Pathway Steps
The cancer treatment pathway begins with a review of the existing reports and continues through follow-up after treatment has finished. Each step produces an output, and the next step is built on it. The table below lists the steps, what happens at each and the typical time; the timings follow the general principles in the ESMO and NCCN guidelines and vary from patient to patient.
| Step | What happens | Typical time |
|---|---|---|
| 1. Pathology and imaging review | Existing reports are read, the diagnosis is confirmed, missing tests are identified. Can be done remotely from sent documents. | First consultation; before it if documents are sent in advance |
| 2. Staging | Imaging and organ function tests establish how far the disease has spread. Scans already done at home are accepted if the images are available. | Usually one to two weeks |
| 3. Molecular assessment | Biomarker and genomic tests are requested where indicated, usually on the existing biopsy block. | Usually two to four weeks |
| 4. Tumour board and treatment plan | The case is discussed at the tumour board; a written plan is explained to the patient, in person or by video. | One to two weeks after tests are complete |
| 5. Treatment and follow-up | Treatment is delivered, response is assessed, follow-up after treatment is planned with the patient's own oncologist where applicable. | Months, depending on treatment; follow-up over years |
Throughout the pathway the patient has one point of contact, the treating doctor; the surgical, radiotherapy and pathology opinions are brought together at the board. For patients abroad, steps 1 and 3 and the explanation of the plan in step 4 can be carried out remotely; staging scans can be done either at home or in Izmir. How to make contact is on the contact page, and the pathway as a whole sits within the patient guide.
Pathology and Imaging Review
The first step is the reading of the pathology report and the imaging by the doctor; the tumour type, grade and biomarker results set the direction of treatment. If the pathology report is incomplete or the biopsy was taken at another centre, the slides and blocks are requested and reviewed by a second pathologist. This review is a verification step and does not mean that the first pathologist was wrong.
Imaging reports are read together with the images themselves; a report on its own is not enough, so DICOM files or a disc are needed. At the consultation the missing tests are listed and the order in which they will be done is given to the patient in writing. What to bring or send is listed on the preparing for your oncology appointment page.
The First Step in Advanced Cancer: Tissue Analysis
A tumour may arise in the lung, the colon or the breast, and each has its own molecular identity; the video explains why tissue biopsy comes first.
Staging
Staging is the set of investigations that establish the size of the tumour (T), lymph node involvement (N) and distant metastasis, meaning spread to other organs (M); the result is expressed as stage 1 to 4. The stage determines whether treatment will be surgery, drug treatment or a combination. Depending on the cancer type, CT, MRI, PET-CT or a bone scan is chosen; not every patient needs a PET-CT.
Staging is accompanied by organ function tests: a blood count, kidney and liver tests, a heart assessment where needed and hepatitis screening. These tests show whether treatment can be given safely. Tumour markers (proteins measured in the blood that rise in some cancers) are not a staging tool; they are interpreted only alongside imaging and during follow-up.
When the Pathology Report Is Not Enough
In some patients pathology alone cannot settle the diagnosis; the video covers analysing the tumour’s origin and identifying its mutations.
When Molecular Tests Are Requested
Molecular tests show the gene changes in the tumour that direct treatment, and they are requested either at diagnosis or when a change of treatment is being considered, depending on the cancer type. The ESMO 2024 recommendations advise comprehensive genomic profiling (tumour genetic testing) as routine in advanced non-small cell lung cancer, cholangiocarcinoma, prostate cancer and ovarian cancer, and in other cancers once standard options have been used. Single-marker tests such as HER2 in breast cancer or RAS and MSI in colorectal cancer are done at the pathology stage.
The existing biopsy block is usually sufficient for testing; if tissue is inadequate, a liquid biopsy (analysis of circulating tumour DNA in a blood sample) is considered. Results take two to four weeks and do not always change treatment. A report from a laboratory abroad is accepted and re-read rather than repeated. The scope of testing is described on the comprehensive genomic profiling page, and how results become a recommendation on the molecular tumour board page.
How the Treatment Plan Is Written
The treatment plan is written by the doctor after the tumour board discussion and explained to the patient at a consultation, in person or by video. Treatment is chosen by the doctor according to stage, pathology and molecular findings; the patient's general condition, other illnesses and preferences are part of the decision. The plan follows the ESMO and NCCN guidelines and is written in English so that it can be shared with doctors at home.
- Goal of treatment
- Stated plainly as curative (intended to remove the disease completely) or palliative (intended to control the disease and reduce symptoms).
- Sequence
- The order of surgery, radiotherapy and systemic treatment, and whether systemic treatment is given before surgery (neoadjuvant) or after it (adjuvant).
- Drugs and schedule
- Drugs are named by their generic name, with the cycle interval and the planned number of cycles; the options are described on the treatments page.
