1. Differentiation of Cancer
1.1. Malignant neoplasm characterized by :
1.1.1. Well-differentiated
1.1.2. Moderately-differentiated
1.1.3. Poorly-differentiated
1.2. Poorly-differentiated are more aggressive and loss it's resemblance
1.3. Better differentiation retain more of it's functional capabilities
1.4. Some new unanticipated function start to present
2. Grading of Cancer
2.1. To detect clinical aggressiveness of a neoplasm
2.2. For making an accurate prognosis
2.3. Based on histological degree of differentiation
2.3.1. Grade I = well-differentiated
2.3.2. Grade II = moderately-differentiated
2.3.3. Grade III = poorly-differentiated
3. Staging of Cancer
3.1. Based on :
3.1.1. size / depth of invasion of primary lesion
3.1.2. extent of spread to regional lymph node
3.1.3. presence or abscence of blood borne metastases
3.2. To aid in treatment planning and give some indication of prognosis
3.3. Assessment through :
3.3.1. CF
3.3.2. Imaging
3.3.3. Surgical exploration
3.3.4. Pathological evaluation of resected specimen
3.4. 'TNM' Staging
3.4.1. T= primary 't'umour
3.4.2. N = regional lymph 'n'ode involvement
3.4.3. M = 'm'etastases
4. Spreading of Cancer
4.1. 1) Local Invasion
4.1.1. Cancer growth with :
4.1.1.1. progressive infiltration
4.1.1.2. invasion
4.1.1.3. destruction of surrounding tissue
4.1.2. To differentiate between benign and malignant
4.1.3. lack of well-defined plane compared to it's normal tissue
4.2. 2) Metastases
4.2.1. secondary tumour that implant from primary tumour (discontinuous)
4.2.2. Occur in malignant tumour except Gliomas and basal cell carcinoma
4.2.3. larger tumor, rapid growing and poorly differentiated state have higher metastases.
5. Pathway of Spread
5.1. 1) Direct seeding of body cavity and surfaces
5.1.1. Malignant neoplasm penetrates peritoneal cavity , pleural , pericardial, subarachnoid or joint space.
5.1.2. Seeding into peritoneal cavity
5.1.2.1. ovarian carcinoma spreading to entire peritoneal cavity without infiltrating the underlying structures
5.1.2.2. Pseudomyxoma peritonei (begins with a tumour in appendix which spit gelatinous ascites to peritoneal cavity that will result in compression of organs and destroy it.
5.2. 2) Lymphatic spread
5.2.1. common =in carcinoma, rare = sarcoma
5.2.2. through lymphatic vessel at tumour margin
5.2.3. pattern of lymph nodes involvement depends on site of primary tumour & natural routes of lymphatic drainage
5.2.4. Ca breast commonly involved axillary lymph nodes first
5.3. 3) Hematogenous spread
5.3.1. common = sarcoma , also be seen in carcinoma
5.3.2. Venous invasion more common as it has low resistant than thick-walled arteries
5.3.3. Follow the venous flow drainage the site of the neoplasm. For example :
5.3.3.1. Portal area drainage into the liver & all caval blood flows to the lungs
5.3.3.2. Cancers close to the verterbral column spread through the paraverterbral plexus (batson plexus)
5.3.3.3. Renal cancer invade branches of renal vein -> grow snakelike fashion up toinf. vena cava ->reach rt side of heart.
5.3.4. some tumour metastasize to unrelated site