OBJECTIVES By the end of this segment, the community participant will be able to:

Transcription

1 Cancer 101: Cancer Diagnosis and Staging Linda U. Krebs, RN, PhD, AOCN, FAAN OCEAN Native Navigators and the Cancer Continuum (NNACC) (NCMHD R24MD002811) Cancer 101: Diagnosis & Staging (Watanabe-Galloway & Krebs) 1 OBJECTIVES By the end of this segment, the community participant will be able to: 1. Describe what is meant by the term biopsy 2. Describe how tumors may behave differently from one another 3. Give two examples of the stages of cancer and their meanings 4. Give two reasons why staging is important Cancer 101: Diagnosis & Staging (Watanabe-Galloway & Krebs) 2 1

2 Introduction Review: What Is Cancer? Cancer develops when cells grow and multiply without order or control. Under normal circumstances, new cell growth and old cell death are kept in balance. In cancer, this balance is disrupted. Cancer 101: Diagnosis & Staging (Watanabe-Galloway & Krebs) 4 2

3 Review: Normal Tissue Cancer 101: Diagnosis & Staging (Watanabe-Galloway & Krebs) 5 Review: Beginning of Cancerous Growth Cancer 101: Diagnosis & Staging (Watanabe-Galloway & Krebs) 6 3

4 Review: Cancerous Tumor Cancer 101: Diagnosis & Staging (Watanabe-Galloway & Krebs) 7 Benign (not cancer) tumor cells grow only locally and cannot spread by invasion or metastasis Review: Benign versus Malignant Tumors Malignant (cancer) cells invade neighboring tissues, enter blood vessels, and metastasize to different sites Cancer 101: Diagnosis & Staging (Watanabe-Galloway & Krebs) 8 4

5 Review: Benign versus Malignant Tumors Malignant tumors are cancer. Cells in malignant tumors can grow out of control and invade or damage other parts of the body. When cancer (malignant tumors) spreads from the original site to another part of the body, it is called metastasis. Cancer 101: Diagnosis & Staging (Watanabe-Galloway & Krebs) 9 Diagnosing Cancer 5

6 Diagnosing Cancer A cancer diagnosis is made by examining cells or a piece of tissue under the microscope. A diagnosis of cancer can only be confirmed by examining the cells/tissue; other tests only suggest the presence of cancer The cells/tissue can be collected in a variety of methods Cancer 101: Diagnosis & Staging (Watanabe-Galloway & Krebs) 11 Diagnosing Cancer Tissue or cells can be collected and examined in a variety of ways: Cytology (pap smear) Biopsy Surgical excision Tissue analysis (staining of tissues; frozen section) 12 6

7 Diagnosing Cancer A biopsy (bye-op-see) is the removal of a small piece of tissue (a group of cells) for microscopic examination Biopsy is the most common and best method used to diagnose cancer 13 Diagnosing Cancer Types of biopsies: Punch Biopsy Needle Biopsy Fine needle Core Surgical Biopsy Incisional Excisional Biopsy types for breast cancer 14 7

8 Diagnosing Cancer All biopsy tissues should be examined by a pathologist The microscopic examination helps the doctor determine: If the biopsy tissue is cancer If it is cancer, how aggressive the cancer may be ( will it spread easily or be harder to treat). 15 Diagnosing Cancer: Next Steps Once the cancer diagnosis has been made, more testing may be needed to find the primary site (where the cancer started). The primary site helps determine the type of treatment for the cancer. 16 8

9 Diagnosing Cancer: Additional Methods History and physical exam Radiologic studies MRI Ultrasound Nuclear Medicine scans PET scans Visualization (endoscopy) Laboratory studies Tumor markers Diagnosing Cancer: Next Steps It also is important to know if the cancer is fast or slow growing and where it is in the body (is it localized in one place or has it spread to other places?) The next steps are to look at the primary tumor (grading) and look to see where the tumor is located in your body (staging) 18 9

10 Tumor Grading Tumor Grading Review of the cells can show how close the cells look to the original tissue where the tumor is located For example, how close does the tumor in your breast look to normal, noncancerous breast tissue? 20 10

11 Tumor Grading A pathologist assigns a grade to the cancer The more different from the original tissue, the more likely the cancer is to be very aggressive and/or fast growing Usually, a lower grade means a slowergrowing cancer, which is less likely to spread 21 Histologic tumor grade Grade 1 (well differentiated): Do not appear to be growing rapidly Grade 2 (moderately differentiated) Between grades 1 and 3 Grade 3 (poorly differentiated) Highest grade, lacks normal features and tends to grow and spread more aggressively

