2 1 A N N U A L R E P O R T (USING 29 STATISTICAL DATA) C A R O L I N A S M E D I C A L C E N T E R CAROLINAS MEDICAL CENTER CANCER NETWORK CAROLINAS MEDICAL CENTER CAROLINAS MEDICAL CENTER-MERCY CAROLINAS MEDICAL CENTER-PINEVILLE CAROLINAS MEDICAL CENTER-UNIVERSITY
Cancer Committee Chairman s Report.........2 Cancer Liaison Physician s Report.............3 Cancer Committee Membership..............4 Cancer Conferences.........................5 General Tumor Board CMC Network........6 Leading Sites - 29 Estimate................7 Cancer Data - Network Cancer Data.............................8 Age by Sex Distribution...................1 Race Distribution........................1 TNM Stage Distribution..................11 Stage by Sex............................11 State & National Comparison..............12 County Distribution......................13 Carolinas Medical Center Oncology Quality Assurance...............14 Cancer Data............................16 Age by Sex Distribution...................18 Race Distribution........................18 TNM Stage Distribution..................19 Stage by Sex............................19 State & National Comparison..............2 County Distribution......................2 Carolinas Medical Center-Mercy Cancer Data............................21 Age by Sex Distribution...................23 Race Distribution........................23 TNM Stage Distribution..................25 Stage by Sex............................25 State & National Comparison..............26 County Distribution......................27 Carolinas Medical Center-University Cancer Data............................28 Age by Sex Distribution...................3 Race Distribution........................3 TNM Stage Distribution..................31 Stage by Sex............................31 State & National Comparison..............32 County Distribution......................33 Carolinas Medical Center-Pineville Cancer Data............................34 Age by Sex Distribution...................36 Race Distribution........................36 TNM Stage Distribution..................37 Stage by Sex............................37 State & National Comparison..............38 County Distribution......................39 Major Site Report: Cervix Major Site Report........................4 Race/Ethnicity of Cervix Uteri Cancer.......41 Stage of Cervix Uteri Cancer...............41 Age Group of Cervix Uteri Cancer..........42 Histology of Cervix Uteri Cancer...........42 First Course Treatment of Cervix Uteri Cancer...........................43 Observed Survival for Cases Diagnosed in 23 Data............................44 Observed Survival for Cases Diagnosed 25-29 Data.......................44 Contact Information.......................45 1
Cancer Committee Chairman s Report Carolinas Medical Center s Blumenthal Cancer Center remains at the forefront of the fight against cancer. Within the CMC facilities in Charlotte, Carolinas Medical Center continues to serve as the largest provider of cancer services for Carolinas HealthCare System. Importantly, the development and incorporation of CMC- Mercy, CMC-Pineville and CMC-University within the cancer realm has increased our total number of new cancer cases being accessioned through our sister facilities to nearly 4,6 cases. Blumenthal Cancer Center is committed to maintaining our position as a leader in cancer care. We are proud of the care we provide, and excited about new opportunities to help more patients and families in the Carolinas and beyond. We value your support and partnership in this important work. JEFFREY S. KNEISL, MD Our Cancer Liaison Report defines some of the specific achievements for 29. Below, I have included some of the goals that were reached by the CMC Cancer Committee during 21, as well as the goals that were set for 211. The American College of Surgeons requires all accredited cancer facilities to designate achievement goals in several domains each year. These domains include clinical, community outreach, quality improvement, and cancer programmatic goals. During 21, the Cancer Committee achieved four goals: (1) Clinical: Evaluate and amplify molecular diagnostic testing (2) Community Outreach: Evaluate patient and family centered care opportunities such as expansion of ACS programs and the development of a Family Advisory Council (3) Quality Improvement: Develop QI survey of awareness of NCCN guidelines in cancer network (4) Programmatic: Evaluate the feasibility of implementation of an oncology-specific electronic medical record For 211, the Cancer Committee established the following goals: (1) Clinical: Develop and expand patient navigator program (2) Community Outreach: Implement Patient Family Advisory Council (3) Quality Improvement: Implement QI survey of NCCN guidelines and clinical stage of top five sites at all network facilities (4) Programmatic: Unification of cancer registry operations among CHS facilities Our achievements in 21 were substantial and continue to demonstrate the dedication of our team. Our wonderful staff, nurses and physicians continuously strive to provide excellent patient care and service to patients and their families affected by cancer in our region. Respectfully submitted, Jeffrey S. Kneisl, MD, FACS Medical Director, Blumenthal Cancer Center 2
