Utility of Molecular Diagnostics in Cancer Management Flashcards
Outline tumour pathology.
- Tumours evolve slowly as a consequence of gene mutation.
- Tumours grow locally and then metastasise to distant sites.
- Tumours can secrete a variety of proteins and tumour cells can be shed (e.g. sputum, urine, blood).
- Tests may involve evaluation of secreted products, evaluation of presence of tumour cells, evaluation of tumour nucleic acids, evaluation of tumour tissue.
What may tests for tumour pathology involve?
Tests may involve evaluation of secreted products, evaluation of presence of tumour cells, evaluation of tumour nucleic acids, evaluation of tumour tissue.
What is the purpose of tumour staging?
- Tumour staging is about mapping out how far a tumour has spread.
- Tumours grow locally at first - measured by the T-stage. Eventually tumours will metastasise to distant sites and lymph nodes (M- Stage).
- The greater the stage, the poorer the prognosis is going to be.
What is CEA?
- CEA is carcinoembryonic antigen.
- CEA is expressed at low levels in the normal colon but is expressed at high levels and secreted by colorectal cancers.
- It is a prognostic factor and it can be monitored to test for recurrence.
What antigen can be monitored to test for the recurrence of colorectal cancer?
- CEA is carcinoembryonic antigen.
- CEA is expressed at low levels in the normal colon but is expressed at high levels and secreted by colorectal cancers.
- It is a prognostic factor and it can be monitored to test for recurrence.
What are serological markers of tumours?
Many tumours aberrantly produce proteins which can be secreted (e.g. CEA in CRC). May be new proteins or proteins that are found normally but are produced at a much higher level by tumours.
These proteins can be used for diagnosis, prognosis, monitoring, and possibly screening.
Examples include:
- CEA produced by CRC
- CA125 produced by ovarian cancers
- AFP produced by hepatocellular cancers
- CA19.9 produced by pancreatic cancers
- PSA produced by prostate cancers
- Markers may have different values in different settings.
List some serological tumour markers.
- CEA produced by CRC
- CA125 produced by ovarian cancers
- AFP produced by hepatocellular cancers
- CA19.9 produced by pancreatic cancers
- PSA produced by prostate cancers
What type of cancer is CEA a marker for?
CEA is a marker for CRC.
What type of cancer is CA125 a marker for?
CA125 is a marker for ovarian cancers.
What type of cancer is AFP a marker for?
AFP is a marker for hepatocellular cancers.
What type of cancer is CA19.9 a marker for?
CA19.9 is a marker for pancreatic cancers.
What type of cancer is PSA a marker for?
PSA is a marker for prostate cancers.
How can tumour cells be detected/collected?
- Tumour cells can be shed from external surfaces or into the blood.
- Tumour cells can also be aspirated from masses.
- Abnormal fluid collections (such as pleural effusions) can be tested for the presence of tumour cells.
- Circulating tumour cells (CTC) can be detected in the blood.
- Externally shed cells, blood samples or aspirated cells can be directly visualised for in the presence of tumour cells (i.e. cytological examination).
- Supplementary tests can be performed on the cells.
- This methodology can be used for screening, diagnosis, surveillance, and possible prognosis.
What tests can be done on collected tumour cells? Outline some examples of cytological examination.
- Cytological examination - just looking at the actual cells rather than histological specimens preserved in wax etc.
- Sometimes may be easier just to take smear of cells.
- Variety of different stains used. For histology specimens use haematoxin and eosin as general rule. For cytology use predominantly PAP smear or Giemsa. Diagnosis usually depends on assessing the size and morphology of the nuclei.
- The cervical cancer screening program is dependent on cytological examination of cells.
- Surveillance for bladder cancer can be done by cytological examination of urine.
- Generally prefer to use biopsy but cytological examination of masses can give rapid diagnosis or can be used when biopsy may be difficult (e.g. lung, biliary tract).
- Abnormal fluid collections (such as pleural effusions) can be tested for the presence of tumour cells.
What are the main 2 stains used in the examination of cytology specimens?
For cytology use predominantly PAP smear or Giemsa.
Give some examples of where cytology is used as a cancer screening tool.
- The cervical cancer screening program is dependent on cytological examination of cells.
- Surveillance for bladder cancer can be done by cytological examination of urine.