diagnostic evaluation for malignent disease.pptx
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Physical assessment, lab tests, imaging studies, and tissue diagnosis are used to evaluate patients for possible malignant disease. Lab tests may include blood tests, urine tests, and tumor marker tests. Imaging studies like x-ray, ultrasound, CT, MRI, and nuclear scans provide images of internal organs and tissues. Tissue is obtained through non-invasive or invasive procedures like biopsy and endoscopy and is examined histologically with immunohistochemistry and molecular pathology to make a final diagnosis of cancer.
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TARGET AUDIENCE
Medical/surgical/radiation oncologists, pathologists, nurse practitioners, physician assistants, oncology nurses, and other health care professionals involved in the treatment of patients with soft tissue sarcoma.
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to
Distinguish patient and tumor characteristics that can inform personalized therapeutic approaches in soft tissue sarcoma
Evaluate emerging data on novel therapies for soft tissue sarcoma
Appraise multidisciplinary strategies to optimize treatment outcomes of patients with advanced soft tissue sarcoma
FACULTY
Shreyaskumar R. Patel, MD
Robert R. Herring Distinguished Professor of Medicine
Center Medical Director, Sarcoma Center
The University of Texas
MD Anderson Cancer Center
Kathleen Polson, NP
Nurse Practitioner
Dana-Farber Cancer Institute
Brian Rubin, MD, PhD
Professor of Pathology
Chairman, Robert J. Tomsich Pathology and Laboratory Medicine Institute
Cleveland Clinic Cancer Center
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Gain insights and perspectives from this multidisciplinary panel of experts as they discuss cases and explore strategies to optimize treatment outcomes for patients with advanced soft tissue sarcoma. This distinguished Virtual Tumor Board features Shreyaskumar R. Patel, MD, Medical Director of the Sarcoma Center at the University of Texas MD Anderson Cancer Center; Kathleen Polson, NP, Nurse Practitioner at Dana-Farber Cancer Institute; and Brian Rubin, MD, PhD, Professor of Pathology at Cleveland Clinic Cancer Center
STATEMENT OF NEED
Sarcomas, which represent 1% to 2% of adult cancers, are a rare, heterogeneous group of neoplasms originating in the connective tissue. Soft tissue sarcomas, which begin in the muscle, tendons, fat, lymph, blood vessels, and nerves, encompass more than 80 histological subtypes. Approximately 25% of patients develop metastatic disease after curative-intent surgery, and for these patients, treatment options are limited and prognosis is very poor. In recent decades, the identification of genetic alterations in soft tissue sarcoma has led to the rise of targeted therapy, significantly expanding the therapeutic landscape. Remaining up to date on pathological characteristics and emerging data on novel therapies is crucial (Riskjell et al, 2023; NCI, 2023). In this Virtual Tumor Board, Shreyaskumar R. Patel, MD, Medical Director of the Sarcoma Center at the University of Texas MD Anderson Cancer Center; Kathleen Polson, NP, Nurse Practitioner at Dana-Farber Cancer Institute; and Brian Rubin, MD, PhD, Professor of Pathology at Cleveland Clinic Cancer Center, will present cases and explore multidisciplinary strategies to optimize treatment outcomes for patients with advanced soft tissue sarcoma.
TARGET AUDIENCE
Medical/surgical/radiation oncologists, pathologists, nurse practitioners, physician assistants, oncology nurses, and other health care professionals involved in the treatment of patients with soft tissue sarcoma.
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to
Distinguish patient and tumor characteristics that can inform personalized therapeutic approaches in soft tissue sarcoma
Evaluate emerging data on novel therapies for soft tissue sarcoma
Appraise multidisciplinary strategies to optimize treatment outcomes of patients with advanced soft tissue sarcoma
FACULTY
Shreyaskumar R. Patel, MD
Robert R. Herring Distinguished Professor of Medicine
Center Medical Director, Sarcoma Center
The University of Texas
MD Anderson Cancer Center
Kathleen Polson, NP
Nurse Practitioner
Dana-Farber Cancer Institute
Brian Rubin, MD, PhD
Professor of Pathology
Chairman, Robert J. Tomsich Pathology and Laboratory Medicine Institute
Cleveland Clinic Cancer Center
Oncology
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Describe the structure and function of taste buds.