Cancer Liaison Physician s Report The cancer program at Carolinas Medical Center continues to expand at a remarkable pace. Our 3,416 accessioned cases in 29 were a full 7.6 percent increase over those accessioned in 28. This continues a trend seen over many years. Many of our readers may not be aware that accession cases do not include several hundred additional cancer cases that are seen in consultation for second opinions, or completing cancer care that may have been initiated elsewhere. As a network program, it is also important to note that 1,183 other cases were diagnosed at CMC-Pineville, CMC-Mercy and CMC-University. All total the CMC Cancer Network accessioned 4,599 cases. RICHARD L. WHITE, JR., MD Our mix of patients reflects the national trends that one would expect with the most common diagnoses representing breast, lung and prostate cancer. We also have substantial numbers of patients who have been cared for with GYN malignancies, melanoma, kidney cancer and brain cancer, given our notable programs in the care of patients with these specific diagnoses. Of our 3,416 patients, 343 were recruited to clinical trials. This continues our strong presence in research and our emphasis on clinical trials and the acquisition of tissue for further study. This 1 percent stands in stark contrast to the national average for enrollment in clinical trials of approximately 4 percent. We continue to accrue well to both industry and cooperative group trials. In addition, 67 patients participated in Total Cancer Care TM, a research partnership with H. Lee Moffitt Cancer Center and Research Institute. Community outreach under the leadership of Kevin Platé of the cancer center has remained at a very high level. Carolinas HealthCare System was involved in 55 community events that allowed interaction with 82,14 participants. Many of these events are combined efforts with the American Cancer Society continuing our goal to develop stronger partnerships between the Cancer Committee and the American Cancer Society. We are proud of these efforts as we continue our work as a network accredited program. It is clear that cancer care in the Charlotte region continues to move forward allowing better care for patients in our region. Richard L. White, Jr., MD, FACS Cancer Liaison Physician Chief, Division of Surgical Oncology 3
Cancer Committee Membership Asim Amin, MD Vice Chair Jeff Aho Lisa Amacker-North, MS Lisa Barber, RN John Barkley, MD Emily Bellard, CNS Ross Bellavia, MD Wendy Brick, MD Rose Bryan Rachel Burns, RD Benjamin Calhoun, MD Teresa Flippo, MD Kris Gaston, MD Nehemie Georges Sharon Gilkerson, CTR Andrew Gilman, MD Debra Godfrey Michael Haake, MD QI Chair Rita Harmon-Law Chris Hummer Scott Kerr Mark King Gwen Lambert, RN Nancy Lane Tracia Lewis, ACS Spencer Lilly Steven Limentani, MD Bob Massengill Andrea Mauth Katie Mileham, MD Joshua Miller, MD Jeffrey S. Kneisl, MD Chairman Scott Moroney Reza Nazemzadeh, MD QI Chair - Mercy Javier Oesterheld, MD Sridhar Pal, MD QI Chair - Pineville Cathy Parris, RN Kevin Platé Heather Presley Vishwa Raj, MD Chan Roush Stuart Salmon, MD QI Chair - University Jonathan Salo, MD Terry Sarantou, MD Gail Satterfield Grace Sauzier, RN David Tait, MD Paige Tedder, RHIT, CTR Suzanne Thibodeau, RN Raymond Tsao, MD Meg Turner, MSW Allison Walls, PharmD Eric Wang, MD Ritu Ward Carol Weida, MD Quality Control Coordinator Brook White, MS Patricia White, MD Richard L. White, Jr., MD ACoS Liasion Physician Phyllis Wingate-Jones Warden Woodard, MD 4
Cancer Conferences Cancer conferences conducted under the auspices of the Cancer Committee include: Breast Tumor Board (Teleconferenced) Bone and Soft Tissue Tumor Conference Brain Tumor Conference (Teleconferenced) General Tumor Board (Teleconferenced) Genitourinary Conference GI Tumor Planning Conference Gynecology Tumor Board (Teleconferenced) Head and Neck Conference (Teleconferenced) Immunotherapy/Melanoma Tumor Conference Lung Tumor Conference Lung Tumor Planning Conference Small Tumor Kidney Conference Urology Conference All conferences offer continuing medical education (CME) credit through the Area Health Education Center (AHEC). Three of these conferences are coordinated by Cancer Data Services by Janice Wallace. Jonathan Salo, MD, serves as cancer conference coordinator and works with physicians to schedule case presentations. We continue to teleconference our General Tumor Board Conference between CMC, CMC- Mercy, CMC-Pineville and CMC-University. We have also had participation from Wallace Thompson Hospital in Union, SC. We continue to use web-based video conferencing for the Breast Tumor Board and the Head and Neck Conference. This technology allows for both interactive conferencing with users over the Internet and allows archiving of presentations for later review. Dr. Salo updated the Cancer Committee during the year regarding case presentations and multidisciplinary attendance at conferences by diagnostic radiology, interventional radiology, medical oncology, pathology, radiation oncology and surgery. We are making plans to expand the use of video conferencing for cancer conferences, both within CMC facilities in Charlotte and with Carolinas Physicians Network (CPN) and area physicians. 5
