Diagnosis of Tumors 😊

Diagnosis of Tumors

1. Tumor Markers (Blood Tests)

notion image
notion image
Marker
Associated Tumor(s)
Beta hCG
Choriocarcinoma
Calcitonin
Medullary Carcinoma Thyroid
Calretinin
Mesothelioma
Catecholamines
Pheochromocytoma
5-HIAA
Carcinoid Tumor
Alpha-fetoprotein (AFP)
Yolk Sac Tumor, HCC, Hepatoblastoma
CEA
M/c: Colon Cancer (also pancreas, lung)
PSA & PAP
Prostate Cancer
Immunoglobulins
Multiple Myeloma
NSE
Neuroendocrine Tumors, Neuroblastoma
CA 125
Ovarian Cancers (surface epithelial tumours)
CA 19-9
Pancreatic Cancer
CA 15-3
Breast Cancer
NMP 22
Recurrent Urinary Bladder Cancer

22 -> dudobar (recurrent)
notion image

Field Cancerization

notion image

2. FNAC (Fine Needle Aspiration Cytology):

notion image
  • Uses Franzen handle.
  • Pitfall: Cannot diagnose Follicular Thyroid Carcinoma 
    • needs biopsy

3. Biopsy (True Cut Biopsy): 

  • Gold standard for tumor diagnosis.

4. Immunohistochemistry (IHC):

  • Stains brown due to DAB (Diaminobenzidine)
      • Cystic BRAIN TUMORS
        • Craniopharyngioma
        • JPA
      Marker
      Positive In
      Mnemonic / Note
      Cytokeratin (CK)
      Carcinoma
      C for C
      Vimentin
      Sarcoma
      ã…¤
      CD45 / LCA
      Leucocyte Common Antigen
      Lymphoma
      L for L
      HMB45
      S 100
      Melanoma
      M for M
      CD1A
      Langerhans Cell Histiocytosis (LCH)
      ã…¤
      CD99
      Granulosa Cell Tumor (ovary)
      99-year-old granny
      (MIC2)
      Ewing Sarcoma (bone)
      Mitu → childhood tumor
      Glial Fibrillary Acidic Protein (GFAP)
      Tumor markers in glioma
      (Astrocytoma,
      Glioblastoma multiforme)
      ã…¤
      Lamin
      Progeria:
      Disorder of premature ageing
      (Hutchinson Gilford)
      ã…¤
      • Mnemonic:
        • Sarcoma
          • Vimal Sar
          • Also remember Rape (Rhabdomyosarcoma) Syn (Synovial) Mnemonic
        • Car
          • Sit (Cytokeratin) inside Car
          • Remember car → bike → took another route
            • Helmet (HCC → Fibrolamellar)
            • Rc book (RCC)
            • Phone (Follicular CA)
        • Granulosa cell tumor mnemonic
          • 99 year old granny ex ne vilikkan poi.
          • (99 (CD 99) year old granny → hyper estrogenism () → Called Ex (Call exner) → offered coffee (coffee bean) → she shouldve inhibited (inhibin) her)
        • Ewings sarcoma Mnemonic:
          • Mittu (MIC2) (11 year old) → Onion () kazhichapo wings () vannu → to Wings to Fly (EWS-FLI1) in Right (Homer wright) direction to get Pasta (Pas +ve).
          • Mittu thirichu vannapo 22 vayassai (t(11:22))
      notion image
      notion image
      notion image
      notion image
      notion image
      notion image
      Condition
      Feature
      NF1
      Chromosome 17
      NF2
      Chromosome 22
      DermatoFIBROSARCOMA protrubans
      t (17;22)
      Nodular Fascitis
      t (22;17)
      notion image
      notion image
      notion image
      notion image
      notion image
      notion image
      notion image
      notion image
      notion image
      notion image
      notion image

5. CK7/CK20 Profile (Cytokeratin 7 & 20):

  • Differentiates carcinoma origins.
      • Profile
      Tumors
      Mnemonic
      CK7+, CK20+
      - Bladder Cancer, 
      - Ovarian Mucinous Tumors
      Both B.O.
      CK7-, CK20-
      - RCC
      - HCC
      - Squamous Cell Ca (SCC),
      - Small Cell Ca (SCC)
      CCC
      CK7+, CK20-
      Female tumors & tumors above colon
      - Breast,
      - Endometrial,
      - Other Ovarian (      non-mucinous),
      - Lung Adeno,
      - Salivary Gland,
      - Thyroid
      Lady luck 7
      CK7-, CK20+
      Tumors below colon: 
      - Colorectal Ca, 
      - Merkel Cell Ca
      CM20
 
Check whether 7 + or -
  • If 7 + → Female
    • If 20 + → Ovary affected → Mucinous ovary + Bladder
    • If 20 - → Full female
  • If 7 (-) → Male
    • 20 + → elderly → colon; merkel
    • 20 - → liver, kidney, lungs smoking and alcohol
        • notion image

Paraneoplastic Syndromes

Paraneoplastic Syndrome
Associated Tumor
SIADH
ADH or Atrial natriuretic hormones
• Small Cell Carcinoma of Lung
• Intracranial neoplasms
• Most common
Cushing's Syndrome
ACTH / ACTH-like substance
• Small Cell Carcinoma of Lung,
• Renal Cell Carcinoma
Lambert-Eaton Myasthenic Syndrome

Acromegaly
• Small Cell Carcinoma of Lung
Hypercalcemia
PTHrP, TGF-α, TNF, IL-1
• Squamous Cell Carcinoma of Lung
• Breast carcinoma
• Adult T-cell leukemia / lymphoma
• K sound
Migratory Thrombophlebitis (Trousseau Phenomenon)
• Adenocarcinoma of Lung
• Avara (roaming) adenocarcinoma
Acanthosis Nigricans
• GIST
Hypoglycemia
Insulin / insulin-like
• Ovarian carcinoma
• Fibrosarcoma
Hyperglycemia
• Bone Tumors (e.g., Osteosarcoma)
Myasthenia Gravis /
Pure Red Cell Aplasia
• Thymoma
Osteomalacia
(Robbins 10th ed.)
• Phosphaturic Mesenchymal Tumor (PMT)
Polycythemia
Erythropoietin
• Renal carcinoma
• Cerebellar haemangioma
• Hepatocellular carcinoma
Disseminated intravascular coagulation (DIC)
Tumor products activating clotting cascade
• Acute promyelocytic leukemia
• Prostatic carcinoma

Vitamin D Resistant Rickets

  • ↑↑ FGF 23 levels → ↑ renal phosphate wasting → ↓ Vitamin D
      1. Congenital Hypophosphatemic Rickets
          • X Linked Dominant
          • PHEX gene
          • Mnemonic: Phex Phosphate FGF
      1. Acquired Hypophosphatemic Rickets
          • Some benign mesenchymal tumors
          • Secrete FGF-23
          • Phosphaturia & hypophosphatemia.
Â