1 / 56

Abstracting Stage or Extension of disease

Abstracting Stage or Extension of disease. Abstracting Colon and Rectum (Bowel) Cancer. Colorectal Risk Factors. Age > 50 Male > female Diet high in animal fat, red meat low in fiber (fruits and vegetables) Intestinal polyps Obesity Sedentary lifestyle Alcohol Hereditary syndromes.

dessa
Download Presentation

Abstracting Stage or Extension of disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Abstracting Stage or Extension of disease

  2. Abstracting Colon and Rectum(Bowel) Cancer

  3. Colorectal Risk Factors • Age > 50 • Male > female • Diet • high in animal fat, red meat • low in fiber (fruits and vegetables) • Intestinal polyps • Obesity • Sedentary lifestyle • Alcohol • Hereditary syndromes

  4. ColorectalDiagnostic Evaluation • Physical exam, rectal exam • Barium enema • Endoscopy • Sigmoidoscopy • Colonoscopy • CT scan or other imaging • Metastatic evaluation • Liver scan • CEA blood test

  5. Esophagus Liver Stomach Transverse Gallbladder colon Ascending Jejunum colon Sigmoid colon Appendix Rectum Colorectal Regional Anatomy

  6. Colon Anatomy Source: UICC TNM-interactive, Wiley-Liss, 1998

  7. Rectosigmoid junction Rectum Anatomy Source: UICC TNM-interactive, Wiley-Liss, 1998

  8. Layers of Colon Wall • Mucosa • Surface epithelium • Lamina propria (basement membrane) • Muscularis mucosae • Submucosa • Muscularis Propria • Circular layer • Longitudinal layer • Subserosa • Serosa

  9. Along the colon epicolic peri-/paracolic mesenteric Along blood vessels (varies by location of tumor) Right, middle, left colic Ileocolic Inferior mesenteric for some sites sacral for rectum Colorectal Regional Nodes Image source: Mediclip 1998, Williams and Wilkins

  10. Colorectal Histology • Adenocarcinoma • arising in a polyp • adenomatous • villous • tubulovillus • de novo • NOS • mucinous • signet ring • other

  11. Mucosa Lamina propria Submucosa Muscularis propria Submucosa Serosa or perirectal tissue ColorectalSummary Staging • In Situ – non-invasive, intraepithelial • Localized • Intramucosal • Invasive in polyp • Transmural • Layers of colorectal wall

  12. Colorectal Summary Staging • Regional direct extension • Invasion of/through serosa • Adjacent sites (varies by location of tumor) • pericolic/perirectal fat • cul de sac • greater omentum • kidney, stomach, spleen, pelvic wall • Regional to lymph nodes • epi-/para-/pericolic/perirectal • Varies by location of tumor

  13. ColorectalSummary Staging • Regional to nodes and direct extension • Distant metastases • Distant lymph nodes -- varies by location of tumor • Distant direct extension to other organs – varies by location of tumor • Hematogenous metastases • Liver, lung

  14. Abstracting Lung Cancer

  15. Lung Cancer Facts • Most common cancer worldwide • Highest rates in men: eastern Europe and North America • Highest rates in women: North America and Europe • Lowest rates in Africa and Asia • Nearly avoidable if person is not exposed to tobacco smoke

  16. Lung Diagnostic Evaluation • Medical history • Physical exam, chest exam • Chest x-ray • CT or other imaging • Endoscopy • Bronchoscopy, mediastinoscopy • Sputum cytology • Biopsy • Evaluation for metastases Source: UICC TNM-interactive, Wiley-Liss, 1998

  17. Larynx Thyroid Trachea Thymus Pleura Lungs Heart Intercostal Ribs muscles Aorta Sternum (cut away) Diaphragm Lung Regional Anatomy

  18. Trachea C33.9 Carina Upper lobe C34.1 Fissures Fissure Middle lobe C34.2 Lower lobe C34.3 Lung Anatomy

  19. Lung Regional Nodes Regional* Lymph Node Stations 1 Anterior mediastinal 2 Paratracheal 3 Pre- and retro-tracheal 4 Lower paratracheal (azygos) 7 Carinal; subcarinal 8 Paraesophageal 9 Peripulmonary ligament 10 Hilar* 11 Interlobar* 12 Peribronchial* 13 Segmental* 14 Subsegmental* *regional if on same side as primary tumor; distant if bilateral or contralateral Source: Workbook for Staging of Cancer, 2nd ed., pages 110-111

