Cancer examinations

CANCER EXAMINATIONS

echography
tumor markers
CBC
X-rays
CT
MRI
PET
biopsy =>

light microscopy
IHC , e.g. for differential diagnosis between :

fibrous meningioma and fibrillary astrocytoma (GFAP⁺)
metastases of

prostate adenocarcinoma (PSA ⁺)
thyroid carcinomas (TG⁺, thyroid transcription factor I⁺)
pulmonary adenocarcinoma (surfactant proteins⁺)
breast carcinomas and mullerian carcinomas (ER ⁺, PR ⁺)

TEM , e.g. for differential diagnosis between :

cytoplasm :

signs of metaplasia
tubular myelin, intranuclear surfactant apoprotein tubular inclusions (surfactant-producing pulmonary adenocarcinoma )
Clara cell granules (Clara cell adenocarcinomas )
uniform short microvilli with filamentous cores and core rootlets (colonic adenocarcinomas and some pulmonary adenocarcinoma )
Birbeck granules of Langerhans cells (most frequently associated with non-mucinous bronchioloalveolar cell carcinomas )
lipid droplets glycogen and cytoplasmic crystals (renal cell carcinoma )
intracytoplasmic hyaline globules (pulmonary adenocarcinoma )
differential diagnosis between smooth muscle cancers and skeletal muscle cancers
melanoma (melanosomes )
blood vessels cancers (Weibel-Palade bodies )
mitochondria

renal cell carcinoma
oncocytoma (large eosinophilic cells with small nucleus) => oxyphil adenomas and carcinomas (bilateral in kidney (malignant variant), thryoid nodules, and salivary glands) have worse prognosis

intracytoplasmic inclusions (in sarcomas)

glycogen inclusions in SRBCT

abundant in Ewing's sarcoma
moderate in neuroblastoma
absent in immunoblastic lymphoma

lipid inclusions

multiloculated adipocytes (lipoma , ...)
uniloculated adipocytes (hibernoma )

crystals

alveolar soft part sarcoma : a very rare tumor (< 1% if all soft tissue tumors) simulating renal cell carcinoma
Reinke crystals (Leydig cell of testicle and of ovarian hilus)

soft
oncogenic viral inclusions

cell membrane : despite ~~desmosomes~~ are peculiar of epithelial cells, their absence cannot exclude epithelial origin and exceptionally mesenchymal cells can generate atypical abortive desmosomes. So the differential diagnosis between epithelial and mesenchymal origin is based on presence of terminal web.
basement membrane

differential diagnosis between neurofibrosarcoma (no basement membrane) and spindle cell schwannoma (basement membrane)

visualization of tumours and metastases by real-time imaging in live animals 2 days after injection of bacteria and vaccina virus engineered to express GFP . They are still present in the primary tumour after 45 days^ref
luminescent semiconductor quantum dots (QDs) probes encapsulated with an ABC triblock copolymer and linked to tumor-targeting ligands and drug-delivery functionalities accumulate at tumors both by the enhanced permeability and retention of tumor sites and by antibody binding to cancer-specific cell surface biomarkers^ref
proteomic pattern diagnostics : protein microarray ^ref
optic stretcher : of all the physical properties of a cell, elasticity is the one which varies most dramatically between normal and cancer cells. Just 50 tumour cells need to be present in a sample for the optical stretcher to be able to diagnose cancer. In comparison, more traditional methods, such as looking at tissue samples under a microscopy, need 10,000-100,000 tumour cells to be present to make a diagnosis. It has been observed before that cancer cells have a less well defined skeleton than normal cells and so it is reasonable that they would change shape more in response to external forces. The optical stretcher could also be used to separate out stem cells from adult blood, again, based on their elasticity. When a laser beam from the device enters a cell, the light gains momentum because of the different conditions inside. According to the law of conservation of momentum, the cell must lose an equal but opposite amount, so its membrane bends towards the light source. When the laser light leaves the cell, it loses momentum and drags the cell's opposite edge along with it. By applying a continuous beam, the cell gets stretched to its limit. Without a strong cytoskeleton, cancerous cells are 40% easier to extend than their healthy counterparts. And cells from 'metastasized' tumours — those that have spread through the body — are an additional 30% more stretchy than early-stage cancer cells. This means that the laser could potentially assess how far the disease has advanced. The softest ones are the most aggressive. Currently, doctors cannot diagnose metastasis without discovering the location of the secondary tumours. The new laser-based method would pick up on metastasis based on cell elasticity alone. In breast cancer, for example, this would mean fewer mastectomies carried out unnecessarily on the basis of guesswork about how far the disease has spread. The test should be much more sensitive than cancer tests that simply use molecular markers to tag renegade cells. When cancer-causing genes begin to act in a cell they produce a small change in its structural proteins, but this has an exponential impact on elasticity. The underlying changes in the cell's DNA, which are the focus of current cancer-detection methods, are nowhere near as dramatic. Given a sample that contains at least 50 tumour cells, the laser can spot cancer > 90% of the time. Nevertheless, further studies are needed to determine whether it can spot all types of cancer. Talk that such a machine could replace a microscope for cancer screening is rather premature

tumor stagings (most definition is different for each kind of cancer => the prognosis for a given stage depends on what kind of cancer it is)

TNM staging (don't applies to blood cancers) :

clinical classification (cTNM) : findings during diagnostic evaluation, including imaging and diagnostic laparoscopy
surgical classification (sTNM) : findings during surgery, including frozen sections, cytology, and macroscopic examination of the resected specimen, including therapeutic laparoscopy
pathological classification (pTNM) : findings bases on gross and microscopic examination of materials obtained by resection
final classification (fTNM) : comprehensive findings based on clinical, surgical and pathological findings. When there is conglict between surgical and pathological findings, the pathological findings take precedeence

primary tumor (T). The multiplicity (m) or the actual number of simultaneous multiple tumors should be indicated in square parentheses following the T category of the primary tumor

TX : primary tumor cannot be assessed
T0 : no evidence of primary tumor
Tis : carcinoma in situ (high-grade dysplasia)
T1 : (for gastrointestinal cancers : tumour invades lamina propria and submucosal coat)

T1a : ...
T1b : ...
T1c : ...

