Follow-up of cancer patients consists of periodic follow-up examinations and tests, specific to each location. The oncologist informs the patient and relatives about the mandatory examinations and periods, through which each of them is realized. Most often such tests are performed by specialists, working in different sectors of medical institutions.
It is important to note, that the listed follow-up algorithms are of a recommended nature and can always be modified by the attending oncologist according to the individual characteristics of the patient, the specifics of his disease and clinical manifestations.
ABBREVIATIONS:
PET/CT – positron emission tomography
SPECT/CT – single-photon emission computed tomography
CT – computed tomography
MRI - magnetic resonance imaging
KS – bone scintighaphy
ASAT – aspartate aminotransferase
ALAT – alanine aminotransferase
GGT - gamma glutamyl transferase
EBV – Epstein-Barr virus
LT – radiotherapy
CT - chemotherapy
EGD - esophagogastroduodenoscopy
AFP – alpha fetoprotein
β-hCG - follicles beta chorion gonadotropin
LDH – lactate dehydrogenase
Type of examinations and follow-up schedule according to the localization of oncological diseases:
In breast cancer
| Tracking Schedule Frequency | ||
| First review | 4-6 weeks after completion of treatment (LT, HT or surgery). | |
| First year 0-1 | To everybody 3-4 months | |
| 2-5 year | To everybody 6 months | |
| After the 5th year | 1 time per year | |
| Research | ||
| History and physical examination | Complete history and physical examination | |
| Laboratory researches | PAC and biochemistry ( creatinine, urea, ASAT, TOOL, glucose,Tu marker - SA 15-3. | |
| Imaging research | X-ray - in clinical indications. Ultrasound of abdominal organs. Bone scintigraphy - in clinical indications. CT scan of abdomen and small pelvis - in clinical indications. SPECT/CT - at the discretion of the attending physician. MRI - at the discretion of the attending physician. PET/CT – for restaging, assessment of the therapeutic response and assessment of further behavior. | |
In carcinoma of the body of the uterus
| Tracking Schedule Frequency | ||
| First review | 4-6 weeks after completion of treatment | |
| First year 0-1 | To everybody 3-4 months | |
| 2-5 year | To everybody 6 months | |
| After the 5th year | 1 time per year | |
| Research | ||
| History and physical examination | Complete history and physical examination | |
| Laboratory researches | PAC and biochemistry ( creatinine, urea, ASAT, TOOL, glucose,Tu marker - CA 125. Cytosmear from the vaginal hammer. | |
| Imaging research | Radiography - in clinical indications. Ultrasound of abdominal organs. CT of the abdomen and pelvis - in clinical indications. PET / CT - for restoration, assessment of the therapeutic response and assessment of further behavior. | |
In cervical cancer
| Tracking Schedule Frequency | ||
| First review | 4-6 weeks after completion of treatment, in residual tumor 1x per month | |
| First year 0-1 | To everybody 3 months | |
| 2-5 year | To everybody 6 months | |
| After the 5th year | 1 time per year | |
| Research | ||
| History and physical examination | Complete history and physical examination including vaginal examination. Cytosmear. | |
| Laboratory researches | PAC and biochemistry ( creatinine, urea, ASAT, TOOL, glucose,Your marker is SEA, SCC, Cyfra 21-1. Cytosmear from the vaginal hammer | |
| Imaging research | X-ray – when clinically indicated. Ultrasound of abdominal organs. CT scan of abdomen and pelvis or MRI – when clinically indicated. PET/CT – for restaging, assessment of the therapeutic response and assessment of further behavior. | |
In cancer of the head and neck
| Tracking Schedule Frequency | ||
| Year 0-1 | To everybody 1-3 months | |
| First year 1-2 | To everybody 2-4 months | |
| 3-5 year | To everybody 4-6 months | |
| After 5+ year | 1 time per year | |
| Research | ||
