What are the features suggesting poor prognosis?

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Advanced stage.
Poor differentiation.
Signet cell carcinoma
Adjacent structures involvement
Obstructing lesion
Ulcerative lesion
High CEA

What is the difference between staging & grading?

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Staging: describes the size of a tumour and how far it has spread from where it originated.
(e.g. Stage I, II, III, etc. or TNM staging)
Grading: describes the appearance of the cancerous cells under microscope.
(e.g. Grade I – well differentiated, Grade III – poorly differentiated)

If this patient had a concomitant cancer at his anorectum, what is the most likely type/ pathology?

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Squamous cell carcinoma

Resection has been done, only 1 out of 19 LN was involved, what is the N status?

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N1a

A few month later, the patient develops hepatic metastasis with ascites. Ascitic tap show atypical cells. What pathological test will you do to prove the origin?

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Immunohistochemistry

Difference between IHC and Tumour markers?
Tumour markers

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Proteins found in the body.
Produced by cancer cells or healthy cells in response to cancer

IHC

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It is a method of localizing specific antigens in tissues or cells
Based on antigen antibody recognition

What is IHC in simple words?

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It is a method of localizing specific antigens in tissues or cells based on antigen antibody recognition

How does it work?

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The antibodies are usually linked to an enzyme or a fluorescent dye.
When the antibodies bind to the antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope.

What is the type of Ag-Ab reaction in IHC?

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Complement fixation.

How IHC helps in decision of chemotherapy?

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IHC gives information about the type of cells and tissue to be targeted, and accordingly help in the plan of chemotherapy (i.e. the type of chemotherapy to be used and the effectiveness of chemotherapy).

How tyrosine kinase inhibitor works?

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Work by inhibition of tyrosine kinase enzymes which are signal transducers for cellular growth and division, thus prevent cancer cells from active division.
Examples are: Imatinib, sorafenib, gefitinib, sunitinib

Six months later the patient develops a large pelvic tumour, is this patient at high risk of developing venous thromboembolism?

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Yes, because of:
Hypercoagulability (due to malignancy).
Venous stasis → (due to compression of the pelvic veins by the pelvic tumour).

Diagnosis of PE?

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Clinical Examinations (SoB, reduced sats, etc.)
Chest X-ray
D-dimer
If leg pain I will go for Doppler (to exclude DVT)
If PE suspected the gold standard is CTPA

Complications of PE

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Pulmonary hypertension
Pleural effusion
Arrhythmia
Cardiac arrest

What are the contents of blood thrombus and how is it formed?

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Aggregated platelets and red blood cells that form a plug.
Mesh of cross-linked fibrin protein.

How to obtain plasma from blood?

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By taking sample of blood then adding anticoagulant and then centrifugation for 15 min

This patient will have malignant ascites in late stages. How to treat it?

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By palliative chemotherapy
Paracentesis
Intra peritoneal chemotherapy
Hyperthermia intra peritoneal chemotherapy