Classification, Grading and Staging Flashcards
Causes of Enlargement
Inflammatory Hyperplastic Non-neoplastic Cyst Neoplastic = specimen from Mass
Microscopic diagnosis of malignancy
Cells relationship Invasion Nucleus: - increased nuclear staining due to increased DNA present - nucleus size variation - mitotic activity
Tumour diagnosis
Dependant on Histological findings
Modified by
-Special tests (e.g. looking for antigen)
Immuno-peroxidase methods
-Chromosomal Analysis doing FISH or Molecular techniques with actual DNA
Recent classification of CNS tumours
chromosomal abnormalities really important in diagnosis
Mutants in wildtype
Monoclonality
PArticular groupd of cells all deriving form one cell
-important in neoplasia
-e.g. chromosomal abboration in all cells of the tumour all originating form one cell
If you show a collection of cells is monoclonal, good evidence for neoplasm
Monoclonal= Neoplastic
In some situations Monoclonal = Malignant
-But mainly Malignant is Multi-clonal/Polyclonal (increased cel replication therefore more susceptible to mutation)
Monoclonality re Leukemia or Lymphoma
Leukemia or Lymphoma not solid
-cannot be benign
If you can show that the collection of cells is monoclonal (all originating from one cell) –> is equivilant to malignant
Multiple Myeloma
A Malignant neoplasm of plasma cells
-not normally in big numbers in bone marrow, but do arise in bones
-top of skull can be a eroded out by a collection (collections can destroy bones)
Produces a single antibody molecule (specific with specific affinity)
-if becomes neoplastic then all will produce same chemical/antibody
Conduct Electrophoresis on plasma: (separate out into a, b, and y globulin antibodies)
Monoclonal kappa-light chain producing population
Y gamma Monoclonal band (sharp peak because all been produced by one cell, all chemically the same)
Suppressed normal y globulin
-dense collection of plasma cells in bladder. Staining for chains. Treated for neoplasm.
-can also use lymph nodes and use fluids, mark for Kappa or Landa chains or other antigens, and determine whether major population is monoclonal.
Why Classify Tumours?
Because Tumours differ in:
- Cell of origin (therefore Distribution)
- Behaviour
- -> and therefore:
a. Clinical Presentation
b. Prognosis
c. Treatment
Tumour Grading Definition
A measure of the RATE of tumour growth based on tumour histology
-e.g. in breast
Tumour Grading
Breast: 3-9 2-5 Grade 1 -resembles glands of normal breast (round and open) 5-6 Grade 2 -merging together, few lumen, nuclei more irregular 7-9 Grade 3 -no tubules -nuclei large and open, big nulceoli with mitotic activity 1. Differentiation 2. Nuclear Changes -pleomorphism -enlargement -hyperchromasia 3. Mitotic Activity
Tumour Staging
A measure of the EXTENT of tumour growth based on clinical, radiological and pathological features
- clinical (breast carcinoma fixed to skin, tumour is growing into derm)
- radiological (lymph nodes)
- pathological
Grading and Staging
Extent= Rate x Duration
Rate of Growth measures (grading)
Extent of Growth measures (staging)
Rate of Growth measures (Grading)
(Pure) Histological grading Tumour Infiltrating Lymphocytes Cytogenic Changes Proliferation indices (how many mitoses/cells seen to be active proliferation) Suppressor-/ Oncogenes
Extent of Growth measures (Staging)
- Stage
- clinical
- radiological
- pathological - Serum Markers (proteins produced in large amounts by tumours, identifies extent of tumour)
- e.g. PSA prostate specific antigen of ten Cancer. 50 likely to be Metastatic
TNM staging system
T for Tumour (characterisitcs - size, structures it has invaded)
N for Nodal metastasis (lymph)
M for distant Metastasis (not nodal)
AJCC stage equivilant
T1= in submucosa Dukes stage A= AJCC Stage I (T2N0Mx) Dukes stage B= AJCC Stage II (T3N0Mx) Dukes stage C= AJCC Stage 1 (T3N1Mx) P= pathological R= radiological/Clinical stage
Spread of Cancer
Local Spread (continuous with main tumour)–> fat and neighbouring organs
Metastasis
-Lymphatic spread
-Venous Spread
-Serosal Cavities (e.g. Peritoneum)
-Nerves (e.g. salivary gland or prostatic tumours)
Spread of Cancer Lympahtics
Lymphatic vessel Lymph node Macroscopic apparent Lymphatic Spread: -can see tumour on surface of serosa Lung: Lymphangitis Carcinoma Breast: Peau d'orange -rigid -unnatural falling --> tumour has invaded into dermis, blocking some lymphatic channels -orange peel appearance, skin become oedematis, dips=hair follicles go in, stopping swelling (lymphatic blockage)
Spread to Bone
Common
esp. for Axial skeleton (spine , prox limbs)
Multiple myeloma
-Pathological Fracture (little movement breaks weakened bone)
-Hypercalcaemia (high blood calcium levels due to massive destruction of bone
-Pain (collapse of vertebrae, erosion, microfractures) - important for treating cancer patients
