Med student - NCCN guidelines

[metview]

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Hi everyone,

I am set to do a few rad onc rotations, and it seems from previous threads that it is a good idea to know the NCCN guidelines for the disease site that I will be rotating on. I just signed up for it and looked at the guidelines. The PDF documents are > 100 pages. Should I know/read all of that? Or, is there something I should focus on from the guidelines? Thanks for your help!

 

[Cancerdancer]

Know the recs for any individual patient you're seeing, that is all that would be expected

 

[evilbooyaa]

More than anything else, go to the staging section, figure out what TNM and clinical stage the patient is. Try to do all of this the day before. Also know what the staging work-up is for that tumor site/histology (usually one of the first sections once someone has a diagnosis or a suspicious mass)

Then you can go to the treatment areas following the algorithm for that stage of disease and look intelligent when you're presenting the patient.

 

[metview]

Thank you both for the replies. For the staging part, will I have to determine the stage myself or is the patient's stage documented prior to coming in for consultation? If the former, where in the NCCN guidelines do they show how to stage a cancer? Would it be page 11/153 for rectal cancer guidelines attached?

Thanks!

 

[evilbooyaa]

Thank you both for the replies. For the staging part, will I have to determine the stage myself or is the patient's stage documented prior to coming in for consultation? If the former, where in the NCCN guidelines do they show how to stage a cancer? Would it be page 11/153 for rectal cancer guidelines attached?

Thanks!

They may be, but even attendings in other specialties aren't 100% about staging. I'm sure I'm not 100% either. Better to review imaging and make TNM staging decision yourself. For rectal cancer it's hard to have a very accurate T stage unless there's been an endorectal ultrasound or at least MRI of the pelvis.

For the rectal cancer PDF, go to page 3. All of the blue links (I'm assuming you're using it on a computer as a PDF rather than a printed out version) can be clicked on to take you to them. Click on 'Staging (ST-1)' which takes you to page 45, which has the details on the TNM staging classification for rectal cancer. This page is what I am talking about in determining the patient's stage, as much as you can, with the information at hand.

Page 11 is the staging work-up necessary for a patient with biopsied rectal cancer.

There is a difference between knowing the stage for a patient (what their TNM stage is) versus knowing how to stage them (what exams do you get to figure out what their TNM staging is)

Most of the time, if you're meeting a patient that was referred from another oncologist, they have already gone through most of the appropriate staging work-up (although sometimes it isn't ordered or is pending). If they haven't (as outlined on page 11), that would be the first step (to finish what was necessary) prior to recommending treatment.

My recommendation was that you at least know the TNM stage of the patient (as much as possible), similar to knowing all of page 45 from the rectal Ca pdf. The next step up is knowing what staging exams should be done for patients with this diagnosis (Page 11). The next step up is knowing what the treatment should be for that patient, based on the stage of disease they are (follow the guidelines for the stage of disease mentioned).

 

[metview]

They may be, but even attendings in other specialties aren't 100% about staging. I'm sure I'm not 100% either. Better to review imaging and make TNM staging decision yourself. For rectal cancer it's hard to have a very accurate T stage unless there's been an endorectal ultrasound or at least MRI of the pelvis.

For the rectal cancer PDF, go to page 3. All of the blue links (I'm assuming you're using it on a computer as a PDF rather than a printed out version) can be clicked on to take you to them. Click on 'Staging (ST-1)' which takes you to page 45, which has the details on the TNM staging classification for rectal cancer. This page is what I am talking about in determining the patient's stage, as much as you can, with the information at hand.

Page 11 is the staging work-up necessary for a patient with biopsied rectal cancer.

There is a difference between knowing the stage for a patient (what their TNM stage is) versus knowing how to stage them (what exams do you get to figure out what their TNM staging is)

Most of the time, if you're meeting a patient that was referred from another oncologist, they have already gone through most of the appropriate staging work-up (although sometimes it isn't ordered or is pending). If they haven't (as outlined on page 11), that would be the first step (to finish what was necessary) prior to recommending treatment.

My recommendation was that you at least know the TNM stage of the patient (as much as possible), similar to knowing all of page 45 from the rectal Ca pdf. The next step up is knowing what staging exams should be done for patients with this diagnosis (Page 11). The next step up is knowing what the treatment should be for that patient, based on the stage of disease they are (follow the guidelines for the stage of disease mentioned).

Awesome post! Thanks so much!