Sutter Health

Sutter Health
2001
A N N U A L C A N C E R R E P O RT
2 0 0 0 S TAT I S T I C A L R E V I E W
Sutter Health Cancer Programs
Table of Contents
Table of Contents
Introduction
1
Sutter Health Cancer Program Facilities
2
Clinical and Patient Support Services
3
Cancer Service Line Planning
4
Annual Summary of Program Activities
5
Overview of Cancer Registries
14
Statistical Overview of Sutter Health Cancer 2000 Registry Data
16
Focus on Prostate Cancer
22
Primary Site Tables
30
Introduction
A year of development,
expansion and continued
improvements
The year 2000 brought development, expansion and continued improvements to the wide
array of cancer services available to patients of Sutter Health’s nine American College of
Surgeons-accredited cancer programs. Community outreach and education programs,
major involvement in clinical research trials and acquisition of new technologies for
cancer prevention, screening and treatment were significant components of this year’s
achievements.
Through a strong network of physician leadership, the Sutter Health Breast Project
moved forward, reaching more women with better quality care. In addition, several of our
institutions held focused educational events on prostate, colorectal and skin cancer,
offering screenings, question and answer sessions, support groups and lectures led by
experts in each field. Important relationships between Sutter Health hospitals and with
our community partners were strengthened this year, resulting in a broader range of both
technical and social support services for our patients. Details are outlined on pages 5 - 13
in our individual site summaries, a new section of the report this year.
Our concept of cancer care delivery as a service line was more fully developed with our
first annual Service Line Planning Retreat held in January. Dr. Leverton gives details of
these important developments on page 4.
Our cancer registry data show that our programs are growing statistically. We are very
proud of the commitment of our Cancer Registrars to faithfully document the details of
each case, providing us with invaluable information to track and trend outcomes for our
patients and the public (see pages 14 & 15).
Pages 16 through 21 present a comprehensive statistical analysis of new cancer cases
seen in 2000 at the nine major cancer programs in the Sutter Health system.
In this year's report, our clinical focus is on prostate cancer, the most common cancer
seen among Sutter Health males and the second most common cancer overall. On pages
22-29 Patrick Swift, M.D., provides us with an analysis of the Sutter Health prostate
cancer experience over the 1994-2000 time period.
The accomplishments of the Sutter Health Cancer Programs are wholly dependent upon
the tireless efforts of a team of caring professionals, without whom we could not strive to
reach our goal: “No matter where you are in Northern California, you’ll find the best
cancer care available at Sutter Health.”
Sutter Health Cancer Program Group
1
Sutter Health Cancer
Program Facilities
This report and the activities described within it
are the products of the medical directors, program
managers and registrars at each Sutter Health
affiliate. Their contributions are gratefully
acknowledged.
The Sutter Health Cancer Programs offer a full spectrum of diagnostic, treatment,
education, and support services for people with cancer. These services range from
advanced treatment such as bone marrow transplant, to specialized forms of
radiation therapy and cryosurgery, to complementary medicine approaches.
ABSMC-Alta Bates
Michael Cassidy, MD
Pam Davis
Stephen Bishop
Services are offered in nine geographic locations throughout the San Francisco
Bay Area, the Central Valley and the state Capitol region.
CPMC
Kathleen Grant, MD
K. Alice Mack*
Joyce Louie
EMC
Mike Forrest, MD
Ronnie Bayduza
Sheila Fimreite
MHA
David Shiba, MD
Bev Paderes
Cheryl Casey
MGH
Lloyd Miyawaki, MD
Mimi Haberfelde
Kelley Bottomley
MPHS
Garrett Smith, MD
Sheila Littrell
Kathy Berliner
ABSMC – Summit
Larry Strieff, MD
Andrea Edge
Jenny Trace
SMCS
Vincent Caggiano, MD
Joan Mengelkoch
Annette Glass
SRMC
Uma Gowda, MD
Deborah Dix
Diana Pope
The data analysis contributed by Eric Gold,
Oncology Analyst/Programmer at
Alta Bates Medical Center, and developmental
editing by Sue Gotelli, Project Coordinator, Sutter
Health Clinical Integration Department,
are also gratefully acknowledged.
*Cancer Program Liaison
2
Sutter Health Cancer Programs are available at:
Alta Bates Summit Medical Center –
Alta Bates
(ABMC)
2450 Ashby Avenue
Berkeley, CA 94705
510-204-2793
Mills-Peninsula Health Services
(MPHS)
Dorothy E. Schneider Cancer Center
100 South San Mateo Dr.
San Mateo, CA 94401
650-696-4509
California Pacific Medical Center
(CPMC)
2333 Buchanan Street
P.O. Box 7999
San Francisco, CA 94118
415-750-6080
Alta Bates Summit Medical Center –
Summit
(SMC)
350 Hawthorne Avenue
Oakland, CA 94609
510-655-4000
Eden Medical Center
(EMC)
20103 Lake Chabot Road
Castro Valley, CA 94546
510-537-1234
Sutter Medical Center, Sacramento
(SMCS)
2800 L Street
Sacramento, CA 95816
916-454-6500
Marin General Hospital
(MGH)
250 Bon Air Road
P.O. Box 8010
Greenbrae, CA 94912
415-925-7115
Sutter Roseville Medical Center
(SRMC)
One Medical Plaza
Roseville, CA 95661
916-781-1617
Memorial Hospitals Association,
Regional Cancer Center
(MHA)
1700 Coffee Road
Modesto, CA 95355
209-526-4500
Clinical and Patient
Support Services
The table below displays the scope and variety of services offered within the
Sutter Health Cancer Programs and the facilities in which they are offered. See
page two for facility names and addresses.
SERVICES
CLIN IC A L
Apheresis
Bone Marrow Transplant
Cancer Surgery
Clinical Trials
Complementary Medicine Program
Comprehensive Breast Center
ABMC
CPMC
EMC
MGH
MHA
MPHS
SMC
Cryosurgery
Cumulative Tumor Conference
Gamma Knife
Gynecological Cancer Clinic
High Dose Radiation Brachytherapy
Infusion Center
Inpatient Care
IORT
Liver Transplantation for Hepatoma
Pediatric Hematology and Oncology
Pediatric Neurosurgery
Positron Emission Tomography
Prevention Trials
Prostate Seed
Radiation Oncology
Stereotactic Breast Biopsy
SUP PO RT
Cancer Information Line
Cancer Library
Cancer Registry
Cancer Surveillance Program
Children’s Bereavement Art Group
Counseling
Home Care
Hospice
Oncology Nutrition Counseling
Spiritual Counseling
Support Groups
Temporary Housing
3
SMCS
SRMC
Cancer Service Line
Planning
Integrating a Health Care System through Cancer Care Services
Ian Leverton, M.D., VP, Clinical Integration
Throughout 2001, Sutter Health has
continued its commitment to be the
foremost provider of high quality care to
its patients suffering from cancer and
associated diseases. In the 2000 edition
of this report, we described some early
work on our systemwide development of
“Cancer as a Service Line.” We have
attempted to embody the very many
complex operational issues and processes within this concept in one simple
but powerful sentence. That sentence has
become our guiding principle and, some
might say, our mantra: “No matter where
you are in Northern California, you’ll find
the best cancer care available at Sutter
Health.”
Clinical Integration and Planning and
Business Development were jointly
charged with the responsibility to provide
the support and infrastructure that would
allow our clinicians and administrators to
make this statement a reality. In July 2000
we formed the Cancer Service Line
Planning Group. Comprised of medical
and surgical oncologists, oncology unit
managers and administrators, the group
began the difficult task of “planning for the
plan.” As a result of this work, in January
2001 we held a Cancer Service Line
Planning Retreat. Approximately 100
representatives from hospitals, ambulatory care settings and physician groups
across Sutter Health attended. In coming
together in this way, these representatives
demonstrated their commitment to
providing the best possible care to our
patients. Their dedication and enthusiasm
created the foundation of the Cancer
Service Line Strategic Direction and
Action Plan. This plan was presented to
Sutter Health’s Senior Management Team
4
in August 2001 where it was endorsed and
granted funding for the next step towards
our goal. This step involves the development of a cross-system inventory of our
current capacity to deliver best quality
cancer care and a “gap analysis” showing
areas needing to be addressed. This
inventory will significantly influence our
implementation of this Service Line. This
inventory and analysis is being undertaken
by Oncology Associates, a consulting
group.
The development of “Cancer as a Service
Line” is a complex, ambitious and longterm project. However it is exciting,
extremely important and offers tremendous
potential for social good and the professional development of our doctors and our
health care delivery system.
The death of Dr. Gale Katterhagen left a
great personal and professional void for
many of us. His development and support
of Sutter Health’s Breast Cancer Initiative
serves as a wonderful example of one
person’s ability, by sheer hard work and
commitment, to improve the delivery of
health care across an entire system.
We are very fortunate that others share Dr.
Katterhagen’s beliefs and have taken over
the clinical responsibility for the Breast
Cancer Initiative. The initiative is now led
by Dr. Lisa Bailey, surgical oncologist at
Alta Bates Summit Medical Center and Dr.
Michael Cassidy, medical oncologist at Alta
Bates Summit. They are very ably supported by Dr. Andrea Metkus, general
surgeon at Mills Peninsula Health Services,
Dr. David Adkins, medical oncologist at
Gould Medical Group and Dr. Vincent
Caggiano, Cancer Center Medical Director,
Sutter Medical Center, Sacramento. With
their help and encouragement, the Breast
Cancer Initiative will continue to further
increase the quality of care we deliver to our
patients with breast cancer.
We will keep the care of cancer patients high
on Clinical Integration’s list of priorities in
2002. We will also study screening for
colorectal cancer and the development of
Palliative Care capabilities across our system
as likely areas for focus in the near future.
Clinical trials offering our patients access to
the very latest in chemotherapy, radiation and
surgery continue unabated across the
system. We hope under the auspices of the
Sutter Health Institute for Research and
Education (SHIRE) to establish a single IRB
for the system. This would allow the trial of a
drug or other treatment modality to be
implemented systemwide—an option that
would attract patients, doctors and pharmaceutical companies alike.
In conclusion, Sutter Health and the Cancer
Program Group will continue to strive to
achieve our vision: “No matter where you are
in Northern California, you’ll find the best
cancer care available at Sutter Health.”
Annual Summary of
Program Activities - ABMC
ALTA BATES MEDICAL
CENTER
program by combining the complementary
strengths of both hospitals.
Norman Cohen, M.D.
Cancer Committee Chair
Clinical research is a strong component of
the overall ABMC Cancer Program. ABMC
participates in National Cancer Institutesponsored cooperative group programs
through the Sutter Institute for Medical
Research. Additionally, the Alta Bates
Comprehensive Cancer Center (ABCCC)
offers pharmaceutical company studies
that provide access to new biologic and
pharmacological agents not otherwise
available to patients.
Alta Bates Medical Center (ABMC)
provides comprehensive care for its more
than 1,450 new cancer patients each year.
The panoply of services provided by its
physicians and allied health professionals
varies from technically sophisticated
diagnostic and therapeutic resources to
caring social support services. A full range
of inpatient and outpatient services for all
phases of malignant disease, from
prevention and screening to comprehensive medical, surgical, and radiation
therapy for all cancer sites are offered at
both the main hospital on Ashby Avenue
and the outpatient cancer center located at
the Herrick facility in downtown Berkeley.
Comprehensive diagnostic and therapeutic
services are offered for patients with
breast cancer—the single most common
cancer diagnosis at ABMC, comprising
approximately 25% of all diagnoses. The
Sutter Breast Quality Indicator Criteria
have served as a stimulus to improve our
performance: the targets for all criteria
have been matched or exceeded.
Specialty conferences, regular Tumor
Boards and didactic programs have
enhanced the cancer education program
for both professionals and the community
at large. During the past year, it has been
expanded to include patient forums where
experts present topics of interest in an
informal atmosphere, encouraging
interactive participation.
The Multidisciplinary Cancer Committee
coordinates programs and forwards
recommendations to the Executive Board
of the Medical Staff. As a result of the
merger of Alta Bates Medical Center and
Summit Medical Center, we anticipate the
Cancer Committees of both organizations
will be unified under joint leadership. This
action will strengthen the overall cancer
5
The ABCCC Radiation Oncology unit
provides a full range of services, including
3D conformal radiation and brachytherapy,
in both permanent seed implantation and
High Dose Radiation. The ABCCC
Radiation unit now offers IMRT as part of
its development as a center of excellence
for the Varian Company.
Other highlights of the ABMC Cancer
Program for 2000 include:
•
Participation in the National Cancer
Institute-sponsored Star Trial, a
randomized double-blinded clinical trial
to compare the effectiveness of
raloxifene with that of tamoxifen in
preventing breast cancer in postmenopausal women.
•
Breast Cancer Awareness Month
Activities, including special Tumor
Boards, public lectures and forums
and didactic presentations by breast
cancer specialists.
•
Consolidation of Bone Marrow
Transplant Programs with Sutter
Medical Center, Sacramento.
•
Purchase and installation of Linear
Accelerator at the Ashby facility.
•
Institution of CareGiver classes for
patients’ families.
•
Institution of Cancer Center Orientation classes.
•
Development of video for patients on
treatment options for prostate cancer.
Annual Summary of
Program Activities - CPMC
CALIFORNIA PACIFIC
MEDICAL CENTER
Kathleen Grant, M.D.
Chief, Division of Hematology
and Medical Oncology
During 2000 the Cancer Program at
California Pacific Medical Center had
multiple focus areas:
•
research
•
integrating supportive services
•
tracking hospital cancer data
accurately
•
facilitating a team approach to
cancer care
These areas were all embedded in the
education of the interns and residents of
our large teaching program.
The Cancer Registry accessioned 1,584
new cases in the year 2000, with the
leading diagnoses being breast cancer
(374 cases), colorectal cancer (208
cases), prostate cancer (195 cases), lung
cancer (129 cases), and lymphoma,
Hodgkin’s and non-Hodgkin’s (92 cases).
Sixty-four cancers of the liver and biliary
tree were seen, reflecting CPMC’s
expertise in liver disease, including
transplant and the skills of interventional
radiology. Female cases were slightly
more common than male. Individuals
between the ages of 60 and 79 constituted 45% of the accessioned cases.
There are 23,903 cases in the Cancer
Registry database, referenced from
January 1, 1985, with a follow-up rate of
93%. The Cancer Registry also supports
the weekly Tumor Board, with 110 cases
presented in 2000, and participation in the
ACOS National Cancer Database and
patient care evaluation studies.
6
Seventy-three research protocols through
the National Cancer Institute, pharmaceutical companies and the Institute for
Health and Healing are available to
CPMC oncologists. Staffed by a full-time
and two part-time research coordinators,
45 patients were enrolled on research
studies in 2000.
