What kinds of procedures and treatments are there for a malignancy?
- Diagnostic procedures
- Clinical examination
- Imaging (X-ray, CT, Ultrasound, MRI, PET scan)
- Occasionally there is no diagnostic procedure because of the presentation of the patient.
- Occasionally diagnosis happens after treatment, although usually scans are obtained prior to this
- Cytotoxic chemotherapy
- Endocrine therapy
- Targeted therapy (-mabs and -nibs)
- Other treatments
- Follow up
- Usually with clinical examination and diagnostic imaging
- Further biopsy may be performed to confirm malignancy.
The above list is likely to grow as I think more about this topic.
A database that contains diagnostic information would ideally include:
- primaryKey (unique for each event)
- diagnosisType (selectable from a list e.g. Examination/X-Ray/CT/MRI/PET/US/Cytology/Biopsy/Surgery)
- diagnosisDate (the date of the diagnostic event)
- diagnosisFindingsShort (a brief description of the diagnostic findings)
- diagnosisFindingsLong (the complete diagnostic report, perhaps included as a PDF file)
For particular diagnosisTypes there would be child tables For example, a diagnosisType 'Biopsy' might include.
- primaryKey (linked to the primaryKey for diagnosisEvent)
- biopsySite (the anatomical site the biopsy occurred on, preferably using ICD-O-3 as this gives good anatomical description (or another anatomical coding system).
- biopsyDiagnostic (whether the biopsy was diagnostic or not)
For particular biopsySites, patients with a diagnostic biopsy could have a further child table.
- primaryKey (again linked to the primaryKey for diagnosisEvent and diagnosisBiopsy)
- histologyCode (the ICD-O-3 or equivalent code for the histological type, e.g. 8070/3)
- histologyDesc (the ICD-O-3 description of the histology)
- histologyGrade (the grade of disease)
- oestrogenReceptor (whether oestrogen receptor is present or not)
- oestrogenReceptorPercent (the number of cells with positive staining, 'null' if receptor staining not present)
- oestrogenReceptorStrength (the strength of staining)
- progesteroneReceptor (whether progesterone receptor is positive or not)
- Additional progesteroneReceptor fields as for oestrogenReceptor above
- eRBB2ReceptorIHC (the strength of ERBB2 activation, usually recorded as 0, +1, +2, +3, 'null' if not done)
- eRBB2ReceptorISH (whether there was amplification of ERBB2 in the tumour cells on ISH)
- eRBB2ReceptorISHType (the type of ISH that was performed, 'null' if not performed)
If the diagnosis is made at the time of surgery, then a similar field could be created to a diagnosisBiopsy (e.g. diagnosisSurgery)
One difficult that may arise is when there is insufficient evidence to complete a full diagnosis entry (for instance, a skin cancer where the biopsy is inconclusive). This often depends on the clinicians judgement as to whether treatment proceeds.
I will expand on this topic further in the future.