TUMOR BOARD Test Form

Case Demographics	Male Female Age City State BMI Tumor Board Case ID:
Cancer Symptom	Acute Lymphoblastic Leukemia, Adult Acute Lymphoblastic Leukemia, Childhood Acute Myeloid Leukemia, Adult Acute Myeloid Leukemia, Childhood Adrenocortical Carcinoma Adrenocortical Carcinoma, Childhood AIDS-Related Cancers AIDS-Related Lymphoma Anal Cancer Appendix Cancer Astrocytoma, Childhood Cerebellar Astrocytoma, Childhood Cerebral Basal Cell Carcinoma, see Skin Cancer (Nonmelanoma) Bile Duct Cancer, Extrahepatic Bladder Cancer Bladder Cancer, Childhood Bone Cancer, Osteosarcoma and Malignant Fibrous Histiocytoma Brain Stem Glioma, Childhood Brain Tumor, Adult Brain Tumor, Brain Stem Glioma, Childhood Brain Tumor, Central Nervous System Embryonal Tumors, Childhood (See What Are Childhood Central Nervous System Embryonal Tumors?) Brain Tumor, Cerebellar Astrocytoma, Childhood Brain Tumor, Cerebral Astrocytoma/Malignant Glioma, Childhood Brain Tumor, Ependymoblastoma, Childhood (See What Are Childhood Central Nervous System Embryonal Tumors?) Brain Tumor, Ependymoma, Childhood Brain Tumor, Medulloblastoma, Childhood Brain Tumor, Medulloepithelioma, Childhood (See What Are Childhood Central Nervous System Embryonal Tumors?) Brain Tumor, Pineal Parenchymal Tumors of Intermediate Differentiation, Childhood (See What Are Childhood Central Nervous System Embryonal Tumors?) Brain Tumor, Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma, Childhood Brain Tumor, Visual Pathway and Hypothalamic Glioma, Childhood Brain and Spinal Cord Tumors, Childhood (Other) Breast Cancer Breast Cancer and Pregnancy Breast Cancer, Childhood Breast Cancer, Male Bronchial Tumors, Childhood Burkitt Lymphoma Carcinoid Tumor, Childhood Carcinoid Tumor,Gastrointestinal Carcinoma of Unknown Primary Central Nervous System Embryonal Tumors, Childhood (See What Are Childhood Central Nervous System Embryonal Tumors?) Central Nervous System Lymphoma, Primary Cerebellar Astrocytoma, Childhood Cerebral Astrocytoma/Malignant Glioma, Childhood Cervical Cancer Cervical Cancer, Childhood Childhood Cancers Chordoma, Childhood Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia Chronic Myeloproliferative Disorders Colon Cancer Colorectal Cancer, Childhood Cutaneous T-Cell Lymphoma, see Mycosis Fungoides and Sézary Syndrome Embryonal Tumors, Central Nervous System, Childhood (See What Are Childhood Central Nervous System Embryonal Tumors?) Endometrial Cancer Ependymoblastoma, Childhood (See What Are Childhood Central Nervous System Embryonal Tumors?) Ependymoma, Childhood Esophageal Cancer Esophageal Cancer, Childhood Ewing Family of Tumors Extracranial Germ Cell Tumor, Childhood Extragonadal Germ Cell Tumor Extrahepatic Bile Duct Cancer Eye Cancer, Intraocular Melanoma Eye Cancer, Retinoblastoma Gallbladder Cancer Gastric (Stomach) Cancer Gastric (Stomach) Cancer, Childhood Gastrointestinal Carcinoid Tumor Gastrointestinal Stromal Tumor (GIST) Gastrointestinal Stromal Cell Tumor, Childhood Germ Cell Tumor, Extracranial, Childhood Germ Cell Tumor, Extragonadal Germ Cell Tumor, Ovarian Gestational Trophoblastic Tumor Glioma, Adult Glioma, Childhood Brain Stem Glioma, Childhood Cerebral Astrocytoma Glioma, Childhood Visual Pathway and Hypothalamic Hairy Cell Leukemia Head and Neck Cancer Hepatocellular (Liver) Cancer, Adult (Primary) Hepatocellular (Liver) Cancer, Childhood (Primary) Hodgkin Lymphoma, Adult Hodgkin Lymphoma, Childhood