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

<Colorectal xmlns="http://hl7.org/fhir" id="Colorectal-genexample-6">
  <subject>
    <reference value="Patient/8003608166687541"/>
  </subject>
  <requester>
    <reference value="Practitioner/8003616566682137"/>
  </requester>
  <performer>
    <reference value="Organization/8003623233350148"/>
  </performer>
  <preAnalytic>
    <clinicalInformation value="R colon"/>
    <perforation value="2667000"/>
    <clinicalObstruction value="2667000"/>
    <tumourLocation value="9040008"/>
    <typeOfOperation>
      <code value="235326000"/>
    </typeOfOperation>
    <preoperativeRadiotherapy value="373067005"/>
  </preAnalytic>
  <macro>
    <specimenLength>
      <value value="155"/>
      <unit value="mm"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="mm"/>
    </specimenLength>
    <tumourSite value="9040008"/>
    <maxTumourDiameter>
      <value value="23"/>
      <unit value="mm"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="mm"/>
    </maxTumourDiameter>
    <distanceNearerProxOrDistal>
      <value value="40"/>
      <unit value="mm"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="mm"/>
    </distanceNearerProxOrDistal>
    <distNonperitonCircumMargin>
      <value value="30"/>
      <unit value="mm"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="mm"/>
    </distNonperitonCircumMargin>
    <tumourPerforation value="2667000"/>
    <lymphNodes value="440622005"/>
    <otherMacroComments value="(Query add the narrative comments here)"/>
    <natureAndSiteOfBlocks
                           value="Block A - margins,
B - appendix tip,
C - appendix body and base,
D to I - tumour,
J - apical node bisected,
K - periapical node bisected,
L to R - four lymph nodes each,
S - one bissected lymph node,
T to V - remainder of appendix,
W to Y - caecal base,
Z to AA - terminal ileum. PL4"/>
  </macro>
  <micro>
    <tumourType value="35917007"/>
    <histologicalGrade value="399415002"/>
    <maxDegreeLocalInvasion value="395707006"/>
    <proximalOrDistalResectionMargins value="not_involved"/>
    <marginsMicroClearance value="30mm"/>
    <nonperitonealisedCircumMargin value="not_involved"/>
    <microClearanceRectum>
      <value value="30"/>
      <unit value="mm"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="mm"/>
    </microClearanceRectum>
    <lymphNodeInvolvement value="52101004"/>
    <lymphNodesDetails>
      <site value="pN1b"/>
      <numPos value="3"/>
      <numExamined value="31"/>
    </lymphNodesDetails>
    <intramuralVeinInvasion value="not_identified"/>
    <extramuralVeinInvasion value="not_identified"/>
    <smallVesselInvasion value="395717001"/>
    <perineuralInvasion value="369731000"/>
    <histoConfDistMetastases value="2667000"/>
    <relCoexistPathabnorm>
      <other
             value="Mixed adenoneuroendocrine carcinoma of the appendix (See above description) - pT4a, pN0, Mx, Stage IIB.
Low grade appendiceal mucinous neoplasm (LAMN)"/>
    </relCoexistPathabnorm>
    <microResidualTumourStatus value="R0 - No residual tumour"/>
  </micro>
  <ancillaryTests>
    <mlh1 value="normal_staining"/>
    <pms2 value="normal_staining"/>
    <msh2 value="normal_staining"/>
    <msh6 value="normal_staining"/>
    <comments
              value="Immunoperoxidase stains show preservation of nuclear staining in the tumour cells for the DNA mismatch repair enzymes hMLH1, hMSH2, hMSH6 and PMS2, so that high-level microsatellite instability (MSI-H) is very unlikely.
MSI stains were also performed on the mixed adenoneuroendocrine carcinoma and the tumour cells display preservation of nuclear staining for PMS2, MLH1, MSH6 and MSH2 indicating a low probability of microsatellite instability."/>
    <msi>
      <code value="373121007"/>
    </msi>
    <braf>
      <code value="373121007"/>
    </braf>
    <kras>
      <code value="373121007"/>
    </kras>
  </ancillaryTests>
  <synthesisOverview>
    <tumourStageT value="395707006"/>
    <tumourStageN value="n1b"/>
    <tumourStageM value="mx"/>
    <tumourStageGrouping value="261639007"/>
    <tumourStagingSystem value="AJCC 2010, 7th edition"/>
    <residualTumourStatus value="r0"/>
    <overarchingComment
                        value="It is difficult to be accurate as regards to size of the adenoneuroendocrine carcinoma in the appendix.  However, adding together all the blocks that contain the tumour, the estimated maximum tumour size is 25mm in length."/>
  </synthesisOverview>
</Colorectal>