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1 forms
  1. StudyEvent: Surgical Reporting Form, GOG-0209, Form C
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
Form Completion Date
Item
Date form originally completed (m d y)
date
C19464 (NCI Thesaurus ObjectClass)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Amendment date
Item
Date form amended (m d y)
date
C19464 (NCI Thesaurus ObjectClass)
C0680532 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Person Amending Form
Item
Person amending form, last name
text
C25191 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1547383 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Initials
Item
Patient Initials (First, Middle, Last)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Patient Study ID
Item
Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Person Completing Form Last Name
Item
Person completing form, last name
text
C25190 (NCI Thesaurus ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1301584 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
Item Group
Gynecologic Surgical Procedure
Surgery Date
Item
Surgery Date (m d y)
date
C25164 (NCI Thesaurus ValueDomain)
C1628561 (UMLS CUI-1)
C25367 (NCI Thesaurus ValueDomain-2)
C15329 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
TumorPercentageRemovedAmount
Item
Percent of gross tumor removed (%)
float
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25417 (NCI Thesaurus ValueDomain)
C25650 (NCI Thesaurus Property)
C0849355 (UMLS 2011AA Property)
GrossTumorResidualRemainingInd-2
Item
Residual gross tumor
boolean
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C43566 (NCI Thesaurus ObjectClass-2)
C0439806 (UMLS 2011AA ObjectClass-2)
C37895 (NCI Thesaurus Property)
C1609982 (UMLS 2011AA Property)
C25649 (NCI Thesaurus Property-2)
C1527428 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Operative procedure performed (check all that apply)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C28016 (NCI Thesaurus ObjectClass-2)
C0205480 (UMLS 2011AA ObjectClass-2)
CL.1
Code List
Operative procedure performed (check all that apply)
CL Item
Bilateral Salpingo-oophorectomy (bilateral salpingo-oophorectomy)
CL Item
Deep Lymphadenectomy (Deep lymphadenectomy)
CL Item
Exenteration (Exenteration)
CL Item
Hemivolvectomy (Hemi volvectomy)
CL Item
Interval Debulking (Interval debulking)
CL Item
Omentectomy (omentectomy)
C0198614 (NCI Metathesaurus)
CL Item
Other, Specify (other specify)
CL Item
Para-aortic Node Sampling/dissection (para-aortic node sampling/dissection)
CL Item
Pelvic Node Sampling/dissection (pelvic node sampling/dissection)
CL Item
Primary Debulking (Primary debulking)
CL Item
Radical Hysterectomy (radical hysterectomy)
CL Item
Radical Trachelectomy (radical trachelectomy)
CL Item
Radical Vulvectomy (Radical vulvectomy)
CL Item
Reassessment Laparotomy (Reassessment laparotomy)
CL Item
Superficial Lymphadenectomy (Superficial lymphadenectomy)
CL Item
Total Abdominal Hysterectomy (Total abdominal hysterectomy)
CL Item
Total Vaginal Hysterectomy (Total vaginal hysterectomy)
CL Item
Unilateral Salpingo-oophorectomy (unilateral salpingo-oophorectomy)
C28012 (NCI Thesaurus)
C0205092 (UMLS 2011AA)
C15323 (NCI Thesaurus-3)
C0036132 (UMLS 2011AA-4)
GynecologicSurgicalProcedurePerformedSpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C28016 (NCI Thesaurus ObjectClass-2)
C0205480 (UMLS 2011AA ObjectClass-2)
Item
Surgical approach
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25424 (NCI Thesaurus Property)
C0449445 (UMLS 2011AA Property)
CL.2
Code List
Surgical approach
CL Item
Open (open)
CL Item
Laparoscopic Surgery (Laparoscopic)
C15725 (NCI Thesaurus)
C0751429 (UMLS 2011AA)
Item
Stage
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C28016 (NCI Thesaurus ObjectClass-2)
