NCI Cooperative Group On-Study Form (CALGB-90104) Combination Chemotherapy in Treating Patients With Bladder Cancer Source Form: NCI FormBuilder:

  1. 8/26/12 8/26/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
Uploaded on:

January 8, 2015

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Creative Commons BY-NC 3.0 Legacy
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Bladder Cancer NCT00014534 On-Study - NCI Cooperative Group On-Study Form (CALGB-90104) - 2056020v3.0

No Instruction available.

  1. StudyEvent: NCI Cooperative Group On-Study Form (CALGB-90104)
    1. No Instruction available.
Mskcc 00-138; Calgb-90104; Ecog
Form Administration
Are data amended?
Disease Description For Muscle Invasive Bladder Cancer
Has the patient had a prior history of superficial disease?
Histologic Type (mark all that apply)
Histologic Grade (check the highest grade)
Pathologic T Stage (Indicate highest stage at the current presentation of disease)
Pathologic N Stage (Distant Metastasis)
Pathologic M Stage
Lymph Node Type
Lymph Node Involvement
Is the tumor(s) at the surgical margin?
Muscle Invasive Bladder Disease: Prior Treatment Affecting The Bladder
Prior Intravesical Therapy (Note: If no, skip to Prior Surgery below)
Type of Prior Immunotherapy
Type of Prior Chemotherapy
Prior Surgery (for urothelial disease)
Prior Surgery Type
Any Other Prior Therapy
Ccrr Module For Nci Cooperative Group On-study Form (calgb-90104)

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