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
