Diagnosis and Staging

Question 1

T/F all cancers have screening modalities

Answer 1

F

Question 2

Two thirds of all cancer cases are those _____

Answer 2

> 65 yo (1 in 3 men, and 1 in 4 women > 70 yo)

Question 3

How does suspicion of cancer arise?

Answer 3

● Pull in elements from history and physical exam
● Duration of symptoms and chronicity
● Family history
● Social History
● Review of systems

Question 4

Examples of subtle (or not so subtle) symptoms of cancer

Answer 4

● Dyspnea on exertion from anemia caused by leukemia
● Cough from lung cancer
● Jaundice from tumors along the hepatobiliary tree
● Seizures from brain tumors
● Bleeding or diarrhea from colon cancer
● Bleeding from blood coagulation abnormalities
● Hormonal disturbance from an endocrine tumor
● Symptoms of primary tumor or metastasis?

Question 5

Overall Melanoma incidence

Answer 5

● 32:100,000 Caucasion
● 4.7: 100,000 Hispanic
● 1.1 :100,000 African Americans

Question 6

Subungal melanoma

Answer 6

Black stripe on nail.

Question 6

Acral melanoma is found

Answer 6

On the bottom of the foot

Question 7

In nearly every case ____ is required for diagnosis

Answer 7

tissue biopsy

Question 8

Excisional biopsy-

Answer 8

• is preferred (entire tumor)
  Effort is made to take an area of normal tissue at the margin. This helps to ensure the whole cancer is removed

Question 9

_____- involves removing a piece of the
tumor

Answer 9

Incisional biopsy

Question 10

_____ - takes less tissue

Answer 10

Core-needle biopsy

Question 11

____ - more limited (cell suspension)

Answer 11

Fine-needle aspiration
“Negative” result cannot rule out cancer definitively

Question 12

In addition to their mass, a tumor can also alter _____ of the tissue affected

Answer 12

function

Question 13

Cytologic Sampling

Answer 13

: ie. cell sampling
● Allows for a less invasive method for sample collection
● Cells are evaluated within a fluid

Question 14

Examples of cytologic sampling

Answer 14

● Aspiration of a cystic tumor
● Abnormal fluid analysis (pleural or
ascitic fluid)
● Normal fluid analysis (urine, CSF)
● Washing (bronchial, bladder)

Question 15

Pathologic Sampling

Answer 15

: ie. tissue sampling
● Allows for a larger sample to be obtained,
increasing the chance of making the diagnosis
● Hematoxylin and Eosin Stain (H&E Stain)

Question 16

Examples of Pathologic Sampling

Answer 16

● CT or US guided needle biopsy
● Endoscopic sampling
● Needle biopsy by physical exam
● Surgical biopsy

Question 17

These cancers do not produce
solid tumors like other malignancies

Answer 17

Hematologic malignancies, such as
Leukemias, Multiple Myeloma, and
Myelodysplastic Syndromes

Question 18

Allows visualization of the blood cell types

Answer 18

CBC with a peripheral blood smear

Question 19

Genes of the tumor

Answer 19

● Oncogene expression
● Drug resistance genes
● Apoptosis- related genes
● Genes associated with metastasis

Question 20

Clinical vs. Pathological staging

Answer 20

● Clinical Staging
○ Physical exam, radiographs and imaging
● Pathologic Staging
○ Based on inspection during surgery and biopsy via histology, including resection of lymph nodes

Question 21

Tumor Node Metastasis (TNM) Staging

Answer 21

● Tumor size
○ 1-4 (Higher score equates to larger tumor)
● Nodal Involvement
○ N0 (absent) and N1 (present), N2
● Metastatic disease
○ M0 (absent) and M1 (present)

Question 22

Staging leads to _____

Answer 22

information about Prognosis

Question 23

Ideally, Nodal Staging should occur at the time of ____

Answer 23

surgical resection if surgery occurs

Question 24

Metastatic Spread features

Answer 24

● Distant sites
● Often locations of metastasis can be
predicted based on tendency of
specific cancers to spread to common
adjacent or distant sites

Question 25

TX:

Answer 25

Main tumor cannot be measured

Question 26

T0

Answer 26

Main tumor cannot be found

Question 27

T1, T2, T3, T4

Answer 27

refers to the size and/or extent of the main tumor

Question 28

NX

Answer 28

Cancer in nearby lymph nodes cannot be measured

Question 29

N0

Answer 29

No cancer found in nearby lymph nodes

Question 30

N1, N2, N3

Answer 30

refers to the number and location of the
lymph nodes

Question 31

MX

Answer 31

Metastasis cannot be measured

Question 32

M0

Answer 32

Cancer has not spread to other parts of the body

Question 33

M1

Answer 33

Cancer has spread to other parts of the body

Question 34

What are the ways we look for cancer?

Answer 34

● Plain X-ray
● CT Scan
● Ultrasound
● Nuclear Medicine eg. Bone Scan
● Positron Emission Tomography (PET)
● MRI
● Endoscopy w/ biopsy possible

Question 35

CT is best used for

Answer 35

■ Chest
■ Abdomen, liver, pancreas, etc
■ Brain
■ Lymph nodes
■ And many others

Question 36

Ultrasound is best used for

Answer 36

○ Liver
○ Breast
○ Ovaries
○ Many other areas

Question 37

Bone Scan

Answer 37

● Nuclear medicine scan that utilizes a radioactive tracer that is injected
● Scans the entire skeleton for increased tracer uptake

Question 38

Positron Emission Tomography (PET)

Answer 38

● Another Nuclear Medicine scan that obtains physiologic images by detecting positrons emitted after the patient is injected with a tracer
● Measures area of increased metabolic
activity

Question 39

What scan is this?

Answer 39

Bone scan

Question 40

What imaging is this?

Answer 40

PET

Question 41

Why might combining PET with MRI or CT be a good idea?

Answer 41

Can help make the images easier to interpret

Question 42

MRI imaging is used for

Answer 42

○ CNS
○ Soft tissue
○ Amongst many others