Wednesday, 21 February 2018

Gleason score

«The Gleason is a grade assigned to prostate cancer specimens that reflects the degree of aggressiveness based on the tumor's resemblance to normal glandular tissue. A primary (or predominant) pattern is recorded followed by a secondary or lesser pattern. The Gleason score is the sum of the primary and secondary pattern values and can be between 2 and 10» [1].

The original Gleason grading system diagram:

Source: Gordetsky J, Epstein J. Grading of prostatic adenocarcinoma: current state and prognostic implications. Diagn Pathol. 2016 Mar 9;11:25. Available at: https://doi.org/10.1186/s13000-016-0478-2. The link to the Creative Commons Attribution 4.0 International License is http://creativecommons.org/licenses/by/4.0/.

«Grade 1: small, well-formed glands, closely packed;
Grade 2: well-formed glands, but more tissue between them;
Grade 3: darker cells, some of which have left the gland and are invading the surrounding tissue;
Grade 4: few recognizable glands with many cells invading the surrounding tissue;
Grade 5: no recognizable glands; sheets of cells throughout the surrounding tissue» [1].
The current guidelines for the Gleason grading system and recent changes from the 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma include five distinct grade groups based on the modified Gleason score groups. Grade Group 1 = Gleason score ≤6, Grade Group 2 = Gleason score 3 + 4 = 7, Grade Group 3 = Gleason score 4 + 3 = 7, Grade Group 4 = Gleason score 8, Grade Group 5 = Gleason scores 9 and 10. This new ISUP grading system is simpler and more accurately reflects prostate cancer biology, and it is recommended by the World Health Organization (WHO) to be used in conjunction with Gleason grading [10].
Bibliographic references:
[1] Shah A. 53 - Low-Risk Prostate Cancer. In: Hristov B, Lin S, Christodouleas J. Radiation Oncology. 2nd ed. Philadelphia, USA: Wolters Klumer Health; 2015:364.
[2] Gordetsky J, Epstein J. Grading of prostatic adenocarcinoma: current state and prognostic implications. Diagn Pathol. 2016 Mar 9;11:25. Available at: https://doi.org/10.1186/s13000-016-0478-2The link to the Creative Commons Attribution 4.0 International License is http://creativecommons.org/licenses/by/4.0/.

Ratio of free to total PSA (prostate-specific antigen)

«The end product of normal PSA (prostate-specific antigen) biosynthesis within the prostate epithelium and ducts is inactive "free PSA", a fraction of which diffuses into circulation. In prostate cancer, tumors disrupt the prostate basement membrane and allow precursor forms of PSA to leak into the circulation, which decreases the relative proportion of free PSA. Hence, the ratio of free-to-total PSA will be lower in men with prostate cancer. A ratio of <7% is highly suspicious for prostate cancer, whereas a ratio of >25% is rarely associated with malignancy.»
Bibliographic reference: Shah A. 53 - Low-Risk Prostate Cancer. In: Hristov B, Lin S, Christodouleas J. Radiation Oncology. 2nd ed. Philadelphia, USA: Wolters Klumer Health; 2015:366.

Sunday, 4 February 2018

Abscopal effect


Reirradiation in breast cancer

Photo by Dr. Francisco Branco, slide by Dr. Pedro Fernandes, in Breast Cancer Weekend, on January 26, 2018, Instituto Português de Oncologia - Porto - Francisco Gentil, Porto, Portugal.

Wednesday, 17 January 2018

Cost-Effectiveness of Primary Radiation Therapy Versus Radical Prostatectomy for Intermediate- to High-Risk Prostate Cancer

Cost-Effectiveness of Primary Radiation Therapy Versus Radical Prostatectomy for Intermediate- to High-Risk Prostate Cancer: To compare, using a cost-effectiveness analysis, the quality-adjusted life expectancy
(QALE) and cost between the 2 treatment options for intermediate- to high-risk prostate
cancer: (1) radiation (RT) with androgen deprivation therapy (ADT) or (2) radical
prostatectomy (RP) followed by adjuvant RT for patients with risk factors.

Sunday, 31 December 2017

TGR (tumor regression grade) in rectal cancer

Pathological features, or TGR, of rectal cancer after preoperative radiochemotherapy:
Source: Dworak O, et al, 1997, cited by Park YJ, Oh BR, Lim SW, Huh JW, Joo JK, Kim YJ, Kim HR. Clinical significance of tumor regression grade in rectal cancer with preoperative chemoradiotherapy. J Korean Soc Coloproctol. 2010 Aug;26(4):279-86. Available at: https://doi.org/10.3393/jksc.2010.26.4.279.

TRG (tumor regression grade) in esophageal carcinoma

Pathological response grading or TRG following neoadjuvant chemoradiation in oesophageal cancer:
Source: Mandard AM, et al., 1994, cited by Gillham CM, Reynolds J, Hollywood D. Predicting the response of localised oesophageal cancer to neo-adjuvant chemoradiation. World J Surg Oncol. 2007 Aug 23;5:97. Available at: https://doi.org/10.1186/1477-7819-5-97.