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-11",
  "subject" : {
    "reference" : "Patient/8003608833364953"
  },
  "requester" : {
    "reference" : "Practitioner/8003616566682137"
  },
  "performer" : {
    "reference" : "Organization/8003623233350148"
  },
  "preAnalytic" : {
    "clinicalInformation" : "Ca restum; family history CRC; low anterior resection, proximal and distal donuts.
The histopathology report on previous rectal biopsy, xxxx-xxxx from 24/9/2015, is noted.",
    "perforation" : "not-stated",
    "clinicalObstruction" : "not-stated",
    "tumourLocation" : [
      "34402009"
    ],
    "typeOfOperation" : {
      "code" : "4558008"
    },
    "anteriorResectionType" : "62482003",
    "preoperativeRadiotherapy" : "not-stated"
  },
  "macro" : {
    "specimenLength" : {
      "value" : 165,
      "unit" : "mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "mm"
    },
    "tumourSite" : "34402009",
    "maxTumourDiameter" : {
      "value" : 30,
      "unit" : "x25mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "x25mm"
    },
    "distanceNearerProxOrDistal" : [
      {
        "value" : 30,
        "unit" : "mm (distal)",
        "system" : "http://unitsofmeasure.org",
        "code" : "mm (distal)"
      }
    ],
    "distNonperitonCircumMargin" : {
      "value" : 5,
      "unit" : "mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "mm"
    },
    "tumourPerforation" : "2667000",
    "relToAntPeritonealReflection" : "entirely_above",
    "intactnessOfMesorectum" : "408657005",
    "natureAndSiteOfBlocks" : [
      "A and B - shave of the distal resection margin
C and D - shave of the proximal resection margin
E - surgical high tie of mesentery with one apical lymph node
F and G - one full face section of the tumour showing deepest invasion and closest circumferential margin
H and I - second full face section of the tumour showing deepest invasion and slosest circumferential margin
J - one full face section of tumour with ?invovled lymph node 
K -  four lymph nodes
L - four lymph nodes
M - three lymph nodes
N and O - lymph nodes taken from mesentery distal to tumour:
N - three lymph nodes
O -  three lymph nodes"
    ]
  },
  "micro" : {
    "tumourType" : "35917007",
    "histologicalGrade" : "399611001",
    "maxDegreeLocalInvasion" : "395707006",
    "proximalOrDistalResectionMargins" : "not_involved",
    "marginsMicroClearance" : "5mm",
    "microClearanceRectum" : {
      "value" : 5,
      "unit" : "mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "mm"
    },
    "lymphNodeInvolvement" : "52101004",
    "lymphNodesDetails" : [
      {
        "site" : "pN2a",
        "numPos" : "4",
        "numExamined" : "16"
      }
    ],
    "extramuralTumourDeposits" : "52101004",
    "apicalNodeInvolvement" : "52101004",
    "intramuralVeinInvasion" : "369733002",
    "extramuralVeinInvasion" : "369734008",
    "smallVesselInvasion" : "present_and_extensive",
    "perineuralInvasion" : "369731000",
    "histoConfDistMetastases" : "not-stated",
    "relCoexistPathabnorm" : [
      {
        "code" : "260386005"
      }
    ],
    "microResidualTumourStatus" : "R0",
    "neoadjuvantTherapy" : "not_applicable"
  },
  "_ancillaryTests" : {
    "mlh1" : "normal_staining",
    "pms2" : "normal_staining",
    "msh2" : "normal_staining",
    "msh6" : "normal_staining",
    "comments" : "High-level microsatellite instability (MSI-H) is very unlikely.",
    "msi" : {
      "code" : "373121007"
    },
    "braf" : {
      "code" : "373121007"
    },
    "kras" : {
      "code" : "373121007"
    }
  },
  "synthesisOverview" : {
    "tumourStageT" : "395707006",
    "tumourStageN" : "n2a",
    "tumourStageM" : "mx",
    "tumourStageGrouping" : "261639007",
    "tumourStagingSystem" : "AJCC 2010, 7th edition",
    "residualTumourStatus" : "r0",
    "diagnosticSummary" : "Diagnostic Summary:
Specimen type:Low anterior resection
Tumour site: Rectum
Tumour type: Adenocarcinoma NOS, microsatellite stable, variable differentiation including poorly differentiated areas
Tumour stage: pT3cN2aMx; stage IIIB
Completeness of excision: R0

Diagnosis:
1. Low anterior resection rectum:
- High grade adenocarcinoma NOS, 30x25mm, microsatellite stable
- Venous invasion, lymphatic permeation and perineural invasion present
Lymph nodes
- +4/16; metastatic carcinoma in four of sixteen nodes
- Apical node involved
- extranural satellite deposits x2.
TNM class AJCC Stage (7th) 
- pT3cN2aMX; stage IIIB; R0
2. Proximal donut - Benign colonic tissue
3. Distal  donut - Benign rectal tissue"
  }
}