ID

3406

Description

CALGB Non-Small Cell Lung Cancer Staging Form (AJCC V.7.0) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=85DE3B43-56B5-4D38-E040-BB89AD4369BA

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=85DE3B43-56B5-4D38-E040-BB89AD4369BA

Mots-clés

20/09/2012 20/09/2012 -
09/01/2015 09/01/2015 - Martin Dugas

Téléchargé le

20 septembre 2012

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy

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On-Study - CALGB Non-Small Cell Lung Cancer Staging Form (AJCC V.7.0) - 3082176v1.0

model
Détails

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy complete the form electronically. After entering all data, click the "Print and/or Submit to CALGB" button located at the bottom of the last page of the form. Retain a copy of the form for your records. Submit supporting documentation by fax (919-416-4990) or mail. If data are amended, circle amended items, check the "Yes" box, and submit by fax or mail

1 Formulaires

StudyEvent: CALGB Non-Small Cell Lung Cancer Staging Form (AJCC V.7.0)
1. INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy complete the form electronically. After entering all data, click the "Print and/or Submit to CALGB" button located at the bottom of the last page of the form. Retain a copy of the form for your records. Submit supporting documentation by fax (919-416-4990) or mail. If data are amended, circle amended items, check the "Yes" box, and submit by fax or mail

Name

Type

Description | Question | Decode (Coded Value)

Type de données

Alias

Header Module

Item Group

Unnamed1

CALGBFormIdentifierNumber

Item

CALGB Form

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus ObjectClass)
C1516238 (UMLS 2011AA ObjectClass)

ProtocolCALGBIdentifierNumber

Item

CALGB Study No.

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus Property)
C1516238 (UMLS 2011AA Property)

PatientCALGBIdentifierNumber

Item

CALGB Patient ID

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus Property)
C1516238 (UMLS 2011AA Property)

CurrentStageCompleteAssessmentDate

Item

Date Current Staging Assessment Completed (MM DD YYYY)

date

C25471 (NCI Thesaurus ObjectClass)
C0521116 (UMLS 2011AA ObjectClass)
C16899 (NCI Thesaurus ObjectClass)
C1300072 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

DataAmendedInd-3

Item

Are data amended

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)

CL.1

Code List

Are data amended

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

Unnamed1

Item Group

Unnamed2

PatientInitialsName

Item

Patient Initials (Last, First Middle)

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)

PatientMedicalRecordNumber

Item

Patient Hospital No.

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25198 (NCI Thesaurus Property)
C0034869 (UMLS 2011AA Property)

CombinedInstitutionName

Item

Institution/Affiliate

text

C25454 (NCI Thesaurus ObjectClass)
C0205195 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)

ParticipatingGroupName

Item

Participating Group

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

ProtocolParticipatingIdentifierNumber

Item

Participating Group Study No

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

PatientParticipatingIdentifierNumber

Item

Participating Group Patient ID

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

Staging

Item Group

Staging

AssessmentMethodType

Item

Method of Evaluation (Staging Method)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)

CL.2

Code List

Method of Evaluation (Staging Method)

CL Item

Chest Radiography (Chest CT)

C38103 (NCI Thesaurus)
C0039985 (UMLS 2011AA)

CL Item

Chest X-ray (Chest x-ray)

CL Item

Pet Scan (PET scan)

CL Item

Histology (Histology)

C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)

CL Item

Cytology (Cytology)

C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)

TNMDescriptionType

Item

TNM descriptors (Mark all that apply with an X. as determined by the Staging Method indicated above)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25384 (NCI Thesaurus ObjectClass)
C1515169 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

CL.3

Code List

TNM descriptors (Mark all that apply with an X. as determined by the Staging Method indicated above)

CL Item

Multiple Primary Tumors (m)

CL Item

Recurrent (r)

C14173 (NCI Thesaurus)
C2945760 (UMLS 2011AA)

CL Item

Post-treatment (y)

CL024863 (NCI Metathesaurus)

TumorSizeDiameterMeasurement

Item

Tumor Size (cm)

double

C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25681 (NCI Thesaurus Property)
C0456389 (UMLS 2011AA Property)

Clinical T Stage

Item Group

Clinical T Stage

LungTumorClinicalTStage

Item

T Stage (Primary tumor)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25728 (NCI Thesaurus Property)
C0475455 (UMLS 2011AA Property)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain)
C1515946 (UMLS 2011AA ValueDomain)

CL.4

Code List

T Stage (Primary tumor)

CL Item

No Evidence Of Primary Tumor (T0)

CL Item

Tumor <=3 Cm In Greatest Dimension, Surrounded By Lung Or Visceral Pleura, Without Bronchoscopic Evidence Of Invasion More Proximal Than The Lobar Bronchus (i.e., Not In The Main Bronchus) (T1)

