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UG-Urinary Bladder.html
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<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<title>Carcinoma of the urinary bladder</title>
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<style>
table, th, td {
border: 1px solid silver;
border-collapse: collapse;
padding: 4px;
}
</style
</head>
<body>
<img id="top" src="top.png" alt="">
<div id="form_container">
<div class="form_description">
<h2><a href=".\cap\Cancer-Protocols-2023-09-Update\Genitourinary Protocol Folder\Bladder_4.2.0.0.REL_CAPCP.pdf" target="_blank">
<div class="tooltip">
Carcinoma of the urinary bladder
<span class="tooltiptext">click to access explanations in the original CAP template</span>
</div>
</a>
</h2>
</div>
<form>
<p> This is additional protocol for <a href=".\cap\Cancer-Protocols-2023-09-Update\Genitourinary Protocol Folder\Bladder.Bx.TURBT_4.2.0.0.REL_CAPCP.pdf" target="_blank">biopsy and TURBT specimens</a>.</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Gross core data elements:</label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- Procedure:</label>
</td>
<td>
<select class="element select large" ID="A01">
<option value=""></option>
<option value="Partial cystectomy">Partial cystectomy</option>
<option value="Radical cystectomy (total cystectomy)">Radical cystectomy (total cystectomy)</option>
<option value="Radical cystoprostatectomy">Radical cystoprostatectomy</option>
<option value="Anterior exenteration">Anterior exenteration</option>
<option value="Other (specify):">Other (specify):</option>
<option value="Not specified">Not specified</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Tumor site:</label>
</td>
<td>
<select class="element select large" ID="A02">
<option value=""></option>
<option value="Trigone">Trigone</option>
<option value="Right lateral wall">Right lateral wall</option>
<option value="Left lateral wall">Left lateral wall</option>
<option value="Anterior wall">Anterior wall</option>
<option value="Posterior wall">Posterior wall</option>
<option value="Dome">Dome</option>
<option value="Other (specify):">Other (specify):</option>
<option value="Not specified">Not specified</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Tumor size:</label>
</td>
<td>
<select class="element select large" ID="A03">
<option value=""></option>
<option value="Greatest dimension (mm): ">Greatest dimension (mm): </option>
<option value="All dimensions (mm x mm x mm): ">All dimensions (mm x mm x mm):</option>
<option value="Cannot be determined (explain):">Cannot be determined (explain):</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Microscopic descriptions:</label></legend>
<p><label class="description">- Tumor histology and immunohistochemical studies: </label>
<textarea ID="A04" class="element textarea medium"></textarea>
</p>
<p>
<table border="1">
<col width="50%">
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Genitourinary-Protocol-Folder\Bladder_4.1.0.0.REL_CAPCP.pdf#page=10" target="_blank">Histologic type (WHO 5e)</a>:</label>
</td>
<td>
<select class="element select large" ID="A05">
<option value=""></option>
<option value="Papillary urothelial carcinoma, noninvasive">Papillary urothelial carcinoma, noninvasive</option>
<option value="Urothelial carcinoma in situ">Urothelial carcinoma in situ</option>
<option value="Urothelial carcinoma, invasive (conventional)">Urothelial carcinoma, invasive (conventional)</option>
<option value="Urothelial carcinoma, microcystic">Urothelial carcinoma, microcystic</option>
<option value="Urothelial carcinoma, nested">Urothelial carcinoma, nested</option>
<option value="Urothelial carcinoma, tubular and microcystic">Urothelial carcinoma, tubular and microcystic</option>
<option value="Urothelial carcinoma, lymphoepithelioma-like">Urothelial carcinoma, lymphoepithelioma-like</option>
<option value="Urothelial carcinoma, plasmacytoid">Urothelial carcinoma, plasmacytoid</option>
<option value="Urothelial carcinoma, sarcomatoid">Urothelial carcinoma, sarcomatoid</option>
<option value="Urothelial carcinoma, giant cell">Urothelial carcinoma, giant cell</option>
<option value="Urothelial carcinoma, poorly differentiated">Urothelial carcinoma, poorly differentiated</option>
<option value="Urothelial carcinoma, lipid-rich">Urothelial carcinoma, lipid-rich</option>
<option value="Urothelial carcinoma, clear cell">Urothelial carcinoma, clear cell </option>
<option value="Urothelial carcinoma with squamous differentiation (with %):">Urothelial carcinoma with squamous differentiation (with %):</option>
<option value="Urothelial carcinoma with glandular differentiation (with %)">Urothelial carcinoma with glandular differentiation (with %)</option>