| History and physical examination | Complete history and physical examination including local ENT status - nasopharyngoscopy, laryngoscopy. Hearing examination, speech, swallowing - in clinical indications. | |
| Laboratory researches | PAC and biochemistry ( creatinine, urea, ASAT, TOOL, glucose,TLC and free T4 each 6-12 months. Other endocrine tests for clinical indications. EBV virus - Epstein-Barr - on request. | |
| Imaging research | MRI - 3 months after completion of treatment, then once a year. Chest radiography, abdomen, K S, PET / CT - with clinical signs or symptoms of relapse. | |
In lung carcinoma
| Tracking Schedule Frequency | ||
| First visit after completion of LT or HT | 4-6 weeks after treatment. | |
| Year 0-2 | To everybody 4-6 months | |
| 3+ year | 1 time per year | |
| Research | ||
| History and physical examination | Complete history and physical examination. | |
| Laboratory researches | In clinical indications. | |
| Imaging research | CT with chest contrast. MRI of the brain - in clinical indications. PET / CT - in clinical indications and to assess the therapeutic response, restoration and assessment for further behavior | |
In carcinoma of the esophagus
| Tracking Schedule Frequency | ||
| First visit after LT treatment | 4-6 week after LT (definitive or preoperative) | |
| First year 0-3 | To everybody 3-6 months | |
| 3-5 year | To everybody 6 months | |
| After 5+ year | 1 time per year | |
| Research | ||
| History and physical examination | Complete anamnesis and physical examination. Consultation with a nutritionist. EGD - esophagogastroduodenoscopy in clinical indications. Dilatation in anastomotic stenoses in clinical indications. | |
| Laboratory researches | In clinical indications. | |
| Imaging research | CT of the chest and abdomen or PET / STOther imaging studies in clinical indications. | |
In gastric carcinoma
| Tracking Schedule Frequency | ||
| First visit | 4-6 weeks after completion of treatment | |
| First year 0-3 | To everybody 3-6 months | |
| 3-5 year | To everybody 6 months | |
| After 5+ year | 1 time per year | |
| Research | ||
| History and physical examination | Complete history and physical examination | |
| Laboratory researches | PAC and biochemistry ( creatinine, urea, ASAT, TOOL), glucose. Here the marker is CA. 72-4, SEA, CA. 19-9 | |
| Imaging research | Chest radiography - in clinical indications. CT of the abdomen and pelvis in clinical indications. | |
In carcinoma of the liver
| Tracking Schedule Frequency | ||
| First visit | 4-6 weeks after completion of treatment. | |
| First year 0-1 | To everybody 3-6 months | |
| 2-5 year | To everybody 6 months | |
| After 5+ year | 1 time per year | |
| Research | ||
| History and physical examination | Complete history and physical examination. | |
| Laboratory researches | PAC and biochemistry ( creatinine, urea, ASAT, TOOL, GGT, glucose).Alpha fetoprotein of each 3 months for 2 years, if initially elevated, then on 6 months. | |
| Imaging research | CT or MRI with contrast of each 3-6 months for 2 years, then once a year | |
Pancreatic cancer
| Tracking Schedule Frequency | ||
| First visit | 4-6 weeks after completion of treatment | |
| First year 0-1 | To everybody 3-4 months | |
| 2-5 year | To everybody 6 months | |
| After 5+ year | 1 time per year | |
| Research | ||
| History and physical examination | Complete history and physical examination | |
| Laboratory researches | PAC and biochemistry ( creatinine, urea, ASAT, TOOL, glucose).You marker SA 19-9 when displaying | |
| Imaging research | Chest radiography in indications. Abdominal and pelvic CT in indications. | |
In localization, carcinoma of the colon and rectum
| Tracking Schedule Frequency | ||
| First visit | 4-6 weeks after completion of treatment. | |
| First year 1-2 | To everybody 3-4 months | |
| 3-5 year | To everybody 6 months | |
| After 5+ year | 1 time per year | |
| Research | ||
