Lecture 22: Histopathology case studies / Neoplastic phenotype 2

Question 1

What is meant by prognosis?

Answer 1

1. Prediction of probable outcome of a disease based on:
   a. individuals condition
   b. Usual course of disease in similair situations
2. Important neoplastic diseases:
   a. Benign neoplasms: usually good prognosis
   b. Malignant neoplasms: prognosis variable

Question 2

What does the prognosis depend on in neoplastic disease?

Answer 2

1. Type of neoplasm
   a. Grade
   b. Stage
   c. Functional characteristics
   d. Complications of the neoplasm or its therapy
2. Effectiveness of treatment available
3. Co-morbidity (other, co-existing diseases)
   a. Chronic heart, lung, kidney disease, etc

Question 3

What is meant by grade and stage of neoplasms?

Answer 3

1. Grade (Differentiation of a neoplasm)
   a. “How similar or different from equivalent normal
   cells/architecture”
   b. Usually 2-3 grades, somtimes 4
2. Stage (how advanced the neoplasm is)
   a. Size
   b. Extent of local invasion
   c. Presence and extent of metastases (lymph node/distant sites)

Question 4

Are benign neoplasms graded?

Answer 4

No, only malignant

Question 5

What does determining the stage of a neoplasm determine?

Answer 5

1. Extent or severity of malignant neoplasm
2. This helps:
   a. Plan treatment (taking account of patients wishes and co-
   morbidity)
   b. Estimate the prognosis

Question 6

What is the TNM Staging System?

Answer 6

1. Local extent of ‘primary Tumour’ (T)
2. Have cancer cells spread to nearby ‘lymph Nodes’ (N)
3. Is there ‘distant Metastasis’ (M)

Question 7

Explain the grading and staging of bladder cancer as an eg

Answer 7

1. Most bladder cancer shows urothelial differentiation (urothelial
   carcinoma)
2. Often shows blood in urine, also may result in frequent, urgent,
   uncomfortable urination
3. Two grades of carcinoma:
   a. low-grade
   b. high-grade
4. Tumour stages:
   a. Tis
   b. Ta
   c. T1
   d. T2
   e. T3
   f. T4
5. Lymph node stages:
   a. N0
   b. N1
   c. N2
   d. N3
6. Distant metastasis stages:
   a. M0
   b. M1
7. Different groups
   a. Stage group 1, 2, 3, 4
8. Survival rates in men:
   a. 5-year net survival (56.1% 2013-2017) (58.6% 2012-2016)
   b. a decrease in survival rates can be seen
   c. why? maybe shortage of Bacille Calmette-Guerin (BCG)
   d. Used to treat higher-risk bladder cancer patients

Question 8

What are tumour markers?

Answer 8

1. Aids diagnosis: increasingly important to histopathologists and
   haematologists
2. Prognostic factors: may help define therapy
3. Targets for therapy: adds specificity to therapy

Question 9

What are examples of tumour markers?

Answer 9

1. Oestrogen receptor (ER) in breast cancer
2. Epidermal growth factor receptor (HER2) in breast cancer

Question 10

Explain histopathological diagnosis of neoplasms

Answer 10

Why might this be challenging?
1. Poor differentiation of the tumour
2. Tumour necrosis
3. Tumour mimicry - malignant melanoma
4. Rare tumours
5. Unusual site of origin
6. Primary v. metastatic tumour

7. Benign tumours can mimic neoplasms:
   a. inflammatory / reparative conditions
   b. Drug effects
   c. Radiotherapy
   d. Hyperplasias

Question 11

What dies therapy look like?

Answer 11

Based on:
1. Tumour types
2. Grade & stage
3. Tumour markers

Takes into account co-morbidity and life expectancy

Patients wishes important

Question 12

What is the multidisciplinary team (MDT)?

Answer 12

1. Surgeon
2. Radiologist
3. Pathologist
4. Medical oncologist / radiation oncologist
5. Cancer care nurse
6. Supportive and palliative care specialist

Question 13

How can we improve cancer therapies?

Answer 13

1. Prevention - public education
2. Earlier diagnosis - public education, better healthcare access, GP
   training
3. Continue to improve diagnostic methods
4. Continue to improve therapies