KMU (PIM&R)

1. Approach to Cancer Diagnosis
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2. Clinical Suspicion
• Cause of symptoms where the diagnosis is not
obvious.
• Thorough clinical history
• Family history
• Social history (eg, smoking),
• Occupational history (eg, shipyard worker,
miner),
• Diet and geographic origin
• Sexual and childbearing history

3. • Physical examination is directed toward finding
localizing symptoms or signs
• Mass lesion that may be sampled by biopsy or
aspiration

4. Early Diagnosis
• Routine (screening) examinations of asymptomatic
individuals
• Routine cytologic screening in the form of annual
cervical smears (papanicolaou smears)
• Dysplastic epithelium can be detected
• Unfortunately, screening methods do not exist for
most other types of cancer.
• Public education campaigns
• To examine their breasts monthly to detect small
lumps and to undergo mammography after age 40
years every 2 or 3
• 50 and older are encouraged to undergo
sigmoidoscopy every 3–5

5. Cytologic Diagnosis
• Samples obtained by a variety of techniques.
• (1) Exfoliated cells can be identified in samples of
sputum, urine, cerebrospinal fluid, and body fluids.
Recognition of malignant cells in blood (as in the
leukemias) or bone marrow smears (leukemias,
myeloma, metastatic carcinoma
• (2) Brushing or scraping of epithelium or of a lesion
that has been visualized by endoscopy
• (3) A fine (22-gauge) needle can be passed into
virtually any location to aspirate material directly
from a mass lesion (fine-needle aspiration (FNA)

9. • Remarkably accurate performed by a trained
pathologist.
• Immunoperoxidase techniques improved the
reliability of cell and tumor identification.
• Cytologic diagnosis must be confirmed by histologic
diagnosis
• In many centers, radical surgery is undertaken on the
basis of positive results on fine-needle aspiration for
carcinomas such as those of the breast, pancreas, and
thyroid.

10. Histologic Diagnosis
• Definitive method of establishing the diagnosis
• A trained pathologist with an adequate specimen
• Immunohistology, special stains, and electron
microscopy
• Excisional biopsy
• Incisional biopsy or
• With a large-bore cutting needle.

11. Techniques
Frozen Section Method
• Providing information while the patient is still on the
operating table (often within 15 minutes).
• Cytologic details in the preparation are poor, and the
diagnosis is less accurate than when processed tissue
(paraffin sections) is used.

13. Paraffin Section Method
• Provide the best material for microscopic diagnosis.
• Small blocks of formalin-fixed tissue are dehydrated
• Embedded in paraffin
• 24 hours.
• Hematoxylin and eosin (H&E) the standard stain
• Nuclei blue,
• Eosin stains cytoplasm and extracellular material
pink.

14. Immunoperoxidase Techniques
• Immunohistochemical stains use specific labeled
antibodies—identify marker antigens in cells and
tissues
• When the peroxidase label reacts with a substrate,
it produces a colored product that identifies the
location of the antigen in the tissues.
• This method is analogous to the use of fluorescent
labeled antibody method but gives better results
on paraffin sections

15. Immunohistochemistry.
• Specific monoclonal antibodies
• The identification of cell products or surface markers.
Some examples of the

16. Utility of immunohistochemistry in the diagnosis
or management of malignant neoplasms
• Categorization of undifferentiated malignant
tumors
• Categorization of leukemias and lymphomas
• Determination of site of origin of metastatic
tumors
• Detection of molecules that have prognostic or
therapeutic significance

17. Anticytokeratin immunoperoxidase stain of a
tumor of epithelial origin (carcinoma)

18. Electron Microscopy
• Special fixation (in glutaraldehyde) and processing
• Ultrastructural features visible
• Useful in recognizing many types of neoplasms, eg,
anaplastic squamous carcinoma, melanoma,
endocrine tumors, and muscle cell tumors.

19. Flow Cytometry
Rapidly and quantitatively measure several individual
cell characteristics
• Membrane antigens (classification of leukemias and
lymphomas)
• DNA content of tumor cells

20. They say that life is a school, but nobody
mentioned the tuition fee!

21. • Information provided by pathologic diagnosis

22. Type of Neoplasm
• The name of the neoplasm will be given in the
pathology report.
Biologic Behavior
• The pathology report will state whether the
neoplasm is benign or malignant

23. Histologic Grade
• Describes the degree of differentiation of the
neoplasm
• Either in words (eg, well), moderately, or poorly
differentiated adenocarcinoma) or
• In numbers (eg, grade I, II, or III transitional cell
carcinoma of the bladder—grade I being the least and
III the most malignant)

24. Degree of Invasion
• Planning treatment of some neoplasms;
• In malignant melanoma of the skin,
• The treatment is based on the depth of infiltration
• In bladder neoplasms, it is imperative to state whether
or not muscle invasion has occurred in the biopsy
specimen

25. Pathologic Stage
• Extent of spread of a neoplasm.
• Extent of infiltration and metastasis (eg, depth of
invasion of the wall of a viscus; lymph node, bone
marrow, or organ involvement).
• Determines further treatment
• Valuable guide to prognosis.

26. Serologic Diagnosis
• Theoretically, it may be possible to diagnose cancer
by detecting cancer cell products in the serum,
• Molecules secreted by malignant cells or antigens
released by periodic death of such cells.
• No general serologic screening methods exist for
cancer, but several tests are of value for certain
tumors

27. Serologic Assays for Cancer Diagnosis or
Follow-Up.
Substance in Serum Cancer Type
Carcinoembryonic antigen (CEA) Gastrointestinal tract cancer (especially
colon),.
–Fetoprotein (AFP) Hepatoma, yolk sac tumors.
Human chorionic gonadotropin (hCG) Greatly elevated in choriocarcinoma
Prostatic acid phosphatase; prostate–
specific epithelial antigen
Two separate molecules; levels of both are
elevated in metastatic prostatic cancer.
Monoclonal immunoglobulin Myeloma, some B cell lymphomas.
Specific hormones Endocrine neoplasms and ectopic hormone–
producing tumors.
CA 125 Ovarian carcinoma;

28. Radiologic Diagnosis
• CT and magnetic resonance imaging (MRI) scans, are
invaluable for localizing masses as part of the
primary diagnosis or for staging tumors.
• As a general rule, radiologic findings suggestive of
cancer must be confirmed by either cytologic or
histologic examination of biopsy material before
treatment can be started.

29. Have a nice day