The Cancer Supportive Services Committee has as its charge the development
and integration of oncology services at
CPMC. This group brings together
support services through the Breast
Health Center and the Women’s Health
Resource Center, genetic counseling,
lymphedema services, complementary
programs through the Institute of Health
and Healing, as well as nutritional,
psychiatric and social services. An
ombudsman position is being developed
to facilitate patient access to needed
services.
The Skilled Nursing Unit at the West
Campus now has a new Palliative Care
Unit, with four designated beds, a staff
trained in end-of-life care issues and
amenities funded by Foundation grants
from grateful patients.
Annual Summary of
Program Activities - EMC
EDEN MEDICAL CENTER
Michael R. Forrest, M.D.
Cancer Committee Chair
The year 2000 was characterized by
significant changes and improvements in
the cancer services at Eden Medical
Center.
In July we achieved a significant milestone in our efforts to provide truly
comprehensive breast cancer services:
the addition of stereotactic breast biopsy
capabilities on-site. This has been a major
goal of the Cancer Committee. Through
our participation in the Sutter Health
Breast Project, we will continue to monitor
the impact of this technology on our ability
to diagnose breast cancer at its earliest
stages. In addition we have continued to
offer a broad spectrum of educational
efforts aimed at both the public and health
care providers, advocating breast selfexam and screening mammography. We
continue to participate in the Alameda
County Breast Cancer Early Detection
Program.
The year 2000 marked the opening of a
Lymphedema Clinic at Eden Medical
Center. The Lymphedema Clinic has
proven to be a valuable service in treating
lymphedema patients and in providing
education on preventive techniques to
susceptible patients and to health care
professionals. Patient care services were
further enhanced when we added an
Enterostomal Nurse as part of the staff at
Eden Medical Center. New ultrasound
imaging equipment in Radiology has also
improved and expanded diagnostic
capabilities for cancer patients and others.
During the year the Pathology Department
conducted a study of 55 cases of operable invasive breast carcinoma. As no
sentinel lymph nodes could be found in
five cases, a total of 49/55 cases were
evaluated. Thirty-six of these cases had a
7
negative sentinel lymph node and axillary
lymph nodes. Thirteen cases had a
positive sentinel lymph node and either a
negative or a positive axillary lymph node
dissection. No cases had a negative
sentinel lymph node and a positive axillary
lymph node.
Throughout the year we accelerated our
efforts to meet all the accreditation
standards of the American College of
Surgeons in preparation for the June,
2001 survey. While the results have not
yet been received, we fully expect a
favorable survey outcome. As part of our
preparation for the survey, and in recognition of the high incidence of urologic
cancers at Eden, we added a urologist to
the Cancer Committee.
A broad range of educational opportunities
was offered to clinical and medical staff
members, with well over a dozen cancerrelated educational programs, conferences
and symposia. In addition, the hospital
provided numerous support groups and
educational programs for the public. They
also sponsored participation in community
events such as the “Great American
Smokeout” and the “Relay for Life.”
Providing cancer services in the current
environment comes with significant
challenges. Eden Medical Center remains
committed to meeting these challenges to
best serve the needs of our patients and
our community.
Annual Summary of
Program Activities - MGH
MARIN GENERAL HOSPITAL
Timothy Crowley, M.D., Medical Director
and Cancer Committee Chair
The Marin General Hospital Cancer
Institute had a busy and productive year.
Goals for the program included: focusing
on health and wellness public education
for cancer risk reduction; increasing early
detection of cancer through improved
access to screening; adding diagnostic
pathways to the breast and colorectal
treatment pathways; and improving
documentation of cancer patient staging
at diagnosis.
MGH sponsored a Breast Health Fair in
2000, featuring low-cost mammograms,
free clinical breast exams and breast selfexamination instruction. One hundred
twelve women were screened, with one
follow-up required and no cancers found.
Six outreach programs were held in
underserved areas of the community,
resulting in the subsequent diagnosis of
three new breast cancer cases. A new
monthly Post-Surgical Workshop began in
2000 to encourage appropriate arm
exercise and educate women about
lymphedema precautions. A group of
twenty-five women started a self-led
lymphedema support group with the
support of the Breast Program. Three ongoing breast cancer support groups met
during the year, including general support,
in-treatment, and post-treatment, as well
as a Parenting and Cancer group, made
available through philanthropic support.
The CIRCLE Resource Center, a free
information and lending library, experienced a 50% increase in professional
information requests, and an 8% increase
in public requests during 2000.
8
The MGH Humanities Program was
formally joined with the Institute for Health
and Healing at California Pacific Medical
Center in 2000. The benefits include more
efficient use of resources, greater
community promotion of programs and an
expanded array of services.
The Pathology department began
implementation of CAP protocols per the
American College of Pathology. Breast,
prostate, endometrial, ovary, kidney and
bladder templates were created, with
more to follow, to ensure standardization
of pathology cancer reporting.
Seven community education programs
were held, addressing prevention and
early detection as well as survivorship
issues. Prevention and early detection
focus was on breast, prostate, colorectal
and skin cancer. Survivorship programs
included “Look Good, Feel Better” with
the American Cancer Society, as well as
“Ask the Expert” sessions for breast
cancer patients. At the annual Community
Skin Screening, 11 volunteer dermatologists screened 381 people, resulting in
sixty presumptive diagnoses of skin
cancer, of which three were melanoma.
We conducted three professional education programs in 2000. These included:
“Review of Current Guidelines in the
Management of Lung Cancer,” by Thierry
Jahan, M.D. and David Jablons, M.D.,
medical and surgical oncologists from
University of California, San Francisco;
“Pain Management,” presented by Robin
Denning, M.D., anesthesiologist; and an
interactive “Oncology Roundtable”
discussion.
Both the Breast Cancer and Colorectal
Cancer clinical pathways were revised to
include screening, work-up and treatment updates in 2000. Clinical indicators
tracked with the Sutter Health Breast
Project demonstrated Marin General
above the benchmarks for axillary
dissection rate for ductal carcinoma in
situ, surgical conservation rate by tumor
size and adjuvant therapy rate. A Cancer
Pain subcommittee of the hospitalwide
Pain Quality Improvement Committee
developed new assessment and
documentation tools to be used across
the continuum of care, and revised the
Cancer Pain Guidelines, originally
developed in 1997.
Fifty-four national trials were open to
accrual, in addition to numerous
pharmaceutical studies. Thirty-five
patients were screened, and sixteen
were enrolled into clinical trials in 2000.
Six women were enrolled into the STAR
study, the second phase of the Breast
Cancer Prevention Trial.
Oncology care continues to evolve
rapidly with new research and improved
treatment methods. The Marin General
Hospital Cancer Institute continues to
look at ways to improve community
health through cancer risk reduction,
and quality of life for cancer patients
through earlier diagnosis, cutting-edge
cancer therapies and a holistic
approach to care.
Summary of Program
Activities - MHA
MEMORIAL HOSPITALS
ASSOCIATION REGIONAL
CANCER CENTER
David Shiba, M.D., Ph.D., Medical Director,
Memorial Regional Cancer Center and
Cancer Committee Chair
During 2000 Memorial Hospitals Association Regional Cancer Center continued as
the leader in providing “state-of-the-art”
care for patients in Stanislaus and parts
of San Joaquin, Tuolumne, Merced and
Calaveras counties.
The Cancer Registry continued to grow
totaling 16,124 cases. In 2000, 925 cases
were accessioned including 804 analytic
cases. The follow-up rate was 94%.
Our multidisciplinary cancer conferences
grew from three per month (breast and
two general conferences) to weekly when
in July 2000 a gynecologic-oncology
conference was added. A total of 127
cases were presented in 2000.
The Inpatient Oncology Unit continued to
be filled to capacity. This 27-bed unit with
lead-shielded rooms and positive and
negative pressure rooms, chair beds, a
kitchen facility and a library for family
members provides a homelike environment including chemotherapy, biological
therapy, pain and symptom management,
radiation therapy implantation, palliative
and hospice care. The staff includes
nationally certified and hospital certified
nurses.
Radiation therapy grew in numbers as
well as acquiring new technology.
Preparations for the Varian 2100 with
multileaf collimation and IMRT capabilities
were begun in 2000 with extensive
remodeling of the radiation therapy
center. ADAC, a new treatment planning
system, was generously donated by the
Memorial Hospital Foundation and should
arrive in March 2002.
9
Since 1994, Memorial Regional Cancer
Center has been an affiliate member of
the ECOG (Eastern Cooperative Oncology Group) through Stanford University,
giving our patients access to the highest
quality treatment through participating in
clinical research trials. Research studies
available to our adult population in 2000
included treatment for lymphoma,
Hodgkin’s and malignant diseases of the
breast, colon, anus, prostate and lung.
Three percent of cancer patients diagnosed and/or treated by MHA medical
staff were enrolled in clinical trials during
the year.
Many support groups, patient education
programs, community projects, screening
education activities and professional
health care education programs comprised a well-rounded, comprehensive
cancer program at the Memorial Regional
Cancer Center in 2000.
•
“Bear Facts,” a new support group for
kids whose parents have cancer, was
launched.
•
“I Can Cope,” an educational program, continued to provide invaluable
information for cancer patients and
their families.
•
“Modesto Relay for Life” raised over
$250,000 for the local chapter of the
American Cancer Society.
•
The 8th annual “Daffodil Delight” held
in honor of National Cancer Survivors
Day drew almost 200 patients and
friends.
•
Prostate Cancer Screening was held
in September with six abnormal
results detected in 51 men. Modesto’s
chapter of US TOO! provided six
volunteers at the screening.
•
Memorial Regional Cancer Center cohosted with Modesto Radiology
Imaging and Cable One television, “A
Day of Awareness” for Breast Cancer
Awareness month, providing education on screening guidelines, early
detection, and resources and services
available in the community. The
production “Breast Cancer: A Family
Affair” was also co-sponsored with the
American Cancer Society and Breast
Cancer Early Detection Program.
•
During the Great American SmokeOut on November 16th, 30 quit kits
were distributed and 118 people took
a tobacco and smoking cessation
quiz. Memorial Regional Cancer
Center also took the American Cancer
Society’s “Teens Kick Ash” campaign
to three local high schools.
Nationally known speakers brought the
latest in cancer treatments to our professional community in CME-sponsored
events. The 16th Annual Memorial
Regional Cancer Symposium focused on
gastrointestinal cancer, bringing leading
GI surgeons, radiation therapists and
medical oncologists to our community.
The end of 2000 was focused on preparing for the ACOS reaccreditation survey in
November. The Memorial Regional
Cancer Center will apply for the highest
level of accreditation for a community
hospital cancer program.
Annual Summary of
Program Activities - MPHS
MILLS-PENINSULA HEALTH
SERVICES
Garrett Smith, M.D.
Director, Cancer Program
The past year was one of transition for
the Cancer Program at Mills-Peninsula
Health Services (MPHS). Sadly, we lost a
member of our family with the passing of
J. Gale Katterhagen, M.D. His commitment and leadership, exemplified by
leading the Sutter Health Breast Project,
will be sorely missed.
We remain committed to the Breast
Project. Our data continue to reflect
outstanding results with early detection
based on stereotactic biopsy and ultrasound. Twenty-five percent of all breast
cancer cases are diagnosed at Stage 0
(DCIS), and 66% of all cases diagnosed
are Stage I or better. More women come
to MPHS for breast care than ever before,
and we have expanded our service to
underserved areas of San Mateo County
while maintaining quality and superb
patient satisfaction.
The past twelve months represented the
first full year since the November 2000
opening of our new Dorothy E. Schneider
Cancer Center in the Mills Health Center.
This center has exceeded all expectations
as a flagship community resource. For the
first time, multi-specialty services are fully
integrated into a place of compassionate
care and healing. We now evaluate and
treat over 120 patients every day. The
new center includes many programs in
rehabilitation and physical therapy, as well
as our successful lymphedema program,
community education, two
multidisciplinary tumor boards, a second
opinion consultation service, and a breast
cancer risk-reduction program. We have
also expanded our Care Management
Program, utilizing Clinical Nurse Specialists to facilitate hospital discharge and
follow patients throughout MPHS.
10
At the new Cancer Center, Steven Weller
M.D., leads radiation oncology services.
Our referrals continue to expand, and our
team continues to implement the very
latest technology. Our new linear accelerators feature the latest multi-leaf
collimator technology to improve precision
and minimize radiation side effects. We
are a high-volume referral center for
prostate HDR brachytherapy. We have
also received funding to expand our 3-D
treatment planning systems with IMRT
functionality in early 2002. We continue to
lead the Bay Area in the advanced
treatment of breast and prostate cancer.
Our Cancer Center received a renewed
accreditation by The American College of
Surgeons, Commission on Cancer. We
actively participate in the Sutter Health
Clinical Initiatives, including the Breast
Project, Palliative Care Committee and
other Clinical Integration efforts.
We have maintained active participation
in the Sutter Health Cancer Research
Group, and have enrolled patients in
National Cancer Institute sponsored
clinical trials through SWOG, RTOG, and
the NSABP.
In October 2001, MPHS launched a Lung
Cancer Screening Program, utilizing
Spiral CT Scan for the early detection of
lung cancer in asymptomatic high-risk
patients. Mills-Peninsula Hospital
Foundation is covering the cost of the
screening and work-up for 400 patients
over the next two years. This protocol is
tied to a communitywide smoking
cessation program.
MPHS is a charter member of the
California Hospital Initiative in Palliative
Services (CHIPS), and will work with this
organization and the Center to Advance
Palliative Care (CAPC) in creating a novel
Palliative Care Program in our community.
The program will bring together a
multidisciplinary team of physicians,
nurses, social workers, chaplaincy and
nutritionists to form both a Palliative Care
Consult Service as well as an inpatient
Palliative Care Unit located at the Mills
Health Center.
MPHS is partnering with CPMC’s Institute
for Health and Healing. The IH&H at MillsPeninsula will open this winter to extend
Complementary Medicine to our community. We will continue to offer classes and
programs in meditation, tai chi and
acupuncture, with additional emphasis on
fitness and nutrition. Expansion of a
community library and Healing Store will
complete our program.
The Dorothy E. Schneider Cancer
Program embraces a host of complementary and alternative therapies available to
both inpatients and outpatients. These
therapies have been offered through a
number of MPHS departments for several
years. In order to simplify access for the
community, they will be coordinated
through the Dorothy E. Schneider Center,
providing a single contact point for these
wellness-focused services. MPHS will
continue to offer massage, tai chi, yoga
and mindfulness based stress reduction
programs and services, with a continued
emphasis on the importance of fitness
and nutrition. A store in the Mills Health
Center, offering books, tapes, vitamins
and products focused on healing and
wellness, will open in early 2002.