General Tumor Board CMC Network SITE 29 Abdomen / Gastric 25 Adrenal 5 Adrenocortical 2 Ampullary 1 Aplastic Anemia 1 Anus / Anal 11 Appendix 1 Atypical Dermal 1 Bladder 65 Bones/Soft Tissue 468 Breast 145 Carcinoid 7 Cervix 1 Cholangiocarcinoma 6 Colon 46 Colorectal 3 Didactic 12 Duodenal 1 Endometrium 3 Esophagus 9 Extra Adrenal Parganglioma 1 Fallopian Sarcoma 1 Gallbladder 2 Gastrinoma 1 GE Junction 2 Germ Cell Tumor 1 GI Stromal 1 Gist 5 HCC 3 Hepatic Hemangioma 1 Hepatoma 1 Hodgkin s 2 Hyperleukocytosis 1 IPMN 2 Insulinoma 2 Islet Cell 2 Ivc Sarcoma 1 Jejenum 2 Kidney 297 Klaskin Tumor 1 Liver 19 SITE 29 Lung 65 Lymph 7 Malignant PE Coma 1 Malignant Temporal Lobe 1 MDS 1 Mediastinal 4 Mesenteric Mass 1 Mesothelioma 1 Metastatic Crc 1 Multiple Primary Cancer 1 Myxoid Liposarcoma 1 Neck 1 Neuroendoctrine 2 Ocular Melanoma 1 Oral Cavity 2 Ovary 7 Ovarian Thrombosis 1 Pancreas 39 Parotid 2 Pelvic Sarcoma 1 Pelvic 1 Pelvis 1 Penis 2 Pericardua Cyst 1 SITE 29 Plasmacytoma 1 PHN 1 Portal Venous Obst 1 Positive BRCA 1 Prostate 23 Renal Cell 46 Retroperitoneum 2 Rectosigmoid 1 Rectum 22 Sarcoma 1 Scrotum 1 Skin 228 Small Bowel 2 Stomach 2 Testis 12 Thoracic Synovial 1 Thymus 1 Thyroid 5 Tongue 3 Uterine 3 Uterus 1 Urothelial 1 Vulva 3 Totals 1668 6
Leading Sites of New Cases and Deaths 29 Estimates Estimated New Cases* Estimated Deaths Male Female Male Female Prostate Breast 192,28 (25%) 192,37 (27%) Lung & Bronchus Lung & Bronchus 116,9 (15%) 13,35 (14%) Colon & Rectum Colon & Rectum 75,59 (1%) 71,38 (1%) Urinary Bladder Uterine Corpus 52,81 (7%) 42,16 (6%) Melanoma of the Skin Non-Hodgkin Lymphoma 39,8 (5%) 29,99 (4%) Non-Hodgkin Melanoma Lymphoma of the Skin 35,99 (5%) 29,64 (4%) Kidney & Renal Pelvis Thyroid 35,43 (5%) 27,2 (4%) Leukemia Kidney & Renal Pelvis 25,63 (3%) 22,33 (3%) Oral Cavity & Pharynx Ovary 25,24 (3%) 21,55 (3%) Pancreas Pancreas 21,5 (3%) 21,42 (3%) All Sites All Sites 766,13 (1%) 713,22 (1%) Lung & Bronchus Lung & Bronchus 88,9 (3%) 7,49 (26%) Prostate Breast 27,36 (9%) 4,17 (15%) Colon & Rectum Colon & Rectum 25,24 (9%) 24,68 (9%) Pancreas Pancreas 18,3 (6%) 12,21 (6%) Leukemia Ovary 12,59 (4%) 14,6 (5%) Liver & Non-Hodgkin Intrahepatic Bile Duct Lymphoma 12,9 (4%) 9,67 (4%) Esophogus Leukemia 11,49 (4%) 9,28 (3%) Urinary Bladder Uterine Corpus 1,18 (3%) 7,78 (3%) Non-Hodgkins Liver & Lymphoma Intrahepatic Bile Duct 9,83 (3%) 6,7 (2%) Kidney & Renal Pelvis Brain & Nervous System 8,16 (3%) 5,59 (2%) All Sites All Sites 292,54 (1%) 269,8 (1%) 29, American Cancer Society, Inc. Surveillance and Health Policy Research * Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary/bladder. 7
29 Tumor Board Registry Statistics - Network REVIEW OF ANALYTIC ACCESSIONS SEX TNM STAGE Total Male Female O I II III IV UNK N/A All Sites 4255 1875 238 35 1114 791 49 572 386 597 Oral Cavity 13 74 29 1 14 1 15 48 12 3 Lip Tongue 32 22 1 5 2 4 17 4 Oropharynx 8 8 1 1 5 1 Hypopharynx 1 1 1 Other 62 43 19 1 9 7 1 25 7 3 Digestive System 659 356 33 23 19 159 118 152 74 24 Esophagus 34 28 6 5 6 3 1 1 Stomach 54 27 27 18 5 5 19 5 2 Colon 172 82 9 13 25 39 37 46 11 1 Rectum 9 47 43 6 22 9 21 11 12 9 Anus/Anal Canal 11 4 7 3 1 4 1 1 1 Liver 127 93 34 2 38 35 19 14 1 Pancreas 14 46 58 8 4 8 35 12 1 Other 67 29 38 1 1 18 8 11 9 1 Respiratory System 439 231 28 1 15 22 87 175 43 6 Nasal/Sinus 11 7 4 2 1 1 4 1 2 Larynx 25 21 4 2 2 13 8 Lung/Bronchus 4 2 2 1 11 2 84 157 34 3 Other 3 3 1 1 1 Blood & Bone Marrow 163 99 64 1 1 161 Leukemia 116 71 45 1 1 114 Multiple Myeloma 43 25 18 43 Other 4 3 1 4 Bone 19 15 4 4 3 4 8 Connect/Soft Tissue 53 32 21 18 6 9 5 12 3 Skin 338 23 135 5 161 39 36 21 24 7 Melanoma 326 197 129 5 159 39 36 2 2 2 Other 12 6 6 2 1 4 5 8
SEX TNM STAGE Primary Site Total Male Female O I II III IV UNK N/A Breast 784 2 782 136 291 187 47 28 95 Female Genital 421 421 29 184 27 8 4 31 3 Cervis Uteri 64 64 1 28 7 13 7 4 4 Corpus Uteri 19 19 2 12 9 21 13 13 12 Ovary 113 113 24 6 4 18 12 13 Vulva 41 41 24 7 4 3 1 2 Other 13 13 2 5 1 3 1 1 Male Genital 385 385 18 287 28 19 32 1 Prostate 366 366 6 283 27 19 31 Testis 17 17 11 4 1 1 Other 2 2 1 1 Urinary System 276 179 97 65 16 18 31 25 28 3 Bladder 131 93 38 62 21 13 1 1 15 Kidney/Renal 144 86 58 3 85 4 21 15 13 3 Other 1 1 1 Brain & CNS 217 94 123 217 Brain (Benign) 4 17 23 4 Brain (Malignant) 83 48 35 83 Other 94 29 65 94 Endocrine 127 55 72 49 1 9 7 6 55 Thyroid 72 27 45 49 1 9 7 6 Other 55 28 27 55 Lymphatic System 18 1 8 53 32 29 47 17 2 Hodgkin's Disease 24 12 12 6 9 5 3 1 Non-Hodgkin's 156 88 68 47 23 24 44 16 2 Unknown Primary 75 46 29 75 Other/Ill-Defined 16 4 12 1 1 4 1 9
AGE DISTRIBUTION - NETWORK 7 6 5 4 3 2 1-9 1-19 2-29 3-39 4-49 5-59 6-69 7-79 8-89 9-99 Age Range Male Female - 9 22 22 1-19 19 2 2-29 29 52 3-39 76 177 4-49 195 374 5-59 444 587 6-69 67 563 7-79 343 362 8-89 118 189 9-99 18 3 TOTALS 1871 2376 AGE RANGE Male Female RACE DISTRIBUTION - NETWORK White Black Other Race Cases Percent White 3125 73% Black 884 21% Other 246 6% TOTAL 4255 1% 1
CASES TNM STAGE DISTRIBUTION - NETWORK 12 1114 1 8 791 6 4 49 35 2 572 597 386 TNM Stage NBR Cases Percent 35 7% I 1114 26% II 791 19% III 49 12% IV 572 13% UNK 386 9% N/A 597 14% TOTAL 4255 1% I II III IV UNK N/A TNM STAGE CASES STAGE BY SEX - NETWORK 8 7 6 5 4 3 Stage Male Female 98 27 I 334 78 II 459 332 III 219 271 IV 38 264 UNK 164 222 N/A 293 34 TOTALS 1875 238 2 1 I II III STAGE IV UNK N/A Male Female 11
STATE AND NATIONAL COMPARISONS - NETWORK 4 35 3 PERCENTAGE 25 2 15 1 5 B r east Lung Prostate Colorectal Bladder NH Lymphoma Corpus Uteri Melanoma Leukemia Cervix All Other Kind of Cancer CMC Network NC Estimates US Estimates Type CMC NC US TOTAL 4,255 42,27 1,479,35 percent of total Breast 18% 13% 13% Lung 9% 16% 15% Prostate 9% 7% 13% Colorectal 6% 1% 1% Bladder 3% 4% 5% NH Lymphoma 4% 4% 4% Corpus Uteri 4% 2% 3% Melanoma 8% 5% 5% Leukemia 3% 3% 3% Cervis 2% 1% 1% All Others 34% 34% 29% 12
