[{"id":"herpes-simplex-and-zoster-antiviral-prophylaxis","name":"Aciclovir prophylaxis against herpes simplex and shingles during cancer treatment","tldr":"The viruses behind cold sores and shingles stay in the body for life and can flare when cancer treatment weakens the immune system. People having intensive leukaemia treatment, a stem cell transplant, or myeloma drugs such as bortezomib are usually given an antiviral tablet, aciclovir or valaciclovir, to prevent this. Most people having ordinary chemotherapy for a solid tumour do not need it.","route":"/protocols/herpes-simplex-and-zoster-antiviral-prophylaxis/","kind":"protocol","cancerIcon":"aml","facets":{"kind":["Protocol"],"cancers":["Acute myeloid leukaemia","Acute lymphoblastic leukaemia","Multiple myeloma","Chronic lymphocytic leukaemia"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Acute myeloid leukaemia","href":"/cancers/aml/","tip":"Acute myeloid leukaemia is an aggressive blood cancer where, after 40 years of the same chemotherapy, a wave of targeted drugs (FLT3, IDH, BCL-2, menin) arrived."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."},{"label":"Multiple myeloma","href":"/cancers/multiple-myeloma/","tip":"Multiple myeloma is a plasma-cell cancer with more new drug classes than any other: proteasome inhibitors, IMiDs, CD38 antibodies, BCMA CAR-T, bispecifics, and an ADC."},{"label":"Chronic lymphocytic leukaemia","href":"/cancers/cll/","tip":"A slow leukaemia that no longer needs chemotherapy: BTK inhibitors and venetoclax control it for years, often in fixed-duration courses."}],"tags":[{"label":"antiviral-prophylaxis","href":"/tagged/antiviral-prophylaxis/","tip":"Every record tagged antiviral-prophylaxis."},{"label":"infection-prevention","href":"/tagged/infection-prevention/","tip":"Every record tagged infection-prevention."}]},"sortKeys":{"year":0}},{"id":"acute-oncology-telephone-triage","name":"Acute oncology telephone triage: the 24-hour helpline and the UKONS red, amber and green grading","tldr":"During cancer treatment you should have a phone number answered day and night. A trained nurse asks set questions about each symptom and grades it green, amber or red. Green means advice for home, one amber a review within 24 hours, and red (or two ambers) being seen in person as soon as possible. A temperature of 37.5 °C or more, or below 36 °C, always means urgent assessment.","route":"/protocols/acute-oncology-telephone-triage/","kind":"protocol","schematic":{"id":"epro-symptom-monitoring","sections":["supportive-care","ai-computation"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."},{"label":"telephone-triage","href":"/tagged/telephone-triage/","tip":"Every record tagged telephone-triage."}]},"sortKeys":{"year":0}},{"id":"chemotherapy-induced-anaemia-esa-and-iron","name":"Anaemia during chemotherapy: investigation, iron and erythropoiesis-stimulating agents","tldr":"Chemotherapy often lowers the red blood cells, causing tiredness and breathlessness. Your team should first look for other causes such as low iron or blood loss. If the treatment is not aimed at cure, injections that stimulate red cell production (ESAs) or a blood transfusion are options; if the aim is cure, ESAs are not used because of their risks.","route":"/protocols/chemotherapy-induced-anaemia-esa-and-iron/","kind":"protocol","schematic":{"id":"transfusion-support","sections":["supportive-care"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"anaemia","href":"/tagged/anaemia/","tip":"Every record tagged anaemia."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"antibacterial-prophylaxis-in-neutropenia","name":"Antibacterial (fluoroquinolone) prophylaxis during expected severe neutropenia","tldr":"Some people on intensive chemotherapy, such as for acute leukaemia, are offered an antibiotic tablet while their white cells are lowest,. Guidelines disagree on who should have it: NICE offers it to more adults; children's and Australian guidelines limit it to the highest risk, as it breeds resistant germs. It does not replace calling the team at once with a fever.","route":"/protocols/antibacterial-prophylaxis-in-neutropenia/","kind":"protocol","cancerIcon":"aml","facets":{"kind":["Protocol"],"cancers":["Acute myeloid leukaemia","Acute lymphoblastic leukaemia","Childhood cancers"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Acute myeloid leukaemia","href":"/cancers/aml/","tip":"Acute myeloid leukaemia is an aggressive blood cancer where, after 40 years of the same chemotherapy, a wave of targeted drugs (FLT3, IDH, BCL-2, menin) arrived."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."},{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."}],"tags":[{"label":"antimicrobial-prophylaxis","href":"/tagged/antimicrobial-prophylaxis/","tip":"Every record tagged antimicrobial-prophylaxis."},{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."}]},"sortKeys":{"year":0}},{"id":"anticipatory-nausea-and-vomiting","name":"Anticipatory nausea and vomiting before chemotherapy: prevention and treatment","tldr":"Some people feel sick, or are sick, before a chemotherapy session, set off by the hospital or a smell: a learned reaction to sickness in earlier cycles. The best protection is good anti-sickness medicine from the first cycle. If it happens, tell your team: relaxation training helps, and a calming tablet such as lorazepam the night before and on the morning of treatment can be offered.","route":"/protocols/anticipatory-nausea-and-vomiting/","kind":"protocol","schematic":{"id":"antiemetic-therapy","sections":["supportive-care"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"nausea-and-vomiting","href":"/tagged/nausea-and-vomiting/","tip":"Every record tagged nausea-and-vomiting."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"antiemetic-prophylaxis-by-emetic-risk","name":"Antiemetic prophylaxis for chemotherapy by emetic risk","tldr":"Sickness from chemotherapy is now largely preventable. The anti-sickness medicines you are given depend on how likely your chemotherapy is to cause sickness: for the strongest regimens that is four medicines before treatment and some for the days after, for the mildest none at all. If you are still sick, tell your team: there is a next step.","route":"/protocols/antiemetic-prophylaxis-by-emetic-risk/","kind":"protocol","schematic":{"id":"antiemetic-therapy","sections":["supportive-care"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"nausea-and-vomiting","href":"/tagged/nausea-and-vomiting/","tip":"Every record tagged nausea-and-vomiting."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"antifungal-prophylaxis-in-haematology","name":"Antifungal prophylaxis for people at high risk of invasive fungal infection","tldr":"People on the most intensive leukaemia treatment, or a stem cell transplant from a donor, are at risk of serious mould infections in the lungs. Most are offered a preventive antifungal medicine, usually posaconazole, while their immunity is lowest. Other cancer treatments usually do not need one. These drugs interact with many medicines, so the pharmacist checks every combination.","route":"/protocols/antifungal-prophylaxis-in-haematology/","kind":"protocol","cancerIcon":"aml","facets":{"kind":["Protocol"],"cancers":["Acute myeloid leukaemia","Acute lymphoblastic leukaemia","Childhood cancers"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Acute myeloid leukaemia","href":"/cancers/aml/","tip":"Acute myeloid leukaemia is an aggressive blood cancer where, after 40 years of the same chemotherapy, a wave of targeted drugs (FLT3, IDH, BCL-2, menin) arrived."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."},{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."}],"tags":[{"label":"antimicrobial-prophylaxis","href":"/tagged/antimicrobial-prophylaxis/","tip":"Every record tagged antimicrobial-prophylaxis."},{"label":"antifungal","href":"/tagged/antifungal/","tip":"Every record tagged antifungal."},{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."}]},"sortKeys":{"year":0}},{"id":"checkpoint-inhibitor-baseline-and-monitoring","name":"Baseline tests and monitoring before and during checkpoint inhibitor treatment","tldr":"Before immunotherapy such as pembrolizumab or nivolumab starts, your team checks your blood count, kidney and liver tests, thyroid and often cortisol and sugar levels, and asks about autoimmune and lung conditions. Some tests are repeated before each dose, because immunotherapy side effects are often found on a blood test before you feel them.","route":"/protocols/checkpoint-inhibitor-baseline-and-monitoring/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."}]},"sortKeys":{"year":0}},{"id":"vte-risk-assessment-and-thromboprophylaxis-ambulatory","name":"Blood clot risk assessment and preventive anticoagulation during outpatient cancer treatment","tldr":"Cancer and its treatment raise the chance of a blood clot in a leg or lung. Most people having treatment as outpatients do not need a blood thinner, but some do: your team can work out your risk with a simple score from your blood count, weight and type of cancer. Everyone should know the signs of a clot: a swollen, painful leg or sudden breathlessness or chest pain.","route":"/protocols/vte-risk-assessment-and-thromboprophylaxis-ambulatory/","kind":"protocol","cancerIcon":"pancreatic","facets":{"kind":["Protocol"],"cancers":["Pancreatic ductal adenocarcinoma","Multiple myeloma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Pancreatic ductal adenocarcinoma","href":"/cancers/pancreatic/","tip":"Almost every pancreatic tumour carries a KRAS mutation, and for the first time drugs against it work: daraxonrasib nearly doubled survival in previously treated disease in 2026. Pancreatic cancer has been the hardest common cancer to treat once advanced; that is what is starting to change."},{"label":"Multiple myeloma","href":"/cancers/multiple-myeloma/","tip":"Multiple myeloma is a plasma-cell cancer with more new drug classes than any other: proteasome inhibitors, IMiDs, CD38 antibodies, BCMA CAR-T, bispecifics, and an ADC."}],"tags":[{"label":"thrombosis","href":"/tagged/thrombosis/","tip":"Every record tagged thrombosis."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"irae-haematological","name":"Blood side effects of checkpoint inhibitors: low platelets, haemolysis, neutropenia and marrow failure","tldr":"Rarely, immunotherapy makes the immune system attack blood cells, causing low platelets (easy bruising or bleeding), destruction of red cells (tiredness, breathlessness, yellow skin, dark urine) or low white cells (infections). These are found on blood tests and treated with steroids and other medicines, usually with a haematologist involved.","route":"/protocols/irae-haematological/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"haematology","href":"/tagged/haematology/","tip":"Every record tagged haematology."}]},"sortKeys":{"year":0}},{"id":"bone-health-on-hormone-therapy","name":"Bone health on aromatase inhibitors, ovarian suppression and androgen deprivation therapy","tldr":"Some hormone treatments for breast and prostate cancer thin the bones and raise the chance of a fracture. When you start an aromatase inhibitor or treatment that stops the ovaries working, a bone density scan is offered; on prostate hormone therapy your fracture risk may be checked. Exercise, a good diet and not smoking help, and bone-strengthening medicine is offered if the bones are thin.","route":"/protocols/bone-health-on-hormone-therapy/","kind":"protocol","cancerIcon":"breast-cancer","facets":{"kind":["Protocol"],"cancers":["Breast cancer","Prostate cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Breast cancer","href":"/cancers/breast-cancer/","tip":"Breast cancer is not one disease, and the result that decides which page you need is the receptor result: whether the cancer carries oestrogen and progesterone receptors, and whether it carries too much HER2. Those two answers give four boxes, not three, with a page for each. Grade and stage do not change which page you read; they change what happens on it."},{"label":"Prostate cancer","href":"/cancers/prostate/","tip":"Prostate cancer is the home of theranostics: PSMA PET finds it, PSMA radioligands treat it. Hormonal therapy remains the foundation, with PARP and AKT inhibitors added by genotype."}],"tags":[{"label":"bone-health","href":"/tagged/bone-health/","tip":"Every record tagged bone-health."},{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."}]},"sortKeys":{"year":0}},{"id":"breast-screening-after-chest-radiotherapy-at-a-young-age","name":"Breast screening after chest radiotherapy at a young age","tldr":"Women who had radiotherapy to the chest as children, teenagers or young adults, for example for Hodgkin lymphoma, have a much higher chance of breast cancer at a young age. They should be offered yearly breast MRI and mammograms, starting at 25 or 30 or 8 years after the radiotherapy, whichever is later. In England this is arranged through the NHS very high risk screening programme.","route":"/protocols/breast-screening-after-chest-radiotherapy-at-a-young-age/","kind":"protocol","cancerIcon":"hodgkin-lymphoma","facets":{"kind":["Protocol"],"cancers":["Hodgkin lymphoma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Hodgkin lymphoma","href":"/cancers/hodgkin-lymphoma/","tip":"Hodgkin lymphoma is one of the most curable cancers, where the goal is now to cure with less toxicity, using brentuximab and, from 2026, first-line nivolumab."