The CAP Cancer Reporting Protocols provide guidelines for doctors to follow when reporting cancer cases. The protocols collect essential data elements and ensure that all cases are reported consistently, no matter which clinician or hospital reports the case.

Reporting using a structured format makes data retrieval, and analysis, easier for doctors and experts to use for the following purposes:

  • cancer surveillance
  • research
  • education
  • quality assurance
  • planning

These protocols are used to report on various cancers, including:

  • colon
  • thyroid
  • ovarian
  • kidney

This article looks at the various cancer protocols from the College of American Pathologists (CAP) and some of the data they collect.

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CAP Cancer Reporting and Biomarker Reporting Protocols provide a standardized structure for doctors and other healthcare professionals to manage and interpret clinical data.

Clinical data is information collected about a patient, including their lab results, procedures, samples of the cancer itself or other tissues, and other relevant information.

The protocols help doctors to complete reports about a person, more effectively and consistently. This ensures that oncologists at different clinics can read the report and know exactly what was done and discovered.

This is especially useful when you look for a second opinion with a new clinic or hospital or need to move your care for other reasons. Ultimately, this improves the care and outcomes of people with cancer.

CAP cancer protocols came into existence over 35 years ago in response to the need for more consistent and accurate reporting of cancer cases. In particular, there was a need for greater standardization in how doctors reported tumor markers. Tumor markers refer to biological substances that can indicate cancer.

Traditional pathology reports were narrative-style, unstructured text, which could contain varied content and was often difficult to interpret. The CAP Cancer Protocols introduced a more standardized and uniform way of reporting, with specific sections for each type of data.

Pathologists and other healthcare professionals may generate reports for people with cancer after a biopsy or surgery when they take tissue samples for analysis in the laboratory.

Following the CAP cancer guidelines should allow doctors to make more informed decisions about treatment and offers patients the best possible care.

They may be used for various cancer types.

Doctors should use the 28-page CAP cancer protocols for colon cancer for all carcinomas of the colon and rectum. It covers colectomies and rectal resections, both referring to procedures that cut parts of the organ.

Doctors will not use it to report on:

  • well-differentiated neuroendocrine tumors, where the cancer cells and healthy cells look alike
  • lymphoma, cancers that start in the lymph system
  • sarcoma, cancers that start in the soft tissue

The protocol contains the following information:

  • Tumor site within the gastrointestinal tract: for example, cecum, ileocecal valve, sigmoid colon, rectum
  • Specimen integrity: indicates whether the sample taken from the person is intact or fragmented
  • Polyp size in centimeters: polyps refer to extra pieces of tissue in the colon
  • Polyp configuration: notes the lengths and where it has a stalk
  • Histologic type: for example, adenocarcinoma, signet-ring cell carcinoma, squamous cell carcinoma
  • Histologic grade: for example, well-differentiated or undifferentiated
  • Other organ and tissue involvement

Reporting on histological types and grades requires tissue samples to be examined under a microscope by an expert.

Doctors should use the 22-page CAP cancer protocols for the thyroid gland to report thyroid cancer.

To assess the gland, the CAP recommends the following types of procedures:

  • thyroidectomy, removing part of or all of the thyroid gland
  • lobectomy, removing one lobe of the thyroid
  • partial excision, removing a specific part of the gland

It covers details for all types of thyroid cancer, including:

  • papillary (the most common type)
  • follicular (occurs more commonly in women and middle-aged people)
  • medullary (a rare type of cancer)
  • anaplastic (the least common type and often has poorer outcomes)
  • poorly differentiated

Doctors will not use the protocol for the following procedures:

  • biopsy
  • primary resection specimen with no residual cancer or samples showing no signs of cancer following certain treatment
  • cytologic specimens, these look at the structure and function of the cells

They may not also use it for the following tumor types:

  • noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)
  • thyroid carcinomas arising from struma ovarii
  • thyroid carcinomas arising in thyroglossal duct cysts
  • lymphoma
  • sarcoma

The protocol contains the following information:

  • Procedure: used to collect the sample
  • Tumor site: for example, right or left lobe
  • Polyp size: in centimeters
  • Histologic type: for example, follicular carcinoma or anaplastic carcinoma
  • Histologic grade: For example, well-differentiated or undifferentiated
  • Lymph node involvement: assesses whether cancer has spread to any lymph nodes and their location
  • Other tissue and organ involvement
  • How quickly the cancer cells are growing

Doctors should use the 19-page CAP Cancer Protocols for primary tumors of the ovary, fallopian tube, or peritoneum. These are different areas where tumors may develop.

Doctors will not use it to report certain cancer types, such as:

  • primary epithelial borderline tumors and carcinomas
  • carcinosarcoma
  • malignant germ cell tumors
  • malignant sex cord-stromal tumors

Doctors should use the protocol for these procedures:

  • oophorectomy (removal of the ovary)
  • salpingo-oophorectomy (removal of the ovary and the fallopian tube)
  • salpingectomy (removal of one or both fallopian tubes)
  • subtotal resection (part of the tumor is cut out)
  • removal of a tumor in fragments

The protocol contains the following information:

  • Tumor site: for example, right ovary, left ovary, fallopian tube
  • Ovarian or fallopian tube surface involvement: this shows the extent to which the cancer has spread
  • Lymph node involvement: assesses whether cancer has spread to any lymph nodes and their location
  • Tumor size: in centimeters
  • Histologic type: for example, serous carcinoma, endometrioid borderline tumor, clear cell carcinoma
  • Histologic grade: for example, well-differentiated or undifferentiated
  • Ascites: this is the presence of any fluid in the abdomen
  • Other tissue or organ involvement

Doctors should use the 15-page CAP Cancer Protocols for kidney cancer to report invasive carcinoma of renal tubular origin. This refers to the cancer cells that may line certain structures found in the kidney. It covers all types of all renal cell carcinoma from specimens from partial or total kidney removal — or nephrectomy.

Doctors should not use the protocol for these procedures:

  • biopsy
  • primary resection specimen with no residual cancer
  • cytologic specimens

They also will not use it for the following tumor types:

  • urothelial tumors
  • Wilm’s tumors
  • lymphoma
  • sarcoma

The protocol contains the following information:

  • Procedure used to collect the sample: for example, needle biopsy or incisional biopsy
  • Tumor site: for example, right or left kidney
  • Histologic type: for example, clear cell renal cell carcinoma, multilocular clear cell renal cell neoplasm of low malignant potential, papillary renal cell carcinoma
  • Tumor size: in centimeters
  • Histologic grade
  • Necrosis: death of body tissue
  • Lymphovascular invasion: this refers to cancer infiltrating the lymphatic channels (which are important in helping regulate fluids in the body) or the presence of blood vessels in the original tumor

CAP Cancer Reporting and Biomarker Reporting Protocols are a resource tool to help pathologists to report comprehensive and standardized cancer data.

Using the protocols means that doctors report all relevant data using standardized terminology and do not miss any important information.

This makes it easier to compare data from different doctors and different centers and ultimately makes it easier to improve and streamline patient care.