10 Effects of neoplasms on the host Flashcards
What do malignant neoplasms have the ability to do ? which contrast benign neoplasms which grow but remain ….
spread , invade locally, distantly from the site of origin
localised
What are the hallmarks of malignant neoplasia ?
- growth signals
- growth
- avoid programmed cell death (apoptosis)
- limitless replication potential
- sustained angiogenesis
- local tissue invasion and distant blood bourne/lymphatic/transcoelomic metastasis
What enables cancer cells to acquire an autonomus drive to proliferate ?
activation of oncogenes such as ras or myc
How do cancer cells bypass the normal inhibition of growth ?
inactivating tumour suppressor genes such as Rb that normally inhibit cell growth
In what ways can cancer cells invade and spread to other parts of the body ?
- blood-borne metastasis
- lymphatic metastasis
- trans coelomic metastasis
What are the key features of malignant tumor cells under the microscope ?
- large, variably shaped nuclei
- many dividing cells + disorganised arrangement
- variation in size & shape
- loss of normal features
How are the effects that a patient who has neoplasm categorised into ?
- local
- distant
- systemic
What are the local effects a patient with neoplasm may have ?
- mechanical pressure or obstruction
- tissue destruction/erosion/invasion
mechanical pressure or obstruction depends on tumour…. ?
site and size
what symptoms are associated with a lump caused by a tumor ?
pain and discomfort
A tumour may present as a lump , list some examples of lumps throughout the body ?
- breast
- neck/axillary/inguinal in lymphoma or if spread to lymph nodes has occured
- salivary gland
- scrotal (part of testicle)
How my lumps in the body be found in a patient ?
through :
* examination
* screening
* imaging
What is not much present at the beginning and not often a presenting symptom of patients with neoplasm ?
pain
Which cancers are suggested by new onset of abdominal discomfort ?
- gastric
- pancreatic
- colonic
Pain does develop with …. of the tumour
spread/growth
Pain through the forms of the following imply what tumour or malignancy ?
1. headache
2. bone pain
- brain tumours
- bone tumours or haemotological malignancy
What condition can result from bronchial obstruction by a tumor ?
pneumonia
what difficulty might a person face if a tumor obstructs their gastrointestinal (GI) tract, specifically the esophagus ?
swallowing
what condition can occur if a tumor obstructs the common bile duct ?
jaundice
what symptoms might result from an intra-cranial space-occupying lesion ?
raised intracranial pressure, seizures and loss of function
what complications can arise from ureteric obstruction caused by a tumor ?
urinary tract infection and renal failure
GI tract obstruction is due to what?
narrowing of the lumen by the mass
what is perforation in GI tract ?
a medical emergency where…
there’s a hole / tear in the wall of any part of the GI system including stomach , small intestine, large intestine or other related organs
what is intussusception in GI tract ? what can it cause ?
when a part of the intestine slides into an adjacent part of the intestine , like the segments of a telescope - this can cause blockage
What is herniation of GI tract ?
when part of the intestine protrudes through a weakened opening in the abdominal wall or other surrounding tissue
What’s a complication of herniation in GI tract ?
strangulation of bowel cutting of blodo supply leading to ischemia & necrosis if. not treated promptly
what are adhesions in GI tract?
bands of fibrous scar tissue that form between abdominal tissues and organs often as a result of surgery , infection , inflammation
What are volvulus in GI tract ?
twisting of a part of the intestine around itself or the mesentery that supports it, causing an obstruction
Between bowel obstruction and intussusception, which is more commonly caused by tumors?
bowel obstruction
In the context of tumor-induced obstructions, which is more commonly affected: the small bowel or the large bowel?
small bowel
What severe complication can occur if a tumor erodes through the bowel?
perforation
What type of tissue response can tumors cause, leading to additional complications?
fibrous tissue response, leading to the formation of adhesions
What are some possible symptoms a patient with colon cancer could present with ?
- may be none
- new and persistent (over 2 or 3 weeks) change in bowel habits
- rectal bleeding or blood in stool
- vomiting
- new and/or persistent abdominal discomfort e.g. cramps, bloating, gas or pain
- tenesmus (feeling bowels don’t empty completely )
- weakness or fatigue
- unexplained weight loss
What type of cancer is commonly associated with causing jaundice due to biliary obstruction?