}],"tags":[{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."},{"label":"late-effects","href":"/tagged/late-effects/","tip":"Every record tagged late-effects."},{"label":"screening","href":"/tagged/screening/","tip":"Every record tagged screening."}]},"sortKeys":{"year":0}},{"id":"car-t-bridging","name":"Bridging therapy while CAR T cells are manufactured","tldr":"Making CAR T cells from your own blood takes several weeks. During that wait many people have a short course of treatment, called bridging, to keep the cancer under control so they are well enough for the CAR T cells. It is given only after the blood cells have been collected, and is chosen so it will not cause infections or organ problems that could delay the infusion.","route":"/protocols/car-t-bridging/","kind":"protocol","cancerIcon":"dlbcl","facets":{"kind":["Protocol"],"cancers":["Diffuse large B-cell lymphoma","Primary mediastinal (thymic) large B-cell lymphoma","Mantle cell lymphoma","Follicular lymphoma","Acute lymphoblastic leukaemia","Multiple myeloma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Diffuse large B-cell lymphoma","href":"/cancers/dlbcl/","tip":"Diffuse large B-cell lymphoma (DLBCL) is an aggressive but curable lymphoma. CAR-T cures about 40% of relapsed patients, and off-the-shelf bispecifics are now approved."},{"label":"Primary mediastinal (thymic) large B-cell lymphoma","href":"/cancers/primary-mediastinal-b-cell-lymphoma/","tip":"Primary mediastinal B-cell lymphoma is a fast-growing lymphoma of the thymus behind the breastbone that mostly affects young women. Immunochemotherapy cures about nine in ten, radiotherapy can now be skipped when the end-of-treatment scan is clear, and PD-1 antibodies and CAR-T cells rescue many of those who relapse."},{"label":"Mantle cell lymphoma","href":"/cancers/mantle-cell-lymphoma/","tip":"An uncommon B-cell lymphoma driven by cyclin D1 that used to behave badly in almost everyone. BTK inhibitors, CAR-T and now BCL2 drugs have changed it from chemotherapy-plus-transplant to targeted combinations."},{"label":"Follicular lymphoma","href":"/cancers/follicular-lymphoma/","tip":"Follicular lymphoma is the most common slow-growing lymphoma, with a rearrangement of the BCL2 gene in more than 90% of cases (NCI PDQ). Most people live with it for decades, treated only when it causes problems; it can be controlled repeatedly with anti-CD20 antibodies, chemotherapy, bispecifics or CAR-T but rarely cured, and a small share transform into an aggressive lymphoma each year."}],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"car-t","href":"/tagged/car-t/","tip":"Every record tagged car-t."}]},"sortKeys":{"year":0}},{"id":"cancer-related-fatigue-screening-and-management","name":"Cancer-related fatigue: screening, treatable causes and management","tldr":"Tiredness that rest does not fix is one of the commonest effects of cancer and its treatment, for months or years. Your team should ask about it and look for treatable causes such as anaemia, low thyroid, pain, poor sleep, low mood or a medicine. What helps most is exercise suited to you, cognitive behavioural therapy and mindfulness. Modafinil is not recommended, nor methylphenidate routinely.","route":"/protocols/cancer-related-fatigue-screening-and-management/","kind":"protocol","schematic":{"id":"cancer-related-fatigue-management","sections":["rejuvenation","supportive-care","nutrition-lifestyle"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"fatigue","href":"/tagged/fatigue/","tip":"Every record tagged fatigue."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."},{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."}]},"sortKeys":{"year":0}},{"id":"central-line-insertion-bundle","name":"Central line insertion bundle: preventing bloodstream infection at the time of placement","tldr":"When a central line is put in, the team follows a checklist: clean hands, a cap, mask, sterile gown and gloves for the person inserting it, a sterile drape over the whole body, and chlorhexidine in alcohol on the skin, left to dry. Someone watches and can stop the procedure if a step is missed. For long treatments such as chemotherapy, a tunnelled line or a port is usually the right kind of line.","route":"/protocols/central-line-insertion-bundle/","kind":"protocol","schematic":{"id":"implanted-ports","sections":["chemotherapy","supportive-care","devices"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"clabsi","href":"/tagged/clabsi/","tip":"Every record tagged clabsi."},{"label":"vascular-access","href":"/tagged/vascular-access/","tip":"Every record tagged vascular-access."}]},"sortKeys":{"year":0}},{"id":"central-line-maintenance-bundle","name":"Central line maintenance bundle: preventing bloodstream infection after insertion","tldr":"A central line (a Hickman, PICC or port) lets germs straight into the blood, so every touch is planned. Hands are cleaned, the connector is scrubbed with antiseptic each time, the dressing is kept clean and dry and changed weekly, and every day someone asks whether the line is still needed. Families caring for a line at home are taught the same steps before they leave hospital.","route":"/protocols/central-line-maintenance-bundle/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."}],"tags":[{"label":"clabsi","href":"/tagged/clabsi/","tip":"Every record tagged clabsi."},{"label":"vascular-access","href":"/tagged/vascular-access/","tip":"Every record tagged vascular-access."},{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."}]},"sortKeys":{"year":0}},{"id":"irae-hypophysitis-adrenal","name":"Checkpoint inhibitor hypophysitis and adrenal insufficiency: emergency treatment, replacement and steroid emergency card","tldr":"Immunotherapy can damage the pituitary or adrenal glands so the body stops making cortisol, a hormone needed to survive illness. Anyone on immunotherapy who becomes very unwell should be treated for low cortisol at once while tests are done. Most then need hydrocortisone tablets for life, a steroid emergency card, and to know how to double the dose when ill. Immunotherapy can usually carry on.","route":"/protocols/irae-hypophysitis-adrenal/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"endocrine","href":"/tagged/endocrine/","tip":"Every record tagged endocrine."}]},"sortKeys":{"year":0}},{"id":"chemotherapy-induced-peripheral-neuropathy-assessment-and-prevention","name":"Chemotherapy nerve damage (peripheral neuropathy): assessment, dose changes and prevention","tldr":"Some chemotherapy drugs, such as paclitaxel, docetaxel, oxaliplatin, vincristine and bortezomib, can damage the nerves in the hands and feet, causing tingling, numbness or pain. Tell your team at every visit: the dose can be lowered or delayed before the damage lasts. No medicine is proven to prevent it; cooling or compressing the hands is being tested. Duloxetine can help painful nerve damage.","route":"/protocols/chemotherapy-induced-peripheral-neuropathy-assessment-and-prevention/","kind":"protocol","schematic":{"id":"frozen-gloves-compression-taxane","sections":["supportive-care","chemotherapy","rejuvenation"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"neuropathy","href":"/tagged/neuropathy/","tip":"Every record tagged neuropathy."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"chronic-pain-in-cancer-survivors","name":"Chronic pain in cancer survivors: assessment, non-opioid treatment first and careful opioid use","tldr":"Pain can last for years after cancer treatment. Tell your team about any pain, especially new pain, which should be checked for cancer coming back. Most long-lasting pain is best managed first with exercise, talking therapies, physiotherapy and non-opioid medicines; acupuncture helps joint pain from aromatase inhibitors. Opioids can be tried with care, because long-term use carries real risks.","route":"/protocols/chronic-pain-in-cancer-survivors/","kind":"protocol","schematic":{"id":"pain-management","sections":["supportive-care"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"pain","href":"/tagged/pain/","tip":"Every record tagged pain."},{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"paediatric-clostridioides-difficile","name":"Clostridioides difficile infection in children with cancer or after stem cell transplant","tldr":"C. difficile is a gut germ that can cause bad diarrhoea, often after antibiotics. In children having cancer treatment it is treated with an antibiotic by mouth, chosen by how severe it is. Children with it are kept apart from others to stop it spreading, and probiotics and faecal transplants are not used routinely during treatment.","route":"/protocols/paediatric-clostridioides-difficile/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."}],"tags":[{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."},{"label":"infection","href":"/tagged/infection/","tip":"Every record tagged infection."}]},"sortKeys":{"year":0}},{"id":"crs-grading-and-management","name":"Cytokine release syndrome after CAR T-cell therapy: ASTCT grading, tocilizumab and steroids","tldr":"After CAR T-cell therapy, the immune cells can release a flood of chemical messengers, causing fever, low blood pressure and breathing trouble: cytokine release syndrome. Any fever after CAR T-cell therapy needs the treating centre at once. Teams grade it from 1 to 4 and treat with tocilizumab and, if needed, steroids; infection is treated at the same time because the two look alike.","route":"/protocols/crs-grading-and-management/","kind":"protocol","schematic":{"id":"car-t","sections":["cell-therapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"car-t","href":"/tagged/car-t/","tip":"Every record tagged car-t."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."}]},"sortKeys":{"year":0}},{"id":"dental-assessment-before-bone-modifying-agents","name":"Dental assessment before bone-modifying agents and jaw osteonecrosis prevention","tldr":"Medicines that strengthen bone in cancer, such as zoledronic acid and denosumab, can rarely cause a patch of jawbone to break down, usually after a tooth is taken out. Before you start, see a dentist so any problem teeth can be treated first, keep your mouth very clean, and tell your dentist about the medicine. Report any jaw pain, loose teeth or exposed bone in the mouth.","route":"/protocols/dental-assessment-before-bone-modifying-agents/","kind":"protocol","schematic":{"id":"bone-modifying-agents","sections":["supportive-care","rejuvenation"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"bone-health","href":"/tagged/bone-health/","tip":"Every record tagged bone-health."},{"label":"oral-care","href":"/tagged/oral-care/","tip":"Every record tagged oral-care."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"treatment-induced-diarrhoea-grading-and-management","name":"Diarrhoea from chemotherapy, targeted therapy and radiotherapy: grading, loperamide, octreotide and when to admit","tldr":"Treatment diarrhoea can turn dangerous quickly, especially with a low blood count. Drink plenty and start loperamide at the first loose stool if your team has told you to. Call the 24-hour line at once if it does not settle within a day, if there are seven or more stools a day, or with fever, blood, vomiting or dizziness. If cancer tablets are the cause and loperamide fails, stop them and ring.","route":"/protocols/treatment-induced-diarrhoea-grading-and-management/","kind":"protocol","schematic":{"id":"probiotics-treatment-diarrhoea","sections":["supportive-care","radiation","chemotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"diarrhoea","href":"/tagged/diarrhoea/","tip":"Every record tagged diarrhoea."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"distress-screening-and-referral","name":"Distress screening with the distress thermometer, and referral by need","tldr":"Many people with cancer feel worried, low or overwhelmed, and money, work or caring for others add to it. Clinics often ask you to mark a scale from 0 to 10 for your distress in the past week and tick a list of problems. A score of 4 or more is a signal for the team to talk it through and offer help, such as a psychologist, social worker or chaplain. Screening only helps when someone acts on it.","route":"/protocols/distress-screening-and-referral/","kind":"protocol","schematic":{"id":"psycho-oncology","sections":["supportive-care","rejuvenation"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."},{"label":"psychosocial","href":"/tagged/psychosocial/","tip":"Every record tagged psychosocial."