12 Tumor Grading Well differentiated tumor cells look and function similarly to normal cells of the same type. Poorly differentiated or undifferentiated tumor cells look abnormal and disorganized. Prostate cancer 23 Cancer Staging 12

13 Cancer Staging Staging is the process used to: Identify the location of the tumor Show how far the cancer has spread in the body. Staging helps determine the type and amounts of treatment to be used 25 Cancer Staging Staging helps determines a person s prognosis In general, the smaller the tumor and the less it has spread at the time of diagnosis, the more likely the patient will survive for a long time 26 13

14 Cancer Staging: Types Clinical staging Surgical staging Pathologic staging TNM Staging Other staging methods/systems Staging for recurrence 27 Cancer Staging: TNM Staging Classification System Most common staging system; used throughout the world T = Tumor (primary tumor location and size) N = Nodes (spread to lymph nodes; how many) M = Metastasis [ma-tas-ta-sis] (spread to other parts of the body; other organs) 28 14

15 Cancer Staging: Pathologic Staging Stages 0-IV are also used by health care providers Stage 0: cancer is only in the cells in which it began; no invasion of underlying tissues Stage I, II, III: higher numbers indicate more extensive disease; greater tumor size; and/or spread of cancer to nearby lymph nodes and/or organs adjacent to the tumor Stage IV: cancer has spread to another organ 29 Example: Colon Cancer Stages 30 15

16 Cancer Staging: Role of the Bloodstream and Lymphatic System Some cancer cells may break away from the primary cancer and travel through the bloodstream or lymphatic system to another part of the body 31 Spread of Cancer The four common designations for the spread of cancer are: In situ: Early cancer that has not spread to neighboring tissues. Local: Cancer is found only in the organ where it started to grow. Regional: Cancer has spread to the surrounding tissues or lymph nodes. Distant: Cancer has spread to other organs and systems of the body

17 Example of Cancer Diagnosis and Staging: Breast Cancer Possible Breast Cancer Evaluate signs and symptoms Imaging tests to evaluate breast health Biopsy Breast cancer grading and staging Next steps 34 17

18 Breast Anatomy and Physiology 35 18

19 37 Signs and symptoms A new lump or mass Swelling of all or part of a breast Skin irritation or dimpling Breast or nipple pain Nipple retraction (turning inward) Redness, scaling or thickening of the nipple or breast skin Nipple discharge other than breast milk 38 19

20 Signs and symptoms (cont d) If breast symptoms and/or the results of a physical exam suggest breast cancer might be present, more tests will be done. These might include imaging tests, blood tests, looking at samples of nipple discharge, or doing biopsies of suspected areas. 39 Imaging tests used to evaluate breast disease Diagnostic mammograms Digital mammograms Magnetic resonance imaging (MRI) of the breast Breast ultrasound Ductogram 40 20

21 Diagnostic Mammogram Follow up after on breast problems or abnormal screening mammogram. More pictures are taken to carefully study the area of concern Results of the diagnostic mammogram: That the abnormality is not worrisome at all. Routine mammogram screening 41 Diagnostic Mammogram Results of the diagnostic mammogram (cont): The abnormality has a high likelihood of being benign (not cancer). Come back sooner for next screening (e.g., 4-6 months) The lesion is more suspicious a biopsy or another test is needed for diagnosis 42 21

22 Other Imaging Tests MRI: Use radio waves and strong magnets instead of x-rays. May be used to decide the size of the cancer and to look for other cancers Ultrasound: Also known as sonography; uses sound waves. May be particularly helpful in women with very dense breasts

23 Making the Diagnosis by Biopsy Fine needle aspiration Uses a thin, hollow needle is to take tissue cells Core biopsy: Uses a larger needle to take a larger tissue sample Surgical (open) biopsy: Removes all or part of the abnormal tissue Excisional biopsy removes all Incisional biopsy - removes part 45 Identifying the Type of Breast Cancer The most common type begins in the milk ducts of the breasts and is called ductal carcinoma The second most common begins in the lobules of the breast and is call lobular carcinoma There are many other different types 46 23

24 47 Next Steps in Diagnosing & Staging Breast Cancer Identifying the tumor type and grading the tumor cells Staging the tumor through blood tests, scans and other examinations Deciding on what treatment is needed and when treatment should begin Discussing treatment options with the patient and family 48 24