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Grading and staging of tumors and paraneoplastic syndrome

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Grading and staging of tumors
paraneoplastic syndrome

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Grading and staging of tumors and paraneoplastic syndrome

  1. 1. GRADING AND STAGING OF TUMORS & PARANEOPLASTIC SYNDROME Shiksha Choytoo Roll No. 12 22 September 2014
  2. 2. Introduction Grading and staging are systems developed to quantify the extent of a neoplasm in a given case and its clinical aggressiveness and to compare the end results of various treatment modalities.
  3. 3. GRADING
  4. 4. Grading • It is done on two basis: 1. level of differentiation 2. Number of mitotic figures per high power field • It is done by histopathological exam. By pathologist.
  5. 5. Differentiation • It is the extent to which the tumor cells represent their normal counter part both morphologically and functionally. • Lack of differentiation is anaplasia.
  6. 6. Mitotic Figure per HPF • Cell under mitosis are easy to spot • The chromosomes are visible as tangled, dark- staining threads. • We call these “mitotic figures”. • Helps in grading of tumor.
  7. 7. • The malignancy of tumor can be graded into 4 categories. • Recommended by the American Joint commission on Cancers and other bodies
  8. 8. GRADES DESCRIPTION GX Grade cannot be assessed G1 Well differentiated (Low grade) G2 Moderately differentiated (Intermediate grade) G3 Poorly differentiated (High grade) G4 Undifferentiated (High grade- ANAPLASIA)
  9. 9. Gleason Scale
  10. 10. Grading of CA Prostate
  11. 11. Grading of CA Breast
  12. 12. STAGING
  13. 13. • It is based on 1. Tumor size and/or extent reached 2. Lymph node status 3. presence or absence of metastasis • It is done by detailed clinical examination, usually along with radiological exam. (x- ray, CT scan, MRI, Ultrasonography) • Sometimes surgical exploration may be required.
  14. 14. • There are two systems of staging 1. Union for international cancer control (UICC) The TNM system 2. American Joint Committee on Cancer (AJCC) • Most medical facilities use the TNM system as their main method for cancer reporting.
  15. 15. TNM System T • TUMOR SIZE N • NODAL STATUS M • +/- METASTASIS
  16. 16. Tumor size TUMOR (T) DESCRIPTION TX Primary tumor cannot be evaluated T0 No evidence of primary tumor Tis Carcinoma in situ T1 Tumor < 2cm T2 Tumor 2-5cm T3 Tumor > 5cm
  17. 17. Eg: CA Prostate
  18. 18. • NOTE CA in situ abnormal cells are present but have not spread to neighbouring tissue; although not cancer, CIS may become cancer sometimes called preinvasive cancer
  19. 19. Lymph Node Status LYMPH NOTE STATUS (N) DESCRIPTION NX Regional lymph nodes cannot be evaluated N0 No regional lymph node involvement N1 3 Lymph nodes + Axillary N2 10 Lymph nodes+
  20. 20. Distant Metastasis (+/-) METASTASIS DESCRIPTION MX Distant metastasis cannot be evaluated M0 No distant metastasis M1 Distant metastasis is present
  21. 21. Eg: CA Breast
  22. 22. System based on AJCC STAGE DESCRIPTION Stage 0 Carcinoma in situ Stage I Stage II Stage III Higher numbers indicate more extensive disease: Larger tumor size and/or spread of the cancer beyond the organ in which it first developed to nearby lymph nodes and/or tissues or organs adjacent to the location of the primary tumor Stage IV The cancer has spread to distant tissues or organs
  23. 23. Importance of grading and staging • Helps the doctor plan the appropriate treatment • Estimates patients’ prognosis trials and comparing the results of different trials. • Helps health care providers and researchers exchange information about patients. • It also gives them a common terminology for evaluating the results various treatments
  24. 24. NOTES • Not all cancers have TNM Designation, eg cancers of spinal cord and brain ( they are staged according to cell type and grade) • Most of the cancers of blood and bone marrow does not have a clear cut staging system • Ann Arbor staging classification – lymphomas • Another staging system, developed by the International Federation of Gynecology and Obstetrics (FIGO), is used to stage cancers of the cervix, uterus, vagina, ovary and vulva.
  25. 25. PARANEOPLASTIC SYNDROME
  26. 26. Definition Paraneoplastic syndromes are defined as symptoms complexes occurring in cancer bearing patients which cannot be explained on the basis of • Local spread • Distant spread • Elaboration of hormone belonging to that particular site from the tumor arose.
  27. 27. Significance • May be the 1st manifestation of occult neoplasm • It may mimic metastatic disease and confuse treatment • It may be a serious clinical manifestation that prove fatal
  28. 28. Paraneoplastic syndromes can be grouped into the following 4 categories: • Endocrinopathies • Neurological • Musculocutaneous • Vascular and hematological
  29. 29. Endocrinopathies CLINICAL SYNDROME UNDERLYING CANCER CAUSAL MECHANISM Cushing Syndrome •Small cell CA lung •Pancreatic cancer Production of ACTH or ACTH like substances SIADH- Syndrome of inappropriate ADH secretion •Small cell CA lung •Intracranial neoplasm Ectopic ADH or atrial Natriuretic hormone Hyper calcemia •Squamous cell CA lung •CA Breast •Renal cell CA •Ovarian CA •Adult T cell LL Production of parathomone related peptide, TGF-alpha, TNF-alpha, IL-1
  30. 30. Hypoglycemia •Fibrosarcoma •Hepatocellular CA Production of insulin and insulin like substance Carcinoid Syndrome •Bronchial CA •Pancreatic Cancer •Gastric cancer •Serotonin •Bradykinin Polycythemia Renal Cell CA Erythropoetin
  31. 31. Nerve and Muscle Syndm. CLINICAL SYNDROME UNDERLYING CANCER CAUSAL MECHANISM Myesthenia gravis likes syndrome Bronchogenic CA Immunological Disorders of CSN & PNS CA Breast DERMATOLOGICAL DISORDERS Acanthosis Nigricans •Gastric CA •CA Lung •Uterine CA Immunological & secretion of epidermal GF
  32. 32. Dermatomyositis CA Lung CA Breast Immunological OSSEOUS,ARTICULAR AND SOFT TISSUE CHANGES Hypertropic osteoarthritis and clubbing of finger Bronchogenic CA Unknown
  33. 33. Vascular & Hematological Changes CLINICAL SYNDROME UNDERLYING CANCER CAUSAL MECHANISM Venous thrombosis or migratonis thrombophlebitis •Pancreatic cancer •Bronchogenic CA •Mucin secreting adenocarcimoma Tumor products and mucin activated clotting pathway DIC Acute promylocytic leukemia Muccin activated coagulation cascade NBTE( Non bacterial endocarditis) Disceminated/ Advanced CA Anemia Thymic neoplasm Unknown OTHERS Nephrotic syndrome Various cancers Deposition of tumor antigens & antibodies or immune complexes
  34. 34. References • Class Notes • Robbins and Cotran- pathology textbook • Internet • Wikipedia
  35. 35. Thank you

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