}]},"sortKeys":{"year":0}},{"id":"egfr-inhibitor-rash-prophylaxis","name":"EGFR inhibitor rash: pre-emptive skin care, antibiotics and dose changes","tldr":"Drugs that block EGFR, such as cetuximab, panitumumab, amivantamab and EGFR tablets for lung cancer, very often cause an acne-like rash. Starting skin care on day one makes a bad rash much less likely: doxycycline or minocycline for the first weeks, moisturiser, sunscreen, and sometimes a mild steroid cream. Tell your team early if it spreads or hurts: a pause or lower dose may help.","route":"/protocols/egfr-inhibitor-rash-prophylaxis/","kind":"protocol","cancerIcon":"colorectal","facets":{"kind":["Protocol"],"cancers":["Colorectal cancer","EGFR-mutated non-small-cell lung cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Colorectal cancer","href":"/cancers/colorectal/","tip":"The cancer where screening works best and where immunotherapy can make some tumours disappear entirely; chemotherapy still carries most metastatic disease, now with antibodies and targeted combinations chosen by RAS, BRAF, mismatch repair and which side of the bowel the tumour started on."},{"label":"EGFR-mutated non-small-cell lung cancer","href":"/cancers/egfr-mutant-nsclc/","tip":"EGFR-mutated lung cancer is driven by a single faulty growth receptor and is treated first with a pill rather than chemotherapy. Osimertinib keeps the disease under control for about a year and a half on average, adding chemotherapy or the antibody amivantamab extends that further, and three years of osimertinib after surgery roughly halves the risk of death in early-stage disease."}],"tags":[{"label":"skin-toxicity","href":"/tagged/skin-toxicity/","tip":"Every record tagged skin-toxicity."},{"label":"egfr-inhibitor","href":"/tagged/egfr-inhibitor/","tip":"Every record tagged egfr-inhibitor."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"survivorship-care-plan-and-treatment-summary","name":"End of treatment: treatment summary, survivorship care plan and handover to primary care","tldr":"When main treatment ends, you should get a written summary of the treatment you had, side effects to look out for, signs the cancer might be back, who to contact, and the follow-up planned. In England it goes to you and your GP. Trials found the written plan alone did not make people feel better; it works best with a real conversation about who looks after you next.","route":"/protocols/survivorship-care-plan-and-treatment-summary/","kind":"protocol","schematic":{"id":"survivorship-care-plan","sections":["supportive-care","rejuvenation"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."}]},"sortKeys":{"year":0}},{"id":"exercise-during-and-after-cancer-treatment","name":"Exercise during and after cancer treatment: assessment, dose and referral","tldr":"Exercise is safe for most people during and after cancer treatment and helps with tiredness, fitness, strength and mood. The usual aim is to build up to about 30 minutes of moderate activity such as brisk walking three times a week, plus strength exercise twice a week, starting low. Some people should be checked first, for example with cancer in the bones, heart or lung disease, or nerve damage.","route":"/protocols/exercise-during-and-after-cancer-treatment/","kind":"protocol","cancerIcon":"colon-cancer","facets":{"kind":["Protocol"],"cancers":["Colon cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Colon cancer","href":"/cancers/colon-cancer/","tip":"Colon cancer is bowel cancer arising in the large bowel above the rectum. It shares its biology with colorectal cancer but is treated differently from rectal cancer: surgery comes first without radiotherapy, chemotherapy afterwards is decided by stage and increasingly by a blood test for leftover tumour DNA, and the side the tumour started on changes which drugs work once it has spread."}],"tags":[{"label":"exercise","href":"/tagged/exercise/","tip":"Every record tagged exercise."},{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"eye-care-with-ocular-toxic-antibody-drug-conjugates","name":"Eye care with antibody-drug conjugates that harm the cornea: belantamab, mirvetuximab, tisotumab and enfortumab","tldr":"Some antibody-drug conjugates damage the front surface of the eye (the cornea), causing dry, gritty or painful eyes and blurred vision. With belantamab, mirvetuximab and tisotumab, an eye specialist examines you before and during treatment, you use eye drops on a schedule, and no contact lenses. Report any change in your sight at once: the dose can be paused or lowered, and most problems improve.","route":"/protocols/eye-care-with-ocular-toxic-antibody-drug-conjugates/","kind":"protocol","cancerIcon":"multiple-myeloma","facets":{"kind":["Protocol"],"cancers":["Multiple myeloma","Relapsed or refractory multiple myeloma","Platinum-resistant ovarian cancer","Recurrent or metastatic cervical cancer","Bladder & urothelial cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Multiple myeloma","href":"/cancers/multiple-myeloma/","tip":"Multiple myeloma is a plasma-cell cancer with more new drug classes than any other: proteasome inhibitors, IMiDs, CD38 antibodies, BCMA CAR-T, bispecifics, and an ADC."},{"label":"Relapsed or refractory multiple myeloma","href":"/cancers/myeloma-relapsed-refractory/","tip":"Myeloma almost always returns, and each return is harder to treat. Two kinds of immune therapy aimed at the BCMA protein on myeloma cells, CAR-T cells (KarMMa-3, CARTITUDE-4) and off-the-shelf bispecific antibodies (MajesTEC), now give deep remissions after other drugs fail, and a second target, GPRC5D, gives another option."},{"label":"Platinum-resistant ovarian cancer","href":"/cancers/platinum-resistant-ovarian-cancer/","tip":"Platinum-resistant ovarian cancer grows back within six months of platinum chemotherapy, or during it, and used to be treated with single chemotherapy drugs that shrink a tumour one time in ten. The antibody-drug conjugate mirvetuximab soravtansine, the cortisol-blocking drug relacorilant and pembrolizumab in PD-L1-positive tumours have each extended survival in phase 3 trials since 2023."},{"label":"Recurrent or metastatic cervical cancer","href":"/cancers/recurrent-metastatic-cervical-cancer/","tip":"Recurrent or metastatic cervical cancer has spread beyond the pelvis or come back where it cannot be cured by surgery or radiotherapy. Pembrolizumab added to chemotherapy and bevacizumab is the first treatment, and the antibody-drug conjugate tisotumab vedotin or the PD-1 antibody cemiplimab extend life when it progresses."}],"tags":[{"label":"ocular-toxicity","href":"/tagged/ocular-toxicity/","tip":"Every record tagged ocular-toxicity."},{"label":"antibody-drug-conjugate","href":"/tagged/antibody-drug-conjugate/","tip":"Every record tagged antibody-drug-conjugate."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"irae-ocular","name":"Eye side effects of checkpoint inhibitors: dry eye, uveitis and optic neuritis","tldr":"Immunotherapy can occasionally cause dry, gritty eyes or inflammation inside the eye (uveitis), and rarely of the nerve to the eye. Red or painful eyes, sensitivity to light, floaters, blurred or double vision, or drooping eyelids should be reported so an eye specialist can see you. Most is treated with eye drops and immunotherapy usually continues; sudden loss of vision is an emergency.","route":"/protocols/irae-ocular/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"ophthalmology","href":"/tagged/ophthalmology/","tip":"Every record tagged ophthalmology."}]},"sortKeys":{"year":0}},{"id":"fertility-preservation-before-cancer-treatment","name":"Fertility discussion and preservation before cancer treatment","tldr":"Some cancer treatments can make it harder or impossible to have children later. Before treatment, your team should discuss this and, if you want, refer you quickly to a fertility specialist. Freezing sperm, eggs, embryos or ovarian tissue are the established options; an injection to rest the ovaries during chemotherapy can be added for some women with breast cancer but does not replace freezing.","route":"/protocols/fertility-preservation-before-cancer-treatment/","kind":"protocol","schematic":{"id":"fertility-preservation","sections":["supportive-care","rejuvenation"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"fertility","href":"/tagged/fertility/","tip":"Every record tagged fertility."},{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."},{"label":"aya","href":"/tagged/aya/","tip":"Every record tagged aya."}]},"sortKeys":{"year":0}},{"id":"paediatric-fertility-preservation","name":"Fertility preservation for children and young people before cancer treatment","tldr":"Some cancer treatments can stop a child having children of their own later. Before treatment, the team should talk with the family about this risk and refer them to a fertility specialist if they want, or are unsure. Teenagers who have started puberty can bank sperm or eggs; for younger girls ovarian tissue can be frozen, and for younger boys testicular tissue freezing is still experimental.","route":"/protocols/paediatric-fertility-preservation/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."}],"tags":[{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."},{"label":"fertility","href":"/tagged/fertility/","tip":"Every record tagged fertility."}]},"sortKeys":{"year":0}},{"id":"paediatric-fever-and-neutropenia","name":"Fever and neutropenia in children with cancer or after stem cell transplant","tldr":"A child having cancer treatment who gets a fever, or seems unwell, needs to be seen in hospital straight away, using the team's number. There blood cultures are taken from every channel of the central line and one strong antibiotic is started through a drip. Children at low risk may finish at home or by mouth, and antibiotics can often stop after two days if cultures stay clear.","route":"/protocols/paediatric-fever-and-neutropenia/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers","Acute lymphoblastic leukaemia","Acute myeloid leukaemia"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."},{"label":"Acute myeloid leukaemia","href":"/cancers/aml/","tip":"Acute myeloid leukaemia is an aggressive blood cancer where, after 40 years of the same chemotherapy, a wave of targeted drugs (FLT3, IDH, BCL-2, menin) arrived."}],"tags":[{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."},{"label":"neutropenic-sepsis","href":"/tagged/neutropenic-sepsis/","tip":"Every record tagged neutropenic-sepsis."}]},"sortKeys":{"year":0}},{"id":"colorectal-cancer-follow-up-after-curative-treatment","name":"Follow-up after curative treatment for colorectal cancer","tldr":"After an operation to cure bowel cancer, you will usually have regular blood tests (CEA) and CT scans for the first 3 years, and a colonoscopy about a year after surgery. The aim is to find a return early enough to operate again. How often you are tested differs between countries, and the large trials found that testing more often does not, on average, help people live longer.","route":"/protocols/colorectal-cancer-follow-up-after-curative-treatment/","kind":"protocol","cancerIcon":"colorectal","facets":{"kind":["Protocol"],"cancers":["Colorectal cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Colorectal cancer","href":"/cancers/colorectal/","tip":"The cancer where screening works best and where immunotherapy can make some tumours disappear entirely; chemotherapy still carries most metastatic disease, now with antibodies and targeted combinations chosen by RAS, BRAF, mismatch repair and which side of the bowel the tumour started on."}],"tags":[{"label":"follow-up","href":"/tagged/follow-up/","tip":"Every record tagged follow-up."},{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."}]},"sortKeys":{"year":0}},{"id":"breast-cancer-follow-up-after-treatment","name":"Follow-up after treatment for early breast cancer","tldr":"After treatment for early breast cancer, the main test is a yearly mammogram, usually for 5 years and then through the national screening programme. Routine scans and blood tests are not recommended when you are well, because the evidence does not show they help. You should get a written plan saying who to contact and which symptoms to report.","route":"/protocols/breast-cancer-follow-up-after-treatment/","kind":"protocol","cancerIcon":"breast-cancer","facets":{"kind":["Protocol"],"cancers":["Breast cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Breast cancer","href":"/cancers/breast-cancer/","tip":"Breast cancer is not one disease, and the result that decides which page you need is the receptor result: whether the cancer carries oestrogen and progesterone receptors, and whether it carries too much HER2. Those two answers give four boxes, not three, with a page for each. Grade and stage do not change which page you read; they change what happens on it."}],"tags":[{"label":"follow-up","href":"/tagged/follow-up/","tip":"Every record tagged follow-up."},{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."}]},"sortKeys":{"year":0}},{"id":"food-safety-and-neutropenic-diet","name":"Food safety during cancer treatment and the evidence against neutropenic diets","tldr":"Strict lists of banned foods (the 'neutropenic diet') do not prevent infections in trials, in children or adults, and they make eating harder. What matters is ordinary food safety: clean hands and surfaces, raw meat kept apart, fruit and vegetables washed, meat and eggs cooked through, and no unpasteurised milk or cheese, mouldy food or unsafe water. Transplant teams may differ.","route":"/protocols/food-safety-and-neutropenic-diet/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers","Acute myeloid leukaemia","Acute lymphoblastic leukaemia"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."