EBOT flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

TNM staging

T describes primary tumour size and invasion, N regional lymph node involvement, M distant metastasis. Prefixes c, p, y and r denote clinical, pathological, post-neoadjuvant and recurrent staging respectively.

ECOG performance status

A 0-5 scale of functional status: 0 fully active, 1 restricted in strenuous activity, 2 ambulatory and self-caring, 3 limited self-care, 4 completely disabled, 5 dead. It guides treatment intensity and trial eligibility.

RECIST 1.1 response

Target lesions are measured by longest diameter. Complete response means all target lesions disappear and nodes regress below 10 mm short axis. Progressive disease is at least 20% increase plus 5 mm absolute increase.

Paraneoplastic hypercalcaemia

Cancer-related hypercalcaemia often mediated by PTHrP, classically in squamous cell carcinomas. Treat with intravenous fluids plus a bisphosphonate or denosumab; calcitonin gives rapid but transient control. Correct calcium for albumin.

Log-kill hypothesis

Cytotoxic chemotherapy kills a constant fraction, not a constant number, of tumour cells per dose. This is why dose intensity, schedule and repeated cycles matter for cure and relapse prevention.

Febrile neutropenia

Fever of at least 38.3 °C once, or 38.0 °C sustained over one hour, with absolute neutrophil count below 0.5 ×10⁹/L or expected to fall. Start empirical anti-pseudomonal antibiotics within 60 minutes.

Immune-related adverse events

Organ inflammation caused by checkpoint inhibitors, including colitis, pneumonitis, hepatitis, thyroiditis and hypophysitis. Grade 3-4 events usually require drug interruption, high-dose corticosteroids and specialist review.

Pseudo-progression

An apparent increase in tumour size or new lesions during immunotherapy that is followed by response. Confirm with repeat imaging before abandoning a potentially effective checkpoint inhibitor.

DPYD deficiency

Inherited deficiency of dihydropyrimidine dehydrogenase reduces fluoropyrimidine breakdown, causing severe or fatal toxicity. Genotype or phenotype testing before 5-fluorouracil or capecitabine dosing reduces this risk.

Alpha/beta ratio

A radiosensitivity parameter. Late-responding normal tissues have low alpha/beta around 3 Gy, while tumours and early-responding tissues are near 10 Gy. This underpins safe hypofractionation.

Hypofractionated radiotherapy

Delivery of larger radiation doses per fraction (typically above 2 Gy) in fewer sessions. It exploits the lower alpha/beta of many tumours and improves convenience, with attention to late normal-tissue tolerance.

Radiation recall

An inflammatory reaction confined to a previously irradiated field, triggered by a systemic agent such as doxorubicin, gemcitabine or a taxane given weeks to months after radiotherapy.

Stereotactic body radiotherapy

Delivery of a few high-dose, precisely targeted fractions to an extracranial lesion using image guidance and motion management. Also called SABR; used for small lung, liver, adrenal and prostate tumours.

R0 resection

Surgical removal of a tumour with no residual disease at the microscopic margin. R1 indicates microscopic residual tumour and R2 macroscopic residual tumour, both associated with worse local control.

Sentinel lymph node biopsy

Injection of dye or radiotracer to identify the first draining node or nodes. A negative sentinel node can spare regional lymphadenectomy in selected breast cancer and melanoma cases.

Neoadjuvant therapy

Systemic or radiation treatment given before planned surgery to shrink tumour, increase resectability, test in vivo response and treat micrometastasis. Pathological response after neoadjuvant therapy carries prognostic value.

Multidisciplinary tumour board

A meeting of surgeons, medical and radiation oncologists, pathologists, radiologists and allied staff who agree on a documented management plan using stage, histology, biomarkers and patient factors.

Opioid rotation

Switching from one opioid to another using equianalgesic dose tables. A 25-50% dose reduction is applied for incomplete cross-tolerance when converting between strong opioids.

Naloxone

An opioid antagonist used to reverse opioid-induced respiratory depression. It must be titrated carefully to restore breathing without precipitating severe pain or acute withdrawal.

Malignant bowel obstruction

Bowel obstruction caused by advanced intra-abdominal cancer, often managed medically with antisecretory agents such as octreotide, dexamethasone, antiemetics and analgesics rather than by surgery.

CORD compression

Spinal cord compression from tumour causes back pain, weakness, sensory level and bladder dysfunction. Give immediate dexamethasone and urgent whole-spine MRI, then surgery or radiotherapy.

Superior vena cava syndrome

Obstruction of the superior vena cava causing facial and upper limb swelling, distended neck veins and dyspnoea. Urgent imaging is followed by radiotherapy, stenting or systemic therapy according to histology.

Tumour lysis syndrome

Metabolic crisis with hyperuricaemia, hyperkalaemia, hyperphosphataemia, hypocalcaemia and renal failure after rapid tumour breakdown. Prevention with hydration and allopurinol or rasburicase is central.

Cytokine release syndrome

A systemic inflammatory response after CAR-T or bispecific antibody therapy, with fever, hypotension and organ dysfunction. Managed by severity grading, supportive care, tocilizumab and corticosteroids.

Phase I trial

First-in-human study designed mainly to establish safety, tolerability and maximum tolerated dose, and to describe pharmacokinetics. Efficacy is a secondary aim in most oncology phase I studies.

Intention-to-treat analysis

Analysis of all randomised participants according to original allocation, regardless of adherence. It preserves randomisation and gives an unbiased estimate of real-world treatment effect.

Number needed to treat

The reciprocal of the absolute risk reduction. It estimates how many patients must receive a treatment for one additional patient to benefit, conveying clinical importance better than relative risk.

Lead-time bias

Apparent survival improvement caused solely by earlier diagnosis, which advances the time of detection without changing the time of death. It can falsely suggest screening benefit.

Informed consent

Valid consent requires capacity, adequate information about diagnosis, options, risks, benefits and alternatives including no treatment, voluntariness, and documentation of the discussion.

Decision-making capacity

The ability to understand relevant information, retain it, weigh it and communicate a choice. It is decision-specific and time-specific, and is not determined by diagnosis alone.

Duty to disclose errors

Clinicians should promptly and honestly tell patients about harmful medical errors, explain what happened, apologise, and describe steps to prevent recurrence. This is an ethical duty and often a legal one.

Chemotherapy safety checks

Independent double-check of patient identity, drug, dose, route and infusion rate before administration. Standardised order sets and error reporting systems reduce preventable chemotherapy harm.