● Cytogenic analysis of specimens
○ Chromosome banding/karyotyping- used to visualize bands between A-T
and G-C pairs to search for abnormalities, such as translocations,
deletions, and breakpoints
○ Flow cytometry- looks for ploidy. Method of analyzing popul;ations of
cells in suspension for various properties
■ Works best for acute leukemia, can work for lymphoma
■ Not used for solid tumors
○ Fluorescence in situ hybridization (FISH)- uses fluorescently labeled
sequences of DNA to probe for complementary strands in the sample
○ Comparative genomic hybridization- labeled tumor DNA is co-cultured
with normal labeled reference DNA hybridized to standard metaphase
chromosome
● Molecular diagnostic techniques
○ PCR amplifies the amount of DNA (making copies)
○ Southern blotting typically uses enzymatic digestion of sample,
electrophoretic separation of products, then probing/blotting
● Tumor markers useful for monitoring specific malignancies
○ Prostate cancer PSA and prostate acid phosphatase
○ Breast cancer Ca15-3, CA27.29, HER2/NEU
○ Ovarian cancer CA125
○ Pancreatic cancer CA19-9
○ Colorectal cancer CEA (carcinoembryonic antigen)
○ Testicular cancer AFP (alpha-fetoprotein)
○ Thyroid cancer thyroglobulin (contraindicated if the pt has antibodies)
● Imaging methods used in oncology
○ Traditional radiographs- xray and development on films. Useful for
detection of bone tumors/lung ca. Mammo specific to breast cancer
○ CT scans- rotating source of x rays and image digitalization for a greater
clarity and multiple views
○ Angiography: vascular introduction of iodinated contrast media while
taking several images (similar injections can be done w/ CT scans)
○ Ultrasound- high frequency sound waves to produce an image. Most
effective in detecting malignancies in neck/pelvic region or
gallbladder/liver areas
○ MRI- electromagnetic field to produce digitalized image. Primarily used
for detection of tumors in brain/spinal cord/musculoskeletal tissues
○ SPECT- injection of long half-life radioisotropes racers to look at profusion
into bone or thyroid areas
, ○ PET- injection of position emitter tracers, usually couples w/ agents
involved w/ glycolytic metabolism
● Diagnostics for specific types of cancers
○ Prostate cancer
■ Men >50- annual PSA testing w/ prostate exam (DRE)
■ If mass is found during DRE- US can be used to determine between
solid or cystic mass. bx can be performed in conjunction to evaluate
for cancer cells
■ Once presence of cancer is confirmed, CT and MRI will be
performed to assess any enlarged lymph nodes or mets to other
organs. Bone scan will also be performed to check for any bony
mets
○ Lung cancer
■ Usually discovered after a pt c/o respiratory illness that lingers and a
tumor is detected on chest x-ray
■ After suspicion lesion detected on x-ray- CT will be performed
■ PET scans to assist w/ staging. For definitive diagnosis and
histological typing- a bx is required- done by bronchoscopy, FNA, or
mediastinoscopy.
