Oncology Terminology

Oncology Terminology 1 Cancer Classification ✥Cancers are classified based on a ✵Tissues of origin 2 ✵Stage 3 ✵Grades ✥Classification dictates treatment approach 3 Go Type of Tissue Cancer Naming Benign Malignant Epithelium Surface epithelium Papilloma Carcinoma (Squamous, epidermoid) Glandular tissue Adenoma Adenocarcinoma Suffix Typeofcancer Ma -carcinomaerrand cat Connective Tissue Fibrous tissue Fibroma Fibrosarcoma Bone Osteoma Osteosarcoma Smooth muscle Leiomyoma Leiomyosarcoma Striated muscle Rhabdomyoma Rhabdomyosarcoma Fat Lipoma Liposarcoma -sarcoma Lymphoid Tissue and Hematopoietic Cells (Bone Marrow Elements) Lymphoid tissue Plasma cells White blood cells NO Lymphoma Benign Myeloma Leukemia Neural tissue Glial tissue Glioma Glioblastoma, astrocytoma Nerve sheath Neurofibroma Neurofibrosarcoma Melanocytes Pigmented nevus Melanoma Other Gonadal tissue Teratoma Teratocarcinoma 4 Cancer Staging Stage What it means Stage 0 Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer Stage I, Stage II, and Stage III Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues. Stage IV The cancer has spread to distant parts of the body. Stage What it means In situ Abnormal cells are present but have not spread to nearby tissue Localized Cancer is limited to the place where it started, with no sign that it has spread Regional Cancer has spread to nearby lymph nodes, tissues, or organs Distant Cancer has spread to distant parts of the body Unknown There is not enough information to figure out the stage 5 Cancer Staging (TNM staging) Primary Tumor (T) TX T0 T 1, 2, 3, 4 Main tumor cannot be measured Main tumor cannot be found Refers to the size and/or extent of the main tumor. The higher the number after the T, the larger the tumor or the more it has grown into nearby tissues. Reginal Lymph Nodes (N) NX: N0: N1, N2, N3: 0661 (M): Distant Metastasis MX M0 M1 (also just “M”) Cancer in nearby lymph nodes cannot be measured. There is no cancer in nearby lymph nodes Refers to the number and location of lymph nodes that contain cancer. The higher the number after the N, the more lymph nodes that contain cancer. Metastasis cannot be measured Cancer has not spread to other parts of the body Cancer has spread to other parts of the body 8 Use in clinical setting ✥Patient’s tumor is T2N0M0 ✥Patient has a T3N4M mammary adenocarcinoma ✥Only T1-T2 with N0 maximum were included in this trial ✥Patients with T3+N2+M were excluded from this trial 9 Tumor Gradesa the fast callstaregrowing How Grade What it means GX Grade cannot be assessed (undetermined grade) G1 G2 G3 G4 Well differentiated (low grade) Moderately differentiated (intermediate grade) Poorly differentiated (high grade) Undifferentiated (high grade) Why is tumor grade important? 10 Why is tumor grade important? Lowerthegrade better theproggosis grade Higher Bowfaster betterfortan mat fastertreat 11 Naming of cancers ✥Involves use of one or more of the above methods ✵Tissue/organ of origin ✵Cell type of origin ✵TNM staging ✵Grade ✵Examples T1N1M0 DCIS G1 Stage 2 pancreatic cancer G3 Colorectal adenocarcinoma with distant mets 12 Cancer therapy evaluation CTEP 13 Goals of treatment ✥Goal and intent of cancer therapy is individualized, and patient centered. Based on various factors such as 0 ✵Patient’s age, comorbidities, and choice ✥Remission – decrease or disappearance of signs and symptoms of cancer (cancer may still be present in the body)* ✥Intent of Rx ok intent ✵Curative i ✵Palliativemastilltreatigteconcarbutatcowerdoseforpt care ✵Hospice care End of life care *NCI dictionary 14 Terms used in cancer treatment ✥Mainstay of treatment of most cancers is surgery (applies to solid tumors) ✵Followed by radiation ✥Pharmacotherapy ✵Primary chemotherapy When only chemotherapy is used - hematologic ✵Adjuvant therapy “In addition to”; given after surgery, mainly as secondary prevention ✵Neo-adjuvant therapy Prior to surgery 15 Terms Used in Assessing Outcomes EXPB DIMM 887mm ✥ Evaluate cancer therapy for brag fig ✵ Effectiveness Grizmm ✵ Adverse effects progressive ✥ Remission† - A decrease in or disappearance of signs and symptoms of cancer. disease ✵ Partial remission, some, but not all, signs and symptoms of cancer have disappeared. ✵ Complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. RECIST criteria Abbreviation Definition Description CR Complete Response Disappearance of all target lesions PR Partial response SD PD ≥ 30% decrease in the sum of the longest diameter of the target lesion Small changes that do not meet other Stable disease categories ≥ 20% increase in the sum of the longest Progressive disease diameter of target lesions 16 Terms used in assessing outcomes Abbreviation Definition Description OS Overall survival # of patients that survive by the end of study length DFS Disease free survival PFS Progression free survival TTP (or) TTR Time to progression (or) recurrence DR Duration of response ORR Percent of patients with confirmed complete response or confirmed partial response. Objective response rate Confirmed = persistent upon repeat imaging study ≥4 weeks after initial documentation for CR and ≥6 weeks for SD. Length of time during which a patient survives with no sign of the disease Length of time from randomization to first documentation of objective tumor progression or to death due to any cause (whichever comes first) Length of time from randomization