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UG-Urethra.html
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<html xmlns="http://www.w3.org/1999/xhtml">
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<title>Carcinoma of the Urethra and Periurethral Glands</title>
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<style>
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<body>
<img id="top" src="top.png" alt="">
<div id="form_container">
<div class="form_description">
<h2><a href=".\cap\Cancer-Protocols-2024-12-Update\Genitourinary Protocol Folder\Urethra_4.3.0.0.REL.CAPCP.pdf" target="_blank">
<div class="tooltip">
Carcinoma of the urethra and periurethral glands
<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-2024-12-Update\Genitourinary Protocol Folder\Urethra.Bx_4.3.0.0.REL.CAPCP.pdf" target="_blank">biopsy specimen</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 urethrectomy">Partial urethrectomy</option>
<option value="Total urethrectomy">Total urethrectomy</option>
<option value="Urethrectomy with cystectomy">Urethrectomy with cystectomy</option>
<option value="Urethrectomy with cystoprostatectomy">Urethrectomy with cystoprostatectomy</option>
<option value="Urethrectomy with penectomy">Urethrectomy with penectomy</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="Male, penile urethra">Male, penile urethra</option>
<option value="Male, bulbomembranous urethra">Male, bulbomembranous urethra</option>
<option value="Male, prostatic urethra">Male, prostatic urethra</option>
<option value="Female, anterior urethra">Female, anterior urethra</option>
<option value="Female, posterior urethra">Female, posterior urethra</option>
<option value="Urethra, not otherwise specified">Urethra, not otherwise 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" name="A04" class="element textarea medium"></textarea>
</p>
<p>
<table border="1">
<col width="50%">
<tr>
<td>
<label class="description">- Histologic type (WHO 5e):</label>
+ Specify Percentages of Histologic Subtypes and Divergent Differentiations Present (totaling 100%)
</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, micropapillary">Urothelial carcinoma, micropapillary</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 (glycogen-rich)">Urothelial carcinoma, clear cell (glycogen-rich)</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, NOS">Adenocarcinoma, NOS</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="Littre gland adenocarcinoma">Littre gland adenocarcinoma</option>
<option value="Skene gland adenocarcinoma">Skene gland adenocarcinoma</option>
<option value="Cowper gland adenocarcinoma">Cowper gland adenocarcinoma</option>
<option value="Other histologic type not listed (specify):">Other histologic type not listed (specify):</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Genitourinary-Protocol-Folder\Urethra_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="A15">
<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\Urethra_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="A16">
<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="A17" value=" - Papillary"><label class="choice">Papillary</label>
<input class="element checkbox" type="checkbox" id="A18" value=" - Solid/nodule"><label class="choice">Solid/nodule</label>
<input class="element checkbox" type="checkbox" id="A19" value=" - Flat"><label class="choice">Flat</label>
<input class="element checkbox" type="checkbox" id="A20" value=" - Ulcerated"><label class="choice">Ulcerated</label>
<input class="element checkbox" type="checkbox" id="A21" value=" - Cannot be determined"><label class="choice">Cannot be determined</label>
<input class="element checkbox" type="checkbox" id="A22" value=" - Other (specify):"><label class="choice">Other (specify):</label>
</td>
</tr>
<tr>
<td>
<label class="">+ <a href=".\cap\Cancer-Protocols-2021-06-Update\Genitourinary-Protocol-Folder\Urethra_4.1.0.0.REL_CAPCP.pdf#page=13" target="_blank">Lymphatic and / or Vascular Invasion</a>: </label>
</td>
<td>
<select class="element select large" ID="A23">
<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">- Perineural invasion: </label>
</td>
<td>
<select class="element select large" ID="A24">
<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\Urethra_4.1.0.0.REL_CAPCP.pdf#page=13" target="_blank">Tumor extension (Male, Urothelial carcinoma of penile and bulbomembranous urethra)</a>:</label>
<input class="element checkbox" type="checkbox" id="A26" value=" - Noninvasive papillary carcinoma"><label class="choice">Noninvasive papillary carcinoma</label>
<input class="element checkbox" type="checkbox" id="A27" value=" - Carcinoma in situ"><label class="choice">Carcinoma in situ</label>
<input class="element checkbox" type="checkbox" id="A28" value=" - Tumor invades subepithelial connective tissue"><label class="choice">Tumor invades subepithelial connective tissue</label>
<input class="element checkbox" type="checkbox" id="A29" value=" - Tumor invades adjacent structures"><label class="choice">Tumor invades adjacent structures</label>
