Oncology Overview: Cancer Staging Primer Flashcards
A diagnosis of cancer must be based upon….
Pathology: usuaully based upon a biopsy obtained EARLY in the evaluation.
What are the basics of cytology?
Cytology: cellular morphology
▪ Aspiration of tumor (fine needle aspiration)
▪ Removal and analysis of abnormal fluid (eg: pleural
fluid, ascites)
▪ Review and analysis of normal fluid (e.g. CSF)
▪ Washings/lavage with saline (e.g., bladder, lung)
What are the pros and cons of cytology?
- Advantages: Less invasive; may distinguish malignancy vs. benign disease
▪ Disadvantage: CELLULAR samples only (not tissue), so may limit further classification
What are the basics of pathologic sampling?
Pathology: tissue morphology
- core needle biopsy
- surgical biopsy
- excisional biopsy
What are the pros and cons of pathologic sampling?
Pros: TISSUE collection allows for further classification may be determined
▪ Determination of invasiveness
▪ Evaluation of malignant tissue in relationship to
normal tissue
Cons: more invasive
Name the six types of neoplasm
Carcinoma Melanoma Lymphoma Sarcoma Germ Cell CNS Tumors
Name the 7 types of Carcinoma
Adenocarcinoma (most common) Squamous Cell (most common) Neuroendocrine Hepatocellular Thyroid Renal Cell Other
What 3 things do you consider when trying to find out if the cancer is primary or metastatic?
▪ Clinical presentation
▪ Location and number of tumor(s)
▪ Pattern of metastatic spread
What 3 factors might you consider when deciding what/where to biopsy?
- Most accessible site
▪ Site most likely to yield diagnostic results
▪ Site most likely to influence treatment
What is cancer staging?
Determining:
- HOW MUCH cancer is in the body
- WHERE the cancer is located.
Describes SEVERITY of the cancer based on:
- Characteristics of the primary tumor
- Extent of the SPREAD around the body.
Why do cancer staging?
▪ Indication of PROGNOSIS
▪ Establish the best TREATMENT PLAN
▪ Evaluate EFFECTIVENESS of treatment
▪ COMMUNICATE “the same language” to other clinicians
▪ Provide standardization for valid RESEARCH
What are the three parameters of Clinical Staging?
T =Tumor: The extent of the primary tumor
N =Nodes: The absence or presence and extent of REGIONAL lymph node metastasis
M =Mets: The absence or presence of distant METASTASIS
Tumor (T) Stage: Which types of cancer are staged by SIZE and which are staged by DEPTH of penetration?
Size: Lung, Breast, Ovarian, Prostate
Depth: Bowel, Bladder, Melanoma
Nodal (N) Stage: What do you consider when assigning the nodal stage?
Based on number and location of regional nodes
(distant node is metastasis via hematologic spread)
Nodes can be assessed by
- Clinical evaluation if PALPABLE
- Imaging for size and appearance (CT,MRI,U/S)
- Biopsy or aspiration (IF it will affect treatment!)
- Surgically (at time of primary tumor resection)
Metastasis (M) Stage: What do you consider when assigning the metastasis stage?
- History and PE
- Patterns of metastasis
- Consensus guidelines about radiologic evaluation
- Surgical evaluation is rarely used for metastatic staging
What do the staging numbers signify for Primary Tumor (T)
TX Primary tumor cannot be evaluated
T0 No evidence of a primary tumor
Tis Carcinoma In Situ
T1, T2, T3, T4 Increasing size and extent of tumor
What do the staging numbers signify for Regional Lymph Nodes? (N)
NX Regional lymph nodes cannot be evaluated
N0 No evidence of disease in lymph nodes
N1, N2, N3 Increasing disease involvement in regional lymph nodes
What do the staging numbers signify for Distant Metastasis (M)?
MX Distant metastasis cannot be evaluated
M0 No evidence of metastasis
M1 Distant metastasis
What is the difference between clinical and pathological staging?
- Clinical Stage: before starting therapy or having surgery
▪ Pathological Stage: surgical exploration and tissue histology.
▪ Both should be recorded if possible.
Based on TNM score, how do you decide whether the cancer is Stage I, II, III or IV?
Depends on the cancer
If a patient has M1 cancer, what stages are possible?
Stage IV only
Can a patient have N1 and have Stage I cancer?
No. Regardless of cancer, Stage I must have N=0
What is the basis of histopathologic grading?
Histology and morphology of cancerous cells seen with a microscope
Which is more important: grading or staging?
Equally important: a small but aggressive cancer can be more dangerous than a large, indolent cancer.
What are Grades GX through G4?
GX: Grade cannot be evaluated G1: Well-differentiated G2: Moderately differentiated G3: Poorly differentiated G4: Very poorly differentiated/Anaplastic
What is the difference between well-differentiated cells and poorly-differentiated cells?
Well-differentiated: closely resemble the normal cells in architecture (and less aggressive)
Poorly-differentiated: do not resemble the normal cells (more aggressive)
What are other kinds of cancer qualifiers in considering prognosis and therapies besides Stage and Grade?
Age Serum Markers (eg: PSA, CEA-125) Tumor Genetics (eg: EGFA expression in lung cancer) Patient Genetics (eg: BRCA)
If the patient has a stage I cancer, what is the
effective treatment most likely to be?
Depends on the location: surgical resection (because it is self-contained) with or without chemo or radiation
Why are biopsies of tissue so important for
determining cancer treatment?
Staging, histology/grading, treatment, gene therapy
At which stage(s) of cancer is radiation therapy the
most likely to be useful?
When it is still localized, so stages I, II and III.
If the patient has a stage IV cancer, which treatment
is most likely to be effective?
Chemo and/or radiation to shrink the tumor, then resection if possible