Carcinoma of the head of the pancreas
What happens to the biliary system above the site of obstruction in cases of carcinoma of the head of the pancreas?
it becomes dilated
Which organ often shows dilatation in addition to the biliary system in patients with carcinoma of the head of the pancreas?
gall bladder
Which blood levels are elevated due to the obstruction caused by carcinoma of the head of the pancreas?
Raised blood conjugated bilirubin levels
What enzyme level in the blood is typically raised in patients with biliary obstruction due to carcinoma of the head of the pancreas?
Raised alkaline phosphatase
What may be the symptoms and signs that a patient with pancreatic cancer might have ?
FUJ VALID
symptoms
* Unexplained weight loss
* Fatigue
* Vomiting
* Vague abdominal pain
* Itchiness
signs
* Light coloured stool
* Dark yellow urine
* Jaundice
What is peau d’orange a condition of ?
where the skin of the breast takes on the appearance and texture similar to that of an orange peel, characterised by dimpled or pitted skin
space occupying lesion is mostly in reference to ?
brain & spinal cord
what may a space occupying lesion be ?
a tumour or maybe something else like a brain abscess
Why is the skull considered a rigid structure in adults?
it is made of bone and has a fixed volume and capacity
What are the main contents inside the skull?
the meninges (coverings of the brain), the brain, cerebrospinal fluid (CSF), and blood vessels
What happens to intracranial pressure if there is a growing mass inside the skull?
Any growing mass inside the skull will increase intracranial pressure
How can a growing mass affect the flow of cerebrospinal fluid (CSF)?
It can can obstruct the flow of CSF leading to increased pressure
What effect can a tumor, also known as a space-occupying lesion, have on brain tissue?
can press on brain tissue, causing damage and increased intracranial pressure.
Why can a meningioma, despite being benign, be fatal?
it can increase intracranial pressure or press on critical areas of the brain, disrupting vital functions
What are possible general & neurological symptoms a patient with an intracranial tumor (meningioma) may complain of ?
- general
* headache - worse in early morning/night-time
* nausea & vomiting - neurological
* Visual changes: Seeing double (diplopia).
* Hearing loss or ringing in the ears
* Memory loss
* Seizures
* Weakness
* Speech and language difficulty
What are possible symptoms a patient with an intracranial tumor (meningioma) may complain of that is not general e.g. headache , nausea and vomiting or neurological ?
behavioral + cognitive:
* behavioral and mood changes
* work/school problems
sensory:
* sensory disturbances
other:
* loss of appetite
What types of primary tumors can lead to renal failure?
- renal tumours
- nephromblastoma
- uterine cancer
- ovarian cancer
- prostate cancer
Which parts of the urinary system can be affected by tumors leading to renal failure?
Any part of the urinary system can be affected, including the renal pelvis, ureters, bladder, and urethra
What is para-proteinaemia ?
an abnormal increase in paraproteins (also known as monoclonal or M proteins a type of WBC responsible for producing antibodies) in the blood
Which type of cancer is para-proteinaemia associated with in the context of renal failure ?
myeloma
What is tumor lysis syndrome ?
condition caused by the rapid breakdown of tumor cells, leading to the release of their contents into the bloodstream
Which type of leukemia is tumour lysis syndrome commonly associate with ?
acute lymphoblastic leukaemia (ALL)
What are some nephrotoxic agents that can cause renal failure as a treatment-related side effect?
cisplatin
ifosfamide
How does a tumor exert pressure effects on surrounding tissues?
by growing in size and compressing the surrounding tissues
What is local invasion and how does it contribute to tissue destruction?
process by which a tumor or metastasis spreads into and destroys the surrounding tissues
causing significant damage and disruption of normal tissue structures
What is local necrosis and how is it related to tumors?
death of tissue in a localized area, often caused by the growth of a tumor, which deprives the surrounding tissue of nutrients and blood supply.
Tumours can erode into ..1.. leading to bleeding into different …2… and ..3…. resulting in symptoms such as blood in ..4… and blood through the …5..
- blood vessels
- body cavities
- tissues
- sputum, vomit, stools , urine
- vaginal opening
- What does ‘infarction of tumor’ refer to?
- often caused by …?
- refers to the death of tumor tissue due to a loss of blood supply
- often caused by the rapid growth of the tumor outpacing its blood supply.
