Cancer Care Program - Staff and Physicians

Primary CNS tumours

All referrals come from Neurosurgery.

• Pathology (unless discussed and not required – this must be noted in referral letter)
• Updated imaging

Ideally, all cases should be discussed at tumour board.

Patients with previous cancer history and metastatic tumours 

• Referred to oncology team who treated original tumour

Refer to local Colposcopy service.

• All relevant pathology slides/blocks AND the path report from biopsy/surgical specimen (if done)
• Relevant OR report (if done)

Pathology

• Pap test (last 2)

• All relevant pathology slides/blocks AND the path report from biopsy/surgical specimen (if done)
• Relevant OR report (if done)

Pathology

• Pathology reviewed by QEII Gyne pathology

Blood work

• CBC
• Biochemistry
• Creatinine

Imaging

• Pelvic MRI with cervix protocol

Referral letter must specify if referral is for:  

• New diagnosis – metastatic for neoadjuvant treatment  
• New diagnosis – for adjuvant treatment  
• Recurrence

AND

• Name of surgeon involved in treatment plan
• If metastatic, name of any other surgical specialist(s) patient has been referred to

Pathology

• Pathology report documenting cancer diagnosis, including:
  • Biomarkers
  • Mismatch repair deficiency
  • If metastatic, BRAF and all RAS mutations (if available)

Blood work   

• CEA
• CBC
• Na
• K
• Cl
• Creatinine
• Albumin
• INR/PTT
• If metastatic, bili and AST/ALT

Imaging reports

• CT abdomen/pelvis
• CXR/CT chest
• If metastatic, must include CT chest
• Any available recent imaging reports related to current presenting problem

Operative reports

• Endoscopy report
• If metastatic and potentially resectable, consultation report from specialist (if available)
• Any other operative reports relevant to the cancer

• All relevant pathology slides/blocks AND the path report from biopsy/surgical specimen (if done)
• Relevant OR report (if done)

Pathology

• Pathology reviewed by QEII Gyne pathology

Blood work

• CBC
• Biochemistry
• (Na, K, Cl, Urea, Creatinine, Calcium)

Imaging

• Imaging reports (if done)

OR reports

• Endometrial bx / D&C
• Hysterectomy (If done)

Prior to referring to medical or radiation oncology, all patients should be referred to Thoracic Surgery (fax referral to 902 473-6144 or via Ocean e-referral). 

• Referral stating the diagnosis and clinical stage.
• Referral should state if surgical resection is planned (i.e., induction versus definitive therapy).

• Pathology, including biomarkers  
• Any imaging

• All relevant pathology slides/blocks AND the path report from biopsy/surgical specimen (if done)
• Relevant OR report (if done)

Pathology

• Pathology: biopsy and/or surgical (if done)

Blood work

• CBC
• Biochemistry (Na, K, Cl, Urea, Creatinine, Calcium)
• LFT
  • Quantitative βHCG

Imaging

• CXR (if done)

OR reports

• If done

Fax to your local gynecologist.

• All relevant pathology slides/blocks AND the path report from biopsy/surgical specimen (if done)
• Relevant OR report (if done)

Pathology

• Pap test
• Pathology: biopsy and/or surgical (if done)

Blood work

• CA 125
• CEA
• CBC
• Biochemistry (Na, K, Cl, Urea, Creatinine, Calcium)
• LFT and enzymes (Total Protein, Albumin, Alkaline Phosphatase, ALT, AST, Total and Direct Bilirubin, GGT,LDH)
• Electrolytes

Pathology   

• HCC can be diagnosed with a triphasic CT, with an elevated AFP in a cirrhotic patient, without tissue confirmation.  

Blood work  

• CBC
• Creatinine
• Calcium
• LFTs (AST, ALT, ALP)
• LDH
• Total bilirubin
• Albumin
• Electrolytes
• AFP
• Glucose
• Magnesium
• INR, PT

Imaging

• CT chest/abdomen/pelvis

Other reports  

• History and physical
• OR reports

Adjuvant:

Required information:

• All pathology (initial biopsy, WLE, SLNBx)
  • BRAF (if results not available, indicate that the request has been made)
  • Body imaging (PET or CT C/A/P)
  • Brain imaging (MRI preferred, CT acceptable)
• If results from the required information are not completed, confirmation that they have been ordered/booked is required. 

