Evaluation of suspected malignancies

Author: Mikael Häggström

General notes

Further reading: Starting pathology (handbook) Learning pathology Emergency pathology Fixation Gross processing Evaluation: Suspected malignancies Immunohistochemistry Consultation Reporting Secrets

The most important aspects of a tumor is whether it is malignant or not, and staging.

Staging

The primary focus of tumor evaluation is to distinguish benign from malignant types, and in case of malignancy the primary focus is to determine its stage, generally by the TNM classification:

T: size or direct extent of the primary tumor Tx: tumor cannot be assessed Tis: carcinoma in situ T0: no evidence of tumor T1, T2, T3, T4: size and/or extension of the primary tumor N: degree of spread to regional lymph nodes Nx: lymph nodes cannot be assessed N0: no regional lymph node metastasis N1: regional lymph node metastasis present; at some sites, tumor spread to closest or small number of regional lymph nodes N2: tumor spread to an extent between N1 and N3 (N2 is not used at all sites) N3: tumor spread to more distant or numerous regional lymph nodes (N3 is not used at all sites) M: presence of distant metastasis M0: no distant metastasis M1: metastasis to distant organs (beyond regional lymph nodes)

Typing and grading

Beyond determining overall malignancy and staging, classification of tumors into a specific histopathologic type or grade is of relatively less value. In cases of clearly non-malignant tumors where it is difficult to determine the specific histopathologic type or grade, it is generally acceptable to conclude the evaluation and report it as such, unless the clinician specifically requests otherwise. For potentially malignant or high-risk tumors, typing and grading often still affects the management.

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