ONKOLOŠKI ' INŠTITUT V LJUBLJANI REGISTER RAKA ZA SR SLOVENIJO Ljubljana, Vrazov trg 4 B. RAVNIHAR Epidemiological Aspects of Cancer Registration in Slovenia, Yugoslavia DELO ŠT. LJUBLJANA, 1968 ONKOLOŠKI INŠTITUT V LJUBLJANI THE INSTITUTE OF ONCOLOGY, LJUBLJANA REGISTER RAKA ZA SR SLOVENIJO CANCER REGISTRY OF SLOVENIA Vrazov trg 4, Ljubljana, Jugoslavija - Yugoslavia B. RAVNIHAR Epidemiological Aspects of Cancer Registration • o1 ' XT i in Slovenia, Yugoslavia LJUBLJANA, marec - March, 1968 THE INSTITUTE OF ONCOLOGY, LJUBLJANA Director: Professor Bozena Ravnihar, M.D. EPIDEMIOLOGICAL ASPECTS OF CANCER REGISTRATION IN SLOVENIA, YUGOSLAVIA (A brief review) B.Ravnihar In Slovenia a countrywide permanent cancer st registration has been introduced January 1 , 195o, based on compulsory notification of all recognized cases of cancer. In this connection the Cancer Registry of Slovenia has been established at the Institute of Oncology, Ljubljana. Registration area, its population and medical services Since the " background " of cancer registration, i.e. the country and its population, is of prime interest from the epidemiological point of view, some main physical and demographic features of Slovenia shall be presented first, together with a brief information on medical services, as they represent an important factor regarding the reliability of compiled data. Slovenia, one of the six republics of the Socialist Federal Republic of Yugoslavia, occupies the most northwestern part of the state and covers an area of 2o.255 square kilometers. According to the official mid-year population estimates, the population accounted 1,676.ooo (806.156 malea, 869.844 females) in the year 1967 (1). - 2 - According to the last census, .March 1961, the population comprises: 95,6% native Slovenes, 3,2% other Slavic nations, and 1,2% non-Slavic nationalities (2). The main occupational composition of the population is: industry 31,4%, agriculture 31,3%, professionals 7,8%, commerce 7,6%, personal services 4,3% and others 17,6% (3). Of the total population only lo,4% live in conurbation of more than loo.ooo inhabitants. In the towns considered as " statistical urban area " (almost all with over lo.ooo population) there live 22% of the total population (4,5). The largest city Ljubljana, the capital of the Socialist Republic of Slovenia, counts 224.261 inhabitants (1965) (6). In Slovenia there is a birth-, death-, and migration registration system, and reliable vital statistics based on this registration are available. Relatively well developed medical services cover the whole country, and are accessible to all. In 1965 the average number of persons per physician was 993, and per hospital bed 122 (7). Private practice hardly exists (only 0,4% of the physicians). The average life expectancy for the new-born in 1961 was calculated to be 68 years for males and 72 for females. The average age of the deceased in the period 1960 • 1964 was 60.1 in males and 66.4 in females (8). In 1964 the total number of deaths accounted 16.729 (lo,3 per Looo population), of these 2.347, i.e. - 3 - 14,0% due to cancer (lnt«List No.14o-2o5). Cancer is in the second place among the causes of death. In the period 1958 - 1965 the average annual cancer mortality rate was 139,5 per loo.ooo population (151,8 for males, 128,2 for females) (9). In 1964, 91% of deaths have been certified by a physician, the rest by lay-coroners. Autopsy was performed in 11% of the deceased (lo). Cancer registration in Slovenia The aims and tasks of the Slovene Cancer Registry are, in brief, as follows: - Compilation of data on all newly diagnosed cases of cancer in the population of Slovenia. - Compilation of periodical follow-up information as to the condition of the registered patients until the end of their lives. - Furnishing of statistical surveys and reports on cancer incidence and on the survival of the patients, as well as the end results of cancer therapy. The main items of information collected by the Registry are: ages sex, area of residence, primary site of cancer, histological type of cancer, stage at diagnosis, when and where the diagnosis was established, when and where the first treatment was given, type of treatment, findings at follow-up, and survival. - 4 - The Registry should thus provide the health authorities and the medical profession with all basic information necessary for planning and evaluating the cancer control program, and the organization of medical care. On the other han^ the information should serve as a sound basis for clinical and epidemiological investigations. According to the compulsory cancer notification regulations all clearly malignant neoplasms, or those considered very likely to be malignant, have to be reported, regardless of having been microscopically confirmed or not. Besides, the following neoplasms of benign, or Mborder-line11 character, or undefined whether malignant or not, as: "carcinoma-in-situ", papilloma of the urinary bladder, carcinoid, brain tumor - any, mixed tumor of salivary gland, and polycythemia rubra vera, have to be reported as well. This group of neoplasms is not included in our regular tabulations, except tumors of the brain clearly designed as malignant (Int.List No.193) and "carcinoma-in-situ". In this connection it should be noted that cancer cases and not cancer patients count as units in the register. The cancer notification comprises also nonresidents who are treated in the hospitals of Slovenia but they are not included