In this Lab report I will be discussing about a patient who is 64 years of age and a heavy smoker. He presents with these symptoms of difficulty in breathing and blood when he coughs. The G.P made a provisional diagnosis of tuberculosis or cancer but this case is forwarded to the Biomedical Scientist for the conformation of the diagnosis
Cancer is a disease characterised by uncontrollable cell growth. Some of the basic factors which cause lung cancer are genetic factors and exposure to carcinogens.
Cancer cells are non-specialized, abnormal cells and are characterized by undifferentiated and uncontrolled cell division. Cancer in situ is a tumour located in its place of origin whereas malignant tumours produce secondary’s at various other sites away from the primary tumour.
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Various characteristics found in cancer cells help them to be distinguished from the normal cells. They have abnormal nuclei with many chromosomal irregularities. They form tumours because they do not exhibit contact inhibition. They induce angiogenesis
Cancer is caused by the activation of the ONCO gene causes carcinogenesis to progress thus causing cancer. The nucleus of cancer cells is very dissimilar to a normal cell and thus is also has many chromosomal differences whereas a normal cell has definitive nucleus with a specific chromosomal pattern surrounded by cytoplasm having a specific cell wall. These cells clump together to form massive tumours which initiates angiogenesis and cause nearby blood vessels to form a capillary network that circulates blood to the tumour area.
In a normal lung tissue the trachea and bronchi are composed of basal mucous secretary cells, alveoli are composed of Type 1 and type 2 pneumocytes and bronchioles are composed of Ciara cells.
Malignancy is the term used to define cancerous cells and they are referred as such because they have the ability to attack and destroy normal cells and spreading to other parts of the body.
What are the cellular features of malignancy and how can some of these features be recognised by Biomedical Scientists and Pathologists?
Various tests such as histopathology of the biopsy specimen may provide information about the molecular changes (such as mutations, fusion genes, and numerical chromosome changes) that has happened in the cancer cells, and may thus also indicate the future behaviour of the cancer (prognosis) and best treatment.
Anaplasia, Mitotic activity, growth pattern, invasion and metastases are some of the cellular features of malignancy.
Are there any other tests a Biomedical Scientist may perform to help diagnose or monitor malignancy?
Cytogenetics and immunohistochemistry are other types of testing that the pathologist may perform on the tissue specimen.
Cytogenetics is a lab based process which involves adding a mitotic inhibitor to the sample under test. This inhibitor stops cell division at mitosis allowing large number of cells to be studied especially the nuclei thus making it easier to rule out malignancy.
Immunochemistry is another process used by pathologists to study the antigen-antibody reaction for the final confirmation of cancer. It is also used to find out the localisation and distribution of biological markers and different types of proteins in a tumour.
How can some of these features of malignancy be recognised by Biomedical Scientists and Pathologists?
These tests may provide information about the molecular changes (such as mutations, fusion genes, and numerical chromosome changes) that has happened in the cancer cells, and may thus also indicate the future behaviour of the cancer (prognosis) and best treatment.
RISK FACTORS ASSOCIATED WITH LUNG CANCER!
Smoking, radon gas, industrial exposure, air pollution, physical activity, diet, alcohol and family history are some of the main risk factors associated with lung cancer.
H & E: It’s used to determine the state of a tissue or how much is it affected by inflammation. It’s mostly commonly used staining technique used in pathology to determine whether a patient has cancer or not. There is no need for differentiation or bluing of the specimen when haematoxylin is used as this particular kind of dye only defines nuclei so it stands out and the rest remains colourless. This technique is more reliable when more than one performs the test on the same block from the specimen.
The specimen is fixated to preserve structure and wax infiltration supports the tissue making it easier to cut into thin small sections.
Dewaxing is carried out to ensure that staining chemicals used later on do not react with the wax.
Xylene is a chemical that is miscible with molten wax and is used to remove alcohol which doesn’t mix with wax.
The sample is then washed and dehydrated to remove excess fixative which might affect later stages.
The sample is then stained in Haematoxylin Z for 8 minz and then washed with water to prevent in from reacting with the next staining solution.
The sample is now stained with Scott’s (5% Sodium bicarbonate) which blues haematoxylin and prevents the loss of tissue sample from the glass slides. The blue colouring seen is due to the bluing of nuclear chromatin and membrane.
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After rinsing with water again, this time the sample is stained with Eosin for 3 minutes. This counterstain gives cytoplasm a pinkish colour creating a contrast and thus making it easier for an individual to distinguish between the nucleus (blue) and cytoplasm.
The sample is lastly dehydrated so that the water does not affect the infiltration process and then cleared with xylene so that the tissue becomes transparent.
Lastly the sample is mounted carefully at a slight angle to avoid air bubbles from appearing obstructing our view under the microscope.
How may these results tie in with other findings in different departments?
How do these results and the work of Biomedical Scientists help the patient?
At first all suspected primary lung cancer referrals are forwarded to the chest clinic for the final conformation of the diagnosis and management. Histology results and chest radiology results are used to identify these patients.
All these referred patients are first assessed by respiratory physicians in the outpatients department. Diagnostic tests such as Chest X-ray, bronchoscopy, lung function tests, CT scan and needle biopsy are carried out. If desirable expected results are not found at first bronchoscopy then other tests such as exercise test, angiogram, bone scan, echocardiography are carried out to decide which treatment has to be given.
Treatments include surgery, radiotherapy and chemotherapy.
What other departments are involved?
Medical Physician, Radiation Oncologist, Radiologist and Pathologist are the main persons involved in deciding the whole management of the individual and the disease.
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