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ID

6901

Beskrivning

Esophageal Cancer - Adjuvant On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A9A2-3FA4-E034-080020C9C0E0

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A9A2-3FA4-E034-080020C9C0E0

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2015-01-08 2015-01-08 - Martin Dugas
Uppladdad den

8 januari 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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    On-Study - Esophageal Cancer - Adjuvant On-Study Form - 2020201v2.31

    Engelsk

    No Instruction available.

    1 Formulär  
    1. StudyEvent: Esophageal Cancer - Adjuvant On-Study Form
      1. No Instruction available.
    Crf Header
    Beskrivning

    Crf Header

    Coordinating Group Protocol Number
    Beskrivning

    CoordinatingGroupProtocolNumber

    Datatyp

    text

    Coordinating Group Code
    Beskrivning

    CoordinatingGroupCode

    Datatyp

    text

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

    Protocol Title

    Datatyp

    text

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

    PatientStudyID,CoordinatingGroup

    Datatyp

    text

    Patient Study ID, Participating Group
    Beskrivning

    PatientStudyID,ParticipatingGroup

    Datatyp

    text

    Participating Group Code
    Beskrivning

    ParticipatingGroupCode

    Datatyp

    text

    Institution Name
    Beskrivning

    InstitutionName

    Datatyp

    text

    Affiliate Name
    Beskrivning

    AffiliateName

    Datatyp

    text

    Patient Name, Last
    Beskrivning

    PatientName,Last

    Datatyp

    text

    Patient Name, First
    Beskrivning

    PatientName,First

    Datatyp

    text

    Patient Name, Middle
    Beskrivning

    PatientName,Middle

    Datatyp

    text

    Esophageal: Form Administration
    Beskrivning

    Esophageal: Form Administration

    Person Completing Form, Last Name
    Beskrivning

    PersonCompletingForm,LastName

    Datatyp

    text

    Person Completing Form, First Name
    Beskrivning

    PersonCompletingForm,FirstName

    Datatyp

    text

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

    AmendedDataInd

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474
    UMLS 2011AA ObjectClass
    C1511726
    NCI Thesaurus Property
    C25416
    UMLS 2011AA Property
    C1691222
    Esophageal: Adjuvant Disease Description
    Beskrivning

    Esophageal: Adjuvant Disease Description

    Primary Site
    Beskrivning

    PrimarySite

    Datatyp

    text

    Primary Site, Other
    Beskrivning

    PrimarySite,Other

    Datatyp

    text

    Disease Involvement Site
    Beskrivning

    DiseaseInvolvementSite

    Datatyp

    text

    Disease Involvement Site, Adjacent Specify
    Beskrivning

    DiseaseInvolvementSite,AdjacentSpecify

    Datatyp

    text

    Disease Involvement Site, Other
    Beskrivning

    DiseaseInvolvementSite,Other

    Datatyp

    text

    Histologic Type
    Beskrivning

    HistologicType

    Datatyp

    text

    Histologic Type, Other Name
    Beskrivning

    HistologicType,OtherName

    Datatyp

    text

    Histologic Grade
    Beskrivning

    HistologicGrade

    Datatyp

    text

    T Stage, Pathologic
    Beskrivning

    TStage,Pathologic

    Datatyp

    text

    N Stage, Pathologic
    Beskrivning

    NStage,Pathologic

    Datatyp

    text

    M Stage, Pathologic
    Beskrivning

    MStage,Pathologic

    Datatyp

    text

    Esophageal: Adjuvant Prior Treatment
    Beskrivning

    Esophageal: Adjuvant Prior Treatment

    Prior Surgery Ind
    Beskrivning

    PriorSurgeryInd

    Datatyp

    text

    Tillbaka till toppen

    Similar models

    No Instruction available.

