ii: Treatment Structure

What kinds of procedures and treatments are there for a malignancy?

  • Diagnostic procedures
    • Clinical examination
    • Imaging (X-ray, CT, Ultrasound, MRI, PET scan)
    • Biopsy
    • 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
  • Treatment
    • Surgery
    • Radiotherapy
    • 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.

Diagnostic Structure

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.

Header: diagnosisBiopsy

  • 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.

Header: diagnosisBiopsyBreast

  • 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.