Hospital Environment Aids In Patient Satisfaction

Do patients respond better in updated treatment centers or hospital rooms?
http://www.nytimes.com/2010/12/16/health/views/16chen.html?src=me&ref=health

A New Look At Cancer Treatment

Below is an article I found on the internet showcasing a new possible treatment for cancer:

Cancer research continues to yield exciting breakthroughs as scientists learn more about the molecular and biological activity of cancer cells.
One important new area of research is called autophagy. Haven't heard of it? You will. Here is a simplified explanation. When cancer cells are mired deep in the core of a tumor, they have limited access to oxygen, growth factors and nutrients from the blood vessels that feed the tumor. So when things get tough for cancer cells, the start eating themselves to get what they need to survive. This is autophagy.

Normal cells rely on autophagy to maintain a balance or during times of stress. Cancer cells do too, not just to survive in the inhospitable environment of a tumor, but also to ward off the effects of chemotherapy and radiation.

When autophagy is activated, (when the "self-cannibalism" begins) it is "an intrinsic cell-survival mechanism that cancer cells turn on to recoup essential building blocks when they're being poisoned or irradiated," according to Dr. John Cleveland of The Scripps Research Institute.

Therefore, a greater understanding autophagy's role in cancer has led researchers to investigate whether blocking autophagy can make cancer treatments more effective, cutting off what amounts to an important escape route.

The research is in early stages and there may be substantial differences in the autophagy activity in different cancer types, or even from tumor to tumor. Still, according to Dr. Ravi Amaravadi from the University of Pennsylvania Abramson Cancer Center, the available evidence suggests that autophagy "seems to be a process that could be important in many cancers."

A number of clinical trials testing autophagy inhibition are actively recruiting patients with a variety of cancers, including breast, colorectal, myeloma, and chronic lymphocytic leukemia. They are testing an off-patent drug called hydroxychloroquine, or HCQ. The largest trial to date involving HCQ is for patients with newly diagnosed glioblastoma multiforme, a brain cancer. There is also a Phase I/II trial testing authophagy inhibition in patients with stage II or III pancreatic cancer.

The September 7 issue of the National Cancer Institute Bulletin contains the complete article from which this summary is drawn. To dig deeper, consult the American Society of Clinical Oncology's work in this area.

http://archive.constantcontact.com/fs044/1103192011442/archive/1103732946090.html

Surviving & Thriving: Life With Cancer

Surviving & Thriving: Life With Cancer is hosted by Kevin Begos, CR's podcast correspondent, and Kim Thiboldeaux, the president and CEO of The Wellness Community.
Download a podcast by clicking on the link below

http://www.crmagazine.org/archive/Crpodcasts/Pages/SurvivingThriving.aspx

Metastatic Pancreatic Cancer

Report indicates pancreatic spread is slow going...
"A principal finding is that pancreatic tumors are not aggressive cancers. To the contrary, they grow slowly, taking an average of 21 years to become fatal. This creates an opportunity for detecting and removing the cancers at an early stage. At present they are diagnosed far too late, when a patient has on average only two more years to live and the cancer has already spread from the pancreas to other tissues."
http://www.nytimes.com/2010/10/28/health/28cancer.html?_r=4

AJCC Cancer Staging Quick Charts

This page lists downloads of various sites illustrating AJCC staging:
http://www.cancerstaging.org/staging/index.html

Skin Cancer Google Book Online

Skin cancer: an illustrated guide to the aetiology, clinical features

http://books.google.com/books?id=UAsPUT_IsfwC&printsec=frontcover&dq=Skin+cancer:+an+illustrated+guide+to+the+aetiology,+clinical+features&hl=en&ei=IH6zTMjhF4L48Aaw8KSjCQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CC4Q6AEwAA#v=onepage&q&f=false

From the CoC Flash

On Monday, October 4, 2010 the Commission on Cancer (CoC) will officially launch the new CAnswer Forum to replace the Inquiry and Response System. The Inquiry and Response System will remain accessible as a view only resource so that users can continue to research previously submitted questions and answers. The shift to this new platform will provide an opportunity for the user community to become more engaged in, and participate in a dialogue about how they interpret and use the data standards to abstract cancer cases, and how they interpret and use the cancer program standards to support accreditation. Thus the new system will allow for knowledge sharing among the user community working with data and cancer program standards on a daily basis.
The CAnswer Forum is a web-based and robust virtual bulletin board accessible to all cancer care professionals. The new format includes specific forums for discussion on all relevant topics such as American Joint Committee on Cancer TNM staging, CoC Cancer Program Standards, Collaborative Stage (CS), Facility Oncology Registry Data Standards (FORDS), National Cancer Data Base (NCDB) Quality Tools, Multiple Primary/Histology (MP/H), ICD-0, Hematopoietic disease, and related topics. The user community can post questions to various forums as well as answer questions that others may have posted, thus serving as a resource available 24 hours a day, 7 days a week. The exceptions to this community-based system include the Collaborative Stage Forum inquires which will be answered by the Collaborative Stage Technical Advisory Panel (CTAP) and the Multiple Primary/Histology (MP/H), ICD-0, and hematopoietic inquires which will be answered by a panel from SEER.
All participants will be required to complete a one-time registration within the new CAnswer Forum and create a user ID and password (if you are a CoC Data links user, you may want to use the same password). To register please go to the following link, h:ttp://cancerbulletin.facs.org/forums/ and become an active participant in this new virtual environment by sharing your knowledge and lending your expertise to support the cancer care community.
Once you register and navigate to the home page in the system you will notice a host of supportive and instructional information. Click on “help” and the system will bring you to the FAQ documents where you will find everything you need to know about how to use the system, e.g. General Forum Use, Settings and Profile features, and Reading and Posting questions. Don’t miss the resource section where you can access the former Inquiry and Response System. Additional resources will be posted here in the near future and the Forum Calendars where educational program dates are posted.
We invite you to access the new CAnswer Forum today!
If you have any questions regarding the CAnswer Forum, please email CAnswerforum@facs.org

Mammography Screening Controversy

A video discussion on the new breast screening guidelines:
http://www.patientpower.info/program/screening-controversy-and-the-next-wave-of-patient-empowerment

SEER RX UPDATE

http://seer.cancer.gov/tools/seerrx/

Sebaceous Carcinoma

I thought I would write a little about uncommon and interesting cancers that I have run across. Here is one I have seen just recently:

Sebaceous Carcinoma

First noted in 1891 this cancer is thought to arise from the sebaceous glands in the skin and can be found anywhere on the body where these glands are  found. It is commonly overlooked as a benign lesion which often delays treatment. A great majority of these tumors can be found in the periocular region, with just 25% of reported tumors occurring on the head and neck. In head and neck sebaceous carcinomas, the parotid gland represents 30% of cases. The clinical course of this carcinoma is aggressive in nature with significant local recurrence and metastatic disease. Site of distant mets are liver, lungs, bone and brain, and can occur as late as five years after initial diagnosis. Women develop this cancer more than men and it has greater frequency in the Asian population.
Sebaceous Carcinoma is associated with Muir-Torre syndrome, a rare autosomal dominant disease characterized by skin lesions, including benign and malignant sebaceous neoplasms, keratoacanthomas, and internal visceral malignancies (gastrointestinal and other sites).
This syndrome is a subtype of hereditary nonpolyposis colorectal cancer syndrome, occurring in approximately 5 out of every 200 patients. Approximately 60% will develope metastatic disease with a 50% survival rate calculated at 12 years. Lesions outside the head and neck have a more aggressive course. Cutaneous sebaceous neoplasms can precede or follow a diagnosis of visceral malignancy, although they usually develop later.
•Sebaceous carcinomas most commonly occur on the eyelids, where they generally arise from the meibomian glands and the glands of Zeiss. They may also occur almost anywhere on the skin, including the ears, the feet, the penis, and the labia. On the eyelids, the tumor appears as a firm, yellow nodule with a tendency to ulcerate. Clinically, these lesions are often mistaken for chalazia, chronic blepharoconjunctivitis, or carbuncles. Sebaceous carcinoma of the eyelid can invade the orbit and can frequently metastasize and cause death. Extraocular tumors can also metastasize but are less likely to cause death.

•The most common visceral neoplasm in MTS is colorectal cancer, occurring in almost one half of patients. The tumors are usually proximal to the splenic flexure. The second most common site is the genitourinary tract, representing approximately one quarter of visceral cancers. A wide variety of other cancers, including breast cancer, lymphoma and rarely leukemia, salivary gland tumors, lower and upper respiratory tract tumors, and chondrosarcoma, are reported. Intestinal polyps occur in at least one quarter of patients. Other benign tumors described in MTS include ovarian granulosa cell tumor, hepatic angioma, benign schwannoma of the small bowel, and uterine leiomyomas.

http://emedicine.medscape.com/article/1101433-overview

Deleting From Your Computer

Everyone has things on there computer, whether personal or professional, that they need to delete. But this article points out that some of this information may not be truly deleted and can remain on the computer.

Here's how to make sure it's completely gone:
http://daol.aol.com/articles/what-is-delete?icid=maing%7Cmaing7%7C5%7Clink3%7C15798

"Forgetting to delete pertinent information from any hard drive is worrisome. Copy machines also pose risks. As CBS reported in April, since 2002, most copiers are installed with hard drives that save images of all copied documents. When these machines are then sold or discarded, the stored information, which can include private information such as medical records, frequently remain intact.
Many users are still convinced that when they delete a document or file on their computer, it vanishes into thin air -- but that’s hardly the case.
As “Sam,” a security engineer who wishes to remain anonymous because of the nature of his job, explains: “When a user ‘deletes’ a file, it's not really gone. Deleted files are sent to the Trash folder. At this point, files can still be recovered.” However, even if the Trash folder is emptied, it doesn’t mean the file has disappeared completely. “But the longer a deleted file is left on a drive, the greater the chance the file cannot be recovered,” Sam says.
There are a number of programs out there that help ensure that your deleted files are really deleted. In addition to guarding your privacy by removing traces of your Internet browsing history and files and programs you have used, Computer Checkup Premium also cleans registries, removes clutter by clearing out temporary files, and helps solve the problem of a fragmented hard drive by rearranging data so it can be accessed more quickly.
If you have accidentally deleted files, Computer Checkup Premium also offers an '"undelete" function.
Then there are times when you really do need to permanently delete everything. If you are in the process of donating or selling your computer, or if you have sensitive information stored on it which you wish to be deleted permanently (such as medical information, bank or legal documents, or Social Security numbers), tech experts recommend reformatting your hard drive or performing a disk wipe. According to The Tech FAQ, “Formatting the hard drive or any of its partitions will completely erase all data that is present.”
A thorough “disk wipe” will essentially overwrite your hard drive to the point where recovery is impossible. As “Sam” explains, “When the U.S. Government wants to delete information from an entire hard drive, it employs the Department of Defense disk wipe, which means the entire drive has its data overwritten with a random pattern of zeros and ones (binary data) three times. At this point, any data on the hard drive is considered unrecoverable. In some instances, the platters are removed from the hard drive and dipped in caustic acid -- referred to as ‘erase by physical destruction.’
Users can (and should) erase the hard drives of their old computers so their data cannot be found by anyone else (think Paul McCartney). One program "Sam" and other tech experts recommend is Darik’s Boot and Nuke, which will delete the contents of a hard drive with certainty.
Sensitive information carelessly stored on computers can lead to identity theft, and also harks the growing need for computer forensics.
In 2007, for example, a forensics expert found that the new publisher of the Minneapolis Star Tribune had transferred sensitive information over from his St. Paul Pioneer Press computer, where he previously worked. In another case, the insurer Health Net was recently sued as a result of a missing computer hard drive that stored the medical records of several thousand customers.
Deleting files from your computer is similar to shredding documents: Store what you need, and digitally “shred” those you don’t.

Error Corrections to the AJCC Seventh Edition Staging Manual

http://www.cancerstaging.org/products/errata.html

Eight Signs of Cancer

"A team of scientists say they've identified the top warning signs of cancer -- which could help catch the disease before it spreads.The eight symptoms they've pinpointed can accurately predict the risk of various cancers in specific age groups. Researchers are  so confident of the findings, published in the British Journal of General Practice, that they advise seeing a specialist immediately unless there's another good explanation for the problem.
-- Breast lump (possible symptom of breast cancer)

-- Rectal bleeding (indicative of colon cancer, especially in older people)

-- Blood in the urine (a sign of urology-related cancers)

-- Coughing up blood (possible symptom of lung cancer)

-- Difficulty swallowing (a symptom of cancer of the esophagus)

-- Anemia and iron deficiency (possible sign of colon cancer)

-- Bleeding after menopause (possible symptom of cancers of the female reproductive organs)

-- Rectal exam showing signs of cancerous cells (potential symptom of prostate cancer)

The researchers say having a doctor diagnose the significance of those eight symptoms as soon as they're noticed has the potential to increase the number of cancer cases caught early. That, in turn, can dramatically improve a patient's chances of survival.
The focus is more on common cancers and looking for symptoms a doctor hasn't already detected (like anemia or an abnormal rectal exam) and general warning signs of multiple kinds of cancer, like unexplained weight loss and a sudden loss of appetite.
"We recommend research and development of general practice computer systems to produce effective warning flags when the symptoms, signs or test results with a risk of 5 percent or more ... are entered for patients within the specified sex and age groups," it was noted in the study.
Dr. Kevin Barraclough, another U.K. general practitioner, wrote in an editorial published with the study that some of the symptoms would more likely mean cancer in certain age and gender groups than in others. Anemia, for instance, probably isn't a sign of bowel cancer in a 21-year-old woman but may be in a 60-year-old man.
And cancer can be difficult to detect because there are more than 200 different types and it produces a host of symptoms; ''So if you notice an unusual or persistent change in your body, it's important to get it checked out.''

