This page is part of the RCPA Cancer Protocols IG (v0.1.0: Release 1 Draft) based on FHIR R3. . For a full list of available versions, see the Directory of published versions

Generated Example

{
  "resourceType" : "Colorectal",
  "id" : "Colorectal-genexample-10",
  "subject" : {
    "reference" : "Patient/8003608166687558"
  },
  "requester" : {
    "reference" : "Practitioner/8003616566682137"
  },
  "performer" : {
    "reference" : "Organization/8003623233350148"
  },
  "preAnalytic" : {
    "clinicalInformation" : "Ca rectum - was quite large. Post long course radio Tx.  Pre radio Tx staging T3N1M0",
    "tumourLocation" : [
      "34402009"
    ],
    "typeOfOperation" : {
      "code" : "4558008"
    },
    "preoperativeRadiotherapy" : "373066001",
    "typeOfCourse" : "260384008",
    "RecurrenceDescription" : "Presence of distant metastasis:  Absent."
  },
  "macro" : {
    "specimenLength" : {
      "value" : 270,
      "unit" : "mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "mm"
    },
    "tumourSite" : "34402009",
    "maxTumourDiameter" : {
      "value" : 15,
      "unit" : "x10mm (ulcer)",
      "system" : "http://unitsofmeasure.org",
      "code" : "x10mm (ulcer)"
    },
    "distanceNearerProxOrDistal" : [
      {
        "value" : 75,
        "unit" : "mm (distal)",
        "system" : "http://unitsofmeasure.org",
        "code" : "mm (distal)"
      }
    ],
    "distNonperitonCircumMargin" : {
      "value" : 15,
      "unit" : "mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "mm"
    },
    "tumourPerforation" : "2667000",
    "relToAntPeritonealReflection" : "entirely_below",
    "intactnessOfMesorectum" : "408657005",
    "otherMacroComments" : "Entire ulcer/tumour bed embedded",
    "natureAndSiteOfBlocks" : [
      "A - proximal margin
B - distal margin
C to I - ulcer
J - apical node bisected
K - periapical node
L to O - four lymph nodes in each, above anterior peritoneal reflection
P to U - lymph nodes below anterior peritoneal reflection
P - four lymph nodes
Q - three lymph nodes
R - one bisected lymph node
S - two lymph nodes with posterior margin
T - three lymph nodes
U - two lymph nodes"
    ]
  },
  "micro" : {
    "tumourType" : "35917007",
    "histologicalGrade" : "399415002",
    "maxDegreeLocalInvasion" : "395707006",
    "proximalOrDistalResectionMargins" : "not_involved",
    "marginsMicroClearance" : "15mm",
    "nonperitonealisedCircumMargin" : "not_involved",
    "microClearanceRectum" : {
      "value" : 15,
      "unit" : "mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "mm"
    },
    "lymphNodeInvolvement" : "52101004",
    "lymphNodesDetails" : [
      {
        "site" : "pN 1b",
        "numPos" : "2 (with fibrosis regarded as treatment effect in additional 3 nodes)",
        "numExamined" : "23"
      }
    ],
    "extramuralTumourDeposits" : "2667000",
    "apicalNodeInvolvement" : "2667000",
    "intramuralVeinInvasion" : "not_identified",
    "extramuralVeinInvasion" : "369734008",
    "smallVesselInvasion" : "not_identified",
    "perineuralInvasion" : "385001000",
    "histoConfDistMetastases" : "not-stated",
    "relCoexistPathabnorm" : [
      {
        "code" : "260386005"
      }
    ],
    "microResidualTumourStatus" : "R0",
    "neoadjuvantTherapy" : "grade_2"
  },
  "_ancillaryTests" : {
    "pms2" : "normal_staining",
    "msh2" : "loss_of_staining",
    "msh6" : "loss_of_staining",
    "comments" : "There is strong nuclear staining (normal pattern) ini only a minor component of the residual tumour (block 1C) and attenuated (MSH2) or loss (MSH6) to staining in the rest.  Whilst this abnormal staining pattern is likely to be secondary to the neoadjuvant therapy, thurther investigation to exclude germline mutation in MSH2 and MSH6 should be considered.",
    "msi" : {
      "code" : "373121007"
    },
    "braf" : {
      "code" : "373121007"
    },
    "kras" : {
      "code" : "373121007"
    }
  },
  "synthesisOverview" : {
    "tumourStageT" : "395707006",
    "tumourStageN" : "n1b",
    "tumourStageM" : "m0",
    "tumourStageGrouping" : "261639007",
    "tumourStagingSystem" : "AJCC 2010, 7th edition",
    "residualTumourStatus" : "r0",
    "diagnosticSummary" : "Diagnostic Summary:
Specimen type:Anterior resection
Tumour site: Upper rectum 300mm above level of anterior peritoneal reflection
Tumour type: Adenocarcinoma NOS Low grade (post therapy) microsatellite stable
Tumour stage: ypT3 N1b cMx cM0; stage IIIB
Completeness of excision: R0

Diagnosis:
1. Upper rectum:
Upper rectum
- Redidual adenocarcinoma NOS, minimal response to therapy (TRG 2)
- Extramural venous invasion
Lymph nodes
- +2/23; metastatic carcinoma in two of twenty-three nodes, treatment related changes in additional three nodes, apical node clear.
TNM class AJCC Stage (7th) 
- ypT3N1b cM0; stage IIIB; R0
MMR IHC
- Pending, supplementary report to follow
2. Distal rectal donut - No evidence of malignancy"
  }
}