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Cytopathologist
Patient Doctor
Radiologist
Laboratory
Patient
Minimal mistake
Maximal patient service
Oncology aspect
Diagnose: Staging
Medical Status: Risk group
- Anamnesa (co-morbid)
- Physic, Laboratory, ECG
- Performance status (Karnosfky-ECOG)
Patients & family Aspect
Information about :
- indication chemotherapy
- regimen & cycle of Chx
- Side effect of drug
- living with chemotherapy
- informed consent
Outcome & Side Effect Monitoring
Survival Diagnose
Objective & management
& Subjective Outcome
Mechanism chemotherapy in cellular level
Reduction of tumor after Chemotherapy
Rational , patient financial ?
( influence on the response to chemotherapy )
Mechanisme of Actions
G2 M Hydrocortisone
2-10h Chalones
Purin antagonis
Hydroxy urea
Actinomycin D
S G1
Cyclophosphamide Mytomycin
6-20h 18-30h
6-Marcaptopurine
Doxorubicin
6-Thioguanine
Tumor invisible
Immune resistance
(Remission) 103 of host
(1 úg)
(humoral&cellular)
1. TUMOR SIZE :
- Complete remission (CR)
- Partial remission (PR)
- No Changes (Stable Disease = St D)
- Progressive Disease (PD)
2. Marker Tumour :
- CEA, CA15-3, MCA Breast Ca
- CEA, CA19-9 Pancreas Ca, Colorectal Ca
- HCG Chorio Ca
- PSA Prostat Ca
3. Objective-Qualitative :
- Change of Clinical sign : Brain Ca-neurology sign
SUBJECTIVE RESPONSE EVALUATION
Palliative
PHARMACOLOGY
When Side effect become: NADIR point (degree of SE)
Onset of SE, Specificity of organ target
1 6 11 16 21 26
nadir Chemotherapy day
Chemotherapy day
FEBRILE NEUTROPENIA
CRITERIA :
• NEUTROPENIA :
absolute count of neutrophill in circulating blood < 2000 cells/mm3
• FEVER :
body temperature > 38.50C in 3 x measurement per 24 hours
DEGREE OF NEUTROPENIA
Empiric antibacterial
Empiric antibacterial
G-CSF
Sterile room
Chemotherapy day
1. Onset of SE :
- Immediately ( < 1 Hour post Chemotx) Anaphylaxsis
- early (1- 48 hours ) Nausea-Vomiting profuse
- delayed (2 days -2 months ) leucopenia
- Late (after 2 months ) myopathy, neuropathy
Better Communication
Unity of work rhythm
Minimal mistake
Maximal patient service
RESUME :