Diagnosis Checklist
Fill out this Diagnosis Checklist before you start looking for a clinical trial. The checklist will help you know which clinical trials you are eligible to join.
See Step 3 for details about how to obtain the information you need for the checklist.
TIP: Download the PDF version of this guide and save it to your own computer. Then you can print it out and fill in the answers to these questions to keep for later use.
1. What kind of cancer do you have? Write down the full medical name.
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2. Where did the cancer first start? Many cancers spread to the bones, liver, or elsewhere. However, the type of cancer you have is determined by where it first showed up. For example, breast cancer that spreads to the bone is still breast cancer.
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3. What is the cancer's cell type? This information will be in your pathology report.
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4. If there's a solid tumor, what size is it?
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5. If there is a solid tumor, where is it located? If the tumor has spread, list all locations.
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6. What stage is the cancer? The stage describes the extent of cancer in the body and whether it has spread from the original site. There are different staging systems for different cancers.
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7. Have you had cancer before, different from the one you have now? If so, answer questions 1-6 for the other cancer, as well.
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8. What is your current performance status? An assessment from your doctor indicating how well you are able to perform ordinary tasks and carry out daily activities.
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9. If you have not yet had any treatment for cancer, what treatment(s) have been recommended to you?
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10. If you have had treatment for cancer, please list (for example: type of surgery; chemotherapy, immunotherapy, or radiation).
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11. Bone marrow function (blood tests that check whether your blood count is normal):
- A. White blood cell count
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- B. Platelet count
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- C. Hemoglobin/hematocrit
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12. Liver function (blood tests that check whether your liver function is normal):
13. Renal function (blood test that checks whether your kidney function is normal):
Serum creatinine
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Who Produced This Guide?
Representatives from several organizations worked together to produce this guide.
- The U.S. National Cancer Institute - The federal government's chief cancer research agency and part of the U.S. National Institutes of Health
- The U.S. Food and Drug Administration - the division of the U.S. Department of Health and Human Services charged with ensuring the safety and effectiveness of new drugs and other products
- The Summit Series on Cancer Clinical Trials, sponsored by a variety of nonprofit groups including patient advocates, physicians, nurses, and others involved in the U.S. cancer clinical trial system.
Source: http://www.cancer.gov/clinicaltrials/finding/treatment-trial-guide/page15
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