To begin an evaluation of a cancer we need more information about this condition:
- The causes of its occurrence
- The stage of the disease is
- Prognostic factors.In order to understand in detail all details of the disease and all the related aspects that you have known every detail of the above. This information will be obtained from your physician specialist.
To obtain full medical name of the disease, its staging, and information related to the type of cells and ultimately prognostic factors will be performed some tests. Copies of the results of any investigations that you will make will be saved for subsequent evaluation.
If you choose to document on the condition that in the literature, it can be extremely useful both for finding general information and to discover the latest information strictly related to that form of cancer.
Treatment is tailored to each type cancers and is dependent on body condition from which to start cancer cell type, stage of disease.
Cancerous disease occurs due to uncontrolled division of certain cells with particular characteristics, thus causing the appearance of a tumor mass. These cells that initiated the uncontrolled division of cells are called primary. Of primary cells forming tumor cells can detach from entering the circulation seeding other areas, giving rise to secondary tumors – metastasis. Metastatic tumor cells in tumors retains primary cell type of origin.
For example, in malignant tumors of the colon may occur especially in liver metastases. These metastatic liver tumors from primary tumors should be clearly differentiated liver situation where different therapeutic attitude. Also have a differentiated metastatic bone tumor in breast cancer by primary bone tumor.
There are important differences that need to be made even between tumors that start in the same organ, differences in prognosis and treatment are important from one form to another. For this distinction will be made that will allow a precise exploration is the type of cancer in order to optimal therapeutic approach.
Cancer diagnosis is a laborious process that, although at first it may be clear evidence of a cancer will be determined after the items that will help shape that accurate diagnosis of cancer – the exact type and evolutionary stage.
The exact type of cancer and the histopathological diagnosis can be known precisely only after examining the biopsy tissue by pathologist. But there are some forms of cancer in organs that can be guessed from the beginning what it histopathological type. For example, in prostate cancer in the vast majority of cases we meet with forms of adenocarcinoma and also in cervical cancers frequently encountered carcinomas.
Staging of cancer
The stage just like other prognostic factors will be specified after surgery and intraoperative assessment of tumor and satellite adenopathy. Postoperatively will be examined and evaluated by the pathologist entire tumor with lymph nodes excised. So the stage is only presumptive preoperative tumor staging.
Despite these diagnostic uncertainties in the initial phase can begin, however depending on diagnosis treatment that we have at this stage, followed by certification of the exact type of cancer treatment shifted complex depending on the specific cancer.
This division of cancers by stage is to classify patients by similar degrees of disease states and systematized to offer a vision of treatment and prognosis. Thus patients with similar stages in similar forms of cancer, will have a similar prognosis and treatment. But therapeutic results may differ from one patient to another depending on various factors such as general health, their beliefs and preferences related to treatment, different biochemical affinity for certain drug treatments, etc..
This concept of staging cancers can be applied to all cancers except leukemia. In this form of cancer are localized cancer cells form a tumor but is among circulating cells in the blood of the patient, tumor staging classic for not being able to accomplish.
For staging of solid tumors there are two systems:
- The classic that takes into account in particular the size of the tumor and divided tumors in stages I to IV
- TNM staging – more modern and complex.
- Stage I: generally includes small tumors without invasion and which in most cases are perfectly curable with favorable prognosis
- Stage II and III tumors include local invasion of surrounding tissue and lymph nodes, the mainstay of treatment and prognosis are different depending on the time cells and the organ of origin;
- Stage IV: in this stage are in general inoperable tumors, metastasis and prognosis reserved.
Unfortunately known cancers tend to relapse months or years after surgery with radical intent, which completely resected primary tumor. This is due to the persistence of cancer cells and the subsequent development of macroscopic tumor formation.
If the tumor occurs in the same area was primary tumor relapse talking about and if tumors occur away from the primary tumor is called metastasis. These cases of recurrence and / or metastasis are considered stage IV.
Staging of classes I to IV is replaced by the current TNM staging more detailed and precise.
