Tumor Diagnosis And Prognosis. Stage Avd Grade Flashcards Preview

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Flashcards in Tumor Diagnosis And Prognosis. Stage Avd Grade Deck (10)

Techniques used in investigation and diagnosis of a tumour

Tumour markers


Tumour markers

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


Biopsy techniques

Needle biopsy
Transvascular biopsy
Direct excision
-> 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


Tumour grade

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


Tumour stage

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


Dukes staging for neoplasms of the rectum

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%


TNM tumour staging

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


Three main therapies

Multimodal therapy is common
Pathology decides therapy


Main cellular targets for tumour therapy

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


Examples of tumours with various prognosis

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

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