COUNTY DISTRIBUTION OF CANCER CASES - NETWORK 1. Mecklenburg 2147 2. York, SC 462 3. Union 261 4. Gaston 22 5. Cabarrus 172 6. Lincoln 17 7. Cleveland 12 8. Lancaster, SC 81 9. Iredell 81 1. Rowan 59 11. Catawba 58 12. Stanly 48 13. Burke 41 14. Anson 39 15. Rutherford 38 16. Chester, SC 28 17. Caldwell 28 18. Chesterfield, SC 2 19. Richmond 19 2. Montgomery 12 21. Cherokee, SC 8 22. Union, SC 8 8 66 1 1 59 2 37 4 23. Watauga 8 24. Greenville, SC 7 25. Spartanburg, SC 7 26. Ashe 6 27. Buncombe 6 28. Marlboro, SC 6 29. Richland, SC 6 3. Lexington, SC 5 31. Alexander 4 32. Brunswick 4 33. Florence, SC 4 34. Kershaw, SC 4 35. Marion, SC 4 36. Sumter, SC 4 37. Haywood 4 38. Moore 4 39. New Hanover 4 4. Robeson 4 41. Scotland 4 42. Wilkes 4 43. Horry, SC 3 23 8 26 6 62 1 17 31 64 71 28 4 9 1 1 7 13 41 11 81 1 27 1 58 6 59 15 6 17 46 47 38 7 62 12 4 3 3 22 56 2 58 2 61 1 24 7 21 8 25 7 22 8 67 1 65 1 2 462 16 28 3 5 42 4 48 3 5 1 172 2147 3 261 8 81 34 4 79 1 44 3 54 2 12 48 14 39 18 2 77 1 2 12 44. Forsyth 3 45. Guilford 3 46. Henderson 3 47. Polk 3 48. Surry 3 49. Alamance 2 5. Aiken, SC 2 51. Beaufort, SC 2 52. Charleston, SC 2 53. Cumberland 2 54. Davidson 2 55. Durham 2 56. Oconee, SC 2 57. Orangeburg, SC 2 58. Pickens, SC 2 59. Macon 2 6. Transylvania 2 61. Anderson, SC 1 62. Avery 1 63. Carteret 1 64. Davie 1 45 3 49 2 76 1 19 19 28 6 38 4 69 1 41 4 4 4 35 29 33 4 6 36 4 4 74 1 55 2 43 3 53 2 78 1 32 4 72 1 81 1 73 1 39 4 65. Newberry, SC 1 66. Graham 1 67. Saluda, SC 1 68. Hertford 1 69. Lee 1 7. McDowell 1 71. Madison 1 72. Nash 1 73. Pender 1 74. Person 1 75. Pitt 1 76. Randolph 1 77. Rockingham 1 78. Sampson 1 79. Stokes 1 8. Swain 1 81. Wayne 1 North Carolina 3539 South Carolina 672 Out of State 51 Total 4252 75 1 68 1 63 1 5 2 57 2 51 2 52 2 NORTH CAROLINA.............. 3539 SOUTH CAROLINA................672 OTHER OUT OF STATE............. 51 TOTAL.......................4252 13
Quality Assurance Report I am pleased to report a busy and successful year of effort on the part of the Quality Assurance (QA) Committee. In addition to the two clinical practice guideline (CPG) studies that evaluate practice patterns and compare to the National Cancer Center Network Guidelines, other in-house reviews were accomplished. Data was assimilated for presentation to the ACOS surveyors for the successful accreditation of our cancer network. The first CPG study performed was an evaluation of the utilization of postoperative radiotherapy, and chemotherapy secondarily, in appropriate stage III and non-metastatic stage IV head and neck cancers. Of the patients reviewed, 11 MICHAEL HAAKE, MD matched the criteria for evaluation, and seven of these received the recommended adjuvant therapy. The reason for not receiving the therapy in the other patients included lack of patient compliance with follow up, refusal of treatment and a patient with dementia deemed inappropriate for therapy. No recommendations of change in practice were made, and it was felt that this recently published guideline had been well incorporated by the physicians taking care of these patients. The second CPG study looked at the utilization of endoscopic ultrasound in appropriate non-metastatic esophageal patients. It was evident on this review that this technology, though only recently added to the diagnostic capability in the CHS system, was being used per the NCCN recommendations. Between 27 and 28, the use of this technology had tripled. The attractiveness of CHS to specialists trained in new techniques allows for rapid incorporation of these techniques into the cancer program. The equip studies of utilization of chemotherapy, hormonal agents and radiotherapy in the adjuvant treatment of breast cancer is an ongoing review, and the CHS network continues to report greater than 9 percent appropriate use of such therapies. In the ongoing review of the Cancer Program Practice Profile Reports (CP3R) looking at issues of colon cancer diagnostic and adjuvant therapy issues (lymph node retrieval, use of adjuvant chemotherapy), CHS maintains greater than 9 percent acceptable practice rate. A review of breast cancer sentinel lymph node pathology was undertaken by the pathology department and another study reviewed the accuracy of thyroid FNA biopsy material. These studies noted the accuracy rate was well in line with the prevailing national standards. The QA Committee tallies improvements that have occurred in the cancer program and addresses future improvements. It was determined that the AJCC staging and the NCCN guidelines for a given oncologic problem presented at cancer conferences would be emphasized and this would be recorded as accomplished at that conference. The General Tumor Board and the Breast Conference were in charge of initiating this requirement. Dr. Salo sent a letter to the heads of other cancer conferences to launch this activity in the future. A major improvement of note that was tallied by the QA Committee included the opening of Pineville Radiation Therapy Center, a major addition in the oncologic care offered in this region. Other improvements included a nurse navigator hired to aid in guiding lung cancer patients through their necessary clinics, tests and follow-up and the construction of templates used by the radiology department 14
for reporting cancer related imaging results. Another improvement was the creation of order sets for chemotherapy administration for breast, GI, lung cancer and an order set for febrile neutropenia. With the announcement of Levine Cancer Institute, the QA Committee anticipates the opportunity for an exciting broadening role in helping to monitor and address cancer care quality issues in the future. I am touched by the great efforts of the QA Committee members and registry staff this past year, and I appreciate the physicians who enthusiastically agreed to aid in helping analyze and present the studies done this year. Quality Assurance Chairmen Michael Haake, MD Stuart Salmon, MD Sridhar Pal, MD Assurance Director Quality Assurance Chair Quality Assurance Chair CHS Oncology Quality CMC-Pineville CMC-University 15
