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CCF Annual Conference - CCA and Physical Activities
1.
First Name
2.
Last Name
*
3.
Email
(Required.)
*
4.
What is the patient's gender
(Required.)
Male
Female
Non binary
*
5.
What is the patient's race? [Select all that apply]
(Required.)
White or Caucasian
Black or African American
American Indian or Alaska Native
Asian or Asian American
Native Hawaiian or other Pacific Islander
Hispanic or Latino
Other (please specify)
*
6.
What was the year of cholangiocarcinoma diagnosis? (YYYY)
(Required.)
*
7.
What was the patient age (yrs) at the time of cholangiocarcinoma diagnosis?
(Required.)
*
8.
What is/was the type of cholangiocarcinoma that the patient had?
(Required.)
Intrahepatic cholangiocarcinoma
Cancer develops in the hepatic bile ducts or the smaller intrahepatic biliary ducts inside the liver
Perihilar extrahepatic cholangiocarcinoma
Cancer develops where the right and left hepatic ducts have joined and are leaving the liver
Distal extrahepatic cholangiocarcinoma
Cancer outside the liver after the right and left hepatic bile ducts have joined to form the common bile duct
Unsure
*
9.
Please select who is filling out the survey:
(Required.)
Patient
Caregiver
Former Caregiver for a patient who has passed away
Current Progress,
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