  20. Lung Histologies • Small cell carcinoma (oat cell) • Small cell neuroendocrine • Non-small cell carcinoma • Squamous cell carcinoma • Adenocarcinoma • Bronchioloalveolar carcinoma • Large cell undifferentiated carcinoma • Large cell neuroendocrine carcinoma • Other • Carcinoid

  21. LungSummary Staging • In Situ – rare • Localized – invasive • Confined to lung • Confined to carina, hilus, mainstem bronchus • Involving mainstem bronchus from other part of lung

  22. LungSummary Staging • Regional direct extension • Chest wall (1), • Diaphragm (2), • Pleura (3) • Trachea (4), • Esophagus • Superior sulcus (5) • Major blood vessel Superior sulcus Trachea Clavicle 5 4 3 1 Ribs 2 Pleura Pleural space Pericardium Diaphragm Source: UICC TNM-interactive, Wiley-Liss, 1998

  23. Lung Lymph Nodes 4 Regional Nodes 1 Hilar, bronchial, peribronchial, intrapulmonary 2 Subcarinal, mediastinal, other named/numbered nodes in mediastinum Regional LN, NOS Distant Nodes 3 Contralateral/bilateral mediastinal, hilar 4 Any scalene, any supraclavicular 2 3 1 3 2 Adapted from R S Snell: Clinical Anatomy for Medical Students, 5th ed. 1995.

  24. Lung Summary Staging • Distant metastases • Distant lymph nodes • contralateral/bilateral hilar, mediastinal • scalene, supraclavicular • Direct extension • heart, pleural effusion, vertebrae, abdominal organs • Hematogenous metastases • liver, bone, brain

  25. Basis of Diagnosis 0 Death certificate only 1 Clinical – unlikely 2 Clinical investigation – x-rays, scans, endoscopy 4 Specific tumor markers – none 5 Cytology – sputum cytology, FNA biopsy 6 Histology of a metastasis – brain, liver 7 Histology of a primary tumor – most likely 9 Unknown

  26. Prostate Cancer

  27. Prostate Cancer Facts • Second most common cancer in men worldwide • Highest rates in developed nations • American Afro-Americans have highest rate • Lowest rates in Africa and Asia • Incidence rate increasing • Associated with more use of TURP and PSA • Raw numbers of cases increasing • World population aging

  28. Prostate Risk Factors • Age > 50 • Diet • High in animal fat, red meat • Low in fiber (fruits and vegetables) • High intake of calcium • Family history • Males with prostate cancer • Females with breast cancer • Benign prostatic hypertrophy • Incidental finding on TURP

  29. ProstateDiagnostic Evaluation • Physical exam, rectal exam • PSA blood test • Endoscopy (cystoscopy) • Transrectal ultrasound (TRUS), biopsy • CT scan or other imaging • Metastatic evaluation • Bone scan if indicated

  30. Posterior Middle Plexus of Anterior lobe lobe Santorini lobe Peritoneal surface Seminal vesicle Bladder Base of prostate Rectum Pubic bone Puboprostatic ligament Apex of prostate Denonvillier's fascia Penis and Urethra Deep transverse perineal muscle Prostate Regional Anatomy

  31. Prostate Regional Nodes (Pelvic) Internal iliac Sacral/presacral External iliac Hypogastric (obturator) Not shown: Periprostatic Perivesical Image source: MediClip, Grant’s Atlas Images 3: Perineum, Pelvis and Lower Limb. Williams and Wilkins, 1998

  32. Prostate Summary Staging • In Situ – non-invasive, intraepithelial • Localized – confined to prostate • Intracapsular involvement • one lobe, both lobes • Involving capsule but not beyond Source: UICC TNM-interactive, Wiley-Liss, 1998

  33. ProstateSummary Staging • Regional direct extension • Extracapsular/periprostatic extension • Bladder neck, bladder, NOS • Adjacent skeletal muscle • Rectum • Seminal vesicles • Regional to lymph nodes • Pelvic nodes, NOS • External and internal iliac • Sacral