},{"label":"Acute myeloid leukaemia","href":"/cancers/aml/","tip":"Acute myeloid leukaemia is an aggressive blood cancer where, after 40 years of the same chemotherapy, a wave of targeted drugs (FLT3, IDH, BCL-2, menin) arrived."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."}],"tags":[{"label":"neutropenic-diet","href":"/tagged/neutropenic-diet/","tip":"Every record tagged neutropenic-diet."},{"label":"food-safety","href":"/tagged/food-safety/","tip":"Every record tagged food-safety."},{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."}]},"sortKeys":{"year":0}},{"id":"g-csf-prophylaxis-by-febrile-neutropenia-risk","name":"G-CSF prophylaxis by febrile neutropenia risk","tldr":"Some chemotherapy lowers the white cells that fight infection so much that a fever becomes dangerous. If your treatment carries a high risk of this, or you had an infection with low white cells on an earlier cycle, you may be given injections of a growth factor (G-CSF) after each cycle to help your white cells recover faster.","route":"/protocols/g-csf-prophylaxis-by-febrile-neutropenia-risk/","kind":"protocol","schematic":{"id":"g-csf-growth-factors","sections":["supportive-care"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"neutropenia","href":"/tagged/neutropenia/","tip":"Every record tagged neutropenia."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"geriatric-assessment-before-systemic-cancer-therapy","name":"Geriatric assessment before systemic cancer therapy in older adults","tldr":"If you are 65 or over and about to start chemotherapy, targeted therapy or immunotherapy, your team should check more than the cancer: how well you move and manage day to day, memory, mood, other illnesses, medicines, nutrition and who supports you. The results help choose a treatment you can tolerate and find problems that can be fixed, such as falls, poor nutrition or too many tablets.","route":"/protocols/geriatric-assessment-before-systemic-cancer-therapy/","kind":"protocol","schematic":{"id":"geriatric-assessment","sections":["supportive-care"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"geriatric-oncology","href":"/tagged/geriatric-oncology/","tip":"Every record tagged geriatric-oncology."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"allo-hct-gvhd-prophylaxis","name":"GVHD prophylaxis after allogeneic stem cell transplant: choosing the regimen","tldr":"After a donor transplant, everyone takes medicines to stop the donor's immune cells attacking their body (graft-versus-host disease). The combination depends on the donor, the pre-transplant treatment and whether the cells came from blood or marrow. Newer combinations reduce graft-versus-host disease; in the main trial they did not lengthen life, and each has its own side effects.","route":"/protocols/allo-hct-gvhd-prophylaxis/","kind":"protocol","schematic":{"id":"allogeneic-hsct","sections":["cell-therapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"transplant","href":"/tagged/transplant/","tip":"Every record tagged transplant."},{"label":"gvhd","href":"/tagged/gvhd/","tip":"Every record tagged gvhd."}]},"sortKeys":{"year":0}},{"id":"hand-hygiene-in-cancer-care","name":"Hand hygiene in cancer care: staff, patients, families and visitors","tldr":"Clean hands are the single most important way to stop infections spreading to someone whose immunity is low. Staff clean their hands at five set moments around every patient, usually with alcohol rub, and with soap and water when hands are dirty or when there is diarrhoea such as C. difficile. Patients, families and visitors should clean their hands too, and ask staff to if they have not.","route":"/protocols/hand-hygiene-in-cancer-care/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."}],"tags":[{"label":"hand-hygiene","href":"/tagged/hand-hygiene/","tip":"Every record tagged hand-hygiene."}]},"sortKeys":{"year":0}},{"id":"hand-foot-syndrome-prevention-and-dose-modification","name":"Hand-foot syndrome and hand-foot skin reaction: prevention, skin care and dose changes","tldr":"Capecitabine, liposomal doxorubicin and tablets such as sorafenib and regorafenib can make the palms and soles red, sore, peeling or blistered. From the start, avoid rubbing, heat and long soaks, wear well-fitting shoes and moisturise daily; with sorafenib, a 10 per cent urea cream from day one helps. If hands or feet become painful or limit what you do, stop capecitabine and call your team.","route":"/protocols/hand-foot-syndrome-prevention-and-dose-modification/","kind":"protocol","schematic":{"id":"vitamin-b6-pyridoxine","sections":["supportive-care","chemotherapy","nutrition-lifestyle"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"hand-foot-syndrome","href":"/tagged/hand-foot-syndrome/","tip":"Every record tagged hand-foot-syndrome."},{"label":"skin-toxicity","href":"/tagged/skin-toxicity/","tip":"Every record tagged skin-toxicity."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"paediatric-cisplatin-hearing-protection","name":"Hearing protection for children receiving cisplatin","tldr":"Cisplatin can permanently damage a child's hearing. For many children whose cancer has not spread, a drug called sodium thiosulfate, given as a short drip six hours after each dose of cisplatin, roughly halves the chance of hearing loss. Hearing is tested during treatment and for years after, and any loss is referred to a hearing specialist.","route":"/protocols/paediatric-cisplatin-hearing-protection/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers","Hepatoblastoma","Medulloblastoma","Osteosarcoma","Neuroblastoma","Germ cell tumours of childhood and adolescence"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."},{"label":"Hepatoblastoma","href":"/cancers/hepatoblastoma/","tip":"Hepatoblastoma is a childhood liver cancer, mostly of toddlers, cured in most standard-risk cases with cisplatin chemotherapy and surgery, including liver transplant when the tumour cannot be cut out. Sodium thiosulfate given after cisplatin halves the permanent hearing loss cisplatin causes, and became the first approved otoprotectant in 2022."},{"label":"Medulloblastoma","href":"/cancers/medulloblastoma/","tip":"Medulloblastoma is the most common malignant childhood brain tumour, arising in the cerebellum. Surgery, radiation to the whole brain and spine, and chemotherapy cure about 70%, at a heavy cost to thinking and growth; treatment is now being tailored to four molecular subgroups so that the low-risk children get less."},{"label":"Osteosarcoma","href":"/cancers/osteosarcoma/","tip":"Osteosarcoma is the most common bone cancer, mostly in teenagers. Chemotherapy plus surgery cures about two-thirds when it has not spread; because no new drug has beaten that chemotherapy in a large trial in 30 years, the next gains are being sought in cellular therapy against GD2, HER2 and B7-H3."}],"tags":[{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."},{"label":"ototoxicity","href":"/tagged/ototoxicity/","tip":"Every record tagged ototoxicity."}]},"sortKeys":{"year":0}},{"id":"cardio-oncology-risk-assessment-and-cardiac-surveillance","name":"Heart risk assessment and monitoring before, during and after heart-toxic cancer treatment","tldr":"Some cancer treatments, such as anthracyclines (doxorubicin, epirubicin) and trastuzumab, can weaken the heart. Before they start, your team should check your heart risk, usually with blood pressure, blood tests, an ECG and a heart scan, repeated during treatment; a fall in heart function does not always mean stopping. Afterwards, tell any doctor about new breathlessness, swelling or chest pain.","route":"/protocols/cardio-oncology-risk-assessment-and-cardiac-surveillance/","kind":"protocol","schematic":{"id":"cardio-oncology","sections":["supportive-care","rejuvenation"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"cardio-oncology","href":"/tagged/cardio-oncology/","tip":"Every record tagged cardio-oncology."},{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."}]},"sortKeys":{"year":0}},{"id":"hepatitis-b-screening-and-reactivation-prophylaxis","name":"Hepatitis B testing before cancer treatment and prevention of reactivation","tldr":"Hepatitis B can sleep in the liver for years and wake up when cancer treatment weakens the immune system, sometimes damaging the liver badly. A blood test before treatment finds people at risk. Those who have it, or have had it and get high-risk treatment such as rituximab or a stem cell transplant, take an antiviral tablet during and for at least a year after treatment, or are checked closely.","route":"/protocols/hepatitis-b-screening-and-reactivation-prophylaxis/","kind":"protocol","cancerIcon":"non-hodgkin-lymphoma","facets":{"kind":["Protocol"],"cancers":["Non-Hodgkin lymphoma","Diffuse large B-cell lymphoma","Chronic lymphocytic leukaemia"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Non-Hodgkin lymphoma","href":"/cancers/non-hodgkin-lymphoma/","tip":"Non-Hodgkin lymphoma is not one disease but a family of more than sixty cancers of the lymphocytes, the white blood cells of the immune system. About 95 per cent come from B cells and the rest from T or NK cells; some grow over years and are watched, others grow over weeks and are treated to cure. The family is the map; the subtype is the disease, and the subtype is what decides the treatment."},{"label":"Diffuse large B-cell lymphoma","href":"/cancers/dlbcl/","tip":"Diffuse large B-cell lymphoma (DLBCL) is an aggressive but curable lymphoma. CAR-T cures about 40% of relapsed patients, and off-the-shelf bispecifics are now approved."},{"label":"Chronic lymphocytic leukaemia","href":"/cancers/cll/","tip":"A slow leukaemia that no longer needs chemotherapy: BTK inhibitors and venetoclax control it for years, often in fixed-duration courses."}],"tags":[{"label":"hepatitis-b","href":"/tagged/hepatitis-b/","tip":"Every record tagged hepatitis-b."},{"label":"infection-prevention","href":"/tagged/infection-prevention/","tip":"Every record tagged infection-prevention."}]},"sortKeys":{"year":0}},{"id":"hot-flushes-on-endocrine-therapy-non-hormonal-options","name":"Hot flushes on breast cancer endocrine therapy and prostate cancer hormone therapy: non-hormonal options","tldr":"Hormone treatments for breast and prostate cancer often cause hot flushes, sometimes for years. After breast cancer, hormone replacement therapy is usually ruled out. Options include cognitive behavioural therapy, hypnosis, venlafaxine, some SSRIs (not with tamoxifen), gabapentin and, in a large trial, elinzanetant. For men, NICE suggests medroxyprogesterone first. Herbal remedies are not advised.","route":"/protocols/hot-flushes-on-endocrine-therapy-non-hormonal-options/","kind":"protocol","cancerIcon":"breast-hr-positive","facets":{"kind":["Protocol"],"cancers":["HR-positive / HER2-negative breast cancer","Prostate cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"HR-positive / HER2-negative breast cancer","href":"/cancers/breast-hr-positive/","tip":"HR-positive breast cancer is the most common breast cancer, driven by oestrogen. It was treated for years with hormone-blocking pills, now joined by CDK4/6 inhibitors, PI3K-pathway drugs, degraders, and ADCs."},{"label":"Prostate cancer","href":"/cancers/prostate/","tip":"Prostate cancer is the home of theranostics: PSMA PET finds it, PSMA radioligands treat it. Hormonal therapy remains the foundation, with PARP and AKT inhibitors added by genotype."}],"tags":[{"label":"symptom-management","href":"/tagged/symptom-management/","tip":"Every record tagged symptom-management."},{"label":"hot-flushes","href":"/tagged/hot-flushes/","tip":"Every record tagged hot-flushes."}]},"sortKeys":{"year":0}},{"id":"hypercalcaemia-of-malignancy-management","name":"Hypercalcaemia of malignancy: assessment, intravenous fluids, bisphosphonate or denosumab","tldr":"Some cancers raise the calcium level in the blood. It causes thirst, passing a lot of urine, constipation, sickness, tiredness and confusion, and can be dangerous. A blood test confirms it. Treatment is a drip of fluid, then a medicine that stops calcium leaving the bones (a bisphosphonate such as zoledronic acid, or denosumab), alongside treatment of the cancer itself.","route":"/protocols/hypercalcaemia-of-malignancy-management/","kind":"protocol","facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."},{"label":"metabolic","href":"/tagged/metabolic/","tip":"Every record tagged metabolic."}]},"sortKeys":{"year":0}},{"id":"hyperleukocytosis-leukostasis","name":"Hyperleukocytosis and leukostasis in acute leukaemia: supportive care, cytoreduction and leukapheresis","tldr":"In some leukaemias the white cell count is so high that the blood thickens and blocks small vessels in the lungs, brain and kidneys. This leukostasis is an emergency. The cells are brought down quickly with hydroxyurea and then chemotherapy; sometimes a machine filters them out. Blood transfusions are avoided unless really needed, because they thicken the blood further.","route":"/protocols/hyperleukocytosis-leukostasis/","kind":"protocol","cancerIcon":"aml","facets":{"kind":["Protocol"],"cancers":["Acute myeloid leukaemia","Acute lymphoblastic leukaemia","Leukaemia"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Acute myeloid leukaemia","href":"/cancers/aml/","tip":"Acute myeloid leukaemia is an aggressive blood cancer where, after 40 years of the same chemotherapy, a wave of targeted drugs (FLT3, IDH, BCL-2, menin) arrived."