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GYN-Vulva.html
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<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<title>Vulva CA</title>
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<style>
table, th, td {
border: 1px solid silver;
border-collapse: collapse;
padding: 4px;
}
</style>
</head>
<body>
<img id="top" src="top.png" alt="">
<div id="form_container">
<div class="form_description">
<h2>
<a href=".\cap\Cancer-Protocols-2024-06-Update\Gynecologic Protocol Folder\Vulva_5.1.0.0.REL_CAPCP.pdf" target="_blank">
<div class="tooltip">
Primary carcinoma of the vulva
<span class="tooltiptext">click to access explanations in the original CAP template</span>
</div>
</a>
</h2>
</div>
<form>
<!--
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Gross descriptions:</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=" - Local excision">Local excision</option>
<option value=" - Wide excision">Wide excision</option>
<option value=" - Partial vulvectomy">Partial vulvectomy</option>
<option value=" - Total vulvectomy">Total vulvectomy</option>
<option value=" - Radical vulvectomy">Radical vulvectomy</option>
<option value=" - Other (specify):">Other (specify):</option>
<option value=" - Not specified">Not specified</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label class="description">- Tumor site:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A02" value=" - Right vulva"><label >Right vulva</label><br>
<input class="element checkbox" type="checkbox" id="A03" value=" - Right vulva, labium majus"><label >Right vulva, labium majus</label><br>
<input class="element checkbox" type="checkbox" id="A04" value=" - Right vulva, labium minus"><label >Right vulva, labium minus</label><br>
<input class="element checkbox" type="checkbox" id="A05" value=" - Right vulva, Bartholin gland"><label >Right vulva, Bartholin gland</label><br>
<input class="element checkbox" type="checkbox" id="A06" value=" - Left vulva"><label >Left vulva</label><br>
<input class="element checkbox" type="checkbox" id="A07" value=" - Left vulva, labium majus"><label >Left vulva, labium majus</label><br>
<input class="element checkbox" type="checkbox" id="A08" value=" - Left vulva, labium minus"><label >Left vulva, labium minus</label><br>
<input class="element checkbox" type="checkbox" id="A09" value=" - Left vulva, Bartholin gland"><label >Left vulva, Bartholin gland</label><br>
<input class="element checkbox" type="checkbox" id="A10" value=" - Clitoris"><label >Clitoris</label><br>
<input class="element checkbox" type="checkbox" id="A11" value=" - Other, specify:"><label >Other, specify:</label><br>
<input class="element checkbox" type="checkbox" id="A12" value=" - Not specified"><label >Not specified</label><br>
</td>
</tr>
<tr>
<td>
<label class="description">- Tumor size:</label>
</td>
<td>
<select class="element select large" ID="A13">
<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>
<tr>
<td>
<label class="description">- Tumor focality:</label>
</td>
<td>
<select class="element select large" ID="A14">
<option value=""></option>
<option value=" - Unifocal">Unifocal</option>
<option value=" - Multifocal">Multifocal</option>
<option value=" - Not specified">Not specified</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="A15" class="element textarea medium"></textarea>
</p>
<p>
<table border="1">
<col width="50%">
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-11-Update\Vulva_4.2.0.2.REL_CAPCP.pdf#page=13" target="_blank">Histologic type (WHO 5e)</a>:</label>
</td>
<td>
<select class="element select large" ID="A16">
<option value=""></option>
<option value="Squamous cell carcinoma, HPV-associated">Squamous cell carcinoma, HPV-associated</option>
<option value="Squamous cell carcinoma, HPV-independent">Squamous cell carcinoma, HPV-independent</option>
<option value="Basal cell carcinoma, NOS">Basal cell carcinoma, NOS</option>
<option value="Phyllodes tumor, borderline">Phyllodes tumor, borderline</option>
<option value="Phyllodes tumor, malignant">Phyllodes tumor, malignant</option>
<option value="Adenocarcinoma, NOS">Adenocarcinoma, NOS</option>
<option value="Adenocarcinoma of anogenital mammary-like glands">Adenocarcinoma of anogenital mammary-like glands</option>
<option value="Adenocarcinoma, intestinal type">Adenocarcinoma, intestinal type</option>
<option value="Paget disease, extramammary">Paget disease, extramammary</option>
<option value="Sweat gland adenocarcinoma">Sweat gland adenocarcinoma</option>
<option value="Apocrine adenocarcinoma">Apocrine adenocarcinoma</option>
<option value="Eccrine adenocarcinoma ">Eccrine adenocarcinoma </option>