■ If pleural effusion is present, a thorocentesis will be performed to
test for presence of cancer cells
○ Colorectal cancer
■ Regular DRE and sigmoidoscopy/colonoscopy done every 5 yrs
■ Bx of suspicious lesion taken
■ Once a malignant lesion has been identified, the section of the colon
can be resected. Possible neo-ad radiation/chemo therapy to shrink
tumor before surg
■ PET scans for monitoring
○ Cervical cancer
■ Pap smears every 3 yrs for 21-29 and every 5 yrs for 30-65
■ If abx cells detected, colposcopy performed (apply acetic acid to
cervix and performing exam under magnification)
■ If abx colposcopy, bx is of cervical tissue is done
■ HPV testing can be done for possible cause of abx cells
■ If cervical cancer is diagnosed, CT of pelvis and abd to assess for free
fluid in abd or presence of lymph nodes/other lesions
○ Ovarian cancer
■ Usually detected after it has spread to other areas (typically when
pts c/o secondary symptoms
, ■ Screenings only performed for high risk - CA-125 blood testing +
transvaginal US
■ Laparoscopic surgery to obtain tissue samples from ovaries for
definitive diagnosis
■ If cancer is confirmed other testing (CT, chest x-ray, bone scans) will
be done to assess for mets
○ Testicular cancer
■ Men >15 yrs should perform regular TSE
■ When a lump is identified, US done to determine if it is a cystic or
solid mass. Bx done for definitive diagnosis
■ If positive for cancer, orchiectomy (removal of testis) is done
■ Further scans for mets
■ Renal studies to determine any renal involvement
○ Bladder cancer
■ No routine screening
■ Urinalysis can detect presence of blood
■ Cytoscopy to visualize bladder wall, bx can also be done during this
test
■ IVP (intravenous pyelogram) used to assess whether malignancy is
located within bladder or higher urinary system
■ CT and MRI to check for presence of tumors and check for mets to
surrounding organs
■ Tumor marker testing available for pts who have history of bladder
tumors to assess rate for recurrence
○ Hodgkin’s disease, non-hodgkin lymphoma, multiple myeloma
■ Hodgkins is definitively diagnosed by performing bx on suspected
lymph tissue (cells examined for reed-sternberg cells)
■ Non-hodgkin lymphoma is also diagnosed thru LN bx and
examined to differentiate between hodgkins and non
characteristics
■ Multiple myeloma is diagnosed thru testing that assesses the
presence of elevated levels of specific proteins present with the
disease (elevated heavy-chain M proteins in blood and elevated
light-chain M proteins in urine). Electrophoresis performed on
blood and urine. Bone marrow bx to assess for increased plasma
cells
■ PET scans for staging, PET + FDG to determine if remaining masses
are still malignant
○ Skin cancer
, ■ Melanoma usually presents as a dark/pigmented tumor on skin
surface
■ Lymphoscintigraphy used to identify lymphatic drainage routes
that might provide a conduit for metastatic cells
■ If mets- MRI/CT or PET w/ FDG
○ Head and neck cancers
■ No screening, but oral exams recommended to HR pts
■ Endoscopy can be performed to view larynx/pharynx/trachea
■ CT to look for tumors in head or neck/LN disease/mets to other
organs
■ MRI preferred for more specific visualization of lesions
■ Definitive diagnosis thru bx- FNA or incisional
○ Pancreate, liver, other types of cancers
■ Pancreatic carcinoma: CT scanning w/ angiography
■ Liver cancer: CT w/ angio, MRI w/ gadolinium. For primary
hepatoma use PET w/ FDG for mets from colon/other cancers
■ Endocrine cancers: depends on tumor sites
● Adrenal- CT using I-meta-iodobenzyl guanidine
● Thyroid- radioiodine imaging or PET w/ FDG if tumor
doesn’t absorb radioiodine
● Neuroendocrine- CT w/ radio-tagged octreotide analogs
■ Esophageal + gastric cancers: CT to stage, endoscopic US for
invasiveness
■ Sarcomas (soft tissue tumors): usually MRI
