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United States Department of TransportationUnited States Department of Transportation

Guide for Aviation Medical Examiners

Decision Considerations – Aerospace Medical Dispositions
Item 38. Abdomen and Viscera – Malignancies

Colon Cancer/Colorectal Cancer – All Classes
Disease/Condition Evaluation Data Disposition
A.
Non metastatic-treatment completed 5 or more years ago
If no recurrence or ongoing treatment: ISSUE
Summarize this history in Block 60.
B.
Pedunculated cancerous polyp (Adenocarcinoma) removed by colonoscopy less than 5 years ago
Review a status report. If it shows:
  • Local lesion only (TNM stage 0 or I);
  • Complete resection with no additional treatment needed;
  • Follow up is annual or less frequent colonoscopy;
  • No clinical concerns.
ISSUE
Summarize this history in Block 60.
C.
Non metastatic and no High Risk features*

Treatment completed less than 5 years ago

Follow CACI worksheet. Follow the CACI-Colon Cancer/Colorectal Cancer Worksheet (PDF).

Note in Block 60.

D.
HIGH RISK features*

Or

Metastatic disease (Refers to distant metastatic disease such as: lung, liver, lymph nodes, peritoneum, brain.)

Submit the following to the FAA for review:

☐ Status report or treatment records from treating oncologist that provide the following information:

  • Initial staging,
  • Disease course including recurrence(s)
  • Location(s) of metastatic disease (if any),
  • Treatments used,
  • How long the condition has been stable,
  • If any upcoming treatment change is planned or expected and prognosis;
☐ Medication list. Dates started and stopped. Description of side effects.
☐ Treatment records including clinic notes;
☐ Operative notes and discharge summary, if applicable;
☐ Colonoscopy reports;
☐ Pathology reports;
☐ Results of MRI/CT or PET scan reports that have already been performed (In some cases, the actual CDs will be required in DICOM format for FAA review.); and
☐ Lab reports.
  • CBC and CEA performed within the last 90 days;
  • Previous tumor marker lab results (such as CEA).

DEFER

Submit the information to the FAA for a possible Special Issuance.

Followup Special Issuance - Will be per the airman's authorization letter

Other Malignancies Submit all pertinent medical records, operative/pathology reports, current oncological status report, including tumor markers, and any other testing deemed necessary. Requires FAA Decision

*Notes: High Risk features for FAA purposes include the following. These DO NOT CACI qualify:

  • CEA increase or CEA did not decrease with colectomy;
  • Chemotherapy ever (including neoadjuvant);
  • Familial Adenomatous Polyposis (FAP);
  • High risk pathology per the treating oncologist;
  • Incomplete resection or positive margins;
  • Lynch syndrome;
  • Metastatic disease (Refers to distant metastatic disease such as: lung, liver, lymph nodes, peritoneum, brain)
  • Pathology of any type other than adenoma (ex: lymphoma, GIST, carcinoid);
  • Radiation therapy;
  • Recurrence; and or
  • Sessile polyp with invasive cancer surgically treated only, no additional chemo/radiation.

An applicant with an ileostomy or colostomy may also receive FAA consideration. A report is necessary to confirm that the applicant has fully recovered from the surgery and is completely asymptomatic.

In the case of a history of bowel obstruction, a report on the cause and present status of the condition must be obtained from the treating physician.

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