Metastatic:

Required information:

• All pathology reports
• Body imaging (PET or CT C/A/P)
• Brain imaging (MRI preferred, CT acceptable)
   

• All referrals must have been discussed by Thoracic Cancer Site Team.
• Requires referral from Thoracic Surgery stating the diagnosis and clinical stage.
• Referral should state if surgical resection is planned (i.e., induction versus definitive therapy).

Any pathology, blood work, imaging and operative reports pertaining to diagnosis.

• Requires referral from Thoracic Surgery stating the diagnosis and clinical stage.
• Referral should state if surgical resection is planned.
   

1. Post surgery for consideration of Adjuvant Chemotherapy:

• Include original consult letter to the thoracic surgeon (preferred).
• To allow for timely consultation, please ask for expedited pathology results, including molecular results. Adjuvant treatment should be started within 8-10 weeks of surgery (at the latest 12 weeks).
• Post-surgical pathology report available. 

2. Locally advanced and metastatic for consideration of Radiation and/or Chemotherapy:

• Prior to referring to medical or radiation oncology, all patients should be seen by Thoracic Surgery (fax referral to 902 473-6144 or via Ocean e-referral). 
• Referral stating the diagnosis and clinical stage.
• Referral letter should state if surgical resection is planned (i.e., induction versus definitive therapy) and rationale.
• Biopsy results with adequate tissue for molecular/PD-L1 testing.
• CT scan chest and abdomen (ideally within the last 2 months).

All patients should also be referred to HPB surgical service to determine resectability of disease. Referrals to HPB surgeons can be made through:

• Fax: 902 473-5297

OR

• Ocean
  • Launch Ocean from your EMR.
  • Refer to General surgery and indicate cancer, suspected or confirmed, pancreatic.
  • In the absence of EMR, log in through Ocean web portal.  

Patients presenting with obstructive jaundice that is not stone-related should immediately and directly be referred to the QEII for Level 3 or 4 ERCP.

ERCP Central Booking Halifax

• Fax: 902-473-5548

Information to accompany a referral for medical and radiation oncology:

• Confirmation patient has been referred to HPB surgery and ERCP (if jaundiced)
• Full history and physical exam (including lymph nodes and any palpable masses)

Pathology

• Pathology report available

OR

• Provide confirmation that a referral for biopsy (EUS/ERCP) has been made

Imaging

• CT chest/abdomen/pelvis
• Blood work
• INR
• CBC
• Total bilirubin
• Albumin
• AST, ALT, ALP
• Creatinine
• Random glucose
• CA19-9
• CEA 

• Women with carcinomatosis should be referred to Gynecologic Oncology unless there is strong clinical suspicious or histologic diagnosis of a non-gynecologic primary (e.g., colorectal or appendiceal mass, concurrent rectal bleeding, etc.).  See Gynecology Oncology Referral information above.

All other patients meeting the criteria below will be referred to the Atlantic Peritoneal Oncology Program through OCEAN (choose Peritoneal Oncology) or via fax to 1-902-423-1629. The Cancer Care Program Referral form is not required.

• Any male patient with imaging suspicious/concerning for peritoneal carcinomatosis, including peritoneal carcinomatosis of unknown origin
• Any patient with appendiceal mass or mucocele
• Any patient with confirmed appendiceal neoplasia on final pathology (e.g., incidental neuroendocrine tumor in appendectomy specimen)
• Any patient with imaging suspicious for peritoneal carcinomatosis with a recent diagnosis of colorectal adenocarcinoma (<5-years)
• Any patient with biopsy confirmed peritoneal carcinomatosis of gastrointestinal origin
• Any patient with peritoneal mesothelioma, including papillary and multi-cystic mesothelioma

Required information for referral:

• Consultation letter highlighting presenting signs, symptoms and findings
• All relevant pathology slides/blocks and the path report from biopsy/surgical specimen (if done)
• OR report (if done)

NOTE: All new diagnoses of rectal cancer are to be:

• Referred to the provincial GI Luminal CST
  • Referral form

AND

• Presented by the surgeon prior to being seen by medical or radiation oncology

Referral letter must include:  

