Upload
brielle-tennies
View
223
Download
0
Tags:
Embed Size (px)
Citation preview
Module 6:Module 6:
Clinical Stage Clinical Stage and Gradeand Grade
IntroductionIntroduction
• Stage and grade determine prognosis
• Staging reflects the clinical extent of the tumor
• Grading a tumor reflects its histologic subtype
• Of the two, staging is the primary indicator of prognosis
Tumor progressionTumor progression
• Tumors may occur spontaneously or
follow a series of cellular and tissue
changes known as epithelial dysplasia
Histologic alterations in Histologic alterations in epithelial dysplasiaepithelial dysplasia
• Enlarged nuclei and cells• Increased nuclear-to-cytoplasmic ratio• Hyperchromatic nuclei• Pleomorphic (abnormally shaped) nuclei and
cells• Increased mitotic activity• Abnormal mitotic figures• Multinucleation of cells• Keratin or epithelial pearls• Loss of typical epithelial cell cohesiveness
Neville, Damm, & Bouquot (2002). Oral and maxillofacial pathology (2nd ed.) Philadelphia: Saunders
Sapp, Eversole, & Wysocki (2004). Contemporary oral and maxillofacial pathology (2nd ed.) St. Louis: Mosby
Sapp, Eversole, & Wysocki (2004). Contemporary oral and maxillofacial pathology, 2nd ed. St. Louis: Mosby, p. 181
Histologic alterations observed Histologic alterations observed in epithelial dysplasiain epithelial dysplasia
Architectural changes in Architectural changes in epithelial dysplasiaepithelial dysplasia
• Bulbous rete pegs
• Basilar hyperplasia
• Hypercellularity
• Altered maturation
pattern of
keratinocytes
Neville, Damm, & Bouquot (2002). Oral and maxillofacial pathology (2nd ed.) Philadelphia: Saunders
Sapp, Eversole, & Wysocki (2004). Contemporary oral and maxillofacial pathology (2nd ed.) St. Louis: Mosby
Carcinoma Carcinoma in situin situ• When the entire thickness from the basal
level to the mucosal surface is affected, the term carcinoma in situ is used
• Once dysplastic cells breach the basement membrance and invade the underlying connective tissue, carcinoma in situ becomes squamous cell carcinoma
Neville, Damm, & Bouquot (2002). Oral and maxillofacial pathology (2nd ed.) Philadelphia: SaundersSapp, Eversole, & Wysocki (2004). Contemporary oral and maxillofacial pathology (2nd ed.) St. Louis: Mosby
Sapp, Eversole, & Wysocki (2004). Contemporary oral and maxillofacial pathology, 2nd ed. St. Louis: Mosby, p. 188
Malignant cells
have penetrated
through the
basement
membrane into
the underlying
connective tissue
Transition of epithelial dysplasia Transition of epithelial dysplasia to invasive squamous cell to invasive squamous cell carcinomacarcinoma
GradingGrading• Degree of differentiation exhibited by cells
• How closely cells resemble normal tissue structure
• Grade I – low grade
• Grade II – moderately differentiated
• Grade III – poorly differentiated
Neville, B. W., Damm, D. D., Allen, C. M., & Bouquot, J. E. (2002). Oral and maxillofacial pathology (2nd ed.). Philadelphia: W. B. Saunders.
StagingStaging
• Based upon the size and extent of
metastatic spread of the lesion
• Tumor-node-metastasis (TNM) system
used for most cancers
Staging – TNM Staging – TNM systemsystem
• Size, in cm, of the tumor (T)
• Involvement of lymph nodes (N)
• Presence or absence of distant metastasis (M)
Size of primary tumor (T) in cm
TX No information available on primary tumor
T0 No evidence of primary tumor
Tis Carcinoma in situ at primary site
T1 Tumor less than 2 cm
T2 Tumor 2-4 cm in diameter
T3 Tumor greater than 4 cm
T4 Tumor has invaded adjacent structures
Staging – “T”Staging – “T”
Lymph node involvement (N)
NX Nodes not assessed
N0 No clinically positive nodes (not palpable)
N1 Single clinically positive ipsilateral (on same side) node
less than 3 cm
N2 Single clinically positive ipsilateral node 3 to 6 cm; or
Multiple ipsilateral nodes with all less than 6 cm; or
bilateral or contralateral nodes with none greater
than 6 cm
N3 Node or nodes greater than 6 cm
Staging – “N”Staging – “N”
Staging – “M”Staging – “M”
Distant metastasis (M)
MX Distant metastasis not assessed
M0 No distant metastasis
M1 Distant metastasis is present
TNM TNM Staging Staging SystemSystem
Stage TNM Classification
0 Tis N0 M0
I T1 N0 M0
II T2 N0 M0
III T3 N0 M0
T1 N1 M0
T2 N1 M0
T3 N1 M0
IV T4 N0 M0
T4 N1 M0
Any T N2 M0
Any T N3 M0
Any T Any N M1
SummarySummary
• Stage and grade of tumors indicates
prognosis
• Treatment plans based upon stage and
grade, among other factors
• TNM system used with most cancers