ID

6888

Beschrijving

Superficial Bladder Cancer - On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A961-3FA4-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A961-3FA4-E034-080020C9C0E0

Trefwoorden

Versies (2)
  1. 19-09-12 19-09-12 -
  2. 08-01-15 08-01-15 - Martin Dugas
Geüploaded op

8 januari 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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On-Study - Superficial Bladder Cancer - On-Study Form - 2019333v2.31

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: Superficial Bladder Cancer - On-Study Form
    1. No Instruction available.
Crf Header
Beschrijving

Crf Header

Coordinating Group Protocol Number
Beschrijving

CoordinatingGroupProtocolNumber

Datatype

text

Coordinating Group Code
Beschrijving

CoordinatingGroupCode

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Protocol Title
Beschrijving

Protocol Title

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS CUI-1
C2986303
NCI Thesaurus Property
C42774
Patient Study ID, Coordinating Group
Beschrijving

PatientStudyID,CoordinatingGroup

Datatype

text

Patient Study ID, Participating Group
Beschrijving

PatientStudyID,ParticipatingGroup

Datatype

text

Participating Group Code
Beschrijving

ParticipatingGroupCode

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Institution Name
Beschrijving

InstitutionName

Datatype

text

Affiliate Name
Beschrijving

AffiliateName

Datatype

text

Patient Name, Last
Beschrijving

PatientName,Last

Datatype

text

Patient Name, First
Beschrijving

PatientName,First

Datatype

text

Patient Name, Middle
Beschrijving

PatientName,Middle

Datatype

text

Bladder: Form Administration
Beschrijving

Bladder: Form Administration

Person Completing Form, Last Name
Beschrijving

PersonCompletingForm,LastName

Datatype

text

Person Completing Form, First Name
Beschrijving

PersonCompletingForm,FirstName

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Amended Data Ind
Beschrijving

AmendedDataInd

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Bladder: Disease Description For Superficial Bladder Carcinoma
Beschrijving

Bladder: Disease Description For Superficial Bladder Carcinoma

Initial Diagnosis Date, Pathologic
Beschrijving

InitialDiagnosisDate,Pathologic

Datatype

date

Prior Recent Recurrence Date
Beschrijving

PriorRecentRecurrenceDate

Datatype

date

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25279
UMLS 2011AA Property
C0332162
Pathologic Diagnosis Date
Beschrijving

PathologicDiagnosisDate

Datatype

date

Prior Papillary Occurrences
Beschrijving

PriorPapillaryOccurrences

Datatype

float

Prior CIS Occurrences
Beschrijving

PriorCISOccurrences

Datatype

float

Bladder Tumors Present
Beschrijving

BladderTumorsPresent

Datatype

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
Bladder Tumors Largest Diameter
Beschrijving

BladderTumorsLargestDiameter

Datatype

text

Histologic Type
Beschrijving

HistologicType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
NCI Thesaurus ValueDomain-2
C25526
UMLS 2011AA ValueDomain-2
C0205462
Histologic Type, Other Name
Beschrijving

HistologicType,OtherName

Datatype

text

Histologic Grade
Beschrijving

HistologicGrade

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25526
UMLS 2011AA ValueDomain
C0205462
NCI Thesaurus ValueDomain-2
C18000
UMLS 2011AA ValueDomain-2
C0919553
T Stage, Pathologic
Beschrijving

TStage,Pathologic

Datatype

text

Cytology Date
Beschrijving

CytologyDate

Datatype

date

Alias
NCI Thesaurus ObjectClass
C16491
UMLS 2011AA ObjectClass
C0010819
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
Cytology Result
Beschrijving

CytologyResult

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16491
UMLS 2011AA ObjectClass
C0010819
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
Cytology Result, Other
Beschrijving

