Form:Lung Reference High Risk to Case Set B v1.0


CDE IDCDE Description
* 1063Site Participant ID (Go To: 422)
* 422EDRN Site ID (Go To: 423)
* 423EDRN Protocol ID (Go To: 1219)
* 1219Date of contact (MM/DD/YYYY): (Go To: 2655)
* 2655Proposed study group (Go To: 1216)
 
Permissible Values (value):Set B Controls: High Risk with CT nodule (8)
 
 Set B Controls: High risk with no nodule (9)
   1216Date of diagnosis of lung cancer (histological or cytopathological report) (MM/DD/YYYY): (Go To: 1220)
   1220Disease status: (Go To: 1302)
 
Permissible Values (value):Relapsed (1)
 
 Refractory (2)
 
 Stable Disease (3)
 
 Progression (4)
 
 Recurrence/relapse (5)
 
 Primary (advanced) (6)
 
 No evidence of disease (7)
 
 Unknown/refused (9)
   1302Age at diagnosis (Go To: 1338)
* 1338Histologic confirmation? (Go To: 1257)
 
Permissible Values (value):No (0)
 
 Yes (1)
   1257Histologic type (lung): (Go To: 720)
 
Permissible Values (value):Squamous cell carcinoma (1)
 
 Papillary squamous cell carcinoma (2)
 
 Clear cell squamous cell carcinoma (3)
 
 Small cell squamous cell carcinoma (4)
 
 Basaloid squamous cell carcinoma (5)
 
 Small cell carcinoma (6)
 
 Combined small cell carcinoma (7)
 
 Adenocarcinoma (8)
 
 Acinar adenocarcinoma (9)
 
 Papillary adenocarcinoma (10)
 
 Bronchioloalveolar carcinoma (11)
 
 Non-mucinous (12)
 
 Mucinous (13)
 
 Mixed mucinous and non-mucinous or indeterminate (14)
 
 Solid adenocarcinoma with mucin formation (15)
 
 Adenocarcinoma with mixed subtypes (16)
 
 Large cell carcinoma (17)
 
 Other (95)
 
 Unknown/refused (99)
   720Anatomical site (Go To: 1241)
 
Permissible Values (value):Bladder (1)
 
 Bladder peritoneum (2)
 
 Bowel peritoneum/serosa (3)
 
 Corpus (4)
 
 Cervix (5)
 
 Cul-de-sac (6)
 
 Diaphram (7)
 
 Fallopian tube (8)
 
 Omentum (9)
 
 Paracolic gutter (10)
 
 Pelvic wall (11)
 
 Peritoneum/uterine serosa (12)
 
 Vagina (13)
 
 Ovary (14)
 
 Mainstem bronchus (15)
 
 Carina (16)
 
 Upper lobe (UL) (17)
 
 Lower lobe (LL) (18)
 
 Middle lobe (ML) (19)
 
 Ureter (20)
 
 Renal pelvis (21)
 
 Endometrium (22)
 
 Lymph node (25)
 
 Other (95)
 
 Responses are organ-specific (999)
   1241Histologic dimensions - height (cm): (Go To: 1242)
   1242Histologic dimensions - width (cm): (Go To: 1243)
   1243Histologic dimensions - depth (cm): (Go To: 1244)
   1244Histologic dimensions - volume (ml): (Go To: 1245)
   1245Distance/pleural margin (mm): (Go To: 1246)
   1246Distance/bronchial margin (mm): (Go To: 786)
   1217Date of thoracotomy (MM/DD/YYYY): (Go To: 1234)
   1234Chest X-ray date (MM/DD/YYYY): (Go To: 1235)
   1235Chest X-ray nodule size (cm): (Go To: 1236)
   1236Chest X-ray nodule location: (Go To: 2656)
   2656Chest X-ray nodule shape: (Go To: 1237)
 
Permissible Values (value):Smooth (0)
 
 Lobulated (2)
 
 Spiculated (5)
 
 Unknown (99)
   1237Chest CT date: (Go To: 1238)
   1238Chest CT nodule size (cm): (Go To: 1239)
   1239Chest CT nodule location: (Go To: 2657)
   2657CT nodule shape: (Go To: 1268)
 
Permissible Values (value):Smooth (0)
 
 Lobulated (2)
 
 Spiculated (5)
 
 Unknown (99)
   1268PET scan date (MM/YYYY): (Go To: 1269)
   1269PET scan standardized uptake value (SUV) for the lesion: (Go To: 1273)
 
Permissible Values (value):Less than 2.5 (1)
 
 Greater than or equal to 2.5 (2)
   1273PET scan standardized uptake value (SUV) for the liver: (Go To: 1274)
   1274PET scan other hotspots: (Go To: 786)
 
