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-9",
  "subject" : {
    "reference" : "Patient/8003608333353852"
  },
  "requester" : {
    "reference" : "Practitioner/8003616566682137"
  },
  "performer" : {
    "reference" : "Organization/8003623233350148"
  },
  "preAnalytic" : {
    "clinicalInformation" : "Rectosigmoid adeno ca.; high anterior resection.",
    "perforation" : "not-stated",
    "clinicalObstruction" : "not-stated",
    "tumourLocation" : [
      "49832006"
    ],
    "typeOfOperation" : {
      "code" : "4558008"
    },
    "anteriorResectionType" : "75540009",
    "preoperativeRadiotherapy" : "not-stated"
  },
  "macro" : {
    "specimenLength" : {
      "value" : 175,
      "unit" : "mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "mm"
    },
    "tumourSite" : "34402009",
    "maxTumourDiameter" : {
      "value" : 40,
      "unit" : "mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "mm"
    },
    "distanceNearerProxOrDistal" : [
      {
        "value" : 40,
        "unit" : "mm",
        "system" : "http://unitsofmeasure.org",
        "code" : "mm"
      }
    ],
    "distNonperitonCircumMargin" : {
      "value" : 25,
      "unit" : "mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "mm"
    },
    "tumourPerforation" : "2667000",
    "natureAndSiteOfBlocks" : [
      "A - proximal resection margin
B - distal resection margin
C - proximal edge of tumour
D and E - closest serosal surface and attached epiploic appendicies
F - tumour + fat
G - distal edge of tumour + radial margin
H- Q - lymph nodes from peritoneal fat
H - apical lymph node
I - next most apical lymph node bisected
J - apical fat
K - next most apical node bisected
L - three nodes
M to O - each contain one node bisected
P - four nodes
R - lymph node furtherest away from bowel wall
S - five possible nodes
T - one node
U and V - sigmoid mesentery."
    ]
  },
  "micro" : {
    "tumourType" : "35917007",
    "histologicalGrade" : "399611001",
    "maxDegreeLocalInvasion" : "395707006",
    "proximalOrDistalResectionMargins" : "not_involved",
    "marginsMicroClearance" : "21mm",
    "nonperitonealisedCircumMargin" : "not_involved",
    "microClearanceRectum" : {
      "value" : 21,
      "unit" : "mm",
      "system" : "http://unitsofmeasure.org",
      "code" : "mm"
    },
    "lymphNodeInvolvement" : "2667000",
    "lymphNodesDetails" : [
      {
        "site" : "pN0",
        "numPos" : "0",
        "numExamined" : "13"
      }
    ],
    "extramuralTumourDeposits" : "2667000",
    "apicalNodeInvolvement" : "2667000",
    "intramuralVeinInvasion" : "not_identified",
    "extramuralVeinInvasion" : "not_identified",
    "smallVesselInvasion" : "not_identified",
    "perineuralInvasion" : "385001000",
    "histoConfDistMetastases" : "not-stated",
    "relCoexistPathabnorm" : [
      {
        "code" : "260386005"
      }
    ],
    "microResidualTumourStatus" : "R0, complete resection, margins histologically negative, no residual tumour left after resection (primary tumour, regional nodes)."
  },
  "_ancillaryTests" : {
    "mlh1" : "normal_staining",
    "pms2" : "normal_staining",
    "msh2" : "normal_staining",
    "msh6" : "normal_staining",
    "comments" : "Preserved nuclear staining for mismatch repair proteins MLH1, PMS2, MSH2 and MSH6 indicates a low likelihood of microsatellite instability phenotype.",
    "braf" : {
      "code" : "373121007"
    },
    "kras" : {
      "code" : "373121007"
    }
  },
  "synthesisOverview" : {
    "tumourStageT" : "395707006",
    "tumourStageN" : "n0",
    "tumourStageM" : "mx",
    "tumourStageGrouping" : "261614003",
    "tumourStagingSystem" : "AJCC 2010, 7th edition",
    "residualTumourStatus" : "r0",
    "diagnosticSummary" : "Diagnostic Summary:
Specimen type:High anterior resection
Tumour site: Rectum-sigmoid colon
Tumour type: Adenocarcinoma
Tumour stage: pT3. n0, Mx, R0
Completeness of excision: Completely excised

Diagnosis:
1. Anterior resection:
- Moderately differentiated adenocarcinoma, recto-sigmoid, completely excised.
- Focus suspicious for lymphovascular invasion
- no evidence of malignancy in thirteen lymph nodes (0/13)
- pT3, n0, MX, R0, stage IIA (Dukes stage B)
2. Distal donut - No evidence of malignancy
3. Proximal donut - No evidence of malignancy"
  }
}