Metastatic Disease Flashcards
What is metastatic disease?
The process whereby malignant cells spread from the primary tumour site to distant organs through the lymphatic system or blood stream.
What are the two main classifications of cancer?
- Based on primary site of cancer 2. Based on histopathological type 3. Based on location of metastasis
What type of cells do carcinomas originate from?
Epithelial cells
What are sarcomas?
Cancers that originate from mesenchymal cells in muscles/bones.
Which types of cancer cause widespread disease without forming discrete metastases?
Lymphomas and leukaemia
What is an adenocarcinoma?
A type of cancer that originates in organs with glandular or secretory tissue, e.g. breast or colon.
Where are squamous cell carcinomas commonly found?
In areas exposed to environmental damage, e.g. skin, lungs, cervix.
What is a melanoma?
A type of cancer that originates in melanocytes of skin, eyes, intestines.
What is lymph node metastasis?
Spread of cancer to nearby lymph nodes.
What is distant metastasis?
Spread through blood vessels to distant sites, e.g. liver, lung, bone, brain.
What are some systemic features of metastatic disease?
- Fatigue
- Unexplained weight loss
- Fever
What are site-specific features of lung metastasis?
- Dyspnoea
- Cough
- Haemoptysis
- Pleuritic chest pain
- Pleural effusions
What are site-specific features of liver metastasis?
- Asymptomatic hepatomegaly
- Jaundice
- RUQ pain
- Ascites
What are site-specific features of brain metastasis?
- Headaches (worse in morning)
- Seizures
- Focal neurological deficits
- Altered mental status
What are paraneoplastic syndromes?
Symptoms that are not directly caused by the local presence of cancer but are a consequence of the cancer’s effects on the body.
Name three examples of paraneoplastic syndromes.
- Hypercalcaemia
- Cushing’s syndrome
- Lambert-Eaton syndrome
Most common tumours causing bone metastases
- prostate
- breast
- lung
Most common sites of bony metastases
- spine
- pelvis
- ribs
- skull
- long bones
Symptoms of bone metastases
- bone pain
- pathological fractures
- hypercalcaemia
- raised ALP
Cancer types causing lung metastases
- breast
- colorectal
- renal cell
- bladder
- prostate
X-ray findings in lung metastases
‘Cannonball metastases’
Most associated with renal cell cancer.
Three types of metastatic bone tumours
- osteoblastic
- osteolytic
- mixed
Blastic - lower risk spontaneous fracture
Lytic - larger risk of spontaneous fracture
What is Mirel Scoring System used for?
Stratify risk of spontaneous fracture for bone metastases of varying types
Signs and symptoms of spinal metastases
- unrelenting back pain
- pain worse with sneezing, coughing, straining
- pain worse at night
- tenderness of spine