What are pathological fractures and how can they be caused by tumors?
are breaks in bones that occur in areas weakened by the presence of a tumor
which disrupts the normal bone structure and makes them more susceptible to fractures.
In the context of cancer spread what are the following ?
1. seeding refers to…
2. leptomneingeal spread involves …
3. trans-coelomic spread involves …
- refers to the spread of cancer cells from the primary tumor to other parts of the body
2.involves the dissemination of cancer cells to the membranes surrounding the brain and spinal cord
3.involves the spread of cancer cells across body cavities, such as the peritoneal cavity
What is ‘angiogenic steal’ and how does it affect normal tissue?
refers to the process by which a tumor diverts blood supply from normal tissue to itself by promoting angiogenesis depriving normal tissues of necessary nutrients and oxygen
What happens when a primary tumor or secondary metastasis erodes into blood vessels?
it can cause bleeding into various body parts and is a common way tumors present themselves
What are some common presentations of bleeding due to tumor erosion into blood vessels?
- haemoptysis (coughing up blood)
- haematemesis (vomiting blood)
- haematuria (blood in urine)
- PV bleeding (vaginal bleeding)
- rectal bleeding
- bleeding from a skin lesion
What does hemorrhage indicate about the tumor’s progression?
suggests that the tumor has started to spread
How can a larger hemorrhage affect the size of a lesion and its symptoms?
can result in a sudden increase in the size of the lesion
leading to the sudden onset of new symptoms, such as those seen in brain tumors or ovarian tumors.
What are the potential consequences of a life-threatening or fatal hemorrhage caused by a tumor?
severe complications or death.
How does lymphatic spread of tumors occur ?
when cancer cells travel through the lymphatic system, initially affecting nearby lymph nodes and then potentially spreading to more distant lymph nodes
What may lymphatic spread of tumours present as ?
lumps or with symptoms related to site of spread
What are some common destinations for blood-borne spread of tumors?
lungs
brain
liver
bone
What is transcoelomic spread and where does it occur?
it is the dissemination of cancer cells across body cavities, such as the peritoneum.
systemic effects of cancer ?
- Immune system impaired patients susceptible to Infection
- Pyrexia (fever)
- Cachexia (weight loss)
- Haematological = e.g., anaemia
- Endocrine = e.g., paraneoplastic
- Non-metastatic (nerve and muscle dysfunction locally, affect movement and sensation near tumor site)
- Skin e.g., polymyosistis , rashes, ulcers,
- general malaise, fatigue, tiredness
how does cancer cause cachexia ?
Because it increases metabolic demands
- Marked weight loss & tissue wasting (muscle)
- Associated with later stages of malignant neoplasm
+/- Anorexia/malabsorption
Why is unexplained weight loss always concerning?
it can indicate underlying health issues, including malignancies or other serious conditions, that require investigation.
How is cachexia defined in the context of cancer?
marked weight loss and tissue wasting, particularly of muscle mass.
With which stages of malignant neoplasms is cachexia commonly associated?
later stages of malignant neoplasms, as the disease progresses.
What factors contribute to the process of cachexia in cancer patients?
IN FARM
- intercurrent infections
- nausea and vomiting
- fever
- anorexia (loss of appetite)
- release of substances such as tumor necrosis factor (TNF) from the neoplasm
- malabsorption (difficulty absorbing nutrients)
- How does cancer impact phagocyte activity in the immune system?
- which impairs immune system’s ability to… ?
- decreased phagocyte activity
- engulf and destroy pathogens and cancer cells
- What effect does cancer have on bone marrow in terms of immune function?
- Effect results in reduced production of WBCs , what does it impair body’s ability to do ?
- suppression of function
- mount an immune response
How does cancer affect both the humoral and cellular immune systems?
disrupt both immune responses, compromising immune surveillance and defence mechanisms
- What does autoimmunity refer to in the context of cancer-related immune dysfunction?
- which can occur as a result of …… in cancer ?
- production of autoantibodies that attack the body’s own tissues
- immune dysregulation
Cancer can lead to the formation of immune complexes, which are what ?
clusters of antigens and antibodies that can trigger inflammation and tissue damage
What iatrogenic effect can chemotherapy have on the immune system?
It can suppress the immune system, making patients more susceptible to infections and other complications
How does cancer affect immune system ?
- decreased phagocyte activity
- bone marrow suppression
- humoral / cellular systems affected
- autoimmunity = autoantibodies
- immune complex formation
How does cancer cause infection ?
