1. Professor Adrienne M Flanagan
Pathology
Cancer
Professor Adrienne M Flanagan

2. What is the role of the pathologist?
Postmortem?
Tissue diagnosis – benign vs malignant (cancer)
What type of cancer
Carcinoma - epithelium
Lymphoma - lymphoreticular
Leukaemia – circulating malignant lymphoreticular cells
Sarcoma – connective tissue / muscle (smooth & skeletal) bone, cartilage, endothelium, fibroblasts, fat, tendon/ligament

3. Diagnosis determines treatment
Grade of tumour
Stage of tumour
Fully excised

4. What information is acquired from pathological examination?
Tumour type
Tumour grade
Tumours stage
Excision margins
Other features of prognostic value

5. What information is acquired from pathological examination?
Tumour type
Tumour grade
Tumours stage
Excision margins
Other features of prognostic value

7. Type of tumour Benign Vs Malignant vs low malignant potential
Macroscopic
Microscopic

9. Germline Or
Somatic?

10. What are the microscopic features
that distinguish benign from malignant tumours?
Architecture
Cell morphology – pleomorphism
- mitotic figures

12. Endometrial carcinoma
Tumour type
Breast carcinoma
Ductal
Lobular
Tubular
Endometrial carcinoma
Endometrioid
Papillary carcinoma
others

13. Tumour Grade
How closely a tumour resembles
its tissue of origin?

14. Staging

15. Tumour Stage Extent of Disease 2cm Pathological Staging: Size
Lymph Node status
Radiology
Clinical

16. C erb B2 CerbB2 overexpressed in approx 25% of breast cancersTK
185-kd transmembrane
glycoprotein
receptor p185 HER2
Correlates with poor outcome
in node+ and node- ve disease
Recombinant humanised anti-Her2
monoclonal antobody [Herceptin]
Signal 1
Signal 2
Cobleigh et al. J Clin Oncol
222 with metastatic disease &
previous chemotherapy
9 CR, 37 PR [total 22%]
Median duration of survival 13 months
Toxicity
Fevers, chills
4.7% cardiac dysfunction

17. Sarcoma

18. Why is it useful to have all of this information?
Prevention – screen, cervical and breast cancer
Early diagnosis
Choose best treatment
Provide a useful prognosis

19. Cancer of the large bowel
Ways in which pathologists can and have contributed to understanding the progression of cancer
Compare outcome
Identify the genetic changes which are associated with progression of disease
Cancer of the large bowel

25. Cervical intraepithelial neoplasia
Dysplasia grade 1, 2, 3
Cervical intraepithelial neoplasia
Carcinoma in situ

27. Determines treatment Cervical carcinoma
If cancer invades less than 3mm deep from the surface, it is likely to be curable if resected (stage 1a)
Less than1% of people will have lymph node deposits
Stage 1b - 90% survival – still within cervix
Stage II – 75% - beyond cervix
Stage III – 35% - into pelvic side wall
Determines treatment

29. Typing histologically is essential
Polyps
Typing histologically is essential
Epithelial
Hyperplastic
Adenomatous
Smooth muscle
Vascular

30. Multi-Step Carcinogenesis (eg, Colon Cancer)
Normal
epithelium
Hyper-
proliferative
Early
adenoma
Late
Carcinoma
Metastasis
Loss of
APC
Activation
of K-ras
18q
DCC
p53
Other
alterations
Fearon ER. Cell 61:759, 1990
Inter-
mediate
DCC – deletado no câncer de colon

31. The End