How to approach any cancer patient

Cancer Initial test Specific orders Consultation/surgery

HD Uric acid, LDH Lymph node biopsy
PET CT
Laryngeal Cancer CT neck Direct laryngoscopy + Consult otolaryngology
Biopsy
Lung Cancer Sputum Gram Bronchoscopy + Biopsy Consult thoracic surgery
stain, Culture,
Cytology
CXR (If pneumonia
>> Levofloxacin)
Gastric Cancer Ferritin, Iron and Endoscopy upper GI + Gastrectomy
TIBC Biopsy
Colon Cancer Ferritin, Iron and Polyethylene glycol Colectomy
TIBC Colonoscopy + Biopsy
CEA
Pancreatic Cancer Amylase, Lipase Pancreatic needle biopsy
CA 19-9
Renal Cell Cancer Ferritin, Iron and Nephrectomy
TIBC
Bladder Cancer Urine cytology Cystoscopy + Biopsy Consult urology
Transurethral resection
bladder tumor
Prostate Cancer PSA total Prostate fine-needle Consult urology
Spine X-ray aspirate
lumbosacral Bone scan
Prostate U/S
Breast Cancer Breast ultrasound Breast fine-needle
Mammography aspirate
Cervical Cancer Pap smear Colposcopy + Cervical consult Ob-Gyn
HPV DNA probe biopsy, endocervical
test, cervix curretage

Endometrial Cancer Ferritin, Iron and Endometrial biopsy Consult Ob/Gyn

TIBC Hysterectomy,
CA-125 laparoscopic
Pap smear

Ovarian cancer Pelvic US Consult Ob/Gyn

Alpha-fetoprotein TAH-BSO by laparotomy,
CA-125

Valvular Cancer Pap smear Vulvar biopsy Consult Ob/Gyn

Sequencing
Initial visit
Physical exam (Don’t forget Rectal/Genitalia/LN/Skin)
+
D Diagnosis
Labs
Routine: CBC/BMP/LFT/PT/PTT/TSH/ESR/UA/FOBT F: B HCG
+
Initial test: as in table

Second visit
Specific test: as in table

+
Imaging:
CT chest
CT Abd

+
A Advise patient cancer diagnosis
A Advise patient, advance directive (if metastatic)
A Advise patient, (Diet, Exercise, relevant bad habits)
Reassure patient

After confirmation of diagnosis with lab or radiology

C Consult hematology/oncology
C Consult, radiation therapy
C Consult general surgery

If operation will be done

Admit to Ward
+
Admission orders as per Cheat sheet
+
Surgery orders as per Cheat sheet

M Monitoring with tumor markers and any abnormal lab like CBC in 2 min screen