22 Neoplasia 3 Flashcards
Describe methods of tumor detection and diagnosis,
Imaging
Blood tests
Biopsy
Cytopathology
Resection
Imaging: US, Xray, CT
Blood tests: PSA (prostate cancer, prostatitis, DRE)
hCG
CA-125: ovarian
Cytopathology: FNA (+/-US); cavity taps
Biopsy Skin, GI biopsies, endobronchial biopsy
Resection
~Cytological Diagnosis~
- Assess ?
- Screening: ?
- Diagnosis:
? - commonly thyroid
?: pleural, peritoneal most common
~Cytological Diagnosis~
- Assess nuclei, nucleoli, chromatin pattern; cellularity and basic architecture
- Screening: PAP
- Diagnosis:
Fine needle aspiration (FNA) - commonly thyroid
Fluids: pleural, peritoneal most common
Describe the applications and limitations of tumor associated antigens in the diagnosis and follow-up of patients with cancer
Tumor associated antigens
- Screening: false negatives/positives (eg psa for prostate)
- Diagnosis: Testicular cancer (hCg, LD, AFP) // Ovarian mass: CA-125
- Followup (eg CEA for colon)
Differentiate between in-situ and invasive neoplasms
In-situ:
A condition in which abnormal cells that look like cancer cells under a microscope are found only in the place where they first formed and** haven’t spread** to nearby tissue. At some point, these cells may become cancerous and spread into nearby normal tissue.
invasive cancer:
occurs when cancer cells have spread beyond the tissue and cells where the cancer first developed, and have spread to otherwise healthy surrounding tissue
understand the concepts of tumor grade and stage
TMN?
Gynecological malignancies?
Lymphomas?
Sarcomas?
STAGE assesses the extent of spread
-Pathological staging
-TNM Tumor, node, metastasis
-FIGO - gynecological malignancies
-Ann Arbor - lymphomas
-French federation - sarcomas
What is TNM (Stage)
Tumor, Node, Metastasis
- Criteria for each dependent on tumor type
- T stage: breast = size ; bowel = depth ; testicle = extent of invasion
- N Stage: Number of nodes, size of deposit, matting, extranodal extension
- M stage: criteria for “distant” varies (ovary allowed to metastasize in the pelvis as part of T
understand the concepts of tumor grade and stage
The grade assesses the ? of the tumor
- Tumor Type dependent:
-Breast (?)
-Prostate (?)
-Colon (?)
The grade assesses the differentiation of the tumor
- Tumor Type dependent:
-Breast (Nottingham score)
-Prostate (Gleason score)
-Colon (architecture)
screening of asymptomatic populations
- Cervix
- Breast
- Testicle
- Prostate
- Special circumstances
screening of asymptomatic populations
- Cervix: pap smear
- Breast: self-exams, mammograms
- Testicle: self-exam
- Prostate: Digital rectal exam
- Special circumstances:
-Hereditary nonpolyposis colorectal cancer (HNPCC) Colonoscopy, upper endoscopy, FIT test, urinalysis, LFTs, pap, US of uterus and ovaries
-breast cancer susceptibility gene (BRCA) Breast and ovary screening or prophylactic removal
TISSUE DIAGNOSIS
? - tissue fragments with architecture
? : large blocks of tissue with organ-level relationships - (4)
TISSUE DIAGNOSIS
Biopsies - tissue fragments with architecture
-Making the diagnosis
-Guiding the next step (Cure? surgery, chemo, radiation) Palliation
Resection specimens : large blocks of tissue with organ-level relationships
-Staging tumor
-Grading tumor
-Guiding further therapy
-Prognostic information
When is metastasis a risk?
When tumor invades beyond the basement membrane
What is Clinical Stage grouping?
- Considers combinations of pathological stage
- Guides treatment decisions
- Variable dependent on tumor (eg thyroid carcinoma is age dependent)
Colon cancer (TNM staging)
- pT1:
- pT2
- pT3
- pT4a
- pT4b
Colon cancer (TNM staging)
- pT1: Tumor invades submucosa
- pT2: tumor invades muscularis propria
- pT3: tumor invades throught muscularis propria into pericolorectal tissues
- pT4a: Tumor penetrates the visceral peritoneum
- pT4b: Tumor directly invades or is adherent to other organs or structures
What is HSIL?
High grade squamous intraepithelial lesion (HSIL) is a squamous cell abnormality associated with human papillomavirus (HPV)
- forms on surface of certain organs, such as the cervix, vagina, vulva, anus, and esophagus.
What is colonic adenoma?
An adenoma is a type of polyp, or unusual growth of cells that form a small clump. A colon adenoma forms in the lining of your colon.
Cecal adenocarcinoma
Cecal adenocarcinoma is a common malignant tumor with high mortality
Squamous cell carcinoma?
Squamous cell carcinoma (SCC) and adenocarcinoma are the most common tumours of the cervix. These types of cervical cancer usually develop from precancerous changes in the cervix because of infection with the human papillomavirus (HPV).