C0205480 (UMLS 2011AA ObjectClass-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C25523 (NCI Thesaurus Property)
C1522242 (UMLS 2011AA Property)
CL.3
Code List
Stage
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (1)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (1A)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (1B)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (1C)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (2)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (2A)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (2B)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (2C)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (3)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (3A)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (3B)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (3C)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (4)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (4A)
CL Item
Refer To Figo Staging For Specific Gynecologic Cancer (4B)
CL Item
Persistent (Persistent)
CL Item
Recurrent (Recurrent)
C14173 (NCI Thesaurus)
C2945760 (UMLS 2011AA)
CL Item
Not Available (Not available)
Item Group
Miscellaneous Assessment
LargestMalignantNeoplasmLongestDiameterMeasurement
Item
Greatest diameter of largest residual gross tumor mass
float
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25550 (NCI Thesaurus ObjectClass-2)
C0443228 (UMLS 2011AA ObjectClass-2)
C25285 (NCI Thesaurus Property)
C1301886 (UMLS 2011AA Property)
C25558 (NCI Thesaurus Property-2)
C1522425 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
MicroscopicDiseasePresentInd-2
Item
Microscopic disease only
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
AscitesPresentInd-3
Item
Ascites
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C2885 (NCI Thesaurus ObjectClass)
C0003962 (UMLS 2011AA ObjectClass)
Item
Cytology of peritoneal or ascitic fluids
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
CL.7
Code List
Cytology of peritoneal or ascitic fluids
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Suspicious (Suspicious)
C0750493 (NCI Metathesaurus)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Unavailable (Unavailable)
Item Group
Summary of operative findings
Item
Summary of operative findings (*)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C28016 (NCI Thesaurus ObjectClass)
C0205480 (UMLS 2011AA ObjectClass)
CL.8
Code List
Summary of operative findings (*)
CL Item
Uterus-corpus (Uterus-corpus)
CL Item
Uterus-cervix (Uterus-cervix)
CL Item
Vagina (Vagina)
C12407 (NCI Thesaurus)
C0042232 (UMLS 2011AA)
CL Item
Fallopian Tube - Rt. (Fallopian tube - rt.)
CL Item
Fallopian Tube - Lt. (Fallopian tube - lt.)
CL Item
Ovary - Rt. (Ovary - rt.)
CL Item
Ovary - Lt. (Ovary - lt.)
CL Item
Bladder - Mucosa (Bladder - mucosa)
CL Item
Bladder - Muscularis (Bladder - muscularis)
CL Item
Ureter - Rt. (Ureter - rt.)
CL Item
Ureter - Lt. (Ureter - lt.)
CL Item
Parametrium - Rt. (Parametrium - rt.)
CL Item
Parametrium - Lt. (Parametrium - lt.)
CL Item
Labium Major - Rt. (Labium major - rt.)
CL Item
Labium Major - Lt. (Labium major - lt.)
CL Item
Labium Minor - Rt. (Labium minor - rt.)
CL Item
Labium Minor - Lt. (Labium minor - lt.)
CL Item
Clitoris (Clitoris)
CL Item
Urethra (Urethra)
CL Item
Introitus (Introitus)
CL Item
Perineal Body (Perineal body)
CL Item
Anus (Anus)
C43362 (NCI Thesaurus)
C0003461 (UMLS 2011AA)
CL Item
Pelvic - Rt. (Pelvic - rt.)
CL Item
Pelvic - Lt. (Pelvic - lt.)
CL Item
Pelvic Bladder (Pelvic bladder)
CL Item
Pelvic Cul-de-sac (Pelvic cul-de-sac)
CL Item
Ant. Abdomen (Ant. Abdomen)
CL Item
Gutters - Rt. (Gutters - rt.)
CL Item
Gutters - Lt. (Gutters - lt.)
CL Item
Subdiaphragm - Rt. (subdiaphragm - rt.)
CL Item
Subdiaphragm - Lt. (subdiaphragm - lt.)