<option value="Porocarcinoma, NOS">Porocarcinoma, NOS</option>
<option value="Adenoid cystic carcinoma">Adenoid cystic carcinoma</option>
<option value="Adenosquamous carcinoma">Adenosquamous carcinoma</option>
<option value="Carcinoma, poorly differentiated, NOS">Carcinoma, poorly differentiated, NOS</option>
<option value="Small cell neuroendocrine carcinoma">Small cell neuroendocrine carcinoma</option>
<option value="Large cell neuroendocrine carcinoma">Large cell neuroendocrine carcinoma</option>
<option value="Combined small cell neuroendocrine carcinoma">Combined small cell neuroendocrine carcinoma</option>
<option value="Combined large cell neuroendocrine carcinoma">Combined large cell neuroendocrine carcinoma</option>
<option value="Neuroendocrine tumor, NOS">Neuroendocrine tumor, NOS</option>
<option value="Neuroendocrine tumor, grade 1">Neuroendocrine tumor, grade 1</option>
<option value="Neuroendocrine tumor, grade 2">Neuroendocrine tumor, grade 2</option>
<option value="Myoepithelial carcinoma">Myoepithelial carcinoma</option>
<option value="Epithelial-myoepithelial carcinoma">Epithelial-myoepithelial carcinoma</option>
<option value="Carcinoma, type cannot be determined">Carcinoma, type cannot be determined</option>
<option value="Other (specify):">Other (specify):</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Histologic grade:</label>
</td>
<td>
<select class="element select large" ID="A17">
<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="Not applicable">Not applicable</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-11-Update\Vulva_4.2.0.2.REL_CAPCP.pdf#page=14" target="_blank">Depth of invasion</a>:</label>
</td>
<td>
<select class="element select large" ID="A18">
<option value=""></option>
<option value="Specify depth of invasion (mm): ">Specify depth of invasion (mm)</option>
<option value="Cannot be determined (explain):">Cannot be determined (explain):</option>
</select>
</td>
</tr>
<tr>
<td>
<label > + <a href=".\cap\Cancer-Protocols-2021-11-Update\Vulva_4.2.0.2.REL_CAPCP.pdf#page=14" target="_blank">Tumor border</a>:</label>
</td>
<td>
<select class="element select large" ID="A19">
<option value=""></option>
<option value="Pushing">Pushing</option>
<option value="Infiltrating">Infiltrating</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label class="description">- Other tissue/ organ involvement:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A20" value=" - Not applicable"><label class="choice">Not applicable</label>
<input class="element checkbox" type="checkbox" id="A21" value=" - Not identified"><label class="choice">Not identified</label>
<input class="element checkbox" type="checkbox" id="A22" value=" - Vagina, lower one-third"><label class="choice">Vagina, lower one-third</label>
<input class="element checkbox" type="checkbox" id="A23" value=" - Vagina, upper two-thirds"><label class="choice" >Vagina, upper two-thirds</label>
<input class="element checkbox" type="checkbox" id="A24" value=" - Urethra, lower one-third"><label class="choice">Urethra, lower one-third</label>
<input class="element checkbox" type="checkbox" id="A25" value=" - Urethra, upper two-thirds"><label class="choice">Urethra, upper two-third</label>
<input class="element checkbox" type="checkbox" id="A26" value=" - Anus"><label class="choice">Anus</label>
<input class="element checkbox" type="checkbox" id="A27" value=" - Bladder mucosa"><label class="choice">Bladder mucosa</label>
<input class="element checkbox" type="checkbox" id="A28" value=" - Rectal mucosa"><label class="choice">Rectal mucosa</label>
<input class="element checkbox" type="checkbox" id="A29" value=" - Pelvic bone"><label class="choice">Pelvic bone</label>
<input class="element checkbox" type="checkbox" id="A30" value=" - Other organs/tissue (specify):"><label class="choice">Other organs/tissue (specify):</label>
<input class="element checkbox" type="checkbox" id="A31" value=" - Cannot be determined (explain):"><label class="choice">Cannot be determined (explain):</label>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-11-Update\Vulva_4.2.0.2.REL_CAPCP.pdf#page=16" target="_blank">Lymphatic and / or Vascular Invasion</a>: </label>
</td>
<td>
<select class="element select large" ID="A32">
<option value=""></option>
<option value="Not identified">Not identified</option>
<option value="Present">Present</option>
<option value="Equivocal (explain):">Equivocal (explain):</option>
<option value="Cannot be determined">Cannot be determined</option>
</select>
</td>
</tr>
<tr>
<td>
<label > + Perineural invasion: </label>
</td>
<td>
<select class="element select large" ID="A33">
