Division Co-Chiefs: Andrew Jennis, MD, Donald McCain, MD
Quality Indicators
(Medical/Surgical/Radiation):
- Colon Cancer
- ? 12 nodes removed at surgery
- medical oncology evaluation for adjuvant treatment
- Rectal Cancer
- Total Mesorectal Excision (TME) surgery
- Medical oncology evaluation for neoadjuvant treatment
- Complete Resection (Ro)
- Radiation oncology consultation.
- Esophageal Cancer
- Pre-operative medical oncology evaluation
- Complete resection (Ro)
- ? 12 nodes removed at surgery
- Gastric Cancer
- Pre-operative medical oncology evaluation
- Complete resection (Ro)
- ? 12 nodes removed at surgery
- at least D1, if not D2 surgery
- laparoscopy at time of surgery to rule out peritoneal disease
- Pancreas Cancer
- Medical oncology evaluation for adjuvant treatment
- Laparoscopy at time of surgery to rule out peritoneal disease
- Hepatocellular Cancer
- Complete resection (Ro)
All Patients
- All patients with solid tumors are staged according to ACoS standards.
- All patients who are receiving chemotherapy have a plan documented prior to administration of therapy.
Diagnostic Work Up:
Colon Cancer
| ICD 9 Codes |
|
153.1
|
|
153.2
|
|
153.3
|
|
153.4
|
|
153.5
|
|
153.6
|
|
153.7
|
|
153.8
|
|
153.9
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Chemistry Screen
|
|
CEA
|
|
Colonoscopy
|
|
CT Chest/Abdomen/Pelvis
|
|
PET Scan (if potentially curable Stage IV)
|
|
MRI Liver (if potentially resectable hepatic metastases)
|
|
| Prognostic Work Up |
|
Stage
|
|
Pre-operative CEA
|
|
Pathologic Features (differentiation, lymphovascular invasion, etc.)
|
|
GI tract obstruction/perforation
|
|
# of lymph nodes in pathologic sample
|
|
Percentage of lymph nodes examined involved with cancer
|
|
Molecular characteristics (under study)
|
|
Rectal Cancer
| ICD 9 Codes |
|
154.0
|
|
154.1
|
|
154.2
|
|
154.3
|
|
154.8
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Chemistry Screen
|
|
CEA
|
|
Colonoscopy
|
|
CT Chest/Abdomen/Pelvis
|
|
Transrectal Ultrasound
|
|
PET (if potentially curable Stage IV)
|
|
MRI Liver (if potentially resectable hepatic metastases)
|
|
| Prognostic Work Up |
|
Stage
|
|
Pathologic Features
|
|
# of lymph nodes in pathologic sample
|
|
Anatomic location of cancer within the rectum (proximal v. distal)
|
|
Esophogeal Cancer
| ICD 9 Codes |
|
150.1
|
|
150.2
|
|
150.3
|
|
150.4
|
|
150.5
|
|
150.6
|
|
150.7
|
|
150.8
|
|
150.9
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Chemistry Screen
|
|
CEA
|
|
Endoscopy
|
|
Endoscopic Ultrasound
|
|
CT Chest/Abdomen
|
|
PET Scan
|
|
| Prognostic Work Up |
|
Stage
|
|
Performance Status / Nutritional Status
|
|
Gastric Cancer
| ICD 9 Codes |
|
151.0
|
|
151.1
|
|
151.2
|
|
151.3
|
|
151.4
|
|
151.5
|
|
151.6
|
|
151.8
|
|
151.9
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Chemistry Screen
|
|
CEA
|
|
Chest X-Ray
|
|
Endoscopy
|
|
Endoscopic Ultrasound
|
|
CT Abdomen/Pelvis
|
|
PET Scan
|
|
Laparoscopy at time of surgery
|
|
| Prognostic Work Up |
|
Stage
|
|
Performance Status / Nutritional Status
|
|
Hepatocellular Carcinoma
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Chemistry Screen
|
|
Alphafetoprotein
|
|
HepBsAg, HepBcAb
|
|
Hep C Ab
|
|
Chest X-Ray
|
|
CT or MRI Liver
|
| Bone scan |
| CT Chest/Abdomen/Pelvis with contrast |
| Breast MRI with and without gadolineum |
| PET Scan |
|
| Prognostic Work Up |
|
Stage
|
|
Childs Cirrhosis Class
|
|
Gallbladder Cancer
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Chemistry Screen
|
|
Chest X-Ray
|
|
CT or MRI Abdomen
|
|
|
Cholangiocarcinoma
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Chemistry Screen
|
|
CEA
|
|
Chest X-Ray
|
|
CA 19-9
|
|
CT or MRI Abdomen
|
|
ERCP (for extrahepatic cholangiocarcinoma)
|
|
| Prognostic Work Up |
|
Stage
|
|
Resectability
|
|
Small Intestine Cancer
| ICD 9 Codes |
|
152.0
|
|
152.1
|
|
152.2
|
|
152.3
|
|
152.8
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Chemistry Screen
|
|
CEA
|
|
Chest X-Ray
|
|
CT or MRI Abdomen/Pelvis
|
|
|
Anal Cancer
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Chemistry Screen
|
|
CEA
|
|
HIV (if indicated)
|
|
Proctoscopy
|
|
CT or MRI Abdomen/Pelvis
|
|
|
Anal Cancer
| ICD 9 Codes |
|
157.0
|
|
157.1
|
|
157.2
|
|
157.3
|
|
157.4
|
|
157.8
|
|
157.9
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Chemistry Screen
|
|
CA 19-9
|
|
Chest X-Ray
|
|
CT or MRI Abdomen/Pelvis
|
|
Endoscopic Ultrasound (if potentially resectable)
|
|
Consider ERCP
|
|
| Prognostic Work Up |
|
Stage
|
|
Surgical resectability
|
|
Post-operative CA 19-9
|
|
Performance Status
|
|
