Form:	DCP Follow-up Form v1.3

CDE ID	CDE Description
* 421	EDRN Participant ID (Go To: 866)
* 866	Date of follow-up visit: (Go To: 423)
* 423	EDRN Protocol ID (Go To: 422)
* 422	EDRN Site ID (Go To: 929)
* 929	EDRN Staff ID of the person who collected the data: (Go To: 1046)
* 1046	Is participant alive? (Go To: 905)
	Permissible Values (value): No (0) (Go To: 1048)
	Yes (1) (Go To: 905)
	Unknown/refused (9) (Go To: 1218)
1218	Last date known alive (MM/DD/YYYY): (Go To: 905)
1048	Date of death (Go To: 1047)
1047	Cause of death: (Go To: 905)
* 905	New primary cancer [other than basal/squamous cell skin cancer] confirmed by a doctor since last routine study contact? (Have you been diagnosed with a new primary cancer [other than basal/squamous cell skin cancer] since your last routine study contact?) (Go To: 1711)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 742)
	Unknown/refused (9)
* 742	Cancer type/location (Go To: 510)
	Permissible Values (value): Bladder (1)
	Bone (2)
	Brain (3)
	Breast (4)
	Cervix (5)
	Colon (6)
	Esophagus (7)
	Head & neck (mouth, nose, and throat) (8)
	Kidney (9)
	Liver (10) (Go To: 1052)
	Leukemia (11)
	Lung (12)
	Lymphoma, including Hodgkins (13)
	Ovary (14)
	Pancreas (15)
	Prostate (16)
	Rectum (17)
	Skin (melanoma, no basal or squamous) (18)
	Stomach (19)
	Thyroid (20)
	Uterus (21)
	Testis (24)
	Vagina (26)
	None (44)
	Other (95) (Go To: 728)
	Other, specify: (97)
	Unknown/refused (999)
* 1052	Is hepatocellular carcinoma (HCC) the type of liver cancer the participant has been diagnosed with? (Go To: 510)
	Permissible Values (value): No (0)
	Yes (1)
728	Cancer type/location (Other, specify) (Go To: 510)
510	Date of diagnosis (MM/YYYY) (Go To: 996)
1206	Is pathology report for current hepatocellular carcinoma available? (Go To: 1051)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 968)
968	Date of procedure that generated pathology report (MM/DD/YYYY): (Go To: 706)
706	Method of acquisition (Go To: 1711)
	Permissible Values (value): Biopsy (1)
	Excised during surgery (2)
	Fine needle aspirate (3)
	Autopsy (4)
* 1711	Were any imaging tests performed since last routine contact? (Go To: 514)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1051)
	Unknown/refused (9)
* 1051	Number of liver imaging tests performed since participant's last routine study contact: (Go To: 955)
955	Date of imaging test (MM/DD/YYYY): (Go To: 956)
956	Type of abdominal imaging: (Go To: 965)
	Permissible Values (value): Ultrasound (1)
	CT scan (2)
	Angiogram (3)
	MRI (4)
	Other, specify: (97) (Go To: 957)
957	Type of abdominal imaging (other, specify): (Go To: 965)
965	Number of lesions (Go To: 966)
966	Maximum diameter of largest lesion (in cm) (Go To: 958)
958	Evidence of arterial hypervascularization? (Go To: 959)
	Permissible Values (value): No (0)
	Yes (1)
959	Evidence of portal vein thrombosis? (Go To: 960)
	Permissible Values (value): No (0)
	Yes (1)
960	Evidence of metastases, including extrahepatic portal or hepatic vein? (Go To: 514)
	Permissible Values (value): No (0)
	Yes (1)
514	Have you had any full-blooded brothers, sisters, sons, or daughters born into your family since last routine study contact? [Not including half-siblings, step-siblings, or step-children.] (Go To: 1086)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 870)
	Unknown/refused (9)
870	Number of blood-related daughters born into participant's family since last routine study contact: (How many blood-related daughters have been born into your family since your last routine study contact?) [Not including adopted, foster, or step-daughters] (Go To: 869)
869	Number of blood-related sons born into participant's family since last routine study contact: (How many blood-related sons have been born into your family since your last routine study contact?) [Not including adopted, foster, or step-sons] (Go To: 872)
872	Number of blood-related brothers born into participant's family since last routine study contact: (How many blood-related brothers have been born into your family since your last routine study contact?) [Not including adopted, foster, half-sisters or step-brothers] (Go To: 871)
871	Number of blood-related sisters born into participant's family since last routine study contact: (How many blood-related sisters have been born into your family since your last routine study contact?) [Not including adopted, foster, half-sisters or step-sisters] (Go To: 1086)
1086	Have any of your first degree blood relatives (biological parents, siblings, children) been diagnosed with cancer [other than basal/squamous cell skin cancer] since your last routine study contact? [Not including half-siblings, step-siblings, or step-children.] (Go To: 1712)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1087)
	Unknown/refused (9)
* 1087	How many of the participant´s living and deceased first degree blood relatives have been diagnosed with cancer [other than basal/squamous cell skin cancer] since last routine study contact? (How many of your living and deceased first degree blood relatives (biological parents, siblings, children) have been diagnosed with cancer [other than basal/squamous cell skin cancer] since your last routine study contact? [Not including half-siblings, step-siblings, step-parents, or step-children].) (Go To: 1201)
* 1201	Relative type (mother, brother, etc) (Go To: 520)
	Permissible Values (value): Brother (1)
	Sister (2)
	Son (3)
	Daughter (4)
	Father (5)
	Mother (6)
	Unknown/refused (9)
* 520	Age when diagnosed (Go To: 741)
* 741	Cancer type/Location (Go To: 729)
	Permissible Values (value): Bladder (1)
	Bone (2)
	Brain (3)
	Breast (4)
	Cervix (5)
	Colon (6)
	Esophagus (7)
	Head & neck (mouth, nose, and throat) (8)
	Kidney (9)
	Liver (10)
	Leukemia (11)
	Lung (12)
	Lymphoma, including Hodgkins (13)
	Ovary (14)
	Pancreas (15)
	Prostate (16)
	Rectum (17)
	Skin (melanoma, no basal or squamous) (18)
	Stomach (19)
	Thyroid (20)
	Uterus (21)
	Testis (24)
	Vagina (26)
	Other (95)
	Other, specify: (97) (Go To: 729)
	Unknown/refused (99)
	Unknown/refused (999)
729	Cancer type/Location (Other, specify) (Go To: 1712)
1712	Was AFP evaluated since last routine contact? (Go To: 1097)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 969)
	Unknown/refused (9)
* 969	Date of AFP (MM/DD/YYYY): (Go To: 1035)
* 1035	AFP(ng/ml): (Go To: 1097)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)