To read the full article go to: http://www.aolhealth.com/condition-center/cancer/eight-signs-of-cancer

You Tube Education

 You Tube isn't just for talking cats or laughing babies. You Tube EDU educational presentations cover many subjects including medicine and cancer. The link is below:

http://www.youtube.com/edu?edu_search_query=cancer&action_search=1  

Also for new registrars or those going through registry classes, you can log into You Tube and get informational videos on many subjects--for examle: typing in  Gleason's Score or Bloom Richardson Score will get you videos of physicians explaining just what these mean.

Something I've always wanted to do: Mini Medical School

Free Medical School lectures for life long learners:

http://itunes.apple.com/WebObjects/MZStore.woa/wa/viewiTunesUCollection?id=384237262
http://www.youtube.com/view_play_list?p=D7B0DBD8C28BDEA2

"Stanford Continuing Studies is proud to present the Stanford Mini Med School, a series arranged and directed by Stanford’s School of Medicine. Featuring more than thirty distinguished faculty, scientists, and physicians from Stanford’s prestigious medical school, this series of courses will offer students a dynamic introduction to the world of human biology, health and disease, and the groundbreaking changes taking place in medical research and health care. The fall quarter course will get started with a journey inside human biology. We will start by familiarizing ourselves with the world of very small things. We will take a close look at DNA, stem cells, and microbes, and see how these and other small players form the building blocks of the human body. This will allow us to understand how human organs develop (and can also regenerate), how our nervous and immune systems work, and how diseases can afflict us. From there, the course will move beyond the individual and take a more global view of health. How do pandemics take shape? How does the environment affect our collective health? And how can we finally implement a healthcare system that makes sense for our nation? Various experts from the Stanford School of Medicine will address these and other big picture questions during the first course in the Stanford Mini Med School."

If your interest doesn't lie in medicine there are other free classes online:
http://www.openculture.com/freeonlinecourses

And free online textbooks:
http://www.openculture.com/free_textbooks

And Audio Books:
http://www.openculture.com/category/audio_books

And I highly recommend following the Open Culture Blog.

FOLKMAN'S WAR

Dr. Judah Folkman fought a long battle with a medical community that didn't believe in the idea solid tumors could secret chemicals in order to establish their own blood supply. His steadfast work in the face of adversity hearld the dawning of a new era and greater understanding of how cancer cells ensure their development and survival.
http://www.pbs.org/wgbh/nova/cancer/
The processes required for a normal cell to transform into a cancer cell include the ability to master self sufficiency in growth signals, ensuring that the cell maintains an insensitivity to antigrowth signals, evasion of the cell's encoded programmed death, continued replication and metastasis, and most importantly ensuring a steady blood supply or angiogenesis.
Cancer caught on video: http://www.pbs.org/wgbh/nova/cancer/cells.html
Through Folkman's work, science has discovered a way in which to cut off the newly formed blood supply to these rogue cells, breaking the cycle established for their continued survival. For a more detailed look at Dr. Folkman's work read the article in the July/August 2010 edition of Cancer Journal for Clinicians:
http://caonline.amcancersoc.org/cgi/content/full/60/4/222
And for a closer look at Dr. Folkman's life and achievements:
http://www.amazon.com/Dr-Folkmans-War-Angiogenesis-Struggle/dp/0375502440/ref=sr_1_1?ie=UTF8&s=books&qid=1282485925&sr=8-1

Medical Matrix

Medical matrix is your guide to peer reivewed, updated clinical medical resources.
http://www.medmatrix.org/_SPages/Oncology.asp

Pathology Outlines

"PathologyOutlines.com is a free, no-registration website with a unique, comprehensive, regularly updated textbook of surgical and clinical pathology (chapters are in center section of this page). Each chapter has numerous links to images and references. We also have extensive lists of related jobs, conferences, fellowships and books (buttons are on left side of this page)."

Examples of what you can find:

Bloods:
http://pathologyoutlines.com/leukemia.html

A good visual of Clark Level and brief points on melanoma staging :
http://www.pathologyoutlines.com/topic/skintumorclarkslevels.html

What is Herceptin?

Herceptin (Trastuzumab) is a drug used in HER2 positive breast cancer. Here is a short video on how this drug works:

http://www.youtube.com/watch?v=66z6BmeA00I

A video at the Herceptin website:

http://www.herceptin.com/breast-cancer-resources/videos.jsp

Herceptin is approved for the adjuvant treatment of HER2-overexpressing, node-positive or node-negative (ER/PR-negative or with one high-risk feature) breast cancer.

Cancer 101

Cancer:
http://www.youtube.com/watch?v=HonoQ6mE6dY&feature=related
http://www.youtube.com/watch?v=LEpTTolebqo&feature=fvw

Metastasis:
http://www.youtube.com/watch?v=rrMq8uA_6iA&feature=related

What is Radiation Like?

Video posted on My Cancer Advisor let you see what it's like to undergo radiation therapy.

"Radiation treatments are used in the majority of patients with cancer, and yet most patients have little idea of what to expect. This video is helpful in showing what happens during the course of a single radiation treatment."

http://mycanceradvisor.com/2010/07/26/what-is-radiation-treatment-like/

Youtube Radiation Video:
http://www.youtube.com/watch?v=OK7yOyI6GLI&feature=related 

How to Highlight the CSv2 Manual

Here's step by step instructions for using tools to get the most out of your electronic manual :
http://www.cancerstaging.org/cstage/manuals/pdfinstructions.pdf 

Anatomy Pages

Nice printout of anatomy of the colon, kidney and pelvic lymph nodes.
http://acad.rosalindfranklin.edu/cms/anatomy/2009-2010/notes/anatomy/56_intestines_posterior_abd_wall/intestines.html

And a little bit more on my favorite subject:
http://acad.rosalindfranklin.edu/cms/anatomy/histohome/content.html