29 Tumor Board Registry Statistics - CMC REVIEW OF ANALYTIC ACCESSIONS SEX TNM STAGE Total Male Female O I II III IV UNK N/A All Sites 3481 1485 1996 238 947 593 42 48 318 53 Oral Cavity 88 66 22 13 9 13 41 9 3 Lip Tongue 25 18 7 4 2 3 13 3 Oropharynx 8 8 1 1 5 1 Hypopharynx 1 1 1 Other 54 39 15 9 6 9 22 5 3 Digestive System 59 281 228 15 75 131 93 112 63 2 Esophagus 24 19 5 2 4 3 6 9 Stomach 46 23 23 17 4 4 13 6 2 Colon 13 54 49 8 1 21 21 35 7 1 Rectum 59 31 28 4 11 7 15 8 7 7 Anus/Anal Canal 8 4 4 2 1 2 2 1 Liver 119 86 33 2 38 34 13 13 1 Pancreas 98 42 56 6 4 7 31 13 1 Other 52 22 3 1 8 15 7 6 7 8 Respiratory System 352 188 164 85 18 63 147 35 4 Nasal/Sinus 8 5 3 2 1 4 1 Larynx 22 19 3 1 1 12 8 Lung/Bronchus 319 161 158 82 16 62 13 27 2 Other 3 3 1 1 1 Blood & Bone Marrow 141 83 58 1 1 139 Leukemia 11 59 42 1 1 99 Multiple Myeloma 36 21 15 36 Other 4 3 1 4 Bone 19 15 4 4 3 4 8 Connect/Soft Tissue 49 3 19 16 5 9 5 11 3 Skin 315 193 122 42 152 38 37 22 19 5 Melanoma 36 187 119 42 15 38 37 21 16 2 Other 9 6 3 2 1 3 3 16
SEX TNM STAGE Primary Site Total Male Female O I II III IV UNK N/A Breast 646 2 644 127 241 144 32 25 77 Female Genital 41 41 25 178 26 83 4 31 27 Cervix Uteri 66 66 1 27 7 16 7 4 4 Corpus Uteri 183 183 1 116 8 21 13 13 11 Ovary 19 19 23 6 39 18 12 11 Vulva 38 38 21 7 4 3 1 2 Other 6 6 2 1 3 Male Genital 275 275 6 22 23 9 17 Prostate 262 262 217 21 9 15 Testes 1 1 5 1 2 2 Other 14 14 2 5 1 4 1 1 Urinary System 216 136 8 29 93 16 28 24 23 3 Bladder 85 58 27 27 15 11 9 8 15 Kidney/Renal 13 78 52 2 78 4 19 16 8 3 Other 1 1 1 Brain & CNS 186 84 12 186 Brain (Benign) 33 16 17 33 Brain (Malignant) 8 45 35 8 Other 73 23 5 73 Endocrine 1 49 51 4 1 8 7 2 42 Thyroid 58 23 35 4 1 8 7 2 Other 42 26 16 42 Lymphatic System 136 77 59 37 25 17 41 14 2 Hodgkin s Disease 18 1 8 4 8 2 3 1 Non-Hodgkin s 118 67 51 33 17 15 38 13 2 Unknown Primary 6 38 22 6 Other/Ill Defined 14 3 11 1 1 3 9 17
AGE DISTRIBUTION - CMC 6 5 4 3 2 1-9 1-19 2-29 3-39 4-49 5-59 6-69 7-79 8-89 9-99 Age Range Male Female - 9 21 22 1-19 19 2 2-29 25 44 3-39 61 143 4-49 157 317 5-59 352 517 6-69 471 472 7-79 274 298 8-89 92 143 9-99 9 16 TOTALS 1481 1992 AGE RANGE Male Female RACE DISTRIBUTION - CMC White Black Other Race Cases Percent White 2737 79% Black 677 19% Other 67 2% TOTAL 3481 1% 18
CASES TNM STAGE DISTRIBUTION - CMC 1 947 8 6 593 4 42 2 238 48 53 318 TNM Stage NBR Cases Percent 238 7% I 947 27% II 593 17% III 42 12% IV 48 14% UNK 318 9% N/A 53 14% TOTALS 3481 1% I II III IV UNK N/A TNM STAGE CASES STAGE BY SEX - CMC 7 6 5 4 3 Stage Male Female 57 181 I 28 667 II 329 264 III 175 227 IV 256 224 UNK 134 184 N/A 254 249 TOTALS 1485 1996 2 1 I II III STAGE IV UNK N/A Male Female 19
STATE AND NATIONAL COMPARISONS - CMC 4 35 3 25 PERCEN TAGE 2 15 1 5 B r east Lung Prostate Colorectal Bladder NH Lymphoma Corpus Uteri Melanoma Leukemia Cervix All Other Kind of Cancer CMC Main NC Estimates US Estimates Type CMC NC US TOTAL 3,481 42,27 1,479,35 percent of total Breast 19% 13% 13% Lung 9% 16% 15% Prostate 7% 7% 13% Colorectal 5% 1% 1% Bladder 2% 4% 5% NH Lymphoma 3% 4% 4% Corpus Uteri 5% 2% 3% Melanoma 9% 5% 5% Leukemia 3% 3% 3% Cervis 2% 1% 1% All Others 36% 34% 29% 2
COUNTY DISTRIBUTION OF CANCER CASES - CMC 1. Mecklenburg 1683 2. York, SC 318 3. Union 228 4. Gaston 196 5. Cabarrus 135 6. Cleveland 117 7. Lincoln 95 8. Iredell 71 9. Lancaster, SC 65 1. Rowan 56 11. Catawba 54 12. Stanly 43 13. Burke 39 14. Rutherford 36 15. Anson 35 16. Caldwell 27 17. Chester, SC 22 18. Richmond 18 19. Chesterfield, SC 15 2. Montgomery 11 21. Cherokee, SC 8 22. Watauga 8 23. Greenville, SC 7 24. Spartanburg, SC 7 25. Ashe 6 26. Marlboro, SC 6 27. Richland, SC 6 28. Union, SC 6 29. Buncombe 5 3. Lexington, SC 5 31. Alexander 4 32. Brunswick 4 33. Florence, SC 4 34. Kershaw, SC 4 35. Haywood 4 36. Moore 4 37. New Hanover 4 38. Robeson 4 39. Scotland 4 4. Forsyth 3 41. Marion, SC 3 42. Guilford 3 43. Sumter, SC 3 44. Henderson 3 45. Polk 3 46. Surry 3 47. Wilkes 3 48. Aiken, SC 2 49. Alamance 2 5. Beaufort, SC 2 51. Charleston, SC 2 52. Cumberland 2 53. Horry, SC 2 54. Davidson 2 55. Durham 2 56. Orangeburg, SC 2 57. Pickens, SC 2 58. Macon 2 59. Transylvania 2 6. Anderson, SC 1 61. Avery 1 62. Carteret 1 63. Fairfield, SC 1 64. Davie 1 65. Newberry, SC 1 66. Oconee, SC 1 67. Graham 1 68. Saluda, SC 1 69. Hertford 1 7. Lee 1 71. McDowell 1 72. Madison 1 73. Nash 1 74. Pender 1 75. Person 1 76. Randolph 1 77. Rockingham 1 78. Sampson 1 79. Stokes 1 8. Swain 1 81. Wayne 1 North Carolina 2938 South Carolina 496 Out of State 46 Total 348 22 8 25 6 47 3 46 3 79 1 77 1 76 1 69 1 8 67 1 1 58 2 35 4 61 1 16 31 64 72 27 4 8 1 1 71 13 39 11 71 1 29 1 54 5 56 14 7 95 44 45 36 6 592 117 4 3 3 196 66 1 57 2 6 1 23 7 21 8 24 7 24 7 65 1 2 318 17 22 63 1 5 1 135 1683 3 228 9 65 34 4 4 3 54 2 12 43 15 35 19 15 2 11 42 3 49 2 76 1 18 18 26 6 36 4 7 1 39 4 55 2 52 2 73 1 81 1 74 1 38 4 62 1 68 1 3 5 41 27 33 3 6 43 4 3 53 2 32 4 48 2 56 2 5 2 51 2 NORTH CAROLINA.............. 2938 SOUTH CAROLINA............... 496 OTHER OUT OF STATE............. 46 TOTAL.......................348 21
