Cancer

Module details

Title

Cancer

Type

Specialist

Module code

SLS321

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with knowledge and understanding of the principles of carcinogenesis, malignancy and metastasis. They will understand and apply cellular pathology to the diagnosis and management of a range of common cancers. They will apply cellular pathology techniques in cancer and gain experience of interpreting results from patient investigations.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Plan and implement, using aetiology and clinical presentation information, a diagnostic process to identify common cancers and their prognosis. Essential Skin malignancy Breast malignancy Hepatobilary malignancy Gastrointestinal malignancy Genitourinary malignancy Respiratory malignancy Gynaecological malignancy Male reproductive malignancy Endocrine  Desirable Haemopoietic malignancy Neuromuscular malignancy Ear, nose and throat malignancy Osteoarticular malignancy Vascular malignancy Neurological malignancy.	Action View
# 2	Learning outcome 2	Competency Perform the examination of and record details of the macroscopic examination of tissue received from named cancers. Essential Skin malignancy Breast malignancy Hepatobilary malignancy Gastrointestinal malignancy Genitourinary malignancy Respiratory malignancy Gynaecological malignancy Male reproductive malignancy Endocrine  Desirable Haemopoietic malignancy Neuromuscular malignancy Ear, nose and throat malignancy Osteoarticular malignancy Vascular malignancy Neurological malignancy.	Action View
# 3	Learning outcome 1	Competency Perform dissection and sample cancer resection specimens received in accordance with local protocols.	Action View
# 4	Learning outcome 2	Competency Perform to quality standards basic and appropriate specialised histopathological techniques as part of the systematic investigation of tissue received from a minimum of 10 different named cancers.	Action View
# 5	Learning outcome 3	Competency Use and evaluate new equipment relevant to the histological investigation of cancer.	Action View
# 6	Learning outcome 4	Competency Present orally the evidence base for three different diagnostic algorithms and/or prognostic indicators used by your unit in the investigation and management of cancer patients.	Action View
# 7	Learning outcome 5	Competency Identify and interpret national and international cancer targets and survival statistics for at least three common cancers.	Action View
# 8	Learning outcome 4,5	Competency In discussion with a pathologist interpret in the correct clinical context the results of: macroscopic examination basic microscopic examination appropriate specialised techniques diagnostic from specimens received from a range of named cancers. To include: Essential Skin malignancy Breast malignancy Hepatobilary malignancy Gastrointestinal malignancy Genitourinary malignancy Respiratory malignancy Gynaecological malignancy Male reproductive malignancy Endocrine   Desirable Haemopoietic malignancy Neuromuscular malignancy Ear, nose and throat malignancy Osteoarticular malignancy Vascular malignancy Neurological malignancy.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform interpretation of clinical details from 10 examples of cancer organ resections and prioritise samples according to clinical urgency.	DOPS
Perform interpretation of clinical details from 10 examples of cancer resections and plan the investigations to be performed and annotate the request accordingly.	DOPS
Perform specimen dissection of a range of cancer resection sample types requiring dissection with a knife and select appropriate samples from those specimens to enable a diagnosis to be made.	DOPS
Perform assessment and marking of relevant specimen excision margins to enable correct orientation of the samples.	DOPS
Perform dictated description of 10 cancer resection specimens being dissected.	DOPS
Perform microtomy on 10 different tissue types from different cancer resections and stain with H and E stain.	DOPS
Evaluate and perform a prognostic indicator assessment using the appropriate demonstration technique to a named cancer type.	DOPS
Perform microscopical interpretation of stained slides and produce a quality assessment evaluation report.	DOPS
Perform microscopical interpretation of stained slides from 6 different major organ types	DOPS
From evidence gathered and discussions with relevant clinical colleagues, produce a clinical pathway document detailing the impact of the diagnostic process on the overall patient pathway.	OCE
From evidence gathered and discussions with relevant clinical colleagues, produce a reflective account of the learning acquired	OCE
Perform microscopical interpretation of H and E stained slides from 6 different major organ types and demonstrate to a Consultant Histopathologist normal and abnormal morphology, relating their morphologic appearance to the clinical condition.	OCE
Perform microscopical interpretation of stained slides from 6 different major organ types and demonstrate to a Consultant Histopathologist the algorithmic processes used to determine a differential diagnosis.	OCE
In discussion with a Consultant Histopathologist, use information gathered from the algorithmic process to produce a preliminary diagnosis for 6 specimens from different major organ types.	OCE
Discuss differential diagnosis at a relevant MDT meeting.	OCE

