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MoD > Lesson 11 > Flashcards

Lesson 11 Flashcards

1
Q

What is neoplasia?

A

An abnormality of cellular differentiation, maturation, and control of
growth

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2
Q

What are general rules regarding neoplasms?

A
  • Neoplasms are benign/malignant depending on several features.
  • The ability of malignant neoplasms to spread from site of origin
  • Benign neoplasms grow but remain localised
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3
Q

What are the hallmarks of malignancy?

A 
Sustaining proliferative signalling
Evading growth suppressors
Activating invasion and metastasis
Enabling replicative immortality 
Inducing angiogenesis
Resisting cell death
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4
Q

What are some common features of tumour cells when looked at under a microscope?

A

Large, variable shaped nuclei
Many dividing cells, disorganised arrangement
Variation in size and shape
Loss of normal features

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5
Q

What are two different classification of effects of neoplasm?

A

Local effects

Systemic effects

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6
Q

What are local effects of neoplasm?

A 
Mechanical pressure or obstruction
Tissue destruction
Non-metastatic hypercalcaemia
Haemorrhage 
Infection
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7
Q

What is mechanical pressure or obstruction and what are some examples?

A

Depends on tumour site/size
Very common

GI tract obstruction and intussusception
Jaundice
Raised intercranial pressure
Renal failure

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8
Q

What is intussusception?

A

a serious condition in which part of the intestine slides into an adjacent part of the intestine

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9
Q

Describe GI tract obstruction and intussception

A
  • Bowel obstruction - more common than intussusception
  • Small bowel - more common than large bowel
  • Desmoplastic reaction – fibrous tissue response (adhesions)
  • CT scan
  • Urgent operation
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10
Q

Describe jaundice?

A

• Head of pancreas or CBD (cortico-basal degradation)
• Dilatation of the biliary system
above obstruction
• Often dilatation of gall bladder

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11
Q

What is Corticobasal degeneration (CBD) caused by?

A

increasing numbers of brain cells becoming damaged or dying over time

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12
Q

Describe raised intracranial pressure?

A
  • Skull is a fixed volume/size inside
  • Any growing mass will increase pressure in the skull
  • Meningioma, though benign, can be fatal as a result
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13
Q

Describe non-metastatic hypercalcaemia

A
  • Hypercalcaemia without secondary tumour being present in the skeleton
  • Ectopic hormone production lung and kidney - PTHRP
  • Prostaglandin production
  • TNF
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14
Q

Describe haemorrhage

A
  • Epithelial ulcers bleed
  • Ulceration of GI tract can cause life-threatening haemorrhage
  • Chronic – microcytic anaemia - iron deficiency
  • Mechanism: Increased tumour vascularisation (angiogenesis), thin walled vessels and tumour necrosis
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15
Q

Describe infection

A
  • Common in malignancy
  • Local or systemic
  • Local – drainage blocked, retained secretions
  • Neoplastic B-cell proliferation eg. in lymphomas and CLL causes decline in antibody response
  • Hodgkin’s lymphoma we see a defective immune response (mycobacteria, viruses, fungi)
  • Iatrogenic defective immune response
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16
Q

What are examples of systemic effects?

A
  • Pyrexia
  • Cachexia
  • Immune system
  • Haematological effects
  • Endocrine effects
  • Bone and soft tissue (non-metastatic)
  • Nerve and muscle (non-metastatic)
  • Skin
17
Q

Explain pyrexia

A
  • Common in malignancy
  • Especially lymphomas and leukaemias
  • Also disseminated carcinomas
  • Cytokines - IL-1, TNFα
18
Q

What is cachexia?

A
  • Definition – Marked weight loss and tissue wasting, notably muscle
  • Associated with later stages of malignant neoplasms
  • Factors adding to the process are anorexia, malabsorption, release of substances from the neoplasm (possibly TNF)
19
Q

Explain the immune system?

A
  • Decreased phagocyte activity
  • Bone marrow suppression
  • Humoral and cellular systems affected • Iatrogenic effect
  • Autoimmunity: autoantibodies
  • Immune complex formation
20
Q

Describe haematological effects?

