Pathological Changes seen with Neoplastic Disease

Question 1

What is metastases

Answer 1

Spread of the tumour
Formed by cancer cells that have left the primary tumour and travelled through blood and lymphatic vessels
Invasion and metastasis are the major causes of cancer related morbidity and mortality

Question 2

Parts of the Metastasis Cascade

Answer 2

Localised Invasion
Intravasation (cells enter blood)
Transport through circulation
Arrest in micro vessels of various organs
Extravasation
Formation of micro metastasis
Colonisation (formation of macro metastasis)

Question 3

What is the transcoelomic pathway of metastases

Answer 3

dissemination of malignant tumours throughout the surfaces and organs of the abdominal and pelvic cavity covered by \peritoneum.

Question 4

Which tumours are likely to spread transcoelomically

Answer 4

Cancers on the surface of abdominal organs
E.g. Mesotheliomas, ovarian/pancreatic adenocarcinomas

Question 5

What is carcinomatosis

Answer 5

cancer in one part the body has spread, blanketing another part of the body with several new tumours
usually of epithelial origin

Question 6

What is lymphatic metastases

Answer 6

Tumours metastasise to lymph nodes
Lymph nodes closest to the tumour are colonised earliest and develop the largest tumour masses

Question 7

What is haematogenous metastases

Answer 7

Tumour spread through blood vessel walls
Tumours generally invade veins rather than arteries as the walls are easier to invade
They ultimately enter the lungs and liver

Question 8

Tumour type likely to undergo haematogenous metastases

Answer 8

Sacaromas

Question 9

Tumours likely to metastasise to lung (4)

Answer 9

Osteosarcoma
hemangiosarcoma
Melanoma
Mammary tumours
Others (thyroid, tonsillar and pancreatic)

Question 10

Tumours likely to metastasise to Liver, spleen and kidney (2)

Answer 10

Mast cell tumours
Hemangiosarcoma

Question 11

Tumours likely to metastasise to Bone (3)

Answer 11

Mammary gland tumours
Prostatic carcinoma
Urinary Bladder tumours

Question 12

Tumours likely to metastasise to brain and adrenal glands (1)

Answer 12

RARE
Bronchogenic carcinoma

Question 13

Direct effect of neoplasia

Answer 13

Space occupying lesion- puts pressure on surrounding tissues leading to pressure atrophy or necrosis
particular problem in areas defines by bone such as thorax, brain or bone marrow

Question 14

Indirect effects of neoplasia/ paraneoplastic syndrome

Answer 14

Haematological, endocrinological and metabolic complications caused by cancer
Caused by products of tumours not the tumours themselves
these complications may be the main presenting sign
Cause a profound clinical problme
Can hallmark a particular tumour

Question 15

What is cachexia

Answer 15

Weight loss- most common syndrome in cancer

Question 16

Why does cancer cachexia occur

Answer 16

Results form altered carbohydrate, protein adn lipid metabolism
Complex pathogenesis die to TNF-a, IL-1, IL-6, prostaglnadins

Question 17

Why does fever with cancer occur

Answer 17

tumour- induced production of cytokines (IL-1)

Question 18

What is an endocrine neoplasm

Answer 18

Functioning endocrine tumour
-> hypoglycaemia: most common cause is insulinoma (beta cell/ islet cell carcinoma or adenoma)

Question 19

what is a non-endocrine neoplasm

Answer 19

Tumour produces hormonally active substances which are not normally found in the tissue of the tumour origin

Question 20

How can hypercalcaemia be caused by a non-endocrine neoplasm

Answer 20

Many tumours produce PTH-related protein
e.g. lymphoma,, multiple myelomas, adenocarcinoma of anal glands

Question 21

What is hypertrophic pulmonary osteopathy

Answer 21

Radial periosteal new bone growth affecting distal limbs
Most commonly associated with lung tumours

Question 22

What is myelofibrosis

Answer 22

Overgrowth of nonneoplastic fibroblasts in the bone marrow, which impairs normal haematopoiesis -> cytopenia ( low blood cell count)

Question 23

Other paraneoplastic clinical syndromes

Answer 23

Vascular and haematological disorder
Epidermal necrosis- pancreatic and hepatic tumours
Nodular dermatofibrosis- renal adenocarcinoma
alopecia- pancreatic carcinoma
exfoliative dermatitis- thymoma
Myasthenia gravis- thymoma, hepatic carcinoma and osteogenic sarcoma