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) |
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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 |
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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)
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Degree of differentiation often relates to clinical behavior of particular tumor |
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Based on microscopic appearance of cancer cells, pathologists commonly describe tumor grade by 4 degrees of severity |
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Grade 1 Often well-differentiated / low-grade tumors
Generally considered least aggressive in behaviour
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Grade 3/4 Usually poorly differentiated / undifferentiated high-grade tumors
generally most aggressive in behaviour
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*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
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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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