in the incidence reports. Compulsory notification concerns the hospital departments mainly, as it is assumed that every patient - 5 - in whom cancer diagnosis has been established or suspected, is sent to a hospital. Moreover, from hospitals the best quality of reporting can be expected. Hospitals are obliged to report every cancer patient every time when admitted to an in- or outpatient department, regardless whether the patient had been in another hospital before, or not. The attending physicians and the record clerks are responsible for notification. They are requested to complete their reports after the discharge or death of the patient, and to submit to the Registry as complete information about the disease as possible, including histological and possibly also autopsy findings. A special record form is used for cancer notification. The collecting of complete and accurate information about the individual patients is greatly facilitated by the fact that sooner or later, about 45% of all cancer patients from Slovenia are admitted to the Institute of Oncology, Ljubljana,-the seat of the Registry. Non-hospital establishments for out-patient care are requested to notify those newly diagnosed cancer cases only, which have not been sent to the hospital for one reason or another. In addition, all pathological institutions, histological and cytological laboratories are requested to provide the Registry with copies of their examination reports whenever the diagnosis of a clearly malignant neoplasm or other reportable neoplasm has been established. - 6 - Cancer patients who for one reason or another escape the registration during their lives can be brought to the attention of the Registry through the official death certificates. Death certificates in which cancer is mentioned are passed to the Registry by the Republic Institute of Public Health. Death certificates of persons not reported to the Registry before are thoroughly checked and a query is made for additional information by contacting the certifying physician, or, if necessary, the close relatives of the deceased. If it is found that the deceased had been previously treated for his cancer in a hospital, a report is requested from the hospital concerned, and > j.f submitted, the case is not registered as obtained from the death certificate. During the last decade about 15% of the recorded cases have been registered annually on the basis of death certificates only. However, there were no more than about 7/o of cases in which the death certificate was the only source of data without any additional information. In the Registry the file of reported cases is routinely matched against the file of death certificates. All records received are also checked for duplication (against alphabetical file), and for accuracy. If necessary, additional information and explanations are always requested from the hospitals or physicians. Cancer cases which remain undiagnosed (for instance in old people in a few backward rural areas, who avoid visiting the doctor), and cancer patients who the - 7 - the hospitals omitted to report and have been definitely cured of cancer, may also escape registration. It is impossible to ascertain the number of such cases. It is' roughly estimated that altogether they might represent no more than 5% of the real incidence. On the other hand it could be assumed that there are certainly cases which were erroneously identified and recorded as malignant in view of the fact that about 25% of the•registeredcases (in the last period) have not been microscopically confirmed. In spite of these deficiencies in registration it is believed that they do not have an appreciable influence on the total recorded incidence rates for the various sites. Follow-up In conducting the follow-up program the Registry is responsible for obtaining information on every recorded cancer patient at least once a year, up to the end of his life. Periodical follow-up,examinations are more or less regularly carried out by the Institute of Oncology and the few existing regional cancer clinics (dispensaries), but, unfortunately, only exceptionally by hospitals. If no information on the patient has been received for more than one year, a questionnaire is sent to either the local physician or to the regional health center. If necessary, the community authorities, the patient's relatives, or even the patient himself are asked for information. - 8 - In spite of considerable efforts in collecting follow-up information, still about 7% of the total number of recorded patients are lost to follow-up within the first five years following the diagnosis, most of them being non-residents, however» ' The purpose of collecting follow-up information is not only to check the end-results of the treatment and the survival of the patients, it is also to improve the accuracy of information in individual cases. Information acquired during the further course of the disease, sometimes at a subsequently performed operation, or by histological verification, or by autopsy, do not seldom change the previously recorded clinical diagnosis as to the malignancy or supposed primary site and type of the neoplasm. Consequently, the incidence figures for a particular period can never reach absolute stability, as already pointed out by Doll et al.