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Cancer Protocol Templates

Please direct questions or comments regarding CAP Cancer Protocols to cancerprotocols@cap.org.

Laboratories across the country and around the world rely on the CAP to help them stay current with the latest evidence-based practices and maintain quality and proficiency among the entire pathology team.

The CAP Cancer Protocols provide guidelines for collecting the essential data elements for complete reporting of malignant tumors and optimal patient care. These protocols incorporate the latest standards to help pathologists and laboratories keep abreast of the advances and updates in cancer reporting, including:

  • The World Health Organization Classification of Tumors (Blue Books)
  • The American Joint Committee on Cancer Staging Manual

Synoptic reporting using the CAP electronic Cancer Protocols (eCP) also helps laboratories and hospitals comply with requirements for organizations like the American College of Surgeons Commission on Cancer, the CAP Laboratory Accreditation Program, and more.

The CAP Biomarker Reporting Protocols are intended to provide reporting guidance for commonly ordered biomarkers and are not required for accreditation purposes.

Current Release Updates

Published Date

September 2026

On September 16, 2026, the College of American Pathologists (CAP) released updates to the CAP Cancer Protocols, with changes across 14 protocols. Key highlights include:

  • Breast, Phyllodes Tumor: Protocol now required for accreditation of malignant phyllodes tumors, with WHO 6th Edition updates, revisions to reporting and display items, addition of optional Tumor Necrosis reporting, enhancements to Margins and Additional Findings sections, pTNM classification updates, and an eCP-only ASCII technical update.
  • Breast, Biomarker: Updates to ER, PgR, and HER2 scoring criteria and scoring systems, including revised HER2 IHC reporting, addition of scoring methodology fields for ER, HER2, and optional PgR reporting, formatting enhancements, and eCP-only ASCII technical updates.
  • Bile Duct (Distal Extrahepatic, Intrahepatic & Perihilar): WHO 6th Edition updates, revisions to Histologic Type, Tumor Extent, and Additional Findings questions, accreditation updates, and modifications to margin-related terminology and reporting.
  • GIST, Biopsy: Protocol expanded to support all GIST anatomic sites, with WHO 6th Edition updates, revisions to tumor site and histologic type reporting, updates to treatment effect and risk assessment content, enhanced biomarker reporting guidance, and eCP-only technical updates.
  • GIST, Biomarker: Expanded molecular and immunohistochemical testing options, including new NTRK fusion gene analysis reporting, updates to KIT and PDGFRA testing, revised result value selections, improved organization of biomarker content, and eCP-only technical updates.
  • GIST, Resection: Protocol expanded to support all GIST anatomic sites, with WHO 6th Edition updates, revisions to reporting questions and display items, enhancements to treatment effect and risk assessment reporting, updates to staging and margin content, new biomarker and molecular testing options, and eCP-only technical updates.
  • Kidney Wilms Tumor, Resection: Minor formatting and reporting updates, including enhancements to answer positioning and conditional reporting logic, revisions to staging guidance within Explanatory Note F, and updates to support structured reporting consistency.
  • Hematopathology (Lymphoid, Myeloid & Mixed/Ambiguous Lineage Neoplasms): Molecular Alterations Detected reporting updated to include new “Not Performed” answer options and revisions to specific molecular result values.
  • Other Updates (CNS, Bladder & Gynecologic): Technical and metadata updates were made to the Central Nervous System and Bladder protocols, and the Vaginal Biopsy protocol has been retired.

All changes are outlined in the Summary of Revisions (PDF, 117 KB)

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

Cancer Reporting and Biomarker Reporting Protocols

Browse by Body Site

Breast

Central Nervous System

Endocrine

Gastrointestinal

Genitourinary

Gynecologic

Vagina, Biopsy
Current Version: Protocol Retired

Head and Neck

HPV-Independent Oropharynx and Hypopharynx
Current Version: Apr-26
Major Salivary Glands
Current Version: Protocol Retired

Hematologic

Ophthalmic

Pediatric

Skin

Thorax

Bone and Soft Tissue

General

CAP Cancer Protocol Usage Limitations, Copyright, and Terms of Use

© 2026 College of American Pathologists (CAP). All rights reserved.

The College of American Pathologists (CAP) does not permit reproduction of any substantial portion of these protocols without its written authorization. The CAP hereby authorizes use of these protocols by physicians and other health care providers in reporting on surgical specimens, in teaching, and in carrying out medical research for nonprofit purposes. This authorization does not extend to reproduction or other use of any substantial portion of these protocols for commercial purposes without the written consent of the CAP.

The CAP also authorizes physicians and other health care practitioners to make modified versions of the Protocols solely for their individual use in reporting on surgical specimens for individual patients, teaching, and carrying out medical research for non-profit purposes.

The CAP further authorizes the following uses by physicians and other health care practitioners, in reporting on surgical specimens for individual patients, in teaching, and in carrying out medical research for non-profit purposes: (1) Dictation from the original or modified protocols for the purposes of creating a text-based patient record on paper, or in a word processing document; (2) Copying from the original or modified protocols into a text-based patient record on paper, or in a word processing document; (3) The use of a computerized system for items (1) and (2), provided that the protocol data is stored intact as a single text-based document, and is not stored as multiple discrete data fields.

All customized or derivative versions of CAP cancer protocols remain the property of the College of American Pathologists and may not be reproduced, distributed, shared, or incorporated into any artificial intelligence system, including but not limited to machine learning and data mining, without prior written authorization from the CAP.

Other than uses (1), (2), and (3) above, the CAP does not authorize any use of the Protocols in electronic medical records systems, pathology informatics systems, cancer registry computer systems, computerized databases, mappings between coding works, or any computerized system without a written license from the CAP.

Any public dissemination of the original or modified protocols is prohibited without a written license from the CAP.

The Protocols include tumor staging data used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this information is the AJCC Cancer Staging System (2020).

The CAP developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the CAP recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the required data elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the CAP cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of this document.

The inclusion of a product name or service in a CAP publication should not be construed as an endorsement of such product or service, nor is failure to include the name of a product or service to be construed as disapproval.

Questions or comments?Contact us to learn more about our cancer protocols