Cancer Committee Activities The North Mississippi Medical Center Cancer Committee remained very busy in 2002. The Cancer Committee continues to oversee weekly Cancer Conferences. This year, 189 prospective cases were presented during 49 conference meetings. Physicians, as well as other health care professionals, attend these conferences, which promote a multidisciplinary approach to cancer treatment. The conferences also provide continuing education hours approved by the Mississippi State Medical Association to physicians who attend. In addition to our regular Cancer Conferences, we had the privilege of hosting Dr. Henry Friedman, head of Medical/Pediatric Neuro-Oncology from Duke University, who discussed different treatment options for brain tumors. Videoconferencing capabilities at the NMMC Education Center enabled us to participate in the videoconference, Changing Strategies of TNM Staging: Introduction to the AJCC 6th Edition, and allowed us to broadcast our weekly cancer conference for physicians and other health care professionals at the NMMC Cancer Center. Our Cancer Committee actively participates in clinical trials, and the number of active protocols continues to increase. The Cancer Committee set the following goals for 2002: Continue to follow approved guidelines for American College of Radiology and maintain a three-year approval by the American College of Surgeons as a Community Hospital Cancer Program. Improve the cancer survival rate of people in our region. Participate in clinical trials with a minimum of 2 percent annual caseload entered into clinical trials annually. Continue promoting awareness and screening standards at the primary care physician level for breast, colon, cervix, prostate, lung and skin cancers. Promote a higher quality of life for cancer patients. Increase awareness of support groups. Continue to promote the Joyce B. Atwell Cancer Resource Library. Continue to increase the utilization of Cancer Registry for cancer date incidences and survival reporting compared to national statistics. Maintain survival status reports for each specialty group meeting. Continue multidisciplinary specialty conferences that report the top five primary sites diagnosed and treated at NMMC. These sites include urologic, breast, lung, gastrointestinal and lymphoma. As the year progresses from 2002 to 2003, we continue our interest in oncology care, including screening programs, diagnostic and therapeutic procedures, clinical trials and end-of-life care. It is our hope that you will continue to support us and participate when possible in the coming years. Sincerely,
Andrew H. Kellum, M.D., F.A.C.P.
Chairman, Cancer Committee Physician Members: Andrew Kellum, M.D., Chairman, Hematology/Oncology Phil Mathis, M.D., Vice Chairman, Surgery Kevin Bond, M.D., Liaison Physician, Urology James Shirley, M.D., Liaison Physician, Surgery Emeritus Chris Bergmann, M.D., Diagnostic Radiology Dominic Cannella, M.D., Neurosurgery Bert Duncan, M.D., Radiation Oncology Eric Emig, M.D., Diagnostic Radiology Richard Griswold, M.D., Pathology Jeff Houin, M.D., Dermatology William Kahlstorf, M.D., OB/GYN Roger Lowery, M.D., Otolaryngology Robert McAuley, M.D., Surgery Charles Montgomery, M.D., Hematology/Oncology John Phillips, M.D., Gastroenterology Ray Reed, M.D., Radiation Oncology Jim Rish, M.D., Pulmonology Vishal Sachdev, M.D., Cardiothoracic Surgery Staff Members: Laura Brower, RN, MSN, Administration Cindy Edwards, LMSW, Social Work Shelia Jinkins, CTR, Cancer Registry Joellen Murphree, RN, Clinical Quality Jeannine Peters, Pharm.D., Pharmacy Rev. Dick Stevens, Chaplain Marthe Thomas, RN, Clinical Data Manager Paula Turner, M.Ed., Director, Cancer Center Tommie Wood, RN, Oncology C A N C E R C O M M I T T E E The Cancer Registry is an essential component of the multidisciplinary cancer program at North Mississippi Medical Center and functions within the
guidelines of the American College of Surgeons-Commission on Cancer approvals
program. One of our goals is to maintain data that provides results of diagnostic and therapeutic efforts, as well as information that enhances the overall care of patients
with cancer. Last year, the registry completed 31 data requests from NMMC
physicians, administrators and
departments. The registry participates in the National Cancer Data
Base (NCDB) call for data and
reports cancer cases to the
Central Cancer Registry in
Jackson, Miss., as well as the
Commission on Cancer
Facility Information Profile
System (FIPS) and the
American Cancer Society
(ACS). This information is
used by researchers to
determine cancer trends,
treatment patterns, education
and screening guidelines. Under the supervision of the Cancer Committee, the
Cancer Registry maintains a
complete database of all cancer
cases diagnosed and/or treated
at NMMC. This data now
includes more than 18,500
cases identified since January
1989. Annual follow-up is one of the many functions
performed by the Cancer
Registry. This directly benefits
patients by reminding
physicians and patients that routine medical examinations are encouraged.
