USE THE DIAGNOSIS SECTION
The following examples will help to illustrate how we model patient disease in the system. It is essential to capture the diagnosis history accurately as each entry can be linked to additional clinical data (treatment, lab reports, screening).
We use the following terms and definitions when discussing the concept of ‘diagnosis’ within ATiM.
Primary: the first place in the body cancer starts is called the primary site. This primary site is how the cancer is named no matter where cancer spreads. So a lung cancer that spreads to the liver is still called lung cancer, not liver cancer. Sometimes it’s not clear where cancer may have originated. In a small number of cancers, the cancer is found when it has spread to one or more sites, and doctors aren’t sure where it started. This type of cancer is called cancer of unknown primary, or CUP.
Recurrence: cancer recurrence is defined as the return of cancer after treatment and after some time during which cancer cannot be detected. A recurrence is locoregional. (The length of time is not clearly defined and can differ between disease sites.)
Progression: progression is when cancer spreads or gets worse and is different than a recurrence. With a progression, there was no period of time where the patient was declared in remission or cancer-free. A progression is locoregional.
Secondary: a distant tumour that forms as a result of spread (metastasis) of cancer from the place where it started (the primary site). Secondary cancer may occur after a period of cancer-free status (remission) for the patient. We call these types of cancers secondaries rather than a recurrence.
Remission: remission means that the signs and symptoms of cancer are reduced. Remission can be partial or complete. In a complete remission, all signs and symptoms of cancer have disappeared.
In May 1998, a patient is diagnosed with breast cancer and the disease is restricted to the breast and some auxiliary lymph nodes. She gets treatment and is well for two years. In August 2000 this patient complains of headaches and a CT scan shows she has brain metastatic disease. No tissue is collected for the bank.
A patient has surgery for colorectal cancer in December 2005, and tissue is collected for the Tumour Bank. In August 2008 this patient has a breast resection and tissue is collected for the Tumour Bank. This cancer is thought to be unrelated to the previous colorectal cancer.
A patient undergoes surgery for a metastatic ovarian tumour and tissue is collected for the Tumour Bank. The ovarian tumour is deemed to be a progression of breast cancer, which was previously diagnosed and documented in the patient’s chart.