Diagnosis and Treatment

Diagnosis and Treatment
Because the “all other” cancer sites are such a heterogeneous group, their diagnosis and management are highly varied. This following section will provide a brief overview of the major diagnostic and treatment steps taken for many of these cancer sites:
 
Oropharyngeal Tumors 
Diagnosis: surgical biopsy of abnormal lesions detected on physical or otolaryngoscopic examination. Biopsy performed by a dentist, oral surgeon, general surgeon, or otolaryngologist, depending on the location of the lesion. All of the above specialty care is available by referral to providers at W.W. Hastings Indian Medical Center (HIMC) or Claremore Indian Hospital.
Treatment: combination of surgical excision, radiation therapy, or chemotherapy, depending on the location, stage, and histology of the lesion. Management of these tumors is generally done by CHS referral to non-IHS specialists.
 
Digestive Organs
Diagnosis: initial diagnostic steps include laboratory and imaging studies which may include: CBC, liver function tests, alkaline phosphatase, alpha fetoprotein, CT or ultrasound of the abdomen and pelvis, and esophageal gastric duodenoscopic (EGD) exam with biopsy. All of these tests are available at HIMC or Claremore Indian Hospital. Further testing beyond the scope of IHS facilities may include endoscopic retrograde cholangiopancreatogram (ERCP) with biopsy and brushings, magnetic resonance cholangiopancreatogram (MRCP), positron emission tomography (PET) scan, and endoscopic ultrasound with biopsy. Each of these procedures is performed by CHS referral to non-IHS specialists.
Treatment: combination of surgical excision, radiation therapy, or chemotherapy, depending on the location, stage, and histology of the lesion. Management of these tumors is generally done by CHS referral to non-IHS specialists.
 
Respiratory System and Intrathoracic Organs
Diagnosis: initial diagnostic steps include laboratory and imaging studies which may include: CBC, serum chemistry and liver function tests, alkaline phosphatase, chest radiograph, echocardiogram, or chest CT. Each of these tests can be performed at HIMC or Claremore Indian Hospital. Further testing may include chest MRI or full body PET scan, which are performed by CHS referral to outside facilities. Tissue confirmation requires a biopsy in the form of bronchoscopy with needle biopsy, CT guided needle biopsy, or video-assisted thorascopic surgery with biopsy. Each of these procedures is performed by CHS referral to non-IHS specialists.
Treatment: combination of surgical excision, radiation therapy, or chemotherapy, depending on the location, stage, and histology of the lesion. Management of these tumors is generally done by CHS referral to non-IHS specialists.
 
Bones, Joints, and Articular Cartilage
Diagnosis: initial diagnostic steps include laboratory and imaging studies, which may include CBC, serum chemistries, alkaline phosphatase, plain radiographs, and CT. Each of these tests can be performed at HIMC or Claremore Indian Hospital. Biopsy to confirm the diagnosis can be performed by referral to orthopedic surgery at HIMC, or by referral to an orthopedic oncologist at a non-IHS facility. Further testing such as MRI and bone scan is performed at outside non-IHS facilities. 
Treatment: treatment with surgery, radiation therapy or chemotherapy, depending on the location, stage, and histology of the lesion. Management of these tumors is generally done by CHS referral to non-IHS specialists.
 
Skin Cancer
Diagnosis: initial diagnostic step is excisional biopsy by a general surgeon at HIMC or Claremore Indian Hospital.
Treatment: treatment with further surgery, radiation therapy, or chemotherapy, depending on the location, stage, and histology of the lesion. General surgeons at HIMC or Claremore can often perform surgery with curative intent, and other adjuvant therapies are performed by CHS referral to non-IHS specialists.
 
Hematopoietic, Reticuloendothelial, and Lymphoma
Diagnosis: initial diagnostic steps may include laboratory or imaging studies such as CBC, serum chemistries, liver function tests, plain radiographs, or CT. Further testing may involve bone marrow aspiration and biopsy. All of these procedures can be performed at HIMC or Claremore Indian Hospital. Further diagnosis may involve MRI, PET scan, and CT-guided biopsy, which are performed by CHS referral to non-IHS specialists.
Treatment: combination of surgical excision, radiation therapy, or chemotherapy, depending on the location, stage, and histology of the lesion. Management of these tumors is generally done by CHS referral to non-IHS specialists.
 
Urinary and Kidney Cancer
Diagnosis: initial diagnostic steps may include laboratory or imaging studies such as CBC, serum chemistries, urinalysis, 24-hour urine cytology, plain radiographs, ultrasound, or CT at HIMC or Claremore Indian Hospital. Further diagnostic studies may involve cystoscopy, MRI, and CT-guided biopsy, which are performed by CHS referral to non-IHS specialists.
Treatment: combination of surgical excision, radiation therapy, or chemotherapy, depending on the location, stage, and histology of the lesion. Management of these tumors is generally done by CHS referral to non-IHS specialists.
 
Ovarian Cancer
Diagnosis: initial diagnostic steps may include laboratory or imaging studies such as CBC, serum chemistries, CA-125, pelvic and transvaginal ultrasound, and CT at HIMC or Claremore Indian Hospital. Confirmation of the diagnosis requires a biopsy, which is usually done by a gynecologic oncologist at the time of surgery with curative intent. The referral to a gynecologic oncologist is through CHS, while the other diagnostic workup can be performed at HIMC or Claremore.
Treatment: combination of surgical excision and/or chemotherapy, depending on the location, stage, and histology of the lesion. Management of these tumors is done by CHS referral to non-IHS specialists.
 
Testicular Cancer
Diagnosis: initial diagnostic workup involves an imaging study such as ultrasound of the scrotum, as well as CT to evaluate for metastatic disease. Laboratory studies may include CEA, alpha-fetoprotein, and beta-HCG. All of these studies can be performed at HIMC or Claremore.
Treatment: combination of surgical excision, radiation therapy, and/or chemotherapy, depending on the location, stage, and histology of the lesion. Management of these tumors is done by CHS referral to non-IHS specialists.
 
Central Nervous System and Ocular Tumors
Diagnosis: initial diagnostic workup involves an imaging study such as head CT with contrast, which can be performed at HIMC or Claremore. Further evaluation with MRI, requires CHS referral to non-IHS facilities. Confirmation of the diagnosis generally occurs at the time of neurosurgery with curative intent.
Treatment: combination of surgical excision, radiation therapy, and/or chemotherapy, depending on the location, stage, and histology of the lesion. Management of these tumors is done by CHS referral to non-IHS specialists.
 

Comprehensive Cancer Control Plan

The Cherokee Nation Comprehensive Cancer Control (CNCCC) Project assists in the development of networks and collaboration that produce an infrastructure for a comprehensive approach to cancer within the Cherokee Nation. Since 2003, coalition members and partners have come together to discuss the burden of cancer in Cherokee Nation. Coalition members and partners include local, regional, state and national representatives committed to identifying areas of cancer concern, planning interventions, prioritizing greatest areas of identified need, and then implementing identified strategies and/or providing needed resources. This is the second edition of the Cherokee Nation Comprehensive Cancer Control Plan and will serve, like the first, as an information resource for health care professionals and community members, as well as a tool for the Cherokee Nation Comprehensive Cancer Control Coalition and its respective entities. The coalition is committed to the process of enhancing infrastructure for comprehensive cancer control in the Cherokee Nation with the ultimate goal of reducing morbidity and mortality among the Cherokee community.