(ll)j therefore they are obviously more reliable for the remote perioda than for the recent ones, Coding In, the Registry the reported data on cancer patients are coded and transferred onto IBM punch cards. The code used for anatomical sites keeps strictly to the International Classification of Diseases,given by WHO. The code used for histological types is in accordance with the three digit Malignancy and Histology Code which was issued by WHO in 1956 (WHO/HS/CANC/24.1.2.) For the purpose of incidence studies all cases are classified according to the calendar year in which the -9 - diagnosis was first established. Tabulation and publications The collected data are tabulated, and the basic information applying to the sex- and age- specific cancer incidence rates, according to the site, are presented every year in the Registry's annual report. They are forwarded also to the World Health Organization and published in the " Epidemiological and Vital Statistics Report "; up to now they have been published for the years 1952 - 1964 (12). In addition, the Institute of Oncology- has issued a monograph in English with the incidence, survival and other relevant data for the whole period 195o - 1955 (13). Further, the report comprising incidence data for the period 1956 - 196o, and information on the salient features of the Registry, is presented in the UICC publication " Cancer Incidence in Five Continents " (11). Cancer incidence In this place only some of the most outstanding features of cancer incidence in Slovenia, which might be of interest from the epidemiological point of view, shall be given. They are based on the data collected by the Registry up to now, and presented in the publications cited above. The incidence is defined as the number of cancer cases diagnosed in each year and reported to the Registry by hospitals,plus the number of deceased with cancer during the same period, who have not been reported to the Registry before as cases. - lo - In the year 1964, for instance, the total number of new cancer cases registered amounted to 3A46, which represents an incidence rate per loo.ooo population- of 211,3 (213,l in males, 2o9,6 in females). Trend While in the period 195o - i960 the crude incidence rates exhibited a rather steap increase (137,0 in 195o, 2o6,5 in i960), the total cancer risk in the current decade appears to tend to stabilization. However, the incidence rates for some cancers exhibit perceptible changes. This is first of all true for lung cancer in males, which shows a steady increase (e.g. in 1961: 32,7 and in 1964: 44,9 per loo.ooo male population), and which can be brought into correlation with the increasing consumption of cigarettes. In 1964 the number of newly diagnosed lung cancer cases in males almost reached the number of newly diagnosed cases of cancer of the stomach which is the leading site in males, and in the second place in females. In the last years, however, a tendency toward declination is being observed in this cancer. Most common cancers The most common cancers, as percentage of the total number of new cases in 1964, are given in Table l., and the crude incidence rates for the five leading sites in the same year are presented in Table 2. - 11 -TABLE l. The most common cancers as percentage of the total number of new cases, by aexs Slovenia, 1964. Kales Femalea Int. Int. List A Site Per Cent List A Site Per C No. No. 44-59 All sites 100 44-59 All sites 100 46 Stomach 21,3 52 Cervix uteri 20,0 (& ca in situ) 50 21,1 46 Stomach l4,l 55 Skin 9,1 51 Sreadt 13.2 44 Buccal cpvi'tj •6,3 55 Skin 10,2 & pharynx 54 Prostate 5,3 53 Uteru.s - other 5,2 48 & unapec. Rectum 3,9 47 Intestine 3,5 59 Lymphomas 3,2 48 Rectum 3,4 47 Intestine 2,8 50 Lung 2,8 49 Larynx 2,8 58 Leukaemia 58 Leukaemia 2,5 44 Buccal cavity 2,2 & pharynx 45 Oeaophagu.s 2,2 TABLE 2. The cancar incidence ratea per 100.000 population for the five leading sites, by aex: Slovenia, 1964. ^^as Females Int. Int. List A Site Rate List A Site Rate Bo. No. 46 Stomach 45,6 52 Cervix uteri 41,8 50' (& ca in situ) Lung 44,9 45 Stomach 29,5 55 Skin 19.5 51 Breast 25,7 44 Buccal cavity 13,4 55 Skin 21,4 & pharynx 54 Prostate 11,4 53 Uterus-other 10,8 & unspec. parta - 12 - If in females the " carcinoma-in-situ " cases would be excluded from cases of cancer of the cervix uteri, the rates of this cancer would approach that of cancer of the stomach, but would still dominate. Further, it should be pointed out that the frequency of cancer of the ovary, as of the specific site, is also relatively high, but this cannot be seen if case distribution by site is made according to List A of .the IOD (in which malignant neoplasms of the ovary are included under " all other and unspecified sites A 57). Thus, cancer of the ovary would be in the sixth place on the female site-frequency list. In the publication " Cancer Incidence in Five Continents " (11) the age-adjusted incidence rates by sex and site, calculated from the average annual incidence in the period 1956 - 196o, are presented for Slovenia, together with the relevant data of 31 other cancer registries in 23 countries. The incidence is adjusted to the .age distribution of three standard populations: African, World and European. The cancer epidemiologist may find this presentation of special interest. However, as emphasized by the editors of the publication, one has to be very careful in drawing conclusions from comparisons of the given rates between the countries. In this connection attention should be drawn also to the article of Doll and Cook (14), concluding that O No single index is capable of replacing the individual sex- and age-specific incidence rates...". -13 - Geographical incidence variations The given list of most common cancers in our country indicates to which one's our attention is particularly drawn, also from the etiological point of view. International variations in incidence rates of these cancers are well known, but in Slovenia itself rather great differences in incidence rates are observed between the particular geographical regions, which could perhaps be attributed to the influence of the environmental factors. The magnitude of these variations in most common sites can be seen from Table 3. TABLE • 3. The lowest and the highest crude average annual incidence rates perloo.ooo population of relevant regions, by most common sitea: Slovenia, 1956 - i960. Int. Site Sex Incidence rate Sloveni List A lowest highest w average 46 Stomach male&female 18,6 65,3 28,4 5o Lung male 13,7 53,o 28,8 55 Skin male&female lo,o 47,9 19,7 52 Cervix female 7,3 52,2 29,2 uteri 51 Breast female 13,7 37,l 24,4 - 14 - It is a special characteristic of Slovenia that although small,it shows a great deal of variety with regard to its geographical featu.res. There are alpine and costal regions, the Pannonian plain and the Karat, and still other apecific regions yet. Accordingly, the population living in these regions differs considerably in customs, habits, food, etc® Since differences in the age composition, in the proportion of the population living in urban and rural areas, and differences regarding health services between the regions do not appear to be significant, understanding of the reasons for incidence variations observed would be worth-while further investigations. Epidemiological studies on cancer etiology The cancer incidence data by site and their variations, according to the standard factora, as provided by cancer registry, may of course permit the formulation of a hypothesis only, regarding the etiology of a particular cancer, If a hypothesis should be proved, a special study is needed, requiring special methodology in collecting information on the study-as well as on control- cases. In planning an epidemiological study the registry can render most valuable assistance in choosing atudy samples, or in furniahing basic information on relevant cancer cases. On the other hand the registry could be of assistance in assessing the completeness of cases comprised in the study. - 15 - As to the epidemiological investigations on cancer etiology in Slovenia, a study of breast cancer -in relation to lactation, childbearing and other relevant factors - as part of an international collaborative project, is being conducted by the Institute of Oncology in Slovenia. In the near past some investigations concerning stomach cancer in relation to the diet pattern have been carried out, partly also within the frame of an international study (15,16). Since it is assumed that the factors influencing the incidence of cancer might also predetermine the course of the disease, the end-results data which can be provided by the registry are not useful only in evaluating the effectiveness of cancer therapy, but might contribute t.o the epidemiological investigations too, as already pointed out by Haenszel (17). Conclusions Concluding, we wish to emphasize that according to our experiences the keeping of population-based permanent cancer registry is rather demanding regarding the staff and the funds. However, all endeavors are worth while in view of the important assistance which the continuous cancer registration in a defined " population can render to the epidemiological investigations of malignant diseases, provided that the registration ia complete, and the incidence data reliable. This is certainly more likely to be achieved if the - 16 - size of population is manageable for a registry, and on the other hand, large enough to yield a sufficient number of cases for analysis within an acceptable period. Besides, the health education of the. population and the health services should be on an appropriate level. SUM.MARY In the Socialist Republic of Slovenia the countrywide cancer registration was started January 1st 195o, based on compulsory notification of all recognized malignant neoplasms in the area. The registration is being carried out by the Cancer Registry of Slovenia, established at the Institute of Oncology, Ljubljana. In view of the one of the most important functions of the Registry, i.e. the cancer incidence studies in a defined population, the main physical and demographical features of the registration area, and of its medical services, are described in the first place. Further, accounts of registration and follow-up procedurea, of coding and tabulation are given, as well as information on the Registry's publications. The percentage distribution and the incidence rates of most common cancers in Slovenia are presented in tables. Attention is drawn to the geographical variations observed. - 17 - The valuable assistance which the cancer registry can render to the investigations of cancer etiology is pointed out. Possible contribution of end-resul-tadata is indicated. Epidemiological studies which have been carried out up to now by the Institute of Oncology, mainly as a part of international collaborative projects, have been devoted to stomach and breast cancer. In view of the experiences acquired the problems and conditions which might influence the success of cancer registration are briefly outlined. - 18 -REFERENCES lo Statistički bilten (Statistical Bulletin), 496, 1967» Savezni zavod za statistiku (Federal Institute for Statistics), Beograd. 