patoloji-ders-notlari

Title

Serdar Balcı

Clinicopathological Features of Neoplasia and Epidemiology

Serdar BALCI, MD

Clinical problems caused by both benign and malignant tumors

Effects of Tumor on Host

Cancer Cachexia

Progressive loss of body fat

Progressive loss of lean body mass

Profound weakness

Anorexia

Anemia

Cachexia

Cancer cachexia: understanding the molecular basis Nature Reviews Cancer, 14, 754–762 (2014)

Cancer cachexia: understanding the molecular basis Nature Reviews Cancer, 14, 754–762 (2014)

Cancer cachexia: understanding the molecular basis Nature Reviews Cancer, 14, 754–762 (2014)

Paraneoplastic Syndromes

Hypercalcemia due to bone metastasis is not considered as paraneoplastic

If hypercalcemia is due to PTH related protein then it is a paraneoplastic syndrome

Robbins Basic Pathology

Robbins Basic Pathology

Grade (Derece)

Different Grades for Different Tumors

Criteria for the individual grades vary with each form of neoplasia

Fuhrman Grade

Gleason Grade and Score

FIGO grade

Cancer Grading Manual

Cancer Grading Manual

Cancer Grading Manual

Cancer Grading Manual

Cancer Grading Manual

Cancer Grading Manual

Stage (Evre)

Based on

The size of the primary lesion or its extend to local tissues

Its extent of spread to regional lymph nodes

The presence or absence of metastases

Stage

Atlas of Staging in Gynecological Cancer

Atlas of Staging in Gynecological Cancer

Arch Pathol Lab Med. 2009 Oct;133(10):1539-51

cancerstaging.org

Laboratory Diagnosis of Cancer

Morphologic Methods

Tumor Markers

Molecular Diagnosis

Morphologic Methods

Clinical information is necessary in all cases But absolutely necessary in some cases

Radiation-induced changes in the skin or mucosa can be similar to cancer

Sections taken from a healing fracture can mimic an osteosarcoma

Giant cell tumor of bone vs bone cysts vs hyperparathyroidism

Specimen

Types of Specimens

Radical Surgery

Excisional biopsy

Tru-cut (needle) biopsy

Int J Surg Case Rep. 2014; 5(1): 30–33

Frozen Section

http://www.ihcworld.com/

Fine Needle Aspiration

Exfoliative Cytology

Cytologic (Papanicolaou) smears

Robbins Basic Pathology

Immunohistochemistry

Bancroft’s Theory and Practice of Histological Techniques

Flow cytometry

Tumor Markers

Tumor-associated enzymes, hormones, and other tumor markers in the blood

NOT for definitive diagnosis of cancer

Useful screening tests

Quantitating the response to therapy

Detecting disease recurrence

PSA

CEA

AFP

CA-125

CA19-9

Molecular Diagnosis

Bancroft’s Theory and Practice of Histological Techniques

Robbins Basic Pathology

Molecular Profiling of Tumors

Expression Profiling

Robbins Basic Pathology

Molecular Profiling of Tumors

Two types of mutations

Driver mutations

A new classification

BRAF-omas???

Robbins Basic Pathology

Factors effecting clinical outcome

Factors effecting survival

Histologic Type of Tumor

Grade

Presence of preinvasive component

Tumor size

Perineural invasion

Lympatic invasion

Venous invasion

Stage T, N, M

Clues for hereditary syndromes

Markers used in pathology

Diagnostic

Predictive

Prognostic

Therapeutic

Product of a pathologist is a report

What do we expect to see in a report?

All morphologic, phenotypic, molecular features that are effecting the clinical outcome

Checklists, CAP

cap.org/cancerprotocols

Epidemiology

Epidemiologic data is used to find factors that are associated with cancer

Smoking → Lung cancer

Dietary fat and fiber → Colon cancer

Environmental, racial (hereditary), cultural influences

Cancer Incidence

http://globocan.iarc.fr/Pages/fact_sheets_population.aspx

Cancer Rates changes over time

Geographic and Environmental Variables

Environmental carcinogens are everywhere

In the workplace, in food, and in personal practices

Sunlight

Asbestos

Certain occupation

Certain features of diet

Cigarette smoking

Chronic alcohol consumption

Age at first intercourse

Number of sex partners

?questions to think?

Why do we see cancer in older people?

Why do we see cancer in newborns?

Why certain cancers have peaks at certain ages?

Age

Heredity

characterized by chromosomal or DNA instability and high rates of certain cancers

Why all smokers do not get cancer?

Polymorphisms in drug-metabolizing enzymes

Genome-wide association studies (GWAS) in lung cancer

Identified variants in a nicotinic acid receptor

Associated with the number of cigarettes smoked

Indirectly increase lung cancer risk by enhancing the addictiveness of cigarettes

?My uncle used to smoke 3 packages per day, he did not get cancer?

Acquired Preneoplastic Lesions

What is the risk of malignant change in a benign neoplasm?

Early Detection of Cancer

N Engl J Med 373;18 October 29, 2015

How can you find cancer statistics?

SEER: seer.cancer.gov/

Globocan: globocan.iarc.fr/

http://www.cancerindex.org/Turkey