- Impaired innate defenses
- Impaired innate defenses such as retained secretions
- Impaired immune function/homeostasis
- Infections common in malignancy
- Blocked lymphatics
- Iatrogenic defective immune response
- Consideration of what vaccines can be given
- Dormant infection (e.g., CMV/JC in transplant, VZV immunity)
How does chemotherapy impact rapidly dividing tissues in the body?
Chemotherapy affects all rapidly dividing tissues, including healthy tissues such as gastrointestinal mucosa, hair follicles, and importantly, the bone marrow.
What is the primary purpose of chemotherapy in cancer treatment?
to kill tumor cells and inhibit their growth
Which healthy tissues are particularly affected by chemotherapy?
gastrointestinal mucosa, hair follicles (resulting in hair loss), and bone marrow
What are the common hematological effects of chemotherapy?
- anaemia (low RBC count)
- thrombocytopenia (low platelet count)
- lymphopenia (low lymphocyte count)
What is neutropenia, and why is it significant in chemotherapy?
Neutropenia is a condition characterized by a low neutrophil count
It is significant in chemotherapy because it increases the risk of severe infections
How can sepsis develop in chemotherapy patients, and why is it considered urgent?
Chemotherapy-induced neutropenia can predispose patients to infections that may rapidly progress to sepsis,
Which malignancies is pyrexia (fever) common in ?
- lymphomas
- leukemia
- disseminated carcinomas
Why is pyrexia common in certain malignancies ?
Due to factors like cytokine release and immune system dysregulation
What role do cytokines like IL-1 and TNFα play in causing fever in malignancies?
can induce a cytokine storm, triggering fever as part of an inflammatory response seen in malignancies.
- What does febrile neutropenia refer to ?
- what is it often due to ?
- refers to fever in patients with low neutrophil counts (neutropenia)
- chemotherapy-induced immunosuppression
Why is febrile neutropenia concerning ?
it indicates a heightened risk of severe infections, including sepsis
List what anaemias in malignancies can result from :
- iron deficiency (microcytic)
- folate deficiency (macrocytic)
- autoimmun hemolytic anaemia (due to autoantibodies)
- decreased erythropoietin (EPO) secretion
How can anaemia due to malignancy-related decreased erythropoietin secretion be managed?
erythropoietin (EPO) supplementation
What condition involves increased red cell production and can occur in malignancies?
- Polycythaemia
- can occur in malignancies as a response to certain tumor types or due to bone marrow involvement
How can malignancies affect platelets and clotting?
through bone marrow involvement, hematological complications, or bone metastases
leading to thrombocytopenia or coagulation disorders
When might treatment with G-CSF (Granulocyte Colony-Stimulating Factor) be used in malignancy treatment?
particularly after what ?
used to facilitate recovery of cell counts where rapid cell count recovery is crucial for further treatment.
particularly after high-dose chemotherapy or in conditions like neuroblastoma or acute myeloid leukemia (AML),
Example of primary polycythaemia (increased RBC prod) associated with malignancies?
rubra vera
what is rubra vera ?
a myeloproliferative disorder characterised by overproduction of RBCs in bone marrow, independent of erythropoietin levels
Which malignancies can lead to secondary polycythaemia ?
often due to increased production of ….
- renal adenocarcinoma
- adrenal adenoma
- liver cell carcinoma
erythropoietin
How does ectopic erythropoietin production contribute to polycythaemia in malignancies?
can stimulate excessive red blood cell production, leading to polycythaemia even in the absence of normal physiological triggers
What characterizes the endocrine effects of neoplasms?
unregulated hormone production without normal homeostatic control
Give an example of a benign neoplasm that can produce excess growth hormone
leading to what conditions ?
Pituitary adenoma
acromegaly or gigantism
Which benign neoplasm can cause hyperparathyroidism by overproducing parathyroid hormone (PTH)?
Parathyroid adenoma
What term describes the phenomenon where a neoplasm produces hormones at a site not normally associated with hormone production?
Ectopic hormone production, also known as para-endocrine syndromes,
Provide an example of an ectopic hormone-producing neoplasm
Bronchial carcinoma can secrete adrenocorticotropic hormone (ACTH), causing ectopic Cushing’s syndrome.
Which organs can produce PTH-related protein in neoplastic conditions?
