Cancer diagnosis - To detect various typesof cancer.pptx

To diagnose various types of cancer

1. LAB DIAGNOSIS OF CANCER Neoplasia - KHUSHI GOYAL ( MBBS 2nd year)

2. History and clinical examinations - Radiological imaging - Ct scan , MRI , PET scan X ray Biochemical assays - Tumour marker analysis Histological methods - Parrafin embedding technique , Frozen section Cytological methods - FNAC( Fine needle aspirations cytology) , Exfoliative cytology Biopsy Immunohistochemistry Molecular diagnosis – PCR, Flow Cytometry, FISH(fluorescence in situ hybridization)

3. GRADING and STAGING of TUMOUR Parameters to quantify the probable clinical extent and spread of a given neoplasm GRADING Based on cytological appearance Degree of diffrentiation Number of mitosis Architectural Features ( ranges from poorly diffrentiated to well diffrentiated) STAGING To determine the extent or Spread of tumour ( TNM system ) T - Size of primary Tumour ( T1 to T4 ) N - Regional Lymph node involvement ( N0 , N1 to N3) M - Metastasis ( M0 , M1 to M3 )

4. Tumor markers Tumor markers are the biochemical indicators of the presence of a tumor HELPS IN - 1. Detection of cancer 2. Effectiveness Of treatment 3. Follow up ( recurrence ) These include - Hormones , cytoplasmic proteins , enzymes and all surface antigens

5. Hitsological methods 1 . PARAFFIN EMBEDDING TECHNIQUE In this method 10% formalin-fixed tissue is used The representative tissue peice from larger tumour mass or biopsy is processed through a tissue processor having an overnight cycle Which is embedded in paraffin wax for making tissue blocks These blocks are trimmed followed by fine sectioning These sections are then stained with haematoxylin And eosin and examined microscopically

6. 2 . Frozen section In this technique Cryostat machine and fresh unfixed tissue in used The tissue biopsy is quickly frozen to ice at about - 25°C that acts as embedding medium and then sectioned Sections are then ready for rapid H and E or toludiene blue staining Frozen section is rapid intraoperative diagnostic procedure for tissues

7. Cytological methods EXFOLIATIVE CYTOLOGY Exfoliative cytology is a diagnostic procedure that involves the examination of cells shed or scraped from the surface of tissues. This technique is used to detect cellular abnormalities, including cancer and precancerous conditions, as well as other diseases and infections. 2. Common Applications - Papanicolaou (Pap) Smear : A test to detect cervical cancer and precancerous conditions in women. - Sputum Cytology : Analysis of cells in mucus coughed up from the lungs to detect lung cancer. - Urine Cytology : Examination of cells in urine to detect cancers of the urinary tract. - Pleural Fluid Cytology: Analysis of cells in the pleural fluid (around the lungs) to diagnose infections, cancer, or other diseases.

8. 2. FNAC ( Fine needle aspiration cytology ) Study of cells by putting a fine needle introduced under vaccum into the lesion Palpable lesion - Direct FNAC Ex - Cancer of breast ,Thyroid , Lymph nodes Deep seated lesions - ultrasound guided FNAC Ex - pancreas , pelvic lymph Nodes , liver A 25 - 27 G needle i used Sample collected - 1. Air dried - Romanowsky stain 2. Fixed in 95% ethanol - PAP STAIN

9. Contraindications for FNAC Bleeding defect Hyatid cyst ( risk of anaphylaxis) Pancreatitis Emphysema or pulmonary hypertension Bacteremia / septicemia

10. 3. BIOPSY Gold standard test for tumour diagnosis True cut biopsy - Only a core of tissue is collected and examined Excision biopsy - Entire Lump is excised Tissue fixation - 1. Use 10% formalin for light microscopy 2. Use 2 to 2.5% glutaraldehyde for electron micrscopy *H&E or Toluidene blue stain is used

11. 4. IMMUNO HISTO CHEMISTRY IHC uses specific antibodies to detect antigens(markers) in a tissue sample Categorization of undifferentiated Malignant tumours In many cases , malignant tumours of diverse origin resemble each other because of limited diffrentiation . Thus , Antibody specific To intermediate filaments are diagnostic in such cases

12. 2. Determination of site of origin of metastatic tumours Ex - PSA - prostate cancer Thyroglobulin - Thyroid cancer 3. Detection of molecules that have prognostics or therapeutic significance Ex - Estrogen / progesterone receptors in breast cancer cells ( These cancers are susceptible to anti- estrogen therapy ) Stains for ALK proteins - Lung cancers and lymphomas

13. 5. Flow cytometry Used to identify cellular antigens expressed by “ Liquid tumors “ ( that arise from blood forming tissues) Liquid tumours - B cell and T cell lymphoma Leukemia Myeloid neoplasms Monoclonal antibodues are directed against various lympho- hematopoetic cells Advantage over IHC - Multiple antigens can be assessed simontaneously on individual Cells

14. References Robbins and Cotran,Pathologic basis of disease(10 edition) Harsh Mohan, Textbook of pathology (7 edition) National Cancer Institute (cancer.gov)

15. Thank you !

16. Study of cells shed off into body cavities Also known as - PAP Smears Widely used to screen for cervical carcinoma often at an in- situ Stage Cancer cells have lowered cohesiveness and exhibit a range of morphological changes Shed cells can be evaluated for anaplastic features which indicates their origin of tumour Also used for - endometrial Cancer , breast , lung ,prostate ,bladder tumours and gastric carcinoma Respiratory/exfoliative cytology, which includes bronchial washing, sputum, bronchoalveolar lavage, and bronchial brushing cytology.

17. Why do we need Exfoliative Cytology: According to Von Hamm - Cytology is not a substitute but an adjunct to the surgical biopsy. It is a quick, simple, painless and bloodless procedure. It helps as a check against false-negative biopsies. It is especially helpful in follow-up detection of recurrent carcinoma in previously treated cases. it is valuable for screening lesions whose gross appearance is such that biopsy is not warranted.

18. Procedure : - Sample Collection : Cells are collected from the relevant body surface or fluid - Fixation and Staining : The collected cells are fixed (preserved) and stained to enhance visibility under a microscope. - Microscopic Examination: A cytologist or pathologist examines the stained cells under a microscope to identify abnormalities. Exfoliative cytology plays a crucial role in the early detection and management of various diseases, particularly cancers, by allowing for the non-invasive examination of cells.

19. Exfoliative cytological study has significant role in cancer diagnosis. Normal epithelium undergoes exfoliation of its superficial cells due to physiological turnover. The cells of the deeper layers are adherent to each other normally. When the epithelium becomes seat of any pathological condition, the cells may lose their cohesiveness, and the cells in the deeper layer may shed along with the superficial cells These exfoliated cells as well as cells which are scrapped off by means of specific instruments can be studied qualitatively and quantitatively.