If this is taken into account both staging both tumor size (T), lymph node invasion (N) and metastases (M). They are assessed separately and then classified with numbers by associating the three elements sets stage of disease.
For example T1N1M0 stage consists of a stage 1 tumor, invasion of lymph node metastases grade 1 and no. TNM staging is typical of all forms of cancer and may give a more accurate idea of the progress of the disease.
T – Tumor
Tumor classification is made by the numbers 0-4:
T0 – is minimal tumor that has not yet begun to invade local structures, this stage is called the tumor “in situ”
T1, 2,3 – represent intermediate stages between tumor “in situ” and invasion of adjacent organs, stages defined differently from one tumor type to another
T4 – defines large tumor that invades all neighboring structures by direct extension and in most cases is inoperable.
N – lymph nodes
Refers to lymph node invasion. It is the line of lymphatic channels throughout the body and lymphatic stations are filtering role and antibody synthesis. When cancer cells are shed from the tumor formation, they remain trapped in the lymph nodes, nodules increase in size and become hard consistency, their invasion was visible macroscopically. Other times their invasion is not visible macroscopic nodal evidarii but after surgery and sent to the histopathology can highlight their invasion. Lymph node invasion is considered when regional nodes are affected. When lymph nodes are invaded remote primary tumor then it is classified as metastasis.
N0 – is the stage without lymphatic invasion
N1, 2,3 – are intermediate stages which differ from one type of cancer to another
N4 – is extensive lymph invasion along an axis lymph.
M – metastasis
There are two stages for M: 0 and 1:
M0 – when not reveal any metastasis, and
M1 – when we highlighted peripheral metastases.
As shown TNM system is more accurate than staging system from I to IV, and more adaptable to each type of tumor. But correlations can be made between the two staging systems, for example in staging TNM stage II are: T1-2N1M0 – that we are dealing with a small tumor-environments with minimal local invasion, with a small number of invaded lymph nodes without metastasis.
There are variations and changes of staging systems for certain cancers because not enough splits into four stages. Thus appeared substages and IIa, IIIb and the TNM system, T1b, T2a, etc.. The differences between these substages are defined for each type of cancer in part.
Even in stage M1 – with metastases, the prognosis differs than one type of cancer to another, the origin of cancers in renal tissue may have a favorable prognosis in this stage as opposed to those that start in the colon. Differences Parvin and the location of metastases: liver, lung, bone, brain with different functional implications and different developments.
Both tumor staging systems are constantly improving and will probably suffer changes in order to adapt them. The goal is to be inferred with confidence prognosis and most appropriate therapeutic attitude.
The differences are large from a type of cancer to another depending on the type and invasiveness of cells making up the tumor TNM system lately adding another letter G – representing the degree of invasiveness of the cells revealed by microscopic pathologist: G1, 2,3,4. Depending on the grading and prognosis of cancer cells differ greatly.
Establishing the degree of invasiveness will be made after departure from normal microscopic changes and the degree of cell division. High grades are generally aggressive cancers with local invasion and rapid development and nodular shortly with high tendency metastasis.
Tumor grade will be able to establish so only after microscopic examination by the pathologist when he has a tumor fragment or after surgery when it will completely remove the primary tumor and affected lymph nodes or a fragment derived from tissue biopsy performed and she in turn and Interventional puncture or biopsy.
Specific molecular test results may play an important role in prognosis and in dictating the type of treatment. An example of specific biological implications in therapeutic attitude is the estrogen receptors in certain tumors according to the group into two classes: positive and negative estrogen. The positive estrogen-containing cell surface receptors for estrogen their favorable results with hormonal treatments.
There are other molecular tests which differ depending on the outcome of treatment and prognosis, the range of these explorations are extremely large and constantly growing.
To diagnose the degree, type cells and perform specific tests, you have therefore provide a pathologist named biopsy tissue fragments, fragment will be obtained during surgery for removal of large primary tumor or local anesthesia through a small surgery biopsy performed solely for the purpose of sampling, and in other ways that will be discussed below. Pathologist specializing in the investigation of biopsy tissue fragments A report following the explorations that will make making available to the treating physician’s needed to start a specific type of treatment and prognosis.