<option value="Urothelial carcinoma with trophoblastic differentiation (with %)">Urothelial carcinoma with trophoblastic differentiation (with %)</option>
<option value="Urothelial carcinoma with Mullerian differentiation (with %)">Urothelial carcinoma with Mullerian differentiation (with %)</option>
<option value="Squamous cell carcinoma">Squamous cell carcinoma</option>
<option value="Verrucous carcinoma">Verrucous carcinoma</option>
<option value="Squamous cell carcinoma in situ (no invasive carcinoma identified)">Squamous cell carcinoma in situ (no invasive carcinoma identified)</option>
<option value="Adenocarcinoma">Adenocarcinoma</option>
<option value="Adenocarcinoma, enteric">Adenocarcinoma, enteric</option>
<option value="Adenocarcinoma, mucinous">Adenocarcinoma, mucinous</option>
<option value="Adenocarcinoma, mixed">Adenocarcinoma, mixed</option>
<option value="Adenocarcinoma, signet-ring cell">Adenocarcinoma, signet-ring cell</option>
<option value="Adenocarcinoma in situ (no invasive carcinoma identified)">Adenocarcinoma in situ (no invasive carcinoma identified)</option>
<option value="Clear cell carcinoma">Clear cell carcinoma</option>
<option value="Endometrioid carcinoma">Endometrioid carcinoma</option>
<option value="Small cell neuroendocrine carcinoma (with %)">Small cell neuroendocrine carcinoma (with %)</option>
<option value="Large cell neuroendocrine carcinoma (with %)">Large cell neuroendocrine carcinoma (with %)</option>
<option value="Well differentiated neuroendocrine carcinoma (with %)">Well differentiated neuroendocrine carcinoma (with %)</option>
<option value="Other histologic type not listed (specify):">Other histologic type not listed (specify):</option>
<option value="Carcinoma, type cannot be determined:">Carcinoma, type cannot be determined:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Genitourinary-Protocol-Folder\Bladder_4.1.0.0.REL_CAPCP.pdf#page=13" target="_blank">Histologic grade for urothelial carcinoima</a>:</label>
</td>
<td>
<select class="element select large" ID="A13">
<option value=""></option>
<option value="Low grade">Low grade</option>
<option value="High grade">High grade</option>
<option value="Other (specify):">Other (specify):</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Genitourinary-Protocol-Folder\Bladder_4.1.0.0.REL_CAPCP.pdf#page=13" target="_blank">Histologic grade for SCC or adenoCA</a>:</label>
</td>
<td>
<select class="element select large" ID="A14">
<option value=""></option>
<option value="G1: Well differentiated">G1: Well differentiated</option>
<option value="G2: Moderately differentiated">G2: Moderately differentiated</option>
<option value="G3: Poorly differentiated">G3: Poorly differentiated</option>
<option value="GX: Cannot be assessed">GX: Cannot be assessed</option>
<option value="Other (specify):">Other (specify):</option>
<option value="Cannot be determined (explain):"> Cannot be determined (explain):</option>
<option value="Not applicable"> Not applicable</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label class="">+ Tumor configuration:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A15" value=" - Papillary"><label class="choice">Papillary</label>
<input class="element checkbox" type="checkbox" id="A16" value=" - Solid/nodule"><label class="choice">Solid/nodule</label>
<input class="element checkbox" type="checkbox" id="A17" value=" - Flat"><label class="choice">Flat</label>
<input class="element checkbox" type="checkbox" id="A18" value=" - Ulcerated"><label class="choice">Ulcerated</label>
<input class="element checkbox" type="checkbox" id="A19" value=" - Cannot be determined"><label class="choice">Cannot be determined</label>
<input class="element checkbox" type="checkbox" id="A20" value=" - Other (specify):"><label class="choice">Other (specify):</label>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Genitourinary-Protocol-Folder\Bladder_4.1.0.0.REL_CAPCP.pdf#page=16" target="_blank">Lymphatic and / or Vascular Invasion</a>: </label>
</td>
<td>
<select class="element select large" ID="A21">
<option value=""></option>
<option value="Not identified">Not identified</option>
<option value="Present">Present</option>
<option value="Cannot be determined">Cannot be determined</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="">+ Perineural invasion: </label>
</td>
<td>
<select class="element select large" ID="A22">
<option value=""></option>
<option value="Not identified">Not identified</option>
<option value="Present">Present</option>
<option value="Cannot be determined">Cannot be determined</option>
</select>
</td>
</tr>
</table>
</p>
<p><label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Genitourinary-Protocol-Folder\Bladder_4.1.0.0.REL_CAPCP.pdf#page=14" target="_blank">Tumor extension</a> :</label>
