Tumor Diagnosis And Prognosis. Stage Avd Grade

Question 0

Tumour markers

Answer 0

Some tumours liberate products that can be detected in blood/urine/CSF
May aid diagnosis
Used to detect recurrence
HCG-> tumours with trophoblast element
PSA-> prostate-specific antigen from carcinoma
AFP-> alpha fetoprotien-> liver, germ cells

Question 1

Techniques used in investigation and diagnosis of a tumour

Answer 1

Symptoms
Signs
Imaging
Tumour markers
Biopsy

Question 2

Biopsy techniques

Answer 2

Needle biopsy
Endoscopic
Transvascular biopsy
Direct excision
Curettage
-> fix in formalin solutions for histology, special stains and immunohistochemistry
->fix in gluteraldehyde for electron microscopy
-> send fresh for cytogenetics, tumour genetics
Histology used to predict behaviour

Question 3

Tumour grade

Answer 3

Use cellular cytology
Based on:
Degree of differentiation
Variation in size and shape-> pleomorphism
Number of cells containing mitotic figures-> mitotic index
Low grade-> slow growing-> good prognosis

Question 4

Tumour stage

Answer 4

Based on the size of the tumour, the degree to which it has locally invaded and the extent to which it has spread

Question 5

Dukes staging for neoplasms of the rectum

Answer 5

A-> not extending through musculairs propria-> >90% 5 year survival
B-> extending through musculairs propria but no nodal involvement-> 70%
C-> any involvement of bowel wall, any depth, nodal involvement-> 30%
D-> distant metastasis-> 5-10%

Question 6

TNM tumour staging

Answer 6

Based upon extent of local tumour spread, regional lymph node involvement and the presence of distant metastasis.
Applied to many different types of tumour with varying criteria
T-> tumour-> refers to size and local extent
-> 0=normal, 1-2 increasing size and 3 invasion
N-> nodes-> refers to lymph node involvement-> the higher the number the more involved 0-2
M-> metastases-> extent of distant metastases
-> 0=none, 1=demonstrable metastases X=suspected metastases

Question 7

Three main therapies

Answer 7

Surgery 
Radiotherapy 
Chemotherapy
Multimodal therapy is common
Pathology decides therapy

Question 8

Main cellular targets for tumour therapy

Answer 8

Cytotoxic drugs:
-> alkylation agents-> impede replication by forming covalent bonds with DNA
-> anti metabolites-> block one or more of the metabolic pathways involved in DNA synthesis
-> cytotoxic antibiotics-> prevent cell division
-> plant derivatives-> effect the formation of the mitotic spindle
Hormones-> physiological antagonists,agonists or hormones synthesis inhibitors disrupt hormone dependent tumour growth
Monoclonal antibodies-> block cell proliferation, inhibit lymphocyte proliferate, prevents angiogenesis
Protein kinase inhibitors-> inhibit protein kinases

Question 9

Examples of tumours with various prognosis

Answer 9

Excellent-> thyroid
Moderate-> kidney, prostate, cervix, breast
Poor-> pancreas, brain, oesophagus