Neoplasia PT-2 Test II Flashcards
Clinical Aspects of Neoplasia
Malignant and Benign tumors can cause problems due to;
Location (effects on adjacent structures)
Functional activity (hormone production)
Bleeding/Infection
Symptoms from tumor rupture/infection
Cachexia
Local & Hormonal Effects of Neoplasia
Location
Intracranial tumors can displace/destroy important tissue, obstruct (i.e. bowel etc) or pressure surrounding structures
Hormone Production
Overproduction of different hormones may cause a variety of effects i.e. hypo/hyperglycemia due to increased insulin or PTH production.
Cancer Cachexia
A multifactorial syndrome characterized by ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and causes a progressive functional weakening.
Targets for therapy of Cachexia
Cachexia faces complications from both metabolic disturbances and anorexia. Cytokines, and inflammation trigger the hypermetabolic state, Genetics, lipolysis and lipid mobilizing factor as well as some cancer treatments can all have a negative effect on a PT.
Treatments usually consist of Nutrition, nutraceuticals, drugs, exercise, and treatment objectives aimed at increasing lean body mass (for survival and quality of life) and fat mass (for survival
What are Paraneoplastic syndromes?
Tumor-associated syndromes where the symptoms are not directly related to the spread of the tumor
They may be the earliest clinical manifestation of a neoplasm and can mimic distant spread.
Paraneoplastic Syndromes
Syndrome - Mechanism - Example
Cushing Syndrome - ACTH-like substance - Lung small cell anaplastic (oat-cell) carcinoma
Hypercalcemia - PTH like substance - Lung (squamous cell) carcinoma
Hyponatremia - Inappropriate ADH secretion - Lung small cell anaplastic (oat-cell) carcinoma
Polycythemia - Erythropoietin-like substance - Renal Cell Carcinoma
Trousseau Syndrome - Hypercoagulable state - Various carcinomas
Hypoglycemia - insulin-like substance - Various Carcinomas and sarcomas
Mechanisms of Paraneoplastic hypercalcemia
Tumor secretion of Parathyroid hormone-related protein (PTHrP)
Osteolytic metastases with local release of cytokines (including osteoclast activating factors)
Tumor production of 1,25-dihydroxy vitamin D (Calcitriol)
Paraneoplastic Neurologic Syndromes
A heterogeneous group of disorders caused by mechanisms other than metastases, metabolic, and nutritional deficits, infections, coagulopathy, or side effects of cancer treatment.
Pathogenesis
Antibodies directed against intracellular neuronal: Ex Type 1 and 2 Anti-neuronal nuclear antibodies (ANNA-1 or ANNA-2)
Antibodies directed against neuronal cell surface or synaptic proteins: Ex antibodies against the anti-N-methyl-D-aspartate (NMDA) receptor.
Paraneoplastic Hypoglycemia
Tumor secretion of IGF-2 causes
Increase glucose uptake at muscles
Decrease lipolysis and free fatty acids in Fat
Decrease in Insulin and Glucagon in Pancreas
Decrease in Glucose output, IGF-1, Acid labile subunit and IGFBP-3 as well as Increase in IGFBP-2 at Liver
Decrease in growth Hormone at the Pituitary gland
Grading and Staging of Tumors
Grading
Based on degree of differentiation
Generally, higher-grade tumors are more aggressive than lower-grade tumors.
Staging
Based on the size of the primary Tumor and the extent of local and distant spread.
Grading of Tumors
Grade 1-4
1 - Well differentiated (low grade)
2,3 - Adenocarcinoma
4 - Undifferentiated (high grade)
Staging of Tumor
Stage 0 - Initial phase
Stage 1 - Infiltration into muscular layer with lymph involvement.
Stage 2 - Full involvement of the muscular layer up to the serosa with lymph and angio involvement.
Stage 3 - break through the basement layer
Stage 4 - Metastases
Histologic& Cytological methods of Cancer Diagnosis
Cytologic (Pap) Smears
Examination of exfoliated cells for cancer of uterine cervix or of endometrium
Histologic examination (Most important method)
When possible cytologic diagnosis must be confirmed with biopsy
Flow Cytometry &FNA methods of Cancer diagnosis
Flow cytometry
Measures presence of membrane antigens or DNA content of tumor cells (Leukemia, Lymphoma)
Fine-needle Aspiration (FNA)
Involves aspiration of cells and fluids from tumor or masses, (Breast, thyroid, lymph nodes). Needle puncture made, and pressure applied to biopsy site.
Immunohistochemistry methods of cancer diagnosis
Detects cell products or surface markers using specific antibodies.
Used for diagnosis of undifferentiated tumors
Determination of site of the origin of metastases
Detection of molecules with prognostic or therapeutic significance.
Circulating Tumor Cells (CTC)
A subpopulation of tumor cells originated from the primary cancer
Have the potential to disseminate and proliferate as a metastatic lesion.
Clinical applications of CTCs
Can be used for research or Early diagnosis/prognosis.
Can be used to develop personalized treatments.
Can also be used for new drug research.
