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Answer question number 6

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I have enough information from my knowledge and the textbook sources to provide a thorough answer. Here is the complete answer to Question 6:

Q-6: Cancer | Cytopathological Specimens | Advantages of FNAC

(1 + 2 + 2 = 5 marks)

1. What is Cancer? (1 mark)

Cancer is a term used for any malignant neoplasm - a group of diseases characterized by uncontrolled, purposeless proliferation of cells that invade surrounding tissues and have the capacity to spread (metastasize) to distant sites in the body via blood or lymphatics. Unlike benign tumors, cancer cells lack normal differentiation, ignore growth-regulatory signals, evade apoptosis, and are potentially lethal if untreated.

2. Specimens Used in the Laboratory for Cytopathological Examination (2 marks)

Cytopathological (cytological) examination studies individual cells or small clusters of cells rather than tissue architecture. The specimens used include:

A. Exfoliative Cytology (shed cells collected from body surfaces/cavities):

SpecimenExample Use
SputumBronchogenic carcinoma
Bronchial washings/brushingsLung cancer
UrineTransitional cell carcinoma of bladder/ureter
Cerebrospinal fluid (CSF)CNS tumors, meningeal carcinomatosis
Pleural/peritoneal/pericardial fluidMetastatic carcinoma
Cervical/vaginal smears (Pap smear)Carcinoma cervix - most classic example
Gastric washingsGastric carcinoma
Nipple dischargeBreast carcinoma

B. Fine Needle Aspiration Cytology (FNAC):

  • Cells aspirated from a mass (palpable or image-guided) using a fine needle (22-25 gauge)
  • Used for: breast lump, thyroid nodule, lymph node, salivary gland, soft tissue mass, liver, kidney

C. Imprint/Scrape Cytology:

  • Touch preparations from cut surfaces of biopsies or surgical specimens

3. Advantages of FNAC (2 marks)

FNAC has become the preferred first-line diagnostic tool for palpable masses due to multiple advantages:
  1. Simple and rapid - Can be performed as an outpatient procedure; results available within hours (same-day diagnosis possible with on-site evaluation)
  2. Minimally invasive / safe - Uses a fine needle (22-25 gauge); no incision, no sutures, minimal risk of bleeding or infection
  3. Cost-effective - Inexpensive compared to open surgical biopsy or core needle biopsy
  4. No anesthesia required - Performed under local anesthesia or even without it, reducing risk
  5. No tumor seeding risk - The fine needle track does not seed tumor cells along the needle path (unlike large-bore needle biopsies)
  6. High diagnostic accuracy - Sensitivity >80%, specificity >90% for most lesions (e.g., thyroid nodules)
  7. Can be repeated easily - Multiple passes from the same lesion or repeated procedures are well tolerated
  8. Avoids unnecessary surgery - Can differentiate benign from malignant lesions preoperatively, helping plan appropriate surgical management
  9. Can be used for deep-seated lesions - Under ultrasound or CT guidance, FNAC can reach lesions not palpable clinically (e.g., liver, pancreas, mediastinum)
  10. Allows ancillary tests - Material obtained can be used for immunocytochemistry, flow cytometry, microbiological culture, and molecular testing
Sources: Sabiston Textbook of Surgery, 21st ed. (FNA - "most accurate and cost-effective invasive procedure"); Bailey and Love's Short Practice of Surgery, 28th ed.
Summary mnemonic for FNAC advantages - "SAFE ROAD":
  • Simple/Same-day results
  • Accurate (high sensitivity/specificity)
  • Financially cost-effective
  • Easy to repeat
  • Rapid
  • Outpatient (no hospitalization)
  • Anesthesia not required
  • Deep lesions accessible (image-guided)
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