Cancer Protocol Templates

• 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 of 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 September 20, 2023, the College of American Pathologists released updates to the CAP Cancer Protocols. The release featured three new protocols, as well as content changes to 30 protocols.

Highlights of this release include:

• Three new hematology cancer protocols including Precursor and Mature Lymphoid Malignancies, Myeloid and Mixed / Ambiguous Neoplasms, and Plasma Cell Malignancies. These new protocols reflect current WHO guidelines.
• Four existing hematology cancer protocols will be retired: Bone Marrow, Hodgkin Lymphoma, Non-Hodgkin Lymphoma and Plasma Cell.
• 12 pediatric protocols updated to reflect current WHO guidelines; these protocols will soon be required for CAP accreditation.
• 13 genitourinary protocols updated to reflect current WHO guidelines.
• Anus Local Excision updated to reflect AJCC version 9 content.

All changes are outlined in the September 2023 Summary of Revisions.

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

On June 21, 2023, the College of American Pathologists released updates to 6 CAP Cancer Protocols.

Highlights of this release include:

• Five Head and Neck Cancer Protocols were revised to reflect the WHO 5th Edition (Blue Books) including updates to Histologic Types, Grades, and Explanatory Notes.
• The Breast Invasive Resection protocol was revised to include conditional Residual Cancer Burden (RCB) reporting following neoadjuvant treatment.

All changes are outlined in the June 2023 Summary of Revisions.

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

The CAP released an accelerated update to the CAP Cancer Uterine Cervix Resection Protocol on April 5th, 2023. This update addresses an incorrect section header text for pTNM Classification to reflect use of AJCC 9th Version content.

The staging classifications themselves are not affected, as they were updated to the AJCC 9th Version in October 2020.

CAP Cancer Protocol users should refrain from using versions 5.1.0.0 and 4.003.001 of the CAP Cancer Protocol for Uterine Cervix Resection, as these versions are invalid.

All changes are outlined in the April 2023 Summary of Changes.

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

On March 22, 2023, the College of American Pathologists released updates to 10 CAP Cancer Protocols.

Highlights of content changes in this release include:

• Thyroid protocol updated to reflect current WHO guidelines
• Breast Biomarker and Breast Invasive Resection protocols now include notes for HER2neu Low Expression
• Breast Invasive Biopsy has been updated to reflect the size of largest invasive focus in the limited biopsy sample
• Gynecologic Biomarker has been updated to clarify content elements
• Ovary protocol includes content clarification, updates to TNM modifiers, LVI visible text, and contains critical information updated in explanatory notes
• Cervix Resection and Excision protocols also include content clarification, updates to LVI visible text, and TNM modifiers (Resection only)
• Stomach Resection has changes to Histologic Grade Requirements
• Adrenal Resection contains critical information updated in explanatory notes

All changes are outlined in the Summary of Revisions.

On December 14, 2022, the College of American Pathologists released updates to 15 CAP Cancer Protocols.

Highlights of content changes in this release include:

• NEW GYN Biomarker (not required for accreditation) replaces the retired Endometrium Biomarker protocol
• Updated Pediatric biopsy and resection protocols based on WHO 5th edition
• Updated Adrenal gland protocol based on WHO 5th edition
• Updated GIST biopsy, resection and biomarker protocols include content and explanatory notes
• Updated pTNM Classification remodeling

All changes are outlined in the Summary of Revisions.

On September 21, 2022, the College of American Pathologists released updates to 10 CAP Cancer Protocols. All changes are outlined in the Summary of Revisions with updates now available on www.cap.org.

New Cancer Reporting Protocol:

• Protocol for the Examination of Tumors of the Brain and Spinal Cord (v1.0.0.0), which combines Integrated Diagnosis and Histological Assessment

Retired Cancer Reporting Protocol:

• Protocol for the Examination of Specimens from Patients with Tumors of the Central Nervous System (v4.0.0.0), which includes separate case summaries for Integrated Diagnosis, Histological Assessment, and Biomarker Reporting

There are no changes to this release that affect accreditation dates.

Other key content changes include:

• The Expert Consultation question was made optional and an explanatory note was added in the Rhabdomyosarcoma and Ewing Sarcoma Biopsy and Resection templates
• Added Other (specify) and Cannot be determined (explain) answer options to the Margin Status question in the Breast Phyllodes template
• Updated the reporting note under Pathologic Stage Classification in the Lung Resection template

All changes are outlined in the Summary of Revisions.

June 2022 CAP Cancer Protocol Update: Clarifications

• Anus and Appendix templates. While these updates include American Joint Committee on Cancer (AJCC) 9th version content, pathologists may continue to use the previous AJCC 8th version tumor stage classification system for cancer reporting until the updated content is required for use on January 1, 2023. The CAP released the updated cancer protocols ahead of the release of the 9th version staging system to allow organizations and laboratory information system (LIS) vendors sufficient time to make changes in their systems reflecting these updates.
• Protocol for Cutaneous Squamous Cell Carcinoma of the Head and Neck. This protocol is required for accreditation.

Previous Updates

On June 22, 2022, the College of American Pathologists released updates to 12 CAP Cancer Protocols. All changes are outlined in the Summary of Revisions.

New Cancer Reporting Protocol:

• Protocol for Cutaneous Squamous Cell Carcinoma of the Head and Neck

Changes affecting accreditation date:

• Anus and Appendix templates were updated to include AJCC 9th version content
• Added answers under Histologic Type to include Squamous Cell Carcinoma grading in the Major Salivary Gland template
• Deleted Tumor Modifier question and combined answer list with TNM Descriptors question for the Endometrium template
• Deprecated Hepatoblastoma from the Histologic Type answers in the Hepatocellular Carcinoma template
• Changed Distance from Invasive Carcinoma to Closest Margin from optional to core in the Lung template
• Updated the pN3a staging classification in the Breast Invasive template

Other key content changes include:

• Updated pN0 staging classification in the Breast Phyllodes template
• Changed the HER2 ISH question to conditional from optional, changed the Ki-67 question to core from optional, and deprecated the Multiparametric Gene Expression question in the Breast Biomarker template

All changes are outlined in the Summary of Revisions. Provide your feedback about the CAP cancer protocols to cancerprotocols@cap.org .

The College of American Pathologists March 2022 release updated 19 CAP Cancer Protocols.

Highlights of these content changes include:

• NEW Protocol – Phyllodes Tumor of the Breast
• All Pediatric Biopsy and Resection Protocols have an added question for Expert Consultation; for Wilms Tumor resection, this change affects the accreditation date
• Deprecated the Distance from Tumor to Vascular, Ureteral, and Soft Tissue Margin Questions for Wilms Tumor Resection: this change affects the accreditation date
• Lymphovascular Invasion was changed from an optional to a core element in the Breast Invasive Resection template which affects the accreditation date
• Clarified Number of Isolated Tumor Cells in the Uterine Sarcoma Resection template which affects the accreditation date
• Other minor content changes include explanatory note updates, corrections of typographical errors, and clarification of answer choices for peritoneal ascitic fluid

All changes are outlined in the Summary of Revisions.