Annual Summary of
Program Activities - SMC
SUMMIT MEDICAL CENTER
Lisa Bailey, M.D., Medical Director,
Sutter Health Cancer Programs
Over this last year we have carefully
reviewed the quality of cancer care at our
institution, ensuring the highest quality of
care to all of our community. Thus far, we
have reviewed the care of patients with
cancer of the esophagus, stomach,
pancreas, colon, rectum, anus and
thyroid, and these data have been shared
with the medical staff both in our tumor
board as well as other staff conferences.
We are proud of the results of this survey
and the excellent care that is given by our
physicians. We have also participated in
the Sutter Health Breast Cancer Project,
which measures eleven criteria quarterly
to determine the quality of care of patients
with breast cancer. We are very pleased
with the high level of early detection of
breast cancer at Summit, as well as the
excellent care that our patients receive.
We are now in the process of reviewing
our institution’s data on prostate cancer
detection and treatment.
We have a weekly tumor board as well as
a weekly breast cancer tumor board, both
of which review cases prospectively,
providing multidisciplinary review and
recommendations.
We have been meeting regularly with
oncology representatives from the Alta
Bates cancer program to plan the
eventual merger of the two programs into
one cohesive oncology service.
One of the commitments of which we are
particularly proud at Summit Medical
Center is our dedication to providing
community outreach, screening, and
education about cancer. This summer the
Markstein Cancer Education and Prevention Program partnered with the American
Cancer Society to present two free
11
community lectures to the East Bay
Chinese speaking community on
colorectal cancer. The lectures took place
in Oakland Chinatown and drew a
combined attendance of 250 people. The
lectures were presented in Cantonese with
simultaneous translation in Mandarin.
The Markstein Center, offering sigmoidoscopy services for colorectal screening, has
seen a 15% increase in appointment
requests in the past year.
In recognition of National Prostate Cancer
Awareness Week, the Markstein Center
also sponsored a free community prostate
cancer screening for men unable to
access routine health care. Outreach was
focused on men at risk—African American
and Hispanic men ages 40-70. Volunteer
physicians from both Summit Medical
Center and Alta Bates Comprehensive
Cancer Center participated in the screening. Men received a digital rectal exam
and a PSA blood test. In addition to the
exam, men had an opportunity to meet
individually with representatives from the
Bay Area Tumor Institute to hear about
participation in the new SELECT clinical
trials assessing the efficacy of Vitamin E
and Selenium as a prophylactic against
prostate cancer. Each patient also
received a private consultation with the
nurse health educator to discuss the
finding of the physical exam. Of the 88
men screened, seven had abnormal
physical findings needing further follow-up.
We look forward to continued improvements in cancer care services for the
patients of Summit Medical Center.
Annual Summary of
Program Activities - SMCS
SUTTER MEDICAL CENTER,
SACRAMENTO
Vincent Caggiano, M.D., FACP
Medical Director, Sutter Cancer Center
Cancer Committee Chair
The Breast Cancer Pretreatment Evaluation Program and the Sutter Lung Clinic
were both established during 2000. Both
programs feature a multidisciplinary team
of physicians and nurse coordinators to
evaluate breast cancer and lung cancer
patients respectively. A team of medical,
surgical and radiation oncologists along
with diagnostic radiologists, and where
appropriate, pulmonary medicine physicians, pathologists, and other physicians,
evaluate newly diagnosed patients to
expedite treatment decisions and
encourage enrollment in clinical trials.
The Gamma Knife Radiosurgery Treatment Review, a multidisciplinary conference for all cases referred for Gamma
Knife radiosurgery, was formalized under
the Cancer Center Tumor Conferences. A
Pediatric Brain Tumor Conference was
also established on a regular basis.
The Breast Cancer Disease Management
Project included an ongoing quarterly
review of all measures. SMCS was
pleased to observe substantial improvement in the following areas: axillary node
dissection in DCIS; needle biopsy rate;
percent of newly diagnosed breast cancer
cases less than two centimeters in
diameter; and percent of cases referred
for adjuvant radiation and/or chemohormonal therapy.
Physician review of abstracting revealed
that during the year 2000, 132 abstracts
were reviewed with satisfactory performance.
Paula Haley, Integrated Quality Service
Coordinator, reported on a study documenting discussion of the risks, benefits
and alternatives with patients scheduled
12
to receive first chemotherapy at SMCS.
Considerable improvement was noted
from the initial pilot study performed in
1999. Additionally, review of physician
office charts indicated that although the
risk/benefit discussion occurred in the
physician’s office, documentation was not
always present in the hospital record.
Kim Etcheberry, RN, Patient Support
Services Manager, reported on a study
performed at the Gynecologic Oncology
Clinic detailing patient arrival/wait time,
physician lateness and time patient spent
with physician. Recommendations for
modifications to the scheduling template
were made as a result of this review.
The Central Area Pharmacy Performance
Improvement activities included discussion
of adverse drug events, medication errors,
chemotherapy dosing and narcotic PCA
dosing with threshold goals. Only inpatient
cancer patients were included, and a
recommendation was made to include
outpatient cancer patients treated in the
infusion center for 2002.
Members of the Diagnostic Imaging
Division of SMCS presented their quality
assurance functions. Issues identified
included the need for correlation of
pathology reports with mammogram and
review of central lines used for IV contrast.
The Cancer Surveillance Program of
Region 3 provided an extensive review of
all new cancer cases from 1988 to 1997.
This review will be conducted annually to
identify trends in cancer incidence in
Region 3 of the California Cancer Registry.
The Bone Marrow Transplant (BMT)
Program, in conjunction with the Infusion
Services Department, developed an
interdisciplinary process for tracking
outpatient and inpatient post-BMT complications, specifically to track unexpected
hospital admissions, improve quality of life,
promote continuum of care and ultimately
improve patient outcomes.
Annual Summary of
Program Activities - SRMC
SUTTER ROSEVILLE
MEDICAL CENTER
Uma Gowda, M.D.
Medical Director Oncology
Cancer Committee Chair
The Sutter Roseville Medical Center
accomplished much in 2000. The Cancer
Committee, in conjunction with hospital
administration and the Foundation,
oversaw the expansion of many services
to meet the needs of our community and
patients.
In keeping with our goal of providing “the
best technology, right in your neighborhood”, the Prostate Seed Implant
Program, first implemented in April 1999,
expanded its services to more patients
and more physicians. This procedure,
performed jointly by urologists and
radiation oncologists, increases choices
for many men facing treatment for
prostate cancer. Increasing our physician
base allowed more patients access to this
procedure. The Cancer Committee
oversees the credentialing and monitoring
of this program.
The year 2000 also saw the beginning of
construction on our Breast Health Center,
a new service center available to women
in our community. Opened in Spring 2001,
the Breast Health Center offers state-ofthe-art mammography, stereotactic
biopsy, ultrasound and other related
breast services under one roof. Within the
Breast Health Center is the Breast Health
Nurse, a registered nurse with extensive
oncology background, who is available to
see patients for educational needs,
follow-up, self-breast exam and support
services.
13
In conjunction with the opening of the
Breast Health Center, the Sutter Roseville
Medical Center also opened the Elma
Wolf Cancer Resource Center. The
resource center, named for the wife of
one of our benefactors, provides educational materials, referrals and information
to the public.
The Cancer Committee remained active
in the Sutter Health Breast Cancer
project, working with the medical staff by
bringing education and consultation
through CME and Tumor Board presentations to improve breast services provided
to women in our community.
In October 2000, the Sutter Roseville
Medical Center added a research
coordinator position. This service has
made it easier to place patients on clinical
trials. Within two months we placed as
many patients on trials as the preceding
ten months.
We look forward to even greater achievements in delivery of cancer care services
in the coming year.
Overview of Cancer
Registries
Stephen Bishop, Coordinator
Cancer Data Services
Alta Bates Summit Medical Center
As of the end of 2000, the
Sutter Cancer Registries are
actively following 55,293
living patients.
The ability to look at our
combined Sutter Health data
provides a unique opportunity
to evaluate care across our
network.
Cancer Registries are an integral part of the Sutter Health Cancer Programs, providing
data management services to meet mandatory state cancer reporting regulations, as
well as the data needs of clinicians, administrators and other qualified users across the
Sutter Health network. At the national level, Sutter Cancer Registries also provide data
for the Survival, Epidemiology and End Results (SEER) Program of the National Cancer
Institute (NCI), and the National Cancer Database (NCDB) of the Commission on Cancer
(COC). The Sutter Cancer Registries have collected data for a total of 136,2361 cases,
with 9,669 new cases entered for the calendar year 2000.
Each registry is charged with the responsibility to identify, collect, manage, analyze and
disseminate pertinent information for all patients that have been diagnosed and/or
treated for cancer at that facility. The local registry databases contain demographic and
clinical information from diagnosis through treatment, as well as annual lifetime follow-up
data. The cancer registrars from each facility meet regularly during the year to discuss
issues relating to data quality and to insure standardization of data for systemwide
studies and quality improvement initiatives.
The follow-up process, in addition to providing critical information about disease status
and treatment outcomes, also performs a valuable service for physicians and patients by
reminding them that regular reassessment of the disease is vital for early detection of
recurrences or subsequent primaries. As of the end of 2000, the Sutter Cancer Registries are actively following 55,293 living patients. As required by the American College of
Surgeons, all Sutter Health Cancer Program hospitals must contact at least 90% of all
patients in their registries within the previous 15 months. This is known as the follow-up
success percentage and the 2000 cumulative percentage for each hospital is listed in
Table 1 (page 15).
Data collected by each hospital are shared and aggregated for combined reports,
studies and cancer statistics for the Sutter Health Cancer Programs as a whole. The
ability to look at our combined Sutter Health data provides a unique opportunity to
evaluate care across our network. However, past efforts have been made more difficult
by the lack of a unified cancer database with realtime query and reporting functions.
Toward this end, the initial research into the acquisition of the software and hardware
necessary to establish a true centralized cancer registry database was begun in the
latter part of 2000. It is expected that the process will be completed and a centralized
Sutter Health Cancer Program Registry will be in operation by the second half of 2002.
Through comparison with regional and national statistics, the combined information
system enables Sutter clinicians to more effectively monitor trends in the incidence,
staging, treatment, outcome and survival of cancer patients treated within our network. In
addition to their normal data reporting responsibilities, the Sutter Cancer Registries
received a total of 269 special requests for data in 2000.
Cancer Registry personnel typically have at least some responsibility to provide administrative and clerical support for their local Tumor Board meetings. A Tumor Board is a
multidisciplinary gathering of physician specialists that diagnose and treat cancer. Its
purpose, according to the Cancer Program Standards of the Commission on Cancer, is
to provide multidisciplinary consultative services to all patients with cancer, “…at a time
when management of the patient could be influenced by the discussion, including
1
14
Total cancer cases in all registries is less than previous years due to a change in reference date of a participating
Sutter hospital.
Overview of Cancer
Registries
Overview of Cancer Registries continued
In 2000, 1,779 patients were
presented at the Tumor Boards
of Sutter Health Cancer
discussion of management options at any time during the course of a patient’s disease…” General Tumor Boards are open to any primary site. Specialty Tumor Boards
are offered for specific sites at individual hospitals. In 2000, 1,779 patients were presented at the Tumor Boards of Sutter Health Cancer Programs.
Each Cancer Program facility is accredited by the American College of Surgeons and is
regularly resurveyed to assure continuous compliance with its accreditation standards.
The program Cancer Registrars are certified by National Cancer Registrars Association.
Programs.
The following table briefly summarizes the activity volumes
of each registry for calendar year 2000:
Table 1
ABMC
CPMC
EMC
MGH
MHA
MPHS
SMC
SMCS
SRMC
Total Cases in Database
20,124
23,903
7,736
15,047
16,124
18,340 16,502
12,301
6,159
Total Cases in 2000
1,461
1,584
391
848
925
1,289
1,101
1,392
678
Total Active Follow-up
8,684
9,904
2,970
6,075
4,733
8,628
6,210
6,025
2,064
Follow-up Success %
93%
93%
91%
94%
94%
93%
90%
86%
92%
354
110
84
96
127
285
106
475
142
General Tumor Board
107
110
84
96
80
99
56
165
142
Breast Tumor Board
247
N/A
0
N/A
26
186
50
6
N/A
0
N/A
0
N/A
21
N/A
32
304
N/A
11
46
12
31
37
20
38
35
39
Tumor Board Case Presentations
Other Special Tumor Boards
Total Data Requests
NA = Not available
15
Statistical Overview
We analyzed over 8,100 new
cases of cancer diagnosed
and/or treated at an
accredited Sutter Health
Statistical Overview of Sutter Health 2000 Cancer Registry Data
Eric Gold, Oncology Analyst/Programmer
Vincent Caggiano, M.D., Medical Director, Sutter Cancer Center
This overview represents an analysis of over 8,100 new cases of cancer diagnosed and/
or treated at the nine American College of Surgeons accredited Sutter Health institutions
during 2000. This represents a very small (< 2%) decrease in systemwide volume over
last year’s totals.
PATIENT VOLUME BY CLASS OF CASE (See Fig. 1, page 19)
institution during 2000.
Figure 1 shows the variability in the number of cancer cases reported in 2000 at each of
the nine Sutter hospitals. Year 2000 case volume ranged from 391 at EMC to 1,584 at
CPMC for a total of 9,669 cases systemwide. Eighty-five percent of these cases (8,189)
were newly diagnosed and/or received the first course of treatment at one of the nine
Sutter centers. These are designated as “analytic” cases and all further analyses are
restricted to these data.
AGE AT DIAGNOSIS
Females account for 58%
and males account for 42%
of the newly diagnosed
cancers seen in 2000.
Overall — Generally similar patterns were seen at all institutions, with the number of
cancer patients peaking in the 70-79 age range. Fifty percent of cancer patients were
diagnosed in the 60-79 age range and 82% were age 50 or over at the time of diagnosis.
The median age at diagnosis was 66 years. The median age ranged from 61 (ABMC) to
70 (EMC). ABMC and SMCS had the youngest cancer patient populations and EMC,
MPHS, SMC and SRMC had the oldest. These trends reflect differences in both the
underlying demographics of the communities served and the relative incidence of the
most prevalent cancers seen at each institution. The male cancer patient population is
slightly older than the female cancer patient population (median age 68 vs. 64). These
data are consistent with those seen over the last five years in the Sutter Health cancer
patient population.
AGE DISTRIBUTION BY GENDER (See Fig. 2, page 19)
Males — The nine hospitals show only minor differences. At most of the institutions the
greatest number of cases fell into the 70-79 age group. Overall, almost 60% of the males
were diagnosed in the 60-79 age range.
