Cancer Colon

Question 1

Stem; A 70 year old man , colonoscopy performed and showed rectal tumor, a biopsy was done showing Adenocarcinoma .

Q1: what arc the fcatures suggesting poor prognosis ?

Answer 1

Poor Differentiation
signet cell Ca. /
High CEA /
advanced age /
Ulceration / Obstructive lesion

Question 2

Q2: what is the difference between staging & grading ?

Answer 2

S; describe criteria based on surgical, clinical and radio criteria like size and the involvement
G; Microscopic features of tumor cells

Question 3

Q3. if this patient had a concomitant cancer at his anorectum , what is the most likely type \ pathology ?

Answer 3

Sq.Cell.Ca

Question 4

Q4: Resection has been done, only 1 out of 19 LN were involved, What is
the N status ?

Answer 4

N1a

Question 5

Q5: A few month later, the patient developed hepatic metastasis with ascites, Ascitic tap show atypical cells, what pathological test will you do to prove the origin ?

Answer 5

IHC and Tumor markers(CEA)

Question 6

Q6. DD between IHC and Tumor makers ?

Answer 6

IHC; Ag-Ab recognition
Marker; Specific markers produced by tumor cells itself or body in response to tumor

Question 7

Q7. What is IHC in simple words ?

Answer 7

study of Ag-AB recognition

Question 8

Q8: How does it work ?

Answer 8

Examine Ag in tumor by Abs attached to enzyme or specific dye when reaction happen color of dye changes and can be detected under microscopy

Question 9

Q9. what is the type of AG-AB reaction in IHC?

Answer 9

Complement Fixation

Question 10

Q10: How IHC helps in decision of chemotherapy ?

Answer 10

Guide the treatment

Question 11

Q11: how tyrosine kinase inhibitor works ?

Answer 11

In inhibite cell receptors mediated by tyr kinase that promote the proliferation of tumor cell and this will lead to arrest of cell cycle and prevent proliferation

Question 12

Q12: Six months later the patient develops a large pelvic tumor, is this patient at high risk of developing venous thromboembolism?

Answer 12

Yes, because of hypercoagulability state / endothelial injury by tumor invasion

Question 13

Q13: Diagnosis of PE ? Complications of PE?

Answer 13

Triple assessment – > Exam Wells Score (determine possibility of PE) /D-Dimer X-ray – Ct angio / Doppler on LL
Complication– > pulm. HTN / Death

Question 14

Q14: What are the contents of blood thrombus and how is it formed?

Answer 14

Platelets / WBCs / RBCs / Mesh network

Question 15

Q15. How to obtain plasma from blood?

Answer 15

Centrifugation