Lior Dangoor, 33y, diagnosed 06/07, RCC, clear cell, Stage IV, grade 3.
Mets to opposite (right) adrenal, spine, ribs, pelvis, lungs.
 
6.8
2014
 

Glossary

Anti-angiogenesis
Cancer
Clear cell
Creatinine
CRP
ESR
Graft versus host disease (GVHD)
Graft versus tumor effect (GVT)
Hemoglobin
High Dose Interleukin-2 (HD IL-2)
Imaging Techniques
Immunotherapy
Metastasis
Platelets
Red blood cells (RBC)
Renal cell carcinoma (RCC)
Stage/Grade
Sutent (Sunitinib)
T-cells
Stem cell transplant
Tumor markers
Vaccine
White blood cells (WBC)

Anti-angiogenesis

Angiogenesis is the formation of new blood vessels. Anti-angiogenesis is a form of targeted therapy that stops tumors from making new blood vessels. Anti-angiogenesis drugs, such as Sutent, Nexavar and Avastin, don’t attack cancer cells directly. Instead, they target the blood vessels these cells need to survive and grow. For the most part, these drugs tend to have milder side effects than chemotherapy drugs.

Cancer

Cancer is the abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize (spread). Cancer can involve any tissue of the body and have many different forms in each body area. Most cancers are named for the type of cell or organ in which they start.

Clear cell

Subtypes of RCC come from the description of the cell’s appearance and other characteristics. Clear cell is the most common type of RCC and represents between 66% and 75% of all cases. When viewed under a microscope, the cells that make up clear cell RCC appear very pale or clear. Much of today’s research is focused on this disease subtype since it is the most common type of RCC. Some other subtypes of RCC are papillary, chromophobe, collecting duct and sarcamatoid.

Creatinine

Blood creatinine levels are an indication of kidney function. Elevated levels are a sign of abnormal function. Normal range: 0.67-1.17.

CRP

CRP, or C-Reactive Protein, is non-specific test that serves as a general indication of acute inflammation. Normal range < 0.5.

ESR

ESR stands for erythrocyte sedimentation rate. It is a test that indirectly measures how much inflammation is in the body. Normal range: < 15.

Graft versus host disease (GVHD)

A frequent complication of allogeneic stem cell transplant in which the engrafted donor cells attacks specific organs and tissue of the host such as the skin, liver, or gastrointestinal tract. This is due to the fact that cells from the donor and the patient, although matched for tissue type, are still considered foreign to each other. GVHD is referred to as acute when it occurs within the first 3 months after transplantation and chronic when it occurs after 3 months. GVHD can be prevented or controlled in some cases, but it is very dangerous and can result in death. Since GVHD seems to predict graft vs tumor effect, a small amount may be a good thing. The difficult part of transplants is achieving GVT with a minimal amount of GVHD.

Graft versus tumor effect (GVT)

Occurs when a donor’s immune cells recognize and attack as foreign the cancer cells found in the patient’s body.

Hemoglobin

The amount of oxygen carrying protein contained within the red blood cells. Low hemoglobin suggests anemia. Normal range: 13.1-17.2.

High Dose Interleukin-2 (HD IL-2)

Interleukin-2 is a cytokine, which is a protein that acts as a regulator of the body’s immune system. By giving the patient large doses of this protein, it is hoped that the body’s own immune system will destroy the cancer cells. HD IL-2 is highly toxic and must be given in a hospital setting where the patient can be closely monitored. It is administered for several brief cycles, usually 5-7 days each. Only a select few respond to HD IL-2, around 22% achieve a partial response and 5% a complete response, but it remains the only FDA approved therapy that has demonstrated a durable, complete response in kidney cancer.

Imaging Techniques

Computed Tomography (CT)
A highly specialized x-ray that provides a very accurate cross section picture of specific areas of the body. CT scans vary from older machines that take 16-slice images (or possibly even fewer) to newer ones that use 64 slices or a helical (spiral) pattern of imaging. These images can be looked at separately as a slice through the body or can be combined to create a 3D simulation of the tissue.

Magnetic resonance imaging (MRI)
A highly specialized scan that is similar to a CT scan, but may be better suited for assessing certain areas of the body, such as the bones. MRIs use magnetic energy (no radiation) to gather data. The test requires the patient to lie still for a long time in a narrow space. MRI scans are often used in cases where CT scans may not be able to view an area of the body well enough.

Bone scan
Used to check for the spread of cancer to the bones. It is done by injecting small amounts of a radioactive material into the bloodstream. Areas in the bone that take up an abnormally high amount of the tracer may be cancerous. Bone scans are not however entirely reliable. Often a bone has to be seriously deteriorated for it to show up on the scan. For example, of all of Lior’s numerous bone mets, only the one which caused the pathological fracture in his rib showed up on a bone scan.