ABMC
Alta Bates Medical Center
CPMC
California Pacific Medical Center
EMC
Eden Medical Center
MGH
Marin General Hospital
MHA
Memorial Hospitals Association
MPHS
Mills-Peninsula Health Services
SMC
Summit Medical Center
SMCS
Sutter Medical Center, Sacramento
SRMC
Sutter Roseville Medical Center
16
Females — The nine hospitals show similar patterns. Overall females show a flatter
distribution than males. Although overall as in the males, the female cancer patient
population peaked in the 70-79 age range, only 43% of the females were diagnosed in
the 60-79 age range (vs. 57% in males). These gender differences probably reflect
differences in the age at diagnosis for the two most dominant gender-specific cancers:
prostate and breast cancer (see Figure 5, page 20). Within each gender, prostate and
breast cancer account for 30% and 42%, respectively, of all newly-diagnosed cases. The
median age at diagnosis for prostate cancer was 69 vs. 59 for breast cancer.
GENDER RATIO (See Fig. 3, page 20)
As seen in past years in the Sutter Health system, the female cancer patient population
is significantly larger than the male population. Females account for 58% and males
account for 42% of the newly diagnosed cancers seen in 2000. This trend was observed
at all nine institutions. The largest disparity in gender ratio was at ABMC, EMC and
SMCS, while gender distribution was most equal at SMC and SRMC.
Statistical Overview
The top ten cancer sites
comprise 76% of the
cancers seen in the
Sutter Health system.
GENDER RATIO CONT.
These differences are a reflection of the relative incidence of male-specific cancers (mostly
prostate) and female-specific cancers (mostly breast and uterus, see Figure 5, page 30).
For example, while ABMC, EMC and SMCS have the highest incidence of breast and
uterine cancers relative to prostate cancer, SRMC and SMC have the lowest incidence of
breast and uterine cancers relative to prostate cancer.
It is important to note that the female-to-male ratio in population-based registries such as
the California Cancer Registry is 1:1, whereas our Sutter hospital-based registries record a
preponderance of female patients. These differences are due to hospital referral patterns
and the inherent nature of these two different types of cancer registries.
RACE/ETHNICITY (See Figure 4, page 20)
The distribution of patients by race/ethnic group reflects the diversity seen in the communities served by each institution. The SMC cancer patient population is the most ethnically
diverse with the fewest Caucasians (45%) and the largest African-American component
(26%). ABMC also has a relatively large African-American component, with SMC and ABMC
accounting for 75% of the entire Sutter Health African-American cancer patient population.
CPMC also has a relatively diverse patient population with the largest Asian* component
(20%). CPMC and SMC together account for over half of the Asian Sutter Health population. Relatively large Hispanic components are seen at EMC (11%) and MHA (9%).
* Asian includes Asian and Pacific Islander.
TOP 10 PRIMARY CANCER SITES (See Fig. 5, page 20)
The distribution of the most prevalent cancers seen in the Sutter Health system has
changed very little over the past five years. The top ten cancer sites comprise 76% of the
cancers seen in the Sutter Health system. Female breast cancer accounts for one-quarter
of all cancers seen in the Sutter Health System. Prostate (13%), lung (12%), colorectal
(11%), and non-Hodgkin’s lymphoma (4%) account for 39% of cancers newly diagnosed in
2000. Some additional trends observed were:
17
•
Breast Cancer: Highest relative incidence seen at ABMC and MPHS (28%), and the
lowest at SRMC (17%).
•
Prostate Cancer: Highest relative incidence seen at SMC (22%). Underlying demographic data indicate that SMC has a relatively older population with a relatively large
African-American component. SMCS had the lowest incidence (4%) and in this particular case, it appears that demographic factors do not play the major role. Instead, the low
proportion of newly diagnosed prostate cases seen at SMCS is likely the result of
community referral patterns. Many of the prostate cancer cases are diagnosed in
physician offices and referred for treatment at a large, independent radiation oncology
center. Appropriately, the SMCS cancer registry does not record these patients and the
result is an under-representation of prostate cancer in the SMCS database.
•
Lung cancer: Highest relative incidence at SRMC (17%) and MHA (16%), and the
lowest at CPMC (9%) and MGH (8%).
•
Colorectal cancer: Highest relative incidence at CPMC (14%), and the lowest at
ABMC (7%).
•
Uterine cancer: Highest relative incidence at ABMC (7%) and the lowest at MPHS (2%).
•
Bladder cancer: Highest relative incidence at SRMC and EMC (9%) and the lowest at
ABMC (2%).
Statistical Overview
RELATIVE INCIDENCE OF MAJOR INVASIVE CANCERS —
COMPARISON WITH STATE AND NATIONAL ESTIMATES*
(See Fig. 6, page 21)
Overall Sutter Health Compared with CA and US:
Oral, Lung, Pancreas, Colon/Rectum, — Sutter Health was generally similar to national and statewide estimates.
Urinary, Leukemia/Lymphomas,
Uterus, Ovary and Prostate
Female Breast — Much higher than seen in California and the U.S. (38% vs. 31% and 30%).
Individual Sutter Health Institutions Compared with CA and US:
Oral
Lung
— Relatively low rate in SRMC males compared with California and the U.S. (<1% vs. 3%).
— Relatively high rates in EMC, MHA and SRMC males compared with California and the
U.S. (21%, 19%, 19% respectively vs. 15% for CA and 14% for U.S.).
Relatively low rate in MGH and CPMC males compared with California and the U.S.
(9% and 11% vs. 15% and 14%).
Relatively high rates in SRMC and MHA females compared with California and the U.S.
(17% and 16% vs. 12%).
Relatively low rate in CPMC, MGH and ABMC females compared with California
and the U.S. (8%, 8% and 9% vs. 12%).
Colorectal — Relatively low rate in ABMC females compared with California and the U.S. (7% vs. 11%).
Urinary
— Relatively high rates in EMC and SRMC males compared with California and the U.S.
(14% vs. 9% and 10%).
— Relatively low rates in ABMC males compared with California and the U.S.
(6% vs. 9% and 10%).
Leukemia/Lymphomas
— Relatively high rate in SMCS males (12%) and low rate seen in EMC males (4%)
compared with California and the U.S. (8% and 9%).
Uterus — Relatively high rate at ABMC compared with California and the U.S. (11% vs. 8% and 6%).
Ovary
— Relatively high rate at ABMC compared with California and the U.S. (7 % vs. 4%).
Prostate — The most variable of any of the major sites examined. Ranges from 45% at SMC
down to 12% at SMCS ( vs. 31% and 29% for CA and U.S.).
Female Breast — Ranges from 51% at MGH down to 28% at SRMC ( vs. 31% for CA and 30% for U.S.).
It is important to note that hospital cancer registry data reflect patients diagnosed and treated in the
hospital, unlike population-based cancer registry data such as those reported by the California Cancer
Registry and at the SEER registry of the National Cancer Institute, which represent all patients
diagnosed in a defined population.
*Both state and national estimates are derived from NCI SEER data published by the American
Cancer Society.
18
Statistical Overview
165
Figure 1
2000 Sutter Health Cancer Cases
Patient Volume by Class of Case
Number of Cases
190
Non-Analytic
1419
293
Analytic
180
1271
152
1109
121
114
1099
949
804
734
179
499
86
305
ABMC CPMC
Figure 2
MGH
20–29 30–39 40–49 50–59 60–69 70–79 80–89
2000 Sutter Health Analytic Cancer Cases
Age Distribution by Gender
EMC
%
♂ABMC
2
%
♂CPMC
1
%
2
2
3
♂SRMC
0
%
4
3
3
23
1
15
21
27
1
32
2
13
1
27
35
15
3
28
36
5
19
23
1
15
2
17
26
6
12
1
Males
19
4
0
1
1
1
90+
1
10
21
20
12
10
14
21
18
2
22
2
28
18
4
23
20
18
15
2
11
18
23
31
11
1
15
17
20
24
17
4
2
15
20
18
24
18
3
2
14
18
19
24
14
5
2
12
19
23
25
16
3
♀Sutter
31
20–29 30–39 40–49 50–59 60–69 70–79 80–89
2
17
90+
20
3
♀SRMC
27
16
1
19
2
♀SMCS
13
28
9
2
26
7
2
♀SMC
19
9
1
17
24
6
♀MPHS
13
5
2
♀MHA
32
SMCS SRMC
7
♀MGH
12
12
♀ABMC
♀EMC
26
SMC
20–29 30–39 40–49 50–59 60–69 70–79 80–89
♀CPMC
13
31
6
1
31
4
♂Sutter
1
17
31
♂SMCS
2
%
3
9
16
♂SMC
0
%
10
♂MPHS
1
%
8
♂MHA
1
%
2
23
90+
29
7
♂MGH
1
%
6
♂EMC
0
%
3
24
MHA MPHS
2
15
20
20
5
23
13
2
20–29 30–39 40–49 50–59 60–69 70–79 80–89
Females
90+
Statistical Overview
Figure 3
65
2000 Sutter Health Analytic Cancer Cases
65
62
60
Gender Ratio
57
55
54
58
56
50
50
46
40
45
53
51
47
44
43
42
38
35
36
% 30
20
Figure 4
10
2000 Sutter Health Analytic Cancer Cases
♂♀ ♂♀ ♂♀ ♂♀ ♂♀ ♂♀ ♂♀ ♂ ♀ ♂♀ ♂♀
Race/Ethnicity
0
100
91
EMC
MGH
MHA MPHS
SMC
SMCS SRMC Sutter
93
87
85
82
79
80
ABMC CPMC
74
70
64
60
%
45
40
26
20
19
20
5 3
2 1 2
0
Caucasian
ABMC
3
7
10
17
7
1
African American
CPMC
EMC
MGH
10
7
3 2
11
10
5 4
2
Asian
MHA
9
9
5 4 4 4 5
3
1 0 0 0 1 1
Hispanic
MPHS
SMC
1 0
4
Unknown
SMCS
SRMC
Sutter
Figure 5 Top 10 Primary Sites (Overall)
2000 Sutter Health Analytic Cancer Cases by Institution and by Gender
ABMC
Prostate
10
Lung
11
15
5
7
3
3
3
3
3
3
6
4
4
1
1
1
Melanoma
3
1
2
1
2
1
1
2
%
%
%
2
1
3
%
Males
25
15
12
13
17
12
12
10
11
3
4
3
4
3
3
3
4
4
3
4
3
Sutter
17
4
9
4
SRMC
25
13
10
3
%
22
12
12
3
SMCS
20
16
16
9
SMC
28
11
8
10
3
MPHS
21
19
Ovary
Pancreas
20
9
MHA
30
9
14
2
MGH
25
12
3
Uterus
Bladder
EMC
25
7
Colorectal
NonHodgkin’s
Lymphoma
CPMC
26
Breast
6
3
1
1
3
1
2
1
1
3
2
2
2
1
2
%
Females
%
4
%
2
%
%
Statistical Overview
Relative Incidence of Major Invasive Cancers
Comparison with State and National Estimates
Figure 6
2000 Sutter Health Analytic Cancer Cases
4 3
5
5 4
5 4
3
Males
0
4 3 3
2 1 1
2
2 2
1
1 1 2
1 2
Females
Oral
21
19
16
14 14
11
17
19
15 15 14
16
13
9
9 8
11
8
14
17
12
11 12
11
51
44
Lung
2 2 1
2 3
2
1
2
4
2 2 2
2 2 2
3 2 2 3
0
4
37
2 2 2
40
38
33
Pancreas
14
45
42
10
11
15
13
10
8 8
11 11 10
11
7
37
29
32 31 31
28
29
28
15
9
9
14
12
6
8
10
2 3 2 3 3 3 3 2
9 9
6 5
7
5
5
0 0 0
Urinary
12
4
0 0
0 0 0 0 0 0 0
Breast
9 9 10
7 8
0 0 0 0 0 0 0 0 0 0 0 0
Prostate
0 0 0
14
10
9
7 8 9
6
11
3 4
0 0
5
7
16
22 21 23
18 16
17
7
20
22 22
19
15
0 0
14
17
14
17 18
0 0 0 0 0 0 0
3 2 3
5
2 3
5
4
3 4 4
Ovary
20 21
All Other Sites
ABMC
21
CPMC
EMC
MGH
MHA
6
Uterus
0 0 0
23
8
7
5 7 6 4 6 5 5 6 6 6 6
32
22
6 6 7 7
5 5 5 5
0 0 0 0 0 0 0
Leukemia/Lymphomas
24 24
31 30
12 11 11 10 12 11 11 11
Colon & Rectum
26
23
38
34 35
MPHS
SMC
SMCS
SRMC
Sutter
CA
US
Focus on Colorectal
Prostate Cancer
Cancer
Patrick Swift. M.D.,
Medical Director Radiation Oncology
Alta Bates Comprehensive Cancer Center
Prostate cancer is
responsible for 11% of
all male cancer-related
deaths, second only
to lung cancer.
This study represents an
analysis of 6,542 new cases of
prostate cancer diagnosed
and/or receiving first course of
Focus on Prostate Cancer
Prostate cancer is the most common non-skin cancer reported in U.S. males, with an
estimated 198,100 new cases expected in 2001. This represents 31% of all new cancer
diagnoses in men. There will be an estimated 38,500 deaths due to this disease in the
same year, representing 11% of all male cancer-related deaths, second only to lung
cancer. As the baby boomer population continues to age, the severity of the problem will
continue to grow. An awareness of the importance of prostate screening with digital rectal
examinations and PSA testing has increased over the past decade. This is due in part to
more personally affected prominent individuals coming forth publicly to educate the
population on the problem, such as Andy Grove, (former CEO of Intel), Nelson Mandela
and General Norman Schwarzkopf. The call for screening, however, still needs to be
accepted more widely in certain communities in the country, if we are to lower the mortality
rate for this disease. It is unclear whether prostate cancer detected through early screening has led to a reduction in morbidity and mortality. Further work on developing methods
of prevention is also needed, such as the ongoing SELECT Trial (testing the value of
selenium and vitamin E as preventive agents for men at high risk for prostate cancer).
Within Sutter Health, the care and management of prostate cancer patients continues to
improve. As screening guidelines of the American Cancer Society and American Urologic
Association are implemented, the disease is diagnosed at an earlier stage—prior to the
development of symptoms. Over the past decade, major accomplishments have been
realized in the reduction of morbidity associated with the two main treatment modalities,
surgery and radiation therapy. Improved surgical techniques have led to a reduction in the
need for transfusions, shortened hospital stays, and improved sexual outcome through
nerve-sparing procedures. Newer techniques, such as the laparoscopic prostatectomy, are
being explored as ways of furthering this trend. In radiation oncology, powerful treatment
planning programs combined with improved imaging techniques, such as magnetic
resonance imaging with spectroscopy, have made it safer to deliver higher doses of
radiation via external means. This results in increasing local control of the disease. The
rapid expansion of brachytherapy for carefully selected patients has also marked a
significant change in the management of this disease. Whether or not these treatment
innovations and diagnosis at earlier stages due to screening translate into improved longterm survival still remains to be seen.
