When it comes to the toxic side effects of chemotherapy, many patients have the feeling of talking about the tiger, and some of them even give up the treatment because they are afraid of the toxic side effects of chemotherapy, I would like to talk about the toxic side effects of chemotherapy with you in several times.
Chemotherapy drugs, also known as cytotoxic drugs, have certain effects on the normal cells of the body while killing the rapidly proliferating tumor cells, that is, toxic side effects. For different organ systems, there are familiar effects on gastrointestinal tract: nausea, vomiting, diarrhea, etc.; effects on hematopoietic system: decrease of white blood cells, anemia, etc.; there are also some rare side effects, some of which are specific to certain special drugs, so we will not go into them here. In addition, in order to better evaluate the side effects of drugs, these toxic side effects must be graded, generally into grade I, grade II, grade III and grade IV, corresponding to increasingly heavy side effects in that order, so that doctors can deal with different degrees of side effects. This grading system has two major systems, the more rigorous and systematic one is the NCI-CTC standard of the National Cancer Institute, but the grading system is very detailed and has more than 70 pages, what I list below is a simple grading system of WHO, which is relatively easy to use.
Common toxic and side-effect grading criteria of anticancer drugs (WHO)
Toxic and side-effect indicators
Grading (degree) 0 Ⅰ Ⅱ Ⅲ Ⅳ
Blood system
Hemoglobin (g/L) ≥110 95~109 80~94 65~79 <65
Leukocytes (×109/L) ≥4.0 3.0~3.9 2.0~2.9 1.0~1.9 <1.0
Granulocytes (×109/L) ≥2.0 1.5~1.9 1.0~1.4 0.5~0.9 <0.5
Platelets (×109/L) ≥100 75~99 50~74 25~49 <25
Bleeding None Petechiae Mild blood loss Obvious blood loss Severe blood loss
Gastrointestinal tract
Bilirubin ≤1.25×N 1.26~2.50×N 2.6~5.0×N 5.1~10.0×N >10×N
Glutaminase ≤1.25×N 1.26~2.50×N 2.6~5.0×N 5.1~10.0×N >10×N
Alkaline phosphatase ≤1.25×N 1.26~2.50×N 2.6~5.0×N 5.1~10.0×N >10×N
Oral cavity No abnormality Erythema, pain Erythema, ulcer, can eat Ulcer, can only eat liquid food Cannot eat
Nausea and vomiting None Nausea Transient vomiting Vomiting, requiring treatment Difficult to control vomiting
Diarrhea None Transient (<2 days) Tolerable (>2 days) Intolerable, requires treatment Bloody diarrhea
Kidney, bladder
Urea nitrogen ≤1.25×N 1.26~2.50×N 2.6~5.0×N 5.1~10.0×N >10×N
Creatinine ≤1.25×N 1.26~2.50×N 2.6~5.0×N 5.1~10.0×N >10×N
Proteinuria None +, ++,++++, ++++, Nephrotic syndrome
<0.3g/100ml 0.3~1.0g/100ml >1.0g/100ml
Hematuria None Microscopic hematuria Severe hematuria Severe hematuria, with blood clots Urinary tract obstruction
Lung Asymptomatic Mild dyspnea with activity Dyspnea at rest Complete bed rest
Fever (drug-related) None <38℃ 38~40℃ >40℃ Fever with low pressure
Allergy None Edema Bronchospasm, bronchospasm, allergic reaction
Injectable treatment not required Injectable treatment required
Skin None Erythema Dry peeling, wet dermatitis, ulcers Exfoliative dermatitis Blistering, pruritus Necrosis, surgery required
Hair None Mild alopecia Moderate, patchy alopecia Complete alopecia, alopecia, hair loss
Regrowable Non-regrowable
Infection (specific site) None Mild infection Moderate infection Severe infection Severe infection with hypotension
Heart
Normal rhythm rate Sinus tachycardia, unifocal PVCs, multifocal PVCs Ventricular arrhythmia
Resting heart rate >100 beats/min Atrial arrhythmia
Cardiac function Normal Asymptomatic, transient cardiac insufficiency, symptomatic, asymptomatic, no cardiac function
But abnormal cardiac signs but no treatment required Adequate, treatment effective Inadequate, treatment ineffective
Pericarditis None Pericardial effusion, symptomatic, pericardial tamponade, pericardial tamponade, asymptomatic
Asymptomatic, but no fluid aspiration required Fluid aspiration required Surgery required
Neurological
Consciousness Consciousness Short-term drowsiness Drowsiness of no duration Drowsiness of more than coma
50% of wakefulness More than 50% of wakefulness
Peripheral nerves Normal sensory abnormalities or severe sensory abnormalities Intolerable sensations Paralysis
Hypotonic reflexes or mild weakness Abnormal or significant motor deficits
Constipation None Mild Moderate Bloating Abdominal distention, vomiting
Pain (not caused by tumor) None Mild Moderate Severe Difficult to control
N = upper limit of normal