Hypopharyngeal Cancer Hypothalamic and Visual Pathway Glioma, Childhood Intraocular Melanoma Islet Cell Tumors (Endocrine Pancreas) Kaposi Sarcoma Kidney (Renal Cell) Cancer Kidney Cancer, Childhood Laryngeal Cancer Laryngeal Cancer, Childhood Leukemia, Acute Lymphoblastic, Adult Leukemia, Acute Lymphoblastic, Childhood Leukemia, Acute Myeloid, Adult Leukemia, Acute Myeloid, Childhood Leukemia, Chronic Lymphocytic Leukemia, Chronic Myelogenous Leukemia, Hairy Cell Lip and Oral Cavity Cancer Liver Cancer, Adult (Primary) Liver Cancer, Childhood (Primary) Lung Cancer, Non-Small Cell Lung Cancer, Small Cell Lymphoma, AIDS-Related Lymphoma, Burkitt Lymphoma, Cutaneous T-Cell, see Mycosis Fungoides and Sézary Syndrome Lymphoma, Hodgkin, Adult Lymphoma, Hodgkin, Childhood Lymphoma, Non-Hodgkin, Adult Lymphoma, Non-Hodgkin, Childhood Lymphoma, Primary Central Nervous System Macroglobulinemia, Waldenström Malignant Fibrous Histiocytoma of Bone and Osteosarcoma Medulloblastoma, Childhood Medulloepithelioma, Childhood (See What Are Childhood Central Nervous System Embryonal Tumors?) Melanoma Melanoma, Intraocular (Eye) Merkel Cell Carcinoma Mesothelioma, Adult Malignant Mesothelioma, Childhood Metastatic Squamous Neck Cancer with Occult Primary Mouth Cancer Multiple Endocrine Neoplasia Syndrome, Childhood Multiple Myeloma/Plasma Cell Neoplasm Mycosis Fungoides Myelodysplastic Syndromes Myelodysplastic/Myeloproliferative Diseases Myelogenous Leukemia, Chronic Myeloid Leukemia, Adult Acute Myeloid Leukemia, Childhood Acute Myeloma, Multiple Myeloproliferative Disorders, Chronic Nasal Cavity and Paranasal Sinus Cancer Nasopharyngeal Cancer Nasopharyngeal Cancer, Childhood Neuroblastoma Non-Hodgkin Lymphoma, Adult Non-Hodgkin Lymphoma, Childhood Non-Small Cell Lung Cancer Oral Cancer, Childhood Oral Cavity Cancer, Lip and Oropharyngeal Cancer Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Ovarian Cancer, Childhood Ovarian Epithelial Cancer Ovarian Germ Cell Tumor Ovarian Low Malignant Potential Tumor Pancreatic Cancer Pancreatic Cancer, Childhood Pancreatic Cancer, Islet Cell Tumors Papillomatosis, Childhood Paranasal Sinus and Nasal Cavity Cancer Parathyroid Cancer Penile Cancer Pharyngeal Cancer Pheochromocytoma Pineal Parenchymal Tumors of Intermediate Differentiation, Childhood (See What Are Childhood Central Nervous System Embryonal Tumors?) Pineoblastoma and Supratentorial Primitive Neuroectodermal Tumors, Childhood Pituitary Tumor Plasma Cell Neoplasm/Multiple Myeloma Pleuropulmonary Blastoma Pregnancy and Breast Cancer Primary Central Nervous System Lymphoma Prostate Cancer Rectal Cancer Renal Cell (Kidney) Cancer Renal Cell (Kidney) Cancer, Childhood Renal Pelvis and Ureter, Transitional Cell Cancer Respiratory Tract Carcinoma Involving the NUT Gene on Chromosome 15 Retinoblastoma Rhabdomyosarcoma, Childhood Salivary Gland Cancer Salivary Gland Cancer, Childhood Sarcoma, Ewing Family of Tumors Sarcoma, Kaposi Sarcoma, Soft Tissue, Adult Sarcoma, Soft Tissue, Childhood Sarcoma, Uterine Sézary Syndrome Skin Cancer (Nonmelanoma) Skin Cancer, Childhood Skin Cancer (Melanoma) Skin Carcinoma, Merkel Cell Small Cell Lung Cancer Small Intestine Cancer Soft Tissue Sarcoma, Adult Soft Tissue Sarcoma, Childhood Squamous Cell Carcinoma, see Skin Cancer (Nonmelanoma) Squamous Neck Cancer with Occult Primary, Metastatic Stomach (Gastric) Cancer Stomach (Gastric) Cancer, Childhood Supratentorial Primitive