<input class="element checkbox" type="checkbox" id="A30" value=" - Tumor invades adjacent structures, corpus spongiosum"><label class="choice">Tumor invades adjacent structures, corpus spongiosum</label>
<input class="element checkbox" type="checkbox" id="A31" value=" - Tumor invades adjacent structures, periurethral muscle"><label class="choice">Tumor invades adjacent structures, periurethral muscle</label>
<input class="element checkbox" type="checkbox" id="A32" value=" - Tumor invades adjacent structures, corpus cavernosum"><label class="choice">Tumor invades adjacent structures, corpus cavernosum</label>
<input class="element checkbox" type="checkbox" id="A84" value=" - Tumor invades adjacent structures, scrutum"><label class="choice">Tumor invades adjacent structures, scrutum</label>
<input class="element checkbox" type="checkbox" id="A33" value=" - Tumor invades adjacent structures, urinary bladder wall"><label class="choice">Tumor invades adjacent structures, urinary bladder wall</label>
<input class="element checkbox" type="checkbox" id="A34" value=" - Tumor invades adjacent structures, rectum"><label class="choice">Tumor invades adjacent structures, rectum</label>
<input class="element checkbox" type="checkbox" id="A35" value=" - Tumor invades adjacent structures, other (specify):"><label class="choice">Tumor invades adjacent structures, other (specify):</label>
</p>
<p><label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Genitourinary-Protocol-Folder\Urethra_4.1.0.0.REL_CAPCP.pdf#page=13" target="_blank">Tumor extension (Male, Urothelial carcinoma of the prostatic urethra)</a>:</label>
<input class="element checkbox" type="checkbox" id="A85" value=" - Noninvasive papillary carcinoma"><label class="choice">Noninvasive papillary carcinoma</label>
<input class="element checkbox" type="checkbox" id="A37" value=" - Carcinoma in situ, involvement of the prostatic urethra"><label class="choice">Carcinoma in situ, involvement of the prostatic urethra</label>
<input class="element checkbox" type="checkbox" id="A38" value=" - Carcinoma in situ, involvement of the prostatic ducts"><label class="choice">Carcinoma in situ, involvement of the prostatic ducts</label>
<input class="element checkbox" type="checkbox" id="A39" value=" - Tumor invades urethral subepithelial connective tissue immediately underlying the urothelium"><label class="choice">Tumor invades urethral subepithelial connective tissue immediately underlying the urothelium</label>
<input class="element checkbox" type="checkbox" id="A40" value=" - Tumor invades the prostatic stroma surrounding ducts either by direct extension from the urothelial surface or by invasion from prostatic ducts"><label class="choice">Tumor invades the prostatic stroma surrounding ducts either by direct extension from the urothelial surface or by invasion from prostatic ducts</label>
<input class="element checkbox" type="checkbox" id="A41" value=" - Tumor invades the periprostatic fat"><label class="choice">Tumor invades the periprostatic fat</label>
<input class="element checkbox" type="checkbox" id="A42" value=" - Tumor invades adjacent structures"><label class="choice" >Tumor invades adjacent structures</label>
<input class="element checkbox" type="checkbox" id="A43" value=" - Tumor invades adjacent structures, extraprostatic invasion of the urinary bladder wall"><label class="choice">Tumor invades adjacent structures, extraprostatic invasion of the urinary bladder wall</label>
<input class="element checkbox" type="checkbox" id="A86" value=" - Tumor invades adjacent structures, extraprostatic invasion of seminal vesicle"><label class="choice">Tumor invades adjacent structures, extraprostatic invasion of seminal vesicle</label>
<input class="element checkbox" type="checkbox" id="A44" value=" - Tumor invades adjacent structures, rectum"><label class="choice">Tumor invades adjacent structures, rectum</label>
<input class="element checkbox" type="checkbox" id="A45" value=" - Tumor invades adjacent structures, Other (specify):"><label class="choice">Tumor invades adjacent structures, Other (specify):</label>
</p>
<p><label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Genitourinary-Protocol-Folder\Urethra_4.1.0.0.REL_CAPCP.pdf#page=13" target="_blank">Tumor extension (female)</a>:</label>
<input class="element checkbox" type="checkbox" id="A47" value=" - Noninvasive papillary carcinoma"><label class="choice">Noninvasive papillary carcinoma</label>
<input class="element checkbox" type="checkbox" id="A48" value=" - Carcinoma in situ"><label class="choice">Carcinoma in situ</label>
<input class="element checkbox" type="checkbox" id="A49" value=" - Tumor invades subepithelial connective tissue"><label class="choice">Tumor invades subepithelial connective tissue</label>
<input class="element checkbox" type="checkbox" id="A50" value=" - Tumor invades adjacent structures"><label class="choice" >Tumor invades adjacent structure</label>
<input class="element checkbox" type="checkbox" id="A51" value=" - Tumor invades adjacent structures, periurethral muscle (fibromuscular and adipose tissue)"><label class="choice" >Tumor invades adjacent structures, periurethral muscle (fibromuscular and adipose tissue)</label>
