ID

6915

Description

Gastric Cancer - Adjuvant On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A9A6-3FA4-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A9A6-3FA4-E034-080020C9C0E0

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
Uploaded on

January 8, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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On-Study - Gastric Cancer - Adjuvant On-Study Form - 2020203v2.31

English

No Instruction available.

1 forms  
  1. StudyEvent: Gastric Cancer - Adjuvant On-Study Form
    1. No Instruction available.
Crf Header
Description

Crf Header

Coordinating Group Protocol Number
Description

CoordinatingGroupProtocolNumber

Data type

text

Coordinating Group Code
Description

CoordinatingGroupCode

Data type

text

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

Protocol Title

Data type

text

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

PatientStudyID,CoordinatingGroup

Data type

text

Patient Study ID, Participating Group
Description

PatientStudyID,ParticipatingGroup

Data type

text

Participating Group Code
Description

ParticipatingGroupCode

Data type

text

Institution Name
Description

InstitutionName

Data type

text

Affiliate Name
Description

AffiliateName

Data type

text

Patient Name, Last
Description

PatientName,Last

Data type

text

Patient Name, First
Description

PatientName,First

Data type

text

Patient Name, Middle
Description

PatientName,Middle

Data type

text

Gastric: Form Administration
Description

Gastric: Form Administration

Person Completing Form, Last Name
Description

PersonCompletingForm,LastName

Data type

text

Person Completing Form, First Name
Description

PersonCompletingForm,FirstName

Data type

text

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

AmendedDataInd

Data type

text

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

Gastric: Adjuvant Disease Description

Primary Site
Description

PrimarySite

Data type

text

Primary Site, Other
Description

PrimarySite,Other

Data type

text

Disease Involvement Site
Description

DiseaseInvolvementSite

Data type

text

Disease Involvement Site, Adjacent Specify
Description

DiseaseInvolvementSite,AdjacentSpecify

Data type

text

Disease Involvement Site, Other
Description

DiseaseInvolvementSite,Other

Data type

text

Histologic Type
Description

HistologicType

Data type

text

Histologic Type, Other Name
Description

HistologicType,OtherName

Data type

text

Histologic Grade
Description

HistologicGrade

Data type

text

T Stage, Pathologic
Description

TStage,Pathologic

Data type

text

N Stage, Pathologic
Description

NStage,Pathologic

Data type

text

M Stage, Pathologic
Description

MStage,Pathologic

Data type

text

Gastric: Adjuvant Prior Treatment
Description

Gastric: Adjuvant Prior Treatment

Prior Surgery Ind
Description

PriorSurgeryInd

Data type

text

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No Instruction available.

1 forms
  1. StudyEvent: Gastric Cancer - Adjuvant On-Study Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
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
Gastric: 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
Gastric: 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
Gastric: 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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