Scribd Logo
Upload

Welcome to Scribd!

  • 7 views

    AP8 - Spread of Tumours

    Uploaded by

    spoelstratjibbe
    This document discusses various aspects of tumour spread and progression. It covers tumour invasion factors like decreased cellular adhesion and secretion of proteolytic enzymes. It describes the process of tumour metastasis through detachment, invasion, intravasation, evasion of host defenses, adherence and growth at distant sites. Common routes of metastasis include hematogenous spread to liver, lung and bone, and lymphatic spread. Tumours can cause local effects like compression and tissue destruction as well as systemic effects like weight loss, paraneoplastic syndromes, and metabolic abnormalities. Prognosis depends on tumour grade, stage, type and molecular features, with higher grade and stage generally indicating worse prognosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    AP8 - Spread of Tumours

    Uploaded by

    spoelstratjibbe
    7 views24 pages
    This document discusses various aspects of tumour spread and progression. It covers tumour invasion factors like decreased cellular adhesion and secretion of proteolytic enzymes. It describes the process of tumour metastasis through detachment, invasion, intravasation, evasion of host defenses, adherence and growth at distant sites. Common routes of metastasis include hematogenous spread to liver, lung and bone, and lymphatic spread. Tumours can cause local effects like compression and tissue destruction as well as systemic effects like weight loss, paraneoplastic syndromes, and metabolic abnormalities. Prognosis depends on tumour grade, stage, type and molecular features, with higher grade and stage generally indicating worse prognosis.

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses various aspects of tumour spread and progression. It covers tumour invasion factors like decreased cellular adhesion and secretion of proteolytic enzymes. It describes the process of tumour metastasis through detachment, invasion, intravasation, evasion of host defenses, adherence and growth at distant sites. Common routes of metastasis include hematogenous spread to liver, lung and bone, and lymphatic spread. Tumours can cause local effects like compression and tissue destruction as well as systemic effects like weight loss, paraneoplastic syndromes, and metabolic abnormalities. Prognosis depends on tumour grade, stage, type and molecular features, with higher grade and stage generally indicating worse prognosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views24 pages

    AP8 - Spread of Tumours

    Uploaded by

    spoelstratjibbe
    This document discusses various aspects of tumour spread and progression. It covers tumour invasion factors like decreased cellular adhesion and secretion of proteolytic enzymes. It describes the process of tumour metastasis through detachment, invasion, intravasation, evasion of host defenses, adherence and growth at distant sites. Common routes of metastasis include hematogenous spread to liver, lung and bone, and lymphatic spread. Tumours can cause local effects like compression and tissue destruction as well as systemic effects like weight loss, paraneoplastic syndromes, and metabolic abnormalities. Prognosis depends on tumour grade, stage, type and molecular features, with higher grade and stage generally indicating worse prognosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 24

    Spread of Tumours

    Dr Mampho Bapela
    26 May 2020
    Contents
    • Tumour invasion
    • Tumour metastasis
    – Routes of metastasis
    • Clinical effects of tumours
    – Local effects
    – Metabolic effects
    • Prognosis
    – Tumour grade
    – Tumour stage
    • Tumour screening
    Tumour Invasion
    • Invasion is the number one important feature of malignancy
    • Factors affecting invasion:
    – Decreased cellular adhesion
    – Secretion of proteolytic enzymes
    • A balance between matrix metalloproteinases and tissue inhibitors of
    metalloproteinases determine the invasiveness of a given tumour
    – Abnormal or increased cell motility

    • Invasion occurs at tissue planes offering least resistance (perineurial


    and perivascular)
    • Pagetoid infiltration invasion within epithelial structures without
    bridging the basemsnent membrane
    Tumour Metastasis
    • The process of spread of a malignant tumour from its site
    of origin(primary tumour) to distant site (secondary
    tumours).
    • Tumour cells complete a sequence of events before
    forming metastases:
    – Detachment of tumour cells from neighbours
    – Invasion of surrounding connective tissue
    – Intra-vasation into the lumen of vessels
    – Evasion of host defence mechanisms
    – Adherence to endothelium at distant site
    – Extra-vasation of cells from the vessel lumen at distant site
    – Survival and growth in new environment
    Routes of Metastasis
    – Haematogenous:
    • Commonly involve the liver, lung, bone and brain
    • Bone metastasis: top 5 sites of origin are Lung, breast, kidney,
    thyroid and prostate

