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Tumor Stager >> NON-HODGKIN (DLCBL)

Last name
First name
Date of birth (DD/MM/YYYY)
Date of diagnosis (DD/MM/YYYY)
Age in years
Symptoms
Fever (>38C) yes no
Night sweats (changing of clothes) yes no
Weight loss (>10% BW in 6 Mon) yes no
Bulky disease (Tumor >5 cm) yes no
risk factor(s)
Extranodal disease Solitary
Lung left
Lung right
Skeleton (supradiaphr.)
Pleura
Pericardium
Disseminated
Lung left
Lung right
Skeleton
Pleura
Pericardium
Bone marrow
Liver
LDH (above upper limit of normal value) yes no
ECOG 2 or higher?
(Please click on ECOG for explanation)
yes no

Waldeyer throat ring

cervical/supracl. right

cervical/supracl. left

infracl. right

infracl. left

axillary right

axillary left

hilar

mediastinal

Spleen

para-aortal

mesenteric

iliac right

iliac left

inguinal right

inguinal left


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