• Name of surgeon to whom patient has been referred for treatment plan  
• Date patient discussed at provincial GI Luminal CST case conference   
• Whether the referral is for:
  • A new diagnosis – non metastatic  
  • A new diagnosis – metastatic  
  • Adjuvant treatment  
  • Recurrence  

Pathology   
Pathology report documenting cancer diagnosis, including:

• Biomarkers
• Mismatch repair deficiency
• If metastatic, BRAF and all RAS mutations (if available)

Blood work  

• CEA   
• CBC
• Na
• K
• Cl
• Creatinine
• Albumin
• INR/PTT  
• If metastatic:
  • Bilirubin
  • AST/ALT

Imaging  

• CT chest/CXR  
• CT abdomen and pelvis  
• MRI pelvis  
• Any available recent imaging reports related to current presenting problem

Reports  

• Endoscopy report  
• Any other operative reports relevant to the cancer

Pathology

• Pathology report, with any related molecular studies

Imaging  

• Images of primary   
• If metastatic:
  • CT lung

Reports

• Any OR reports of relevant or recent surgery

Required information:

• Pathology
• Consults from surgery and/or rad onc stating no role for local therapy (CST note acceptable)

Prior to referring to medical or radiation oncology, all patients' cancer should be seen by Thoracic Surgery (fax referral to 902 473-6144 or via Ocean e-referral). 

These diagnoses are considered urgent. Referrals and investigations should be expedited once histological diagnosis made.

Required:    

• Histologic confirmation
• CT scan chest 

Order but do not wait for results: 

• CT scan abdomen and pelvis if not already done.

The referring physician must speak directly to a medical oncologist for urgent situations such as:  

• Inpatients, in order to coordinate care
• Airway compromise, or extensive disease with significant involvement of the liver or bone

If Monday-Friday (08:00-04:00), please speak to the Cancer Care Program Referral Office (902-473-5140) to determine the medical oncologist assigned to the case. If after hours or on weekends, please speak to the medical oncologist on call.

• All relevant pathology slides/blocks AND the path report from biopsy/surgical specimen (if done)
• Relevant OR report (if done)

Pathology

• Pathology: biopsy and/or surgical (if done)
• Cytology of ascites (if done)

Blood work

• βHCG (quantitative)
• AFP
• LDH
• CEA
• CA125

Imaging

• CT abdomen/pelvis

• All relevant pathology slides/blocks AND the path report from biopsy/surgical specimen (if done)
• Relevant OR report (if done)

Pathology

• Cytology of ascites (if done)
• Pathology: biopsy and/or surgical (if done) reviewed by QEII Gyne pathology

Blood work

• CA 125
• CEA
• CBC
• Biochemistry (Na, K, Cl, Urea, Creatinine, Calcium)
• LFT and enzymes (Total Protein, Albumin, Alkaline Phosphatase, ALT, AST, Total and Direct Bilirubin, GGT,LDH)

Imaging

• CT abdomen/pelvis

OR reports

• If done

• All referrals must have been discussed by Thoracic Cancer Site Team. 
• Requires referral from Thoracic Surgery.
   

Pathology

Blood work

• TSH
• Free T4
• Serum thyroglobulin

Pathology

• Final anatomic pathology report of biopsied confirmation of malignancy

Blood work

• CBC and diff
• INR
• Full chemistry profile, including:
  • Calcium
  • Albumin
  • AST/ALT
  • Bilirubins (total and direct)
  • LDH

Imaging

• All: CT chest/abdomen/pelvis
• Females: Mammogram within 6 to 12 months of current diagnosis

Tumour markers:

• All: CEA, CA 19-9, AFP
• Males: PSA, Beta HCG
• Females: Ca-125

This includes Vulvar Intraepithelial Neoplasia (VIN) and Vaginal Intraepithelial Neoplasia (VAIN).

• All relevant pathology slides/blocks AND the path report from biopsy/surgical specimen (if done)
• Relevant OR report (if done)

Pathology

• Diagnostic biopsy reviewed by QEII Gyne pathology
• Pap smear cytology

Other

• Attach a letter with details
• Attach picture/diagram