    – Lymphatic:
    • The tumour arrives in the lymph node via the afferent channel
    • Groups of lymph nodes typically involved in a contiguous fashion

    – Transcoelomic:
    • Pleural, peritoneal and pericardial spread
    • Malignant effusion
    • Nodules on mesothelial surfaces
    Routes of mets
    Clinical Effects of Tumours
    • Local effects:
    – Compression and displacement of tissues
    – Tissue destruction by invasion
    – Ulceration and blood loss of tumours on mucosal
    surfaces

    • Clinical effects depend on the size of the


    tumour and the location
    • Benign tumour may cause clinical problems
    due to:
    – Pressure on adjacent tissues
    – Obstruction to the flow of fluid
    – Production of a hormone
    – Transformation into a malignant neoplasm
    • Additionally, malignant tumours cause clinical
    problems due to:
    – Destruction of adjacent tissue
    – Formation of secondary tumours (metastases)
    – Blood loss from ulcerated surfaces
    – Paraneoplastic effects causing weight loss and
    debility
    – Anxiety and pain
    • Major types of tumour products:
    – Substances appropriate for the cell of origin
    • e.g. Keratin pearls in squamous cell carcinoma

    – Substance inappropriate for the cell of origin


    • e.g. ACTH production by small cell carcinoma of the lung

    – Foetal reversion substances


    • Alpha feto protein(AFP) in hepatocellular carcinoma

    – Substances required for growth and invasion


    • Matrix metalloproteinases

    • Tumour products may be used in the diagnosis and


    monitoring of tumours:
    – Tested on histological sections (immunohistochemical stains)
    – Concentration measured in serum (AFP, CEA, PSA)
    – Tumour derived DNA/DNA fragments
    • Metabolic effects:
    – Tumour type specific effects:
    • Thyrotoxicosis resulting from thyroid adenoma
    • Hyperparathyroidism resulting from a parathyroid adenoma

    – Unexpected/inappropriate tumour effects:


    • Paraneoplastic syndromes
    – e.g. ACTH production by small cell carcinoma of the lung
    • Others finger clubbing in patients with lung cancer

    – Non-specific metabolic effects:


    • Weight loss and debility (cachexia)
    • Neuropathies and myopathies associated with lung
    carcinoma
    • Venous thrombosis associated with mucin producing
    adenocarcinoma
    • Glomerular injury due to immune complex disease
    Prognosis
    • Depends on the innate characteristics of a
    tumour.

    • Effectiveness of modern cancer therapy.

    • Prognostic indices include:


    – Tumour type
    – Degree of differentiation(grade)
    – Extend of spread (stage)
    – Molecular pathological features
    • Tumour grade:
    – Assessment of the degree of differentiation
    – Contributing features include: mitotic activity, nuclear size, chromatin and
    shape
    – Degree of resemblance to normal tissue
    – Grading systems exist for many tumour types
    – Gleason grading system for prostate adenocarcinoma
    – Modified Bloom-Richardson histological grading system for breast carcinoma
    • Tumour stage:
    – Clinical, radiological and histopathological
    evaluation of the tumour spread
    – Examples include Dukes staging system for
    colorectal carcinoma and TNM

    • The AJCC TNM staging system:


    – Generally applicable to most tumours
    – T = Tumour size
    – N = Lymph node metastasis
    – M = Distant metastases
    References
    1. Robbins and Cotran Pathologic Basis of
    Disease. 9th Edition. Neoplasia Chapter

    2. Robbins and Cotran Basic Pathology 9th


    edition. Neoplasia Chapter

    Under ood Pa holog a Clinical approach


    7th Edition. Neoplasia and carcinogenesis
    chapter

    You might also like