site of primary cancer:
 1 Lung
 2 Breast
 3 Colon

Date of diagnosis: / /

Date of death: / /

No. of months survived:

Staging:
 0 In situ
 1 Local
 2 Reg./Dir. Ext.
 3 Reg./Nodes
 4 Dir. Ext./Nodes
 5 Regional, Nos.
 6 Non-Local
 7 Distant
 S8 Lymphoma/IV
 9 Unknown

HISTOLOGY:
 1 Epidermoid carcinoma (squamous cell)
 2 Large cell anaplastic carcinoma
 3 Adenocarcinoma (incl. bronchiolar car.)
 S4 Small cell carcinoma (oat cell)
 5 Inflammatory
 S6 No histological diagnosis (clinical)
 7 Undetermined

INITIAL TREATMENT:
 1 Surgery
 2 Radiation Therapy
 3 Chemotherapy
 4 Other (Single)