There are several ways to collect biopsy material.
Types of biopsies
Excisional biopsy – is important in tumor excision of a fragment or entire formation in order to be examined. Currently this form of biopsy is largely replaced by new forms but there are certain types of tumors that are more important data obtained with higher accuracy only after wide excision of the malignant tissue.
Incisional biopsy – when only a small portion of tissue is taken for biopsy. This type of biopsy is common for superficial tumors of soft tissue – tissue, fatty tissue, muscle and can establish whether we are dealing with a malignant or benign tumor.
Endoscopic biopsy – is the usual way of taking biopsy gastrointestinal tumors but urinary tract (cystoscopy), abdominal cavity (laparoscopy), inside joints (arthroscopy), tracheobronchial tree (bronchoscopy), etc.. Digestive tract is performed with the endoscope – a tube-shaped device equipped with light source and pensions microcamera pinching. This sampling system requires no incisions and biopsy will be used to introduce the endoscope body holes. It will directly visualize the lesion and will tweak the special clamp a piece of tumor tissue biopsy enough. The fragment will be drawn out of the body and will be submitted for examination by the pathologist specialized service.
Colposcopy with biopsy – is a gynecologic procedure that has become usual and practice in order to evaluate patients with cervical changes. First is explored cervix and tissue fragments that shall be taken for biopsy will be taken from the area where the most obvious changes occur.
Fine needle biopsy – is based on a very simple technique that is used as the syringe needle will be inserted into the tumor mass and aspiration will extract cancer cells to be placed on a microscope slide and will be offered pathology lab for examination. The result of the expert can come in a few minutes.
Tumors in organs such as the pancreas, liver, lungs or glands such as the thyroid, breast, can benefit from this type of biopsy and the diagnosis that can be subsequently intervene surgically. Fine needle biopsy can be practiced under radiological control, ultrasound or CT scan guidance to imaging. It may be general or local anesthesia depending on the situation and patient tolerance.
Another type of biopsy used primarily in dermatology is the removal of small skin slices using a special device. Injuries is minimal and will heal spontaneously or at least will be able to practice applying a suture.
Bone marrow biopsy – in case of abnormal cells in the circulating blood, an unexplained anemia, a too large number of circulating blood cells or platelets drop will require a marrow biopsy from which these cells – bone marrow – which is located inside of bones.
In adult bone marrow biopsy is taken usually from the posterior superior iliac crest of the pelvic girdle. It is on the back of the pelvis on both sides of the sacrum. It is a difficult maneuver and can be practiced by hematologist and even by your internist or family.
It can make a local anesthetic in the syringe needle to be inserted deeper anesthesia membrane covering the bone – periosteum. After this we use a sharp needle with trocar thick, mounted on a syringe. The needle will be inserted to the medullary space and aspiration will harvest bone quantity required. It looks like the blood but may contain small pieces of fat. This content taken from bone marrow expose on a glass slide and will be made available pathologist or hematologist for microscopic examination.
Preparing parts biopsy for examination
After the biopsy tissue is extracted from the body ill follow several procedures to obtain microscopic preparation itself in the form of blades. There are two techniques for obtaining histological sections with a thickness of 5 micrometers (0.0005 millimeters) to be displayed on glass slides for microscopic examination.
The first technique is the paraffin to obtain permanent preparations that will have the capacity to be examined in a long time. Fresh preparation will be introduced in a solution with a role that will be fixed in several hours time proportional to the size of the preparation. The solution is in most cases 10% formaldehyde which has the ability to preserve protein preparation and their subsequent distorted. This is probably the most important step in obtaining high quality dishes. Preparations so fixed in formaldehyde solution will be placed in specialized machines, where during the night will go through cycles of replacement water in their composition paraffin. The next morning the qualified personnel – technicians Histology – will take tissue preparations are in paraffin blocks and carry out fine sections using a special device called a microtome. These sections will be performed in paraffin block and shall contain within them the section of biopsy material. These extremely thin sections will be taken with great care and will be displayed on glass slides for microscopic examination.