CL Item

Tumor > 3 Cm But <=7 Cm Involves Main Bronchus, >=2 Cm Distal To The Carina Invades Visceral Pleura (pl1 Or Pl2) Associated With Atelectasis Or Obstructive Pneumonitis That Extends To The Hilar Region But Does Not Involve The Entire Lung (T2)

CL Item

Tumor > 7 Cm Or One That Directly Invades Any Of The Following: Parietal Pleural (pl3) Chest Wall (including Superior Sulcus Tumors), Diaphragm, Phrenic Nerve, Mediastinal Pleura, Parietal Pericardium; Or Tumor In The Main Bronchus (T3)

CL Item

Tumor Of Any Size That Invades Any Of The Following: Mediastinum, Heart, Great Vessels, Trachea, Recurrent Laryngeal Nerve, Esophagus, Vertebral Body, Carina, Separate Tumor Nodule(s) In A Different Ipsilateral Lobe (T4)

CL Item

Primary Tumor Cannot Be Assessed (TX)

CL Item

Tis Carcinoma In Situ (Tis)

LungTumorTStageTwoPresentType

Item

T2 tumor with any of the following (Mark all that apply with an X.)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C66833 (NCI Thesaurus Property)
C0205448 (UMLS 2011AA Property)
C25728 (NCI Thesaurus Property)
C0475455 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.12

Code List

T2 tumor with any of the following (Mark all that apply with an X.)

CL Item

> 3 But <= 7 Cm (> 3 but <= 7 cm)

CL Item

Atelectasis/obstructive Pneumonia Extending To Hilum But Not Involving The Entire Lung (Atelectasis/obstructive pneumonia extending to hilum but not involving the entire lung)

CL Item

Invades Visceral Pleura (Invades visceral pleura)

CL Item

Involves Main Bronchus >= 2 Cm Distal To The Carina (Involves main bronchus >= 2 cm distal to the carina)

LungTumorTStageThreePresentType

Item

T3 tumor with any of the following (Mark all that apply with an X.)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25728 (NCI Thesaurus Property)
C0475455 (UMLS 2011AA Property)
C66834 (NCI Thesaurus Property)
C0205449 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.13

Code List

T3 tumor with any of the following (Mark all that apply with an X.)

CL Item

> 7 Cm (> 7 cm)

CL Item

Atelectasis/obstructive Pneumonia Of Entire Lung (Atelectasis/obstructive pneumonia of entire lung)

CL Item

Directly Invading Chest Wall, Diaphragm, Phrenic Nerve, Mediastinal Pleura, Or Parietal Pericardium (Directly invading chest wall, diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium)

CL Item

Separate Tumor Nodule(s) In The Same Lobe (as Primary Tumor) (Separate tumor nodule(s) in the same lobe (as primary tumor))

CL Item

Tumor In The Main Bronchus < 2 Cm Distal To The Carina (Tumor in the main bronchus < 2 cm distal to the carina)

LungTumorTStageFourPresentType

Item

T4 tumor of any size with invasion of (Mark all that apply with an X.)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C66835 (NCI Thesaurus Property)
C0205450 (UMLS 2011AA Property)
C25728 (NCI Thesaurus Property)
C0475455 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.14

Code List

T4 tumor of any size with invasion of (Mark all that apply with an X.)

CL Item

Carina (Carina)

C25264 (NCI Thesaurus)
C0225594 (UMLS 2011AA)

CL Item

Esophagus (Esophagus)

C12389 (NCI Thesaurus)
C0014876 (UMLS 2011AA)

CL Item

Great Vessels (Great vessels)

CL Item

Heart (Heart)

C12727 (NCI Thesaurus)
C0018787 (UMLS 2011AA)

CL Item

Mediastinum (Mediastinum)

C12748 (NCI Thesaurus)
C0025066 (UMLS 2011AA)

CL Item

Recurrent Laryngeal Nerve (Recurrent laryngeal nerve)

CL Item

Separate Tumor Nodules In A Different Ipsilateral Lobe (Separate tumor nodules in a different ipsilateral lobe)

CL Item

Trachea (Trachea)

C12428 (NCI Thesaurus)
C0040578 (UMLS 2011AA)

CL Item

Vertebra (Vertebra)

C12933 (NCI Thesaurus)
C0549207 (UMLS 2011AA)

Clinical N Stage

Item Group

Clinical N Stage

LungTumorClinicalNStage

Item

N Stage (Regional lymph nodes)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25580 (NCI Thesaurus Property)
C0456532 (UMLS 2011AA Property)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain)
C1515946 (UMLS 2011AA ValueDomain)