| History and physical examination | Complete history and physical examination. | |
| Laboratory researches | PAC and biochemistry ( creatinine, urea, ASAT, TOOL, glucose).Your SEA marker, if it was promoted initially.There marker SA 19-9 | |
| Imaging research | CT of the chest, abdomen, small pelvis once a year for the first 3 years.More frequent examinations in high-risk patients.Proctoscopy - for everyone 6 months for 5 years in patients after lower anterior resection.Colonoscopy in the first year or on 3-6 month, if it has not been performed before treatment. | |
In bladder carcinoma
| Tracking Schedule Frequency | ||
| First visit | 2 weeks after treatment. | |
| First year 0-1 | To everybody 3 months | |
| 2-5 year | To everybody 6 months | |
| After 5+ year | 1 time per year | |
| Research | ||
| History and physical examination | Complete history and physical examination. Cystoscopy for superficial carcinoma or after bladder preservation for invasive disease | |
| Laboratory researches | PAC and biochemistry ( creatinine, urea, ASAT, TOOL, glucose).Cytological examination of urine. | |
| Imaging research | Chest radiography of 6 months in invasive disease. Other studies of the urinary system (ST or MRI) to everybody 3-6 months in invasive disease. | |
In carcinoma of the prostate gland
| Tracking Schedule Frequency | ||
| First visit | 4-6 weeks after completion of LT. | |
| First year 0-1 | To everybody 3-4 months. | |
| 2-5 year | To everybody 6 months. | |
| After 5+ year | 1 time per year. | |
| Research | ||
| History and physical examination | Complete history and physical examination. Once a year rectal smear. | |
| Laboratory researches | PSA to everyone 6-12 months for 5 years, then 1 x per year.Other studied in clinical indications. | |
| Imaging research | Depending on the clinical indications. | |
In testicular seminoma
| Tracking Schedule Frequency | ||
| Year 1-3 | To everybody 3-4 months | |
| 4-7 year | To everybody 6 months. | |
| 7+ years | To everybody 12 months. | |
| Research | ||
| History and physical examination | Complete history and physical examination. | |
| Laboratory researches | PKK, biochemistry - creatinine, urea, liver tests - ASAT, TOOL, GGT.AFP, β-hCG, LDH | |
| Imaging research | CT of the abdomen and small pelvis in observed cases. CT of the small pelvis 1x per year for 3 years in patients after paraaortic irradiation. Chest radiography at alternative visit. | |
The necessary documents for carrying out PET/CT and SPECT/CT when submitting documents are medical referral/request form MH No. 119/98, histological examination, copies of current epicrisis and conducted imaging studies, which a commission of specialists approves for the conduct of PET / CT and SPECT / CT. On the day of the test you need to wear a coupon 8A (procedure № 36 for PET / CT and procedure № 37 за SPECT/CT), issued by a specialist. The examination is carried out after at least 2 weeks after completion of chemotherapy, 6 weeks after surgery and 12 weeks after radiotherapy, and the results are usually ready by 2 working days.
During the clinical follow-up period, it is extremely important to meet the deadlines and conduct the necessary tests. Clinical follow-up is done to control the disease, reporting the effect of the treatment - surgical, radiotherapy, chemotherapeutic, achieving quality of life and definitive recovery. Therefore, going through such a period is not simply the presence of a diagnosis, treatment and clinical trials. For many patients, this is a constant challenge. One of the main goals of clinical follow-up and the work of the psycho-oncologist at this stage is to help cancer patients to maintain relationships and lead a normal life..
Prepared by:
Assoc. Dr. Vaska Vasileva MD. Radiation therapy clinic, metabolic brachytherapy and medical oncology, UMHAT "Queen Joanna-ISUL" EAD
Ivayla Georgieva Clinical Psychologist KDKHO UMHAT "Queen Joanna-ISUL" EAD