Continued surveillance ensures early detection of a possible recurrence or a new
primary malignancy. The statistical worth of survival is supported when successful
follow-up exceeds 90 percent. Our current follow-up rate is 95 percent. During 2002, 1,432 cases were accessioned into the registry. Of those, 1,299 were analytic (newly diagnosed and/or treated at NMMC) and 133 were non-
analytic (diagnosed and treated elsewhere or diagnosed prior to reference date). Located on the first floor of the NMMC Cancer Center, the registry is available Monday through Friday from 7:30 a.m. to 4:30 p.m. For Cancer Registry
information and statistics, call Shelia Jinkins, CTR; Jewell Johnson, CTR; Sandra
Oliver, CTR; or Christy West, RHIT; at (662) 377-3053. 1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002 C A N C E R R E G I S T R Y C A S E S ANALYTICAL CASES 0 200 400 600 800 1,000 1,200 1,400 1,600 Y
ear of Diagnosis 1989 - 2002 = Number of Cases 1,181 1,171 1,089 1,168 1,240 1,210 1,215 1,267 1,299 1,341 1,515 1,300 1,412 1,299 C A N C E R R E G I S T R Y The following data is from North Mississippi Medical Centers Cancer Registry for calendar year 2002. A total of 1,432 cases were added to the registry. Of the 1,432 cases, 133 cases were non-analytical. The American College of
Surgeons no longer requires non-analytical (physician office, class 6 cases) to be abstracted; however, the Cancer
Committee and Cancer Registry choose to continue to abstract
these cases. These figures are not included in our analytical
statistics. Cancer of the lung is again the most prevalent site with 248 new cases during 2002. Breast cancer is the second most prevalent
site with 202, and prostate cancer is third with 159 cases. In
fourth and fifth place were colon/rectal with 141 and lymphoma
with 48. The Cancer Committee will continue to use the Cancer Registrys data to provide effective screening programs that will
increase early detection and diagnosis among residents of our
communities. The registry will continue to monitor the incidence
of cancer as well as the survival data for cancer patients in our
region. This data will be used to further enhance our
multidisciplinary team approach to treating cancer. Early detection in the war against cancer is extremely important for long-term survival. It is the goal of the Cancer Committee to support all efforts to increase the early diagnosis of cancers and to take the lead in this
endeavor. As always, NMMCs team of physicians and other health care professionals commit to provide state-of-the-
art cancer treatment in a compassionate and cost effective manner. Phil Mathis, M.D.