● Epidemiology terms
○ Incidence rate- new cases diagnosed in given time period
○ Prevalence rate- total number of active cases during given time period
○ Mortality rate- # of ppl who died from specific disease in given period
○ Case-fatality rate (CFR)- mortality rate among only those diagnosed w/
certain disease. Percentage
○ Survival rate- likelihood of living at least a given time (usually 5-10 yrs)
after being diagnosed
○ Absolute risk- likelihood of being diagnosed w/ disease in given period
○ Relative risk- likelihood of being diagnosed w/ particular disease among
those subject to an identified risk factor (modifiable or non-modifiable)
○ Attributable risk- difference in likelihood of being diagnosed w/ particular
disease between those exposed to risk factor vs those not exposed
● Risk factors for cancer
○ Non modifiable factors
■ Age (median age of diagnosis for cancer is 60+)
○ Chromosome banding/karyotyping- used to visualize bands between A-T
and G-C pairs to search for abnormalities, such as translocations,
deletions, and breakpoints
○ Flow cytometry- looks for ploidy. Method of analyzing popul;ations of
cells in suspension for various properties
■ Works best for acute leukemia, can work for lymphoma
■ Not used for solid tumors
○ Fluorescence in situ hybridization (FISH)- uses fluorescently labeled
sequences of DNA to probe for complementary strands in the sample
○ Comparative genomic hybridization- labeled tumor DNA is co-cultured
with normal labeled reference DNA hybridized to standard metaphase
chromosome
● Molecular diagnostic techniques
○ PCR amplifies the amount of DNA (making copies)
○ Southern blotting typically uses enzymatic digestion of sample,
electrophoretic separation of products, then probing/blotting
● Tumor markers useful for monitoring specific malignancies
○ Prostate cancer PSA and prostate acid phosphatase
○ Breast cancer Ca15-3, CA27.29, HER2/NEU
○ Ovarian cancer CA125
○ Pancreatic cancer CA19-9
○ Colorectal cancer CEA (carcinoembryonic antigen)
○ Testicular cancer AFP (alpha-fetoprotein)
○ Thyroid cancer thyroglobulin (contraindicated if the pt has antibodies)
● Imaging methods used in oncology
○ Traditional radiographs- xray and development on films. Useful for
detection of bone tumors/lung ca. Mammo specific to breast cancer
○ CT scans- rotating source of x rays and image digitalization for a greater
clarity and multiple views
○ Angiography: vascular introduction of iodinated contrast media while
taking several images (similar injections can be done w/ CT scans)
○ Ultrasound- high frequency sound waves to produce an image. Most
effective in detecting malignancies in neck/pelvic region or
gallbladder/liver areas
○ MRI- electromagnetic field to produce digitalized image. Primarily used
for detection of tumors in brain/spinal cord/musculoskeletal tissues
○ SPECT- injection of long half-life radioisotropes racers to look at profusion
into bone or thyroid areas
, ○ PET- injection of position emitter tracers, usually couples w/ agents
involved w/ glycolytic metabolism
● Diagnostics for specific types of cancers
○ Prostate cancer
■ Men >50- annual PSA testing w/ prostate exam (DRE)
■ If mass is found during DRE- US can be used to determine between
solid or cystic mass. bx can be performed in conjunction to evaluate
for cancer cells
■ Once presence of cancer is confirmed, CT and MRI will be
performed to assess any enlarged lymph nodes or mets to other
organs. Bone scan will also be performed to check for any bony
mets
○ Lung cancer
■ Usually discovered after a pt c/o respiratory illness that lingers and a
tumor is detected on chest x-ray
■ After suspicion lesion detected on x-ray- CT will be performed
■ PET scans to assist w/ staging. For definitive diagnosis and
histological typing- a bx is required- done by bronchoscopy, FNA, or
mediastinoscopy.
