Lecture notes for medical students

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2. Classification

3. Classification
Classification Vs. Grade Vs. Staging.
• Classification is histological types of
cancer.
• Grading is measurement of aggressiveness
of malignancy.
• Staging is measurement of how much
spread has occurred.

4. Staging

5. Staging
General Scheme of Staging
4stages
• Stage I- Small tumor limited to organ of
origin.
• Stage II- stage I tumour with mobile lymph
nodes in regional lymh node area.
• Stage III- Locally advanced tumour/fixed
lymoh nodes
• Stage IV- Distant mets.

6. Stage TNM
• 0
• I
• IIA
• IIB
• Tis N0, M0
• T1, N0, M0
• T0, N1,MO
• T1,N1,M0
• T2,NO,M0
• T2,N1,MO
• T3,NO,MO

7. Stage TNM
• IIIA
• IIIB
• IIIC
• IV
• T0 -- T3,N1/N2,MO
• T4,N1/2,MO
• AnyT,N3,M0
• AnyT,AnyN,,M1

8. Primary Tumor (T)

9. Primary Tumor (T)
 TX Primary tumor cannot be assessed
 T0 No evidence of primary tumor
 Tis Carcinoma in situ
 T1 >2cm
 T2 2-5cm
 T3 >5cm
 T4 fixed to chest wall or skin

10. Regional Lymph Nodes (N)

11. Regional Lymph Nodes (N)
• NX Regional lymph nodes cannot be assessed
(e.g.,previously removed)
• N0- No regional lymph node metastases
• N1- Metastases to movable ipsilateral
• N2- Metastases in ipsilateral level I, II axillary
lymph nodes that are clinically fi xed or matted
• N3- Metastases in ipsilateral infraclavicular lymph
node(s) ,ipsilateral internal mammary lymph
node(s) ,ipsilateral supraclavicular lymph node(s)

12. Regional Lymph Nodes (N)

13. Regional Lymph Nodes (N)
Levels of Lymph nodes
• Level I --Lateral to P. Minor
• Level II –Deep to P.Minor
• Level III – Medial to Minor

14. Metastasis

15. Metastasis
• Mx –Cannot be assesed
• Mo- No Mets
• M1- Mets +nt

16. Pathological Classification

17. Pathological Classification
• Noninvasive Epithelial Cancers
• Invasive Epithelial Cancers
• Mixed Connective and Epithelial
Tumors

18. Classification
Noninvasive Epithelial Cancers
• LCIS- Lobular Carcinoma In situ
• DCIS –Ductal Carcinoma In Situ or
intraductal carcinoma
– Papillary
– Cribriform,
– Solid
– Comedo types

19. Classification
Invasive Epithelial Cancers
• Invasive lobular carcinoma (10%)
• Invasive ductal carcinoma
– Invasive ductal carcinoma, infiltrating ductal
carcinoma NOS (not otherwise specified) (50-70%)
– Tubular carcinoma (2%-3%)
– Mucinous or colloid carcinoma (2%-3%)
– Medullary carcinoma (5%)
– Invasive cribriform carcinoma (1%-3%)
– Invasive papillary carcinoma (1%-2%)
– Adenoid cystic carcinoma (1%)
– Metaplastic carcinoma (1%)
– Inflammatory breast cancer

20. Classification
• Modern classification schemes are replacing these
older morphologic descriptions with the
determination of molecular markers and breast
cancer subtype by microarray analysis.
• Categorizing breast cancer according to the
expression of molecular targets of treatments is
practical.
• 21-gene test
• MammaPrint assay. analyzes data from 70 genes
to develop a risk profile. The test provides a
simple readout of low-risk or high-risk disease

21. Classification
Molecular Markers and Breast
Cancer Subtypes
• Immunohistochemical detection- triple-negative
breast cancers- high grade, ER- and progesterone
receptor (PR)–negative, and negative for the
human epidermal growth factor receptor 2 (HER-
2/neu; HER-2, erb-B2/neu protein) cell surface
receptor
• basal-like breast cancer describes a specific
subtype of breast cancer as defined by microarray
analysis

22. Classification
Mixed Connective and Epithelial Tumors
• Phyllodes tumors, benign and malignant
• Carcinosarcoma
• Angiosarcoma
• Adenocarcinoma

23. Classification
Grade- low grade cancers tend to be less
aggressive than high grade cancers.
Nottingham Histologic Score system (also
termed “the Elston-Ellis modification of
Scarff-Bloom-Richardson grading system.

24. Grade

25. Grade
Three histologic features are used
1. The amount of gland formation (the cell
“differentiation,” or how well the tumor
cells are trying to recreate normal glands)
2. The nuclear features (the degree of
"pleomorphism" or how "ugly" the tumor
cells look)
3. The mitotic activity (how much the tumor
cells are dividing, or proliferating)

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