clinical aspects of neoplasia hs
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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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