CytologyResult,Other

Datatype

text

Superficial Bladder Disease: Prior Treatment Affecting The Bladder
Beschrijving

Superficial Bladder Disease: Prior Treatment Affecting The Bladder

Prior Intravesical Therapy Ind
Beschrijving

PriorIntravesicalTherapyInd

Datatype

text

Prior Immunotherapy Type
Beschrijving

PriorImmunotherapyType

Datatype

text

Prior Immunotherapy Count
Beschrijving

PriorImmunotherapyCount

Datatype

float

Prior Immunotherapy Other Agent
Beschrijving

PriorImmunotherapyOtherAgent

Datatype

text

Prior Intravesical Chemotherapy Type
Beschrijving

PriorIntravesicalChemotherapyType

Datatype

text

Prior Intravesical Chemotherapy Count
Beschrijving

PriorIntravesicalChemotherapyCount

Datatype

float

Prior Intravesical Chemotherapy Other Agent
Beschrijving

PriorIntravesicalChemotherapyOtherAgent

Datatype

text

Prior Pelvic RT Ind
Beschrijving

PriorPelvicRTInd

Datatype

text

Prior Surgery Ind
Beschrijving

PriorSurgeryInd

Datatype

text

Prior Surgery Type
Beschrijving

PriorSurgeryType

Datatype

text

Prior Surgery, TURBT Count
Beschrijving

PriorSurgery,TURBTCount

Datatype

float

Prior Surgery, Other Type
Beschrijving

PriorSurgery,OtherType

Datatype

text

Prior Other Therapy Ind
Beschrijving

PriorOtherTherapyInd

Datatype

text

Prior Other Therapy Name
Beschrijving

PriorOtherTherapyName

Datatype

text

Allows Documentation Of Any Additional Cooments
Beschrijving

Allows Documentation Of Any Additional Cooments

Comments
Beschrijving

Comments

Datatype

text

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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: Superficial Bladder Cancer - On-Study Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Crf Header
CoordinatingGroupProtocolNumber
Item
Coordinating Group Protocol Number
text
CoordinatingGroupCode
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Protocol Title
Item
Protocol Title
text
C25320 (NCI Thesaurus ObjectClass)
C2986303 (UMLS CUI-1)
C42774 (NCI Thesaurus Property)
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group
text
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
PatientName,Last
Item
Patient Name, Last
text
PatientName,First
Item
Patient Name, First
text
PatientName,Middle
Item
Patient Name, Middle
text
Item Group
Bladder: Form Administration
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Amended Data Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Bladder: Disease Description For Superficial Bladder Carcinoma
InitialDiagnosisDate,Pathologic
Item
Initial Diagnosis Date, Pathologic
date
PriorRecentRecurrenceDate
Item
Prior Recent Recurrence Date
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
PathologicDiagnosisDate
Item
Pathologic Diagnosis Date
date
PriorPapillaryOccurrences
Item
Prior Papillary Occurrences
float
PriorCISOccurrences
Item
Prior CIS Occurrences
float
Item
Bladder Tumors Present
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
CL.2
Code List
Bladder Tumors Present
CL Item
There Is One Bladder Tumor Present (single)
CL Item
There Is More Than One Bladder Tumor Present (multiple)
Item
Bladder Tumors Largest Diameter
text
CL.3
Code List
Bladder Tumors Largest Diameter
CL Item
The Bladder Tumors Largest Diameter Is Equal To Or Greater Than 3 Centimeters (> or = 3 cm)
CL Item
The Bladder Tumors Largest Diameter Is Less Than 3 Centimeters (< 3 cm)
Item
Histologic Type
text
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C25526 (NCI Thesaurus ValueDomain-2)
C0205462 (UMLS 2011AA ValueDomain-2)
CL.4
Code List
Histologic Type
CL Item
Cis Only (CIS only)
CL Item
Adenocarcinoma (adenocarcinoma)
C2852 (NCI Thesaurus)
C0001418 (UMLS 2011AA)
CL Item
Other Specify (other, specify)
CL Item
Transitional Cell Carcinoma (transitional cell carcinoma)
C2930 (NCI Thesaurus)
C0007138 (UMLS 2011AA)
CL Item
Papillary And Cis (papillary and CIS)
CL Item
Small Cell Carcinoma (small cell carcinoma)
C3915 (NCI Thesaurus)
C0262584 (UMLS 2011AA)
CL Item
Squamous Cell Carcinoma (squamous cell carcinoma)
C2929 (NCI Thesaurus)
C0007137 (UMLS 2011AA)
CL Item
Papillary (papillary)
C14166 (NCI Thesaurus)
