Neoplastic Behavior

Question 1

What does TNM stand for?

Answer 1

Tumor
Nodes
Metastisis

Question 2

How bad is the tumor or what it will do to the host is predicted by…(4 things)

Answer 2

Histologic type
Location
Grade
Other prognostic factors

Question 3

Biologic Behavior Locally:

Primary Effects

Answer 3

Hemorrhage (hemangiosarcoma; bleeds)

Pain (osteosarcoma, neurofibrosarcoma)

Destruction of normal function (hepatocellular carcinoma)

Question 4

Biologic Behavior Locally:

Secondary Effects

Answer 4

Pathologic fracture

Neurologic deficits

Question 5

Biologic Behavior Distance:
Secondary Effects (functional tumor)
Pituitary Adenoma

Answer 5

Secretes ACTH

Hyperadrenocorticism

Question 6

Biologic Behavior Distance:
Secondary Effects (functional tumor)
Pheochormocytoma

Answer 6

Secretes catecholomines

Hypertension
Tachycardia

Question 7

Biologic Behavior Distance:
Secondary Effects (functional tumor)
Insulinoma

Answer 7

Secretes insulin

Hypoglycemia

Question 8

Biologic Behavior Distance:
Secondary Effects (functional tumor)
Sertoli cell tumor

Answer 8

Secretes estrogen

Feminization and aplastic anemia

Question 9

Biologic Behavior Distance:
Secondary Effects (functional tumor)
Thyroid adenoma

Answer 9

Secretes T4

Hyperthyroidism

Question 10

Biologic Behavior Distance:
Secondary Effects (paraneoplastic disorders)
Hypertrophic Osteopathy

Answer 10

Associated with lung tumors and large abdominal masses

Question 11

True or False: Patients rarely die from their primary tumor, they die from metastasis

Answer 11

True

Question 12

Matastasis Cascade

5 Steps

Answer 12

Cell detachment and vascular invasion

Transport and survival in the circulation (evasion of host defense mechanisms)

Aggregation with platelets and fibrin and arrest at new location (tumors often have a place they desire but can get lodged in capillary beds)

Extravasation into the surrounding parenchyma

Establishment of a new growth (angiogenesis)

Question 13

What is late metastasizing?

Examples

Answer 13

Spread long after primary tumor appears
Slow rate of growth

TVT, sertoli cell tumor, hemangiopericytoma

Question 14

Early/Rapid metastasizing

Answer 14

Metastasis has occured often before primary tumor is detected

Osteosarcoma, hemangiosarcoma, oral melanoma

Question 15

Pattern of metastasis

Lymphatic

Answer 15

Carcinomas; travel via lymphatics

Perianal gland carcinomas spread to sublumbar lymph nodes

Question 16

Pattern of metastasis

Hematogenous

Answer 16

Sarcomas via blood (osteosarcoma to lung, hemangiosarcoma to liver)

Lymph node involvement tends to be poor prognosis (not typical for hematogenous sarcomas)

Question 17

Pattern of metastasis

Both-round cell tumors

Answer 17

Lymphoma
Mast cell tumors
Histiocytic tumors

Question 18

What are prognostic factors

Answer 18

What the pathologist should tell you! Diagnosis (hopefully)

Histologic diagnosis
Margins
Invasiveness

Question 19

Prognostic factors

Invasiveness

Answer 19

Tumors invading the basement membrane, blood vessels, or lymphatics, tend to have poorer prognosis

Question 20

Prognostic Factors Histology:

Grade (5 things)

Answer 20

Attempt to predict which tumors will metastasize or carry a poorer prognosis

Degree of differentiation (if cannot tell tissue type poor prognosis)

Percent necrosis (higher than rapidly growing)

Invasiveness, presence of markers, vessel invasion

Mitotic index (# mitosis/10 HPF)

Numeric or descriptive

Question 21

Prognostic Factors:
Mitotic Index
Examples

Answer 21

Generally expressed as number of mitosis/10 high power (40x) field

3 for melanomas
5-7 for mast cell tumors
20 for soft tissue sarcomas (usually do not metastisize)

Question 22

Prognostic Factors:

Staging

Answer 22

TLM (tumor lymph node metastisis method)

Determination of what the tumor has actually done to the patient at the time of diagnostic – will surgery be curative

Question 23

Prognostic Factors:

Staging Uses

Answer 23

Aids in prognostication
Aids in treatment planning (surgery only, chemotherapy, radiation, or all 3)
Aids in evaluation of treatment results

Question 24

Initial workup of mass

5 things

Answer 24

PE and History
Always check draining lymph node
CBC, Chem, UA
Thoracic Rads (if meted than may not be worth further diagnostics)
Cytology

Question 25

What is T-Staging

Answer 25

Tumor evaluation ``` Could inform you on prognosis Measure it (always) Image it (radiograph, ultrasound -FNA, biopsy-) ```

Question 26

T-Staging | Advanced Imaging

Answer 26

Tumor Evaluation CT scan: Best for bones and screening for metastasis MRI Best for local soft tissue exam Can help evaluate treatment

Question 27

What is N-Staging?

Answer 27

Evaluation of Lymph Node May have to image them Aspiration: 100% sensitive and 96% specific (cellular changes? inflammation?)

Question 28

N-Staging | Front Leg

Answer 28

Prescapular

Question 29

N-Staging | Hind leg below knee

Answer 29

Popliteal

Question 30

N-Staging | Hind leg above knee, ventral abdomen

Answer 30

Inguinal node

Question 31

N-Staging | Anal/perianal area

Answer 31

Sublumbar nodes

Question 32

N-Staging | Lungs

Answer 32

Hilar nodes

Question 33

N-Staging | Abdomen

Answer 33

Sternal node

Question 34

M-Staging | How is this accomplished?

Answer 34

Evaluate for metastasis Where tumor may go depends on tumor histology and grade ``` Imaging studies: Thoracic radiographs +/- thoracic CT Abdominal ultrasound/CT Cardiac ultrasound ```

Question 35

``` M-Staging Abdominal ultrasound (or CT) indications ```

Answer 35

Intra-abdominal masses or organ infiltration (lymph nodes, GI) Tumors on caudal half of body with tendency to metastasize; mast cell tumors, perianal gland tumors, mammary tumors Tumors with high propensity for visceral or lymphatic metastasis (spleen or liver); mast cell tumors, histiocytic tumors, lymphoma, hemangiosarcoma

Question 36

M-Staging | Tumor types commonly found in spleen

Answer 36

Mast cell tumor Histiocytic Sarcomas Lymphoma

Question 37

M-Staging | Tumor types commonly found in liver

Answer 37

Mast cell tumor Lymphoma Melenoma

Question 38

Staging | Why is it helpful?

Answer 38

Aids in giving a prognosis Aids in treatment planning Aids in evaluation of treatment Avoids the disappointment of discovering pre-existing metastatic disease after expensive and toxic therapy has already been instituted

Question 39

What does Stage I-T1N0M0 Indicate?

Answer 39

Tumor limited to site of origin and resectable | Long term prognosis good to excellent

Question 40

What does Stage II - T2N1M0 Indicate?

Answer 40

Local spread, involvement of local lymph node Chance of long term survival 40-60%

Question 41

What does Stage III - T3N2M0 Indicate?

Answer 41

Extensive local spread, tumor not resectable Chance of long term survival 20%

Question 42

What does Stage IV - T4N3M+ Indicate?

Answer 42

Distant metastsis, primary not resectable Chance of survival <5%