- Where treatment is delivered
- Whether cycles are given in Izmir, at home under the patient's own oncologist, or in combination, and which tests are done where.
- Side effects and contact
- The expected side effects, when to go to an emergency department and who to contact.
Important: This page describes a process; it does not give medical advice and does not replace a consultation. Timings are general principles; the timing and plan for an individual patient are given only by the doctor.
Follow-Up During and After Treatment
During treatment, follow-up consists of an examination and a blood test before each cycle and, at set intervals, imaging to assess response. Imaging is usually done every two to three cycles, that is every eight to 12 weeks, and the change in the tumour is measured against standard criteria (RECIST 1.1). If the disease progresses or side effects prevent continuation, the doctor changes the treatment line; this is an expected part of the pathway. Patients who return home between cycles can have blood tests and scans done locally and send the results for review.
After treatment is complete, follow-up is planned according to cancer type: usually every three to six months for the first two years, every six to 12 months thereafter, with the interval widening after five years. Follow-up includes examination, blood tests and the imaging that the guideline recommends; no unnecessary scans are added. For international patients, follow-up is usually shared with the patient's own oncologist, with a written schedule and the summary of treatment received.
During treatment, a temperature of 38 °C or higher, breathlessness, bleeding, vomiting or diarrhoea that will not stop and sudden confusion need an emergency department; call the local emergency number (112 in Türkiye) or go to the nearest hospital. WhatsApp and e-mail are not suitable for emergencies.
Frequently Asked Questions
How long is it from diagnosis to treatment?
For most patients the interval from diagnosis to the start of treatment is two to four weeks, and it depends on how quickly the staging scans and, where needed, the molecular test are reported. If pathology and imaging are already complete, the plan can be discussed at the first consultation. Guidelines advise keeping the interval short for fast-growing tumours and waiting for complete results in slow-growing ones rather than starting with incomplete information. Timings vary from patient to patient and are not a commitment.
Why is the pathology slide reviewed again?
The slide is reviewed again so that the diagnosis is firm enough to carry a treatment plan. Tumour type, grade and receptor or biomarker results directly determine the treatment, and a second pathologist may find a missing stain or a difference in classification. Review does not imply that the first pathologist was wrong; it is a verification step. Additional immunohistochemistry or a molecular test on the existing block can be requested at the same time, which avoids a repeat biopsy.
Which tests are used for staging?
Staging uses imaging that shows the size of the tumour, lymph node involvement and any distant spread; depending on the cancer type this is CT, MRI, PET-CT or a bone scan. Not every patient needs a PET-CT; guidelines state which method suits which tumour type and stage. Blood count, kidney and liver tests, and where relevant a heart assessment, are added. The choice of tests is made by the doctor for each patient; scans already done at home are not repeated without a reason.
Is the plan given in writing?
Yes. The treatment plan is given to the patient as a written summary in English covering diagnosis, stage, goal of treatment, the drugs proposed by generic name, the schedule, expected side effects and the frequency of check-ups. The summary can be passed to the patient's own oncologist or to another centre. For patients discussed at the molecular tumour board, the board's recommendation and its evidence level are included. The plan is not a contract; it is updated according to response and side effects, and every change is explained.
How often are check-ups during treatment?
During treatment there is an examination and a blood test before every cycle, and imaging to assess response is usually planned every two to three cycles, that is every eight to 12 weeks. For targeted therapy and immunotherapy the interval depends on the drug and the guideline. Tumour markers, where measured, are interpreted together with imaging and never on their own. Patients who return home between cycles can have blood tests and scans done locally and send the results for review.
Can the plan change?
Yes. The plan changes if imaging shows that the disease has progressed, if side effects make it unsafe to continue, or if a new molecular finding opens a different option. The change and its reason are explained to the patient and written into the summary. A change of treatment line is an expected part of the pathway rather than a failure; guidelines define first-line, second-line and later treatments separately for each cancer. Where the patient is being treated at home, the revised plan is shared with the local oncologist.
Related Pages
Patient Guide
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Preparing for Your Appointment
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Second Opinion
Open the Page
Comprehensive Genomic Profiling
Open the Page
Molecular Tumour Board
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Treatments
Open the Page
International Patients
Open the Page
Contact
Open the PageSources and Guidelines
- European Society for Medical Oncology. ESMO Clinical Practice Guidelines (diagnosis, treatment and follow-up). Link
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Link
- Mosele MF et al. Recommendations for the use of next-generation sequencing (NGS) for patients with advanced cancer in 2024: a report from the ESMO Precision Medicine Working Group. Ann Oncol 2024;35(7):588-606. Link
- Eisenhauer EA et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer 2009;45(2):228-247. Link
- National Cancer Institute. Cancer Staging. Link
- Cancer Research UK. Tests and scans: how cancer is diagnosed and staged. Link