ID

3318

Description

Colorectal Cancer - Surgery Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A9B6-3FA4-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A9B6-3FA4-E034-080020C9C0E0

Keywords

Versions (1)
  1. 9/19/12 9/19/12 -
Uploaded on

September 19, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Treatment - Colorectal Cancer - Surgery Form - 2020211v2.31

English

No Instruction available.

1 forms  
  1. StudyEvent: Colorectal Cancer - Surgery Form
    1. No Instruction available.
Colorectal: Surgical Procedure
Description

Colorectal: Surgical Procedure

Prior RT Ind
Description

PriorRTInd

Data type

text

Prior Chemotherapy Ind
Description

PriorChemotherapyInd

Data type

text

Prior Immunotherapy Ind
Description

PriorImmunotherapyInd

Data type

text

Tumor Location
Description

TumorLocation

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
Tumor Location, Other
Description

TumorLocation,Other

Data type

text

Surgical Approach
Description

SurgicalApproach

Data type

text

Obstruction Ind
Description

ObstructionInd

Data type

text

Tumor Spillage Ind
Description

TumorSpillageInd

Data type

text

Lymph Nodes Removed Ind
Description

LymphNodesRemovedInd

Data type

text

En Bloc Resection Ind
Description

EnBlocResectionInd

Data type

text

Alias
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C15232
UMLS 2011AA ObjectClass
C0728940
NCI Thesaurus ObjectClass
C25733
UMLS 2011AA ObjectClass
C1516835
Tumor Adherence Ind
Description

TumorAdherenceInd

Data type

text

Tumor Adherence, Specify Organ
Description

TumorAdherence,SpecifyOrgan

Data type

text

Distance to Distal Bowel
Description

DistancetoDistalBowel

Data type

double

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Distance to Proximal Bowel
Description

DistancetoProximalBowel

Data type

double

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Distance to Distal Mesorectal
Description

DistancetoDistalMesorectal

Data type

double

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Radial Margins Disease Free Gross Ind
Description

RadialMarginsDiseaseFreeGrossInd

Data type

text

Radial Margins Disease Free Micro Ind
Description

RadialMarginsDiseaseFreeMicroInd

Data type

text

Assessment Site
Description

AssessmentSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
Evaluation Ind
Description

EvaluationInd

Data type

text

Metastasis Confirmed
Description

MetastasisConfirmed

Data type

text

Metastasis Completely Resected
Description

MetastasisCompletelyResected

Data type

text

Surgeon Name
Description

SurgeonName

Data type

text

Allows Documentation Of Any Additional Cooments
Description

Allows Documentation Of Any Additional Cooments

Comments
Description

Comments

Data type

text

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No Instruction available.

1 forms
  1. StudyEvent: Colorectal Cancer - Surgery Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Colorectal: Surgical Procedure
Item
Prior RT Ind
text
CL.1
Code List
Prior RT 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 Chemotherapy Ind
text
CL.2
Code List
Prior Chemotherapy 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 Immunotherapy Ind
text
CL.3
Code List
Prior Immunotherapy 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
Tumor Location
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
CL.4
Code List
Tumor Location
CL Item
Appendix (Appendix)
C12380 (NCI Thesaurus)
C0003617 (UMLS 2011AA)
CL Item
Ascending Colon (Ascending colon)
C12265 (NCI Thesaurus)
C0227375 (UMLS 2011AA)
CL Item
Cecum (Cecum)
C12381 (NCI Thesaurus)
C0007531 (UMLS 2011AA)
CL Item
Descending Colon (Descending colon)
C12268 (NCI Thesaurus)
C0227389 (UMLS 2011AA)
CL Item
Transverse Colon (Transverse colon)
C12385 (NCI Thesaurus)
C0227386 (UMLS 2011AA)
CL Item
Other, Specify (Other, specify)
CL Item
Rectum (Rectum)
C12390 (NCI Thesaurus)
C0034896 (UMLS 2011AA)
CL Item
Sigmoid (Sigmoid)
CL Item
Splenic Flexure (Splenic flexure)
C12267 (NCI Thesaurus)
C0227387 (UMLS 2011AA)
CL Item
Hepatic Flexure (Hepatic flexure)
C12266 (NCI Thesaurus)
C0227385 (UMLS 2011AA)
TumorLocation,Other
Item
Tumor Location, Other
text
Item
Surgical Approach
text
CL.5
Code List
Surgical Approach
CL Item
Abdominal Perineal Resection (Abdominal perineal resection)
CL Item
Left Colectomy (Left colectomy)
C51624 (NCI Thesaurus)
C0192865 (UMLS 2011AA)
CL Item
Low Anterior Resection (Low anterior resection)
CL Item
Transverse Colectomy (Transverse colectomy)
CL Item
Sigmoidectomy (Sigmoidectomy)
C0192866 (NCI Metathesaurus)
CL Item
Sphincter-preserving Rectal Resection (Sphincter-preserving rectal resection)
CL Item
Total Colectomy (Total colectomy)
CL Item
Right Colectomy (Right colectomy)
Item
Obstruction Ind
text
CL.6
Code List
Obstruction Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Tumor Spillage Ind
text
CL.7
Code List
Tumor Spillage Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Lymph Nodes Removed Ind
text
CL.8
Code List
Lymph Nodes Removed Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
En Bloc Resection Ind
text
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15232 (NCI Thesaurus ObjectClass)
C0728940 (UMLS 2011AA ObjectClass)
C25733 (NCI Thesaurus ObjectClass)
C1516835 (UMLS 2011AA ObjectClass)
CL.9
Code List
En Bloc Resection Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Tumor Adherence Ind
text
CL.10
Code List
Tumor Adherence 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)
TumorAdherence,SpecifyOrgan
Item
Tumor Adherence, Specify Organ
text
DistancetoDistalBowel
Item
Distance to Distal Bowel
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
DistancetoProximalBowel
Item
Distance to Proximal Bowel
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
DistancetoDistalMesorectal
Item
Distance to Distal Mesorectal
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Item
Radial Margins Disease Free Gross Ind
text
CL.11
Code List
Radial Margins Disease Free Gross Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Radial Margins Disease Free Micro Ind
text
CL.12
Code List
Radial Margins Disease Free Micro 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
Assessment Site
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
CL.13
Code List
Assessment Site
CL Item
Celiac (Celiac)
CL Item
Liver (Liver)
C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)
CL Item
Omentum (Omentum)
C33209 (NCI Thesaurus)
C0028977 (UMLS 2011AA)
CL Item
Portohepatic (Portohepatic)
CL Item
Periaortic (Periaortic)
CL Item
Peritoneal Surface (Peritoneal surface)
CL Item
Ovaries (Ovaries)
Item
Evaluation Ind
text
CL.14
Code List
Evaluation Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Metastasis Confirmed
text
CL.15
Code List
Metastasis Confirmed
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Na (Not applicable)
Item
Metastasis Completely Resected
text
CL.16
Code List
Metastasis Completely Resected
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Na (Not applicable)
SurgeonName
Item
Surgeon Name
text
Item Group
Allows Documentation Of Any Additional Cooments
Comments
Item
Comments
text
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