NEOPLASIA (2) LECTURE 17 Flashcards
A patient presents which a lump within her left breast, which is confirmed via a biopsy to be neoplastic.
What information is needed to determine her prognosis?
Is the growth?
- benign vs malignant
- stage
- grade
- tumour type/sub type
- prescence of certian mutations
Question 1 for diagnosis
Is the tumour benign or malignant?
Benign - remember no invasice potential. They do NOT penetrate adjacent tissues. Remain LOCALISED, OVERGROWTHS BUT WHERE THEY ARE! They are MORE DIFFERENTIATED then malignant tumours.
Not life threatening (usually) and main problems are from location, size and pressure on other tissues, may cause harmorrhage
Malignant - invasice potential. have the abiloty ti penetrate adjacent tissues and they are abelt o spread to distant sites. VARIABLE DIFFERENTIATON and can metastisise via LYMPH, BLOOD or CAVATIES
REMEMBER - carcinoma in situ!
What are some complications of MALIGNANT TUMOURS?
Local Effects - depends of the type and size. invasion and destruction -> damage to vital structures, ulceration, haemorrhage or performation, blockage of lumen, hormore production
Systemic Effects - weight loss
Metastisis Effects -bone pain/fracture, headache,shortness of breath, jaundice
What is METASTISIS?
How does cancer metastises?
Invades BM –> Passage through extracellular material –> intracasation –> interacton with host lymphoid cells –> tumour cell EMBOLIS –> adhesion to BM –> extracasation –> deposit
Cancer can metastisies eith bye
- THE BLOOD (tumour enters draining veins)
- LYMPHATIC SPREAD (tumour enters lymphatic vessels)
3>. TRANSCOELOMIC SPREAD (along pleural spaces)
What is the difference between METASTISIS AND DIRECT INVASION?
Metastases versus Direct Invasion
Metastses - not directly linked to original tumour site
Direct Invasion - extension of original tumour (e.g. moves to organ next door)
What are the PROGNOSTIC FACTORS of Cancer?
- Specific tumour type
- grade
- stage
Specific Tumour type - how to name
PREFIX:
Adeno (glandular)
Squamous Cell
Leiomyo (smooth muscle)
Oseto (bone)
SUFFIX
benign = “oma”
Malignant = either
carcinoma (from epithelium) or sarcoma (bone, cartliage, muscle)
GRADE - What is it?
= Evaluates differentiation.
“The extent to which the tumour cells resemble their normal counterparts histologically”
WELL DIFFERENTIATED = look at lot like the normal cells
POORLY DIFFERENTIATED = do not look like the normal cells - more damage to the genome.
STAGE - What is it?
“refers to progression the malignancy has made in terms of local spread and metastisis
incorporates the size or depth of invasion of the primary tumour and where it has metastisised (if it has)
- determined by a combination of radiological and pathological assessment
What are the STAGES?
Usually FOUR stages
TNM SYSTEM COMMON
T = extent of PRIMARY TUMOUR: T0-T4
N = Regional lymph nnode metastases: N0-N3
M = abscence or prescence of distant metastises: M0-M1
THEN
Stage 1, 2 normally refer to size
Stage 3 = always means sperad to LYMPH
Stage 4 = always means metastisis
TREATMENT OPTIONS
- surgery
- chemothearapy
- radiotherapy
BUT NOT SPECIFIC :(
Today –> we are looking to develop TARGETED THERAPIES
TARGETED THERAPIES
Some cancers have receptors on them which make it harder to treat (e.g. the HER2 Receptor) which indicates a worse prognosis
SO we TARGET this wioth herceptin a drug that binds to the HER2 receptors, makes it unable to divide and reduces tumour growth!
Sometimes cancer also respond to specific hormones
END STAGE CANCER
Malignant tumours can lead to death from
- cachexia (fatigue)
- secondary infections from poor nutrition and effects of treatment
- damage to vital organ structures
PREVENTION
THIS IS THE KEY!
diet, exercise, screening, no smoking and safe workplaces
SO MUCH EASIER TO TREAT IF DIAGNOSED EARLY