CL Item
Stomach (Stomach)
C12391 (NCI Thesaurus)
C0038351 (UMLS 2011AA)
CL Item
Duodenum (Duodenum)
C12263 (NCI Thesaurus)
C0013303 (UMLS 2011AA)
CL Item
Jejunum (Jejunum)
C12388 (NCI Thesaurus)
C0022378 (UMLS 2011AA)
CL Item
Ileum (Ileum)
CL Item
Appendix (Appendix)
C12380 (NCI Thesaurus)
C0003617 (UMLS 2011AA)
CL Item
Ascending Colon (Ascending colon)
C12265 (NCI Thesaurus)
C0227375 (UMLS 2011AA)
CL Item
Transverse Colon (Transverse colon)
C12385 (NCI Thesaurus)
C0227386 (UMLS 2011AA)
CL Item
Descending Colon (Descending colon)
C12268 (NCI Thesaurus)
C0227389 (UMLS 2011AA)
CL Item
Sig. Mucosa (Sig. Mucosa)
CL Item
Sig. Muscularis (Sig. Muscularis)
CL Item
Small Bowel (Small bowel)
CL Item
Large Bowel (Large bowel)
CL Item
Liver Surface (Liver surface)
CL Item
Liver Parenchyma (Liver parenchyma)
CL Item
Spleen (Spleen)
C12432 (NCI Thesaurus)
C0037993 (UMLS 2011AA)
CL Item
Gall Bladder (Gall bladder)
CL Item
Pancreas (Pancreas)
C12393 (NCI Thesaurus)
C0030274 (UMLS 2011AA)
CL Item
Kidney - Rt. (Kidney - rt.)
CL Item
Kidney - Lt. (Kidney - lt.)
CL Item
Adb. Ureter - Rt. (Adb. Ureter - rt.)
CL Item
Adb. Ureter - Lt. (Adb. Ureter - lt.)
CL Item
Omentum - Gastrocolic (Omentum - gastrocolic)
CL Item
Omentum - Infracolic (Omentum - infracolic)
CL Item
Left Scalene (Left scalene)
CL Item
Para-aortic - Rt. (Para-aortic - rt.)
CL Item
Para-aortic - Lt. (Para-aortic - lt.)
CL Item
Common Iliac - Rt. (Common iliac - rt.)
CL Item
Common Iliac - Lt. (Common iliac - lt.)
CL Item
External Iliac - Rt. (External iliac - rt.)
CL Item
External Iliac - Lt. (External iliac - lt.)
CL Item
Obturator - Rt. (Obturator - rt.)
CL Item
Obturator - Lt. (Obturator - lt.)
CL Item
Internal - Rt. (Internal - rt.)
CL Item
Internal - Lt. (Internal - lt.)
CL Item
Superficial Gr. - Rt. (Superficial gr. - rt.)
CL Item
Superficial Gr. - Lt. (Superficial gr. - lt.)
CL Item
Deep Groin - Rt. (Deep groin - rt.)
CL Item
Deep Groin - Lt. (Deep groin - lt.)
Item
Exam (*Examined: 1=tumor present; 2=no tumor; 3=suspicious; 4=organ absent; 5=not examined)
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C28016 (NCI Thesaurus ObjectClass)
C0205480 (UMLS 2011AA ObjectClass)
CL.9
Code List
Exam (*Examined: 1=tumor present; 2=no tumor; 3=suspicious; 4=organ absent; 5=not examined)
CL Item
Tumor Present (Tumor present)
CL Item
No Tumor (No tumor)
CL Item
Suspicious (Suspicious)
C0750493 (NCI Metathesaurus)
CL Item
Organ Absent (Organ absent)
CL Item
Not Examined (Not examined)
Item
Proc (*Procedure: 1=removed partially; 2=removed completely; 3=biopsy only; 4=left intact; 5=not applicable)
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus Property)
C28016 (NCI Thesaurus ObjectClass)
C0205480 (UMLS 2011AA ObjectClass)
CL.10
Code List
Proc (*Procedure: 1=removed partially; 2=removed completely; 3=biopsy only; 4=left intact; 5=not applicable)
CL Item
Removed Partially (Removed partially)
CL Item
Removed Completely (Removed completely)
CL Item
Biopsy Only (Biopsy only)
CL Item
Left Intact (Left intact)
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
Item Group
Comments
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
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