Kidney, liver, and adrenal neoplasms are known to produce and secrete PTH-related protein, which can lead to hypercalcemia and related symptoms.
Endocrine effects of neoplasms
1) Appropriate hormone production
Pituitary adenoma producing GH
Parathyroid adenoma producing PTH → gigantism
2) Ectopic hormone production (para-neoplastic syndromes)
Squamous cell lung cancer secretes hormones that mimic PTH → hypercalcaemia
How does hypercalcemia occur in the context of bone involvement by neoplasms?
when tumors directly invade bone tissue, leading to increased osteoclast activity. This activity causes bone destruction and the release of calcium into the bloodstream.
What are examples of neoplasms that can directly invade bone, causing hypercalcemia?
primary bone tumors like osteosarcoma, bone marrow malignancies such as multiple myeloma
secondary tumors/metastases present in the skeleton.
How does direct invasion of bone lead to increased osteoclast activity and bone destruction?
Direct invasion of bone by tumors stimulates osteoclasts, which are responsible for breaking down bone tissue
What is the mechanism by which bone destruction due to neoplastic invasion contributes to hypercalcemia?
Neoplastic invasion of bone triggers osteoclasts to resorb bone, releasing calcium ions into the bloodstream and causing hypercalcemia
What characterizes hypercalcemia as a para-neoplastic syndrome?
without the presence of primary or secondary tumors in the skeleton or bone marrow, such as in cases of myeloma.
How does ectopic hormone production contribute to hypercalcemia in para-neoplastic syndromes?
they can lead to hypercalcemia by mimicking the action of parathyroid hormone (PTH) and promoting calcium release from bones
What are the effects of hypercalcemia on bone metabolism?
increases bone resorption, where calcium is released from bones into the bloodstream, contributing to elevated calcium levels
How does hypercalcemia affect renal absorption of calcium and phosphate?
increases renal absorption of calcium while decreasing phosphate absorption, leading to further imbalance in mineral metabolism
What metabolic process is enhanced in hypercalcemia due to increased levels of 1 alpha hydroxylation of Vitamin D?
the intestinal absorption of calcium, exacerbating hypercalcemia
What skin manifestations are associated with polymyositis and dermatomyositis in relation to malignancy?
include pain and weakness in proximal muscles, joint pain and stiffness, and the presence of telangiectasias, particularly noticeable on the cuticles.
What percentage of cases of polymyositis and dermatomyositis in patients over 40 years of age are associated with malignancy?
approx 50%
Which malignancies are commonly associated with polymyositis and dermatomyositis?
gastrointestinal (GI) tract, bladder, bronchus, and other organs
How do telangiectasias typically present in patients with polymyositis and dermatomyositis?
which are small dilated blood vessels, are almost always present on the cuticles in patients with the conditions mentioned
Skin manifestations and malignancy
- polymositis
- dermatomyositis
- telangiectasia (cuticles)
- itch skin (pruritus)
Acanthosis nigrans:
1. affects what regions ?
2. what increases
3. 2/3 in …. carcinomas
- axilla, back of neck, periareolar
- skin thickens & pigmentation
- stomach
What are examples of para-neoplastic syndromes involving neurology?
- myopathy , myositis and myasthenia
- peripheral sensori-motor neuropathies
- cerebellar ataxia
- encephalopathy.
What defines leukemia as a disease?
clonal malignant proliferation of immature (blast) white blood cells
What are the main types of acute leukemia?
- acute lymphoblastic leukemia (ALL)
- acute myeloblastic leukaemia (AML)
What are the main types of chronic leukemia ?
- chronic lymphocytic leukemia (CLL)
- chronic myelocytic leukemia (CML)
What are some general symptoms associated with leukemia?
malaise, anorexia, weight loss, fever, and night sweats
Why is bone pain common in leukemia?
due to infiltration of leukemic cells into the bone marrow and surrounding bones
Leukemia causes bone marrow dysfunction leading to conditions like what ?
- anemia (low RBC count)
- thrombocytopenia (low platelet count)
- increased susceptibility to infections
What is a common physical finding in patients with leukemia related to the liver and spleen?
Hepatosplenomegaly (enlargement of the liver and spleen)
How is leukemia typically diagnosed?
which allows for the examination of ..1… and …2.. of the blood cells including abnormal ..3… cells
through a blood film (peripheral blood smear),
- morphology
- quantity
- leukemic