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."},{"label":"Leukaemia","href":"/cancers/leukaemia/","tip":"Leukaemia means cancer of the blood-forming cells, but the four main types share little beyond the name: acute lymphoblastic and acute myeloid leukaemia are emergencies treated with intensive therapy, while chronic lymphocytic and chronic myeloid leukaemia are slow diseases controlled for years with pills. Each has its own page."}],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."},{"label":"haematology","href":"/tagged/haematology/","tip":"Every record tagged haematology."}]},"sortKeys":{"year":0}},{"id":"hyponatraemia-siadh","name":"Hyponatraemia and SIADH in cancer: emergency hypertonic saline, safe correction and treating the cause","tldr":"Low sodium in the blood is common in cancer, especially small-cell lung cancer, and can also come from some cancer drugs, sickness or diarrhoea. Vomiting, confusion, drowsiness or a fit with low sodium is an emergency: hospital teams give a strong salt drip in small doses and check often, because raising sodium too fast can damage the brain. Then the cause is treated.","route":"/protocols/hyponatraemia-siadh/","kind":"protocol","cancerIcon":"sclc","facets":{"kind":["Protocol"],"cancers":["Small-cell lung cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Small-cell lung cancer","href":"/cancers/sclc/","tip":"A fast-growing lung cancer. About a third of cases are confined to one side of the chest and are treated to cure with chemotherapy and radiotherapy together; the rest respond to chemotherapy and relapse quickly. After 30 years without progress, durvalumab consolidation, the T-cell engager tarlatamab and antibody-drug conjugates have each lengthened survival since 2024."}],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."},{"label":"electrolytes","href":"/tagged/electrolytes/","tip":"Every record tagged electrolytes."}]},"sortKeys":{"year":0}},{"id":"icans-grading-and-management","name":"ICANS after CAR T-cell therapy: ICE score, ASTCT grading, steroids and seizure management","tldr":"In the weeks after CAR T-cell therapy, some people become confused, struggle to find words or write, become very sleepy, or rarely have seizures. This is ICANS. Nurses check a short test of orientation, naming, writing and counting (the ICE score). Steroids such as dexamethasone treat it, and most people recover. A carer who notices confusion or odd speech should call the centre at once.","route":"/protocols/icans-grading-and-management/","kind":"protocol","schematic":{"id":"car-t","sections":["cell-therapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"car-t","href":"/tagged/car-t/","tip":"Every record tagged car-t."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."}]},"sortKeys":{"year":0}},{"id":"iec-hs-management","name":"IEC-HS after CAR T-cell therapy: recognition and stepwise treatment","tldr":"Rarely after CAR T-cell therapy the immune system stays switched on after cytokine release syndrome has settled, and starts damaging the blood, liver and clotting (IEC-HS). It shows as very high ferritin, falling blood counts, low clotting proteins and liver test changes. It is treated with anakinra and steroids, adding other drugs if it worsens, while infection and relapse are ruled out.","route":"/protocols/iec-hs-management/","kind":"protocol","schematic":{"id":"car-t","sections":["cell-therapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"car-t","href":"/tagged/car-t/","tip":"Every record tagged car-t."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."}]},"sortKeys":{"year":0}},{"id":"irae-hepatitis","name":"Immune-mediated hepatitis from checkpoint inhibitors, by grade","tldr":"Immunotherapy can inflame the liver, usually without symptoms, so liver blood tests are checked before every dose. If the tests rise, immunotherapy is paused and steroids are given; severe cases mean stopping immunotherapy. Yellow skin or eyes, dark urine or pale stools need a call to your cancer team the same day.","route":"/protocols/irae-hepatitis/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."}]},"sortKeys":{"year":0}},{"id":"irae-colitis","name":"Immune-related diarrhoea and colitis from checkpoint inhibitors, by grade","tldr":"Immunotherapy drugs such as pembrolizumab, nivolumab and ipilimumab can make the immune system attack the bowel, causing diarrhoea, tummy pain or blood in the stool. Ring your cancer team's 24-hour line as soon as diarrhoea starts. Mild cases are watched; anything more is treated with steroids, and if steroids do not work within a few days, with a drip such as infliximab.","route":"/protocols/irae-colitis/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."}]},"sortKeys":{"year":0}},{"id":"irae-myocarditis","name":"Immune-related myocarditis from checkpoint inhibitors","tldr":"Rarely, immunotherapy inflames the heart muscle. It usually starts in the first three months and can be fatal, so new chest pain, breathlessness, palpitations, fainting, or new muscle weakness, drooping eyelids or double vision need urgent assessment. It is treated in hospital with very high-dose steroids straight away.","route":"/protocols/irae-myocarditis/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"cardio-oncology","href":"/tagged/cardio-oncology/","tip":"Every record tagged cardio-oncology."}]},"sortKeys":{"year":0}},{"id":"irae-pneumonitis","name":"Immune-related pneumonitis from checkpoint inhibitors, by grade","tldr":"Immunotherapy can inflame the lungs. A new cough, breathlessness or chest pain during or after immunotherapy should be reported to your cancer team the same day. A CT scan of the chest confirms it, and steroids are the main treatment; severe cases need hospital and steroids through a drip.","route":"/protocols/irae-pneumonitis/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."}]},"sortKeys":{"year":0}},{"id":"irae-skin","name":"Immune-related skin reactions from checkpoint inhibitors, including blistering and severe erosive rashes","tldr":"Rash and itching are among the commonest and earliest side effects of immunotherapy, usually a few weeks in, and most are mild. Blisters, peeling skin, sore skin, or sores in the mouth, eyes or genitals are different: they can be serious and need the cancer team the same day.","route":"/protocols/irae-skin/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"dermatology","href":"/tagged/dermatology/","tip":"Every record tagged dermatology."}]},"sortKeys":{"year":0}},{"id":"irae-diabetes","name":"Immune-related type 1 diabetes and diabetic ketoacidosis from checkpoint inhibitors","tldr":"Rarely, immunotherapy destroys the cells that make insulin. Blood sugar can rise within days and become dangerous (diabetic ketoacidosis). Thirst, passing a lot of urine, being sick or feeling drowsy need urgent help. It is treated with insulin, which is almost always lifelong, and not with steroids.","route":"/protocols/irae-diabetes/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"endocrine","href":"/tagged/endocrine/","tip":"Every record tagged endocrine."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."}]},"sortKeys":{"year":0}},{"id":"car-t-infection-prevention","name":"Infection screening, prophylaxis and immunoglobulin replacement around CAR T-cell therapy","tldr":"Infections are the commonest serious problem in the months after CAR T-cell therapy. You are first tested for hepatitis B, HIV and other viruses. Afterwards most centres give tablets against shingles, cold sores and a type of pneumonia for at least six months, check antibody levels, and may give antibody infusions if they are low and infections recur. Any fever needs a call to the team at once.","route":"/protocols/car-t-infection-prevention/","kind":"protocol","schematic":{"id":"car-t","sections":["cell-therapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"car-t","href":"/tagged/car-t/","tip":"Every record tagged car-t."},{"label":"infection","href":"/tagged/infection/","tip":"Every record tagged infection."}]},"sortKeys":{"year":0}},{"id":"insomnia-in-adults-with-cancer","name":"Insomnia in adults with cancer: screening, assessment and CBT-I first","tldr":"Trouble sleeping is very common during and after cancer treatment, and it often lasts. Your team should ask about your sleep at every stage. The treatment with the best evidence is cognitive behavioural therapy for insomnia (CBT-I), face to face or online. Sleeping tablets can help for a short time but are not recommended for long-term use; exercise can help too.","route":"/protocols/insomnia-in-adults-with-cancer/","kind":"protocol","schematic":{"id":"cbt-insomnia-cancer","sections":["supportive-care","rejuvenation"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."},{"label":"sleep","href":"/tagged/sleep/","tip":"Every record tagged sleep."}]},"sortKeys":{"year":0}},{"id":"irinotecan-early-cholinergic-syndrome-and-late-diarrhoea","name":"Irinotecan: early cholinergic syndrome and late diarrhoea","tldr":"Irinotecan can cause two kinds of diarrhoea. The first comes during or soon after the drip, with sweating, watery eyes and cramps; an atropine injection stops it. The second starts a day or more later and can be serious: take 4 mg of loperamide at the first loose stool, then 2 mg every 2 hours, and call your team if it is not controlled in 24 hours, or with blood, fever or faintness.","route":"/protocols/irinotecan-early-cholinergic-syndrome-and-late-diarrhoea/","kind":"protocol","schematic":{"id":"ugt1a1-genotyping","sections":["diagnostics","chemotherapy","supportive-care"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"diarrhoea","href":"/tagged/diarrhoea/","tip":"Every record tagged diarrhoea."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"irae-rheumatological","name":"Joint, muscle and other rheumatic side effects of checkpoint inhibitors","tldr":"Immunotherapy can cause joint pain and swelling, stiffness in the shoulders and hips, a dry mouth and eyes, or, rarely, muscle inflammation. Mild cases are treated with painkillers or anti-inflammatories; others need steroids and a rheumatologist, and immunotherapy often continues. Muscle weakness, trouble swallowing or breathlessness is urgent, because muscle inflammation can affect the heart.","route":"/protocols/irae-rheumatological/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"rheumatology","href":"/tagged/rheumatology/","tip":"Every record tagged rheumatology."}]},"sortKeys":{"year":0}},{"id":"irae-nephritis","name":"Kidney inflammation (immune-related nephritis) from checkpoint inhibitors","tldr":"Immunotherapy can occasionally inflame the kidneys. It usually causes no symptoms and is found when the creatinine on a routine blood test rises. Other causes are looked for first, some medicines may be stopped, immunotherapy is paused, and steroids are given if the immunotherapy is the cause. Some people can later restart.","route":"/protocols/irae-nephritis/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"nephrology","href":"/tagged/nephrology/","tip":"Every record tagged nephrology."}]},"sortKeys":{"year":0}},{"id":"car-t-apheresis","name":"Leukapheresis to collect T cells for CAR T-cell manufacture","tldr":"Every CAR T-cell treatment made from your own cells starts with leukapheresis: over a few hours, blood is taken from a vein, a machine keeps the white cells it needs, and the rest is returned. The date is booked with the manufacturer. Where possible it is done before more chemotherapy, which can weaken the T cells, and some recent treatments need a gap before collection.","route":"/protocols/car-t-apheresis/","kind":"protocol","schematic":{"id":"car-t","sections":["cell-therapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"car-t","href":"/tagged/car-t/","tip":"Every record tagged car-t."}]},"sortKeys":{"year":0}},{"id":"car-t-lymphodepletion","name":"Lymphodepleting chemotherapy before CAR T-cell infusion","tldr":"A few days before CAR T cells are given, a short course of chemotherapy, usually fludarabine and cyclophosphamide, lowers your own white cells to make room for the CAR T cells to grow. The team first checks that your CAR T cells are ready and that you have no uncontrolled infection. The doses and timing follow the instructions for your product.","route":"/protocols/car-t-lymphodepletion/","kind":"protocol","cancerIcon":"dlbcl","facets":{"kind":["Protocol"],"cancers":["Diffuse large B-cell lymphoma","Follicular lymphoma","Acute lymphoblastic leukaemia"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Diffuse large B-cell lymphoma","href":"/cancers/dlbcl/","tip":"Diffuse large B-cell lymphoma (DLBCL) is an aggressive but curable lymphoma. CAR-T cures about 40% of relapsed patients, and off-the-shelf bispecifics are now approved."