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Grading and staging of tumors and paraneoplastic syndrome
This document discusses grading and staging of tumors and paraneoplastic syndrome. Grading is done based on differentiation and mitotic figures, with tumors graded on a scale of G1 to G4. Staging uses the TNM system to describe tumor size (T), lymph node involvement (N), and metastasis (M). Together, grading and staging provide information on prognosis and guide treatment. Paraneoplastic syndromes are unrelated to direct tumor involvement and may be caused by hormones or antibodies. Examples include endocrinopathies, neurological disorders, dermatological changes, and vascular/hematological syndromes associated with certain cancers. Grading, staging, and recognizing paraneoplastic syndromes help characterize cancers and their systemic
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Grading and staging of tumors and paraneoplastic syndrome
- 1. GRADING AND STAGINGOF TUMORS & PARANEOPLASTIC SYNDROME Shiksha Choytoo Roll No. 12 22 September 2014
- 2. Introduction Grading and stagingare 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.
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- 4. Grading • It isdone 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. Differentiation • It isthe extent to which the tumor cells represent their normal counter part both morphologically and functionally. • Lack of differentiation is anaplasia.
- 6. Mitotic Figure perHPF • 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. • The malignancyof tumor can be graded into 4 categories. • Recommended by the American Joint commission on Cancers and other bodies
- 8. GRADES DESCRIPTION GX Gradecannot be assessed G1 Well differentiated (Low grade) G2 Moderately differentiated (Intermediate grade) G3 Poorly differentiated (High grade) G4 Undifferentiated (High grade- ANAPLASIA)
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- 10. Grading of CAProstate
- 11. Grading of CABreast
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- 13. • It isbased 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. • There aretwo 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. TNM System T •TUMOR SIZE N • NODAL STATUS M • +/- METASTASIS
- 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
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- 18. • NOTE CA insitu abnormal cells are present but have not spread to neighbouring tissue; although not cancer, CIS may become cancer sometimes called preinvasive cancer
- 19. Lymph Node Status LYMPHNOTE 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. Distant Metastasis (+/-) METASTASISDESCRIPTION MX Distant metastasis cannot be evaluated M0 No distant metastasis M1 Distant metastasis is present
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- 22. System based onAJCC 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. Importance of gradingand 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. NOTES • Not allcancers 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.
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- 26. Definition Paraneoplastic syndromes aredefined 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. Significance • May bethe 1st manifestation of occult neoplasm • It may mimic metastatic disease and confuse treatment • It may be a serious clinical manifestation that prove fatal
- 28. Paraneoplastic syndromes canbe grouped into the following 4 categories: • Endocrinopathies • Neurological • Musculocutaneous • Vascular and hematological
- 29. Endocrinopathies CLINICAL SYNDROME UNDERLYING CANCER CAUSAL MECHANISM Cushing Syndrome •Smallcell 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. Hypoglycemia •Fibrosarcoma •Hepatocellular CA Productionof insulin and insulin like substance Carcinoid Syndrome •Bronchial CA •Pancreatic Cancer •Gastric cancer •Serotonin •Bradykinin Polycythemia Renal Cell CA Erythropoetin
- 31. Nerve and MuscleSyndm. 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. Dermatomyositis CA Lung CABreast Immunological OSSEOUS,ARTICULAR AND SOFT TISSUE CHANGES Hypertropic osteoarthritis and clubbing of finger Bronchogenic CA Unknown
- 33. Vascular & HematologicalChanges 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. References • Class Notes •Robbins and Cotran- pathology textbook • Internet • Wikipedia
- 35.