Grading and staging Flashcards
What is the difference between grading and staging?
Grading of a neoplasm uses information about the differentiation status of the cell while staging uses information about the extent and spread of the tumour
What is grading based on?
The degree to which the neoplasm resembles the tissue of origin through use of microscopic observation under H and E staining
What is the numeric system used for grading tumours?
G1= well differentiated G2= moderately differentiated G3= poorly differentiated Gx= Grade cannot be assessed due to poor quality of biopsy material
What microscopic changes in the nuclei of malignant neoplastic cells can be observed?
Pleomorphism (variation of the size and shape), Hyperchromasia (alteration in staining as increased amounts of DNA results in more intense staining), altered nuclear/cytoplasmic ratio, aneuploidy, aberrant mitoses
What are tumour biomarkers that can be seen in the serum?
Carcinoembryonic antigen, alpha-fetoprotein, human chorionic gonadotropin and prostatic acid phosphatase
What are the three main factors that the stage is based on for epithelial tumours?
Tumour size and number of tumours
Lymph node involvement
Presence or absence of metastasis
How are neoplasm of the brain and spinal cord classified?
Cell type and grade
How are haematological malignancies staged?
As there is no solid tumour bulk a different system is used the Rai system
What is the most common system of staging epithelial malignancy?
The TMN classification where the T is based on the size and /or extent of tumour
N is based on the extent of lymph node involvement
M is based on if distant metastases are present
What are the different T scores in the TMN classification system?
Tis= Tumour in situ, non invasive
T1= Small, minimally invasive within primary organ site
T2= Larger, more invasive within the primary organ site
T3= larger and/or invasive beyond the margins of the primary organ site
T4 very large and very invasive spreading to adjacent organs
What are the different N scores in the TMN classification system?
N0= No lymph node involvement N1= Regional Lymph node involvement N2= Extensive regional lymph node involvement N3= more distant lymph node involvement
What are the different M scores in the TMN classification system?
M0= No distant metastases M1= Distant metastases present
What are the different grades in the WHO system?
WHO grade I: lesions with low proliferative potential, a frequently discrete nature which can be resected
WHO grade II: lesions that are generally infiltrating but low in mitotic activity which can be resected but may recur
WHO grade III: High mitotic activity, clearly infiltrative and anaplastic and therefore malignant
WHO grade IV: Lesions that are mitotically active, necrotic and with rapid progression
What are the different stages in the Rai system used for leukemia?
Rai stage 0: >10,000 lymphocytes per mm3, lymph nodes spleen and liver are not enlarged and erythrocytes and platelet counts are near normal
Rai stage 1: lymphocytosis plus enlarged lymph nodes, spleen and liver are not enlarged, erythrocyte and platelet counts are near normal
Rai stage 2: Lymphocytosis plus an enlarged spleen (and possibly liver), with or without enlarged lymph nodes, erythrocyte and platlet counts are near normal
Rai stage 3: Lymphocytosis plus anemia, with or without enlarged lymph nodes, spleen or liver, platelet counts are near normal
Rai stage 4: Lymphocytosis plus thrombocytopenia, with or without anemia, enlarged lymph nodes, spleen or liver
What are the effects of neoplasia on the body?
Neoplastic masses may impinge on a vital area of the body obstructing or destroying it suich as airways, nerves or blood vessles
Local destruction may be caused due to invasion or lysis of epithelial surfaces/ vascular channels leading to ulceration, bleeding and risk of infection
