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1 forms
  1. StudyEvent: Pathology Form, GOG-0209, Form F
    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)
Last Name
Item
Patient Name, Last
text
C25191 (NCI Thesaurus ValueDomain)
C1301584 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
First Name
Item
Patient Name, First
text
C25191 (NCI Thesaurus ValueDomain)
C1443235 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
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
Primary Disease Assessment
Item
Primary site
text
CL.1
Code List
Primary site
CL Item
Cervix (Cervix)
C12311 (NCI Thesaurus)
C0007874 (UMLS 2011AA)
CL Item
Endometrium (Endometrium)
C12313 (NCI Thesaurus)
C0014180 (UMLS 2011AA)
CL Item
Fallopian Tube (Fallopian tube)
C12403 (NCI Thesaurus)
C0015560 (UMLS 2011AA)
CL Item
Gestational Trophoblastic Disease (GTD)
CL Item
Ovary (Ovary)
C12404 (NCI Thesaurus)
C0029939 (UMLS 2011AA)
CL Item
Peritoneum (Peritoneum)
C12770 (NCI Thesaurus)
C0031153 (UMLS 2011AA)
CL Item
Uterine Sarcoma (Uterine sarcoma)
CL Item
Vagina (Vagina)
C12407 (NCI Thesaurus)
C0042232 (UMLS 2011AA)
CL Item
Vulva (Vulva)
C12408 (NCI Thesaurus)
C0042993 (UMLS 2011AA)
CL Item
Other, Specify (Other, specify)
PrimarySite,Other
Item
Other, specify (Primary Site)
text
Item
Histologic type (check one)
text
CL.2
Code List
Histologic type (check one)
CL Item
Adenocarcinoma, Unspecified (Adenocarcinoma, unspecified)
CL Item
Adenocarcinoma With Squamous Differentiation (Adenocarcinoma with squamous differentiation)
CL Item
Adenosquamous (Adenosquamous carcinoma)
CL Item
Clear Cell Carcinoma (Clear cell carcinoma)
CL Item
Endometrioid Adenocarcinoma (Endometrioid adenocarcinoma)
C3769 (NCI Thesaurus)
C0206687 (UMLS 2011AA)
CL Item
Mixed Epithelial Carcinoma, Specify Components (Mixed epithelial carcinoma)
CL Item
Mucinous Adenocarcinoma (Mucinous adenocarcinoma)
C26712 (NCI Thesaurus)
C0007130 (UMLS 2011AA)
CL Item
Serous Adenocarcinoma (Serous adenocarcinoma)
C40101 (NCI Thesaurus)
C0206701 (UMLS 2011AA)
CL Item
Small Cell Carcinoma (Small cell carcinoma)
C3915 (NCI Thesaurus)
C0262584 (UMLS 2011AA)
CL Item
Squamous Cell Carcinoma (Squamous cell carcinoma, invasive)
C2929 (NCI Thesaurus)
C0007137 (UMLS 2011AA)
CL Item
Transitional Cell Carcinoma, Including Brenner Tumor (Transitional cell carcinoma (including Brenner))
CL Item
Undifferentiated Carcinoma (Undifferentiated carcinoma)
C3692 (NCI Thesaurus)
C0205698 (UMLS 2011AA)
CL Item
Villoglandular Carcinoma (Villoglandular carcinoma)
CL Item
Carcinosarcoma/mesodermal (mullerian) Mixed Tumor (Carcinosarcoma, homologous)
CL Item
Carcinosarcoma/mesodermal (mullerian) Mixed Tumor (Carcinosarcoma, heterologous)
CL Item
Endometrial Stromal Sarcoma (Endometrial stromal sarcoma, high grade)
C8973 (NCI Thesaurus)
C0206630 (UMLS 2011AA)
CL Item
Leiomyosarcoma (Leiomyosarcoma)
C3158 (NCI Thesaurus)
C0023269 (UMLS 2011AA)
CL Item
Mucinous Tumor Of Low Malignant Potential (Mucinous tumor of LMP)
CL Item
Serous Tumor Of Low Malignant Potential (Serous tumor of LMP)
CL Item
Mixed serous/mucinous LMP (Mixed serous/mucinous LMP)
CL Item
Granulosa Cell Tumor (Granulosa cell tumor)
C3070 (NCI Thesaurus)
C0018206 (UMLS 2011AA)
CL Item
Sex-cord/stromal, Unclassified (Sex cord/stromal, unclassified)
CL Item
Dysgerminoma (Dysgerminoma)
C2996 (NCI Thesaurus)
C0013377 (UMLS 2011AA)
CL Item