Positron emission tomography (PET)
Produces images based on the chemical and physiological changes related to a naked celebrities cell’s metabolism. PET scans can help distinguish necrotic (dead) from active tumors. As a relatively slow growing cancer, RCC cells do not usually have enough metabolic activity to show up on a PET scan, and their effectiveness for kidney cancer is controversial.

Immunotherapy

Treatments that promote or support the body’s immune system response to a disease such as cancer. Kidney cancer is one of a handful of cancers that may respond to immunotherapy.

Metastasis

The spread of cancer cells to one or more sites elsewhere in the body, often by way of the lymph system or bloodstream. If a cancer metastasizes, the cells in the new tumor come from the original (primary) tumor, so that a metastatic RCC tumor in the lung is made up of cancerous kidney cells (not lung cells). The most common sites of metastasis for RCC are the lungs, bones, liver, and brain.

Platelets

Blood cells that help prevent bleeding by causing blood clots to form. High platelet counts can be a sign of cancer. Low platelet counts are a side effect of treatment (like Sutent). Normal range: 150-450

Renal cell carcinoma (RCC)

RCC is the most common type of kidney cancer, accounting for about 9 out of 10 kidney cancers. Cancer can begin in any organ or tissue of the body. Kidney cancer starts in the kidneys.

Red blood cells (RBC)

Carry oxygen to all parts of the body. Normal range: 4.2-5.6.

Stage/Grade

Staging of a cancer is the process of classifying how far a cancer has spread, while grading determines the aggressiveness and characteristics of the cancer’s cells. Both systems range on a scale of 1 to 4, where the higher the number, the worse the prognosis. Stage IV refer to cancer that has spread to at least one distant organ such as the lungs, bone, or brain.

Sutent (Sunitinib)

Sutent is a targeted therapy that works against cancerous cells by interfering with their ability to communicate and reproduce, namely by preventing the development of new blood vessels tumors need to grow. It is a type of tyrosine kinase inhibitor, a type of vascular endothelial growth factor (VEGF) receptor inhibitor, and a type of angiogenesis inhibitor. It is taken daily in pill form.
The development of targeted therapies in the past few years (Sutent was approved in 2006 – other such therapies include Nexavar, Torisel and Avastin) has brought about a real revolution in the treatment of RCC, which previously had very few treatment options other than interleukin-2. However, they are not known to “cure” cancer, nor to lead to complete responses. They herald a new model of kidney cancer as a chronic disease. These drugs tend to have fewer side effects than general chemotherapy drugs.

T-cells

A type of white blood cell that is of key importance to the immune system and is at the core of adaptive immunity, the system that tailors the body’s immune response to specific pathogens. The T cells search out and destroy targeted foreign cells.

Stem cell transplant

Allogeneic (from a donor) stem cell transplant (STC) has been a successful treatment for patients with hematologic cancers for more than three decades now. Its powerful and potentially curative nature has recently led investigators to explore it for solid tumors. For RCC it has been most extensively researched at the National Cancer Institute by Dr. Richard Childs. The idea is to replace the patient’s immune system with the immune system from a matched sibling, in the hope that the new immune system will not attack the patient’s normal tissue excessively (because the donor is matched) but that it may be able to recognize cancer cells as abnormal and destroy them.
The process begins with a low dose regimen of chemotherapy (“nonmyeloablative”) in order to suppress the immune system. This lasts about one week. After this conditioning regimen, the stem cells are infused (painlessly). The patient is then maintained on immunosuppressive drugs, in order to prevent the complication of graft vs. host disease. Response is associated with withdrawal of immunosuppressive drugs, which normally takes 3-6 months to, and so it may take 4-6 months before any graft vs. tumor response is seen. The patient is usually hospitalized for the first month or so, if no complications arise, but may return several times at any sign of graft vs. host disease.
Some early studies of this technique have been promising, especially those conducted by Dr. Childs at the NIH, who has achieved around 30-50% partial responses and around 10% complete responses. But this treatment can also cause major complications, and treatment related mortality is still high.

Tumor markers

Substances, usually proteins, that may be found in tumor tissue or released by a tumor in the blood. Tumor markers are not diagnostic for cancer but they can help detect the presence of cancer and aid in monitoring treatment. No specific tumor markers are known for RCC, but when Lior was diagnosed his CA 15.3 levels were extremely high (81), making it a marker to watch.

Vaccine

A modified version of a germ or other substance related to a disease, usually given by injection. It is used to stimulate the immune system to resist that disease for a period of time, or even permanently. Development of cancer vaccines is the subject of intense research. In RCC the use of vaccines in combination with other treatments and substances like IL-2 and anti-CTLA4 is being experimented.

White blood cells (WBC)

Include lymphocytes, neutrophils, eosinophils, macrophages, and mast cells. White blood cells are made by bone marrow and help the body fight infections and other diseases. Low WBC counts are a side effect of treatment (like Sutent). Normal range: 4.5-11.

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26.10.09
   
WBC2.2
Hemoglobin11.6
Platelets187
Creatinine0.8
CRP1.7
ESR90
CA 15.331.3
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