Pod Cast on Survivorship Issues for Breast Cancer Patients

Breast cancer has been the most studied cancer in the field of psycho oncology. Because 75% of breast cancer patients will become breast cancer survivors, needs go beyond diagnosis and treatment. Adjustment to life after breast cancer can pose special challenges. 
Some points of this webinar:
1) Psycho social distress in dealing with a cancer diagnosis--points of stress for the cancer patient,  interventions to address these stresses,
2) Use of community based services--should be routinely offered to patients, private based medical practices do not routinely employ psycho-social professionals, patients often seen many different physicians in various busy outpatient offices this creates fragmentation of care and can add an additional psychological burden, patients reluctant to discuss psycho social problems with physician
3) Lack of insurance, or mental health services provided at lower payment level, no screenings for psycho social problems
4) Programs should be put into  place and monitored with quality assurance program to ensure compliance with standards of care, physician education and training in communication skills
5) Determine eligibility criteria so that the patient population that needs these services get them and those that do not need them are not subjected to additional or unwanted services

Below is the pod cast discussing survivorship and the psychological stresses involved:
http://media.nap.edu/podcasts/nax39breastcanc.mp3

National Academy Press: More podcasts are available at their website. You may also read full texts on cancer topics free online.
http://www.nap.edu/topicpage.php?topic=387

The National Academies Press (NAP) was created by the National Academies to publish the reports issued by the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council, all operating under a charter granted by the Congress of the United States. The NAP publishes more than 200 books a year on a wide range of topics in science, engineering, and health, capturing the most authoritative views on important issues in science and health policy. The institutions represented by the NAP are unique in that they attract the nation's leading experts in every field to serve on their award-winning panels and committees. This is the right place for definitive information on everything from space science to animal nutrition.

Good Anatomy Reference Site

http://www.innerbody.com/htm/body.html 

Video Science Life on Bladder Cancer

Dr. FAQ: Gary Steinberg on Bladder Cancer
http://sciencelife.uchospitals.edu/2010/07/15/dr-faq-gary-steinberg-on-bladder-cancer/  

Eye Cancer Network

For those registrars that frequently have eye cancer cases, or for those of us who aren't familiar with the diagnosis, here is a website that showcases cancer of the eye.

"The Eye Cancer Network is the first online-based community dedicated to eye tumor patients. This site was developed to help patients around the world find much needed information and research on the various forms of ocular tumors and related eye diseases. This includes detailed descriptions, images and information about the diagnosis and treatments for each of these disorders."



http://www.eyecancer.com/Default.aspx

Online Privacy and Security Training

Each and every day Cancer Registrars work with private medical information and security/protection of that information is vital. The NHI website  provides online educational training on information security. This training can also help you be aware of how to protect your private information in the home setting.
Visit this online course at:
http://irtsectraining.nih.gov/publicUser.aspx

Painters Face Increase In Bladder Cancer Risk

TUESDAY, July 20 (HealthDay News) -- Professional painters may face an increased risk for bladder cancer and that risk seems to rise with the number of years they work, a new study suggests.
Researchers analyzed nearly 3,000 cases of bladder cancer in professional painters that were reported in 41 previous studies. Some of those studies also classified plasterers, glaziers, wallpaper hangers, artists and decorators as painters.
After taking into account smoking (a key risk factor for bladder cancer), the review authors concluded that painters were 30 percent more likely to develop bladder cancer than the general population.
While there was some evidence that female painters were more likely to develop bladder cancer than male painters, only four of the studies included separate results for women.
The number of years a person worked as a painter had a significant effect on bladder cancer risk. People who worked as a painter for more than 10 years were more likely to develop the disease than those who'd been painters for less than 10 years, according to the report published online July 20 in Occupational and Environmental Medicine.
It's not known which chemicals in paint increase the risk of bladder cancer and the link between being a painter and bladder cancer is complicated by work variability, differing levels of exposure and changes to the composition of paint over time, the researchers noted. Painters are exposed to some of the same chemicals that are found in cigarette smoke, including aromatic amines, they added.
There is now sufficient evidence that painters are at increased risk, Neela Guha of the International Agency for Research on Cancer in Lyon, France, and colleagues concluded.
"Because several million people are employed as painters worldwide, even a modest increase in the relative risk is remarkable," the researchers wrote in their report.

ICD 9 Long List for Co-Morbidity Fields

If your software doesn't have access to ICD9 codes or you don't have a coding sheet provided here is a printout of 2009-2010 ICD-9 list for comorbitity fields:
http://www.aafp.org/fpm/icd9/icd9-long.pdf

And here's another list:
http://en.wikipedia.org/wiki/List_of_ICD-9_codes

ICD 10 Listing of Codes:
http://www.cdc.gov/nchs/icd/icd10cm.htm#10update 

Meningiomas

Meningiomas are primarily bengin tumors originating in the lining of the brain and spinal column. Though benign, these tumors are not easily dismissed. There is a complexity in treatment decision making and it seems that any route taken in dealing with this condition can be a difficult one for both patient and family.
The following article includes a reference to patient advocacy in getting these tumors collected by the cancer registry, a step forward to greater understanding of meningiomas and the treatment options considered with this diagnosis.

http://www.cns.org/publications/clinical/54/pdf/cnb00107000091.pdf

Education resource:
http://www.braintumortreatment.com/Brain-Tumors/Tumor-Types/Meningioma.aspx/?9gtype=content&9gkw=meningioma%20tumors&9gad=4988104037.1&9gag=1527298907&gclid=CJmHvN-vl6MCFRxEgwodkjsHoQ 