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- 2. Steps to diagnosis Malignancy Lab test Physical assessment Imaging Tissue diagnosis Endoscopy
- 3. Physical Assessment • Detailed history • Symptoms evaluation • Physical examination
- 5. Lab test • Blood • Urine • Other fluids • Tumour marker
- 6. Blood for • Blood chemistry – Metabolites, electrolytes, enzymes, BUN, Creatinine • Cancer gene mutation test – BRCA1, BRCA2 mutation • CBC – cell types, Hb% • Cytogenic analysis – PBF, Bone marrow analysis • Immuno-phenotyping – Identify cells based on cell surface antigens (Leukaemia)
- 7. Sputum for Cytology – Ca Lung Urine for -RBC -cytology Ascitic fluid for -cytology
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- 11. X-ray
- 12. USG • Trans-abdominal • EUS • Trans anal • Trans vaginal • Trans perineal
- 13. Computed Tomography scan • Also called CAT scan • 1-10 mm slice • Tomos means slice • Absorbs radiation in abdominal CT 500 times than CXR • Invented in 1972 • 7th generation in running
- 14. MRI • Use Hydrogen ion • Contraindications • T1 & T2 relaxation time
- 15. Nuclear scan • Thyroid scan : 123 I • Bone scan : 99-m Tc • PET scan: 18 FDG • MIBG scan: 131 I • MIBI (Sistamibi)scan : 99-m Tc • Gallium scan: 67 Ga • Breast scan (molecular breast imaging): 99-m Tc
- 16. PET scan
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- 18. MIBI scan • Detect parathyroid, Breast malignancy,
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- 20. Scopes • Endoscopy • Capsule endoscopy • Balloon endoscopy • Colonoscopy • Virtual colonoscopy • ERCP • Thoracoscopy
- 21. Endoscopic image enhancement • White light assessment • Chromoendoscopy • Narrow band imaging (NBI) • Confocal Laser endo- microscopy (CLE)
- 22. Confocal Laser endo-microscopy (CLE)
- 23. Tissue diagnosis • Needle biopsy – FNAC – Core biopsy – Vacuum assisted biopsy • Endoscopic biopsy • Skin biopsy – Punch biopsy – Shave biopsy – Incisional biopsy – Excisional biopsy • Bone marrow biopsy • Surgical biopsy • Image guided biopsy • SLNB • Frozen section biopsy • Touch imprint cytology
- 28. Immunohistochemistry • Detects antigen by using dye labelled antibody • Some IHC stains used for tumours – lymphomaCD45, CD3, CD20 – Melanoma S100 – NET chromogranin, Ki67 – Prostate PSA – Thyroid thyroglobulin – Colo-rectalCK20 – GIST CD117 – Breast Her2, Ki67
- 29. Diagnosis of molecular pathology • Multiple tests that assess molecules like protein, RNA, DNA in Tissue • Useful for : – diagnosis, – Prognosis – Identifying patients with a hereditary cancer risk, – Determining treatment – Identifying residual disease after treatment
- 30. Diagnosis of molecular pathology • Methods: – In situ hybridization – Polymerase chain reaction – FISH – Flow cytometry
- 31. And finally, The cancer is Diagnosed
Editor's Notes
- Physical assessment
- Meta-Iodo-Benzyl-Guanidine. The treatment uses a radioactive form of iodine called iodine 131. The radioactive iodine circulates through your body in the bloodstream. The neuroendocrine tumour (NET) cells pick up the radioactive iodine wherever they are in the body.
- CD = cluster of differentiation
- In situ hybridization is used to reveal the location of specific nucleic acid sequences on chromosomes or in tissues Flow cytometry (FC) is a laser - or impedance-based technique used for cell counting, cell sorting, biomarker detection