to the first documented disease recurrence Time from the first documentation of objective tumor response (CR or PR) to the first documentation of objective tumor progression or death due to any cause 17 Terms Used in Assessing Outcomes ✥Evaluate cancer therapy for ✵ Effectiveness ✵ Adverse effects ✥✥CTCAE (Common Terminology Criteria for Adverse Events) ✵ NCI provided descriptive terminology used for AE reporting ✵ Grades - refer to severity of AE with unique clinical descriptions Grade 1: Mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2: Moderate; minimal, local or noninvasive intervention indicated; limiting age- appropriate instrumental ADL* Grade 3: Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care ADL** the Grade 4: Life-threatening consequences; urgent intervention indicated Grade 5: Death related to AE ✥Dose Limiting toxicity 18 Dose Limiting Toxicity ✥Most of the cancer therapeutic agents are given at maximum tolerated dose Ifyousee one ✵Produce various AEs and toxicities ✵Acceptable side effects/toxicity ✵Grade of the AEs/toxicities Stargivemoredigs tocoverthatse ✵Treating AEs with more drugs Poly pharmacy - common in cancer treatment ✥Dose limiting toxicity (DLT): describes side effects of a drug or other treatment that are serious enough to prevent an increase in dose or level of that treatment* ✵Most drugs have one/more DLTs 19 Toxicities of Rx is Intervention Mild SE Side Effect nor Grade 1 Grade 2 Grade 3 Grade 4 dog Diarrhea Bloody diarrhea, over 7 3 – 4 loose stools a day 5 – 7 loose stools a day or loose stools a day or or mild diarrhea diarrhea lasting more needing iv Rx or feeling lasting < 1 week than a week dizzy when standing Fatigue Normal activity reduced by less than 25% Activity reduced by 25 – 50% Mood disturbance Mild anxiety, able to carry tasks Moderate anxiety, Severe mood changes interfering with ability to requiring medical Rx, work unable to work Nausea Moderate discomfort or Mild or transient, intake decreased for less reasonable food intake than 3 days Vomiting 1 – 2 episodes per day 3 – 5 episodes per day or ≥ 7 episodes, over 24 hours Hemodynamic collapse, or mild vomiting for mild vomiting lasting for requiring iv Rx or feeling requiring hospitalization less than 1 week more than 1 week dizzy when standing Alopecia Partial/patchy CTCAE Hemodynamic collapse, requiring hospitalization Normal activity reduced Unable to care for by over 50%; can not work yourself Severe discomfort or intake reduced for more than 3 days Acute psychosis, suicidal ideation Hospitalization required, feeding tubes required Complete Grade 5 - Death due to toxicity 20 Howmuchptisactive noDescription (ECOG Scale) Description (Karnofsky Scale) Kanofsky Score (%) ECOG Score No complaints; no evidence of disease 100 0 Fully active, able to carry on all pre-disease performance without restriction Able to carry on normal activity; minor signs or symptoms of disease 90 Normal activity with effort; some signs or symptoms of disease 80 1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work Cares for self; unable to carry on normal activity or to do active work 70 2 Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours 3 Capable of only limited self-care; confined to bed or chair more than 50% of waking hours 4 Completely disabled; cannot carry on any self-care; totally confined to bed or chair 5 Dead Requires occasional assistance but able to care for most personal needs 60 Requires considerable assistance and frequent medical care 50 Disabled; requires special care and assistance 40 Severely disabled; hospitalization indicated, although death not imminent 30 Very sick; hospitalization necessary; requires active supportive treatment 20 Moribund; fatal processes progressing rapidly Dead 10 0 21 Tumor markers and lab tests ✥Blood markers of cancer ✵Sensitivity of the assays Normal range versus range in various stages of cancer Blood levels before clinical symptoms of cancer ✵Specificity and selectivity Cancer specific versus site/organ specific PSA for prostate cancer • Also elevated in BPH, prostatitis, prostate biopsy, urethral endoscopy and DRE 22 Clinical use of serum tumor markers Tumor marker Cancer PSA Prostate Monitoring Screening Staging or Diagnostic (Outcome or (Asymptomatic) Prognosis Progression) Other conditions X CA-125 Ovarian CEA Colon, Pancreas CA 19-9 Pancreatic hCG Germ cell of ovaries and testes AFP Hepatocellular, Testicular (nonseminomatous) Just as example; will learn with specific cancers X X X X BPH, prostatitis, prostate biopsy, urethral endoscopy, DRE X X Endometriosis, ovarian cysts, liver disease, PID, pregnancy X Hepatic cirrhosis, hepatitis, pancreatitis, peptic ulcer disease, ulcerative colitis, Chrohn’s X Pancreatitis, gastric and colon cancer X Pregnancy, occasionally other cancers X Pregnancy, hepatitis, cirrhosis, occasionally in pancreatic, gastric, colon and lung cancers X X X X X X 23 Tumor markers and lab tests ✥Blood markers of cancer ✵Specificity and selectivity Cancer specific versus site specific PSA for prostate cancer • Also elevated in BPH, prostatitis, prostate biopsy, urethral endoscopy and DRE ✵Sensitivity of the assays Normal range versus range in various stages of cancer Blood levels before clinical symptoms of cancer ✥Tumor markers ✵Specific receptors to be targeted with treatment ✵Genetic markers for prognostic purposes 24 Only a pathologist diagnoses cancer! 25