},{"label":"Follicular lymphoma","href":"/cancers/follicular-lymphoma/","tip":"Follicular lymphoma is the most common slow-growing lymphoma, with a rearrangement of the BCL2 gene in more than 90% of cases (NCI PDQ). Most people live with it for decades, treated only when it causes problems; it can be controlled repeatedly with anti-CD20 antibodies, chemotherapy, bispecifics or CAR-T but rarely cured, and a small share transform into an aggressive lymphoma each year."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."}],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"car-t","href":"/tagged/car-t/","tip":"Every record tagged car-t."}]},"sortKeys":{"year":0}},{"id":"lymphoedema-risk-reduction-surveillance-and-treatment","name":"Lymphoedema after breast cancer: risk reduction, surveillance, early compression and treatment","tldr":"After surgery or radiotherapy to the armpit nodes, the arm can swell (lymphoedema). Measuring the arm before surgery and at check-ups can find swelling early, when a compression sleeve may stop it becoming permanent. Exercise, including weights, is safe. Infection raises the risk; the old bans on blood pressure, needles or flying are not well supported. Report arm swelling, heaviness or redness.","route":"/protocols/lymphoedema-risk-reduction-surveillance-and-treatment/","kind":"protocol","cancerIcon":"breast-cancer","facets":{"kind":["Protocol"],"cancers":["Breast cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Breast cancer","href":"/cancers/breast-cancer/","tip":"Breast cancer is not one disease, and the result that decides which page you need is the receptor result: whether the cancer carries oestrogen and progesterone receptors, and whether it carries too much HER2. Those two answers give four boxes, not three, with a page for each. Grade and stage do not change which page you read; they change what happens on it."}],"tags":[{"label":"lymphoedema","href":"/tagged/lymphoedema/","tip":"Every record tagged lymphoedema."},{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."},{"label":"breast-cancer","href":"/tagged/breast-cancer/","tip":"Every record tagged breast-cancer."}]},"sortKeys":{"year":0}},{"id":"malignant-bowel-obstruction","name":"Malignant bowel obstruction in advanced cancer: medicines, decompression, stents, surgery and nutrition","tldr":"Advanced bowel, ovarian or other abdominal cancer can block the bowel. Cramping pain, a swollen tummy, being sick and not passing wind or stools need urgent assessment; a CT scan confirms it. Treatment depends on what you want from care and how well you are: some people have a stent or an operation, many have medicines for sickness and pain, sometimes with a tube to drain the stomach.","route":"/protocols/malignant-bowel-obstruction/","kind":"protocol","cancerIcon":"colorectal","facets":{"kind":["Protocol"],"cancers":["Colorectal cancer","Ovarian cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Colorectal cancer","href":"/cancers/colorectal/","tip":"The cancer where screening works best and where immunotherapy can make some tumours disappear entirely; chemotherapy still carries most metastatic disease, now with antibodies and targeted combinations chosen by RAS, BRAF, mismatch repair and which side of the bowel the tumour started on."},{"label":"Ovarian cancer","href":"/cancers/ovarian/","tip":"Usually found late. PARP inhibitors transformed maintenance therapy, and ADCs against folate receptor and CDH6 are arriving for platinum-resistant disease."}],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."},{"label":"palliative","href":"/tagged/palliative/","tip":"Every record tagged palliative."}]},"sortKeys":{"year":0}},{"id":"malignant-pericardial-effusion","name":"Malignant pericardial effusion: tamponade, drainage, cytology and preventing recurrence","tldr":"Cancer can cause fluid to build up in the sac around the heart. When there is a lot, the heart cannot fill properly: breathlessness, a fast heartbeat, feeling faint or low blood pressure need emergency care. A heart ultrasound finds the fluid, and a needle and drain remove it. Because it often comes back, doctors may leave a drain in for a few days or make an opening in the sac.","route":"/protocols/malignant-pericardial-effusion/","kind":"protocol","cancerIcon":"nsclc","facets":{"kind":["Protocol"],"cancers":["Non-small-cell lung cancer","Breast cancer","Non-Hodgkin lymphoma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Non-small-cell lung cancer","href":"/cancers/nsclc/","tip":"Non-small-cell lung cancer is the proving ground for precision medicine: a dozen targetable mutations each with a matched pill, immunotherapy for the rest, and ADCs and bispecifics arriving now. Because most cases are still found late, low-dose CT screening is the other half of the story."},{"label":"Breast cancer","href":"/cancers/breast-cancer/","tip":"Breast cancer is not one disease, and the result that decides which page you need is the receptor result: whether the cancer carries oestrogen and progesterone receptors, and whether it carries too much HER2. Those two answers give four boxes, not three, with a page for each. Grade and stage do not change which page you read; they change what happens on it."},{"label":"Non-Hodgkin lymphoma","href":"/cancers/non-hodgkin-lymphoma/","tip":"Non-Hodgkin lymphoma is not one disease but a family of more than sixty cancers of the lymphocytes, the white blood cells of the immune system. About 95 per cent come from B cells and the rest from T or NK cells; some grow over years and are watched, others grow over weeks and are treated to cure. The family is the map; the subtype is the disease, and the subtype is what decides the treatment."}],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."}]},"sortKeys":{"year":0}},{"id":"metastatic-spinal-cord-compression-emergency","name":"Metastatic spinal cord compression: recognition, MSCC coordinator, MRI, dexamethasone, radiotherapy and surgery","tldr":"Cancer that has spread to the spine can press on the spinal cord. New back or neck pain that is severe, worse at night or on coughing, or any weakness, numbness, or trouble passing urine or stools, needs a same-day call to your cancer team. The hospital should do an MRI of the whole spine within 24 hours, give dexamethasone, and plan radiotherapy or surgery quickly, to keep you walking.","route":"/protocols/metastatic-spinal-cord-compression-emergency/","kind":"protocol","cancerIcon":"prostate","facets":{"kind":["Protocol"],"cancers":["Prostate cancer","Breast cancer","Lung cancer","Multiple myeloma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Prostate cancer","href":"/cancers/prostate/","tip":"Prostate cancer is the home of theranostics: PSMA PET finds it, PSMA radioligands treat it. Hormonal therapy remains the foundation, with PARP and AKT inhibitors added by genotype."},{"label":"Breast cancer","href":"/cancers/breast-cancer/","tip":"Breast cancer is not one disease, and the result that decides which page you need is the receptor result: whether the cancer carries oestrogen and progesterone receptors, and whether it carries too much HER2. Those two answers give four boxes, not three, with a page for each. Grade and stage do not change which page you read; they change what happens on it."},{"label":"Lung cancer","href":"/cancers/lung-cancer/","tip":"Lung cancer splits into non-small-cell disease, about 85 percent of it, and small-cell disease, which was 6.6 percent of English cases in 2024 and 9.1 percent of Welsh ones (National Lung Cancer Audit, State of the Nation 2026); the two behave and are treated very differently. Screening, staging and the things both types share are common ground; the rest belongs to each subtype."},{"label":"Multiple myeloma","href":"/cancers/multiple-myeloma/","tip":"Multiple myeloma is a plasma-cell cancer with more new drug classes than any other: proteasome inhibitors, IMiDs, CD38 antibodies, BCMA CAR-T, bispecifics, and an ADC."}],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."}]},"sortKeys":{"year":0}},{"id":"nausea-and-vomiting-in-advanced-cancer","name":"Nausea and vomiting in advanced cancer not caused by cancer treatment","tldr":"In advanced cancer, nausea and vomiting often have a cause that can be found and treated, such as constipation, a high calcium level, a medicine, or a blocked bowel. Your team will look for the cause, stop medicines that may worsen it, and choose an anti-sickness medicine that suits it, under the skin or by a small pump if tablets will not stay down. Say if it is not improving.","route":"/protocols/nausea-and-vomiting-in-advanced-cancer/","kind":"protocol","schematic":{"id":"palliative-care","sections":["supportive-care"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"nausea-and-vomiting","href":"/tagged/nausea-and-vomiting/","tip":"Every record tagged nausea-and-vomiting."},{"label":"palliative","href":"/tagged/palliative/","tip":"Every record tagged palliative."}]},"sortKeys":{"year":0}},{"id":"neratinib-diarrhoea-prophylaxis-and-dose-escalation","name":"Neratinib: diarrhoea prevention with loperamide or dose escalation","tldr":"Neratinib, a tablet for HER2-positive breast cancer, causes diarrhoea in almost everyone. Prevent it in one of two ways agreed before you start: loperamide on a fixed schedule from the first tablet for eight weeks, or a lower starting dose built up over two weeks. Drink about two litres a day, and call your team at once if diarrhoea is severe or comes with weakness, dizziness or fever.","route":"/protocols/neratinib-diarrhoea-prophylaxis-and-dose-escalation/","kind":"protocol","cancerIcon":"breast-her2-positive","facets":{"kind":["Protocol"],"cancers":["HER2-positive breast cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"HER2-positive breast cancer","href":"/cancers/breast-her2-positive/","tip":"HER2-positive breast cancer was once the most aggressive subtype and is now one of the most treatable, thanks to trastuzumab and, more recently, Enhertu."}],"tags":[{"label":"diarrhoea","href":"/tagged/diarrhoea/","tip":"Every record tagged diarrhoea."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"irae-neurological","name":"Neurological side effects of checkpoint inhibitors: myasthenia gravis, Guillain-Barré syndrome, meningitis and encephalitis","tldr":"Immunotherapy rarely inflames the nerves, the brain or the junction between nerve and muscle. Drooping eyelids, double vision, trouble swallowing or speaking, weakness spreading up the legs, numbness, severe headache with a stiff neck, confusion or a seizure need urgent assessment. Treatment is quick high-dose steroids, often with immunoglobulin or plasma exchange, and a neurologist.","route":"/protocols/irae-neurological/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"neurology","href":"/tagged/neurology/","tip":"Every record tagged neurology."}]},"sortKeys":{"year":0}},{"id":"neutropenic-enterocolitis","name":"Neutropenic enterocolitis (typhlitis): imaging, cultures, antibiotics and conservative care","tldr":"During intensive chemotherapy, when white cells are very low, the bowel wall can become inflamed and infected. Fever with tummy pain, diarrhoea or bloating is an emergency: ring your treatment helpline at once. In hospital it is confirmed with an ultrasound or CT scan and treated with strong antibiotics through a drip, fluids, pain relief and resting the bowel, with surgeons asked to see you.","route":"/protocols/neutropenic-enterocolitis/","kind":"protocol","cancerIcon":"aml","facets":{"kind":["Protocol"],"cancers":["Acute myeloid leukaemia","Acute lymphoblastic leukaemia"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Acute myeloid leukaemia","href":"/cancers/aml/","tip":"Acute myeloid leukaemia is an aggressive blood cancer where, after 40 years of the same chemotherapy, a wave of targeted drugs (FLT3, IDH, BCL-2, menin) arrived."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."}],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."},{"label":"neutropenic-sepsis","href":"/tagged/neutropenic-sepsis/","tip":"Every record tagged neutropenic-sepsis."}]},"sortKeys":{"year":0}},{"id":"nutrition-screening-and-support-during-cancer-treatment","name":"Nutrition screening and support during cancer treatment","tldr":"Weight loss and poor eating are common in cancer and make treatment harder. Your weight and eating should be checked from diagnosis onwards. If you are losing weight or eating less, you should get dietary advice, help with symptoms that stop you eating, and drinks or other supplements if needed. Staying active helps keep your muscles.","route":"/protocols/nutrition-screening-and-support-during-cancer-treatment/","kind":"protocol","schematic":{"id":"cachexia-therapy","sections":["supportive-care","nutrition-lifestyle"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"nutrition","href":"/tagged/nutrition/","tip":"Every record tagged nutrition."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"oral-mucositis-prevention-and-oral-care","name":"Oral care and oral mucositis prevention during cancer treatment","tldr":"Some cancer treatments cause painful mouth sores. See a dentist first if you can, check your mouth daily, keep brushing gently with a soft brush even when counts are low, rinse with salt and baking soda rather than an alcohol mouthwash, and tell your team early about pain or sores. Depending on treatment, the team may add ice chips during the drip, a benzydamine mouthwash or a low-level laser.","route":"/protocols/oral-mucositis-prevention-and-oral-care/","kind":"protocol","cancerIcon":"head-and-neck","facets":{"kind":["Protocol"],"cancers":["Head and neck squamous cell carcinoma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Head and neck squamous cell carcinoma","href":"/cancers/head-and-neck/","tip":"Cancers of the mouth and throat, increasingly caused by HPV. Immunotherapy is first line for advanced disease and now used before surgery."