2. Savezni zavod za statistiku (Federal Institute for Statistics), Beograd - unpublished data. 3. Statistički bilten (Statistical Bulletin), 398, 1966. Savezni zavod za statistiku (Federal Institute for Statistics), Beograd. 4. Mesečni statistični pregled SR Slovenije (Monthly Statistical Survey of the S.R.Slovenia), 14,8, 1965. Zavod SR Slovenije za statistiko (Institute for Statistics of the S.S.Slovenia), Ljubljana. 5. Statistički bilten (Statistical Bulletin), 193, i960. Savezni zavod za statistiku (Federal Institute for Statistics), Beograd. 6„ Mesečni statistični pregled SR Slovenije (Monthly Statistical Survey of the S.R.Slovenia), 14,6,1965. Zavod SR Slovenije za statistiko (Institute for Statistics of the S.R.Slovenia), Ljubljana. 7. Zdravstveni delavci, zdravstvene šole in zdravstveni zavodi v SR Sloveniji v letu 1965 (Medical personnel, medical schools and medical institutions in S.R. Slovenia in 1965). Zavod za zdravstveno varstvo -Republiški zdravstveni center (Institute of Public Health of the S.R.Slovenia - Republic Health Center), Ljubljana. -19 - 8. Novak, K., Poprečna starost prebivalstva in poprečna doba doživetja (The average age of the population and the average life expectancy). Prikazi in študije (Surveys and Studies), 13: 15 - 2o, 1967. Zavod SR Slovenije za statistiko (Institute for Statistics of the S.R.Slovenia), Ljubljana. 9. Novak, K., Umrljivost po najpogostejših vzrokih smrti v SR Sloveniji (Mortality according to the most common causes of death in S.R.Slovenia). Prikazi in študije (Surveys and Studies), 13: 9 - 15, 196?. Zavod SR Slovenije za statistiko (Institute for Statistics of the S.R.Slovenia), Ljubljana. 10. Statistički godišnjak (Annual Statistical Report), 1966. Savezni zavod za statistiku (Federal Institute for Statistics), Beograd. 11. Doll, R., Payne, P.M., and Waterhouse, J.A.H., Cancer incidence in five continents. International Union Against Cancer, Springer-Verlag, Berlin, 1966. 12. Epidemiological and Vital Statistics Report, WHO, 14: . 425 - 5o6, 1961 16: 671 - 772, 1963 17: 643 - 736, 1964 19: 573 - 660, 1966 13® Ravnihar, B., Valentin A., Božič T., Doič I.,and Pečirer, D., Cancer in Slovenia, 1955. Oncological Institute, Slovene Cancer Registry, Ljubljana, 1967. - 2o - 14. Doll, Re, Cook, P«, Summarizing indices for comparison of cancer incidence date. Int.J. Cancer, 2: 269 - 279, 1967* 15® Wynder, L«, Kmet, J., Dungal, N. and Segi, M., An epidemiological investigation of gastric cancer. Cancer 16s 1461 - 1466, 1963. 16* Kmet, J., Upliv lokalne ishrane na kretanje morbidi-teta raka želuca u Jugoslaviji (Influence of the local food on stomach cancer morbidity in Yugoslavia). Onkološki inštitut (Institute of Oncology), Ljubljana, 1964. Separate monograph (cyclostyle). 17. Haenszel, W.M., Contribution of end results data to cancer epidemiology. International Symposium on End Results of Cancer Therapy, NCI Monograph 15, 1964, U.S. Department of Health Education, and Welfare, Public Health Service. Address of author: Dr0Bo2ena Ravnihar, Professor The Institute of Oncology Vrazov trg 4 Ljublj ana9 Yugoslavia TUMOR RECORD FRONT ONKOLOŠKI INSTITUT LJUBLJANA l. CENTRALNI REGISTER RAKA SRS ŠT. (pusti prazno) ........................ 2. BOLNIŠNICA ODDELEK ALI KLINIKA za rakavo obolenje 3. ŠTEVILKA PRIJAVE 4. PRIIMEK ............................... DEKLIŠKI PRIIMEK IME ............................................... 5. SPOL: □ moški □ ženski 6. ROJEN: dan............................ mesec................................ 7. NARODNOST .......................................................-................ leto 8. STALNO BIVALIŠČE: kraj ........................................................................................ulica . občina...................................................................................................okraj „„, .......št.................pošta republika ..................... DATUM | dan mesec leto 10. SPREJEMA 11. ODPUSTA 12. SMRTI 9. SPREJET V TA ODDELEK ALI KLINIKO: □ prvič □ ponovno zaradi: □ iste bolezni □ nov. malignoma 13. POSLAN V TA ODDELEK ALI KLINIKO ZARADI □ preiskave □ zdravljenja □ prvega □ ponovnega 14. ALI JE BIL KDAJ POPREJ UGOTOVLJEN DRUG MALIGNOM? □ da □ ne (če »da« navedi diagnozo, naslov zavoda, kjer je bil ugotovljen oz. zdravljen in ime lečečega zdravnika) Diagnoza................................................................................................................................................................ Naslov Priimek in zavoda ........................................................................................................................ ime zdravnika 15. ALI JE BIL SEDANJI MALIGNOM 2e POPREJ UGOTOVLJEN: □ da □ ne (če »da« navedi naslov zavoda, priimek in ime zdravnika) Naslov Priimek in zavoda ....................................................................................................................... ime zdravnika ............................. 16. DATUM, KO JE BIL PRVIČ UGOTOVLJEN SEDANJI MALIGNOM: mesec .......................................................................................■ leto 19... 