STUDY OF SUTTER HEALTH CASES FROM 1994–2000
treatment at the nine Sutter
Health institutions during the
1994–2000 time period.
This study represents an analysis of 6,542 new cases of prostate cancer diagnosed and/
or receiving first course of treatment at the nine Sutter Health institutions during the 1994–
2000 time period. For homogeneity of data purposes, only adenocarcinomas were
included. During early stages of data analysis we discovered that the standard cancer
registry data set has not kept pace with the rapid changes in the understanding of prostate
cancer. For full comprehension of the Sutter Health prostate cancer experience, we will
need to make changes in data collection and coding.
NUMBER OF ANALYTIC CASES AND PERCENT OF TOTAL
REGISTRY CASES
22
Figure 1 (page 26) shows the volume distribution of prostate cancer cases at each Sutter
Health hospital. Over the seven-year span of this study, prostate cancer case volume
generally reflected the size of the underlying oncology population at each hospital.
Relative incidence (proportion of prostate cancer in the entire cancer patient population)
during this period ranged from 7% (SMCS) to 17% (SMC) with prostate cancer representing 12% of Sutter cancer cases overall.
Prostate Cancer
AGE AT DIAGNOSIS
The overall median age at diagnosis was 69 years and ranged from 67 (SMCS) to 71
(EMC). At all other hospitals, median age was in the 68-70 range. Distribution by age
group was similar throughout Sutter hospitals, peaking in the 60-79 age group, which
represented 75% of the cases overall (Figure 2, page 26). There were a relatively few
cases in the 50-59 and the 80-89 age groups (15% and 8%, respectively), with only rare
cases diagnosed prior to age 50 or after the age of 80.
Overall, stage of disease has
The time period encompassed by this study includes the years since PSA testing
achieved widespread acceptance. This practice is likely to be stable over the coming
decade. In the decade before this period, the average age at diagnosis tended to be
older, as patients were diagnosed after developing symptoms. The PSA test has allowed
patients to be diagnosed at an earlier age with earlier disease.
been shown to be one of the
most important predictors of
RACE/ETHNICITY
The racial and ethnic variations noted for each institution reflect the diversity of the
communities served (Figure 3, page 26). Sutter Health serves a broad population base
throughout Northern California. CPMC has the highest percentage of Asian patients
(23%), Modesto and Eden have the highest percentage of Hispanic patients (11% and
10%, respectively), and Alta Bates and Summit and have the highest proportion of
African-Americans (31% and 22%, respectively). These findings are consistent with sitespecific studies done over the last eight years.
outcome after treatment for
prostate cancer.
TNM STAGE AT DIAGNOSIS
Stage Group
T(umor)
N(odes)
Stage I
1a
0
Stage II
1a
0
0
Stage II
1b
0
0
Stage II
1c
0
0
Stage II
1
0
0
Stage II
2
0
0
Stage III
3
0
0
Stage IV
4
0
0
Stage IV
Any
1
0
Stage IV
Any
Any
1
Table 1
Overall, stage of disease has been shown to be one of the most important predictors of outcome after treatment for prostate cancer. Table 1
1
shows the current AJCC TNM scoring scheme for prostate cancer. A
2,3,4
difficulty was identified while reviewing the staging information: those
Any
patients treated surgically tended to be classified according to their
Any
pathologic stage, while those treated primarily with radiation tended to be
Any
clinically staged. This difference makes it impossible to cleanly compare
Any
outcomes of different treatment modalities according to stage, since
Any
clinical staging underestimates extent of disease in up to a third of
Any
patients. Clinical staging under-represents the proportion of patients with
Any
microscopic spread to lymph nodes (or microscopic extension to seminal
Any
vesicles or outside the capsule), whereas surgical (pathological) sampling
will identify a number of such cases. In future data acquisition, attempts
will be made to capture both clinical and pathologic TNM staging information for prostate
cancer cases. In this study “mixed” staging was used to classify patients: if present,
pathological staging information was used, otherwise the clinical stage was used.
M(etastases) Histologic Grade
0
Figure 4 (page 27) shows that the large majority of men were diagnosed with clinical T1c
(non-palpable, PSA elevated) or T2 (clinically palpable but organ confined), and only 617% with clinical or surgically-proven extension beyond the capsule. The difference in the
percentages of patients with T1a-b disease reflects variation in the frequency of performing TURP procedures among clinicians at each organization.
When stage was analyzed by race (Figure 5, page 27), there were no major differences
noted except that Hispanic men tended to have relatively less Stage II (localized) disease
and relatively more Stage III (regional) disease, possibly suggesting a need for increased
screening outreach to the Hispanic population.
23
Prostate Cancer
Grade of disease is another
major outcome predictor
prostate cancer.
Gleason Score Grade Assigned to:
2-4
Grade 1
5-6
Grade 2
7
Grade 2? or 3?
8-10
Grade 3
Table 2
The two major treatment
Another major outcome predictor for prostate cancer is grade of disease. At the beginning of the time period of this study (1994), grade was routinely broken into the standard
for
groupings of well-differentiated (1), moderately well differentiated (2), and poorly
differentiated (3). During the 1990’s, the Gleason’s grading system gradually supplanted
this older system. It gained widespread acceptance when a number of studies established the prognostic power of the Gleason pattern score. In this system, an initial score
of 1 through 5 was given to the cells based on their histologic appearance. Since
variable levels of differentiation are often noted within biopsies from a single individual, a
two-digit system was adopted, with the first digit indicating the predomiDescription
nant histologic pattern, and the second number representing the
well differentiated
secondary pattern. For example 4+3 would indicate a preponderance of
moderately differentiated
cells graded as 4 with a smaller percentage of better-differentiated grade
moderately poorly differentiated
3 cells. The Gleason pattern score is currently built into most prospective
poorly differentiated
intergroup clinical trials due to its perceived importance as a powerful
prognosticator. The AJCC Staging Guidelines attempted to create a grid for translating
between the two systems, but compounded the problem by creating a category called
“moderately poorly differentiated” for those patients given a score of 7, (see Table 2).
The Northern California system for registering grade did not include this additional
category, so that patients with a pattern score of 7 were placed in the grade II group by
some, while others felt they should more appropriately be placed in the grade III group. It
is clear that in future registration, the actual Gleason pattern score, using a two-digit
system, will be important for the correct outcome analysis.
approaches to early prostate
cancer are surgery
(in the form of variations on
the standard radical
prostatectomy) and radiation
(external radiation,
brachytherapy or some
combination of the two).
HISTOLOGIC GRADE AT DIAGNOSIS
In the current interpretation, grade 1 patients are those with a combined Gleason score
of 2–4, grade 2 with combined scores of 5–6, grade 3 with scores of 7–10. The majority
of patients at all institutions were recorded as grade 2, although some variability has
been observed (Figure 6, page 28). For instance, EMC and CPMC had the lowest
percentages of patients classified as grade 2 and the highest classed as grade 3. Two
possible explanations for this are inter-pathologist variability in applying the grading
system, or alternatively those patients with a Gleason’s score of 7 were placed in
different groups by different registrars.
When analyzed according to race, Asian/Pacific Islanders had a greater likelihood of
being diagnosed as grade 3 than the other racial groups (Figure 7, page 28). There was
no difference noted between Caucasians, African-Americans or Hispanics.
TREATMENT MODALITIES
The two major treatment approaches to early prostate cancer are surgery (in the form of
variations on the standard radical prostatectomy) and radiation (external radiation,
brachytherapy or some combination of the two). Hormonal ablation therapy, in conjunction with radiation, is playing a more prominent role for patients with locally aggressive or
regional disease, and as sole therapy for patients with advanced regional or metastatic
disease.
Each of the Sutter hospitals has a different set of contractual agreements in place with
health plans in their individual communities, as well as different arrangements for the
delivery of radiation services. Whereas the majority of centers have their own Radiation
Oncology departments, Sutter Medical Center, Sacramento, utilizes a totally outpatient
facility, independent of the hospital. Several centers also provide radiation services for
24
Prostate Cancer
Focus on Prostate Cancer continued
Sutter Health continues to
provide an outstanding
array of treatment options
for the communities served,
with excellent reported
outcomes.
other health care systems that do not have their own Radiation Oncology departments,
providing care for patients diagnosed outside the system. Therefore, there is a steady
stream of patients into and out of the various Sutter institutions in northern California,
affecting the analysis of percentage of patients undergoing surgery or radiation as the
primary treatment modality in each institution.
Figure 8 (page 28) displays the primary treatment delivered for prostate cancer as
recorded at each institution. At first glance, it would seem that a far greater percentage of
patients undergo radical prostatectomies at SMCS than at MGH or ABMC, but the full
explanation is that patients treated with radiation in the SMCS community are not treated
within the Sutter system, and so are not recorded. At the same time, the facilities at
ABMC and MGH provide radiation treatment for patients referred from a variety of
urologists outside the Sutter system, making the percentage of radiation patients
compared to surgical cases artificially inflated.
5-YEAR RELATIVE SURVIVAL
In order to facilitate valid comparison of Sutter Health outcome data to national trends,
we analyzed a subset of cases comparable to the most recently published SEER data:
1992–1997. Figure 9 (page 29) shows that overall five-year relative survival rates are
comparable to estimates reported by SEER for Northern California and for the entire
U.S. Survival trends based on age and race are shown in Figure 10 (page 29), and
again Sutter Health compares favorably with regional and national trends. The Sutter
Health prostate cancer population also shows a similar trend to national data for African
Americans having lower overall survival rates. However, Figures 5 and 7 show no clear
evidence that African-American men are being diagnosed at later stage or at a higher
grade than Caucasian men in the Sutter Health System. This suggests that co-morbidity
in the African-American population may play a significant role in this difference in
outcome. These findings suggest another possible avenue of further investigation.
CONCLUSION
Prostate cancer remains a major focus of each of the cancer centers within the Sutter
system. The magnitude of the problem, while relatively stable in terms of percentages
within the population, will continue to grow given the aging of the growing population of
Northern California. Enhanced screening will lead to a rise in newly diagnosed cases in
most areas. Sutter Health continues to provide an outstanding array of treatment options
for the communities served, with excellent reported outcomes.
This analysis has pointed out several opportunities for improvement in future data
acquisition with regard to prostate cancer. Given the relatively slow course of the disease
in most men, any meaningful survival analysis has to extend at least ten years from
diagnosis. Databases must be designed that can rapidly adjust to include new prognostic
factors as they are shown to have major clinical relevance over time. Some of these
factors are PSA levels, rate of rise of PSA, Gleason pattern scores, both clinical and
surgical staging for all cases, and the percentage of biopsies involved at initial diagnosis.
Newer genetic markers are being identified that, in all likelihood, will make the current
prognostic indicators less relevant in the next decade.
25
Focus on Prostate
Cancer
Figure 1
1149
1137
1994-2000 Sutter Health Prostate Cancer
Number of Analytic Cases and Percent
of Total Registry Cases
981
784
748
556
#
466
397
324
Number of Prostate Cancer Cases, 1994-2000
12%
%
16%
13%
11%
14%
10%
17%
7%
11%
Percent of Total Registry Cases, 1994-2000
ABMC CPMC
Figure 2
1994-2000 Sutter Health Prostate Cancer
%
Age at Diagnosis
Sutter
EMC
MGH
MHA MPHS
15
8
50-59
SMCS SRMC
38
37
2
40–49
SMC
60–69
70–79
1
80–89
90+
Age at Diagnosis
Figure 3
1994-2000 Sutter Health Prostate Cancer
Race/Ethnicity
95
91
84
77
62
84
82
76
66
67
%
31
23
22
7 8
Caucasian
ABMC
26
CPMC
12
2 3
5
6
1
African American
EMC
MGH
MHA
5
5
1 1
8 8 6
2 3
3
Asian/Pacific Islander
MPHS
SMC
11
10
7
SMCS
2
5 4 5
6 5
Hispanic
SRMC
Sutter
Focus on Prostate
Cancer
Figure 4
1989-1999 Sutter Health Colorectal Cancer
Race/Ethnicity
81
80
76
72 73 71
71
75 73
64
%
15
13
5
2
7
4
3
11
7
2
Stage I
ABMC
9
6
3
Stage II
CPMC
EMC
MGH
17
16 15
12 11
11 12
6
8
4
3
Stage III
MHA
MPHS
6
7
5
9
7
6
Stage IV
SMC
SMCS
SRMC
Sutter
Figure 4
1994-2000 Sutter Health Prostate Cancer
TNM Stage at Diagnosis
See Table 1 (page 23) for explanation of TNM stage groups
74
74
74
65
Figure 5
1994-2000 Sutter Health Prostate Cancer
TNM Distribution by Race/Ethnicity
%
19
7
7
8
Stage I
Caucasian
27
12
7
Stage II
African-American
8
9
Stage III
5
8
6
6
Stage IV
Asian/Pacific Islander
Hispanic
Focus on Prostate
Cancer
Figure 6
78
77
75
1994-2000
Sutter Health Prostate Cancer
72
68
67
Histological Grade
See Table 2 (page 24) for explanation
of histologic groups
59
70
69
55
%
29
26
25
19
11
8
14
23
23
18
21
16
12
7
4
7
4
4
4
7
Grade 1
ABMC
Grade 2
CPMC
EMC
MGH
MHA
Grade 3
MPHS
SMC
SMCS
SRMC
Sutter
Figure 7
1994-2000 Sutter Health Prostate Cancer
70
70
71
Histological Grade Distribution
By Race/Ethnicity
61
%
28
7
7
6
6
Grade 1
Figure 8
1994-2000 Sutter Health Prostate Cancer
Caucasian
Treatment Modalities
22
20
20
Grade 2
African-American
Grade 3
Asian/Pacific Islander
Hispanic
83
S = Surgery
R = Radiation Therapy
H = Hormonal Therapy
None = No Cancer-directed Treatment
52
%
46
40
3536
35
40 39
3132
25
22
2524
16
10
31
30
26
28
23
22
18
16
12
13
12
8
1
S alone
ABMC
28
1
R alone
CPMC
R+H
EMC
MGH
2
5
7 7
2 2
3 2
None
MHA
5
4
7
9
3 4
5
3 4
7 5
H alone
MPHS
10
6
4 3
2
7
5
3 5 3
S+H
SMC
2 2 2 1 3 2 3 3 1 2
S+R
SMCS
1
3 1 2 2
1 1 1 2 1
S+R+H
SRMC
Sutter
Focus on Prostate
Cancer
Figure 9
1994-1999 Sutter Health Prostate Cancer
Sutter Hospitals vs. U.S. and
San Francisco Bay Area,
1992-1997
5-Year Relative Survival
100
100
98
99
100
100
99
100
96
93
100
80
60
40
20
0
ABMC CPMC EMC MGH MHA MPHS SMC SMCS SRMC Sutter
95% Five-year Relative Survival; SEER data, U.S., 1992-97
94% Five-year Relative Survival; SEER data, SF Bay Area 1992- 97
Figure 10
1994-2000 Sutter Health Prostate Cancer
5-Year Relative Survival
Overall Sutter vs. U.S. and
San Francisco Bay Area,
1992-1997
Sutter
5-Year Relative Survival
100
96
100
95
95
95
SF Bay Area
100
96
96
95
90
90
80
60
40
20
0
29
99
U.S.