<input class="element checkbox" type="checkbox" id="A52" value=" - Tumor invades adjacent structures, anterior vagina"><label class="choice">Tumor invades adjacent structures, anterior vagina</label>
<input class="element checkbox" type="checkbox" id="A53" value=" - Tumor invades adjacent structures, urinary bladder wall"><label class="choice">Tumor invades adjacent structures, urinary bladder wall</label>
<input class="element checkbox" type="checkbox" id="A54" value=" - Tumor invades adjacent structures, rectum"><label class="choice">Tumor invades adjacent structures, rectum</label>
<input class="element checkbox" type="checkbox" id="A55" value=" - Tumor invades adjacent structures, other (specify):"><label class="choice">Tumor invades adjacent structures, other (specify):</label>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Surgical margins: </label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- Proximal mucosal margin:</label>
</td>
<td>
<select class="element select large" ID="A56">
<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">Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma</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">- Distal mucosal margin:</label>
</td>
<td>
<select class="element select large" ID="A57">
<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">Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma</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">- Deep soft tissue margin:</label>
</td>
<td>
<select class="element select large" ID="A58">
<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">Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma</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="A59">
<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">Uninvolved by invasive carcinoma and carcinoma in situ/ noninvasive urothelial carcinoma</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" name="A60" class="element text large" ID="A60" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Number of lymph nodes involved:</label>
</td>
<td>
<input type="text" name="A61" class="element text large" ID="A61" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Extracapsular spread:</label>
</td>
<td>
<select class="element select large" ID="A62">
<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" name="A63" class="element text large" ID="A63" size="20">
</td>
</tr>
<tr>
<td>
<label class="description">- Size of largest lymph node involved (mm), specify site:</label>
</td>
<td>
<input type="text" name="A64" class="element text large" ID="A64" 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="A80" value=" - Not applicable"><label class="choice" >Not applicable</label>
<input class="element checkbox" type="checkbox" id="A81" value=" - Not identified"><label class="choice" >Not identified</label>
<input class="element checkbox" type="checkbox" id="A82" value=" - Other (specify):"><label class="choice" >Other (specify):</label>
<input class="element checkbox" type="checkbox" id="A83" 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\Urethra_4.1.0.0.REL_CAPCP.pdf#page=15" target="_blank">Pathologic Stage Classification (AJCC 8e)</a>:</label></legend>
<p>
<table border="1">
<col width="75%">
<tr>
<td valign="top">
<label class="description"> - TNM Descriptors:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A65" value="m (multiple primary synchronous tumors in a single organ) "><label class="choice">m (multiple primary synchronous tumors in a single organ)</label>
<input class="element checkbox" type="checkbox" id="A66" value="r (recurrent) "><label class="choice">r (recurrent)</label>
<input class="element checkbox" type="checkbox" id="A67" value="y (post treatment) "><label class="choice">y (post treatment)</label>
</td>
</tr>
<tr>
<td>
<label class="description"> - Primary tumor (pT) (for the male penile urethra and female urethra):</label>
</td>
<td>
<select class="element select large" ID="A68">
<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: Carcinoma in situ">pTis: Carcinoma in situ</option>
<option value="pT1: Tumor invades subepithelial connective tissue">pT1: Tumor invades subepithelial connective tissue</option>
<option value="pT2: Tumor invades any of the following: corpus spongiosum, periurethral muscle">pT2: Tumor invades any of the following: corpus spongiosum, periurethral muscle</option>
<option value="pT3: Tumor invades any of the following: corpus cavernosum, anterior vagina">pT3: Tumor invades any of the following: corpus cavernosum, anterior vagina</option>
<option value="pT4: Tumor invades other adjacent organs (eg, invasion of the bladder wall)">pT4: Tumor invades other adjacent organs (eg, invasion of the bladder wall)</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description"> - Primary tumor (pT) (for prostatic urethra):</label>
</td>
<td>
<select class="element select large" ID="A69">
<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: Carcinoma in situ involving the prostatic urethra or periurethral or prostatic ducts without stromal invasion">pTis: Carcinoma in situ involving the prostatic urethra or periurethral or prostatic ducts without stromal invasion</option>
