Evaluation of suspected malignancies: Difference between revisions

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{{General notes}}
{{General notes}}
The most important aspects of a tumor is whether it is malignant or not, and staging.
The most important aspects of a tumor is whether it benign or malignant. If malignant, then staging is necessary.<ref name=cancer>{{cite web |url= http://www.cancer.gov/cancertopics/factsheet/detection/staging |title=Cancer staging |date= |publisher=National Cancer Institute |accessdate=4 January 2013}}</ref>
 
==Benign or malignant==
{|class="wikitable"
!  !! Benign<ref name=amboss>{{cite web|url=https://www.amboss.com/us/knowledge/General_oncology|title=General oncology|website=Amboss|accessdate=2020-01-29}}</ref> !! Malignant<ref name=amboss/>
|-
! Gross examination
|
*Well demarcated from surrounding tissue
|
*Usually no tumor capsule
Possibly:
*Necrosis
*Infiltration or invasion into surrounding tissue
*Bleeding
|-
! Microscopy
| Almost no irregularities of cellular structures
| Nuclear atypia:
*Enlargement
*Pleomorphism
*Nuclear polychromasia, which means variability in nuclear chromatin content.
*Numerous mitotic figures
|}


==Staging==
==Staging==
The primary focus of tumor evaluation is to distinguish benign from malignant types, and in case of malignancy the primary focus is to determine its stage, generally by the TNM classification:<ref>{{cite web |url= http://www.cancer.gov/cancertopics/factsheet/detection/staging |title=Cancer staging |date= |publisher=National Cancer Institute |accessdate=4 January 2013}}</ref>
Staging is generally done by TNM classification. Specific TNM systems should be used, as per the manual by the American Joint Committee on Cancer (AJCC), whenever applicable. Otherwise, a general system may be used:<ref name=cancer/>
{|class="wikitable"
{|class="wikitable"
|
|

Revision as of 06:23, 29 January 2020

Author: Mikael Häggström [note 1]

General notes edit

Further reading:

The most important aspects of a tumor is whether it benign or malignant. If malignant, then staging is necessary.[1]

Benign or malignant

Benign[2] Malignant[2]
Gross examination
  • Well demarcated from surrounding tissue
  • Usually no tumor capsule

Possibly:

  • Necrosis
  • Infiltration or invasion into surrounding tissue
  • Bleeding
Microscopy Almost no irregularities of cellular structures Nuclear atypia:
  • Enlargement
  • Pleomorphism
  • Nuclear polychromasia, which means variability in nuclear chromatin content.
  • Numerous mitotic figures

Staging

Staging is generally done by TNM classification. Specific TNM systems should be used, as per the manual by the American Joint Committee on Cancer (AJCC), whenever applicable. Otherwise, a general system may be used:[1]

T: size or direct extent of the primary tumor

    • Tx: tumor cannot be assessed
    • Tis: carcinoma in situ
    • T0: no evidence of tumor
    • T1, T2, T3, T4: size and/or extension of the primary tumor

N: degree of spread to regional lymph nodes

    • Nx: lymph nodes cannot be assessed
    • N0: no regional lymph node metastasis
    • N1: regional lymph node metastasis present; at some sites, tumor spread to closest or small number of regional lymph nodes
    • N2: tumor spread to an extent between N1 and N3 (N2 is not used at all sites)
    • N3: tumor spread to more distant or numerous regional lymph nodes (N3 is not used at all sites)

M: presence of distant metastasis

    • M0: no distant metastasis
    • M1: metastasis to distant organs (beyond regional lymph nodes)

Typing and grading

Beyond determining overall malignancy, probable origin and staging, classification of tumors into a specific histopathologic type or grade is of relatively less value. In cases of clearly non-malignant tumors where it is difficult to determine the specific histopathologic type or grade, it is generally acceptable to conclude the evaluation and report it as such, unless the clinician specifically requests otherwise. For potentially malignant or high-risk tumors, typing and grading often still affects the management.

Additional slices

  • Additional slices are indicated for example in cases where re-excision does not identify tumor cells in a clearly non-radical primary excision or biopsy.[notes 1]

Notes

  1. ↑ In such cases, step slices are taken rather than serial ones.
  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.0 1.1 . Cancer staging. National Cancer Institute. Retrieved on 4 January 2013.
  2. ↑ 2.0 2.1 . General oncology. Amboss. Retrieved on 2020-01-29.

Image sources


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