Neuroectodermal Tumors, Childhood T-Cell Lymphoma, Cutaneous, see Mycosis Fungoides and Sézary Syndrome Testicular Cancer Throat Cancer Thymoma and Thymic Carcinoma Thymoma and Thymic Carcinoma, Childhood Thyroid Cancer Thyroid Cancer, Childhood Transitional Cell Cancer of the Renal Pelvis and Ureter Trophoblastic Tumor, Gestational Unknown Primary Site, Carcinoma of, Adult Unknown Primary Site, Cancer of, Childhood Unusual Cancers of Childhood Ureter and Renal Pelvis, Transitional Cell Cancer Urethral Cancer Uterine Cancer, Endometrial Uterine Sarcoma Vaginal Cancer Vaginal Cancer, Childhood Visual Pathway and Hypothalamic Glioma, Childhood Vulvar Cancer Waldenström Macroglobulinemia Wilms Tumor Women's Cancers
Cancer Symptoms	Blood in the urine, pain or burning upon urination; frequent urination; or cloudy urine Pain in the bone or swelling around the affected site; fractures in bones; weakness, fatigue; weight loss; repeated infections; nausea, vomiting, constipation, problems with urination; weakness or numbness in the legs; bumps and bruises that persist Dizziness; drowsiness; abnormal eye movements or changes in vision; weakness, loss of feeling in arms or legs or difficulties in walking; fits or convulsions; changes in personality, memory or speech; headaches that tend to be worse in the morning and eas A lump or thickening of the breast; discharge from the nipple; change in the skin of the breast; a feeling of heat; or enlarged lymph nodes under the arm Rectal bleeding (red blood in stools or black stools); abdominal cramps; constipation alternating with diarrhea; weight loss; loss of appetite; weakness; pallid complexion Blood in urine; dull ache or pain in the back or side; lump in kidney area, sometimes accompanied by high blood pressure or abnormality in red blood cell count Weakness, paleness; fever and flu-like symptoms; bruising and prolonged bleeding; enlarged lymph nodes, spleen, liver; pain in bones and joints; frequent infections; weight loss; night sweats Wheezing, persistent cough for months; blood-streaked sputum; persistent ache in chest; congestion in lungs; enlarged lymph nodes in the neck Change in mole or other bump on the skin, including bleeding or change in size, shape, color, or texture Painless swelling in the lymph nodes in the neck, underarm, or groin; persistent fever; feeling of fatigue; unexplained weight loss; itchy skin and rashes; small lumps in skin; bone pain; swelling in the abdomen; liver or spleen enlargement A lump in the mouth, ulceration of the lip, tongue or inside of the mouth that does not heal within a couple of weeks; dentures that no longer fit well; oral pain, bleeding, foul breath, loose teeth, and changes in speech Abdominal swelling; in rare cases, abnormal vaginal bleeding; digestive discomfort Urination difficulties due to blockage of the urethra; bladder retains urine, creating frequent feelings of urgency to urinate, especially at night; bladder not emptying completely; burning or painful urination; bloody urine; tenderness over the bladder; ndigestion or heartburn; discomfort or pain in the abdomen; nausea and vomiting; diarrhea or constipation; bloating after meals; loss of appetite; weakness and fatigue; bleeding - vomiting blood or blood in the stool Abnormal vaginal bleeding, a watery bloody discharge in postmenopausal women; a painful urination; pain during intercourse; pain in pelvic area
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