Tumor Staging

[Cristagali]

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Question about 56 y/o male with colon adenocarcinoma. Which is the worse prognosis: a) Lymphatic invasion b) mitotic activity c) neoplasm of Liver d) poor cell differentiation e) regional lymph node mets. I think it is c) distant mets, since you see distant mets only in Stage IV. Right? 😕

 

[doc05]

right.

 

[Cristagali]

Thanks 😎

 

[bigfrank]

As far as the specifics of staging, I would NOT worry about it for the Step I. Trust me, you're not going to get a question that describes a scenario and then asks you to diagnose by stage -- not gonna happen!

But the reasoning you exhibited in your original question will come in handy. You're gonna do so well. I know we're all pulling for you!

 

[Row Jimmy]

Yup, Tumor, Node, Metastasis in that order (TNM) denote stage levels. So traveling to a Node is worse than just a tumor and traveling to another organ is the most ominous.

You reasoned it out perfectly.

Good luck,

RJ

 

[undecided05]

You may not get that question on Step I, but it's very likely to get quite few questions like that for Step II.

 

[carrigallen]

Question about 56 y/o male with colon adenocarcinoma. Which is the worse prognosis: a) Lymphatic invasion b) mitotic activity c) neoplasm of Liver d) poor cell differentiation e) regional lymph node mets. I think it is c) distant mets, since you see distant mets only in Stage IV. Right? 😕

Just wondering, but "neoplasm of liver" doesn't necessarily mean metasis, does it?. In fact, couldn't/shouldn't it mean primary liver tumor? On the other hand, does anyone even bother biopsying liver masses which are secondary to another cancer? It is always assumed to be a metasis?

It would make a radical difference in the treatment options if the mass was actually a primary liver cancer.

I think the prognosis for a second primary tumor is not as poor as a metasis. I don't know anything about staging though.

 

[Cristagali]

you are right, but this is one of those two step questions that seem to be more common on USMLE. Colon to liver is a very common met route. They assume you know that or want to find out. probably the better answer to the question should be "malig. neoplasm in the liver", but my feeling is they won't be that generous! ha! 😀

 

[GrandMasterB]

Some tricks that might come up in questions.... Colon mets to liver are resected if one to four- I believe. You also resect colonic tumors even with significant metastatic burden -for palliation. I also don't think that you use radiation for colon tumors- but you do for anal cancer. I don't remember how you work up the type of leesion in a liver- but I think there are only a couple of hypervascular lesions in liver- rcc, colon?hcc?- not sure if these two are, thyroid- so these would be enhancing with gadolinium on mri.

 

[carrigallen]

Some tricks that might come up in questions.... Colon mets to liver are resected if one to four- I believe.

Also, I think it depends on the size and location of the mets in the liver - eg if they are in the center, they might not touch them. They do have other methods available for these though, like cryoablation and stereotactics I think.