ONC 3
ONC 3.2 Nasopharyngeal Cancer= MRI orbits/Face/ Neck without and with contrast- CXR
What does nasopharyngeal mean?
tumor is in either in the upper part of the pharynx, connecting with the nasal cavity.
Think of the nasopharyngeal swabs performed in clinical where they touch
ONC 8.3 Stage IV with oligometastatic disease on conventional imaging and individual is a candidate for aggressive surgical resection or other localized treatment of metastases with a curative intent.
What does this indication mean?
Terms document defines Oligometastatic- Limited or low burden of metastatic disease.
This indication is saying the metastatic disease is not widespread, and can be easily removed or radiated. Example liver lesion metastatic, which can be resected or radiated.
ONC 11.2 Multifocal, what does that mean?
Terms document- Multifocal- multiple tumors arising from 2 or more places.
The intent of the Gl is that for simple breast cancers- such as a single tumor that can be treated with a lumpectomy- doesn't need MRI breast statistically. Example- Clinical would have a mammogram with multiple calcifications, more than one possible tumor.
Oncocytoma Renal cell cancer, is this the appropriate Gl for review?
Yes
ONC 17.0 or cell type document
ONC 3.2 induction chemotherapy response= CT neck with contrast OR MRI orbits/face/ neck wwo
What does induction chemotherapy mean?
First line of treatment, no resection. There is curative intent, doesn't mention neoadjuvant therapy (shrink tumor prior to resection or XRT)
Found in the terms document.
ONC 8.3 What is superior sulcus tumor suspected?
Terms document defines it- Superior sulcus tumor suspected- a neoplasm of pulmonary origin that is located in the most apical recess of the pulmonary sulcus (i.e., the thoracic costovertebral gutter) and that arises from the lung apex.
Its at the top or apex of the lung
ONC 11.2 Lymph system imaging is indicated for stage 0, I, II, why?
Tip Check resource manual
state III and IV have established extent of disease and mapping of SLNs is not required
ONC 17.4 Follow up after ablation therapy of RCC, what does ablation mean?
Terms document defines Ablation- minimally invasive surgical method to treat solid cancers. Special probes are used to “burn” or “freeze” cancers without the usual surgery.
Tip- notice it's not stage specific criteria or ablation technique specific.
ONC 3.3 Inconclusive conventional imaging (CT or MRI)= PET/ CT 78815
What does inconclusive mean? What needs to be considered?
The finding on the CT or MRI was neither positive (consistent with metastatic disease) or negative (no evidence of disease).
The ability of the PET needs to be considered per ONC 1.4. Ex- lesions need to be 8 mm or greater, PET cannot answer infection vs cancer so cannot be differential diagnosis.
ONC 8.4 Measurable disease undergoing active treatment. What does that mean?
There is disease that is able to be followed on imaging either from last imaging or from the start of therapy.
ONC 11.2 What does inconclusive mean? What needs to be considered?
The finding on the CT or Bone Scan was neither positive (consistent with metastatic disease) or negative (no evidence of disease).
The ability of the PET needs to be considered per ONC 1.4. Ex- lesions need to be 8 mm or greater, PET cannot answer infection vs cancer so cannot be differential diagnosis.
ONC 17.2 post nephrectomy, what is the criteria that determines the frequency of the imaging?
Stage
ONC 3.4 If post treatment imaging shows residual abnormalities= One of the following once within 6 months of prior imaging: CT neck w or MRI orbit, face, neck wwo
When does the timeframe count start for this indication?
6 month= 24 weeks time frame starts from the date of the post therapy imaging.
Residual means there was something to point to on the last imaging that was a concern but no workup for cancer or restarting of the treatment. - in the terms document
ONC 8.5 Individuals treated with radiation therapy and residual abnormality on imaging may undergo CT Chest, what is the timeframe?
CT Chest every 3 months for the first year after therapy, every 6 months for 2 years, and then annually thereafter.
Why is it more frequent? Because there is still an abnormal finding, so we want to follow it closer to make sure it doesn't progress or turn to cancer
ONC 11.3 Assessing for residual disease after surgery, what does that mean?
Client had all disease resected - determined by checking measurbale disease prior to surgery and the Operative note- could be mastectomy, lumpectomy. No other measurable disease. With no measurable disease we go to surveillance.
ONC 17.4 RCC- renal cell cancer on active surveillance. What does that mean?
Terms document defines it as - Active surveillance- regimented monitoring- closely watching a patient's condition without providing treatment unless evidence condition is progressing or getting worse.
Tip wat the size of the mass it determines the frequency of imaging. Look at box 1 and 2
ONC 3.2 Known Stage III or IV disease = PET 78815
What is the minimum TNM score for an oral carcinoma?
T1,T2, T3, Any
N1
M0 = stage III per the staging document
In a client with Lung cancer, CT Chest obtained 3 months ago that revealed a lung nodule. Which GL would you go to for follow up?
ONC 31.1. ONC 8.5 links us there.
We would not use recurrence because the nodule has not been deemed cancer at this time and it was from 3 months ago, if they were concerned it was cancer they would have worked it up.
ONC 11.4 measurable metastatic disease on maintenance therapy or being monitored off therapy. What does that mean?
Client has stable disease seen on imaging that is either being treated or watching it closely this way if there is progression active treatment can resume.
Stage IV disease, has distant metastatic disease can have imaging how frequent?
Every 3 months for up to 5 years after completion of active treatment.
Tip- maintenance therapy, adjuvant = surveillance not active treatment