    1 Formulär
    1. StudyEvent: Esophageal Cancer - Adjuvant On-Study Form
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    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
    Item
    Participating Group Code
    text
    CL.1
    Code List
    Participating Group Code
    CL Item
    Http://ctep.info.nih.gov. (http://ctep.info.nih.gov.)
    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
    Esophageal: 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.2
    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
    Esophageal: Adjuvant Disease Description
    Item
    Primary Site
    text
    CL.3
    Code List
    Primary Site
    CL Item
    Antrum (Antrum)
    CL Item
    Upper Thoracic Esophagus (Upper thoracic esophagus)
    CL Item
    Cardia (Cardia)
    C0007144 (NCI Metathesaurus)
    CL Item
    Cervical Esophagus (Cervical esophagus)
    C12250 (NCI Thesaurus)
    C0227186 (UMLS 2011AA)
    CL Item
    Diffuse (Diffuse)
    C14175 (NCI Thesaurus)
    C0205219 (UMLS 2011AA)
    CL Item
    Esophagus, Not Otherwise Specified (Esophagus, NOS)
    CL Item
    Fundus (Fundus)
    C13378 (NCI Thesaurus)
    C0740422 (UMLS 2011AA)
    CL Item
    Gastro-esophageal Junction (Gastro-esophageal junction)
    CL Item
    Head Of Pancreas (Head of pancreas)
    C0227579 (NCI Metathesaurus)
    CL Item
    Linitus Plastica (Linitus plastica)
    CL Item
    Lower Thoracic Esophagus, Excluding The Gastro-esophageal Junction (Lower thoracic esophagus (excludes G-E junction))
    CL Item
    Mid-thoracic Esophagus (Mid-thoracic esophagus)
    CL Item
    Other, Specify (Other, specify)
    CL Item
    Pancreas, Not Otherwise Specified (Pancreas, NOS)
    CL Item
    Pylorus/pyloric Channel (Pylorus/Pyloric channel)
    CL Item
    Stomach, Not Otherwise Specified (Stomach, NOS)
    CL Item
    Tail Of Pancreas (Tail of pancreas)
    C0227590 (NCI Metathesaurus)
    CL Item
    Uncinate Process (Uncinate process)
    CL Item
    Body Of Pancreas (Body of pancreas)
    C0227582 (NCI Metathesaurus)
    PrimarySite,Other
    Item
    Primary Site, Other
    text
    Item
    Disease Involvement Site
    text
    CL.4
    Code List
    Disease Involvement Site
    CL Item
    Adjacent Structures, Specify (Adjacent structures, specify)
    CL Item
    Adjacent Viscera (Adjacent viscera)
    CL Item
    Adjacent Viscera/vessels (Adjacent viscera/vessels)
    CL Item
    Bone (Bone)
    C12366 (NCI Thesaurus)
    C0262950 (UMLS 2011AA)
    CL Item
    Distant Lymph Nodes (Distant lymph nodes)
    CL Item
    Liver (Liver)
    C12392 (NCI Thesaurus)
    C0023884 (UMLS 2011AA)
    CL Item
    Regional Lymph Nodes (Regional lymph nodes)
    CL Item
    Other, Specify (Other, specify)
    CL Item
    Peritoneal Disease (Peritoneal disease)
    CL Item
    Peritoneum (Peritoneum)
    C12770 (NCI Thesaurus)
    C0031153 (UMLS 2011AA)
    CL Item
    Primary Tumor/esophagus (Primary tumor/esophagus)
    CL Item
    Primary Tumor/pancreas (Primary tumor/pancreas)
    CL Item
    Primary Tumor/stomach (Primary tumor/stomach)
    CL Item
    Lung (Lung)
    C12468 (NCI Thesaurus)
    C0024109 (UMLS 2011AA)
    DiseaseInvolvementSite,AdjacentSpecify
    Item
    Disease Involvement Site, Adjacent Specify
    text
    DiseaseInvolvementSite,Other
    Item
    Disease Involvement Site, Other
    text
    Item
    Histologic Type
    text
    CL.5
    Code List
    Histologic Type
    CL Item
    Acinar Cell Carcinoma (Acinar cell carcinoma)
    C3768 (NCI Thesaurus)