<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 > + <a href=".\cap\Cancer-Protocols-2021-11-Update\Vulva_4.2.0.2.REL_CAPCP.pdf#page=18" target="_blank">p16 IHC</a>: </label>
</td>
<td>
<select class="element select large" ID="A63">
<option value=""></option>
<option value="Positive">Positive</option>
<option value="Negative">Negatve</option>
<option value="Other (specify):">Other (specify):</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="">+ <a href=".\cap\Cancer-Protocols-2021-11-Update\Vulva_4.2.0.2.REL_CAPCP.pdf#page=18" target="_blank">p53 IHC</a>:</label>
</td>
<td>
<select class="element select large" ID="A64">
<option value=""></option>
<option value="Normal (wild type)">Normal (wild type)</option>
<option value="Abnormal (mutated)">Abnormal (mutated)</option>
<option value="Abnormal, Overexpression Basal overexpression (uniform strong, diffuse nuclear expression in basal cells)">Abnormal, Basal overexpression (uniform strong, diffuse nuclear expression in basal cells)</option>
<option value="Abnormal, Parabasal / diffuse overexpression">Abnormal, Parabasal / diffuse overexpression</option>
<option value="Abnormal, Null (lack of nuclear or cytoplasmic expression))">Abnormal, Null (lack of nuclear or cytoplasmic expression)</option>
<option value="Abnormal, Cytoplasmic only (lacks nuclear expression)">Abnormal, Cytoplasmic only (lacks nuclear expression)</option>
</select>
</td>
</tr>
</table>
</p>
<p>
HPV-ISH is not available, PCR-sequencing type test can be ordered.
</p>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Surgical margins for invasive tumor: </label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- Peripheral margins:</label>
</td>
<td>
<select class="element select large" ID="A34">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Deep margins:</label>
</td>
<td>
<select class="element select large" ID="A35">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Surgical margins for Squamous Precursor Lesion(s): </label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- Peripheral margins:</label>
</td>
<td>
<select class="element select large" ID="A79">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Deep margins:</label>
</td>
<td>
<select class="element select large" ID="A80">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Surgical margins for HSIL: </label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- Peripheral margins:</label>
</td>
<td>
<select class="element select large" ID="A81">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Deep margins:</label>
</td>
<td>
<select class="element select large" ID="A82">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Surgical margins for dVIN: </label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- Peripheral margins:</label>
</td>
<td>
<select class="element select large" ID="A83">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Deep margins:</label>
</td>
<td>
<select class="element select large" ID="A84">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Surgical margins for VAM / HPVi (p53wt) vaVIN: </label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- Peripheral margins:</label>
</td>
<td>
<select class="element select large" ID="A85">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Deep margins:</label>
</td>
<td>
<select class="element select large" ID="A86">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Surgical margins for Paget Disease: </label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- Peripheral margins:</label>
</td>
<td>
<select class="element select large" ID="A87">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Deep margins:</label>
</td>
<td>
<select class="element select large" ID="A88">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved, specify closest distance and location:">Uninvolved, specify closest distance and location:</option>
<option value="Involved, specify location:">Involved, specify location:</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="70%">
<tr>
<td>
<label class="description">- Number of regional lymph nodes examined:</label>
</td>
<td>
<input type="text" class="element text large" ID="A36" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Number of sentinel lymph nodes examined:</label>
</td>
<td>
<input type="text" class="element text large" ID="A37" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Number of lymph nodes with metastasis > or = 5 mm:</label>
</td>
<td>
<input type="text" class="element text large" ID="A38" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Number of lymph nodes with metastasis < 5 mm (exclude ITC):</label>
</td>
<td>
<input type="text" class="element text large" ID="A39" size="10">
</td>
</tr>
<tr>
<td>