prognosis Flashcards
what is a prognostic factor
a situation or condition, or characteristic of a patient which can be used to estimate the chance of recovery from a disease or the chance the disease comes back
what is a predictive factor
measurement that is associated with response or lack or response to a particular therapy
what is overall survival
% of people with a specific type and stage of cancer who have not died from any cause during a certain period of time after diagnosis
what is cancer-specific survival
% of patients with a specific type and stage of cancer who have not died from their cancer during a certain period of time.
what is disease-free survival
% of patients who have no signs of cancer during a certain period of time after treatment
2 other names for disease-free survival
recurrence-free and progression-free
why do we need prognostic factors
identify people who have a good or bad outcome. those with good outcomes may not benefit from adjuvant therapy
determinants of cancer prognosis (5)
- What is the tumour
- how well is it differentiated
- size, how much spread
- other clinical factors
- is therapy even possible?
example of tumours with excellent prognosis
thyroid
example of tumours with moderate prognosis (4)
kidney, prostate, cervix and breast
example of tumours with poor prognosis (3)
pancreas, brain, oesophagus
what dictates the grade of tumour
differentiation
what is pleomorphism
variation in size and shape of constituent cells of the tumour
is the grade of the tumour worse or better with more pleomorphism
worse, there is more differentiation
how do more mitotic figures indicate worse grade of tumour
it indicates more proliferation
what is the mitotic index
proportion of cells containing mitotic figures
what is necrosis revelvant for
grading sarcomas
characteristics of low grade tumours
slow growing, good prognosis
what is a sarcoma
cancer that arises from soft tissues
what is the Ki67 index
proliferative index of tumours
difference between stage and grade
stage is how big the tumour is and how far it has gone and grade is how differentiated it is
characteristics of high grade tumours
fast growing, poor prognosis
what is the TNM system
Tumoour Node and Metastasis. Based upon the extent of local tumour spread, regional lymph node involvement and the presence of distant metastases
TNM - What does T mean
size/ extent/ depth of primary tumour
TNM - What does Tx mean
cannot be assessed
TNM - What does Tis mean
carcinoma in situ
TNM - What does T0 mean
no evidence of tumour
TNM - What does T1, T2, T3, T4 mean
depend on increasing size, extent or depth of the primary tumour
TNM - What does N mean
degree of involvement of regional lymph nodes
TNM - What does Nx mean
cannot be assessed
TNM - What does N0 mean
no evidence of tumour in nodes
TNM - What does N1 mean
spread to limited number of regional nodes
TNM - What does N2 mean
midway between 1/2
TNM - What does N3 mean
greater number of regional nodes or distant nodes
TNM - What does M mean
distant metastases
3 most common places for tumours to metastasize to
lung, liver and bone
TNM - What does M0 mean
no distant metastases
TNM - What does M1 mean
deposits in distant organs
TNM - T staging of colon cancer, T1
invades submucosa
TNM - T staging of colon cancer, T2
invades muscularis proproa
TNM - T staging of breast cancer. Size in cm for T1
<2cm
TNM - T staging of breast cancer. Size in cm for T2
> 2cm but <5cm
TNM - T staging of breast cancer. Size in cm for T3
> 5cm
TNM - T staging of breast cancer. Size in cm for T4
involvement of chest wall, skin or inflammatory breast cancer
TNM - T staging of colon cancer, T3
invades through the muscularis propria into the subserosa
TNM - T staging of colon cancer, T4
invades other organs or structures and /or perforates visceral peritoneum
TNM - N staging of breast cancer, N1
involved lymph nodes in the armpit but the nodes are not stuck to surrounding tissues
TNM - N staging of breast cancer - levels
1st level: Axillary, 2nd level: internal mammary, 3rd level: clavicular
TNM - N staging of breast cancer, N2
stuck LNs in armpit/ involves LNs behind breast bone but not both
TNM - N staging of breast cancer, N3
involved LNs above and below the clavicle or armpit and breast bone LNs both involved
TNM - N staging of colon cancer
depends on the number of nodes involved
TNM - M staging of breast cancer, M0
no metastatic disease
TNM - M staging of breast cancer, M1
distant metastatic disease
TNM - M staging of colon cancer, subclassifiers - M1a
metastasis confined to one organ without peritoneal metastases
TNM - M staging of colon cancer, subclassifiers - M1b
metastases in more than 1 organ
TNM - M staging of colon cancer, subclassifiers - M1c
metastases to the peritoneum with or without other organ involvement
what is the NPI
Nottingham Prognostic Index, prognostic decision making system for breast cancer which incorporates size, grade and lymph node stage.
NPI equation
tumour size (cm) x 0.2 + histological grade (1-3) + number of +ve lymph nodes [1= 0 nodes, 2= 1-3 nodes, 3 = >3 nodes]
what is pTNM
pathological TNM
what is yTNM
TNM after neo-adjuvant chemoradiation
what is lymphovascular invasion parameters [V0-V2]
when the tumour has invaded vascular structures
what is surgical resection status shown as
R0-R2
what are the serum tumour markers
proteins in the blood when a tumour is present [S0-S3]
what is V0
no vascular invasion
what is V1
microscopic vascular invasion
what is V2
macroscopic vascular invasion
what is R0
resection margin clear
what is R1
microscopic involvement of margin
what is R2
macroscopic involvement of margin, surgery cannot get all of it out
what are tumour markers released in
Cerebral spinal fluid, urine and blood
what are tumour markers used for
aiding diagnosis and following up after treatment
what is SX
serum markers not available or not performed
what is S0
serum markers are in normal limits
what are S1-3
progressively increased level of serum markers
what are serum makers commonly used for
prognosticating testicular cancer
inclusion of biomarkers for prognostic staging
tumour grade, hormone receptors (estrogen and progesterone) and HER2
inclusion of multigene panels for prognostic staging
oncotype DX
how are lymphomas staged
according to the number of sites they have. Stage 1 = 1 above diaphragm, stage 2 = 2 above diaphragm, stage 3 = above and below diaphragm, stage 4 = involvement of spleen/liver etc
what does the addition of b to the stages of lymphoma mean (e.g. stage 1b)
there are symptoms of fever, night sweats and weight loss
what is performance status
measure of how well a person is able to carry on ordinary daily activities while living with cancer and provides an estimate of what treatments the patient may tolerate
what is the ECOG
Easter Cooperative Oncology Group, tells us what category the patient is in for their performance status
what does ECOG 0 mean
fully active, can carry out all pre-disease performance without restriction
what does ECOG 4 mean
completely disabled, cannot carry out self care, totally confined to bed or chair
who decided treatment plan
MDT -> oncologists, surgeons, nurses, pathologists, radiologists