Vice Chairman, Cancer Committee T O P F I V E P R I M A R Y S I T E S A AN NA AL LY YT TIIC CA AL L C CA AS SE ES S Last year, 1,432 new patients with cancer were added to the Cancer Registry, bringing the total number of cases to almost 19,000 in the 14 years since the registrys reference date in 1989. The NMMC Cancer Program is accredited by the Commission on Cancer, which is a multidisciplinary program of the American College of Surgeons, and the American College of Radiology. These organizations establish guidelines
to assure that our program adheres to the highest standards. This allows comparison of treatment modalities and
outcomes with programs across the United States, thus assuring that cancer patients in this area receive the best and
most up-to-date treatment. This also allows our participation in various cooperative studies that assess new treatment
regimens. All physicians and other health care professionals involved in the care of cancer patients at NMMC participate in weekly conferences to discuss specific cancer cases, including diagnosis, staging and treatment options. Leading
cancer experts present programs several times a year at NMMC on topics related to cancer and its management. The Cancer Committee is comprised of physicians from medical oncology, radiation oncology, diagnostic radiology, pathology, various surgical specialties and the liaison physicians. Also represented are other health care
professionals who participate in the care of cancer patients. This committee meets quarterly and establishes policies
and goals for the comprehensive NMMC cancer program. As Liaison Physicians, we express our appreciation to those who enable us to maintain an approved, comprehensive cancer program. Kevin Bond, M.D., F.A.C.S. James Shirley, M.D. Liaison Physician Liaison Physician Lung ........................................................248
Breast ........................................................202
Prostate ....................................................159
Colon/Rectum ..........................................141
Lymphoma..................................................48 All Patients D A T A A N A L Y S I S L I A I S O N R E P O R T PRIMARY SITE CLASS OF CASE SEX MIXED AJCC STAGE AT DX CASES A N/A M F 0 I II III IV 88 UNK INV BUCCAL CAVITY & PHARYNX Lip 7 6 1 6 1 0 4 2 0 0 0 0 0 Tongue 10 10 0 6 4 1 3 0 1 5 0 0 0 Salivary Glands 5 5 0 4 1 0 4 0 1 0 0 0 0 Floor of Mouth 2 2 0 1 1 0 0 1 1 0 0 0 0 Gum & Other Mouth 3 3 0 2 1 0 0 1 1 1 0 0 0 Nasopharynx 3 3 0 3 0 0 0 0 1 2 0 0 0 Tonsil 2 2 0 1 1 0 0 0 2 0 0 0 0 Hypopharynx 2 2 0 1 1 0 1 0 0 1 0 0 0 Other Buccal Cavity & Pharynx 1 1 0 1 0 0 0 0 0 0 0 1 0 DIGESTIVE ORGANS Esophagus 8 8 0 7 1 0 0 2 2 2 1 