grading and staging of tumours

Question 1

what is meant by grading of a tumour

Answer 1

degree of differentiation (how similar it is to its tissue of origin) can only be assessed histologically

Question 2

what is meant by the stage of a tumour

Answer 2

extent of tumour spread

Question 3

what is grade 1 tumour

Answer 3

well differentiated, resembles the tissue of origin

tend to behave less aggressively

Question 4

how is grading of a tumour assessed

Answer 4

can only be assessed histologically

Question 5

how can we assess stage of a tumour

Answer 5

tissue biopsy
or
imaging

Question 6

methods of tissue biopsy that can be used to asses stage of a tumour

Answer 6

FNA, endoscopic biopsy, excision biopsy

Question 7

methods of imaging that can be used to asses stage of a tumour

Answer 7

xray, ultrasound, CT, MRI

Question 8

5 ways in which tumours can spread

Answer 8

1 - directly into adjacent tissue 
2 - into lymphatics
3 - via blood vessels
4 - along nerves
5 - across coelomic cavities

Question 9

what are the three types of staging systems used clinically

Answer 9

TNM -> Most common
Dukes -> used for colorectal carcinoma
Ann Arbor -> for Hodgkin’s lymphoma

Question 10

what is the TNM staging system

Answer 10

TNM= tumour, nodes, metastases 
tumour = size/depth of spread
nodes = if regional nodes have been invaded N1, if distant nodes N2
Metastases = if non M0, if one M1, if unknown MX

Question 11

clinical treatment if tumour shown by mammogram but no discrete mass identified

Answer 11

mostly lumpectomy

or mastectomy if lumpectomy not clear

Question 12

presentation of stage 4 breast tumour

Answer 12

appears as peau d’orange

Question 13

what staging system is used for colorectal cancer

Answer 13

duke’s staging system, which measures spread through bowel wall and into the nodes

Question 14

what are the stages in duke’s staging system

Answer 14

A = Tumour confined to bowel wall (patients have 80-95% chance of 5yr survival)
B = Tumour invaded through bowel wall but not present in nodes (55-67% 5y survival)
C = Tumour has spread to lymph nodes (30-45% chance of 5yr survival)

Question 15

what staging system is used in Hodgkins lymphoma

Answer 15

Ann Arbor staging system

uses # of groups of lymph nodes that have been invaded

Question 16

what are the stages of the Ann Arbor staging system

Answer 16

Stage I = One node group
Stage II = >1 node group, on the same side of the diaphragm
Stage III = node groups on either side of the diaphragm
Stage IV = non-lymphoreticular organs involved (e.g. liver, lungs)

Question 17

effect of chemotherapy on tumour stage and prognosis

Answer 17

may modify stage (ideally reduce stage)

BUT prognosis of the patient is determined by the stage of the tumour PRIOR to treatment.

Question 18

what are the main factors involved in predicting tumour prognosis

Answer 18

classification (histological subtype), grade, stage, molecular features, site of tumour, production of ECM, hormone secretion, host reaction to tumour

Question 19

what is the significance of production of ECM of a tumour

Answer 19

is called desmoplastic reaction. enhances tumour spread and makes it harder for chemotherapeutic drugs to reach the tumour

Question 20

what is a desmoplastic reaction

Answer 20

production of ECM due to presence of tumour.

Question 21

what is a desmoplastic stroma

Answer 21

is a hypovascular environment produced in response to the neoplasm which promotes tumour growth and invasion

Question 22

clinically how do we treat tumours with desmoplastic stroma

Answer 22

target the stroma with synthetic anti-MMP this may permit better access for chemotherapeutic drugs

Question 23

why is the host reaction to the tumour signifiant

Answer 23

A lymphocytic response helps regress melanomas

- tumours more aggressive in immunocompromised patients

Question 24

what is cachexia

Answer 24

wasting syndrome is loss of weight, muscle atrophy, fatigue, weakness, loss of appetite

Question 25

what drives cancer cachexia weight loss

Answer 25

driven by cytokines including TNF and ILs so will not respond to extra nutrition alone