Under
Age 65
Age 65
and Over
Caucasian
AfricanAmerican
Primary Site Tables
ALTA BATES SUMMIT
MEDICAL CENTER –
ALTA BATES
Legend:
N/R = Not recorded
Refers only to those primary sites for which a TNM staging
scheme exists and the stage group is not recorded.
Abbreviations: A = analytic; N/A = non-analytic;
M = male; F = female
Tabulations for stage at diagnosis include analytic cases only.
30
ABMC 2000 Primary Site Table
Primary Site
All Sites
Lip
Tongue
Salivary Glands, Major
Gum
Floor of Mouth
Mouth, Other & NOS
Tonsil
Oropharynx
Nasopharynx
Hypopharynx
Pharynx & Ill-defined
Esophagus
Stomach
Small Intestine
Colon
Rectum & Rectosigmoid
Anus,Anal Canal,Anorectum
Liver
Gallbladder
Bile Ducts
Pancreas
Retroperitoneum
Peritoneum,Omentum,Mesent
Other Digestive
Nasal Cavity,Sinus,Ear
Larynx
Lung/Bronchus-Small Cell
Lung/Bronchus-Large Cell
Pleura
Other Respiratory & Thoracic
Leukemia
Myeloma
Other Hematopoietic
Bone
Soft Tissue
Melanoma of Skin
Kaposis Sarcoma
Other Skin Ca
Breast
Cervix In Situ Ca
Cervix Uteri
Corpus Uteri
Uterus NOS
Ovary
Vagina
Vulva
Other Female Genital
Prostate
Testis
Penis
Other Male Genital
Bladder
Kidney and Renal Pelvis
Ureter
Other Urinary
Eye
Brain
Other Nervous System
Thyroid
Other Endocrine
Hodgkins Disease
Non-Hodgkins Lymphoma
Unknown or Ill-defined
Cases
1461
%
100%
Class of Case
A
N/A
1271
190
Gender
M
F
538
923
5
0.3%
4
1
4
2
2
4
1
8
1
2
14
16
2
74
30
4
13
1
3
23
0.1%
0.1%
0.3%
0.1%
0.5%
0.1%
0.1%
1.0%
1.1%
0.1%
5.1%
2.1%
0.3%
0.9%
0.1%
0.2%
1.6%
1
1
4
1
7
1
1
12
15
2
67
26
3
11
1
2
20
1
1
7
4
1
2
2
2
3
1
5
1
2
9
7
1
30
15
4
7
1
3
9
1
1
2
11
12
156
4
1
36
24
3
2
17
41
5
4
367
0.1%
0.1%
0.1%
0.8%
0.8%
10.7%
0.3%
0.1%
2.5%
1.6%
0.2%
0.1%
1.2%
2.8%
0.3%
0.3%
25.1%
1
1
1
10
8
127
4
1
23
22
3
2
15
37
3
4
336
30
85
3
61
5
15
5
159
9
1
2.1%
5.8%
0.2%
4.2%
0.3%
1.0%
0.3%
10.9%
0.6%
0.1%
29
82
1
52
3
15
5
127
9
1
31
20
2.1%
1.4%
25
17
6
3
1
2
32
0.1%
0.1%
2.2%
1
1
30
1
2
14
1
18
45
32
1.0%
0.1%
1.2%
3.1%
2.2%
13
1
17
38
27
1
1
2
1
1
1
4
29
13
2
2
4
2
31
9
8
78
3
19
15
2
2
10
20
4
4
4
1
3
2
9
2
32
Distribution of Stage at Diagnosis
I
II
III
IV
N/R
289
341
153
180
95
1
1
2
3
2
1
1
4
2
3
5
9
1
44
15
1
1
3
6
1
3
14
1
1
2
2
4
78
1
1
17
9
1
7
21
1
363
8
2
2
2
24
10
1
4
2
1
14
5
3
3
1
1
3
8
1
12
6
1
4
1
1
6
3
3
1
4
9
5
1
1
1
3
22
1
1
1
8
3
4
29
2
2
2
62
1
1
6
1
20
2
3
5
2
2
1
3
2
1
7
6
53
114
1
126
23
1
13
2
7
2
14
47
8
5
6
10
1
4
11
1
4
2
3
5
4
20
9
1
1
2
8
8
159
9
1
2
101
2
9
14
1
8
1
1
6
2
1
7
14
16
2
16
10
23
9
14
1
8
22
23
1
2
1
2
1
30
85
3
61
5
15
5
24
6
1
1
1
1
7
5
0
104
14
2
8
6
4
2
1
3
5
2
3
2
3
19
9
5
4
3
1
10
2
1
1
1
1
1
Primary Site Tables
CALIFORNIA
PACIFIC MEDICAL
CENTER
Legend:
N/R = Not recorded
Refers only to those primary sites for which a TNM staging
scheme exists and the stage group is not recorded.
Abbreviations: A = analytic; N/A = non-analytic;
M = male; F = female
Tabulations for stage at diagnosis include analytic cases only.
31
CPMC 2000 Primary Site Table
Primary Site
All Sites
Lip
Tongue
Salivary Glands, Major
Gum
Floor of Mouth
Mouth, Other & NOS
Tonsil
Oropharynx
Nasopharynx
Hypopharynx
Pharynx & Ill-defined
Esophagus
Stomach
Small Intestine
Colon
Rectum & Rectosigmoid
Anus,Anal Canal,Anorectum
Liver
Gallbladder
Bile Ducts
Pancreas
Retroperitoneum
Peritoneum,Omentum,Mesent
Other Digestive
Nasal Cavity,Sinus,Ear
Larynx
Lung/Bronchus-Small Cell
Lung/Bronchus-Large Cell
Pleura
Other Respiratory & Thoracic
Leukemia
Myeloma
Other Hematopoietic
Bone
Soft Tissue
Melanoma of Skin
Kaposis Sarcoma
Other Skin Ca
Breast
Cervix In Situ Ca
Cervix Uteri
Corpus Uteri
Uterus NOS
Ovary
Vagina
Vulva
Other Female Genital
Prostate
Testis
Penis
Other Male Genital
Bladder
Kidney and Renal Pelvis
Ureter
Other Urinary
Eye
Brain
Other Nervous System
Thyroid
Other Endocrine
Hodgkins Disease
Non-Hodgkins Lymphoma
Unknown or Ill-defined
Cases
1584
%
100%
Class of Case
A
N/A
1419
165
11
6
0.7%
0.4%
10
5
1
5
5
0.1%
0.3%
0.3%
4
1
1
1
Gender
M
F
738
846
0
150
Distribution of Stage at Diagnosis
I
II
III
IV
N/R
420
314
195
202
49
8
3
3
3
1
5
1
4
4
1
5
5
1
2
4
3
1
1
1
1
1
1
2
2
2
0.3%
0.1%
4
1
3
1
1
2
1
1
1
13
24
3
147
61
19
38
5
4
25
0.8%
1.5%
0.2%
9.3%
3.9%
1.2%
2.4%
0.3%
0.3%
1.6%
12
20
2
140
60
18
34
5
4
23
10
13
1
75
24
15
28
1
2
14
3
11
2
72
37
4
10
4
2
11
3
2
1
1
9
1
35
10
1
7
2
4
1
0.3%
0.1%
4
1
1
1
3
7
12
117
1
0.4%
0.8%
7.4%
0.1%
7
12
110
1
7
7
64
1
5
53
33
13
2.1%
0.8%
23
11
10
2
16
4
17
9
2
6
26
16
5
374
0.1%
0.4%
1.6%
1.0%
0.3%
23.6%
2
4
19
5
5
352
2
7
11
3
15
16
3
3
8
49
2
26
1
3
2
195
8
4
0.5%
3.1%
0.1%
1.6%
0.1%
0.2%
0.1%
12.3%
0.5%
0.3%
7
48
1
19
1
2
1
170
8
3
52
32
1
3.3%
2.0%
0.1%
43
27
1
9
5
42
21
1
10
11
56
12
3.5%
0.8%
45
11
11
1
33
9
23
3
13
3
6
86
36
0.8%
0.2%
0.4%
5.4%
2.3%
13
2
6
73
33
3
1
2
53
20
10
2
4
33
16
1
4
1
7
1
1
4
2
7
22
1
1
1
7
1
1
25
1
1
13
3
2
13
6
8
25
19
7
3
1
2
1
2
14
2
1
17
2
2
5
1
1
5
1
3
1
1
3
2
3
11
10
2
371
80
8
49
2
26
1
3
2
43
17
1
5
5
5
1
19
7
1
1
1
1
21
3
1
2
3
1
4
135
1
1
98
4
37
1
1
7
1
2
5
37
3
1
1
5
19
12
1
8
1
8
1
5
1
2
5
1
28
6
3
114
1
15
1
23
7
11
1
5
3
1
4
5
33
1
195
8
4
1
7
46
1
12
1
1
5
7
2
2
1
7
3
2
35
4
3
2
1
14
1
1
18
1
3
Primary Site Tables
EDEN MEDICAL
CENTER
Legend:
N/R = Not recorded
Refers only to those primary sites for which a TNM staging
scheme exists and the stage group is not recorded.
Abbreviations: A = analytic; N/A = non-analytic;
M = male; F = female
Tabulations for stage at diagnosis include analytic cases only.
32
EMC 2000 Primary Site Table
Primary Site
All Sites
Lip
Tongue
Salivary Glands, Major
Gum
Floor of Mouth
Mouth, Other & NOS
Tonsil
Oropharynx
Nasopharynx
Hypopharynx
Pharynx & Ill-defined
Esophagus
Stomach
Small Intestine
Colon
Rectum & Rectosigmoid
Anus,Anal Canal,Anorectum
Liver
Gallbladder
Bile Ducts
Pancreas
Retroperitoneum
Peritoneum,Omentum,Mesent
Other Digestive
Nasal Cavity,Sinus,Ear
Larynx
Lung/Bronchus-Small Cell
Lung/Bronchus-Large Cell
Pleura
Other Respiratory & Thoracic
Leukemia
Myeloma
Other Hematopoietic
Bone
Soft Tissue
Melanoma of Skin
Kaposis Sarcoma
Other Skin Ca
Breast
Cervix In Situ Ca
Cervix Uteri
Corpus Uteri
Uterus NOS
Ovary
Vagina
Vulva
Other Female Genital
Prostate
Testis
Penis
Other Male Genital
Bladder
Kidney and Renal Pelvis
Ureter
Other Urinary
Eye
Brain
Other Nervous System
Thyroid
Other Endocrine
Hodgkins Disease
Non-Hodgkins Lymphoma
Unknown or Ill-defined
Cases
391
%
100%
Class of Case
A
N/A
305
86
1
Gender
M
F
161
230
1
2
Distribution of Stage at Diagnosis
0
I
II
III
IV N/R
20
89
62
34
57
18
2
2
1
0.5%
0.5%
0.3%
1
2
1
1
5
0.3%
0.3%
1.3%
1
1
5
5
9
3
29
9
2
3
1.3%
2.3%
0.8%
7.4%
2.3%
0.5%
0.8%
2
8
3
24
8
1
2
3
1
8
2.0%
4
1
0.3%
1
1
3
15
50
1
0.3%
0.8%
3.8%
12.8%
0.3%
1
2
10
37
1
11
5
1
2.8%
1.3%
0.3%
4
2
1
7
3
4
2
1
7
3
8
2.0%
7
1
3
5
2
2
1
84
21.5%
75
9
84
8
44
19
1
9
0.3%
2.3%
8
1
1
1
9
5
3
5
1.3%
4
1
5
2
2
3
0.8%
3
35
3
9.0%
0.8%
26
3
9
35
3
19
4
4.9%
1.0%
17
4
2
16
2
3
2
6
1.5%
6
3
3
1
9
2.3%
5
4
3
6
3
1
1
16
20
0.3%
4.1%
5.1%
10
16
1
6
4
8
8
1
8
12
4
2
1
1
1
2
1
1
2
1
3
5
1
1
1
5
3
2
10
6
1
2
6
1
19
3
1
1
3
4
4
2
6
2
1
1
1
1
5
1
1
3
1
1
2
10
1
1
8
3
1
3
2
2
1
3
1
1
2
1
1
1
5
13
1
3
8
24
1
7
26
1
3
1
7
8
19
1
5
1
1
2
3
2
7
1
1
6
2
16
3
1
4
4
2
1
1
3
3
1
4
Primary Site Tables
MARIN GENERAL
HOSPITAL
Legend:
N/R = Not recorded
Refers only to those primary sites for which a TNM staging
scheme exists and the stage group is not recorded.
Abbreviations: A = analytic; N/A = non-analytic;
M = male; F = female
Tabulations for stage at diagnosis include analytic cases only.