■ If pleural effusion is present, a thorocentesis will be performed to
test for presence of cancer cells
○ Colorectal cancer
■ Regular DRE and sigmoidoscopy/colonoscopy done every 5 yrs
■ Bx of suspicious lesion taken
■ Once a malignant lesion has been identified, the section of the colon
can be resected. Possible neo-ad radiation/chemo therapy to shrink
tumor before surg
■ PET scans for monitoring
○ Cervical cancer
■ Pap smears every 3 yrs for 21-29 and every 5 yrs for 30-65
■ If abx cells detected, colposcopy performed (apply acetic acid to
cervix and performing exam under magnification)
■ If abx colposcopy, bx is of cervical tissue is done
■ HPV testing can be done for possible cause of abx cells
■ If cervical cancer is diagnosed, CT of pelvis and abd to assess for free
fluid in abd or presence of lymph nodes/other lesions
○ Ovarian cancer
■ Usually detected after it has spread to other areas (typically when
pts c/o secondary symptoms
, ■ Screenings only performed for high risk - CA-125 blood testing +
transvaginal US
■ Laparoscopic surgery to obtain tissue samples from ovaries for
definitive diagnosis
■ If cancer is confirmed other testing (CT, chest x-ray, bone scans) will
be done to assess for mets
○ Testicular cancer
■ Men >15 yrs should perform regular TSE
■ When a lump is identified, US done to determine if it is a cystic or
solid mass. Bx done for definitive diagnosis
■ If positive for cancer, orchiectomy (removal of testis) is done
■ Further scans for mets
■ Renal studies to determine any renal involvement
○ Bladder cancer
■ No routine screening
■ Urinalysis can detect presence of blood
■ Cytoscopy to visualize bladder wall, bx can also be done during this
test
■ IVP (intravenous pyelogram) used to assess whether malignancy is
located within bladder or higher urinary system
■ CT and MRI to check for presence of tumors and check for mets to
surrounding organs
■ Tumor marker testing available for pts who have history of bladder
tumors to assess rate for recurrence
○ Hodgkin’s disease, non-hodgkin lymphoma, multiple myeloma
■ Hodgkins is definitively diagnosed by performing bx on suspected
lymph tissue (cells examined for reed-sternberg cells)
■ Non-hodgkin lymphoma is also diagnosed thru LN bx and
examined to differentiate between hodgkins and non
characteristics
■ Multiple myeloma is diagnosed thru testing that assesses the
presence of elevated levels of specific proteins present with the
disease (elevated heavy-chain M proteins in blood and elevated
light-chain M proteins in urine). Electrophoresis performed on
blood and urine. Bone marrow bx to assess for increased plasma
cells
■ PET scans for staging, PET + FDG to determine if remaining masses
are still malignant
○ Skin cancer
, ■ Melanoma usually presents as a dark/pigmented tumor on skin
surface
■ Lymphoscintigraphy used to identify lymphatic drainage routes
that might provide a conduit for metastatic cells
■ If mets- MRI/CT or PET w/ FDG
○ Head and neck cancers
■ No screening, but oral exams recommended to HR pts
■ Endoscopy can be performed to view larynx/pharynx/trachea
■ CT to look for tumors in head or neck/LN disease/mets to other
organs
■ MRI preferred for more specific visualization of lesions
■ Definitive diagnosis thru bx- FNA or incisional
○ Pancreate, liver, other types of cancers
■ Pancreatic carcinoma: CT scanning w/ angiography
■ Liver cancer: CT w/ angio, MRI w/ gadolinium. For primary
hepatoma use PET w/ FDG for mets from colon/other cancers
■ Endocrine cancers: depends on tumor sites
● Adrenal- CT using I-meta-iodobenzyl guanidine
● Thyroid- radioiodine imaging or PET w/ FDG if tumor
doesn’t absorb radioiodine
● Neuroendocrine- CT w/ radio-tagged octreotide analogs
■ Esophageal + gastric cancers: CT to stage, endoscopic US for
invasiveness
■ Sarcomas (soft tissue tumors): usually MRI
● Epidemiology terms
○ Incidence rate- new cases diagnosed in given time period
○ Prevalence rate- total number of active cases during given time period
○ Mortality rate- # of ppl who died from specific disease in given period
○ Case-fatality rate (CFR)- mortality rate among only those diagnosed w/
certain disease. Percentage
○ Survival rate- likelihood of living at least a given time (usually 5-10 yrs)
after being diagnosed
○ Absolute risk- likelihood of being diagnosed w/ disease in given period
○ Relative risk- likelihood of being diagnosed w/ particular disease among
those subject to an identified risk factor (modifiable or non-modifiable)
○ Attributable risk- difference in likelihood of being diagnosed w/ particular
disease between those exposed to risk factor vs those not exposed
● Risk factors for cancer
○ Non modifiable factors
■ Age (median age of diagnosis for cancer is 60+)