17. ALI JE BIL BOLNIK 2E ZDRAVLJEN ZARADI SEDANJEGA MALIGNOMA? □ da □ ne (če »da« izpolni podatke pod 18) 18. ZAVOD IN DATUM PREHODNEGA ZDRAVLJENJA SEDANJEGA MALIGNOMA PO ČASOVNEM ZAPOREDJU: Naslov zavoda: Datum: 1................................................................................................................................................................................od................................................do............................................... 2..................................................................................................................................................................................od................................................do.............................................. 3.......................................................................................................................................................................................od................................................do................................................ 19. STANJE MALIGNOMA OB SPREJEMU (označi eno ali več, le če je bolnik že bil poprej zdravljen zaradi sedanjega malignoma): primarna lokalizacija: □ brez malignoma □ ostanek, progres □ recidiv □ nov pojav regionalna lokalizacija: □ brez malignoma □ ostanek, progres □ recidiv □ nov pojav oddaljena lokalizacija: □ brez malignoma □ ostanek, progres □ recidiv □ nov pojav 20. VRSTA IN PRIMARNA LOKALIZACIJA (navedi) ............. 21. METASTATIČNA LOKALIZACIJA: regionalna (navedi) oddaljena (avedi) ... . 22. HISTOLOŠKA DIAGNOZA □ CITOLOŠKA DIAGNOZA □ (navedi vrsto in v oklepaju označi s »H« če je diagnoza histološka in s »C« če je citološka): DATUM: primarni malignom metastaze ........................ 23. DIAGNOZA UGOTOVLJENA MIKROSKOPSKO: □ da □ □ biopsija □ □ kiretaža □ operativni preparat □ autoptičen preparat □ □ hemogram □ kostni mozeg □ parafinski preparat koncentriranih tekočin (označi eno ali več): ne □ dvomljiva eksfoliativna citodiagnostika aspiracijska citodiagnostika — iz eksudata — iz solidnega tumorja MIKROSKOPSKO NEPREVERJENA, PAČ PA UGOTOVLJENA: □ rentgenološko □ eksplorativna operacija □ endoskopsko □ druge klinične ali laboratorijske metode (navedi) Pri ustreznem podatku prečrtaj kvadratek! Izpolni vsakikrat, ko je bolnik sprejet, bodisi v stalež — 2770-66 bodisi ambulantno! Obrni! THE INSTITUTE OF ONCOLOGY, LJUBLJANA l. CANCER REQSTRY OF SLOVENIA REGISTER No. (leave blank) - 2. HOSPITAL DEPARTMENT or CLINIC TUMOR RECORD (English translation) FRONT 3, RECORD No. 4. FAMILY NAME . MAIDEN FAMILY NAME FIRST NAME _ S. SEX : O m t;Ie O female 6. DATE OF BIRTH: day__monto_ . year 7. NATIONALITY 8. ADDRESS: place . No. post (pennonent residence) community _ district republic 9. ADMITTED TO THIS DEPARTMENT OR CLINIC: □ first tirne □ repeatedly: for the same □ condition □ new cancer DATE 10. ADMISSION 11. DISCHARGE 12. DFATH day month 1:3. ADMITTED TO THIS DEPARTMENT OR CLINIC FOR □ examination □ treatment □ first □ repeated 8 s " B ea on s 0 8 & 4> Is S] ea .s t;I ea = g 5 -S .s" ■a 14. HAS EVER BEFORE ANOTHER CANCER BEEN DIAGNOSED? □ ycs □ no (if «yes" give the diaunosis, institution where diagnosed or treated, and name of the aUe/iiling physician) Diaqrnsis--!___ Institution _________ Name oi physician 15. HAS THIS ■ CANCER EVER BEEN PREVIOUSLY DIAGNOSED? Dyes □ no (if «yes" give institution andi name o{ physician) Institution Name of physlcit;I 16. DATE OF FIRST DIAGNOSIS OF THIS CANCER: month year 19 17. HAS THE PATIENT BEEN PREVIOUSLY TREATED FOR THE PRESENT CANCER? Dyes Dno (if "yes^ fill in item 18) 18. INSTITUTION AND DATE OF PREVIOUS TREATMENT OF PRESENT CANCER BY SEQUENCE: Instltutlon: Dote: 1. _______iron', _ 2 .__irom _ 3. _ from to to to 19. CONDITION AT ADMISSION fcheckon« ormore only if the patient has been previously treated for present cancer): primary site : □ no cancer □ rcsiduol cancer, protjrcssinq □ rccurrcnco □ new appearance re(Jional site: □no cancer □ remduol concer, proqressinq □ recurrence Q ncw appearance remote site : □ no cancer □ residuol cancer, proaicssinatro-nažne sestre): 32. NAJBLIŽJI SORODNIK ALI PRIJATELJ: Priimek in ime ............................................................................................................................ Naslov DATUM PRIJAVE: ZDRAVSTVENI ADMINISTRATOR: ZDRAVNIK, KI JE IZPOLNIL dan mesec leto........ ALI PREGLEDAL PRIJAVNICO: Podpis Podpis (Priimek in ime tiskano) /Priimek in ime tiskano) a S ■s 8 c — •s 24, STAGE OF DISEASE (fill in only if patient has not A. STAGE BEFORE TREATMENTffirsi clinical impression) check only for cancers of the following sites:cervix uteri, breast, bladder,upper digestive and respiratory organs (according to the international classification - TNM) TUMOR RECORD been previously treated for present caicer): BACK □o a T0 □ i a II Dm a IV a t1 □ t2 a t3 □ t4 a N0 a N1 □ n2 a n3 □ m B. STAGE BASED ON ALL EVIDENCE AVAILABLE,INCLUDJNG THAT DERIVED FROM SUR G ERY OR AUTOPSY (oorrected clinical impression) check for ali cancers, also for those checked under A. □ in situ (based only on histoloffl) □ localised' □ regional spread: □ lymph nodes involvement □ no lymph nodes involvement O remote or diffuse spread; generalization O undelined 25. TYPE OF TREATMENT (check one or more): SURGICAL REMOVAL OF CANCER (specify) including removal of endocrine gland (specify) Surgery for hoimonal effect (specify) DATE: TELERADIOTHERAPY (specify the unit and i^tàated site) Teletherapy for hormonal effect (specify) from from to to RADIUM OR ISOTPES - SEALED SOURCES (specify) Irom RADIOACTIVE ISOTOPES - OPEN SOURCES (specify) lrom CHEMOTHERAPY (specify) from HORMONE THERAPY (honnons, antihonnons, steroids - specify) OTHER CANCER - DIRECTED THERAPY (specify) lrom lrom 26. NO CANCER-DlRECTEDTREATMENT (reason - check one): O refused by patient □ not indicated (specify reason) □ other reason ( specify) ________ u w =0 Zl. CONDITION: □ on discharge or □ at death □ no evidence of cancer □ preseice of cancer □ presence of cancer unknown, uncertain 28. CAUSE OF DEATH (death certificate) direct antecedent undirect underlying condition other significant conditions a) b) c) 29. AUTOPSY : □ yes □ no AUTOPSY FINDINGS (Attention - cancer, metastases!) 