Neoplastic Behavior Flashcards
What does TNM stand for?
Tumor
Nodes
Metastisis
How bad is the tumor or what it will do to the host is predicted by…(4 things)
Histologic type
Location
Grade
Other prognostic factors
Biologic Behavior Locally:
Primary Effects
Hemorrhage (hemangiosarcoma; bleeds)
Pain (osteosarcoma, neurofibrosarcoma)
Destruction of normal function (hepatocellular carcinoma)
Biologic Behavior Locally:
Secondary Effects
Pathologic fracture
Neurologic deficits
Biologic Behavior Distance:
Secondary Effects (functional tumor)
Pituitary Adenoma
Secretes ACTH
Hyperadrenocorticism
Biologic Behavior Distance:
Secondary Effects (functional tumor)
Pheochormocytoma
Secretes catecholomines
Hypertension
Tachycardia
Biologic Behavior Distance:
Secondary Effects (functional tumor)
Insulinoma
Secretes insulin
Hypoglycemia
Biologic Behavior Distance:
Secondary Effects (functional tumor)
Sertoli cell tumor
Secretes estrogen
Feminization and aplastic anemia
Biologic Behavior Distance:
Secondary Effects (functional tumor)
Thyroid adenoma
Secretes T4
Hyperthyroidism
Biologic Behavior Distance:
Secondary Effects (paraneoplastic disorders)
Hypertrophic Osteopathy
Associated with lung tumors and large abdominal masses
True or False: Patients rarely die from their primary tumor, they die from metastasis
True
Matastasis Cascade
5 Steps
Cell detachment and vascular invasion
Transport and survival in the circulation (evasion of host defense mechanisms)
Aggregation with platelets and fibrin and arrest at new location (tumors often have a place they desire but can get lodged in capillary beds)
Extravasation into the surrounding parenchyma
Establishment of a new growth (angiogenesis)
What is late metastasizing?
Examples
Spread long after primary tumor appears
Slow rate of growth
TVT, sertoli cell tumor, hemangiopericytoma
Early/Rapid metastasizing
Metastasis has occured often before primary tumor is detected
Osteosarcoma, hemangiosarcoma, oral melanoma
Pattern of metastasis
Lymphatic
Carcinomas; travel via lymphatics
Perianal gland carcinomas spread to sublumbar lymph nodes
Pattern of metastasis
Hematogenous
Sarcomas via blood (osteosarcoma to lung, hemangiosarcoma to liver)
Lymph node involvement tends to be poor prognosis (not typical for hematogenous sarcomas)
Pattern of metastasis
Both-round cell tumors
Lymphoma
Mast cell tumors
Histiocytic tumors
What are prognostic factors
What the pathologist should tell you! Diagnosis (hopefully)
Histologic diagnosis
Margins
Invasiveness
Prognostic factors
Invasiveness
Tumors invading the basement membrane, blood vessels, or lymphatics, tend to have poorer prognosis
Prognostic Factors Histology:
Grade (5 things)
Attempt to predict which tumors will metastasize or carry a poorer prognosis
Degree of differentiation (if cannot tell tissue type poor prognosis)
Percent necrosis (higher than rapidly growing)
Invasiveness, presence of markers, vessel invasion
Mitotic index (# mitosis/10 HPF)
Numeric or descriptive
Prognostic Factors:
Mitotic Index
Examples
Generally expressed as number of mitosis/10 high power (40x) field
3 for melanomas
5-7 for mast cell tumors
20 for soft tissue sarcomas (usually do not metastisize)
Prognostic Factors:
Staging
TLM (tumor lymph node metastisis method)
Determination of what the tumor has actually done to the patient at the time of diagnostic – will surgery be curative
Prognostic Factors:
Staging Uses
Aids in prognostication
Aids in treatment planning (surgery only, chemotherapy, radiation, or all 3)
Aids in evaluation of treatment results
Initial workup of mass
5 things
PE and History Always check draining lymph node CBC, Chem, UA Thoracic Rads (if meted than may not be worth further diagnostics) Cytology
What is T-Staging
Tumor evaluation
Could inform you on prognosis Measure it (always) Image it (radiograph, ultrasound -FNA, biopsy-)
T-Staging
Advanced Imaging
Tumor Evaluation
CT scan:
Best for bones and screening for metastasis
MRI
Best for local soft tissue exam
Can help evaluate treatment
What is N-Staging?
Evaluation of Lymph Node
May have to image them
Aspiration:
100% sensitive and 96% specific (cellular changes? inflammation?)
N-Staging
Front Leg
Prescapular
N-Staging
Hind leg below knee
Popliteal
N-Staging
Hind leg above knee, ventral abdomen
Inguinal node
N-Staging
Anal/perianal area
Sublumbar nodes
N-Staging
Lungs
Hilar nodes
N-Staging
Abdomen
Sternal node
M-Staging
How is this accomplished?
Evaluate for metastasis
Where tumor may go depends on tumor histology and grade
Imaging studies: Thoracic radiographs \+/- thoracic CT Abdominal ultrasound/CT Cardiac ultrasound
M-Staging Abdominal ultrasound (or CT) indications
Intra-abdominal masses or organ infiltration (lymph nodes, GI)
Tumors on caudal half of body with tendency to metastasize; mast cell tumors, perianal gland tumors, mammary tumors
Tumors with high propensity for visceral or lymphatic metastasis (spleen or liver); mast cell tumors, histiocytic tumors, lymphoma, hemangiosarcoma
M-Staging
Tumor types commonly found in spleen
Mast cell tumor
Histiocytic Sarcomas
Lymphoma
M-Staging
Tumor types commonly found in liver
Mast cell tumor
Lymphoma
Melenoma
Staging
Why is it helpful?
Aids in giving a prognosis
Aids in treatment planning
Aids in evaluation of treatment
Avoids the disappointment of discovering pre-existing metastatic disease after expensive and toxic therapy has already been instituted
What does Stage I-T1N0M0 Indicate?
Tumor limited to site of origin and resectable
Long term prognosis good to excellent
What does Stage II - T2N1M0 Indicate?
Local spread, involvement of local lymph node
Chance of long term survival 40-60%
What does Stage III - T3N2M0 Indicate?
Extensive local spread, tumor not resectable
Chance of long term survival 20%
What does Stage IV - T4N3M+ Indicate?
Distant metastsis, primary not resectable
Chance of survival <5%
