Tumor staging and grading: a primer.

Cancer staging and grading are used to predict the clinical behavior of malignancies, establish appropriate therapies, and facilitate exchange of precise information between clinicians. The internationally accepted criteria for cancer staging, the tumor-node-metastasis (TNM) system, includes: (1) tumor size and local growth (T); (2) extent of lymph node metastases (N); and (3) occurrence of distant metastases (M). Clinical stage is established before initiation of therapy and depends on the physical examination, laboratory findings, and imaging studies. Pathologic stage is determined following surgical exploration of disease spread and histological examination of tissue. The TNM classification system has evolved over 50 years to accommodate increasing knowledge about cancer biology. Efforts are ongoing to keep the system both synchronized with the most sophisticated cancer technology and simple for ease of clinician/patient use. Upcoming molecular technologies, such as genomic and proteomic profiling of tumors, microRNA profiling, and even ex vivo living tumor tissue treatment, could improve the current TNM staging system. This chapter describes the current TNM system using breast, lung, ovarian, and prostate cancer examples.

Proteomic analysis of human breast cancer tissue with laser-capture microdissection and reverse-phase protein microarrays.

Despite recent advances in breast cancer therapy, women with similar types of breast cancers may respond very differently to standard treatments. The emerging field of clinical proteomics has the potential to revolutionize breast cancer therapy. The ultimate goal of clinical proteomics is to characterize information flow through protein cascades for individual patients. After the protein networks have been elucidated, drug therapies may be specially designed for each patient. The following review describes the proteomic technologies of laser-capture microdissection (LCM) and reverse-phase protein arrays (RPPAs). These technologies allow scientists to analyze relative abundances of key cellular signaling proteins from pure cell populations. Cell survival and apoptotic protein pathways are currently being monitored with LCM and RPPAs at the National Institutes of Health, in phase II clinical trials of metastatic breast and ovarian cancers. Ultimately, proteomics will become an integral component of tracking and managing individualized breast cancer therapy.