Date:
Patient:
MRN:
Clincian: (Medical Oncologist, Surgical Oncologist, Gastroenterologist)
Reason for Visit:
Follow-up for GIST
Evaluation of symptoms and response to treatment (if applicable)
Review of imaging results
Treatment plan discussion
History of Present Illness:
Briefly describe the patient’s current status:
Time since diagnosis of GIST
Presence and severity of any symptoms (abdominal pain, bleeding, early satiety) – symptoms may be vague or absent
Current treatment regimen (surgery, tyrosine kinase inhibitors – TKIs) and response to therapy
Past Medical History:
Underlying conditions (important for treatment considerations)
Family History:
Family history of GIST (extremely rare)
Social History:
Not typically relevant for GIST
Physical Exam:
Vital Signs: May be normal or abnormal depending on the stage of cancer and presence of complications.
Abdominal: Palpation for masses (may not be present in early stages).
Labs:
Blood tests:
Complete Blood Count (CBC) – to assess for anemia or signs of bleeding.
Basic Metabolic Panel (BMP) – to assess overall health and kidney function (important for some medications).
Genetic testing: May be considered to identify mutations in KIT or PDGFRA genes, which can guide treatment decisions.
Consider mentioning other labs ordered as needed based on suspicion of other conditions.
Imaging:
Previous imaging studies: Briefly describe the findings of the imaging studies used for diagnosis (endoscopy with biopsy, abdominal CT scan with contrast) at the time of diagnosis. This should include:
Location and size of the tumor
Liver involvement (metastases)
Current imaging studies: Describe the findings of any recent imaging studies used to monitor disease progression or assess response to treatment (CT scan, PET scan).
Assessment:
Summarize the current disease status based on symptoms, physical exam, labs, and imaging:
Stage of GIST using a staging system (e.g., Miettinen or Fletcher staging system).
Treatment received and response to therapy (tumor shrinkage, improvement in symptoms).
Consideration of recurrence if applicable.
Plan:
Outline the treatment plan based on the assessment:
Surgery: Complete surgical resection of the tumor with clear margins is the mainstay of treatment for localized GIST.
Tyrosine kinase inhibitors (TKIs): Medications that target specific molecular pathways in GIST cells. Used for advanced or recurrent disease, or after surgery to reduce the risk of recurrence (adjuvant therapy). Examples include imatinib, sunitinib, avapritinib.
Clinical trial participation: Discuss potential benefits and risks of participation.
Supportive care: Focus on symptom management and improving quality of life.
Prognosis:
Briefly discuss the prognosis. The prognosis for GIST depends on the stage at diagnosis, mutation status, and response to treatment. Early-stage, completely resected GISTs have a better prognosis than advanced stages.
Emphasize the importance of regular follow-up to monitor for recurrence.
Education:
Document any education provided to the patient regarding:
The nature of GIST, its stages, and treatment options
The potential side effects of treatment and how to manage them
The importance of regular follow-up and monitoring for recurrence
The emotional impact of a cancer diagnosis and available support resources
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the diagnosis and treatment plan, and any concerns they may have about their condition.
Consider mentioning the importance of maintaining a healthy diet as tolerated during treatment.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with a medical oncologist, surgical oncologist, or gastroenterologist for diagnosis, treatment recommendations, and prognosis.