Health Plans Must Provide Some Tests at No Cost

July 15, 2010 by The New York Times, Robert Pear

WASHINGTON — The White House on Wednesday issued new rules requiring health insurance companies to provide free coverage for dozens of screenings, laboratory tests and other types of preventive care.
The new requirements promise significant benefits for consumers — if they take advantage of the services that should now be more readily available and affordable.
In general, the government said, Americans use preventive services at about half the rate recommended by doctors and public health experts.
The rules will eliminate co-payments, deductibles and other charges for blood pressure, diabetes and cholesterol tests; many cancer screenings; routine vaccinations; prenatal care; and regular wellness visits for infants and children.
Other services that must be offered at no charge include counseling to help people stop smoking; screening and counseling for obesity; and tests for infection with the virus that causes AIDS.
“Getting rid of cost-sharing is a long-overdue step in the right direction,” said Kenneth E. Thorpe, a professor of health policy at Emory University in Atlanta. “But we will have to do a major public education campaign to get people to take advantage of these clinical preventive services.”
The rules stipulate that no co-payments can be charged for tests and screenings recommended by the United States Preventive Services Task Force, an independent panel of scientific experts. The rules apply to new health plans that begin coverage after Sept. 23 and to existing health plans that make significant changes after that date. The administration said the requirements could increase premiums by 1.5 percent, on average.
Kathleen Sebelius, the secretary of health and human services, said the rules would extend benefits to 31 million people in new employer-sponsored plans and 10 million people in new individual plans next year.
In many cases, insurers will be allowed to charge for goods and services needed to treat a condition detected in a screening. For example, consumers can receive free screenings for depression and high cholesterol, but they might be charged co-payments for antidepressants and cholesterol-lowering drugs.
In some cases, the task force has specified how frequently a service, like colonoscopy, should be performed. If the guidelines are silent, the rules say, an insurer may use “reasonable medical management techniques to determine the frequency” of services.
The administration is working on a supplemental list of free preventive services for women.
The Planned Parenthood Federation of America says insurance plans should be required to cover contraceptives without co-payments.
“For women, what could be more basic preventive care than birth control?” asked Cecile Richards, the president of Planned Parenthood.
Other services that must be provided without charge include genetic counseling for certain women with a family history of breast cancer, counseling to promote breast-feeding by new mothers and screening for osteoporosis in older women.
Ms. Sebelius said that 100,000 deaths could be averted each year if doctors and patients effectively used five services: colorectal and breast cancer screening, flu vaccines and counseling on smoking cessation and on aspirin therapy to prevent heart disease.

http://rxroundtable.org/2010/07/15/health-plans-must-provide-some-tests-at-no-cost/

Quality Indicators for Colonoscopy

Excellent starting point for studies, this website is full of Guidelines. Here is the page that covers colonoscopy :
http://www.guideline.gov/summary/summary.aspx?doc_id=9299&nbr=4969&ss=6&xl=999

The National Guideline Clearinghouse™ (NGC) is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]).

The NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.

Avastin in Her2 Neg Breast Cancer Fails to Show Promise

Interesting article that showcases clinical trials using Avastin in Her2 Neu negative breast cancer. The results of these trials failed to show signficant benefit.
http://www.medpagetoday.com/HematologyOncology/BreastCancer/21276

(Thanks Judy!)

Lung Cancer

Underfunding of lung cancer comes from the stigma that all cases are caused by smoking.
http://www.nytimes.com/2010/07/13/health/13brod.html?ref=health

Lymphoma

Here is a pdf file that covers lymphoma, complete with table that lists lymph node areas and a diagram illustrating where to find lymph nodes in the body:
https://crawb.crab.org/txwb/CRA_MANUAL/Vol1/chapter%2016c_Lymphoma%20Forms.pdf

Brain Tumors

From the American Brain Tumor Association, here is an educational booklet for better understanding of tumor affecting the brain :
http://www.abta.org/siteFiles/SitePages/E2E7B6E1D9BBEAD2103BCB9F2C80D588.pdf

Vital Signs

CDC Releases Vital Signs


The Centers for Disease Control and Prevention (CDC) released a new report this week, Vital Signs , tracking the progress of breast and colorectal cancer screening in the United States. The CDC estimates that at least 10,000 lives could be saved each year if more people got screened. The Affordable Care Act will greatly improve screening rates by improving access to insurance coverage and removing cost barriers to screening. The report provides solid evidence that improvements in screening rates could yield dramatic results: 1,900 colorectal cancer deaths could be prevented each year for every 10% increase in colonoscopy screenings, while 560 deaths from breast cancer could be prevented for every 5% increase in mammogram screenings.
The full report can be found at: http://www.cdc.gov/vitalsigns/. Liz Ward, the American Cancer Society’s vice president of surveillance and health policy research, is quoted in the Associated Press story on the report: Colon Cancer Screenings Up, Breast Rate Stalled.

Human Atlas Videos

Great website with videos on cancer (and other disease) including treatment modalities like this one:

http://www.medbroadcast.com/channel_humanatlas_info_details.asp?video_id=135&channel_id=2055&relation_id=68852

Finding County information

If you need to find out a county in the US, here is a helpful website:

http://en.wikipedia.org/wiki/List_of_counties_in_Ohio

For additional states, just change the state name at the end of web address.

MedScape Article Unknown Primary and symptoms at the site of metastatic disease

Patients have early dissemination of their cancer without symptoms at the primary site. The symptoms are often at the site of metastases.

•Ascites should lead one to evaluate for a GI or an ovarian primary.

•An axillary mass in a female should make the clinician check for breast cancer.

•A cervical node should lead to a thorough ENT examination.

•A brain metastasis should lead to a search for a lung, breast, or kidney primary.

•Bone metastasis should lead to evaluation for prostate, breast, lung, renal, or thyroid primary.

•A testicular mass should lead to measurement of tumor markers such as beta-human chorionic gonadotropin (beta-HCG) and alpha-fetoprotein (AFP).

http://emedicine.medscape.com/article/280505-overview

Lab Tests Online

If you are looking for an explanation of tumor markers  or wonder what a specific test is for, this website will help.
http://www.labtestsonline.org/

Website Directory

Centers for Disease Control and Prevention (CDC)


National Program of Cancer Data

www.cdc.gov/cancer/npcr

American College of Surgeons (ACoS)

http://www.facs.org/

National Cancer Institute (NCI)

www.nci.nih.gov/

National Cancer Registrars Association (NCRA)

http://www.ncra-usa.org/

American Cancer Society

http://www.cancer.org/

Cancer Quest

Teaches biology of cancer and cancer treatments

http://www.cancerquest.org/

International Agency for Research on Cancer (IARC)

www.iarc.fr/

SEER Surveillance Epidemiology and End Results

http://www.seer.cancer.org/

COMING SOON: The AJCC e-Staging Tool

From the CoC website:

The AJCC e-Staging Tool provides cancer registrars with an easy-to-use staging form and calculator.

From Springer and the American Joint Committee on Cancer:

Features

Contains all 57 Staging Forms for staging primary sites from the AJCC Cancer Staging Manual, 7th Edition

An elegant, simple user interface

Captures clinical and/or pathologic stage at any point in the patient workup

Includes an interactive introduction to the principles and practice of cancer staging

Available for three concurrent users at your facility, at one low subscription price

Benefits

Provides an easy-to-use workflow interface for cancer staging

The quickest, most accessible method for compliance with Commission on Cancer requirements for cancer staging

Staging forms can be shared among members of the patient management team and saved in tandem with electronic and print patient records

Generates HL7 code that can be saved to the user's computer and imported directly into an Electronic Health Records system

Availability

The AJCC e-Staging Tool will be available in an individual version that can support three concurrent users, for the low cost of $49.95.

Launch Date

Keep checking the http://www.cancerstaging.net/ for more information about the launch date of the AJCC e-Staging Tool, as well as information on how to subscribe!