<input class="element checkbox" type="checkbox" id="A24" value=" - Noninvasive papillary carcinoma"><label class="choice">Noninvasive papillary carcinoma</label>
<input class="element checkbox" type="checkbox" id="A25" value=" - Urothelial carcinoma in situ, “flat tumor”"><label class="choice">Urothelial carcinoma in situ, “flat tumor”</label>
<input class="element checkbox" type="checkbox" id="A26" value=" - Tumor invades subepithelial connective tissue"><label class="choice">Tumor invades subepithelial connective tissue</label>
<input class="element checkbox" type="checkbox" id="A27" value=" - Tumor invades muscularis propria"><label class="choice">Tumor invades muscularis propria</label>
<input class="element checkbox" type="checkbox" id="A28" value=" - Tumor invades muscularis propria, superficial (inner half)"><label class="choice">Tumor invades muscularis propria, superficial (inner half)</label>
<input class="element checkbox" type="checkbox" id="A29" value=" - Tumor invades muscularis propria, deep (outer half)"><label class="choice">Tumor invades muscularis propria, deep (outer half)</label>
<input class="element checkbox" type="checkbox" id="A30" value=" - Tumor invades perivesical tissue"><label class="choice">Tumor invades perivesical tissue</label>
<input class="element checkbox" type="checkbox" id="A31" value=" - Tumor invades perivesical tissue, microscopic"><label class="choice">Tumor invades perivesical tissue, microscopic</label>
<input class="element checkbox" type="checkbox" id="A32" value=" - Tumor invades perivesical tissue, macroscopic"><label class="choice">Tumor invades perivesical tissue, macroscopic</label>
<input class="element checkbox" type="checkbox" id="A33" value=" - Tumor invades adjacent structures"><label class="choice" >Tumor invades adjacent structures</label>
<input class="element checkbox" type="checkbox" id="A34" value=" - Tumor invades adjacent structures, prostate (transmural invasion from the bladder tumor)"><label class="choice">Tumor invades adjacent structures, prostate (transmural invasion from the bladder tumor)</label>
<input class="element checkbox" type="checkbox" id="A35" value=" - Tumor invades adjacent structures, seminal vesicles"><label class="choice">Tumor invades adjacent structures, seminal vesicles</label>
<input class="element checkbox" type="checkbox" id="A36" value=" - Tumor invades adjacent structures, uterus"><label class="choice">Tumor invades adjacent structures, uterus</label>
<input class="element checkbox" type="checkbox" id="A37" value=" - Tumor invades adjacent structures, vagina"><label class="choice">Tumor invades adjacent structures, vagina</label>
<input class="element checkbox" type="checkbox" id="A38" value=" - Tumor invades adjacent structures, adnexae"><label class="choice">Tumor invades adjacent structures, adnexae</label>
<input class="element checkbox" type="checkbox" id="A39" value=" - Tumor invades adjacent structures, pelvis wall"><label class="choice">Tumor invades adjacent structures, pelvis wall</label>
<input class="element checkbox" type="checkbox" id="A40" value=" - Tumor invades adjacent structures, abdominal wall"><label class="choice">Tumor invades adjacent structures, abdominal wall</label>
<input class="element checkbox" type="checkbox" id="A41" value=" - Tumor invades adjacent structures, rectum"><label class="choice">Tumor invades adjacent structures, rectum</label>
<input class="element checkbox" type="checkbox" id="A42" value=" - Tumor invades adjacent structures, other (specify):"><label class="choice">Tumor invades adjacent structures, other (specify):</label>
<input class="element checkbox" type="checkbox" id="A43" value=" - Cannot be assessed"><label class="choice">Cannot be assessed</label>
<input class="element checkbox" type="checkbox" id="A23" value=" - No evidence of primary tumor"><label class="choice">No evidence of primary tumor</label>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Surgical margins of excision specimen: </label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- Right ureteral margin:</label>
</td>
<td>
<select class="element select large" ID="A44">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by invasive carcinoma">Uninvolved by invasive carcinoma</option>
<option value="Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma, specify distance:">Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma, specify distance:</option>
<option value="Involved by invasive carcinoma">Involved by invasive carcinoma</option>
<option value="Involved by carcinoma in situ/noninvasive high-grade urothelial carcinoma">Involved by carcinoma in situ/noninvasive high-grade urothelial carcinoma</option>
<option value="Involved by noninvasive low-grade urothelial carcinoma/urothelial dysplasia">Involved by noninvasive low-grade urothelial carcinoma/urothelial dysplasia</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Left ureteral margin:</label>
