Updated April 2025

Appendix 4.1 - CAP electronic Cancer Protocol

The College of American Pathologists (CAP) electronic Cancer Protocol (eCP) are a standardized list of common Question/Answer pairs used in reporting cancer surgical pathology data and were endorsed as a national standard by the Canadian Association of Pathologists on July 14, 2009. As of fiscal year 2010/11, CCO began implementing the CAP electronic Cancer Protocol (eCP) standard with hospitals across the province. Now that all participating hospitals have completed implementation, the latest CAP eCP release is mandated across Ontario. The list of mandated CAP Cancer Protocol (eCP) and Effective dates can be found in Appendix 4.1.

To date, CCO Pathology Laboratory Medicine Program mandated use of 6 CAP biomarker templates; which became available in the October 2013 (Lung & CRC), December 2013 (Breast), June 2014 (Gastric HER2), July 2015 (Melanoma Biomarker Template), and July 2016 (Endometrium: Biomarker Reporting Template).

Body System	Mandated electronic Cancer Protocol (eCP)	eCP Template ID	Accepted eCP Release Versions	CAP original Release Date	OH Effective Date
Bone and Soft Tissue	BONE: Resection	138.1000043	3.005.001	Jun-24	Apr-25
Bone and Soft Tissue	SOFT TISSUE: Resection	168.1000043	3.005.001	Jun-24	Apr-25
Breast	DCIS OF THE BREAST: Biopsy	360.1000043	1.002.001	Jun-21	Apr-22
	DCIS OF THE BREAST	211.1000043	3.003.021	Mar-22	Apr-23
	INVASIVE CARCINOMA OF THE BREAST: Biopsy	362.1000043	1.004.001	Sep-23	Apr-24
	INVASIVE CARCINOMA OR THE BREAST	189.1000043	4.010.001	Jun-24	Apr-25
	PHYLLODES OF THE BREAST: Resection	547.1000043	1.001.011	Sep-23	Apr-23
Central Nervous System	CENTRAL NERVOUS SYSTEM	551.1000043	1.000.000	Sep-22	Apr-23
Gastrointestinal	AMPULLA OF VATER: Ampullectomy, Pancreaticoduodenectomy (Whipple Resection)	131.1000043	3.004.001	Jun-21	Apr-22
	ANUS: Abdominoperineal Resection	134.1000043	4.000.001	Jun-22	Apr-23
	APPENDIX, NEUROENDOCRINE TUMOR (CARCINOID TUMORS): Excision (Appendectomy) or Resection	193.1000043	3.000.001	Dec-23	Apr-25
	APPENDIX: Resection (Appendectomy with or without right hemicolectomy)	135.1000043	4.001.001	Sep-23	Apr-24
	COLON AND RECTUM NEUROENDOCRINE TUMORS (Carcinoid Tumors): Resection, Including Transanal Disk Excision of Rectal Neoplasms	196.1000043	3.000.001	Dec-23	Apr-25
	COLON AND RECTUM: Excisional Biopsy (Polypectomy)	127.1000043	2.013.001	Dec-23	Apr-25
	COLON AND RECTUM: Resection, Including Transanal Disk Excision of Rectal Neoplasms	126.1000043	3.008.011	Jun-24	Apr-25
	DISTAL EXTRAHEPATIC BILE DUCTS: Local or Segmental Resection, Pancreaticoduodenectomy	142.1000043	3.004.001	Jun-21	Apr-22
	DUODENUM AND AMPULLA NEUROENDOCRINE TUMOR	342.1000043	2.000.011	Jun-24	Apr-25
	ESOPHAGUS: Endoscopic Resection, Esophagectomy, or Esophagogastrectomy	141.1000043	3.003.021	Jun-22	Apr-23
	GALLBLADDER: Resection/Cholecystectomy	144.1000043	3.003.011	Mar-22	Apr-23
	GASTROINTESTINAL STROMAL TUMOR (GIST): Resection	145.1000043	3.005.001	Mar-22	Apr-24
	HEPATOCELLULAR CARCINOMA: Hepatic Resection	151.1000043	3.006.001	Jun-22	Apr-23
	INTRAHEPATIC BILE DUCTS: Resection	194.1000043	2.003.011	Jun-21	Apr-22
	JEJUNUM AND ILEUM NEUROENDOCRINE TUMOR	343.1000043	2.000.001	Dec-23	Apr-25
	PANCREAS (ENDOCRINE): Resection	156.1000043	4.000.001	Jun-24	Apr-25
	PANCREAS (EXOCRINE): Resection	157.1000043	3.004.032	Jun-22	Apr-23
	PERIHILAR BILE DUCTS: Local or Segmental Resection, Hilar Resection with or without Hepatic Resection	195.1000043	2.004.011	Jun-21	Apr-22
	SMALL INTESTINE: Segmental Resection, Pancreaticoduodenectomy (Whipple Resection)	166.1000043	3.003.011	Mar-22	Apr-23
	STOMACH, NEUROENDOCRINE TUMORS: Endoscopic Resection, Gastrectomy	201.1000043	3.000.001	Dec-23	Apr-25
	STOMACH: Local Resection, Gastrectomy	170.1000043	3.006.001	Jun-22	Apr-24
Genitourinary	ADRENAL GLAND: Needle biopsy (Core, Incisional, Excisional); Resection	129.1000043	3.007.011	Mar-22	Apr-24
