Sentinel Cancer Case

(p133-134, text). * Define metastasis. * Development of a secondary tumor in a location distant from the primary tumor. * Accomplished via lymphatic channels and circulation. * Trace the pathways for the hematologic and lymphatic spread of metastatic cancer cells. Evidence of disseminate disease presence in lymph that drain the tumor area, tumor cells lodge first in the initial lymph node that receives drainage from the tumor site, once in this lymph node cells may die b/c of the lack of a proper environment, remain dormant for unknown reasons, or grow in a discernible mass, If they survive and grow cancer cells, may spread from more distant lymph nodes to the thoracic duct, and the gain access to the blood vasculature, cancer cells may gain access to the blood vasculature from the initial node and more distant lymph nodes by way of tumor-associated blood vessels that may infiltrate the tumor mass. Sentinel

If the lymph nodes in the armpit or neck are enflamed then the procedure is simple, however if it is only the nodes in the chest a mediastinoscopy or a less common thoracotomy is required. This involves opening the chest, or in the case of thoracotomy the neck, so that the entire lymph may be taken out. To test the stage of the disease the following tests are available depending on preference and the position of the lymph nodes. A CT scan or Ultrasound shows lymph nodes in the stomach area, abnormalities in the liver or spleen problems. A lymphograph can detect pelvic and abdominal problems, bone marrow biopsy test the bone marrow as the Hodgkin’s disease often spreads to the marrow. A laparotomy involves the surgeon opening one’s abdomen to see the organs. At times the spleen is removed as it is often infected with Hodgkin’s disease and it being gone often helps with radiotherapy. Laparotomy is less frequent as scanning type tests are more often used. Liver biopsy tests the liver, this is only necessary in certain circumstances. A gallium scan entails an injection of gallium, and because of the way Hodgkin’s disease takes up gallium parts of the nodes which are otherwise difficult to see are visible. Blood tests are often done as well and new methods of testing are being developed. In any of these cases if a Reed-Sternberg cell is found

GROSS DESCRIPTION: Exam of the specimen designated “left fallopian tube” reveals the presence of a fallopian tube measuring 6 cm in length and 2.3 cm in average diameter. Sectioning of the tube shows it to be

The N category describes whether or not the cancer has spread into nearby lymph nodes.

N1 – Cancer cells are in the upper levels of lymph nodes in the armpit but the nodes are not stuck to surrounding tissues

First and foremost, thing to do when a patient comes with cervical lymphadenopathy is to get a detailed history. The history should include questions such as the onset of lump; pain on lump; if the lump is unilateral or bilateral and other lumps present anywhere else in the body; any associated symptoms like fever, cough, sore throat, shortness of breath, hemoptysis, night sweats, weight loss, or poor appetite; and any recent foreign travel, upper respiratory infection or TB exposure. It may be necessary to obtain a detailed sexual, smoking and drug abuse history. Next step is the physical examination by palpating the nodes to assess the size, shape, matting and consistency (Mohseni et al., 2014). In addition, check for tenderness, mobility, erythema and warmth. It is important to

Assessing metastatic involvement of the lymph nodes in breast cancer patients is important in planning surgical and adjuvant therapies. A trend toward breast-conserving therapies with the goal of improving quality of life for breast cancer patients has driven the need to accurately assess lymph nodal staging. The concept of a sentinel lymph node (SLN) biopsy is a valuable tool in evaluating metastatic spread of primary breast tumors (Maaskant-Braat et al.,2012; Noushi et al., 2013). Tokin et al. (2012) describe how the process of tumor spread via the lymphatics occurs to the first draining lymph node, then to subsequent nodes within the same basin and beyond. Breast lymphoscintigraphy has emerged as a useful means of identifying the SLN, although many patient factors, choice of radiopharmaceutical, injection technique, and imaging protocol may affect the successful outcome. The ideal exam protocol would combine speed, accuracy, and sensitivity to identifying the SLN with the least amount of burden to the patient and resources involved (Povoski et al., 2006; Sadeghi et al., 2009; Tokin et al., 2012).

59). Dr. Holmes, who uses ARM, offers a similar solution for reducing metastatic risk. After surgery, he uses anti-cancer medications, and sometimes radiation therapy to kill remnant cancer-cells in the ARM nodes. However, this is already common practice for surgeons after they perform surgery on any of their cancer patients. This may indicate that for some reason, surgeons are still not comfortable with leaving cancer-cells in ARM nodes. If a patient’s surgeon does not practice ARM for this reason, it would be beneficiary to ask him/her about whether NAC could be an option and also why standard anti-cancer treatments do not alleviate his/her concerns about ARM’s oncological safety.

Oral cancer is a devastating disease. Over eight thousand American lives are taken by oral cancer and only a fourth of these patients do not excessively drink alcohol or smoke tobacco, which are the two main causes of oral cancer (The Oral Cancer Foundation). Survival rates for oral cancer could be much higher if the population would take precautionary measures to reduce their chances of being diagnosed with oral cancer. When the use of alcohol and tobacco are decreased, the chances of acquiring oral cancer are also decreased. By visiting the dentist at least once every year, new lesions could be found. Unfortunately, only seven percent of the population, who visits the dentist regularly, receives a thorough oral cancer exam(The Oral

cancer. The use of film mammography can be very hard to recognize breast cancer in

The anatomical structure of mediastinum is complicated, such as cardiac-artery, heart, trachea, esophagus, lymph nodes. Many diseases can cause a mediastinal lesions. Because of the intricate pathogenesis and lacking of specific clinical symptoms, many procedures are unable to diagnose mediastinal lesions without invasive procedures. In the past, physicians mainly used mediastinoscopy, and even thoracotomy to check and treat mediastinal lesion. Undoubtedly, this increases the surgical risk and the treatment cost. Naturally, the mediastinoscopy has been the diagnostic standard for staging tissue confirmation of suspected metastatic mediastinal lymph nodes [55]. However, mediastinoscopy is a highly invasive procedure, which requires general anesthesia,

The etiology of oral malignant melanoma is unknown, in contrst to cutaneous melanoma which is liked to sun exposure .Nevi are considered a potential source of some oral melanomas, but the sequence of event is poorly understood. Currently most melanomas are thought to arise de novo(19,20). The role of inhaled and ingested carcinogens as from tobacco use chronic irritation from ill-fitting dentures in their pathogenesis has been suggested, similar to squamous cell carcinoma. It is possible that physical and/or chemical stimulation play a role in physiologic oral pigmentation. Axel and Hedin suggested that hyperproduction of the melanocytes in oral epithelium may be caused by physical and chemical stimulation, resulted in oral pigmented lesions.

A total of 1855 biopsy specimens were accessioned at our biopsy services during the study period (2002 – 2006). In this period, 37 cases were salivary gland neoplasms accounting to 1.99% of all biopsy specimens accessioned. Of 37 cases, 11 were benign neoplasms (29.72%) and 26 were malignant (70.27%). The common tumors overall was Pleomorphic adenoma (PA) and Muco-epidermoid carcinoma (MEC) (Table 1).

Results: lymph nodes harvested in the neoadjuvant group, maximum number was 23, minimum number was 1 while the median was 7. In the group which did not receive neoadjuvant therapy the maximum number was 34, minimum number was 11 while the median was 11. The P value was statistical significant less than 0.000.

Saliva is a unique fluid and interest in it as a diagnostic medium has advanced exponentially in the last 10 years.The literature is replete with articles,2500+ since 1982, describing the use of saliva, gingival crevicular fluid, and mucosal