30. PATIENT SENT TO (give address): home _ to other hospital ______ elswhere ._____ 31. PATIENT SHALL BE UNDER CARE OF: (give address ofthe institution or the name of physician or visiting nurse): 32. NEAREST RELATIVE OR FRIEND: Family name and name ___ Address DATE OF REPORT day month RECORD CLERK Signature PHYSICIAN FILLING-IN OR CHECKING THE RECORD REPORT: Signature to to to to to a> O 1'. year (Family and first name in block letters) (Family and first name in block letters) FOLLOW-UP REPORT FRONT 1. CENTRALNI' REGISTER RAKA LRS ŠT........................................................................................... 2. USTANOVA, KI POROČA................................................................................................. POROČILO o kontroli bolnika 3. PRIIMEK ......................................................................................................................................................................................................... 4. ROJEN: dan mesec leto DEKLIŠKI PRIIMEK IME................................................................................................................................................ ...................... 5, STALNO BIVALIŠČE: kraj .................................................................................. ulica ..................................................... št.............. pošta . občina................................................................................... okraj ..................................................................... republika ...................... • PRIJAVLJENA DIAGNOZA (prim. lok.) HISTOLOŠKA DIAGNOZA 7. DATUM ZADNJEGA PREGLEDA, KI JE BIL JAVLJEN CENTRALNEMU REGISTRU: dan leto 19 8. DATUM ZADNJEGA POROČILA, KI GA JE PREJEL CENTRALNI REGISTER : dan leto 19. .. 9. DATUM ZADNJEGA PREGLEDA PRI VAS: dan •.............. mesec................................................... leto 19.. . 10. DATUM ZADNJEGA POROČILA, KI STE GA DOBILI O BOLNIKU: dan mesec ................................................... leto 19 11. ALI SE JE DIAGNOZA SPREMENILA OD ZADNJEGA PREGLEDA, KI JE BILJAVLJEN CENTRALNEMU REGISTRU? □ da □ ne (če »da« navedi) vrsta in primarna lokalizacija histološka diagnoza 12. ALI JE BIL BOLNIK ZDRAVLJEN OD ČASA ZADNJEGA PREGLEDA, KI JE BIL JAVLJEN CENTRALNEMU REGISTRU? □ da □ ne (če »da« navedi) zakaj kdaj (datum) . kje (naslov ustanove) 13. STANJE BOLNIKA: (označi eno ali več) □ pri zadnjem pregledu: □ brez znakov malignoma □ malignom prisoten □ prisotnost maligncma neznana,negotova □ po dobljenem poročilu: □ brez znakov malignoma □ malignem prisoten □ prisotnost malignoma neznana,negotova □ ob smrti: □ brez znakov milignoma □ malignom prisoten □ prisotnost malignoma neznana, negotova 14. IZVOR PODATKOV O NAVEDENEM STANJU BOLNIKA: □ PREGLEDAL ZDRAVOTK: v tej ustanovi (navedi priimek in ime) ............ v drugi ustanovi (navedi priimek, ime in naslov) mesec mesec izven zdravstvene ustanove (navedi priimek, ime in naslov) Pri ustreznem pcdalku prečrtaj kvadratek! DZS-8558-60 — LP 4182 60 Obrni! l. CANCER REGISTRY OF SLOVENIA REGISTER No. _!_ 2. REPORTING INSTITUTION FRONT FOLLOW-UP REPORT (English translation) 4. DATE OF BIRTH: 3. FAMIIY MAMF day MAIDEN FAMIIY NAME month year FIRST NAME 5. ADDRESS OF PERMANENT RESIDENCE: place _ street _ No. _ post community ____ district ___ republic - 6. RECORDED DIAGNOSIS (primary site) HISTOLOGICAL DIAGNOSIS 7. DATE OF LAST FOLLOW-UP EXAMINATION REPORTED 8. DATE OF LAST REPORT RECEIVED BY THE REGISTRY: TO THE REGISTRY: day_ month _ year 19 _ day__montli _ year 19_ 9. DATE OF LAST FOLLOW-UP EXAMINATION BY YOU: 10. DATE OF LAST REPORT YOU RECEIVED ABOUT PATIENT day_ month___year 19'_ day _ month _ year 19 _ 11.^HAS DIAGNOSIS CHANGED SINCE LAST FOLLOW-UP EXAMINATION REPORTED TO THE REGISTRY ? O yes O no (if "yes" yive) type of cancer histological diagnosis 12. WAS PATIENT TREATED SINCE LAST EXAMINATION REPORTED TO REGISTRY ? O yes □ no (if "yes* specify) tor which reason____. when (date) _ where (instirution) ___ 13. STATUS OF PATIENT: □ at last examination : □ acro rdin g to repo rt recei ved (chec/c one or more) O no evidence of cancer O no evidence of cancer O presence of cancer O presence of cancer O presence of cancer O presence of cancer unknown, uncertain unknovm, uncertain 14. SOURCE OF INFORMATION ON THE GIVEN STATUS OF THE PATIENT: □ EXAMINED BY PHYSICIAN: m lhis institulion (give family name aiil name) _ in anolher institulion (yive family name, nmne mid address) _ in no institution (yive family name, name and address) □ at deafu:' O no evidence of cancer O presence of cancer O presence of cancer unknown, uncertain Check the relevant dala crossing the square ! Tum over ! I FOLLOW-UP REPORT FRONT IZVOR PODATKOV (nadaljevanje): □ POROČILO: bolnih\ samega: □ pismeno □ ustno bolnikovega svojca ali prijatelja (navedi) od drugod (navedi) 15. PRIPOMBE O POSEBNOSTIH, ki zadevajo potek bolezni in stanje bolnika: 16. BOLNIKA BO KONTROLIRAL (navedipriimek in ime zdravnika, patronažne sestre oziroma naslov ustanove): 17. ALI JE BOLNIK UMRL V ČASU OD ZADNJEGA PREGLEDA, KI JE BIL JAVLJEN CENTRALNEMU REGISTRU? O da □ ne(če »da« navedi) datum smrti ...................................................................................kraj smrti ...................................................................................................................................... 