• The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to the Oncology.

    Implementing Rules

    Acceptable Means of Compliance

    Guidance Material

    MED.B.090 Oncology

     (a) Before further consideration is given to their application, applicants with primary or secondary malignant disease shall undergo satisfactory oncological evaluation. Such applicants for a class 1 medical certificate shall be referred to the medical assessor of the licensing authority. Such applicants for a class 2 medical certificate shall be assessed in consultation with the medical assessor of the licensing authority.

    (b) Applicants with a documented medical history or clinical diagnosis of an intracerebral malignant tumour shall be assessed as unfit.

     

    CLASS 1 - AMC1 MED.B.090

    (a) Applicants who have been diagnosed with a malignant disease may be assessed as fit provided that:

    (1) after primary treatment, there is no evidence of residual malignant disease likely to jeopardise flight safety;

    (2) time appropriate to the type of tumour and primary treatment has elapsed;

    (3) the risk of inflight incapacitation from a recurrence or metastasis is sufficiently low;

    (4) there is no evidence of short or long-term sequelae from treatment. Special attention should be paid to applicants who have received anthracycline chemotherapy;

    (5) satisfactory oncology follow-up reports are provided to the medical assessor of the licensing authority.

    (b) An OML should be applied as appropriate.

    (c) Applicants receiving ongoing chemotherapy or radiation treatment should be assessed as unfit.

    (d) Applicants with pre-malignant conditions of the skin may be assessed as fit if treated or excised as necessary and there is regular follow-up.
     

    On reporting a diagnosis of malignancy, applicants should be assessed as unfit.

    Recertification can be considered following receipt of a satisfactory specialist report with the information in the 15 point Oncology Request table (PDF).

    Note 1: All Class 1 applicants shall be referred to the AMS.   

    For recertification:  

    • Treatment completed
    • Full recovery
    • No symptoms that could affect flight safety
    • No complications, or if any, appropriate investigation and specialist referral may be required  

    Chemotherapy

    1. Recertification a minimum of 6 weeks after the last dose of chemotherapy, subject to satisfactory blood tests results (FBC, U&Es, LFTs, relevant tumour markers as a minimum).

    2. If any complications from treatment, need full recovery.  If unresolved, may require appropriate specialist assessment, e.g. neuropathy may require a specialist neurology assessment. 
    3. Class 1 pilots who have had anthracycline (e.g. doxorubicin, adriamycin, daunorubicin) require cardiological assessment in accordance with the anthracycline (PDF) flow chart.  

    CLASS 2 - AMC2 MED.B.090   
    (a) Applicants who have been diagnosed with a malignant disease may be considered for a fit assessment provided that:


    (1) after primary treatment, there is no evidence of residual malignant disease likely to jeopardise flight safety;

    (2) time appropriate to the type of tumour and primary treatment has elapsed;

    (3) the risk of in-flight incapacitation from a recurrence or metastasis is sufficiently low;

    (4) there is no evidence of short or long-term sequelae from treatment that may jeopardise flight safety;
     

    (5) arrangements for an oncological follow-up have been made for an appropriate period of time.

    (b) Applicants receiving ongoing chemotherapy or radiation treatment should be assessed as unfit.

    (c) Applicants with pre-malignant conditions of the skin may be assessed as fit if treated or excised as necessary and there is a regular follow-up.
     

    Radiotherapy

    1. Recertification a minimum of 4 weeks after the last dose of radiotherapy. 

    2. If any complications from treatment, need full recovery.  If unresolved, appropriate specialist assessment required e.g. radiation pneumonitis/pulmonary fibrosis requires a specialist respiratory assessment. 

    Surgery 

    As a guide, minimum post-operative grounding periods: 

     Minor 
     e.g. skin lesion 1 Week
     

    Intermediate 
     e.g. prostatectomy (TURP) 6 weeks
     

    Major 
     e.g. hemicolectomy 3 months

    Metastatic disease 

    Metastatic disease is disqualifying for Class 1 and Class 2 certification. 

    In exceptional cases, Class 2 OSL may be considered by CAA Medical only. 

    Incapacitation risks are based on: 
       1) Risk of a recurrence 
       2) Site of the recurrence 
       3) Risk of a recurrence at that site leading to an 
       incapacitation. 

    CAA Oncology Certification Charts (PDF) have been developed based on these medical incapacitation risks:  
       2-5%  per annum Class 2 OSL 
       ≤ 1%  per annum Class 1 OML & Class 
       2 unrestricted 
       0.1%  per annum Class 1 Unrestricted 

         UK CAA Oncology Certification Charts (PDF) exist for these tumour types:   


    Colorectal 
    Breast cancer 
    Malignant melanoma 
    Testicular germ cell tumour
    Renal cell carcinoma 
    Non-small cell lung cancer  

    All Class 1 lymphoid malignancies must be referred to the CAA.

    The above guidance is also available in Ernsting’s Textbook of Aviation Medicine 5th Edition, Chapter 28, Malignant Disease.

    UK CAA Guidance on certification after Prostate Cancer (PDF)