<option value="pT1: Tumor invades urethral subepithelial connective tissue immediately underlying the urothelium">pT1: Tumor invades urethral subepithelial connective tissue immediately underlying the urothelium</option>
<option value="pT2: Tumor invades the prostatic stroma surrounding ducts either by direct extension from the urothelial surface or by invasion from prostatic ducts">pT2: Tumor invades the prostatic stroma surrounding ducts either by direct extension from the urothelial surface or by invasion from prostatic ducts</option>
<option value="pT3: Tumor invades the periprostatic fat">pT3: Tumor invades the periprostatic fat</option>
<option value="pT4: Tumor invades other adjacent organs (eg, extraprostatic invasion of the bladder wall, rectal wall)">pT4: Tumor invades other adjacent organs (eg, extraprostatic invasion of the bladder wall, rectal wall)</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description"> - Regional lymph nodes (pN):</label>
</td>
<td>
<select class="element select large" ID="A70">
<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 the inguinal region or true pelvis (perivesical, obturator, internal [hypogastric] and external iliac), or presacral lymph node">pN1: Single regional lymph node metastasis in the inguinal region or true pelvis (perivesical, obturator, internal [hypogastric] and external iliac), or presacral lymph node</option>
<option value="pN2: Multiple regional lymph node metastasis in the inguinal region or true pelvis (perivesical, hypogastric, obturator, internal and external iliac, or presacral lymph node)">pN2: Multiple regional lymph node metastasis in the inguinal region or true pelvis (perivesical, hypogastric, obturator, internal and external iliac, or presacral lymph node)</option>
</select>
</td>
</tr>
<tr>
<td >
<label class="description"> - Distant metastasis (pM): </label>
</td>
<td>
<select class="element select large" ID="A71">
<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>
</select>
</td>
</tr>
<!--
<tr>
<td>
- Specify site(s):
<input type="text" name="A72" class="element text large" ID="A72" 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="A73" value=" - Keratinizing squamous metaplasia"><label class="choice">Keratinizing squamous metaplasia</label>
<input class="element checkbox" type="checkbox" id="A74" value=" - Inflammation/regenerative changes"><label class="choice">Inflammation/regenerative changes</label>
<input class="element checkbox" type="checkbox" id="A87" value=" - Therapy-related changes (specify):"><label class="choice">Therapy-related changes (specify):</label>
<input class="element checkbox" type="checkbox" id="A88" value=" - Cautery artifact"><label class="choice">Cautery artifact</label>
<input class="element checkbox" type="checkbox" id="A75" value=" - Metaplasia (specify type):"><label class="choice">Metaplasia (specify type):</label>
<input class="element checkbox" type="checkbox" id="A76" value=" - Urethritis cystica et glandularis"><label class="choice">Urethritis cystica et glandularis</label>
<input class="element checkbox" type="checkbox" id="A77" value=" - Intestinal metaplasia"><label class="choice">Intestinal metaplasia</label>
<p>- Other (specify):
<input type="text" name="A78" class="element text medium" ID="A78" size="35">
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<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=" - Condyloma acuminata"><label class="choice">Condyloma acuminata</label>
<input class="element checkbox" type="checkbox" id="A08" value=" - Squamous dysplasia (low, intermediate, high grade)"><label class="choice">Squamous dysplasia (low, intermediate, high grade)</label>
<input class="element checkbox" type="checkbox" id="A09" value=" - Urothelial papilloma"><label class="choice">Urothelial papilloma</label>
<input class="element checkbox" type="checkbox" id="A10" value=" - Urothelial papilloma, inverted type"><label class="choice">Urothelial papilloma, inverted type</label>
<input class="element checkbox" type="checkbox" id="A11" 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="A12" value=" - Urothelial proliferation of uncertain malignant potential"><label class="choice">Urothelial proliferation of uncertain malignant potential</label>
<input class="element checkbox" type="checkbox" id="A13" value=" - Urothelial dysplasia"><label class="choice">Urothelial dysplasia</label>
<input class="element checkbox" type="checkbox" id="A14" value=" - Cannot be assessed (explain):"><label class="choice" >Cannot be assessed (explain):</label>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<label class="description">- Additional notes:</label>
<textarea ID="A79" name="A79" class = "element textarea medium" style="border-color:Grey;"></textarea>
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Last upated on 23-Dec-2024,<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>
Urethra Resection 4.3.0.0 (Dec-2024), <br>
html form 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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