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pathologic diagnosis of cancer
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- 2. Introduction • Establishing adiagnosis of cancer begins with a thorough history and physical examination. • There should always be a strong correlation between the clinical diagnosis of cancer and the results of diagnostic tests.
- 3. MAIN METHODS OFDIAGNOSIS • RADIOLOGICAL DIAGNOSIS • CYTOLOGICAL DIAGNOSIS • HISTOLOGICAL DIAGNOSIS • HAEMATOLOGICAL DIAGNOSIS • IMMUNOHISTOCHEMISTRY • ELECTRONMICROSCOPY • MOLECULAR DIAGNOSIS • TUMOUR MARKS
- 4. DIAGNOSTIC TESTS: INVASIVE TESTS 1.CYTOLOGICAL 2. HISTOLOGICAL 3. Tumour Markers NON-INVASIVE TESTS 1. X-ray 2. Ultrasound 3. CT scan/PET SCAN 4. MRI
- 5. RADIOLOGICAL DIAGNOSIS: • Theyare early tools for diagnosis of cancer. Includes: 1. X-RAY 2. ULTRASOUND 3. CT-SCAN 4. MRI 5. PET SCAN
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- 11. CYTOLOGICAL DIAGNOSIS (FOR STUDYINGCYTOPATHOLOGY) • Consists of 2 types of methods: 1. Exfoliative cytology/PAP test: 2. Fine needle aspiration cytology (FNAC):
- 12. FNAC & EXFOLIATIVE CYTOLOGY HELPS IN STUDYING THECANCER CELLS (cell morphology) i.e, CYTOPATHOLOGY
- 13. i) Exfoliative cytology: •Exfoliative cytopathology—the Papanicolaou method, or Pap test—is the study of normal and disease-altered, spontaneously exfoliated, or mechanically dislodged cells for the detection and diagnosis of various infections, abnormal hormonal activities, and precancerous or cancerous lesions.
- 14. • Spontaneously exfoliatedcells in: Sputum Pleural, peritoneal and pericardial effusions; Urine, gastric secretions, and CSF. samples
- 15. • Mechanically dislodgedcells from (SMEAR TESTS) CERVIX (pap smear test) ORAL CAVITY samples
- 18. ii) Fine NeedleAspiration Cytology. • FNAC is a diagnostic procedure used to investigate lumps or masses. • Useful in investigating deep-seated lesions in the body which do not shed off cells freely.
- 19. • Used fordiagnosis of tumours of - BREAST - PALPABLE TUMOURS OF SKIN - LYMPH NODES - SALIVARY GLANDS - THYROID GLANDS
- 20. Advantages of FNAC •Easy procedure • Inexpensive • It helps to differentiate between benign and malignant lesions.
- 21. Disadvantages of FNAC: •In situ vs Invasive carcinoma cannot be differentiated • Vascular or lymphatic invasion cannot be assessed. • Grading cannot be done • Complications –bleeding, nerve damage. • Only cellular morphology is seen, no basement membrane. (FNAB: FINE NEEDLE ASPIRATION BIOPSY IS USED FOR STUDYING HISTOLOGY OF CANCER TISSUE)
- 22. 3. HISTOLOGICAL DIAGNOSIS: •Histopathology: Study of tissue under microscope. • BIOPSY is the method used to collect tissue. BIOPSY HELPS IN STUDYING THE CANCER TISSUE i.e,HISTOPATHOLOGY
- 23. BIOPSY • Removal oftissue for diagnostic purpose. TYPES: 1. INCISIONAL BIOPSY 2. EXCISIONAL BIOPSY 3. NEEDLE BIOPSY (Fine needle aspiration biopsy)
- 24. • An incisionalbiopsy is a medical test to remove a piece of tissue from a lesion or mass. • An excisional biopsy is a medical test in which the whole lesion or mass is removed and tested.
- 25. • Fine needleaspiration biopsy is a type of biopsy procedure. • In fine needle aspiration, a thin needle is inserted into an area of abnormal-appearing tissue or body fluid. • As with other types of biopsies, the sample collected during fine needle aspiration can help make a diagnosis of tumour.
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- 28. FINE NEEDLE ASPIRATIONBIOPSY
- 29. TUMOUR MARKERS • Tumourmarkers are the substances produced by tumour cells or by the host as a response to the presence of tumour. • They are found in body fluids or tissues or tumour surface of patients with cancer.
- 30. • They areused as a marker to diagnose the presence of malignancy. • Their concentration increases with disease progression and when the tumour metastasize.
- 31. • Tumour Markerscan be: Enzymes. Serum Proteins. Cell surface proteins like Receptors. Cytoplasmic Proteins Hormones. Oncogenes & Oncoproteins. Tumour Suppressor Genes & their proteins. Oncofeotal Antigens.
- 32. 1. ONCOFETAL ANTIGENS: I.Alpha-foetoprotein (AFP): II. Carcino-embryonic antigen (CEA). i) ALPHA-FOETOPROTEIN (AFP): • This is a glycoprotein synthesized normally by foetal liver cells. • Their serum levels are elevated in Hepatocellular carcinoma and Non- seminomatous germ cell tumours of the testis. • Certain non-neoplastic conditions also have increased serum levels of AFP e.g. in Hepatitis, Cirrhosis, Toxic liver injury and Pregnancy.
- 33. 2. Carcino-Embryonic Antigen(CEA): • It is also a glycoprotein normally synthesized in embryonic tissue of the gut, pancreas and liver. • Their serum levels are high in cancers of the Gastrointestinal tract, Pancreas and Breast. • As in AFP, CEA levels are also elevated in certain non- neoplastic conditions e.g. in Ulcerative Colitis, Crohn’s Disease, Hepatitis and Chronic Bronchitis.
- 34. 2. ENZYMES: 1. ProstateAcid Phosphatase (PAP): Prostatic carcinoma. 2. Neuron-Specific Enolase (NSE): Neuroblastoma, Oat cell carcinoma lung. 3. Lactic Dehydrogenase (LDH): Lymphoma, Ewing’s Sarcoma.
- 35. 3. HORMONES 1. HumanChorionic Gonadotropin (hCG): Germ cell tumours of testis. 2. Calcitonin: Medullary carcinoma thyroid 3. Catecholamines and Vanillylmandelic acid (VMA): Neuroblastoma, pheochromocytoma 4. Ectopic hormone production: Paraneoplastic syndromes.
- 36. 4. CANCER ASSOCIATEDANTIGENS (CA-CANCER ANTIGEN/ CARBOHYDRATE ANTIGEN/ CARCINOMAANTIGEN) 1. CA-125: Ovarian cancer 2. CA 15-3: Breast cancer 3. CA 19-9: Colon, pancreas, breast cancers 4. CD30: Hodgkin’s disease, anaplastic large cell lymphoma (ALCL) 5. CD25: Hairy cell leukaemia (HCL), adult T cell leukaemia lymphoma (ATLL 6. Monoclonal Immunoglobulins: Multiple myeloma. 7. Prostate Specific Antigen (PSA): Prostate carcinoma.