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4/ CAN > Lecture 11 - Role of Pathology in Diagnosis and Management of Neoplastic Disease > Flashcards

Lecture 11 - Role of Pathology in Diagnosis and Management of Neoplastic Disease Flashcards

1
Q

What does a pathologist do?

A
  • a person who examines and provides reports on specimens from living people
  • a medically qualified prison who specialises in pathology as a postgraduate subject
  • a person who does post mortems
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2
Q

A knowledge of pathology helps to explain…

A

the clinical features and natural history of most common diseases

  • in order to understand changes in disease tissues, one needs to know about normal tissues biology
  • also important for prognosis and treatment
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3
Q

What 4 things are involved in the role of pathology in the diagnosis and management of neoplastic disease?

A
  1. understanding tumour pathology and pathological assessments
  2. types of specimens received
  3. techniques used: gross/microscopic, immunohistochemistyr, molecular biology
  4. pathology as a clinical discipline (including MDT meetings)
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4
Q

Why is an understanding of tumour pathology important? x3

A
  1. clinical presentation and natural history
  2. terms used to classify neoplasms and their clinic relevance
  3. treatment options
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5
Q

Describe briefly 3 differences between benign and malignant lumps

A 
Benign = smooth, well circumscribed and mobile 
Malignant = irregluar, poorly-defined, may be fixed to adjacent tissues
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6
Q

Clinical assessment of breast lumps:

  • describe a fibroadenoma
  • describe a breast carcinoma
A 
Fibroadenoma
- commonest benign breast neoplasm 
- mostly occur in younger women 
- smooth, well circumscribed, highly mobile of palpation 
Breast carcinoma 
- commonest malignant breast neoplasm 
- mostly occur in older women 
- irregular, poorly circumscribed, rarely mobile on palpation (due to local invasion)
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7
Q

How can neoplasms be classified in terms of their origin/differentiation?

A
  • most malignant neoplasms are epithelial

- most benign neoplasms are mesenchymal

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8
Q

In which layer do majority of colonic neoplasms arise and why?

A

glandular epithelium of mucosa

  • in contract with a high conc of carcinogens
  • high turnover of cells, susceptible to mutations affecting dividing cells
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9
Q

How does clinical presentation differ in colon carcinomas arising the cecum/ascending colon and in the signmoid colon?

A

Cecum/ascending colon
- often polypoid
- rarely cause bowel obstruction
- incidiuous presentation e.g. anaemia, weight loss
Sigmoid colon
- often stenosing
- frequently cause bowel obstruction or paradoxical diarrhoea

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10
Q

What are the 3 types of specimens that can be obtained for pathological assessment?

A
  1. Biopsies
    - endoscopic biopsies e.g. GI tract, bronchus
    - needle biopsies (radiologically guided)
    - punch biopsies e.g. skin
  2. Cytology specimens (cells)
    - smears e.g. cervical
    - endoscopic brushings
    - body fluids
    - fine needle aspiration specimens
  3. Surgical resection specimens
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11
Q

What is the main role of biopsies and cytology specimens?

A
  • mainly taken to confirm a diagnosis of malignant and identify histological type
  • information used to plan further treatment
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12
Q

What are the limitations of biopsying tumours?

A
  • tumour heterogeneity

- targeting the lesion accurately: small lesions, inaccessible, surrounding stromal reaction e.g. pancreatic cancer

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13
Q

What is the advantage and disadvantage of cytology specimens?

A

Advantage
- less invasive
- fine needles are much thinner
- may provide access to sites not suitable for biopsy e.g. pancreas
Disadvantage
- smaller tissue samples provided, interpretation may be more difficult than larger specimens obtained using biopsy

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14
Q

What are the surgical resection specimens used for?

A
  • surgery is intended to be a definitive treatment for cancer, or palliative in some cancers
    Pathological Assessments are used to:
  • confirm diagnosis of malignancy
  • determine the aggressiveness of a tumour (grading)
  • assess the extent of spread (staging)
  • examine completeness of excision
    This info can be used to determine further treatment e.g. adjuvant chemotherapy
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15
Q

Describe the TMN staging method

A 
T = tumour
- size and or extent of spread of primary lesion 
N = nodes
- extend of spread to lymph nodes
M = metastases
- presence/absence of distant metastases
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16
Q

Describe the Duke’s system for staging colorectal cancer

A 
A = confined to submucos/muscle
B = through muscle to serosa
C = lymph node involvement 
D = distant metastases
17
Q

What are the 5 year survival statistics for each stage of Duke’s classification

A 
multiples of 30!
Stage A = 90% survival 
Stage B = 60% survival 
Stage C = 30% survival 
Stage D = >1% survival
18
Q

What can be established on macroscopic assessment of tumour resection specimens?

A 
size, shape
extent of local spread 
proximity to surgical resection margins 
identification of lymph nodes
other e.g. colour, haemorrhage, necrosis
19
Q

What can be established on microscopic assessment of tumour resection specimens?

A 
Confirms of establishes a diagnosis or cancer 
Features that are assessed include:
- histological type (glandular, squamous)
- degree of differentiation (grading)
- frequency of mitosis 
- local invasion (staging 
- vascular invasion 
- examination of lymph nodes
20
Q

What is included in the Royal College of Pathologist’s minimum datasets for reporting cancers?

A
  • prognostic information
  • accurate date for caner registration
  • feedback on the quality of resection
  • selecting patients for adjuvant therapy (including clinical trials)
  • auditing effectiveness of pre-operative staging procedures
21
Q

What are the two features required of a substance used in immunohistochemistry?

A

can binding to a specific marker on cell

has a mechanism of secondary visualisation e.g. fluorescense

22
Q

What are the 3 things that can be derived from immunohistochemistry?

A
  1. establishing a diagnosis of malignancy
    e. g. clonality in lymphoid neoplasms, B and T cells inflitrates
  2. Prognostic markers
    e. g. Ki-67 labelling index for metastatic potential
  3. identifying therapeutic options
    e. g. HER 2 present? perceptive use
23
Q

What is Ki-67 labelling index?

A
  • a stain that may be used to determine low or high metastatic potential
  • most cases well-differentiated by conventional histological criteria and behaviour difficult to predict
  • Ki67 labelling index <2% - low metastatic potential
  • Ki67 labelling index >20% - high metastatic potential
24
Q

What are the 2 molecular techniques?

A
  1. in situ hybridisation
    - probes recognising RNA and DNA can be applied to tissue sections
    - e.g for kappa and lambda chains
    - e.g. EBV virus present
  2. RNA or DNA extracted from fresh or paraffin embeddd samples of tumour tissue
25
Q

What is post-transplant lymphoproliferative disease?

A
  • spectrum of lymphoproliferative disease occurring in the setting of immmunosupression
  • range from polyclonal lymphoid hyperplasia to monoclonal malignant lymphoma
  • majority related to infected with EBV
  • virus infects B lymphocytes, remains in latent phase, controlled by EBV- specific T cell response
  • immunosuppressive drugs interfere with T cell function and enable uncontrolled division of EBV infected B cells
  • most cases present during first 12 moths post traplant - focal mass or diffuse infiltrates
26
Q

What is the role of the MDT?

A
  • many important decisions relating to the diagnosis and treatment of malignant neoplasms now take place in the setting of MDT meetings
  • core members include: histopathologists, radiologists, surgeons, oncologists, other HCPs
  • the presence of recognised MDT meetings and regular attendance by core members is now a requirement in order for a hospital to be recognised as a Cancer Treatment Centre
  • regularly monitored by Cancer peer Review Teams

4/ CAN (39 decks)

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