	KIDNEY: Nephrectomy, Partial or Radical	150.1000043	3.005.001	Jun-24	Apr-25
	PENIS: Incisional Biopsy, Excisional Biopsy, Partial Penectomy, Total Penectomy, Circumcision	210.1000043	3.004.001	Sep-23	Apr-24
	PROSTATE NEEDLE BIOPSY - CASE LEVEL	507.1000043	1.001.001	Sep-23	Apr-24
	PROSTATE GLAND: Radical Prostatectomy	128.1000043	3.006.001	Sep-23	Apr-24
	RENAL PELVIS AND URETER: Resection	337.1000043	3.005.001	Sep-23	Apr-24
	TESTIS: Radical Orchiectomy	171.1000043	3.005.001	Sep-23	Apr-24
	TESTIS: Retroperitoneal Lymphadenectomy	172.1000043	3.004.001	Sep-23	Apr-24
	URETHRA: Partial or Total Urethrectomy; Cystectomy, Cystoprostatectomy; Anterior Exenteration	203.1000043	3.006.001	Mar-22	Apr-23
	URINARY BLADDER: Biopsy and Transurethral Resection of Bladder Tumor (TURBT)	202.1000043	1.007.001	Sep-23	Apr-24
	URINARY BLADDER: Cystectomy, Partial, Total, or Radical; Anterior Exenteration	180.1000043	3.004.001	Sep-23	Apr-24
Gynecologic	ENDOMETRIUM: Hysterectomy, With or Without Other Organs or Tissues	117.1000043	4.000.001	Dec-23	Apr-25
	OVARY or FALLOPIAN TUBE or PRIMARY PERITONEUM	336.1000043	1.008.001	Jun-24	Apr-25
	TROPHOBLAST: Dilation and Curettage, Resection	176.1000043	3.002.021	Jun-21	Apr-22
	UTERUS (SARCOMA): Hysterectomy & Myomectomy, with or without other organs or Tissues	216.1000043	2.005.001	Mar-22	Apr-23
	UTERINE CERVIX: Trachelectomy, Hysterectomy, Pelvic Exenteration	182.1000043	4.004.001	Jun-22	Apr-24
	VAGINA: Resection	186.1000043	3.006.031	Mar-22	Apr-23
	VULVA	187.1000043	4.001.001	Jun-24	Apr-25
Head and Neck	CUTANEOUS SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK***	549.1000043	1.000.011	Sep-22	Apr-23
	LARYNX (SUPRAGLOTTIS, GLOTTIS, SUBGLOTTIS): Incisional Biopsy, Excisional Biopsy, Resection	205.1000043	3.006.001	Mar-22	Apr-24
	LIP AND ORAL CAVITY: Incisional Biopsy, Excisional Biopsy, Resection	206.1000043	3.008.001	Mar-22	Apr-24
	MAJOR SALIVARY GLANDS: Incisional biopsy, Excisional Biopsy, Resection	152.1000043	3.007.001	Jun-22	Apr-24
	NASAL CAVITY AND PARANASAL SINUSES: Incisional Biopsy, Excisional Biopsy, Resection	207.1000043	3.006.001	Mar-22	Apr-24
	PHARYNX (OROPHARYNX, HYPOPHARYNX, NASOPHARYNX): Incisional Biopsy , Excisional Biopsy, Resection	208.1000043	3.006.001	Sep-23	Apr-24
	THYROID GLAND: Resection	175.1000043	4.005.001	Mar-22	Apr-24
Hematologic	PRECURSOR AND MATURE LYMPHOID MALIGNANCIES	570.1000043	1.000.000	Sep-23	Apr-24
	MYELOID AND MIXED / AMBIGUOUS LINEAGE NEOPLASMS	571.1000043	1.000.000	Sep-23	Apr-24
	PLASMA CELL MALIGNANCIES AND IMMUNOGLOBULIN DEPOSITION RELATED DISORDERS	572.1000043	1.000.000	Sep-23	Apr-24
Skin	New - Invasive Melanoma Biopsy	578.1000043	1.000.000	Jun-21	Apr-25
	New - Invasive Melanoma Resection	579.1000043	1.001.001	Jun-21	Apr-25
	MERKEL CELL CARCINOMA OF THE SKIN: Incisional Biopsy, Excision, Re-Excision, Lymphadenectomy	198.1000043	2.003.001	Jun-21	Apr-22
Thorax	LUNG: Resection	119.1000043	3.008.011	Jun-21	Apr-24
	MALIGNANT PLEURAL MESOTHELIOMA	160.1000043	3.003.011	Jun-21	Apr-22
	THYMUS: Resection	174.1000043	3.003.021	Mar-22	Apr-23
Biomarkers	BREAST: Biomarker Reporting Template	169.1000043	1.008.001	Jun-21	Apr-22
	COLON AND RECTUM: Biomarker Reporting Template	228.1000043	1.002.001	Jun-21	Apr-22
	DNA Mismatch Repair Biomarker Testing for Checkpoint Inhibitor Immunotherapy (Recommended)	347.1000043	1.000.031	Aug-18	Apr-19
	Gynecologic Biomarker Reporting Template	567.1000043	1.001.001	Sep-23	Apr-24
	General IHC Quantitative Biomarkers (Recommended)	515.1000043	1.002.001	Sep-23	Apr-24
	LUNG: Biomarker Reporting Template	227.1000043	2.001.001	Jun-21	Apr-22
	Head and Neck Biomarkers	522.1000043	1.000.001	Sep-23	Apr-22
	Melanoma: Biomarker Reporting Template	253.1000043	1.000.022	Aug-15	Apr-18
	STOMACH: Gastric HER2 Biomarker Reporting Template	223.1000043	1.003.001	Jan-18	Apr-19
	Thyroid: Biomarker Reporting Template	255.1000043	1.001.001	Feb-20	Apr-22

