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Oncology Part 1 Cheat Sheet by

Oncology Quick Notes

Important Notes

Diagnosis = 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 & Signs

Unexpl­ained 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 Tests

CBC
ESR, LDH, CRP
Urine analysis
Specific changes in typical blood parameters
Tumor markers
FC (flow cytometry)

Tumor Markers

CEA (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 Classi­fic­ation

Tumour (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 + Antion­cogene

BRCA-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 - ECOG

0
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 (%) Criteria

100
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 Trials

Phase 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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