Radiological Diagnosis

• It include:
 X ray
 Ultrasound
 CT scan
 MRI
• These are one of the best early methods of cancer diagnosis.
 X-ray:
 It is a most common technique.
 An x-ray is a test that uses small amounts (doses) of radiation to
take pictures of the inside of your body.
 These is used for detection of stomach and small intestinal
growths and cancer.
 Ultrasound:
 Ultrasound is a non-invasive diagnostic technique used to image inside the
body.
 Ultrasound probes, called transducers, produce sound waves that have
frequencies above the threshold of human hearing (above 20KHz), but most
transducers in current use operate at much higher frequencies (in the
megahertz (MHz) range).
 An examination in which sound waves are bounced off tissue and echoes are
converted into picture.

 CT scan: (computerized tomography)

 A computerized tomography (CT) scan combines a series of X-ray images
taken from different angles around your body and uses computer processing
to create cross-sectional images (slices) of the bones, blood vessels and soft
tissues inside your body.
 CT scan images provide more-detailed information than plain X-rays do.
 MRI: (magnetic resonance imaging)
 Medical imaging technique that uses a magnetic field and computer-
generated radio waves to create detailed images of the organs and tissues in
your body.
 It uses powerful magnetic field to create detail computerized images of the
body’s, soft tissue, large blood vessels and major organs.
 Frozen Section
• Frozen section is quick diagnostic method. The tissue is
quickly frozen at around -20 C for frozen section.
• Cryostant which makes the tissue hard.
• Tissue is immediately sectioned and stained
• The whole process from receiving, staining to diagnosis can be
completed within 10 to 15 days
 Haematological Diagnosis
 Marrow is aspirated by bone marrow and aspiration needle
biopsied by trephine needle.
 It is useful in the diagnosis of Leukemia
 Molecular Diagnosis
Polymerase chain reaction (PCR)
Fluorescent in situ hybridization (fish)
It us useful for detecting translocation ( genetic
change in which a piece of one chromosome
breaks off and attaches to another chromosome)
characteristic of many tumors.
 Immunohistochemistry
 Large number of monoclonal antibodies are available
which are useful for:
 Typing of a malignant tumor.
 Poorly differentiated tumours are difficult to
morphologically type but if it shows positivity for
cytokeratin antibody then it can be typed as carcinoma.
 T cell or B cell monoclonal antibody positivity in the T
cell or B cell lymphoma.
 Classification of leukemia and lymphomas.
 Determination of site of primary in metastatic tumour.
TUMOR MARKERS
 Introduction
 A tumor marker is anything present in or produced by cancer
cells or other cells of the body in response to cancer or
certain benign (noncancerous) conditions.
 Different types of tumor marker are:
A. Circulating Tumor Marker:
Can be found in the blood, urine, stool, or other bodily
fluids of some patients with cancer. Circulating tumor
markers are used to:
 Estimate prognosis
 Determine the stage of cancer
 Detect cancer that remains after treatment (residual disease) or
that has returned after treatment
 Assess how well a treatment is working
 Monitor whether the treatment has stopped working
Circulatory Tumor Markers alone may not be enough to
diagnose cancer. For example, noncancerous conditions can
sometimes cause the levels of certain tumor markers to
increase. In addition, not everyone with a particular type of
cancer will have a higher level of a tumor marker associated
with that cancer.
Therefore, measurements of circulating tumor markers are
usually combined with the results of other tests, such
as biopsies or imaging, to diagnose cancer.
Commonly used circulating tumor markers
include calcitonin (measured in blood), CA-125/ cancer
antigen 125 (measured in blood), beta-2-
microglobulin (measured in blood, urine, or cerebrospinal
fluid), etc.
B. Tumor tissue (or cell) markers:
Can be found in the actual tumors themselves, typically
in a sample of the tumor that is removed during a
biopsy. Changes like tumor gene mutations, patterns of
tumor gene expression, and non genetic changes in
tumor DNA are evaluated.
Tumor tissue markers are used to:
Diagnose, stage, and/or classify cancer
Estimate prognosis
Select an appropriate treatment (e.g., treatment with
a targeted therapy)
Estrogen receptor and progesterone receptor, etc.
are some tumor tissue marker.
Serum Tumor Markers:
i. Oncofetal proteins
Originate within tumor cells and enter the bloodstream
either by secretion from the tumor or as a breakdown
product of tumor cells. Normally oncofetal proteins are
present during embryogenesis and may increase with
certain cancers, making them potentially useful tumor
markers.
Carcinoembryonic antigen (CEA) and alpha-fetoprotein
(AFP) are the most widely used oncofetal protein tumor
markers.
CEA is a useful marker for cancers of the lung, colon-
rectum, breast, ovary, and prostate. CEA is the most useful
tumor marker to distinguish benign from malignant pleural
effusions.
ii. Hormones and Ectopic hormones
Inhibin concentrations with Granulosa Theca cell Tumor
(GTCT).
Serum Parathormone concentration with adenomas and
carcinomas of the parathyroid glands.
Parathyroid hormone related protein concentration with
hypercalcemia of malignancy.
Thyroxine/ Thyroglobulin: Thyroid carcinoma
Adenocorticotropic Hormone/ Cortisol:
Hyperfunctioning adrenocortical tumors
Sex Steroid Hormones in Mammary gland tumor and
granulosa theca cell tumor.
Insulin is the hallmark of insulinoma (beta cell tumor,
pancreatic islet cell tumor).
iii. Enzymes
 Lactate Dehydrogenase, Serum Alkaline Phosphatase, Prostatic Acid
Phosphatase, Thymidine Kinase can be studied for malignancies and
prognosis.
iv. Immunoglobulins
 A long-standing use of a serum tumor marker in veterinary medicine is
the measurement of serum immunoglobulins.
v. Tumor associated antigens
 CA-125 /cancer antigen 125
Serum CA-125 may be elevated in cancers such as endometrial cancer,
cancer of the fallopian tubes, lung cancer, breast cancer, and cancer of the
gastrointestinal tract and non neoplastic diseases such as endometriosis.
CA-125 has not found application in veterinary medicine.
Miscellaneous several tumor markers
a. Fibronectin: Fibronectin (FN) is a large glycoprotein that is a component of
the extracellular matrix and occurs in its soluble form in plasma.
FN/albumin ratio was higher in dogs with malignant effusions compared to
those with congestive heart failure.
b. Sialic acid: Sialic acid describes derivatives of neuraminic acid, which are
potentially useful tumor markers because of the aberrant glycosylation (the
systematic addition of one or more carbohydrates to proteins or lipids) in
cancer cell membranes.
c. Acute Phase Proteins: APP that may have use as tumor markers include
ceruloplasmin (Cp), complement components C3 and C4, α1-acid
glycoprotein (AGP), α1-proteinase inhibitor (α1-antitrypsin), α1-
antichymotrypsin, haptoglobin (Hp), fibrinogen (Fbn), C-reactive protein
(CRP), and serum amyloid A (SAA).
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