Diagnosis & Staging

Question 1

What lab tests are commonly used to diagnose cancer?

Answer 1

• Lab tests (chemistry - high or low can be d/t Ca)
• CBC (particularly for leukemias)
• Cancer gene mutation testing
• Cytogenetic analysis (changes in chromosomes in WBC’s or bone marrow)
• Immunophenotyping (identifies cells based on antigens presented; good for blood cancer monitoring)
• Sputum cytology
• Tumor marker tests (presence, levels or activity that may be signs of cancer)
• Urinalysis (Dx kidney and urothelial Ca)
• Urine cytology (bladder Ca dx)

Question 2

What are common tumor imaging techniques?

Answer 2

• MRI scan (visualizes tissue hidden by bone)
• xray
• CT scan (not useful when surrounded by bone; shows difference in tissue density)
• PET scan
• Nuclear medicine
• Contrast within these studies can better visualize malignancies
• Ultrasound

Question 3

What tumor marker is specific for prostate Ca?

Answer 3

PSA

Question 4

What tumor marker is specific for testicular Ca?

Answer 4

AFP and HCG

Question 5

What tumor marker is specific for ovarian Ca?

Answer 5

CA-125

Question 6

What tumor marker is specific for melanoma Ca?

Answer 6

S100

Question 7

What are examples of invasive diagnostic imaging?

Answer 7

• Endoscopy

- Biopsy

Question 8

What is a pathology report?

Answer 8

• Document containing diagnosis as was determined by examining cells and tissues under a microscope
• Can contain information about size, shape and appearance of specimen (the gross description)
• Critical in cancer diagnosis and stating and therefore tx options; treatment options for cancers from within the same organ can differ significantly based on the histopathology

Question 9

What is absolutely necessary before diagnosing cancer?

Answer 9

A histologic tissue confirmation, often obtained by biopsy

Question 10

What is a tumor grade?

Answer 10

The description of a tumor based on how abnormal the tumor cells and tissue look under a microscope

Question 11

What does ‘ well differentiated’ mean?

Answer 11

• The cells of the tumor and organization of its tissue are close to those of normal cells and tissue
  = Tend to grow at a slow rate

Question 12

What does “undifferentiated” or “poorly differentiated” mean?

Answer 12

Abnormal looking cells and may lack normal tissue structures

Question 13

What does stage refer to?

Answer 13

The size and/or extent of the primary tumor, and whether or not Ca cells have spread in the body

Question 14

What is the difference between grade 1-4 tumors?

Answer 14

G1: Well differentiated (low grade)
G2: Moderately differentiated (intermediate)
G3: Poorly differentiated (high grade)
G4: Undifferentiated ( high grade)

Question 15

What is the TNM system?

Answer 15

• Most widely used cancer staging system
• T = size and extent of main tumor
• N = number of nearby lymph nodes with Ca
• M = indicates if it has metastasized

Question 16

What are the different types of T staging?

Answer 16

TX: Non-measurable tumor
T0: Main tumor cannot be found (abnormal cells may be present)
T1-4: Size/extent of main tumor. The higher the number = the larger the tumor or the more it has grown into nearby tissues

Question 17

What are the different types of N staging?

Answer 17

NX: Ca in lymph nodes cannot be measured
N0: No Ca in nearby lymph nodes
N1-3: Number and location of lymph nodes with Ca (higher number = more)

Question 18

What are the different types of M staging?

Answer 18

MX: Met cannot be measured
M0: Ca has not spread
M1: Ca has spread

Question 19

What Ca types have different staging systems?

Answer 19

Brain and spinal cord tumors and blood cancers

Question 20

After numbers have been determined for TMN, many cancers are said to be in 1 of 5 stages. Describe them:

Answer 20

Stage 0: Early cancer present only in the layer of cells where it began

Stage I, II or III: Higher stage = Ca with greater tumor size and/or spread

Stage IV: Ca has spread to another organ(s)

Question 21

What are the two different types of tumor markers?

Answer 21

• A tumor marker is anything present in/produced by cancer cells, or characteristics present in response to Ca
• Can detect how aggressive Ca is, whether it can be treated with targeted therapy, or to track treatment response

1) Circulating tumor markers: found in the blood, urine or other body fluids
2) Tumor tissue markers: found in actual tumors, typically from the biopsy. used for diagnosis, stating, prognosis and treatment selection