33
MGH 2000 Primary Site Table
Primary Site
All Sites
Lip
Tongue
Salivary Glands, Major
Gum
Floor of Mouth
Mouth, Other & NOS
Tonsil
Oropharynx
Nasopharynx
Hypopharynx
Pharynx & Ill-defined
Esophagus
Stomach
Small Intestine
Colon
Rectum & Rectosigmoid
Anus,Anal Canal,Anorectum
Liver
Gallbladder
Bile Ducts
Pancreas
Retroperitoneum
Peritoneum,Omentum,Mesent
Other Digestive
Nasal Cavity,Sinus,Ear
Larynx
Lung/Bronchus-Small Cell
Lung/Bronchus-Large Cell
Pleura
Other Respiratory & Thoracic
Leukemia
Myeloma
Other Hematopoietic
Bone
Soft Tissue
Melanoma of Skin
Kaposis Sarcoma
Other Skin Ca
Breast
Cervix In Situ Ca
Cervix Uteri
Corpus Uteri
Uterus NOS
Ovary
Vagina
Vulva
Other Female Genital
Prostate
Testis
Penis
Other Male Genital
Bladder
Kidney and Renal Pelvis
Ureter
Other Urinary
Eye
Brain
Other Nervous System
Thyroid
Other Endocrine
Hodgkins Disease
Non-Hodgkins Lymphoma
Unknown or Ill-defined
Cases
848
%
100%
Class of Case
A
N/A
734
114
7
3
2
1
3
5
2
0.8%
0.4%
0.2%
0.1%
0.4%
0.6%
0.2%
6
3
1
1
3
5
2
2
2
6
9
3
53
25
6
4
3
2
11
0.2%
0.2%
0.7%
1.1%
0.4%
6.3%
2.9%
0.7%
0.5%
0.4%
0.2%
1.3%
2
2
3
6
2
45
24
5
3
3
2
7
1
0.1%
1
2
7
9
63
0.2%
0.8%
1.1%
7.4%
2
7
8
52
12
7
1
1
8
12
2
3
230
3
9
21
1.4%
0.8%
0.1%
0.1%
0.9%
1.4%
0.2%
0.4%
27.1%
0.4%
1.1%
2.5%
4
4
1
8
7
1
2
218
3
7
19
13
1.5%
10
2
1
160
6
0.2%
0.1%
18.9%
0.7%
2
1
136
6
33
21
3.9%
2.5%
17
1
Gender
M
F
383
465
4
1
1
1
3
4
2
3
3
1
8
1
1
1
4
2
1
5
6
1
19
16
2
3
1
1
8
Distribution of Stage at Diagnosis
0
I
II
III
IV
N/R
54
210
187
90
73
82
3
2
2
1
2
1
1
2
3
1
1
2
1
1
1
1
1
4
2
1
7
1
1
5
2
1
1
2
1
1
1
3
2
34
9
4
1
2
1
3
1
3
3
1
1
9
6
2
1
1
14
2
2
1
11
7
1
2
2
2
3
1
2
1
7
3
1
3
16
1
4
20
2
1
3
1
103
59
1
14
2
12
1
2
1
3
1
2
2
3
3
2
82
12
6
5
2
2
5
4
1
3
4
4
1
1
3
1
1
1
1
11
8
3
1
5
1
1
12
2
6
4
28
6
4
1
1
3
4
2
1
2
2
1
5
35
1
6
6
3
1
5
8
2
2
2
228
3
9
21
3
13
2
1
24
160
6
29
17
4
4
25
14
8
7
2.0%
16
1
9
8
6
0.7%
6
1
5
6
31
12
0.7%
3.7%
1.4%
5
25
12
3
17
4
3
14
8
1
6
5
1
28
3
2
1
12
1
1
1
31
6
6
6
2
1
2
4
3
1
11
4
1
18
Primary Site Tables
MEMORIAL HOSPITALS
ASSOCIATION,
REGIONAL CANCER
CENTER
Legend:
N/R = Not recorded
Refers only to those primary sites for which a TNM staging
scheme exists and the stage group is not recorded.
Abbreviations: A = analytic; N/A = non-analytic;
M = male; F = female
Tabulations for stage at diagnosis include analytic cases only.
34
MHA 2000 Primary Site Table
Primary Site
All Sites
Lip
Tongue
Salivary Glands, Major
Gum
Floor of Mouth
Mouth, Other & NOS
Tonsil
Oropharynx
Nasopharynx
Hypopharynx
Pharynx & Ill-defined
Esophagus
Stomach
Small Intestine
Colon
Rectum & Rectosigmoid
Anus,Anal Canal,Anorectum
Liver
Gallbladder
Bile Ducts
Pancreas
Retroperitoneum
Peritoneum,Omentum,Mesent
Other Digestive
Nasal Cavity,Sinus,Ear
Larynx
Lung/Bronchus-Small Cell
Lung/Bronchus-Large Cell
Pleura
Other Respiratory & Thoracic
Leukemia
Myeloma
Other Hematopoietic
Bone
Soft Tissue
Melanoma of Skin
Kaposis Sarcoma
Other Skin Ca
Breast
Cervix In Situ Ca
Cervix Uteri
Corpus Uteri
Uterus NOS
Ovary
Vagina
Vulva
Other Female Genital
Prostate
Testis
Penis
Other Male Genital
Bladder
Kidney and Renal Pelvis
Ureter
Other Urinary
Eye
Brain
Other Nervous System
Thyroid
Other Endocrine
Hodgkins Disease
Non-Hodgkins Lymphoma
Unknown or Ill-defined
Cases
925
%
100%
Class of Case
A
N/A
804
121
Gender
M
F
410
515
2
4
2
1
1
1
3
3
1
1
1
5
10
0
46
Distribution of Stage at Diagnosis
I
II
III
IV
N/R
230
190
116
122
42
4
5
1
1
3
5
0.4%
0.5%
0.1%
0.1%
0.3%
0.5%
4
3
1
1
2
4
1
1
8
16
2
74
27
5
5
3
5
24
0.1%
0.1%
0.9%
1.7%
0.2%
8.0%
2.9%
0.5%
0.5%
0.3%
0.5%
2.6%
1
1
8
15
2
72
23
5
5
3
5
21
1
0.1%
1
6
24
123
7
0.6%
2.6%
13.3%
0.8%
5
22
107
7
1
2
16
5
13
60
7
1
11
63
18
9
1.9%
1.0%
10
6
8
3
10
6
8
3
5
8
0.5%
0.9%
4
6
1
2
3
3
2
5
3
183
0.3%
19.8%
3
166
17
1
2
2
181
15
23
1.6%
2.5%
12
22
3
1
15
23
8
13
26
2
5
2.8%
0.2%
0.5%
22
2
5
4
26
2
5
3
9
1
1
110
10
2
11.9%
1.1%
0.2%
88
9
2
22
1
1
4
1
31
17
2
2
1
21
3.4%
1.8%
0.2%
0.2%
0.1%
2.3%
25
15
2
2
6
2
13
5
39
24
2
4
3
35
15
4
1
1
3
9
3
1
2
1
1
1
2
1
1
2
3
2
1
1
3
6
2
39
12
1
4
2
2
15
1
1
1
2
2
22
9
1
3
3
2
4
1
5
1
1
23
9
2
15
4
11
1
1
2
2
3
2
3
12
1
5
2
7
30
2
11
38
1
1
5
4
2
8
4
1
2
3
6
1
2
1
4
4
1
4
75
1
9
4
3
1
4
1
2
3
1
1
1
1
1
1
1
1
110
10
2
3
3
25
9
2
1
3
2
1
25
81
46
12
8
8
1
1
1
10
6
19
1
2
21
11
2
1
1
9
1.4%
12
1
5
8
10
1
0.5%
4.2%
2.6%
5
27
22
12
2
2
17
11
3
22
13
1
6
4
2
1
1
1
12
1
1
2
1
7
2
8
Primary Site Tables
MILLS-PENINSULA
HEALTH SERVICES
Legend:
N/R = Not recorded
Refers only to those primary sites for which a TNM staging
scheme exists and the stage group is not recorded.
Abbreviations: A = analytic; N/A = non-analytic;
M = male; F = female
Tabulations for stage at diagnosis include analytic cases only.
35
MPHS 2000 Primary Site Table
Primary Site
All Sites
Lip
Tongue
Salivary Glands, Major
Gum
Floor of Mouth
Mouth, Other & NOS
Tonsil
Oropharynx
Nasopharynx
Hypopharynx
Pharynx & Ill-defined
Esophagus
Stomach
Small Intestine
Colon
Rectum & Rectosigmoid
Anus,Anal Canal,Anorectum
Liver
Gallbladder
Bile Ducts
Pancreas
Retroperitoneum
Peritoneum,Omentum,Mesent
Other Digestive
Nasal Cavity,Sinus,Ear
Larynx
Lung/Bronchus-Small Cell
Lung/Bronchus-Large Cell
Pleura
Other Respiratory & Thoracic
Leukemia
Myeloma
Other Hematopoietic
Bone
Soft Tissue
Melanoma of Skin
Kaposis Sarcoma
Other Skin Ca
Breast
Cervix In Situ Ca
Cervix Uteri
Corpus Uteri
Uterus NOS
Ovary
Vagina
Vulva
Other Female Genital
Prostate
Testis
Penis
Other Male Genital
Bladder
Kidney and Renal Pelvis
Ureter
Other Urinary
Eye
Brain
Other Nervous System
Thyroid
Other Endocrine
Hodgkins Disease
Non-Hodgkins Lymphoma
Unknown or Ill-defined
Class of Case
A
N/A
1109
180
4
1
12
2
6
Cases
1289
5
14
6
%
100%
0.4%
1.1%
0.5%
4
1
2
1
2
4
0.3%
0.1%
0.2%
0.1%
0.2%
0.3%
4
1
2
1
1
4
12
21
2
84
31
7
4
1
4
25
1
6
0.9%
1.6%
0.2%
6.5%
2.4%
0.5%
0.3%
0.1%
0.3%
1.9%
0.1%
0.5%
12
18
2
76
31
7
2
1
3
21
1
6
14
23
123
1
2
20
14
1.1%
1.8%
9.5%
0.1%
0.2%
1.6%
1.1%
13
22
109
1
2
12
7
1
5
44
1
1
325
1
7
28
0.1%
0.4%
3.4%
0.1%
0.1%
25.2%
0.1%
0.5%
2.2%
1
5
16
1
307
1
6
26
17
1.3%
13
1
226
7
2
1
56
15
3
3
0.1%
17.5%
0.5%
0.2%
0.1%
4.3%
1.2%
0.2%
0.2%
1
177
7
2
1
48
13
3
2
14
1.1%
12
6
43
36
Gender
M
F
603
686
2
3
9
5
5
1
3
0
109
Distribution of Stage at Diagnosis
I
II
III
IV
N/R
300
326
134
135
40
3
1
3
4
1
3
1
3
2
1
1
1
2
1
2
1
1
3
3
8
2
1
4
1
1
14
8
7
28
1
18
8
14
1
34
12
4
2
2
13
1
1
10
14
64
1
2
8
5
1
3
26
1
1
1
2
1
1
2
1
1
1
2
3
3
2
2
4
26
8
3
29
12
2
13
4
1
1
2
1
4
7
1
50
19
3
2
1
2
12
1
5
3
1
4
3
1
5
4
9
59
2
3
4
1
3
2
1
2
11
47
3
1
1
6
17
4
1
8
2
10
34
1
2
12
9
1
1
2
18
3
65
1
2
4
6
3
2
118
89
11
7
5
19
1
5
2
1
1
2
4
17
2
1
8
2
1
1
30
3
123
14
2
8
2
10
3
1
1
8
5
1
2
1
2
3
1
1
226
7
2
1
42
12
2
2
14
3
1
1
10
4
13
1
0.9%
9
3
1
11
4
4
1
0.5%
3.3%
2.8%
6
41
32
2
4
4
24
13
2
19
23
1
14
3
11
1
3
1
8
2
2
1
2
1
1
10
324
1
7
28
49
2
4
1
17
2
2
1
27
1
1
13
Primary Site Tables
Primary Site Tables
ALTA BATES SUMMIT
MEDICAL CENTER –
SUMMIT
Legend:
N/R = Not recorded
Refers only to those primary sites for which a TNM staging
scheme exists and the stage group is not recorded.
Abbreviations: A = analytic; N/A = non-analytic;
M = male; F = female
Tabulations for stage at diagnosis include analytic cases only.
36
SMC 2000 Primary Site Table
Primary Site
All Sites
Lip
Tongue
Salivary Glands, Major
Gum
Floor of Mouth
Mouth, Other & NOS
Tonsil
Oropharynx
Nasopharynx
Hypopharynx
Pharynx & Ill-defined
Esophagus
Stomach
Small Intestine
Colon
Rectum & Rectosigmoid
Anus,Anal Canal,Anorectum
Liver
Gallbladder
Bile Ducts
Pancreas
Retroperitoneum
Peritoneum,Omentum,Mesent
Other Digestive
Nasal Cavity,Sinus,Ear
Larynx
Lung/Bronchus-Small Cell
Lung/Bronchus-Large Cell
Pleura
Other Respiratory & Thoracic
Leukemia
Myeloma
Other Hematopoietic
Bone
Soft Tissue
Melanoma of Skin
Kaposis Sarcoma
Other Skin Ca
Breast
Cervix In Situ Ca
Cervix Uteri
Corpus Uteri
Uterus NOS
Ovary
Vagina
Vulva
Other Female Genital
Prostate
Testis
Penis
Other Male Genital
Bladder
Kidney and Renal Pelvis
Ureter
Other Urinary
Eye
Brain
Other Nervous System
Thyroid
Other Endocrine
Hodgkins Disease
Non-Hodgkins Lymphoma
Unknown or Ill-defined
Class of Case
A
N/A
949
152
1
9
3
Cases
1101
1
9
3
%
100%
0.1%
0.8%
0.3%
3
3
6
1
0.3%
0.3%
0.5%
0.1%
3
2
4
3
6
31
3
77
20
4
16
3
3
15
1
0.3%
0.5%
2.8%
0.3%
7.0%
1.8%
0.4%
1.5%
0.3%
0.3%
1.4%
0.1%
3
5
27
3
70
16
4
12
1
2
10
1
2
6
9
129
3
1
20
10
2
0.2%
0.5%
0.8%
11.7%
0.3%
0.1%
1.8%
0.9%
0.2%
5
9
114
3
1
14
5
2
10
18
3
3
204
0.9%
1.6%
0.3%
0.3%
18.5%
9
12
3
3
187
29
32
3
15
9
4
1
239
3
2
2.6%
2.9%
0.3%
1.4%
0.8%
0.4%
0.1%
21.7%
0.3%
0.2%
25
25
2
13
8
3
1
205
3
2
37
16
1
1
2
2
3.4%
1.5%
0.1%
0.1%
0.2%
0.2%
14
3
27
33
Gender
M
F
559
542
1
9
2
1
1
2
1
1
6
1
1
4
3
4
24
7
4
4
2
1
5
2
1
15
36
10
2
10
2
2
5
5
6
65
2
6
5
14
5
1
1
6
3
12
3
2
1
17
4
7
1
2
1
1
0
66
Distribution of Stage at Diagnosis
I
II
III
IV
N/R
212
268
123
112
115
2
3
2
1
1
1
2
7
3
41
10
2
6
1
1
10
1
2
1
3
64
1
1
6
5
1
1
1
12
2
15
5
2
1
2
19
3
1
2
5
2
1
1
2
1
1
1
6
1
19
4
1
1
1
2
3
6
10
2
7
2
1
1
9
7
1
2
1
1
1
1
1
1
2
22
1
11
2
7
6
5
2
4
1
203
37
1
67
29
32
3
15
9
4
1
5
35
1
3
29
1
1
2
1
1
3
1
42
1
9
2
1
30
10
11
6
5
6
4
3
1
5
4
2
3
160
2
1
10
3
2
34
239
3
2
34
14
1
1
1
3
2
11
6
1
2
26
10
1
1
1
1
1.3%
13
1
5
9
7
0.3%
2.5%
3.0%
3
24
29
3
4
2
15
17
1
12
16
1
11
20
1
1
1
1
17
6
7
2
4
2
5
1
1
1
25
5
5
1
5
3
1
2
1
1
1
3
1
2
1
2
1
2
8
1
1
Primary Site Tables
SUTTER MEDICAL
CENTER,
SACRAMENTO
Legend:
N/R = Not recorded
Refers only to those primary sites for which a TNM staging
scheme exists and the stage group is not recorded.
