Date:
Patient:
MRN:
Attending Physician:
Oncologist: (If applicable)
Reason for Visit:
New diagnosis of Ewing’s sarcoma
Follow-up for Ewing’s sarcoma treatment
Evaluation of treatment response
Management of treatment side effects
History of Present Illness:
Briefly describe the patient’s presentation:
Age at diagnosis
Symptoms at presentation (pain, swelling, limited movement)
Location of the tumor
Any systemic symptoms (fever, weight loss)
Past Medical History:
Include any relevant past medical conditions, such as:
Previous surgeries or fractures
Any genetic syndromes associated with Ewing’s sarcoma (Li-Fraumeni syndrome)
Family History:
History of cancer in first-degree relatives
Social History:
Activity level before diagnosis
Physical Exam:
General: Appearance of health, signs of pain or tenderness
Musculoskeletal: Palpation of the tumor site, range of motion in affected joint(s)
Neurologic: If relevant to tumor location (e.g., nerve compression)
Labs:
List recent complete blood count (CBC) with differential, electrolytes, liver function tests, and bone marrow aspiration/biopsy results (definitive diagnosis).
Consider mentioning other tests as relevant, such as LDH (lactate dehydrogenase) – a tumor marker.
Imaging:
Mention recent imaging studies:
X-ray (may show bone lesions)
CT scan (tumor size and extent)
MRI scan (soft tissue involvement)
PET scan (assess for metastatic disease)
Pathology:
Briefly summarize the pathology report, including:
Confirmation of Ewing’s sarcoma diagnosis
Immunohistochemical staining results (specific markers for Ewing’s sarcoma)
Staging:
Assign disease stage based on tumor size, lymph node involvement, and presence of distant metastasis (based on AJCC TNM staging system for Ewing’s sarcoma).
Treatment Plan (if applicable):
Outline the treatment plan based on stage and patient factors:
Chemotherapy: Specify the planned chemotherapy regimen (e.g., VAC – Vincristine, Adriamycin, Cyclophosphamide).
Surgery: Describe the planned surgery (limb salvage surgery vs. amputation) and reconstruction if applicable.
Radiation therapy: Mention the planned radiation therapy field and dosage.
Clinical trial participation (if applicable): Briefly discuss the rationale and potential benefits/risks.
Response to Treatment (if applicable):
Summarize the response to treatment based on recent imaging studies and clinical evaluation.
Mention any changes in treatment plan due to response or side effects.
Prognosis:
Briefly discuss the patient’s prognosis based on stage, response to treatment, and other factors.
Notes:
Include any additional relevant information not covered above, such as patient’s understanding of the diagnosis and treatment plan, and emotional well-being.
Consider mentioning any supportive care needs (pain management, physical therapy, nutritional counseling).
Disclaimer: This is a template and should be adapted to the specific needs of each patient.