L14: Pathology Of Cancer- Management Flashcards
When we classify neoplasms into benign what are the features of benign
Smooth
Well circumscribed
Mobile
When we classify neoplasms as malignant what are the features of malignant
Irregular
Poorly defined
Fixed to adjacent structures
For example what are the 2 classifications of breast lumps
Fibroadenoma- benign
Breast carcinoma- malignant
What are the fibroadenoma features
Smooth
Well circumscribed
Mobile
What are the features of breast carcinoma
Irregular
Poorly circumscribed
Rarely moves on palpation
Tethered to other tissue
Why does the majority of cancer arise from epithelial cells n the mucosa layer
- It is a region exposed to high concentration of carcinogen
- It has a high rate turnover so the rate of mutation is higher
What are the sites of colon carcinoma
Ascending Colon
Sigmoid colon
What is the clinical presentation of colon carcinoma at the ascending colon
Often polyploid
Rarely causes bowel obstruction
Anaemia
Weight loss
What is the clinical presentation of sigmoid colon carcinoma
Often stenosing
Bowel obstruction
Alteration in bowel habit e.g diarrhoea as only liquid can pass the narrowing
What are the 3 types of specimens we can collect
1) biopsy
2) cytology specimen
3) surgical resection specimen
What are biopsy
Removing a small piece of tissue
What do cytology specimens collect
Cells
How are cytology specimens obtained, give examples
Smears
Endoscopic brushing
Body fluid
Fine needle aspiration
What does surgically resected specimen O’Brien
Removes all cancer
What are the limitations to biopsy
- Tumour heterogeneity- different parts of the tumour may have a different appearance and this may be missed as we collect a small piece
- targeting the lesion accurately is difficult if the lesion is small, inaccessible, surrounding stromal reaction
What is surgical resection of tumour also a method of
Treatment of cancer
What is the less invasive method for obtaining a specimen
Cytology specimen
What are the disadvantages of cytology specimen
Specimen can be small
Reminder: what is grading about
The degree of differentiation
Reminder: what is staging about
The extend of the spread
When we use the TNM staging system, what is T and how is it scored
T- tumour size from 1 to 4 (increasing size)
What is N in the TNM staging
Nodes: extent of lymph node spread
What is M in the TNM stage and how is it scored
Metastasis scored 0=no metastasis or 1=metastasis
When we get a tumour resection sample what do we look
Macroscopic assessment
Microscopic assessment
In a macroscopic assessment what do we look at
Size
Shape
Extent of local spread
Identity of lymph nodes
In a microscopic assessment what do we look for
Historical type Grade Frequency of mitosis Local invasion- to determine benign or malignant Vascular invasion Lymph node
What is immunohistochemistry
Identifying a specific tumours antigen by developing fluorescently tagged antibodies that bind to the antigens
What are the 3 reasons immunohistochemistry can be used
1) Establish a diagnosis malignancy
2) used a prognostic marker
3) identify therapeutic options as expression of a specific antigen can be targeted
What is in-situ hybridisation
Applying probes that recognise DNA or RNA sequences
When is in situ hybridisation commonly used
EBV related neoplasms
Name a EBV repeated neoplasms
Post transplant lymphoproliferative disease
What is post transplant lymphoproliferative disease
Patients that receive organ transplant are on immunosuppressive drugs and EBV can therefore affect to the B lymphocytes
What are nucleic acid molecular techniques
When you take out a sample of tissue and look at the nucleic acid sequence
By looking at the nucleic acid what can be identified
Immunoglobulin genes
Specific gene mutations that allow for personalised medicine
