Cancer Registration: Principles and Methods - IARC

228 Appendix 3(a)
Seceret tilfaelde af malign lidelse - lndberetning fra et Patologisk lnstitut
lndsendes 111: Kr3llens Bek3mpelse. Cancerregisterel. Rosenviengets Hovedvej 35. Box 839.2100 Kbh. 0. lIL 01 268866
,B.n.r..-l.O.lualrlsr.,.....- ....
n*,
CPR- nr. -
Efternavna -
FOrnavnea -
Adresse a -
Stilling (a) -
Dadsdafo -
Sidsle indl.
Personal identification number (10-digits) provided to all Danish
citizens 1 April 1968. Composed of date, month, year of birth, and
,-digit check-number including sex. and century of birch.
Family name (and maiden name)
Firsr name(s)
Address
(municipality and county)
Occupation
lndl dato
Date of admission
a~hese variables are all coded
in the Central Population Register
from which information at the date
of tumour diagnosis is linked to
the Registry turnour record.
Occupation may however be more
specific on the form and thus be
coded manually.
Date of death = date of diagnosis if no other information
than this form is available
Sygehus aldeling
Hospital and department
s1,t 1 I I I I I l~ccupation
Dlagdalo
for behold^ Cancerteg~s~esel
For registry use
Xonchlyear of
diagnosis
TODO 1 I I I ICD-0 topography
Sektions nr.
Reference number of autopsy
Afd. nr.
illg. Sundhedsstyrelsen
Reference number for department according to
the Danish Board of Health
"dared
Lat ral'ty of paired organs and
stage of disease
Sekllonssygehus Hospital where autopsy was performed
FOR TUMORER. DER INDBERETTES TIL CANCERREGISTERET (se velledntng pa bagslden)
ln- see r e v d
1 UlElechods oE conf irmarion
1 , J~reatment within first
months
Primaer Tumor 1 - First primary tumour
Endelig sektionsdiagnose: - Final autopsy diagnosis (only tumour diagnosis)
lkun lumordnagnosen)
Histologisk diagnose: - Morphology (text)
Histo1ogtsk ver~likalion:
Histologically verified
;s NO.
riel
Udbredelse: 'r8R31' 815&#9' \ b ? h ~ & a % ~ ~ 'd%\?y"?T' ~ ~ ~ ~
Stage of disease
Uvenlel (tilla?ldigt) 5ektionslund: 07%' 0 %%j
Incidental autopsy finding
hvis ne] anlor behandlende hosp~talsald. - if no, please indicate rhe treating hospital department Diagnose& Year of diagnosis
Prim~r Tumor 2
Endelig sektionsdiagnose:
oiun ~unnora~agnosen~
Histologisk diagnose:
D~nstitutes of pathology are supposed to report autopsy findings on cancer patients already known.
Thc institutes encounter multiple primaries more often than clinical departments and were hesitant
to fill in multiple forms. We have thus alloved for notification of more than one rumour on
this form, especially since additional information on each turnobr will be searched for at the
clinical departments. In 1980 approximately 37% of all knovn deceased cancer patients had autopsy
performed and 2% of the yearly incidence were incidental autopsy findings (Storm b Andersen.
Ugeskr. Laeger. 1986)
-
Hislologisk ver~likalion: U ia U nei
Udbredelse: [rl lokal [7 regional 0 Ijernmelasl. [7 uoplysl
Uvenlel (lillieldigt) seklionslund: ja 0 nej
hvis nej anfor behandlende hospilalsald.
Diagnosear
Primaer Tumor 3
Endelig seklionsdiagnose:
(run lurnordtaqnorenl
Histologisk diagnose:
Histologisk verilikalion: U ia [7 nei
Udbredelse: lokal 17 regional ljernrnelast. uoplysl
Uvenlel (lill2eldigl) seklionslund: ja nei
hvis nej anlor behandlende hospitalsald.
Diagnosear
Bemaerkninger
Special remarks
Dalo - dace
Undershrill - signature (must be hD)
I
Figure 2. Danish Cancer Registry: registration.form for use by an institute of pathology