Endodermal Sinus Tumor (yolk Sac Tumor) (Endodermal sinus tumor)
CL Item
Germ Cell Tumor, Mixed (Germ cell tumor, mixed)
CL Item
Teratoma, Immature, Specify Components (Teratoma, immature)
CL Item
Teratoma, Mature (Teratoma, mature cystic)
CL Item
Normal Tissue (Normal tissue)
C33177 (NCI Thesaurus)
CL Item
Benign (Benign NOS)
C14172 (NCI Thesaurus)
C0205183 (UMLS 2011AA)
CL Item
Fibroma (Fibroma)
C3041 (NCI Thesaurus)
C0016045 (UMLS 2011AA)
CL Item
Serous Cystadenoma (benign) (Serous cystadenoma (benign))
CL Item
Mucinous Cystadenoma (benign) (Mucinous cystadenoma (benign))
CL Item
Other, Specify (Other, specify)
TumorHistologicCategorySpecify
Item
Other, specify (Histologic Type)
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25161 (NCI Thesaurus Property)
C0008902 (UMLS 2011AA Property)
Item
Histologic grade (Differentiation)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C28016 (NCI Thesaurus ObjectClass-2)
C0205480 (UMLS 2011AA ObjectClass-2)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C25526 (NCI Thesaurus ValueDomain)
C0205462 (UMLS 2011AA ValueDomain)
C18000 (NCI Thesaurus ValueDomain-2)
C0919553 (UMLS 2011AA ValueDomain-2)
CL.3
Code List
Histologic grade (Differentiation)
CL Item
Grade 1-well Differentiated (1)
CL Item
Grade 2-moderately Differentiated (2)
CL Item
Grade 3-poorly Differentiated (3)
CL Item
Indeterminate (Indeterminate)
C48658 (NCI Thesaurus)
C0205258 (UMLS 2011AA)
CL Item
Grade Unknown (Unknown)
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
Item
Method of evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
CL.6
Code List
Method of evaluation
CL Item
Surgery (Surgery)
C17173 (NCI Thesaurus)
C0038894 (UMLS 2011AA)
CL Item
Biopsy (Biopsy)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
C15189 (NCI Thesaurus-3)
C0005558 (UMLS 2011AA-4)
CL Item
Other, Specify (Other, specify)
CL Item
Cytology (Cytology)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Second look (Second look)
CL Item
Persistent (Persistent)
CL Item
Recurrence (Recurrence)
LesionAssessmentDate
Item
Date of evaluation (m d y)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
SpecimenIdentifierNumber
Item
ID # of the blocks/slides
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
Item
Specimen site
text
CL.7
Code List
Specimen site
CL Item
Bladder Peritoneum (Bladder peritoneum)
CL Item
Bowel Peritoneum/serosa (Bowel peritoneum/serosa)
CL Item
Cervix (Cervix)
C12311 (NCI Thesaurus)
C0007874 (UMLS 2011AA)
CL Item
Corpus (Corpus)
CL Item
Cul-de-sac (Cul-de-sac)
CL Item
Diaphragm (Diaphragm)
C12702 (NCI Thesaurus)
C0011980 (UMLS 2011AA)
CL Item
Endometrium (Endometrium)
C12313 (NCI Thesaurus)
C0014180 (UMLS 2011AA)
CL Item
Fallopian Tube (Fallopian tube)
C12403 (NCI Thesaurus)
C0015560 (UMLS 2011AA)
CL Item
Omentum (Omentum)
C33209 (NCI Thesaurus)
C0028977 (UMLS 2011AA)
CL Item
Ovary (Ovary)
C12404 (NCI Thesaurus)
C0029939 (UMLS 2011AA)
CL Item
Paracolic Gutter Left (Paracolic gutter left)
CL Item
Paracolic Gutter Right (Paracolic gutter right)
CL Item
Pelvic Wall Left (Pelvic wall left)
CL Item
Pelvic Wall Right (Pelvic wall right)
CL Item
Peritoneum/uterine Serosa (Peritoneum/uterine serosa)
CL Item
Lymph Node(s) (Lymph nodes, specify)
CL Item
Metastatic Site (Metastatic site, specify)
CL Item
Other (Other, specify)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
SpecimenSite,LymphNode
Item
Lymph nodes, specify (Specimen Site)
