Important NotesDiagnosis = histopathology* | Nadir | Period when side effect of syst. chemotherapy most severe | Nadir for most of cytostatic drugs | Minimal number of leukocytes after chemotherapy that most often falls b/w 6 & 14 days | Primary prevention of febrile neutropenia | risk of FN ≥ 20%
Filgrastim (or) Filigrastin | Absorbed dose of ionizing radiation | Dose quantity which is the measure of energy deposited in matter by ionizing radiation / unit mass
SI = Gray (Gy) | Monoclonal antibody drugs | Usually end in -mab | Tyrosine Kinase Inhibitors | Targeted therapy in adenocarcinoma
--> erlotinib, gefitinib, afatinib | WHO Analgesic Ladder | 3 Steps
Step 1: Non-opioid + optional adjuv. analgesics for mild pain
Step 2: Weak opioid + non-opioid & adjuv. analgesics for mild - moderate pain
Step 3: Strong opioid + non-opioid & adjuv. analgesics for moderate - severe pain |
* excluding CLL, CML t(9;22), etc. General Symptoms & SignsUnexplained pain | Skin Changes | Palor (anemia) | Fever of unknown origin | Night sweats | Jaundice | Cachexia or substantial body weight loss in short period of time (10%) |
Blood TestsCBC | ESR, LDH, CRP | Urine analysis | Specific changes in typical blood parameters | Tumor markers | FC (flow cytometry) |
Tumor MarkersCEA (carcinoembryonic antigen) | used in colorectal ca. monitoring
Not specific (lung, prostate, breast ca.)
Elevated in inflammation | AFP (alpha-fetoprotein) | conc. in hepatocellular carcinomas & some testicular ca. (nonseminomas) | b-HCG (human chorionic gonadotropin) | in gestational trophoblastic neoplasia (eg: chorioncarcinoma), some ca. & embryonic-type tumors: neuroblastoma & nephroblastoma | CA125 | In 80% of ovarian ca.
Assessment of tumor mass | CA 15-3 | In disseminated breast ca. , not used for monitoring | Thyreoglobulin | In papillary & follicular thyroid ca. | Calcitonin | In medullary thyroid ca. | PSA (prostate-specific antigen) | Highly specific for prostate | CA 19-9 | Gastrointestinal tract ca. (not specific) |
| | 7 Cancer Warning Signals (CAUTION)Change in bowel / bladder habits | A sore throat that does not heal | Unusual bleeding or discharge | Thickening of lump in breast or elsewhere | Indigestion / difficulties in swallowing | Obvious change in wart or mole | Nagging cough or hoarseness |
This is by American Cancer Society TNM ClassificationTumour (extent) | Nodes (region) | Metastasis (distant) | T0 | N0 | M0 | T1 | N1 | M1 | T2 | N2 | T3 | N3 | T4 | Tx - can't be assessed | Nx - can't be assessed |
cTNM - clinical
pTNM - pathological
ycTNM - treated tumours
*in pM --> only pM1 possible!