Such preparations will pass obtained by a staining procedure. The most commonly used dyes for microscopic preparations hematoxylin (a natural product made from the wood of a Central American shrub called Haematoxylon campechianum) and aniline – an artificial dye. Are used combinations of dyes such as hematoxylin – eosin stained preparation that will shades from pink and orange to blue. In this way it will come out more easily distinct cellular elements. Typically cell nuclei are stained in dark blue and the cytoplasm and organelles have different coloration shades from pink to orange.
Preparations icy – Extemporaneous – are created in order to be examined shortly after biopsy and they are not as good quality as permanent preparations. Pathologist takes biopsy tissue from surgery, freeze it via a specialized and perform subsequent sections, the blades will be examined under a microscope and can thus provide a result surgeon will tailor the surgical approach according to this result.
This is a quick process and very useful for the surgeon and patient bringing an important benefit, which will be able to make optimal surgery for their disease.
As frozen preparation information can be obtained about the nature of tumor cells through fine needle puncture and exposure of cells on the blade. In this case the blade could view in a very short time under the microscope. Point can be guided ultrasound imaging or computer tomography.
Assessment piece begins by examining its macroscopic pathological and ticket completed in the operating room. In most cases fragments of tissue are small and are sent along this note that are made specific mentions about the song – from the organ fragment comes from the area to which represent dimensions.
For example, a sigmoid polyp obtained by colonoscopy completed ticket will be accompanied by the following data: polyp size, surface (smooth or rough Bösel), consistency (hard or soft), implantation (pedunculated or sessile) existence or mucosal infiltration colon in that area, color, friability, if bleeding or not expressing the distance in centimeters from the anus and disposal colic wall (anterior or posterior), etc.. All this information is useful both piece examining pathologist and surgeon to adapt conditions of polyp surgery, if it be required.
When you are sent to the pathologist whole organs or parts of organs as a result of resection, these papers will be accompanied by descriptive data containing all of the song. For example if practiced splenectomy for Hodgkin’s disease (a cancer of lymph tissue) will complete the following information: spleen weight, dimensions, describing its surface, texture, color, whether or not defective the capsule are intact vessels of the spleen hilum or if we are dealing with thrombosis of its hilum, if we lymphadenopathy in the hilum and how many nodules are visible or affect their size.
Pathologist will perform sections of spleen and will make preparations for microscopic examination in those areas that are pathologically altered or that seem suspicious. By examining preparations will make accurate diagnosis of Hodgkin’s disease or other damage. Not all sections contain pathological changes but some of them accurate diagnosis is very important and also a great responsibility pathologist to it depending on the entire subsequent treatment. Along with the description of the type of lesions detected by microscopic examination of the sections will be precisely and area of origin.
This consists of viewing under microscope slides prepared from various tissues and the establishment of a pathologist of all elements of a complete pathological.
An example of such a report would be pathological if sigmoid polyp described above follows: section through a structure with a central shaft vascular polypoid mucosa covered with adenomatous predominant tubular structure (this is available within the mucosal cell columns covering polyp and that the sigmoid colon is cylindrical multilayered). In the cell nucleus is observed degree of hipercromatoza (representing an intense mitotic activity within the nuclei with marked tendency multiplication) with almost complete loss of cytoplasm (cell contents of the nucleus and the cell membrane are organelles). No stromal invasion is highlighted (ie no tendency to invade deeper layers – submucosa, muscle, serosa).
In this case are described precancerous changes in the lining of potentially malignant polyp but currently shows a favorable prognosis.
After examining the macroscopic and microscopic subsequent final report will be issued – diagnosis. It will be in this example: biopsy colonoscopy in the sigmoid colon adenomatous polyp representing.
In this form of expression concise diagnosis includes many important data such as: location of the lesion in the colon, called the sigmoid portion, biopsy sampling method by colonoscopy, which is the structure sent – polyp and microscopic examination results and viewing the changes that appear in the microstructure polyp – adenomatous.