Since therapy of lung cancer that has metastasized beyond curability by surgery alone almost always involves a medical oncologist, it is probably better to make the referral to him prior to further expensive diagnostic testing. Attention should be paid to more unusual presentations of lung cancer such as those where the symptoms are only a complaint of hoarseness or shoulder pain. Any symptom described by the patient which is not immediately explainable by known physical phenomena should be heard with a concern of cancer. Any suspected involvement of lung cancer should be referred to a medical oncologist. The simple complete blood count is an inexpensive and useful diagnostic test available to the chiropractor.
Anemia can be the only presenting sign of a gastrointestinal or rectal tumor.
A referral to a hematologist or medical oncologist is certainly not required as long as a trained professional evaluates the anemia. On the other hand, a direct referral to a subspecialist who also practices general or internal medicine may be the most appropriate and often the least costly course of action. Anemia, particularly when associated with abnormal leukocytes, is often the first laboratory evidence of leukemia, lymphoma, and myeloma. Any abnormality in numbers or percentages of granulocytes, platelets, lymphocytes, or myeloma should prompt a referral or additional testing. Therefore, bone pain with a normal CBC still demands further testing or referral.