C0205312 (UMLS 2011AA)
HistologicType,OtherName
Item
Histologic Type, Other Name
text
Item
Histologic Grade
text
C25526 (NCI Thesaurus ValueDomain)
C0205462 (UMLS 2011AA ValueDomain)
C18000 (NCI Thesaurus ValueDomain-2)
C0919553 (UMLS 2011AA ValueDomain-2)
CL.5
Code List
Histologic Grade
CL Item
Tumor Grade Cannot Be Assessed (grade cannot be assessed (GX))
CL Item
Well Differentiated (well differentiated (G1))
C14171 (NCI Thesaurus)
C0205615 (UMLS 2011AA)
CL Item
Poorly Differentiated (poorly differentiated (G3))
C14167 (NCI Thesaurus)
C0205617 (UMLS 2011AA)
CL Item
Moderately Differentiated (moderately differentiated (G2))
C14162 (NCI Thesaurus)
C0205616 (UMLS 2011AA)
Item
T Stage, Pathologic
text
CL.6
Code List
T Stage, Pathologic
CL Item
No Evidence Of Primary Tumor (T0)
CL Item
Tumor Invades Subepithelial Connective Tissue (T1)
CL Item
Tumor Invades Superficial Muscles (inner Half) (T2a)
CL Item
Tumor Invades Deep Muscles (outer Half) (T2b)
CL Item
Primary Tumor Cannot Be Assessed (Tx)
CL Item
Tumor Invades Perivesical Tissue Macroscopically (extravesical Mass) (T3b)
CL Item
Inflammatory Carcinoma (T4)
C0334385 (NCI Metathesaurus)
CL Item
Noninvasive Papillary Carcinoma (Ta)
CL Item
Carcinoma In Situ: "flat Tumor" (Tis)
CL Item
Tumor Invades Perivesical Tissue Microscopically (T3a)
CytologyDate
Item
Cytology Date
date
C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
Item
Cytology Result
text
C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
CL.7
Code List
Cytology Result
CL Item
Inflammatory Changes With Or Without Dyscariosis (Inflammatory changes with or without dyscariosis)
CL Item
Moderate Dysplasia Or Papillary Clusters (suspect) (Moderate dysplasia or papillary clusters (suspect))
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Normal Tissue (Normal exfoliated cells)
C33177 (NCI Thesaurus)
CL Item
Severe Dysplasia (Severe dysplasia)
C8364 (NCI Thesaurus)
C0334048 (UMLS 2011AA)
CL Item
Numerous Atypical And Malignant Cells (Numerous atypical and malignant cells)
CL Item
Other (Other, specify)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CytologyResult,Other
Item
Cytology Result, Other
text
Item Group
Superficial Bladder Disease: Prior Treatment Affecting The Bladder
Item
Prior Intravesical Therapy Ind
text
CL.8
Code List
Prior Intravesical Therapy Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Immunotherapy Type
text
CL.9
Code List
Prior Immunotherapy Type
CL Item
Interferon (Interferon)
C20493 (NCI Thesaurus)
C0733470 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Bcg (BCG)
C1328 (NCI Thesaurus)
PriorImmunotherapyCount
Item
Prior Immunotherapy Count
float
PriorImmunotherapyOtherAgent
Item
Prior Immunotherapy Other Agent
text
Item
Prior Intravesical Chemotherapy Type
text
CL.10
Code List
Prior Intravesical Chemotherapy Type
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Thiotepa (Thiotepa)
C875 (NCI Thesaurus)
C0039871 (UMLS 2011AA)
CL Item
Mmc (MMC)
PriorIntravesicalChemotherapyCount
Item
Prior Intravesical Chemotherapy Count
float
PriorIntravesicalChemotherapyOtherAgent
Item
Prior Intravesical Chemotherapy Other Agent
text
Item
Prior Pelvic RT Ind
text
CL.11
Code List
Prior Pelvic RT Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Surgery Ind
text
CL.12
Code List
Prior Surgery Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Prior Surgery Type
text
CL.13
Code List
Prior Surgery Type
CL Item
Patient Previosly Had A Turbt (TURBT)
CL Item
Patient Previosly Had A Radical Cystectomy (radical cystectomy)
CL Item
Patient Previosly Had A Partial Cystectomy (partial cystectomy)
CL Item
Patient Previously Had Other Surgery, Specify (other, specify)
PriorSurgery,TURBTCount
Item
Prior Surgery, TURBT Count
float
PriorSurgery,OtherType
Item
Prior Surgery, Other Type
text
Item
Prior Other Therapy Ind
text
CL.14
Code List
Prior Other Therapy Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
PriorOtherTherapyName
Item
Prior Other Therapy Name
text
Item Group
Allows Documentation Of Any Additional Cooments
Comments
Item
Comments
text
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