Tricky Path Question

[kaboodle]

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I was wondering if you can help me. I came across a question that for some reason I am having trouble with. Could you help me out?

A patient has been diagnosed with colon cancer. What will you see microscopically that dictates the worst prognosis.

A. Spread through regional lymph nodes.
B. Poorly differentiated with invasion.
C. Undifferentiated with invasion.
D. Well differentiated with invasion.

I think it's B, but I wanted to be sure I understand.....Thanks 👍

 

[Pox in a box]

I was wondering if you can help me. I came across a question that for some reason I am having trouble with. Could you help me out?

A patient has been diagnosed with colon cancer. What will you see microscopically that dictates the worst prognosis.

A. Spread through regional lymph nodes.
B. Poorly differentiated with invasion.
C. Undifferentiated with invasion.
D. Well differentiated with invasion.

I think it's B, but I wanted to be sure I understand.....Thanks 👍

I don't want to give this away for you but think about how cancer is staged. Look up the TNM system then examine your options. If you still need help, I'll comment further.

 

[kaboodle]

Oh man....please don't judge me based on that, I feel like such a fool. I see now that the answer is A. I guess that was a good sign to close the books for the night and get some sleep. Thanks pox, your the man!

 

[Idiopathic]

👍

 

[dynx]

might be worth noting that this would not be the correct answer if this was stomach cancer.

 

[MD999]

I was wondering if you can help me. I came across a question that for some reason I am having trouble with. Could you help me out?

A patient has been diagnosed with colon cancer. What will you see microscopically that dictates the worst prognosis.

A. Spread through regional lymph nodes.
B. Poorly differentiated with invasion.
C. Undifferentiated with invasion.
D. Well differentiated with invasion.

I think it's B, but I wanted to be sure I understand.....Thanks 👍

Don't worry. I came across almost the same question I believe in the NBME Sample Assessment Test and I had to think about that one for a bit too.
Knowing the Grading system is money, especially for easy points (as this one can have potential to be).

 

[Idiopathic]

might be worth noting that this would not be the correct answer if this was stomach cancer.

TNM still holds true. Spread to nodes is always a worse prognostic factor than local invasion, and distant mets is always the worst, regardless of the cancer type.

 

[dynx]

TNM still holds true. Spread to nodes is always a worse prognostic factor than local invasion, and distant mets is always the worst, regardless of the cancer type.

I am going off a distant memory and I can't think of reasoning to support it but I am pretty sure that the rules are different for stomach cancer. Anybody else have any idea what im saying?

edit...yeah I was right: "the morphological feture having the greatest impact on clinical outcome is the depth of invasion. Early gastric carcinoma is defined as a lesion confined to the mucosa and submucosa regardless of the presence or absense of perigastric lymph node metastases" From Robbins 7th pg 824. They gave us the specific numbers in our class notes...lymph node involvment is not as important as depth in this case for some reason.

 

[elektra]

Always always by general rule and sense common staging (TNM) is the best predictor of proognosis, in wich the spread to adjacent organs always have the worst prognosis because thats mean sistemic invasion of the tumor, so option A is the best choice the other options that give you different stages of cell diferentiation are all distractors.

 

[HtSht2BoneDoc]

I was wondering if you can help me. I came across a question that for some reason I am having trouble with. Could you help me out?

A patient has been diagnosed with colon cancer. What will you see microscopically that dictates the worst prognosis.

A. Spread through regional lymph nodes.
B. Poorly differentiated with invasion.
C. Undifferentiated with invasion.
D. Well differentiated with invasion.

I think it's B, but I wanted to be sure I understand.....Thanks 👍

Thats A. anttime you spread into the lymph nodes its worse. Use the TNM method. This is increasinf in severity from T to N to M. Your answer B would fall under T. A falls under the N. So by definition it has a worse prognosis. this is in the first aid

 

[dynx]

Thats A. anttime you spread into the lymph nodes its worse. Use the TNM method. This is increasinf in severity from T to N to M. Your answer B would fall under T. A falls under the N. So by definition it has a worse prognosis. this is in the first aid

Anytime, that is, EXCEPT...

 

[pujllay]

Dukes Classification is used for staging of colorectal cancer:

Duke A - mucosa
Duke B - muscularis mucosa
Duke C - nodal metastases
Duke D - liver mestastases

There's further subclassification into b1, b2, c1, c2, etc. I don't think they'll be using TNM staging in colorectal cancer questions but not sure about that. Regional lymph node involment is Duke C1.