Regional Lymph Node Identification

The following link is a great resource for any registrar who has difficulty identifying regional lymph node stations when abstracting.

http://www.radiologyassistant.nl/en/4646f1278c26f

Thanks Theresa!

Timeline of Cancer

Take a walk through history with this timeline that shows the history of cancer. From the mummies of Egypt to the development of the first cancer vaccine:
http://www.cancerquest.org/images/HistoryOfCancer/HistoryofCancer.swf

Chemo Drug List

For a list of chemo drug classifications and the cancers they treat visit:

http://www.guide2chemo.com/sites/all/themes/test/tools/drug.pdf

Intraoperative Radiotherapy for Breast Cancer

New developments in radiation treatment for breast cancer.

From the website:
"Intraoperative radiotherapy (IORT) with low-energy X-rays (30-50 KV) is an innovative technique that can be used both for accelerated partial breast irradiation (APBI) and intraoperative boosting in patients affected by breast cancer. Immediately after tumor resection the tumor bed can be treated with low-distance X-rays by a single high dose. Whereas often a geographic miss in covering the boost target occurs with external beam boost radiotherapy (EBRT), the purpose of IORT is to cover the tumor bed safely."

Read more on this at:
http://www.ncbi.nlm.nih.gov/pubmed/16277101

NCDB Call for Data Changes 2011

Find the latest information on NCDB call for data scheduling:
http://newsmanager.commpartners.com/acscoc/issues/2010-06-30/4.html
http://www.facs.org/cancer/ncdb/registrars.html

USA Today Supplement

USA Today showcases the latest  advancements in cancer treatment and what it means to survive through cancer treatment and beyond. This supplement includes articles covering:

Personalized medicine in the treatment of cancer; changing life habits to help prevent cancer;  patients need access to information about Clinical trials; what it means to be a cancer survivor and the latest advances in the treatment of cancer

http://www.canceradvocacy.org/assets/documents/usa-today-beating-cancer.pdf

Mammograms

Here is an article from The American College of Radiology that outlines practice guidelines for both screening and diagnostic mammography. The article outlines specification of the various types of mammography, assessment BI-RADS descriptions, and timeliness in reporting results to the patient. The article can be found at:
http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/breast/Screening_Diagnostic.aspx

Study Finds Percentage of Breast Cancer Patients Not Taking Medication

From the website:
"A new study of nearly 8,800 women with early-stage breast cancer found that fewer than half  approximately 49 percent  completed their full regimen of hormone therapy according to the prescribed schedule. Investigators found that younger women were particularly likely to discontinue treatment. The findings underscore the need to both better understand the reasons behind such treatment non-compliance and also develop interventions to reduce it."
http://www.biosciencetechnology.com/News/Feeds/2010/06/products-chemicals-and-reagents-fewer-than-half-of-breast-cancer-patients-adhere-t/

Colorectal Cancer Coalition

This organization is dedicated to winning the fight against colorectal cancer. They produce a newsletter called C3:Momentum which is full of valuable information,  including free online webinars. The website is a wealth of information including advocacy and patient resources. They can be found at:
http://www.fightcolorectalcancer.org/  and on Facebook.com/colorectalcancer.

CANCER SURVIVORSHIP WEB PRESENTATION

Brown Bag Chat: Cancer Survivorship:
Online replay of an internet based discussion on Survivorship:
http://www.oncolink.org/blogs/index.php/2010/06/cancer-survivorship/

Reading on the web

CANCER MEDICINE
This edition of the text was printed in 2000, and will probably not be a good resource for current treatment modalities, but otherwise offers a great reference to general cancer information. The table of contents allows the reader to "click on" a link that connects to a particular chapter in the book.
New editions of this manual are available for those wishing to read more current material.

From the website:
"Cancer Medicine is the best known and respected work in the field of oncology and was the first comprehensive textbook devoted to reporting and assessing the rapid and continuous development in the diagnosis and treatment of cancer. Cancer Medicine is widely recognized as a leading reference resource for medical oncologists, radiation oncologists, internists, surgical oncologists, and others who treat cancer patients. Cancer Medicine e.5 continues this high standard while providing updated information in all areas of oncology - including molecular biology, pathology, imaging interventional radiology, endoscopy, surgical oncology, radiation oncology, and medical oncology."

http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cmed

Melanoma

Now that it is summer, there are plenty of magazine articles on skin cancer awareness. One I recently read shows, not only what melanoma looks like, but the different types involved and where they are most likely to occur. So, I thought I'd share that information here:
Superficial spreading melanoma is the most common of all types 70% and occurs most often on the upper back in men and back and legs in women. These are flat or slightly raised, irregular borders, and varigated in color. Changes in a mole is sometimes noted.
Nodular melanoma  is typically found on the trunk and legs. These appear as raised a dark brown or black bump, but may also be red, blue, gray, tan or skin toned. Ulceration or bleeding is common. this lesion has rapid growth over weeks or months. Nodular melanoma makes up 10-15% of cases.
Lentigo Melanoma occurs in sun exposed areas, head, neck and arms. These appear as tan to brown/black patches. Irregular borders mimic large asymmetrical sun spot. These lesions are slow growing. 15% of new cases diagnosed.
Acral Lentiginous Melanoma make up 29 to 79% of cases in blacks, asians, and hispanics; 2 to 8% in caucasians. These lesions appear on the soles of feet, palms of hands and under fingernails and toenails. Appears as irregular brown/black pigmentation on skin or under nails. Ulceration in this lesion is common.


Source: Redbook magazine (http://www.redbookmag.com/)

Patient Resources

This website is an excellent place to start if you're looking for information about cancer or cancer treatments. This organization produces an outstanding resource in their publication "Cancer Guide" and they now have individualized cancer guides that are site specific.  If you aren't familiar with these materials, you owe it to yourself to check out this site and order some of these free materials.

http://www.patientresource.net/Home.aspx

Facebook offers Networking and Cancer Registrar training

Facebook is a great way to network with others and you can find Cancer Registars on Facebook.

http://www.facebook.com/group.php?gid=49137561355#!/group.php?gid=49137561355&v=info

Michele Webb is offering  Cancer Registry training and has announced a free teleseminar covering the subject. For those interested in becoming a registrar or those who will be taking their entrance exams--this looks like a great opportunity to learn more. Below is the information:

Michele Webb "It's official and I'm getting really excited! On Tues, June 22nd @ 6 pm PST I'll be hosting my first free 60 min teleseminar on "How to Become a Cancer Registrar." Anyone that wants to attend can register at http://CancerRegistryTraining.com/register.html. This is going to be fun!"

