grading, staging and classification

Question 1

why classify tumours?

Answer 1

because tumours differ in:

• cell origin and therefore distribution
• behaviour

helpful in clinical presentation, prognosis and treatment

Question 2

tumour grading

Answer 2

is a measure of the RATE of tumour growth based on histology

Question 3

what are the 3 different factors taken into account when grading breast tissue

Answer 3

• differentiation
• nuclear changes
• mitotic activity

Question 4

tumour staging

Answer 4

is the measure of the EXTEND of tumour based on clinical, radiological and pathological features

Question 5

Difference between grading and staging

Answer 5

Rate x Duration = extend

grading = rate of growth
staging = extend of growth

Question 6

TNM staging

Answer 6

T = extend of tumour
N = lymph nodes involved
M = metastasis

Question 7

spread of cancer

Answer 7

local spread 
&
metastasis 
-lymphatic spread
- venous spread
- serosal cavities
- nerves

Question 8

carcinomas

Answer 8

• most common malignant tumours
• cancers originating from epithelial tissues
• preceded by in situ growth phase
• cytokeratin positive
• spread to lymph nodes, bone, viscera
  treatment mainly surgical

Question 9

spread to bone

Answer 9

• pathological fracture
• hypercalcaemia
• pain

Question 10

benign epithelial tumours

Answer 10

• adenomas, in glands
• morphology (regular tight packed cells)
• some are premalignant

Question 11

Melanocytic tumours

Answer 11

common tumours of the skin, also other sites
- benign (Naevi) and malignant (melanoma)
- arise during embryogenesis from the neural crest
- can define in situ phase for melanoma (unlike CT tumours)
- spread via lymphatics and blood stream
- morphology = cytokeratin negative, S100 positive
treatment mainly surgical

Question 12

connective tissue tumours

Answer 12

• cannot define in situ pahse
• spread via blood stream, mainly to lungs
• sarcomas rare, benign tumours common
• mainly cytokeratin negative
• spindle shape under microscope
  treatment = surgery + radiation + chemotherapy

Question 13

lymphomas

Answer 13

• all malignant
• no in situ phase
• spread to other lymph nodes
• cytokeratin negative
• leukocyte common antigen positive
• can be Hodgkin’s or non-Hodgkin’s, and B cells
  treatment = chemotherapy + radiotherapy

Question 14

Hodgkin’s lymphoma

Answer 14

characterized by a multinucleated cell called:

reed-Sternberg cell

Question 15

Non-Hodgkin’s lymphoma

Answer 15

small cell = low grade
-go for a long time, usually incurable

large cell = high grade
- some can be treated and cured by chemotherapy

Question 16

Leukaemia

Answer 16

• uncommon
• only malginant type
• no in situ phase
• bone marrow
  treatment = chemotherapy

Question 17

the most aggressive cancers present with

Answer 17

undifferentiated
poorly differentiated
anaplastic (de-differentiated)
pleomorphic (very inrregular nuclear)

Question 18

immunohistochemistry

Answer 18

• cytokeratin = carcinoma
• leukocyte common antigen = lymphoma
• S100 = melanoma