Cancer Protocol Templates

On September 17, 2025, the College of American Pathologists (CAP) released updates to the CAP Cancer Protocols, with changes across 11 protocols. Key highlights include:

1. Lung, Resection: Addition of a conditionally reported Size of Tumor in Centimeters (cm) question for in situ carcinomas
2. Lung, Biomarker: Updates/Additions to PD-L1, BRAF, NTRK, NRG1, and Tumor Mutational Burden sections
3. Colon & Rectum, Resection: Correction of display item note
4. Ophthalmic Protocols (Retinoblastoma & Uveal Melanoma): Updates to pTNM Classification section and eCP-only metadata and explanatory notes updates
5. Central Nervous System & Hematologic Protocols (3): eCP-only metadata and explanatory notes updates
6. GYN Biomarker:
   1. All immunohistochemical tests made optional (previously required)
   2. HER2 In Situ Hybridization Testing Status added as a required element for reporting Equivocal (score 2+) protein overexpression in HER2 Status for Trastuzumab Use
   3. MLH1 Promoter Methylation Analysis Status added as a required element for reporting Loss of nuclear expression of MLH1 and PMS2 in Immunohistochemistry (IHC) Interpretation for Mismatch Repair (MMR) Proteins
   4. Other minor updates
7. General IHC Quantitative Biomarkers: Addition of optional Cold Ischemic Time, Fixative, and Fixation Time, Membranous Staining Intensity questions, and added responses for reporting internal controls

All changes are outlined in the Summary of Revisions.

If you have questions or concerns, please email CancerProtocols@cap.org.

• Request access to eCP Data Dictionary.
• Read the cancer protocol frequently asked questions.
• Download the definition of Synoptic Reporting With Examples.
• Visit the cancer protocol resources webpage to read about current issues with units of measurements.
• Integrate the Cancer Protocol & Biomarker Templates into your LIS workflow. Learn about our electronic Cancer Protocols.
• Download a compressed file containing all current CAP cancer protocols.
• Download the current summary of revisions.
• Download the summary of required elements.
• Provide your feedback about the CAP cancer protocols to CancerProtocols@cap.org.
• June 2021 news release.

Current and previous cancer reporting and biomarker reporting protocols can be downloaded using the links in the table below.

On June 18, 2025, the College of American Pathologists released updates to the CAP Cancer Protocols. The release has changes to 23 protocols. Highlights of the Q2 release includes:  

1. Gastrointestinal Protocols (8): Addition of Treatment Effect questions, Histologic Types, and Tumor Size questions to account for Multifocal Invasive Carcinoma with additional neoplasms.
2. Pediatric Protocols (11): Updates to Accreditation Requirements Statement (requirement for biopsy protocols)*, reformatting of explanatory notes and references, and acceptable range metadata (eCP only).
3. Kidney Resection: Update to Lymphatic and/or Vascular Invasion question.
4. Bladder Biopsy: Update to the Muscularis Propria (detrusor muscle) question to include Present, negative for tumor and Present, involved by tumor answers.
5. Pleural Mesothelioma: Update to Histologic Grade as required only for epithelioid mesothelioma.
6. Breast Biomarker Reporting: Update to Test Method Questions for Conditional Reporting

All changes are outlined in the June 2025 Summary of Revisions under resources.

If you have questions or concerns, please email cancerprotocols@cap.org.

On March 19, 2025, the College of American Pathologists released updates to the CAP Cancer Protocols. The release has content changes to 9 protocols. Highlights of the Q1 release includes:  

1. New Cancer Protocols: Paraganglioma Pheochromocytoma and PitNET  
2. Breast Biomarker: Content and explanatory note updates to include modifications to ER testing, PgR and HER2 sections  
3. Wilms Resection: Added International Society of Pediatric Oncology (SIOP) staging elements in addition to minor modifications of Children’s Oncology Group (COG) staging elements
4. Invasive Melanoma Resection & Biopsy: Removal of pT staging elements from Melanoma biopsy.  Revision of Margins sections and updates to other content and explanatory notes in both the resection and biopsy protocols.
5. Testis: Updated to accommodate partial orchiectomy specimens  

All changes are outlined in the March 2025 Summary of Revisions.

If you have questions or concerns, please email cancerprotocols@cap.org.

On December 11, 2024, the College of American Pathologists released updates to the CAP Cancer Protocols. The release has content changes to 9 protocols. Highlights of the Q4 release includes:

1. Cutaneous Head and Neck SCC: Updates to content and explanatory notes, including WHO Histologic Types. LVI question update from "Lymphovascular Invasion" to "Lymphatic and/or Vascular Invasion"
2. Endometrium Uterus:
   • UPDATED Cover Page Instructions: Recommended for primary resection specimen with no residual cancer (e.g., following neoadjuvant therapy and / or following cancer diagnosis on previous biopsy / curettage)
   • Restored the FIGO 2009 Staging/2018 FIGO Cancer Report elements
   • Extensive updates to the case summary and explanatory notes
3. Pharynx: AJCC Version 9 updates to Nasopharynx pTNM Classifications, associated content, and explanatory notes
4. Urethra, Resection & Biopsy: Tumor Extent update
5. Gynecologic Biomarker: Updates to HER2 testing and addition of subclonal loss of MMR expression, subclonal abnormal p53 expression, PD-L1 and folate receptor testing.
6. AJCC Version 9 updates to content and explanatory notes to: Diffuse Pleural Mesothelioma, Lung Resection, and Thymus

All changes are outlined in the December 2024 Summary of Revisions.

If you have questions or concerns, please email CancerProtocols@cap.org.

On June 19, 2024, the College of American Pathologists released updates to the CAP Cancer Protocols. The release features content changes to 16 protocols.

Highlights of the Q2 updates include: 

• Invasive Melanoma of The Skin: Excision, Re-Excision: pN Category staging correction and overall editing in conjunction with AJCC for improved clarity of classifications.
• Breast Invasive Resection: All individual Residual Cancer Burden (RCB) reporting parameters are now optional and explanatory note updated to clarify use of “y” prefix and gross sampling for RCB Score reporting
• Kidney Resection and Biopsy: WHO 5th edition update to content and explanatory notes
• Vulva Resection: Separated “Margin Status for Paget Disease” elements from the “Margin Status for Precursor Lesions of Squamous Cell Carcinoma” question and semantic change to pT3 and pN0(i+) staging terminology
• Bone & Soft Tissue Resection and Biopsy: Updates to content and explanatory notes, including WHO Histologic Types and addition of core and optional questions

All changes are outlined in the June 2024 Summary of Revisions.

If you have questions or concerns, please email cancerprotocols@cap.org.