CL.8

Code List

N Stage (Regional lymph nodes)

CL Item

No Regional Lymph Node Metastasis (N0)

CL Item

Metastasis In Ipsilateral Peribronchial And/or Ipsilateral Hilar Lymph Nodes And Intrapulmonary Nodes, Including Involvement By Direct Extension (N1)

CL Item

Metastasis In Ipsilateral Mediastinal And/or Subcarinal Lymph Node(s) (N2)

CL Item

Metastasis In Contralateral Mediastinal, Contralateral Hilar, Ipsilateral Or Contralateral Scalene, Or Supraclavicular Lymph Node(s) (N3)

CL Item

Regional Lymph Nodes Cannot Be Assessed (NX)

Clinical M Stage

Item Group

Clinical M Stage

LungTumorClinicalMStage

Item

M Stage (Metastasis)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25727 (NCI Thesaurus Property)
C0456533 (UMLS 2011AA Property)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain)
C1515946 (UMLS 2011AA ValueDomain)

CL.9

Code List

M Stage (Metastasis)

CL Item

No Distant Metastasis (no Pathologic M0; Use Clinical M To Complete Stage Group) (M0)

CL Item

Separate Tumor Nodule(s) In A Contralateral Lobe; Tumor With Pleural Nodules Or Malignant Pleural (or Pericardial) Effusion (M1a)

CL Item

Distant Metastasis (M1b)

C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)
C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)

LungTumorMStageOnePresentType

Item

M1a metastasis with any of the following (Mark all that apply with an X.)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C66832 (NCI Thesaurus Property)
C0205447 (UMLS 2011AA Property)
C25727 (NCI Thesaurus Property)
C0456533 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.17

Code List

M1a metastasis with any of the following (Mark all that apply with an X.)

CL Item

Separate Tumor Nodules In A Contralateral Lobe (Separate tumor nodules in a contralateral lobe)

CL Item

Tumor With Pleural Nodules Or Malignant Pleural (or Pericardial) Effusion (Tumor with pleural nodules or malignant pleural (or pericardial) effusion)

NeoplasmSpecimenMetastaticAnatomicLocationSpecify

Item

Specify site

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C25421 (NCI Thesaurus Property)
C0002808 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)

Pathologic T Stage

Item Group

Clinical T Stage

LungTumorPathologicTStage

Item

T Stage

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25610 (NCI Thesaurus Property)
C1521733 (UMLS 2011AA Property)
C25728 (NCI Thesaurus Property)
C0475455 (UMLS 2011AA Property)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain)
C1515946 (UMLS 2011AA ValueDomain)

CL.11

Code List

T Stage

CL Item

No Evidence Of Primary Tumor (T0)

CL Item

Tumor <=3 Cm In Greatest Dimension, Surrounded By Lung Or Visceral Pleura, Without Bronchoscopic Evidence Of Invasion More Proximal Than The Lobar Bronchus (i.e., Not In The Main Bronchus) (T1)

CL Item

Tumor <=2 Cm In Greatest Dimension (T1a)

CL Item

Tumor > 2 Cm But <=3 Cm In Greatest Dimension (T1b)

CL Item

Tumor > 3 Cm But <=5 Cm In Greatest Dimension (T2a)

CL Item

Tumor > 5 Cm But <=7 Cm In Greatest Dimension (T2b)

CL Item

Tis Carcinoma In Situ (Tis)

CL Item

Primary Tumor Cannot Be Assessed (TX)

LungTumorTStageTwoPresentType

Item

T2 tumor with any of the following (Mark all that apply with an X.)

text

CL.12

Code List

T2 tumor with any of the following (Mark all that apply with an X.)

CL Item

> 3 But <= 7 Cm (> 3 but <= 7 cm)

CL Item

Atelectasis/obstructive Pneumonia Extending To Hilum But Not Involving The Entire Lung (Atelectasis/obstructive pneumonia extending to hilum but not involving the entire lung)

CL Item

Invades Visceral Pleura (Invades visceral pleura)

CL Item

Involves Main Bronchus >= 2 Cm Distal To The Carina (Involves main bronchus >= 2 cm distal to the carina)

LungTumorTStageThreePresentType

Item

T3 tumor with any of the following (Mark all that apply with an X.)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25728 (NCI Thesaurus Property)
C0475455 (UMLS 2011AA Property)
C66834 (NCI Thesaurus Property)
C0205449 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.13

Code List

T3 tumor with any of the following (Mark all that apply with an X.)