A 
• Anaemia: 
	iron deficiency (microcytic)
	folate deficiency (macrocytic)
	autoimmune haemolytic anaemia (autoantibodies) 
	decreased erythropoietin secretion
• Increased red cell production 
• Effect on platelets and clotting
21
Q

Explain increased red cell production

A 
• Increase in red cell mass
• Commonest in: 
	Renal adenocarcinoma
	Uterine fibroleiomyoma 
	Liver cell carcinoma
• Can occur in other neoplasms
• Possibly ectopic erythropoietin production
22
Q

Explain platelets and clotting

A
  • Thrombocytopenic purpura – decrease in platelet count
  • Conversely, an increased risk of clots
  • Recurrent migratory thrombophlebitis - bronchus, pancreas, stomach, female genital tract
23
Q

What are endocrine effects of neoplasms?

A

• Appropriate hormone production
e.g. Pituitary adenoma producing growth hormone, ACTH or
prolactin
Parathyroid adenoma producing parathyroid hormone

• Ectopic hormone production (Paraendocrine syndromes) e.g. Bronchial and pancreatic carcinoma causing ACTH production
Bronchus, kidney, liver, and adrenal neoplasms producing PTH

24
Q

What is clubbing?

A

Most severe form - periosteum over terminal phalanges, wrists + ankles thickens + new bone formed from stem cells in periosteum (called hypertrophic pulmonary osteoarthropathy)

HPO is commonest in pleural mesothelioma, less so in small-cell bronchial ca

25
Q

Explain non-metastatic nerve and muscle tissue changes

A
  • Encephalomyeloneuropathy – degeneration of CNS ganglion cells predominates
  • Myopathies (+/- features of myasthenia)
  • Demyelinating disorders
26
Q

What are skin manifestations of malignancy?

A
  • Polymyosistis and dermatomyositis (Telangiectasias are almost always present on the cuticles)
  • Acanthosis nigrans
  • affects axilla, back of neck, periareolar region
  • the skin thickens and pigmentation increases
  • two thirds are in stomach carcinomas
27
Q

What are biomarkers of malignancy?

A
  • Alterations in gene expression in malignant transformation produce either inappropriate substances or expression of new antigens
  • Tumour biomarkers can be comprised of hormones, enzymes and immunoglobulins
  • Many tumour markers are expressed as protein antigens e.g. PSA, CA 125
28
Q

What are isoenzyme biomarkers?

A
  • Acid phosphatase – in prostate cancer
  • Placental ALP - in sera with various malignant diseases
  • Novel gamma-glutamyltranspeptidase (gamma-GTP) isoenzyme - 60% of sera from patients with HCC
  • Variant ALP - specific tumour marker for hepatocellular carcinoma (HCC
29
Q

What are tumour associated antigen biomarkers?

A
  • PSA
  • CA 125 - ovarian cancer BUT may also be increased in uterine, cervical, pancreatic, lung, colon , breast and other GI cancers. CA 125 raised in pregnancy, pancreatitis, pelvic inflammatory disease, liver disease, lung inflammation
  • CEA (carcino-embryonic antigen) - used to monitor colorectal cancer disease and treatment BUT also raised in cancer of the lung, breast, pancreas, stomach, cervix and many others. Inflammatory conditions such as inflammatory bowel disease, pancreatitis, hepatitis also cause raised CEA levels
30
Q

What are red flags of lung related neoplasia?

A

Age 40 years and over with:
•Persistent cough for more than three weeks;
•Recurrent chest infections;
•Coughing up blood

31
Q

What are red flags of oral related neoplasia?

A

Red and white patches, and ulcers that do not heal within three weeks;
An unexplained lump in the neck, on the lips or in the mouth.

32
Q

What are red flags of lower GI related neoplasia?

A
  • Age 40 years and over with unexplained weight loss and abdominal pain
  • Age 50 years and over with unexplained rectal bleeding;
  • Age 60 years and over with changes in their bowel habit
33
Q

What are red flags of skin moles?

A

Any age:
•New mole persisting for more than four weeks;
•Significant change in an existing mole.

34
Q

What are renal tract red flags?

A

Age 45 years and over with:
•Visible blood in the urine;
•Persistent change in the bladder habit for four weeks;
•Problems with urination — ask during medicine use review.

35
Q

What are red flags of the head and neck?

A
  • Unexplained lump in neck;
  • Unexplained ulceration in mouth lasting more than three weeks;

Age 45 years and over with:
•Persistent hoarseness for four weeks

36
Q

What are red flags of breast tissue?

A
  • Age 30 years and over and have an unexplained breast lump with or without pain
  • Age 50 years and over with any of the following symptoms in one nipple only:
    • Discharge;
    • Retraction;
    • Other changes of concern
  • With an area of persistent skin changes on breast;
  • Age 30 years and over with an unexplained lump in the axilla

MoD (11 decks)

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