Diagnosis and Staging Flashcards
T/F all cancers have screening modalities
F
Two thirds of all cancer cases are those _____
> 65 yo (1 in 3 men, and 1 in 4 women > 70 yo)
How does suspicion of cancer arise?
● Pull in elements from history and physical exam
● Duration of symptoms and chronicity
● Family history
● Social History
● Review of systems
Examples of subtle (or not so subtle) symptoms of cancer
● 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?
Overall Melanoma incidence
● 32:100,000 Caucasion
● 4.7: 100,000 Hispanic
● 1.1 :100,000 African Americans
Subungal melanoma
Black stripe on nail.
Acral melanoma is found
On the bottom of the foot
In nearly every case ____ is required for diagnosis
tissue biopsy
Excisional biopsy-
- 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
_____- involves removing a piece of the
tumor
Incisional biopsy
_____ - takes less tissue
Core-needle biopsy
____ - more limited (cell suspension)
Fine-needle aspiration
“Negative” result cannot rule out cancer definitively
In addition to their mass, a tumor can also alter _____ of the tissue affected
function
Cytologic Sampling
: ie. cell sampling
● Allows for a less invasive method for sample collection
● Cells are evaluated within a fluid
Examples of cytologic sampling
● Aspiration of a cystic tumor
● Abnormal fluid analysis (pleural or
ascitic fluid)
● Normal fluid analysis (urine, CSF)
● Washing (bronchial, bladder)
Pathologic Sampling
: 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)
Examples of Pathologic Sampling
● CT or US guided needle biopsy
● Endoscopic sampling
● Needle biopsy by physical exam
● Surgical biopsy
These cancers do not produce
solid tumors like other malignancies
Hematologic malignancies, such as
Leukemias, Multiple Myeloma, and
Myelodysplastic Syndromes
Allows visualization of the blood cell types
CBC with a peripheral blood smear
Genes of the tumor
● Oncogene expression
● Drug resistance genes
● Apoptosis- related genes
● Genes associated with metastasis
Clinical vs. Pathological staging
● Clinical Staging
○ Physical exam, radiographs and imaging
● Pathologic Staging
○ Based on inspection during surgery and biopsy via histology, including resection of lymph nodes
Tumor Node Metastasis (TNM) Staging
● 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)
Staging leads to _____
information about Prognosis
Ideally, Nodal Staging should occur at the time of ____
surgical resection if surgery occurs
Metastatic Spread features
● Distant sites
● Often locations of metastasis can be
predicted based on tendency of
specific cancers to spread to common
adjacent or distant sites
TX:
Main tumor cannot be measured
T0
Main tumor cannot be found
T1, T2, T3, T4
refers to the size and/or extent of the main tumor
NX
Cancer in nearby lymph nodes cannot be measured
N0
No cancer found in nearby lymph nodes
N1, N2, N3
refers to the number and location of the
lymph nodes
MX
Metastasis cannot be measured
M0
Cancer has not spread to other parts of the body
M1
Cancer has spread to other parts of the body
What are the ways we look for cancer?
● Plain X-ray
● CT Scan
● Ultrasound
● Nuclear Medicine eg. Bone Scan
● Positron Emission Tomography (PET)
● MRI
● Endoscopy w/ biopsy possible
CT is best used for
■ Chest
■ Abdomen, liver, pancreas, etc
■ Brain
■ Lymph nodes
■ And many others
Ultrasound is best used for
○ Liver
○ Breast
○ Ovaries
○ Many other areas
Bone Scan
● Nuclear medicine scan that utilizes a radioactive tracer that is injected
● Scans the entire skeleton for increased tracer uptake
Positron Emission Tomography (PET)
● 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
What scan is this?
Bone scan
What imaging is this?
PET
Why might combining PET with MRI or CT be a good idea?
Can help make the images easier to interpret
MRI imaging is used for
○ CNS
○ Soft tissue
○ Amongst many others