Learning outcomes

1. Identify and confirm the clinical presentation of a range of common cancers.
2. Perform to quality standards a range of established histopathological techniques to named cancers.
3. Identify and evaluate new equipment, methods, or procedures to enhance the contribution of the histopathology laboratory to the diagnosis and management of cancer.
4. Apply diagnostic algorithms and prognostic indicators to the investigation and management of cancer patients.
5. Draft preparation and interpretation of reports that involve histopathological findings as part of the investigation of cancer.
6. Work in partnership with other clinical specialisms as part of the diagnosis and review of a range of common cancers.

Learning outcomes

1. Describe the biology of normal and abnormal growth.
2. Describe the processes of tumour growth, angiogenesis, apoptosis and metastasis.
3. Explain the role of oncogenes in cancer development and the molecular basis of oncogenesis.
4. Describe and justify the use of diagnostic algorithms to aid the diagnosis of malignant disease.
5. Describe the use of prognostic indicators to provide advice on clinical and surgical treatment in a multidisciplinary setting.
6. Discuss and critically evaluate the application of clinical and surgical treatment modalities for cancer, including the underpinning evidence base.
7. Discuss and justify the relevance of national and international targets and achievements in the diagnosis, management and survival of cancer patients.
8. Discuss the partnership of histopathology to other clinical specialisms in the investigation and management of cancer and patient care.

Indicative content

• Principles of the initiation and mechanisms of malignant growth and metastasis, including:
  • genetic deregulation and the role of proto-oncogenes and oncogenic viruses
  • the role of telomerase activation in tumourgenesis
  • cell proliferation
  • signalling pathways
  • apoptosis
  • the role of hormones
  • angiogenesis
• The principles and significance of clonality
• The principles of radioactive and chemical carcinogenesis
• Karyotyping and familial predisposition to certain types of cancer
• Tumour–host interactions
• Aetiology, homeostasis, pathogenesis and the main clinical features, including age-related factors, of malignant diseases encountered in organ group-specific malignant disease, including:
  • skin malignancy
  • breast malignancy
  • hepatobilary malignancy
  • gastrointestinal malignancy
  • genitourinary malignancy
  • vascular malignancy
  • respiratory malignancy
  • gynaecological malignancy
  • male reproductive malignancy
  • endocrine malignancy
  • haemopoietic malignancy
  • neuromuscular malignancy
  • ENT malignancy
  • ophthalmic malignancy
  • osteoarticular malignancy
• Application of a wide range of histological techniques to the diagnosis of cancer
• The processes of grading and staging of cancer
• Role of diagnostic prognostic and predictive markers in the clinical management of patients
• National screening programmes for cancer
• The role of clinical and surgical treatment options in the management of disease
• The impact of diagnostic histopathology on clinical outcomes
• Multidisciplinary team meetings
• Cancer targets – fast-track from GP to treatment (to include initial diagnosis of organ-specific tumour site, e.g. breast, prostate)

Activities

• Participate in multidisciplinary review meetings at which histopathology results from cases of cancer are presented as part of the clinical record. Wherever possible include those cases in your portfolio of named cancers. Record the outcomes of the multidisciplinary review meetings.
• Include details of investigations undertaken, with explanations, in the portfolio of cases prepared for learning outcome 1.
• Perform a detailed evaluation of one new piece of equipment, method or procedure. Critically appraise the results of the evaluation and produce a report with recommendations.
• Participate in the application of the three different diagnostic algorithms and/or prognostic indicators to your portfolio of cases in named cancers.
• Write a histopathology report of a range of common cancers appreciating the partnership between the histopathology laboratory and other clinical specialisms.
• Suggest ways in which improved diagnostics could lead to better clinical outcomes in your three selected common cancers.
• Prepare a portfolio of a minimum of 10 illustrative cases from different common malignancies. Include the plan of laboratory investigation. To be developed further in learning outcomes 2 and 6.