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Anatomy Flashcards

1
Q

Mechanisms of spread from malignant tumours

A

Direct extension local spread - can happen to an extent in benign
Lymphatic spread -> occurs only in malignant
Haematogenous -> occurs only in malignant

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2
Q

Benign tumour … metastasise

A

Never

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3
Q

What is a malignant tumour

A

A tumour site not continuous with the primary tumour

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4
Q

Do tumours affect the surrounding area

A

All tumours types benign, metastasis, primary and secondary can affect the surrounding structures
Their affect depends on the structure
Pituitary a pea size tumour can have a large affect
Whereas a tumour in the abdomen can be asymptomatic for a long time due to the large space it can fill

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5
Q

Benign tumour typical features

A 
Small 
Boundary well demarcated 
Well differentiated 
Slow growing - takes a while to develop symptoms 
Non invasive 
Non metastatic
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6
Q

Malignant features

A

Large
Poorly demarcated
Poorly differentiated
Rapidly growing
Haemorrhaging recruit blood vessels to feed it
Often veins which can break which leads to haemorrhage
Necrosis
Metastatic especially when it invades blood/lymph

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7
Q

Lymphatic capillaries are made of

A

Endothelial cells

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8
Q

Attachment of these cells to each other

A

Do not touch

They slide next to each other gaps between them allow fluid to pass through

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9
Q

When do they overlap

A

To form valves

Make it a one way system

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10
Q

How long does fluid sit in the capillaries for

Why

A

Can be a long time
No pump system or pressure dependent on surrounding structures
Arteries and veins and muscles

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11
Q

Ending of the tubes

A

Blind ending

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12
Q

Lumen size

A

Wide lumen, progressively wider 15-75 micrometers diameter

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13
Q

Where do lymph vessels run

A

In beds

Like me

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14
Q

Structure

A

Only endothelial cells and are lie veins when bigger so have little structure and become flat when empty

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15
Q

Superficial lump system drains

A

Skin
Mucous membranes
Serious lining of cavities

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16
Q

Hat do superficial lymph vessels drain with

A

Drain in parallel with veins

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17
Q

Deep system drains

A

Organs
Skeletal tissue
Muscle tissue

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18
Q

Where do deep vessels drain with

A

Parallel with para aortic nodes -> surround branches of the aorta
E.g. External and interval iliac nodes, renal nodes

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19
Q

Where do they drain to left side and lower abdomen and leg of the right drain

A

Thoracic duct

Cisterns chyli

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20
Q

What is the cisterna chyli

A

Dilated sac at the lower end of the Thoracic duct

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21
Q

When does the cisterns chyli receive lymph from

A

Intestinal trunk

The right and left lymphatic trunk and lower limbs

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22
Q

Where us it situated ref peritoneum

A

Retro peritoneal

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23
Q

Location cc ref vertebrae

A

L1 and l2

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24
Q

Cc contents

A

Milky white contents as it receives fatty chyle from intestines
It acts as a conduit for the lipid products of digestion

