Surgical Oncology Resident
Division of Surgical Oncology
Department of Surgery
East Carolina University, Brody School of Medicine
Table of Contents:
Weekly Schedule Page 3
NC Tissue Consortium Page 4
Communication Page 5
Admissions Page 6
Deportment Page 6
Pain Management Page 8
Operating Room Conduct Page 8
Education Page 8
Rounding Page 9
Consultations Page 11
Clinic Page 12
Tumor Board Page 12
Chain of Command Page 12
Reading Schedule Page 14
Surgery Oncology Investigations Page 15
Breast Issues Page 21
Clinical Pathways Page 23
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
GI Tumor Board
r. Fitzgerald in the O
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r. Zervos in the O
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(led by Chief
Surgical Oncology Rotation Schedule for Residents
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North Carolina Tissue Bank:
The Division of Surgical Oncology supports the North
Carolina Tissue Consortium, a tissue bank sponsored
by the UNC Lineberger Comprehensive Cancer
Center. The objective of the NCTC is to promote
cancer- related and basic science research by
providing a facility for procurement, processing, and
storage of normal and malignant human specimens.
Patients are approached for consent to participate in
research during their clinic visit prior to surgery. No
specimen is procured unless the patient has been
appropriately informed and signed a consent form for
procurement. On the day of surgery, tissue bank
staff is paged by a circulating nurse to retrieve the
specimen and transport it to the pathology
department for assessment. Tissue is only procured
after the pathologist has obtained the appropriate
specimen information for patient care (e.g.
diagnosis, inking of margins, etc.). All samples are
frozen and stored at the Brody School of Medicine
until requested for use by an investigator.
SURGICAL ONCOLOGY SERVICE MANUAL
Communication is first in this manual for a reason. COMMUNICATION is
always first. When in doubt, call. When not in doubt, call. You will receive
a call schedule at the beginning of the rotation – attending call coverage
begins during the week when that attending leaves the hospital and from that
time Friday evening until 7 am Monday. You are only responsible to
communicate with the on-call attending during off hours – they will decide
whether to contact the patient specific off call attending. During business
hours, communicate directly with the attending of record.
Texting is here to stay but until a text message is acknowledged it is only a
ONE WAY form of communication. This is due to different attending
preferences about carrying cell phones and sporadic cellular coverage at
PCMH. Please, do not communicate or report your intention to carry out a
test or procedure by text message unless that text is acknowledged as
received by the intended recipient. Absence of this acknowledgement can
be regarded as the message not being received or communicated.
Since we all carry pagers and pager coverage is universal, this form of
communication does not require acknowledgement of receipt. Remember,
when in doubt, communicate. You will NEVER be discouraged from doing
so. Paging is the preferred method by which to contact the attending.
Cell phone calls are the easiest method of communication provided the
phone is answered or within range. Again, don’t assume that any voice
message left on a cell phone has been received or appropriately
communicated for the reasons stated above. Paging is the only foolproof
method of one-way communication.
If you are not notified of a patient transfer after hours, discuss this with the
on call attending. Ideally, any patient accepted from an outside hospital or
asked to go to the ER will be discussed with the on call resident before that
patient arrives. Regardless of time of day, after you have had a chance to
meet the patient and go over their records, contact the responsible attending
to discuss the plan of care. This can save hours, if not days from the ensuing
hospitalization as the accepting attending may be privy to information or
details of the patient’s illness that are not apparent in the patient’s record and
may have a specific plan of care in mind.
If an attending is out of town, you can not admit a patient under their name
regardless of whether or not there is an established relationship with that
patient. Admit those patients to the responsible covering physician.
Cancer is a serious illness. On this service it is commonly a terminal
diagnosis. Many of you have been touched by cancer either personally or
though family. Please keep in mind the following general guidelines:
When a patient is informed of a cancer diagnosis, they will remember the
exact words in which it is imparted to them for the rest of their life. It is
important to keep this in mind in patients who do not yet know their
diagnosis or pathology. Unless you are asked directly by a patient, and you
feel comfortable, do not discuss pathology or new diagnoses of cancer until
the attending has a chance to do so. Simply state that “The pathology is
complete and Dr. _____ will discuss it with you when he or she rounds.”
Discussion of intraoperative findings “his belly was ate up with cancer” with
patients or family members may be taken out of context and create
insurmountable obstacles in subsequent care and treatment planning. As
with anything else in life, presentation is everything, learn from your
attending in this regard so that you can add this skill to your armamentarium.
This is the art of medicine, and is not easily taught. Complete
understanding of the implications of a diagnosis or pathology report is
crucial in having a meaningful discussion about pathology.
Similarly, present yourselves with the necessary countenance to impart your
seriousness about the task at hand. Do not laugh, joke or carry on in patient
care areas, that is anywhere on 1 south, the ASU, the recovery room.
Anywhere that a patient or patient’s family might have opportunity to
observe or overhear. Keep this in mind regardless of the patient’s state of
consciousness or even their own frame of mind. You would be surprised
what a patient is capable of comprehending despite being seemingly
You are our eyes and ears, our representatives when we cannot be there,
please act accordingly and, whenever in doubt, just treat the patient or
patient’s family the way that you or your family member would wish to be
treated under like circumstances.
All laparotomy patients should receive postop pain management in the form
of a PCA without basal rate. Do not institute a basal rate without the
permission of the attending. A standard PCA dose is 1mg morphine every 6
minutes with a 10 mg lockout. Dilaudid is 0.2-0.4 mg every 6 minutes.
Again, basal rates are forbidden unless explicitly requested by the attending.
Oncology nurses are acutely aware of pain issues and oftentimes may
request that you increase pain medications beyond doses that you feel
comfortable with or feel are appropriate. Remember, you are ultimately
responsible for the orders that you write. Use discretion and sound medical
judgment in deciding how much pain medicine beyond standard doses is
appropriate for a given situation.
Patients with epidural catheters should not have PCA pumps. Similarly,
unexplained hypotension in a patient with an epidural should be managed
initially with cessation of the epidural dose. If this does not correct the
problem, contact the attending. Epidurals are generally removed between
postoperative days 3-5. Beyond that they generally hinder the progress of the
patient. Anticipate removal of epidural catheters in patients tolerating liquids
and hold Lovenox or other blood thinners accordingly.
OPERATING ROOM CONDUCT
The operating room is your classroom – treat it accordingly: show up on
time and prepare for your case lesson. Your attending will apply t