*** The CUTANEOUS SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK Template is to be used for ALL RESECTABLE tumours.
For the time being, the CUTANEOUS SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK Template will be EXCLUDED from the OH Pathology

Data Quality metrics (Synoptic and Completeness rates).

Note: OH-CCO will continue to exclude ALL biopsy pathology reports (synoptic and/or narrative format) from the pathology data quality indicators available in iPortTM.

The following electronic Cancer Checklists are excluded from monthly reporting and are optional for use:

Body System	Excluded electronic Cancer Protocol (eCP)	eCP Template ID
Bone and Soft Tissue	BONE: Biopsy	136.1000043
	SOFT TISSUE: Biopsy	167.1000043
Gastrointestinal	ANUS: Excisional Biopsy or Local Excision (Transanal Disk Excision)	133.1000043
	GASTROINTESTINAL STROMAL TUMOR (GIST): Biopsy	197.1000043
Genitourinary	KIDNEY: Biopsy	149.1000043
	PROSTATE GLAND: Transurethral Prostatic Resection (TUR), Enucleation Specimen (Subtotal Prostatectomy)	190.1000043
	PROSTATE NEEDLE BIOPSY - SPECIMEN LEVEL	508.1000043
	URETER, RENAL PELVIS: Biopsy	179.1000043
	URETHRA: Biopsy	204.1000043
Gynecologic	UTERINE CERVIX: Excision (Cone/LEEP)	183.1000043
	VAGINA: Biopsy	185.1000043
Ophthalmic	RETINOBLASTOMA: Enucleation, Partial or Complete Exenteration	163.1000043
	UVEAL MELANOMA: Resection (Local Resection, Enucleation, Limited or Complete Exenteration)	184.1000043
Pediatric	EWING SARCOMA/PRIMITIVE NEUROECTODERMAL TUMOR: Biopsy	209.1000043
	EWING SARCOMA/PRIMITIVE NEUROECTODERMAL TUMOR: Resection	161.1000043
	EXTRAGONADAL GERM CELL TUMOR: Biopsy	369.1000043
	EXTRAGONADAL GERM CELL TUMOR: Resection	212.1000043
	HEPATOBLASTOMA (PEDIATRIC LIVER): Biopsy	363.1000043
	HEPATOBLASTOMA (PEDIATRIC LIVER): Resection	147.1000043
	KIDNEY: Biopsy for Pediatric Renal Tumor	366.1000043
	KIDNEY: Resection for Pediatric Renal Tumor	188.1000043
	NEUROBLASTOMA: Biopsy	364.1000043
	NEUROBLASTOMA: Resection	153.1000043
	RHABDOMYOSARCOMA AND RELATED NEOPLASMS: Biopsy	365.1000043
	RHABDOMYOSARCOMA AND RELATED NEOPLASMS: Resection	164.1000043
Other	GENERAL TUMOR: Biopsy (recommended)	326.1000043
	GENERAL TUMOR: Resection (recommended)	312.1000043
Biomarker	GIST: Biomarker Reporting Template	242.1000043

