grading and staging of tumours Flashcards
what is meant by grading of a tumour
degree of differentiation (how similar it is to its tissue of origin) can only be assessed histologically
what is meant by the stage of a tumour
extent of tumour spread
what is grade 1 tumour
well differentiated, resembles the tissue of origin
tend to behave less aggressively
how is grading of a tumour assessed
can only be assessed histologically
how can we assess stage of a tumour
tissue biopsy
or
imaging
methods of tissue biopsy that can be used to asses stage of a tumour
FNA, endoscopic biopsy, excision biopsy
methods of imaging that can be used to asses stage of a tumour
xray, ultrasound, CT, MRI
5 ways in which tumours can spread
1 - directly into adjacent tissue 2 - into lymphatics 3 - via blood vessels 4 - along nerves 5 - across coelomic cavities
what are the three types of staging systems used clinically
TNM -> Most common
Dukes -> used for colorectal carcinoma
Ann Arbor -> for Hodgkin’s lymphoma
what is the TNM staging system
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
clinical treatment if tumour shown by mammogram but no discrete mass identified
mostly lumpectomy
or mastectomy if lumpectomy not clear
presentation of stage 4 breast tumour
appears as peau d’orange
what staging system is used for colorectal cancer
duke’s staging system, which measures spread through bowel wall and into the nodes
what are the stages in duke’s staging system
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)
what staging system is used in Hodgkins lymphoma
Ann Arbor staging system
uses # of groups of lymph nodes that have been invaded
what are the stages of the Ann Arbor staging system
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)
effect of chemotherapy on tumour stage and prognosis
may modify stage (ideally reduce stage)
BUT prognosis of the patient is determined by the stage of the tumour PRIOR to treatment.
what are the main factors involved in predicting tumour prognosis
classification (histological subtype), grade, stage, molecular features, site of tumour, production of ECM, hormone secretion, host reaction to tumour
what is the significance of production of ECM of a tumour
is called desmoplastic reaction. enhances tumour spread and makes it harder for chemotherapeutic drugs to reach the tumour
what is a desmoplastic reaction
production of ECM due to presence of tumour.
what is a desmoplastic stroma
is a hypovascular environment produced in response to the neoplasm which promotes tumour growth and invasion
clinically how do we treat tumours with desmoplastic stroma
target the stroma with synthetic anti-MMP this may permit better access for chemotherapeutic drugs
why is the host reaction to the tumour signifiant
A lymphocytic response helps regress melanomas
- tumours more aggressive in immunocompromised patients
what is cachexia
wasting syndrome is loss of weight, muscle atrophy, fatigue, weakness, loss of appetite