T2 : ... (for gastrointestinal cancers : tumor invades muscularis propria)

T2a : ...
T2b : ...
T2c : ...

T3 : .... (for gastrointestinal cancers : tumor invades adventitia)

T3a : ...
T3b : ...
T3c : ...

[ T4 : ...] (for gastrointestinal cancers : tumor invades adjacent structures)

locoregional lymph node metastasis (N)

NX : regional lymph nodes cannot be assessed
N0 : no regional lymph node metastasis
N1 : ...

N1a : metastasis in a single regional lymph node
N1b : metastasis in multiple regional lymph nodes

N2 : ...
N3 : ...
N4 : juxtaregional lymph nodes

distant metastasis (M) : including nonregional lymph nodes

MX : distant metastasis cannot be assessed
M0 : no distant metastasis
M1 : distant metastasis

M1a :
M1b :

PUL : pulmonary metastases
OSS : osseous metastases
BRA : brain metastases
HEP : hepatic metastases
LYN : lymph nodal metastases
SKI : skin metastases

facultative descriptions

lymphatic infiltration (L)

LX : lymphatic invasion cannot be assessed
L0 : absence of lymphatic invasion
L1 : presence of lymphatic invasion

vascular infiltration (V)

VX : vascular invasion cannot be assessed
V0 : absence of vascular invasion
V1 : presence of vascular invasion

tumor rest after treatment (R)

RX : presence of tumor rest cannot be assessed
R0 : absence of tumor rests
R1 : presence of microscopic tumor rest
R2 : presence of macroscopic tumor rest

in Japanese classification of gastric cancer only :

proximal margin (PM) :

PM(-) : no involvement of the proximal margin
PM(+) : involvement of the proximal margin
PMX : unknown

distal margin (DM) :

DM(-) : no involvement of the distal margin
DM(+) : involvement of the distal margin
DMX : unknown

lymph node dissection (D)

D0 : no dissection or incomplete dissection of the Group 1 nodes
D1 : dissection of all the Group 1 nodes
D2 : dissection of all the Group 1 and Group 2 nodes
D3 : dissection of all the Group 1, Group 2, and Group 3 nodes

lateral margin (LM) :

LM(-) : no involvement of the mucosal lateral margin
LM(+) : involvement of the mucosal lateral margin
LMX : unknown

vertical margin (VM) :

VM(-) : no involvement of the submucosal vertical margin
VM(+) : involvement of the submucosal vertical margin
VMX : unknown

Certainty factors (C1, C2 and C3 can be applied to TNM stages, while C4 corresponds to pTNM staging) :

C1 : signs detected with standard diagnostic devices
C2 : signs detected with special diagnostic devices
C3 : signs detected with surgical exploration, including biopsy and/or cytology
C4 : signs of disease extension after surgical operation and pathological examination of excised tissue
C5 : information from necropsy

AJCC/Union Internationale Contre Cancer (UICC) system overall stage groupings (roman numeral staging)

stage 0 : T0 or Tis, N0, M0
stage I : T1 or T2, N0, M0
stage II : T2 or T3 or T4, N0 or N1, M0

stage IIA :
stage IIB : N1

stage III : any T, N > 0, M0
stage IV : any T, any N, M1
recurrent

locally recurrence :
distant recurrence : disease that recurs as metastases

others, e.g. :

Dukes' classification system for colorectal cancers
FIGO classification : any of the classification systems established by the International Federation of Gynecology and Obstetrics for the staging of gynecological cancers. Cancers at any particular site are staged from 0 to IV with 0 being precancerous or in situ and IV being highly malignant or invasive; subdivisions using letters may also be used, as IA, IB, IIA, IIB, and so on.
Okuda staging system for hepatocellular carcinoma (HCC)

tumor grading (how abnormal (appearance or mitotic index) cells from your tumor appear under the microscope : the higher the grade, the more aggressive and fast growing the can). For most kinds, it is a somewhat secondary factor, but for a few kinds of cancers, notably certain brain tumors, prostate cancer , and lymphomas, it is extremely important

grade X : undefined grade
grade I (G1) : well differentiated neoplasm (e.g. keratin pearls in squamous cell carcinomas; >95% of tumor composed of glands in adenocarcinomas)
grade II (G2) : moderately differentiated neoplasm (e.g. 50%-95% of tumor composed of glands in adenocarcinomas)
grade III (G3) : poorly differentiated neoplasm (e.g. 5-49% of tumor composed of glands in adenocarcinomas)
grade IV (G4) : undifferentiated or anaplastic neoplasm (e.g. <5% of tumor composed of glands in adenocarcinomas)
Broders' index : an index of malignancy based on the fact that the more undifferentiated or embryonic the cells of a tumor, the more malignant the tumor.

grade 1 contains 25% undifferentiated cells
grade 2, 50% undifferentiated cells
grade 3, 75% undifferentiated cells
grade 4, all cells undifferentiated.

smell

^ref