18. VZROK SMRTI (mrliSki list): neposreden a) ....................................................................................................................................................................................................... predhoden b) ....................................................................................................................................................................................................... c) ...................................................................................................................................................................................................... drug dodaten ..........................................................................................................................-........................................................................... 19. OBDUKCUA: □ da □ ne OBDUKCIJSKI IZVID: (pozor malignom, metastaze!) ............................................................................................................................................................ Kdo je izvršil obdukcijo(pr;;mek in ime obducenta in naslovprosekture) . Datum poročila Poročilo izpolnil: Poročilo pregledal zdravnik: dan mesec leto (priimek in ime, tiskano) (priimek in ime, tiskano) 19... Podpis Podpis FOLLOW-UP REPORT FRONT SOURCE OF INFORMATION (continueil): □ REPORT: from patient himself; O cy letter O personal from patient s relative or friend (specify) - from elswhere (specify) 15. SPECIAL NOTES, relating to the course of disease and status of patient: 16. PATIENT WILL BE UNDER FOLLOW-UP BY (give family name and name of physician, of visiting nurse, and the institution): 17. has patient died since last report to the registry? o yes o no (if "yes" give) date of death _ place of death 18. CAUSE OF DEATH (death certificate): undirect a) antecedent b) c) other con tributtng 19. AUTOPSY: □ yes — no AUTOPSY FINDINGS: (attention-cancer, metastases l) By whom the autopsy was perfonned (family name and first name of the and address of the p^fological department) Date of report day month year 19 Filled in cy: (family name and name, in Mock letters) Reviewed by physician: (family name and name, in Mock letters) Signature Signature CODE SHEET Obrazec za kodificiranje Priimek Dekliški priimek Ime Last name Maiden name First name Stolpec 1 Obeležje Šifro Column Field Itan Code 1-3 A __ — Hospital, Department Number B -- — Hospital - First Course of Treatment Tekoča št. --- — 7-12 C št. primero Current No. Case Number Leto _ _ Year 13 D Spol . Sex 14 E Narodnost ........................................ .................................. Nationali ty Področje — — Region 15-19 F Področje stolnega bivališča Okraj — Residence District Občino _ — Community 20-21 G Starost ob diagnozi ............................... .......................... _ _ Age at Diagnosis 22 H Opredelitev primero Class of Case 23-26 1 Dotum prve diagnoze ................................................................. --- — Date of First Diag-iosis 27-30 J Datum sprejema v področju registra ............................. --- — Date of Admission to Registry 31 K Malignost ................................................................................... Malignancy 32-34 l Primarna lokaiizacija .. ............................. .................... Primary Site 35 M Zaporedno število ......................................................................... Sequence Number 36-38 N Histološka vrsto .............................................................................. Histological Type 39 o Potrditev diagnoze ..... Diagnostic Confirmation 40 P Stadij bolezni ............................................................................. Stage of Disease 41--43 Q Zdravljenje pred sprejemom ................................................ -- — Tumor Treatment -Prior to Admission 44—46 R Zdravljenje prvi potek ................................................................. -- _ Tumor Treatment - First Course 47-49 s Zdravljenje nadaljnji potek ....................................... __ _ Tumor Treatment - Subsequent Courses 50-53 ss Datum zadnje kontrole ali smrti ........................................ ___ __ _ Date of Last Follow-up or Death 54 T Kroj smrti .......................................................................................... Where the Patient Died 55 u Stonje ob kontroli oli smrti ................................................... Status at Follow-up or Death 56-59 v Dobo preživetja od diagnoze .............................................. ___ — Survl val Time since Diagnosis 60-63 z Vzroki smrti ......................................................................................... Cause of Dealh 64 zz Obdukcija ......................................................................................... Autopsy Pozorl Preskoči 13 stolpcevl Attention I Leave blank 13 columns i 78 w Opis luknjane kartice .............................................. _ Pun^) Card Description 79-80 VY Leto zamenjave luknjane kartice ............................ — — Y ear of Replacement of Punch Card 1347-67