CL Item

> 7 Cm (> 7 cm)

CL Item

Atelectasis/obstructive Pneumonia Of Entire Lung (Atelectasis/obstructive pneumonia of entire lung)

CL Item

Separate Tumor Nodule(s) In The Same Lobe (as Primary Tumor) (Separate tumor nodule(s) in the same lobe (as primary tumor))

CL Item

Tumor In The Main Bronchus < 2 Cm Distal To The Carina (Tumor in the main bronchus < 2 cm distal to the carina)

LungTumorTStageFourPresentType

Item

T4 tumor of any size with invasion of (Mark all that apply with an X.)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C66835 (NCI Thesaurus Property)
C0205450 (UMLS 2011AA Property)
C25728 (NCI Thesaurus Property)
C0475455 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.14

Code List

T4 tumor of any size with invasion of (Mark all that apply with an X.)

CL Item

Carina (Carina)

C25264 (NCI Thesaurus)
C0225594 (UMLS 2011AA)

CL Item

Esophagus (Esophagus)

C12389 (NCI Thesaurus)
C0014876 (UMLS 2011AA)

CL Item

Great Vessels (Great vessels)

CL Item

Heart (Heart)

C12727 (NCI Thesaurus)
C0018787 (UMLS 2011AA)

CL Item

Mediastinum (Mediastinum)

C12748 (NCI Thesaurus)
C0025066 (UMLS 2011AA)

CL Item

Recurrent Laryngeal Nerve (Recurrent laryngeal nerve)

CL Item

Separate Tumor Nodules In A Different Ipsilateral Lobe (Separate tumor nodules in a different ipsilateral lobe)

CL Item

Trachea (Trachea)

C12428 (NCI Thesaurus)
C0040578 (UMLS 2011AA)

CL Item

Vertebra (Vertebra)

C12933 (NCI Thesaurus)
C0549207 (UMLS 2011AA)

Pathologic N Stage

Item Group

Clinical N Stage

LungTumorPathologicNStage

Item

N Stage

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25610 (NCI Thesaurus Property)
C1521733 (UMLS 2011AA Property)
C25580 (NCI Thesaurus Property)
C0456532 (UMLS 2011AA Property)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain)
C1515946 (UMLS 2011AA ValueDomain)

CL.15

Code List

N Stage

CL Item

No Regional Lymph Node Metastasis (N0)

CL Item

Metastasis In Ipsilateral Peribronchial And/or Ipsilateral Hilar Lymph Nodes And Intrapulmonary Nodes, Including Involvement By Direct Extension (N1)

CL Item

Metastasis In Ipsilateral Mediastinal And/or Subcarinal Lymph Node(s) (N2)

CL Item

Metastasis In Contralateral Mediastinal, Contralateral Hilar, Ipsilateral Or Contralateral Scalene, Or Supraclavicular Lymph Node(s) (N3)

CL Item

Regional Lymph Nodes Cannot Be Assessed (NX)

Pathologic M Stage

Item Group

Clinical M Stage

LungTumorPathologicMStage

Item

M Stage

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25610 (NCI Thesaurus Property)
C1521733 (UMLS 2011AA Property)
C25727 (NCI Thesaurus Property)
C0456533 (UMLS 2011AA Property)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain)
C1515946 (UMLS 2011AA ValueDomain)

CL.16

Code List

M Stage

CL Item

Distant Metastasis (M1)

C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)
C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)

CL Item

Separate Tumor Nodule(s) In A Contralateral Lobe; Tumor With Pleural Nodules Or Malignant Pleural (or Pericardial) Effusion (M1a)

CL Item

Distant Metastasis (M1b)

C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)
C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)

LungTumorMStageOnePresentType

Item

M1a metastasis with any of the following (Mark all that apply with an X.)

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C66832 (NCI Thesaurus Property)
C0205447 (UMLS 2011AA Property)
C25727 (NCI Thesaurus Property)
C0456533 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.17

Code List

M1a metastasis with any of the following (Mark all that apply with an X.)

CL Item

Separate Tumor Nodules In A Contralateral Lobe (Separate tumor nodules in a contralateral lobe)

CL Item

Tumor With Pleural Nodules Or Malignant Pleural (or Pericardial) Effusion (Tumor with pleural nodules or malignant pleural (or pericardial) effusion)

NeoplasmSpecimenMetastaticAnatomicLocationSpecify

Item

Specify site

text

Footer Module

Item Group

Overall Response

ResponsiblePersonName

Item

Completed by (Last name, First name)

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

FormOriginalCompleteDate

Item

Date Form Originally Completed (MM DD YYYY)

date

C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25604 (NCI Thesaurus Property)
C0205313 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)

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On-Study - CALGB Non-Small Cell Lung Cancer Staging Form (AJCC V.7.0) - 3082176v1.0

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