}],"tags":[{"label":"mucositis","href":"/tagged/mucositis/","tip":"Every record tagged mucositis."},{"label":"oral-care","href":"/tagged/oral-care/","tip":"Every record tagged oral-care."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"paediatric-platelet-transfusion-thresholds","name":"Platelet transfusion thresholds for children with cancer","tldr":"Chemotherapy can lower platelets, the blood cells that stop bleeding. A child who is not bleeding is usually given a platelet transfusion only when the count falls below 10, because giving them earlier does not prevent more bleeding. Higher counts are needed before a lumbar puncture or surgery, and for a child who is bleeding.","route":"/protocols/paediatric-platelet-transfusion-thresholds/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers","Acute lymphoblastic leukaemia","Acute myeloid leukaemia"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."},{"label":"Acute myeloid leukaemia","href":"/cancers/aml/","tip":"Acute myeloid leukaemia is an aggressive blood cancer where, after 40 years of the same chemotherapy, a wave of targeted drugs (FLT3, IDH, BCL-2, menin) arrived."}],"tags":[{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."},{"label":"transfusion","href":"/tagged/transfusion/","tip":"Every record tagged transfusion."}]},"sortKeys":{"year":0}},{"id":"pneumocystis-pneumonia-prophylaxis","name":"Pneumocystis pneumonia (PJP) prophylaxis with co-trimoxazole","tldr":"Pneumocystis is a fungus that can cause a dangerous pneumonia in people whose immune system is weakened by some cancer treatments, steroids or a stem cell transplant. An inexpensive antibiotic, co-trimoxazole, taken a few times a week or daily, prevents it very well. People who cannot take it have other options: atovaquone, dapsone or an inhaled medicine once a month.","route":"/protocols/pneumocystis-pneumonia-prophylaxis/","kind":"protocol","cancerIcon":"all-leukemia","facets":{"kind":["Protocol"],"cancers":["Acute lymphoblastic leukaemia","Chronic lymphocytic leukaemia","Non-Hodgkin lymphoma","Glioma & glioblastoma","Childhood cancers"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."},{"label":"Chronic lymphocytic leukaemia","href":"/cancers/cll/","tip":"A slow leukaemia that no longer needs chemotherapy: BTK inhibitors and venetoclax control it for years, often in fixed-duration courses."},{"label":"Non-Hodgkin lymphoma","href":"/cancers/non-hodgkin-lymphoma/","tip":"Non-Hodgkin lymphoma is not one disease but a family of more than sixty cancers of the lymphocytes, the white blood cells of the immune system. About 95 per cent come from B cells and the rest from T or NK cells; some grow over years and are watched, others grow over weeks and are treated to cure. The family is the map; the subtype is the disease, and the subtype is what decides the treatment."},{"label":"Glioma & glioblastoma","href":"/cancers/glioblastoma/","tip":"Gliomas are now diagnosed by molecular class, and three classes got their first targeted drugs in 2024-25 (vorasidenib for IDH-mutant glioma, tovorafenib for BRAF-altered paediatric glioma, dordaviprone for H3 K27M). Glioblastoma is the hardest to treat: surgery, radiotherapy with temozolomide and tumour treating fields are its backbone, with CAR-T into the brain and focused ultrasound in trials."}],"tags":[{"label":"pneumocystis","href":"/tagged/pneumocystis/","tip":"Every record tagged pneumocystis."},{"label":"infection-prevention","href":"/tagged/infection-prevention/","tip":"Every record tagged infection-prevention."}]},"sortKeys":{"year":0}},{"id":"paediatric-chemotherapy-nausea-vomiting-prevention","name":"Preventing chemotherapy sickness (nausea and vomiting) in children","tldr":"How likely a child's chemotherapy is to cause sickness decides which anti-sickness medicines they get, given before the chemotherapy, not after the child is sick. The strongest chemotherapy gets three medicines together. If a child is still sick, the team steps up the medicines straight away and for the next cycle, because sickness that is not controlled makes the next cycle worse.","route":"/protocols/paediatric-chemotherapy-nausea-vomiting-prevention/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."}],"tags":[{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."},{"label":"nausea-and-vomiting","href":"/tagged/nausea-and-vomiting/","tip":"Every record tagged nausea-and-vomiting."}]},"sortKeys":{"year":0}},{"id":"paediatric-oral-mucositis-prevention","name":"Preventing mouth sores (oral mucositis) in children having cancer treatment or a stem cell transplant","tldr":"Some chemotherapy and transplants cause painful sores in the mouth and throat. Older children who can manage it suck ice during short infusions of certain drugs, and children having a stem cell transplant or radiotherapy to the head and neck have gentle red-light treatment inside the mouth. Good daily mouth care and a dental check before treatment help too.","route":"/protocols/paediatric-oral-mucositis-prevention/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."}],"tags":[{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."},{"label":"mucositis","href":"/tagged/mucositis/","tip":"Every record tagged mucositis."}]},"sortKeys":{"year":0}},{"id":"paediatric-procedural-pain-and-sedation","name":"Procedural pain and sedation for children with cancer: needles, lumbar punctures and marrow tests","tldr":"Children with cancer have many needles, lumbar punctures and bone marrow tests. An international guideline says every needle procedure should use numbing cream and distraction, and every child having a lumbar puncture should be offered deep sedation or a general anaesthetic. Sedation is given by a trained team with monitoring, after the child and family are prepared for what will happen.","route":"/protocols/paediatric-procedural-pain-and-sedation/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers","Acute lymphoblastic leukaemia"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."}],"tags":[{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."},{"label":"procedural-pain","href":"/tagged/procedural-pain/","tip":"Every record tagged procedural-pain."},{"label":"sedation","href":"/tagged/sedation/","tip":"Every record tagged sedation."}]},"sortKeys":{"year":0}},{"id":"icaht-prolonged-cytopenia","name":"Prolonged low blood counts after CAR T-cell therapy (ICAHT): grading, work-up and treatment","tldr":"Low blood counts are the commonest side effect of CAR T-cell therapy. Most recover within weeks, but in some people counts stay low for months, raising infection risk. Teams check counts often, give growth factor injections, transfusions and infection-preventing tablets, and look at the bone marrow if counts stay low after about a month. Some need their own stored stem cells.","route":"/protocols/icaht-prolonged-cytopenia/","kind":"protocol","schematic":{"id":"car-t","sections":["cell-therapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"car-t","href":"/tagged/car-t/","tip":"Every record tagged car-t."}]},"sortKeys":{"year":0}},{"id":"neutropenic-precautions-and-daily-life","name":"Protective measures and daily life during neutropenia: hand hygiene, visitors, pets, plants, school and swimming","tldr":"Clean hands, for everyone, matter most. A 2024 guideline for children with cancer says many old restrictions can go: children can keep pets, go to school even when their white count is low, keep plants and swim, unless they have a PICC line. Still avoid building sites and digging in soil, bath toys that hold water, cleaning pet litter or cages, and ill visitors. Transplant units are stricter.","route":"/protocols/neutropenic-precautions-and-daily-life/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."}],"tags":[{"label":"neutropenic-precautions","href":"/tagged/neutropenic-precautions/","tip":"Every record tagged neutropenic-precautions."},{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."},{"label":"safe-living","href":"/tagged/safe-living/","tip":"Every record tagged safe-living."}]},"sortKeys":{"year":0}},{"id":"raised-intracranial-pressure","name":"Raised intracranial pressure in cancer: recognition, urgent scan, dexamethasone and referral","tldr":"Cancer in or spreading to the brain can raise the pressure inside the skull. A headache that is worse in the morning or on coughing, being sick without feeling sick, new confusion, a fit or a change in vision needs a same-day call to your cancer team. Usually a brain scan is done and a steroid called dexamethasone is started to reduce the swelling, then lowered as soon as it can be.","route":"/protocols/raised-intracranial-pressure/","kind":"protocol","cancerIcon":"secondary-brain-tumours","facets":{"kind":["Protocol"],"cancers":["Brain metastases","Brain and spinal cord tumours","Glioma & glioblastoma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Brain metastases","href":"/cancers/secondary-brain-tumours/","tip":"Brain metastases are cancers that have spread to the brain from elsewhere, most often from the lung, breast or skin. Focused radiation aimed at each spot (radiosurgery) has largely replaced radiation to the whole brain, and for some cancers modern targeted drugs and immunotherapy reach the brain well enough to shrink the deposits on their own."},{"label":"Brain and spinal cord tumours","href":"/cancers/brain-tumours/","tip":"Brain and spinal cord tumours range from slow-growing meningiomas and low-grade gliomas to glioblastoma, the commonest malignant brain tumour in adults, and a distinct set of childhood tumours such as medulloblastoma and diffuse midline glioma. Molecular markers now define them, and treatment is surgery, radiotherapy and, for some, drugs chosen by those markers."},{"label":"Glioma & glioblastoma","href":"/cancers/glioblastoma/","tip":"Gliomas are now diagnosed by molecular class, and three classes got their first targeted drugs in 2024-25 (vorasidenib for IDH-mutant glioma, tovorafenib for BRAF-altered paediatric glioma, dordaviprone for H3 K27M). Glioblastoma is the hardest to treat: surgery, radiotherapy with temozolomide and tumour treating fields are its backbone, with CAR-T into the brain and focused ultrasound in trials."}],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."}]},"sortKeys":{"year":0}},{"id":"red-cell-and-platelet-transfusion-thresholds","name":"Red cell and platelet transfusion thresholds in cancer care","tldr":"During cancer treatment your red cells or platelets may fall. Blood or platelet transfusions are given when the levels fall below set points, or when you are bleeding, rather than to bring the numbers back to normal. Giving less blood at higher thresholds has proved just as safe in trials, and spares people the risks of transfusion.","route":"/protocols/red-cell-and-platelet-transfusion-thresholds/","kind":"protocol","schematic":{"id":"transfusion-support","sections":["supportive-care"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"transfusion","href":"/tagged/transfusion/","tip":"Every record tagged transfusion."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"car-t-referral-and-eligibility","name":"Referral and eligibility assessment for CAR T-cell therapy","tldr":"CAR T-cell therapy is given at specialist centres, and a team there decides. For large B-cell lymphoma that does not respond to first treatment or returns within a year, CAR T cells are now the standard next step, so early referral matters. The centre checks your fitness, heart, brain and blood, and you will need to stay near the hospital, with someone to help, for at least two weeks after.","route":"/protocols/car-t-referral-and-eligibility/","kind":"protocol","cancerIcon":"dlbcl","facets":{"kind":["Protocol"],"cancers":["Diffuse large B-cell lymphoma","Primary mediastinal (thymic) large B-cell lymphoma","Follicular lymphoma","Mantle cell lymphoma","Acute lymphoblastic leukaemia","Multiple myeloma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Diffuse large B-cell lymphoma","href":"/cancers/dlbcl/","tip":"Diffuse large B-cell lymphoma (DLBCL) is an aggressive but curable lymphoma. CAR-T cures about 40% of relapsed patients, and off-the-shelf bispecifics are now approved."},{"label":"Primary mediastinal (thymic) large B-cell lymphoma","href":"/cancers/primary-mediastinal-b-cell-lymphoma/","tip":"Primary mediastinal B-cell lymphoma is a fast-growing lymphoma of the thymus behind the breastbone that mostly affects young women. Immunochemotherapy cures about nine in ten, radiotherapy can now be skipped when the end-of-treatment scan is clear, and PD-1 antibodies and CAR-T cells rescue many of those who relapse."