29 Tumor Board Registry Statistics - CMC-Mercy REVIEW OF ANALYTIC ACCESSIONS SEX TNM STAGE Total Male Female O I II III IV UNK N/A All Sites 195 99 96 14 44 19 36 36 14 32 Oral Cavity Lip Tongue Oropharynx Hypopharynx Other Digestive System 68 35 33 7 19 8 14 14 4 2 Esophagus 1 1 1 Stomach 5 3 2 1 1 3 Colon 18 7 11 4 3 5 5 1 Rectum 28 14 14 2 12 5 3 4 2 Anus/Anal Canal 2 2 1 1 Liver 8 8 1 1 3 3 Pancreas 5 2 3 2 1 2 Other 1 1 1 Respiratory System 57 31 26 1 14 2 16 18 5 1 Nasal/Sinus Larynx Lung/Bronchus 57 31 26 1 14 2 16 18 5 1 Other Blood & Bone Marrow 4 2 2 4 Leukemia 3 2 1 3 Multiple Myeloma 1 1 1 Other Bone Connect/Soft Tissue 1 1 1 Skin 3 3 1 2 Melanoma 3 3 1 2 Other 22
SEX TNM STAGE Primary Site Total Male Female O I II III IV UNK N/A Breast 4 4 1 1 1 1 Female Genital 1 1 1 Cervis Uteri Corpus Uteri Ovary 1 1 1 Vulva Other Male Genital 9 9 1 5 3 Prostate 9 9 1 5 3 Testis Other Urinary System 13 8 5 4 6 1 2 Bladder 9 7 2 4 3 1 1 Kidney/Renal 4 1 3 3 1 Other Brain & CNS 1 3 7 1 Brain (Benign) 2 2 2 Brain (Malignant) 2 2 2 Other 6 1 5 6 Endocrine 7 1 6 1 6 Thyroid 1 1 1 Other 6 1 5 6 Lymphatic System 8 4 4 3 2 3 Hodgkin's Disease 3 1 2 1 1 1 Non-Hodgkin's 5 3 2 2 1 2 Unknown Primary 8 5 3 8 Other/Ill-Defined 2 1 1 1 1 23
3 25 2 15 1 5 AGE DISTRIBUTION - CMC-MERCY Age Range Male Female 1-19 1 2-29 1 1 3-39 3 7 4-49 9 1 5-59 23 16 6-69 27 27 7-79 26 2 8-89 6 9 9-99 4 5 TOTALS 99 96 1-19 2-29 3-39 4-49 5-59 6-69 7-79 8-89 9-99 AGE RANGE Male Female RACE DISTRIBUTION - CMC-MERCY White Black Other Race Cases Percent White 135 69% Black 5 26% Other 1 5% TOTAL 195 1% 24
TNM STAGE DISTRIBUTION - CMC-MERCY CASES 5 4 3 2 1 14 44 19 36 36 14 32 TNM Stage NBR Cases Percent 14 7% I 44 23% II 19 1% III 36 18% IV 36 18% UNK 14 7% N/A 32 16% TOTAL 195 1% I II III IV UNK N/A TNM STAGE CASES STAGE BY SEX - CMC-MERCY 25 2 15 1 Age Range Male Female 1-19 1 2-29 1 1 3-39 3 7 4-49 9 1 5-59 23 16 6-69 27 27 7-79 26 2 8-89 6 9 9-99 4 5 TOTALS 99 96 5 I II III STAGE IV UNK N/A Male Female 25
STATE AND NATIONAL COMPARISONS - CMC-MERCY 4 35 3 25 PERCENTAGE 2 15 1 5 B r east Lung Prostate Colorectal Bladder NH Lymphoma Corpus Uteri Melanoma Leukemia Cervix All Other Kind of Cancer CMC-Mercy NC Estimates US Estimates Type CMC NC US TOTAL 195 42,27 1,479,35 percent of total Breast 2% 13% 13% Lung 29% 16% 15% Prostate 5% 7% 13% Colorectal 25% 1% 1% Bladder 5% 4% 5% NH Lymphoma 3% 4% 4% Corpus Uteri % 2% 3% Melanoma 2% 5% 5% Leukemia 2% 3% 3% Cervis % 1% 1% All Others 29% 34% 29% 26
COUNTY DISTRIBUTION OF CANCER CASES - CMC-MERCY 1. Mecklenburg 135 6. Cabarrus 5 11. Iredell 2 2. York, SC 14 7. Lincoln 5 12. Burke 1 3. Gaston 9 8. Stanly 3 13. Cleveland 1 4. Union 7 9. Catawba 2 14. Richmond 1 5. Anson 5 1. Chesterfield, SC 2 16. Wilkes 1 North Carolina 177 South Carolina 16 Out of State 2 Total 195 15 1 11 1 9 2 12 2 13 1 7 6 3 9 2 14 1 135 6 5 4 7 8 3 5 7 14 1 1 2 NORTH CAROLINA............... 177 SOUTH CAROLINA................ 16 OTHER OUT OF STATE.............. 2 TOTAL........................195 27
29 Tumor Board Registry Statistics - CMC-University REVIEW OF ANALYTIC ACCESSIONS SEX TNM STAGE Total Male Female O I II III IV UNK N/A All Sites 387 22 167 2 62 145 4 54 38 28 Oral Cavity 7 6 1 1 1 3 2 Lip Tongue 4 4 1 2 1 Oropharynx Hypopharynx Other 3 2 1 1 1 1 Digestive System 56 35 21 1 7 13 1 17 8 Esophagus 2 2 1 1 Stomach 5 4 1 1 1 3 Colon 27 16 11 1 5 4 7 7 3 Rectum 4 3 1 1 1 1 1 Anus/Anal Canal 1 1 1 Liver 8 6 2 3 3 2 Pancreas 2 1 1 1 1 Other 7 3 4 1 2 1 1 2 Respiratory System 43 25 18 8 3 9 18 4 1 Nasal/Sinus 3 2 1 1 1 1 Larynx 1 1 1 Lung/Bronchus 39 22 17 7 3 8 18 3 Other Blood & Bone Marrow 8 6 2 8 Leukemia 6 5 1 6 Multiple Myeloma 2 1 1 2 Other Bone Connect/Soft Tissue 2 2 1 1 Skin 4 2 2 1 1 1 1 Melanoma 4 2 2 1 1 1 1 Other 28
SEX TNM STAGE Primary Site Total Male Female O I II III IV UNK N/A Breast 88 88 3 29 34 8 4 1 Female Genital 8 8 4 1 1 2 Cervis Uteri 1 1 1 Corpus Uteri 4 4 2 1 1 Ovary 3 3 1 2 Vulva Other Male Genital 111 111 3 88 8 5 6 1 Prostate 17 17 88 8 5 6 Testis 3 3 3 Other 1 1 1 Urinary System 25 16 9 14 5 1 2 3 Bladder 17 11 6 13 1 1 2 Kidney/Renal 8 5 3 1 4 3 Other Brain & CNS 9 4 5 9 Brain (Benign) 1 1 1 Brain (Malignant) 2 1 1 2 Other 6 2 4 6 Endocrine 3 1 2 2 1 Thyroid 2 2 2 Other 1 1 1 Lymphatic System 18 11 7 3 3 4 5 3 Hodgkin's Disease 2 2 1 1 Non-Hodgkin's 16 9 7 3 2 4 4 3 Unknown Primary 3 3 3 Other/Ill-Defined 2 1 1 2 29
AGE DISTRIBUTION - CMC-UNIVERSITY 1 8 6 4 2 Age Range Male Female - 9 1 2-29 2 5 3-39 5 18 4-49 23 29 5-59 74 41 6-69 82 37 7-79 27 21 8-89 5 12 9-99 1 4 TOTALS 22 167-9 2-29 3-39 4-49 5-59 6-69 7-79 8-89 9-99 AGE RANGE Male Female RACE DISTRIBUTION - CMC-UNIVERSITY White Black Other Race Cases Percent White 26 53% Black 143 37% Others 38 1% TOTAL 387 1% 3
CASES TNM STAGE DISTRIBUTION - CMC-UNIVERSITY 15 145 12 9 6 62 54 3 4 38 28 2 I II III IV UNK N/A TNM STAGE TNM Stage NBR Cases Percent 2 5% I 62 16% II 145 37% III 4 1% IV 54 14% UNK 38 1% N/A 28 7% TOTAL 387 1% CASES STAGE BY SEX - CMC-UNIVERSITY 1 8 6 4 Age Range Male Female 12 8 I 13 49 II 1 45 III 25 15 IV 34 2 UNK 23 15 N/A 13 15 TOTALS 22 167 2 I II III STAGE IV UNK N/A Male Female 31
STATE AND NATIONAL COMPARISONS - CMC-UNIVERSITY 4 35 3 25 PERCENTAGE 2 15 1 5 B r east Lung Prostate Colorectal Bladder NH Lymphoma Corpus Uteri Melanoma Leukemia Cervix All Other Kind of Cancer CMC-University NC Estimates US Estimates Type CMC NC US TOTAL 387 42,27 1,479,35 percent of total Breast 23% 13% 13% Lung 1% 16% 15% Prostate 28% 7% 13% Colorectal 8% 1% 1% Bladder 4% 4% 5% NH Lymphoma 4% 4% 4% Corpus Uteri 1% 2% 3% Melanoma 1% 5% 5% Leukemia 2% 3% 3% Cervis % 1% 1% All Others 19% 34% 29% 32
