2. Type of cancer, GI neoplasm or GI polyp diagnosis
3. New cancer or Recurrence or progression (2) of cancer details
Date of diagnosis
date
Source of information supporting diagnosis date
text
Procedure specification
text
Other source of information specification
text
Site of Primary cancer
text
Only complete specify box if no primary cancer site has been selected OR if 'Other gastrointestinal cancer, specify' OR 'Other cancer site, specify' OR 'Small intestinal cancer other, specify' is selected from the site list, otherwise leave blank
text
3Metastatic disease = cancer that has spread beyond primary organ (i.e. lymph nodes, contiguous structure, secondary location)
boolean
metastatic disease location
integer
metastatic disease other location
boolean
Note: If there are multiple metastatic sites, please list them in the "Other location(s), specify" section
text
4. Benign GI Polyp(s) (1), other benign GI neoplasm(s), and those neoplasms unable to be determined as benign or malignant
Date of procedure
date
Location of polyp/neoplasm Small intestine
boolean
Location of polyp/neoplasm Colon
boolean
Location of polyp/neoplasm Anus
boolean
Location of polyp/neoplasm Stomach
boolean
Location of polyp/neoplasm Esophagus
boolean
Location of polyp/neoplasm Biliary system
boolean
Location of polyp/neoplasm Liver
boolean
Location of polyp/neoplasm Pancreas
boolean
Location of polyp/neoplasm Other
boolean
Location of polyp/neoplasm Other specification
text
5. Required source documents sent
Source documents to send (source documents are required if you answered Yes to question 1): Pathology Report Operative Report Imaging study report Oncology/surgical consult notes Endoscopy Report (upper and lower) GI capsule study report Hospital Discharge Summary (if applicable)
text
required source documents sent date
date
CEC Status
[read-only] Item is not required
text
[hidden] Item is not required
text
[hidden]. Item is not required.
integer
[hidden]
date
[hidden]. Item is not required.
text
Use AE Sequence number from the corresponding SAE/AE form (the last item on the form, in the "Non- Clinical" section) [hidden]. Item is not required.
text
Copy Adverse Event term from corresponding SAE/AE form [hidden]. Item is not required.
text