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25
Location thoracic duct ref vertebrae
Second lumbar extends to the root of the neck
26
Where does thoracic duct drain into
Left subclavian vein where it meets internal jugular making the brachiocephalic vein
27
Where dies thoracic trunk collect lymph from
``` Intercostal left bronchiomediastinal Left subclavian and left jugular nodes All body except Right internal jugular Right subclavian nodes Right bronchiomediastinal nodes ```
28
Where does the lymph drain into that doesn't drain into the thoracic trunk
Right subclavian vein
29
Mechanisms of cancer spread
Direct extension Lymphatic spread Haematogenous spread
30
What is direct extension
Local spread on adjacent tissues Does not necessarily spread into tissues of the same system Prostrate -> neck of the bladder Reproductive to urinary Lots of tissue types - epithelium through bm then mucosa then peritoneum
31
Lymphatic spread
Vessels and nodes Sometimes spread stops when it reaches a lymph node but this is not reliable Predictable can predict which nodes metastasis from different cancer will spread to
32
Haematogenous spread
Blood vessels | Veins especially as veins are thin walled easier for cancer to enter them
33
What is the metastatic cascade
1) uncontrolled division 2) transformation 3) angiogenesis 4) motility and invasion 5) embolism and circulation 6) arrest in the capillary beds - after the heart first capillary beds they reach is the lungs - cancer often metastasis primary mets Passes the lungs can then form primary mets anywhere Or primary mets in lungs can then go to pulmonary vessels get secondary mets elsewhere in the body 7) adherence 8) extravasation not organ parenchyma 9) response to micro environment 10) tumour cell orolferation and angiogenesis 11) metastasis 12) metastasis of metastasis
34
Direct local primary spread where to
Tumour penetrates into a natural space - subarachnoid, peritoneal, pleural Commonly associated with seeding in body cavities - can get plaques of cancer cells known as cakes Most common peritoneal cavity - mental cake in ct scan -> omentum good blood supply
35
Cancer present in smaller space will affect other structures
Small space cancer can compress other structures | In large spaces can go undetected - abdomen ovarian cancer can get very large before any abdominal problems
36
Site of primary tumour is important
Left, right, superior, inferior Symptoms Pain discomfort
37
E.g. Lung cancer
``` Sidedness Physically close to important structures Subclavian Phrenic nerve Root of neck ```
38
What happens if right sided close to midline
``` Compress superior vena cava Impaired venomous return Congested neck vein Finger clubbing Recurrent laryngeal Vocal cord paralysis speech impediment and breathlessness ```
39
Lymphatic secondary spread why is it the most common route
Lymph vessels have no basement membrane and veins do | So it is easier for cancer to invade lymph than veins
40
Are there any functional lymphatic within the tumour
No | They rely on adjacent lymphatic system
41
What are nodes like that have metastasis
Painless but hard full of metastatic cells
42
Can regional lymph nodes be effective barriers
Yes Can destroy malignant cells Localised
43
How do nodes that have metastasis treated
Removed by surgery | Chemotherapy
44
Are enlarged lymph nodes indicators of fully disseminated disease
Not necessarily
45
What is the sentinel lymph node
The first node in a regional basin to be involved - first node to receive the lymph drainage from a tumour
46
What happens to this sentinel node
Biopsied to help predict likely spread of the cancer
47
Where are lymph nodes important especially
Breast cancer Colon cancer Melanoma
48
Can cancer skip lymph nodes | Why
Yes | Occlusion or venous lymph anastomoses
49
Example of secondary spread breast | What is the breast
Modified sweat glands
50
Where does the breast lie
Within superficial fascia | Overlies pectoralis major muscle overlies ribs 2-6
51
Where can direct spread be to
Can spread directly to the pectoralis major and then to the thoracic cavity
52
What are coopers ligaments
Connective tissue in the breast that helps to maintain breast shape
53
How can you tell if cancer is effecting coopers ligaments
Shape of breast change
54
Mammograms useful not useful
Useful after the menopause not useful before Need to use ultrasound or MRI Due to the inc density of breast tissue at younger age
55
What is a lymphoscintigraphy
Nuclear medicine imaging that provides pictures of the lymph system used to identify the sentinel lymph node
56
Why haematogenous spread to the veins not arteries
Thin walls more easily invaded that arteries | And low pressure more likely to adhere
57
Cancer spread follows patter of venous drainage
Drain colon via sigmoid veins, colic veins, jejunal veins | Git to the venous portal vein here they can spread to the liver
58
Bone metastasis
``` Rare Poor prognosis Prostate Breast Lung Thyroid Usually spreads to spine ```
59
Pathological features of cancerous bone
Cancerous bone wide and very reduced density of bone Spine involved compression Breast cancer met to the Boone picking up shopping can cause a humerus fracture
60
Bone metastasis following prostate cancer
Via paravertebral veins Mets to sacrum, lumbar spine Pelvis first valveless veins connect prostate to paravertebral veins Bone weakness displacement and fractures
61
Brain mets more or less common than primary tumour
More common
62
What is spread to the brain limited by
Blood brain barrier
63
Prognosis with brain mets
Poor due to limited space
64
Areas of brain most likely to have mets
``` Meninges Parenchyma - cerebrum 80% - brainstem 5% - cerebellum 15% ```
65
Lung mets easy or difficult to differentiate from primary tumour
Difficult
66
Diagnosis
Plain film and ct
67
Radiotherapy what does it do?
Irradiate - kills dividing cells | Can also target the skin so can cause burns
68
Chemotherapy
Cytotoxic drugs Immunotherapy Hormone therapy
69
Administration of cytotoxic drugs
Via hepatic artery
70
Surgery
Tends not to be curative | 5 year survival poor
71
Why is surgery performed
To relieve mass effect/compression Remove lymph nodes Patient must be fit enough to go under - anaesthetic

CAN (21 decks)

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