Oncology pathways

1. This pathway is a records problem first

More than any other area on this site, oncology is decided on paper before anyone meets you. An institution reviewing an overseas case is reading documents, and what it can conclude is bounded by what those documents actually say.

What a review normally turns on:

• The pathology report, the histological diagnosis, and where relevant the immunohistochemistry and molecular results. If blocks or slides exist, note that they exist; institutions sometimes ask to review them.
• Imaging as DICOM, not as photographs of a screen or a printed film. A radiologist needs the series, not a picture of it.
• Staging, with its system and edition named, for example AJCC 8th edition. “Stage III” on its own is ambiguous, because the same tumour can fall in different stages under different editions of the AJCC system. A stage without its edition will be queried rather than assumed, and we never supply the missing edition by guessing.
• Treatment to date: what was given, at what dose, for how long, and how it was stopped. Prior treatment shapes what remains available.
• Current status, recent bloods, performance status, comorbidities, current medicines with generic names.

Our part is to render all of that accurately. Unfavourable findings are translated exactly as written. Ambiguities are flagged as ambiguities rather than resolved by guesswork, the seven rules we work to are on preparing your records.

2. How assessment works

1. Submission. The translated set goes to the institution.
2. Departmental review. A case is read by the relevant department, often more than one where the situation crosses specialties.
3. An answer. Which is one of three things: the institution will accept the case and indicate what the next step is; it asks for more, commonly slides, blocks, or more recent imaging; or it declines.

The third answer happens, and it happens for reasons that have nothing to do with how the request was made: the case may be outside what that department does, the institution may judge travel unwise in the current situation, or a bed or a programme may be unavailable. An intermediary cannot argue a case into acceptance and should not imply otherwise.

3. What nobody can tell you from here

Whether to travel. Whether a given treatment is appropriate for you. What outcome to expect. How one institution’s results compare with another’s.

We will not answer any of those, and we would treat a confident answer from any intermediary as a reason to stop dealing with them. Those questions belong to the physician treating you at home and to the institution that has reviewed your case, people who have seen the whole picture and carry responsibility for the advice.

What we will do is make sure both sides read the same facts, and tell you plainly when something in your documents is unclear enough to change what an institution can conclude.

4. Trials, and the Lecheng question

Two questions come up constantly in this area and both have honest, limited answers.

Clinical trials. Eligibility is decided by the trial protocol, not by willingness to travel or ability to pay. Institutions filed to run drug trials are on a public register, which we publish in full, see all hospitals, but a filing tells you an institution is authorised to run trials, not that it has one open that you could join.

Hainan Lecheng. The pilot zone permits licensed use of certain medicines and devices not otherwise registered in China. What it does and does not allow, and the rules on taking medicine out of the zone, are set out in the Lecheng guide, along with an explicit list of what we could not verify. We never handle medicines, in any form.

5. What drives the cost

We do not publish treatment prices for this area, and the reason is not caution for its own sake: a figure attached to a diagnosis is meaningless until a plan exists, and publishing one invites people to make decisions on a number that will not survive contact with their case. What we can tell you is what the total is built from, admission and bed, drugs, imaging and laboratory work, procedures, consumables and implants where relevant, and the follow-up schedule. What a hospital bill contains sets out each line.