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CAN > Anatomy > Flashcards

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
Q

Location thoracic duct ref vertebrae

A

Second lumbar extends to the root of the neck

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26
Q

Where does thoracic duct drain into

A

Left subclavian vein where it meets internal jugular making the brachiocephalic vein

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27
Q

Where dies thoracic trunk collect lymph from

A 
Intercostal 
left bronchiomediastinal 
Left subclavian and left jugular nodes 
All body except 
Right internal jugular 
Right subclavian nodes 
Right bronchiomediastinal nodes
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28
Q

Where does the lymph drain into that doesn’t drain into the thoracic trunk

A

Right subclavian vein

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29
Q

Mechanisms of cancer spread

A

Direct extension
Lymphatic spread
Haematogenous spread

30
Q

What is direct extension

A

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
Q

Lymphatic spread

A

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
Q

Haematogenous spread

A

Blood vessels

Veins especially as veins are thin walled easier for cancer to enter them

33
Q

What is the metastatic cascade

A

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
Q

Direct local primary spread where to

A

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
Q

Cancer present in smaller space will affect other structures

A

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
Q

Site of primary tumour is important

A

Left, right, superior, inferior
Symptoms
Pain discomfort

37
Q

E.g. Lung cancer

A 
Sidedness 
Physically close to important structures 
Subclavian 
Phrenic nerve 
Root of neck
38
Q

What happens if right sided close to midline

A 
Compress superior vena cava 
Impaired venomous return 
Congested neck vein 
Finger clubbing 
Recurrent laryngeal 
Vocal cord paralysis speech impediment and breathlessness
39
Q

Lymphatic secondary spread why is it the most common route

A

Lymph vessels have no basement membrane and veins do

So it is easier for cancer to invade lymph than veins

40
Q

Are there any functional lymphatic within the tumour

A

No

They rely on adjacent lymphatic system

41
Q

What are nodes like that have metastasis

A

Painless but hard full of metastatic cells

42
Q

Can regional lymph nodes be effective barriers

A

Yes
Can destroy malignant cells
Localised

43
Q

How do nodes that have metastasis treated

A

Removed by surgery

Chemotherapy

44
Q

Are enlarged lymph nodes indicators of fully disseminated disease

A

Not necessarily

45
Q

What is the sentinel lymph node

A

The first node in a regional basin to be involved - first node to receive the lymph drainage from a tumour

46
Q

What happens to this sentinel node

A

Biopsied to help predict likely spread of the cancer

47
Q

Where are lymph nodes important especially

A

Breast cancer
Colon cancer
Melanoma

48
Q

Can cancer skip lymph nodes

Why

A

Yes

Occlusion or venous lymph anastomoses

49
Q

Example of secondary spread breast

What is the breast

A

Modified sweat glands

50
Q

Where does the breast lie

A

Within superficial fascia

Overlies pectoralis major muscle overlies ribs 2-6

51
Q

Where can direct spread be to

A

Can spread directly to the pectoralis major and then to the thoracic cavity

52
Q

What are coopers ligaments

A

Connective tissue in the breast that helps to maintain breast shape

53
Q

How can you tell if cancer is effecting coopers ligaments

A

Shape of breast change

54
Q

Mammograms useful not useful

A

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
Q

What is a lymphoscintigraphy

A

Nuclear medicine imaging that provides pictures of the lymph system used to identify the sentinel lymph node

56
Q

Why haematogenous spread to the veins not arteries

A

Thin walls more easily invaded that arteries

And low pressure more likely to adhere

57
Q

Cancer spread follows patter of venous drainage

A

Drain colon via sigmoid veins, colic veins, jejunal veins

Git to the venous portal vein here they can spread to the liver

58
Q

Bone metastasis

A 
Rare 
Poor prognosis 
Prostate 
Breast 
Lung 
Thyroid 
Usually spreads to spine
59
Q

Pathological features of cancerous bone

A

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
Q

Bone metastasis following prostate cancer

A

Via paravertebral veins
Mets to sacrum, lumbar spine
Pelvis first valveless veins connect prostate to paravertebral veins
Bone weakness displacement and fractures

61
Q

Brain mets more or less common than primary tumour

A

More common

62
Q

What is spread to the brain limited by

A

Blood brain barrier

63
Q

Prognosis with brain mets

A

Poor due to limited space

64
Q

Areas of brain most likely to have mets

A 
Meninges 
Parenchyma 
- cerebrum 80%
- brainstem 5% 
- cerebellum 15%
65
Q

Lung mets easy or difficult to differentiate from primary tumour

A

Difficult

66
Q

Diagnosis

A

Plain film and ct

67
Q

Radiotherapy what does it do?

A

Irradiate - kills dividing cells

Can also target the skin so can cause burns

68
Q

Chemotherapy

A

Cytotoxic drugs
Immunotherapy
Hormone therapy

69
Q

Administration of cytotoxic drugs

A

Via hepatic artery

70
Q

Surgery

A

Tends not to be curative

5 year survival poor

71
Q

Why is surgery performed

A

To relieve mass effect/compression

Remove lymph nodes

Patient must be fit enough to go under - anaesthetic

CAN (21 decks)

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