COUNTY DISTRIBUTION OF CANCER CASES - CMC-UNIVERSITY 1. Mecklenburg 283 7. Union 5 13. Lancaster, SC 1 2. Cabarrus 38 8. Cleveland 3 14. Oconee, SC 1 3. Gaston 18 9. Catawba 2 15. Pitt 1 4. Iredell 8 1. Rowan 2 16. Stokes 1 5. Lincoln 8 11. Stanly 2 6. York, SC 7 12. Chester, SC 1 North Carolina 372 South Carolina 1 Out of State 5 Total 387 16 1 14 1 8 3 9 2 5 8 3 18 6 7 4 8 1 283 1 2 2 38 7 5 11 2 15 1 12 1 13 1 NORTH CAROLINA............... 372 SOUTH CAROLINA................ 1 OTHER OUT OF STATE.............. 5 TOTAL........................387 33
29 Tumor Board Registry Statistics - CMC-Pineville REVIEW OF ANALYTIC ACCESSIONS SEX TNM STAGE Total Male Female O I II III IV UNK N/A All Sites 61 185 416 48 186 128 72 62 4 65 Oral Cavity 16 9 7 1 2 2 1 1 Lip Tongue 7 3 4 1 1 5 Oropharynx Hypopharynx Other 9 6 3 2 1 5 1 Digestive System 79 33 46 18 21 13 2 5 2 Esophagus 8 7 1 3 1 2 2 Stomach 4 1 3 2 2 Colon 36 11 25 7 1 7 1 2 Rectum 12 5 7 5 4 1 1 1 Anus/Anal Canal 2 2 1 1 Liver 1 1 1 Pancreas 7 2 5 2 3 2 Other 9 6 3 1 3 3 2 Respiratory System 57 21 36 11 3 21 19 3 Nasal/Sinus Larynx 3 1 2 1 1 1 Lung/Bronchus 53 19 34 11 3 2 17 2 Other 1 1 1 Blood & Bone Marrow 16 13 3 16 Leukemia 9 8 1 9 Multiple Myeloma 7 5 2 7 Other Bone Connect/Soft Tissue 5 5 2 2 1 Skin 28 12 16 8 11 1 2 2 2 2 Melanoma 25 12 13 8 11 1 2 2 1 Other 3 3 1 2 34
SEX TNM STAGE Primary Site Total Male Female O I II III IV UNK N/A Breast 228 228 17 15 71 17 2 16 Female Genital 19 19 4 7 1 3 1 1 2 Cervis Uteri 1 1 1 Corpus Uteri 1 1 1 6 2 1 Ovary 4 4 1 1 1 1 Vulva 4 4 3 1 Other Male Genital 31 31 3 22 3 3 Prostate 26 26 1 21 2 2 Testis 5 5 2 1 1 1 Other Urinary System 36 29 7 19 7 3 1 3 3 Bladder 29 25 4 19 5 3 2 Kidney/Renal 7 4 3 2 1 1 3 Other Brain & CNS 26 9 17 26 Brain (Benign) 5 5 5 Brain (Malignant) 6 5 1 6 Other 15 4 11 15 Endocrine 25 8 17 1 1 4 1 Thyroid 15 5 1 1 1 4 Other 1 3 7 1 Lymphatic System 27 15 12 11 4 7 4 1 Hodgkin's Disease 4 2 2 2 2 Non-Hodgkin's 23 13 1 9 4 5 4 1 Unknown Primary 7 4 3 7 Other/Ill-Defined 1 1 1 35
AGE DISTRIBUTION - CMC-PINEVILLE 1 8 6 4 2 Age Range Male Female 2-29 4 6 3-39 11 36 4-49 22 74 5-59 26 95 6-69 58 94 7-79 38 66 8-89 21 4 9-99 5 5 TOTAL 185 416 2-29 3-39 4-49 5-59 6-69 7-79 8-89 9-99 AGE RANGE Male Female RACE DISTRIBUTION - CMC-PINEVILLE White Black Other Race Cases Percent White 467 78% Black 87 14% Other 47 8% TOTAL 61 1% 36
CASES TNM STAGE DISTRIBUTION - CMC-PINEVILLE 2 186 15 128 1 72 62 65 5 48 4 TNM Stage NBR Cases Percent 23 25 I 36 15 II 38 9 III 19 53 IV 28 34 UNK 1 3 N/A 31 34 TOTAL 185 416 I II III IV UNK N/A TNM STAGE CASES STAGE BY SEX - CMC-PINEVILLE 15 12 9 6 Age Range Male Female 1-19 1 2-29 1 1 3-39 3 7 4-49 9 1 5-59 23 16 6-69 27 27 7-79 26 2 8-89 6 9 9-99 4 5 TOTALS 99 96 3 I II III STAGE IV UNK N/A Male Female 37
STATE AND NATIONAL COMPARISONS - CMC-PINEVILLE 4 35 3 25 PERCEN TAGE 2 15 1 5 B r east Lung Prostate Colorectal Bladder NH Lymphoma Corpus Uteri Melanoma Leukemia Cervix All Other Kind of Cancer CMC-Pineville NC Estimates US Estimates Type CMC NC US TOTAL 1 42,27 1,479,35 percent of total Breast 38% 13% 13% Lung 9% 16% 15% Prostate 4% 7% 13% Colorectal 8% 1% 1% Bladder 5% 4% 5% NH Lymphoma 4% 4% 4% Corpus Uteri 2% 2% 3% Melanoma 4% 5% 5% Leukemia 1% 3% 3% Cervis % 1% 1% All Others 25% 34% 29% 38
COUNTY DISTRIBUTION OF CANCER CASES - CMC-PINEVILLE 1. Mecklenburg 39 1. Stanly 3 19. Horry, SC 1 2. York, SC 169 11. Burke 2 2. Marion, SC 1 3. Union 4 12. Iredell 2 21. Montgomery 1 4. Lancaster, SC 23 13. Lincoln 2 22. Rowan 1 5. Chester, SC 9 14. Union, SC 2 23. Sumter, SC 1 6. Gaston 9 15. Alexander 1 24. Transylvania 1 7. Cabarrus 6 16. Buncombe 1 25. Wake 1 8. Chesterfield, SC 4 17. Caldwell 1 9. Rutherford 3 18. Catawba 1 North Carolina 384 South Carolina 21 Out of State 7 Total 61 17 1 15 1 11 18 2 1 13 2 6 9 16 1 9 3 24 1 2 12 2 1 39 22 1 7 6 3 169 4 14 2 5 4 9 23 1 3 21 1 8 4 25 1 23 1 2 1 19 1 NORTH CAROLINA............... 384 SOUTH CAROLINA............... 21 OTHER OUT OF STATE.............. 7 TOTAL........................61 39
Major Site Report: CERVIX The cervix is the narrow portion of the uterus that opens at the top of the vagina. In the United States, cervical cancer is the eighth most common cancer in women. In 21, the American Cancer Society (ACS) has estimated that 12,2 cases will be diagnosed and 4,21 deaths will occur. Incidence rates have gradually decreased over past decades in Caucasian and African American women. The incidence of cervical cancer is greater worldwide than in North America. While the predominance of patients are Caucasian the actual risk is slightly higher for African American and Hispanic women (Figure 1). Prognosis is related to the stage of disease at diagnosis and to a lesser degree, the pathologic subtype. Staging has traditionally been defined by the International B. MCCALL, MD Federation of Gynecology and Obstetrics (IFGO). The American Joint Committee on Cancer (AJCC) recently published a new edition of the AJCC Cancer Staging Manual, which includes revisions to the staging for this disease. The majority of patients present with earlier stage disease (I and II). This breakdown for patients seen in The Carolinas HealthCare System (CHS) is seen in Figure 2. The age at presentation is included and mirrors the national averages (Figure 3). The prevalence of histological subtypes of cervical cancer correlates with the predominate cell type, squamous cells. The breakdown for CHS is seen in Figure 4. The Papanicolaou test or Pap smear, one of the