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 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.

On December 13, 2023, the College of American Pathologists released updates to the CAP Cancer Protocols. The release featured two new protocols, as well as content changes to 11 protocols.

Highlights of the Q4 updates include:  

• Two NEW melanoma protocols: Invasive Melanoma, Excision (v1.0.0.0) and Invasive Melanoma, Biopsy (v1.0.0.0) 
• Two existing melanoma cancer protocols were retired: Melanoma, Biopsy (v4.3.1.0) and Melanoma, Excision (v4.3.0.2) 
• Colon, Resection protocol was updated to remove transanal disk procedure and add submucosal invasion for pT1 tumors 
• Colon Biopsy protocol was updated to include transanal disk procedure
• Six gastrointestinal NET cancer protocols updated to reflect WHO and AJCC content  
• Two gynecologic cancer protocols updated to reflect AJCC and/or FIGO content 

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

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

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.