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Oncology Referral Guidelines

Recommended diagnostic tests prior to referral

URGENT CASES: Please call 509-335-0711 and ask for the Oncology service to discuss the possibility of an expedited appointment.

To optimize efficiency, reduce delays in care, and ensure the most productive initial oncology consultation, we recommend the following minimum staging diagnostics prior to referral when feasible. These guidelines are not absolute requirements but are strongly encouraged whenever possible. If there is any uncertainty regarding the appropriate workup or next steps, please do not hesitate to contact our service as we are happy to discuss cases prior to referral.

General requests

  • Diagnostic tests performed within 1 month of the consultation generally do not need to be repeated unless the patient’s clinical status changes. Given that appointment wait times at WSU are at least 2–4 weeks, we recommend completing these tests within 1–2 weeks of the scheduled appointment to minimize the need for repeat testing, although exceptions may apply.
  • Baseline bloodwork and urinalysis are recommended prior to referral. They provide an important initial assessment of the patient’s overall health and help guide decision-making regarding referral.
  • Perform 3-view thoracic radiographs (right lateral, left lateral, VD/DV) for most solid tumors to assess for pulmonary metastasis or other subclinical respiratory disease; this is strongly recommended.
  • Cytology (FNA) is often sufficient for initial diagnosis and is preferred prior to referral when feasible. Biopsy and histopathology with grade is desirable (especially for mast cell tumors and soft tissue sarcoma) but not essential.
  • Advanced imaging (CT/MRI) is typically coordinated through WSU and does not need to be completed prior to referral unless previously discussed. If already performed, repeat imaging may be required depending on the planned treatment (e.g. radiation therapy requires CT imaging to be performed at WSU for treatment planning).
  • If staging diagnostics are not feasible due to patient stability, cost, or logistical constraints, referral without prior staging is acceptable.

Lymphoma – multicentric lymphoma

  • Minimum recommendation:
    • Cytologic or histopathologic confirmation (e.g., lymph node FNA)

Canine lymphoma – half-body irradiation (HBI) candidates
Required to be performed within 7 days of the radiation consult. Patient MUST be in complete remission.

Please contact the Oncology service 4–6 weeks before the anticipated HBI treatment date or at the start of the CHOP protocol, so we can begin coordinating and scheduling the radiation oncology consultation in advance.

  • 3-view thoracic radiographs (right lateral, left lateral, VD/DV)
  • Abdominal ultrasound
  • FNA and cytology of the liver, spleen, and a peripheral lymph node (previously enlarged)
  • Immunophenotyping, including one of the following (optional but strongly recommended for prognosis):
    • Flow cytometry
    • PARR (PCR for antigen receptor rearrangement)
    • Immunocytochemistry
    • Immunohistochemistry

Feline lymphoma – nasal lymphoma


Important: Staging should be performed prior to initiating prednisolone, as corticosteroids can alter disease presentation and obscure accurate assessment.

  • 3-view thoracic radiographs
  • Abdominal ultrasound
  • Fine-needle aspiration (FNA) and cytology of both kidneys

Mast cell tumors (MCT)

  • 3-view thoracic radiographs
  • Abdominal ultrasound
  • FNA and cytology of the liver and spleen – especially if confirmed higher grade tumors
  • Regional lymph node evaluation (FNA strongly recommended, even if normal in size)
  • For guidance on whether to pursue biopsy and histologic grading prior to referral, please contact our service. Tumor grade from biopsy can be very helpful for the initial consultation.

Osteosarcoma

  • 3-view thoracic radiographs and 2-view radiographs of the affected limb
  • FNA and cytology of the bone lesion are helpful but not required

Soft tissue sarcomas (STS)

  • 3-view thoracic radiographs
  • For guidance on whether to pursue biopsy and histologic grading prior to referral, please contact our service. Tumor grade from biopsy can be very helpful for the initial consultation.

Mammary tumors

  • 3-view thoracic radiographs
  • Abdominal ultrasound

Melanoma

  • 3-view thoracic radiographs
  • Regional lymph node FNA (recommended, even if normal in size)

Apocrine gland anal sac adenocarcinoma (AGASACA) 

  • 3-view thoracic radiographs
  • Abdominal ultrasound

Hemangiosarcoma

  • 3-view thoracic radiographs
  • Abdominal ultrasound
  • Echocardiogram (optional)

Important notes

  • These recommendations are intended to streamline care, not delay referral.
  • If staging has not been performed, our team is happy to coordinate all diagnostics.
  • Early referral is encouraged, particularly for rapidly progressive or complex cases.

Submission of diagnostics

Please submit all available medical records and diagnostic results prior to the appointment:

Referral coordination: vth.info@wsu.edu (Attn: Oncology)

Oncology: vth.oncology@wsu.edu