oncology Flashcards
how we go about cancer we wonder?
1 what it is DIAGNOSIS
2 how far it has gone STAGING
3 what to do TREATMENT
diagnostics for cancer
- FNA (fine needle aspirate)
- Biopsy
- Bone marrow sampling
- Clonality test
- Flow cytometry
FNA technique
-22 0r 22 gauge needle
- mast cell tumors will release histamines so you can see reactions immediently so can use ultrasound guidance.
interpreting cytology smears 4 steps
1 are the cells nucleated
2 is the population uniform
3 what types of cells are there? 3 types:
epithelial
mesenchymal
round cells
4 malignancy criteria?
three cells types in cancer
-epithelial: very condensed cells, adenocarcinoma, ademona, squamous cell carcinoma
-mesenchymal: have a tail, more spread out. osteosarcoma, soft tissue sarcoma
-round cells: cancer of blood, lymphoma, mast cell tumor
round cell tumors DDx
- Lymphoma
- Mast cell tumor
- Histiocytic sarcoma
- Histiocytoma
- Plasma cell tumor
- Melanoma
tissue biopsy types
tru cut
punch
wedge
excisional
when to biopsy
1 what are my DDX
2 dose the result change my case management? you may treat differently depending on what it is.
histopathy report has?
1 diagnosis
2 grade, mitotic count
3 margins
immunohistochemistry report
1 diagnostic conformation
2 prognosis (high metastatic risk, poor prognosis)
some cancers may not form a mass but show up on bloodwork example:
patients may present with
* Cytopenia
* Increased cell count
* Circulating atypical cells
* Monoclonal gammopathy
-this is when we do BM testing
Bone marrow testing: need sedation or GA, use sternal 22G needle into bone marrow
why are lymphocyte BM tests can be tricky?
-hard to differentiate between neoplastic or reactive
-so we do other tests as well a PCR for antigen receptor rearrangement or Flow cytometry for lymphocytes
how to work on a cancer diagnosis case
-Mass on physical exam? Let’s start with FNA.
* Epithelial vs Mesenchymal vs Round cell
-Biopsy ONLY IF the result will change your approach
* Different forms of biopsy techniques – each has pros/cons
* Histopath is not perfect – 2nd opinion/IHC may be needed
-Blood cancer diagnostics are unique
* Bone marrow sampling; PARR/Flow cytometry for lymphocytic cancers
steps to staging cancer tumors
TNM classification
1 assessing the primary tumor T: TUMOR SIZE
2 LYMPH NODE N: assessment of the regional lymph nodes
3 M DISTANT METASTASIS: look at common distant metastasis sights such as lungs, liver, bone, brain.
TNM classification T
Tumor size
-physical exam, external measurement
-radiographs
-CT: soft tissue/ bone/ lungs
-MRI: soft tissue/ muscle/ nerve
TNM classification N
LYMPH NODE N: assessment of the regional lymph nodes
-palpate
-FNA or biobsy of LN for histo confirmation of prescnece of metastatic cancer cells
-abdominal ultrasound/ CT/ MRI
CT for LN metastasis
Normal LN on CT ≠ No metastasis
CT: sensitivity 10-12%; specificity 91-96%
Anatomically closest LN
≠ draining LN in 28-62%
assessing Sentinel LN
Sentinel LN = 1st draining LN
* Color dye, radiopaque agent, near-infrared fluorescence
* Used for cancers that commonly metastasize to LNs
Ex) Mast cell tumors, oral tumors, anal sac carcinoma
metastasis can be systemic, tests to do?
3-view or 4-view rads / CT
Abdominal ultrasound / CT +/- FNA
Neuro exam, CT / MRI
Physical exam
why staging matters?
Treatment/monitoring
plan changes
Prognosis changes
