theme 1 b

criteria for malignancy

• invasion

• cytonuclear atypia

• LVSI = lymphovasc invasion

benign

• no invasion

• no atypia

  • slow growing

pre-malignant lesion

• cytonuclear atypia

• no invasion

dysplasia

• disrodered epi growth with cellular atypia

mes tumor examples

• x + oma → benign

• x + sarcoma → malignant

T stage classification 

• T1 → limited to sub and mucosa 

• T2 → extension into but not through muscularis propria 

• T3 → invasion of perirectal fat

• T4 → invasion of adjadent 

N stage classifification

• N0 → no involvement

• N1 → in < 4 regional nodes

• N2 → in > 4 regional nodes

• N3 → distant nodes

M stage classification 

M0 → no metastasis

M1 → distant metastasis 

CRC adenocarcinoma 

1. hyperprolif → small polyp

2. adenomatous polyp → dysplasia 

3. sever dysplasia → carcinoma in situ 

4. invasion though basement membrane → invasive adenocarcinoma

patho vs clinical staging

• cTNM → before treatment

• pTNM → after surgery

• ypTNM → after neoadjuvant treatment

diag imaging techniques

• CT/MRI/PET → evaluate tumor extent and meta

• ultrasound → real time tissue evalu

• X-rat

FISH of CISH

• detect specific gene translocation/amplificatie 

• eg HER2

NGS (next gen seq) + WGS + WES + panel seq 

• parallel seq of multiple genes at once

• shows → point mut, insert/delet, gene fusion

tumor markers

• produced by tumor cells or by body (in response to tumor0

• may be present in serum or other body fluids

PSA = prostate specific antigen

• glycoportein made by pros epi

• elevated in pros cancer and BPH → > 3 ng/l

• screening, diag and moni

AFP = alpha-fetoprotein

• normally produced by fetal liver

• eleva in hepatocellylar carcinoma and testi (non-semi) cancer

• diag and tretment moni

• > 10 ng/ml

CEA = carcino embryonic antigen

• fetal glycoprot re-expressed in adult cancers

• eleva in CRC, BRC and lung cancer 

• recurr monitor 

• > 10 ng/ml 

CA-125

• product of MUC16

• eleva in ovarian cancer

• diag and follow up

CA 19-9

• carbohydrate ag expressed in fetal stomach epi

• for pancreatic cancer, begin liver and GI disease

• > 37 U/ml

hCG

• normally prod by placenta

• eleva in testi cancers (esp non-semi)

• diagnosis + follow up

• > 10 ml U/ml

tumor markers in testi cancer

• semi → inc hCG, normal AFP

• non-semi → incr hCG + AFP

carcinoma of unknow primary - CUP

• metastatic cancer

• prim orgin cannot be found

NGS → known hotspot

• gene specific location

• BRAF - V600E

tumor growth impacts blood composition = 4

• anemia → due to inflamm

• hypercoagulability → higher risk of thrombosis

• eleva tumor/infla markers

• metabolic changes → high lactate from Warburg

PCR

• good for hot spot

• cheap and fast

• zoek je precies deze: 

  • BRAF V600

  • EGFR 19 del

  • KRAS G12/G13

epi tumor 2 kinds → not yet naming of tumor

• strat squa

• glandular/ductal

strat sq tumor

• benign = papilloma

• malignant = strat squa carcinoma

gland/duct tumor

• benign → adenoma

  • cystoma if cystic

• malignant → adenocarcinoma

CA15-3

malignancy of mamma = BRC