</td>
<td>
<select class="element select large" ID="A45">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by invasive carcinoma">Uninvolved by invasive carcinoma</option>
<option value="Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma, specify distance:">Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma, specify distance:</option>
<option value="Involved by invasive carcinoma">Involved by invasive carcinoma</option>
<option value="Involved by carcinoma in situ/noninvasive high-grade urothelial carcinoma">Involved by carcinoma in situ/noninvasive high-grade urothelial carcinoma</option>
<option value="Involved by noninvasive low-grade urothelial carcinoma/urothelial dysplasia">Involved by noninvasive low-grade urothelial carcinoma/urothelial dysplasia</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Urethral margin:</label>
</td>
<td>
<select class="element select large" ID="A46">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by invasive carcinoma">Uninvolved by invasive carcinoma</option>
<option value="Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma, specify distance:">Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma, specify distance:</option>
<option value="Involved by invasive carcinoma">Involved by invasive carcinoma</option>
<option value="Involved by carcinoma in situ/noninvasive high-grade urothelial carcinoma">Involved by carcinoma in situ/noninvasive high-grade urothelial carcinoma</option>
<option value="Involved by noninvasive low-grade urothelial carcinoma/urothelial dysplasia">Involved by noninvasive low-grade urothelial carcinoma/urothelial dysplasia</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Soft tissue margin:</label>
</td>
<td>
<select class="element select large" ID="A47">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by invasive carcinoma">Uninvolved by invasive carcinoma</option>
<option value="Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma, specify distance:">Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma, specify distance:</option>
<option value="Involved by invasive carcinoma">Involved by invasive carcinoma</option>
<option value="Involved by carcinoma in situ/noninvasive high-grade urothelial carcinoma">Involved by carcinoma in situ/noninvasive high-grade urothelial carcinoma</option>
<option value="Involved by noninvasive low-grade urothelial carcinoma/urothelial dysplasia">Involved by noninvasive low-grade urothelial carcinoma/urothelial dysplasia</option>
</select>
</td>
</tr>
<tr>
<td>
<label >- Other margin(s) (specify):</label>
</td>
<td>
<select class="element select large" ID="A48">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by invasive carcinoma">Uninvolved by invasive carcinoma</option>
<option value="Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma, specify distance:">Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma, specify distance:</option>
<option value="Involved by invasive carcinoma">Involved by invasive carcinoma</option>
<option value="Involved by carcinoma in situ/noninvasive high-grade urothelial carcinoma">Involved by carcinoma in situ/noninvasive high-grade urothelial carcinoma</option>
<option value="Involved by noninvasive low-grade urothelial carcinoma/urothelial dysplasia">Involved by noninvasive low-grade urothelial carcinoma/urothelial dysplasia</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class="description"> Regional lymph nodes: </label></legend>
<p>
<table border="1">
<col width="75%">
<tr>
<td>
<label class="description">- Number of regional lymph nodes examined:</label>
</td>
<td>
<input type="text" class="element text large" ID="A49" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Number of lymph nodes involved:</label>
</td>
<td>
<input type="text" class="element text large" ID="A50" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Extranodal extension:</label>
</td>
<td>
<select class="element select large" ID="A51">
<option value=""></option>
<option value="Not identified">Not identified</option>
<option value="Present">Present</option>
<option value="Cannot be determined">Cannot be determined</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Size of largest metastatic deposit (mm), specify site:</label>
</td>
<td>
<input type="text" class="element text large" ID="A52" size="20">
</td>
<tr>
<tr>
<td>
<label class="description">- Size of largest lymph node involved (mm), specify site:</label>
</td>
<td>
<input type="text" class="element text large" ID="A53" size="20">
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class="description"> Distant Metastasis: </label></legend>
<input class="element checkbox" type="checkbox" id="A72" value=" - Not applicable"><label class="choice" >Not applicable</label>