most historic and effective screening test in oncology, is used to detect premalignant and malignant (cancerous) processes in the ectocervix. The latest in the various sophisticated classification systems for premalignant conditions are used by the pathology specialist at CHS. Malignant transformation appears almost categorically associated with Human Papillomavirus and encouraging reduction in the incidence of cancerous precursors with HPV vaccines have led to FDA approval and more widespread indications. While the overall five year survival in treated cervical cancer is about 72 percent, women with Stage I disease have an 8-9 percent survival and those with Stage II have a 5-65 percent five year survival. Only 25-35 percent of patients with Stage III disease and fewer than 15 percent of those with Stage IV disease are alive after five years. The standard treatment modalities for cervical cancer include surgery, radiation therapy and chemotherapy. The majority of cervical cancers are treated non-surgically with radiation. This is usually with a combination of external beam therapy and internal treatment or brachytherapy. Multiple prospective randomized trials show an overall survival advantage to use of platin-based systemic chemotherapy given concurrently with radiation. Surgery and radiation are equally effective for early stage small volume disease. Potential benefits of surgery over radiation in this subset may be offset by the need for adjuvant radiation (+/- chemotherapy) if high risk features are found. Technological breakthroughs relating to more preferential delivery of external beam radiation (3-D and Intensity Modulated Radiotherapy), are improving the therapeutic ratio and leading to improved controls rates and reduced toxicities. The breakdown for treatment modality at CHS is similar to national averages (Figure 5). Improved education on the importance of screening, advanced systems for detecting and classifying precancerous conditions, effective HPV vaccines, sophisticated imaging and targeting of radiation matched with the synergistic sensitizing systemic agents, have contributed to the improved outcomes and reduced incidence of this malignancy. Carolinas HealthCare System will continue its uncompromising commitment to excellence in the individualized treatment of this disease through a comprehensive multi-modality approach. American Cancer Society: Cancer Prevention and Early Detection Facts and Figures 21 FDA Licenses New Vaccine for Prevention of Cervical Cancer. U.S. Food and Drug Administration. 26-6-8. 4
RACE/ETHNICITY OF CERVIX UTERI CANCER DIAGNOSED IN 2 TO 28 (FIGURE 1) White Black Hispanic API Native American Unknown Race Cases Percent White 313 64.1% Black 136 27.81% Hispanic 26 5.32% API 9 1.84% Native American 2.41% Other Unknown 3.61% TOTAL 489 1% STAGE OF CERVIX UTERI CANCER DIAGNOSED IN 2 TO 28 (FIGURE 2) CASES 2 15 1 Stage Number Percentage 2.41% I 196 4.8% II 154 31.49% III 98 2.4% IV 31 6.34% UNK 8 1.64% TOTAL 489 1% 5 I II III IV V STAGE 41
CASES 15 12 9 6 3 AGE GROUP OF CERVIX UTERI CANCER DIAGNOSED IN 2 TO 28 (FIGURE 3) Age Group Number Percentage 2-29 29 5.93% 3-39 13 26.58% 4-49 135 27.61% 5-59 93 19.2% 6-69 59 12.7% 7-79 32 6.54% 8-89 1 2.4% 9 and over 1.2% TOTAL 489 1% 2-29 3-39 4-49 5-59 6-69 7-79 8-89 9 & over AGE RANGE PERCENTAGE 5 4 3 2 1 HISTOLOGY OF CERVIX UTERI CANCER DIAGNOSED IN 2 TO 28 (FIGURE 4) Squamous Cell Carcinoma, NOS Keratinizing Squamous Cell Carcinoma, NOS Large Cell, Nonkeratinizing Squamous Cell Carcinoma Adenocarcinoma, NOS HISTOLOGY Adenosquamous Carcinoma Other Specified Types Histology Number Percentage Squamous Cell Carcinoma, NOS 242 49.49% Keratinizing Squamous Cell Carcinoma, NOS 4 8.18% Large Cell, Nonkeratinizing Squamous Cell Carcinoma 5 11.66% Adenocarcinoma, NOS 17 1.22% Adenosquamous Carcinoma 83 3.48% Other Specified Types 83 6.97% TOTAL 489 1% 42
FIRST COURSE TREATMENT OF CERVIX UTERI CANCER DIAGNOSED IN 2 TO 28 (FIGURE 5) PERCENTAGE 4 35 3 25 2 15 1 First Course Treatment Number Percentage Surgery Only 29 5.93% Radiation Only 13 26.58% Surgery & Radiation 135 27.61% Radiation & Chemotherapy 188 38.45% Surgery, Radiation & Chemotherapy 93 19.2% 5 Other Specified Therapy 59 12.7% Surgery Only Radiation Only Surgery & Radiation Radiation & Chemotherapy Surgery, Radiation & Chemotherapy FIRST COURSE TREATMENT Other Specified Therapy No 1st Course Rx No 1st Course Rx 32 6.54% TOTAL 489 1% 43
Cummulative Survival Rate 1 8 6 4 2 OBSERVED SURVIVAL FOR CASES DIAGNOSED IN 23 DATA FROM 183 FACILITIES (NATIONAL) (FIGURE 6) Chart Stage Total 168 I 368 II 1839 III 1655 IV 877 Cummulative Survival Rate 1 8 6 4 2 Dx 1 year 2 years 3 years 4 years 5 years Years From Diagnosis 1 98.7 97.2 96.2 95.8 93.8 1 97.6 94.3 92.1 89.7 87.3 1 91.7 8.2 73 67.8 64.5 1 79.4 62.6 53.5 48.7 44.8 1 48.7 29.6 21.8 17.9 16.1 OBSERVED SURVIVAL FOR CASES DIAGNOSED 25-29 DATA FROM CMC NETWORK (FIGURE 7) Chart Stage Total 6 I 123 II 5 III 17 IV 11 Begin % 1 year 2 years 3 years 4 years 5 years Years From Diagnosis 1 97.4 92.5 9.8 9.8 81.7 1 1 1 1 1 1 1 8 8 8 8 8 1 93.1 93.1 74 74 74 1 36.3 18.1 18.1 18.1 18.1 44
Contact Us For more information on Blumenthal Cancer Center at CMC or to make patient referrals, please contact us at: 8-84-9376 or 74-355-2884 www.blumenthalcancercenter.org Learn More about our Cancer Network Partners CMC-Mercy 74-34-5 www.cmc-mercy.org CMC-Pineville 74-667-1 www.cmc-pineville.org CMC-University 74-863-6 www.cmc-university.org Other Resources American Cancer Society 8-ACS-2345 www.cancer.org 45