The Importance of A Multidisciplinary Team

Today I was privilaged to see how a multidisciplinary team works together in decision making. I followed a close family member as he navigated the first office visits for suspected cancer. The team of specialists ranged from pulmonary medicine, thoracic surgery, radiation oncology and medical oncology.

The pulmonary medicine specialist was most concerned with a pulmonary co-morbidity and how this would play a major part in the health of the patient over the next twenty four months. He was not as concerned about the suspicious lung nodule that was an incidental finding on X-ray, feeling strongly that it was not as pressing as the immediate condition of worsening COPD.
Recommendation, wait a month and repeat CT scan. Antibiotic to combat residual pneumonia in the lungs.

The thoracic surgeon's opinion mirrored pulmonary medicine, with the addition of stressing that the test results were still inconclusive as to the diagnosis of the nodule. Recommendation was to wait for a month, repeat CT scan and look to see if the nodule had changed in size. General opinion would lead to the belief that this nodule probably was not cancer and even if it was, would be slow growing due to a PET scan that indicated limited uptake of contrast. Uptake by the lymph nodes was thought to be due to infection and/or inflammation.

Radiation Oncology was VERY different, with recommendation that a lymph node biopsy be conducted. Discussion centered on some uptake at the subcarinal and hilar lymph nodes. Biopsy of these nodes would not compromise the patient and could be done for definitive diagnosis. Assessment by this professional leaned more towards a cancer diagnosis and evaluation for staging the patient so that a treatment plan could be formulated. Extensive discussion focused on treatment options for various stages should the biopsy be negative or reveal cancer spread to lymph nodes.

The radiation oncologist explained that this case would be included in a tumor board discussion that would include all physicians involved with the case, as well as others with similiar knowledge and experience. After presentation of this case, the radiation oncologist would share the tumor board concensus with the patient.

From this experience, I got to witness the various thought processes, analysis and conclusions that each physician went through in an individualized setting. It was surprising to see the varying degree of importance and urgency each placed on the possiblity of a cancer diagnosis. It was also very encouraging to hear that each one will come to the table and as a team work together to provide the very best possible care in a difficult and challenging situation.

Looking at Quality Improvement on the Web

Below is an informative website focusing on tools that can be used to improve quality in health care:
"IHI.org is an Internet system that provides resources, at low or no cost, to people all over the world to help them take effective action to improve health care. It will be helpful to people in many different roles in the health care system — including (but not limited to) physicians, nurses, other clinicians, managers, executives, policy-makers, educators, and interested members of the lay public.
IHI’s policy is to make the content posted on IHI.org free and open to all, as often as possible. Our goal is for thousands of users around the world to access our resources in order to promote the improvement of health care quickly and broadly."
http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/

A highlight of the PDCA Cycle used in getting from a 'problem faced' to 'problem solved'.
http://www.hci.com.au/hcisite3/toolkit/pdcacycl.htm#Plan-Do-Check-Act

American Cancer Society Survivors Network

A website for survivors from The American Cancer Society:
http://csn.cancer.org/csnhome

NAACCR Everything for 2010

NAACCR is pleased to announce “Everything 2010” a “one-stop-shop” for 2010 change implementation. We have gathered important information, programs, documentation and updates concerning 2010 and placed them in one convenient location for you.

http://www.naaccr.org/index.asp?Col_SectionKey=28&Col_ContentID=544

SEER Abstracting Forms for 2010 cases

SEER Abstract Addendum Generator for 2010 Cases Abstracted under Collaborative Stage version 1 (CSv1)

Based on the site and histology entered by the user, the correct schema will be chosen and a document opened in Microsoft Word with a listing of new fields and CS fields including the names of all of the CS site-specific factors for this schema.

http://seer.cancer.gov/tools/absgenerator/

The Latest In Melanoma Research

New England Journal of Medicine:

Improved Survival with Ipilimumab in Patients with Metastatic Melanoma

http://content.nejm.org/cgi/content/full/NEJMoa1003466

http://www.msnbc.msn.com/id/37514210/ns/health-cancer/

Study: Radiation boosts prostate cancer survival

http://www.dailyfinance.com/article/study-radiation-boosts-prostate-cancer/1101012

CHICAGO -Doctors are reporting a key advance in treating men with cancer that has started to spread beyond the prostate: survival is significantly better if radiation is added to standard hormone treatments.

Patient Treatment Guides

My Cancer Advisor is a great resource for patients and professionals alike. This organization prints a Cancer Guide that is a valuable tool for patient understanding, but would also be an excellent reference to the beginning registrar. It contains articles covering the various forms of cancer, along with diagrams and staging information. These are updated frequently and can be ordered free from http://www.patientresource.net/

Recently I found that they are offering a patient treatment guide for Breast, Colon and Ovarian that breaks the diseases out by stage and addresses appropriate treatment for that particular stage, siting NCCN guidelines in the references. Below are the links to these files:
http://www.patientresource.net/Treatment_Charts.aspx

New NCDB Submission Changes

NCDB has changed their submission process. Consult the latest version of the CoC Flash for details.
Below is a link to the new submission schedule:

http://www.facs.org/cancer/ncdb/callfordataschedule.pdf

CoC Website showcases 2010 Changes

From the CoC Flash:
"A new comprehensive CoC web site,
http://www.facs.org/cancer/ncdb/2010atyourfingertips.html is now available to give staff in CoC-accredited programs easy access to resources for data and standards changes implemented in 2010. The content includes links to manuals and educational materials for new and changed codes and coding instructions, recommendations for implementing the 2010 data changes, links to software resources for converting and editing registry data, and links to information about the 2010 changes in CoC standards and surveys."

CSv2 Site and Instructions: http://www.cancerstaging.org/cstage/manuals/index.html

SEER tool for abstracting 2010 cases prior to software upgrade:
http://seer.cancer.gov/tools/absgenerator/

Where in the world is...

This is the most interesting site. It's called Google Earth and when downloaded to your computer you simply type in any address or business and a satellite map is displayed. You can also click on a geographical site and a window will display that tells you how to map from the current location to another location.

Website Description: Google Earth lets you fly anywhere on Earth to view satellite imagery, maps, terrain from galaxies in outer space to the canyons of the ocean. You can explore rich geographical content, save your toured places, and share with others.

http://earth.google.com/intl/en/download-earth.html

A tour of what this website and download can do:

http://earth.google.com/tour.html

2010 reference sheet to the CS SSF Schema

From the Florida Cancer Data Services website is a reference sheet to the CS SSF Schema:
http://fcds.med.miami.edu/downloads/dam2010/CS_SSF_by_Schema.pdf

Focus on the Lung Part One: Risk and Oncogene Mutations

Lung cancer is the leading cause of cancer in the US among both men and women.
In the 1960's the Surgeon General's Report loosely associated cigarette smoking with cancers of the trachea, lung, bronchus, larynx and lip.

