The Common Toxicity Criteria (CTC) define adverse events following cancer therapy. It was designed for use in clinical trials of different therapeutic regimens. Criteria are given for the severity of hemorrhage occurring as a result of the cancer therapy.
Specific areas:
(1) CNS hemorrhage or bleeding
(2) epistaxis
(3) hematemesis
(4) hematuria (not associated with vaginal bleeding in a woman)
(5) hemoptysis
(6) hemorrhage or bleeding associated with surgery (in excess of expected blood loss at time of surgery)
(7) melena or GI bleeding
(8) petechiae or purpura (hemorrhage or bleeding into skin or mucosa)
(9) rectal bleeding or hematochezia
(10) vaginal bleeding in a woman
(11) other site, not listed
In addition to specifying the site of bleeding, the hemorrhage may be classed based on the platelet count:
(12) hemorrhage or bleeding with grade 3 or 4 thrombocytopenia (< 50,000 per µL)
(13) hemorrhage or bleeding without grade 3 or 4 thrombocytopenia (>= 50,000 per µL)
where:
• If grade 3 or 4 thrombocytopenia is present, then both the site and the "hemorrhage with grade 3 or 4 thrombocytopenia" are indicated.
• If grade 3 or 4 thrombocytopenia is absent, then "hemorrhage or bleeding without grade 3 or 4 thrombocytopenia" is indicated only if "other site not listed" is indicated.
Grade 0: none of the findings present
|
Complication |
Finding |
Grade |
|
generic |
none |
0 |
|
|
mild |
1 |
|
|
requires transfusion |
3 |
|
|
catastrophic bleeding requiring major non-elective intervention |
4 |
|
CNS hemorrhage |
none |
0 |
|
|
bleeding seen on scan without clinical consequences |
3 |
|
|
hemorrhagic stroke or vascular event with neurologic signs and symptoms |
4 |
|
hematuria |
none |
0 |
|
|
microscopic hematuria |
1 |
|
|
intermittent gross bleeding without clots |
2 |
|
|
persistent gross bleeding or clots |
3 |
|
|
open surgery; necrosis or deep bladder ulceration |
4 |
|
petechiae or purpura |
none |
0 |
|
|
rare petechiae of skin |
1 |
|
|
petechiae or purpura in dependent areas of skin |
2 |
|
|
generalized petechiae or purpura of skin or petechiae of any mucosal site |
3 |
|
rectal bleeding |
none |
0 |
|
|
mild without transfusion or medication |
1 |
|
|
persistent, requiring medication or break from radiation |
2 |
|
|
requires transfusion |
3 |
|
|
catastrophic bleeding requiring major non-elective intervention |
4 |
|
vaginal bleeding (if female) |
none |
0 |
|
|
spotting requiring < 2 pads per day |
1 |
|
|
requires >= 2 pads per day but not transfusion |
2 |
|
|
requires transfusion |
3 |
|
|
catastrophic bleeding requiring major non-elective intervention |
4 |
where:
• Hematuria Grade 3 may require catheterization or intrumentation or transfusion.
• Medications for Grade 2 rectal bleeding may include steroid suppositories.
Specialty: Hematology Oncology