  34. ProstateSummary Staging • Regional to nodes and direct extension • Distant metastases • Distant lymph nodes • common iliac • inguinal • other • Direct extension to pelvic wall or pubic bone • Sigmoid colon, penis • Hematogenous metastases • Bone, lung

  35. Prostate Basis of Diagnosis 0 Death certificate only 1 Clinical – possibly by digital rectal exam 2 Clinical investigation – cystoscopy, bone scan 4 Specific tumor markers – PSA 5 Cytology – 6 Histology of a metastasis – bone 7 Histology of a primary tumor – most likely 9 Unknown

  36. Abstracting Cervix Cancer

  37. Cervix Risk Factors • Human papilloma virus • Intercourse at early age; multiple sexual partners • History of STD • Smoking

  38. Ovary Fallopian tube Corpus uteri Cervix Bladder Vagina Pubic bone Rectum Female Genital Regional Anatomy Image source: MediClip, Grant’s Atlas Images 3: Perineum, Pelvis and Lower Limb. Williams and Wilkins, 1998

  39. Female Genital Anatomy Source: UICC TNM-interactive, Wiley-Liss, 1998

  40. Female GenitalRegional Nodes (Pelvic) Source: UICC TNM-interactive, Wiley-Liss, 1998

  41. CervixSummary Staging • In Situ – non-invasive, intraepithelial • Preinvasive • CIS (carcinoma in situ) • Cervical intraepithelial neoplasia III • FIGO Stage 0

  42. CervixSummary Staging • Localized -- invasive • Confined to cervix • FIGO Stage I • Regional direct extension • Corpus, vagina, parametrium, ligaments, fallopian tube, ovary • Bladder, rectum, ureter Source: UICC TNM-interactive, Wiley-Liss, 1998

  43. Cervix Summary Staging • Regional to lymph nodes • Pelvic nodes, NOS; paracervical, parametrial • Common, external and internal iliac • Sacral, NOS • Regional to nodes and direct extension • Distant metastases • Distant lymph nodes – aortic, inguinal, other • Direct extension • bladder or rectal mucosa, sigmoid, small bowel • Hematogenous metastases • liver, lung, bone

  44. Basis of Diagnosis 0 Death certificate only 1 Clinical – unlikely 2 Clinical investigation – colposcopy 4 Specific tumor markers – none 5 Cytology – Pap smear 6 Histology of a metastasis – unlikely 7 Histology of a primary tumor – most likely 9 Unknown

  45. Abstracting Breast Cancer

  46. Breast Cancer Facts • Highest rates in developed world • Netherlands and USA • Lowest rates in Africa and Asia • China—lowest incidence and mortality • Traditional low rates in Eastern Europe and Far East beginning to rise

  47. Pectoralis muscle Skin Serratus anterior muscle Fatty parenchyma Ducts Chest wall Intercostal muscles Areola Nipple Ribs Lobules Breast Sagittal View

  48. C50.4 C50.2 C50.2 C50.4 UOQ UIQ UOQ UIQ 12 12 11 1 11 1 10 2 10 2 9 3 9 3 8 4 8 4 7 5 7 5 6 6 LIQ LIQ LOQ LOQ C50.5 C50.3 C50.3 C50.5 RIGHT BREAST LEFT BREAST Clock Positions and Quadrants

  49. 6 4 5 2 3 7 1 8 Breast Regional Anatomy 1 Superficial axillary nodes (low axillary, Level I) 2 Brachial axillary lymph nodes 3 Interpectoral axillary lymph nodes (Rotter’s nodes, Level II) 4 Deep axillary lymph nodes (high axillary, apical, Level III) 5 Infraclavicular lymph lymph nodes (subclavicular) 6 Supraclavicular lymph nodes 7 Parasternal lymph nodes (internal mammary nodes) 8 Paramammary or intramammary lymph nodes (Level I) Adapted from: Pocket Atlas of Human Anatomy, third edition. H Feneis, Georg Thieme Verlag, Stuttgart, 1994. Used with permission.

  50. Summary Staging • In Situ • Non-invasive • Intraductal • DCIS, LCIS • Non-infiltrating • Tis • Stage 0

More Related