Abbreviations: A = analytic; N/A = non-analytic;
M = male; F = female
Tabulations for stage at diagnosis include analytic cases only.
37
SMCS 2000 Primary Site Table
Primary Site
All Sites
Lip
Tongue
Salivary Glands, Major
Gum
Floor of Mouth
Mouth, Other & NOS
Tonsil
Oropharynx
Nasopharynx
Hypopharynx
Pharynx & Ill-defined
Esophagus
Stomach
Small Intestine
Colon
Rectum & Rectosigmoid
Anus,Anal Canal,Anorectum
Liver
Gallbladder
Bile Ducts
Pancreas
Retroperitoneum
Peritoneum,Omentum,Mesent
Other Digestive
Nasal Cavity,Sinus,Ear
Larynx
Lung/Bronchus-Small Cell
Lung/Bronchus-Large Cell
Pleura
Other Respiratory & Thoracic
Leukemia
Myeloma
Other Hematopoietic
Bone
Soft Tissue
Melanoma of Skin
Kaposis Sarcoma
Other Skin Ca
Breast
Cervix In Situ Ca
Cervix Uteri
Corpus Uteri
Uterus NOS
Ovary
Vagina
Vulva
Other Female Genital
Prostate
Testis
Penis
Other Male Genital
Bladder
Kidney and Renal Pelvis
Ureter
Other Urinary
Eye
Brain
Other Nervous System
Thyroid
Other Endocrine
Hodgkins Disease
Non-Hodgkins Lymphoma
Unknown or Ill-defined
Cases
1392
%
100%
Class of Case
A
N/A
1099
293
6
3
0.4%
0.2%
5
3
4
0.3%
4
2
0.1%
4
2
1
14
34
7
105
48
8
17
2
3
26
0.3%
0.1%
0.1%
1.0%
2.4%
0.5%
7.5%
3.4%
0.6%
1.2%
0.1%
0.2%
1.9%
4
1
1
9
28
7
89
38
4
14
2
3
24
3
0.2%
3
2
5
17
155
3
0.1%
0.4%
1.2%
11.1%
0.2%
2
3
15
120
2
57
13
4
5
14
46
2
2
321
4.1%
0.9%
0.3%
0.4%
1.0%
3.3%
0.1%
0.1%
23.1%
31
5
1
3
12
36
2
280
12
35
3
40
0.9%
2.5%
0.2%
2.9%
10
35
2
29
9
1
76
8
3
0.6%
0.1%
5.5%
0.6%
0.2%
8
1
48
7
3
42
24
1
1
1
49
1
33
5
6
69
38
3.0%
1.7%
0.1%
0.1%
0.1%
3.5%
0.1%
2.4%
0.4%
0.4%
5.0%
2.7%
28
17
1
1
1
36
31
5
5
48
32
1
Gender
M
F
550
842
4
1
0
89
2
2
2
3
4
2
2
1
3
1
5
6
16
10
4
3
8
20
7
46
27
2
10
2
2
10
Distribution of Stage at Diagnosis
I
II
III
IV
N/R
286
244
167
180
40
1
2
1
1
1
6
14
59
21
6
7
2
1
16
26
8
3
2
2
10
2
41
4
1
2
5
4
2
1
12
13
2
6
2
28
5
1
2
3
4
1
11
3
18
8
1
1
1
1
9
54
3
8
19
7
1
2
8
18
1
1
1
6
12
5
11
9
2
1
318
1
51
109
1
99
13
8
2
8
3
4
11
9
3
1
36
2
7
1
1
2
6
1
1
21
2
28
1
76
8
3
14
7
32
13
1
1
26
1
3
3
4
37
14
10
11
2
1
9
1
2
28
2
12
35
3
40
9
1
3
1
38
6
3
3
6
28
2
1
3
1
1
1
5
2
4
1
1
11
1
3
7
80
1
11
1
21
6
1
4
5
1
22
10
1
4
1
1
5
1
2
10
75
3
2
13
1
2
1
2
3
2
2
35
1
1
4
6
24
2
4
3
16
1
1
1
4
3
2
9
6
2
2
1
1
1
1
2
1
1
1
1
23
30
2
2
32
24
4
1
1
20
8
1
2
2
6
1
7
14
2
3
16
2
1
3
4
Primary Site Tables
SUTTER ROSEVILLE
MEDICAL CENTER
Legend:
N/R = Not recorded
Refers only to those primary sites for which a TNM staging
scheme exists and the stage group is not recorded.
Abbreviations: A = analytic; N/A = non-analytic;
M = male; F = female
Tabulations for stage at diagnosis include analytic cases only.
38
SRMC 2000 Primary Site Table
Primary Site
All Sites
Lip
Tongue
Salivary Glands, Major
Gum
Floor of Mouth
Mouth, Other & NOS
Tonsil
Oropharynx
Nasopharynx
Hypopharynx
Pharynx & Ill-defined
Esophagus
Stomach
Small Intestine
Colon
Rectum & Rectosigmoid
Anus,Anal Canal,Anorectum
Liver
Gallbladder
Bile Ducts
Pancreas
Retroperitoneum
Peritoneum,Omentum,Mesent
Other Digestive
Nasal Cavity,Sinus,Ear
Larynx
Lung/Bronchus-Small Cell
Lung/Bronchus-Large Cell
Pleura
Other Respiratory & Thoracic
Leukemia
Myeloma
Other Hematopoietic
Bone
Soft Tissue
Melanoma of Skin
Kaposis Sarcoma
Other Skin Ca
Breast
Cervix In Situ Ca
Cervix Uteri
Corpus Uteri
Uterus NOS
Ovary
Vagina
Vulva
Other Female Genital
Prostate
Testis
Penis
Other Male Genital
Bladder
Kidney and Renal Pelvis
Ureter
Other Urinary
Eye
Brain
Other Nervous System
Thyroid
Other Endocrine
Hodgkins Disease
Non-Hodgkins Lymphoma
Unknown or Ill-defined
Cases
678
%
100%
Class of Case
A
N/A
499
179
Gender
M
F
326
352
Distribution of Stage at Diagnosis
0
I
II
III
IV N/R
43
107
117
51
82
61
1
2
1
0.1%
0.3%
0.1%
1
2
1
1
1
13
7
2
45
18
0.1%
1.9%
1.0%
0.3%
6.6%
2.7%
9
5
2
39
13
2
1
1
25
1
1
0.3%
0.1%
0.1%
3.7%
0.1%
0.1%
1
5
17
87
4
0.1%
0.7%
2.5%
12.8%
0.6%
1
3
14
70
3
2
3
17
1
1
3
7
49
3
2
10
38
1
23
11
3.4%
1.6%
12
2
11
9
9
7
14
4
5
0.7%
2
3
2
3
17
2.5%
10
7
8
9
2
4
2
112
0.3%
16.5%
2
85
1
27
1
112
18
33
4
17
0.6%
2.5%
3
16
1
1
4
17
14
2
1
2.1%
0.3%
0.1%
7
2
1
7
14
2
1
103
7
1
15.2%
1.0%
0.1%
74
5
1
29
2
103
7
1
34
18
3
5.0%
2.7%
0.4%
29
16
3
5
2
26
10
1
8
8
2
1
7
0.1%
1.0%
1
6
1
1
5
2
4
1
5
30
21
0.6%
0.1%
0.7%
4.4%
3.1%
4
1
3
17
4
1
1
1
15
10
2
1
1
4
2
1
8
3
6
5
19
7
2
6
11
1
1
2
13
17
5
4
2
26
11
1
1
1
1
8
6
2
2
11
1
6
2
1
4
1
2
1
1
19
1
1
1
6
2
1
9
4
2
1
1
14
3
1
11
1
1
4
1
1
1
2
10
1
1
2
4
22
1
7
31
1
5
2
2
23
1
4
1
3
6
1
1
1
14
1
1
1
4
1
1
2
62
3
3
6
2
4
6
2
5
1
2
3
2
1
1
1
3
1
1
4
15
11
1
3
1
1
1
1
3
1
18
2
2
2
6
2
Primary Site Tables
SUTTER HEALTH
NETWORK
Legend:
N/R = Not recorded
Refers only to those primary sites for which a TNM staging
scheme exists and the stage group is not recorded.
Abbreviations: A = analytic; N/A = non-analytic;
M = male; F = female
Tabulations for stage at diagnosis include analytic cases only.
39
Sutter Health Network
2000 Primary Site Table
Primary Site
All Sites
Lip
Tongue
Salivary Glands, Major
Gum
Floor of Mouth
Mouth, Other & NOS
Tonsil
Oropharynx
Nasopharynx
Hypopharynx
Pharynx & Ill-defined
Esophagus
Stomach
Small Intestine
Colon
Rectum & Rectosigmoid
Anus,Anal Canal,Anorectum
Liver
Gallbladder
Bile Ducts
Pancreas
Retroperitoneum
Peritoneum,Omentum,Mesent
Other Digestive
Nasal Cavity,Sinus,Ear
Larynx
Lung/Bronchus-Small Cell
Lung/Bronchus-Large Cell
Pleura
Other Respiratory & Thoracic
Leukemia
Myeloma
Other Hematopoietic
Bone
Soft Tissue
Melanoma of Skin
Kaposis Sarcoma
Other Skin Ca
Breast
Cervix In Situ Ca
Cervix Uteri
Corpus Uteri
Uterus NOS
Ovary
Vagina
Vulva
Other Female Genital
Prostate
Testis
Penis
Other Male Genital
Bladder
Kidney and Renal Pelvis
Ureter
Other Urinary
Eye
Brain
Other Nervous System
Thyroid
Other Endocrine
Hodgkins Disease
Non-Hodgkins Lymphoma
Unknown or Ill-defined
Class of Case
Cases
9669
6
58
28
5
18
18
30
6
23
11
10
91
167
27
688
269
55
102
19
25
182
3
18
2
10
64
138
1003
24
4
230
106
11
16
65
220
29
23
2200
4
115
299
11
217
19
42
11
1303
61
15
1
335
167
11
8
63
160
1
118
10
56
386
252
%
100%
0.1%
0.6%
0.3%
0.1%
0.2%
0.2%
0.3%
0.1%
0.2%
0.1%
0.1%
0.9%
1.7%
0.3%
7.1%
2.8%
0.6%
1.1%
0.2%
0.3%
1.9%
0.0%
0.2%
0.0%
0.1%
0.7%
1.4%
10.4%
0.2%
0.0%
2.4%
1.1%
0.1%
0.2%
0.7%
2.3%
0.3%
0.2%
22.8%
0.0%
1.2%
3.1%
0.1%
2.2%
0.2%
0.4%
0.1%
13.5%
0.6%
0.2%
0.0%
3.5%
1.7%
0.1%
0.1%
0.7%
1.7%
0.0%
1.2%
0.1%
0.6%
4.0%
2.6%
A
8189
4
51
25
3
17
15
25
5
21
10
8
72
142
25
622
239
47
85
16
22
149
3
17
2
7
55
120
846
22
4
133
64
7
11
57
150
13
21
2006
4
99
281
6
169
16
39
10
1051
57
14
1
278
140
11
7
49
134
0
106
8
49
299
220
N/A
1480
2
7
3
2
1
3
5
1
2
1
2
19
25
2
66
30
8
17
3
3
33
0
1
0
3
9
18
157
2
0
97
42
4
5
8
70
16
2
194
0
16
18
5
48
3
3
1
252
4
1
0
57
27
0
1
14
26
1
12
2
7
87
32
Gender
M
4268
2
43
16
0
14
11
25
5
13
9
8
62
100
13
304
132
34
65
5
12
81
2
2
1
5
50
77
507
20
2
124
54
8
9
31
119
28
14
16
0
0
0
0
0
0
0
0
1303
61
15
1
254
99
8
6
36
91
1
22
5
28
209
106
F
5401
4
15
12
5
4
7
5
1
10
2
2
29
67
14
384
137
21
37
14
13
101
1
16
1
5
14
61
496
4
2
106
52
3
7
34
101
1
9
2184
4
115
299
11
217
19
42
11
0
0
0
0
81
68
3
2
27
69
0
96
5
28
177
146
Distribution of Stage at Diagnosis
0
681
0
0
0
0
1
0
2
0
0
0
0
3
2
0
29
12
12
1
0
0
0
0
0
0
0
3
0
0
0
0
2
0
0
0
1
46
0
1
365
4
0
2
0
1
2
18
0
0
0
3
0
149
3
5
2
6
4
0
1
0
0
0
1
I
2143
3
6
15
1
6
6
1
0
2
0
1
6
29
5
128
72
17
7
2
3
13
1
0
0
0
23
5
146
5
0
0
0
0
4
18
38
1
5
804
0
50
182
2
44
3
7
6
112
35
9
0
53
59
2
2
33
2
0
57
0
9
102
1
II
2049
1
11
5
1
3
1
3
1
4
4
0
16
18
2
201
59
10
9
4
4
15
1
0
0
0
12
3
58
0
0
0
0
0
1
15
21
0
2
601
0
19
13
0
12
5
5
0
769
5
0
0
35
24
0
0
0
0
0
18
0
23
34
1
III
1063
0
11
1
0
3
1
9
1
3
2
2
10
31
5
143
49
4
14
3
1
17
0
2
0
0
12
37
220
5
0
0
0
0
0
8
15
0
5
104
0
20
48
1
58
2
6
1
97
8
2
0
11
21
1
1
0
0
0
18
1
8
40
1
IV
1143
0
21
3
1
4
6
10
2
10
4
3
17
41
9
86
28
0
27
7
6
79
1
1
1
2
4
64
352
4
0
6
0
0
2
2
9
0
1
56
0
7
17
2
39
3
3
2
47
5
0
0
18
22
1
1
1
3
0
5
2
6
86
4
N/R
542
0
2
1
0
0
1
0
1
2
0
2
20
21
4
35
19
4
27
0
8
25
0
0
1
5
1
11
70
8
4
0
0
0
4
13
21
0
7
76
0
3
19
1
15
1
0
1
26
4
0
1
12
11
2
1
0
0
0
7
5
3
37
0
Sutter Health