<input class="element checkbox" type="checkbox" id="A73" value=" - Not identified"><label class="choice" >Not identified</label>
<input class="element checkbox" type="checkbox" id="A74" value=" - Non-regional lymph node(s) (specify):"><label class="choice" >Non-regional lymph node(s) (specify):</label>
<input class="element checkbox" type="checkbox" id="A75" value=" - Other (specify):"><label class="choice" >Other (specify):</label>
<input class="element checkbox" type="checkbox" id="A76" value=" - Cannot be determined: "><label class="choice" >Cannot be determined: </label>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class="description"> <a href=".\cap\Cancer-Protocols-2021-06-Update\Genitourinary-Protocol-Folder\Bladder_4.1.0.0.REL_CAPCP.pdf#page=16" target="_blank">Pathologic Stage Classification (AJCC 8e)</a>:</label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td valign="top">
<label class="description"> - TNM Descriptors:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A54" value="m (multiple primary tumors) "><label class="choice">m (multiple primary tumors)</label>
<input class="element checkbox" type="checkbox" id="A55" value="r (recurrent) "><label class="choice">r (recurrent)</label>
<input class="element checkbox" type="checkbox" id="A56" value="y (post treatment) "><label class="choice" >y (post treatment)</label>
</td>
</tr>
<tr>
<td>
<label class="description"> - Primary tumor (pT) :</label>
</td>
<td>
<select class="element select large" ID="A57">
<option value=""></option>
<option value=" pT not assigned (cannot be determined based on available pathological information)"> pT not assigned (cannot be determined based on available pathological information)</option>
<option value="pT0: No evidence of primary tumor">pT0: No evidence of primary tumor</option>
<option value="pTa: Non-invasive papillary carcinoma">pTa: Non-invasive papillary carcinoma</option>
<option value="pTis: Urothelial carcinoma in situ: “flat tumor”">pTis: Urothelial carcinoma in situ: “flat tumor”</option>
<option value="pT1: Tumor invades subepithelial connective tissue">pT1: Tumor invades subepithelial connective tissue</option>
<option value="pT2: Tumor invades muscularis propria">pT2: Tumor invades muscularis propria</option>
<option value="pT2a: Tumor invades superficial muscularis propria (inner half)">pT2a: Tumor invades superficial muscularis propria (inner half)</option>
<option value="pT2b: Tumor invades deep muscularis propria (outer half)">pT2b: Tumor invades deep muscularis propria (outer half)</option>
<option value="pT3: Tumor invades perivesical soft tissue">pT3: Tumor invades perivesical soft tissue</option>
<option value="pT3a: Tumor invades perivesical soft tissue microscopically">pT3a: Tumor invades perivesical soft tissue microscopically</option>
<option value="pT3b: Tumor invades perivesical soft tissue macroscopically (extravesical mass)">pT3b: Tumor invades perivesical soft tissue macroscopically (extravesical mass)</option>
<option value="pT4: Extravesical tumor directly invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall">pT4: Extravesical tumor directly invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall</option>
<option value="pT4a: Extravesical tumor invades directly into prostatic stroma, seminal vesicles, uterus, or vagina">pT4a: Extravesical tumor invades directly into prostatic stroma, seminal vesicles, uterus, or vagina</option>
<option value="pT4b: Extravesical tumor invades pelvic wall, abdominal wall">pT4b: Extravesical tumor invades pelvic wall, abdominal wall</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description"> - Regional lymph nodes (pN): </label>
</td>
<td>
<select class="element select large" ID="A58">
<option value=""></option>
<option value="pN not assigned (no nodes submitted or found)">pN not assigned (no nodes submitted or found)</option>
<option value="pN not assigned (cannot be determined based on available pathological information)">pN not assigned (cannot be determined based on available pathological information)</option>
<option value="pN0: No regional lymph node metastasis">pN0: No regional lymph node metastasis</option>
<option value="pN1: Single regional lymph node metastasis in true pelvis (perivesical, obturator, internal [hypogastric] and external iliac), or presacral lymph node">pN1: Single regional lymph node metastasis in true pelvis (perivesical, obturator, internal [hypogastric] and external iliac), or presacral lymph node</option>
<option value="pN2: Multiple regional lymph node metastasis in true pelvis (perivesical, hypogastric, obturator, internal and external iliac, or presacral lymph node)">pN2: Multiple regional lymph node metastasis in true pelvis (perivesical, hypogastric, obturator, internal and external iliac, or presacral lymph node)</option>
