Division Co-Chiefs: Viswanathan Rajaraman, MD, Mark Pascal, MD
Quality Indicators
(Medical/Surgical/Radiation):
- Radiation therapy started within 3 weeks after a diagnosis is made. (Radiation)
- If there is no history of seizures, anti-convulsants should be stopped no later than 1 month after surgery. (Surgical)
- Diagnosis of brain tumor (Anaplastic or glioblastoma), Grade 2 or higher, and less than 80 or 85 years old should receive chemotherapy. (Medical)
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:
Limited (1-3) Metastatic Lesions
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| Diagnostic Work Up |
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Known history of cancer:
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Exam/Test
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History & Physical Examination
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MRI Brain with and without gadolineum
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Stereotactic or open biopsy/resection or subtotal resection, if there is a doubt of a diagnosis of Central Nervous System lesions
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Pathology review
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No known history of cancer:
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Exam/Test
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History & Physical Examination
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CT Chest/Abdomen/Pelvis with contrast
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Stereotactic or open biopsy/resection if no other accessible tumor for biopsy
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Pathology review
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| Prognostic Work Up |
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Control of Central Nervous System disease
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Systemic disease load
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Multiple (>3) Metastatic Lesions
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| Diagnostic Work Up |
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Known history of cancer:
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Exam/Test
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History & Physical Examination
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MRI Brain with and without gadolineum
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No known history of cancer:
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Exam/Test
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History & Physical Examination
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CBC
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CT Chest/Abdomen/Pelvis with contrast
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Stereotactic or open biopsy/resection if there are no other extracranial accessible tumors
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Pathology review
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| Prognostic Work Up |
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Systemic disease load
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Histology
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Metastatic Spine Tumors
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| Diagnostic Work Up |
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Exam/Test
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History & Physical Examination
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Neurologic Examination
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MRI Cervical/Thoracic/Lumbar sacral spine with and without gadolineum for pain and/or spinal radiculopathy/myelopathy
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Stat MRI Cervical/Thoracic/Lumbar sacral spine with and without gadolineum if there is rapid deterioration
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Bone scan if indicated
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CT Cervical/Thoracic/Lumbar sacral spine with and without contrast if indicated
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X-ray Cervical/Thoracic/Lumbar sacral spine PA and lateral
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CT guided biopsy or Open biopsy
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Pathology review
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| Prognostic Work Up |
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Tumor location
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Histology
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Systemic disease load
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Neuro deficit
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Carcinomatous
| ICD 9 Codes |
| 192.0 |
| 192.1 |
| 192.2 |
| 192.3 |
| 192.8 |
| 192.9 |
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| Diagnostic Work Up |
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Exam/Test
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History & Physical Exam with careful Neurologic Evaluation
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CBC
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MRI Brain & Cervical/Thoracic/Lumbar sacral spine with and without gadolinium
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Lumbar puncture & cerebrospinal fluid exam
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| Prognostic Work Up |
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KPS
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Neurologic deficits
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Amount of systemic disease
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Bulky CNS disease
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Encephalopathy
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Treatment options
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Neoplasm of Uncertain Behavior of the Pituitary Gland and Craniopharyngeal Duct
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| Diagnostic Work Up |
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Exam/Test
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History & Physical Examination
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Neurologic Evaluation
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Ophthalmology Examination
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CT Brain with and without contrast
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MRI Brain with and without gadolinium
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Complete endocrine work-up
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| Prognostic Work Up |
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Lesion size, symptoms
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Histology
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Age
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