    C0206685 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    CL Item
    Adenosquamous Carcinoma (Adenosquamous carcinoma)
    C3727 (NCI Thesaurus)
    C0206623 (UMLS 2011AA)
    CL Item
    Ductal Adenocarcinoma (Ductal adenocarcinoma)
    CL Item
    Mixed-type (ductal-endocrine Or Acinar-endocrine) (Mixed-type (ductal-endocrine or acinar-endocrine))
    CL Item
    Mucinous Adenocarcinoma (Mucinous adenocarcinoma)
    C26712 (NCI Thesaurus)
    C0007130 (UMLS 2011AA)
    CL Item
    Mucinous Noncystic Carcinoma (Mucinous noncystic carcinoma)
    CL Item
    Neuroendocrine Carcinoma (Neuroendocrine carcinoma)
    C3773 (NCI Thesaurus)
    C0206695 (UMLS 2011AA)
    CL Item
    Other, Specify (Other, specify)
    CL Item
    Signet Ring Cell Carcinoma (Signet ring cell carcinoma)
    C3774 (NCI Thesaurus)
    C0206696 (UMLS 2011AA)
    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
    Tubular Adenocarcinoma (Tubular adenocarcinoma)
    C3682 (NCI Thesaurus)
    C1883403 (UMLS 2011AA)
    CL Item
    Undifferentiated (anaplastic) Carcinoma (Undifferentiated (anaplastic) carcinoma)
    CL Item
    Undifferentiated Carcinoma With Osteoclast-like Giant Cells (Undifferentiated carcinoma with osteoclast-like giant cells)
    CL Item
    Adenocarcinoma (Adenocarcinoma)
    C2852 (NCI Thesaurus)
    C0001418 (UMLS 2011AA)
    HistologicType,OtherName
    Item
    Histologic Type, Other Name
    text
    Item
    Histologic Grade
    text
    CL.6
    Code List
    Histologic Grade
    CL Item
    Tumor Is Moderately Differentiated According To Who Grading System (Moderately differentiated (Grade II))
    CL Item
    Tumor Is Poorly Differentiated According To Who Grading System (Poorly differentiated (Grade III))
    CL Item
    Tumor Is Well Differentiated According To Who Grading System (Well differentiated (Grade I))
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    CL Item
    Tumor Is Undifferentiated According To Who Grading System (Undifferentiated (Grade IV))
    Item
    T Stage, Pathologic
    text
    CL.7
    Code List
    T Stage, Pathologic
    CL Item
    T0, According To Ajcc Criteria (T0)
    CL Item
    T1, According To Ajcc Criteria (T1)
    CL Item
    T2, According To Ajcc Criteria (T2)
    CL Item
    Tis, According To Ajcc Criteria (Tis)
    CL Item
    T4, According To Ajcc Criteria (T4)
    CL Item
    Tx, According To Ajcc Criteria (TX)
    CL Item
    T3, According To Ajcc Criteria (T3)
    Item
    N Stage, Pathologic
    text
    CL.8
    Code List
    N Stage, Pathologic
    CL Item
    No Lymph Node Involvement According To Ajcc Guidelines (use For Esophageal, Gastric, And Pancreatic) (N0)
    CL Item
    N1, According To Ajcc Criteria (N1)
    CL Item
    Lymph Node Involvement Cannot Be Assessed According To Ajcc Guidelines (use For Esophageal, Gastric, And Pancreatic) (NX)
    CL Item
    N3, According To Ajcc Criteria (N3)
    CL Item
    N2, According To Ajcc Criteria (N2)
    Item
    M Stage, Pathologic
    text
    CL.9
    Code List
    M Stage, Pathologic
    CL Item
    No Distant Metastases According To Ajcc Guidelines (M0)
    CL Item
    Distant Metastases Presence Or Absence Cannot Be Assessed According To Ajcc Guidelines (MX)
    CL Item
    Distant Metastases Present According To Ajcc Guidelines (M1)
    Item Group
    Esophageal: Adjuvant Prior Treatment
    Item
    Prior Surgery Ind
    text
    CL.10
    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)
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