m - multiple primary tumors @ single site [eg: T2(m) T1c(5)]
aTNM - @ autopsy
rTNM - @ recurrence
V Venous invasion
L Lymphatic invasion
Pn - Perineural invasion Oncogene + AntioncogeneBRCA-1 & BRCA-2 | Breast ca. , ovarian ca. | MGMT | Glioblastoma | PALB-2 | Breast ca. , ovarian ca. , pancreatic ca. | RAS | lung ca. , ovarian ca. , colon ca. , etc. | EGFR | lung ca. , glioblastoma, breast invasive ductal ca. , colon ca. | p-53 | Li-Fraumeni syndrome
breast ca. soft tissue sarcoma, osteosarcoma, brain tumors, pancreatic ca. , adrenal gland ca. , gastric ca. , colorectal ca. | DCC (deleted colorectal ca.) | cause spectrum of neurological disorders | ATM | Ataxia-Telangiesctasia (AT)
breast ca. risk, pancreatic ca. risk. ovarian ca. risk. prostate ca. , melanoma, etc. | Rb | retinoblastoma, bladder ca. , small cell lung ca. | C-SIS | gliomas | C-ERB-B | glioblastoma, breast ca. | C-ABL | chronic myeloid leukemia | C-MYC | leukemias, breast ca. , etc. | C-BCL-2 | chronic lymphocytic leukemia, malignant melanoma | NK-1 | neurofibroma, pheochromocytoma, leukemia |
| | Assessment Scale - ECOG0 | Fully active, able to carry on all pre-disease performance w/o restriction | 1 | Restricted in physically strenuous activity b/ ambulatory & able to carry out work of a light or sedentary nature
eg: light house work, office work | 2 | Ambulatory & capable of all selfcare b/ unable to carry out any work activities. Up and about >50% of waking hours | 3 | Capable of only limited selfcare, confined to bed or chair >50% of waking hours | 4 | Completely disabled. Can't carry on any selfcare. Totally confined to bed or chair | 5 | Dead |
Karnofsky PSS Definitions Rating (%) Criteria100 | Normal no complaints ; no evidence of disease | 90 | Able to carry on normal activity ; minor signs or symp. of disease | 80 | Normal activity with effort ; some signs or symp. of disease | 70 | Cares for self ; unable to carry on normal activity or to do active work | 60 | Requires occasional assistance, b/ is able to care for most of his personal needs | 50 | Requires considerable assistance & freq. medical care | 40 | Disable ; req. special care & assistance | 30 | Severely disabled ; hospital admission is indicated although death not imminent | 20 | Very sick ; hospital admission necessary ; active supportive treatment necessary | 10 | Moribund ; fatal processess progressing rapidly | 0 | Dead |
100-80 --> Able to carry on normal activity & to work ; no special care needed
70-50 --> Unable to work ; able to live at home & care for most personal needs ; varying amount of assistance needed
40-0 --> Unable to care for self ; requires equivalent of institutional or hospital care ; disease may be progressing rapidly Degree of Differentiation (G)Degree of differentiation often relates to clinical behavior of particular tumor | Based on microscopic appearance of cancer cells, pathologists commonly describe tumor grade by 4 degrees of severity | Grade 1 Often well-differentiated / low-grade tumors
Generally considered least aggressive in behaviour | Grade 3/4 Usually poorly differentiated / undifferentiated high-grade tumors
generally most aggressive in behaviour |
*Definition: Degree of abnormality of cancer cells, measure of differentiation, extent to which cancer cells are similar in appearance & func. to healthy cells of same tissue type | | Phases of Clinical TrialsPhase I | First clinical trial of given agent in human being
Goal:
•Initial determination of safety of an agent administration
•Determination of pharmacokinetic profile | Phase II | Initial trial of therapeutic efficacy
•Preliminary determination of therapeutic efficacy
•Determination of relationship b/w dose & effect
•Cont. of phase I safety determination
•If necessary modification of dosage | Phase III | Systematic trial of therapeutic effectiveness
•Evaluation in randomized, multicenter clinical trial in comparison to std. therapy also in double blind trial (not applicable to anticancer drugs, b/c there is no anticancer placebo effect)
•Evaluation using pt. survival time
•Cont. of evaluation of adverse reactions & interaction w/ other concomitantly administered medicines
--Kaplan-Meyer survival curve-- | Phase IV | Trial performed after intro of new drug to market
•New indications
•New methods of administration
•Combo w/ other new drugs unavailable in preregistration time
•Comparison trials w/ other similar drugs | Meta-analysis [study of studies] | Formalized, systematic review of results of available phase II & III trials (sometimes only phase III trials) on same subject
Aim:
•To increase precision & significance of comparable trials through data aggregation
•In case of contradictory results of indiv. trials reaching common conclusion |
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