pathologic diagnosis of cancer

1. PATHOLOGIC DIAGNOSIS OF
CANCER

2. Introduction
• Establishing a diagnosis of cancer begins with
a thorough history and physical examination.
• There should always be a strong correlation
between the clinical diagnosis of cancer and
the results of diagnostic tests.

3. MAIN METHODS OF DIAGNOSIS
• RADIOLOGICAL DIAGNOSIS
• CYTOLOGICAL DIAGNOSIS
• HISTOLOGICAL DIAGNOSIS
• HAEMATOLOGICAL DIAGNOSIS
• IMMUNOHISTOCHEMISTRY
• ELECTRONMICROSCOPY
• MOLECULAR DIAGNOSIS
• TUMOUR MARKS

4. DIAGNOSTIC TESTS:
INVASIVE TESTS
1. CYTOLOGICAL
2. HISTOLOGICAL
3. Tumour Markers
NON-INVASIVE TESTS
1. X-ray
2. Ultrasound
3. CT scan/PET SCAN
4. MRI

5. RADIOLOGICAL DIAGNOSIS:
• They are early tools for diagnosis of cancer.
Includes:
1. X-RAY
2. ULTRASOUND
3. CT-SCAN
4. MRI
5. PET SCAN

7. ULTRASOUND

8. CT-SCAN

9. MRI SCAN

10. PET SCAN

11. CYTOLOGICAL DIAGNOSIS
(FOR STUDYING CYTOPATHOLOGY)
• Consists of 2 types of methods:
1. Exfoliative cytology/PAP test:
2. Fine needle aspiration cytology (FNAC):

12. FNAC
&
EXFOLIATIVE
CYTOLOGY
HELPS IN STUDYING
THE CANCER CELLS
(cell morphology)
i.e, CYTOPATHOLOGY

13. i) Exfoliative cytology:
• Exfoliative cytopathology—the Papanicolaou
method, or Pap test—is the study of normal and
disease-altered, spontaneously exfoliated, or
mechanically dislodged cells for the detection
and diagnosis of various infections, abnormal
hormonal activities, and precancerous or
cancerous lesions.

14. • Spontaneously exfoliated cells in:
 Sputum
 Pleural, peritoneal and pericardial
effusions;
 Urine, gastric secretions, and
 CSF.
samples

15. • Mechanically dislodged cells from (SMEAR TESTS)
 CERVIX (pap smear test)
 ORAL CAVITY
samples

18. ii) Fine Needle Aspiration Cytology.
• FNAC is a diagnostic procedure used to
investigate lumps or masses.
• Useful in investigating deep-seated lesions in
the body which do not shed off cells freely.

19. • Used for diagnosis of tumours of
- BREAST
- PALPABLE TUMOURS OF SKIN
- LYMPH NODES
- SALIVARY GLANDS
- THYROID GLANDS

20. Advantages of FNAC
• Easy procedure
• Inexpensive
• It helps to differentiate between benign and malignant
lesions.

21. Disadvantages of FNAC:
• In situ vs Invasive carcinoma cannot be differentiated
• Vascular or lymphatic invasion cannot be assessed.
• Grading cannot be done
• Complications –bleeding, nerve damage.
• Only cellular morphology is seen, no basement membrane.
(FNAB: FINE NEEDLE ASPIRATION BIOPSY IS USED
FOR STUDYING HISTOLOGY OF CANCER TISSUE)

22. 3. HISTOLOGICAL DIAGNOSIS:
• Histopathology: Study of tissue under
microscope.
• BIOPSY is the method used to collect tissue.
BIOPSY
HELPS IN STUDYING
THE CANCER TISSUE
i.e,HISTOPATHOLOGY

23. BIOPSY
• Removal of tissue for diagnostic purpose.
TYPES:
1. INCISIONAL BIOPSY
2. EXCISIONAL BIOPSY
3. NEEDLE BIOPSY (Fine needle aspiration biopsy)

24. • An incisional biopsy is a medical test to
remove a piece of tissue from a lesion or mass.
• An excisional biopsy is a medical test in
which the whole lesion or mass is removed and
tested.

25. • Fine needle aspiration biopsy is a type
of biopsy procedure.
• In fine needle aspiration, a thin needle is
inserted into an area of abnormal-appearing
tissue or body fluid.
• As with other types of biopsies, the sample
collected during fine needle aspiration can
help make a diagnosis of tumour.

26. EXCISIONAL BIOPSY

27. INCISIONAL BIOPSY

28. FINE NEEDLE ASPIRATION BIOPSY

29. TUMOUR MARKERS
• Tumour markers are the substances produced
by tumour cells or by the host as a response to
the presence of tumour.
• They are found in body fluids or tissues or
tumour surface of patients with cancer.

30. • They are used as a marker to diagnose the
presence of malignancy.
• Their concentration increases with disease
progression and when the tumour metastasize.

31. • Tumour Markers can be:
 Enzymes.
 Serum Proteins.
 Cell surface proteins like Receptors.
 Cytoplasmic Proteins
 Hormones.
 Oncogenes & Oncoproteins.
 Tumour Suppressor Genes & their proteins.
 Oncofeotal Antigens.

32. 1. ONCOFETAL ANTIGENS:
I. Alpha-foetoprotein (AFP):
II. Carcino-embryonic antigen (CEA).
i) ALPHA-FOETOPROTEIN (AFP):
• This is a glycoprotein synthesized normally by foetal liver cells.
• Their serum levels are elevated in Hepatocellular carcinoma and Non-
seminomatous germ cell tumours of the testis.
• Certain non-neoplastic conditions also have increased serum levels of AFP
e.g. in Hepatitis, Cirrhosis, Toxic liver injury and Pregnancy.

33. 2. Carcino-Embryonic Antigen (CEA):
• It is also a glycoprotein normally synthesized in
embryonic tissue of the gut, pancreas and liver.
• Their serum levels are high in cancers of the
Gastrointestinal tract, Pancreas and Breast.
• As in AFP, CEA levels are also elevated in certain non-
neoplastic conditions e.g. in Ulcerative Colitis, Crohn’s
Disease, Hepatitis and Chronic Bronchitis.

34. 2. ENZYMES:
1. Prostate Acid Phosphatase (PAP): Prostatic
carcinoma.
2. Neuron-Specific Enolase (NSE): Neuroblastoma,
Oat cell carcinoma lung.
3. Lactic Dehydrogenase (LDH): Lymphoma, Ewing’s
Sarcoma.

35. 3. HORMONES
1. Human Chorionic Gonadotropin (hCG): Germ
cell tumours of testis.
2. Calcitonin: Medullary carcinoma thyroid
3. Catecholamines and Vanillylmandelic acid
(VMA): Neuroblastoma, pheochromocytoma
4. Ectopic hormone production: Paraneoplastic
syndromes.

36. 4. CANCER ASSOCIATED ANTIGENS
(CA-CANCER ANTIGEN/ CARBOHYDRATE ANTIGEN/
CARCINOMAANTIGEN)
1. CA-125: Ovarian cancer
2. CA 15-3: Breast cancer
3. CA 19-9: Colon, pancreas, breast cancers
4. CD30: Hodgkin’s disease, anaplastic large cell lymphoma (ALCL)
5. CD25: Hairy cell leukaemia (HCL), adult T cell leukaemia lymphoma
(ATLL
6. Monoclonal Immunoglobulins: Multiple myeloma.
7. Prostate Specific Antigen (PSA): Prostate carcinoma.