Form 4 Initial Biospecimen and Cancer Count Information Form

Data Collection for Public Cancer Epidemiology Descriptive Cohort Database (NCI)

Attachment C1_CEDCD Biospecimen and Cancer Count Information Form.xlsx

Attachment C1 Initial Biospecimen and Cancer Count Information Spreadsheet

OMB: 0925-0706

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Biospecimen and Cancer Count Information Spreadsheet






























































































































































































Biospecimen and Cancer Count Information Spreadsheet




































1 Cohort Name:
2 Specify if the cancers are Incident Cancers or Prevalent Cancers:
3 Notes:

ICD-9 ICD-10/O Cancer Type Males Females Blood Buccal Feces Lymphocytes Tumor Tissue Sputum Urine Other Specify: Other Specify:
4

No Cancer










5 141-149 C00-C14 Oropharyngeal










6 150 C15 Esophagus










7 151 C16 Stomach










8 152 C17 Small intestine










9 153 C18 Colon










10 154 C19-C21 Rectum and anus










11 155 C22 Liver and intrahepatic bile ducts










12 156 C23, C24 Gall bladder and extrahepatic bile duct










13 157 C25 Pancreas










14 162 C33, C34 Trachea, bronchus, and lung










15 170 C40 Bone










16 172 C43 Melanoma (excluding genital organs)










17 174-175 C50 Breast










18 180 C53 Cervix










19 182 C54 Corpus, body of uterus










20 183 C56 Ovary, fallopian tube, broad ligament










21 185 C61 Prostate










22 188 C67 Bladder










23 189 C64-C66, C68 Kidney and other unspecified urinary organs including renal pelvis, ureter, urethra










24 191 C71 Brain










25 193 C73 Thyroid










26 200-202 C81-C85 Lymphoma (HL and NHL)










27 203 C90 Myeloma










28 204-208 C91-C95 Leukemia










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