Tumour Diagnosis and Prognosis Flashcards
Factors determining Tumour Prognosis
Tumour Grade
Tumour Stage
Tumour Markers
Melanomas
Tumours on skin
What is needed for definitive tumour diagnosis
Tissue Biopsy Sampling
What is suspicious here
Dark Shadow on left (reversed) t requiring more investigation
Tumour Markers
Certain tumours liberate products that can be detected in blood/urine/CSF samples
May aid diagnosis but may also be used to follow up therapy when blood levels increase, often before imaging can detect tumour recurrence
HCG & Tumours
human chorionic gonadotrophin marker released from tumours with trophoblast elements
AFP & Tumours
Alpha fetoprotein
Liver cancer, germ cell tumours
Tumour marker
PSA
Prostate Specific Antigen
It is produced by the prostate; raised levels MAY indicate prostate cancer
Types of Biopsy
Needle Biopsy Techniques
Mark, Anaesthatise Area, Prepare it with a scalpel, Insert Needle and Extract
Biopsy Handling
Fix in formalin solution for routine histology, special stains and immunohistochemistry
Fix in glutaraldehyde for electron microscopy
Send fresh for cytogenetics, tumour genetics (frozen in liquid Nitrogen)
Cervical Smear
Take a swab of the cervix with a tissue and spread the tissues out
This shows early dysplastic growth
**Form of diagnostic cytology
Pap Smear
Cervical Smear
How Histology of Neoplasms allows prediction of Behaviour
- Analysis of the degree of differentiation and growth pattern of the tumour.
- Evaluation of how far a tumour has spread
**Special techniques may be used to obtain further prognostic information
Grade of Tumour
The degree of differentiation of tumour cells relative to normal tissue of origin
Determined by:
- Variation in size and shape of constituent cells of the tumour (pleomorphism)
- The proportion of cells containing mitotic figures (mitotic index)
General rule of low grade and high grade tumour prognosis
Low grade tumours are slow growing and have a good prognosis
High grade tumours are fast growing and have a poor prognosis
***These are very general rules that have to be considered with all other clinical aspects
Nottingham histologic score
Assessment of the degree of differentiation of a carcinoma from semi-quantitative analysis of its morphological characteristics
- Tubule formation
- Nuclear pleomorphism
- Mitotic counts
Tubule formation
Are the tumours forming ducts?
If the majority of the tumour is undergoing tubule formation, this is betterI think??
Breast Cancer Tumour Grade
Prognosis of Grade 1, 2 & 3 Breast Cancer Tumour
Factors determining Tumour Stage
- The size of a primary tumour
- The degree to which it has locally invaded
- The extent to which it has spread by distant metastasis
Tumour Grade vs Stage
Grade - Histological & Cytological Features of a tumour
Stage - The time dependent factors of a tumour that indicate how badly its grown
TNM System
Staging system for most tumour types
Tumour, Node, Metastatic Site (Think of it chronologically)
Based upon local tumour spread, Regional lymph node involvement and presence of distant metastases
Can be applied to many different tumour types, but each tumour site has different specific criteria
Discuss the T of the TNM System
Size of tumour
Discuss the N of the TNM System
Refers to he number of lymph nodes that the cancer has spread to or a tumour’s enlargement into tumours
Discuss the M of the TNM System
TX (TNM)
Primary tumour cannot be assessed
T0 (TNM)
No evidence of primary tumour
Tis (TNM)
Carcinoma in-situ (Group of abnormal neoplastic cells that are pre-cancerous)
T4 (TNM)
Tumour of any size growing into chest wall or skin, including inflammatory breast cancer
Differences between T1, T2 & T3 (TNM)
Specific size in cm
NX (TNM)
Nearby lymph nodes cannot be assessed (e.g. previously removed)
N0 (TNM)
Cancer has not spread to nearby lymph nodes
Differences between N1, N2, N3
Number of lymph nodes to which a tumour has spread
MX (TNM)
Metastasis cannot be assessed
What prognostic stage would T2N1M0 be
IIB
Stages of Breast Cancer Tumour
Dukes Staging for Colorectal Carcinoma
Not massively used as TNM has gained prominence
Stage and Prognosis
The stage of a tumour is generally the most important indicator of likely prognosis and of appropriate therapy
Early stage tumours (localised) may be treatable by relatively conservative measures
Advanced stage tumours (extensive spread) may require aggressive treatment
Breast Cancer Prognosis based on Stage
Main modes of therapy for neoplastic disease
Surgery
Radiotherapy
Chemotherapy
Targeted therapy
Multimodal therapy is common
How important is pathology in deciding appropriate tumour therapy
Very important lol
Remission
Reduction in cancer signs and symptoms
May be partial or complete (remember breaking bad)
Tumour with excellent prognosis
Thyroid Tumour
Tumours with moderate prognosis
Kidney, prostate, cervix, breast
Tumours with very poor prognosis
Pancreas, Brain, Oesophagus
