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Oncology - Inpatient Oncology - Fast Facts | NEJM Resident 360

A structured approach to understanding a cancer diagnosis informs the formulation and implementation of an individual patient’s care plan. The assessment of a hospitalized cancer patient should begin with establishing the following key points before proceeding to other elements of the patient’s history and examination.

Assessment of Hospitalized Cancer Patients

Key Point	Useful Information
Cancer type

• Anatomical location of primary tumor (e.g., bladder)

• Histologic type or subtype (e.g., urothelial cancer)

| | Cancer grade |

• Based on microscopic assessment of the appearance of the tissue cells and amount of abnormality on pathologic examination

• Can be graded as low, intermediate, or high

| | Cancer stage |

• Refers to tumor location, size, and extent in the body

• Informs the prognosis and treatment plan

• Commonly used staging system: the American Joint Committee on Cancer and the Union for International Cancer Control (AJCC/UICC) tumor-node-metastasis (TNM) classification system

  • Early stage (I and II): smaller tumors without prominent lymph node involvement or metastases

  • Late stage (III and IV): locally advanced disease, invasion of surrounding structures, or an increased number of involved lymph nodes; distant metastatic spread also defines stage IV

| | Associated prognostic genetic mutations |

• Germline mutations can be associated with higher risk for cancer (e.g., BRCA1 and BRCA2 gene mutations associated with breast and ovarian cancer)

• Somatic mutations can affect prognosis or treatment (e.g., epidermal growth factor receptor [EGFR] and anaplastic lymphoma kinase [ALK] gene mutations associated with non–small-cell lung cancer)

| | Disease course and aim of treatment |

• Establish goal of current cancer treatment: curative or palliative (to prolong life and avoid symptoms or complications associated with the malignancy)

• Review treatment to date (timing and other details):

  • Local therapies: surgery, radiation

  • Systemic therapies: traditional chemotherapy, targeted therapies, immune checkpoint inhibitors

• Understand response to treatments to date

| | Reason for hospitalization |

• Can be unrelated to the cancer, due to complications of treatment (e.g., neutropenic fever from chemotherapy, colitis from immune checkpoint inhibitor), or due to complications of disease (e.g., biliary obstruction from pancreatic cancer)

• Some patients may present for inpatient care with debilitating symptoms of cancer and require palliative care

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