Within the past two decades, cigarette manufactures have changed the design of their product adding filters that remove much of the tar from inhaled tobacco smoke. These filters also retain more of the nicotine causing deeper inhalation by smokers and a longer smoke retention period within the lung to satisfy nicotine cravings. This has resulted in a shift in histology patterns with decreasing amounts of squamous cell carcinoma and increasing amounts of adenocarcinomas being reported.

Cigarette smoke emits about 4,800 compounds. Lung cancer develops from chronic exposure of cell DNA to metabolically active carcinogens. These compounds can alter and damage DNA in a number of ways including chromosonal aberrations, DNA stand breaks, and oncogene inactivation. Geneic factors also play a role in the risk of developing lung cancer.

Risk Factors: Age related increase in lung cancer is lowest in men and women who have never smoked, an intermediate risk in those that have quit at various ages, and highest in those who continue to smoke. Factors to look for include: duration of smoking, number of cigarettes per day, and age at time time of smoking cessation

• The longer one lives after cessation of smoking the greater the risk of developing lung cancer.
• The greater the consumption of tobacco, the greater the risk of developing lung cancer.

Occupational expose can also contribute to the development of lung cancer. Examples include graphite electrode manufacturing, coke oven plants, exposure to diesel exhaust, workers exposed to cadmium, and those working in the synthetic rubber and various plastics.

Predictive markers of survival metatasis, gender and weight loss. Some studies indicate that weight loss in lung cancer patients is associated with poor therapy outcome and reduction in patient survival, though how weight loss affects survival outcome is not clear.

Oncogene mutation: K-ras mutations are found in adenocarcinoma, not in small cell carcinoma, and are not associated with a patients sex, prior therapy status, or tumor extent. p53 tumor suppressor gene is inactived by mutation in more than 50% of non-small cell lung carcinomas and is found in 90% of small cell lung carcinomas. In early stage lung cancer, sputum can sometimes reveal K-ras or p53 cellular mutations. EGFR has been associated with lung tumor progression.

Information taken from the text: Oncology An Evidence Based Approach
http://www.amazon.com/Oncology-Evidence-Based-Approach-Chang/dp/0387242910

Hematopoietic and Lymphoid Neoplasms

With the 2010 changes involving hematopoietic and lymphoid neoplasms, I was searching the internet looking for some recommendation on a good book for understanding the complexity of these disorders.
I happened to read a cancer registry newsletter covering the subject and this book came highly recommended.

From Amazon.com: PDQ Hematology is a concise and focused introduction to clinical hematology. It succinctly covers the most important aspects of the field with an emphasis on clinical features, diagnosis, and treatment. PDQ Hematology thoroughly examines those conditions frequently encountered by physicians and includes general principles for more unusual or complicated diseases. The text also incorporates a discussion of malignant lymphomas as well as the usual clinical hematology topics (such as anemia and leukemia). The extensive use of tables and diagrams make this portable book an accessible and practical companion.

You can preview this reference online at:
http://www.meduweb.com/showthread.php?t=10089

Another site I found that is very helpful for any type of cancer including Hematopoietic:
http://www.cancer.gov/cancertopics/pdq

" PDQ (Physician Data Query) is NCI's comprehensive cancer database. It contains summaries on a wide range of cancer topics; a registry of 8000+ open and 19,000+ closed cancer clinical trials from around the world; and a directory of professionals who provide genetics services. PDQ also contains the NCI Dictionary of Cancer Terms, with definitions for 6000+ cancer and medical terms, and the NCI Drug Dictionary, which has information on 1200+ agents used in the treatment of cancer or cancer-related conditions."

And of course, the educational modules for understanding the reporting of Hematopoietic & Lymphoid Neoplasms can be found at:
http://www.seer.cancer.gov/tools/heme/training/

Here is a printed list of the hematopoietic coding changes for 2010:
http://publichealth.lsuhsc.edu/tumorregistry/PDF/Hematopoietic%20Histology%20Codes.pdf

Flash cards that review hematology (leukemia starts at card 77)
http://quizlet.com/507151/hematopoietic-and-lymphoid-pesek-flash-cards/

And for those of us with questions about the changes for the 2010 data:
http://health-information.advanceweb.com/Editorial/Content/Editorial.aspx?CC=223046

Cells That Live Forever, the Story of Henrietta Lacks

When Henrietta Lacks first stepped foot inside John Hopkins Hospital in Baltimore, she wasn't thinking of changing the world. She arrived at John Hopkins because she was suffering from unexplained vaginal bleeding that would later turn out to be a fatal form of cervical cancer.

The year was 1951, a time when medical science was desperately looking for malignant cells that would grow and proliferate outside the human body. If this could be accomplished, medicine would be closer to understanding and possibly finding a cure for cancer. This was no small feat, little was known about what it took keep these cells alive and contamination of the cell culture was common. Bacteria and other microorganisms could easily destroy any growing cell colony.

But all that was about to change.

Henrietta was just thirty years old when she was diagnosed. The cancer turned out to be a very aggressive type, presenting as a grape colored lesion located at the four o'clock position on the surface of the cervix. The lesion bled easily and seemed to be capable of spreading rapidly. The physician who examined Henrietta took a sample of this tissue and sent it to the lab for analysis.
Some of this tissue ended up in the hands of George Gey.

George Gey was the head of tissue culture research at Hopkins and he set about starting a culture using Henrietta cells. Amazingly these cells turned out to be quite different than any they had seen before. The cells reproduced at an astounding rate, doubling their numbers within the first twenty-four hours. It soon became apparent that George Gey was looking at the first immortal human cells. Soon other labs requested samples for cancer research and Gey responded by sending Henrietta's cells to any scientist who wanted them. Soon these cells would find their way into mass production and turn out to be instrumental in the development of the polio vaccine, drugs for the treatment of various chronic illnesses, secrets of cancer and gene mapping.

Immortality had come to Henrietta Lacks and it was found under a microscope. There, the cells taken from that first biopsy, reproduced faster than any other cells had before, even cancer cells. These cells took on life of their own living independently from the organism they had come from, reproducing and spreading on their own.

Science gave them a name HeLa cells.

In 1991, it was decided that this group of cells should be given its own genus and species: Helacyton gartleri. A new species observed developing from another.

In her short life, Henrietta Lacks had opened the door for the scientific world to take a huge step forward in the advancement of knowledge and achievement in medicine.

The book "The Immortal Life of Henrietta Lacks" can be found at Amazon.com and Barnes and Nobel book stores.