1 0 Stomach 16 15 1 7 9 1 1 3 3 5 0 1 1 Small Intestine 5 5 0 3 2 0 1 2 0 0 1 0 1 Colon 95 92 3 48 47 4 17 27 22 19 0 2 1 Rectum & Rectosigmoid 49 49 0 26 23 3 16 12 11 3 0 2 2 Anus, Anal Canal & Anorectum 5 5 0 2 3 1 1 1 2 0 0 0 0 Liver & Intrahepatic Bile Duct 4 4 0 3 1 0 0 1 1 2 0 0 0 Gallbladder 1 1 0 0 1 0 0 0 1 0 0 0 0 Other Biliary 7 7 0 3 4 0 1 1 0 2 0 3 0 Pancreas 30 30 0 12 18 0 1 4 5 18 0 1 1 Peritoneum, Omentum & Mesentery 1 1 0 0 1 0 0 0 0 0 0 0 1 RESPIRATORY SYSTEM Nasal Cavity/Middle Ear & Accessory Sinuses 5 4 1 2 3 0 0 0 0 2 2 0 0 Larynx 9 9 0 5 4 1 4 1 0 3 0 0 0 Lung & Bronchus 256 248 8 170 86 0 61 15 67 99 0 2 4 Trachea, Mediastinum & Other Respiratory Organs 1 1 0 0 1 0 0 0 0 0 1 0 0 SOFT TISSUE Soft Tissue (Including Heart) 13 12 1 8 5 0 3 3 1 4 0 0 1 SKIN (Excluding Basal & Squamous) Melanomas - Skin 52 37 15 27 25 14 11 7 4 1 0 0 0 Other Nonepithelial Skin 2 2 0 1 1 0 0 1 0 1 0 0 0 BREAST Breast 206 202 4 0 206 35 72 69 15 8 1 0 2 FEMALE GENITAL SYSTEM Cervix Uteri 56 52 4 0 56 29 9 4 4 5 0 0 1 Corpus Uteri 25 24 1 0 25 2 16 4 1 0 0 0 1 Uterus, NOS 2 1 1 0 2 0 0 0 0 0 0 0 1 Ovary 18 18 0 0 18 0 2 1 6 8 0 0 1 P R I M A R Y S I T E I N C I D E N C E PRIMARY SITE CLASS OF CASE SEX MIXED AJCC STAGE AT DX CASES A N/A M F 0 I II III IV 88 UNK INV FEMALE GENITAL SYSTEM (Continued) Vagina 3 3 0 0 3 1 1 0 1 0 0 0 0 Vulva 3 2 1 0 3 1 0 1 0 0 0 0 0 Other Female Genital Organs 1 1 0 0 1 0 0 1 0 0 0 0 0 MALE GENITAL SYSTEM Prostate 231 159 72 231 0 0 1 139 10 9 0 0 0 Testis 13 13 0 13 0 0 8 2 3 0 0 0 0 Penis 2 2 0 2 0 0 0 1 1 0 0 0 0 Other Male Genital 1 1 0 1 0 0 1 0 0 0 0 0 0 URINARY SYSTEM Bladder 49 46 3 34 15 21 15 8 0 2 0 0 0 Kidney & Renal Pelvis 36 36 0 24 12 0 24 4 1 7 0 0 0 Ureter 2 2 0 1 1 1 0 0 1 0 0 0 0 Other Urinary Organs 1 1 0 0 1 0 1 0 0 0 0 0 0 EYE & ORBIT Eye & Orbit 3 1 2 2 1 0 0 0 0 0 1 0 0 BRAIN & OTHER NERVOUS SYSTEM Brain 15 15 0 4 11 0 0 0 0 0 15 0 0 Other Nervous System 1 1 0 0 1 0 0 0 0 0 1 0 0 ENDOCRINE SYSTEM Thyroid 19 19 0 6 13 0 5 7 5 1 0 0 1 LYMPHOMAS Hodgkin Lymphoma 6 6 0 3 3 0 2 1 3 0 0 0 0 Non-Hodgkins Lymphoma 45 42 3 29 16 0 21 3 8 10 0 0 0 MULTIPLE MYELOMA Multiple Myeloma 12 12 0 6 6 0 0 0 0 0 12 0 0 LEUKEMIAS Lymphocytic 10 7 3 5 5 0 0 0 0 0 7 0 0 Myeloid & Monocytic 8 8 0 6 2 0 0 0 0 0 8 0 0 Other 2 2 0 0 2 0 0 0 0 0 2 0 0 OTHER Ill-defined & Unspecified Sites 33 32 1 14 19 0 0 0 0 0 32 0 0 Invalid Site 35 27 8 13 22 0 21 5 1 0 0 0 0 TOTALS 1,432 1,299 133 743 689 115 328 334 186 220 84 13 19 Headings: A=Analytic N/A=Non-Analytic M=Male F=Female
Nonpatient or physician office cases are no longer required by ACOS; therefore, these cases are considered non-analytic and
are excluded from the sex and stage statistics on this table.
