Metastasis & Manifestation Flashcards by Maggie Gilman

What is metastasis?

The invasive nature of neoplasms which allows them to penetrate into blood vessels, lymphatics, and body cavities to travel to distant anatomical territories

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metastasis unequivocally marks a neoplasm as ____

malignant
(benign do not metastasize)

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What are the main pathways of metastasis?

Hematogenous
lymphatic
direct seeding/extension

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What are the most common metastatic patterns of renal cell carcinoma?

Kidney ——> Lung
Kidney ——> Bone

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What percentage of newly diagnosed cancer patients with solid malignant neoplasms clinically present with metastasis?

50%

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what factors of a neoplasm increase the likelihood that it will metastasize?

the more aggressive, rapidly growing, and larger the neoplasm

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What is the metastatic pattern of breast adenocarcinoma?

Breast ——> Axillary lymph nodes via lymphatics

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what is the most common site of hematogenous metastatic spread?

liver (all venous drainage here)

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What is the metastatic pattern of colon cancer?

Colon ——> liver via hematogenous spread

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Metastatic spread strongly reduces the possibility of cure (TRUE/FALSE)?

TRUE

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What is reactive hyperplasia?

Response to persistent infection often in the lymph nodes
(evidence of a processed infection)

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Reactive hyperplasia is neoplastic (TRUE/FALSE)?

FALSE

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name 4 features/tissue changes associated with neoplastic disease

hyperplasia
metaplasia
dysplasia
tumor giant cells

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What is the sequence of events in the evolution of a neoplasia of epithelial cell origin?

Hyperplasia ——> Dysplasia ——> Carcinoma in situ ——> Malignant Neoplasia

(dysplasia redux)

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Dysplasia is non-reversible (TRUE/FALSE)?

FALSE

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What are general local clinical manifestations of neoplasia?

Swelling
Irritation
Blood vessel damage
Visceral damage
Compromised organ function

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what is hematochezia? what is it indicative of?

frank red blood in stool due to lower GI bleed (sigmoid, rectum)

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What is the most common cause of hematochezia?

Hemorrhoid

What is melena? What is it indicative of?

Black tar stool indicative of an upper GI bleed

What are examples of clinical presentations of blood vessel damage?

Ulceration
Hemorrhage
Hematuria
Melena
Thrombosis
Necrosis
Secondary infection
Hematochezia

What are examples of clinical presentations of visceral damage?

Obstruction
Intussusception
Perforation

What is intussusception?

Bowel swallows in on itself and clamps or pinches leading to bowel strangulation and gangrenous necrosis

What is perforation in regards to visceral damage?

Organ contents begin to spill out into the peritoneal cavity

Benign neoplasms only function in indigenous hormonal secretion? (TRUE/FALSE)

TRUE

name 2 types of hormone production/secretion by malignant tumors

indigenous ectopic

What is an indigenous hormonal secretion?

When a benign or malignant tumor secretes a hormone that is native to the tissue of origin

What are examples of indigenous hormonal secretions by neoplasms?

- Pancreatic neoplasm secreting insulin - Parathyroid neoplasms secreting PTH - Pheochromocytoma secreting aldosterone

What is an ectopic hormonal secretion?

When a malignant tumor secretes a hormone that is NOT native or normally produced by the that tissue

What are examples of ectopic hormonal secretions by malignant neoplasms?

- Lung neoplasm secreting ACTH (Cushing Syndrome) - Lung neoplasm secreting PTH

What is a paraneoplastic syndrome?

Syndromes that a patient does not have but is caused by a neoplasm

What are examples of paraneoplastic syndromes?

- Endocrinopathies (Cushing syndrome, hypercalcemia) - Neuromyopathologies (myasthenic syndrome) - Vascular disorders: thrombosis (diffuse intravascular coagulation/clotting, Trousseau syndrome)

What is cachexia?

Extreme wasting and malnutrition causing net loss of body mass, fat, and muscle due to TNF increasing muscle breakdown and decreasing fat storage

Cachexia is only a symptom of malignant neoplasms (TRUE/FALSE)?

TRUE

What cytokine is responsible for cachexia?

TNF

What leukocyte is responsible for cachexia?

Macrophage

What mechanisms of neoplasms can cause hypercalcemia?

- Primary bone neoplasm - Metastasis to bone (from lungs or brain) - PTH-secreting tumor

What is myasthenic syndrome?

- Paraneoplastic (neuromyopathic) syndrome - lung carcinoma tumor cells elicit antibody formation - Ab to tumor cells "cross-react" with neuronal endings - results in blockage of presynaptic calcium channels preventing ACh production (flaccid paralysis)

What is Cushing syndrome?

Increased cortisol often (but not always) caused by increased production of ACTH

What neoplasm can cause Cushing syndrome?

Lung carcinoma

A lactotrope pituitary adenoma would cause an increase in what secretion? Would this secretion be considered indigenous or ectopic?

Prolactin indigenous

What is the number one indicator of malignancy?

Invasion

What is trousseau syndrome?

Paraneoplastic syndrome where clotting factor is exhausted and a patient exsanguinates and bleeds out of every pore

how could a tumor cause vascular paraneoplastic symptoms?

thrombosis as a result of increased synthesis of coagulation proteins induced by malignant cells