text
SpecimenSite,Metastatic
Item
Metastatic site, specify (Specimen Site)
text
SpecimenSite,Other
Item
Other, specify (Specimen Site)
text
Item Group
Secondary Disease Assessment
Item
Method of evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
CL.6
Code List
Method of evaluation
CL Item
Surgery (Surgery)
C17173 (NCI Thesaurus)
C0038894 (UMLS 2011AA)
CL Item
Biopsy (Biopsy)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
C15189 (NCI Thesaurus-3)
C0005558 (UMLS 2011AA-4)
CL Item
Other, Specify (Other, specify)
CL Item
Cytology (Cytology)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Second look (Second look)
CL Item
Persistent (Persistent)
CL Item
Recurrence (Recurrence)
LesionAssessmentDate
Item
Date of evaluation (m d y)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
SpecimenIdentifierNumber
Item
ID # of the blocks/slides
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
Item
Specimen site
text
CL.7
Code List
Specimen site
CL Item
Bladder Peritoneum (Bladder peritoneum)
CL Item
Bowel Peritoneum/serosa (Bowel peritoneum/serosa)
CL Item
Cervix (Cervix)
C12311 (NCI Thesaurus)
C0007874 (UMLS 2011AA)
CL Item
Corpus (Corpus)
CL Item
Cul-de-sac (Cul-de-sac)
CL Item
Diaphragm (Diaphragm)
C12702 (NCI Thesaurus)
C0011980 (UMLS 2011AA)
CL Item
Endometrium (Endometrium)
C12313 (NCI Thesaurus)
C0014180 (UMLS 2011AA)
CL Item
Fallopian Tube (Fallopian tube)
C12403 (NCI Thesaurus)
C0015560 (UMLS 2011AA)
CL Item
Omentum (Omentum)
C33209 (NCI Thesaurus)
C0028977 (UMLS 2011AA)
CL Item
Ovary (Ovary)
C12404 (NCI Thesaurus)
C0029939 (UMLS 2011AA)
CL Item
Paracolic Gutter Left (Paracolic gutter left)
CL Item
Paracolic Gutter Right (Paracolic gutter right)
CL Item
Pelvic Wall Left (Pelvic wall left)
CL Item
Pelvic Wall Right (Pelvic wall right)
CL Item
Peritoneum/uterine Serosa (Peritoneum/uterine serosa)
CL Item
Lymph Node(s) (Lymph nodes, specify)
CL Item
Metastatic Site (Metastatic site, specify)
CL Item
Other (Other, specify)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
SpecimenSite,LymphNode
Item
Lymph nodes, specify (Specimen Site)
text
SpecimenSite,Metastatic
Item
Metastatic site, specify (Specimen Site)
text
SpecimenSite,Other
Item
Other, specify (Specimen Site)
text
Item Group
Footer Module
ParticipatingGroupIdentifierCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C1257890 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Study Number Participating Group
Item
Participating Group Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Patient Study ID, Participating Group
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item Group
Ccrr Module For Pathology Form, Gog-0209, Form F
Evaluation method, specify
Item
Other, Specify
text
C25685 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C1521902 (UMLS CUI-2)
C16847 (NCI Thesaurus Property)
Item
Disease Status
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CL.8
Code List
Disease Status
CL Item
Primary Gyn Disease Continues To Be Present Following Initial Treatment (Persistent)
CL Item
Recurrence Of Same Gyn Disease Previously Treated Successfully (Recurrence)
CL Item
Progression Of Gyn Disease Per Recist Criteria (Progression)
Evaluation method, specify
Item
Other, Specify
text
C25685 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C1521902 (UMLS CUI-2)
C16847 (NCI Thesaurus Property)
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