},{"label":"Follicular lymphoma","href":"/cancers/follicular-lymphoma/","tip":"Follicular lymphoma is the most common slow-growing lymphoma, with a rearrangement of the BCL2 gene in more than 90% of cases (NCI PDQ). Most people live with it for decades, treated only when it causes problems; it can be controlled repeatedly with anti-CD20 antibodies, chemotherapy, bispecifics or CAR-T but rarely cured, and a small share transform into an aggressive lymphoma each year."},{"label":"Mantle cell lymphoma","href":"/cancers/mantle-cell-lymphoma/","tip":"An uncommon B-cell lymphoma driven by cyclin D1 that used to behave badly in almost everyone. BTK inhibitors, CAR-T and now BCL2 drugs have changed it from chemotherapy-plus-transplant to targeted combinations."}],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"car-t","href":"/tagged/car-t/","tip":"Every record tagged car-t."}]},"sortKeys":{"year":0}},{"id":"irae-rechallenge","name":"Restarting a checkpoint inhibitor after an immune-related side effect","tldr":"After an immunotherapy side effect has settled, your team may offer to restart the same treatment. About 3 in 10 people who restart have the same side effect again, and some side effects (such as heart or nerve inflammation, or very severe reactions) usually mean stopping for good. It is a shared decision that weighs the cancer benefit against the risk.","route":"/protocols/irae-rechallenge/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."}]},"sortKeys":{"year":0}},{"id":"scalp-cooling-during-chemotherapy","name":"Scalp cooling during chemotherapy: suitability, preparation and cooling times","tldr":"A cold cap worn before, during and after a chemotherapy drip can help some people keep much of their hair, especially with taxanes such as paclitaxel and docetaxel. It is not suitable for blood cancers or for people very sensitive to cold. For taxanes, trials show 20 minutes afterwards works as well as longer. It does not always work, and results depend on the chemotherapy.","route":"/protocols/scalp-cooling-during-chemotherapy/","kind":"protocol","cancerIcon":"breast-cancer","facets":{"kind":["Protocol"],"cancers":["Breast cancer"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Breast cancer","href":"/cancers/breast-cancer/","tip":"Breast cancer is not one disease, and the result that decides which page you need is the receptor result: whether the cancer carries oestrogen and progesterone receptors, and whether it carries too much HER2. Those two answers give four boxes, not three, with a page for each. Grade and stage do not change which page you read; they change what happens on it."}],"tags":[{"label":"alopecia","href":"/tagged/alopecia/","tip":"Every record tagged alopecia."},{"label":"scalp-cooling","href":"/tagged/scalp-cooling/","tip":"Every record tagged scalp-cooling."},{"label":"supportive-care","href":"/tagged/supportive-care/","tip":"Every record tagged supportive-care."}]},"sortKeys":{"year":0}},{"id":"sexual-health-assessment-and-interventions","name":"Sexual health after cancer: assessment and interventions for women and men","tldr":"Cancer and its treatment often change sex, desire, body image and relationships, for women and men. Guidelines say your team should raise it so you do not have to. Help includes counselling, alone or as a couple; moisturisers, lubricants and then low-dose vaginal oestrogen for dryness; dilators and pelvic floor physiotherapy; and tablets, devices or injections for erection problems.","route":"/protocols/sexual-health-assessment-and-interventions/","kind":"protocol","schematic":{"id":"sexual-function-after-cancer","sections":["rejuvenation","supportive-care"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"survivorship","href":"/tagged/survivorship/","tip":"Every record tagged survivorship."},{"label":"sexual-health","href":"/tagged/sexual-health/","tip":"Every record tagged sexual-health."}]},"sortKeys":{"year":0}},{"id":"irae-steroid-taper-and-pjp","name":"Steroid taper after immunotherapy side effects, with Pneumocystis prophylaxis and adrenal checks","tldr":"Steroids for an immunotherapy side effect are reduced slowly, usually over at least 4 to 6 weeks, because stopping too fast can bring it back. A month or more of higher-dose steroids weakens defences against Pneumocystis pneumonia, so a preventive antibiotic (usually co-trimoxazole) is often given. Your body's own steroid production may need checking before the last tablets stop.","route":"/protocols/irae-steroid-taper-and-pjp/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"infection-prevention","href":"/tagged/infection-prevention/","tip":"Every record tagged infection-prevention."}]},"sortKeys":{"year":0}},{"id":"svc-obstruction","name":"Superior vena cava obstruction in cancer: recognition, imaging, stenting and treatment of the cause","tldr":"A cancer in the chest, most often lung cancer or lymphoma, can squeeze the large vein that brings blood back from the head and arms. The face, neck and arms swell, and breathing can become difficult: this needs urgent hospital assessment the same day. A CT scan confirms it; a small metal tube (stent) in the vein can relieve symptoms within days, and chemotherapy or radiotherapy treats the cancer.","route":"/protocols/svc-obstruction/","kind":"protocol","cancerIcon":"nsclc","facets":{"kind":["Protocol"],"cancers":["Non-small-cell lung cancer","Small-cell lung cancer","Non-Hodgkin lymphoma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Non-small-cell lung cancer","href":"/cancers/nsclc/","tip":"Non-small-cell lung cancer is the proving ground for precision medicine: a dozen targetable mutations each with a matched pill, immunotherapy for the rest, and ADCs and bispecifics arriving now. Because most cases are still found late, low-dose CT screening is the other half of the story."},{"label":"Small-cell lung cancer","href":"/cancers/sclc/","tip":"A fast-growing lung cancer. About a third of cases are confined to one side of the chest and are treated to cure with chemotherapy and radiotherapy together; the rest respond to chemotherapy and relapse quickly. After 30 years without progress, durvalumab consolidation, the T-cell engager tarlatamab and antibody-drug conjugates have each lengthened survival since 2024."},{"label":"Non-Hodgkin lymphoma","href":"/cancers/non-hodgkin-lymphoma/","tip":"Non-Hodgkin lymphoma is not one disease but a family of more than sixty cancers of the lymphocytes, the white blood cells of the immune system. About 95 per cent come from B cells and the rest from T or NK cells; some grow over years and are watched, others grow over weeks and are treated to cure. The family is the map; the subtype is the disease, and the subtype is what decides the treatment."}],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."}]},"sortKeys":{"year":0}},{"id":"febrile-neutropenia-first-hour","name":"Suspected febrile neutropenia (neutropenic sepsis): the first hour","tldr":"Anyone having cancer treatment who feels unwell, with or without a high temperature, should ring their 24-hour cancer line and be seen in hospital straight away. There they should be given a strong antibiotic through a drip within about an hour, without waiting for the blood count to come back.","route":"/protocols/febrile-neutropenia-first-hour/","kind":"protocol","schematic":{"id":"implanted-ports","sections":["chemotherapy","supportive-care","devices"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"neutropenic-sepsis","href":"/tagged/neutropenic-sepsis/","tip":"Every record tagged neutropenic-sepsis."},{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."}]},"sortKeys":{"year":0}},{"id":"bispecific-step-up-dosing","name":"T-cell engaging bispecific antibodies: step-up dosing, monitoring and outpatient delivery","tldr":"Bispecific antibodies such as teclistamab and elranatamab for myeloma, or glofitamab and epcoritamab for lymphoma, link T cells to cancer cells. The first doses are built up in steps to lower the risk of cytokine release syndrome (fever, low blood pressure) and confusion. Some countries do this in hospital; others let chosen patients go home between doses with a trained carer and a 24-hour number.","route":"/protocols/bispecific-step-up-dosing/","kind":"protocol","cancerIcon":"multiple-myeloma","facets":{"kind":["Protocol"],"cancers":["Multiple myeloma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Multiple myeloma","href":"/cancers/multiple-myeloma/","tip":"Multiple myeloma is a plasma-cell cancer with more new drug classes than any other: proteasome inhibitors, IMiDs, CD38 antibodies, BCMA CAR-T, bispecifics, and an ADC."}],"tags":[{"label":"cell-therapy","href":"/tagged/cell-therapy/","tip":"Every record tagged cell-therapy."},{"label":"bispecific","href":"/tagged/bispecific/","tip":"Every record tagged bispecific."}]},"sortKeys":{"year":0}},{"id":"irae-thyroid","name":"Thyroid inflammation and underactive thyroid from checkpoint inhibitors","tldr":"Immunotherapy often inflames the thyroid gland. It can briefly make the thyroid overactive (racing heart, sweating, shakiness) and then underactive (tiredness, feeling cold), and the underactive phase is often permanent. It is found on routine blood tests, treated with tablets rather than steroids, and immunotherapy usually carries on.","route":"/protocols/irae-thyroid/","kind":"protocol","schematic":{"id":"checkpoint-inhibitor","sections":["immunotherapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"irae","href":"/tagged/irae/","tip":"Every record tagged irae."},{"label":"endocrine","href":"/tagged/endocrine/","tip":"Every record tagged endocrine."}]},"sortKeys":{"year":0}},{"id":"tumour-lysis-syndrome-prevention-and-treatment","name":"Tumour lysis syndrome: risk assessment, prophylaxis and treatment","tldr":"When a fast-growing cancer such as some leukaemias and lymphomas is first treated, many cancer cells can die at once and flood the blood with potassium, phosphate and uric acid, which can damage the kidneys and heart. Teams check who is at risk, give extra fluids and a medicine (allopurinol, or rasburicase for higher risk) before treatment, and check blood tests often in the first days.","route":"/protocols/tumour-lysis-syndrome-prevention-and-treatment/","kind":"protocol","schematic":{"id":"car-t","sections":["cell-therapy"]},"facets":{"kind":["Protocol"],"cancers":[],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[],"tags":[{"label":"acute-oncology","href":"/tagged/acute-oncology/","tip":"Every record tagged acute-oncology."},{"label":"oncological-emergency","href":"/tagged/oncological-emergency/","tip":"Every record tagged oncological-emergency."},{"label":"metabolic","href":"/tagged/metabolic/","tip":"Every record tagged metabolic."}]},"sortKeys":{"year":0}},{"id":"vaccination-around-cancer-treatment","name":"Vaccination before, during and after cancer treatment","tldr":"Before cancer treatment, the team should check which vaccines a person has had and bring them up to date, ideally two to four weeks before. Non-live vaccines such as the flu jab can still be given during treatment. Live vaccines, such as MMR, chickenpox and the nasal flu spray for the patient, must be avoided during treatment and for months after. Family vaccines protect the patient too.","route":"/protocols/vaccination-around-cancer-treatment/","kind":"protocol","cancerIcon":"childhood-cancers","facets":{"kind":["Protocol"],"cancers":["Childhood cancers","Acute lymphoblastic leukaemia","Non-Hodgkin lymphoma","Hodgkin lymphoma","Multiple myeloma"],"year":[]},"cols":{"kind":{"facet":"kind","value":"Protocol","tip":"How care is carried out, step by step: accessing a port, a drug leaking out of the vein, fever during chemotherapy. Each step with its reason and its source, the best-supported version beside the variants in use."},"cancers":[{"label":"Childhood cancers","href":"/cancers/childhood-cancers/","tip":"Cancer in children is rare and different from adult cancer: the common types are leukaemias, brain tumours, lymphomas and embryonal tumours such as neuroblastoma and Wilms tumour, most are curable in well-resourced health systems, and the great challenge is bringing the same cures to the majority of children who live where they are not available."},{"label":"Acute lymphoblastic leukaemia","href":"/cancers/all-leukemia/","tip":"Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager."},{"label":"Non-Hodgkin lymphoma","href":"/cancers/non-hodgkin-lymphoma/","tip":"Non-Hodgkin lymphoma is not one disease but a family of more than sixty cancers of the lymphocytes, the white blood cells of the immune system. About 95 per cent come from B cells and the rest from T or NK cells; some grow over years and are watched, others grow over weeks and are treated to cure. The family is the map; the subtype is the disease, and the subtype is what decides the treatment."},{"label":"Hodgkin lymphoma","href":"/cancers/hodgkin-lymphoma/","tip":"Hodgkin lymphoma is one of the most curable cancers, where the goal is now to cure with less toxicity, using brentuximab and, from 2026, first-line nivolumab."}],"tags":[{"label":"vaccination","href":"/tagged/vaccination/","tip":"Every record tagged vaccination."},{"label":"infection-prevention","href":"/tagged/infection-prevention/","tip":"Every record tagged infection-prevention."},{"label":"paediatric","href":"/tagged/paediatric/","tip":"Every record tagged paediatric."}]},"sortKeys":{"year":0}}]