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

CDE ID	CDE Description
* 1063	Site Participant ID (Go To: 422)
* 422	EDRN Site ID (Go To: 423)
* 423	EDRN Protocol ID (Go To: 1219)
* 1219	Date of contact (MM/DD/YYYY): (Go To: 2733)
2733	Proposed study group (Go To: 1216)
	Permissible Values (value): Set C Cases: Lung cancer (prospective) (21)
	Set C Controls: High Risk (prospective) (23)
	Set C Controls: Other cancers (prospective) (25)
1216	Date of diagnosis of lung cancer (histological or cytopathological report) (MM/DD/YYYY): (Go To: 1220)
1220	Disease 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)
1302	Age at diagnosis (Go To: 1338)
1338	Histologic confirmation? (Go To: 1257)
	Permissible Values (value): No (0)
	Yes (1)
1257	Histologic 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)
720	Anatomical 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)
1241	Histologic dimensions - height (cm): (Go To: 1242)
1242	Histologic dimensions - width (cm): (Go To: 1243)
1243	Histologic dimensions - depth (cm): (Go To: 1244)
1244	Histologic dimensions - volume (ml): (Go To: 1245)
1245	Distance/pleural margin (mm): (Go To: 1246)
1246	Distance/bronchial margin (mm): (Go To: 786)
786	Lung T-Stage, Pathologic (Go To: 789)
	Permissible Values (value): pTX (1)
	pT0 (2)
	pTis (4)
	pT1 (8)
	pT2 (13)
	pT3 (16)
	pT4 (19)
789	Lung N-Stage, Pathologic (Go To: 790)
	Permissible Values (value): pNX (1)
	pN0 (2)
	pN1 (7)
	pN2 (12)
	pN3 (15)
790	Lung M-Stage, Pathologic (Go To: 785)
	Permissible Values (value): pMX (1)
	pM0 (2)
	pM1 (3)
785	Lung T-Stage, Clinical (Go To: 787)
	Permissible Values (value): TX (1)
	T0 (2)
	Tis (3)
	T1 (4)
	T2 (5)
	T3 (6)
	T4 (7)
787	Lung N-Stage, Clinical (Go To: 788)
	Permissible Values (value): NX (1)
	N0 (2)
	N1 (3)
	N2 (4)
	N3 (5)
788	Lung M-Stage, Clinical (Go To: 1240)
	Permissible Values (value): MX (1)
	M0 (2)
	M1 (3)
1240	Reported adenopathy > 1 cm in the mediastinum at time of diagnosis? (Go To: 1266)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
1266	Other 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)
2148	Primary 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)
	Other, specify: (97)
1258	Chemotherapy treatment(s) received: [specify drug(s)] (Go To: 1259)
1259	Chemotherapy start date (MM/YYYY): (Go To: 1260)
1260	Chemotherapy end date (MM/YYYY): (Go To: 1261)
1261	Radiation therapy received: (specify site) (Go To: 1262)
1262	Radiation therapy start date: (MM/YYYY): (Go To: 1263)
1263	Radiation therapy end date: (MM/YYYY): (Go To: 1264)
1264	Total dose to chest: (cGy) (Go To: 1265)
1265	Total dose to other organ(s): (cGy) (Go To: 1282)
1282	Radiation therapy (RT) volume [cubic mm]: (Go To: 1281)
1281	Radiation therapy (RT) complications: (Go To: 1279)
	Permissible Values (value): Pneumonitis requiring steroids (1)
	Esophagitis requiring IVF (2)
	Feeding tube (3)
	Hospitalization (4)
	Other (95)
1279	Response to treatment (imaging criteria) (Go To: 1278)
	Permissible Values (value): No (0)
	Yes (1)
1278	Date of response (MM/DD/YYYY): (Go To: 1280)
1280	Overall survival (OS) in days: (Go To: 1272)
1272	Living status: (Go To: 1218)
	Permissible Values (value): Alive with disease (1)
	Alive with no evidence of disease (NED) (2)
	Dead (3)
	Unknown (99)
1218	Last date known alive (MM/DD/YYYY): (Go To: 1336)
1336	Date of death (MM/DD/YYYY): (Go To: 1332)
1332	Cause of death: (Go To: 1271)
1271	Comorbidities: (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)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)