Cancer Diagnosis and Staging Flashcards
Why is the right diagnosis key?
To provide the right treatment
In terms of clinical diagnosis of cancers, are GPs generalists or specialists?
Specialists
What does cancer staging guide?
Therapy
What is a cancer diagnosis?
Identification of the disease process, i.e. is it cancer? What type is it?
Can be broad or specific
Identification of predictive and prognostic biomarkers
What percentage of malignancies diagnosed in primary care for patients aged 70 or over are treated as emergency admissions?
31%
What would a primary care clinician look at for a diagnosis?
Symptoms Patient history: history of complaint, history of illnesses, risk factors in lifestyle Examination - 'signs' Blood tests Simple imaging, e.g. CXR
What happens after a patient is diagnosed with cancer in primary care?
They are referred to a hospital specialist
What would a hospital specialist look at for a diagnosis?
Retake history, examination and blood tests
Imaging, e.g. X-ray, CT, ultrasound, PET scan
Formulation of differential diagnosis
Give an example of a differential diagnosis for a patient presenting with weight loss, haemoptysis, and lung mass
Infective, e.g. pneumonia, TB
Autoimmune, e.g. vasculitis
Tumour, benign or malignant
What would be the next steps after a patient has been referred and assessed by a hospital specialist?
Tissue diagnosis
What happens during tissue diagnosis?
Definitive answer is reached
Biopsy
Cytology, of FNA, body fluids, e.g. pleural effusion
What are the three types of biopsy?
Minimally invasive, e.g. fibreoptic bronchoscopy
Invasive, e.g. CT-guided needle biopsy OR open surgery/VATS/frozen section
What happens during a frozen section biopsy?
Immediate tissue diagnosis
Useful during surgery
Fresh tissue is frozen, unfixed, stained and examined in minutes
Result is telephoned to surgery
Diagnosis can be prognostic, true or false?
True
Diagnosis can be predictive, true or false?
True
How might tissue diagnosis change in the future?
Molecular tests/biomarkers will become increasingly important: currently direct therapy and have a growing diagnostic role
Role of H&E staining is diminishing
May be some alternatives to tissue biopsy, e.g. liquid biopsy
What are the technical challenges of a liquid biopsy?
Isolation of material
DNA sequencing apporach
Interpretation of data
No ‘dictionary’
What is the main controvery surround liquid biopsies?
Is imaging and blood tests as good as a tissue biopsy?
What is a liquid biopsy?
Tumour DNA can be detectable in the bloodstream from circulating tumour cells and cell-free DNA
Specific mutations are detectable
What is an accurate diagnosis essential for?
Prognosis and therapy
What is the hierarchy of cancer investigations?
GP, radiologist, physician, surgeon, pathologist
Diagnostic tests are no longer improving, true or false?
False, they are improving
Molecular tests are becoming ubiquitous, true or false?
True
What do more treatments and more effective treatments mean about testing?
More complexity of testing
What is the current cancer staging model?
TNM
In cancer staging, what is T in the TNM model?
‘Tumour’
Size and which tissues are involved
In cancer staging, what is N in the TNM model?
‘Nodes’
Is there regional nodal metastasis? Which groups of nodes are involved?
In cancer staging, what is M in the TNM model?
‘Metastasis’
Distant site involvement
Does cancer stage indicate prognosis?
Yes
Fundamentally, what does staging determine?
Whether a treatment is curative in intent (surgical or medical therapy needed)
What is correct cancer staging essential for?
Giving the best treatment as both over and under treating is bad for the patient
The staging criteria are set in stone, true or false?
False, they are always under review as ‘curability’ varies over time
Describe ‘personalised’ biological therapies
Small molecules/antibodies that target sensitive subgroups of tumours
Treatment must be matched to case using biomarkers and sequencing/FISH/IHC on tumour material
Give examples of some ‘personalised’ biological therapies
Tamoxifen, herceptin, tyrosine kinase inhibitors
What is cancer staging?
It describes how far the disease has progressed using tumour size and its spread within the body
Prognostic and guides therapy
How is clinical staging formulated?
From examination and imaging
How is pathological staging different from clinical staging?
Pathological staging is more precise and depends upon prior surgery
Describe the cancer staging criteria
Number system vs. TNM system
Highly detailed, organ-specific
Regularly updated
What is the purpose of the multidisciplinary team meetings (MDT)?
To discuss new diagnoses of malignancy and post-surgery management
One per speciality
Who is involved in the MDT meetings?
The whole clinical team…
Physicians, surgeons, radiologist, pathologist, oncologist, specialist nurses, radiotherapist, MDT coordinator, palliative care specialist etc.
What happens at an MDT meeting?
Each case is presented, correlated with imaging, pathology, nursing needs
Clinical plan is formulated
