major anatomical routes for the spread of infection and malignant disease

Question 1

Diseases such as cancer and infection may spread via a number of anatomical routes:

Answer 1

Direct spread - Fascia and bone will determine how disease spreads

Haematogenous spread (via bloodstream)
Vascular anatomy will determine how disease spreads

Lymphatic spread
Lymphatic anatomy will determine how disease spreads

Transcoelomic and trans-CSF spread (via body cavity)
Disease will spread through a body cavity/potential cavity

Perineural spread
Neural anatomy will determine how disease spreads

breast does loads

Question 2

prostate cancer will spread via Balsons plexus to the

Answer 2

spine

Question 3

sarcomas and many carcinoma spread via

Answer 3

haematogenous

perineal spread is rare - head and neck tumours - Adenoid cystic carcinomas

Question 4

facial layers like in the neck and bone of the ears and paranasal sinuses - weakness permit direct spread

what are the fascias of the neck

Answer 4

superficial cervial fascia - irrelevant

deep fascia - divides he neck into fascial compartments ( investing fascia, pre tracheal and pre vertebral fascia)
carotid sheath regarded at 4th

Question 5

The deep cervical fascia thus divides the neck into several spaces:

Answer 5

Parotid space – parotid gland
Carotid space – carotid artery, internal jugular vein, vagus nerve
Parapharyngeal space - fat
Retropharyngeal space – fat and lymph nodes
Mucosal space – upper aerodigestive tract
Masticator space – muscles of mastication, mandible and teeth
Perivertebral space – spine and spinal cord

some neck spaces extend into mediastinum

Question 6

Infection may break through thin layers of bone and spread outside its place of origin

Answer 6

Ethmoid aircells – lamina papyracea

Temporal bone – tegmen tympani

Question 7

middle ear infections

Answer 7

Severe bacterial middle ear infections may spread by rupturing through thin areas of bone

(post-septal infection) risking blindness

Question 8

infection from maxillary teeth (periodical abscess) spread to where

Answer 8

sinuses

Infection or tumour cells entering the arterial system may lodge in the small vessels at the periphery of the arterial tree

Question 9

intercostal viens drainions breast also continue with vertebral venous plexus so drain to

Answer 9

spine

Question 10

Portal venous system carries blood from GI tract to liver

so bowel cancer spread to where

Answer 10

hepatic mets- to liver

Question 11

does the facial vein have valves

Answer 11

no so blood can flow either inferiorly or superiorly

Question 12

arterial circulation will go to the brain and the venous back to the lungs

septic clot caused by what

Answer 12

dirty needles injected predisposing to the clot

Question 13

what is adjuvant therapy

Answer 13

Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back

Question 14

Infection and tumour cells may spread via body cavities
Subarachnoid space
Pleura
Peritoneum

Answer 14

Extra-axial CSF spaces of the brain and spine are continuous
They are also continuous with the ventricular system (via the Foramina of Luschka and Magendie), and with the central canal of the spinal cord
Infection (meningitis), tumour (leptomeningeal malignancy) and blood (subarachnoid haemorrhage) can therefore spread through these CSF spaces

Question 15

foramina of Luschka drains the fourth ventricle to the cisterna magna if this gets blocked what can happen

Answer 15

hydrocephalus

foramina of mono lateral ventricles to thrive tnricles

cerebral aqueduct drains the thrill to the fourth

Question 16

The potential space contained within the peritoneal sac forms a cavity in which disease can spread:
Malignancies such as ovarian and GI cancer (peritoneal metastases)
Infection (peritonitis)

Answer 16

The potential space between the visceral and parietal pleura forms a cavity in which disease can spread:
Malignancies such as mesothelioma and pleural metastases from e.g. breast
Infection (empyema).

Question 17

what disease may spread along nerves

Answer 17

shingles and polio ( motto paralysis) 
Squamous cell carcinoma	
Melanoma
Lymphoma
Adenoid cystic carcinoma

Question 18

adenoid cystic carcinoma of the parotid gland

May result in

Answer 18

Facial weakness (VIIth nerve)
Facial pain/numbness (Vth nerve)

problem chewing and bottom 1/3