Oncology Flashcards
Define neoplasia
Uncontrolled cell proliferation derived from a single cell which has the ability to self-renew
Hallmarks of cancer (7)
Self-sufficiency from growth factors Insensitivity to anti-growth signals Evasion of apoptosis Limitless replicative capacity Sustained angiogenesis Invasion across tissue boundaries Metastasis - local & distant
Clinical consequences of neoplasia
Expansile growth Destruction of host tissues/function Infiltration & metastasis Necrosis, ulceration, haemorrhage, infection Cachexia Paraneoplastic syndromes Poor QOL SHortened lifespan
What 3 factors are considered in diagnosing neoplasia?
What is it? - cell of origin
How bad is it? - benign/malignant, grading
Where is it? - staging/mets (TNM)
What techniques are available to diagnose cancer?
FNA = diagnostic only
Biopsy (incisional/excisional)
What types of incisional biopsy are available?
Needle Bx (tru-cut)
Skin punch Bx
Surgical wedge Bx
Jamshidi bone Bx
What information should be provided with a laboratory submission for histopathology (e.g. biopsy sample)?
Patient signalment & history
Any in-house diagnostics
Sample description - location, size, colour, texture etc.
Differential diagnoses
What is grading of neoplasia?
Histopathological diagnosis to give information about tumour behaviour & determine “How bad is it?”
What criteria are used for grading neoplasia on histopathology?
Pleomorphism Mitotic figures Degree of necrosis/haemorrhage Evidence of local invasion Presence of metastasis (vascular/lymphatic)
What is staging of neoplasia? What system is used commonlY?
Testing to determine the location(s) of the neoplasia (“where is it?”)
TNM system:
- Tumour characteristics = size, location, firmness, adhesion
- Regional LN involvement (none, local, regional, further)
- Metastases (based on common patterns for that tumour type)
What tools can be used to assess LN involvment in neoplasia (N in TNM)?
Palpation
FNA/cytology
Bx
What tools can be used to assess metastases in neoplasia (M in TNM)?
Imaging - rads, CT, US, scintigraphy
Clin path
Cytology/biopsy
What are the different treatment goals of surgical oncology?
Prevention (e.g. OVH) Diagnosis (incisional bx) Cure (excisional bx) Palliation Cytoreduction (adjunctive therapy)
What 4 levels of margination can be taken on surgery of a neoplastic mass?
Intracapsular (incisional bx)
Marginal (just outside capsule)
Wide (don’t enter the tumour capsule)
Radical (amputation)
How far should lateral & deep margins extend beyond masses on removal?
Lateral = quantitative, defined distance (cm) dependent on tumour type, size, site, stage, grade
Deep = ≥1 fascial plane deeper than the compartment of origin