<option value="pN3: Lymph node metastasis to the common iliac lymph nodes">pN3: Lymph node metastasis to the common iliac lymph nodes</option>
</select>
</td>
</tr>
<tr>
<td >
<label class="description"> - Distant metastasis (pM): </label>
</td>
<td>
<select class="element select large" ID="A59">
<option value=""></option>
<option value="Not applicable - pM cannot be determined from the submitted specimen(s)">Not applicable - pM cannot be determined from the submitted specimen(s)</option>
<option value="pM1: Distant metastasis">pM1: Distant metastasis</option>
<option value="pM1a: Distant metastasis limited to lymph nodes beyond the common iliacs">pM1a: Distant metastasis limited to lymph nodes beyond the common iliacs</option>
<option value="pM1b: Non-lymph node distant metastases">pM1b: Non-lymph node distant metastases</option>
</select>
</td>
</tr>
<!--
<tr>
<td>
- Specify site(s), if known:
<input type="text" class="element text small" ID="A60" size="35">
</td>
</tr>
-->
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class=""> + Additional pathologic findings: </label></legend>
<p>
<input class="element checkbox" type="checkbox" id="A62" value=" - Urothelial dysplasia, low-grade"><label class="choice">Urothelial dysplasia, low-grade</label>
<input class="element checkbox" type="checkbox" id="A63" value=" - Adenocarcinoma of prostate (use protocol for carcinoma of prostate)"><label class="choice">Adenocarcinoma of prostate (use protocol for carcinoma of prostate)</label>
<input class="element checkbox" type="checkbox" id="A64" value=" - Keratinizing squamous metaplasia"><label class="choice">Keratinizing squamous metaplasia</label>
<input class="element checkbox" type="checkbox" id="A65" value=" - Inflammation/regenerative changes"><label class="choice">Inflammation/regenerative changes</label>
<input class="element checkbox" type="checkbox" id="A66" value=" - Metaplasia (specify type):"><label class="choice">Metaplasia (specify type):</label>
<input class="element checkbox" type="checkbox" id="A67" value=" - Cystitis cystica et glandularis"><label class="choice">Cystitis cystica et glandularis</label>
<input class="element checkbox" type="checkbox" id="A68" value=" - Intestinal metaplasia"><label class="choice">Intestinal metaplasia</label>
<input class="element checkbox" type="checkbox" id="A69" value=" - Therapy-related changes, specify:"><label class="choice">Therapy-related changes, specify:</label>
</p>
<p>- Other (specify):
<input type="text" lass="element text medium" ID="A70" size="35">
</p>
<p>
<table border="1">
<col width="40%">
<tr>
<td valign="top">
<label class="">+ Associated epithelial lesions:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A06" value=" - None identified"><label class="choice">None identified</label>
<input class="element checkbox" type="checkbox" id="A07" value=" - Urothelial papilloma"><label class="choice">Urothelial papilloma</label>
<input class="element checkbox" type="checkbox" id="A08" value=" - Urothelial papilloma, inverted type"><label class="choice">Urothelial papilloma, inverted type</label>
<input class="element checkbox" type="checkbox" id="A09" value=" - Papillary urothelial neoplasm, low malignant potential (PUNLMP)"><label class="choice">Papillary urothelial neoplasm, low malignant potential (PUNLMP)</label>
<input class="element checkbox" type="checkbox" id="A10" value=" - Urothelial proliferation of uncertain malignant potential"><label class="choice">Urothelial proliferation of uncertain malignant potential</label>
<input class="element checkbox" type="checkbox" id="A11" value=" - Urothelial dysplasia"><label class="choice">Urothelial dysplasia</label>
<input class="element checkbox" type="checkbox" id="A12" value=" - Cannot be assessed (explain):"><label class="choice">Cannot be assessed (explain):</label>
</td>
</tr>
</table>
</fieldset>
</p>
<p>
<label class="description">- Additional notes:</label>
<textarea ID="A71" class = "element textarea medium" style="border-color:Grey;"></textarea>
</p>
<br><br>
<input type="button" name="copyform" value="Check your Report" onclick="updateDescription(this.form)"/>
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Last upated on 01-Oct-2023,<br>
based on <a href="https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates" target="_blank">US CAP cancer protocol templates</a>,<br>
Urinary Bladder Resection 4.2.0.0 (Sep-2023), <br>
html form was created on <a href="https://www.phpform.org">pForm</a>, <a href="https://www.w3schools.com/">W3 School</a>, <a href="https://stackoverflow.com/">StackOverflow</a>, and <a href="https://icons8.com">Icons8</a>.<br><br>
Anatomical Pathology Division, Queen Mary Hospital, Hong Kong.
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