clinical aspects of neoplasia hs

8/11/2019 Clinical Aspects of Neoplasia Hs

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DR SHWE SIN

FMHS


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It is the effects of neoplasmson the patients

Tumor-Host interactions area two way street

Any tumor even benign one

may cause morbidityandmortality


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Because of:

1. Location and impingementon adjacent

structures (site and size)

2. Functional activity such as hormone

synthesis or the development ofparaneoplastic syndromes

3. Bleedingand infections

4. Symptoms results from ruptureor

infarction5. Cachexiaor wasting


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I. Local effects:

1) Location- impingement and obstruction

2) Bleeding, ulceration, secondary

infection3) Infarction (due to torsion)

4) Functional activity (hormone

production)

II. Cachexia

III. Paraneoplastic syndromes


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Locationis important: Impingement and

obstruction on adjacent structures

e.g - A small (1 cm) pituitary adenoma can

compress and destroy the surrounding normalgland

- A 0.5 cm leiomyoma in the wall of

renal artery may lead to renal ischemia

- A small carcinoma within common bileduct may induce fatal biliary tract

obstruction


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A tumor may ulcerateleading to

bleeding or secondary infection

Benign or malignant neoplasmsthat protrude into gut lumen

may cause intussusception,

obstructionor infarction


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Hormone production is also important:- Adenomas and carcinomas arising in the b-

cells of the islets of the pancreas can

produce fatal hyperinsulinism

- Some adenomas and carcinomas of adrenalcortex elaborate corticosteroids that affect

the patients

- Hormonal activity is more likely in benign

tumor than carcinoma


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Cancer patients suffer

progressive loss of body fat and

lean body massAccompanied by profound

weakness, anorexia, wasting

and anaemiacachexia


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Due to action of cytokinesproduced bytumor and the host (e.g TNF)suppresses appetite and inhibit releaseof free fatty acids

Calorie expenditure remains high and

basal metabolic rate is increasedOther: protein-mobilizing factor called

proteolysis-inducing factor play somerole

Also attributed by grief and anxietyThere is no satisfactory treatment


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Symptom complex

That cannot be readily explained by local ordistant spread

By elaboration of hormonesindigenous to the

tissue of origin paraneoplastic syndromes Appear 10- 15 % of patients

May be - earliest manifestation

- represent significant

clinical problems- lethal

- mimic metastatic

disease


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The most common syndromes are:

- hypercalcemia(e.g breast cancers)- Cushing syndrome (e.glung cancers)

- nonbacterial thrombotic endocarditis (e.ghaematologic malignancies)

Hypercalcemiadue to synthesis of

parathyroid hormone-related protein (PTHrP)by tumor cells

Cushing syndrome- due to ectopicproduction of ACTHor ACH-like polypeptides

by cancer cellsNonbacterial thrombotic endocarditis -

Substances that can cause hypercoagulability


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GRADING:NecessaryHistologic estimate of malignancy of a

tumorFor making accurate prognosisand fortreatmentprotocols

Criteria depends on- degree ofdifferentiation, nuclear pleomorphismand hyperchromasia & number of mitoses

Classified as grade I, II, III or IVOr Well, Moderate and Poorly

differentiated


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STAGING: It is clinical estimate of extent of tumor spread

Staging is determined by surgical explorationor imaging

Two methods of staging are currently used: theTMN system and the AJCC system

Based on :1. Tumorsize (T) T0 to T4

2. local and regional lymph node spread (N) N0to N3

3. distant metastasis (M) M0 to M1/M2

Staging has greater clinical value than grading


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Biopsy and histology

Cytology(Fine needle aspiration

cytology FNAC)

Immunohistohistochemistry(IHC)

and Immunocytochemistry

Flow cytometry

Tumor Markers (e.g CEA)

Molecular diagnosis (e.g PCR)


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Biopsy is the tissue specimen made available for

histological diagnosis

Biopsy & histology is the most important method

of tumor diagnosis

Provides definitive diagnosis (Gold standard)

The specimen must be adequate, representative

and properly preserved

Several sampling are available:- excisional, incisional, punch, wedge, cone and

fine-needle aspiration biopsy

Routine stain- Haematoxylin and Eosin (H&E)


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Fine-needle aspiration of tumors (FNAC &FNAB)- is widely used

Next best to histology

Involves aspiration of cells from mass,followed by cytologic examination of thesmear (? Dysplasia or anaplasia)

Can apply in readily palpable lesionsaffecting breast, thyroid, lymph nodes and

salivary glandsCan also apply in deeper structures (liver,

pancreas and pelvic lymph nodes) by usingModern imaging techniques (USG, CT scan)


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Robbins Basic Pathology, 8thEdition


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clinical aspects of neoplasia hs

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