Localized basal and squamous cell carcinoma of the skin are not included. All Patients S E X Male 641 49.35% Female 658 50.65% Total 1,299 R A C E Caucasian 1,074 82.68% African American 223 17.17% Other 2 0.15% Total 1,299 T O P F I V E P R I M A R Y S I T E S Female: Male: Breast ..................202 Prostate ................159 Lung ......................83 Lung ....................165 Colon/Rectum ........70 Colon/Rectum ........71 Cervix ....................52 Bladder ..................32 Endometrium ........24 Lymphoma ............30 AGE AT DIAGNOSIS 1,299 Analytic Cases 20 & Younger 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90 & Older 0 50 100 150 200 250 300 350 400 Number of Cases 23 62 130 348 249 323 148 13 3 **All statistics are based on analytic case numbers. D E M O G R A P H I C D A T A Tishomingo 82 Alcorn 51 Tippah 37 Union 58 Marshall 3 Lafayette 23 Pontotoc 88 Yalobusha 6 Monroe 113 Calhoun 30 Chickasaw 64 Colbert 1 Webster 28 Clay 35 Lowndes 9 Oktibbeha 22 Choctaw 8 Franklin 5 Marion 32 Lamar 17 Prentiss 75 Itawamba 85 Lee 390 Benton 11 G E O G R A P H I C L O C A T I O N Other Mississippi Counties Grenada ............................1
Leflore ..............................1
Montgomery ......................4
Noxubee ............................1
Panola................................2
Winston ............................5
Total ..........................1,232 Other Alabama Counties Marengo ............................2
Mobile ..............................1
Walker ..............................1
Winston ............................1
Total ................................60 Other Tennessee ..........................6
Texas ................................1
Total ................................7 Total ....................................................................1,299 *All statistics are based on analytic case numbers T ENNESSEE A LABAMA M ISSISSIPPI During 2001, chart reviews were conducted on all analytical cases of Non-Small Cell Lung Carcinoma (NSCLC) made available to
the NMMC Cancer Registry. Demographics and specific risk factors
were analyzed. According to data from the NMMC Cancer Registry, 192 patients were diagnosed with NSCLC in 2001. The vast majority of
these cases were male (135 males versus 57 females), and the majority
of cases occurred in Caucasians (164) versus other ethnic groups (28).
The age of patients at the time of initial diagnosis included four
patients between 30-39; six patients between 40-49; 31 patients
between 50-59; 71 patients between 60-69; 54 patients between 70-79;
and 26 patients between 80-89. Either a past history of smoking or a current smoking history was identified as a risk factor in all but a small percentage of the cases.
Only six cases involved patients who had never smoked. Squamous cell carcinoma was the predominant histologic type noted in the series, followed closely by adenocarcinoma. As is typical
with this disease, the majority of the cases presented at an advanced
stage. The breakdown is as follows: Stage 0, 1; Stage I, 37; Stage II, 22;
Stage III, 34; and Stage IV, 94. The stage was not known in four cases. Treatment involved chemotherapy exclusively in 23 cases and radiation therapy exclusively in 23 cases. Surgery alone was utilized in
31 cases. The majority of cases (70) were treated with combined
chemotherapy and radiation therapy. Surgery combined with
chemotherapy, radiation therapy or both was utilized in 15 cases.
Treatment was not appropriate in 23 cases, and seven patients refused
treatment. Five-year survival rates for this disease have been disappointing. The national five-year survival rate ranges from 35 percent for Stage I
disease to 1.4 percent for Stage IV disease. Our local experience closely
parallels the national statistics. James Rish, M.D.
Pulmonology A N A L Y S I S O F N O N - S M A L L C E L L L U N G C A R C I N O M A Female - 57 Male - 135 0 10 20 30 40 50 60 13 1 1 1 43 58 4 2 3 41 1 1 23 Large cell Sarcomatoid carcinoma Non-small cell Papillary squamous cell Squamous cell Bronchioloalveolar carcinoma Papillary adenocarcinoma Mucin-producing adenocarcinoma Adenosquamous carcinoma Adenocarcinoma Adenocystic carcinoma Neuroendocrine Other 0% 10% 20% 30% 40% NMMC NCDM Stage I Stage II Stage III Stage IV 1% 35% 19% 5% 38% 19% 7% 3% Other African American Caucasian Unknown - 4 IV - 94 III - 34 II - 22 I - 37 0 - 1 G E N D E R R A T I O R A C E R A T I O S T A G E O F D I S E A S E R E L A T I V E 5 Y E A R S U R V I V A L H I S T O L O G Y