Permissible Values (value):Mediastinum (1)
 
 Bone (2)
 
 Brain (3)
 
 Adrenal (5)
 
 Liver (10)
 
 Lung (12)
 
 None (44)
   786Lung T-Stage, Pathologic (Go To: 789)
 
Permissible Values (value):pTX (1)
 
 pT0 (2)
 
 pTis (4)
 
 pT1 (8)
 
 pT2 (13)
 
 pT3 (16)
 
 pT4 (19)
   789Lung N-Stage, Pathologic (Go To: 790)
 
Permissible Values (value):pNX (1)
 
 pN0 (2)
 
 pN1 (7)
 
 pN2 (12)
 
 pN3 (15)
   790Lung M-Stage, Pathologic (Go To: 785)
 
Permissible Values (value):pMX (1)
 
 pM0 (2)
 
 pM1 (3)
   785Lung T-Stage, Clinical (Go To: 787)
 
Permissible Values (value):TX (1)
 
 T0 (2)
 
 Tis (3)
 
 T1 (4)
 
 T2 (5)
 
 T3 (6)
 
 T4 (7)
   787Lung N-Stage, Clinical (Go To: 788)
 
Permissible Values (value):NX (1)
 
 N0 (2)
 
 N1 (3)
 
 N2 (4)
 
 N3 (5)
   788Lung M-Stage, Clinical (Go To: 1240)
 
Permissible Values (value):MX (1)
 
 M0 (2)
 
 M1 (3)
   1240Reported adenopathy > 1 cm in the mediastinum at time of diagnosis? (Go To: 1266)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown/refused (9)
   1266Other lung diseases participant has: (Go To: 2148)
 
Permissible Values (value):COPD (1)
 
 Asthma (2)
 
 Pulmonary fibrosis (3)
 
 Sarcoidosis (4)
 
 Granulomatosis (5)
 
 Cavitary lesion (6)
 
 Bronchiectasis (7)
   2148Primary cancer treatment(s) received: (Go To: 1258)
 
Permissible Values (value):Chemotherapy (1)
 
 Radiation therapy (2)
 
 Surgery (3)
 
 Hormone therapy (4)
 
 Cryotherapy (5)
 
 LHRH agonists or anti-androgens hormone therapy (6)
 
 Unknown/refused (9)
 
 None (44)
 
 Other (95)
   1258Chemotherapy treatment(s) received: [specify drug(s)] (Go To: 1259)
   1259Chemotherapy start date (MM/YYYY): (Go To: 1260)
   1260Chemotherapy end date (MM/YYYY): (Go To: 1261)
   1261Radiation therapy received: (specify site) (Go To: 1262)
   1262Radiation therapy start date: (MM/YYYY): (Go To: 1263)
   1263Radiation therapy end date: (MM/YYYY): (Go To: 1264)
   1264Total dose to chest: (cGy) (Go To: 1265)
   1265Total dose to other organ(s): (cGy) (Go To: 1282)
   1282Radiation therapy (RT) volume [cubic mm]: (Go To: 1281)
   1281Radiation therapy (RT) complications: (Go To: 1279)
 
Permissible Values (value):Pneumonitis requiring steroids (1)
 
 Esophagitis requiring IVF (2)
 
 Feeding tube (3)
 
 Hospitalization (4)
 
 Other (95)
   1279Response to treatment (imaging criteria) (Go To: 1278)
 
Permissible Values (value):No (0)
 
 Yes (1)
   1278Date of response (MM/DD/YYYY): (Go To: 1221)
   1280Overall survival (OS) in days: (Go To: 1272)
   1272Living status: (Go To: 1218)
 
Permissible Values (value):Alive with disease (1)
 
 Alive with no evidence of disease (NED) (2)
 
 Dead (3)
 
 Unknown (99)
   1218Last date known alive (MM/DD/YYYY): (Go To: 1336)
   1336Date of death (MM/DD/YYYY): (Go To: 1332)
   1332Cause of death: (Go To: 1271)
   1271Comorbidities: (Go To: 1097)
 
Permissible Values (value):Myocardial infarction (1)
 
 Congestive heart failure (2)
 
 Peripheral vascular disease (3)
 
 Cerebrovascular disease (4)
 
 Dementia (5)
 
 Chronic pulmonary disease (6)
 
 Connective tissue disease (7)
 
 Ulcer disease (8)
 
 Mild liver disease (9)
 
 Diabetes (10)
 
 Hemiplegia (11)
 
 Moderate or severe renal disease (12)
 
 Diabetes with end organ damage (13)
 
 Moderate or severe liver disease (14)
 
 Metastatic solid tumor (15)
 
 AIDS (16)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)