Body System	Deprecated electronic Cancer Protocol (eCP)	eCP Template ID
Central Nervous System	BRAIN/SPINAL CORD: Biopsy/Resection	139.1000043
	CNS: Histological Assessment	351.1000043
	CNS: Integrated Diagnosis	350.1000043
Gastrointestinal	SMALL INTESTINE NEUROENDOCRINE TUMOR	200.1000043
Genitourinary	PROSTATE GLAND: Needle Biopsy	191.1000043
	PROSTATE GLAND: Needle Biopsy (Note A)	346.1000043
	RENAL PELVIS: Resection/Nephroureterectomy, Partial or Complete	162.1000043
	URETER: Resection	178.1000043
Gynecologic	FALLOPIAN TUBE: Unilateral Salpingectomy, Salpingo-oophorectomy, or Hysterectomy with Salpingo-oophorectomy	143.1000043
	OVARY: Oophorectomy, Salpingo-Oophorectomy, Subtotal Oophorectomy or Removal of Tumor in Fragments, Hysterectomy with Salpingo-Oophorectomy	155.1000043
	OVARY or FALLOPIAN TUBE: Oophorectomy, Salpingectomy, Salpingo-Oophorectomy, Subtotal Oophorectomy or Removal of Tumor in Fragments, Hysterectomy With Salpingo-Oophorectomy or Salpingectomy	257.1000043
Hematologic	BONE MARROW: Aspiration, Core (Trephine) Biopsy	137.1000043
	OCULAR ADNEXA: Biopsy, Resection	192.1000043
	BONE MARROW: Final Integrated Diagnosis	372.1000043
	BONE MARROW: Histologic Assessment	354.1000043
	HODGKIN LYMPHOMA: Biopsy, Resection	148.1000043
	NON-HODGKIN LYMPHOMA/LYMPHOID NEOPLASMS: Biopsy, Resection	154.1000043
	PLASMA CELL NEOPLASM: Targeted Biopsy, Resection, or Bone Marrow Sampling	243.1000043
	OCULAR ADNEXA: Biopsy, Resection	192.1000043
Other	PERITONEUM: Resection	158.1000043
Skin	MELANOMA OF THE SKIN: Biopsy, Excision, Re-Excision	121.1000043
	SQUAMOUS CELL CARCINOMA OF THE SKIN: Biopsy, Excision, Re-excision, Lymphadenectomy	165.1000043
	MELANOMA OF THE SKIN: Excision, Re-Excision	259.1000043
	MELANOMA OF THE SKIN: Biopsy	258.1000043
Thorax	HEART: Resection	146.1000043
Biomarkers	Chronic Myelogenous Leukemia (CML): Biomarker Reporting Template	252.1000043
	Chronic Lymphocytic Leukemia (CLL): Biomarker Reporting Template	251.1000043
	Diffuse Large B-Cell Lymphoma (DLBCL): Biomarker Reporting Template	254.1000043
	Myeloproliferative Neoplasms (MPN): Biomarker Reporting Template (Recommended)	250.1000043
	Endometrium: Biomarker Reporting Template	264.1000043
	Bone Marrow: Biomarker Reporting Template (Recommended)	373.1000043
	CNS: Biomarker Reporting Template	241.1000043

OH-CCO Monthly Synoptic DDF Reporting Inclusions

· All CAP mandated eCCs for malignant surgical resections (that are applicable to your site)

· In-situ resection reports for breast DCIS, urinary bladder, urethra and renal pelvis: ureter

· Benign/borderline resection reports for brain and spinal cord

OH-CCO Monthly Synoptic DDF Reporting Exclusions

· All other benign, borderline, in-situ or metastatic reports (ICDO-3 behavior codes 0, 1, 2 and 6 respectively), with the exception those listed under inclusions

· All biopsy, autopsy, cytology, gynecological cytology biomarker and flow cytometry reports will be electronically excluded if the hospital can send the correct report type in OBR 4

· All hematopoietic checklists (bone marrow, Hodgkin lymphoma, non-Hodgkin lymphoma)

· Consults completed on specimens from outside facilities

· *Reports where diagnosis of cancer is uncertain (sent for consult)

· *Squamous cell carcinoma cases where tumour thickness is <2cm (i.e. any squamous cell carcinoma less than pT2)

· *Re-excisions (except for re-excisions for melanoma and SCC of the skin which are required in DDF format using the appropriate eCCs)

*These are examples of the exclusions that the current CAP checklist DDF templates may not or cannot be appropriately utilized by the reporting pathologists and which CCO cannot electronically exclude from the Synoptic Pathology Reporting Indicator. These exclusions fall into the 10% window.